Muhammad Hamza

Snakebite is Under Appreciated: Appraisal of Burden from West Africa.

Background Snakebite envenoming (SBE) is a major problem in rural areas of West Africa (WA). Compared to other Neglected Tropical Diseases (NTD), the public health burden of SBE has not been well characterized. We estimated the impact of snakebite mortality and morbidity using the Disability Adjusted Life Years (DALYs) metrics for 16 countries in WA. Methods We used the reported annual number of SB deaths and mean age at time of SB and converted these into years of life lost (YLL). Similarly, the years of life lived with disability (YLD) were estimated by multiplying the number of amputations by the respective disability weight of 0.13. Results In WA, the annual cases of SB mortality and amputations ranged from 24 (95% Confidence Interval: 19–29) and 28 (17–48) respectively in Guinea-Bissau with the highest estimates of 1927 (1529–2333) and 2368 (1506–4043) respectively in Nigeria. We calculated that the annual DALYs associated with a SB death ranged from 1550 DALYs (95%CI: 1227–1873 DALYs) in Guinea Bissau to 124,484 DALYs (95%CI: 98,773–150,712 DALYs) in Nigeria. The annual DALYs associated with amputation for the two countries were 149 DALYs (95%CI: 91–256 DALYs) and 12,621 DALYs (95%CI: 8027–21,549 DALYs) respectively. The total burden of SBE was estimated at 319,874 DALYs (95% CI: 248,357–402,654 DALYs) in the 16 countries in WA. These estimates are similar, and in some instances even higher, than for other NTDs encountered in WA (e.g., Buruli ulcer, Echinococcosis, Intestinal Nematode Infections, Leishmaniasis, Onchocerchiasis, Trachoma and Trypanosomiasis) as reported in the Global Burden of Diseases 2010 (GBD). Conclusions The public health burden of SBE in WA is very substantial and similar to other more widely recognized NTDs. Efforts and funding commensurate with its burden should be made available for the control of snakebite in the sub-region.

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.

Anti-retroviral therapy among HIV infected travelers to Hajj Pilgrimage.

BACKGROUND Many countries with high prevalence of human immunodeficiency virus (HIV) infection also have substantial Muslim populations. HIV-infected patients who travel to Hajj in Saudi-Arabia may encounter challenges regarding their anti-retroviral therapy (ART). METHODS In a cohort study in Nigeria, clinically stable patients on ART who were traveling for the 2008 to 2009 Hajj (Hajj-pilgrims [HP]) were selected and compared with consecutively selected Muslim patients who were clinically stable and traveled to and from distances within the country to access ART (non-pilgrims [NP]). Participants were clinically evaluated and interviewed regarding their adherence to ART pre-travel and post-travel, international border passage with medications and reasons for missing ART doses. Post-travel change in CD4 counts and RNA-PCR viral load were measured. Outcomes were proportion who missed >or=1 dose of ART during Hajj compared with pre-travel or post-travel and failure of ART, defined as decline in CD4 cell counts or high viral load or both. RESULTS Thirty-one HP and 27 NP had similar characteristics and were away for (median [range]) 36 days (28-43 days) and 84 days (28-84 days), respectively (p < 0.0001). Those who missed >or= 1 ART doses among HP and NP while away were 16/31 (51.6%) and 5/27 (18.5%), respectively with risk ratio (95% confidence interval [CI]) 2.79 (1.18-6.60). Among HP, the proportions who missed >or= 1 ART doses pre-travel and post-travel were lower than those who missed it during Hajj. Those who failed ART among HP compared with NP were 15/31 (48.4%) and 5/27 (18.5%), respectively with odds ratio (95% CI) 4.13 (1.10-17.21). Reasons for missing ART included forgetfulness, exhaustion of supplies, stigma, spiritual alternatives, or disinclination; five patients were unable to cross airports with medications. CONCLUSIONS Patients who went on Hajj were more likely to miss medications and to have ART failure due to several reasons including inability to cross borders with medications.

Prevalence of hepatitis B and C virus infections among HIV-infected patients in a tertiary hospital in North-Western Nigeria

Introduction: Infections from HIV, Hepatitis B and to some extent Hepatitis C viruses constitute a major public health challenge in sub-Saharan Africa, and there are evidences to suggest that there is faster progression of HIV in those co-infected with either HBV or HCV. The aim of this study was to determine the prevalence of HBV and HCV infections among HIV-infected patients, and describe the socio-demographic features and correlates of HIV and HBV/HCV co-infected patients at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Materials and Methods: This was a cross-sectional study carried out among HIV-positive individuals seen at the adult HIV clinic of AKTH. Four Hundred and forty (440) consecutive HIV-positive adult patients who consented to the study were screened for markers of HBV and HCV using Enzyme-linked Immunosorbent Assay (ELISA) technique. CD 4 Count and serum ALT were also obtained from the recruited patients. Socio-demographic characteristics and Body Mass Index (BMI) were obtained. Differences and relationships between groups were determined using students t-test and Chi-square test where appropriate, and a P < 0.05 was regarded as significant. Results: Prevalence rates of Hepatitis B and C virus infections obtained were 12.3% and 1.6%, respectively. Individuals who were 40 years or younger were the most affected. HBV co-infection was more common among males than females (16.9% vs 9.2%, respectively, P = 0.0153). Mean serum ALT among participants with HIV alone was 31.6 International Units (IU), but was significantly higher (45.3 IU) for those with HIV/HBV co-infection, P = 0.048. Mean CD 4 count for HIV/HBV co-infected participants (259.7 c/mm 3 ) was significantly higher than that for participants with HIV alone (240.0 c/mm 3 ), P = 0.0170 whereas the mean BMI was not significantly different between participants with HIV alone (21.3 kg/m 2 ) versus HIV/HBV co-infected participants (22.2 kg/m 2 ), P = 0.1385. Conclusion: Co-infection with hepatitis B virus is common among HIV-infected patients in our setting and this further reaffirms the need for routine baseline screening for this marker, as it is a major consideration in the initiation and choice of highly active antiretroviral therapy. Furthermore, those found to be negative should be immunized with HBV vaccine to improve the prognosis of their HIV status.

Cost-effectiveness of antivenoms for snakebite envenoming in 16 countries in West Africa

Background Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results The cost/death averted for the 16 countries of interest ranged from

Prevalence and burden of human immunodeficiency virus and hepatitis B virus co-infection in Nigeria: a systematic review and meta-analysis.

1,997 in Guinea Bissau to

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

6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from

Disseminated norcardial infection in a patient with myasthenia gravis on prolonged steroid therapy: A case report

83 (95% Confidence Interval:

Prevalence and risk factors for hepatotoxicity among patients with HIV/AIDS on highly active antiretroviral therapy in North-Western Nigeria

36-

Effectiveness of transfluthrin-coated inflammable-fumes insecticide-paper (Rambo™) in the prevention of malaria in Kano, Nigeria

240) for Benin Republic to