Socioeconomic Status, Benzathine Penicillin Prophylaxis, and Clinical Outcomes in Patients With Rheumatic Heart Disease

Rheumatic heart disease (RHD) is the major cause of acquired heart disease and death for children and young adults in developing countries. Poverty and social disadvantage are thought to influence the clinical outcomes in RHD patients. Guided by the health lifestyle theory, this study assessed the relationship between socioeconomic status and clinical outcomes (heart failure events and mortality) in patients with RHD. It also examined how adherence to penicillin prophylaxis mediates the effect of socioeconomic status (SES) on clinical outcomes. Using the Nigerian database of the REMEDY study, this study was conducted with 243 participants using Poisson regression and logistic regression models. There was statistically significant association between SES and heart failure events (OR=4.77, 95% CI=1.07-21.32, p=0.04). There was no significant association seen between SES and mortality. Penicillin adherence was not a significant mediatory variable in the relationship between SES and heart failure event and between SES and mortality. These findings are consistent with studies showing low SES is a potential factor for increased risk of recurrent heart failure events in RHD patients. It is however at variance with studies that showed an increased risk of heart failure and mortality in patients with poor adherence to penicillin prophylaxis. A positive social change implication might be the need for physicians treating symptomatic patients with RHD to develop specific strategies for patients from lower SES in order to reduce the recurrence of heart failure. Future studies incorporating a composite measure of SES especially that using income as proxy is needed to further improve our understanding of the role of SES in clinical outcome

Food Insecurity and it’s Predictors Among Vulnerable Children

Background: To determine the prevalence of food insecurity and some socio demographic predictors of food insecurity among Vulnerable Children (VC) in Jos, North- central Nigeria. Methods: A cross-sectional comparative study involving 202 VC selected using multi-stage sampling technique across two orphanages and three communities located in sub-urban areas in Jos East, Jos North and Jos South Local Government Area was carried out. A VC was defined as a child who has loss mother, father or both or children who reside with chronically ill parents or reside in institution during the study. Only VC greater than five years but less than 18 years were enrolled. Food security was measured using four questions that were adapted from existing questionnaires. Food insecurity was defined and graded has mild, moderate or high if there was an affirmative response to any one, two or three of four questions. Data generated were analyzed using EPI Info version 3.65 software. The independent variables orphan status, age, gender, place of residence, child level of education, child work, were compared with the dependent variables of food insecurity using bivariate and multivariate analysis. In all statistical test p < 0.05 was considered statistically significant. Results: Of the 202 VC analyzed 38.6 %(78) were girls and 61.4 %(124) were boys with a mean age of 12.7+ 2.6 years. One hundred and two (50.5%) were IVC while 100(49.5%) were HVC. The VC were mostly orphans (83.2% [168]) while 16.8 %(34) were non orphans. All children were enrolled into school, 137 were in primary school, while the rest were in secondary school. Majority of the HVC were cared for by their mother (24.8% 50[VC]), father (1.9% [4]), uncles (8.4% [17]), aunts (10% [5.0]), grandparents (5.4% [11]), and non relatives (8% [4.0]). The overall prevalence of food insecurity was 48.5%. Of the 98 Food insecure VC 65% were HVC compared to 35% observed among IVC(p <0.05); 69.6 % were children older than 12 years compared to 30.4% obsereved in VC who were <12 years. The odds of food insecurity was 2.1 times in older VC aged 13-18 years (CI=1.1-3.9). VC attending Secondary School were 1.9 time likely to be food insecure compared to those in primary school (CI=1.1-3.5). Similarly, HVC were 3.6 times more likely to be food insecure compared to IVC. (CI=1.9-6.9). VC who worked to earn money had a 2.8times odd to be food insecure (CI=1.2-6.24). Paternal orphans were 2.4 times more likely to be food insecure (CI= 1.0-6.5) compared to other group of VC. Being a maternal orphan, a double orphan or non orphan VC does not predict food insecurity. Sexual experience was also not a predictor of food insecurity. Conclusion: The implication of hunger, in an adolescent child who considered himself/herself overworked is enormous on child physical, emotional and social development. This might lead to more children living their homes to seek shelter in orphanages were the food security status even though not perfect is better than the household. This can be prevented if Household VC are actively identified and their families supported with programs that can make them food secure

COVID‑19 Subclinical Infection and Immunity: A Review

The aetiologic agent of COVID-19 is a novel coronavirus, SARS-CoV-2. Like other coronaviruses, it generally induces enteric and respiratory diseases in animals and humans. COVID-19 may be subclinical, and symptomatic, ranging from mild–to-severe disease. The spectrum of presentation is the result of several factors ranging from the inoculum size, inherent host susceptibility, possible cross-reacting circulating antibodies. Subclinical viral infections are associated with widespread community transmission and in some cases like Polio, herd immunity. An understanding of the biology and immune behavior in subclinical coronavirus disease 2019 (COVID-19) might be useful in the quest for vaccine development as well as the current control efforts against the COVID‑19 pandemic. We carried out a narrative review of the available literature on the biology, etiopathogenesis, clinical manifestation of SARS-CoV-2 viral infection, focusing on our current understanding of the disease mechanisms and its clinical manifestation, and the host immune response to the infection. We also highlighted some of the research gaps regarding subclinical infection in COVID‑19 and its potential application for vaccine development and other preventive efforts toward containing the current COVID-19 pandemic

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Cardiovascular disease risk profile in Nigerian school children

>Background: Cardiovascular disease (CVD) is a major cause of death among adults worldwide. It is acknowledged that its risk factors have their roots in childhood. The present study evaluated CVD risk factors in primary school children in a Nigerian peri-urban setting.Methodology: This cross-sectional study was carried out in two primary schools in Jos South local government area, Plateau State, Nigeria. The 241 children studied were chosen using a systematic random sampling technique to select the children from each school. Pretested questionnaire was used to elicit the information on family characteristics and individual characteristics while standard anthropometric and laboratory procedures were used in evaluating the CVD risk factors.Results: Overall, 137 (56.8%) were females (M:F = 0.76), 151 (62.7%) were from the middle class, 59 (24.5%) from lower class while 31 (12.9%) were from the upper class. The overall prevalence of at least one cardiovascular risk factor was 54%. Sedentary lifestyle was the most common CVD risk factor in 32.4% of subjects followed by obesity (13.7%), adverse CVD event in family (11.6%), high low-density cholesterol (10.3%), high total cholesterol (TC) (9.1%), and hypertension (9.1% combine, 7.1% diastolic, and 5.8% systolic). Linear regression analysis showed that body mass index (BMI) for age (β = 0.41, P < 0.001), systolic blood pressure (BP) (β = 0.94, P = 0.03), diastolic BP (β =1.26, P = 0.01), and TC (β = 0.07, P = 0.04) significantly rise with age. BMI for age (P = 0.02) was significantly higher in female subjects compared with their male counterparts.Conclusions: From the findings of the present study, interventions related to modifiable risk factors, such as encouragement of physical exercise and sports in schools, healthy and prudent diet, and weight control programs should be undertaken early in life so as to help control the development of and the epidemic of CVD in later life

Double stigma: a cross-sectional study of Lassa patients with hearing loss in North Central Nigeria

IntroductionLassa fever is a zoonotic infectious disease endemic in West Africa with a high case-fatality rate and reported stigmatization of surviving patients. This study examines discrimination among survivors of Lassa fever (LF) complicated by hearing loss (HL).MethodsThis cross-sectional qualitative study used an in-depth interview guide to collect information from patients with HL about their experience of stigma. Interviews were conducted by a trained team of interviewers at the Jos University Teaching Hospital between January and April 2022 in Hausa language after informed consent was obtained. Recordings of the interviews were transcribed and translated from Hausa to English. Data analysis was conducted using NVivo software using a thematic framework approach.ResultsMost (73%) respondents were male (n = 11); 27% were female (n = 4). The median age was 35 years (interquartile range, 16.5). Some Lassa fever patients experienced stigma and discrimination (53%) including isolation and withdrawal of family and community support during and after illness. HL increased stigma, as some patients were labeled “deaf” by other community members, increasing perceived stigma and devaluation. HL affected the socio-economic wellbeing of some who could not communicate well with their families and customers and constrained social interactions, evoking pain and apathy. Some survivors of LF and victims of its sequelae of HL experienced double stigmatization. While they were ill with LF, a third of respondents reported avoidance and isolation by family and community members who withdrew care and support both to them and their close family members. These forms of stigmatization strained their relationships.ConclusionThere is a need to address stigma in LF survivors who develop HL through concerted community-owned awareness to improve their quality of life along with a robust social support system to aid prevention