Risk factors associated with paediatric tuberculosis in an endemic setting

Background: The success of any tuberculosis (TB) control/intervention programme hinges on the understanding of transmission dynamics of TB within that setting. However, there is paucity of data in high disease burdened countries like Nigeria on the associated risk factors of childhood TB and this supports the need for this research.Objective: This study was undertaken to determine the prevalent associated risk factors of childhood pulmonary TB in a high diseased burdened setting.Subjects and method: We carried out a cross sectional study among children aged 18 months to 15 years in six selected health facilities in Nasarawa State, Nigeria. The subjects were screened for pulmonary TB using chest X-ray, sputum or gastric aspirate acid-fast bacilli microscopy and mycobacterium culture. They were also screened for HIV infection. Detailed information was taken regarding history of contact with adult TB source case, house-hold contact, duration of contact, house-hold size, number of people sleeping in a room, cross ventilation, BCG immunization, socio-economic, educational and HIV status of parents, and ingestion of unpasteurized milk and chronic illness other than TB. The subjects had physical examination for BCG scar and nutritional status.Results: A total of 150 subjects were selected for the study with mean age of 9.12 ± 4.66 years and median age of 10.0 years. The prevalence of definite TB cases found among them was 32% which is 5.5 times higher than the reported national average. The risk factors associated with pulmonary TB include lower socioeconomic status (79.2%), history of contact with an adult TB case source (72.9%), overcrowding (72.9%), absence of cross ventilation (68.8%), ingestion of unpasteurized milk (45.8%) and severe malnutrition among children under five using MUAC parameter (12.5%). The most significant independent predictors of TB in children were absence of cross ventilation (OR = 3.27), contact with adult source case (OR = 2.91) and overcrowding (OR = 2.30).Conclusion: Absent of cross ventilation, contact with adult source case and overcrowding are the most significant predictors of pulmonary TB in children. Although ingestion of unpasteurized milk is a significant predictor and important source of TB, it is not a major source of TB transmission when compared to contact with adult source case (Open TB)

Pattern and Trends of Respiratory Disease Admissions at the Emergency Paediatrics Unit of Jos University Teaching Hospital – A Four Year Review

Aims: Respiratory diseases contributes substantially to the number of Paediatric admissions and deaths especially in low income countries. Understanding the trends will help in health planning and resource distribution. This study is to describe the pattern and trend of respiratory diseases in children in a tertiary healthcare facility in north-central Nigeria. Study Design: This study was a retrospective study including all patients admitted and managed with respiratory diseases. The relevant clinical information was extracted from the hospital records. Place and Duration of Study: The Emergency Paediatric Unit (EPU) of the Jos University Teaching Hospital (JUTH), Jos Nigeria, between January 2012 and December 2015. Methodology: A total of 2277 children aged 6 weeks-18 years were admitted into the unit within the study period. Out of these, 498 (21.9%) were diagnosed with respiratory disease. Clinical records were retrieved and reviewed. Those with inconclusive diagnosis as well as those with associated co-morbidities such as cardiac anomalies were excluded. The data collected were entered and analyzed using Epi Info version 7.2. Student t-test and chi-square test were used to analyze categorical and continuous variables respectively. Results: Pneumonia accounted for 54.4% of total respiratory diseases. Cases of Pneumonia were mostly seen at the peak of the rainy and the harmattan seasons. (March, June/July and October/November). The highest number of cases of respiratory diseases were in the under-fives. The commonest complication was congestive cardiac failure and it was commoner in the younger age group. Conclusion: The prevalence of respiratory diseases remains high and contributes significantly to hospital admissions especially in the under five children. There is need to introduce new vaccines and re-enforce existing immunization against common organisms that cause pneumonia in children. There is also need to introduce policies that would ensure appropriate treatment for children to reduce the burden of these diseases

Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria

<p>Abstract</p> <p>Background</p> <p>The combination of artesunate and mefloquine has been reported to be effective against multi-drug resistant <it>Plasmodium falciparum </it>malaria, which has been reported in Nigeria. The objective of this multi-centre study was to evaluate the efficacy, safety and tolerability of the co-packaged formulation of artesunate and mefloquine in the treatment of uncomplicated malaria in two weight groups: those between 15 – 29 kg and ≥ 30 kg respectively.</p> <p>Methods</p> <p>The trial was conducted in rural communities in the north-east, north-central, south-west and south-eastern parts of Nigeria. The WHO protocol for testing antimalarial drugs was followed. Outpatients having amongst other criteria, parasite density of ≥1,000 μl were enrolled. The co-packaged drugs were administered for 3 days at a dosage of artesunate, 4 mg/kg body wt/day and mefloquine, 25 mg/kg/body wt total) on days 0, 1 and 2. Patients were followed up for 28 days with the assessment of the parasitological parameters on days 1, 2, 3, 7, and 28.</p> <p>Results</p> <p>Four hundred and forty-six (446) patients were enrolled and 431 completed the study. Cure rates in both treatment groups was >90% at day 28. The mean parasite clearance times in treatment groups I and II were 40.1 and 42.4 hours respectively. The combination of artesunate and mefloquine showed good gametocidal activity, (gametocyte clearance time of 42.0 & 45.6 hours in treatment groups I and II respectively). There were no serious adverse events. Other adverse events observed were headache, dizziness, vomiting and abdominal discomfort. There was no significant derangement in the haematological and biochemical parameters.</p> <p>Conclusion</p> <p>This co-packaged formulation of artesunate + mefloquine (Artequin™) is highly efficacious, safe and well-tolerated. It is recommended for the treatment of uncomplicated <it>P. falciparum </it>malaria in Nigeria.</p

Chlorproguanil−Dapsone−Artesunate versus Artemether−Lumefantrine: A Randomized, Double-Blind Phase III Trial in African Children and Adolescents with Uncomplicated Plasmodium falciparum Malaria

Chlorproguanil−dapsone−artesunate (CDA) was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether−lumefantrine (AL) efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD) -deficient patients

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

BACKGROUND: SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria. METHODS: In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software. RESULTS: In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs. CONCLUSIONS: Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC

Safety, reactogenicity, and immunogenicity of a chimpanzee adenovirus vectored Ebola vaccine in adults in Africa: a randomised, observer-blind, placebo-controlled, phase 2 trial.

BACKGROUND: The 2014 Zaire Ebola virus disease epidemic accelerated vaccine development for the virus. We aimed to assess the safety, reactogenicity, and immunogenicity of one dose of monovalent, recombinant, chimpanzee adenovirus type-3 vectored Zaire Ebola glycoprotein vaccine (ChAd3-EBO-Z) in adults. METHODS: This phase 2, randomised, observer-blind, controlled trial was done in study centres in Cameroon, Mali, Nigeria, and Senegal. Healthy adults (≥18 years) were randomly assigned with a web-based system (1:1; minimisation procedure accounting for age, gender, centre) to receive ChAd3-EBO-Z (day 0), or saline placebo (day 0) and ChAd3-EBO-Z (month 6). The study was observer-blind until planned interim day 30 analysis, single-blind until month 6, and open-label after month 6 vaccination. Primary outcomes assessed in the total vaccinated cohort, which comprised all participants with at least one study dose administration documented, were serious adverse events (up to study end, month 12); and for a subcohort were solicited local or general adverse events (7 days post-vaccination), unsolicited adverse events (30 days post-vaccination), haematological or biochemical abnormalities, and clinical symptoms of thrombocytopenia (day 0-6). Secondary endpoints (subcohort; per-protocol cohort) evaluated anti-glycoprotein Ebola virus antibody titres (ELISA) pre-vaccination and 30 days post-vaccination. This study is registered with ClinicalTrials.gov, NCT02485301. FINDINGS: Between July 22, 2015, and Dec 10, 2015, 3030 adults were randomly assigned; 3013 were included in the total vaccinated cohort (1509 [50·1%] in the ChAd3-EBO-Z group and 1504 [49·9%] in the placebo/ChAd3-EBO-Z group), 17 were excluded because no vaccine was administered. The most common solicited injection site symptom was pain (356 [48%] of 748 in the ChAd3-EBO-Z group vs 57 [8%] of 751 in the placebo/ChAd3-EBO-Z group); the most common solicited general adverse event was headache (345 [46%] in the ChAd3-EBO-Z group vs 136 [18%] in the placebo/ChAd3-EBO-Z group). Unsolicited adverse events were reported by 123 (16%) of 749 in the ChAd3-EBO-Z group and 119 (16%) of 751 in the placebo/ChAd3-EBO-Z group. Serious adverse events were reported for 11 (1%) of 1509 adults in the ChAd3-EBO-Z group, and 18 (1%) of 1504 in the placebo/ChAd3-EBO-Z group; none were considered vaccination-related. No clinically meaningful thrombocytopenia was reported. At day 30, anti-glycoprotein Ebola virus antibody geometric mean concentration was 900 (95% CI 824-983) in the ChAd3-EBO-Z group. There were no treatment-related deaths. INTERPRETATION: ChAd3-EBO-Z was immunogenic and well tolerated in adults. Our findings provide a strong basis for future development steps, which should concentrate on multivalent approaches (including Sudan and Marburg strains). Additionally, prime-boost approaches should be a focus with a ChAd3-based vaccine for priming and boosted by a modified vaccinia Ankara-based vaccine. FUNDING: EU's Horizon 2020 research and innovation programme and GlaxoSmithKline Biologicals SA

