Disability Inclusion in the National Strategic Plan for HIV/AIDS: A Review on the National Response of West African Countries.

Objectives: Persons with disabilities (PWD) often experience risks associated with HIV/AIDS including unmet needs and overlooked stigmatization. This could be attributed to certain misconceptions such as PWDs are asexual, and cannot enjoy sexual pleasure, among others. Therefore, this paper sought to investigate the extent of disability inclusion in recent National Strategic Plans (NSPs) for HIV/AIDS in West African countries. Methods: This study was a policy review of NSPs in 13 African countries. Relevant indicators in the UN Convention on the Rights of Persons with Disabilities and the UNAIDS International Guidelines on HIV and Human Rights were used. Six indicators (identification of people living with disability (PLWD) as a key population, the inclusion of principles related to PWD within the NSPs on HIV/AIDS, protecting the rights of PWD, recognition of PWD as a vulnerable population at higher risk of HIV and in need of special protection, providing HIV-related support services for PWD and monitoring and evaluating the impact of HIV on PWD). Results: Findings from this study revealed that only 30% of West African countries recognized disability as an issue of concern. Also, 38.5% of these countries recognize the vulnerability of people with disabilities to HIV. However, only a few (7.6%) provided support in the context of special needs, monitoring, and surveillance specifically for persons with disabilities. Conclusion: Most of the West African NSPs are outdated and due for renewal. Therefore, it is necessary to integrate the needs of persons with disabilities within the context of HIV/AIDS in the NSPs. More importantly, support and services should also be prioritized among the vulnerable groups to optimize inclusion.

Sustainability of pneumococcal conjugate vaccination in Ghana: a cost-effectiveness analysis in the context of donor transition.

Background: Streptococcus pneumonia is responsible for 18% of infant deaths in Ghana. With co-financing from Gavi in 2012, Ghana introduced the PCV13 into the childhood immunization programme to reduce the burden of Streptococcus pneumonia. However, Ghana will graduate to the Gavi fully self-financing phase in 2026, when the nation assumes full responsibility of paying for the PCV13. This research aims to evaluate the health impact and cost-effectiveness of PCV13 immunization in Ghana since its implementation and after the cessation of support from Gavi. Methods: We used the UNIVAC tool to evaluate two main scenarios of cost-effectiveness, from vaccine introduction (2012-2025) and after Gavi transition (2026-2031) in comparison with no vaccination. The sources of data include national data, international estimates and expert opinion. Cost was considered from both the government and societal perspectives. We discounted health outcomes at 3%. Currency values were stated in US Dollars. We tested the robustness of the base case results by performing scenario and sensitivity analyses. Results: PCV13 will reduce the pneumococcal disease burden by 48% from 2012 to 2031. The vaccination programme costs are USD 130 million and USD 275 million in 2012-2025 and 2026-2031 respectively. It also has a budget impact of USD 280 million for the 2026-2031 period from the perspective of government. The incremental cost-effectiveness ratios are USD 89 and USD 73 respectively from the perspectives of government and society in 2012-2025. The incremental cost-effectiveness ratios are USD 530 and USD 510 respectively from the perspectives of government and society in 2026-2031. Conclusion: The PCV13 vaccination programme in Ghana is cost-effective at 50% GDP per capita threshold even when Gavi withdraws co-financing support from 2026 onwards.

Maternal ART throughout gestation prevents caudate volume reductions in neonates who are HIV exposed but uninfected.

Introduction: Successful programmes for prevention of vertical HIV transmission have reduced the risk of infant HIV infection in South Africa from 8% in 2008 to below 1% in 2018/2019, resulting in an increasing population of children exposed to HIV perinatally but who are uninfected (HEU). However, the long-term effects of HIV and antiretroviral treatment (ART) exposure on the developing brain are not well understood. Whereas children who are HEU perform better than their HIV-infected counterparts, they demonstrate greater neurodevelopmental delay than children who are HIV unexposed and uninfected (HUU), especially in resource-poor settings. Here we investigate subcortical volumetric differences related to HIV and ART exposure in neonates. Methods: We included 120 infants (59 girls; 79 HEU) born to healthy women with and without HIV infection in Cape Town, South Africa, where HIV sero-prevalence approaches 30%. Of the 79 HEU infants, 40 were exposed to ART throughout gestation (i.e., mothers initiated ART pre conception; HEU-pre), and 39 were exposed to ART for part of gestation (i.e., mothers initiated ART post conception; HEU-post). Post-conception mothers had a mean (± SD) gestational age (GA) of 15.4 (± 5.7) weeks at ART initiation. Mothers with HIV received standard care fixed drug combination ART (Tenofovir/Efavirenz/Emtricitabine). Infants were imaged unsedated on a 3T Skyra (Siemens, Erlangen, Germany) at mean GA equivalent of 41.5 (± 1.0) weeks. Selected regions (caudate, putamen, pallidum, thalamus, cerebellar hemispheres and vermis, and corpus callosum) were manually traced on T1-weighted images using Freeview. Results: HEU neonates had smaller left putamen volumes than HUU [ß (SE) = -90.3 (45.3), p = 0.05] and caudate volume reductions that depended on ART exposure duration in utero. While the HEU-pre group demonstrated no caudate volume reductions compared to HUU, the HEU-post group had smaller caudate volumes bilaterally [ß (SE) = -145.5 (45.1), p = 0.002, and -135.7 (49.7), p = 0.008 for left and right caudate, respectively]. Discussion: These findings from the first postnatal month suggest that maternal ART throughout gestation is protective to the caudate nuclei. In contrast, left putamens were smaller across all HEU newborns, despite maternal ART.

