Geospatial clustering of newly diagnosed HIV infected adults in Cross River State helps define new “hotspots”

Introduction: A hotspot is a geographical location having evidence of high STIs/HIV prevalence, and/or behaviors that put people at high risk of becoming infected. Therefore, Nigeria, with almost two million people living with HIV, could be considered a giant “hotspot.” The main aim was to describe how the geospatial clustering of newly diagnosed HIV-infected adults in Cross River State helps define new “hotspots.”Methods: Secondary data collected between January 2020 and March 2020, identified and mapped around a presumed hotspot’s radius of influence (ROI), were analyzed using a “Hotspot Analysis” plugin in QGIS software. With a sample size of 3019, both seropositive and seronegative results were geo-referenced and the resultant map was analyzed to determine HIV-positive clusters.Results: From the 3019 spatial locations mapped, 720 (23.9%) were positive cases. Of these, 328 (45.6%) were thus estimated as being associated with the presumed hotspots. The remaining 392 (54.4%) were positive cases identified outside of the ROI of the originally presumed hotspots. The total number of mapped HIV testing services (HTS) points (both negative and positive cases) within the hotspot ROI was 1319, while those outside of the hotspot ROI were 1700.Conclusion: Unique hotspots where social gatherings occur tended to have a wider ROI. Targeted testing in these hard-to-reach communities is recommended

Malaria in Pregnancy in Nigeria: A Literature Review

Malaria is caused by the parasite plasmodium which can be spread to humans through the bite of an infected mosquito. Of the five types of plasmodium (P. Falciparium, P.Ovale, P. Malaria, P. Vivax and P. Knowlesi), the plasmodium falciparium is the deadliest and affects the lives of almost  40 per cent of the world’s population with pregnant women and children  under-five years of age being the most affected. This mini-review involved the collation of findings from recent studies in regards to the prevalence of malaria infection among pregnant women and infants. A systematic analysis of recent literature on the  prevalence of malaria in pregnancy from many authors was carried out and the facts synthesized to make an easy read. From the analysis of literature, Ten Thousand women and 200,000 babies were reported to be dying annually from complications of malaria in pregnancy which recorded a prevalence of 85 per cent in sub-Saharan Africa. More so, Fifty per cent of pregnant women  were discovered to be carrying plasmodium falciparium in their placenta without even experiencing malaria signs/ symptoms, and this development was reported to have been responsible for Twenty per cent of stillbirths and 11 per cent of all maternal deaths. Malaria infection is considered a major threat to the lives and well-being of pregnant women and infants. Therefore, stakeholders should ensure that every clinical diagnosis of malaria in pregnancy is confirmed with a laboratory plasmodium falciparium-based diagnosis before the administration of antimalarial drugs. Furthermore there should be a  stepping –up on the distribution of insecticide treated nets alongside enlightenment of pregnant women on ways of preventing mosquito bite. Instituting the aforementioned approaches is key to improving the health- seeking behaviour of pregnant women in particular and the wider population in general thus enabling them to stay malaria free throughout the period of pregnancy and infancy

Determinants and Differentials of Maternal Reproductive Health Outcomes in Nigeria: A Review of National Demographic Health Survey Data from 1999 to 2013

Women in Sub-Saharan Africa face significant clinical and socio-demographic challenges that translate to poor health outcomes including high maternal morbidity and mortality. Nigeria being the most populous nation in Africa bears a significant burden of both communicable and non-communicable diseases. This study aimed to determine the trends and differentials in indices fuelling poor health outcomes in Nigeria. The study was a review and trend analysis of maternal reproductive health indicators obtained from the Nigeria National Demographic and Health Survey (NDHS) data from 1990 to 2013 including secondary data from WHO, UNICEF and the World Bank. The life expectancy at birth was 54.5 years with an estimated infant mortality rate of 75 per 1000 live births, child mortality rate of 88 per 1,000 live births, under-5 mortality rate of 157 per 1,000 live births and a maternal mortality ratio (MMR) of 545 per 100,000 live births. Contraceptive prevalence was 22% among women in the wealthiest quintile and 3% among those in the poorest quintile.  Only 3% of women with no education used modern contraception as compared to 24% of women with tertiary education. Most of the maternal deaths were due to preventable causes which were largely related to poverty, inimical socio-cultural beliefs and practices as well as clinical factors like haemorrage, hypertension, and indirect causes like inadequate human resource for health, user charges, cultural pregnancy/childbirth beliefs and myths. A community-based participatory research using both qualitative and quantitative methods may shed more light on the non-clinical factors fueling high MMR in Nigeria. Keywords: Maternal and Child Health, maternal mortality, contraceptio

Comparative Analysis of Satisfaction with the Use of Ready-Made Spectacles and Custom-Made Spectacles among School Children in Nigeria: A Randomised Controlled Trial

