From Paper Files to Web-Based Application for Data-Driven Monitoring of HIV Programs: Nigeria's Journey to a National Data Repository for Decision-Making and Patient Care.

BACKGROUND: Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation. OBJECTIVE: We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control. METHODS: Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes. RESULTS: By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start. CONCLUSION: The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control.

Surfactant modified waste ash for the removal of chloro and nitro group substituted benzene from wastewater.

A surfactant-modified coal fly ash was developed as a multifunctional adsorbent for the removal of organic pollutants from wastewater. Sodium dodecyl sulfate (SDS) was used to modify the surface of coal fly ash (CFA). The modified CFA was characterized using scanning electron microscopy (SEM), surface porosity analyzer, thermogravimetric analysis (TGA) and Fourier transform infrared (FTIR) spectroscopy. The results showed that loading CFA with SDS not only improved the functionality and surface morphology of the raw ash for the adsorption of organic pollutants, but also enhanced its thermal stability. The efficiency of the modified fly ash was tested in terms of removal of two non-polar organic pollutants namely chlorobenzene (CB) and nitrobenzene (NB) from aqueous phase. The maximum uptake capacity of chlorobenzene and nitrobenzene with SDS-modified coal fly ash (SCFA) was 225 mg/g and 90 mg/g, respectively. The kinetic analysis was done by controlled kinetic models, i.e., pseudo first and second order kinetic models. The results showed that adsorption of CB and NB onto SCFA followed a pseudo second order kinetic model. The adsorption of chlorobenzene was exothermic over the modified adsorbent while nitrobenzene showed an endothermic behavior. The isotherm analysis depicted the multilayer adsorption of both pollutants onto the surface of the surfactant modified adsorbent. This work has shown that surface modification using surfactants can be a viable option to enhance the adsorption capacity of fly ash for pollutants removal.

Causes of deaths in neonates and children aged 1-59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study.

BACKGROUND: Nigeria has one of the highest under-five mortality rates in the world. Identifying the causes of these deaths is crucial to inform changes in policy documents, design and implementation of appropriate interventions to reduce these deaths. This study aimed to provide national and zonal-level estimates of the causes of under-five death in Nigeria in the 2013-2018 periods. METHODS: We conducted retrospective inquiries into the cause of deaths of 948 neonates and 2,127 children aged 1-59 months as identified in the 2018 Nigeria Demographic and Health Survey (NDHS). The verbal autopsy asked about signs and symptoms during the final illness. The Physician Coded Verbal Autopsy (PCVA) and Expert Algorithm Verbal Autopsy (EAVA) methods were employed to assign the immediate and underlying cause of deaths to all cases. RESULT: For the analysis, sampling weights were applied to accommodate non-proportional allocation. Boys accounted for 56 percent of neonatal deaths and 51.5 percent of the 1-59-months old deaths. About one-quarter of under-5 mortality was attributed to neonatal deaths, and 50 percent of these neonatal deaths were recorded within 48 h of delivery. Overall, 84 percent of the under-5 deaths were in the northern geopolitical zones. Based on the two methods for case analysis, neonatal infections (sepsis, pneumonia, and meningitis) were responsible for 44 percent of the neonatal deaths, followed by intrapartum injury (PCVA: 21 percent vs. EAVA: 29 percent). The three main causes of death in children aged 1-59 months were malaria (PCVA: 23 percent vs. EAVA: 35 percent), diarrhoea (PCVA: 17 percent vs. EAVA: 23 percent), and pneumonia (PCVA: 10 percent vs. EAVA: 12 percent). In the North West, where the majority of under-5 (1-59 months) deaths were recorded, diarrhoea was the main cause of death (PCVA: 24.3 percent vs. EAVA: 30 percent). CONCLUSION: The causes of neonatal and children aged 1-59 months deaths vary across the northern and southern regions. By homing on the specific causes of mortality by region, the study provides crucial information that may be useful in planning appropriately tailored interventions to significantly reduce under-five deaths in Nigeria.

The willingness of cooperative societies to sponsor house ownership in Akure, Nigeria.

