Helena J. Chapman

Advances in Diagnosis and Treatment of Latent Tuberculosis Infection

In the United States, latent tuberculosis infection (LTBI) affects between 10 and 15 million people, of whom 10% may develop active tuberculosis disease. People at increased risk for tuberculosis reactivation include recent immigrants from countries with a high incidence of tuberculosis, children younger than age 5, people who have been infected with Mycobacterium tuberculosis within the past 2 years, or people with immunosuppression for a variety of reasons. Appropriate diagnosis and treatment of LTBI are critical for controlling and eventually eliminating tuberculosis as a public health problem. Although the tuberculin skin test is the traditional diagnostic measure for LTBI, reduced specificity has promoted the development and utilization of the interferon-γ release assays as an in vitro blood test with specific antigens to M. tuberculosis (QuantiFERON-TB Gold In-Tube test and the T.SPOT-TB test are commercially available). Despite the rise of the new diagnostic tests, however, there is still no gold standard for diagnosing LTBI, and epidemiologic risks and comorbidities need to be taken into account before initiating therapy. Current diagnostic tests combined with recommended treatment regimens are valuable tools that, when used correctly, promise to hurry the elimination of tuberculosis.

Is the Beijing strain of Mycobacterium tuberculosis associated with cavitary lung disease

We conducted a cross-sectional study to describe clinical characteristics of patients with pulmonary tuberculosis with and without evidence of pulmonary cavitation on chest radiography and assess whether cavitation is associated with infection with Mycobacterium tuberculosis Beijing strain. Cases were selected from the Tuberculosis Registry (January 1, 2008-November 1, 2011) of the Florida Department of Health (FDOH). Molecular characterization was performed by spoligotyping and MIRU-VNTR. We analyzed 975 cases, where 144 (14.8%) were infected with the Beijing strain. Cavitation was not associated with disease caused by the Beijing strain. Alcohol use (OR = 1.7; 95%CI: 1.249-2.313) was associated with increased risk of cavitation in the unadjusted analyses. Multivariable analyses showed that older age (⩾ 65 years) (OR = 0.5; 95%CI: 0.233-0.871), Hispanic ethnicity (OR = 0.6; 95%CI: 0.312-0.962), and co-infection with HIV (OR = 0.1; 95%CI: 0.068-0.295) demonstrated protective effects to cavitation. Understanding the factors associated with cavitation among pulmonary cases is essential toward improved tuberculosis management and control.

Tobacco use in Nigerian youth: A systematic review

Background Tobacco use is the most important preventable cause of premature death and major risk factor for non-communicable diseases. Due to strict tobacco legislation in the western hemisphere, many African nations like Nigeria have shifted from being a tobacco-producing nation to a tobacco-consuming one. The purpose of this study was to systematically review existing literature on tobacco use among Nigerian adolescents and young people and identify the prevalence, distribution and factors influencing of tobacco smoking. These data are necessary to formulate and adapt control measures aimed at tobacco cessation among young people, and preventing long-term smoking behaviors. Methods Three databases (African Journals Online, PsychInfo, PubMed) were searched for peer-reviewed publications, published between January 2000 and March 2017. Additional searches were completed on Google Scholar, and other documents and reports of the Nigerian government and the Global Youth Tobacco Survey were consulted. Using the PRISMA guidelines to evaluate studies, we included studies that reported prevalence of tobacco use in adolescents or youths, aged 10 to 24, and excluded evaluations of tobacco-related medical conditions. Results A total of 30 studies with a total population of 26,709 were reviewed. Prevalence rates of tobacco smoking ranged from 0.2% to 32.5%. Among the gender-specific studies, the prevalence of smoking among females ranged between 2.2% to 10% while that of males ranged from 1% to 32.5%. Gender distribution among these studies was mixed (80.0%), males only (13.3%) and females only (6.7%). Smoking prevalence was higher among males than females. The most common risk factors for tobacco use included peer influence, family conditions, psychosocial factors and male gender. Additional risk factors included concomitant substance abuse, media advertisements and increasing age. Conclusions Tobacco smoking poses a huge burden to Nigerian youths and various determinants were highlighted in this review. It is imperative that all stakeholders engage in concerted efforts to target both in-school and out-of-school youths in tobacco control strategies.