Refractive error is an important cause of visual impairment in Cross River State (CRS), Nigeria. Optical services and spectacles are not readily available to school children for the treatment. The aim of this study was to compare satisfaction with the use of ready-made spectacles and custom-made spectacles in the treatment of refractive error for school eye health programme. A one month double-blinded randomised controlled trial was used to evaluate satisfaction, symptoms, vision and planned continued use of ready-made and custom-made spectacles in school children 6 -17 years with ≥ 1 diopter of uncorrected refractive error. The sample size for each arm was 63. This research was funded by African Vision Research Institute (AVRI). Full ethical approval was obtained from the ethics committee CRS Ministry of Health, Nigeria. Data was analysed using SPSS and EPI info. Out of the 2110 children refracted with non-cycloplegic method, 243 (11.5%) has significant refractive error and only 104(82.5% response rate) met the inclusion criteria for the intervention study. There was no difference (p >0.05) in satisfaction (96.2% vs 96.2%) and  symptoms ( headache 5.8% vs7.7%; eye strain 3.8% vs 1.9%  ) in the use of ready-made vs custom-made spectacles to the 1 month follow up. Ready-made spectacles are recommended for eye health programmes in schools because it is a cost effective strategy for treatment of refractive errors. The ready-made spectacles should be available in different frame pupillary distance for various powers to reduce discomfort associated with frame induced prismatic effect. Keywords: Eye health, vision care, school-aged children, ready-made spectacles, custom-made spectacle

Prevalence of Presbyopia, Spectacle Correction Coverage and Unmet Need, among Adults in Cross River State, Nigeria.

Purpose: To determine the prevalence of presbyopia, spectacle correction coverage and its unmet needs among adults 35 years and above in the study area.Methods: This cross-sectional descriptive study design used multistage cluster random sampling procedure to select the 616 adults. Data was collected using an interviewer administered semi-structured questionnaire. Visual acuity at distance and near was tested with Snellen’s chart at 6m and 40cm respectively. This was followed by eye examination. Presbyopia was defined as near visual acuity of N8 or worse. Relationship between variables were determined using chi square and multivariate analysis at 5% significant level.Results: The average age of participants was 48.1 years ± 10.4 (range, 35-88 years) and 330 (53.6 %) were males. The prevalence of presbyopia was 73.2% (95% Confidence interval [CI]: 69.5, 76.7). Multiple regression analysis showed that, female sex (Adjusted odds ratio [AOR] =1.58 (95% CI: 1.02, 2.38), older age (AOR =3.29 (95% CI: 1.02, 13.6), unemployment (β = 0.47, p = 0.016, AOR =1.59 (95% CI: 1.26, 4.55), lack of formal education (β = -3.67, p < 0.001, AOR =0.03 (95% CI: 0.007, 0.09) were significantly associated with presbyopia. The spectacle correction coverage and unmet presbyopic need were 40.8%, and 59.2% respectively.Conclusion: The Prevalence of presbyopia and unmet presbyopic correction were high among the participants. This can be addressed through awareness creation and provision of accessible and affordable primary eye care services in the communities

Systematic review and meta-analysis of myopia prevalence in African school children

PURPOSE: Increased prevalence of myopia is a major public health challenge worldwide, including in Africa. While previous studies have shown an increasing prevalence in Africa, there is no collective review of evidence on the magnitude of myopia in African school children. Hence, this study reviews the evidence and provides a meta-analysis of the prevalence of myopia in African school children. METHODS: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases, PUBMED, Scopus, Web of Science, ProQuest, and Africa Index Medicus were searched for published studies on the prevalence of myopia in Africa from 1 January 2000 to 18 August 2021. Studies were assessed for methodological quality. Data were gathered by gender, age and refraction technique and standardized to the definition of myopia as refractive error ≥ 0.50 diopter. A meta-analysis was conducted to estimate the prevalence. Significant heterogeneity was detected among the various studies (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed to examine the effects of outliers. RESULTS: We included data from 24 quality assessed studies, covering 36,395 African children. The overall crude prevalence of myopia over the last two decades is 4.7% (95% CI, 3.9-5.7) in African children. Although the prevalence of myopia was slightly higher in females (5.3%, 95%CI: 4.1, 6.5) than in males (3.7%, 95% CI, 2.6-4.7; p = 0.297) and higher in older [12-18 years 5.1% (95% CI, 3.8-6.3) than younger children (aged 5-11 years, 3.4%, 95% CI, 2.5-4.4; p = 0.091), the differences were not significant. There was a significantly lower prevalence of myopia with cycloplegic compared with non-cycloplegic refraction [4.2%, 95%CI: 3.3, 5.1 versus 6.4%, 95%CI: 4.4, 8.4; p = 0.046]. CONCLUSIONS: Our results showed that myopia affects about one in twenty African schoolchildren, and it is overestimated in non-cycloplegic refraction. Clinical interventions to reduce the prevalence of myopia in the region should target females, and school children who are aged 12-18 years