Housing cooperatives are the organizations among others, which have played important roles in meeting the housing needs of people. In Nigeria, housing finance is through the formal and informal institutions; and personal residences accounted between 75 and 90 per cent of household wealth, that represents between 3 and 6 times their annual income. Finance is an important determinant of success and failure of housing ownership. It, therefore, becomes very necessary to identify viable sources of funding that can promote house-ownership. This paper examined the activities of Cooperative Societies in the provision of funds for house ownership in Nigeria with a focus on Akure. In the conduct of the social survey for the study; two sets of questionnaire were used. The first set of the questionnaire focused on House-owners and 683 sampled houses-owners were administered with the questionnaire in Akure. The second set of questionnaire was administered on the government officers' in-charge of the administration of the cooperative societies in Akure. The answers to the questions in the questionnaire were adequately supplied. The data were subjected to statistical analysis. The findings revealed among others that the main sources of funding house buildings were through personal savings and Cooperative Societies among others. It recommended that prospective house-owners should be encouraged to form and patronise Cooperative Societies as a reliable source for the housing loan.

Impacts of non-oxidative torrefaction conditions on the fuel properties of indigenous biomass (bagasse).

Biomass is considered as the largest renewable energy source in the world. However, some of its inherent properties such as hygroscopicity, lower energy content, low mass density and bio-degradation on storage hinder its extensive application in energy generation processes. Torrefaction, a thermochemical process carried out at 200-300°C in a non-oxidative environment, can address these inherent problems of the biomass. In this work, torrefaction of bagasse was performed in a bench-scale tubular reactor at 250°C and 275°C with residence times of 30, 60 and 90 mins. The effects of torrefaction conditions on the elemental composition, mass yield, energy yield, oxygen/carbon (O/C) and hydrogen/carbon (H/C) ratios, higher heating values and structural composition were investigated and compared with the commercially available 'Thar 6' and 'Tunnel C' coal. Based on the targeted mass and energy yields of 80% and 90% respectively, the optimal process conditions turned out to be 250°C and 30 mins. Torrefaction of the bagasse conducted at 275°C and 90 min raised the carbon content in bagasse to 58.14% and resulted in a high heating value of 23.84 MJ/kg. The structural and thermal analysis of the torrefied bagasse indicates that the moisture, non-structural carbohydrates and hemicellulose were reduced, which induced the hydrophobicity in the bagasse and enhanced its energy value. These findings showed that torrefaction can be a sustainable pre-treatment process to improve the fuel and structural properties of biomass as a feedstock for energy generation processes.

Comparative outcome of overhead and total body phototherapy for treatment of severe neonatal jaundice in Nigeria.

Background: In Nigeria, neonatal jaundice is commonly treated by overhead phototherapy with neonates lying supine, often with effective exposure of less than one half of the body surface. Total body exposure in phototherapy has been in use for less than 2 years in Nigeria, but is available in only five neonatal centres.Aim: To compare the effectiveness of total body exposure (TBPE) with the conventional partial exposure (COPT) for treatment of hyperbilirubinaemia.Methods: Eleven datasets from 10 neonatal units across Nigeria were retrieved. They included neonates with severe hyperbilirubinaemia treated with TBPE using the Firefly® device (MTTS Asia) as a test group. The remainder of the patients, the controls, were treated with COPT. Any requirement for exchange blood transfusion (EBT) in either group was documented. Total serum bilirubin (TSB) >213.8 µmol/L (12.5 mg/dL) was treated as severe hyperbilirubinaemia. The efficiency of the intervention was determined according to the time taken for a severe case to be downgraded to mild at ≤213.8 µmol/L.Results: A total of 486 patients were studied, 343 controls and 143 cases. Mean (SD) postnatal age was 6 days (0.7) for cases and 5 (0.9) for controls, for gestational age (GA) in completed weeks was 36 (0.5) for cases and 37 (0.7) for controls and for birthweight was 2.7 kg (0.25) for cases and 2.7 (0.22) for controls. Mean (SD) pre-intervention TSB was 299.3 (35.7) µmol/L for cases and 327.3 (13.9) for controls. Severity downgrade day was Day 2 (0.4) for cases and Day 5 (1.1) for controls. Overall relative EBT rate was 6% for cases and 55% for controls (p= 0.0001), and early preterm relative EBT rate was 0% for cases and 68% for controls (p < 0.01).Conclusion: TBPE was quicker and safer for reduction of hyperbilirubinaemia and patients rarely required EBT. TBPE is recommended for rapid reduction of serum bilirubin levels and the reduction of treatment costs, morbidity and mortality in low- and middle-income countries.Abbreviations: EBT, exchange blood transfusion; TBPE, total body exposure technique; COPT, conventional partial exposure; TSB, total serum bilirubin; SB, serum bilirubin; NNJ, neonatal jaundice; SCNU, special care neonatal unit; LMIC, low- and middle-income countries; HIC, high-income countries; LED, light-emitting diode.

Predicting the degradation potential of Acid blue 113 by different oxidants using quantum chemical analysis.

In this work, quantum chemical analysis was used to predict the degradation potential of a recalcitrant dye, Acid blue 113, by hydrogen peroxide, ozone, hydroxyl radical and sulfate radical. Geometry optimization and frequency calculations were performed at 'Hartree Fock', 'Becke, 3-parameter, Lee-Yang-Parr' and 'Modified Perdew-Wang exchange combined with PW91 correlation' levels of study using 6-31G* and 6-31G** basis sets. The Fourier Transform-Raman spectra of Acid blue 113 were recorded and a complete analysis on vibrational assignment and fundamental modes of model compound was performed. Natural bond orbital analysis revealed that Acid blue 113 has a highly stable structure due to strong intermolecular and intra-molecular interactions. Mulliken charge distribution and molecular electrostatic potential map of the dye also showed a strong influence of functional groups on the neighboring atoms. Subsequently, the reactivity of the dye towards the oxidants was compared based on the highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) energy values. The results showed that Acid blue 113 with a HOMO value -5.227 eV exhibits a nucleophilic characteristic, with a high propensity to be degraded by ozone and hydroxyl radical due to their lower HOMO-LUMO energy gaps of 4.99 and 4.22 eV respectively. On the other hand, sulfate radical and hydrogen peroxide exhibit higher HOMO-LUMO energy gaps of 7.92 eV and 8.10 eV respectively, indicating their lower reactivity towards Acid blue 113. We conclude that oxidation processes based on hydroxyl radical and ozone would offer a more viable option for the degradation of Acid blue 113. This study shows that quantum chemical analysis can assist in selecting appropriate advanced oxidation processes for the treatment of textile effluent.

Trend and current practices of palm oil mill effluent polishing: Application of advanced oxidation processes and their future perspectives.

Palm oil processing is a multi-stage operation which generates large amount of effluent. On average, palm oil mill effluent (POME) may contain up to 51, 000 mg/L COD, 25,000 mg/L BOD, 40,000 TS and 6000 mg/L oil and grease. Due to its potential to cause environmental pollution, palm oil mills are required to treat the effluent prior to discharge. Biological treatments using open ponding system are widely used for POME treatment. Although these processes are capable of reducing the pollutant concentrations, they require long hydraulic retention time and large space, with the effluent frequently failing to satisfy the discharge regulation. Due to more stringent environmental regulations, research interest has recently shifted to the development of polishing technologies for the biologically-treated POME. Various technologies such as advanced oxidation processes, membrane technology, adsorption and coagulation have been investigated. Among these, advanced oxidation processes have shown potentials as polishing technologies for POME. This paper offers an overview on the POME polishing technologies, with particularly emphasis on advanced oxidation processes and their prospects for large scale applications. Although there are some challenges in large scale applications of these technologies, this review offers some perspectives that could help in overcoming these challenges.

Complete Ectopia Cordis: A Case Report and Literature Review.

Ectopia cordis is a congenital heart exposure defined as complete or partial protrusion of heart through ventral defect in the thoracoabdominal wall alone or with other viscera in cases of pentalogy of Cantrell. This condition was first described by Haller et al. in 1706; since then many advances have been made. Diagnosis of ectopia cordis is done prenatally in well-equipped health facility by antenatal ultrasound scan so that early diagnosis and management plan can be initiated. The index case was delivered to uneducated rural family and admitted at 3 days of life and survived for seven days, even though most literatures state that majority died within four days even with surgery. So, in view of this, we presented this case report to deliberately draw the attention of paediatrician/obstetrician to the fact that even though this condition is rare, proactive search and diagnosis should be made and early treatment should be instituted, so that such a child may be salvaged.

Neonatal septicaemia, bacterial isolates and antibiogram sensitivity in Maiduguri North-Eastern Nigeria.

