Mentorship in health research institutions in Africa: A systematic review of approaches, benefits, successes, gaps and challenges.

BACKGROUND: In Africa, where the burden of diseases is disproportionately high, significant challenges arise from a shortage of skilled researchers, lack of research funding, and limited mentorship opportunities. The continent faces a substantial gap in research output largely attributed to the dearth of mentorship opportunities for early career researchers. OBJECTIVE: To explore existing mentorship approaches, identify challenges, gaps, successes, and benefits, and provide insights for strengthening mentorship programs in African health research institutions. METHODS: We registered the review protocol on the International Prospective Register of Systematic Reviews [CRD42021285018] and searched six electronic databases-EMBASE, AJOL, Web of Science, PubMed, DOAJ, and JSTOR from inception to 10 November 2023, for studies published in English reporting on approaches of mentorship in health research in African countries. We also searched grey literature repositories, institutional websites, and reference lists of included studies for additional literature. Two independent reviewers conducted screening of titles and abstracts of identified studies, full-text screening, assessment of methodological quality, and data extraction. We assessed study quality against the Mixed Methods Appraisal Tool (MMAT). We resolved any disagreements through discussion and consensus. We employed a narrative approach to synthesize the findings. RESULTS: We retrieved 1799 articles and after screening, included 21 studies in the review. The reviewers identified 20 mentorship programs for health researchers (N = 1198) in 12 African countries mostly focusing on early-career researchers and junior faculty members. A few included mid-career and senior researchers. We categorized the programs under three key mentoring approaches: international collaborative programs, regional and in-country collaborations, and specialized capacity-building initiatives. Our review highlighted the following successes and benefits of health research mentorship programs: the establishment of collaborations and partnerships, development of research programs and capacities, improvement of individual skills and confidence, increased publications, and successful grant applications. The gaps identified were limited funding, lack of a mentorship culture, negative attitudes towards research careers, and lack of prioritization of research mentorship. CONCLUSION: Our review highlights a diverse landscape of health research mentorship aspects predominantly targeting early career researchers and heavily driven by the North. There is a need for locally driven mentorship initiatives in Africa to strengthen mentorship to advance health research in the region. TRIAL REGISTRATION: PROSPERO registration number: CRD42021285018.

Vegetation index and livestock practices as predictors of malaria transmission in Nigeria.

Nigeria is the most malaria-endemic country in the world. Vegetation and livestock practices have been linked to malaria transmission but little is known about these in Nigeria. The study aimed to evaluate the influence of vegetation and livestock as predictors of malaria transmission in Nigeria. Secondary data obtained from the Nigerian Demographic and Health Survey's Geospatial Covariate Datasets Manual were used for the analysis. The survey was carried out successfully in 1389 clusters of thirty (30) households each using a two-stage stratified random sampling design. Hierarchical beta regression models were used to model the associations between malaria incidence, enhanced vegetation index (EVI), and livestock practices. The correlation coefficients for vegetation index and livestock-related variables ranged from - 0.063 to 0.074 and varied significantly with the incidence of malaria in Nigeria (P < 0.001). The model showed vegetation index, livestock goats, and sheep as positive predictors of malaria transmission. Conversely, livestock chicken and pigs were observed to reduce the risk of malaria. The study recommends the need to take into account local differences in transmission when developing malaria early warning systems that utilize environmental and livestock predictors.

Extant interspecific hybridization among trematodes within the Schistosoma haematobium species complex in Nigeria.

