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Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.
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Acreditación , Comercio , Atención a la Salud , Nigeria , Humanos , Atención Primaria de Salud , Patentes como Asunto , Política de Salud , Calidad de la Atención de SaludRESUMEN
Objectives: The rise in Carbapenem-resistant Enterobacterales (CRE) is perturbing. To curb the menace of CRE, a comprehensive understanding of its prevalence and epidemiology is crucial. As varying reports abound, the true prevalence of CRE in Nigeria remains unknown. Here, we conducted a systematic review and meta-analysis following standard guidelines to assess the situation of CRE in Nigeria. Methods: We searched electronic databases including Pubmed, ScienceDirect, Scopus, Web of Science, and Google Scholar for articles providing information on CRE in Nigeria. The data gathered were analyzed using OpenMeta Analyst and Comprehensive Meta-Analysis software. The random-effect model was employed to calculate pooled resistance to carbapenem antibiotics. Results: From 321 retrieved records, 57 were finally included. The studies were predominantly from the South-West region (n = 19). Escherichia coli and Klebsiella pneumoniae were the most frequently tested Enterobacterales among the included studies. The pooled prevalence estimate for imipenem resistance among CRE was 11.2 % (95 % CI: 7.9-15.7). Meropenem resistance had an estimate of 13.5 % (95 % CI: 9.1-19.6), whereas ertapenem and doripenem were estimated at 17.0 % (95 % CI: 9.9-27.7) and 37.9 % (95 % CI: 15.0-67.8), respectively. High heterogeneity (I 2 >85 %, p < 0.001) was observed for the estimates. The highest resistance rate to imipenem (28.4 %), meropenem (37.2 %) and ertapenem (46.5 %) were observed for the South-South region. Based on specific CRE genera, Morganella sp. was the most resistant (37.0 %) while Escherichia sp. was the least (9.4 %). Our analyses also revealed a progressive increase in resistance to carbapenem antibiotics over the years. Conclusion: This study highlights carbapenem resistance as a concern in Africa's most populous nation, underscoring the need for proactive measures to address and mitigate the threat of CRE.
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CONTEXT: Coronavirus disease 2019 (COVID-19) is the greatest global health catastrophe of the century, with its vaccine hesitancy compounding the woes. Relevant stakeholders, including pharmacy students (whose education was disrupted) are important bulwarks against these catastrophes, but their COVID-19-related information are scarce. AIMS: We assessed COVID-19 knowledge, its vaccine uptake intentions, and the influence of personality traits among pharmacy undergraduates in a Nigerian university. SETTINGS AND DESIGN: This was a post-lockdown cross sectional study conducted at the Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto. SUBJECTS AND METHODS: A 61-item questionnaire was used to collect data among pharmacy undergraduates who attended Usmanu Danfodiyo University, Sokoto, Nigeria, in May 2021. STATISTICAL ANALYSIS USED: Summary statistics- mean (±standard deviation), range, frequency, proportion; inferential statistics- Chi square statistics, binary logistic regression. RESULTS: The response rate was 88% (168/191). The average COVID-19 knowledge score, the frequency of acceptance, and hesitancy to take COVID-19 vaccine among study participants were 42.9% (95% confidence interval [CI] = 42.1-43.7), 39.1% (95% CI = 37.3%-41.8%), and 61.9% (95% CI = 58.0%-64.2%), respectively. In addition, of the 168 study participants, 73 (43.5%) considered themselves to have high self-esteem, 67 (39.9%) were highly extroverted, 91 (54.2%) highly privately self-conscious, 96 (57.1%) highly publicly self-conscious, and 60 (35.7%) highly self-restrained, with 57 (34.0%) not believing in the existence of COVID-19. COVID-19 knowledge varied significantly by level of study ( F [2,165] = 5.539; P = 0.005; η 2 = 0.06). Similarly, those with high self-esteem were twice as knowledgeable regarding COVID-19 as those with low self-esteem (odds ratio [OR]: 2.02; 95% CI: 1.08-3.78; P = 0.03) with gleaning COVID-19-related information from social media platforms predicting COVID-19 vaccine hesitancy (CVH) (OR: 0.37; 95% CI: 0.16-0.85; P = 0.02). CONCLUSIONS: The observed suboptimal COVID-19 knowledge was associated with participants' low level of self-esteem, and the prevalent CVH was associated with obtaining COVID-19-related information from social media platform.
Résumé Contexte:La maladie du coronavirus 2019 (COVID-19) est la plus grande catastrophe sanitaire mondiale du siècle, avec ses hésitations à vacciner qui aggravent les fléaux. Les intervenants pertinents, y compris les étudiants en pharmacie (dont l'éducation a été perturbée), sont des gardiens importants contre ces catastrophes, mais leurs informations relatives au COVID-19 sont rares.Objectifs:Nous avons évalué les connaissances sur le COVID-19, ses intentions d'adoption du vaccin et l'influence des traits de personnalité chez les étudiants en pharmacie d'une université nigériane.Configuration et conception:Il s'agit d'une étude transversale.Sujets et méthodes:Un questionnaire de 61 points a été utilisé pour recueillir des données auprès des étudiants en pharmacie qui ont étudié à l'Université Usmanu Danfodiyo, Sokoto, au Nigeria, en mai 2021.Analyse statistique Utilisé:Résumé moyenne (± déviation standard), gamme, fréquence, proportion; inferentiel statistiques Chi-square, régression logistique binaire.Résultats:Le taux de réponse était de 88 % (168/191). Le score moyen de connaissances sur le COVID-19, la fréquence d'acceptation et l'hésitation à prendre le vaccin contre le Covid-19 parmi les participants à l'étude étaient respectivement de 42,9% (intervalle de confiance de 95 % [CI] = 42,1 à 43,7), de 39,1% (IC 95 % = 37,3% à 41,8%) et de 61,9% (IC 95% = 58,0 % à 64,2%). En outre, sur les 168 participants à l'étude, 73 (43,5%) se considéraient comme ayant une haute estime de soi, 67 (39,9%) étaient hautement extrovertis, 91 (54,2%) très conscients de soi en privé, 96 (57,1%) sont hautement conscients d'eux-mêmes en public et 60 (35,7%) sont très restreints, avec 57 (34,0%) qui ne croient pas en l'existence de COVID-19. Les connaissances sur le COVID-19 varient considérablement selon le niveau d'étude (F [2,165] = 5,539; P = 0,005; η2 = 0,06). De même, les personnes ayant une haute estime de soi étaient deux fois plus informées au sujet du COVID-19 que celles ayant une faible estime d'eux-mêmes (ratio de probabilité [OR]: 2,02; 95% CI: 1,083,78; P = 0,03) avec la collecte d'informations relatives au Covid-19 provenant des plates-formes de médias sociaux qui prédisaient l'hésitation au vaccin contre le COVid-19 (CVH) (OR: 0,37; 95% IC: 0,160,85; P= 0,02).Conclusions:Les connaissances sous-optimales observées sur le COVID-19 ont été associées à un faible niveau d'estime de soi des participants, et la prévalence de la HCV a été associée à l'obtention d'informations relatives au Covid-19 à partir d'une plate-forme de médias sociaux.
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Vacunas contra la COVID-19 , COVID-19 , Conocimientos, Actitudes y Práctica en Salud , Intención , Personalidad , SARS-CoV-2 , Estudiantes de Farmacia , Humanos , COVID-19/prevención & control , COVID-19/psicología , Estudiantes de Farmacia/psicología , Estudiantes de Farmacia/estadística & datos numéricos , Masculino , Femenino , Estudios Transversales , Nigeria , Vacunas contra la COVID-19/administración & dosificación , Encuestas y Cuestionarios , Adulto , Adulto Joven , Universidades , Vacunación/psicología , Vacunación/estadística & datos numéricos , Vacilación a la Vacunación/psicología , Vacilación a la Vacunación/estadística & datos numéricosRESUMEN
Background: Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM. Methods: A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612). Results: A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies. Conclusion: These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.
