Antiproliferative, antioxidant and antiplasmodial activities of the root bark of Adenodolichos paniculatus (Hua) Hutch (Fabaceae)

Adenodolichos paniculatus Hua & Hutch (Fabaceae) is a plant whose roots are traditionally employed for the treatment of non-communicable diseases such as diabetes and cancer. The powdered root bark of Adenodolichos paniculatus were extracted with dichloromethane followed by 70% methanol to afford dichloromethane (DCM) and hydromethanolic (HME) extracts respectively. Thereafter, fresh powdered root was extracted with water via decoction method and lyophilized to afford aqueous extract (AQE). The extracts were then subjected to standard phytochemical studies, antiproliferative (A2780 ovarian cancer cell assay), antiplasmodial (Dd2 strain of Plasmodium falciparum), antioxidant (DPPH, FRAP and ABTS methods) and brine shrimp lethality assay studies. The DCM extract was found to possess high levels of total phenolics and flavonoids with notable potential antiproliferative (IC50 = 0.14 μg/ml), antiplasmodial (IC50 = 7.50 μg/ml) and cytotoxic (brine shrimp, IC50 = 0.547 μg/ml) activities. However, HME had significant antioxidant (DPPH, IC50 = 17.54 ± 0.03 μg/ml; ABTS, IC50 = 8.08 ± 0.05 μg/ml). Both HME and AQE were found to be inactive against the drug-resistant Dd2 strain of Plasmodium falciparum with an IC50 value ˃100μg/mL. The study revealed the potential of Adenodolichos paniculatus as a promising antiproliferative agent and also corroborated the ethnomedical uses of the plant

Association of Bacterial vaginosis and other Sexually Transmitted Infections with HIV among pregnant women in Nigeria.

OBJECTIVES: To determine the association of Bacterial vaginosis (BV) and other sexually transmissible infections (STIs) with HIV prevalence among pregnant women in Jos, Nigeria. METHODS: This was a cross- sectional study of pregnant women who participated in the Prevention of Mother-to-Child Transmission of HIV program of the AIDS Prevention Initiative in Nigeria, between April 2002 and July 2004, at the Jos University Teaching Hospital in Jos, Nigeria. Blood, high vaginal and endocervical samples were obtained for diagnosis of HIV, BV and other STIs. Data were analyzed for prevalence of HIV, BV and other STIs. Univariate and multivariate logistic regression models generated unadjusted and adjusted odds ratios (OR) as well as 95% confidence intervals (CI) of the association of BV and other STIs with HIV prevalence. P value <0.05 was considered statistically significant. RESULTS: A total of 4,046 pregnant women were studied and 97.6% (3,950/4,046) had complete laboratory records for analysis. The prevalence of HIV was 8.2% (CI: 7.4-9.1); BV 11.9% (CI: 10.9-12.9); Candida 10.7% (CI: 9.7-11.7); mixed infection of BV and Candida 2.8% (CI: 2.3-3.4); Trichomonads 0.6% (CI: 0.3-0.8) and syphilis 0.35% (0.16-0.54). BV, Candida, mixed BV and Candida; and Trichomonads were independently associated with HIV infection [adjusted OR (95% CI), 2.9 (CI: 2.2-3.9); 2.0 (CI: 1.5-2.9); 3.4 (CI: 2.0-5.6), and 3.3 (CI: 1.1-9.7) respectively]. CONCLUSION: HIV prevalence is higher among pregnant women who have BV, Candida and Trichomonads vaginal infections compared with women who have no evidence of infection. The practice of routine screening for BV and other STIs among pregnant women as a strategy for identifying women at risk for prevalent HIV infection should be sustained/ encouraged and the syndromic management of STIs should be integrated into all antenatal care management protocols in antenatal clinics in order to curb the epidemic of heterosexual HIV transmission

Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria.

OBJECTIVE: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. DESIGN: Mathematical and cost modelling. METHODS: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4 <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4 <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. RESULTS: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US$1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US$7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone. CONCLUSIONS: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

Background: The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods: Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results: We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion: HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting

Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria

Abstract Background. Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods. This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results. Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m2, and having a gap in care independently predicted LTFU. Conclusions. Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments

Safety, Efficacy and Acceptabilty of NorplantR Implants in Jos, Northern Nigeria

Context: NorplantR is a long acting reversible progestogen method suitable for women of all ages. It is however not without side effects that may affect its continuous usage. Documentation of such changes is important for counselling acceptors to achieve user\'s satisfaction. Objective: To evaluate the safety, efficacy and acceptability of NorplantR amongst its acceptors. Study Design, Setting and Subjects: This study was part of ongoing prospective longitudinal studies that involved 23 women who had complete records at three years out of the 37 healthy non breast feeding informed volunteers recruited from our family planning clinic in August 1997. Data on socio-demographic characteristics, menstrual pattern, packed cell volume, weights, blood pressure, side effects and user\'s satisfaction were analysed. Results: The mean age and parity of the acceptors were 31.7 ± 3.4 years and 4.7 ± 1.0 respectively. Even though the mean weight at 12months (63.2 ± 11.7kg was not statistically different (p 0.5) from the mean weight at pre-insertion (62.5 + 11.2kg), there were statistical significant increases in weights at 2years (66.9 ± 12.1kg; p= 0.001) and at 3years (65.9 ± 11.6kg; p 0.01). Apart from the slight statistically significant increase (p 0.02) in systolic blood pressure at 2years, the blood pressure changes at 1year and 3years did not show significant changes. Main side effects were menstrual abnormalities, weight changes, headache, abdominal pain and dizziness. The packed cell volume significantly increased. Continuation rate was 100% and there was no pregnancy recorded. Users were satisfied with the method because of its convenience, low risk of pregnancy and long duration of action. Conclusion: NorplantR subdermal implant was an effective safe and acceptable method of contraception amongst the acceptors, despite its minimal side effects. Key Words: NorplantR Implants, Safety, Efficacy and Acceptability NorplantR is a registered trademark of The Population Council for levonorgestrel subdermal implants [ Trop J Obstet Gynaecol, 2004;21:95-99

Audit of antenatal services in primary healthcare centres in Jos, Nigeria

Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is still poor. The high proportion of maternal deaths resulting from late referrals from PHC's to the Jos University Teaching Hospital (JUTH), prompted this study to audit antenatal services in PHC's in Jos. Methods: Six of the 12 PHC's in Jos were randomly sampled and 425 consecutive antenatal clinic attendees were recruited for the study. In each case, the client's records were scrutinized and a detailed history and physical examination was conducted. Details of personal data and of antenatal care provided were tabulated and analyzed using frequencies. Results: The results showed that 35.5% of pregnant women receiving antenatal care at PHCs in the Jos area were clients with high-risk pregnancies. Over two-thirds of the pregnant women received antenatal care in the PHCs without blood pressure surveillance. Maternal weight was regularly checked in 78.1% (332/425) but height was not recorded in any woman. Sickling test/genotype and VDRL were not done and no client received malaria prophylaxis. Conclusion: The study showed that the standard of antenatal care offered in PHCs in Jos fell short of the required level and represents a missed opportunity to impact on the poor maternal and perinatal health statistics in the area. Keywords: antenatal care, standard of care, audit, Nigeria Tropical Journal of Obstetrics and GynaecologyVol. 22(2) 2005: 147-15