BACKGROUND: Natural interspecific hybridization between the human parasite (Schistosoma haematobium [Sh]) and bovine parasites (Schistosoma bovis [Sb], Schistosoma curassoni [Sc]) is increasingly reported in Africa. We developed a multi-locus PCR DNA-Seq strategy that amplifies two unlinked nuclear (transITS, BF) and two linked organellar genome markers (CO1, ND5) to genotype S. haematobium eggs collected from infected people in Ile Oluji/Oke Igbo, Ondo State (an agrarian community) and Kachi, Jigawa State (a pastoral community) in Southwestern and Northern Nigeria, respectively. PRINCIPAL FINDINGS: Out of a total of 219 urine samples collected, 57 were positive for schistosomes. All patients from Jigawa state possessed an Sh mitochondrial genome and were infected with a genetic profile consistent with an Sh x Sb hybrid based on sequences obtained at CO1, ND5, transITS and BF nuclear markers. Whereas samples collected from Ondo state were more varied. Mitonuclear discordance was observed in all 17 patients, worms possessed an Sb mitochondrial genome but one of four different genetic profiles at the nuclear markers, either admixed (heterozygous between Sh x Sc or Sh x Sb) at both markers (n = 10), Sh at BF and admixed at transITS (Sh x Sc) (n = 5), admixed (Sh x Sc) at BF and homozygous Sc at transITS (n = 1) or homozygous Sh at BF and homozygous Sc at transITS (n = 1). SIGNIFICANCE: Previous work suggested that zoonotic transmission of S. bovis in pastoral communities, where humans and animals share a common water source, is a driving factor facilitating interspecific hybridization. However, our data showed that all samples were hybrids, with greater diversity identified in Southwestern Nigeria, a non-pastoral site. Further, one patient possessed an S. bovis mitochondrial genome but was homozygous for S. haematobium at BF and homozygous for S. curassoni at transITS supporting at least two separate backcrosses in its origin, suggesting that interspecific hybridization may be an ongoing process.

Neglected tropical disease (NTD) diagnostics: current development and operations to advance control.

Neglected tropical diseases (NTDs) have become important public health threats that require multi-faceted control interventions. As late treatment and management of NTDs contribute significantly to the associated burdens, early diagnosis becomes an important component for surveillance and planning effective interventions. This review identifies common NTDs and highlights the progress in the development of diagnostics for these NTDs. Leveraging existing technologies to improve NTD diagnosis and improving current operational approaches for deployment of developed diagnostics are crucial to achieving the 2030 NTD elimination target. Point-of-care NTD (POC-NTD) diagnostic tools are recommended preferred diagnostic options in resource-constrained areas for mapping risk zones and monitoring treatment efficacy. However, few are currently available commercially. Technical training of remote health care workers on the use of POC-NTD diagnostics, and training of health workers on the psychosocial consequences of these diagnostics are critical in harnessing POC-NTD diagnostic potential. While the COVID-19 pandemic has challenged the possibility of achieving NTD elimination in 2030 due to the disruption of healthcare services and dwindling financial support for NTDs, the possible contribution of NTDs in exacerbating COVID-19 pandemic should motivate NTD health system strengthening.

Vaccination compliance of selected childhood immunization programs and the socio-determinant factors in Nigeria.

INTRODUCTION: Adherence to full vaccination is important in preventing childhood diseases. The aim of this study was to evaluate the level of compliance to full vaccination and identify the socio-cultural factors associated with full vaccination compliance in children. METHODOLOGY: The socioeconomic variables associated with each of the four binary dependent variables of whether or not a child is fully vaccinated against tetanus, BCG, measles, and pentavalent were determined using logistic regression. RESULTS: While compliance to full tetanus and BCG vaccinations was > 60% at the national level, less than 50% and 10% full vaccination compliance were recorded for pentavalent and measles vaccinations, respectively. The South East region of Nigeria recorded the overall highest full vaccination compliance while the least performing region was the North West zone. The mother or guardian literacy level, employment status, antenatal care attendance, and internet usage were strong predictors of full vaccination compliance (p < 0.05). CONCLUSIONS: The socio-cultural factors associated with achieving full vaccination coverage in Nigeria in this study should drive the implementation of policies that will be best suited to each geopolitical zone of Nigeria.

Soil-transmitted helminthiasis (STH) endemicity and performance of preventive chemotherapy intervention programme in Nigeria (in year 2021).

Preventive chemotherapy (PC) is an important tool to address transmission and reduce morbidities associated with soil-transmitted helminths (STHs). The aim of the study is to assess the PC implementation programme coverage and relate the same to the endemicity of STH in Nigeria. The secondary data collected by the World Health Organization (WHO) through the expanded special project for elimination of neglected tropical diseases (ESPEN) and made available at the ESPEN portal was used for the study. The PC implementation coverage and frequency of treatment were evaluated and related to STH endemicity levels in Nigeria. STH was actively transmitted in all six geopolitical zones of Nigeria. The southern part of Nigeria was more endemic compared with northern Nigeria. There was no PC intervention in preschoolers and effective PC coverage (19.3%) fell below the WHO ≥ 75% PC coverage index benchmark in school children. The percentages of children that harbour low, moderate, and high STH infections were 41.5, 41.6, and 13.4%, respectively. Multiple treatments did not necessarily reduce the endemicity of STH on certain occasions. STH continues to be a public health threat in Nigeria. The current treatment strategies should be reviewed to accommodate preschoolers in PC implementation programmes. Treatment should be integrated with the WASH programme in order to achieve a lasting impact.

Access to COVID-19 vaccines and testing in Africa: the importance of COVAX - Nigeria as a case study.

Since pandemic declaration, the vulnerability of countries with serious economic challenges and limited health resources became evident. This vulnerability has been put to the test once again with the appearance of Omicron as another variant of concern. Although great efforts have been made to develop effective and safe vaccines, they need to be made available globally at an affordable price to all governments and distributed equitably to maximize immediate and long-term efforts to contain the virus and advance global public health. Potential sources of unfair allocation of COVID-19 vaccines are not hard to find. The COVID-19 Vaccine Global Access Facility (COVAX) has so far shipped over 406 million COVID-19 vaccines to 144 eligible participants. From that batches, about 115 million doses (28%) were allocated to 49 African countries. If proactive measures are not undertaken, Nigeria, pointed here as a case study, and Sub-Saharan Africa countries may not be self-reliant for COVID-19 vaccines. This report raises a discussion on the difficulties in accessing vaccines and diagnostics in sub-Saharan Africa, compared to high- and middle-income countries. Now more than ever, it is crucial to note that there is no overcoming a pandemic without coordinated action for actions that go beyond borders. The coordinated effort to raise vaccination rates in the African continent is not a humanitarian action aimed exclusively at Africa, but more than that, it is an effort for the benefit of global public health.

Addressing Malnutrition in Children: An Appraisal of the Ondo State Nutrition Program.

Background The report of the 2013 Nigeria Demographic and Health Survey (NDHS 2013) showed Ondo State had one of the worst indices for stunting and underweight in the southwestern geopolitical zone of the country, a development that was considered "unacceptable" by the state government. In the bid to reverse the ugly trend, the State Primary Health Care Development Agency put in place a comprehensive nutrition program in 2015 tagged "Nutrition Rebirth," aimed at reversing the high prevalence of malnutrition among under-five children in the State. Aims This study seeks to evaluate the Ondo State comprehensive nutrition program by comparing the children's nutritional status pre- and post-period under review in the implementation of the program. This provides a measure of assessment of the performance of the program as implemented in the period under review. Materials and methods This study covered the period between 2015 and 2017 in the implementation of the nutrition rebirth program. Data for the study were obtained from the NDHS (2013) and NDHS (2018) nutrition of children and women data. Analysis of the NDHS (2013) and NDHS (2018) data commenced simultaneously with field work and lasted for about six and eight months, respectively. Analysis of the data obtained from the NDHS for this study spanned through a period of about three weeks. An ecologic time-trend analysis was used to compare the trends in nutritional status indicators among under-five children in all 18 Local Government Areas (LGAs) in Ondo State. Results Malnutrition among children less than five years dropped in most of the LGAs in 2018. Malnutrition was not associated with children's gender and maternal age in 2013 and 2018. Prevalence of stunting growth and underweight was associated with maternal education, wealth index, residence type, place of delivery, and LGA in 2013 (p < 0.05) but was not in 2018 (p > 0.05). Conclusions The spatial analysis of the Ondo State comprehensive nutrition program showed that the program has a positive impact, reducing malnutrition among children under five years; but critical appraisal of implementation challenges in LGAs with no significant reduction in malnutrition among their children under five years is recommended. The comprehensive and wholistic approach of the program is also recommended for other states and settings with a high prevalence of under-five malnutrition to understudy the possible adaptation, as appropriate.

Ovicidal and miracicidal activities of Calotropis procera and its green-synthesized nanotized derivative: A quest for new antifasciola agents.

