Maternal and Child Health Pipeline Training Programs: A Description of Training Across 6 Funded Programs.

PURPOSE: The HRSA-funded maternal and child health pipeline training programs (MCHPTPs) are a response to the critical need to diversify the MCH workforce, as a strategy to reduce health disparities in MCH populations. These MCHPTPs support students from undergraduate to graduate education and ultimately into the MCH workforce. DESCRIPTION: The models and components of training across the six MCHPTPs funded in 2016-2021 are summarized, to examine the design and delivery of undergraduate pipeline training and the insights gained across programs. ASSESSMENT: Strategies that emerged across training programs were organized into three themes: recruitment, support for student persistence (in education), and pipeline-to-workforce intentionality. Support for student persistence included financial support, mentoring, creating opportunity for students to develop a sense of belonging, and the use of research as a tool to promote learning and competitiveness for graduate education. Finally, the link to Maternal and Child Health Bureau (MCHB) long-term training and other MCHB opportunities for professional development contributed significant nuance to the pipeline-to-workforce objectives of these programs. CONCLUSIONS: The MCHPTPs not only increase the diversity of the MCH workforce, they also actively prepare the next generation of MCH leaders. The intentional connection of undergraduates to the infrastructure and continuum of MCH training, underscores the comprehensive impact of this funding.

Rift valley fever virus infection among livestock handlers in Ibadan, Nigeria.

Livestock handlers are occupationally exposed to Rift Valley fever virus (RVFV) because of frequent and longer contact with mosquito vectors, animal blood and other tissues. We determined the seroprevalence of RVF virus infection among livestock handlers in Ibadan, Nigeria. Blood samples were collected from 265 workers in two major livestock markets and a livestock farm. Questionnaires were administered to obtain information on risk factors that may be associated with RVF virus transmission. The blood samples were tested using enzyme-linked immunosorbent assays (ELISA) to detect multispecies anti-RVF virus IgG/IgM and human anti-RVF virus IgM. In total, 14 (5.3%) of the 265 participants tested positive for anti-RVFV IgG. Seropositive individuals were more among livestock keepers (5.6%) than butchers (3.6%). Workers that frequently visited the livestock rearing areas of the northern part of Nigeria had a statistically significant (P = 0.004) higher rate of infection compared to those that did not. Very few (0.8%) of these workers knew about RVF virus while none had been vaccinated against the virus infection. This study indicates that RVF virus continues to circulate sub-clinically in Nigeria, thus the need to educate and vaccinate individuals who are occupationally at risk of infection.

Psychosocial impact of wheelchair usage on individuals with mobility disability in Ibadan, Nigeria.

BACKGROUND: Wheelchairs provide individuals with mobility impairments opportunity for independent living within their environment. However, using this device may have psychosocial impacts with consequent influence on the quality of life of the users. The psychosocial impact of wheelchair usage among individuals with mobility disability in a Nigerian community was investigated. METHODS: The study is a descriptive cross-sectional survey. People who have been independent users of wheelchair for a minimum of six months prior to the study were recruited from centres for people with disabilities in Ibadan, Nigeria into the study. A profile of their use of the device was documented and the psychosocial impact of wheelchair was assessed using the Psychosocial Impact ofAssistive Devices Scale. Data were analysed using descriptive and inferential statistics at p = 0.05. RESULTS: Sixty consenting individuals with mobility disability participated in this study. Their mean age was 38.7 +/- 14.1 years. Majority (90%) were manual wheelchair users and two-thirds (63.3%) had been using the wheelchair for < or = five years. Approximately a third of the participants use their wheelchairs occasionally. There was no significant difference (p=0.26) in the psychosocial impact of wheelchair usage between male and female users. CONCLUSION: The psychosocial impact of wheelchair was similar between male and female users. However, the impact was higher on the self-esteem of male than female users and lower on their competence than that of their female counterparts. This may be due to stigmatization or a culturally-related unwillingness of men in our environment to be dependent on others.

Prevalence of previously undetected tuberculosis and underlying risk factors for transmission in a prison setting in Ibadan, south-western Nigeria.

