Health workers' perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria.

BACKGROUND: Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) are among the most prevalent neglected tropical diseases (NTDs), affecting 1.5 billion globally, with a significant burden in sub-Saharan Africa, particularly Nigeria. These diseases impair health and contribute to socio-economic challenges, especially in children, undermining educational and future economic prospects. The 2030 NTD Roadmap highlights Mass Drug Administration (MDA) as a critical strategy for controlling these NTDs, targeting vulnerable populations like school-age children. Despite some successes, challenges persist, indicating the need for deeper insights into program implementation. This study focuses on the perspectives of health workers implementing MDA in selected local government areas (LGAs) of Ogun State, Nigeria, aiming to identify challenges and enablers that align with the broader NTD 2030 goals. METHODOLOGY/PRINCIPAL FINDINGS: The study used a qualitative research approach involving focus group discussions and in-depth interviews with health workers engaged in neglected tropical disease control programs in Ogun State, Nigeria, between July and September 2022. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found that the school-based MDA control program's efficacy largely relies on strong collaborations and partnerships, particularly with educators, community heads, and other stakeholders. These alliances and strategic communication methods, like town announcements and media campaigns, have been pivotal in reaching communities. However, the program does grapple with hurdles such as parental misconceptions, limited funds, insufficient staffing, and misalignment with the Ministry of Education. It is recommended to boost funding, foster early stakeholder involvement, enhance mobilization techniques, and consider introducing a monitoring card system similar to immunization. CONCLUSIONS/SIGNIFICANCE: The MDA Integrated Control Programs for STH and SCH in Ogun State schools demonstrate a holistic approach, integrating knowledge, collaboration, communication, and feedback. Health workers have shown commitment and adeptness in their roles. However, achieving maximum efficacy requires addressing critical barriers, such as parental misconceptions and funding challenges. Adopting the recommended strategies, including proactive communication, increased remuneration, and introducing a tracking system, can significantly enhance the program's reach and impact. The involvement of all stakeholders, from health workers to community leaders and parents, is essential for the program's sustainability and success.

Community perception of school-based mass drug administration program for soil-transmitted helminths and Schistosomiasis in Ogun State, Nigeria.

BACKGROUND: Neglected tropical diseases, such as soil-transmitted helminths and Schistosomiasis, are prevalent in sub-Saharan Africa, particularly Ogun State, Nigeria. School-based mass drug administration program is the primary control intervention, but the coverage and uptake of this intervention have been inadequate. This study aimed to investigate community perceptions of school-based mass drug administration programs for these infections in Ogun State, Nigeria, and identify the barriers to their uptake and coverage. METHODOLOGY/PRINCIPAL FINDINGS: The study used a qualitative research approach involving focus group discussions and in-depth interviews with community members and stakeholders engaged in neglected tropical disease control programs in Ogun State, Nigeria. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found several barriers, such as the influence of parents, lack of sufficient knowledge, and side effects. The study recommended strategies such as improving community sensitization and engagement, drug distribution and performance, and enhancing partner collaboration and coordination to improve the school-based mass drug administration programs. CONCLUSIONS/SIGNIFICANCE: The study revealed correct perceptions of transmission but some misconceptions about disease causation, transmission, and drug safety. Participants expressed a desire for better sensitization campaigns and more assurances of their safety. The study recommends strengthening health education messages and increasing the visibility of on-site medical personnel. The findings have implications for improving the performance of these programs and reducing the burden of intestinal parasitic infections in the community. The study highlights the need for community engagement and education, health system support, and partner collaboration to successfully implement mass drug administration programs.

Exploration of the diversity of multi-drug resistant Mycobacterium tuberculosis complex in Lagos, Nigeria using WGS: Distribution of lineages, drug resistance patterns and genetic mutations.

Multidrug-resistant (MDR) or extensively drug-resistant (XDR) Tuberculosis (TB) is a major challenge to global TB control. Therefore, accurate tracing of in-country MDR-TB transmission are crucial for the development of optimal TB management strategies. This study aimed to investigate the diversity of MTBC in Nigeria. The lineage and drug-resistance patterns of the clinical MTBC isolates of TB patients in Southwestern region of Nigeria were determined using the WGS approach. The phenotypic DST of the isolates was determined for nine anti-TB drugs. The sequencing achieved average genome coverage of 65.99X. The most represented lineages were L4 (n = 52, 83%), L1 (n = 8, 12%), L2 (n = 2, 3%) and L5 (n = 1, 2%), suggesting a diversified MTB population. In term of detection of M/XDR-TB, while mutations in katG and rpoB genes are the strong predictors for the presence of M/XDR-TB, the current study also found the lack of good genetic markers for drug resistance amongst the MTBC in Nigeria which may pose greater problems on local tuberculosis management efforts. This high-resolution molecular epidemiological data provides valuable insights into the mechanistic for M/XDR TB in Lagos, Nigeria.

Toxoplasma gondii infection: seroprevalence and associated risk factors for women of childbearing age in Osun State, Nigeria.

Toxoplasmosis is a common parasitic infection caused by an obligate intracellular protozoan, Toxoplasma gondii. Prevalence and risk factors of T. gondii infection in women of childbearing age in Osun State, Nigeria are unknown. This study was aimed to determine the seroprevalence and potential risk factors in acquiring T. gondii infection by women of childbearing age in Osun State, Nigeria. A community-based cross-sectional study was conducted from May 2019 to December 2019 in childbearing age women. Sera of 415 women aged 18-49 years randomly selected were collected and analyzed by enzyme-linked immunosorbent assay (ELISA) test. A questionnaire survey was administered for all study participants to collect socio-demographic and risk factors data. The study revealed that the overall seroprevalence of T. gondii infection was 76.63%, which comprised 6.02% positivity for anti-T. gondii IgM (25/415), 44.10% for IgG (183/415) and 26.51% for IgG plus IgM (110/415). Seroprevalence of IgM antibodies to T. gondii (6.02%) suggested recent infections. Women residing in rural communities and women of Islam religion showed significant association with anti-T. gondii seropositivity (p < 0.05). Residence location and women who are of Islam religion are risk factors to acquire T. gondii infection. Hence, health education and awareness on the disease and its transmission to women of childbearing age group in general and pregnant women in particular should be created during antenatal follow up to reduce the risk of T. gondii infection in pregnant women.

Report of high prevalence of schistosome infection in Biomphalaria snails from a geographic area with no previous prevalence of human schistosomiasis in Nigeria.

Previous study using the traditional method of screening snails for infection reported shedding of Schistosoma cercaria by Biomphalaria snails from a river in Nkalagu, southeastern Nigeria. This is contrary to published reports that Biomphalaria from this part of the country does not shed schistosome cercaria. Here, we employed the use of polymerase chain reaction (PCR) methods to screen and characterize the Biomphalaria snails from Nkalagu. Snails were collected from the River Uzuru in dry season, identified and subjected to molecular assays. Genomic DNA (gDNA) was extracted from whole tissues of the 212 Biomphalaria snails and amplified using conventional PCR to check for the schistosome infection level. Assay for the detection of S. mansoni infection was further done using a nested PCR (nPCR). We amplified the entire internal transcribed spacer 2 (ITS2) regions from gDNA of the 212 snails. The representative samples were sequenced and subjected to BLAST searches to confirm snail species. Of the 212 snails screened, 164 (77.4%) of the snails were infected with schistosomes, but only 16 (9.76%) of the snails were positive for S. mansoni infection. Amplification of the snails' ITS2 region yielded a product of 460 bp, and BLAST searches confirmed the snails to be B. pfeifferi, and BLAST searches confirmed the snails to be B. pfeifferi. This paper reports for the first time the presence of S. mansoni positive B. pfeifferi in Nkalagu, which suggest there may be cases of intestinal schistosomiasis in this part of Nigeria.

Intestinal parasitic infections: Current status and associated risk factors among school aged children in an archetypal African urban slum in Nigeria.

BACKGROUND/PURPOSE: Intestinal parasitic infections (IPIs) among school aged children (SAC) in Nigeria remains endemic, hence the need for regular surveillance to attract the attention of policy makers. This cross-sectional study investigated the current prevalence and factors associated with intestinal parasitic infections among school aged children in an urban slum of Lagos City, Nigeria. METHODS: Single stool samples from 384 school aged children (188 boys and 196 girls) were examined by employing Merthiolate-iodine-formaldehyde concentration (MIFC) and Kato-Katz methods. Demographic characteristics and risk factors were obtained by questionnaires investigation. RESULTS: The overall prevalence was 86.2% in school children, out of them 39.1% had polyparasitism. IPIs showed the highest to the lowest prevalence of 62% (238/384), 25% (97/384), 12.3% (47/384), 11.8% (45/384), 9.9% (38/384), 8.4% (32/384), 3.4% (13/384), and 0.5% (2/384) found in Ascaris lumbricoides, Entamoeba histolytica/dispar, Giardia duodenalis, Endolimax nana, Entamoeba coli, Trichuris trichiura, Blastocystis hominis, and hookworm infections, respectively. MIFC technique showed superiority to Kato-Katz technique in the detection of IPIs (p < 0.0001). Drinking untreated water was a significant risk factor for these school aged children in acquiring protozoan infections after multivariate adjustment (OR = 1.86, 95% CI = 1.08-3.20, p = 0.02). CONCLUSION: Intestinal parasitic infections are very severe among school aged children in the urban slums, thus regular mass de-worming programs, health education, and the provision of safe drinking water is recommended to combat IPIs among the school aged children.

Toxoplasma gondii: seroprevalence and associated risk factors among preschool-aged children in Osun State, Nigeria.

Background: Toxoplasma gondii is an ubiquitous apicomplexan parasite, which causes toxoplasmosis in animals and humans worldwide. However, little is known about T. gondii infection among preschool-aged children in Nigeria. Methods: A cross-sectional study of 272 preschool children aged 2.25±1.09 years from four communities (Edunabon, Erin-Ijesha, Ijebu-jesa and Ile-Ife) in Osun State, Nigeria was conducted between January and July 2016, and the demographic data was obtained via questionnaires. Antibody titres against T. gondii of serum samples were assessed by ELISA. Results: The overall seroprevalence of T. gondii infection was 6.9% (19/272). There was no significant difference in seroprevalence of T. gondii infection between boys (7.04%; 10/142) and girls (6.92%; 9/130; p=0.97). No associations were found between age, gender, parental educational level, occupation and religion, and T. gondii seropositivity. None showed statistical significance between the risk factors tested after multivariate adjustment; nevertheless, residing in Ijebu-jesa community was shown to be associated with an increased risk of infection (p=0.04). Conclusion: This is the first report of T. gondii infection among preschool children in Nigeria. Prevalence studies such as this could help in the development of strategies for the future for disease prevention and control of T. gondii transmission.

Seroepidemiological study and associated risk factors of Toxocara canis infection among preschool children in Osun State, Nigeria.

Human toxocariasis is caused by the nematode, Toxocara canis and it is a poorly understood phenomenon in Nigeria. Seroepidemiological studies have not been previously carried out among the preschool aged children in Nigeria. A cross-sectional study was conducted in pre-school children in four communities from Osun State, Nigeria between January and July 2016. A total of 308 children Aged 9 months and 5 years were studied comprising 53.2% (164/308) male and 46.8% (144/308) female. Blood samples were collected and screened for the presence of anti-Toxocara IgG antibodies by Western blot analysis based on the excretory-secretory antigens of larva T. canis (TcES), targeting low molecular weight bands of 24 - 35kDa specific for T. canis. Questionnaires were given to parents/guardians of the studied children to collect information regarding relationship between infection and host factors. The overall seroprevalence of Toxocara infection was 37.3%. The seroprevalence in the studied preschool children ranged from 18.2% in children less than one year old to a max of 57.6% in children aged 3 years and above. The logistic regression analysis of risk factors showed that children's age (odds ratio (OR)=6.12, 95% confidence interval (CI)=1.25-29.90, p=0.02), contact with dogs (OR=3.17, 95% CI=1.40-7.20, p=0.01) and parent's religion (OR=0.54, 95% CI=0.32-0.91, p=0.02) were the risk factors associated with Toxocara infection. However, after adjustment by multivariate logistic regression analysis, contact with dogs (p=0.02) remained the only statistically significant risk factor. Preschool children were exposed early in life to T. canis infection as 18.18% of children less than one year old were infected. This is the first serological investigation of T. canis infection among preschool children in Nigeria. The results show high levels of exposure to T. canis infection among the studied group and contact with the dog plays the predominant risk factor. It indicates high transmission with the consequent of visceral or ocular larva migrans and neurologic disorder in these children. The results also provide baseline data for effective prevention strategies of toxocariasis in Southwest Nigeria and the study recommends prompt interventional measures, particularly health education on personal hygiene.

Seroprevalence, disease awareness, and risk factors for Toxocara canis infection among primary schoolchildren in Makoko, an urban slum community in Nigeria.

In this study, we investigated the seroprevalence of Toxocara canis infection in southern Nigeria, which previously was unknown, in addition to evaluating disease awareness and potential risk factors for schoolchildren in an urban slum community. In total, 366 primary schoolchildren were investigated for the presence of anti-Toxocara IgG antibodies. Blood was collected and screened by a Western blot analysis based on the excretory-secretory antigens of larval T. canis (TcES), targeting low molecular weight bands of 24-35kDa specific for T. canis. Children were considered seropositive if their serum reacted with TcES when diluted to a titer of 1:32. Questionnaires concerning possible risk factors were given to the schoolchildren to acquire data on this infection. The overall seroprevalence of Toxocara infection was 86.1% (315/366). The logistic regression analysis of risk factors showed that children's age (odds ratio (OR)=2.88, 95% confidence interval (CI)=1.08-7.66, p=0.03), contact with dogs (OR=0.51, 95% CI=0.28-0.94, p=0.03), the age of the dog (OR=0.34, 95% CI=0.18-0.68, p=0.002), the feeding location of the dog (OR=0.31, 95% CI=0.12-0.79, p=0.01), the consumption of raw vegetables (OR=0.89, 95% CI=0.54-1.48, p=0.004), and the drinking of unboiled water (OR=0.48, 95% CI=0.26-0.90, p=0.02) were risk factors associated with Toxocara infection. Although there was a high awareness of dogs being hosts of some parasites in this study, not much was known about T. canis. This is the first serological investigation of T. canis infection among primary schoolchildren in southern Nigeria. The high seroprevalence recorded is an indication of high transmission with the consequent risk of visceral or ocular larval migrans and neurologic toxocariasis in these children. Our findings suggest the need for prompt interventional measures, particularly health education on personal hygiene.

Differentiating Schistosoma haematobium from Schistosoma magrebowiei and other closely related schistosomes by polymerase chain reaction amplification of a species specific mitochondrial gene.

INTRODUCTION: Schistosoma haematobium infection afflicts about 150 million people in 53 countries in Africa and the Middle East. In many endemic areas, S. haematobium is sympatric with Schistosoma bovis, Schistosoma mattheei, Schistosoma curassoni, Schistosoma intercalatum and Schistosoma magrebowiei, its closely related species. In addition, they also develop in the same intermediate snail hosts. Since these schistosome species often infect snails inhabiting the same bodies of water, examining cercariae or infected snails for estimating transmission of S. haematobium is always confounded by the need to differentially identify S. haematobium from these other species. Recently, differentiating S. haematobium by polymerase chain reaction (PCR) from S. bovis, S. mattheei, S. curassoni and S. intercalatum, but not from S. magrebowiei was reported. However, to be able to evaluate residual S. haematobium transmission after control interventions in areas where S. haematobium may be sympatric with S. magrebowiei, a differential tool for accurate monitoring of infected snails is needed. MATERIALS AND METHODS: Thus in this study, we developed a new PCR assay using a pair of primers, ShND-1/ShND-2, to amplify a target sequence of 1117 bp (GenBank accession number KF834975) from S. haematobium mitochondrion complete genome (GenBank accession number DQ157222). Sensitivity of the assay was determined by PCR amplification of different concentrations of S. haematobium gDNA serially diluted from 10ng to 0.1pg. For assay specificity, different concentrations of gDNA from S. haematobium and the other schistosome species, 20 positive urine samples and five controls as well as 20 infected snails were subjected to PCR amplification, while some of the PCR products were sequenced. RESULTS: The assay detected up to 1pg of S. haematobium gDNA, while a differential identification of S. haematobium DNA content from other closely related species was achieved when applied to urine and naturally infected snails. When a protein-protein blast search was carried out using Blastp, the amplified sequence was found to encode a protein that shows a 100% similarity with S. haematobium nicotinamide adenine dinucleotide dehydrogenase subunit 3 (GenBank accession number YP_626524.1). CONCLUSION: The PCR assay was sensitive, specific and was able to successfully differentiate S. haematobium from S. magrebowiei, in addition to its other closely related animal infective schistosome species.

Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents.

BACKGROUND: Depressive disorders often begin during childhood or adolescence. There is a growing body of evidence supporting effective treatments during the acute phase of a depressive disorder. However, little is known about treatments for preventing relapse or recurrence of depression once an individual has achieved remission or recovery from their symptoms. OBJECTIVES: To determine the efficacy of early interventions, including psychological and pharmacological interventions, to prevent relapse or recurrence of depressive disorders in children and adolescents. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 1 June 2011). The CCDANCTR contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). In addition we handsearched the references of all included studies and review articles. SELECTION CRITERIA: Randomised controlled trials using a psychological or pharmacological intervention, with the aim of preventing relapse or recurrence from an episode of major depressive disorder (MDD) or dysthymic disorder (DD) in children and adolescents were included. Participants were required to have been diagnosed with MDD or DD according to DSM or ICD criteria, using a standardised and validated assessment tool. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all trials for inclusion in the review, extracted trial and outcome data, and assessed trial quality. Results for dichotomous outcomes are expressed as odds ratio and continuous measures as mean difference or standardised mean difference. We combined results using random-effects meta-analyses, with 95% confidence intervals. We contacted lead authors of included trials and requested additional data where possible. MAIN RESULTS: Nine trials with 882 participants were included in the review. In five trials the outcome assessors were blind to the participants' intervention condition and in the remainder of trials it was unclear. In the majority of trials, participants were either not blind to their intervention condition, or it was unclear whether they were or not. Allocation concealment was also unclear in the majority of trials. Although all trials treated participants in an outpatient setting, the designs implemented in trials was diverse, which limits the generalisability of the results. Three trials indicated participants treated with antidepressant medication had lower relapse-recurrence rates (40.9%) compared to those treated with placebo (66.6%) during a relapse prevention phase (odds ratio (OR) 0.34; 95% confidence interval (CI) 0.18 to 0.64, P = 0.02). One trial that compared a combination of psychological therapy and medication to medication alone favoured a combination approach over medication alone, however this result did not reach statistical significance (OR 0.26; 95% CI 0.06 to 1.15). The majority of trials that involved antidepressant medication reported adverse events including suicide-related behaviours. However, there were not enough data to show which treatment approach results in the most favourable adverse event profile. AUTHORS' CONCLUSIONS: Currently, there is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents. Limited trials found that antidepressant medication reduces the chance of relapse-recurrence in the future, however, there is considerable diversity in the design of trials, making it difficult to compare outcomes across studies. Some of the research involving psychological therapies is encouraging, however at present more trials with larger sample sizes need to be conducted in order to explore this treatment approach further.

Biting behaviour of Simulium damnosum complex and Onchocerca volvulus infection along the Osun River, Southwest Nigeria.