The Role of Powerlessness Among Health Care Workers in Tuberculosis Infection Control

Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this “knowledge−action” gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge−action gap related to M. tuberculosis infection control practices in two DR health institutions.

Psychosocial health challenges of the elderly in Nigeria: a narrative review

BACKGROUND Globally, national health systems are challenged to build successful aging models to prepare for biomedical, psychological and social changes. The integral component of psychosocial health in overall quality of life and well-being, however, is underscored and requires greater focus. Changing demographics in Nigeria, in addition to cultural considerations and absence of a social security system, present unique challenges to elderly. OBJECTIVE We aimed to review the literature that describes the current situation and challenges in psychosocial health status in the elderly in Nigeria and provide recommendations that promote health and well-being during the aging process. RESULTS Four primary factors affect psychosocial health status of elderly Nigerians, namely: changes in family dynamics, increased demand for healthcare services, increased economic stress, and decreased functional independence. CONCLUSION Like other developing countries, the Nigerian national system faces similar challenges in preparing a national framework that can maximize coverage to citizens in the midst of demographic changes in aging. By focusing on five target areas such as the educational system, health services, community-based initiatives, local or regional policies and national strategies, current framework in Nigeria can be modified to prepare for changing demographics in aging.

Lassa fever in Nigeria: the tale of a reactive health system

The World Report by Talha Burki (Feb 24, p 728) described an unprecedented astronomical rise in Lassa fever cases in Nigeria, for which the first case was reported in 1969 and the epidemiology and endemicity are well understood. Failure of the Nigerian health system to prioritise preparedness activities has been detrimental for prompt control of Lassa fever, which requires robust laboratory facilities, trained health personnel, and coordinated epidemiological surveillance. There fore, we propose a four-pronged plan to ensure consistent and proactive preventive activities that could ameliorate the high proportion of fatalities and long-term debilitation observed in outbreaks of Lassa fever. First, communities should be en couraged to take ownership of environmental protection and hygienic practices to control rodent in vasion into urban dwellings and re duce rodent breeding areas, and to promptly refer cases with concerning symptoms to health facilities. Second, health authorities should prioritise annual training of health workers in the application of universal safety precautions for infection control and regular epidemic response drills, with periodic evaluations. Third, policy makers should provide a description of disease signs and symptoms in local languages, promote culturally appropriate health improvement practices, and publicise toll-free telephone lines for systematic reporting and surveillance. Fourth, the One Health approach should be applied to minimise human health risks by advocating for environmental sustainability, reduced bush burning practices, and preservation of vector habitats. Federal commitment to empower collaborative participation of communities and leaders, develop policies that support health workers’ safety, and promote health author ities’ leadership in epidemiological surveillance could help establish robust preparedness activities that mitigate the burden of Lassa fever. Such action will inevitably transition the health system from reactive to proactive.

Prevalence of communication between mothers and daughters on sexuality and associated factors in Sagamu, southwest Nigeria

Abstract Background: As adolescents transition from childhood to adulthood, effective mother-daughter communication on sexuality plays a role in reducing high-risk behaviours linked to human immunodeficiency virus (HIV) infection and early pregnancy and childbirth. The objective of the study was to examine the prevalence of mother-daughter communication on sexuality and associated factors in Sagamu, southwest Nigeria. Methods: Using multistage sampling, surveys were conducted using 234 female youth enrolled at a secondary school. The chi-square or Fisher’s exact test was used to examine associations between categorical variables. The independent sample t-test was used to compare mean values of variables with reported evidence of mother-daughter communication on sexuality. Results: The mean age of respondents was 16+1.56 years. The majority (89.7%) had engaged in mother-daughter communication on sexuality, but three-quarters (80.8%) of the respondents could not freely discuss sexuality with their mothers. About one-third (31.6%) of the respondents reported at least one sexual encounter with the mean age of sexual debut of 14.23±2.12 years. Mother-daughter communication on sexuality was significantly associated with religion (p=0.047), mother’s age (p=0.019), who the respondents live with (p=0.029), mother’s highest educational status (p<0.001), age of sexual debut (p=0.030), and condom use (p<0.001), but not with freedom to discuss sexuality with their mother (p=0.552) or freedom to introduce male friends to their mother (p=0.077). Conclusion: Despite the high prevalence of mother-daughter communication on sexuality, mothers’ approach appeared unfriendly, as most girls could not freely discuss topics concerning sexuality with their mothers. Poor communication on sexuality was associated with sexual risk behaviours. Mothers should engage in adolescent-friendly transferring of knowledge on sexuality in order to reduce pregnancy rates and HIV transmission in female adolescents.

Medical students’ perceptions about the added educational value of student-run HIV/AIDS educational campaigns in the Dominican Republic

ObjectiveThis purpose of this report was to examine the perceptions of medical students about the strengths, limitations, and recommendations for improvement of the first known student-run HIV/AIDS educational campaigns in the Dominican Republic (DR), as they relate to the added value applied to their educational training.MethodsA retrospective review was conducted on evaluation reports completed by five medical students who coordinated the implementation of three annual HIV/AIDS educational campaigns in five DR communities, between 2012 and 2014. Thematic analysis was used to identify emerging themes related to perceived strengths, limitations, and recommendations for improvement and develop an acronym related to program strengths as value added to medical education.ResultsStudents highlighted that program strengths were the use of social media technology to facilitate communication and culture-based creativity to capture the attention of target audiences; and limitations were inadequate financial support and HIV-related cultural stigma, due to lack of disease knowledge and awareness or perceived contrasts between the federal system and faith-based community. Recommendations for program improvement, such as comprehensive event preparation and knowing the target audience, were described as key to maximizing the delivery of health messages.ConclusionsOur results highlighted that medical students gained expertise in the effective use of social media technology, culture-based creativity, and team synergy to disseminate HIV/AIDS health information across five DR communities. Students participated in these extracurricular community health campaigns, strengthening skills in communication, health advocacy, and leadership for their medical training. They served as human resources for health and can pave the way as future clinicians and indispensable health educators in local and national health collaborations.

Prescripción de antimicrobianos antes y después de una intervención educativa en un país donde el proceso de re-certificación no es obligatorio

Background: The trend in increased antibiotic prescription practices has been associated with higher health care costs and antibiotic resistance. This study examined the adequate or inappropriate antibiotic prescribing practices of health professionals, who work in public and private health centers in the Dominican Republic (DR), before and after their participation in an educational intervention. Methods: Using self-administered questionnaires developed by the Alliance for the Prudential Use of Antibiotics (APUA), this quasi-experimental study evaluated the responses of physicians before (n=525) and after (n=364) their participation in an educational intervention, from August 2006 to February 2007 and March to August 2008, respectively. Statistical analyses included simple proportions, odds ratio and 95% confidence intervals (IC95%). Alpha was set at 0.05. Results: Post-intervention responses improved understanding significantly regarding specific situations for the prescription of cephalosporins, penicillins, macrolides, quinolones, vancomycin and aminoglycosides. Physicians were more likely to respond incorrectly at baseline than post-intervention for cephalosporins (OR=4.2; IC95%:2.9-6.1; p=0.00001), penicillins (OR=1.9; IC95%:1.2-2.9; p=0.006), quinolones (OR=4.0; IC95%:2.5-6.6; p=0.00001)), macrolides (OR: 4.9 IC95%:3.0-7.9; p= 0,00001 vancomycin (OR=2.2; IC95%: 1.2-4.1; p=0.009) and aminoglycosides (OR=2.1; IC95%:1.3-3.3; p=0.002). Conclusions: Educational interventions for health professionals can improve knowledge when designed to target specific topics, including appropriate antibiotic prescribing practices in health centers. These findings reflect the need to initiate a re-certification process for Dominican physicians, which may impact the quality of attention for the users of health services in the DR.