People with congregational tendencies such as the prison inmates constitute an important target group in the global efforts towards the control of tuberculosis (TB). The prison setting in most developing countries particularly Nigeria, currently does not have routine diagnostic procedures for TB despite the existing risks that could facilitate disease transmission. We conducted a cross sectional study among the inmates in a major prison in south-western Nigeria for TB by screening their sputum samples using a simple random sampling method coupled with questionnaire interview, on the assumption of sub-clinical pulmonary TB infection. The overall TB prevalence found was 1.2% (2/164). Significant risk factors that could facilitate disease transmission in the prison included lack of BCG immunization (p = 0.017); history of contact with TB patients (p = 0.020); prolonged cough (p = 0.016) and drug abuse (p = 0.019). Our findings of 1.2% undetected pulmonary TB infection among the inmates though low; still reiterate previous observation that the prison setting constitutes a veritable environment for TB transmission and a threat to public health. Efforts are therefore needed to institute routine screening and reduce the risk factors associated with TB transmission among prison inmates in Nigeria.

Hepatitis B virus DNA in patients with HBsAg in south western Nigeria.

There are about 400 million people with chronic hepatitis B virus (HBV) infection worldwide with a potential of adverse sequelae including hepatocellular carcinoma. Recent data have shown that the level of HBV DNA in serum or plasma of an infected person probably reflects more accurately the replicative activity of the virus and therefore may serve as a better maker for management of the infection. This study was designed to determine the rate of detection of HBV DNA in blood samples of patients with HBsAg positive in Nigeria in comparison with the HBe and anti-HBe used widely as serological markers of infectivity. Plasma samples from 105 patients with HBsAg positive were tested for the presence of HBeAg and anti-HBe using a commercial enzyme-linked immunosorbent assay while plasma HBV DNA was quantified using the COBAS Amplicor HBV Monitor assay. Of the 105 HBsAg samples, 17 (16.2%) and 85 (81%) were positive for HBeAg and anti-HBe, respectively, while 8 (7.6%) were negative for both HBeAg and anti-HBe. HBV DNA was detected in 86 (81.9%) of the samples, out of which 15 (18.1%) and 67 (80.7%) were positive for HBeAg and anti-HBe, respectively. HBV DNA was detected in 78.4% of the HBeAg negative samples and in all the eight samples that were negative for both HBeAg and anti-HBe. The implication of these findings in the management of patients with HBV infection is compelling.

Laser tongue base mucosectomy is a useful diagnostic tool in the management of unknown primary cancers of the head and neck region.

OBJECTIVE: Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary. METHOD: This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status. RESULTS: There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours. CONCLUSION: In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.

Validation of the TNM-8 AJCC classification for HPV-positive oropharyngeal cancers in patients undergoing trans-oral robotic surgery.

High-risk human papillomaviruses (HPV) are associated with some oropharyngeal squamous cell carcinomas (OPSCC). HPV-OPSCC have better survival outcomes compared to HPV negative tumours. The new TNM-8 AJCC staging (2018) is based on ICON-S data with 98% of patients treated with primary chemoradiation. To validate the TNM-8 AJCC classification in HPV-OPSCC treated primarily with surgery (trans-oral robotic surgery or open). There were 102 patients with HPV-OPSCC treated between July 2009 and December 2014 at the Royal Adelaide Hospital. The median age was 57 years (range: 38-83) and mostly males (84.5%). 27.2% were active smokers and 50.5% reformed smokers. Early T-stage cancer in 72.8%. Primary treatment was surgery & adjuvant therapy (70%) while primary chemoradiation (30%). Survival analyses were performed for the 7th and 8th AJCC systems. The reclassification to the AJCC 8th edition staging system resulted in a change of 54 patients from stage 4 to stages 1 and 2. This was mainly an effect of changes with N2a and N2b nodal disease being reclassified to N1. Survival outcomes were comparable with the ICON-S data. The new TNM-8 classification is, therefore, validated in a cohort treated, predominantly, with primary surgery and adjuvant therapy.

Hepatitis B and E viral infections among Nigerian healthcare workers.

BACKGROUND: There is dearth of information on Hepatitis E virus (HEV) infection and its co-infection with HBV among Nigerian healthcare workers (HCWs). Hence, there is the need to determine the rate of HEV infection and its association with HBV among HCWs who are at greater risk of nosocomial infections. METHODOLOGY: Sera from 88 HCWs and 44 non-HCWs healthy adults as controls were tested for the presence of antibody to HEV (anti-HEV). The HCWs were also tested for HBsAg and antibody to Hepatitis B core antigen (anti-HBc) using commercially available ELISA kits. RESULTS: The prevalence of anti-HEV obtained among the HCWs and controls were 43% and 94% respectively (p<0.005) while those of HBsAg and anti-HBc in HCWs were respective 13% and 56%. Overall among HCWs, the prevalence of HBV infection was 65.9%, higher than HEV infection (p<0.005) with only anti-HBc greater among the male participants (p<0.005) while co-infection of HBV with HEV was 27.3%. HEV infection was least among the Paediatricians (18%) and highest among the Surgeons (55%) while HBV infection was similar in all the different occupational groups of HCWs (44-59%) except among the Gynecologists and Obstetricians (80%). CONCLUSION: Infection with HEV is high among Nigerian HCWs but lower than the rate among non-HCWs. It is also co-infected with HBV especially among the different groups of the HCWs and could occur with the diverse clinico-serological patterns of HBV infection.

Challenges of caregivers and needs of children with parents in a Nigerian prison.

Background: Separation of a parent from the family as a result of incarceration has both short-term and long-term effects on the family, even after release from prison. This study is a report of factors and challenges of the family left to adapt to the changed circumstances of separation from parent(s) who are incarcerated. Methods: This was a cross sectional study carried out on 89 caregivers of children whose parents are incarcerated at the Agodi prison, Ibadan who gave informed and written consent to interview their families. Results: Most caregivers had little or no formal education (69.7%) and 67.4% are into petty trading or subsistence farming. A majority of the caregivers reported the need of schooling (85.4%), provision of food (84.3%) and medical care (71.9%) as major challenges, only 25% received any form of support to meet these needs. Twenty-nine (32.6%) respondents reported receiving financial support to provide for the child's feeding. Some caregivers 21 (23.6%), obtained loans to cope with the financial needs of the children while only 3 (3.4%) received support from family or other non-governmental organisations. Conclusion: The caregivers of children of prison inmates face significant challenges in meeting the needs of feeding, health and schooling. Support structures and policies to address these gaps are required.

A 20-year retrospective study of tonsil cancer incidence and survival trends in South East England: 1987-2006.

BACKGROUND: There has been an increasing incidence of tonsil cancer worldwide. Documenting these changes is crucial to cancer prevention and control measures, resource allocation and understanding disease aetiology. OBJECTIVE: To analyse the changing epidemiology of tonsil cancer in South East England over a 20-year period between 1987 and 2006. DESIGN: A retrospective, quantitative study using secondary anonymised data obtained from the Thames Cancer Registry, London. Data were analysed using spss v.17 and survival analyses with Kaplan-Meier and Cox regression. SETTING: This study was conducted in South East of England comprising London, Kent, Surrey and Sussex counties with an average population of 12 million. This population increased from 10.7 to 11.8 million (a 10% increase) between 1987 and 2006. PARTICIPANTS: All patients with tonsil cancer in South East England registered with the Thames Cancer Registry (ICD-10 code C09) between 1987 and 2006. A total of 1794 patients' data were analysed. Ethical Considerations: Ethical approval was granted by the Kent Research Ethics Committee. MAIN OUTCOME MEASURES: Data were analysed for demographic trends including gender, age at diagnosis, yearly incidence and survival. RESULTS: Tonsil cancer incidence has increased significantly from 0.60 to 1.45 per 100,000 in the 20 years (P < 0.001). This increase is mainly amongst men and age groups 40-59 years with a significant reduction in age at diagnosis by 2 years from 61.6 years in the first decade to 59.6 years in the second decade (P < 0.001). Survival was worse in men, older age groups and in the presence of synchronous tumours (P < 0.001). There has been a statistically significant increase in median survival times from tonsil cancer by about 3 years from 2.7 years in the first decade to 5.7 years in the second decade of this study (P < 0.001). CONCLUSIONS: Tonsil cancer incidence has increased in the 20 years of this study in South East England, especially amongst men and age groups 40-59 years. There has also been significant reduction in the mean age at diagnosis and an increase in median survival times for tonsil cancer. Further studies are needed to explain these trends.

Modulation of Cardiopulmonary Toxicity and Oxidative Stress by Phenolic-Rich Fraction of Croton zambiscus Leaves in Rat Exposed to Chronic Mixture of Environmental Toxicants.

Chronic mixed toxicant exposure has been implicated in the aetiology of lung and heart failure through prolonged free radical generations. This study was carried out to assess the protective effect of naturally occurring phenolic components from Croton zambesicus (400 mg/kg C-ZAMB) leaves against cardiopulmonary toxicity induced by chronic mixed toxicant (0.5 mL EOMABRSL) in rats. Chronic cardiopulmonary injury via oral administration of 0.5 ml EOMABRSL for 98 days (non-withdrawal) and 70 days (withdrawal) caused unhealthy alteration in the levels of oxidative stress biomarkers [malondialdehyde (MDA), reduced glutathione (GSH), glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase]. Similarly, both withdrawal and non-withdrawal approaches of EOMABRSL-exposed animals exhibited increase in the activity of eco-51-nucleotidase (51ENT) with corresponding diminution in the activity of lactate dehydrogenase (LDH), i.e. the metabolic fuel for cardiopulmonary wellness. Ultimately, histology examination confirmed hyperplastic, bronchopneumonia and cloudy swelling of cardiovascular cells followed by the accumulation of cellular exudates and haemorrhage in the alveoli and bronchioles. The active antioxidants of 400 mg/kg C-ZAMB leaves were responsible for the biological protection of cardiopulmonary toxicity by modulating the activities of 51ENT and LDH. The oxidative stress was also reversed by 400 mg/kg phenolic C-ZAMB leaves in the heart and lungs. Hence, 400 mg/kg phenolic C-ZAMB leaves may be a natural therapy for the treatment of cardiovascular disorder associated with pulmonary dysfunction in rats.

Biological characterization of Nigerian chicken anaemia virus isolates.

Chicken anaemia virus (CAV) DNA was extracted from thymus, liver and bone marrow samples obtained from broiler and pullet chicken flocks in southwestern Nigeria, which presented with clinical signs and lesions suggestive of both infectious bursal disease and chicken infectious anaemia. While CAV was successfully isolated in MDCC-MSB1 cells from four of the pooled tissue samples, the remaining two samples failed to grow in cells. Monoclonal antibody (MAb) characterization using four MAbs produced against the reference Cuxhaven-1 (Cux-1) CAV isolate showed that Nigerian CAV isolates are antigenically related to each other and to the Cux-1 virus. Pathogenicity studies with the Cux-1 virus and one of the Nigerian isolates (NGR-1) revealed that NGR-1 was more pathogenic that the former. We conclude that although Nigerian CAV isolates are antigenically related to each other, they differ in terms of cell culture growth characteristics and probably pathogenicity. These findings further confirm that CAV exists and can no longer be ignored in poultry disease diagnosis in Nigeria. Cases hitherto diagnosed as IBD may actually be CIA or a co-infection of the two.

Affinity (tropism) of caprine arthritis encephalitis virus for brain cells.

One of the constraints in unraveling the mysteries blurring the advancement of research in the quest to totally put HIV problems under control is getting the appropriate animal model that would truly simulate human cases. This problem is more apparent in studies involving the central nervous system. Consequently, a viable animal model to generate information for the production of drugs and vaccines for the prevention and or control of lentiviral induced dementia in affected host animals is pertinent and vital. In this study, explant cultures prepared from the brain of new-born goat-kid were infected with CaprineArthritis Encephalitis (CAE) virus- a retrovirus affecting goats. The specific brain cell types infected by the (CAE) virus were determined using reverse-transcription polymerase chain reaction (RT-PCR) and transmission electron microscopy (TEM techniques). TEM showed that in 85 - 90% cases, microglia were the cells specifically infected by the virus. Amplification of the genomic sequence of the envelope and the gag genes by RT-PCR confirmed the presence of CAEV proviral DNA in the brain cells of affected animals. No productive infection of the astrocytes was observed. The results of this study showed a lot of similarities in the tropism of CAE virus infection of goat brain cells to that of HIV infection in humans thus suggesting the potential usefulness of the caprine model for the study of HIV neuropathology. The goat model system as a non-primate model therefore could be more adaptable as a simple animal model than primate models with their complexity of anthropological, environmental and safety problems.

Sequence and phylogenetic analysis of chicken anaemia virus obtained from backyard and commercial chickens in Nigeria.

This work reports the first molecular analysis study of chicken anaemia virus (CAV) in backyard chickens in Africa using molecular cloning and sequence analysis to characterize CAV strains obtained from commercial chickens and Nigerian backyard chickens. Partial VP1 gene sequences were determined for three CAVs from commercial chickens and for six CAV variants present in samples from a backyard chicken. Multiple alignment analysis revealed that the 6% and 4% nucleotide diversity obtained respectively for the commercial and backyard chicken strains translated to only 2% amino acid diversity for each breed. Overall, the amino acid composition of Nigerian CAVs was found to be highly conserved. Since the partial VP1 gene sequence of two backyard chicken cloned CAV strains (NGR/CI-8 and NGR/CI-9) were almost identical and evolutionarily closely related to the commercial chicken strains NGR-1, and NGR-4 and NGR-5, respectively, we concluded that CAV infections had crossed the farm boundary.

Relationship between depression and quality of life in Nigerian outpatients with heart failure.

OBJECTIVE: Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). METHODS: We used a cross-sectional study in which outpatients with HF (n=100) completed the WHO Quality of Life Scale-Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. RESULTS: The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. CONCLUSION: Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.

Tumour markers and hepatitis C virus infection in Nigerian patients with liver diseases.

BACKGROUND: Early diagnosis of hepatocellular carcinoma (HCC) is very important and determination of serum levels of tumour markers in patients with chronic liver diseases could be of immense contribution to their management. METHOD: Forty-two adult Nigerian subjects consisting of 14 healthy subjects (Controls) and 28 patients with primary liver mass (es) and histological diagnoses of liver cirrhosis (LC) +/- chronic active hepatitis (CAH) and hepatocellular carcinoma +/- LC were studied. Their blood samples were assayed for Hepatitis B Surface Antigen (HBsAg), antibodies to HCV (anti-HCV), alkaline phosphatase (AP), Aphafeotoprotein (AFP) and Ferritin. RESULTS: The patients had HCC (10) HCC+LC(4), LC+CAH (2) and LC (12). Serum ferritin> 700ng/ml, AP> 375IU/ml and AFP>200IU/ml were detected in 32%, 11% and 32% of the patients respectively with corresponding specificities of 100%, 86% and 100%. Elevated serum levels of AFP and ferritin were found in patients with HCC +/- LC while raised serum AP occurred in those having PHCC without LC. Only combination of either AFP or ferritin to AP gave significant increase in the diagnostic yield of HCC among the patients than the use of only AR Elevated levels of serum AFP correlated with both HBV and HCV while raised serum levels of ferritin were associated with only with HBV CONCLUSION: Although combination of the tumour markers gave a higher diagnostic yield for HCC among Nigerian patients, serum AFP > 200IU/ml seems the best tumour marker in the diagnosis of PHCC among the patients.

High rate of unrecognized dengue virus infection in parts of the rainforest region of Nigeria.

Outbreaks and sporadic dengue virus infections continue to occur in Africa. Several reports of dengue among travellers returning from some African countries to Europe and North America have raised concerns about the epidemiological situation in Africa. We investigated recent dengue infections in febrile patients during the rainy season in various urban centres in the rainforest region of Nigeria, West Africa. This cross-sectional study was conducted for 8 months in 2014 with study participants from Adeoyo Hospital Yemetu - Ibadan, Nigeria. Plasma were collected from 274 febrile patients residing in 11 Local Government Areas of Oyo State. IgM antibodies were determined using semi-quantitative sandwich ELISA. Data was analyzed using Chi - Square and Fisher's exact test with SPSS 16.0. An overall prevalence of 23.4% dengue virus infection was found among study participants. Highest monthly prevalence of 40% was in April and August. The monthly distribution pattern of dengue virus infection indicates efficient virus transmission. Routine diagnosis will enhance dengue virus surveillance and improve patient care in West Africa.

Isolation and preliminary characterization of chicken anemia virus from chickens in Nigeria.

Chicken anemia virus (CAV) was isolated for the first time from the Nigerian chicken population. The virus was recovered from necropsied birds from broiler and pullet flocks that suffered disease outbreaks tentatively diagnosed as infectious bursal disease. A sensitive polymerase chain reaction (PCR) assay detected CAV DNA in tissues of necropsied birds. Restriction endonuclease analysis performed with the 733-bp PCR product and the Cfo I enzyme indicated at least two different CAVs were circulating among the Nigerian chicken population. Four isolates were obtained from pooled liver and thymus tissues using the MDCC-MSB1 cell line. These isolates were found to be antigenically closely related to the Cuxhaven-1 (Cux-1) reference strain of CAV when reacted with four monoclonal antibodies prepared against the Cux-1 virus. One of the isolates (isolate A) induced thymus atrophy, bone marrow aplasia, and low hematocrit values when inoculated into 1-day-old specific-pathogen-free chickens. These findings not only demonstrate that CAV is present in Nigeria, but they also likely represent the first cell culture isolation of the virus in Africa.