Inequities in incidence, morbidity and expenditures on prevention and treatment of malaria in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Malaria places a great burden on households, but the extent to which this is tilted against the poor is unclear. However, the knowledge of the level of the burden of malaria amongst different population groups is vital for ensuring equitable control of malaria. This paper examined the inequities in occurrence, economic burden, prevention and treatment of malaria.</p> <p>Methods</p> <p>The study was undertaken in four malaria endemic villages in Enugu state, southeast Nigeria. Data was collected using interviewer-administered questionnaires. An asset-based index was used to categorize the households into socio-economic status (SES) quartiles: least poor; poor; very poor; and most poor. Chi-square analysis was used to determine the statistical significance of the SES differences in incidence, length of illness, ownership of treated nets, expenditures on treatment and prevention.</p> <p>Results</p> <p>All the SES quartiles had equal exposure to malaria. The pattern of health seeking for all the SES groups was almost similar, but in one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals. The cost of treating malaria was similar across the SES quartiles. The average expenditure to treat an episode of malaria ranged from as low as 131 Naira ($1.09) to as high as 348 Naira ($2.9), while the transportation expenditure to receive treatment ranged from 26 Naira to 46 Naira (both less than $1). The level of expenditure to prevent malaria was low in the four villages, with less than 5% owning untreated nets and 10.4% with insecticide treated nets.</p> <p>Conclusion</p> <p>Malaria constitutes a burden to all SES groups, though the poorer socio-economic groups were more affected, because a greater proportion of their financial resources compared to their income are spent on treating the disease. The expenditures to treat malaria by the poorest households could lead to catastrophic health expenditures. Effective pro-payment health financing and health delivery methods for the treatment and prevention of malaria are needed to decrease the burden of the disease to the most-poor people.</p

Non-invasive management of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) is common and symptoms can be debilitating and lethal. Risk management, exercise, radiological and surgical intervention are all valuable therapies, but morbidity and mortality rates from this disease are increasing. Circulatory enhancement can be achieved using simple medical electronic devices, with claims of minimal adverse side effects. The evidence for these is variable, prompting a review of the available literature. METHODS: Embase and Medline were interrogated for full text articles in humans and written in English. Any external medical devices used in the management of peripheral arterial disease were included if they had objective outcome data. RESULTS: Thirty-one papers met inclusion criteria, but protocols were heterogenous. The medical devices reported were intermittent pneumatic compression (IPC), electronic nerve (NMES) or muscle stimulators (EMS), and galvanic electrical dressings. In patients with intermittent claudication, IPC devices increase popliteal artery velocity (49-70 %) and flow (49-84 %). Gastrocnemius EMS increased superficial femoral artery flow by 140 %. Over 4.5-6 months IPC increased intermittent claudication distance (ICD) (97-150 %) and absolute walking distance (AWD) (84-112 %), with an associated increase in quality of life. NMES of the calf increased ICD and AWD by 82 % and 61-150 % at 4 weeks, and 26 % and 34 % at 8 weeks. In patients with critical limb ischaemia IPC reduced rest pain in 40-100 % and was associated with ulcer healing rates of 26 %. IPC had an early limb salvage rate of 58-83 % at 1-3 months, and 58-94 % at 1.5-3.5 years. No studies have reported the use of EMS or NMES in the management of CLI. CONCLUSION: There is evidence to support the use of IPC in the management of claudication and CLI. There is a building body of literature to support the use of electrical stimulators in PAD, but this is low level to date. Devices may be of special benefit to those with limited exercise capacity, and in non-reconstructable critical limb ischaemia. Galvanic stimulation is not recommended

Advances in Vehicular Ad-hoc Networks (VANETs): challenges and road-map for future development

Recent advances in wireless communication technologies and auto-mobile industry have triggered a significant research interest in the field of vehicular ad-hoc networks (VANETs) over the past few years. A vehicular network consists of vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications supported by wireless access technologies such as IEEE 802.11p. This innovation in wireless communication has been envisaged to improve road safety and motor traffic efficiency in near future through the development of intelligent transportation system (ITS). Hence, governments, auto-mobile industries and academia are heavily partnering through several ongoing research projects to establish standards for VANETs. The typical set of VANET application areas, such as vehicle collision warning and traffic information dissemination have made VANET an interesting field of mobile wireless communication. This paper provides an overview on current research state, challenges, potentials of VANETs as well as the ways forward to achieving the long awaited ITS

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Pharmacognostic standardisation of the leaves of Sansevieria liberica, GER. and LABR. (Fam: Dracaenaceae)