Covid-19 and non-communicable diseases (NCDs) in Africa: a narrative review.

Coronavirus disease 2019 popularly known as COVID-19 is the current pandemic ravaging the world. It has disrupted so many aspects of humans' life including the healthcare systems of all countries. While governments have instituted preventive measures such as social distancing, self-isolation and lockdown in a bid to control the spread of the virus, the absence of vaccine can lead to poor management of key risk factors (including unhealthy diets and physical inactivity) associated with NCDs and limited access to preventive health services can further contribute to development and progression of NCDs. This study provides a review of available evidences from PubMed, google scholar, online databases, and papers from other sources on the impact of COVID-19 pandemic on NCDs in Africa and emphasizes lessons from past pandemics that can be adopted to reduce the burden of the disease.

Antimicrobial resistance and one health in the post COVID-19 era: What should health students learn?

Antimicrobial resistance (AMR) is a critical worldwide health issue that jeopardizes our ability to fight illnesses. However, despite being a natural phenomenon, AMR is exacerbated in the world by inappropriate administration of an antimicrobial medication such as under-use or overuse by the general population, farmers, and various health professionals. The onset of the COVID-19 pandemic has put the world in a shocking state. The pandemic exacerbated the problem of antimicrobial resistance, which was largely caused by irrational off-label use of antivirals, anthelmintics, antimalarials, and, most notably, macrolide antibiotics. As a result, monitoring the AMR progression during the pandemic has been critical. The One Health Approach is progressively becoming the most widely utilized and recommended approach in the ongoing fight against AMR. The aim of this article is to address the lack of teachings in AMR and the One Health Approach in health student training curricula, as well as to provide recommendations that can be implemented as we progress beyond the COVID-19 era.

Will refugees also get vaccinated against COVID-19 in Africa?

Africa has the second-highest number of displaced persons in the world. This number increases continuously due to the ongoing crisis in different countries in sub-Saharan Africa. African refugees are not only prone to COVID-19 but they are also capable of transmitting it across country borders. This article aims to highlight the need for equity in vaccine distribution in Africa to include refugees in each host countries.

Low dose bitter leaf improves sperm quality disrupted in immunosuppressed Wistar rats: An experimental study.

BACKGROUND: Synthetic prednisolone (PRED) is a widely used over-the-counter glucocorticoid. Glucocorticoids have inhibitory effects on the immune system and are often used as immunosuppressive agents. Suppressed immunity may impact fertility via the hypothalamic-pituitary-adrenal axis. Bitter leaf (BL) has been shown to improve sperm parameters, but its effects on immunosuppression-associated infertility have not yet been documented. OBJECTIVE: To determine the fertility effects of bitter leaf on immunosuppressed Wistar rats. MATERIALS AND METHODS: A total of 30 male adult Wistar rats were randomly assigned to 6 groups (n = 5/each). Group A served as a control and were given distilled water in addition to normal feeds, group B received 2 mg/kg PRED for 14 days and served as the standard immunosuppressed group, and groups C-F were immunosuppressed as in B but in addition received 50 mg/kg levamisole, low-dose (250 mg/kg) BL, high-dose (375 mg/kg) BL, and low-dose BL + levamisole, respectively. The CD4 counts, hematological parameters, and sperm parameters were analyzed and compared. RESULTS: There were significant decreases in sperm motility, progressive motility, morphology, and life/death ratio in the animals given PRED only compared to the controls (p = 0.002, 0.001, 0.001, and 0.01, respectively). These were significantly increased in the treated groups, and animals given levamisole and 250 mg/kg BL showed significantly increased sperm counts compared to the controls (p = 0.04 and p = 0.04, respectively). CONCLUSION: Low-dose BL (250 mg/kg) restored the sperm parameters altered by prednisolone administration.

Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study.

The acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in high-burden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic about lifelong ART, however postpartum and LTFU women expressed conditionalities for acceptance and adherence, including minimal ART side effects and potentially serious maternal illness. Providers corroborated user findings, identifying the postpartum period as problematic for lifelong ART acceptability/adherence. Option B plus scale-up in Nigeria will require proactively addressing PMTCT user fears about ART side effects, and continuous education on long-term maternal and infant benefits. Structural barriers such as the availability of trained providers, long clinic wait times and patient access to ART should also be addressed.

Cerebellar Molecular and Cellular Characterization in Rat Models of Alzheimer's Disease: Neuroprotective Mechanisms of Garcinia Biflavonoid Complex.