Parenting Practices among Mothers in Obubra, Cross River State, Nigeria: An Exploratory Study

INTRODUCTION: More than half of Nigeria’s children under the age of five are at risk of poor development that may be linked to parenting practices.  OBJECTIVE: This study explores parenting practices among mothers in Obubra Local Government Area of Cross River State. MATERIALS AND METHOD: Using a Cross-Sectional descriptive design, focus group discussions were held at three communities in Obubra with mothers aged 18 and older. With a sample size of 19, each FGD lasted about 60-90 minutes. Audio tapes were transcribed and data were analyzed to generate themes. Ethical principles were duly observed. RESULTS: Themes influencing parenting included pre- and post-pregnancy support, social support from female family members, and religious, and cultural practices. Participants attended ante-natal clinics but some gave birth at home or at a Traditional Birth Attendant’s (TBA). Some believed that parenting skills are acquired as a child while observing one’s own mother, and practicing with younger siblings. Others said they acquired parenting skills while parenting their own children. Female family members helped mothers with everyday caregiving responsibilities. Corporal punishment was widely practiced. Other harmful cultural practices such as female genital mutilation were on the decline.  CONCLUSION:  Culture, religion, and reliance on female family members play a strong role in parenting, presenting both positive and negative attributes. Using appropriate behavioural change theories, evidence can be provided to these support systems to aid mothers to acquire skills and information necessary for positive parenting practices

Potential Impacts of Roe v. Wade repeal on Sexual and Reproductive Health in Sub‐Saharan Africa

Abstract The United States (US) Supreme Court's decision to repeal Roe v. Wade has had significant implications for abortion care in the US, especially for emergency care. This ruling may also have an impact on sub‐Saharan Africa, where restrictive laws and policies limit women's access to safe and legal abortions. Sub‐Saharan Africa is the region with the highest rate of unwanted pregnancies and unsafe abortions, resulting in 15,000 preventable deaths annually. Although every country in sub‐Saharan Africa has at least one legal basis for abortion, they remain limited. In Nigeria, where 29% of pregnancies are unintended, 48% of these led to abortions, amounting to over 1.4 million abortions between 2015 and 2019. Unsafe abortions are prevalent in the region due to socioreligious stigma, particularly for unmarried women. Criminal charges can result from violating these limitations, with prison terms ranging from 3 to 14 years. The reversal of Roe v. Wade could have significant consequences in abortion‐related policies and politics in sub‐Saharan Africa, encouraging nations to adopt restrictive policies and legitimizing them. The landmark decision of Roe v. Wade may also impact the rate of unsafe abortions in the region, much like the US Mexico City Policy. With the high probability of foreign assistance funds for safe abortions depleted, sub‐Saharan African countries must prepare for this financial vacuum in health response. Therefore, the repeal of Roe v. Wade may lead to increased maternal morbidity and mortality in sub‐Saharan Africa, where access to safe and legal abortions is already limited

[In Press] A systematic review of diabetes risk assessment tools in sub-Saharan Africa

Objectives: To systematically review all current studies on diabetes risk assessment tools used in SSA to diagnose diabetes in symptomatic and asymptomatic patients. Methods: Tools were identified through a systematic search of PubMed, Ovid, Google Scholar, and the Cochrane Library for articles published from January 2010 to January 2020. The search included articles reporting the use of diabetes risk assessment tool to detect individuals with type 2 diabetes in SSA. A standardized protocol was used for data extraction (registry #177726). Results: Of the 825 articles identified, 39 articles met the inclusion criteria, and three articles reported tools used in SSA population but developed for the Western population. None was validated in SSA population. All but three articles were observational studies (136 and 58,657 study participants aged between the ages of 15 and 85 years). The Finnish Medical Association risk tool, World Health Organization (WHO) STEPS instrument, General Practice Physical Activity Questionnaire (GPPAQ), Rapid Eating and Activity Assessment for Patients (REAP), and an anthropometric tool were the most frequently used non-invasive tools in SSA. The accuracy of the tools was measured using sensitivity, specificity, or area under the receiver operating curve. The anthropometric predictor variables identified included age, body mass index, waist circumference, positive family of diabetes, and activity levels. Conclusions: This systematic review demonstrated a paucity of validated diabetes risk assessment tools for SSA. There remains a need for the development and validation of a tool for the rapid identification of diabetes for targeted interventions

Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists

Abstract Background Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). Methods A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. Results A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63–23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74–28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13–9.83, P = .03) were more likely to diagnose glaucoma. Conclusions The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement