Comparative Assessment of Some Rapid Diagnostic Test (RDT) Kits for Malaria Diagnosis in Ibadan, Nigeria

Background:  Deployment of sound diagnostic deliverables remains a crucial component of malaria control and prevention programme in Africa. This study aims to make a comparative assessment of the efficacy of three famous brands of rapid diagnostic kits (RDT) available in Nigerian market, with the traditional Giemsa staining (microscopic) method, in testing for malaria in endemic zones, also to provide relevant information and guidance to individuals, health care service providers, test kit manufacturers as well as health corporate organizations. Methods: Giemsa microscopy along with RDT kits (Acon, Paracheck and SD Bioline) were carried out on 525 patient samples presumed to present with acute uncomplicated malaria by clinical diagnosis. In addition, the total WBC count and haematocrit were conducted on the blood samples. Results: Out of the 525 samples recruited, three hundred (300) 57.1% were found positive by Giemsa microscopy. SD Bioline had a positivity rate of 260 (49.5%) while Acon and Paracheck trailed behind with 200 (38.1%) and 150 (28.6%) samples respectively. The sensitivity, specificity and efficiency of the three RDT kits were as follows: SD Bioline (86.3%, 99.6%, 92%); Paracheck (50%, 97.7%, 70.4%) and Acon (66.7%, 100%, 80.9%) respectively. Children within the age bracket 0-10 years had the highest malaria positivity rate (F=5.29; p< 0.05). 115 (38.3%) of children in this age group were positive for malaria with Mean PCV of 30.65 ± 0.52 compare to non-malaria control. The dominant malaria species was P. falciparum with 280 (93.3%) cases. However, an appreciable cases of P. falciparum & P. vivax 15 (5.0%) along with P. falciparum & P. malariae 5 (1.7%) co-infections were confirmed. It was also observed that the haematocrit value for individuals correlated inversely with the parasite density (r = -0.78; p< 0.05). Conclusion and Recommendation: Giemsa microscopy method still remains the gold standard for malaria diagnosis in limited resources endemic zones and recommends that imported RDT kits for malaria should be validated before use in developing countries. Keywords: Giemsa Microscopy; Rapid Diagnostic Kits; Parasite Density; Co-Infection; Malaria Contro

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures

Occupational Lyme Disease: A Systematic Review and Meta-Analysis

Lyme disease (LD) can have significant consequences for the health of workers. The frequency of infection can be estimated by using prevalence and incidence data on antibodies against Borrelia Burgdoferi (BB). A systematic search of studies published in English between 2002 and 2021 and a meta-analysis were conducted in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases. Out of a total of 1125 studies retrieved, 35 articles were included in the systematic review. Overall, in these studies, outdoor workers showed a 20.5% BB seroprevalence rate. Meta-analysis, performed on 15 studies (3932 subjects), revealed a significantly increased risk in outdoor activities (OR 1.93 95%CI 1.15–3.23), with medium-level heterogeneity (I2 = 69.2%), and non-significant publication bias. The estimated OR in forestry and agricultural workers was 2.36 (CI95% 1.28; 4.34) in comparison with the controls, while a non-significant increase in risk (OR = 1.05, CI95% 0.28; 3.88) was found in the remaining categories of workers (veterinarians, animal breeders, soldiers). The estimated pooled risk was significantly higher in the studies published until 2010 (OR 3.03 95% CI 1.39–6.61), while in more recent studies the odds became non-significant (OR 1.08 95% CI 0.63–1.85). The promotion of awareness campaigns targeting outdoor workers in endemic areas, and the implementation of local programs aimed at controlling range expansion of vectors, are key strategies for protecting workers

Prevalence of diabetes mellitus and the associated behavioral risks factors among the staff of three secondary schools in Owo, Ondo State, Nigeria