AIMS AND OBJECTIVES: The aim and objective of the study was to determine the incidence, bacterial isolates and the antibiogram sensitivity of the isolates in neonates with septicaemia. PATIENTS AND METHODS: The neonates with clinical diagnosis of neonatal septicaemia (NNS) were consecutively enrolled into our special care baby unit. The patients were investigated including blood cultures, cerebrospinal fluid cultures and urine among others. Data were analysed with Statistical Package for Social Sciences software version 16.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Forty-six neonates (42.0%) had a positive blood culture, while 64 (58.0%) were blood culture-negative. Eighteen (39.1%) of those septicaemic neonates with positive blood culture were inborn, while 28 (60.9%) were outborn. The incidence of NNS was 5.9/1000 live births. The male-to-female ratio among septicaemic neonates was 1.9:1. The common risk factors for NNS were prolonged rupture of membrane, prematurity and low socioeconomic status of parents among others. Common clinical features were fever, poor feeding, excessive crying, tachypnoea and hepatomegaly. Staphylococcus aureus 16 (69.6%) and Streptococcus pyogenes 5 (21.8%) were the predominant Gram-positive organisms isolated whereas Escherichia coli 9 (39.1%) and Klebsiella pneumoniae 7 (30.4%) were the predominant Gram-negative organisms isolated. S. aureus was sensitive to cephalosporins and quinolones, but resistant to penicillins. E. coli and K. pneumoniae showed a high resistance (16.7% and 25.6%, respectively) to commonly used aminoglycoside such as gentamycin. CONCLUSION: The burden of NNS was high with high mortality in the study centre. The sensitivity pattern had remarkably changed; however, a combination of cephalosporins such as cefuroxime and gentamycin is still a good option.

Building and Strengthening Infection Control Strategies to Prevent Tuberculosis - Nigeria, 2015.

Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide, accounting for more than 1.5 million deaths in 2014, and is the leading cause of death among persons living with human immunodeficiency virus (HIV) infection (1). Nigeria has the fourth highest annual number of TB cases among countries, with an estimated incidence of 322 per 100,000 population (1), and the second highest prevalence of HIV infection, with 3.4 million infected persons (2). In 2014, 100,000 incident TB cases and 78,000 TB deaths occurred among persons living with HIV infection in Nigeria (1). Nosocomial transmission is a significant source of TB infection in resource-limited settings (3), and persons with HIV infection and health care workers are at increased risk for TB infection because of their routine exposure to patients with TB in health care facilities (3-5). A lack of TB infection control in health care settings has resulted in outbreaks of TB and drug-resistant TB among patients and health care workers, leading to excess morbidity and mortality. In March 2015, in collaboration with the Nigeria Ministry of Health (MoH), CDC implemented a pilot initiative, aimed at increasing health care worker knowledge about TB infection control, assessing infection control measures in health facilities, and developing plans to address identified gaps. The approach resulted in substantial improvements in TB infection control practices at seven selected facilities, and scale-up of these measures across other facilities might lead to a reduction in TB transmission in Nigeria and globally.

Intrauterine growth standards: a cross-sectional study in a population of nigerian newborns.

The aim of the study was to define an intrauterine growth curve for a population of Nigerian newborn babies. A cross-sectional observational study design was adopted. Weight, length and head circumference were all measured in consecutive singleton deliveries at the University of Ilorin Teaching Hospital over a 3-year period. Gestational age (GA) of the babies was estimated from the last menstrual period or first trimester ultrasound. The estimates obtained were clinically validated using the Ballard score. Mean birth weights and percentiles of the weight, length and head circumferences for the respective GA were estimated using the SPSS 15 software package. A total of 5273 babies were recruited for the study with GA ranging from 25-44 weeks. Comparison of the mean birth weights of the various GA with the data from Denver, Colorado, showed that Nigerian babes tended to weigh less at the early GA, although these differences were not statistically significant. Between 26-36 weeks, the average weights of both sexes were similar; however, beyond this time point there was a consistent increase in the average weight of the males over the female babies. Growth curves for Nigerian newborn babies were generated and showed that the mean birth weight of Nigerian preterm babies was lighter than that of babies in Colorado. The impact of these differences on the classification of newborns will require further evaluation.

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting.

BACKGROUND: Despite the advances in management, congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. METHODS: All confirmed cases of CDH were prospectively documented from 2003 till date. RESULTS: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8%) and on the right side in one (17.7%). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. CONCLUSION: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

Background: Despite the advances in management; congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8) and on the right side in one (17.7). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities; the severe early presenting CDH has a dismal prognosis. In contrast; the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted; it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive