Financial inclusion and economic growth of Nigeria (the microfinance option)

The main focus of this study is to establish the relationship between financial inclusion and economic growth with particular reference of microfinance option for the period 1992 to 2013. Using Ordinary Least Square method and employing the Johansen Cointegration tests the study revealed that the activities of microfinance as one of the financial inclusion strategy significantly contribute to economic growth. While total loans and advances of microfinance banks significantly contribute to economic growth, total deposits inversely affect economic growth. The study also established the presence of long-run relationship between the variables considered (GDP, total loans and advances, total deposits, investments and number of microfinance banks) The study reveals that the growth and development of a nation is significantly dependent on the expansion of banking and financial services to the currently financially-excluded class of citizens of the country, as they possess untapped and unexplored valuable potentials that will be of tremendous to the country. In view of the benefits inherent in financial inclusion, this study recommends that microfinance banks should concentrate efforts on low cost deposits which are in line with their operations than competing with the conventional banks in mobilizing fixed deposits that has higher cost attached to it. Financial education is also recommended to enlighten the public on benefits of a financial superstructure

Inflammatory Markers Associated With Subclinical Coronary Artery Disease: The Multicenter AIDS Cohort Study.

BackgroundDespite evidence for higher risk of coronary artery disease among HIV+ individuals, the underlying mechanisms are not well understood. We investigated associations of inflammatory markers with subclinical coronary artery disease in 923 participants of the Multicenter AIDS Cohort Study (575 HIV+ and 348 HIV- men) who underwent noncontrast computed tomography scans for coronary artery calcification, the majority (n=692) also undergoing coronary computed tomography angiography.Methods and resultsOutcomes included presence and extent of coronary artery calcification, plus computed tomography angiography analysis of presence, composition, and extent of coronary plaques and severity of coronary stenosis. HIV+ men had significantly higher levels of interleukin-6 (IL-6), intercellular adhesion molecule-1, C-reactive protein, and soluble-tumor necrosis factor-α receptor (sTNFαR) I and II (all P<0.01) and a higher prevalence of noncalcified plaque (63% versus 54%, P=0.02) on computed tomography angiography. Among HIV+ men, for every SD increase in log-interleukin-6 and log intercellular adhesion molecule-1, there was a 30% and 60% increase, respectively, in the prevalence of coronary stenosis ≥50% (all P<0.05). Similarly, sTNFαR I and II in HIV+ participants were associated with an increase in prevalence of coronary stenosis ≥70% (P<0.05). Higher levels of interleukin-6, sTNFαR I, and sTNFαR II were also associated with greater coronary artery calcification score in HIV+ men (P<0.01).ConclusionsHigher inflammatory marker levels are associated with greater prevalence of coronary stenosis in HIV+ men. Our findings underscore the need for further study to elucidate the relationships of inflammatory pathways with coronary artery disease in HIV+ individuals

HIV infection is an independent risk factor for decreased 6-minute walk test distance.

BackgroundAmbulatory function predicts morbidity and mortality and may be influenced by cardiopulmonary dysfunction. Persons living with HIV (PLWH) suffer from a high prevalence of cardiac and pulmonary comorbidities that may contribute to higher risk of ambulatory dysfunction as measured by 6-minute walk test distance (6-MWD). We investigated the effect of HIV on 6-MWD.MethodsPLWH and HIV-uninfected individuals were enrolled from 2 clinical centers and completed a 6-MWD, spirometry, diffusing capacity for carbon monoxide (DLCO) and St. George's Respiratory Questionnaire (SGRQ). Results of 6-MWD were compared between PLWH and uninfected individuals after adjusting for confounders. Multivariable linear regression analysis was used to determine predictors of 6-MWD.ResultsMean 6-MWD in PLWH was 431 meters versus 462 in 130 HIV-uninfected individuals (p = 0.0001). Older age, lower forced expiratory volume (FEV1)% or lower forced vital capacity (FVC)%, and smoking were significant predictors of decreased 6-MWD in PLWH, but not HIV-uninfected individuals. Lower DLCO% and higher SGRQ were associated with lower 6-MWD in both groups. In a combined model, HIV status remained an independent predictor of decreased 6-MWD (Mean difference = -19.9 meters, p = 0.005).ConclusionsHIV infection was associated with decreased ambulatory function. Airflow limitation and impaired diffusion capacity can partially explain this effect. Subjective assessments of respiratory symptoms may identify individuals at risk for impaired physical function who may benefit from early intervention

Sex Hormone-Binding Globulin Levels Are Inversely Associated With Nonalcoholic Fatty Liver Disease in HIV-Infected and -Uninfected Men.

BackgroundNonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. Elevated sex hormone-binding globulin (SHBG) levels have been observed in the setting of HIV and may protect against some metabolic disorders. We aimed to investigate whether higher SHBG levels may protect against NAFLD in men with/without HIV.MethodsNAFLD was assessed using noncontrast computed tomography in 530 men in the Multicenter AIDS Cohort Study (MACS) who drank <3 alcoholic drinks/d and were uninfected with chronic hepatitis C or B (340HIV+, 190HIV-). Morning serum samples were tested for SHBG, total testosterone (TT), and adiponectin. Multivariable logistic regression was used to assess associations between HIV, SHBG, TT, adiponectin, and NAFLD.ResultsMedian SHBG was highest among HIV+/NAFLD- men and lowest among HIV-/NAFLD+ men. Adjusted for demographics, HIV, visceral adiposity, HOMA-IR, TT, and PNPLA3 genotype, higher SHBG was associated with lower odds of NAFLD (odds ratio [OR], 0.52 per doubling; 95% confidence interval [CI], 0.34-0.80). In separate multivariable models without SHBG, HIV (OR, 0.46; 95% CI, 0.26-0.79) and higher adiponectin (OR, 0.66 per doubling; 95% CI, 0.49-0.89) were associated with lower NAFLD odds, whereas TT was not significantly associated (OR, 0.74 per doubling; 95% CI, 0.53-1.04). Adjusting for SHBG attenuated the associations of HIV (OR, 0.61; 95% CI, 0.34-1.08) and adiponectin (OR, 0.74; 95% CI, 0.54-1.02) with NAFLD.ConclusionsSHBG levels were higher among HIV+ men, were independently associated with lower NAFLD, and could partially explain the associations of HIV and higher adiponectin with lower NAFLD in our cohort. These findings suggest that SHBG may protect against NAFLD, supporting further prospective and mechanistic studies

The Reliability of Using Vitek 2 Compact System to Detect Extended-Spectrum Beta-lactamase-producing Isolates in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta-lactamases that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. The global increased prevalence of ESBL-producing bacteria creates an urgent need for laboratory diagnostic methods that will accurately and rapidly identify the presence of ESBL phenotypes in clinical isolates. The Vitek 2 System (bioMérieux, France) is a rapid automated microbiological system used for bacteria and yeast identification, antimicrobial susceptibility testing (AST), resistance mechanism detection and epidemiologic trending and reporting using its advanced expert system. This present work sought to determine the reliability of routinely using Vitek 2 System to accurately and rapidly detect ESBL-producing E. coli and K. pneumoniae in Accra. The ESBL phenotypes for 400 E. coli and K. pneumoniae isolates were determined using the Vitek 2 system and combined disc synergy method. The results were used to determine the sensitivity, specificity, negative predictive value and positive predictive value of the Vitek 2 ESBL test through comparative analysis with the combined disk synergy method which is the reference method recommended by CLSI. The findings of this work indicated that the sensitivity, specificity, positive predictive value and negative predictive value of Vitek 2 system was 98.5%, 98.9%, 99% and 98.5% respectively. Consequently, Vitek 2 system is a reliable semi-automated microbiology system which may be used for routine, accurate and rapid detection of ESBL strains in health facilities in Accra, Ghana. Keywords: Vitek 2 Compact System, Extended spectrum beta-lactamase, bioMérieux, E. coli and K.  pneumoni

Phenotypic Characterization of AmpC beta-lactamase among Cefoxitin Resistant Escherichia coli and Klebsiella pneumoniae Isolates in Accra, Ghana

AmpC ?-lactamases hydrolyze penicillins, cephalosporins and cephamycins and resist inhibition by clavulanate, sulbactam, and tazobactam. Strains with AmpC genes are inherently resistant to multiple agents, making the selection of an effective antibiotic difficult. This present work sought to investigate the occurrence of AmpC beta-lactamases-producing phenotypes in E. coli and K. pneumoniae and their antimicrobial sensitivity profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected and their antibiotic sensitivity testing for cefoxitin and other 16 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  The isolates resistant to cefoxitin were confirmed as AmpC beta-lactamases-producing phenotypes with disk synergy testing (DST) using cefotaxime or ceftazidime with or without boronic acid. An increase in zone diameter of ?5mm in the presence of boronic acid indicates the presence of AmpC beta-lactamases in the test organism. The results showed that of the 50 cefoxitin resistant isolates screened from 400 bacterial isolates, 5(10%) were AmpC beta-lactamase-producers with 60%, 60%, 60%, 80% and 100% multiply antibiotic resistance in gentamicin, ciprofloxacin, norfloxacin, trimethoprim/sulfamethoxazole and tetracycline respectively. Nitrofurantoin which indicated 100% susceptibility with MIC90 of 32µg/ml may be a therapeutic option especially for non-life-threatening urinary tract infection. Imipenem was the antibiotic of choice with 100% susceptibility rates (MIC90 of ?1µg/ml). Though the insignificant (p>0.05) levels of AmpC beta-lactamase phenotypes may not require routine detection in health facilities, there is the need to implement evolutionary antibiotic administration policies and pragmatic infection control measures in the hospitals.      Keywords: AmpC beta-lactamase, Cefoxitin, ?-lactams, E. coli, K. pneumonia

Fat distribution and longitudinal anthropometric changes in HIV-infected men with and without clinical evidence of lipodystrophy and HIV-uninfected controls: A substudy of the Multicenter AIDS Cohort Study

<p>Abstract</p> <p>Background</p> <p>Fat abnormalities are common among HIV-infected persons, but few studies have compared regional body fat distribution, including visceral fat, in HIV-infected and HIV-uninfected persons and their subsequent trajectories in body composition over time.</p> <p>Methods</p> <p>Between 1999 and 2002, 33 men with clinical evidence of lipodystrophy (LIPO+), 23 HIV-infected men without clinical evidence of lipodytrophy (LIPO-), and 33 HIV-uninfected men were recruited from the four sites of the Multicenter AIDS Cohort Study (MACS). Participants underwent dual-energy x-ray absorptiometry, quantitative computerized tomography of the abdomen and thigh, and circumference measurements of the waist, hip and thigh. Circumference measurements at each semi-annual MACS visit between recruitment and 2008 were used to compare average annual anthropometric changes in the 3 groups.</p> <p>Results</p> <p>Body mass index (BMI) was lower in LIPO+ men than in the LIPO- men and the HIV- uninfected controls (BMI: 23.6 ± 0.4 vs 26.8 ± 1.5 vs 28.7 ± 0.9 kg/m², respectively, p < 0.001). The average amount of visceral adipose tissue (VAT) was similar in all three groups (p = 0.26), but after adjustment for BMI, VAT was higher in the LIPO+ group (169 ± 10 cm²) compared to the LIPO- men (129 ± 12 cm², p = 0.03) and the HIV-uninfected group (133 ± 11 cm², p = 0.07). Subcutaneous adipose tissue (thigh, abdomen) and total extremity fat were less in the HIV-infected men (LIPO+ and LIPO-) than in the HIV-uninfected men. Over an average of 6 years of follow-up, waist circumference increased at a faster rate in LIPO+ group, compared to the LIPO- men (0.51 cm/year vs 0.08 cm/year, p = 0.02) and HIV-uninfected control men (0.21 cm/year, p = 0.06). The annual changes in hip and thigh circumferences were similar in all three groups</p> <p>Conclusion</p> <p>Subcutaneous lipoatrophy was observed in HIV-infected patients, even those without clinical evidence of lipodystrophy, compared to age-matched HIV-uninfected men. Despite markedly lower BMI, HIV-infected men with lipodystrophy had a similar amount of VAT as HIV-uninfected men and tended to have more rapid increases in waist circumference over 6 years of follow-up. These longitudinal increases in waist circumference may contribute to the development of cardiovascular risk in HIV-infected patients with lipodystrophy.</p

Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016

Background: Under-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. Methods: The study used combined data from the 2004–2005, 2010 and 2015–2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights. Results: Between 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities. Conclusion: Our study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania

Phenotypic Determination and Antimicrobial Resistance Profile of Extended Spectrum Beta-lactamases in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases commonly found in the Enterobacteriaceae that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. ESBLs confer resistance to several non-ß-lactam antibiotics. ESBL-producing organisms appear susceptible to cephalosporins in vitro using conventional breakpoints but ineffective in vivo. This work sought to determine the occurrence of ESBL in E. coli and K. pneumoniae and their antibiotic resistance profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected at the Central Laboratory of Korle Bu Teaching Hospital and Advent Clinical Laboratories. They were definitively identified and their minimum inhibition concentration and antibiotic sensitivity testing for 17 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  The isolates were confirmed as ESBL-producing strains using the Combination Disk Synergy Method. The results indicated that 202 (50.5%) of the bacterial isolates were ESBL-producing phenotypes with high resistant to gentamicin, ciprofloxacin, tetracycline and trimethoprim/sulfamethoxazole indicating 82.2%, 79.7%, 70.8% and 97% resistant rates respectively. imipenem and amikacin were the antibiotics of choice with 99% and 94.1% susceptibility rates (MIC90 of ?1µg/ml and 4µg/ml respectively). It is imperative to routinely detect ESBL-phenotypes in health facilities, implement appropriate antibiotic administration policy and infection control measures in the hospitals.   Keywords: Extended Spectrum Beta-lactamase, Antimicrobial Resistance, ?-lactams, K. pneumoniae, E. col

Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria (January–March 2012)

SummaryObjectivesDespite the epidemic nature of Lassa fever (LF), details of outbreaks and response strategies have not been well documented in resource-poor settings. We describe the course of a LF outbreak in Ebonyi State, Nigeria, during January to March 2012.MethodsWe analyzed clinical, epidemiological, and laboratory data from surveillance records and hospital statistics during the outbreak. Fisher's exact tests were used to compare proportions and t-tests to compare differences in means.ResultsThe outbreak response consisted of effective coordination, laboratory testing, active surveillance, community mobilization, contact and suspected case evaluation, and case management. Twenty LF cases (10 confirmed and 10 suspected) were recorded during the outbreak. Nosocomial transmission to six health workers occurred through the index case. Only 1/110 contacts had an asymptomatic infection. Overall, there was high case fatality rate among all cases (6/20; 30%). Patients who received ribavirin were less likely to die than those who did not (p=0.003). The mean delay to presentation for patients who died was 11±3.5 days, while for those who survived was 6±2.6 days (p<0.001).ConclusionsThe response strategies contained the epidemic. Challenges to control efforts included poor local laboratory capacity, inadequate/poor quality of protective materials, fear among health workers, and inadequate emergency preparedness