Cervical cancer screening services targeting adult women in Cross River State, Nigeria.

This study employed a randomized controlled trial to investigate the rate of cervical cancer screening among adult women in Cross River State, Nigeria. For the collection of data, a semi-structured questionnaire was used. The women underwent a health education intervention; they were divided into an experimental group with incentives and one without, as well as a control group. At baseline, only 120 (19.6%) of women had adequate knowledge, 139(22.7%) knew Human Papiloma Virus (HPV) is sexually transmitted, 289(47.1%) knew that HPV causes cervical cancer and 46 (7.6%) had been screened. The intervention yielded a net gain of 14.2 in knowledge and 16.0 points in attitude. There was a 60.3% net gain in uptake screening post intervention. McNemar chi-square yielded a statistically significant difference in knowledge (p<0.05), attitude (p<0.05) and uptake (p<0.05) in the intervention groups compared to the control groups. Recommendations include mobile screening centers and Income-based subsidized tests.

Stable Cellulose Nanofibril Microcapsules from Pickering Emulsion Templates.

Electrostatic attractions are essential in any complex formation between the nanofibrils of the opposite charge for a specific application, such as microcapsule production. Here, we used cationized cellulose nanofibril (CCNF)-stabilized Pickering emulsions (PEs) as templates, and the electrostatic interactions were induced by adding oxidized cellulose nanofibrils (OCNFs) at the oil-water interface to form microcapsules (MCs). The oppositely charged cellulose nanofibrils enhanced the solidity of interfaces, allowing the encapsulation of Nile red (NR) in sunflower oil droplets. Microcapsules exhibited a low and controlled release of NR at room temperature. Furthermore, membrane emulsification was employed to scale up the preparation of microcapsules with sunflower oil (SFO) encapsulated by CCNF/OCNF complex networks.

Facile Production of Biodegradable Bipolymer Patchy and Patchy Janus Particles with Controlled Morphology by Microfluidic Routes.

Patchy and patchy Janus particles composed of poly(dl-lactic acid) (PLA) and polycaprolactone (PCL) regions were produced with a controlled size, patchiness, composition, and shape anisotropy by microfluidic emulsification and solvent evaporation. Isotropic particles composed of PCL patches embedded in the PLA matrix were produced from relatively small drops with a diameter of 14-25 µm because of the fast solvent extraction as a result of high interfacial area of the particles. Anisotropic patchy Janus particles were formed from large drops, 100-250 µm in diameter. A higher degree of polymer separation was achieved using a higher ratio of dichloromethane to ethyl acetate in the organic phase because of the more pronounced patch coarsening via Ostwald ripening. Janus particles with two fully separated polymer compartments were produced by in situ microfluidic mixing of two separate polymer streams within the formed droplets. The advantage of in situ micromixing is that the particle morphology can be changed continuously in a facile manner during drop generation by manipulating the organic stream flow rates. PCL and PLA domains within the particles were visualized by confocal laser scanning microscopy because of the preferential adsorption of rhodamine 6G dye onto PLA domains and higher binding affinity of Nile red toward PCL.

Notifiable disease reporting among public sector physicians in Nigeria: a cross-sectional survey to evaluate possible barriers and identify best sources of information.