BACKGROUND: Studies on biting behaviours and infectivity status of insect vectors are pre-requisites in understanding the epidemiology of the vector- borne diseases and planning effective control measures. A longitudinal study was carried out to investigate the transmission index of Simulium damnosum complex species along Osun River, South Western Nigeria. Adult flies were collected on human attractants from 07:00 to 18:00 hours for two consecutive days from February 2008 to June 2009 at three communities: Osun Eleja, Osun Ogbere and Osun Budepo. The infectivity rate was determined by dissection and Polymerase Chain Reaction amplification (PCR) of 0-150 genes of Onchocerca parasite using the pool screening technique. RESULTS: The results indicated that the majority of the flies collected at the three sampling points were nulliparous as they accounted for 53.90%, 57.86% and 59.58% of the flies dissected at Osun Budepo, Osun Ogbere and Osun Eleja, respectively. The parous rate was higher during the dry season than the wet season but the difference was not statistically significant (p < 0.05). The biting activity of the parous flies showed two peaks at Osun Budepo and three peaks at Osun Eleja and Osun Ogbere. Of the 1,472 flies dissected and 1,235 flies screened by molecular method, none was infected with Onchocerca parasite at the three sampling points however the annual biting rates at the three communities were higher than 1,000 considered as tolerable value for a person living in an onchocerciasis zone by Word Health Organization. CONCLUSION: The study has provided the baseline data for further study on onchocerciasis transmission dynamics and the need to intercept man- simuliid vector contact at the study area.

Prevalence of Schistosoma haematobium Infection in a Neglected Community, South Western Nigeria

Purpose: Schistosomiasis ranks second to malaria among parasitic diseases of socio-economic and public health importance. In Nigeria; urinary schistosomiasis caused by Schistosoma haematobium is endemic. This study aimed at producing an accurate data on the prevalence of urinary schistosomiasis in Apojula; a neglected community located around Oyan Dam; southwest Nigeria; using parasitological and molecular techniques. Methods: Parasitological examinations were carried out on urine samples from 63 participants whose ages ranged between 7 and 63 years. Matched blood and urine samples were also screened for S. hematobium infection by polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat. Results: of the 63 participants; 33 (52.4) were positive for heamaturia while 6 (9.5) had S. haematobium ova in their urine. PCR amplification of S. haematobium Dra1 repeat from their urine and blood samples showed that 59 (93.65) and 62 (98.4) were infected respectively. Conclusion: There was a high prevalence of S. haematobium infection as detected by PCR amplification of schistosome Dra1 repeat from the urine and blood samples of the study participants. In addition; the PCR was able to detect schistosome infection in cases otherwise shown to be negative by parasitological examinations thereby making them also to receive chemotherapy

Study on the susceptibility of Sahel goats to experimental Trypanosoma vivax infection.

Sahel goats, also known as Borno whites are found in the northern semi-arid, tsetse free Sahel region of Nigeria. They are transported alongside cattle from this zone to all other zones in the country, including the tsetse-infested zones, for commercial purposes and are kept for some time in these tsetse-infested zones until they are sold. This study therefore assessed the susceptibility of this breed of goats to trypanosome infection and its response to treatment with Berenil. Six bucks were inoculated intravenously with Trypanosoma vivax through the jugular vein while two served as uninfected control. The mean pre-patent period was 4.5 days and increasing parasitaemia followed the establishment of infection. Onset of parasitaemia was associated with increase in rectal temperature in all the infected goats and the temperature peak coincided with the only parasitaemic peak second week post-infection. The infected goats were treated with Berenil (Hoechst, Germany) 3.5mg/kg body weight at 4 weeks post-infection. The packed cell volume (PCV) continued to fall from a mean 30.73+/-0.01% pre-infection to a mean 13.21+/-0.18% at 1 week post-treatment. Deaths were recorded for 4 of the infected goats 1 week post-treatment while the remaining two died 2 weeks post-treatment, not responding to treatment.