Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria (January–March 2012)

SummaryObjectivesDespite the epidemic nature of Lassa fever (LF), details of outbreaks and response strategies have not been well documented in resource-poor settings. We describe the course of a LF outbreak in Ebonyi State, Nigeria, during January to March 2012.MethodsWe analyzed clinical, epidemiological, and laboratory data from surveillance records and hospital statistics during the outbreak. Fisher's exact tests were used to compare proportions and t-tests to compare differences in means.ResultsThe outbreak response consisted of effective coordination, laboratory testing, active surveillance, community mobilization, contact and suspected case evaluation, and case management. Twenty LF cases (10 confirmed and 10 suspected) were recorded during the outbreak. Nosocomial transmission to six health workers occurred through the index case. Only 1/110 contacts had an asymptomatic infection. Overall, there was high case fatality rate among all cases (6/20; 30%). Patients who received ribavirin were less likely to die than those who did not (p=0.003). The mean delay to presentation for patients who died was 11±3.5 days, while for those who survived was 6±2.6 days (p<0.001).ConclusionsThe response strategies contained the epidemic. Challenges to control efforts included poor local laboratory capacity, inadequate/poor quality of protective materials, fear among health workers, and inadequate emergency preparedness

Cost effectiveness of Tuberculosis Treatment from the Patients' Perspective

Objective: I o compare the cost-effectiveness of two strategies for supervising the Directly Observed Treatment Short course (DOTS) during the intensive phase of Tuberculosis treatment. Methodology: 600 newly diagnosed previously untreated smear-positive pulmonary tuberculosis patients were randomly assigned to the study and control groups. A trained lay supervisor supervised each study group patient at home while nurses supervised the control group patients at the clinic. Results: At the end of the study, the control group incurred personal cost in transport fare 14 times higher, and lost income 6.5 times more, than the study group. Conclusion: It is concluded that home-based lay worker supervised Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, patient's perspective Orient Journal of Medicine Vol.16(3&4) 2004: 1-

Specialty Choice of Residents in the University of Nigeria teaching Hospital, Enugu 1989 - 1999.

Objective: To analyze the specialty choice of residents in the University of Nigeria Teaching Hospital Enugu from 1989 - 1999, and to assess the ratio of community physicians to the clinical specialties of residents. Method: The record of admissions into the residency training programme in the University of Nigeria Teaching Hospital Enugu was analyzed. Simple percentages and proportions of residents in the different specialties were computed and compared with one another and with community medicine. Result: The ratio of community medicine to the other clinical departments of Surgery, Internal medicine, Obstetrics & Gynaecology and Paediatrics is 1:7. When compared individually, each of these four were at a ratio of about 2:1 to community medicine. Conclusion: This study and other studies from other parts of the nation show that Nigeria is producing more core clinicians than community health physicians. As the nation's health policy is anchored on Primary Health Care, Community Health Physicians may be better suited to implement the nation's health policy. It would therefore be beneficial to increase the number of community Health Physicians produced by training institutions in Nigeria. Key Words: Residency training; Health manpower, Primary Health Care; Community physicians Orient Journal of Medicine Vol.16(3&4) 2004: 7-1

A Comparative Study Of Home-Based Lay Worker Supervised And Facility-Based Health Worker Supervised Dots In Enugu, Nigeria

Setting: The chest clinic of the University of Nigeria Teaching Hospital, Enugu Nigeria, the main referral tuberculosis treatment centre for Enugu and its environs. Objective: To compare the efficacy of home-based lay worker supervised DOTS with facility based health worker supervised DOTS during the intensive phase. Design: 600 consecutive newly diagnosed and previously untreated smear positive pulmonary tuberculosis patients were randomly assigned to either of 2 groups: study and control. A relation trained as DOTS supervisor supervised each study group patient at home while the clinic nurses supervised the control group patients at the clinic. Results: At the end of the study, 77.3% of the study group compared with 72.7% of the control group achieved sputum conversion (X2 = 1.7422; P > 0.05). Similarly, 92% of the study group compared with 90% of the control group completed treatment (X2 = 0.7326; P > 0.05). Conclusion: Trained lay supervisors were able to supervise DOTS at home during the intensive phase, and patients supervised by them achieved slightly better results than those supervised by clinic nurses, though the differences were not statistically significant. It is therefore recommended that home based DOTS using trained lay supervisors be incorporated into the national tuberculosis control programme in Nigeria. Key Words: Tuberculosis, Control Programme, DOTS supervision, Nigeria Orient Journal of Medicine Vol.16(2) 2004: 1-

Ophthalmic Presentations in Leprosy Patients in (South-Eastern) Nigeria

Objective: To determine the magnitude and pattern of ocular disorders and blindness among leprosy patients, presenting at three leprosy clinics in South —Eastern Nigeria. Methodology: All the in- patients, as well as the out- patients that presented to the 3 leprosy clinics during the 2- month period of the study were examined. Altogether, 171 patients were studied. All data were entered into the computer and analyzed using the SPSS software package. Results: Ocular examinations revealed that 60.2% of the patients had leprotic lesions. Other findings were cataract 24.6%; pterygium 24.6%; refractive errors 21.6%; glaucoma 12.3%; age- related macular degeneration 4.6%; presumed toxoplasmosis 1.2%; optic atrophy 1.2% and squint 0.6%.A total of 10.5% of patients were blind and 39.8% visually impaired. Cataract accounted for 55.6% blindness. Conclusion: It is concluded that non- leprotic lesions, particularly cataract were responsible for most of the blindness. We recommend that ophthalmic surgeons should organize regular and periodic surgical outreaches to leprosy centers with the aim of dealing with non- leprotic causes of avoidable blindness in such centres. Key Words: Leprosy, Leprotic eye lesions, non-leprotic eye lesions, surgical outreaches. Orient Journal of Medicine Vol.16(3&4) 2004: 18-2

Outcome of pregnancy in adolescent mothers in Mile Four Hospital, Abakaliki, Ebonyi State

Background of the study: This study was undertaken because of the observed worrisome high number of adolescent mothers who delivered in the Mile IV Hospital, Abakaliki. Objectives: The study was undertaken to determine the hospital incidence of adolescent pregnancy and their pregnancy outcomes. Materials and methods: All adolescent pregnancies booking over a one year period were followed up till delivery. The outcome measures were antenatal complications, foetal presentations, mode of delivery, postpartum complications, foetal outcomes and birth weight. Results: The hospital incidence of adolescent pregnancy was 5%. Sixty-eight percent of the mothers were married. Malaria in pregnancy was expectedly the leading antenatal complication and the Caesarean Section rate was 11%. The relative risk for episiotomy in this group of mothers was 0.25. The maternal mortality rate was 1000 per 100,000 and the perinatal mortality rate was 106.8 per 1000 births. Conclusions: This study shows that the incidence of adolescent pregnancy is high in the centre. The rates of interventional deliveries and episiotomies are increased and the perinatal outcomes are poor. There is the need to discourage the existing cultural feature of childhood marriage in some parts of the State. Orient Journal of Medicine Vol. 18(1&2) 2006: 16-2