Improving TB case notification and treatment coverage through data use.

BACKGROUND: This was a study on national TB data. OBJECTIVE: To assess improvement in TB case notification and treatment coverage through improved data use for action in Nigeria. DESIGN: We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. RESULTS: Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (P < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (P < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (P < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020. CONCLUSION: TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.

CONTEXTE: Il s'agit d'une étude sur les données nationales relatives à la TB. OBJECTIF: Évaluer l'amélioration de la notification des cas de TB et de la couverture du traitement grâce à une meilleure utilisation des données pour l'action au Nigéria. MÉTHODE: Nous avons analysé les données du programme secondaire de lutte contre la TB avant et après l'intervention, y compris les données sur l'augmentation des visites de supervision, les mesures incitatives pour les travailleurs de la santé, l'expansion du système DOTS, les activités de proximité et la surveillance des codes géographiques. L'analyse des tendances a été réalisée à l'aide du test du χ2 de Cochran-Armitage pour les tendances linéaires. RÉSULTATS: La recherche de cas est passée de 104 904 cas en 2017 à 138 591 en 2020. On observe une augmentation de 2,0% de 2017 à 2018, de 13,0% de 2018 à 2019 et de 15,0% de 2019 à 2020 (P < 0,001). La couverture DOTS des établissements est passée de 7 389 établissements en 2017 à 17 699 en 2020. On observe une augmentation de 30,0% en 2018, 31,0% en 2019 et 40,0% en 2020 (P < 0,001). Le nombre d'installations déclarantes est passé de 5 854 en 2017 à 12 775 en 2020. Par rapport à 2017, il y a eu une augmentation de 20,0% en 2018, 38,0% en 2019 et 32,0% en 2020 (P < 0,001). Le taux de couverture du traitement est passé de 24% en 2018 à 27% en 2019 et 30% en 2020. CONCLUSION: L'expansion des services de lutte contre la TB, l'amélioration de la surveillance et l'utilisation des données pour la prise de décision sont essentielles pour augmenter la couverture du traitement de la TB.

Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective.

OBJECTIVES: Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT: All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK: Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.

Onchocerciasis among Women in a Rural Guinea Savannah Ecotype of Nigeria: Social Implications for Control

<B>Objectives:</B> The objective of the current study was investigations on the social factors affecting the control of onchocerciasis among women in an endemic savannah community.<br><B>Methods:</B> A randomized sampling of households with women above 18 years of age was conducted in a mesoendemic rural community in the Guinea savannah woodland of northern Nigeria. Two hundred and eighty women were selected randomly from fifty households. Structured questionnaires were administered to the women to solicit their socio-demographic indices. Interviews were conducted as a second exploratory approach.<br><B>Results:</B> The investigation helped these women to change their erroneous beliefs about onchocerciasis. They now perceive the disease as a grave social problem demanding urgent attention. Thirty women (14.4%) were infected with onchocercal symptoms ranging from onchodermatitis, nodules and blindness. There was an increasing prevalence of onchocerciasis with advancing age I.e women 51 years of age and above were mainly affected 17 (51%). Health care utilization was low; only one person (3.33%) had ever sought medical help. Farming was the main occupational risk. There was little knowledge regarding onchocerciasis, 60% of the women did not know the cause and most of the others cited act of God 7 (23.3%) and a sign of aging 5 (16.6%). There was however impressive knowledge of black flies and their habits. All the women were illiterate Muslims. Most of the affected women were involved in the polygamous relationship (43.3%). Health education led all of them to believe they needed treatment. Fear of neglect by husbands was the main reason for their desire for seeking treatment.<br><B>Conclusion:</B> Targeted health education, making use of visual aids should be directed at illiterate women in endemic areas of onchocerciasis. The social implication of neglect by husbands was observed as a predisposing factor that can enable future compliance to ivermectin treatment of onchocerciasis.

Incidence and pattern of injuries among residents of a rural area in South-Western Nigeria: a community-based study.

