Risk Factors, Threats And Prevention Of Highly Pathogenic Avian Influenza (HPAI) In African Countries

Highly pathogenic avian influenza (HPAI) is a viral disease that affects the digestive, nervous and respiratory systems of all domestic and wild birds with high morbidity and mortality. It is highly contagious disease which can be fatal in humans. The avian influenza viruses (AIVs) are classified as types A, B and C with 15 subtypes of the type A. To date, all disease causing HPAI Viruses belong to H5 or H7 subtypes; and affect pigs and humans with the pigs serving as a mixing vehicle for re-assortment of the virus. The domestic ducks get infected without showing clinical signs and serve as a source of infection for domestic poultry. Outbreaks of HPAl in Europe, Asia and Turkey are reported to be associated, with the presence of wet lands and lakes where migratory birds rest. In some African countries like Nigeria, such wet lands exist with free flying wild birds and domestic ducks visiting and resting. The possible source of introduction into a country could be through importation or smuggling of infected poultry products across the borders and through migratory birds that fly through identified pathways. The status of HPAl in many African countries including Nigeria is still under investigation so that appropriate strategies / measures to prevent introduction of the disease into the country can be implemented and / or strengthened through restriction of importation of poultry and poultry products from high risk countries, effective disease surveillance, functional National Veterinary services, quarantine and community based participatory epidemiological system for HPAI surveillance and control. This article reviewed the global epidemiology and risk factors of HPAI infection in Nigeria and other African countries with emphasis on specific preventive measures that can reduce introduction of the virus into the country and the epidemiological surveillance for case detection / identification, screening and management. This review provides useful information and updates for health workers in tropical countries on the trends of AIVs and HPAI, diagnostic criteria using case definitions for both community and health facility levels and management protocols for confirmed cases as recommended by the World health Organization. African Journal of Clinical and Experimental Microbiology Vol. 10 (2) 2009: pp.99-11

Community awareness of bird flu and the practice of backyard poultry in a North-Central State of Nigeria

Introduction. The practice of backyard poultry is a very common practice in many homes in Nigeria. Birds raised at home are usually free ranged, which increases close contact between man and birds, thus increasing the risk of transmission of avian influenza virus to man. This study investigated the awareness of bird flu infection and identifies risk factors associated with the practice of backyard/free ranged poultry among the residents of a state in Northern Nigeria. Methods. This cross-sectional study was carried out in Kwara State using 130 wards selected through cluster sampling technique. Households in each ward were sampled through systematic random sampling technique using the primary health care house numbering register. Semi-structured questionnaire was used to generate relevant information through interview and 650 participants consented and were used for the study. Results. Most of the respondents 604 (92.9%) kept birds in their homes and one-third 204 (33.8%) of this group knew that infection from birds can be transmitted to man. However, less than a third186 (30.8%) of those who keep birds were aware of avian influenza (AI) infection. Out of the 186 respondents, 78 (41.9%) had experienced massive bird deaths in the preceding year prior to the interview. Less than half 81 (43.5%) were willing to report AI or massive deaths occurring in flocks of their birds to designated officers / authority. During outbreaks with massive deaths in birds some of the respondents sold infected live birds 45 (57.7%), few slaughtered and dressed the birds before sale 11 (14.1%), while some slaughtered and consumed the birds in their families 19 (24.4%). Conclusion. The practice of backyard poultry is very high with little knowledge and awareness of mechanism and risk of infection associated with it. This was also reflected in their attitude towards reporting of outbreaks in birds. Public awareness campaign and home visit by environmental and veterinary officers are important strategies that can prevent AI infection transmission among domestic birds and man

Vaccine Storage and Handling Practices among routine immunization service providers in a metropolitan city of North-Central Nigeria

Background: The efficacy of vaccines can be compromised by faulty transport, storage, and handling. This study was conducted to assess the knowledge and practice of vaccine storage and handling among Primary Health Care Workers (PHCWs) offering routine immunization (RI) services in static health facilities in Ilorin metropolis, North-central Nigeria.Methodology: It was a descriptive cross-sectional study carried out among 457 Primary Health Care Workers (PHCWs) in 2 Local Government Authorities in Kwara State, north central Nigeria, using multi stage sampling technique. The research instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using EPI-INFO version 3.5.1 software package. Level of significance was predetermined at p-value of less than 0.05 at 95% confidence interval.Results: About half of the respondents (52.1%) knew the optimal vaccine storage temperature, 35.4% knew that freezing is harmful to certain vaccines. Although, 67.8% were aware of the 'shake test', only 48.4% of them knew how to conduct it. Up to 367 (80.3%) acknowledged that heat is harmful to vaccines. Even though, 267 (58.4%) knew the vaccine vial monitor (VVM) stages, only 248 (45.3%) could interpret the VVM correctly. About 30% of the health facilities (HFs) had adequate vaccine storage equipments while less than one third (28.6%) refrigerators were used exclusively for vaccine storage. However, functioning thermometers were present in all the refrigerators devoted to vaccine storage.Conclusions: Vaccine storage and handling practices among PHCWs providing routine immunization (RI) services in the study area was still sub-optimal. There is need for periodic on the job training and supportive supervision of health workers by middle cadre immunization officers in the local government to improve on the vaccine storage and handling practices of RI service providers.Keywords: Routine immunization, knowledge, vaccine handling, Nigeria, practice

Knowledge and prevalence of risk factors for arterial hypertension and blood pressure pattern among bankers and traffic wardens in Ilorin, Nigeria

Background: High job strain, mental stress, sedentary lifestyle, increase in BMI are among the factors associated with significantly higher incidence of hypertension. The job of bank employees is both sedentary in nature and accompanies high mental stress. The aim of this study is to assess the level of knowledge of risk factors among respondents and to compare the blood pressure pattern of bankers and traffic wardens.Methodology: The study design is a descriptive cross-sectional conducted among bankers and traffic wardens in Ilorin to determine the pattern and knowledge of blood pressure. Self-administered questionnaires, weighing scale (Omron Digital scale), stadiometer and sphygmomanometer were used as the research instruments. Simple random sampling was used to select respondents involved in the study.Results: The prevalence of hypertension in this study was 34.4% in bankers and 22.2% in traffic wardens. The risk factors the bankers commonly had knowledge of are alcohol, obesity, high salt intake, certain drugs, stress, emotional problems and family history while the traffic wardens commonly had knowledge of all these in addition to cigarette smoking. Also, more bankers (32.2%) than traffic wardens (13.3%) were smoking cigarette and more of these cigarette smokers that are bankers (17.8%) had elevated blood pressure compared to the traffic wardens (3.3%).Conclusion: Workers in the banking industry as well as traffic wardens should be better educated about the risk factors of hypertension and bankers should be encouraged to create time for exercise.Key words: Hypertension, risk factors, bankers, traffic warden

Community survey on blood donation practices in a northern state of Nigeria

Introduction. Volunteer blood donors account for less than half of the blood supply in developing countries; and few countries have mobilized efforts to encourage voluntary blood donation (VBD). The objective of this study was to determine the knowledge and blood donation practices among adults in a state in Northern Nigeria. Methods. Descriptive cross sectional study using multistage sampling technique was carried out among 936 respondents. Semi structured interviewer administered questionnaire was used to generate relevant data and information from the respondents. Data entry and analysis was done using EPI-info software package. Results. The knowledge of the respondents on blood donation was low. Less than half 432 (46.2%) knew some indications for blood transfusion. Two hundred and twelve (22.6%) respondents had donated blood in the past but only 1% of these were VBD while 95% were donations based on blood needs by family members, relations and friends. Few respondents 112 (12%) had received blood transfusion in the past, and the main source of blood transfused was paid commercial donors 50 (44.6%). The fear of HIV screening was a major hindrance and limitation to voluntary blood donation among respondents. Conclusion. The gaps in knowledge and practice of VBD can be addressed through public awareness campaigns, and motivational programmes such as free medical services for voluntary blood donors

Cervical epithelial changes in a tertiary hospital in northern Nigeria

Introduction: Cervical cancer is the commonest gynaecological malignancy in Nigeria, accounting for most deaths from cancers in women. Screening remains one of the best ways to prevent this catastrophe.Methodology: This was a cross sectional study conducted among patients that presented for cervical cancer screening at the Jos University Teaching Hospital, Jos, Plateau State, North Central Nigeria over a Five-year period (1st August, 2006-31st July, 2011). Data was analyzed for frequencies using EPI Info 3.5.1, CDC, Atlanta, USA.Results: During the period of study (74.5%) of the 7863 women screened were normal. Inflammatory changes, LSIL and HSIL, were the commonest abnormalities. Eight point four percent (8.4.%) were either ASC-US or ASC-H, 35 (0.4%) were AGUS or AGUS-N. LSIL and HSIL were 547 (7.0%) and 193 (2.4%) respectively. One thousand, six hundred and seventy two (21.2%) were inflammation changes, bacterial infection, or trichomoniasis. Thirty two (0.4%) cases of suspected invasive carcinoma were seen.Conclusion: The abnormal cytological abnormality rate was high. More effort needs to be put in place to ensure that women have access to screening to reduce the burden of cervical cancer in this environment.Keywords: Paps smear, intraepithelial changes, cervical cancer, Jos University Teaching HospitalTrop J Obstet Gynaecol, 30 (1), April 201

Prevalence and risk factors of cervical cancer among women in an urban community of Kwara State, North Central Nigeria

Background. Cervical cancer is the second most common malig- nancy in women worldwide with a high incidence in under-devel- oped countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear and to identify risk factors for cervical cancer among women in Olufadi community, Kwara state, North-central Nigeria. Methods. This was a cross-sectional study involving the screening of women aged 25-64 years for cervical cancer using Papanicolaou smear. Respondents were selected through systematic random sam- pling of households. Interviewer- administered questionnaire and clinical report form were also used to collect data. In addition, Pap smear samples were taken. Data was analyzed using SPSS version 15. Results. Only 10 (5.0%) respondents had positive cytology result, while the rest were normal. Of the 10 positive cytology results, 1(10.0%) was high grade squamous intraepithelial lesion (HGSIL) while the remaining 9(90.0%) were low grade squamous intraepithelial lesion (LGSIL) which corresponds to 0.5% and 4.5% of the total respondents respectively. Risk fac- tors for cervical cancer identified included coitarche, tobacco smoking, number of sexual partners and family history of cervi- cal cancer. Conclusion. The findings from this study attest to the increasing burden of cervical cancer. The high number of positive results obtained from the study coupled with the presence of risk factors was an indication of how useful regular screening will be in the early detection of cervical cancer

A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

<p>Abstract</p> <p>Background</p> <p>Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.</p> <p>Methods</p> <p>The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.</p> <p>Results</p> <p>As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.</p> <p>Conclusions</p> <p>As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.</p

Vector Transmission of Leishmania Abrogates Vaccine-Induced Protective Immunity

Numerous experimental vaccines have been developed to protect against the cutaneous and visceral forms of leishmaniasis caused by infection with the obligate intracellular protozoan Leishmania, but a human vaccine still does not exist. Remarkably, the efficacy of anti-Leishmania vaccines has never been fully evaluated under experimental conditions following natural vector transmission by infected sand fly bite. The only immunization strategy known to protect humans against natural exposure is “leishmanization,” in which viable L. major parasites are intentionally inoculated into a selected site in the skin. We employed mice with healed L. major infections to mimic leishmanization, and found tissue-seeking, cytokine-producing CD4+ T cells specific for Leishmania at the site of challenge by infected sand fly bite within 24 hours, and these mice were highly resistant to sand fly transmitted infection. In contrast, mice vaccinated with a killed vaccine comprised of autoclaved L. major antigen (ALM)+CpG oligodeoxynucleotides that protected against needle inoculation of parasites, showed delayed expression of protective immunity and failed to protect against infected sand fly challenge. Two-photon intra-vital microscopy and flow cytometric analysis revealed that sand fly, but not needle challenge, resulted in the maintenance of a localized neutrophilic response at the inoculation site, and removal of neutrophils following vector transmission led to increased parasite-specific immune responses and promoted the efficacy of the killed vaccine. These observations identify the critical immunological factors influencing vaccine efficacy following natural transmission of Leishmania

Racial disparities in treatment patterns and clinical outcomes in patients with HER2-positive metastatic breast cancer

Data characterizing demographics, treatment patterns, and clinical outcomes in black patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) are limited. registHER is a large, observational cohort study of patients (n = 1,001) with HER2-positive MBC diagnosed ≤6 months of enrollment and followed until death, disenrollment, or June 2009 (median follow-up of 27 months). Demographics, treatment patterns, and clinical outcomes were described for black (n = 126) and white patients (n = 793). Progression-free survival (PFS) following first-line therapy and overall survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Black patients were more likely than white patients to be obese (body mass index ≥30), to have diabetes, and to have a history of cardiovascular disease; they were also less likely to have estrogen receptor or progesterone receptor positive disease. In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %). Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3–32.1; white: 37.3, 95 % CI 34.6–41.1; PFS: black: 7.0, 95 % CI 5.7–8.2; white: 10.2, 95 % CI 9.3–11.2). The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00–1.65); adjusted PFS HR was 1.29 (95 % CI 1.05–1.59). This real-world evaluation of a large cohort of patients with HER2-positive MBC shows poorer prognostic factors and independently worse clinical outcomes in black versus white patients. Further research is needed to identify potential biologic differences that could have predictive impact for black patients or that could explain these differences