Fascioliasis is an important zoonotic disease but treatment with the mainstay drugs poses challenge of parasite resistance. The aim of the study was to determine the anthelmintic efficacy of ethanolic leaf extract of Calotropis procera (CP) and its synthesized silver nanoparticles (AgNPs) against the eggs and miracidia of Fasciola species. The ethanolic extract of C. procera was used to synthesise its corresponding green-synthesis derivative using silver nitrate (CP-AgNPs). The synthesized silver nanoparticles were characterized by Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD) and Scanning Electron Microscopy/Energy Dispersive X-ray (SEM/EDX). The ova and miracidia of Fasciola spp. were exposed to 1, 2, and 4 mg/ml CP ethanolic extracts and its corresponding AgNPs. FTIR showed that the formulation was capped with compounds present in the extract. The XRD showed the crystalline property of CP-AgNPs. The SEM image showed clusters of irregularly shape nanoparticles. The ovicidal activities were concentration dependent and showed highest activities 81.02±4.03% and 92.91±1.25% in 4 mg/ml CP and CP-AgNPs respectively (p < 0.05). The LC50 of CP (1.49 mg/ml) was more than 3 folds higher than that of CP-AgNPs (0.47 mg/ml). While CP did not cause miracidia death after 60 min exposure, however, 100% miracidia death were observed within 30 min exposure in all the tested concentration with CP-AgNPs. The positive control (ABZ) only showed 100% mortality after 60 min of exposure of miracidia. The study showed that green-synthesised C. procera nanoparticles showed superior ovicidal and miracicidal activities over C. procera leaf extracts and could be a source of potential antifasciola agent.

Malaria transmission in Africa: Its relationship with yellow fever and measles.

BACKGROUND: Malaria has been strongly linked to the transmission and pathophysiology of some viral diseases. Malaria and vaccine-preventable diseases often co-exist in endemic countries but the implication of their co-existence on their transmission dynamics and control is poorly understood. The study aims to evaluate the relationships between the incidence of malaria and cases of measles and yellow fever in Africa. METHODS: The malaria incidence, death due to malaria, measles and yellow fever data were sourced from the WHO database. Poisson and zero-inflated time-trend regression were used to model the relationships between malaria and the two vaccine-preventable diseases. P-values <0.05 were considered statistically significant. RESULTS: A significant negative relationship existed between malaria incidence and measles cases (P<0.05), however, malaria showed a positive relationship with yellow fever (P<0.05). The relationships between death due to malaria and measles/yellow fever cases followed similar trends but with a higher level of statistical significance (P<0.001). CONCLUSIONS: Malaria varied negatively with measles cases but positively with yellow fever. The relationships observed in this study could be important for the management of malaria and the studied vaccine-preventable diseases. Increase vaccination coverage and/or malaria treatment could modulate the direction of these relationships.

Diagnostic and therapeutic biomarkers in colorectal cancer: a review.

Colorectal cancer (CRC) is a public health concern and the second most common type of cancer among men and women causing a significant mortality. Biomarkers closely linked to the disease morbidity could holds potential as diagnostic and/or prognostic biomarker for the disease. This review provides an overview of recent advances in the search for colorectal cancer biomarkers through genomics and proteomics according to clinical function and application. Specifically, a number of biomarkers were identified and discussed. Emphasis was placed on their clinical applications relative to the diagnosis and prognosis of CRC. The discovery of more sensitive and specific markers for CRC is an urgent need, and the study of molecular targets is extremely important in this process, as they will allow for a better understanding of colorectal carcinogenesis, identification and validation of potential genetic signatures.

COVID-19 pandemic: an online-based survey of knowledge, perception, and adherence to preventive measures among educated Nigerian adults.

Aims: One of the ways to manage the current coronavirus disease 2019 (COVID-19) pandemic is to monitor the public knowledge, risk perceptions, adherence to preventive measures, and level of preparedness behaviors. This is important in resource-limited countries. This study determined the knowledge and perception regarding COVID-19; adherence to COVID-19 preventive measures; as well as predictors of self-perceived risk of contracting COVID-19 among Nigerian adults. Methods: A cross-sectional study was conducted among Nigerian adults ≥18 years using an online survey. A convenience sampling method was utilized to recruit a total of 1022 study participants. The participants were recruited using the authors' social media networks. Data were analyzed using descriptive and inferential statistics at a 5% level of statistical significance. Results: Generally, a high proportion of respondents had correct knowledge about COVID-19. However, only approximately half (49.8% and 49.9%) had correct knowledge that obesity was a risk factor for COVID-19 and that antibiotics cannot be used to treat COVID-19. Most (84.1%) did not have a self-perceived risk of contracting COVID-19. Most (81.0%) have been avoiding crowded places and 61.3% washed their hands frequently. Predictors of self-perceived risk of COVID-19 were age 40-59 years (OR 2.05, CI 1.217-3.435), ≥ 60 years (OR 4.68, CI 1.888-11.583), and visiting crowded places (OR 2.27, CI 1.499-3.448). Conclusion: Our study recommends more rigorous public health education aimed at improving COVID-19 outbreak response in Nigeria. In addition, physical and social distancing should be emphasized across all age groups with additional focus on the older population.

Dot blot platform as a novel diagnostic kit: rapid, accurate, and on-site detection of Schistosoma mansoni in urine samples of hard to detect individuals.

Rapid diagnostics provide actionable information for patient care at the time and site of an encounter with the health care system. The mainstay of infectious diseases care is early detection (case finding) and treatment completion, but for many, it is hard to identify positive individuals, as is the case of infection with low burden in schistosomiasis, a parasitic disease common in the tropics and subtropics. We developed a new, accurate, and fast Dot blot methodology (iDot) to indirectly detect Schistosoma mansoni in individuals with very low parasite burden using urine samples. Accuracy of 0.74 was obtained with a significant difference between negative and positive patients and a substantial agreement was found when iDot was compared with five available methods. Our analysis also revealed the superiority of iDot in detecting negative individuals from non-endemic sites, thus, presenting the lowest rate of false positives. This new method called iDot is convenient and suitable for qualitative and quantitative detection of schistosomiasis in individuals with low parasite burden.

Modeling the relationship between malaria prevalence and insecticide-treated bed net coverage in Nigeria using a Bayesian spatial generalized linear mixed model with a Leroux prior.

OBJECTIVES: To evaluate malaria transmission in relation to insecticide-treated net (ITN) coverage in Nigeria. METHODS: We used an exploratory analysis approach to evaluate variation in malaria transmission in relation to ITN distribution in 1,325 Demographic and Health Survey clusters in Nigeria. A Bayesian spatial generalized linear mixed model with a Leroux conditional autoregressive prior for the random effects was used to model the spatial and contextual variation in malaria prevalence and ITN distribution after adjusting for environmental variables. RESULTS: Spatial smoothed maps showed the nationwide distribution of malaria and ITN. The distribution of ITN varied significantly across the 6 geopolitical zones (p<0.05). The North-East had the least ITN distribution (0.196±0.071), while ITN distribution was highest in the South-South (0.309±0.075). ITN coverage was also higher in rural areas (0.281±0.074) than in urban areas (0.240±0.096, p<0.05). The Bayesian hierarchical regression results showed a non-significant negative relationship between malaria prevalence and ITN coverage, but a significant spatial structured random effect and unstructured random effect. The correlates of malaria transmission included rainfall, maximum temperature, and proximity to water. CONCLUSIONS: Reduction in malaria transmission was not significantly related to ITN coverage, although much could be achieved in attempts to curtail malaria transmission through enhanced ITN coverage. A multifaceted and integrated approach to malaria control is strongly advocated.

Application of nanotized formulation in the control of snail intermediate hosts of schistosomes.

Schistosomiasis continues to pose significant public health problems in many developing countries. Mass drug administration (MDA) is the most adopted control option but there is increasing evidence for the development of praziquantel-resistant Schistosoma strains. This shortcoming has necessitated the search for other effective methods for the control of schistosomiasis. The breaking of Schistosoma transmission cycles through the application of molluscicides into snail infested freshwater bodies has yielded positive outcomes when integrated with MDA in some countries. However, few of such effective molluscicides are currently available, and where available, their application is restricted due to toxicity concerns. Some nanotized particles with molluscicidal activities against the different stages of snail intermediate hosts of schistosomes have been reported. Importantly, the curcumin-nisin nanoparticle synthesized by our group was very effective and it showed no significant toxicity in a mouse model and brine shrimps. This, therefore, offers the possibility of developing a molluscicide that is not only safe for man but also is environmentally friendly. This paper reviews nanoparticles with molluscicidal potential. The methods of their formulation, activities, probable mechanisms of actions, and their toxicity profiles are discussed. More research should be made in this field as it offers great potential for the development of new molluscicides.

Evaluation of schistosomula crude antigen (SCA) as a diagnostic tool for Schistosoma mansoni in low endemic human population.

The study aimed to determine the potential of schistosomula crude antigen (SCA) as a diagnostic target for anti-S. mansoni antibody detection. Cercariae were transformed into schistosomula, homogenized through sonication, and then centrifuged to obtain the SCA. SCA was evaluated using ELISA and dot blots immunoassays on 30 S. mansoni infected sera samples obtained from chronic patients and 30 non-infected humans' sera samples. Either Kato-Katz or saline gradient method or both were employed as the diagnostic reference. Dot blots immunoassay was further performed on protein eluted from 10 to 12 kDa immunoreactive band identified by Western blot analysis. The area under the ROC curve was 0.95 (AUC 0.95, CI 0.88-1.01, p < 0.0001). The sensitivity and specificity of SCA-ELISA and dot blots assays were 96.67% and 86.67% respectively. The human IgG-specific response against SCA was significantly higher in S. mansoni infected individuals (OD = 0.678 ± 0.249) compared to the non-infected population (OD = 0.235 ± 0.136) (p < 0.0001). Our study showed that SCA and its 10-12 kDa component could be useful as diagnostic tools for chronic schistosomiasis.

Schistosomiasis in Nigeria: Gleaning from the past to improve current efforts towards control.

The effort to control schistosomiasis in Nigeria has been scaled up the past few years. Schistosomiasis affects all age groups, however, school children are at the highest risk of the disease. In the past years, global partners in schistosomiasis control have renewed their commitments. Many countries including few in Africa are working towards eliminating the disease. In Nigeria, the transmission of schistosomiasis is still active. This poses a serious health challenge as morbidity builds up in infected individuals. Mass drug administration (MDA) has helped to reduce morbidity but it is not adequate to abate transmission in many areas of the country. The integration of other aspects of control will provide a more sustainable result. This review attempted to discuss schistosomiasis transmission patterns in Nigeria in different eras. We identified some pitfalls in efforts towards the control of schistosomiasis in Nigeria. We recommended research priority in areas of neglect and advocated for integrated control.

Schistosomiasis Control in Nigeria: Moving Round the Circle?

Background: Schistosomiasis has continued to plague low-resource areas of the Nigerian population. Mass drug administration (MDA) has been the only adopted interventional program for decades. However, it appears this effort does not culminate in transmission and morbidity reduction. Purpose: To highlight the current situation of schistosomiasis in Nigeria, why MDA alone cannot achieve the expected result, identify research needs, and promotion of integrated control approach for schistosomiasis. Method: A viewpoint based on practices, research findings, and personal and professional experience in the field of schistosomiasis control. Conclusion: This viewpoint strongly advocates a commitment to the integrated control approach through the development of robust schistosomiasis control policy for the country. It stressed the need for research priorities in neglected areas of schistosomiasis that are germane for control of the disease. The government's willpower to implement important recommendations from research outcomes is important to achieve success.

Toxoplasmosis in pregnancy: a neglected bane but a serious threat in Nigeria.

Toxoplasmosis is a global health threat in which occurrence in pregnant women poses grave consequences to fetal wellbeing. Studies on prenatal Toxoplasma gondii infection are generally limited in sub-Saharan African countries, including Nigeria. The risk of transmission of toxoplasmosis is very high in Nigeria due to the favourable climatic conditions and prevailing behavioural and socio-economic factors that could aid transmission. Currently, there are no systematic and organized procedures for diagnosis and treatment of maternal toxoplasmosis in Nigeria. These conditions forecast possible unabated transmission in many areas and exponential impact on associated adverse events of the disease during pregnancy. This paper highlights the importance of early diagnosis and treatment during pregnancy which may forestall subsequent development of infection in children delivered by infected mothers. Inclusion of toxoplasmosis control policy in the routine antenatal care of pregnant women is therefore strongly recommended.