The spatio-temporal epidemic dynamics of COVID-19 outbreak in Africa.

Corona virus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in the city of Wuhan, China in December 2019. Although, the disease appeared in Africa later than other regions, it has now spread to virtually all countries on the continent. We provide early spatio-temporal dynamics of COVID-19 within the first 62 days of the disease's appearance on the African continent. We used a two-parameter hurdle Poisson model to simultaneously analyse the zero counts and the frequency of occurrence. We investigate the effects of important healthcare capacities including hospital beds and number of medical doctors in different countries. The results show that cases of the pandemic vary geographically across Africa with notably high incidence in neighbouring countries particularly in West and North Africa. The burden of the disease (per 100 000) mostly impacted Djibouti, Tunisia, Morocco and Algeria. Temporally, during the first 4 weeks, the burden was highest in Senegal, Egypt and Mauritania, but by mid-April it shifted to Somalia, Chad, Guinea, Tanzania, Gabon, Sudan and Zimbabwe. Currently, Namibia, Angola, South Sudan, Burundi and Uganda have the least burden. These findings could be useful in guiding epidemiological interventions and the allocation of scarce resources based on heterogeneity of the disease patterns.

Estimating lifetime malnourished period and its statistics based on the concept of Markov chain with reward.

Malnutrition among women, accessed through body mass index, has great consequences for achieving key national targets. This study introduces the concept of lifetime malnourished period (LMP): the number of years a woman would remain malnourished, either as underweight or overweight given that she is currently malnourished, and its measures of variation. Markov chain with rewards was used to compute the moments of LMP based on age-specific mortality rates and proportion of women of reproductive age that were either underweight or overweight using data from the 2013 Nigeria Demographic and Health Survey. Each of the two malnutrition status was treated as a Bernoulli-distributed reward with probability taken as the proportion of overweight or underweight women at specific age. Findings indicate that the average LMP for an underweight woman in Nigeria at age 15 years is 2.3 years but 5.8 for overweight. The remaining LMP for underweight is lower among women who attain higher level of education than for those with no or primary level of education with standard deviation reducing with age. Further, we found overweight women from the richest households and those from urban areas to have longer years of remaining in that state of health than their other counterparts, and that longevity contributes more to the variance in LMP for overweight than for underweight women.

The spatio-temporal epidemic dynamics of COVID-19 outbreak in Africa

The novel coronavirus (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in the city of Wuhan, China in December 2019. Although, the disease appears on the African continent late, it has spread to virtually all the countries. We provide early spatio-temporal dynamics of COVID-19 within the first 62 days of the diseases appearance on the African continent. We used a two-parameter hurdle Poisson model to simultaneously analyze the zero counts and the frequency of occurrence. We investigate the effects of important healthcare capacities including hospital beds and number of medical doctors in the different countries. The results show that cases of the pandemic vary geographically across Africa with notable high incidence in neighboring countries particularly in West and North Africa. The burden of the disease (per 100,000) was most felt in Djibouti Tunisia, Morocco and Algeria. Temporally, during the first 4 weeks, the burden was highest in Senegal, Egypt and Mauritania, but by mid-April it shifted to Somalia, Chad, Guinea, Tanzania, Gabon, Sudan, and Zimbabwe. Currently, Namibia, Angola, South Sudan, Burundi and Uganda have the least burden. The findings could be useful in implementing epidemiological intervention and allocation of scarce resources based on heterogeneity of the disease patterns.

Sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria.

BACKGROUND: There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. METHODS: This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. RESULTS: The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. CONCLUSION: HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.

Application of Porphyrins in Antibacterial Photodynamic Therapy.

Antibiotics are commonly used to control, treat, or prevent bacterial infections, however bacterial resistance to all known classes of traditional antibiotics has greatly increased in the past years especially in hospitals rendering certain therapies ineffective. To limit this emerging public health problem, there is a need to develop non-incursive, non-toxic, and new antimicrobial techniques that act more effectively and quicker than the current antibiotics. One of these effective techniques is antibacterial photodynamic therapy (aPDT). This review focuses on the application of porphyrins in the photo-inactivation of bacteria. Mechanisms of bacterial resistance and some of the current 'greener' methods of synthesis of meso-phenyl porphyrins are discussed. In addition, significance and limitations of aPDT are also discussed. Furthermore, we also elaborate on the current clinical applications and the future perspectives and directions of this non-antibiotic therapeutic strategy in combating infectious diseases.

Adolescent and Parental Reactions to Puberty in Nigeria and Kenya: A Cross-Cultural and Intergenerational Comparison.

PURPOSE: This qualitative study assesses the cross-cultural and intergenerational reactions of young adolescents and parents to puberty in Ile-Ife, Nigeria, and Nairobi, Kenya. METHODS: Sixty-six boys and girls (aged 11-13 years) and their parents participated in narrative interviews conducted in English or local languages in two urban poor settings in Ile-Ife and Nairobi. All interviews were recorded, transcribed, translated, and uploaded into Atlas.ti software for coding and analysis. RESULTS: Reactions of parents and adolescents to puberty were similar across both sites, with few exceptions. Adolescents' reactions to bodily changes varied from anxiety to pride. Adolescents generally tend to desire greater privacy; trying to hide their developing bodies from others. Most female adolescents emphasized breast development as compared with menstruation as the mark for pubertal initiation, while males emphasized voice changes. Among some ethnic groups in Nairobi, parents and adolescents view male circumcision as the hallmark of adolescence. Parents in both sites reported that with pubertal changes, adolescents tend to become arrogant and engaged in sexual relationships. Parents' reported responses to puberty include: educating adolescents on bodily changes; counseling on sexual relationships; and, provision of sanitary towels to females. Parents' responses are generally focused more on daughters. Approaches used by mothers in educating adolescents varied from the provision of factual information to fear/scare tactics. Compared with their own generation, parents perceive that their own children achieve pubertal development earlier, receive more puberty-related education from mothers, and are more exposed to and influenced by media and information technologies. CONCLUSIONS: Adolescents' responses to their pubertal bodily changes include anxiety, shame, and pride. Adolescents desire greater privacy. Parents' reactions were broadly supportive of their children's pubertal transition, but mothers' communication approaches may sometimes be inappropriate in terms of using fear/scare tactics.

Assessment of knowledge of participants on basic molecular biology techniques after 5-day intensive molecular biology training workshops in Nigeria.

The deployment of molecular biology techniques for diagnosis and research in Nigeria is faced with a number of challenges, including the cost of equipment and reagents coupled with the dearth of personnel skilled in the procedures and handling of equipment. Short molecular biology training workshops were conducted at the Nigerian Institute of Medical Research (NIMR), to improve the knowledge and skills of laboratory personnel and academics in health, research, and educational facilities. Five-day molecular biology workshops were conducted annually between 2011 and 2014, with participants drawn from health, research facilities, and the academia. The courses consisted of theoretical and practical sessions. The impact of the workshops on knowledge and skill acquisition was evaluated by pre- and post-tests which consisted of 25 multiple choice and other questions. Sixty-five participants took part in the workshops. The mean knowledge of molecular biology as evaluated by the pre- and post-test assessments were 8.4 (95% CI 7.6-9.1) and 13.0 (95 CI 11.9-14.1), respectively. The mean post-test score was significantly greater than the mean pre-test score (p < 0.0001). The five-day molecular biology workshop significantly increased the knowledge and skills of participants in molecular biology techniques. © 2017 by The International Union of Biochemistry and Molecular Biology, 45(4):313-317, 2017.

Parotid gland enlargement in pediatric HIV population.

OBJECTIVES: To establish the significance of parotid enlargement, state frequency, cytological features and effect of antiretroviral therapy (ART) on parotid enlargement among a pediatric HIV population. STUDY DESIGN: A 6 month cross sectional survey that utilised clinical features, serial immunological indices and fine needle aspiration cytology. RESULTS: 287 HIV positive children were seen at special paediatric clinic of the University College Hospital, Ibadan, Nigeria, 114 (39.7%) had oral features and among these 24 (8.4%) had parotid involvement comprising of 10 males and 14 females. The overall mean age was 43.4 + 39.7 months compared with 59.6 + 36.5 months in the parotid enlargement group (p = 0.03). Mean ages of parotid enlargement and non enlargement group was significantly different (p = 0.03). The mode of transmission was vertical in (91.7%), 87.5% was bilateral (87.5%) and (75%) presented as a syndrome state with generalised lymphadenopathy. The predominant cytology was lymphoid hyperplasia (62.5%). ART resulted in marked clinical reduction in all the cases and statistically significant improvement in serum indices of CD4 count, CD4% and viral load (p = 0.001, 0.000 & 0.009 respectively). CONCLUSION: HIV positive children often present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of lymphoid hyperplasia predominated. ART resulted in satisfactory reduction of the swellings in most of the cases with no need for further intervention.

Periodontitis and systemic diseases: A literature review.

Studies have revealed possible link between periodontitis and different systemic diseases. There is need to review this interesting subject. The aims are: to provide a comprehensive literature that can easily be consulted, on the subject; to draw the attention of health practitioners to the impact of oral health on the general well-being; and to emphasize the need for a deeper interaction between medical and dental training. The Medline database was searched for relevant literature by combining each of the following terms, "oral health," "oral infection," "periodontitis," with "systemic diseases." Manual library search and review of bibliographies of published literature were also conducted. Periodontitis is a constant potential source of infection and has been considered as a separate risk factor for some cardiovascular, respiratory, endocrine, musculoskeletal, and reproductive system related abnormalities. Oral health impacts on the general well-being, and if comprehensive health care is ever to be achieved, oral health should not be seen as a separate, distant, and less important area of health, which is totally unrelated to lifespan and its quality.

Head and neck cancer--a clinicopathological study in a tertiary care center.

Head and neck cancers display diverse patterns of biological behavior and considerable variation in geographical distribution. This study presents an analysis of head and neck cancer in a Nigerian tertiary healthcare center. It comprises cases diagnosed at the University College Hospital, Ibadan, Nigeria, 1991-2005. Out of 1,750 head and neck tumors, 972 (55.5%) were malignant and 778 (44.5%) were benign. Cancers displayed male predominance, with a gender ratio of 1.8:1. The mean age of cancer patients was 43.8 +/- 19.6 years. Carcinomas constituted 71.7% of head and neck cancers, with 2.4% occurring in children and overall mean age of 48.2 years. Squamous cell carcinoma comprised 66.7% of carcinomas and 47.8% of all head and neck cancers. Hematopoietic malignancies constituted 20.4% of head and neck cancers, and comprised mainly lymphomas, which accounted for 19.3% of all head and neck cancers. The mean age of patients with hematopoietic malignancies was 34.9 years. The most common childhood malignancy was Burkitt's lymphoma, which comprised 28.2% of pediatric head and neck cancers. Connective tissue tumors constituted 7.9% of all cancers, the most common being rhabdomyosarcoma, accounting for 44.2% of sarcomas. The mean age of patients with sarcomas was 26.5 years. There is a need for uniformity in the definition of head and neck cancer so as to permit comparison of international studies. In addition, prospective population-based studies are required to determine the national incidence and to identify risk factors for head and neck cancer in the Nigerian population.

A study of the utility of silver nucleolar organizer regions in categorization and prognosis of salivary gland tumors.

BACKGROUND: this study aimed at assessing the utility of silver nucleolar organizer region (AgNOR) staining in categorization and prognostication of salivary gland tumors. METHODS: Twenty-seven malignant salivary gland tumors, 16 benign neoplasms, and 6 chronic sialadenitis lesions were stained using the technique described by Ploton et al. (1986). RESULTS: The mean AgNOR counts for inflammatory lesions (1.67 +/- 0.19) and benign neoplasms (1.67 +/- 0.11), were less than for malignant neoplasms (3.59 +/- 0.55), P < .05. There was no significant difference between the mean AgNOR counts of different specific histological types and grades of malignant neoplasms. In addition, no correlation was found between mean AgNOR counts and the clinical course of malignant or benign salivary gland neoplasms. CONCLUSION: Our results suggest that AgNOR staining is useful for distinguishing benign from malignant lesions, but is neither helpful for discriminating between histological types and grades of malignant neoplasms, nor prognostication of malignant salivary gland neoplasms.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Ilorin, Nigeria.

BACKGROUND: Nosocomial infections caused by methicillin-resistant strains of Staphylococcus aureus constitute significant epidemiologic problems. Defining an outbreak requires the use of rapid and highly discriminatory epidemiologic methods to determine the epidemic strains involved in such outbreak. STUDY DESIGN: A descriptive laboratory based surveillance study for MRSA was undertaken. One hundred and forty seven Staphylococcus aureus isolates from clinical specimens were screened for methicillin resistance at the University of Ilorin Teaching Hospital between January and December 2001. Fifty one (34.7%) methicillin resistant strains recovered were epidemiologically characterized using Eco R1 restriction enzyme analysis of their plasmid DNAs. RESULT: Forty five (88.2%) MRSA isolates were associated with infections and 6 (11.8 %) were colonizing strains; 36 (70.6%) and 15 (29.4%) were hospital and community acquired respectively. Skin and soft tissues were sites of infection in 36 (70.6 %) cases and surgical, emergency and ICU accounted for 33 (64.7%) isolates. All isolates were resistant to more than two antibiotics but sensitive to vancomycin. Forty two (82.4 %) isolates contained plasmids including 9 (21.4 %) that contained more than one plasmid. Restriction Enzyme Analysis of the Plasmid DNA (REAP) divided the isolates into 9 Eco R1 profiles, with profile 2 accounting for 41.7% of all nosocomial infections in the wards, implying that it is endemic. The remaining nosocomial profiles occurred less frequently, suggesting that they are sporadic strains originating from outside the hospital. The community strains showed diverse digestion pattern indicating that they are from different clones. CONCLUSION: The spread of MRSA can be controlled through reinforcement of appropriate use of antibiotics, hand washing and laboratory surveillance for MRSA, particularly in the surgical wards and intensive care units, in order to identify sources of outbreaks.

