Pattern and Management of Missile Injury to the Oral and Maxillofacial Region: A 12-Year Experience During Boko Haram Insurgency in Maiduguri, North-Eastern Nigeria.

Introduction: Missile injury is a global public health problem, which occurs in both military and civilian settings. Boko Haram insurgency in North-Eastern Nigeria is one of the major violence the country experienced that resulted in many civilian casualties. This study was aimed at exploring the various patterns of the missile injuries to the maxillofacial region during Boko Haram insurgency. Methods: In this retrospective cross-sectional study, relevant information was retrieved from patient records including sociodemographic, causes of missile injuries, site of injuries, pattern of presentation, treatment, and the complications, and analysed using SPSS version 23. Result: A total of 526 patients with various maxillofacial injuries were seen during this 12-year study period, with age ranging from 4 to 65 years, the peak incidence in the age group 31-40 years, 89.5% were males, 92.9% of the injuries were allegedly inflicted by insurgents and comprised of 61.0% gunshot injuries, 24.5% bomb blast, and machete cuts 7.4%. Most of the injuries occurred in the lower third of the face, 39.8%, and mandible was the commonest fractured facial bone. Conclusion: Facial injuries commonly are associated with devastating consequences to survivors and, hence, may require long time monitoring and psychosocial rehabilitations.

Correction: Effectiveness of a monthly schedule of follow-up for the treatment of uncomplicated severe acute malnutrition in Sokoto, Nigeria: A cluster randomized crossover trial.

[This corrects the article DOI: 10.1371/journal.pmed.1003923.].

Datasets for a multidimensional analysis connecting clean energy access and social development in sub-Saharan Africa.

In this article we present datasets used for the construction of a composite indicator, the Social Clean Energy Access (Social CEA) Index, presented in detail in [1]. This article consists of comprehensive social development data related to electricity access, collected from several sources, and processed according to the methodology described in [1]. The new composite index includs 24 indicators capturing the status of the social dimensions related to electricity access for 35 SSA countries. The development of the Social CEA Index was supported by an extensive review of the literature about electricity access and social development which led to the selection of its indicators. The structure was evaluated for its soundness using correlational assessments and principal component analyses. The raw data provided allow stakeholders to focus on specific country indicators and to observe how scores on these indicators contributed to a country overall rank. The Social CEA Index also allows to understand the number of best performing countries (out of a total of 35) for each indicator. This allows different stakeholders to identify which the weakest dimensions are of social development and thus help in addressing priorities for action for funding towards specific electrification projects. The data can be used to assign weights according to stakeholders' specific requirements. Finally, the dataset can be used for the case of Ghana to monitor the Social CEA Index progress over time through a dimension's breakdown approach.

Insecticide susceptibility status in two medically important mosquito vectors, Anopheles gambiae, and Culex quinquefasciatus to three insecticides commonly used in Niger State, Nigeria.

High resistance ability on insecticides among major mosquito vectors of diseases in Nigeria is of growing concern for severe control strategies. The objective of this study was to assess the susceptibility status of females Anopheles gambiae and Culex quinquefasciatus complexes mosquitoes to permethrin (21.5 µg/bottle-pyrethroids), propoxur(12.5 µg/bottle-carbamate) and malathion (50 µg/bottle organophosphate), in Niger State, North-Central, Nigeria. Anopheline and Culecine larvae were collected from the larval habitats of the studied sites (Bosso, Katcha, Lapai, and Shiroro) larvae and pupae were identified guided by standard keys and reared to adults in troughs. Insecticide susceptibility bioassays were performed according to the CDC bottle bioassay standard operating procedures on 3 days old, sugar-fed female Anopheles and Culex mosquitoes. Post-exposure mortality after 24hr and knockdown values for KDT50 were calculated. Knock-down at 1-hour insecticide exposure ranged (84-96 %) permethrin, (94-100 %) propoxur and (100 %) malathion for An. gambiae and (86-97 %) permethrin, (92-100 %) propoxur and (96-100 %) malathion for Cx. quinquefasciatus. Mortality, after 24hr post-exposure was 100 % in malathion, indicating the high effect of the insecticide. Tested samples were found potentially resistant to permethrin recorded against mosquitoes collected from all study sites, in two locations of the study sites to propoxur and one location site to malathion. All the tested mosquitoes were found to be potentially resistant to permethrin, however, mosquitoes tested in Katcha and Shiroro resist potentially to propoxur. Except, Culex quinqufasciatus from Lapai that partially resist malathion, all the tested mosquitoes were found to be susceptible to malathion, across the study sites.

Effectiveness of a monthly schedule of follow-up for the treatment of uncomplicated severe acute malnutrition in Sokoto, Nigeria: A cluster randomized crossover trial.

BACKGROUND: Community-based management of severe acute malnutrition (SAM) involves weekly or biweekly outpatient clinic visits for clinical surveillance and distribution of therapeutic foods. Distance to outpatient clinics and high opportunity costs for caregivers can represent major barriers to access. Reducing the frequency of outpatient visits while providing training to caregivers to recognize clinical danger signs at home between outpatient visits may increase acceptability, coverage, and public health impact of SAM treatment. We investigated the effectiveness of monthly clinic visits compared to the standard weekly follow-up in the outpatient treatment of uncomplicated SAM in northwestern Nigeria. METHODS AND FINDINGS: We conducted a cluster randomized crossover trial to test the noninferiority of nutritional recovery in children with uncomplicated SAM receiving monthly follow-up compared to the standard weekly schedule. From January 2018 to November 2019, 3,945 children aged 6 to 59 months were enrolled at 10 health centers (5 assigned to monthly follow-up and 5 assigned to weekly follow-up) in Sokoto, Nigeria. In total, 96% of children (n = 1,976 in the monthly follow-up group and 1,802 in the weekly follow-up group) were followed until program discharge, and 91% (n = 1,873 in the monthly follow-up group and 1,721 in the weekly follow-up group) were followed to 3 months postdischarge. The mean age at admission was 15.8 months (standard deviation [SD] 7.1), 2,097/3,945 (53.2%) were girls, and the mean midupper arm circumference (MUAC) at admission was 105.8 mm (SD 6.0). In a modified intention-to-treat analysis, the primary outcome of nutritional recovery, defined as having MUAC ≥125 mm on 2 consecutive visits, was analyzed using generalized linear models, with generalized estimating equations to account for clustering. Nutritional recovery was lower in the monthly follow-up group compared to the weekly group (1,036/1,976, 52.4% versus 1,059/1,802, 58.8%; risk difference: -6.8%), and noninferiority was not demonstrated (lower bound of the confidence interval [CI] was -11.5%, lower than the noninferiority margin of 10%). The proportion of children defaulting was lower in the monthly group than in the weekly group (109/1,976, 5.5% versus 151/1,802, 8.4%, p = 0.03). Three months postdischarge, children in the monthly group were less likely to relapse compared to those in the weekly group (58/976, 5.9% versus 78/1,005, 7.8%, p = 0.03), but cumulative mortality at 3 months postdischarge was higher in the monthly group (159/1,873, 8.5% versus 106/1,721, 6.2%, p < 0.001). Study results may depend on context-specific factors including baseline level of care and the clinical status of children presenting to health centers, and, thus, generalizability of these results may be limited. CONCLUSIONS: Where feasible, a weekly schedule of clinic visits should be preferred to maintain effectiveness of SAM treatment. Where geographic coverage of programs is low or frequent travel to outpatient clinics is difficult or impossible, a monthly schedule of visits may provide an alternative model to deliver treatment to those in need. Modifications to the outpatient follow-up schedule, for example, weekly clinic visits until initial weight gain has been achieved followed by monthly visits, could increase the effectiveness of the model and add flexibility for program delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT03140904.

Cost-effectiveness of monthly follow-up for the treatment of uncomplicated severe acute malnutrition: An economic evaluation of a randomized controlled trial.

Severe acute malnutrition (SAM) is a major source of mortality for children in low resource settings. Alternative treatment models that improve acceptability and reduce caregiver burden are needed to improve treatment access. We assessed costs and cost-effectiveness of monthly vs. weekly follow-up (standard-of-care) for treating uncomplicated SAM in children 6-59 months of age. To do so, we conducted a cost-effectiveness analysis of a cluster-randomized trial of treatment for newly-diagnosed uncomplicated SAM in northwestern Nigeria (clinicaltrials.gov ID NCT03140904). We collected empirical costing data from enrollment up to 3 months post-discharge. We quantified health outcomes as the fraction of children recovered at discharge (primary cost-effectiveness outcome), the fraction recovered 3 months post-discharge, and total DALYs due to acute malnutrition. We estimated cost-effectiveness from both provider and societal perspectives. Costs are reported in 2019 US dollars. Provider costs per child were $67.07 (95% confidence interval: $64.79, $69.29) under standard-of-care, and $78.74 ($77.06, $80.66) under monthly follow-up. Patient costs per child were $21.04 ($18.18, $23.51) under standard-of-care, and $14.16 ($12.79, $15.25) under monthly follow-up. Monthly follow-up performed worse than standard-of-care for each health outcome assessed and was dominated (produced worse health outcomes at higher cost) by the standard-of-care in cost-effectiveness analyses. This result was robust to statistical uncertainty and to alternative costing assumptions. These findings provide evidence against monthly follow-up for treatment of uncomplicated SAM in situations where weekly follow-up of patients is feasible. While monthly follow-up may reduce burdens on caregivers and providers, other approaches are needed to do so while maintaining the effectiveness of care.

Optimization and blends study of heterogeneous acid catalyst-assisted esterification of palm oil industry by-product for biodiesel production.

The optimum conditions to produce palm fatty acid distillate (PFAD)-derived-methyl esters via esterification have been demonstrated with the aid of the response surface methodology (RSM) with central composite rotatable design in the presence of heterogeneous acid catalyst. The effect of four reaction variables, reaction time (30-110 min), reaction temperature (30-70°C), catalyst concentration (1-3 wt.%) and methanol : PFAD molar ratio (3 : 1-11 : 1), were investigated. The reaction time had the most influence on the yield response, while the interaction between the reaction time and the catalyst concentration, with an F-value of 95.61, contributed the most to the esterification reaction. The model had an R 2-value of 0.9855, suggesting a fit model, which gave a maximum yield of 95%. The fuel properties of produced PFAD methyl ester were appraised based on the acid value, iodine value, cloud and pour points, flash point, kinematic viscosity, density, ash and water contents and were compared with biodiesel EN 14214 and ASTM D-6751 standard limits. The PFAD methyl ester was further blended with petro-diesel from B0, B3, B5, B10, B20 and B100, on a volumetric basis. The blends were characterized by TGA, DTG and FTIR. With an acid value of 0.42 (mg KOH g-1), iodine value of 63 (g.I2/100 g), kinematic viscosity of 4.31 (mm2 s-1), the PFAD methyl ester has shown good fuel potential, as all of its fuel properties were within the permissible international standards for biodiesel.