Objective: The prevalence of type 2 Diabetes is associated with significant morbidity and mortality, hence the need for early identification of risk factors. This study, therefore, aimed to determine the prevalence of diabetes mellitus and the associated behavioral risks among secondary school staff in Owo, Ondo State, Nigeria.Methods: A cross-sectional survey of 118 staff at three secondary schools in Owo was conducted using a structured interviewer-administered questionnaire. Demographic and clinical data were obtained as well as fasting or random blood glucose measurements using standard methods. Data were analyzed with SPSS version 21.0.Results: The mean age of participants was 43 ± 8 years, 59.3% were females. Type 2 Diabetes Mellitus was found in 2.8% of the participants, 18.5% were hypertensive, 22.0% were Obese while 25.4% had abdominal obesity. In all, 13.6% smoke cigarette, 35.6% drank alcohol, 49.2% does not add at least a spoonful of vegetable to their meals, 27.1% does not engage in physical exercise while 78.0% do not eat fruits at least once a day. About 58.4% of the respondents had at least one risky behaviour. More male respondents (22.9%) had a self-perceived risk of Diabetes Mellitus (p=0.001), 40.0% of female respondents had abdominal obesity (p<0.001). Correlation (r=0.347) exist between Waist/Hip ratio and random blood glucose, (p=0.012)Conclusion: Despite low prevalence of diabetes mellitus, many had at least one risky behaviour. Intensifying efforts on educating the general population on the risk factors for Diabetes Mellitus and lifestyle modification is important.Keywords: Diabetes Mellitus, behavioural risk factors, lifestyle, blood pressure, obesit

ICT Access, Social Infrastructural Facilities and the Performance of Informal Micro- and Small- Business Enterprises (MSBEs) in Nigeria

This paper examines the roles that access to ICT and improved social infrastructure play on the performance levels of informal micro and small business enterprises in Nigerian. For formal sector organisations, studies have been conducted to verify this, but not much is known with respect to micro and small informal sector businesses. This study therefore intends to bridge this yawning gap by carrying out an analysis of the impact of the access to telephone (a major component of ICTs that is fast finding common usage among informal sector enterprise-owners) among informal micro and small businesses in Nigeria. The study relies on primary data on the informal sector enterprises collected by the Nigerian Institute for Social and Economic Research (NISER) in 2014. Basic descriptive statistics in addition to the Ordinary Least Squares Regression model is used in the analyses of the data. Policy measures that will enhance further diffusion of ICT infrastructure among micro and small business to enhance their growth and contributions to income and employment generation are recommended at the end of the paper

Effect of Dietary Fiber Supplementation on Metabolic Endotoxemia: A Protocol for Systematic Review and Meta-Analysis of Randomized Clinical Trials

Introduction: Metabolic endotoxemia (ME) is the main cause of sub-clinical chronic inflammation, which subsequently triggers the onset of several chronic diseases. However, recent reports have indicated that dietary fiber (DF) contributes significantly to ameliorating ME and inflammation. This protocol aims to provide an outline of all procedures in synthesizing the available data on the effect of DF against ME. Methods: Following the PRISMA 2020 guidelines for preparing protocols, this protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) with registration number (CRD42023417833). In this review, we specifically focused on the inclusion of clinical trials that met the following criteria: they were published or available as preprints, employed random, quasi-random, or cross-over designs, and were exclusively documented in the English language. Clinical medical subject headings (MeSH) as search terms were used on prominent databases such as MEDLINE, COCHRANE library, PubMed, World Health Organization International Clinical Trials Registry Platforms, and US National Institutes of Health Ongoing Trials Register Clinicaltrials.gov. Results and discussion: This protocol will guide the exploration of articles that report changes in ME biomarkers in subjects supplemented with DF. The findings of this protocol will ensure a comprehensive evaluation of available evidence, provide a quantitative summary, identify patterns and trends, enhance statistical power, and address heterogeneity, which collectively will clarify the optimal types, doses, and duration of DF interventions for managing ME and low-grade inflammation. Ethics and dissemination: The quantitative data of clinical trials will be collected, and a meta-analysis will be performed using RevMan V.5.3 software. Therefore, no ethical approval is required

Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes and obesity. The study objective was to establish RYGB's effects on glycemic variability (GV) and hypoglycemia. RESEARCH DESIGN AND METHODS: This was a prospective observational study of 10 participants with obesity and prediabetes or type 2 diabetes who underwent RYGB. Patients were studied before RYGB (Pre) and 1 month, 1 year, and 2 years postsurgery with continuous glucose measurement (CGM). A mixed-meal test (MMT) was conducted at Pre, 1 month, and 1 year. RESULTS: After RYGB, mean CGM decreased (at 1 month, 1 year, and 2 years), and GV increased (at 1 year and 2 years). Five of the 10 participants had a percent time in range (%TIR) <3.0 mmol/L (54 mg/dL) greater than the international consensus target of 1% at 1 or 2 years. Peak glucagon-like peptide-1 (GLP-1) and glucagon area under the curve during MMT were positively and negatively associated, respectively, with contemporaneous %TIR <3.0 mmol/L. CONCLUSIONS: Patients undergoing RYGB are at risk for development of postbariatric hypoglycemia due to a combination of reduced mean glucose, increased GV, and increased GLP-1 response

Incidence of and socio-biologic risk factors for spontaneous preterm birth in HIV positive Nigerian women

BACKGROUND: Recent studies have identified HIV as a leading contributor to preterm delivery and its associated morbidity and mortality. However little or no information exists in our sub-region on this subject. Identifying the factors associated with preterm delivery in HIV positive women in our country and sub-region will not only prevent mother to child transmission of HIV virus but will also reduce the morbidity and mortality associated with prematurity and low birth weight. This study was designed to determine the incidence and risk factors for preterm delivery in HIV positive Nigerians. METHOD: The required data for this retrospective study was extracted from the data base of a cohort study of the outcome of prevention of mother to child transmission at the Nigerian Institute of Medical Research, Lagos. Only data of women that met the eligibility of spontaneous delivery after 20 weeks of gestation were included. Ethical approval was obtained from the Institution’s Ethical Review Board. RESULTS: 181 women out of the 1626 eligible for inclusion into the study had spontaneous preterm delivery (11.1%). The mean birth weight was 3.1 ± 0.4 kg, with 10.3% having LBW. Spontaneous preterm delivery was found to be significantly associated with unmarried status (cOR: 1.7;1.52-2.57), baseline CD4 count <200 cells/mm(3)(cOR: 1.8; 1.16-2.99), presence of opportunistic infection at delivery (cOR: 2.2;1.23-3.57), multiple pregnancy (cOR 10.4; 4.24 – 26.17), use of PI based triple ARV therapy (eOR 10.2; 5.52 – 18.8) in the first trimester (cOR 2.5; 1.77 – 3.52) on univariate analysis. However after multivariate analysis controlling for potential confounding variables including low birth weight, only multiple pregnancy (aOR: 8.6; CI: 6.73 – 12.9), presence of opportunistic infection at delivery (aOR: 1.9; CI: 1.1 – 5.7), and 1st trimester exposure to PI based triple therapy (aOR: 5.4; CI: 3.4 – 7.8) retained their significant association with preterm delivery. CONCLUSION: The spontaneous preterm delivery rate among our cohort was 11.1%. HIV positive women with multiple pregnancies, symptomatic HIV infection at delivery and first trimester fetal exposure to PI based triple therapy were found to be at risk of spontaneous preterm delivery. Early booking and non-use of PI based triple therapy in the first trimester will significantly reduce the risk of preterm delivery

Challenges of Residency Training and Early Career Doctors in Nigeria Phase II: Update on Objectives, Design, and Rationale of Study

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I.   Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires,while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statisticalsoftware. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges. Keywords: Early career doctors, Nigeria, residency, resident doctors, trainin