Response of Cocoa Export Market to Climate and Trade Policy Changes in Nigeria

This study examined the response of cocoa export market to climate and trade policy changes in Nigeria. Specific objectives were to describe the trend in cocoa export market and climate/trade policy changes in Nigeria; analyze the level effects of climate change in cocoa productivity arising from farmland area and labour changes, analyze the effects of cocoa productivity and trade policy changes on cocoa export market in Nigeria; forecast the possible future changes in cocoa export market due to climate and trade policy changes; and  make policy recommendations based on the research findings. For the purpose of this study, secondary data were used. A comprehensive trend in cocoa export market and climate/trade policy changes was described. A 2-stage Least Square Dynamic Panel Regression Model was used to address cocoa production and export responses, respectively, while a Monte Carlo simulation test was used to simulate, under various climate and trade/price policy scenarios, for possible climate and trade policy impacts on future cocoa output and export. It was observed that the Nigerian cocoa export market has been fluctuating and would likely continue over time. It was also observed that there has been consistent fluctuation in temperature and precipitation although relatively smaller in comparison to the export market fluctuations but still significant since a minimal increase or decrease in these climate change variables could have a significant impact especially in agriculture compared to trade policy influencing factors. The Monte Carlo simulation test recorded a slight level of relationship between cocoa output/export and climate/trade policy variables. This implies that a 10% increase or decrease in these variables, would have slight effects on cocoa output/export in Nigeria. Based on the findings, it was recommended, among others, that there should be a trade-off between trade policy gains and losses due to forest conversion as a result of cocoa hectarage expansion

Artemether-lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial

BACKGROUND: The therapeutic efficacy of artesunate plus amodiaquine and artemether/lumefantrine were assessed in an area of Nigeria with high levels of Plasmodium falciparum resistance to chloroquine and sulphadoxine-pyrimethamine. PARTICIPANTS: Children aged 6 to 59 months with uncomplicated P. falciparum infection and parasite density 1,000 to 200,000 parasites/μL enrolled following informed consent by parents. METHODS: Eligible children were randomly assigned to receive either a 3-day course of artesunate (4 mg/kg) plus amodiaquine (10 mg/kg) or 6-dose course of artemether/lumefantrine (20/120 mg tablets) over three days. Patients were followed up with clinical and laboratory assessments until day 14 using standard WHO in-vivo antimalarial drug test protocol. RESULTS: A total 119 eligible children were enrolled but 111 completed the study. Adequate clinical and parasitological response (ACPR) was 47 (87.0%) and 47 (82.5%) for artemether-lumefantrine (AL) and artesunate+amodiaquine (AAMQ) respectively (OR 0.7, 95% confidence interval 0.22 to 2.22). Early treatment failure (ETF) occurred in one participant (1.8%) treated with AAQ but in none of those with AL. Two (3.7%) patients in the AL group and none in the AAQ group had late clinical failure. Late parasitological failure was observed in 9 (15.8) and 5 (9.3%) of patients treated with AAQ and AL respectively. None of participants had a serious adverse event. CONCLUSION: Artemether-lumenfantrine and artesunate plus amodiaquine have high and comparable cure rates and tolerability among under-five children in Calabar, Nigeria

EFFECT OF YOGURT INTAKE ON PLASMA GLUCOSE AND SERUM LIPID PROFILE IN APPARENTLY HEALTHY STUDENTS OF COLLEGE OF HEALTH SCIENCES, NNEWI, ANAMBRA STATE, NIGERIA.

This study was designed to investigate the effect of oral intake of yogurt on plasma glucose and serum lipid profile levels (total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein) in apparently healthy students. A total of 30 subjects (16 males and 14 females) were recruited to serve as both test and control groups. Each subject was advised to abstain from milk and similar probiotic food consumption for three weeks. Baseline samples (after an overnight fast and 2 hours postprandial after oral intake of carbohydrate meal) were collected from both males and females at day 0 as control samples, and levels of glucose and lipid profile were evaluated. Subsequently, in addition to their normal diet, each of the subjects received 100ml of yoghurt daily for 21 days. After an overnight fast, post research (test 1stand 2nd) samples (fasting blood sample and 2 hours postprandial after oral intake of carbohydrate meal) were collected on days 11 and 22 respectively and the levels of glucose and lipid profile were re-evaluated. Blood glucose and lipid concentrations were determined using standard methods. There were a significant increase in mean serum triglyceride (TG) value 11days following yogurt intake (intermediate consumption) when compared to the baseline level (0.63±0.15 Vs 0.53±0.19; p<0.05). Also, there was a significant decrease in mean serum TG value 21 days following yogurt intake (post-consumption) when compared to baseline and intermediate levels (0.50±0.19 Vs 0.53±0.19 and 0.50±0.19 Vs0.63±0.15; p<0.05) respectively. There were a significant increase in mean serum high-density lipoprotein (HDL) value 21days following yogurt intake when compared to day 11 (intermediate consumption) and baseline levels (1.36±0.34 Vs 1.14±0.24 and 1.36±0.34 Vs 0.99±0.19; p<0.05) respectively. Also, there was a significant increase in mean serum total cholesterol (TC) value 21 days following yoghurt intake when compared to day 11 and baseline levels (p<0.05) respectively. The low-density lipoprotein (LDL) level remained unchanged 11 and 21 days following yoghurt intake (p>0.05). There was a significant increase in the mean blood glucose level (p<0.05). In conclusion, this study has shown that the lipid profile and blood glucose levels in individuals consuming yogurt may experience significant alterations which may have important clinical implications in the management of diabetes. Further studies may be necessary for understanding the mechanism behind these effects. Keywords: Yogurt; Probiotics; Diabetes mellitus; Cardiovascular disease; Glucose; Lipid profile

EFFECT OF YOGURT INTAKE ON PLASMA GLUCOSE AND SERUM LIPID PROFILE IN APPARENTLY HEALTHY STUDENTS OF COLLEGE OF HEALTH SCIENCES, NNEWI, ANAMBRA STATE, NIGERIA.

This study was designed to investigate the effect of oral intake of yogurt on plasma glucose and serum lipid profile levels (total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein) in apparently healthy students. A total of 30 subjects (16 males and 14 females) were recruited to serve as both test and control groups. Each subject was advised to abstain from milk and similar probiotic food consumption for three weeks. Baseline samples (after an overnight fast and 2 hours postprandial after oral intake of carbohydrate meal) were collected from both males and females at day 0 as control samples, and levels of glucose and lipid profile were evaluated. Subsequently, in addition to their normal diet, each of the subjects received 100ml of yoghurt daily for 21 days. After an overnight fast, post research (test 1stand 2nd) samples (fasting blood sample and 2 hours postprandial after oral intake of carbohydrate meal) were collected on days 11 and 22 respectively and the levels of glucose and lipid profile were re-evaluated. Blood glucose and lipid concentrations were determined using standard methods. There were a significant increase in mean serum triglyceride (TG) value 11days following yogurt intake (intermediate consumption) when compared to the baseline level (0.63±0.15 Vs 0.53±0.19; p<0.05). Also, there was a significant decrease in mean serum TG value 21 days following yogurt intake (post-consumption) when compared to baseline and intermediate levels (0.50±0.19 Vs 0.53±0.19 and 0.50±0.19 Vs0.63±0.15; p<0.05) respectively. There were a significant increase in mean serum high-density lipoprotein (HDL) value 21days following yogurt intake when compared to day 11 (intermediate consumption) and baseline levels (1.36±0.34 Vs 1.14±0.24 and 1.36±0.34 Vs 0.99±0.19; p<0.05) respectively. Also, there was a significant increase in mean serum total cholesterol (TC) value 21 days following yoghurt intake when compared to day 11 and baseline levels (p<0.05) respectively. The low-density lipoprotein (LDL) level remained unchanged 11 and 21 days following yoghurt intake (p>0.05). There was a significant increase in the mean blood glucose level (p<0.05). In conclusion, this study has shown that the lipid profile and blood glucose levels in individuals consuming yogurt may experience significant alterations which may have important clinical implications in the management of diabetes. Further studies may be necessary for understanding the mechanism behind these effects. Keywords: Yogurt; Probiotics; Diabetes mellitus; Cardiovascular disease; Glucose; Lipid profile

Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital

Background: Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies.Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies. Aims: To evaluate the patterns, indications and outcomes of childhood colostomies. Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020. Results: There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung’s Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01) In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73sigmoid colostomies (P =0.013) In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P<0.0001). Mortalities were notedin 1.9% patients. Conclusion: Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD. Keywords: Childhood colostomies; oatterns; indications; outcomes

Obstetric Outcome and Significance of Labour Induction in a Health Resource Poor Setting

