Effectiveness of Treatment Outcomes of Public Private Mix Tuberculosis Control Program in Eastern Nigeria

Effective tuberculosis treatment has been shown to have significant effect on the control of tuberculosis. Completion of treatment of active cases is therefore the most important priority of tuberculosis control programmes. Descriptive statistics with a retrospective cohort study design used to analyze secondary data set (2007-2010) of patients accessing TB-DOTS treatment in two facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health Services Tuberculosis and Leprosy  Control Unit Nnewi North Local Government Area (L.G.A.) Secretariat, DHSTLCU ) as public health facilities and other two facilities ( Immaculate Heart of Catholic Church Hospital, IHCCH  and Diocesan Anglican Communion Hospital, DACH) as private health facilities in Nnewi North L.G.A., Anambra State. Gender of patients were male: female 54%(1016 patients) : 46% (883 patients) and 53%(63 patients) : 47%(56 patients) in public and private health facilities respectively . Using WHO (1996) standards the health facilities adjudged as efficient were: in 2007, private facilities using the indicator  of treatment failure rate; private facilities using the indicator of death rate;  public facilities and private facilities using  the indicator of transfer-out rate ; public facilities using the indicator of  treatment completion rate. In 2008, effective health facilities were: private health facilities using the indicator of failure rate; public and private health facilities using the indicator of transfer-out rate; private facilities using the indicator of treatment completion rate. In 2009, effective health facilities were public and private health facilities using indicator of treatment failure rate; public and private health facilities using the indicator of death rate; public and private facilities using the indicator of transfer out; public and private facilities using the indicator of treatment completion rate. In 2010, effective health facilities were: private health facilities using the indicator of  cure rate; private facilities using the indicator of death rate ; public and private facilities using the indicator of transfer-out; public facilities using the indicator of treatment completion rate. In conclusion, private health facilities were more effective than public health facilities  by the several indicators over the four year period.  Future research is needful to use primary and secondary data sets in assessment of TB control program effectiveness; technical efficiency assessment using non-parametric statistics will assess the validity of assessing effectiveness using only the WHO standards; identify centre-specific factors associated with poor treatment outcome; institutionalizing a reward system for effective TB-DOTS facilities will engender healthy competition in the Public Private Mix for sustained effectiveness; the Monitoring and Evaluation tools especially the treatment card for data capture should be improved upon for comprehensiveness of patients socio-economic history. Keywords: Tuberculosis, Effectiveness, Treatments Outcomes, Public Private Mi

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Perceptions about Sex in Pregnancy among Women Attending Antenatal Clinic in a Tertiary Health Institution in South-East Nigeria

Background: There are varied perceptions about sex in pregnancy among women that often lead to poor sexual performance in pregnancy with the attendant marital disharmony. There is need to assess the perceptions about sex in pregnancy among pregnant women in order to devise effective strategies in addressing this issue. Objective: To study the perceptions about sex during pregnancy among women attending antenatal clinic in a tertiary health institution in Nnewi, South-East Nigeria Methodology: A cross sectional survey of 430 pregnant women attending antenatal care clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, carried out from 1st February 2016 to 31st July 2016.Results: The mean age of the women was 29.2 ± 4.7 years. A majority (96.0%, n=413) of them had at least secondary education. One hundred and eighty (42.1%) were in the second trimester of pregnancy. Out of the 430 women studied, 320(74.4%) had information about sex in pregnancy. The main source of information was the nurses (50.0%). More than half (51.4%, n= 221) of the women had no discussion on sex in pregnancy with their physicians and the respondents initiated the discussion in 40.7% (n=85) of cases. One hundred and fifty four (35.9%) of the women believed that sex was not safe during pregnancy mainly because sex could lead to miscarriages (86.9%; n=134). One hundred and eight (25.2%) of them reported that their husbands were worried about the safety of sex in pregnancy. Most (89.4%, n=380) of the respondents felt that it was not right to deny their partners sex on account of pregnancy and 87.2%(n=374) of them believed that denying their partners sex during pregnancy could lead to marital disharmony.Conclusion: A significant number of the studied women had misconceptions about the safety of sex in pregnancy. We recommend that discussions on sex in pregnancy should be incorporated into the routine antenatal classes.Keywords: Sexual dysfunction, Marital disharmony, Extra marital affairs, Traditional beliefs, Myth

Hysteroscopic characterization and classification of intrauterine adhesions among infertile Nigerian women