Aetiological agents of vaginitis in Nigerian women.

This study focuses on the identification of aetiological agents of vaginitis in Nigerian women. Study subjects are drawn from patients presenting with lower abdominal pain, vaginal discharge and itching at the gynaecology clinic of Lagos University Teaching Hospital and at the Clinical Centre of the Nigerian Institute of Medical Research, Yaba, Lagos, between January 2001 and July 2002. A total of 250 patients gave informed consent to participate in the study. The patients also had pre- and post-test human immunodeficiency virus (HIV) counselling. Each patient completed a questionnaire in order to provide biographical data, past clinical history and socio-economic background information. A cervical swab (CS) and a high-vaginal swab (HVS) were obtained from each patient. Swab samples were examined for pH and under light microscopy by Gram's stain and as wet preparations in 10% potassium hydroxide. Subsequently, samples were cultured on appropriate media at optimal conditions and a drug sensitivity profile for all isolates was determined by standard methods. Blood samples were screened and confirmed for HIV antibodies. Bacterial, fungal and parasitic pathogens were identified or isolated in samples from 241 (96.4%) of the women. Bacterial agents (Neisseria, Streptococcus and Staphylococcus species) were predominant in 128 (51.2%) patients, followed by fungi in 108 (43.2%) and parasites (Trichomonas vaginalis) in five (2.0%). Sensitivity to ciprofloxacin was seen in 40% of Staphylococcus species and in 90% of Neisseria species. Positive HIV serology was seen in 25 (10%) of the 250 women studied, 20 (80%) of which had concurrent microbial infections. Overall, a broad spectrum of microbial agents were shown to be responsible for vaginitis in the group of patients studied.

HIV association with conventional STDS (sexual transmitted diseases) in Lagos State, Nigeria.

The study examined a possible association between HIV infection and conventional sexually transmitted diseases (STDS) in a population of 700 patients seen in some hospitals and clinics in Lagos State between November 1997 and December 1999. The patients were drawn mainly from LUTH and Jolad hospitals in Lagos State. In these hospitals, patients who presented with symptoms of STDS were screened clinically and microbiologically for agents of STDS and HIV antibodies. Screening was carried out using conventional methods. A total of 150 (21.5%) were found positive for various STDS while 550 (78.5%) were negative Also, 109 (15.8%) were sero-positive for HIV while 591 (84.4%) were sero-negative. The frequency of STDS diagnosed were, Treponema pallidum, 38(25.3%), Neisseria gonorrhoea 3(2.0%), Chlamydia trachomatis 26(17.3), Hepatitis B virus 60(40.0%) Staphylococcus aureaus, 20 (13.3%) and Candida albicans 3(2.0%). Data showed that Syphillis was the most prevalent STDS diagnosed while Calbicans and N. gonorrhoea are the least. Amongst the 150 (21.5%) patients positive with STDS, 82(54.65%) were found to be positive for HIV antibodies. The remaining 68(45.3%) patients were negative for HIV. The difference in sero-prevalence on the true group of patients rates was significant. The higher rate in the STDS patients strongly suggest some association between HIV infections andSTDS amongst the patients studied p = 0.05. It was also recorded that HIV-1 infection is four times more prevalent than HIV-2 in these patients.

A comparative trial of liquid lomotil and mist kaolin in childhood diarrhoea.

Lomotil liquid in a dose of 0.3 mg/kg/day has been compared with plain mist kaolin in controlling acute diarrhoea in young children aged 6 weeks to 2 years. Lomotil was found to stop the diarrhoea faster and significantly shorten the period of hospital admission than kaolin (P less than 0.05) in children whose diarrhoea was complicated by moderate dehydration. In those with mild dehydration lomotil had no advantage over kaolin. Children with severe dehydration treated with lomotil spent on the average much shorter period in hospital than those on kaolin, but the numbers were too small to allow for useful comparison. There was no adverse effect observed in any of subjects at the dose of lomotil used.