Mahmood Dalhat

Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis.

Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05–2.53)}, higher income {2.0 (1.35–2.98)}, fatty food {4.6 (2.49–8.50)}, exact number of pills dispensed {4.09 (1.60–10.7)}, and belief in traditional medication for malaria {0.09 (0.01–0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.

Risk factors associated with statewide measles outbreak three months after measles supplemental immunization in Sokoto, Nigeria, 2016

Introduction: measles is a highly contagious viral disease associated with high morbidity and mortality. It is the fifth leading cause of death among under-five children worldwide. On February 12, 2016, an outbreak of Measles was reported from Sokoto State, Nigeria. This measles outbreak occurred despite a Measles supplemental immunization three months earlier. Studies have shown that hospitals may play an important role in the community transmission of Measles. We investigated to confirm the outbreak, describe the sociodemographic characteristics, and identify risk factors for the outbreak. Methods: we conducted a 1:1 unmatched case-control study. We defined a case as any person less than 10 years of age with Measles according to standard case definition while a control was any child less than 10years without history of Measles residing in affected communities of Sokoto State from 1st February to 30th March 2016. We conducted active case search, reviewed health facilities records and line-listed 984 suspected cases. A standard questionnaire was administered to collect information on possible risk factors associated with the Measles outbreak. We conducted univariate, bivariate, and multivariate analysis using Epi info 7.2. Results: of the 984 cases line listed 505 (51.6%) were males, 726 (73.8%) of cases were < 5 years old. Out of the 886 cases whose vaccination status were recorded, 726 (81.9%) were not vaccinated. Significant risk factors after bivariate analysis were father not being civil servant [OR = 5.6; (95% CI = 2.2 - 14.4)], non-vaccination [OR = 2.0; (95% CI = 1.2 - 3.4)], uneducated mother [OR = 2.0; (95% CI = 1.1 - 3.7)], and visiting a health facility 7 - 28 days prior to onset of symptoms [OR = 32.3; (95% CI = 14.7 - 71.1)]. Visiting a health facility during the outbreak remained the only significant independent risk factor after multiple logistic regression. Conclusion: the Measles outbreak may have been exacerbated by visiting a health facility during the outbreak. This finding underpins the importance of improving hospital infection control practices.

Epidemiological and demographic profile of patients with Noma in Nigeria, 1999 - 2015

Introduction : noma (Cancrum oris) is a severe acute gangrene of the tissues of the mouth and face that kills or disfigures its victims. Although rarely reported in developed countries, it is prevalent in sub-Saharan Africa. The incidence in Nigeria is estimated at 6.4 per 1000 children. We described the epidemiology and demographic characteristics of Noma surgical patients in Nigeria from 1999 to 2015. Methods : we conducted a retrospective descriptive study using two data sources. We obtained data on Noma surgical patients for 1999-2015 from Noma Children’s Hospital, Sokoto, Nigeria. Variables analyzed were age, sex, nationality, and location of patients. In addition, we reviewed the 2013 Nigeria Demographic and Health Survey to identify demographic characteristics of location of patients. Results : a total of 1,182 Noma surgical patients were reported with a mean age of 22.4 ± 13.4 years. Those of age group 10-14 years were 209 (17.7%) and constituted majority of patients. Males were 670 (56.7%). Nigerians were 1170 (99.0%) out of which 909 (77.0%) came from five states. There is no access to improved drinking water in 78.1% of households in Kebbi. There is no practice of principles of infant and young child feeding in 99% of households in Zamfara. In Sokoto, 78.5% of females six years and above have no education. In Kano, 74.7% of children had not received measles immunization. In Katsina, 80.2% of households do not have soap and water for hand washing. Conclusion : most patients came from five states in Northwest Nigeria. Northwest Nigeria has demographic risk factors that promote Noma. Access to safe drinking water, good child feeding practices, education of people to improve health seeking behavior, supplementary immunization and good oral and general hygiene should be improved in these areas.

Preparedness for infection prevention and control during a Lassa fever outbreak in Ogun State, Nigeria 2017