BACKGROUND: Despite the high incidence of infectious diseases in developing countries, injuries still contribute significantly to the health burden. There are few reports of rural, community-based injury surveys in Nigeria. This study describes the incidence and pattern of injuries among the residents of a rural area in South-Western Nigeria. METHODS: It was a community based cross-sectional study. Two of six census areas were randomly selected and all households in the two areas visited. Information on the sociodemographic characteristics, individual injury events and outcomes was obtained with a questionnaire. Data were analyzed using SPSS version 11. RESULTS: Information was obtained on the 1,766 persons in 395 households. Fifty-nine injuries were recorded by 54 people, giving an injury incidence of 100 per 1,000 per year (95% CI = 91.4-106.9). Injury incidence among <30 years was 81.6 per 1,000 per year (95% CI = 62.3-83.1); and 126 per 1,000 per year (95% CI = 98.2-137.4) for those > or = 30 years (p = 0.013). Injury incidence for females was 46 per 1,000 per year; and 159 per 1,000 per year (p = 0.000) for males. A significantly higher proportion of males (5%) sustained injury compared to females (2%) (p = 0.043). Falls and traffic injures, 15 (25%) each, were the leading causes of injury; followed by cuts/stabs 12 (21%), and blunt injuries, 9 (15%). Traffic injuries were the leading cause of injuries in all age groups except among the 5-14 years where falls were the leading cause of injury. In thirty-four (58%) of those injuries, treatment was at a hospital/health centre; while in two (3%), treatment was by untrained traditional practitioners. Thirty-nine (66%) of the injuries were fully recovered from, and 19 (32%) resulted in disability. There were 2 fatalities in the 5-year period, one (2%) within the study period. CONCLUSION: Injuries were common in Igbo-Ora, though resultant disability and fatality were low. Males and those aged > or = 30 years had significantly higher proportions of the injured. Falls and traffic injuries were the most commonly reported injuries. Appropriate interventions to reduce the occurrences of injuries should be instituted by the local authorities. There is also need to educate the community members on how to prevent injuries.

A peripheral site of action for the attenuation of baroflex-mediated bradycardia by intravenous mu-opioid agonists.

We previously reported that i.v. DAMGO (Tyr-D-Ala-Gly-NMePhe-Gly-ol), a selective mu-opioid agonist, causes an increase in blood pressure with no change in heart rate in unanesthetized sheep and subsequently demonstrated that DAMGO attenuates baroreflex-mediated bradycardia. To determine the site and mechanism by which mu-agonists inhibit baroreflex sensitivity, we have carried out further investigations by using DAMGO and another mu-agonist, DALDA (Tyr-D-Arg-Phe-Lys-NH2). The bradycardic response to norepinephrine (NE) was significantly blunted after i.v. DAMGO or DALDA in both nonpregnant and pregnant sheep. In contrast, the tachycardic response to sodium nitroprusside (SNP) remained unchanged in the presence of DAMGO or DALDA. In view of the highly restricted distribution of DALDA across the blood-brain barrier (BBB), we hypothesized that the blunting of reflex-mediated bradycardia by mu-opioid agonists can occur peripherally. Pretreatment with the quaternary opioid antagonist, naloxone methiodide (NM), completely blocked the attenuation of baroreflex sensitivity by DAMGO and DALDA in both nonpregnant and pregnant animals. These data suggest that in addition to central mechanisms, mu-opioid agonists can inhibit baroreflex sensitivity at a peripheral site, most likely by inhibiting vagal influence on heart-rate control rather than by acting directly at baroreceptors.

Cardiovascular effects of a mu-selective opioid agonist (tyrosine-D-arginine-phenylalanine-lysine-NH2) in fetal sheep: sites and mechanisms of action.

OBJECTIVE: We investigated the effects of DALDA (tyrosine-D-arginine-phenylalanine-lysine-NH2), a mu-selective opioid peptide, on heart rate and blood pressure in fetal sheep with long-term instrument implantation. STUDY DESIGN: DALDA was given as an intravenous bolus in doses ranging from 0.15 to 0.5 mg/kg. A 0.5 mg/kg dose of DALDA was given in the presence of the opioid antagonist naloxone and its quaternary analog naloxone methiodide (6 mg/h); it was also given in conjunction with the beta-adrenergic antagonist propranolol (2 mg/h). Statistical analyses were performed by 1-way and 2-way analysis of variance. RESULTS: The fetus responded to DALDA with an increase in heart rate with all doses (P <.01) but without any change in blood pressure. This response was abolished by naloxone (P <.001), naloxone methiodide (P =.003), and propranolol (P <.001). CONCLUSIONS: In the fetus intravenous DALDA increases heart rate without any change in blood pressure by way of the mu receptor and through central sympathetic activation. These effects of DALDA are different from those seen in the adult, suggesting different sites and mechanisms of action.

Baroreflex-mediated bradycardia but not tachycardia is blunted peripherally by intravenous mu-opioid agonists.

OBJECTIVE: We sought to test the hypothesis that an intravenous dose of H-Tyr-D-Arg-Phe-Lys-NH2, a highly mu-receptor selective opioid peptide, suppresses baroreflex sensitivity through a peripheral mechanism. STUDY DESIGN: A transient change in mean arterial pressure was produced in chronically instrumented pregnant ewes by norepinephrine or sodium nitroprusside in the absence or in the presence of H-Tyr-D-Arg-Phe-Lys-NH2, a highly mu-selective opioid peptide. In some studies naloxone methiodide, a peripheral opioid antagonist, was infused starting 60 minutes before the administration of H-Tyr-D-Arg-Phe-Lys-NH2 and maintained for a total of 90 minutes. Linear plots were obtained when the changes in mean arterial pressure during the pressure rise were plotted against the changes in heart rate and the sensitivity of the baroreflex was derived as the slope of the linear regression line. RESULTS: We observed (1) lower baroreflex sensitivity after H-Tyr-D-Arg-Phe-Lys-NH2 administration with a hypertensive stimulus; (2) unchanged baroreflex sensitivity after H-Tyr-D-Arg-Phe-Lys-NH2 administration with a hypotensive stimulus; and (3) unchanged baroreflex sensitivity after H-Tyr-D-Arg-Phe-Lys-NH2 administration with a hypertensive stimulus in the presence of naloxone methiodide. CONCLUSION: H-Tyr-D-Arg-Phe-Lys-NH2 suppresses the hypertensive but not the hypotensive arm of the baroreflex through peripheral opioid receptors. These results suggest that mu-opioid receptors are present in the vagus nerves and that the activation of these opioid receptors inhibits reflex bradycardia in pregnant sheep.

Baroreflex-mediated bradycardia is blunted by intravenous mu- but not kappa-opioid agonists.

To assess the cardiovascular effects of systemically administered opioid agonists, changes in blood pressure and heart rate were observed after intravenous (i.v.) administration of U50,488H (trans-3,4-dichloro-N-[2-(1-pyrrolidinyl) cyclohexyl]benzeneacetamide), a selective kappa-opioid receptor agonist, and DAMGO (D-Ala2, N-Me-Phe4, Gly5-ol), a selective mu-opioid-receptor agonist. Intravenous administration of U50,488H (1.2 mg/kg) and DAMGO (0.3 mg/kg) to the awake sheep resulted in an immediate increase in blood pressure. The pressor response to U50,488H was accompanied by an increase in heart rate. In contrast, there was no accompanying change in heart rate in response to DAMGO. We hypothesized that the lack of a reflex bradycardia to the pressor responses of both the mu- and kappa-opioid-receptor agonists was due to a blunting of baroreflex-mediated bradycardia. The reflex bradycardia to norepinephrine (0.6 microg/kg/min) was significantly reduced in the presence of DAMGO but not U50,488H. In view of the lack of effect of U50,488H on the baroreflex, we further hypothesized that the tachycardia it elicited was due to an increase in sympathetic activity. Pretreatment with propranolol (0.1 mg/kg) completely blocked the tachycardia elicited by U50,488H. These data suggest that the lack of a reflex bradycardia to the pressor response of DAMGO is due to a blunting of baroreflex-mediated bradycardia. In contrast, the increase in heart rate caused by U50,488H is mediated by sympathetic activation of the heart.

Cardiovascular and metabolic responses to two receptor-selective opioid agonists in pregnant sheep.

OBJECTIVE: Our purpose was to assess the effects of an intravenous dose of a highly selective mu-(DALDA) and delta-(DPDPE) opioid peptide to determine which class of peptide has the best clinical potential. STUDY DESIGN: Chronically instrumented pregnant ewes received a 0.3 mg/kg intravenous bolus of each peptide with and without opioid receptor blockade by means of a randomized prospective design. RESULTS: Intravenous DALDA produced only mild hypertension and a loss of heart rate variability, whereas DPDPE produced respiratory depression, maternal hypertension, and a fall in heart rate in both mother and fetus. Uterine blood flow, oxygen uptake, and glucose uptake were unchanged with both drugs. The effects of DALDA but not DPDPE were reversed by opioid receptor blockade. CONCLUSION: The delta-selective agonist had multiple nonopioid adverse effects, whereas the mu-selective agonist was well tolerated by the pregnant ewe, suggesting that mu-selective agonists have better potential for clinical use as an analgesic in pregnancy.

Unmasking of activated histamine H3-receptors in myocardial ischemia: their role as regulators of exocytotic norepinephrine release.

We had previously found that histamine H3- receptors are negatively coupled to norepinephrine exocytosis in atrial tissue. We report here that in the presence of H1- and H2- receptor blockers, histamine significantly inhibits the tachycardia and norepinephrine release elicited by sympathetic nerve stimulation is isolated guinea pig hearts, an effect prevented by the H3 antagonist, thioperamide. Sympathetic nerve stimulation also caused a 1.5-fold increase in histamine overflow, which was insufficient to activate H3 receptors because thioperamide affected neither the tachycardia nor the norepinephrine release. Hence. We questioned whether H3 receptors become activated when adrenergic activity is greatly enhanced, as in myocardial ischemia. Guinea pig hearts underwent 10-min global ischemia. At reperfusion, norepinephrine exocytosis was markedly augmented and was associated with a 3.5-fold increase in histamine overflow. (R)alpha-methylhistamine, an H3 agonist, did not modify norepinephrine release, whereas thioperamide doubled it. Thus, in physiologic conditions, cardiac H3 receptors are quiescent, yet available for activation by exogenous ligands. In contrast, in the ischemic myocardium, H3 receptors appear to be fully activated by an endogenous ligand, probably histamine. Hence, cardiac H3 receptors may play an important role by negatively modulating exocytotic norepinephrine release associated with ischemic states.