Pharmacognostic standardization of the leaves of Sansevieria liberica, Ger. and Labr. (Dracaenaceae) has been carried out. The dried powdered leaves were subjected to macroscopic, microscopic, analytical standards and quantitative analysis using standard procedures. Chromatographic fingerprints of both water and ethanol extracts of the leaves were obtained using analytical thin-layer chromatography (TLC) and the retardation factors (Rf-values) of the individual spots were calculated. Macroscopic examination showed dark green coloration on the upper surface and pale green on the lower surface, marked with dark and light green bands, and entire margin marked with red and white lines. Apex is acute, with pinnate (feather-like) venation, fleshy and leathery when dry. Microscopic examination of the powdered leaves showed anomocytic stomata, bundle of xylem fibres (septate), pericyclic fibres, spira vessels, prisms of calcium oxalates, mucilage cells and starch grains. Transverse section of the leaf showed anomocytic stomata, phloem, spongy mesophill, palisade cells, mucilage cell, pericyclic fibres, collenchyma, xylem vessels and prisms of calcium oxalates. The palisade ratio, stomatal number, stomatal index (upper and lower surfaces), vein-islet number, and veinlet termination number were 8.25&plusmn;o.48, 30.25&plusmn;0.63,(54&plusmn;0.02 and 45&plusmn;0.02),15.75&plusmn;0.48 and 12.25&plusmn;0.63 respectively. Percentage composition of the total ash, water soluble ash, sulphated ash, acid-insoluble ash, alcohol soluble extractive value, water soluble extractive value and moisture content were 9.38&plusmn;0.06, 9.31&plusmn;0.06, 3.82&plusmn;0.00, 2.52&plusmn;0.00, 1.27&plusmn;0.02, 1.12&plusmn;0.02 and 27.01&plusmn;0.01 respectively. Retardation factors (Rf-values) of water and ethanol extracts in different solvent systems were (0.41, 0.50, 0.56, 0.65 and 0.35, 0.50, 0.60, 0.65, 0.70, 0.79), (0.59, 0.74 and 0.16, 0.35, 0.40, 0.47, 0.81) and (0.55, 0.70 and 0.42, 0.47, 0.52, 0.87, 0.98) in chloroform: methanol: ammonium hydroxide (5:4:1), chloroform: methanol (1:1) and chloroform: ethanol (1:1) respectively

Field management of Phytophthora blight disease of cocoyam Colocasia esculenta L.) With spray regimes of selected fungicides in Nsukka, south eastern Nigeria

Cocoyam (Colocasia esculenta L). is an important edible tuber crop, but taro leaf blight caused by Phytophthora colocasiae has been the greatest constraint to cocoyam production in Nigeria since 2009. Field trials were conducted to determine the effect of fungicides and the spray regimes on leaf growth, disease incidence, disease severity and tuber yield of cocoyam. The trials were carried out at the Department of Crop Science Research Farm, University of Nigeria, Nsukka for two planting seasons. Treatments with three fungicides (Ridomil Gold Plus, Ridomil+ChampDp 50%:50% mixture and control) and five spray regimes (No spray, weekly spray, 2nd weekly spray, 3rd weekly spray and 4th weekly spray regimes) were laid out in a 3 x 5 factorial in randomized complete block design (RCBD) with three replications. Results showed that fungicide treatments had significant (P &lt; 0.05) variation on number of leaves/stand, disease incidence, disease severity and tuber yields/hectare in both cropping seasons. Thus, there was no significant (P &gt; 0.05) differences between Ridomil and Ridomil+Champ (50%:50%) mixture) on all measured parameters in both cropping seasons. The fungicides and the spray regimes significantly reduced taro leaf blight, improved growth and yields . Ridomil treated cocoyam plots at weekly spray regimes performed best compared to other fungicides and the spray regime treatment options..Key words: Colocasia esculenta, Phytophthora colocasiae, Fungicides, Spray regimes, andNsukka

The efficacy of palm oil sludge in reducing ruminal methanogenesis using rumen simulation technique

The effect of including palm oil sludge in cattle diet (silage) was conducted in vitro in order to ascertain the suppressing effect on ruminal methanogenesis. The silage used for the study was Panicum maximum, Centrocema pubscens, Bracharia decumbens and Andropogon gayanus. The silage were cut into an average size of 3 to 5 cm and ensiled for 21 days. Four treatment diets were formulated with the silage by including palm oil sludge at 0, 10, 20 and 30%, respectively. Treatments were subjected to anaerobic digestion in 10 L bio-digesters. Total gas production, percentage methane production, volatile fatty acids and microbial population of the substrate were measured. Total gas production was significantly suppressed in the treatment having 30% palm oil sludge for about 25 days while a lag phase of 16 days was observed before a significant amount of methane was detected. Acetic acid production increased only in T1 on the first week while T2, T3 and T4 decreased after which their production remained irregular until the end of the experiment. Propionic acid production also increased in T1 and T4 on the first week while T2 and T3 decreased after which their production maintained an undefined pattern as the experiment progressed. Butyric acid production increased in T1, T2, and T4 on the first week while T2 decreased after which an undefined trend of production was established. Microbial population especially methanogens also reached its peak around the same period when there was maximum gas production. It was concluded that ruminal methanogenesis can be suppressed in vitro by the inclusion of 30% palm oil sludge in the silage.Keywords: Bio-digesters, fermentation, in-vitro, methane, silag