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Responses of Plasmodium falciparum infections to antimalarial drugs in north eastern Nigeria – Part 1: 1988 - 1995.

The responses of Plasmodium falciparum strains to different antimalarial drugs were assessed in the north east of Nigeria, using a modified version of the World Health Organization (WHO) extended in vivo field test protocol from 1988 to 1995. The sensitivity of the strains to chloroquine phosphate varied from a delayed clearance of parasitaemia, through Type-RI resistance or recrudescence to asymptomatic Type-RII resistance. Chloroquine was still clinically efficacious against P. falciparum malaria and continued to play a major role in reducing malaria-related morbidity. However, parasitological failure rates were on the increase as demonstrated in Damboa, where a 1.3-fold increase occurred in D7 failure rate over a 7-year period, from 18.7% in 1988 to 24.5% in 1995. This highlighted the need for continued monitoring of the performance of the drug against the parasites, in addition to evaluating the efficacy and tolerability of new products. Second-line drugs, particularly the combinations of pyrimethamine and sulphadoxine (SD-Pyr, Fansidar®), and pyrimethamine and sulfalene (SL-Pyr, Metakelfin®) were clinically and parasitologically efficacious, producing 100% and 97.1% cure rates, respectively. Self-medication, non-compliance with treatment regimens (particularly for multiple dose therapy), sub-standard or even fake drugs/products, in addition to parasite resistance were identified as factors compounding the treatment of P. falciparum malaria. Key Words: Antimalarial drugs; Plasmodium falciparum; North Eastern Nigeria; 1988 – 1995. Journal of Pharmacy and Bioresources Vol.1(1) 2004: 51-6

Summary Description of 24 Cases of Neonatal Malaria Seen at a Tertiary Health Center in Nigeria

Objective: Neonatal malaria is a serious cause of morbidity and mortality in sub-Saharan Africa. Diagnosis of neonatal malaria is difficult because of the similarity in clinical presentation with other neonatal infections. This study aim to highlight the clinical presentations and high mortality still associated with neonatal malaria. Methods: Twenty four out of 41 neonates seen during a 6 months period were studied. Gestational age, age at presentation, birth weight and other clinical symptoms were documented. Questionnaires were used to collect pertinent pregnancy and perinatal history from the mothers. Data was analyzed using SPSS v18 and results expressed in tables using means, frequencies and percentages. Findings: All 24 neonates, 50% of whom were males, had a positive smear for malaria parasite. 29.2% were preterm, 17(70.8%) had congenital malaria, 18(75.0%) mothers used intermittent preventive treatment (IPT) of malaria prophylaxis in the index pregnancy and 1(4.2%) mother had HIV in pregnancy. Fever was the principal presenting symptom and 83.0% responded to treatment with amodiaquine. Conclusion: Neonatal malaria is still an important cause of mortality, a more effective malaria prophylaxis program and routine malaria parasite screening for neonates is recommended