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Presión Sanguínea , Capacidad Cardiovascular , Diabetes Mellitus Tipo 2 , Control Glucémico , Inflamación , Obesidad , Entrenamiento de Fuerza , Humanos , Persona de Mediana Edad , Glucemia/análisis , Glucemia/metabolismo , Presión Sanguínea/fisiología , Capacidad Cardiovascular/fisiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico/fisiología , Inflamación/sangre , Obesidad/terapia , Obesidad/sangre , Obesidad/fisiopatología , Sobrepeso/terapia , Sobrepeso/sangre , Sobrepeso/fisiopatología , Calidad de VidaRESUMEN
BACKGROUND: Client satisfaction is a multidimensional construct focusing on clients' perceptions and evaluations of the treatment and care received. It is one of the factors affecting the outcomes of healthcare and the use of health services. Therefore, we aimed to assess clients' satisfaction with PHC services in Kaduna State, Northwest Nigeria. METHODOLOGY: A cross-sectional descriptive study was conducted in Kaduna State, Northwest, Nigeria which evaluate the satisfaction of clients and caregivers accessing healthcare in PHC centres. A sample size of 217 was determined using Fisher's formula, with a multi-stage sampling technique used to randomly select eligible respondents, who have accessed at least a PHC service in any of the PHCs in the State were included in the study, A semi-structured, interviewer-administered questionnaire was administered, and the data collected was analyzed using SPSS version 23.0. Appropriate statistical tests were used to examine the association between dependent and independent variables, while predictor variables that showed significant association with the outcome variables were further subjected to logistic regression analysis, to determine factors that affect clients' satisfaction with PHC services. Statistical significance was determined at an alpha level set at 0.05 at a 95% confidence interval. RESULTS: Thirty-one percent of the respondents were satisfied with PHC services in Kaduna State with a mean composite satisfaction score of 3.78 ± 0.67. Age, ethnicity, level of education, and occupational status were factors affecting clients' satisfaction with PHC services among the respondents. On multivariate analysis, age, ethnicity, educational status, and occupational status were significant factors affecting clients' satisfaction with PHC services. Clients of Hausa/Fulani extraction are one and a half times less likely to be satisfied with PHC services when compared to clients from other tribes [aOR = 1.5, 95% CI (1.21-4.67); p = 0.003]. In terms of educational status, clients with formal education are one and a one-third times more likely to be satisfied [aOR = 1.3, 95% CI (0.17-0.94)] with PHC service when compared with their counterparts with informal education (p = 0.034). CONCLUSION: Clients' satisfaction with PHC services in Kaduna State, Northwest Nigeria was sub-optimal. Healthcare providers were recommended to improve their attitude bearing in mind clients' peculiarities.
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Satisfacción del Paciente , Atención Primaria de Salud , Humanos , Nigeria , Femenino , Estudios Transversales , Masculino , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven , Adolescente , Calidad de la Atención de Salud , AncianoRESUMEN
FBXW7 is a tumour suppressor gene that functions as E3-ubiquitin-ligase, targeting numerous oncoproteins for degradation, i.e., Cyclin-E, c-Myc, and Notch. FBXW7 performs a pivotal role in regulating cell cycle progression. FBXW7 mutation is frequently implicated in various cancers. Methodology: A systematic review and meta-analysis done on several studies using "Preferred Reporting Items for Systemmatic Reviews and Meta-Analysis (PRISMA)" criteria and registered with PROSPERO (registration-number-CRD42023388845). The preliminary search comprises 1182 articles; however, 58 studies were subsequently chosen after eliminating non-eligible studies. To explore the prevalence of FBXW7 mutation among colorectal cancer patients, data were analysed using "OpenMeta Analyst and comprehensive meta-analysis-3.0 (CMA-3.0)" software. Results: This meta-analysis involves 13,974 respondents; most were males 7825/13,974, (56.0 %). Overall prevalence of FBXW7 mutations was 10.3 %, (95%CI: 8.6-12.4), I2 = 90.5 %, (P < 0.001). The occurrence of FBXW7 mutations was highest in Russia [19.0 %, (95%CI: 9.8-33.7)] and Taiwan [18.8 %, (95%CI: 8.7-35.9)], P-values< 0.05 while the least prevalence was reported in Netherland (4 %) and Italy (5 %), both P-values< 0.001. Overall prevalence of FBXW7 abberation was greatest amongst male gender: "53.9 %, (95%CI: 8.3-62.0 %)", Tumour location (colon): 59.8 %, (95%CI: 53.9-65), tumour site (left): 61.6 %, (95%CI: 53.8-68.9), Tumour-grade (Moderate): 65.9 %, (95%CI: 54.9-75.4 %), and Tumour late-stage: 67.9 %, (95%CI: 49.7-84.3 %), all P-values< 0.001. When stratified according to study-period, an increasing trend was noted from 2018 till present with the highest mutation rate recorded in 2022 (15.3 %). Conclusion: Overall prevalence of FBXW7 mutations was 10.3 % with male gender, left side, and late-stage being most mutated, and these outcomes conform with severally published articles on FBXW7 mutation.
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Introduction: Many COVID-19 patients display adverse symptoms, such as reduced physical ability, poor quality of life, and impaired pulmonary function. Therefore, this systematic review is aimed at evaluating the effectiveness of physical exercise on various psychophysiological indicators among COVID-19 patients who may be at any stage of their illness (i.e., critically ill, hospitalized, postdischarge, and recovering). Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar from 2019 to 2021. Twenty-seven studies, which assessed a total of 1525 patients, were included and analysed. Results: Overall, data revealed significant improvements in the following parameters: physical function, dyspnoea, pulmonary function, quality of life (QOL), lower limb endurance and strength, anxiety, depression, physical activity level, muscle strength, oxygen saturation, fatigue, C-reactive protein (CRP), interleukin 6 (IL-6), tumour necrosis factor-alpha (TNF-α), lymphocyte, leukocytes, and a fibrin degradation product (D-dimer). Conclusions: Physical training turns out to be an effective therapy that minimises the severity of COVID-19 in the intervention group compared to the standard treatment. Therefore, physical training could be incorporated into conventional treatment of COVID-19 patients. More randomized controlled studies with follow-up evaluations are required to evaluate the long-term advantages of physical training. Future research is essential to establish the optimal exercise intensity level and assess the musculoskeletal fitness of recovered COVID-19 patients. This trial is registered with CRD42021283087.
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COVID-19 , Calidad de Vida , Humanos , Adaptación Fisiológica , Ansiedad/terapia , Ansiedad/fisiopatología , COVID-19/psicología , COVID-19/terapia , COVID-19/fisiopatología , Ejercicio Físico/fisiología , Terapia por Ejercicio/métodos , Fuerza Muscular/fisiología , SARS-CoV-2RESUMEN
Wild birds could be a reservoir of medically relevant microorganisms, particularly multidrug-resistant Enterococcus spp. Resistant bacteria's epidemiology and transmission between animals and humans has grown, and their zoonotic potential cannot be ignored. This is the first study to evaluate the status of vancomycin resistant enterococci (VRE) in various wild bird species using meta-analysis and a systematic review. In this study, the pooled prevalence was obtained by analyzing data from published articles on the occurrence of VRE in wild bird species. It's unclear how the antibiotic resistance gene transfer cycle affects wild birds. Google Scholar and PubMed were used to conduct the research. The data and study methodology was assessed and extracted by two reviewers independently, with a third reviewing the results. Heterogeneity between study and publication bias were analyzed using the random effect model. Thirty-eight studies were included in the meta-analysis. 382 out of the 4144 isolates tested, were VRE. The pooled prevalence of VRE among wild birds was estimated at 11.0% (95% CI; 6.9 -17.2%; I2 = 93.204%; P < 0.001). There was high variability between study (t2 = 2.156; heterogeneity I2 = 93.204% with chi-square (Q) = 544.413, degrees of freedom (df) = 37, and P < 0.001). Egger's test verified the funnel plot's bias, while result from the leave-one-out forest plot had no effect on the pooled prevalence.
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Animales Salvajes , Aves , Infecciones por Bacterias Grampositivas , Enterococos Resistentes a la Vancomicina , Animales , Animales Salvajes/microbiología , Aves/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/veterinaria , Infecciones por Bacterias Grampositivas/microbiología , Prevalencia , Enterococos Resistentes a la Vancomicina/aislamiento & purificaciónRESUMEN
AIM: This article summarizes key research presented at the International AIDS Society (IAS) Conference in Brisbane, held in July 2023. CO-MORBIDITIES: The REPRIEVE Trial as a conference highlight, demonstrating significantly fewer major cardiovascular events amongst people with HIV who were randomized to pitavastatin compared to placebo. Key data on weight, hypertension and incident diabetes are also summarized. ANTIRETROVIRAL THERAPY: Novel data on doravirine and islatravir are described as are trials demonstrating efficacy dolutegravir/lamivudine first-line in people without baseline resistance testing and in suppressed switch amongst people with historic lamivudine resistance. HIV CURE: The sixth case of HIV cure secondary to stem cell transplantation is summarized, as are new insights into the central nervous system as an HIV reservoir.
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Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Humanos , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Lamivudine/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.
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The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.
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BACKGROUND: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey. OBJECTIVE: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. METHODS: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). RESULTS: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. CONCLUSIONS: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.
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Infecciones por VIH , Autoevaluación , Humanos , Adolescente , Nigeria , Sector Privado , Investigación Cualitativa , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Tamizaje Masivo/métodosRESUMEN
BACKGROUND: The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS: A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS: Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION: To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.
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Infecciones por VIH , Autoevaluación , Humanos , VIH , Nigeria , Sector Privado , Infecciones por VIH/diagnóstico , Percepción , Tamizaje MasivoRESUMEN
BACKGROUND: Enterococci are Gram-positive cocci found in the guts of humans and animals. The goal of this research is to develop a multiplex PCR assay that can detect the Enterococcus genus, four VRE genes, and three LZRE genes simultaneously. METHODS: Primers used in this study were specifically designed for the detection of 16S rRNA of Enterococcus genus, vanA-vanB-vanC-vanD for vancomycin, cfr methyltransferase, and optrA, and poxtA, as well as an adenosine triphosphate-binding cassette (ABC) transporter for linezolid. A Vibrio cholerae ctxA (internal amplification control) was included. Optimization of primer concentrations and PCR components was also done. This was followed by evaluating the sensitivity and specificity of the optimized multiplex PCR. RESULTS: Final Primer concentrations were optimized as follows: 16S rRNA is 1.0 pmol/µL, vanA is 1.0 pmol/µL, optrA is 1.0 pmol/µL, cfr is 1.0 pmol/µL, poxtA is 0.1 pmol/µL, vanB is 0.08 pmol/µL, ctxA is 0.07 pmol/µL, vanC is 0.8 pmol/µL, and vanD is 0.1 pmol/µL. Further, the optimized concentrations for MgCl2, dNTPs and Taq DNA polymerase were 2.5 mM, 0.16 mM, and 0.75 units respectively, and an annealing temperature of 64.5 °C. CONCLUSIONS: The developed multiplex PCR is sensitive and species-specific. The development of a multiplex PCR assay that will take into account all known VRE genes and linezolid mutation is highly recommended.
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Globally, colorectal carcinoma CRC is the third most common cancer and the third most common reason for cancer-associated mortality in both genders. The GNAS mutations are significantly linked with poor prognosis and failed treatment outcomes in CRC. A systematic review and meta-analysis of multiple studies executed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria and registered with PROSPERO (registration number: CRD42021256452). The initial search includes a total of 271 publications; however, only 30 studies that merit the eligibility criteria were eventually chosen. Data analysis via OpenMeta Analyst and comprehensive meta-analysis 3.0 (CMA 3.0) software were used to investigate the prevalence of GNAS gene mutation among CRC patients. The meta-analysis consisted of 10,689 participants with most being males 6068/10,689 (56.8%). Overall, prevalence of GNAS mutations was 4.8% (95% CI: 3.1−7.3) with I2 = 94.39% and (p < 0.001). In 11/30 studies, the frequency of GNAS gene mutations was majorly in codons R201C [40.7% (95% CI: 29.2−53.2%)] and in codon R201H [39.7% (95% CI = 27.1−53.8)]. Overall prevalence of GNAS mutations was highest among the male gender: 53.9% (95% CI: 48.2−59.5%: I2 = 94.00%, (p < 0.001), tumour location (colon): 50.5% (95% CI: 33.2−67.6%: I2 = 97.93%, (p < 0.001), tumour grade (Well): 57.5% (95% CI: 32.4−79.2%: I2 = 98.10%, (p < 0.001) and tumour late stage: 67.9% (95% CI: 49.7−84.3%: I2 = 98.%, (p < 0.001). When stratified according to study location, a higher prevalence was observed in Japan (26.8%) while Italy has the lowest (0.4%). Overall prevalence of GNAS gene mutations was 4.8% with codons R201C and R201H being the most mutated, and the results conformed with numerous published studies on GNAS mutation.
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Mental health remains one of the most overlooked issues in Nigeria. The burden posed by traditional healers in the provision of mental health services is becoming a public health concern in the country. This article presents a review of the present situation on the mental health service provision in Nigeria by traditional healers and highlights way forward actions for policy makers, government, and other stakeholders. These include the need for a policy direction on the need for establishing an improved system of psychiatric and mental health services in hospitals that will drive cultural acceptability, accessibility, and affordability. Further, there is a need for policy measures to be in place towards creating long term directions and sustainability of documentations of traditional healer's activities, harmful avoidance and improved mental health services in primary health centers. The fact that traditional healers are indispensable in provision of mental health services, call for collaborative effort to improve services such as behavioral change, capacity building and referral practice that could save more lives and reduce severity of complications.
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Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients' life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan−Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients' disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50−69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan−Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, "Gender" (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56−7.81, p-value = 0.040), "Presence of metastases" (HR: 3.76; 95% CI: 1.89−7.32, p-value = 0.010), "Metastasis site: Liver" (HR: 5.04; 95% CI: 1.71−19.05, p-value = 0.039), "Lymphovascular permeation" (HR: 2.94; 95% CI: 1.99−5.92, p-value = 0.021), and "CEA-level" (HR: 2.43; 95% CI: 1.49−5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient's comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.
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While great effort is being placed on reducing disease burdens in Africa, the circulation of falsified and substandard medicines in the continent are reversing the hard-won gains. This commentary provides insights on the high (and increasing) burden, impact and threat that falsified and substandard medicines pose to the region's development. The proposed recommendations, such as a coherent multi-sectorial and government-led strategy, call for a fundamental rethink of approaches towards strong regulations, policies, legislations, community-based approaches, collaborations and investments, which all must be scaled up before this the situation gets out of control. These recommendations are of paramount importance and have the potential to ensure access to genuine medicines and also to avert therapeutic failure and intoxication from dangerous substances. In addition, there will be added benefits to the economic, social, health and well-being of the region. Concerted efforts towards medicine regulations have enormous potential to contribute towards averting many preventable deaths and reducing disease burden in the region. A paradigm shift is necessary to ensure quality medicines reach patients at community and healthcare facilities to prevent this silent epidemic in Africa.