Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria.

BACKGROUND: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. OBJECTIVE: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. METHODS: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: "How will you promote HIV self-testing among young people during COVID-19 pandemic?" Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). RESULTS: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. CONCLUSIONS: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784.

Anti-Hypertensive Effects of Anthocyanins from Hibiscus sabdarifa Calyx on the Renin-Angiotensin-Aldoslestrone System in Wistar Rats.

Hibiscus sabdariffa (HS) has gained attention as an anti-hypertensive agent. In the present study, we hypothesized that anthocyanins from HS may attenuate salt-induced hypertension in rats by suppressing the components of renin-angiotensin-aldoslestrone system (RAAS). Hypertension was induced in the rats by adding 8% NaCl in their diet for six weeks. Wistar rats (n=5 each) were randomly divided into seven groups. Group 1 was the normentensive control group and was fed with normal rat chew and water ad libitum; groups 2 and 3 served as hypertensive control (negative untreated and positive treated with captopril 30mg/kg respectively); groups 4, 5, and 6 served as treatment groups and were administered with graded doses of anthocyanins( 50, 100, 200mg/kg respectively) while group 7 received both 100mg anthocyanins and 30mg captopril per day for 4 weeks. Using HPLC, anthocyanins were isolated from HS calyx following standard protocol. Anthocyanins significantly (p<0.05) reduced blood pressure and heart rate in hypertensive rats in a dose dependent manner. The blood pressure reduction by anthocyanins was associated with a reduction in serum ACE and plasma aldosterone in the hypertensive rats. The effects of anthocyanins on blood pressure and on biomarkers of RAAS were similar to those of captopril, a reference anti-hypertensive drug. The results suggest that anthocyanins exerts a significant (p<0.05) anti-hypertensive potency on rats, probably mediated by the reduction in components of the RAAS. Keywords: hypertension, anthocyanins, renin, aldosterone, rats.

Consumption of calcium carbide-ripened banana by pregnant rats may programme for infertility in female offspring.

One of the substances used in force ripening fruits is commercial grade calcium carbide (CaC2) which contains impurities such as arsine and this has been associated with low birth weight and fetal loss. There is thus a need to further investigate additional risks on offspring. This study was thus designed to evaluate the possible effects of maternal consumption of banana pulp force ripened with CaC2 on the offspring. Sixteen pregnant rats were randomly divided into two test groups and controls of four rats each. Two test groups were fed with pelletized feed mixed with banana pulp ripened by commercial grade CaC2 at concentrations of 50g/5kg and 100g/5kg while the controls had a group fed with pelletized feed mixed with normal ripened banana and another had only pelletized feed. This feeding pattern was done morning and evening ad libitum throughout the gestation period of twenty-one days after which only pelletized feed and water was administered. At delivery, all male offspring were separated and each dam was allowed eight female pups to nurse. Upon weaning after twenty-one days, the mothers were removed leaving eight female offspring in each group. Development of their reproductive system was monitored and recorded using parameters such as vaginal opening day (VOD) and reproductive hormonal assay at the sixth week. A fertility test was also carried out by introducing viable male rats for mating at sixth week postpartum. Trace amount of arsenic was found in the banana pulp of 100g/5kg CaC2 group (0.35ppb). CaC2 exposure was related to delayed onset in puberty, decreased serum FSH and a decreased fertility rate in the 100g/5kg CaC2 group (p<0.05). Consumption of contaminated CaC2 ripened fruits exposes humans to arsenic acid which has harmful effects on reproductive development of offspring.

ECG abnormalities among HIV infected children placed on ART at Enugu, South East of Nigeria.

BACKGROUND: Cardiovascular abnormalities are not much reported among human immunodeficiency virus (HIV) infected children especially in Africa where there is high HIV disease. In addition, the use of highly active antiretroviral therapy (HAART) in such children may have a protective effect on the cardiovascular system. METHODS: Cross-sectional study of randomly selected eighty HIV infected and 80 aged matched non- HIV-infected children were used. HIV-infected children were on HAART for more than 5years and had steadily received the treatment for 6 months prior to the time of the tests. Heights and weights were measured and body mass index calculated. Cardiac indices evaluated were heart rate (HR), PR interval, QRS duration, QT/QTC Interval, P/QRS/T Axis, RV5/SV1 voltage and RV5+SV1 voltage. RESULTS: The average heart rate was significantly higher among HIV infected children on HAART than their non-infected counterparts (P= 0.019). At 0.05 significance level, their PR interval was significantly higher than those in the control group (P=0.050). The average QRS duration result also showed a significant difference between that of test and control subjects (P = 0.022). CONCLUSION: The HAART usage possibly improved the cardiovascular functioning in the infected children but the protective effects diminish with increase age and longer exposure.

Antidiarrheal and antimicrobial activities of the ethanol extract from the Icacina senegalensis root bark.

BACKGROUND: The Icacina senegalensis root bark is traditionally used for the treatment of gastrointestinal disorders in Nigeria. To date, no scientific study has substantiated or refuted this claim. METHODS: The antidiarrheal and antimicrobial activities of the ethanol root bark extract were investigated in rats and against some selected diarrhea-causing microorganisms. RESULTS: The extract significantly decreased the frequency of castor oil-induced diarrhea, and inhibited the masses and volumes of intestinal fluid accumulation in the castor oil-induced enteropooling method. The distance travelled by the charcoal meal was also decreased by the extract gastrointestinal transit method. The extract also strongly inhibited the growth of some selected microorganisms. CONCLUSIONS: The ethanol extract of the I. senegalensis root bark showed antidiarrheal activity, thus justifying its long folkloric use in diarrhea treatment. The extract also demonstrated antimicrobial activity against selected diarrheal causing organisms.

Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students.

BACKGROUND: As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. Most Nigerian medical schools still lack a formal undergraduate medical ethics curriculum. Medical education remains largely focused on traditional medical science components, leaving the medical students to develop medical ethical decision-making skills and moral attitudes passively within institutions noted for relatively strong paternalistic traditions. In conducting a needs assessment for developing a curriculum germane to the Nigerian society, and by extension most of Sub-Saharan Africa, this study determined the views of Nigerian medical students on medical ethics education, ethical issues related to the doctor-patient relationship and the ethical/professional dilemmas they are confronted with. METHODS: Using self-administered 63-item structured questionnaires, a cross-sectional survey of the final year medical students of the University of Nigeria was conducted in July 2015.Using the Statistical Package for the Social Sciences software (SPSS Version 17), frequency counts and percentages were generated. RESULTS: The sample included 100 males (71.4%) and 40 females (28.6%), with the respective mean (SD) age being 24.6(5.61) and 21.8 (6.38) years. Only 35.7% were satisfied with their medical ethics knowledge, and 97.9% indicated that medical ethics should be taught formally. Only 8.6% had never witnessed a medical teacher act unethically. The dilemmas of poor communication between physicians and patients, and the provision of sub-standard care were reported highest for being encountered 'often'. A majority (60.7%) indicated that "a doctor should do his best always, irrespective of the patient's wishes". No significant difference in responses across gender was noted. CONCLUSION: There is a strong desire by the contemporary Nigerian medical student for medical ethics education. Their lack of exposure in medical ethics in an ethically challenging environment suggest a dire need for the development of an appropriate medical ethics curriculum for them and the provision of an ethically conducive learning environment.

Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes.

BACKGROUND: Amlodipine and hydrochlorothiazide (HCTZ) are commonly prescribed in Nigeria either as a monotherapy or in combination with other drugs. The present study was designed to investigate the antihypertensive efficacy of monotherapy with amlodipine or HCTZ and their effects on electrolyte profile in patients with mild to moderate hypertension. METHODS: A single-blind randomized clinical study was used; fifty patients newly diagnosed with mild to moderate hypertension (aged 33 to 60 years) were recruited and divided into two groups: amlodipine or hydrochlorothiazide each comprising of 25 subjects. The subjects received 5mg of amlodipine or 25mg of hydrochlorothiazide in their respective group once daily for 4 weeks. Blood pressure, serum and urine electrolytes were measured at baseline and weekly throughout the experiment. RESULTS: At the end of follow up, amlodipine reduced systolic and diastolic blood pressure significantly more (p<0.001) than HCTZ. At the end of follow up, blood pressure was reduced to normal in 80% of the subjects in amlodipine group compared to 50% in HCTZ. Amlodipine had no significant effect on electrolyte profile of subjects unlike HCTZ which significantly changed both their serum and urine electrolytes. CONCLUSIONS: Monotherapy with amlodipine was more effective than HCTZ in black patients with mild to moderate hypertension and in addition maintained electrolyte balance.

In vivo antiplasmodial activity of Bombax buonopozense root bark aqueous extract in mice infected by Plasmodium berghei.

OBJECTIVE: To evaluate the in vivo antiplasmodial activity and the oral acute toxicity of the Bombax buonopozense root bark aqueous extract. METHODS: The in vivo antiplasmodial activity of the root bark aqueous extract of Bombax buonopozense against early and established rodent malaria infections in chloroquine sensitive Plasmodium berghei strain in mice was investigated, and oral acute toxicity of the aqueous root bark extract of Bombax buonopozense was also evaluated in mice. RESULTS: The findings of this study revealed significant (P < 0.05) and dose dependent decrease in parasitaemia in the parasitized groups treated with varying doses of the extract (50-200 mg/kg p.o.) in both suppressive and curative tests. There was also significant decrease in parasitaemia density in the chloroquine treated group. The aqueous extract was found no toxicity in mice and the oral LD50 was determined to be greater than 5000 mg/kg. CONCLUSION: Bombax buonopozense root bark aqueous extract possesses potent antiplasmodial activity and may therefore, serve as potential sources of new antimalarial agents.

Does consumption of an aqueous extract of Hibscus sabdariffa affect renal function in subjects with mild to moderate hypertension?

Hibiscus sabdariffa (HS) has been traditionally used as a herbal medicine in Nigeria mainly because of its antihypertensive action. In view of the recent increase in the prevalence of renal failure, we have investigated the effect of HS consumption on renal function in Nigerians with mild to moderate hypertension. A total of 78 newly diagnosed but untreated subjects with mild to moderate hypertension attending the medical outpatients unit of Enugu State University Teaching Hospital (Enugu, Nigeria) were recruited for the study. These subjects were randomly divided into three equally sized groups that received HS or lisinopril (treatment groups) or placebo (control group), once daily for 4 weeks. Indices of renal function (urine volume and creatinine clearance) were measured at baseline and weekly throughout the study period. HS and lisinopril significantly increased (P < 0.001) urine volume compared to placebo, and HS significantly (P < 0.001) increased urine volume more than lisinopril. HS significantly increased (P < 0.001) creatinine clearance compared to placebo whereas lisinopril did not. These results indicate that HS consumption improved indices of renal function in our study population of Nigerians with mild to moderate hypertension.

Effects of aqueous extract of Hibiscus sabdariffa on the renin-angiotensin-aldosterone system of Nigerians with mild to moderate essential hypertension: A comparative study with lisinopril.

OBJECTIVES: The present study investigated the effects of aqueous extract of Hibiscus sabdariffa (HS) on the three basic components of renin-angiotensin-aldosterone system: Plasma renin, serum angiotensin-converting enzyme (ACE), and plasma aldosterone (PA) in mild to moderate essential hypertensive Nigerians and compared with that of lisinopril, an ACE inhibitor. MATERIALS AND METHODS: A double-blind controlled randomized clinical study was used. Seventy-eight newly diagnosed but untreated mild to moderate hypertensive subjects attending Medical Outpatients Clinic of Enugu State University Teaching Hospital, Enugu were recruited for the study. Those in Group A received placebo (150 mg/kg/day), Group B were given lisinopril (10 mg once daily) while those in Group C received aqueous extract of HS (150 mg/kg/day). After 4 weeks of treatment, the levels of plasma renin, serum ACE, and PA were determined. RESULTS: HS and lisinopril significantly (P < 0.001) reduced PA compared to placebo by 32.06% and 30.01%, respectively. Their effects on serum ACE and plasma renin activity (PRA) were not significant compared to placebo; they reduced ACE by 6.63% and 5.67% but increased plasma PRA by 2.77% and 5.36%, respectively. CONCLUSION: HS reduced serum ACE and PA in mild to moderate hypertensive Nigerians with equal efficacy as lisinopril. These actions are possibly due to the presence of anthocyanins in the extract.

Maternal mortality trend in South East Nigeria: less than a decade to the millennium developmental goals.

BACKGROUND AND OBJECTIVE: Maternal mortality is increasing despite all global efforts to reverse the trend. In our environment, most studies were based on only a single health institution, leading to varying reports of ratios and causes of maternal death. We sought to determine the ratio, causes, and key risk factors of maternal deaths in institutions located at different socioeconomic settings. METHODS: A retrospective study was carried out in two tertiary and two secondary healthcare institutions in Ebonyi state, Southeastern Nigeria over the 3-year period January 2003 to December 2005. All facilities had emergency obstetric services. Sociodemographic characteristics, causes of maternal death, and factors that contributed to the deaths were noted. RESULTS: The maternal mortality ratio (MMR) was 902.7/100,000 live births. The ratio increased from 756.8 in 2003 to 897.6 in 2004 and then to 1052.2 in 2005. Major risk factors include grand multiparity, maternal age of > or =35 years, low socioeconomic status (SES), and unscheduled emergencies. The commonest cause of maternal death was sepsis (25.8%), followed by obstetric hemorrhage (23.7%). Preeclampsia/eclampsia and anemia accounted for 12.4% each. The MMR as well as the causes of maternal death varied among institutions. CONCLUSIONS: The MMR is worsening. If this trend is not reversed, Nigeria may not be able to achieve the millennium developmental goal number 5 (MDG 5). A prospective, multicenter, community-based study is needed to fully assess the magnitude of the problem.