Rabies epidemiology, prevention and control in Nigeria: Scoping progress towards elimination.

BACKGROUND: Human rabies remains a significant public health problem in Africa with outbreaks reported in most countries. In Nigeria-the most populous country in Africa-rabies causes a significant public health burden partly due to perennial obstacles to implementing a national prevention and control program. METHODS: We conducted a scoping review using standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify and select published articles from Nigeria during 1978-2020 reporting on rabies virus infections (human, canine, livestock, and wildlife), canine bites, knowledge, attitudes and practices (KAP) surveys on rabies and canine ecology studies. We extracted information on study location, year and additional details of each study such as rabies prevalence, general characteristics of offending dogs, dog vaccination status and health-seeking behaviours. FINDINGS: Between 1978 and 2020, 90 published articles met our inclusion criteria. The prevalence of rabies virus antigen detection varied between 3% and 28%, with more studies in the north. Most bites were unprovoked from dog bite studies (36.4%-97%), by dogs with low vaccination rates (12-38%). A more significant proportion of biting dogs were owned (31-90%). Laboratory confirmation for biting was available for only a small proportion of studies (6%; n = 2/32). Of the dogs surveyed during ecology studies, indigenous dogs accounted for the majority (62-98%), used mostly for security purposes (52-98%), with the vaccination rate between 15% and 38% in most states. Studies conducted in areas distant from rabies diagnostic facilities accounted for more human rabies cases and fewer dog rabies cases. CONCLUSION: Significant improvements are necessary to achieve the elimination of human rabies mediated via dogs by 2030.

Patterns and determinants of the double burden of malnutrition at the household level in South and Southeast Asia.

OBJECTIVES: Many developing countries currently face a double burden of malnutrition (DBM) at the household level, defined by the World Health Organization, as when a mother may be overweight or anemic, and a child or grandparent is underweight, in the same household. For the present study, we defined it as the coexistence of overweight or obesity in the mother, and at least one child under the age of 5 undernourished, within the same household. Although underweight has long been considered a major issue in South and Southeast Asia, overweight and obesity have also been identified as a growing problem. The main aim of this study was to assess the DBM at the household level and its major determinants in South and Southeast Asia. METHODS: We used population-representative cross-sectional data from the Demographic and Health Survey, conducted between 2007 and 2017, for eight South and Southeast Asian countries: Bangladesh, India, Nepal, Pakistan, Myanmar, Timor, Maldives, and Cambodia. Multivariate logistic regression was performed to identify the sociodemographic factors associated with DBM. RESULTS: A total of 798,961 households were included in this study. The pooled prevalence of overweight or obesity for the mother and stunted child was 10.0% (95% CI: 8.0.0-12.0), for OBM and wasted child, it was 7.0% (95% confidence interval (CI): 6.0-8.0), and for overweight or obese mother (OBM) and underweight child, it was 7.0% (95% CI: 6.0-8.0). The prevalence of any of these DBM coexistences was 12.0% (95% CI: 10.0-13.0) in all households. Statistically significant positive associations (p < 0.05) were found for each of these coexistences, and a higher age of the mother, mothers with a lower education, the richest household quintile, and households with more than four members. CONCLUSION: It is imperative that "double duty" action policies are developed that tackle the DBM, rather than targeting undernutrition or overnutrition separately. The findings from this study suggest that the promotion of education for women may aid in tackling the double burden on a household level.

Profiling the public health risk of canine rabies transmission in Kogi state, Nigeria.

Recently reports have emerged of rabies outbreaks in townships close to the city of Lokoja, the capital city of Kogi State in Nigeria. Areas in Lokoja are known to have high rates of dog bites and dogs are frequently butchered for human consumption, both of which may constitute risk factors for rabies transmission. However, data on the relative importance of these factors on canine rabies exposure in the densely populated capital of Kogi State is scarce. To understand the risk for public health two separate observational cross-sectional studies were conducted in Lokoja. Firstly, a retrospective study was performed to investigate the human profile of dog bite injuries and quantify the vaccination coverage of offending dogs. Information on dog bite cases and vaccination records covering of 11 years (2003-2013) were obtained from the largest public veterinary clinic (i.e. State Veterinary Clinic) and a private veterinary clinic in Lokoja. Then, an investigation of the presence of rabies antigen in the brain tissues of dogs slaughtered for human consumption in Lokoja was performed. A total of 208 canine brain samples from five slaughter points within the army barracks (the main venue in Lokoja where dogs are slaughtered for human consumption) were examined by fluorescent antibody technique. Out of 95 human dog bite cases, 46 (48.4%) were in persons between 10 and 19 years of age and 57 (60%) were males. There was a statistically significant association between gender of victims and their age, with a greater proportion of bites in males <10 years of age compared to other age groups (P < .001). Our results indicated a higher frequency of dog bites on the legs (51%) than other parts of the body; vaccination rates of offending dogs were lower compared to the general population of dogs presenting to clinics in Lokoja (25% vs 31%, respectively). Rabies antigen was detected in 11/203 (5.3%) brain samples from dogs slaughtered for human consumption. Paediatric dog bites and dog slaughtering practices represent a significant public health risk to residents of Lokoja in the context of rabies exposure. In order to minimize the risk of rabies outbreaks in children and people butchering, handling and consuming dog meat, dog vaccination and health promotion and education should be prioritized to these high risk groups.

Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis.

The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.

Current Progress and Future Directions in the Double Burden of Malnutrition among Women in South and Southeast Asian Countries.

BACKGROUND: In order to combat the double burden of malnutrition the UN General Assembly has established under its Sustainable Development Goal-2 (SDG2) a set of nutritional targets that member countries need to achieve by 2030, with the goal of eradicating all forms of malnutrition worldwide. OBJECTIVES: In order to understand progress towards this goal, we reviewed recent trends and forecast future trends to examine the likelihood of South and Southeast Asian countries achieving the SDG2 target by 2030. We also considered how inequalities based on wealth, education, and urban/rural dwelling influence the current and future prevalence of underweight, overweight, and obesity. METHODS: We used population-representative cross-sectional data from the Demographic and Health Survey, conducted between 1996 and 2016, for 8 South and Southeast Asian countries. We used a Bayesian linear regression model to estimate trends and to forecast the prevalence of underweight, overweight, and obesity by 2030. RESULTS: The overall pooled prevalence of underweight, overweight, and obesity in the South and Southeast Asian region was 22.9%, 21.3%, and 8.6%, respectively. Regional average annual rate of reduction and average annual rate of increase for the period 1996 to 2016 were 1.3% and 8.4% for underweight and overweight/obesity respectively. We estimate that if current trends continue as projected, the proportion of underweight and overweight/obesity will be 6.6% (95% CI: 3.9%, 11.1%) and 76.6% (95% CI: 64.3%, 85.7%) in 2030, respectively. Specific projections based on the wealth index suggested that by 2030 the prevalence of underweight would be highest among the poorest sector of society, and overweight and obesity highest among the richest sector. CONCLUSIONS: We found that despite progress in reducing underweight, nearly two-thirds of the South and Southeast Asian population will be overweight or obese by 2030. Our findings suggest that countries in this region will not achieve the 2030 SDG2 target.

Determination of Ancylostoma caninum ova viability using metabolic profiling.

Differentiation between viable and non-viable hookworm ova in environmental samples is necessary in order to implement strategies to mitigate re-infections in endemic regions. In this study, an untargeted metabolic profiling method was developed that utilised gas chromatography-mass spectrometry (GC-MS) in order to investigate hookworm ova viability. Ancylostoma caninum was used to investigate the metabolites within viable and non-viable ova. Univariate and multivariate statistical analyses of the data resulted in the identification of 53 significant metabolites across all hookworm ova samples. The major compounds observed in viable and non-viable hookworm ova were tetradecanoic acid, commonly known as myristic acid [fold change (FC) = 0.4], and dodecanoic acid, commonly known as lauric acid (FC = 0.388). Additionally, the viable ova had self-protecting metabolites such as prostaglandins, a typical feature absent in non-viable ova. The results of this study demonstrate that metabolic profiling using GC-MS methods can be used to determine the viability of canine hookworm ova. Further studies are needed to assess the applicability of metabolic profiling using GC-MS to detect viable hookworm ova in the mixed (viable and non-viable) populations from environmental samples and identify the metabolites specific to human hookworm species.

An assessment of the feasibility of a poultry tracing scheme for smallholders in Vietnam.

Tracing movements could assist the implementation of bio-containment measures during a disease outbreak. To evaluate the potential for implementing a tracing system for a poultry supply chain in northern Vietnam, a four-month longitudinal study was conducted to identify marketing practices associated with poultry traceability. Poultry sold in batches were traced between farms and markets, and their traceability was assessed upon market arrival. A total of 315 batches were released from the farms; 37% arrived at a market, from which 57.3% were 'traceable'. The results of the multivariable analysis showed that traceability was associated with farms operating through no more than two traders (Odds ratio [OR] = 5.97, 95% CI 1.15-30.92) and batches brought to the market on the day of purchase (OR = 4.05, 95% CI 1.23-13.27). No specific incentives were provided to farmers or traders. Results suggest that there is potential for implementing a poultry traceability scheme, although the tracing methodology should be refined.

Circulating natriuretic peptides in cats with heart disease.

BACKGROUND: Circulating natriuretic peptide concentrations are increased in cats with myocardial dysfunction. HYPOTHESIS: Serum N-terminal fragment of proatrial natriuretic peptide (NT-proANP) and NT-probrain natriuretic peptide (proBNP) concentrations may predict the presence of heart disease (HD) and congestive heart failure (CHF). A positive relationship is also predicted among natriuretic peptide (NP) concentrations, a noninvasive estimate of left ventricular filling pressure (E/E(a)), and an echocardiographic measure of left atrial (LA) size (LA/aortic diameter [Ao]). METHODS: Serum NP concentrations were measured in 28 healthy control and 50 study cats using sandwich enzyme immunoassays. The study group comprised cats, with HD but no CHF (HD - CHF, n = 17) and cats with CHF (HD + CHF, n = 33). The relationship among NP concentrations, LA size, and E/E(a) was examined. The ability of NP to distinguish control from study cats, and HD - CHF from HD + CHF cats, was explored using receiver operator curve analysis. RESULTS: NP concentrations were significantly lower in control than in study cats (P= .0001). The NT-proBNP concentrations were positively correlated with LA/Ao ratio (rho= 0.34; P= .02) and with E/E(a) ratio (rho= 0.68; P < .05). An NT-proBNP concentration of 49 fmol/mL gave a sensitivity and specificity of 100 and 89.3%, respectively, for correctly distinguishing 96.2% of control from study cats. Pairwise comparisons of the areas under the curve identified a statistically significant difference (P= .011) between NT-proANP and NT-proBNP to distinguish control from study cats. NT-proANP and NT-proBNP concentrations were significantly higher in HD + CHF cats than in HD - CHF cats (P= .0023 and .0001, respectively). CONCLUSIONS: Serum concentrations of NT-proANP and particularly NT-proBNP were different in healthy control cats, asymptomatic cats with HD, and cats with CHF, suggesting that measurement of NP concentrations may prove clinically useful as an initial screening test for cats with suspected cardiac disease.