Case-Detection Rate of Direct Sputum Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

The accuracy of sputum smear microscopy, the tuberculosis case-finding method in the Abia State TB Control Programme has never been assessed due to lack of culture facilities. To assess the accuracy of sputum smear microscopy in routine control programme conditions in Abia State, sputum samples from patients undergoing investigation for tuberculosis were analyzed using Ziehl-Neelsen staining technique for sputum smear  microscopy and culture on Löwenstein-Jensen medium as reference standard. Out of 150 participants tested, 51 were smear –positive for acid fast bacilli (positivity rate, 34.0 %, 51/150) while 79 were culture positive for Mycobacterium tuberculosis complex and 12 for non-tuberculous mycobacteria (NTM). Thirty-seven of the 79 culture positive for M. tuberculosis were smear positive giving a ratio of smear to culture positivity of 46.84%. Forty-two (42.4%) of the 99 smear negative cases were culture positive for M. tuberculosis. The sensitivity of smear microscopy was 50.0%(95%CI=39.0-61.0) and specificity was 92.3% (95% CI=86.4-98.2). The prevalence of HIV/TB coinfection among the study participants was 48% (12/25). Although the case- detection rate of smear microscopy was moderate in this study, the large proportion of TB patients missed by smear microscopy is a cause for concern and requires concerted effort to improve the sensitivity of smear microscopy. Introduction of more sensitive diagnostic methods like culture also need to be considered. La précision des frottis, la méthode la recherche de cas de tuberculose  dans le programme de lutte contre la tuberculose dans l’Etat d'Abia n'a jamais été évalué en raison du manque d'installations de culture. Pour évaluer la précision des frottis dans les conditions du programme de  contrôle de routine dans cet Etat , les expectorations de patients subissant une enquête de la tuberculose ont été analysées à l'aide de technique de coloration de Ziehl-Neelsen pour la microscopie des frottis de crachats etde la culture sur milieu de Löwenstein- Jensen en tant que norme de  référence . Sur les 150 participants testés, 51 étaient à frottis positif pour les bacilles acido rapide (taux de positivité, 34,0%, 51/150), tandis que 79 étaient positifs à la culture pour complexe Mycobacterium tuberculosis et 12 pour les mycobactéries non tuberculeuses (NTM). Trente-sept de la culture 79 positive pour M.tuberculosis étaient à frottis positif donnant un ratio de frottis de positivité de la culture de 46,84 %. Quarante-deux  (42,4%) des 99 cas à frottis négatifs étaient positifs à la culture pour M. tuberculosis. La sensibilité de la microscopie des frottis était de 50,0 % (IC à 95% = 39,0 à 61,0) et la spécificité était de 92,3 % (IC à 95% = 86,4 à 98,2). La prévalence du VIH / TB coïnfection parmi les participants à l'étude était de 48% (12 /25). Bien que le taux de microscopique des  frottis de dépistage des cas ait été modéré dans cette étude, la forte proportion de patients atteints de tuberculose manqués par examen microscopique des frottis est un sujet préoccupant et exige un effort concerté pour améliorer la sensibilité de la microscopie des frottis. La présentation des méthodes de diagnostic plus sensibles comme la culture doivent aussi être pris en considération

Assessment of the Diagnostic Potential of Clinotech TB Screen Test for Diagnosis of Pulmonary Tuberculosis in Nigeria

The Clinotech TB Screen test, a 3rd generation multi-antigen rapid chromatographic immunoassay for detection of IgG antibodies in serum against recombinant protein antigens 38kDa, 16kDa and 6kDa, was assessed for its diagnostic potential for diagnosis of active pulmonary TB in routine TB control programme in Abia State, Nigeria. The overall sensitivity and specificity of Clinotech TB Screen test were 24.1% and 87.8% (95% Confidence intervals [CI]: 14.7-33.5% and 80.6-95.0%) respectively. The positive and Negative Predictive Values (PPV and NPV) were 79.2% and 37.5% respectively. The performance of the test was inferior to that of the sputum smear microscopy which had a sensitivity of 50.0% (95% CI, 39.0%-61.0%) and specificity of 92.3(95% CI: 86.4-98.2%). In 37 culture positive smear positive PTB cases, Clinotech TB Screen test was positive in 18(48.65%). The rapid test showed a very low degree of sensitivity in smear –negative culture positive PTB cases; detecting just one (2.38%) out of 42 cases. These results indicate that the diagnostic value of Clinotech TB Screen test for routine diagnosis of PTB in this setting is limited.Key words: Tuberculosis, serological tests, immunochromatographic tests, rapid TB test

Phenotypic assay of adherent E. coli strains using hep-2 cells on diarrheic children in Rivers State of Nigeria

In this paired case-control study of children with diarrhea in Rivers state, the association between HEp-2–adherent Escherichia coli strains and diarrhea was examined. Escherichia coli isolates from stool specimens of children with diarrhea were matched with controls and tested in HEp-2 cell adherence assay. A total of 266 E. coli strains (2 strains for every test subject) from both 83 children with diarrhea and 50 apparently healthy controls were examined for virulent traits using HEp-2 cells. Statistically significant (P<0.05) adherent strains were obtained from the diarrheic children 18 (21.7%) as against 5(10%) from the control. While EPEC (3.6% vs 0%) and EAEC (10.8% vs 4%) strains were significantly associated with diarrhea (P<0.05), EPEC was isolated only in children <3 years old while EAEC was more distributed on the age ranges studied. There was no significant association of DAEC (7.2% vs 2%) strains isolated from the test subjects and the control group (P>0.05%). High prevalence of parasites were seen on both groups although the diarrheal group had a statistical significant (26.5% vs 16%) prevalence (P<0.05), this showed that intestinal parasites are also important factor in the etiology of diarrhea in this area. The parasites were mostly seen in older children from both groups and this might be attributed to their wandering, playing and eating habits. No mixed infection between parasites, parasite and adherent E. coli or between two adherents E. coli was observed. The adherent isolates showed poor sensitivity to traditional drugs like Ampicillin, Cotrimoxazole and Chloramphenicol, while Cefuroxime and Ceftazidime showed good sensitivity. These data suggest that EAEC may be a pathotype that is increasing in incidence as a cause of diarrhea in children in these areas.Keywords: Adherent E. coli (DEC); Enteropathogenic E. coli (EPEC); Enteroaggregative E. coli (EAEC); Diffusely adherent E. coli (DAEC); Mixed Infections; Intestinal Parasite

