Continuing Medical Education: Closing The Gap Between Medical Research And Practice

Continuing medical education (CME) has long been recognized as the key to updating and maintaining the knowledge and skill of health professionals.CME activities are well advocated, accepted and regulated in the developed world with sanctions for non-participation. In developing countries, including West Africa subregion, CME activities are less effective and no practical enforcement to compel individual’s participation. This review examined the importance, scope and regulation of CME activities and identified the barriers to effective CME in developing countries to include lack of motivation, time, finance and lack of access to CME facilities occasioned by underdevelopment in information and communication technology (ICT) and know-how. It is concluded with practical suggestions that; health professionals should embrace CME as a moral and ethical obligation; health organizations and institutions should provide incentives, adequate funding and protected time for CME activities; professional and regulatory bodies should enforce participation and impose sanctions if need be, as the way forward

Current Trends In The Laboratory Diagnosis Of Tuberculosis

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Lassa virus persistence in body fluids after recovery from acute Lassa fever: a 2-year interim analysis of a prospective longitudinal cohort study

Background: There is anecdotal evidence for Lassa virus persistence in body fluids. We investigated various body fluids after recovery from acute Lassa fever and describe the dynamics of Lassa virus RNA load in seminal fluid. The primary objective of this study was to quantitatively describe virus persistence and clearance and assess the infectivity of seminal fluid. Methodology: In this prospective, longitudinal, cohort study, we collected plasma, urine, saliva, lacrimal, vaginal and seminal fluids from Lassa fever survivors at Irrua Specialist Teaching Hospital in Edo State, Nigeria. Inclusion criteria for participants were RT-PCR-confirmed Lassa fever diagnosis and age 18 years and above. Samples were taken at discharge from hospital (month 0) and at months 0·5, 1, 3, 6, 9, 12, 18, and 24 after discharge. Lassa virus RNA was detected using real-time RT-PCR. Infectivity was tested in cell culture and immunosuppressed mice. We used a linear mixed-effect model to analyse the dynamics of virus persistence in seminal fluid over time. Results: Between Jan 31, 2018, and Dec 11, 2019, 165 participants were enrolled in the study, of whom 159 were eligible for analysis (49 women and 110 men). Low amounts of Lassa virus RNA were detected at month 0 in plasma (45%, n=49/110), urine (34%, 37/110), saliva (5%, 5/110), lacrimal fluid (9%, 10/110), and vaginal fluid (21%, n=7/33 female participants). Virus RNA was cleared from these body fluids by month 3. However, 35 (80%) of 44 male participants had viral RNA in seminal fluid at month 0 with a median cycle threshold of 26·5. Lassa virus RNA remained detectable up to month 12 in seminal fluid. Biostatistical modelling estimated a clearance rate of 1·19 log₁₀ viral RNA copies per month and predicted that 50% of male survivors remain Lassa virus RNA-positive in seminal fluid for 83 days after hospital discharge, and 10% remain positive in seminal fluid for 193 days after discharge. Viral RNA persistence in seminal fluid for 3 months or more was associated with higher viraemia (p=0·006), more severe disease (p=0·0075), and longer hospitalisation during the acute phase of Lassa fever (p=0·0014). Infectious virus was isolated from 48 (52%) of 93 virus RNA-positive seminal fluid samples collected between month 0 and 12. Conclusion: Lassa virus RNA is shed in various body fluids after recovery from acute disease. The persistence of infectious virus in seminal fluid implies a risk of sexual transmission of Lassa fever

Prevalence and Impact of Socio-Economic/Enviromental Factors on Soil-Transmitted Helminth Infection in Children Attending Clinic in a Tertiary Hospital in Benin City, Nigeria

Children are important risk group for soil-transmitted helminths (STH). Hence, this study was undertaken to determine the impact of mothers’ educational status, the method of fecal disposal and source of water supply on the prevalence of STH infection. Four hundred and ninety six children, aged 1-15 years, who presented at the Children Out-patient Clinic of the University of Benin Teaching Hospital (UBTH) were screened for STH in their stool, using methods of wet preparation and Stoll's technique for detection and counting of helminthes eggs. A semi-structured, researcher administered questionnaire was used to collect information on socio demographics of mother/care giver, history of de-worming, source of water supply, and method of fecal disposal. The overall prevalence of STH infections was 9.5%, corresponding to 6.9% of Ascaris lumbricoides, 2.4% of hookworm and 0.2% of Trichuris trichiuria. Infection with hookworm was of highest intensity. Age group 6 - 10 had the highest prevalence of STH. Mother/caregivers level of education, method of faecal disposal and source of water supply, all significantly influenced the prevalence of STH infection. There is need for a coordinated, multi-sectarian and multidisciplinary strategy that integrates periodic deworming, health education and environmental sanitation for effective control.Keywords: Soil-transmitted helminths; Prevalence; Children; Benin City

Age and sex prevalence of infectious dermatoses among primary school children in a rural South-Eastern Nigerian community

Introduction: Various dermatoses, due to their morbidity characteristics, have been shown to negatively impact on learning. The most epidemiologically important seem to be the infectious types because of their transmissibility and amenability to simple school-health measures. The aim of this study was to assess the prevalence and sex/age correlates of infectious dermatoses in a rural South-eastern Nigerian community.Methods: The pupils were proportionately recruited from the three primary schools based on school population. Stratified simple random samplingmethod was adopted and a table of random numbers was used to select required pupils from each arm. Clinical and laboratory examination wasdone to establish diagnoses of infectious skin disease. Data collected were analyzed using SPSS version 16. Results: The 400 pupils consisted of 153 males and 247 females. Age range was between 6 and 12 years. The prevalence of infectious  dermatoses was 72.3%. The five most prevalent clinical forms of infectious dermatoses, in order of decreasing prevalence, were tinea capitis (35.2%), scabies (10.5%), tinea corporis (5.8%), tinea pedis (5.5%), and impetigo (5.0%). More cases, generally, occurred among males than females  (80.4% vs 67.2%)); while some specific clinical types, pediculosis and seborrheic dermatitis, exhibited predilection for females. Pyodermas and scabies were significantly more prevalent in the 7-9 age-group; while tinea capitis, tinea corporis, seborrheic dermatitis and pediculosis were more associated with .10 age-group.Conclusion: Infectious dermatoses were highly prevalent in the surveyed population. Many of the clinical types exhibited sex- and age-specificity

A prospective, multi-site, cohort study to estimate incidence of infection and disease due to Lassa fever virus in West African countries (the Enable Lassa research programme)–Study protocol

Background Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses. Method We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (nmin = 1000 per site) will be drawn from the LF cohort (nmin = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM). Discussion Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

HIV - sero Positivity and Intestinal Helminthiasis among Children in a Tertiary Health Facility in Benin-City, Nigeria.

To determine the effect of HIV sero - positivity on the prevalence of intestinal helminthiasis. Descriptive, crossectional study design was undertaken. A cross sectional study among 496 HIV sero- positive (cases) and 490 HIV sero- negative (controls) children 1 – 15 years attending paediatrics clinic were surveyed for intestinal helminthiasis. Faecal samples were collected and examined for the presence of characteristic helminth ova using formol ether concentration method while intensity of infection was determined using McMaster counting chamber. Overall prevalence of intestinal helminthiasis was 15.4%. Prevalence was higher among the cases, 21.4% than the control, 9.5% and the difference in rate of infection was found to be statistically significant (PÂ 0.0000). The prevalence of helminthiasis is significantly higher among the cases than the controls. It is likely that in the cases, HIV status could have accentuated their susceptibility to helminthiasis. Regular deworming of cases alongside improved personal hygiene should be practiced to reduce infection burden.Key words: HIV sero - positive, intestinal helminth, children, health facility

Co‑infections of hepatitis B and C with human immunodeficiency virus among adult patients attending human immunodeficiency virus outpatients clinic in Benin City, Nigeria

Background: Hepatitis B and C viral co‑infections with human immunodeficiency virus (HIV) are known to affect progression, management, and outcome of HIV infection. This study was aimed to access the prevalence of hepatitis B and C co‑infections in HIV‑infected adult patients in the University of Benin Teaching Hospital with a view of understanding the gravity of this problem in the local population.Methods: The descriptive cross‑sectional study was carried out on 342 HIV‑infected adult patients on highly active antiretroviral therapy attending HIV Outpatients Clinic of University of Benin Teaching Hospital, between April and September, 2011. Patients’ sera were screened for hepatitis B surface antigen (HBsAg) and anti‑hepatitis C virus (HCV) using immunochromatographic‑based kits. Clinical stage of HIV and CD4+ cell counts were equally evaluated. Data were analyzed using SPSS version 17.Results: Of the 324 HIV‑infected patients screened, 53 (15.5%) were positive for HBsAg, 24 (7.0%) positive for hepatitis C virus antibodies (HCV‑Ab), while 2 (0.6%) were positive for both viruses. Seroprevalence of HBsAg was higher in male (17.8%) than in female (14.7%) (χ2 = 0.49, P = 0.49), while the reverse is the case for HCV‑Ab; 7.1% for female and 6.7% for male (χ2 = 0.02, P = 0.88). Seroprevalences of HBsAg and HCV‑Ab were also higher among patients in World Health Organization disease stages 3–4 and patients with CD4+ cell count ≤200 cell/μl compared to those in stages 1–2 and with CD4+ cell count >200 cell/μl.Conclusion: Co‑infection with hepatitis B virus and HCV among HIV/acquired immune deficiency syndrome (AIDS) patients is still a problem in our environment. Screening for these viruses among HIV/AIDS patients will allow for early detection and proper management.Keywords: Benin, co‑infection, hepatitis B virus, hepatitis C virus, human immunodeficiency virus/acquired immune deficiency syndrom