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1.
Pan Afr Med J ; 33: 208, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692729

RESUMEN

The Mozambican Field Epidemiology and Laboratory Training Program (Moz-FELTP) is a two-year, competency-based post-graduate training and service program designed to build sustainable public health capacity in applied epidemiology. Despite the efforts, Moz-FELTP residents have historically difficulty to publishing their work for a variety of reasons that includes language barriers, lack of writing skills and motivation, limited budgetary support and lack of effective mentorship. This outline the need for different approaches to continuous improving the publication, such scientific writing mentorship for non-English FELTP residents.


Asunto(s)
Epidemiología/educación , Lenguaje , Edición/estadística & datos numéricos , Investigación/educación , Educación Basada en Competencias , Humanos , Laboratorios , Mentores , Mozambique , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Salud Pública
2.
BMC Infect Dis ; 19(1): 746, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31455256

RESUMEN

BACKGROUND: Antimicrobial resistance is one of the most serious public health threats of the twenty-first century. The implementation of AMR surveillance in Zimbabwe is limited. However, data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (i.e., from 73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that Zimbabwe is affected by AMR. This study was done to determine the magnitude of AMR in Harare and determine the trends of AMR to first-line and to last-resort antibiotics and make recommendations to mitigate the problem. METHODS: A retrospective record review of data collected from the microbiology department at a private laboratory between January 2012 and December 2017 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates. Microsoft Excel 2016 was used to plot trends from 2012 to 2017 and Epi Info™7 was used for statistical analysis. RESULTS: A total of 23,432 isolates, of 12 medically important bacteria were analysed. Forty-three percent of the isolates were from urines, 36.7% were from pus swabs and 7% were from blood. The most common pathogen was Escherichia coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoea (0.2%). Resistance was highest to ampicillin followed by penicillin, both ranging between 70 and 100% over the six years. Statistically significant increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant E. coli and Streptococcus pneumonia and third generation cephalosporin-resistant E. coli. There was an increase in resistance to last-line antibiotics i.e., fluoroquinolone-resistant Salmonella spp. and carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, methicillin-resistant S. aureus showed a decreasing trend. CONCLUSIONS: There is a high burden of drug resistance to common antibiotics in Harare and an emergence of resistance to last-line antibiotics.


Asunto(s)
Bacterias/efectos de los fármacos , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Ampicilina/farmacología , Antibacterianos/farmacología , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Cefalosporinas/farmacología , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Humanos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificación , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Zimbabwe/epidemiología
3.
Pan Afr Med J ; 33(Suppl 2): 8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31404295

RESUMEN

Introduction: Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods: Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results: Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion: Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.


Asunto(s)
Creación de Capacidad , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Laboratorios/organización & administración , Técnicas de Laboratorio Clínico , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Liberia/epidemiología
4.
BMC Health Serv Res ; 19(1): 454, 2019 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-31277655

RESUMEN

BACKGROUND: Visual inspection with acetic acid and cervicography (VIAC) is a method used to screen for cervical cancer. VIAC can be used as part of a "see and treat" strategy. Nine Harare city council health facilities offer VIAC free of charge with the aim of reducing morbidity and mortality from cervical cancer. Between 2014 and 2016, the number of women utilising VIAC dropped by 35%. We analysed records of clients who utilise VIAC at Harare city health facilities to characterise women accessing VIAC and their outcomes to make recommendations for improving the services. METHODS: We conducted a descriptive cross-sectional study using data collected for the Harare city VIAC program. We analysed all records of clients who utilised VIAC services at nine Harare city health facilities from 1 May 2012 to 31 December 2016. RESULTS: We analysed 46,217 records, the median age of the clients was 34 years [Q1 = 27: Q3 = 42]. Of the 46,217 clients screened, 3001 (6.5%) were VIAC positive, and 512 (1.1%) had suspicious of cancer lesions. The prevalence of VIAC positive ranged from 58 to 74 per 1000-screened clients over the 5 years. The prevalence of suspected cancer ranged from 9 to 14 per 1000-screened clients, and there was a general decrease in the prevalence between 2012 and 2016. Of the 3513 clients with VIAC positive or had suspicious of cancer lesions, 2090 (74.1%) did not receive treatment at the site where the screening took place. CONCLUSION: The majority of women who are accessing VIAC services in Harare are middle-aged, multiparous and married women. There is a treatment gap at most of the VIAC centres such that clients are referred to other centres for management. The objective of "see and treat" is not being realised.