Background: There is paucity of data on the application of hysteroscopy in the management of intrauterine adhesions in Nigeria.Objective: To describe the hysteroscopic characterization and classification of intrauterine adhesions seen among infertile Nigerian women managed at the Fertility and Endoscopy Units of Nnamdi Azikiwe University Teaching Hospital Nnewi and Holy Rosary Specialist Hospital Onitsha, Nigeria.Methodology: This is a prospective study. A proforma was used to document intra uterine adhesion findings at hysteroscopy and the collected data were analyzed with STATA software, version 12.0 SE. The ASRM Grading system was used to define the severity of the lesions.Results: Seventy six (47.8%) out of 159 infertile women managed during the period had intrauterine adhesions. The age range of the women was 26-43 years (mean 34.8±5.1) and the mean parity was 0.75± 1.03. Fifty six (73.7%) of the women had secondary infertility and abnormal menstruation was found in 47(61.8%).Adhesions were mainly multiple (88.2%; n=67) and of a combined dense and filmy types (39.5%; n= 30). Obliterative lesions were found in 44(57.9%) while in 10(13.2%) women, it was obstructive. The uterine cavity was partially involved in 48(63.2%) of the women and completely in 19(25.0%). The tubal ostia were involved in 47(61.8%) of the cases. The left ostium was not visualized in 18(23.7%) cases and the right ostium in 22(29.0%) cases. The cervical os was involved in adhesion in 26(34.3%) cases and was completely occluded in 16(21.1%) cases. Severe adhesion was seen in 19(25.0%) of the women.Conclusion: The intrauterine adhesions among the studied women were mainly mild and moderate in severity, multiple, obliterative and of a combined dense and filmy nature.Keywords: Adhesiolysis, Hypomenorrhoea, Amenorrhoea, Infertility, Endometrial lesion

Barriers to postnatal care and exclusive breastfeeding among urbanwomen in southeastern Nigeria

Background: Available evidence shows that only a small proportion of Nigerian women access postnatal care and practice exclusive breastfeeding. Given that both interventions are critical to the survival of both the mother and the new born, it is important to identify factors that militate against an effective postnatal care and exclusive breastfeeding in the country, in order to scale up services. The aim was to determine the major barriers to postnatal care and exclusive breastfeeding among urban women in southeastern Nigeria. Materials and Methods: A cross-sectional survey of 400 urban market women using semistructured questionnaires and focus group discussions. Results: Out of 400 women interviewed, 365 (91.7%) attended postnatal clinic. Lack of knowledge about postnatal care services (42.2%; n = 14), distant location of the hospitals (36.4%; n = 12) and feeling that postnatal visits was not necessary (21.1%; n = 7) were the main reasons for non-attendance to postnatal clinic. With respect to exclusive breastfeeding, 143 (35.9%) of the women practiced EBF. The main reasons for nonpractice of EBF were that EBF was very stressful (26.2%; n = 67), mother′s refusal (23.5%; n = 60), and the feeling that EBF was not necessary (18.1%; n = 46). Thirty five (13.7%) of the women were constrained by time while the husband′s refusal accounted for 1.5% (n = 3) of the reasons for nonpractice of exclusive breastfeeding. Conclusion: Poor knowledge and inaccessibility to health facilities were the main obstacles to postnatal care while the practice of exclusive breastfeeding was limited by the stress and mothers refusal

Increased incidences of Salmonella, Plasmodium falciparum and hepatitis C viral specific circulating immune complexes in participants from malaria endemic and HIV prevalent area of Nigeria

The present study used dissociated circulating immune complexes (CIC) to identity the burden of exposure to certain infectious agents. The participants were divided into HIV seropositive group (n=100) and HIV seronegative group (n=100). Polyethylene glycol (PEG) 6000 and phosphate buffer techniques were used for precipitation and dissociation of CIC in sera. The dissociated CIC were tested for Salmonella typhi antibody, Plasmodium falciparum histidine rich protein (Pf-hrp)-2 antigen and HCV antibody using commercially available kits. Result showed that Salmonella typhi antibody was detected in 76 (76%) of the HIV seropositive participants; Plasmodium falciparum histidine rich protein-2 (Pf-hrp-2) antigen was detected in 48 (48%) of HIV seropositive participants while Hepatitis C viral antibodies was detected in 20 (20%) of the HIV seropositive participants. Similarly, Salmonella typhi antibody was detected in 24(24%) of the HIV seronegative participants, Pf-hrp-2 antigen was detected in 47(47%) of the participants while Hepatitis C viral antibody was detected in 5(5%) of the HIV seronegative participants. There were significant differences between the number of HIV seropositive and seronegative participants with positive Salmonella typhi (P<0.05) and HCV antibody (P<0.05). The rates of homogeniuty and heterogeniuty of CIC in HIV seropositive participants was; 26 (34%) and 50 (66%) for Salmonella typhi antibody, 3 (6%) and 45 (94%) for Pf-hrp-2 antigen and 0 (0%) and 20 (100%) for HCV antibody, respectively. While the rates of homogeniuty and heterogeniuty of CIC in HIV seronegative participants was 1 (4.2%) and 23 (95.8%) for Salmonella typhi antibody; 25 (53%) and 22 (47%) for Pf-hrp-2 antigen and 3 (60%) and 2 (40%) for HCV antibody respectively in all cases. The finding of the present study suggest that HIV infection may enhance susceptibilty to both salmonella typhi and HCV infection but not Plasmodium falciparum. The study thus revealed that Salmonella and HCV infections may constitute the major secondary infection in HIV infected patients and could be a cause for concern as HIV progressed to AIDS