BACKGROUND: Recent evidences suggest that cerebellar degeneration may be associated with the development of Alzheimer's disease (AD). However, previous reports were mainly observational, lacking substantial characterization of cellular and molecular cerebellar features during AD progression. PURPOSE: This study is aimed at characterizing the cerebellum in rat models of AD and assessing the corresponding neuroprotective mechanisms of Garcinia biflavonoid complex (GBc). METHODS: Male Wistar rats were grouped and treated alone or in combination with PBS (ad libitum)/day, corn oil (CO; 2 mL/kgBw/day), GBc (200 mg/kgBw/day), sodium azide (NaN3) (15 mg/kgBw/day) and aluminium chloride (AlCl3) (100 mg/kgBw/day). Groups A and B received PBS and CO, respectively; C received GBc; D received NaN3; E received AlCl3; F received NaN3 then GBc subsequently; G received AlCl3 then GBc subsequently; H received NaN3 and GBc simultaneously while I received AlCl3 and GBc simultaneously. Following treatments, cerebellar cortices were processed for histology, immunohistochemistry and colorimetric assays. RESULTS: Our data revealed that cryptic granule neurons and pyknotic Purkinje cell bodies (characterized by short dendritic/axonal processes) correspond to indistinctly demarcated cerebellar layers in rats treated with AlCl3 and NaN3. These correlates, with observed hypertrophic astrogliosis, increased the neurofilament deposition, depleted the antioxidant system-shown by expressed superoxide dismutase and glutathione peroxidase, and cerebellar glucose bioenergetics dysfunction-exhibited in assayed lactate dehydrogenase and glucose-6-phosphate dehydrogenase. We further showed that GBc reverses cerebellar degeneration through modulation of neurochemical signaling pathways and stressor molecules that underlie AD pathogenesis. CONCLUSION: Cellular, molecular and metabolic neurodegeneration within the cerebellum is associated with AlCl3 and NaN3-induced AD while GBc significantly inhibits corresponding neurotoxicity and is more efficacious when pre-administered.

Ascorbic acid ameliorates behavioural deficits and neuropathological alterations in rat model of Alzheimer's disease.

Exploring the links between neural pathobiology and behavioural deficits in Alzheimer's disease (AD), and investigating substances with known therapeutic advantages over subcellular mechanisms underlying these dysfunctions could advance the development of potent therapeutic molecules for AD treatment. Here we investigated the efficacy of ascorbic acid (AA) in reversing aluminium chloride (AlCl3)-induced behavioural deficits and neurotoxic cascades within prefrontal cortex (PFC) and hippocampus of rats. A group of rats administered oral AlCl3 (100mg/kg) daily for 15days showed degenerative changes characterised by significant weight loss, reduced exploratory/working memory, frontal-dependent motor deficits, cognitive decline, memory dysfunction and anxiety during behavioural assessments compared to control. Subsequent analysis showed that oxidative impairment-indicated by depleted superoxide dismutase and lipid peroxidation (related to glutathione-S-transferase activity), cholinergic deficits seen by increased neural acetylcholinesterase (AChE) expression and elevated lactate dehydrogenase underlie behavioural alterations. Furthermore, evidences of proteolysis were seen by reduced Nissl profiles in neuronal axons and dendrites which correspond to apoptotic changes observed in H&E staining of PFC and hippocampal sections. Interestingly, AA (100mg/kg daily for 15days) significantly attenuated behavioural deficits in rats through inhibition of molecular and cellular stressor proteins activated by AlCl3. Our results showed that the primary mechanisms underlying AA therapeutic advantages relates closely with its abilities to scavenge free radicals, prevent membrane lipid peroxidation, modulate neuronal bioenergetics, act as AChE inhibitor and through its anti-proteolytic properties. These findings suggest that supplementing endogenous AA capacity through its pharmacological intake may inhibit progression of AD-related neurodegenerative processes and behavioural alterations.

Cannabis-induced Moto-Cognitive Dysfunction in Wistar Rats: Ameliorative Efficacy of Nigella Sativa.

BACKGROUND: Cannabis is a widely used illicit drug with various threats of personality syndrome, and Nigella sativa has been widely implicated as having therapeutic efficacy in many neurological diseases. The present study investigates the ameliorative efficacy of Nigella sativa oil (NSO) on cannabis-induced moto-cognitive defects. METHODS: Scopolamine (1 mg/kg i.p.) was given to induce dementia as a standard base line for cannabis (20 mg/kg)-induced cognitive impairment, followed by an oral administration of NSO (1 ml/kg) for 14 consecutive days. The Morris water maze (MWM) paradigm was used to assess the memory index, the elevated plus maze was used for anxiety-like behaviour, and the open field test was used for locomotor activities; thereafter, the rats were sacrificed and their brains were removed for histopathologic studies. RESULTS: Cannabis-like Scopolamine caused memory impairment, delayed latency in the MWM, and anxiety-like behaviour, coupled with alterations in the cerebello-hippocampal neurons. The post-treatment of rats with NSO mitigated cannabis-induced cognitive dysfunction as with scopolamine and impaired anxiety-like behaviour by increasing open arm entry, line crossing, and histological changes. CONCLUSIONS: The observed ameliorative effects of NSO make it a promising agent against moto-cognitive dysfunction and cerebelo-hippocampal alterations induced by cannabis.