Research participants' perception of ethical issues in stroke genomics and neurobiobanking research in Africa.

Background: There is a growing interest in stroke genomics and neurobiobanking research in Africa. These raise several ethical issues, such as consent, re-use, data sharing, storage, and incidental result of biological samples. Despite the availability of ethical guidelines developed for research in Africa, there is paucity of information on how the research participants' perspectives could guide the research community on ethical issues in stroke genomics and neurobiobanking research. To explore African research participants' perspectives on these issues, a study was conducted at existing Stroke Investigation Research and Education Network (SIREN) sites in Nigeria and Ghana. Method: Using an exploratory design, twenty-eight Focus Group Discussions (FGDs) sessions were conducted with stroke survivors (n=7), caregivers(n=7), stroke - free controls(n=7), and Community Advisory Board members(n=7). Data were collected using an interview guide. Interviews were conducted in English and indigenous languages of the community, audio recorded, and transcribed verbatim. Data were analyzed using NVivo (March, 2020) Software. Result: Results revealed that stroke genomics and neurobiobanking research in Africa require researchers' direct attention to ethical issues. Concerns were raised about understanding, disclosure and absence of coercion as components of true autonomous decision making in research participation. Participants argued that the risk and benefits attached to participation should be disclosed at the time of recruitment. Fears around data sharing were voiced as adherence to the principle of privacy and confidentiality were of paramount importance to participants. The preference was to receive the results of incidental findings with no stigma attached from society. Conclusion: Research participants' perspectives are a vital aspect of community engagement in stroke genomics and neurobiobanking research. Findings from this study suggest that research participants are interested in these fields of research in Africa if their concerns about ethical issues are appropriately addressed within the research framework.

Hearing loss among inmates of a juvenile correctional facility in Nigeria.

Background: Good hearing is essential to learning and rehabilitation of adolescent and young adults in juvenile correctional facilities. Hearing screening programme is not commonly in place for this incarcerated group. Objective: To evaluate hearing threshold among inmates of a juvenile correctional facility in Nigeria and compare pattern of hearing loss with a control group. Methods: A total of 135 inmates and equal number of age and sex matched control responded to interviewer-administered questionnaire followed by otoscopy and audiometry. Results: Mean age of inmates was 19 years ±2.0, while that of control was 18yrs ± 2.5. (p-value 0.077). Four (3%) inmates had bleeding from the ear; otoscopy revealed traumatic tympanic membrane perforation in 2(1.5%) of them. Prevalence of hearing loss was 19.2% and for disabling hearing loss it was 1.4%. Conductive hearing loss was the most common 33(24.4%). Inmates had consistently worse mean hearing thresholds than controls across all frequencies tested in both ears (p-value <0.001). Conclusion: Hearing loss is prevalent among inmates of juvenile correctional facility. Rehabilitation programme should be balanced with detail attention to health needs of inmates; including pre-admission and periodic hearing screening.

Psychological and stigma profiles of HIV patients in a North-Central city of Nigeria.

Background: The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of infirmity and disease. Researchers and clinicians have mainly focused on health outcomes that are physically or laboratory measured. These, however, do not reflect how the affected individual feels and functions in daily life. This study assessed the psychological and stigma profiles of patients attending HIV clinics in a North-central State of Nigeria. Methods: The study design was descriptive cross-sectional. A total of 384 HIV-positive patients who were systematically recruited at 5 public service delivery sites in Ilorin, Kwara State, North-central Nigeria participated in the study. Data was analyzed using SPSS software version 20.0. Level of significance was pre-determined at P value < 0.05 at a confidence level of 95%. Results: Fifty-nine percent of respondents reported being anxious about their condition and 25.5% felt depressed. Eighty-six percent received adherence counselling and 82.3% received psychological care from support groups. In the psychological domain, majority (74.5%) of the respondents had high health-related quality of life (HRQoL). There was a statistically significant association between employment status and psychological domain of HRQoL. As regards stigma, majority experienced high stereotype stigma (73.7%) and 67.2% experienced high stigma as pertains disclosure. Conclusion: Health workers should promote psychological support of HIV patients, for example, in form of support groups and adherence counseling. Efforts by government and corporate bodies should be geared towards employment empowerment of PLWHA which may help improve quality of life.

Multilevel Analysis of Individual and Contextual Factors Associated with Polio Non-Vaccination in Africa: Further Analyses to Enhance Policy and Opportunity to Save More Lives.

Background: Africa was certified polio-free in 2020 and to maintain the polio-free status, African countries need to attain and maintain optimal routine polio vaccination coverage. One indicator for optimal polio vaccination coverage is the prevalence of children who have received no polio vaccination through routine services. The objective of the study was to examine the individual-, neighbourhood-, and country-level factors associated with non-vaccination against polio in Africa. Methods: We applied multivariable multilevel logistic regression analyses on recent demographic and health survey data collected from 2010 onwards in Africa. We identified 64,867 children aged 12-23 months (Level 1) nested within 16,283 neighbourhoods (Level 2) from 32 countries (Level 3). Results: The prevalence of non-vaccination for polio ranged from 2.19% in Egypt to 32.74% in Guinea. We found the following factors to be independent predictors of the increased odds of non-vaccination for polio: being a male child, born to mother with no formal education, living in poorer households; being from a polygamous family, living in neighbourhoods with high maternal illiteracy, high unemployment rate, and low access to media. Conclusions: We found that both individual and contextual factors are associated with non-vaccination for Polio.

Unraveling the Ethical, Legal, and Social Implications of Neurobiobanking and Stroke Genomic Research in Africa: A Study Protocol of the African Neurobiobank for Precision Stroke Medicine ELSI Project.

The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine-ELSI Project is to identify, examine, and develop novel approaches to address ELSI issues of biobanking and stroke genomic research in sub-Saharan Africa (SSA). To accomplish the goal we will (1) explore knowledge, attitude, perceptions, barriers, and facilitators influencing ELSI issues related to biobanking and stroke genomic research; (2) use information obtained to craft a community intervention program focused on ELSI issues; and (3) build capacity and careers related to genomics and biobanking for effective client/community engagement while enhancing regulatory, governance, and implementation competences in biobanking science in SSA. A community-based participatory research and mixed-methodological approach, focused on various levels of the social ecological model, will be used to identify and examine relevant ELSI issues. Contextual intervention tools, platforms, and practices will be developed to enhance community understanding and participation in stroke biobanking and genomics research activities while facilitating enduring trust, and equitable and fair utilization of biobanking resources for genetic and trans-omics research. A concurrent capacity building program related to genetic counseling and biobanking will be implemented for early career researchers. The huge potential for neurobiobanking and genomics research in Africa to advance precision medicine applicable to stroke and other neurological disorders requires addressing ELSI challenges while building sustainable research, career, and regulatory capacities in trans-omics and biobanking science.

Multilevel Analysis of the Social Determinants of Health Status and Wellbeing of Rural Farmers in North-central Nigeria

Over the years, rural dwellers have suffered from the unequal distribution of basic facilities when compared to the urban dwellers. This has resulted in situations where their health have been compromised and thus their productive capacity. This paper using a Multilevel Analysis examines these social determinants of health status and wellbeing of rural farmers in North-central, Nigeria. Analytical tools employed include the descriptive statistics and the multivariate multilevel model. The result of the analysis showed that the income, years of schooling, living condition, frequency of physical exercise, alcohol consumption and smoking habit were some of the factors significantly influencing the health status and wellbeing of rural farmers in the study area. Others include exposure to tobacco smoke, access to improved toilet facilities, proper solid waste management and distance to potable water. It also revealed that community level co-variation between health status and wellbeing was stronger than at the individual level. Therefore, it was recommended that efforts should be made by government to provide rural areas with basic potable water sources. The rural dwellers should also be enlightened on the basics of good sanitation and hygiene. This will help reduce diseases and deaths from water-related infections and poor hygiene. Furthermore, laws should be put in place to prohibit smoking of tobacco products in public places. All these will reduce the incidence of disease conditions thereby resulting in a healthier workforce that can thus work together with the government towards the achievement of the sustainable development goals.​

Interventions for the prevention of mycobacterium avium complex in adults and children with HIV.

BACKGROUND: Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and is an independent predictor of mortality and shortened survival. OBJECTIVES: To determine the effectiveness and safety of interventions aimed at preventing MAC infection in adults and children with HIV infection. SEARCH METHODS: We searched MEDLINE, EMBASE, and The Cochrane Library (search date December 2012). SELECTION CRITERIA: Randomised controlled trials comparing different strategies for preventing MAC infection in HIV-infected individuals. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details. Development of MAC infection and survival were compared using risk ratios (RR) and 95% confidence intervals (CI). The quality of evidence has been assessed using the GRADE methodology. MAIN RESULTS: Eight studies met the inclusion criteria. Placebo-controlled trials: There was no statistically significant difference between clofazimine and no treatment groups in the number of patients that developed MAC infection (RR 1.01; 95% CI 0.37 to 2.80). Rifabutin (one study; RR 0.48; 95% CI 0.35 to 0.67), azithromycin (three studies; RR 0.37; 95% CI 0.19 to 0.74) and clarithromycin (one study; RR 0.35; 95% CI 0.21 to 0.58) were more effective than placebo in preventing the development of MAC infection. There was no statistically significant difference between those treated with clofazimine (one study; RR 0.98; 95% CI 0.41 to 2.32), rifabutin (one study RR 0.91; 95% CI 0.78 to 1.05), azithromycin (three studies, pooled RR 0.96; 95% CI 0.69 to 1.32) and placebo in number of reported deaths. One study found that the risk of death was reduced by 22% in patients treated with clarithromycin compared to those treated with placebo (RR 0.78; 95% CI 0.64 to 0.96). Monotherapy vs. monotherapy: Patients treated with clarithromycin (RR 0.60; 95% CI 0.41 to 0.89) and azithromycin (RR 0.60; 95% CI 0.40 to 0.89) were 40% less likely to develop MAC infection than those treated with rifabutin. There was no statistically significant difference between those treated with clarithromycin (RR 0.98; 95% CI 0.83 to 1.15), azithromycin (RR 0.98; 95% CI 0.77 to 1.24) and rifabutin in the number of reported deaths. Combination therapy versus monotherapy: There was no statistically significant difference between patients treated with a combination of rifabutin and clarithromycin and those treated with clarithromycin alone (RR 0.74; 95% CI 0.46 to 1.20); and those treated with combination of rifabutin and azithromycin and those treated with azithromycin alone (RR 0.59; 95% CI 1.03). Patients treated with a combination of rifabutin plus clarithromycin were 56% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.44; 95% CI 0.29 to 0.69). Patients treated with a combination of rifabutin plus azithromycin were 65% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.35; 95% CI 0.21 to 0.59). There was no statistically significant difference in the number of reported deaths in all the four different comparisons of prophylactic agents. AUTHORS' CONCLUSIONS: Based on limited data, azithromycin or clarithromycin appeared to be a prophylactic agent of choice for MAC infection. Further studies are needed, especially direct comparison of clarithromycin and azithromycin. In additions, studies that will compare different doses and regimens are needed.

Interventions for HIV-associated nephropathy.

BACKGROUND: Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretroviral therapy, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. OBJECTIVES: To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. SEARCH METHODS: In January 2012 we searched the Cochrane Renal Group's Specialised Register, AIDS Education Global Information System (AEGIS database), ClinicalTrial.gov, the WHO International Clinical Trials Registry Portal, and reference lists of retrieved articles without language restrictions. In our original review we searched CENTRAL, MEDLINE, EMBASE, and AIDSearch, in addition to contacting individual researchers, research organisations and pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. DATA COLLECTION AND ANALYSIS: We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. For dichotomous outcomes results were to be expressed as risk ratios with 95% confidence intervals, and for continuous scales of measurement the mean difference was to be used. MAIN RESULTS: We identified four relevant ongoing studies: one is still ongoing; two have completed recruitment but are yet to be published; and the fourth study was suspended for unspecified reasons. No completed RCTs or quasi-RCTs were identified. We summarised and tabulated the data from the observational studies, however no formal analyses were performed. AUTHORS' CONCLUSIONS: There is currently no RCT-based evidence upon which to base guidelines for the treatment of HIVAN, however three ongoing studies have been identified. Data from observational studies suggest steroids and angiotensin-converting enzyme inhibitors appear to improve kidney function in patients with HIVAN, however no formal analyses were performed in this review. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.

Interventions for HIV-associated nephropathy.

BACKGROUND: Human immunodeficiency virus associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in Human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretrovirals, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. OBJECTIVES: To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's specialised register, MEDLINE, EMBASE, AIDSearch, reference lists of articles and conference proceedings without language restrictions. We searched the international clinical trials registry platform search portal and also contacted individual researchers, research organisations and pharmaceutical companies that manufacture the drugs used for interventions. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. DATA COLLECTION AND ANALYSIS: We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. We applied the inclusion criteria to identify four relevant ongoing studies, one is ongoing while the remaining two have completed recruitment and are yet to be published. The fourth study was suspended for an unknown reason. MAIN RESULTS: No completed RCTs or quasi-RCTs were identified to be included in the study. AUTHORS' CONCLUSIONS: There is no RCT-based evidence upon which to base guidelines for the treatment of HIVAN. However, steroids and ACEI appear to improve the kidney function of patients in the observational studies that were identified. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.