Introduction: The burden of malaria in Nigeria and Africa is well documented. The current Nigeria anti-malaria drug policy has recommended artemisinin-based combination therapy (ACT) as the first-line drug treatment for uncomplicated malaria since 2005. It is now 8 years since the adoption of ACT and two years to the set time for the achievement of the MDGs. Objective: To assess the adherence of the PHC to the new policy on drug treatment for uncomplicated malaria. Methods: Using a pro-forma, relevant information about drug prescription of malaria cases between January 2008 and December 2009 was extracted from patients’ folders in the 3 comprehensive health centres being used by LAUTECH Teaching Hospital, Osogbo. Additional data were also collected through the use of in-depth interviews. Data were analyzed with Epi-Info software 3.4.2. Results: A total of 8881 episodes of malaria were analyzed of which male children (0-5years) constituted the highest number. The commonest prescribed anti-malaria was oral Chloroquine (21.6%) for the 3 CHC combined. However, for each CHC, CQ was the commonest drug prescribed for Ilie and Atelewo CHC (41.6% and 25.5% respectively), while for Akogun CHC alone, it was Artesunate + SP. Akogun CHC was found to have the highest prescribed pre-packaged ACT. Factors responsible for inappropriate prescription were non-availability and perceived patients' non-affordability and unwillingness to buy drugs. Conclusion: Prescription of CQ and SP as mono-therapy continues to prevail in the CHC. There is urgent need for ensuring compliance to the current and acceptable treatment for malaria. Other means of sustaining availability of anti-malaria drugs should be considered.
Background: The Indian house crow, Corvus splendens (Vieillot) was introduced in Zanzibar, Tanzania by the British and immigrants from India in 1897 to help clean the town. The crow is responsible for polluting the environment, water sources and human surroundings by their droppings and the rubbish they carry. This behavior has led to concern that, the crows may be responsible for the spread of certain pathogens including Salmonella and their persistence in the environment.Given the zoonotic potential of Salmonella, the main aim of this study was to investigate the occurrence of antimicrobial resistant Salmonella infections in Indian house crows and to determine if the isolates were similar to those associated with disease in livestock or humans. Methods: Indian house crows were lured with meat and blood baits to land into the crow live-trap set at the Mabibo compound of the National Institute for Medical Research (NIMR) in Dar es Salaam city in Tanzania. A total of 100 house crows were captured, humanely sacrificed, and their small and large intestines were obtained by using aseptic techniques for microbiological investigations. Culture technique was employed to detect the presence of Salmonella in intestinal contents; and preliminary identification of the isolates was based on colonial characteristics on selective media and microscopic examination of smears following Gram staining. Confirmation of Salmonella species was done by biochemical tests. Antimicrobial susceptibility testing was done by using the disc diffusion method on Mueller Hinton agar. Results and Discussion: Eight isolates were identified by standard microbiological techniques as Salmonella spp. (6 suggestive of Salmonellagallinarum and 2 suggestive of S. Typhi). All isolates were found to be susceptible to ciprofloxacin but resistant to amoxicillin. Lower levels of susceptibility were noted for chloramphenicol and ceftriaxone. Our results demonstrate the presence of antimicrobial resistant Salmonella spp. in the Indian house crows’ population and provide an indication of potential public and poultry health risks associated with these birds in the coastal area. Conclusion: The occurrence of antibiotic resistant S. Typhi and S. gallinarum among Indian house crows has both veterinary and public health consequences as they may be transmitted to poultry and humans. This therefore provides further rationale for the public action on eradicating the house crows.
Aims: Tuberculosis (TB) has been thought associated with developing atherosclerosis, a hallmark of ischemic heart disease (IHD) pathology. Animal studies and human autopsy & case studies have shown association of TB with atherosclerosis. There is paucity of data showing co-suffering by TB and IHD. The objective of the study was to explore the co-suffering by IHD and TB in community endemic for these diseases. Study Design: Retrospective secondary data analysis. Place and Duration of Study: Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India between January 2011 and December 2011. Methodology: Retrospective secondary data analysis done for patients admitted with IHD at tertiary hospital in Jodhpur, Rajasthan, India; a setting endemic for TB and IHD both. Results: Study revealed 1.6% of total admitted cases of IHD were co-suffering with TB. Majority of these (68.2%) reported history of TB diagnosis and/or treatment. About one third (31.8%) cases were co-suffering with current diagnosis and/or treatment for TB. Cases co-suffering by TB & IHD were on average 7 years elder than cases of IHD. This difference in age was statistically significant (p=0.05). Conclusion: The study demonstrated that co-suffering by IHD and TB does exist in setting endemic for both these diseases. Patients older than 53 yrs (Mean age 65.63 yr - 2 SD 12.47 yr) age presenting with clinical features suggestive of IHD should be explored for the history or current status of TB. Studies on co-suffering by these are needed among patients attending peripheral health centres for validation.
Aims: To examine the attitudes and the perceptions of community members and health workers towards leprosy, to study possible determinants of stigma and to provide baseline data for those who are interested in launching de-stigmatising interventions. Study Design: Cross-sectional survey using mixed methods Place and Duration of Study: Raj Pracha Samasai Institute and Chaiyaphum province, Thailand, March- August 2011. Methodology: The study was done using qualitative and quantitative methods in four districts. Interview guidelines, a predefined script and the Explanatory Model Interview Catalogue (EMIC) stigma scale were used as data collection tools. For qualitative data collection, community members were selected by maximum variation sampling based on sex, age and socio-economic status; health workers were selected by including those who were present at the sub-district health promotion hospital at the time of interviewing, and those who were responsible for leprosy and tuberculosis at the district hospital. Focus Group Discussions were conducted among health volunteers who were also community members and had people affected by leprosy in the areas in which they worked. For quantitative data collection, community members were selected by systematic sampling. Health workers were selected by convenience sampling. Content analysis was used for qualitative information. A t-test, a Chi square and multiple regressions were used for quantitative data. A p-value of <0.05 was considered indicative of a statistically significant difference or association. Results: An equal number of community members and health workers was enrolled (n=236). There was significant difference at the 5% level (p=0.007, Chi2 test) between the proportion of community members and of health workers who perceived stigma related to leprosy in the community (75.4% and 85.6%, respectively). A statistically significant association was found between age, education, number of family members and type of house, and those who perceived stigma. All 24 community members, four health volunteers and two health workers in the qualitative sample linked leprosy with disability, while none of the community members or health volunteers knew the cause of leprosy. All thought it to be incurable. Fifteen community members thought leprosy is hereditary. Seventeen community members and two health workers linked leprosy with dirtiness. One out of the two health workers linked leprosy with oozy and bad-smelling wounds. It was also found that people affected avoided social contact, attended health services as little as possible, and experienced negative interaction from others in the community, health workers included. Conclusion: In the perception of community members and health workers leprosy is a disabling disease that is incurable and hereditary, and is associated with dirtiness and oozy and bad-smelling wounds. These negative perceptions may result in reduced quality of life for those affected and hamper their access to health care services. The authors propose that de-stigmatising interventions be prioritised, taking local beliefs, attitudes, and perceptions into consideration.
Background: This study, undertaken in a major tertiary hospital in the Niger Delta region of Nigeria, was designed to examine the incidence of lower lung field tuberculosis in HIV infected and uninfected patients, and in diabetic patients as well as their AFB status and outcome of treatment. Methods: Between January 2011 and December 2013, admission records, HIV status, chest radiographs findings, blood glucose levels and AFB status of all pulmonary tuberculosis patients seen in our hospital were retrieved and retrospectively analyzed according to HIV status, AFB status, chest radiographs findings and blood glucose levels. All the patients with pulmonary tuberculosis who had lesions below an arbitrary line across the hila region in their chest PA radiograph were included in the study as cases of lower lung field tuberculosis. Results: Of the 596 pulmonary tuberculosis patients reviewed, 76 (12.8%) had lower lung field tuberculosis. It was more common in females (14.1%) than in males (10.9%). Majority of the patients (57.9%) were in the 24-34 years age groups. HIV infected cases had significantly higher occurrence at 46.4%. Diabetic patients had an incidence of 15.0%. Bilateral disease was more common (74.6%) and when unilateral the right side was more affected (51.4%). The main radiological findings were cavitation (44.7%), fibrosis (30.6%) and nodular opacities (22.3%). Conclusion: HIV infection and diabetes mellitus increase the risk of lower lung field pulmonary tuberculosis.
Aims: This study evaluated the impact of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project in improving education opportunity, health, and quality of life of orphans and vulnerable children (OVC) in Cambodia. Study Design: Operational intervention study. Place and Duration of the Study: Five provinces in Cambodia, from 2010 to 2014. Methodology: A two-stage cluster sampling method was used to select 756 OVC at midterm and 785 OVC at end line for face-to-face interviews. Outcome indicators from end line (2014) were compared to those obtained at midterm (2012). Where possible, the data were also compared with data obtained from baseline documentation (2010). Results: The percentage of OVC receiving external support for child care surged from 30.0% at baseline to 84.0% at midterm but decreased to 76.8% at end line. Compared to children at midterm, children at end line were significantly more likely to report having attended school regularly in the past 12 months, less likely to suspend study in order to work to help feed the family in the past 12 months, less likely to respond that food supports and other basic needs such as clothes and other household materials were the most important needs for their family today, more likely to perceive that supports for child education were the most important for their family today, less likely to report that their family reduced times for daily meals due to the shortage of food in the past 12 months, and more likely to rate their general health and overall quality of life as fair, good, or very good. Conclusion: This study indicates significant impact of the SAHACOM on education, health, and quality of life of OVC in Cambodia. This community-based model should be adapted for future interventions, taking into account the available resources.
Aims: This study was conducted to develop de-stigmatising interventions aiming to reduce stigma related to leprosy; to improve the quality of life of the people affected; and to draw out lessons on how to set up such interventions elsewhere. Study Design: Intervention study. Place and Duration of Study: Raj Pracha Samasai Institute and Chaiyaphum province, Thailand, April 2011-December 2012. Methodology: De-stigmatising interventions were carried out by 3 different groups, namely a formal health care group, a local volunteer group and a self-help group. A baseline survey was done using both qualitative and quantitative methods. Qualitative data collection was conducted through semi-structured interviews with people affected with leprosy (n=19), community members (n=24) and health workers who were responsible for leprosy and tuberculosis at a district hospital (n=2), and those who were present at a sub-district promotion hospital at the time of interviewing (n=6). One focus group discussion was conducted among health volunteers who had people affected by leprosy in the areas for which they were responsible (n=6). For the quantitative data collection, community members and health workers were interviewed using the Explanatory Model Interview Catalogue (EMIC) stigma scale. To track the course of the interventions, two sets follow-up enquiries were conducted. People affected by leprosy, people with other disabilities, health volunteers, local volunteers, nurses, health workers and administrative officers were interviewed. Focus group discussions were held with health volunteers, with local volunteers and with the self-help group members. Content analysis was used to analyse qualitative data. A T-test, a Chi-square test and multiple linear regression analysis were used to analyse quantitative data. Observation was also conducted to evaluate the outcomes of self-care practice of people affected by leprosy. Results: Full participation of people affected by leprosy was found in interventions implemented by the self-help group, while little and no participation was found in those of the local volunteer and the formal health care group respectively. Self-esteem and social participation of the self-help group’s beneficiaries changed more than that of the local volunteer group, while there was no change in those taking part in the formal health care group. Conclusion: The findings support the study hypothesis that emphasises the importance of participation of different stakeholders. To maximise the likelihood of significant changes in attitudes, tailor-made education needs to be conducted to address negative attitudes and stigma perceptions found in the course of pre-intervention assessment.
Aims: To investigate possible use of Glycosylphosphatidylinositol-specific phospholipase C (GPI-PLC) as a target protein for the development of vaccine against Trypanosoma brucei brucei infection was investigated. Study Design: GPI-PLC from T. brucei brucei was purified, characterized and the protein was used as antigen in raising antibody against the parasite Place and Duration: Department of Biochemistry, Ahmadu Bello University Zaria-Nigeria, between September 2011 and October 2012 Methodology: GPI-PLC was isolated from T. brucei brucei and purified by ammonium sulphate precipitation, gel filtration and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The GPI-PLC was further used to raise antisera in rabbits, which was subsequently used to immunize rats for 14 and 21 days pre-infection to investigate the possible use of T. b. brucei GPI-PLC as target protein in vaccine production against T. b. brucei infection. Results: An overall yield of 48.76% and purification fold of 10.86 were recorded after gel filtration. The result from SDS-PAGE showed the enzyme to be a 39.585 kDa protein with optimum temperature, optimum pH and activation energy to be 35ºC, 8.1 and 19.494 kJ/ mol respectively. The Vmax and Km values were 6.67 × 10-3 µmol/hr and 2.67 × 10-3 µM respectively when 212.5 µg of enzyme was used in the reaction mixture. Immunization with anti GPI-PLC for 14 and 21 days pre-infection significantly lowered the Packed Cell Volume (PCV). Result for the time course of parasitemia following infection with 7.9 x 105 Cells/ml showed a decrease in parasitemia level, thus leading to lowering of mortality rates in Groups immunized with GPI-PLC for 14 and 21 days pre-infection by 20% and 40% respectively relative to Group infected but not treated. Conclusion: These results suggest that GPI-PLC as a target protein significantly reduced the progression of the T. b. brucei infection.
Aims: High prevalence of diabetes mellitus (DM) in TB patients demands that TB health care providers are sensitized and updated on risk factors, screening, diagnosis and management of DM. This study was designed to assess the impact of one day training programme on screening, detection and management of DM. Study Design: One group – pre and post test design. Place and Duration of Study: The one day training session with an inbuilt awareness programme was conducted for TB health care providers and TB patients with diabetes, over a period of 3 years, from since November 2010 involving 22 tuberculosis units of 3 districts in Tamil Nadu, India. Methodology: The impact was assessed using a pretested questionnaire pre and post training, based on the improvement in knowledge among physicians and other health care providers and awareness among patients. Similarly, using a separate questionnaire before and six months after the training programme, improvement in practice was assessed based on an increase in the proportion of staff involved in screening, educating and referring TB patients with diabetes. Appropriate statistical analysis was done using SPSS version 16. Results: There was a significant increase in the knowledge of physicians and other health care providers and in patient’s awareness on all components covered under the training and awareness session respectively. No significant improvement was noted in the knowledge of other TB health care providers, in diet category on the questionnaire. There was a significant improvement in practice based on the substantial increase in the proportion of tuberculosis unit staff conducting DM screening for TB patients using appropriate methods and in referrals for proper management of DM. Conclusion: The training session on DM with an inbuilt awareness campaign for TB patients had a significant impact on the knowledge and practice of TB health care providers.
Aims: The aim of this review is to present the status of Visceral Leishmaniasis (VL) in Bangladesh and various steps taken to achieve the Millennium Development Goal (MDG). Additionally, the review covers the related challenges and opportunities to achieve this goal. Main Body: Currently, 45 out of 64 districts of the country are endemic for VL and 20 million people, around 18% of the total population, are considered to be at risk for VL. However, there is a concern about the total number of VL reported cases. It has been mentioned that the number of cases reported in surveillance data is likely to be at least five times underestimated. The current burden of VL disease is 23.4 times higher compare to the MDG of 1 case per 10,000 populations by 2015. In order to achieve the MDG various national strategies have been taken so far to eliminate VL from Bangladesh. Government of Bangladesh constituted a national steering committee and formed a technical working group to provide support to VL elimination program. Lack of trained and efficient labour force, along with lack of knowledge among the people are big challenges for VL elimination in Bangladesh. In addition, drug unavailability, unfriendly behaviour of health worker and existence of unofficial payment to the heath provider in public hospital work as barriers to achieve MDG. A major challenge towards VL elimination is the rising incidence of Post kalaazar dermal Leishmaniasis. Recent introduction of oral therapy with miltefosine and rapid diagnostic with rk39 as cost effective case management have the potentiality to work against all the barriers. Conclusion: From the public health view and guided by research evidence it seems the elimination of VL from Bangladesh is technically feasible and operationally possible. Ensuring sufficient health worker with adequate training remains the major challenges. Strengthening referral services, adapting active case detection strategies, and creating public awareness are also important for achieving MDG.