Asunto(s)
Detección Precóz del Cáncer/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adolescente , Adulto , Estudios Transversales , Análisis de Datos , Prestación de Atención de Salud , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Adulto Joven , Zimbabwe/epidemiología
5.
BMJ Glob Health ; 4(4): e001427, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31354972

RESUMEN

In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.

6.
Pan Afr Med J ; 32: 61, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31223353

RESUMEN

Introduction: globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. Methods: a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. Results: we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). Conclusion: the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Pipas de Agua/estadística & datos numéricos , Fumar/epidemiología , Tabaco , Adolescente , Adulto , Ciudades , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Prevalencia , Uganda/epidemiología , Adulto Joven
7.
Pan Afr Med J ; 32(Suppl 1): 9, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30949284

RESUMEN

Introduction: Despite the availability of vaccines, pertussis outbreaks still occur in developing countries. In December 2015 we investigated a pertussis outbreak in Kaltungo, Nigeria to identify determinants of infection and institute control measures. Methods: We enrolled 155 cases and 310 unmatched controls. We defined cases as residents of Kaltungo with paroxysmal or whooping cough lasting 2 weeks with or without vomiting and randomly selected neighborhood controls. Using structured questionnaire, we collected data on socio-demographics, clinical and risk factors. We collected twelve nasopharyngeal swabs for laboratory analysis using Polymerase Chain Reaction. Results: Median age was 24 months (range 1-132 months) for cases and 27 months (range 1-189 months) for controls. Female cases and controls were 86 (55.5%) and 150 (48.4%) respectively. A total of 83 (56.6%) cases were in age group 12-59 months. Age-specific-attack-rate was 83/1,786 (4.7%); Age-specific-case-fatality-rate was 21/83 (25.3%); Age-specific-proportional-mortality-ratio was 21/24 (87.5%). A total of 61 (39.4%) zero doses and 30.1% Pentavalent dropouts were documented. Multivariate analysis revealed parental refusal (adjusted OR = 27.8; CI = 8.8-87.7), contact with a case (AOR = 7.9, CI = 4.3-14.7, P = 0.000), belonging to the Muslim faith (AOR = 2.0; CI = 1.1-3.5) and having mothers with informal education only (AOR = 4.7, CI-2.6-8.4) as independent predictors of pertussis infection. Conclusion: Sub-optimal vaccination due to parental refusal and informal education of mothers were major determinants of pertussis infection. We conducted awareness campaigns of key immunization messages targeted at the informal education sector. We ensured appropriate case management, contact vaccination and health education in public gatherings, worship places and schools.


Asunto(s)
Brotes de Enfermedades , Vacuna contra la Tos Ferina/administración & dosificación , Cobertura de Vacunación , Tos Ferina/epidemiología , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Escolaridad , Femenino , Humanos , Lactante , Masculino , Análisis Multivariante , Nigeria/epidemiología , Factores de Riesgo , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricos , Negativa a la Vacunación/estadística & datos numéricos , Tos Ferina/prevención & control
8.
Pan Afr Med J ; 32(Suppl 1): 12, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30949286

