High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach.

BACKGROUND: National-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services in Nigeria using machine learning techniques. METHODS: Essential MCH services in this study included antenatal care, facility-based delivery, childhood vaccinations and treatments of childhood illnesses. We estimated generalised additive models (GAMs) and gradient boosting regressions (GB) for each essential MCH service using data from five national representative cross-sectional surveys in Nigeria from 2003 to 2018 and geospatial socioeconomic, environmental and physical characteristics. Using the best-performed model for each service, we map predicted coverage at 1 km2 and 5 km2 spatial resolutions in urban and rural areas, respectively. RESULTS: GAMs consistently outperformed GB models across a range of essential MCH services, demonstrating low systematic prediction errors. High-resolution maps revealed stark geographic disparities in MCH service coverage, especially between rural and urban areas and among different states and service types. Temporal trends indicated an overall increase in MCH service coverage from 2003 to 2018, although with variations by service type and location. Priority areas with lower coverage of both maternal and vaccination services were identified, mostly located in the northern parts of Nigeria. CONCLUSION: High-resolution spatial estimates can guide geographic prioritisation and help develop better strategies for implementation plans, allowing limited resources to be targeted to areas with lower coverage of essential MCH services.

The contribution of South Africans to the subject of dilated cardiomyopathy - with reference to : cardiovascular collagenosis with parietal endocardial thrombosis : a clinicopathologic study of forty cases.

BACKGROUND: Dilated cardiomyopathy (DCM) is a heart muscle disease that is endemic in Africa. Over the past 50 years, South African investigators have made significant contributions to scientific elucidation of the condition. The objective of this review was to summarise their research on the subject of DCM. METHODS AND RESULTS: We searched PubMed for articles originating from South Africa and focusing on DCM or the related condition, peripartum cardiomyopathy (PCM). Reference lists and prominent South African researchers on DCM were also consulted. The prevalence of DCM is comparable in magnitude to that of other endemic heart conditions such as hypertension and rheumatic heart disease, although by comparison, DCM may cause disproportionate morbidity from heart failure. In the African context, malnutrition, excessive alcohol intake, prior myocarditis and genetic make-up have been proposed as aetiologies, and some or all of these factors may play an interrelated role in individual disease expression. The pathogenesis of DCM is partially due to the mechanical effects of fibrosis, and the immune response to myocardial damage likely affects disease progression. Small trials of pentoxifylline plus conventional therapy have demonstrated a trend towards reduced mortality from heart failure. CONCLUSIONS: Despite half a century of noteworthy research, the pathogenic mechanisms of DCM are still incompletely understood. South Africans have, however, played and should continue to play a critical role in advancing research on DCM.

The Contribution of South Africans to the Subject of Dilated Cardiomyopathy

Background : Dilated cardiomyopathy (DCM) is a heart muscle disease that is endemic in Africa. Over the past 50 years; South African investigators have made significant contributions to scientific elucidation of the condition. The objective of this review was to summarise their research on the subject of DCM. Methods and results : We searched PubMed for articles originating from South Africa and focusing on DCM or the related condition; peripartum cardiomyopathy (PCM). Reference lists and prominent South African researchers on DCM were also consulted. The prevalence of DCM is comparable in magnitude to that of other endemic heart conditions such as hypertension and rheumatic heart disease; although by comparison; DCM may cause disproportionate morbidity from heart failure. In the African context; malnutrition; excessive alcohol intake; prior myocarditis and genetic make-up have been proposed as aetiologies; and some or all of these factors may play an interrelated role in individual disease expression. The pathogenesis of DCM is partially due to the mechanical effects of fibrosis; and the immune response to myocardial damage likely affects disease progression. Small trials of pentoxifylline plus conventional therapy have demonstrated a trend towards reduced mortality from heart failure. Conclusions : Despite half a century of noteworthy research; the pathogenic mechanisms of DCM are still incompletely understood. South Africans have; however; played and should continue to play a critical role in advancing research on DCM

Corynebacterium striatum: a diphtheroid with pathogenic potential.

Although nondiphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, they rarely account for clinical infection. Corynebacterium striatum has rarely been reported to be a pathogen, causing pleuropulmonary infections and bacteremia in only immunocompromised or anatomically altered patients. We noted C. striatum to be the infecting pathogen or copathogen in six patients. To our knowledge, this report describes the first cases of C. striatum causing infection of exist sites of central venous catheters, thrombophlebitis associated with central venous catheters, conjunctivitis, and chorioamnionitis as well as a possible pathogen contributing to peritonitis and pyogenic granuloma. Unlike Corynebacterium jeikeium, which is highly resistant to beta-lactam agents, aminoglycosides, and quinolones, all strains of C. striatum isolated from the patients described in this report were susceptible to vancomycin and aminoglycosides, and all strains except one were susceptible to penicillin G, imipenem, and ciprofloxacin. C. striatum should be recognized as a potential pathogen in both immunocompromised and normal hosts in the appropriate circumstances, and appropriate antimicrobial therapy can quickly lead to resolution of infection.