The Covid-19 era: the view from Nigeria

If we were told that one day the entire world would take its guidance for managing a health crisis from empirical thought, nobody would have believed it. However, with the December 2019 arrival of COVID-19 in China, the world subsequently went into a frenzied state that resulted in widespread adoption of untested strategies or potential cures; circumstantial evidence provided without randomized control trials (RCTs) was published rapidly and widely considered the gold standard in medical research and therapeutics. Nigeria and much of the rest of the world blindly adopted treatments like chloroquine or hydroxychloroquine and various prevention strategies, often without monitoring the efficacy of these treatment and social control strategies. COVID-19 provided Nigeria a critical opportunity to create or strengthen its national laboratory system by building up its Level 3 laboratories in all parts of the country with the capability to perform PCR tests and viral isolation. There was also an opportunity to establish hospitals in every region of a sufficient standard to reduce the numbers of Nigerians travelling abroad to seek medical treatment; to invest in building capacity to develop antiviral medications and vaccines in Nigeria, and to ensure better international health policies. Rather, Nigerian leaders, government, and health managers decided (like most other nations of the world) to shut down society using isolationist policies that were not necessarily tailored to local needs. Despite adopting these methods, COVID-19 cases continued to skyrocket in Nigeria. In the future, before adopting such broad sweeping policies, there should be local tailoring to assess their effectiveness in different communities. Given that the country has much experience in controlling Lassa and Marburg Fever outbreaks, Nigeria should lead by developing new strategies, new protocols, and new local guidelines, based on validated and reproducible studies to ensure that the public health authorities are not caught unaware by any new outbreaks of emerging or remerging diseases

Response of planktonic bacteria of New Calabar River to zinc stress

Toxicity of Zn2+ on four planktonic bacteria isolated from New Calabar River water was assessed via dehydrogenase assay. Pure cultures of the bacterial strains were exposed to various Zn2+  concentrations (0.2 - 2.0 mM) in a nutrient broth amended with glucose and TTC. The responses of the bacterial strains to Zn2+ is concentration-dependent. At 0.2 mM, Zn2+ stimulated dehydrogenase activity in Proteus sp. PLK2 and Micrococcus sp. PLK4. In all strains, dehydrogenase activity was progressively inhibited at concentrations greater than 0.2 mM. The IC50 ranges from 0.236 ± 0.044 to 0.864 ± 0.138 mM. Total inhibition occurred at concentrations ranging from 1.283 ± 0.068 to 2.469 ± 0.045 mM. The order of zinc tolerance is: Micrococcus sp. PLK4 > Proteus sp. PLK2 > Pseudomonas sp. PLK5 > Escherichia sp. PLK1. The result of the in vitro study indicated that the bacterial strains are sensitive to Zn2+ stress. Therefore, Zn2+ contamination would pose serious threat to their metabolism in natural environments.Key words: New Calabar River, zinc toxicity, planktonic bacteria, dehydrogenase

Spontaneous Perforation of the Bile Duct in Infants

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention.La perforation spontan\ue9e des canaux biliaires est une affection rare chez les enfants. A ce jour, moins de 100 cas ont \ue9t\ue9 rapport\ue9s dans la litt\ue9rature anglophone. Un certain nombre de techniques ont \ue9t\ue9 mises en oeuvre pour le diagnostic pr\ue9 op\ue9ratoire, n\ue9anmoins la plupart des cas sont de diagnostic per op\ue9ratoire. Une fille de 3 mois avait pr\ue9sent\ue9 de la fi\ue8vre, vomissements, distension progressive de l'abdomen, ict\ue8re et diarrh\ue9e. L'\ue9chographie de l'abdomen avait montr\ue9 une collection liquidienne localis\ue9e refoulant les anses gr\ueales vers le c\uf4t\ue9 droit de l'abdomen. La paracent\ue8se avait retrouv\ue9 un liquide bilieux. La laparotomie avait not\ue9 un pseudo kyste biliaire, mais le si\ue8ge de la perforation n'\ue9tait plus visible. La paroi du contenant a \ue9t\ue9 excis\ue9e et un drainage externe a \ue9t\ue9 r\ue9alis\ue9. Neuf mois apr\ue8s l'op\ue9ration, les suites \ue9taient simples. Une forte suspicion devrait mener au diagnostic et imposer une intervention pr\ue9coce

A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

BACKGROUND: Malaria is a serious illness among children aged 5 years and below in Zambia, which carries with it many adverse effects including anemia and high parasites exposure that lead to infant and childhood mortality. Due to poor accessibility to modern health facilities, malaria is normally managed at home using indigenous and cosmopolitan medicines. In view of problems and implications associated with management of severe malaria at home, rectal artesunate is being proposed as a first aid drug to slow down multiplication of parasites in children before accessing appropriate treatment. METHODS: A qualitative study using standardised in-depth and Focuss Group Discussions (FGDs) guides to collect information from four (4) villages in Nakonde district, was conducted between February and March 2004. The guides were administered on 29 key informants living in the community and those whose children were admitted in the health facility. Participants in the 12 FGDs came from the 4 participating villages. Participants and key informants were fathers, younger and older mothers including grandmothers and other influential people at household level. Others were traditional healers, headmen, village secretaries, tradtional birth attendants, church leaders and black smiths. FGDs and interview transcriptions were coded to identify common themes that were related to recognition, classification and naming of malaria illness, care-seeking behaviour and community treatment practices for severe malaria. RESULTS: Parental prior knowledge of the disease was important as the majority of informants (23 out of 29) and participants (69 out of 97) mentioned four combined symptoms that were used to recognise severe malaria. The symptoms were excessive body hotness, convulsions, vomiting yellow things and bulging of the fontanelle. On the other hand, all informants mentioned two or more of symptoms associated with severe malaria. In all 12 FGDs, participants reported that treatment of severe malaria commenced with the family and moved into the community as the illness progressed. Although treatment of severe diarrheal effects, were common among the winamwanga, no rectal medicines to treat severe malaria were identified. Apart from the anti-malarial fansidar, which was mentioned by 23 in IDIs and 40 in FGDs, participants and informants also frequently mentioned indigenous medicines provided by healers and other respectable herbalists for repelling evil spirits, once a child had severe malaria. Mothers were the important arms for administration of ant-malarial drugs in the villages. Referrals began with healers to CHWs, where no CHWs existed healers directly referred sick children to the health facility. CONCLUSION: Our findings showed that there is a precedent for rectal application of traditional medicine for childhood illness. Therefore rectal artesunate may be a well-received intervention in Nakonde District, provided effective sensitisation, to mothers and CHWs is given which will strengthen the health care delivery system at community level

Prevalence and risk factors of malaria among children in southern highland Rwanda

<p>Abstract</p> <p>Background</p> <p>Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa, including Rwanda. In the southern highlands, near the district capital of Butare (altitude, 1,768 m), a combined community-and facility-based survey on <it>Plasmodium </it>infection was conducted early in 2010.</p> <p>Methods</p> <p>A total of 749 children below five years of age were examined including 545 randomly selected from 24 villages, 103 attending the health centre in charge, and 101 at the referral district hospital. Clinical, parasitological, haematological, and socio-economic data were collected.</p> <p>Results</p> <p><it>Plasmodium falciparum </it>infection (mean multiplicity, 2.08) was identified by microscopy and PCR in 11.7% and 16.7%, respectively; 5.5% of the children had malaria. PCR-based <it>P. falciparum </it>prevalence ranged between 0 and 38.5% in the villages, and was 21.4% in the health centre, and 14.9% in the hospital. Independent predictors of infection included increasing age, low mid-upper arm circumference, absence of several household assets, reported recent intake of artemether-lumefantrine, and chloroquine in plasma, measured by ELISA. Self-reported bed net use (58%) reduced infection only in univariate analysis. In the communities, most infections were seemingly asymptomatic but anaemia was observed in 82% and 28% of children with and without parasitaemia, respectively, the effect increasing with parasite density, and significant also for submicroscopic infections.</p> <p>Conclusions</p> <p><it>Plasmodium falciparum </it>infection in the highlands surrounding Butare, Rwanda, is seen in one out of six children under five years of age. The abundance of seemingly asymptomatic infections in the community forms a reservoir for transmission in this epidemic-prone area. Risk factors suggestive of low socio-economic status and insufficient effectiveness of self-reported bed net use refer to areas of improvable intervention.</p

In vitro effects of petroleum refinery wastewater on dehydrogenase activity in marine bacterial strains

Toxicity of oil refinery effluent on four bacteria strains isolated from refinery effluent impacted river water sample was assessed via dehydrogenase assay. Pure cultures of the bacterial strains were exposed to various effluent concentrations [12.5 – 100% (v/v)] in a nutrient broth amended with glucose and TTC. The response of the bacterial strains to refinery effluent is concentration-dependent. At 12.5% (v/v), the effluent stimulated dehydrogenase activity in Streptococcus sp. RW3 and Pseudomonas sp. RW4. In all strains, dehydrogenase activity was progressively inhibited at concentrations greater than 12.5% (v/v). The IC50 ranges from 25.46 ± 4.75 to 31.30 ± 2.63% (v/v). The result of the in vitro study indicated that the bacterial strains are sensitive to oil refinery raw wastewater stress. Therefore, the improperly treated effluent when discharged would pose serious threat to the metabolism of the bacterial strains in natural environments

Revisiting public health programming in Nigeria: challenges and solutions

Obinna Ositadimma Oleribe,1 Okey Nwanyanwu,2 Eric Yi-Liang Shen,3 Simon D Taylor-Robinson41Excellence and Friends Management Care Centre (EFMC), Abuja, Nigeria; 2Global Health Services Network, Farmington, MI, USA; 3Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333, Taiwan; 4Faculty of Medicine, Imperial College London, London W2 1PG, UKAbstract: Public health programming has three main components &ndash; capacity development, service provision and documentation with monitoring. However, most funders and programmers now focus on just documentation and monitoring. In this communication, the authors extensively discuss the need for the full complement of public health programming and why it is important to restructure supportive site visits to make them both empowering and impactful to the health care workers resulting in higher quality of public health services and documentation with monitoring. The authors are of the view that following problem identification, comprehensive capacity development of field workers will engender quality service provision and appropriate documentation and monitoring.Keywords: programming, supervisory site visits (SSVs), capacity developmen

Revisiting public health programming in Nigeria: challenges and solutions

Public health programming has three main components – capacity development, service provision and documentation with monitoring. However, most funders and programmers now focus on just documentation and monitoring. In this communication, the authors extensively discuss the need for the full complement of public health programming and why it is important to restructure supportive site visits to make them both empowering and impactful to the healthcare workers resulting in higher quality of public health services and documentation with monitoring. The authors are of the view that following problem identification, comprehensive capacity development of field workers will engender quality service provision and appropriate documentation and monitoring

Filling a gap: HIV pediatric surveillance in resource contrained settings

ABSTRACT: Objectives and Background: While HIV surveillance systems have seen marked improvements in recent years, advances in pediatric surveillance have been limited. HIV prevalence data among children and youth are scarce, hindering prevention, care and treatment programs for these populations. Methods: This paper provides a review of approaches to pediatric HIV surveillance as discussed in March 2009 at the 2nd Global HIV/AIDS Surveillance Meeting in Bangkok, Thailand. Discussion: Pediatric HIV surveillance systems that incorporate data collection on risk factors and HIV prevalence should be established at the country level. A well-functioning case reporting system is ideal; however, this may not be possible in resource-constrained settings. Additional approaches to pediatric HIV surveillance include case-based reporting linked to prevention of mother to child transmission (PMTCT) or early infant diagnosis (EID) programs, population-based household surveys to provide prevalence and behavioral data, testing conducted at immunization clinic visits, and mortality surveillance through methods such as verbal autopsies. In addition, special surveys such as pediatric inpatient surveys, school-based surveys and out-of-school youth surveys may be incorporated to target specific groups for surveillance. Other data sources that may be considered include treatment, tuberculosis (TB), voluntary counseling and testing (VCT), and sexually transmitted infection (STI) registries. Conclusions: Pediatric HIV surveillance is necessary for understanding pediatric needs, improving adherence to international guidelines on HIV diagnoses and treatment of children, and monitoring the impact of intervention programs. As with any surveillance methodology, each approach to pediatric surveillance should be considered in light of available capacity and resources for implementation, sustainability, and limitations.