Objectives. The aim of this study was to evaluate the methods, indications, outcome of induced labor and its significance in obstetric practice in the study area. Methods. This was a retrospective study of cases of induced labor at the Catholic Maternity Hospital in Ogoja, Cross-River State, Nigeria, between January 1, 2002, and December 31, 2011. Data on the sociodemographic characteristics of the parturient, induction methods, indications for induction, outcomes and reasons for failed induction were abstracted from personal case files and the hospital’s maternity/delivery register. The data were analyzed with SPSS15.0 window version. Result. The induction rate in this study was 11.5%. Induction was successful in 75.9% of cases but failed in 24.1%. Misoprostol was the commonest induction method (78.2%). The commonest indication for induction was postdate pregnancy (45.8%). Failed induction was due to fetal distress, prolonged labor, cephalopelvic disproportion and cord prolapse. The induction-delivery interval was 12±3.6 hours. Conclusion. Induction of labor is a common obstetric procedure which is safe and beneficial in well-selected and properly monitored high risk pregnancies where the benefits of early delivery outweigh the risk of continuing the pregnancy

Commonization of HIV/AIDS services in Nigeria: the need, the processes and the prospects

Introduction: with the first case of Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) identified in 1986, the management of HIV/AIDS in Nigeria has evolved through the years. The emergency phase of the HIV/AIDS program, aimed at containing the HIV/AIDS epidemic within a short time frame, was carried out by international agencies that built structures separate from hospitals’ programs. It is imperative that Nigeria shifts from the previous paradigm to the concept of Commonization of HIV to achieve sustainability. Commonization ensures that HIV/AIDS is seen as a health condition like others. It involves making HIV services available at all levels of healthcare. Methods: Excellence & Friends Management Consult (EFMC) undertook this process by conducting HIV tests in people’s homes and work places, referring infected persons for treatment and follow up, establishing multiple HIV testing points and HIV services in private and public primary healthcare facilities. EFMC integrated HIV services within existing hospital care structures and trained all healthcare workers at all supported sites on HIV/AIDS prevention, care and treatment modalities. Results: commonization has improved the uptake of HIV testing and counseling and enrolment into HIV care as more people are aware that HIV services are available. It has integrated HIV services into general hospital services and minimized the cost of HIV programming as the existing structures and personnel in healthcare facilities are utilized for HIV services. Conclusion: commonization of HIV services i.e. integrating HIV care into the existing fabric of the healthcare system, is highly recommended for a sustainable and efficient healthcare system as it makes HIV services acceptable by all

Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study

BACKGROUND: Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs. OBJECTIVE: To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State. METHOD: Audit of 665 patient records at six private and seven government health facilities in 2003. RESULTS: Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%), sulphadoxine-pyrimethamine (22.7%) or artemisinin derivatives alone (15.8%). Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5%) were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments. CONCLUSION: Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common

Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria

BACKGROUND: Septicaemia is a common cause of morbidity and mortality among children in the developing world. This pattern has changed little in the past decade. Physical signs and symptoms, though useful in identifying possible cases have limited specificity. Definitive diagnosis is by bacteriologic culture of blood samples to identify organisms and establish antibiotic susceptibility. These results are usually not available promptly. Therefore a knowledge of epidemiologic and antimicribial susceptibility pattern of common pathogens is useful for prompt treatment of patients. This report highlights the pattern of bacterial isolates in our environment from a retrospective study of our patients' records. METHODS: One thousand, two hundred and one blood samples were analysed from children aged 0–15 years, admitted into the children's wards of the University of Calabar Teaching Hospital, Calabar, Nigeria with features suggesting septicaemia. Samples were collected under aseptic conditions and cultured for aerobic and anaerobic organisms. Isolates were identified using bacteriologic and biochemical methods and antibiotic sensitivity determined by agar diffusion method using standard antibiotic discs. RESULTS: Bacteria was isolated in 552 (48.9%) of samples with highest rates among newborns (271 : 50.8). The most frequent isolates were Staphylococcal aureus (48.7%) and Coliforms (23.4%). Results showed high susceptibilities to the Cephalosporins (Ceftriazone- 100%:83.2%, Cefuroxime-100%:76.5%) and Macrolides (Azithromycin-100%:92.9%) for S. aureus and coliforms respectively. This study underscores the importance of septicaemia as a common cause of febrile illness in children and provides information on common prevalent aetiologic agents and drug susceptibilities of the commonest pathogens. CONCLUSION: Staphylococcus aureus and coliforms were the leading causes of septicaemia in children in this locality, and the third generation cephalosporins and azithromycin were shown to be effective against these pathogens

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030