Auwalu U. Gajida

Survey of poliovirus antibodies in Kano, Northern Nigeria.

INTRODUCTION In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Since then, much progress towards this goal has been made, but three countries including Nigeria remain polio-endemic as of end 2012. To assess the immunity level against poliomyelitis in young children in Northern Nigeria, we conducted a seroprevalence survey in the Kano Metropolitan Area (KMA) in May 2011. METHODS Parents or guardians of infants aged 6-9months or children aged 36-47months presenting to the outpatient department of Murtala Mohammad Specialist Hospital were approached for participation, screened for eligibility and were asked to provide informed consent. After that, a questionnaire was administered and blood was collected for neutralization assay. RESULTS A total of 327 subjects were enrolled. Of these, 313 (96%) met the study requirements and were analyzed (161 [51%] aged 6-9months and 152 [49%] aged 36-47months). Among subjects aged 6-9months, seroprevalence was 81% (95% confidence interval [CI] 75-87%) to poliovirus type 1, 76% (95% CI 68-81%) to poliovirus type 2, and 73% (95% CI 67-80%) to poliovirus type 3. Among subjects aged 36-47months, the seroprevalence was 91% (95% CI 86-95%) to poliovirus type 1, 87% (95% CI 82-92%) for poliovirus type 2, and 86% (95% CI 80-91%) to poliovirus type 3. Seroprevalence was associated with history of oral poliovirus vaccine (OPV) doses, maternal education and gender. CONCLUSIONS Seroprevalence is lower than required levels for poliovirus interruption in the KMA. Persistence of immunity gaps in the 36-47months group is a big concern. Since higher number of vaccine doses is associated with higher seroprevalence, it implies that failure-to-vaccinate and not vaccine failure accounts for the suboptimal seroprevalence. Intensified efforts are necessary to administer polio vaccines to all target children and surpass the threshold levels for herd immunity.

Patterns and predictors of cigarette smoking among HIV-infected patients in northern Nigeria.

The smoking behaviour of persons living with HIV/AIDS in sub-Saharan Africa is poorly documented. We employed a cross-sectional study design to assess the prevalence and predictors of tobacco smoking among HIV-infected patients in northern Nigeria (n = 296). Approximately one quarter of respondents were either current (7.8%) or ex-smokers (17.9%). Smoking rates among HIV-infected women were extremely low. HIV-infected men were at least three times as likely to smoke as their female counterparts living with HIV: adjusted odds ratio (AOR) 3.16, 95% confidence interval (95% CI) 2.17-7.32. Patients with tertiary education were at least twice as likely to smoke compared with their counterparts without formal education (AOR 2.63, 95% CI 1.08-6.67). The preponderance of cigarette smoking among educated HIV-infected men in northern Nigeria offers a unique opportunity for targeted smoking cessation programmes.

Malaria among antenatal clients attending primary health care facilities in Kano state, Nigeria

BACKGROUND Malaria in pregnancy remains a major public health problem especially in sub-Saharan Africa. However, the prevalence of clinical and asymptomatic infection among antenatal client (ANC) attendees is largely unknown, especially at primary health care (PHC) level in northern Nigeria. This study assessed the prevalence of fever, malarial parasitemia and anemia among pregnant women attending PHC facilities in Kano, northern Nigeria. METHODS A cross-sectional descriptive study was conducted among 360 ANCs attending PHC facilities in two Local Government Areas (LGAs) in Kano state. Data were collected using a pre-tested semi-structured interviewer administered questionnaire. Blood samples were also obtained for thin blood smear for malaria parasite using Giemsa staining technique. Hemoglobin was estimated from the Packed Cell Volume (PCV) determined using hematocrit. RESULTS Age of the subjects ranged from 15 to 42 years with a mean +/- SD of 24.0 +/- 6.0. Up to 39.2% (n = 141) (95% Confidence Interval = 34.1-44.4%) of the subjects were found to have malarial parasitemia. Exactly 36.2% (n = 51) of those with parasitemia had fever (temperature >or= 37.5 degrees C) while 63.8% (n = 90) of them were asymptomatic. Anemia, (hemoglobin of <or=11 g/dl) was found in 48.1% (n = 173) of the respondents. A higher proportion of primigravid and secondigravid clients (61% vs. 39%) and younger pregnant women (54.6% vs. 45.4%) had malarial parasitemia compared to multigravid and older women, respectively. Similarly, a significantly higher proportion (67.6%) of anemic ANC clients had malarial parasitemia. (chi2 = 113.25, df = 1, P < 0.05). CONCLUSION Malarial infection is common among the ANC clients attending PHC facilities in Kano state and the infection is commonly associated with anemia. Intermittent Preventive Treatment (IPT) should be provided especially among primigravid, secondigravid and younger mothers at PHC centres.

Adherence to intermittent preventive treatment for malaria in pregnancy in urban Kano, northern Nigeria

Abstract Malaria in pregnancy is associated with substantial risk of maternal and fetal morbidity and mortality. The uptake of preventive antimalarials is low in malaria endemic countries, including Nigeria. Using a cross-sectional study design, we assessed factors associated with uptake and adherence to intermittent preventive treatment for malaria in pregnancy (IPTp) among antenatal attendees in primary health centers in Kano, northern Nigeria (n = 239). A total of 137 respondents (57·3%) reported receiving preventive antimalarials, but only 88 respondents (36·8%) [95% confidence interval (CI): 30·7–43·3%] reported ingesting pills in the clinic under supervision. Factors associated with adherence to IPTp after adjustment for potential confounding included: advanced maternal age [adjusted odds ratio (AOR) (95%CI) = 2·1 (1·3–6·37)], higher educational attainment [AOR (95%CI) = 3·2 (1·32–6·72)], higher parity [AOR (95%CI) = 1·6 (1·07–3·94)], lower gestational age at booking [AOR (95% CI) = 1·72 (1·24–3·91)], and use of insecticide-treated nets [AOR (95%CI) = 2·03 (1·13–3·26)]. There is a need for strengthening health systems and addressing cultural factors that impede efforts at expanding coverage of malaria prevention strategies in Nigeria.

Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State, Nigeria

Highlights • Polio seroprevalence surveys help measure progress towards polio eradication.• Nigeria program conducted multiple seroprevalence surveys in northern states.• This article covers seroprevalence survey in Kano Nigeria in 2013 and 2014.• Data represents levels before and after the interruption of poliovirus transmission.• Significant improvement in seroprevalence in 2014 over 2013, but gaps continue.• Good participation even by vaccine refusers in this health facility based project.

Deaths during tuberculosis treatment among paediatric patients in a large tertiary hospital in Nigeria

Background Despite availability of effective cure, tuberculosis (TB) remains a leading cause of death in children. In many high-burden countries, childhood TB is underdiagnosed and underreported, and care is often accessed too late, resulting in adverse treatment outcomes. In this study, we examined the time to death and its associated factors among a cohort of children that commenced TB treatment in a large treatment centre in northern Nigeria. Methods This is a retrospective cohort study of children that started TB treatment between 2010 and 2014. We determined mortality rates per 100 person-months of treatment, as well as across treatment and calendar periods. We used Cox proportional hazards regression to determine adjusted hazard ratios (aHR) for factors associated with mortality. Results Among 299 children with a median age 4 years and HIV prevalence of 33.4%; 85 (28.4%) died after 1,383 months of follow-up. Overall mortality rate was 6.1 per 100 person-months. Deaths occurred early during treatment and declined from 42.4 per 100 person-months in the 1st week of treatment to 2.2 per 100 person-months after at the 3rd month of treatment. Mortality was highest between October to December period (9.1 per 100 pm) and lowest between July and September (2.8 per 100 pm). Risk factors for mortality included previous TB treatment (aHR 2.04:95%CI;1.09–3.84); HIV infection (aHR 1.66:95%CI;1.02–2.71), having either extra-pulmonary disease (aHR 2.21:95%CI;1.26–3.89) or both pulmonary and extrapulmonary disease (aHR 3.03:95%CI;1.70–5.40). Conclusions Mortality was high and occurred early during treatment in this cohort, likely indicative of poor access to prompt TB diagnosis and treatment. A redoubling of efforts at improving universal health coverage are required to achieve the End TB Strategy target of zero deaths from TB.