Prevalence of diabetes in a semi-urban community in northern Nigeria.

Background: Diabetes mellitus is a growing public health problem both in developing and developed nations. The prevalence of diabetes globally is projected to rise from 2.8% in 2000 to 4.4% in 2030.This study was conducted to assess the prevalence of diabetes in Dakace village, near Zaria Method: This study was part of a larger study to assess the prevalence of cardiovascular disease risk factors among adults in Dakace village, near Zaria. Out of a total of 492 eligible respondents for the study, a subsample of 199 persons was recruited using a systematic sampling technique had their fasting blood glucose levels determined. Body mass indices of the participants were also determined. Results: A total of 199 subjects (94 males and 105 females) participated in this segment of the study. Three subjects had fasting blood glucose (FBG) of more than 7.0mmol/L; one participant a previously known diabetic on medication had a good glycaemic control. The overall prevalence of diabetes was 2.0%.Five participants (2.5%) had impaired fasting glucose (IFG). Among the diabetics, one was overweight (BMI= 27.43Kg/m2) and one was obese (BMI=31.55Kg/m2), while among those with impaired fasting glucose two were overweight. Fortythree subjects (21.6%) were overweight and 15 (7.5%) were obese. Conclusion: The prevalence of diabetes mellitus in this semi-urban community is keeping with what had been reported earlier from across the country.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 414-41

Mortality and cause of death in Abuth, Zaria: 1999-2005

Background: Accurate mortality statistics are needed for policy formulation,implementation and monitoring of health intervention that are aimed at improving the health status of the people. Mortality level is one of the indicators of the quality of life and status of health of a population. However, accurate collection, collation, analysis and interpretation of such data is poorly organised in developing nations, including Nigeria leading to a gap in health policy formulation, implementation and monitoring. Therefore, policies and strategies for disease prevention are based on empirical evidence rather than on data primarily collected to formulate disease specific interventions.Though, hospital data have inherent deficiency in its use to design prevention. However, when accurately generated and adequately managed would provide both qualitative and quantitative information on morbidity and mortality if not for the entire society at least for a segment of the population utilizing it. We implemented a system of death certification to determine causes and pattern of mortality in Ahmadu Bello University Teaching Hospital, Zaria Methods: From May 1999 to November 2005, all case folders of deceased patients were retrieved from the central library of health information management department of the hospital; case folders of deceased patients are required to have in them a completed IFMCCD(International Form of Medical Certification of Cause of Death). All case folders of deceased patients after relevant information were extracted by the staff of health management information department, were passed on to the staff of department of Community Medicine directly involved in this study. The completed cause of death certificates received in the department of Community Medicine (between May 1999 and November 2005), were examined. Coding rules were employed to select the appropriate code for those certificates that were incorrectly completed. The underlying cause of death as identified from the correctly completed IFMCCDS is coded according to ICD-10.Results: For the period under study, there were 4019 deaths: 2212 males and 1807 females. Total of 2914 (72.5%) deaths were certified, using the IFMCCD of which 1641 of them were males and 1273 females and formed the basis of this analysis. Coverage rates ranges from 56.2% in 2001 to 85% in 1999. The proportion of garbage codes ranges from 0% to 2.4% while the three leading causes of death are HIV infection, road traffic accident (RTA), and cardiovascular diseases among the ten. The time-trend of the leading causes of death show RTA maintaining steady upward climb while malaria, septicemia, PEM, sepsis in the neonatal period shows unsteady fluctuation. Conclusion: This study assessed the pattern of mortality and causes of death in ABU Teaching Hospital, Zaria; it also provided information on leading causes of death

A comprehensive review of demand side management in distributed grids based on real estate perspectives

A major challenge in renewable energy planning and integration with existing systems is the management of intermittence of the resources and customer demand uncertainties that are attributed to climates. In emerging distributed grids, state-of-the-art optimization techniques were used for cost and reliability objectives. In the existing literature, power dispatch and demand side management schemes were implemented for various techno-economic objectives. In renewable energy-based distributed grids, power dispatch is strategic to system operations. However, demand side management is preferred, as it allows more options for customer participation and active management of energy in buildings. Moreover, the demand side management can simply follow supplies. This paper investigates the implications of demand side management as it affects planning and operations in renewable energy-based distributed grids. Integration of demand side management in customer-oriented plans such as the time-of-use and real-time-pricing on residential and commercial demands is conceptualised to ensure effective customer participation which maintains the valued comforts. Moreover, the optimised tariff integrated demand side management implementations based on the utility-initiated demand response programmes are envisaged to offset conflicting objectives of the economy and customer comforts within residential and commercial demands and are also viewed as a step towards efficient management of energy in buildings

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015

Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3.3 million new infections (95% uncertainty interval [UI] 3.1-3.4 million). Annual incidence has stayed relatively constant at about 2.6 million per year (range 2.5-2.8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million (95% UI 37.6-40.4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1.8 million deaths (95% UI 1.7-1.9 million) in 2005, to 1.2 million deaths (1.1-1.3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licensePeer reviewe

Global, regional, and national levels of maternal mortality, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Peer reviewe

First-line health care provider performance in the management of common skin diseases using an algorithmic approach as a diagnostic tool in Kano State, Nigeria

Anna Theodora Taal,1 Erik B Post,2 Tijjani Hussaini,3 Augustin Gayus Barminus,4 Tahir Dahiru5 1Netherlands Leprosy Relief, Amsterdam, Netherlands; 2The Royal Tropical Institute, Amsterdam, Netherlands; 3TB and Leprosy Control Programme, Kano State, Nigeria; 4State Dermatology Hospital Garkida, Adamawa State, Nigeria; 5Netherlands Leprosy Relief, Lagos, NigeriaAbstract: Skin diseases are common worldwide, though prevalence rates in rural areas are difficult to estimate, and are primarily based on hospital studies rather than community-based studies. Primary health care providers in rural areas often lack sufficient knowledge about skin diseases, which contributes to poor skin management and subsequently causes considerable morbidity. This study looked at the performance of first-line health care providers in the management of common skin disease, using an algorithmic approach with a flowchart with diagnostic steps. As a reference standard, two dermatologists independently validated the diagnoses and treatment choices made by the providers. The performance of the algorithm was calculated in terms of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value for each skin disease of the algorithm. A total of 19 patent medicine vendors and 12 traditional healers from Kano State in Nigeria diagnosed 4,147 patients with suspected skin symptoms. The most common skin disease was tinea capitis (59.2%), and it was found predominantly among boys below 15 years of age. Together, patent medicine vendors and traditional healers had 82% of the cases correctly diagnosed, and in 82% they prescribed the correct treatment. The sensitivities varied for each skin disease from 94.8% for tinea capitis to 7.1% for contact dermatitis. The specificities varied between 87.0% and 98.6%. Except for tinea capitis, lower PPVs were found for the various skin diseases when compared to earlier studies. In spite of the observed low sensitivities and low PPVs for several diseases, the algorithm seems to offer an improvement in management of common skin diseases at the peripheral level. With adaptations in training, further refinement of the algorithm and refresher training, predictive values and sensitivities can be increased.Keywords: skin disease, community dermatology, diagnostic algorithm, patent medicine vendor, traditional healer, Nigeri