RESUMEN

Introduction: Road traffic accidents are leading cause of injuries and deaths globally. Low income economies are the most affected. Most causes of RTA are predictable and preventable. This study describes trends and causes of road traffic accidents in Anambra State, South Eastern Nigeria. Methods: We conducted a retrospective study of road traffic accidents from 2010 to 2014. Data were obtained from the Federal Road Safety Commission, Anambra State Command. Information extracted included sex, age, cause of accidents, number of people and type of vehicles involved. Cases were recorded as fatal if any victim died, serious if any victim was hospitalized for more than 24 hours and minor if any victim was hospitalized for less than 24 hours. Causes of accidents were classified into human, mechanical, and climatic factors. Univariate analysis to generate frequencies and proportions was conducted using Microsoft Office Excel 2007. Results: A total of 1,141 road traffic accidents consisting 271 fatalities, 652 serious and 218 minor cases were recorded in Anambra State from 2010-2014. Seven thousand, four hundred and forty-four persons involving 1,816 vehicles were involved in RTA that resulted in 448 deaths and 2,785 injuries. More deaths 348 (77%) and injuries 2009 (72%) occurred more in males than females. Major causes of road traffic accidents were loss of vehicle control 256 (17%) and speed violation 207 (14%). There was an increased number of persons involved in RTA in 2014 (1,842) compared with 2010 (299). In all, 3,233 casualties (deaths and injuries) and crashes (fatal, serious and minor) were recorded out of which 900 (27.8%) casualties and 294 (9.1%) crashes occurred in 2013. Conclusion: Leading causes of road traffic accidents are human factors; speed violation, loss of vehicle control and dangerous driving which are sadly preventable. Sensitization and enforcement of safe road principles among commercial vehicles and car drivers will help curb this menace. Government at all levels should implement strong policies aimed at reducing the speed of vehicles on roads.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Conducción de Automóvil/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/tendencias , Adulto , Conducción de Automóvil/normas , Niño , Femenino , Hospitalización/tendencias , Humanos , Masculino , Nigeria/epidemiología , Estudios Retrospectivos
9.
Pan Afr Med J ; 32(Suppl 1): 14, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30949288

RESUMEN

Introduction: Intimate Partner Violence (IPV) is an under-reported public health problem. This study determined the prevalence of IPV and types of IPV, complications and factors associated with IPV among women accessing health services. Methods: we conducted a cross-sectional survey of 702 women accessing maternal and child health services in Enugu State, Nigeria using multi-stage sampling technique. Quantitative data was collected using semi-structured questionnaire, qualitative data by key informant interview (KII). We analysed data using descriptive statistics, bivariate and multivariate logistic regression analysis. The level of statistical significance was set at p-value < 0.05. Qualitative data was analysed using thematic content analysis. Results: mean age of respondents was 27.71 ± 5.14 years and 654 (93.2%) were married. Prevalence of IPV, a year before last pregnancy, was 307 (43.7%) and during last pregnancy was 261 (37.2%). Frequent involvement in physical fights with other men, controlling behaviour and younger aged partners (< 40 years) were independent predictors of IPV experience both before and during pregnancy. Independent predictors of IPV experience before and during pregnancy were younger aged partners (< 40 years). [Adjusted Odds Ratio AOR 1.72; 95% confidence interval (CI) = 1.17, 2.53], partner having controlling behaviour AOR 2.24; 95% C.I=1.51-3.32) and Partner's frequent involvement in physical fights (AOR 2.29; 95% C.I = 1.43-3.66). Having a male child and married/cohabiting were protective against violence. KII revealed poverty, lack of education and infidelity as common triggers of IPV. Conclusion: the prevalence of IPV and types of IPV was high and the predisposing factors of IPV in Enugu were multifactorial. Couple counselling sessions that focus on non-violence conflict resolution techniques is crucial to end IPV.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Parejas Sexuales , Adolescente , Adulto , Factores de Edad , Estudios Transversales , Femenino , Humanos , Recién Nacido , Persona de Mediana Edad , Análisis Multivariante , Nigeria/epidemiología , Embarazo , Prevalencia , Factores Protectores , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
10.
Pan Afr Med J ; 32(Suppl 1): 3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984325

RESUMEN

Introduction: Treatment success requires both a sustainable supply of Antiretroviral Therapy (ART) to clinics and lifelong adherence to treatment by patients. Poor adherence to medication may lead to treatment failure as a result of developing HIV resistance strains. Based on WHO 2014 guideline, over 26 million people will be additionally enrolled globally. Optimal treatment requires identification of patients with suboptimal adherence for targeted intervention. The aim of the study was to determine the predictors of non-adherence to ART. Methods: An unmatched 1:2 case-control study with 68 cases using simple random sampling. A case was defined as an ART patient who failed to achieve increase in CD4 count of 100cell/mm3 in one year. Controls are those with adequate immunological response. Questionnaires were administered for socio-demographic and adherence-related information. Bivariate and multivariable logistic regression was done using Epi Info at 95% Confidence Interval (CI) and precision of 5%. Results: A total of 204 patients were enrolled, mean age of cases was 36 (Standard Deviation Sd=8.8), n=68 and controls 37 (Sd=9.8), n=136. Of enrollees, 69.6% (142) were females. Mean duration on ART was 4.9 years for cases and 4.5 years for controls (standard deviation = ± 2.2 years). The commonest reason for missing drugs was forgetfulness (58% cases). On multivariate analysis, having formal education (Adjusted Odds Ratio [aOR] = 3.03, 95% CI = 1.5-6.0) and income above minimum wage, (aOR = 2.38, 95% CI = 1.06-4.76) were independently associated with non-adherence. The commonest reason for missing drugs was forgetfulness (58% cases). Conclusion: In conclusion, educated people and those with higher income were more likely to be non-adherent and should be the focus of adherence counseling. Some form of reminders like use of telephone should be adopted to address forgetfulness.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Adulto , Estudios de Casos y Controles , Escolaridad , Femenino , Humanos , Renta/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Nigeria , Centros de Atención Secundaria , Factores de Tiempo
11.
Pan Afr Med J ; 32(Suppl 1): 6, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984327

RESUMEN

Introduction: human cytomegalovirus (CMV) has remained a cause of morbidity and mortality in pregnancy and immunocompromised patients. CMV is transmissible through blood transfusion. We conducted a descriptive, cross-sectional study to assess blood donor safety and to determine the prevalence and associated factors for CMV infection among blood donors in Minna, Nigeria. Methods: all consenting blood donors were screened for CMV antibodies (IgM and IgG) using ELISA kit and haematological indices using a haematological analyzer. We administered structured questionnaires to obtain socio-demographic and socio-economic data. Data were subjected to univariate, bivariate and multivariate statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p < 0.05. Results: a total of 345 participantswere recruited, the majority were males 336 (97.4%). Monthly earnings of majority of the blood donors, 136 (40.6%) ranged from ₦18,000 to ₦35,000. The prevalence of CMV infection was 96.2%. The prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6%. Most of the study participants, 274 (79.4%) were family replacement donors. The majority of the blood donors 195 (56.5%) were anaemic (PCV < 36, Hb < 12g/dl). Those with positive CMV were more likely to be of high-income level (OR = 0.32, P = 0.04). Conclusion: the seroprevalence of CMV was high with a significant proportion of donors capable of transmitting CMV infection to blood recipients. The majority of the blood donors were anaemic. High income level is associated with CMV infection. Quality of screening for anemia be improved.


Asunto(s)
Anticuerpos Antivirales/sangre , Donantes de Sangre/estadística & datos numéricos , Seguridad de la Sangre , Infecciones por Citomegalovirus/epidemiología , Adulto , Anemia/epidemiología , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Renta/estadística & datos numéricos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Estudios Seroepidemiológicos , Encuestas y Cuestionarios , Adulto Joven
12.
Pan Afr Med J ; 32(Suppl 1): 7, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984328

RESUMEN

Introduction: tuberculosis (TB) is the commonest opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. World Health Organization (WHO) recommends 85% treatment success rate for all TB cases as an indicator of TB control. The study aimed at determining TB treatment success rate among TB-HIV co-infected patients and identifying predictors of successful treatment among patients in TB treatment sites in Abeokuta, Nigeria. Methods: it was a cross-sectional study among HIV-TB co-infected patients in the two major health facilities in Abeokuta, Nigeria. Socio-demographic characteristics with treatment history were obtained using a semi-structured questionnaire. Sputum samples were collected and tested for acid-fast bacilli (AFB) using a standard method according to national guideline for TB treatment to determine treatment success rate. Treatment success was defined as any HIV positive patient with a diagnosis of TB by acid-fast bacilli (AFB) smear positivity at diagnosis, who after 6 months of complete treatment becomes smear negative. Adjusted odds ratio was used to identify independent predictors of successful treatment outcome with confidence interval set at 95% and level of significance set at P < 0.05. Results: a total of 109 HIV-TB co-infected patients were enrolled for this study. Fifty-nine (54.1%) were females, 106 (97.3%) were newly treated for TB. Eighty-five (78.0%) were treated in a private health facility. A total of 91 had successful treatment outcome with a treatment success rate (TSR) of 83.5%. Eleven (10.1%) died, 5 (4.6%) defaulted, 1 (0.9%) failed treatment, 1 (0.9%) was transferred out. Successful treatment was associated with being newly registered (i.e. receiving TB treatment under the DOTS program for the first time), receiving TB treatment for the first time (adjusted OR = 18, 95%CI: 1.5-482.3) and being treated at a private health facility (adjusted OR = 14.1, 95%CI 4.27-48.4). Conclusion: treatment success rate of TB among HIV-TB co-infected patients in this study slightly falls below the WHO target. Registration status and health facility type were predictors of treatment outcome among study patients. Patients and healthcare workers in public facilities were educated on HIV-TB co-infection management.


Asunto(s)
Antituberculosos/administración & dosificación , Coinfección , Infecciones por VIH/complicaciones , Tuberculosis/tratamiento farmacológico , Adolescente , Adulto , Niño , Estudios Transversales , Terapia por Observación Directa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Adulto Joven
13.
Pan Afr Med J ; 32(Suppl 1): 11, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984330

RESUMEN

Introduction: Sub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas. Methods: We conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection. Results: We screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection. Conclusion: Interplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.


Asunto(s)
Infecciones por VIH/epidemiología , Adolescente , Adulto , Distribución por Edad , Estudios Transversales , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Factores de Riesgo , Distribución por Sexo , Encuestas y Cuestionarios , Adulto Joven
14.
Pan Afr Med J ; 32(Suppl 1): 15, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30984331

RESUMEN

Introduction: strong PMTCT-ART service linkages ensure continuity of care for healthier mothers and children born HIV free. Program data showed weak PMTCT- ART linkages in military health facilities. We conducted a study to assess the PMTCT-adult ART service linkage in two Nigerian military health facilities in Kaduna State. Methods: we conducted a cross-sectional study using mixed methods (interviews and FGDs) in 44 Nigeria Army Reference Hospital (NARH) and 1 Division Hospital, Kaduna. We studied 372 HIV-positive mothers after a delivery of their babies, referred for ART services from January 2009 to December 2013. We conducted FGDs among ANC, PMTCT and ART clinics staff. We analysed data using descriptive and inferential methods. A p-value of < 0.05 was considered significant with 95% confidence intervals (CI) for estimates. Results: of the 372 respondents studied, 320 (86%) accessed PMTCT services from the 44 NARH. Most respondents (206,55.4%) respondents aged < 25 years. One in six (16.7%) respondents had no record of referral. Delivering baby in a separate facility from where PMTCT services were accessed, increased the likelihood of not accessing ART services (odd ratio [OR]: 6.7, 95% CI= 3.3 -13.6). The qualitative study identified poor service integration between PMTCT and ANC clinics. Conclusion: the key factors hindering PMTCT-ART linkage in military health facilities included poor service integration, clients delivering of a baby in a facility separate from where PMTCT services were accessed. The Ministry of Defence HIV programme should strengthen ANC-PMTCT-ART service integration through a centrally coordinated client information management system.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Estudios Transversales , Femenino , Grupos Focales , Infecciones por VIH/prevención & control , Humanos , Recién Nacido , Instalaciones Militares , Madres , Nigeria , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Atención Prenatal/métodos , Adulto Joven
15.
BMC Pregnancy Childbirth ; 19(1): 103, 2019 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-30922242

RESUMEN

BACKGROUND: Maternal Death Surveillance and Response (MDSR) system was established to provide information that effectively guides actions to eliminate preventable maternal mortality. In 2016, Hwange district sent six maternal death notification forms (MDNF) to the province without maternal death audit reports. Timeliness of MDNF reaching the province is a challenge. Two MDNF for deaths that occurred in February and May 2016 only reached the provincial office in September 2016 meaning the MDNF were seven and four months late respectively. We evaluated the MDSR system in Hwange district. METHODS: A descriptive cross-sectional study was conducted. Health workers in the sampled facilities were interviewed using questionnaires. Resource availability was assessed through checklists. Epi Info 7 was used to calculate frequencies, means and proportions. RESULTS: We recruited 36 respondents from 11 facilities, 72.2% were females. Inadequate health worker knowledge, lack of induction on MDSR, unavailability of guidelines and notification forms and lack of knowledge on the flow of information in the system were reasons for late notification of maternal deaths. Workers trained in MDSR were 83.8%. Only 36.1% of respondents had completed an MDNF before. Respondents who used MDSR data at their level were 91.7%, and they reported that MDSR system was useful. Responsibility to complete the MDNF was placed on health workers. Maternal death case definitions were available in 2/11 facilities, 4/11 facilities had guidelines for maternal death audits. It costs $60.78 to notify a maternal death. CONCLUSION: Reasons for late notification of maternal deaths were inadequate knowledge, lack of induction, unavailability of guidelines and notification forms at facilities. The MDSR system is useful, acceptable, flexible, unstable, reliable but not simple. Maternal case definitions and maternal death audit guidelines should be distributed to all facilities. Training of all health workers involved in MDSR is recommended.


Asunto(s)
Recolección de Datos/estadística & datos numéricos , Muerte Materna/estadística & datos numéricos , Vigilancia de la Población/métodos , Adulto , Estudios Transversales , Recolección de Datos/métodos , Recolección de Datos/normas , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Humanos , Embarazo , Adulto Joven , Zimbabwe
16.
BMC Health Serv Res ; 19(1): 117, 2019 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-30760259

RESUMEN

BACKGROUND: The Integrated Disease Surveillance and Response (IDSR) strategy was adopted as the framework for implementation of International Health Regulation (2005) in the African region of World Health Organisation (WHO AFRO). While earlier studies documented gains in performance of core IDSR functions, Uganda still faces challenges due to infectious diseases. IDSR revitalisation programme aimed to improve prevention, early detection, and prompt response to disease outbreaks. However, little is known about health worker's perception of the revitalised IDSR training. METHODS: We conducted focus group discussions of health workers who were trained between 2015 and 2016. Discussions on benefits, challenges and possible solutions for improvement of IDSR training were recorded, transcribed, translated and coded using grounded theory. RESULTS: In total, 22/26 FGDs were conducted. Participants cited improved completeness and timeliness of reporting, case detection and data analysis and better response to disease outbreaks as key achievements after the training. Programme challenges included an inadequate number of trained staff, funding, irregular supervision, high turnover of trained health workers, and lack of key logistics. Suggestions to improve IDSR included pre-service and community training, mentorship, regular supervision and improving funding at the district level. CONCLUSION: Health workers perceived that scaling up revitalized IDSR training in Uganda improved public health surveillance. However, they acknowledge encountering challenges that hinder their performance after the training. Ministry of Health should have a mentorship plan, integrate IDSR training in pre-service curricula and advocate for funding IDSR activities to address some of the gaps highlighted in this study.


Asunto(s)
Personal de Salud/educación , Adulto , Actitud del Personal de Salud , Control de Enfermedades Transmisibles/organización & administración , Enfermedades Transmisibles/epidemiología , Estudios Transversales , Brotes de Enfermedades/prevención & control , Femenino , Personal de Salud/psicología , Humanos , Capacitación en Servicio , Masculino , Práctica Profesional , Vigilancia en Salud Pública , Uganda/epidemiología , Organización Mundial de la Salud
17.
Malar J ; 18(1): 44, 2019 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-30791906

RESUMEN

BACKGROUND: Indoor residual spraying (IRS) with Actellic 300 CS was conducted in Lira District between July and August 2016. No formal assessment has been conducted to estimate the effect of spraying with Actellic 300 CS on malaria morbidity in the Ugandan settings. This study assessed malaria morbidity trends before and after IRS with Actellic 300 CS in Lira District in Northern Uganda. METHODS: The study employed a mixed methods design. Malaria morbidity records from four health facilities were reviewed, focusing on 6 months before and after the IRS intervention. The outcome of interest was malaria morbidity defined as; proportion of outpatient attendance due to total malaria, proportion of outpatient attendance due to confirmed malaria and proportion of malaria case numbers confirmed by microscopy or rapid diagnostic test. Since malaria morbidity was based on count data, an ordinary Poisson regression model was used to obtain percentage point change (pp) in monthly malaria cases before and after IRS. A household survey was also conducted in 159 households to determine IRS coverage and factors associated with spraying. A modified Poisson regression model was fitted to determine factors associated with household spray status. RESULTS: The proportion of outpatient attendance due to malaria dropped from 18.7% before spraying to 15.1% after IRS. The proportion of outpatient attendance due to confirmed malaria also dropped from 5.1% before spraying to 4.0% after the IRS intervention. There was a decreasing trend in malaria test positivity rate (TPR) for every unit increase in month after spraying. The decreasing trend in TPR was more prominent 5-6 months after the IRS intervention (Adj. pp = - 0.60, P-value = 0.015; Adj. pp = - 1.19, P-value < 0.001). The IRS coverage was estimated at 89.3%. Households of respondents who were formally employed or owned any form of business were more likely to be unsprayed; (APR = 5.81, CI 2.72-12.68); (APR = 3.84, CI 1.20-12.31), respectively. CONCLUSION: Coverage of IRS with Actellic 300 CS was high and was associated with a significant decline in malaria related morbidity 6 months after spraying.


Asunto(s)
Transmisión de Enfermedad Infecciosa/prevención & control , Insecticidas/administración & dosificación , Malaria/epidemiología , Malaria/prevención & control , Control de Mosquitos/métodos , Compuestos Organotiofosforados/administración & dosificación , Adolescente , Adulto , Aerosoles/administración & dosificación , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Encuestas y Cuestionarios , Uganda/epidemiología , Adulto Joven
18.
BMC Public Health ; 19(1): 112, 2019 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-30683078

RESUMEN

BACKGROUND: Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. In November 2014, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) was notified of an increase in suspected cholera cases in Gomani, Kwali Local Government Area. NFELTP residents were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak. METHODS: We conducted an unmatched case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Gomani community. We identified community controls. A total of 43 cases and 68 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version 7.1.3.10. RESULTS: The mean age of cases and controls was 20.3 years and 25.4 respectively (p value 0.09). Females constituted 58.1% (cases) and 51.5%(controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae. The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drank from Zamani river (OR 14.2, 95% CI: 5.5-36.8) and living in households(HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3-27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1-0.7). CONCLUSION: Vibrio cholerae was the cause of the outbreak in Gomani. Drinking water from Zamani river, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak.


Asunto(s)
Cólera/epidemiología , Brotes de Enfermedades , Población Rural , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Cólera/prevención & control , Diarrea/epidemiología , Brotes de Enfermedades/prevención & control , Composición Familiar , Heces/microbiología , Femenino , Higiene de las Manos/normas , Humanos , Laboratorios , Masculino , Nigeria/epidemiología , Factores de Riesgo , Ríos/microbiología , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios , Vibrio cholerae/aislamiento & purificación , Purificación del Agua , Adulto Joven
19.
BMC Public Health ; 19(1): 46, 2019 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-30626358

RESUMEN

BACKGROUND: Uganda is a low income country that continues to experience disease outbreaks caused by emerging and re-emerging diseases such as cholera, meningococcal meningitis, typhoid and viral haemorrhagic fevers. The Integrated Disease Surveillance and Response (IDSR) strategy was adopted by WHO-AFRO in 1998 as a comprehensive strategy to improve disease surveillance and response in WHO Member States in Africa and was adopted in Uganda in 2000. To address persistent inconsistencies and inadequacies in the core and support functions of IDSR, Uganda initiated an IDSR revitalisation programme in 2012. The objective of this evaluation was to assess IDSR core and support functions after implementation of the revitalised IDSR programme. METHODS: The evaluation was a cross-sectional survey that employed mixed quantitative and qualitative methods. We assessed IDSR performance indicators, knowledge acquisition, knowledge retention and level of confidence in performing IDSR tasks among health workers who underwent IDSR training. Qualitative data was collected to guide the interpretation of quantitative findings and to establish a range of views related to IDSR implementation. RESULTS: Between 2012 and 2016, there was an improvement in completeness of monthly reporting (69 to 100%) and weekly reporting (56 to 78%) and an improvement in timeliness of monthly reporting (59 to 93%) and weekly reporting (40 to 68%) at the national level. The annualised non-polio AFP rate increased from 2.8 in 2012 to 3.7 cases per 100,000 population < 15 years in 2016. The case fatality rate for cholera decreased from 3.2% in 2012 to 2.1% in 2016. All districts received IDSR feedback from the national level. Key IDSR programme challenges included inadequate numbers of trained staff, inadequate funding, irregular supervision and high turnover of trained staff. Recommendations to improve IDSR performance included: improving funding, incorporating IDSR training into pre-service curricula for health workers and strengthening support supervision. CONCLUSION: The revitalised IDSR programme in Uganda was associated with improvements in performance. However in 2016, the programme still faced significant challenges and some performance indicators were still below the target. It is important that the documented gains are consolidated and challenges are continuously identified and addressed as they emerge.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Vigilancia de la Población/métodos , Evaluación de Programas y Proyectos de Salud , Cólera/epidemiología , Estudios Transversales , Recolección de Datos , Países en Desarrollo , Brotes de Enfermedades , Personal de Salud , Humanos , Uganda/epidemiología
20.
BMC Public Health ; 18(Suppl 4): 1304, 2018 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-30541484

RESUMEN

BACKGROUND: The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world free of wild poliovirus transmission when no wild virus has been found in at least 3 consecutive years, and all laboratories possessing wild poliovirus materials have adopted appropriate measures of containment. Nigeria has made progress towards poliomyelitis eradication with the latest reported WPV type 1 on 21 Aug 2016 after 2 years without any case. This milestone achievement was followed by an inventory of biomedical laboratories completed in November 2015 with the destruction of all identified infectious materials. This paper seeks to describe the poliovirus laboratory containment process in Nigeria on which an effective containment system has been built to minimize the risk of virus re-introduction into the population from the laboratories. METHODS: A national survey of all biomedical facilities, as well as an inventory of laboratories from various sectors, was conducted from June-November 2015. National Task Force (NTF) members and staff working on polio administered an on-site questionnaire in each facility. Laboratory personnel were sensitized with all un-needed materials destroyed by autoclaving and incineration. All stakeholders were also sensitized to continue the destruction of such materials as a requirement for phase one activities. RESULTS: A total of 20,638 biomedical facilities were surveyed with 9575 having laboratories. Thirty laboratories were found to contain poliovirus or potentially infectious materials. The 30 laboratories belonged to the ministries of health, education, defence and private organizations. CONCLUSIONS: This article is amongst the first in Africa that relates poliovirus laboratory containment in the context of the tOPV-bOPV switch in alignment with the Global Action Plan III. All identified infectious materials were destroyed and personnel trained to continue to destroy subsequent materials, a process that needs meticulous monitoring to mitigate the risk of poliovirus re-introduction to the population.


Asunto(s)
Contención de Riesgos Biológicos/métodos , Laboratorios , Poliomielitis/prevención & control , Poliovirus , Humanos , Nigeria
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