Introduction : hospital-acquired infection (HAI) of Lassa fever (LF) during outbreaks often occurs with fatal consequences on healthcare workers (HCWs). In December 2016, Ogun State in southwestern Nigeria experienced LF outbreak in a tertiary health facility with five fatalities including two healthcare workers. We assessed the infrastructural and personnel preparedness (HFIP) of a major tertiary health facility during the outbreak. Methods : a total sampling of all HCWs was done; we administered semi-structured questionnaires to assess their knowledge and practice of infection prevention and control (IPC). Knowledge and practice questions were scored and classified as either good or poor using 70% as cut off. A standardized checklist was used to evaluate the infrastructural preparedness. Odds ratios and logistic regression were computed. The significance level was set at 5%. Results : a total of 13 suspected, 3 probable and 2 confirmed LF cases, with 5 deaths (CFR = 100%) were recorded. Good knowledge of IPC was found among 80 (78%) HCW; however only 45 (44%) reported good IPC practices. Of the 101 HCWs interviewed, 59 (58%) had had training on IPC. Good knowledge was found to be a significant determinant of good practice [AOR = 11.1, 95% CI = 3.3 - 50.0]. There was no significant association between having had IPC training and adoption of good practices (OR = 1.9, 95% CI = 0.8 - 4.2). There were no isolation wards, personal protective equipment (PPEs), IPC guidelines or running water observed at the health facility. Conclusion : lack of IPC infrastructure and poor knowledge on IPC were likely contributors to spread of this outbreak. We sensitized all heads of department and other health facility staff, expanded the health facility infection control committee, established a Lassa fever isolation ward and built the capacity of healthcare workers on IPC.

Knowledge and perception of Zika virus infection and its diagnostic proficiency among physicians in Ekiti State, Nigeria, 2016

Introduction : previous demonstration of Zika virus in humans and the presence of Aedes (Steogmyia) albopictus and Aedes (Steogmyia) aegypti mosquitoes implies that Nigeria is at risk of sustained Zika virus transmission. We investigated to determine knowledge, perception and diagnostic proficiency of physicians regarding Zika virus infection in South-Western Nigeria.

Establishing event based surveillance system in Nigeria: a complementary information generating platform for improved public health performance, March, 2016

Introduction : event-based surveillance (EBS) is the organized and rapid capture of information about events that constitute potential risk to public health. EBS has the potential to complement the existing Integrated Disease Surveillance and Response (IDSR) and permit rapid assessment and response to public health emergencies in Nigeria. There is paucity of data regarding the status of EBS in Nigeria. Methods : we conducted a descriptive cross-sectional study to determine the availability and utility of EBS in Nigeria. A total of 23 State epidemiologists and 30 Disease Surveillance Notification Officers (DSNOs) were interviewed using self-administered, semi-structured questionnaires. We obtained data on respondents’ awareness of event based surveillance system, availability and functionality of the system, common methods used for reporting health related events and availability of the minimum requirements for event based system. We computed descriptive statistics for data obtained. Results : about half, 26 (49%) of the total respondents have heard of event based surveillance system. Of this, only 9(34.6%) described it correctly. Only 17(45.9%) of the 36 States (plus FCT), have some forms of event based reporting structure. Common methods used for reporting were phone calls, SMS, DSNOs and community informants. No State reported the use of social media/e-mail to report health related events. Ten (58.8%) of the 17 States with some form of event based reporting system have the minimum requirements for an event based surveillance system. Conclusion : event-based surveillance system is underutilized in Nigeria. The feasibility and utility of EBS should be assessed for possible optimization and adoption at State and federal levels.

Time delays in the response to the Neisseria meningitidis serogroup C outbreak in Nigeria – 2017

Background Nigeria reports high rates of mortality linked with recurring meningococcal meningitis outbreaks within the African meningitis belt. Few studies have thoroughly described the response to these outbreaks to provide strong and actionable public health messages. We describe how time delays affected the response to the 2016/2017 meningococcal meningitis outbreak in Nigeria. Methods Using data from Nigeria Centre for Disease Control (NCDC), National Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO), and situation reports of rapid response teams, we calculated attack and death rates of reported suspected meningococcal meningitis cases per week in Zamfara, Sokoto and Yobe states respectively, between epidemiological week 49 in 2016 and epidemiological week 25 in 2017. We identified when alert and epidemic thresholds were crossed and determined when the outbreak was detected and notified in each state. We examined response activities to the outbreak. Results There were 12,535 suspected meningococcal meningitis cases and 877 deaths (CFR: 7.0%) in the three states. It took an average time of three weeks before the outbreaks were detected and notified to NCDC. Four weeks after receiving notification, an integrated response coordinating centre was set up by NCDC and requests for vaccines were sent to International Coordinating Group (ICG) on vaccine provision. While it took ICG one week to approve the requests, it took an average of two weeks for approximately 41% of requested vaccines to arrive. On the average, it took nine weeks from the date the epidemic threshold was crossed to commencement of reactive vaccination in the three states. Conclusion There were delays in detection and notification of the outbreak, in coordinating response activities, in requesting for vaccines and their arrival from ICG, and in initiating reactive vaccination. Reducing these delays in future outbreaks could help decrease the morbidity and mortality linked with meningococcal meningitis outbreaks.

Predictors of depression among patients receiving treatment for snakebite in General Hospital, Kaltungo, Gombe State, Nigeria: August 2015

BackgroundSnakebite though neglected, affects 5 million people yearly. More neglected is the psychological effect of envenomation. We determined prevalence and pattern of depression among patients admitted into snakebite wards of Kaltungo General Hospital Nigeria, and percentage recognized by clinicians. We also assessed for factors associated with depression.MethodsIn a descriptive hospital based study, we used Patient Health questionnaire (PHQ-9) to make diagnosis of depression among the patients. We reviewed patients’ clinical records to determine clinicians’ recognition of depression.ResultsOf 187 interviews analyzed, 47 (25%) had depression with none recognized by attending clinicians. Patients with snakebite complications (odd ratio [OR] 3.1, 95% CI 1.1–8.5), and previous history of snakebites (OR 2.7, 95% CI 1.1–6.1) were associated with mild depression. Worrying about family welfare (OR 31.5, 95% CI 6.5–152.9), financial loss (OR 14.6, 95% CI 1.8–121.5) and time loss (OR 14.6, 95% CI 1.8–121.5), past history of snakebites (OR 8.3, 95% CI 1.9–36.5) and lower income (Mean difference −25,069 [84 USD], 95% CI 35,509 [118 USD]–14,630 [49 USD]) were associated with severe depression.ConclusionA quarter of in-patients of snakebite wards of the general hospital had comorbid depression that went unrecognized. Independent predictors of depression such as past history of snakebite, worrying about relations and having snakebite complications could help clinicians anticipate depression among patients. We recommend training of clinicians in the hospital on recognition of common psychological disorders like depression.

Efficacy of antimicrobial lock solutions in preventing catheter-related blood stream infection in haemodialysis patients: a systematic review and meta-analysis of prospective randomised controlled trials

Background: Catheter-related blood stream infection (CRBSI) contributes to morbidity and mortality among patients on haemodialysis (HD). We carried out a systematic review and meta-analysis to assess the efficacy of antimicrobial lock solutions (ALS) in preventing CRBSI. Method: Electronic search of randomised controlled trials (RCTs) comparing ALS with other agents was performed up to January 2013. DerSimonian and Laird meta-analysis was performed to obtain pooled relative risk (RR) from which efficacy of ALS and numbers needed to treat (NNT) were calculated. In a restricted analysis, pooled RRs where compared using a test of interaction to calculate ratio of relative risks (RRR). Meta-regression analysis was employed to explore sources of heterogeneity. Results: Sixteen RCTs involving 2016 individuals met the inclusion criteria. The efficacy of ALS in preventing CRBSI was 80% with NNT of 3 patients to prevent one CRBSI. The RR of CRBSI was significantly lower with ALS compared with heparin-only lock sol...

Impact of Symptomatic HIV- Related Neurocognitive Disorders in Survivalof HIV- Infected Individuals: A Systematic Review and Meta-Analyses

Background: HIV- related symptomatic neurocognitive disorders (SNCD) negatively influence the survival of affected patients. We conducted this meta-analysis to provide pooled estimates of mortality risk attributable to SNCD. Methods: MEDLINE, Google scholar, Cochrane library PsycINFO and EMBASE were the data bases thoroughly searched up to April 2014. Two parallel meta-analyses were performed to derive hazard ratio (HR) and relative risk (RR) of mortality from 7 and 6 studies respectively. The level statistical heterogeneity in the included studies was assessed using I-squared (I2) statistic while metaregression and subgroup analyses mainly explored clinical and methodological heterogeneity. Other assessments were analyses for publication bias, small study effect, single study effect and study quality. Results: Thirteen studies with satisfactory quality met the inclusion criteria. A total of 84 421 HIV+ individuals across 21 countries from Europe and America were involved. Subjects with SNCD have more than twice risk of death compared to subjects without SNCD: HR=2.1, 95% confidence interval (CI)=1.52-2.58; RR=2.46, 95% CI=1.63-3.69. The estimated HR translates in to 72% probability of subjects with SNCD dying earlier than subjects without SNCD. Risk of mortality is associated with declining CD4 cell count (p=0.038) and neurocognitive impairment in psychomotor and memory domains. In subgroup analyses, there was no significant difference in mortality risk with respect to HAART utilization, type of SNCD and availability of demographically adjusted normative scores. Despite limiting generalizability of findings to sub-Saharan Africa, inclusion of studies conducted in developed countries reduces confounding and increases the accuracy of defining pooled estimates. Conclusion: HIV- related SNCD negatively influence survival in affected patients. Routine care of these patients should include neurocognitive screening preferably with a battery assessing domains that are predictive of mortality such as psychomotor and memory domains.