Elijah Afolabi Bamgboye

Is the Epidemiology of Alkhurma Hemorrhagic Fever Changing? : A Three-Year Overview in Saudi Arabia

Background The epidemiology of Alkhurma hemorrhagic fever disease is yet to be fully understood since the virus was isolated in 1994 in the Kingdom of Saudi Arabia. Setting Preventive Medicine department, Ministry of Health, Kingdom of Saudi Arabia. Design Retrospective analysis of all laboratory confirmed cases of Alkhurma hemorrhagic fever disease collected through active and passive surveillance from 1st-January 2009 to December, 31, 2011. Results Alkhurma hemorrhagic fever (AHFV) disease increased from 59 cases in 2009 to 93 cases in 2011. Cases are being discovered outside of the region where it was initially diagnosed in Saudi Arabia. About a third of cases had no direct contact with animals or its products. Almost all cases had gastro-intestinal symptoms. Case fatality rate was less than 1%. Conclusions Findings in this study showed the mode of transmission of AHFV virus may not be limited to direct contact with animals or its products. Gastro-intestinal symptoms were not previously documented. Observed low case fatality rate contradicted earlier reports. Close monitoring of the epidemiology of AHFV is recommended to aid appropriate diagnosis. Housewives are advised to wear gloves when handling animals and animal products as a preventive measure.

The Nigeria wealth distribution and health seeking behaviour: Evidence from the 2012 national HIV/AIDS and reproductive health survey

BackgroundRecently, Nigeria emerged as the largest economy in Africa and the 26th in the world. However, a pertinent question is how this new economic status has impacted on the wealth and health of her citizens. There is a dearth of empirical study on the wealth distribution in Nigeria which could be important in explaining the general disparities in their health seeking behavior. An adequate knowledge of Nigeria wealth distribution will no doubt inform policy makers in their decision making to improve the quality of life of Nigerians.MethodThis study is a retrospective analysis of the assets of household in Nigeria collected during the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus 2). We used the principal component analysis methods to construct wealth quintiles across households in Nigeria. At 5% significance level, we used ANOVA to determine differences in some health outcomes across the WQs and chi-square test to assess association between WQs and some reproductive health seeking behaviours.ResultThe wealth quintiles were found to be internally valid and coherent. However, there is a wide gap in the reproductive health seeking behavior of household members across the wealth quintiles with members of households in lower quintiles having lesser likelihood (33.0%) to receive antenatal care than among those in the highest quintiles (91.9%). While only 3% were currently using modern contraceptives in the lowest wealth quintile, it was 17.4% among the highest wealth quintile (p < 0.05).ConclusionThe wealth quintiles showed a great disparity in the standard of living of Nigerian households across geo-political zones, states and rural–urban locations which had greatly influenced household health seeking behavior.

Operational barriers to the implementation of multidrug therapy and leprosy elimination in Cameroon

BACKGROUND The World Health Organization targeted to eliminate leprosy from the world with multidrug therapy (MDT) by 2000. But, leprosy remains a problem in Essimbiland of Menchum Division of Cameroon, with a prevalence of 1.7/10,000 and high rate of case detection in children. AIMS To assess knowledge and practices on the cure of leprosy, treatment duration, drug availability and problems faced by leprosy patients acquiring drugs in order to enhance MDT implementation and leprosy elimination in Menchum and Boyo divisions. METHODS Observational study in which a structured questionnaire was administered to leprosy patients, their contacts and a control group. RESULTS 480 respondents were interviewed and 405 (84.8%) (95% confidence interval [CI]: 81.6-87.2%) knew that leprosy can be cured. These respondents comprised 166 (92.2%) of 180 contacts, 129 (93.5%) of 138 patients and 110 (67.9%) of 162 controls. Two hundred and fourteen (44.6%) (95% CI: 40.1-48.9%) respondents knew that leprosy treatment is free, comprising of 110 (51.4%) patients, 99 (46.3%) contacts and five (2.3%) controls. A statistically significant difference in the knowledge on free treatment of leprosy was found to exist between leprosy patients, contacts and controls, with leprosy patients having a better knowledge (79.71%) (95% CI: 73-86.42%), followed by contacts (55.0%) (95% CI: 47.73-62.26%) and controls (3.1%) (95% CI: 0.43-5.77%) (P = 0.00). Pertinent problems faced by patients in getting MDT included distant health facilities and poor road network (91[19.0%]), lack of confidence in treatment (56 [11.7%]), MDT shortage (45 [9.4%]), few health facilities (52 [10.8%]), gratification demands (25 [5.2%]), disturbance from other illnesses (24 [5.0]), ignorance (21 [4.4%]) and poor relationship with nurses (24 [5.0%]). CONCLUSION Patients still face problems in getting free MDT. Better MDT implementation and leprosy elimination strategies are proposed.

Social stigma as an epidemiological determinant for leprosy elimination in Cameroon

Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO, but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions, in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers, their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem, tribal stigma and complete rejection by society. From the 480 structured questionnaires administered, there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1% [95% confidence interval (CI): 74.4–81.8%] from a total of 480. Three hundred and ninety nine (83.1%) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95% CI: 79.7–86.5%). Four hundred and three (83.9%) participants indicated that they could have a handshake and embrace a deformed leper (95% CI: 80.7–87.3%). A total of 85.2% (95.0% CI: 81.9–88.4%) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5% (95.0% CI: 67.5%–75.5%) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health.

Child survival dynamics in Nigeria: Is the 2006 child health policy target met?

Background: The childhood mortality rate in Nigeria continued to remain high. Unfortunately, information on the regional trajectories, progress, and sociodemographic determinants of childhood mortality in Nigeria are not readily available. The objectives of this study are to describe the childhood mortality trajectory in Nigeria, assess progress made toward achieving the 2006 child health policy targets, and determine the peculiar factors associated with childhood mortality in Nigeria regions. Materials and Methods: Birth history data from the Nigeria Demographic and Health Surveys for 1990, 2003, 2008 and 2013 were analysed. Childhood mortality levels were derived using indirect demographic techniques. Locally weighted scatterplot smoothing technique was employed to ascertain the childhood mortality trajectory. Weibull frailty models were fitted to determine the influence of unmeasured variables and factors associated with childhood death in each region. Results: Childhood mortality stagnated at 207/1000 live births until the year 2000, after which there was a linear decline to 137/1000 live births in 2010 at an annual rate of 4.91% (confidence interval: 4.52–5.29). The rate of decline was least in the South West (2.97%) and highest in the North Central (7.40%). Multivariate analysis revealed that unmeasured community factors played significant roles in North East and North West. Birth interval < 24 months, multiple births, and young maternal age were risk factors across all regions. Conclusions: Nigeria child survival dynamics differ between the Northern and Southern regions and rural and urban locations. Only the North Central and South-South regions are on course to achieve the 2006 targets for under-five mortality reduction. Multiple birth, short birth intervals, and young maternal age at childs birth were risk factors for childhood mortality in the six geo-political regions in Nigeria.

School absenteeism among orphans and vulnerable children in Lagos State, Nigeria: a situational analysis

ABSTRACT Knowledge of factors associated with school absenteeism among orphans and vulnerable children (OVC) who are at greater risk could facilitate effective policies to mitigate school dropouts. This study assessed the level of school absenteeism and its associated factors among OVC in five local government areas (LGAs) in Lagos State, Nigeria. A cross-sectional study of OVC households in purposively selected five LGAs in Lagos State was conducted. Enrolled vulnerable households were based on the National Household Vulnerability Assessment criteria. School absenteeism was measured by whether the OVC missed any school day, for any reason in the last school week. Data were collected by personal interview using a semi-structured questionnaire. IBM SPSS Statistics, version 20, was used for all analysis of data collected on schooling of OVC aged 10–17 years. Chi-square test and logistic regression model were used to determine significance of associations at 5% level. The 757 OVC participants were aged 13.1±2.2 years and their caregivers were aged 43.1±13.9 years from 1300 households. There was high proportion of school enrolment (85.7%) as well as absenteeism (20%). The rate of absenteeism among OVC was significantly higher among those who involved in household chores (31.2%) and who often sleep at night without food (40.0%). The odds of absenteeism were almost twice higher among OVC who involved in household chores (odds ratio [OR]: 1.93, 95% confidence interval [CI]: 1.14–3.27), whose guardian could not pay unexpected expenses (OR: 1.78, 95% CI: 1.05–3.02) and those from households where there was often no food (OR: 1.84, 95% CI: 1.04–3.27). A high rate of OVC school enrolment might not translate to regular school attendance. Also, a high proportion of school absenteeism can be attributed to OVC engagement in house chores, poor economy and food insecurity. Economic empowerment of OVC caregivers may improve school attendance.

Correlates of the Quality of life of Adolescents in families affected by HIV/AIDS in Benue State, Nigeria.

It was estimated that over 260,000 children are living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) while close to 2 million are directly or indirectly affected by the disease in Nigeria. Improvements in treatments for infected children have been documented in the literature but there is gross knowledge gap on the impact of HIV/AIDS on the quality of life and psychosocial functioning (PSF) of affected children in Nigeria. We comparatively explored the association of quality of life with PSF and other factors among adolescents in families affected by HIV/AIDS (FAHA) and in families not affected by HIV/AIDS (FNAHA). Data were extracted for 960 adolescents from a State wide cross-sectional study in which participants were selected through multistage sampling techniques. Data were collected using questionnaires consisting of demographic information, adapted World Health Organization Quality of Life-BREF and the strength & difficulty questionnaire (SDQ). The quality of life scores were categorized into poor, moderate, and high based on the amount of standard deviation away from the mean while the SDQ scores were categorized into normal, borderline, and abnormal based on the SDQ scoring systems. The chi-square test and the independent t-test were used for bivariate analyses while the logistic regression was used for multivariate analyses at the 5% level of significance. The proportion with poor quality of life (27.0%) was significantly higher among adolescents in FAHA than in FNAHA (p = 0.0001). Adolescents in FAHA (OR:2.32; 95%CI:1.67–4.09) were twice more likely to have poor quality of life than those in FNAHA. In FAHA, adolescents on the borderline of PSF (OR:2.19; 95%CI:1.23–3.89) were twice more likely to have poor quality of life than those with normal PSF. Adolescents in FAHA have poor quality of life than those in FNAHA and also face additional burden of psychosocial dysfunctions. Interventions focusing on functional social support and economic empowerment will benefit adolescents in FAHA in the studied location.

Secular trend and epidemiology of measles in the Kingdom of Saudi Arabia: 2009-2012.

PURPOSE To determine incidence of measles and progress towards its elimination in Saudi Arabia. METHODS A retrospective analysis of routinely collected active and passive surveillance data on measles at the Ministry of Health, Saudi Arabia. All laboratory confirmed measles from (2009-2012) were analyzed to determine measles annual incidences and distribution by age, gender, nationality, seasonality, vaccination status and spatial distribution by region. RESULTS Measles incidence per 1,000,000 populations increased from 3.2 in 2009 to a peak of 12.8in 2011 and a slight fall to 9.9 in 2012. About 50% of cases were in children under-five years, 12% were infants and 33% were 15 years and above. Of the total, 39%were unvaccinated and16% had unknown vaccination status. Fifty-five percent of infants were not due for vaccination. Of children <5 years, 42% received vaccination. Spatial distribution is not countrywide in each of the four years but seemed to concentrate in the central and South West regions with40% in Jizan and Jeddah. CONCLUSION High incidence of confirmed measles among unvaccinated infants requires strengthening of the immunization services. Improvement in measles case surveillance for completeness of vaccination status, vaccination of unvaccinated youths and comprehensive immunization are needed for measles elimination.

Non-protective immunity against tetanus in primiparous women and newborns at birth in rural and urban settings in Ibadan, Nigeria

Introduction Nigeria remains among the few countries that are yet to achieve eradication of neonatal tetanus in the world despite the availability of an effective vaccine. This study investigated immunity against tetanus in primiparous mothers and neonates at birth, and identified associated factors. Methods This cross-sectional study involved consecutive selection of 244 primiparous mother-neonate pairs (119 from rural areas, 125 from urban areas, 137 male neonates and 107 female neonates) delivered at primary healthcare facilities in Ibadan, Nigeria. Socio-demographic characteristics, obstetric history, immunisation and birthweight were obtained from mothers by interview. A validated immunochromatographic rapid diagnostic test kit was used to test for immunity against tetanus. Positive and negative results were interpreted as protective immunity against tetanus (PIaT) and non-protective immunity against tetanus (NPIaT), respectively. Data were analysed using descriptive statistics, Chi-square and logistic regression at p = 0.05. Results The mean age of mothers was 27.9±3.4 years (range: 20-33) and median birthweight was 2700g (range: 1760-3300). Of the 244 mothers, 198 (81.1%) received at least two doses of tetanus toxoid injection during pregnancy and prevalence of NPIaT and PIaT was 28.7% and 71.3%, respectively. The prevalence of PIaT was significantly higher among mothers in urban areas (n= 96; 80.7%) than rural (n=78; 62.4%), p<0.001.The prevalence of NPIaT among neonates was 36.5% (n= 89). Predictors of NPIaT among neonates were residence in rural LGA (OR = 2.22; 95% CI = 1.23-3.99) and maternal tetanus immunisation <2 doses (OR = 11.68; 95% CI = 4.05-21.75). Conclusion Lack of protective immunity against tetanus among neonates of primiparous women in Ibadan is prevalent and a more conscientious enforcement of routine tetanus prevention practices is needed.

The economic strength of caregivers of orphans and vulnerable children in Akwa Ibom and Rivers States, Nigeria

The true statistics of orphans and vulnerable children (OVC) in Nigeria is not well known. Therefore, a lack of empirical data on the economic conditions of OVC in Nigeria has hampered the development of effective intervention strategies to mitigate their economic needs. This study assessed the economic activities and capabilities of caregivers in enrolled vulnerable households in Akwa Ibom and Rivers States into a project being undertaken by Association for Reproductive and Family Health (ARFH) on OVC. A cross sectional survey was conducted in 8 Local Government Areas in Akwa Ibom and Rivers States. Information on demographic and socio-economic characteristics of caregivers or heads of the households were collected. Descriptive statistics, T-test and X2- test were used for data analyses. There were 13,631 respondents/caregivers from both Local Government Areas. The commonest economic activity was petty business. The respondents did not have any prior training on other income generating activities. A sizeable proportion of caregivers saw finance as a major constraint to their business climate. The majority of caregivers of OVC in these states did not earn a living wage. Therefore, they will require vocational, business and financial literacy training for effective household economic strengthening program as an intervention strategy of any project. Key words: Association for reproductive and family health (ARFH), orphans and vulnerable children (OVC), intervention strategy, business and financial literacy training.