BACKGROUND: Since 2001, Nigeria has collected information on epidemic-prone and other diseases of public health importance through the Integrated Disease Surveillance and Response system (IDSR). Currently 23 diseases are designated as "notifiable" through IDSR, including human infection with avian influenza (AI). Following an outbreak of highly pathogenic avian influenza A(H5N1) in Nigerian poultry populations in 2006 and one laboratory confirmed human infection in 2007, a study was carried out to describe knowledge, perceptions, and practices related to infectious disease reporting through the IDSR system, physicians' preferred sources of heath information, and knowledge of AI infection in humans among public sector physicians in Nigeria. METHODS: During November to December 2008, 245 physicians in six Nigerian cities were surveyed through in-person interviews. Survey components included reporting practices for avian influenza and other notifiable diseases, perceived obstacles to disease reporting, methods for obtaining health-related information, and knowledge of avian influenza among participating physicians. RESULTS: All 245 respondents reported that they had heard of AI and that humans could become infected with AI. Two-thirds (163/245) had reported a notifiable disease. The most common perceived obstacles to reporting were lack of infrastructure/logistics or reporting system (76/245, 31%), lack of knowledge among doctors about how to report or to whom to report (64/245, 26%), and that doctors should report certain infectious diseases (60/245, 24%). Almost all participating physicians (>99%) reported having a cell phone that they currently use, and 86% reported using the internet at least weekly. CONCLUSIONS: Although the majority of physicians surveyed were knowledgeable of and had reported notifiable diseases, they identified many perceived obstacles to reporting. In order to effectively identify human AI cases and other infectious diseases through IDSR, reporting system requirements need to be clearly communicated to participating physicians, and perceived obstacles, such as lack of infrastructure, need to be addressed. Future improvements to the reporting system should account for increased utilization of the internet, as well as cell phone and email-based communication.

Influenza viruses in Nigeria, 2009-2010: results from the first 17 months of a national influenza sentinel surveillance system.

BACKGROUND: Influenza surveillance data from tropical, sub-Saharan African countries are limited. To better understand the epidemiology of influenza, Nigeria initiated influenza surveillance in 2008. METHODS: Outpatients with influenza-like illness (ILI) and inpatients with severe acute respiratory illness (SARI) were enrolled at 4 sentinel facilities. Epidemiologic data were obtained, and respiratory specimens were tested for influenza viruses, using real-time reverse-transcription polymerase chain reaction assays. RESULTS: During April 2009-August 2010, 2841 patients were enrolled. Of 2803 specimens tested, 217 (7.7%) were positive for influenza viruses (167 [8%] were from subjects with ILI, 17 [5%] were from subjects with SARI, and 33 were from subjects with an unclassified condition). During the prepandemic period, subtype H3N2 (A[H3N2]) was the dominant circulating influenza A virus subtype; 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09) replaced A(H3N2) as the dominant circulating virus during November 2009. Among persons with ILI, A(H1N1)pdm09 was most frequently found in children aged 5-17 years, whereas among subjects with SARI, it was most frequently found in persons aged ≥ 65 years. The percentage of specimens that tested positive for influenza viruses peaked at 18.9% in February 2010, and the majority were A(H1N1)pdm09. CONCLUSIONS: Influenza viruses cause ILI and SARI in Nigeria. Data from additional years are needed to better understand the epidemiology and seasonality of influenza viruses in Nigeria.

Sickle cell disease prevention: How prepared are the senior secondary school students in Surulere Local Government Area, Lagos, Nigeria?

BACKGROUND:  Sickle cell disease (SCD), a common hereditary disease, can be prevented by preparing young people ahead of the conception of an affected foetus. AIM:  To assess the knowledge and attitude regarding SCD amongst senior secondary school students in Surulere Local Government Area (LGA), Lagos, Nigeria. SETTING:  Senior secondary schools in Surulere LGA. METHODS:  This was a descriptive cross-sectional study amongst 300 senior secondary school students. Data were collected using a self-administered questionnaire and analysed using Stata16. The Chi-square and Fisher's exact tests were used to determine the association between categorical variables. The level of significance was predetermined at p  0.05. RESULTS:  The mean age of the respondents was 15.2 (±1.3) years, with a male-to-female ratio of about 1:2. The majority (90.0%) of the respondents were aware of SCD, 63.0% had good knowledge, although less than half of them (46.3%) knew SCD to be a blood disorder, whilst about two-thirds (53.1%) knew that it was an inherited condition. About one fifth (24.4%) of them knew about prevention by genetic counselling. The majority (97.0%) of them had a positive attitude towards SCD. Over two-thirds (72.6%) were aware of their genotype. The prevalence of SCD was 2.0%, whilst 18.9% of them were carriers of the sickle cell trait. Knowing their SCD status but not necessarily their genotype was significantly associated with their attitude towards the disease (p = 0.014). CONCLUSION:  The prevention of SCD was not known to the majority, and better attitudes were more likely when the SCD status was known. Therefore, routine screening and counselling could potentially aid SCD control.

Monodispersed Sirolimus-Loaded PLGA Microspheres with a Controlled Degree of Drug-Polymer Phase Separation for Drug-Coated Implantable Medical Devices and Subcutaneous Injection.

Monodispersed sirolimus (SRL)-loaded poly(lactic-co-glycolic acid) microspheres with a diameter of 1.8, 3.8, and 8.5 µm were produced by high-throughput microfluidic step emulsification─solvent evaporation using single crystal silicon chips consisted of 540-1710 terraced microchannels with a depth of 2, 4, or 5 µm arranged in 10 parallel arrays. Uniform sized droplets were generated over 25 h across all channels. Nearly 15% of the total drug was released by the initial burst release during an accelerated drug release testing performed at 37 °C using a hydrotropic solution containing 5.8 M N,N-diethylnicotinamide. After 24 h, 71% of the drug was still entrapped in the particles. The internal morphology of microspheres was investigated by fluorescence microscopy using Nile red as a selective fluorescent stain with higher binding affinity toward SRL. By increasing the drug loading from 33 to 50 wt %, the particle morphology evolved from homogeneous microspheres, in which the drug and polymer were perfectly mixed, to patchy particles, with amorphous drug patches embedded within a polymer matrix to anisotropic patchy Janus particles. Janus particles with fully segregated drug and polymer regions were achieved by pre-saturating the aqueous phase with the organic solvent, which decreased the rate of solvent evaporation and allowed enough time for complete phase separation. This approach to manufacturing drug-loaded monodisperse microparticles can enable the development of more effective implantable drug-delivery devices and improved methods for subcutaneous drug administration, which can lead to better therapeutic treatments.

Gender disparities in the socio-economic burden of HIV/AIDS among patients receiving care in an HIV clinic in Lagos, Nigeria.

Background: In sub-Saharan Africa, women are bearing a heavier burden than men in terms of rate of infection and socio-economic impact of HIV/AIDS. This study was aimed at assessing gender disparities in the socio-economic burden of HIV/AIDS. Methods: This descriptive cross-sectional study was conducted among 422 HIV-positive adult patients attending an HIV clinic in Lagos, Nigeria, selected by multi-stage sampling and interviewed using a pretested, semi-structured questionnaire. Bivariate analysis was used to assess how the socioeconomic constructs differed by gender. Results: This study revealed that females suffered more of the socio-economic consequences of having HIV/AIDS than males; cruelty and isolation were significantly higher among the females (p<0.0001), more females (50.0%) were discriminated against at the workplace compared to males (32.1%) (p=0.005), physical abuse (p=0.002) and extortion (p=0.029) were experienced by more of the females than the males. Also, the cost of care outside of antiretroviral therapy was significantly higher among the females (p= 0.002). Conclusion: Quantifying the social and economic disparities between HIV-infected men and women has shown that the burden is by far higher among women than men. Focused interventions are therefore needed to control the spread of the disease and improve the quality of life of HIV-infected women.

Keratin-Chitosan Microcapsules via Membrane Emulsification and Interfacial Complexation.

The continuous fabrication via membrane emulsification of stable microcapsules using renewable, biodegradable biopolymer wall materials keratin and chitosan is reported here for the first time. Microcapsule formation was based on opposite charge interactions between keratin and chitosan, which formed polyelectrolyte complexes when solutions were mixed at pH 5.5. Interfacial complexation was induced by transfer of keratin-stabilized primary emulsion droplets to chitosan solution, where the deposition of chitosan around droplets formed a core-shell structure. Capsule formation was demonstrated both in batch and continuous systems, with the latter showing a productivity up to 4.5 million capsules per minute. Keratin-chitosan microcapsules (in the 30-120 µm range) released less encapsulated nile red than the keratin-only emulsion, whereas microcapsules cross-linked with glutaraldehyde were stable for at least 6 months, and a greater amount of cross-linker was associated with enhanced dye release under the application of force due to increased shell brittleness. In light of recent bans involving microplastics in cosmetics, applications may be found in skin-pH formulas for the protection of oils or oil-soluble compounds, with a possible mechanical rupture release mechanism (e.g., rubbing on skin).

Facile microfluidic production of composite polymer core-shell microcapsules and crescent-shaped microparticles.

HYPOTHESIS: Core-shell microcapsules and crescent-shaped microparticles can be used as picolitre bioreactors for cell culture and microwells for cell trapping/immobilisation, respectively. RESULTS: Monodisperse polylactic acid (PLA) core-shell microcapsules with a diameter above 200µm, a shell thickness of 10µm, and 96% water entrapment efficiency were produced by solvent evaporation from microfluidically generated W/O/W emulsion drops with core-shell structure, and used to encapsulate Saccharomyces cerevisiae yeast cells in their aqueous cores. The morphological changes of the capsules stained with Nile red were studied over 14days under different osmotic pressure and pH gradients. FINDINGS: The shell retained its integrity under isotonic conditions, but buckling and particle crumbling occurred in a hypertonic solution. When the capsules containing 5wt% aqueous Eudragit® S 100 solution in the core were incubated in 10-4M HCl solution, H+ diffused through the PLA film into the core causing an ionic gelation of the inner phase and its phase separation into polymer-rich and water-rich regions, due to the transition of Eudragit from a hydrophilic to hydrophobic state. Crescent-shaped composite microparticles with Eudragit cores and PLA shells were fabricated by drying core-shell microcapsules with gelled cores, due to the collapse of PLA shells encompassing water-rich crescent regions.

Community-based study of contraceptive behaviour in Nigeria.

A cross sectional, community-based, descriptive study among women of reproductive age group (15-49 years) in Nigeria to explore the possible reasons for contraceptive non-use despite reported high awareness was carried out. Data were obtained using a standard questionnaire instrument and applied on 2001 respondents. Contraceptive prevalence among sexually active respondents was 14.8% for all methods, 10.1% for modern methods and only 0.8% for emergency contraceptives. The most frequently stated reasons for non-use of contraceptives, among those who had never used any contraceptives but who did not want more children were: "did not think about it", "against religious belief" and "fear of side effects." Prior counseling significantly improved the continuation rate of contraception. Multivariate analysis showed that older, married and more educated women tended to use contraceptives more. Health-care providers should be trained to offer counseling services to all clients in general, and young, unmarried and uneducated women in particular in order to improve their acceptance of contraceptives.

Sources of contraceptive commodities for users in Nigeria.

BACKGROUND: Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. METHODS AND FINDINGS: A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15-49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15-24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. CONCLUSION: Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills.

Dynamics of double emulsion break-up in three phase glass capillary microfluidic devices.

Pinch-off of a compound jet in 3D glass capillary microfluidic device, which combines co-flowing and countercurrent flow focusing geometries, was investigated using an incompressible three-phase axisymmetric Volume of Fluid-Continuum Surface Force (VOF-CSF) numerical model. The model showed good agreement with the experimental drop generation and was capable of predicting formation of core/shell droplets in dripping, narrowing jetting and widening jetting regimes. In dripping and widening jetting regimes, the presence of a vortex flow around the upstream end of the necking thread facilitates the jet break-up. No vortex flow was observed in narrowing jetting regime and pinch-off occurred due to higher velocity at the downstream end of the coaxial thread compared to that at the upstream end. In all regimes, the inner jet ruptured before the outer jet, preventing a leakage of the inner drop into the outer fluid. The necking region moves at the maximum speed in the narrowing jetting regime, due to the highest level of shear at the outer surface of the thread. However, in widening jetting regime, the neck travels the longest distance downstream before it breaks.

Structured Biodegradable Polymeric Microparticles for Drug Delivery Produced Using Flow Focusing Glass Microfluidic Devices.

Biodegradable poly(DL-lactic acid) (PLA) and poly(lactic-co-glycolic acid) (PLGA) microparticles with tunable size, shape, internal structure and surface morphology were produced by counter-current flow focusing in axisymmetric (3D) glass capillary devices. The dispersed phase was composed of 0.5-2 wt % polymer solution in a volatile organic solvent (ethyl acetate or dichloromethane) and the continuous phase was 5 wt % aqueous poly(vinyl alcohol) solution. The droplets with a coefficient of variation in dripping regime below 2.5% were evaporated to form polymeric particles with uniform sizes ranging between 4 and 30 µm. The particle microstructure and surface roughness were modified by adding nanofiller (montmorillonite nanoclay) or porogen (2-methylpentane) in the dispersed phase to form less porous polymer matrix or porous particles with golf-ball-like dimpled surface, respectively. The presence of 2-4 wt % nanoclay in the host polymer significantly reduced the release rate of paracetamol and prevented the early burst release, as a result of reduced polymer porosity and tortuous path for the diffusing drug molecules. Numerical modeling results using the volume of fluid-continuum surface force model agreed well with experimental behavior and revealed trapping of nanoclay particles in the dispersed phase upstream of the orifice at low dispersed phase flow rates and for 4 wt % nanoclay content, due to vortex formation. Janus PLA/PCL (polycaprolactone) particles were produced by solvent evaporation-induced phase separation within organic phase droplets containing 3% (v/v) PLA/PCL (30/70 or 70/30) mixture in dichloromethane. A strong preferential adsorption of Rhodamine 6G dye onto PLA was utilized to identify PLA portions of the Janus particles by confocal laser scanning microscopy (CLSM). Uniform hemispherical PCL particles were produced by dissolution of PLA domes with acetone.

Community-based survey of unwanted pregnancy in southwestern Nigeria.

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion.

Glass capillary microfluidics for production of monodispersed poly (DL-lactic acid) and polycaprolactone microparticles: experiments and numerical simulations.

HYPOTHESIS: Droplet size in microfluidic devices is affected by wettability of the microfluidic channels. Three-dimensional countercurrent flow focusing using assemblies of chemically inert glass capillaries is expected to minimize wetting of the channel walls by the organic solvent. EXPERIMENTS: Monodispersed polycaprolactone and poly(lactic acid) particles with a diameter of 18-150 µm were produced by evaporation of solvent (dichloromethane or 1:2 mixture of chloroform and toluene) from oil-in-water or water-in-oil-in-water emulsions produced in three-dimensional flow focusing glass capillary devices. The drop generation behaviour was simulated numerically using the volume of fluid method. FINDINGS: The numerical results showed good agreement with high-speed video recordings. Monodispersed droplets were produced in the dripping regime when the ratio of the continuous phase flow rate to dispersed phase flow rate was 5-20 and the Weber number of the dispersed phase was less than 0.01. The porosity of polycaprolactone particles increased from 8 to 62% when 30 wt% of the water phase was incorporated in the organic phase prior to emulsification. The inner water phase was loaded with 0.156 wt% lidocaine hydrochloride to achieve a sustained drug release. 26% of lidocaine was released after 1 h and more than 93% of the drug was released after 130 h.

A ten-year study of penetrating injuries of the colon.

BACKGROUND: Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. PATIENTS AND METHODS: Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. RESULTS: Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent. CONCLUSION: A more liberal use of primary repair is required in our patients with penetrating injuries of the colon.