The role of entero-aggregative Escherichia coli (EAEC) strains on diarrheic children in some southern States of Nigeria

The role of entero-aggregative Escherichia coli (EAEC) strains on diarrheic children in some southern States of Nigeria was carried out in this paired control study. Escherichia coli isolates from stool specimens of children with diarrhea were matched with controls and tested in HEp-2 cell adherence assay. A total of 800 E. coli strains (2 strains for every test subject) from both 250 children with diarrhea and 150 apparently healthy controls were examined for aggregative adhesion using HEp-2 cells. Statistically significant (P<0.05) EAEC strains were obtained from the diarrheic children 40.6% as against 20% from the control. In this study, Bayelsa State recorded the highest isolate with 21.4 vs 12%, followed by Rivers State (10.8% vs 4.0%), then Imo State the least (8.4% vs 4.0%). Children within 4-8 years age range recorded the highest prevalence in the States studied. High prevalence of intestinal parasites were seen on both groups although the diarrheal group had a statistical significant (91% vs 36%) prevalence (P<0.05). The parasites were Giardia lamblia, Ascaris lumbricoides, hookworm and Trichuris trichuria . This showed that intestinal parasites are also important factor in the etiology of diarrhea in this area. There was mixed infection between parasites and EAEC in 5 test subjects in Bayelsa State, but none in the other States and also none from the control. The entero-aggregative E. coli showed marked resistance to conventional antimicrobial agents like cotrimoxazole, ampicillin and chloramphenicol with 80.3%, 81.2% and 61.6% respectively, while the cephalosporins: cefuroxime and ceftazidime showed low resistance with 3.3% and 4.3% respectively, indicating that the cephalosporins will be a good choice for the empirical treatment of bacterial infectious diarrhea in this region.Keywords: HEp-2 cells, Intestinal parasites, Mixed infection, Antimicrobial agents, Cephalosporin

Alcohol use and extramarital sex among men in Cameroon

<p>Abstract</p> <p>Background</p> <p>The spread of HIV in sub-Saharan Africa is believed to be driven by unsafe sex, and identification of modifiable risk factors of the latter is needed for comprehensive HIV prevention programming in the region. Some previous studies suggest an association between alcohol abuse and unsafe sexual behaviour, such as multiple concurrent sexual partnerships and inconsistent condom use in sex with non-spousal non-cohabiting partners. However, most of these studies were conducted in developed countries and the few studies in Africa were conducted among well-defined social groups such as men attending beer halls or sexually transmitted infection clinics. We therefore examined the association between alcohol and extramarital sex (a sign of multiple concurrent sexual partnerships) among men in a population-based survey in Cameroon; a low-income country in sub-Saharan Africa with a high rate of alcohol abuse and a generalised HIV epidemic.</p> <p>Methods</p> <p>We analyzed data from 2678 formally married or cohabiting men aged 15 to 59 years, who participated in the 2004 Cameroon Demographic and Health Survey, using a multivariate regression model.</p> <p>Results</p> <p>A quarter of the men (25.8%) declared having taken alcohol before their last sexual intercourse and 21% indicated that the last sex was with a woman other than their wife or cohabiting partner. After controlling for possible confounding by other socio-demographic characteristics, alcohol use was significantly associated with having extramarital sex: adjusted odds ratio (OR) 1.70, 95% confidence intervals (CI) 1.40 to 2.05. Older age (30–44 years: OR 3.06, 95%CI 2.16–4.27 and 45–59 years: OR 4.10, 95%CI 2.16–4.27), higher education (OR 1.25, 95%CI 1.10–1.45), and wealth (OR 1.71, 95%CI 1.50–1.98) were also significantly associated with higher odds of having extramarital sex. The men were more likely to have used a condom in their last sex if it was extramarital (OR 10.50, 95%CI 8.10–13.66). Older age at first sex (16–19 years: OR 0.81, 95%CI 0.72–0.90 and > 19 years: OR 0.74, 95% CI 0.65–0.87) and being the head of a household (OR 0.17, 95%CI 0.14–0.22) significantly decreased the odds of having sex outside of marriage. Religion and place of residence (whether urban or rural) were not significantly associated with extramarital sex.</p> <p>Conclusion</p> <p>Alcohol use is associated with having multiple concurrent non-spousal sexual partnerships among married men in Cameroon. We cannot infer a causal relationship between alcohol abuse and unsafe sex from this cross-sectional study, as both alcohol use and unsafe sexual behaviour may have a common set of causal personal and social factors. However, given the consistency with results of studies in other settings and the biologic plausibility of the link between alcohol intake and unsafe sex, our findings underscore the need for integrating alcohol abuse and HIV prevention efforts in Cameroon and other African countries with similar social profiles.</p

What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans