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1.
Vaccine ; 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33461831

RESUMO

BACKGROUND: Despite the enormous resources committed to the implementation of supplemental immunisation activities in Nigeria, achieving the required coverage (post-campaign survey) to halt the transmission of vaccine-preventable diseases has continued to seem like an impossibility. A vast volume of data is generated and transmitted during mass vaccination campaigns, but this administrative data does not always culminate into improved coverage. The absence of data-informed guidance from stakeholders with long years of experience in planning and implementing mass vaccination campaigns has impeded achieving 95% coverage in measles campaigns in Nigeria. This study reviews the use of data to guide the implementation of the 2017/2018 measles vaccination campaign in Nigeria. METHODS: A central coordinating body was formed at the national level with the same replicated in every state. Tools were developed to measure the performance of the different phases and activities required for the implementation of a mass vaccination campaign as recommended in the international guidelines. Stakeholders were engaged to help ensure that feedback provided by the national measles technical coordinating committee was implemented at the lower level. RESULTS: Monitoring and analysis of daily data submission caused a proper spread of senior supervisors, vaccination posts location during the campaign and helped identify areas targeted for mop-up. Although the verification of states' microplan increased the operational target population by 11.2%, the process aided the distribution of resources as appropriate. Maps showing the likely areas that needed additional effort to achieve required coverage with recommendation on the necessary approach to be deployed were transmitted to the states implementing the campaign. CONCLUSION: The improvement in the use of data to guide implementation of the Nigeria 2017/2018 measles vaccination campaign caused an increase in the number of states that achieved higher coverage in the post-campaign coverage survey.

2.
Vaccine ; 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33461836

RESUMO

BACKGROUND: Measles is a highly infectious disease with great burden and implication on a displaced population with low immunity status. The disease can cause up to 140,000 deaths annually. Internal displacement during supplemental immunization activities often affects optimal reach and coverage of the campaign as people move and implementation and logistic plans are usually disrupted with attendant missed children. This study documented the process of extension of the measles vaccination campaign (MVC) 2018 for five internally displaced persons (IDPs) camps in Benue state, not previously in the microplan, to increase population herd immunity. METHODS: We obtained population figures and disease surveillance data for five IDPs camps and used it to conduct detailed microplanning to determine the requirement for the conduct of additional days of measles vaccination. Vaccination teams used fixed posts in the camps and temporary posts strategy in designated locations in the host communities. RESULTS: The estimated total population of the IDPs was 170,000 with MVC target population of 9374 which was not earlier planned for. There was reported measles outbreaks in IDP camps in both Guma and Makurdi Local Government areas (LGAs) during period of displacement. Microplans requirement determined 10,421 bundled measles vaccine, 30 health workers, 5 vehicles and 15 motorcycles. A total of 7679 out of 9374 (81.9%) of the eligible children aged 9-59 months were vaccinated during the 3 days of the campaign. CONCLUSION: Non-inclusion of plans on internally displaced population in supplemental immunization activities (SIAs) microplans have a potential risk of vaccine preventable diseases (VPDs) outbreak. Future Measles Vaccination campaigns should take cognizance of internal displacement due to insecurity and other humanitarian emergencies.

3.
Vaccine ; 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33451781

RESUMO

BACKGROUND: Immunisation activities generate sharps and infectious non-sharp waste that have harmful impact on the community and health care workers if disposed of improperly, leading to carbon mono oxide (CO) emissions which contribute to global warming. Health care waste is not effectively managed, especially in some developing countries. However, measles supplemental immunisation activities (SIAs) are used to strengthen routine immunisation system, including waste management. The waste management planning provides an opportunity to build capacity, mobilize resources and strengthen structures to ensure continual disposal of routine immunisation waste. METHODS: We reviewed the Kebbi State and LGA routine immunisation waste management situation and identified existing gaps; developed and implemented the plan for waste management, including strengthening routine immunisation waste management. The process included, reactivation of measles technical coordination committee, mobilizing resources for funding, and sustenance of immunisation waste management. The health care workforce was trained in safe immunisation waste disposal practices. RESULTS: Immunisation waste management committee and the structure was established and strengthened at the state and LGA levels and a total cost of 11,710.70 USD was expended on injection waste management, with an average cost per injection of 0.01 USD. A total of 11,829 safety boxes were incinerated in the state, including those generated from routine immunisation sessions. Twenty-one Local Immunisation Officers, 1097 and 2192 team supervisors and healthcare worker vaccinators respectively were trained on immunisation waste disposal. CONCLUSION: Immunisation waste management strategies protect healthcare workers and reduce the adverse impact on the environment. Improving key areas such as human and financial resources ensures accountability towards sustainable healthcare waste management.

4.
BMJ Glob Health ; 5(10)2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33051282

RESUMO

Public health emergency (PHE) response in sub-Saharan Africa is constrained by inadequate skilled public health workforce and underfunding. Since 2005, the African Field Epidemiology Network (AFENET) has been supporting field epidemiology capacity development and innovative strategies are required to use this workforce. In 2018, AFENET launched a continental rapid response team: the AFENET Corps of Disease Detectives (ACoDD). ACoDD comprises field epidemiology graduates and residents and was established to support PHE response. Since 2018, AFENET has deployed the ACoDD to support response to several PHEs. The main challenges faced during ACoDD deployments were financing of operations, ACoDD safety and security, resistance to interventions and distrust of the responders by some communities. Our experience during these deployments showed that it was feasible to mobilise and deploy ACoDD within 48 hours. However, the sustainability of deployments will depend on establishing strong linkages with the employers of ACoDD members. PHEs are effectively controlled when there is a fast deployment and strong linkages between the stakeholders. There are ongoing efforts to strengthen PHE preparedness and response in sub-Saharan Africa. ACoDD members are a competent workforce that can effectively augment PHE response. ACoDD teams mentored front-line health workers and community health workers who are critical in PHE response. Public health emergence response in sub-Saharan Africa is constrained by inadequacies in a skilled workforce and underfunding. ACoDD can be utilised to overcome the challenges of accessing a skilled public health workforce. To improve health security in sub-Saharan Africa, more financing of PHE response is needed.

5.
Pan Afr Med J ; 36: 127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32849982

RESUMO

Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. Results: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.


Assuntos
Cólera/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças , População Urbana , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Saneamento/normas , Adulto Jovem
6.
BMC Public Health ; 20(1): 600, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357933

RESUMO

BACKGROUND: Integrated disease surveillance and response (IDSR) is the strategy adopted for public health surveillance in Nigeria. IDSR has been operational in Nigeria since 2001 but the functionality varies from state to state. The outbreaks of cerebrospinal meningitis and cholera in 2017 indicated weakness in the functionality of the system. A rapid assessment of the IDSR was conducted in three northeastern states to identify and address gaps to strengthen the system. METHOD: The survey was conducted at the state and local government areas using standard IDSR assessment tools which were adapted to the Nigerian context. Checklists were used to extract data from reports and records on resources and tools for implementation of IDSR. Questionnaires were used to interview respondents on their capacities to implement IDSR. Quantitative data were entered into an MS Excel spreadsheet, analysed and presented in proportions. Qualitative data were summarised and reported by thematic area. RESULTS: A total of 34 respondents participated in the rapid survey from six health facilities and six local government areas (LGAs). Of the 2598 health facilities in the three states, only 606 (23%) were involved in reporting IDSR. The standard case definitions were available in all state and LGA offices and health facilities visited. Only 41 (63%) and 31 (47.7%) of the LGAs in the three states had rapid response teams and epidemic preparedness and response committees respectively. The Disease Surveillance and Notification Officers (DSNOs) and clinicians' knowledge were limited to only timeliness and completeness among over 10 core indicators for IDSR. Review of the facility registers revealed many missing variables; the commonly missed variables were patients' age, sex, diagnosis and laboratory results. CONCLUSIONS: The major gaps were poor documentation of patients' data in the facility registers, inadequate reporting tools, limited participation of health facilities in IDSR and limited capacities of personnel to identify, report IDSR priority diseases, analyze and interpret IDSR data for decision making. Training of surveillance focal persons, provision of IDSR reporting tools and effective supportive supervisions will strengthen the system in the country.


Assuntos
Controle de Doenças Transmissíveis/métodos , Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Epidemias/prevenção & controle , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Vigilância da População/métodos , Vigilância em Saúde Pública/métodos , Humanos , Nigéria , Inquéritos e Questionários
7.
AIDS Behav ; 24(10): 2935-2941, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32300990

RESUMO

Couple HIV counseling and testing (CHCT) is key in preventing heterosexual HIV transmission and achievement of 90-90-90 UNAIDS treatment targets by 2020. We conducted secondary data analysis to assess utilization of CHCT and associated factors using logistic regression. 58/134 participants (49%) had ever utilized CHCT. Disclosure of individual HIV results to a partner [aOR = 16; 95% CI: (3.6-67)], residence for > 1 < 5 years [aOR = 0.04; 95% CI (0.005-0.33)], and none mobility [aOR = 3.6; 95% CI (1.1-12)] were significantly associated with CHCT. Age modified relationship between CHCT and disclosure (Likelihood-ratio test LR chi2 = 4.2 (p value = 0.041). Disclosure of individual HIV results with a partner and residence for more than 1 year improved utilization of CHCT; mobility reduced the odds of CHCT. Interventions should target prior discussion of individual HIV results among couples and mobile populations to increase CHCT.


Assuntos
Aconselhamento/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Programas de Rastreamento/psicologia , Parceiros Sexuais/psicologia , Cônjuges/psicologia , Adolescente , Adulto , Aconselhamento/métodos , Estudos Transversais , Medo , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estigma Social , Revelação da Verdade , Uganda/epidemiologia , Adulto Jovem
8.
Pan Afr Med J ; 33: 208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692729

RESUMO

The Mozambican Field Epidemiology and Laboratory Training Program (Moz-FELTP) is a two-year, competency-based post-graduate training and service program designed to build sustainable public health capacity in applied epidemiology. Despite the efforts, Moz-FELTP residents have historically difficulty to publishing their work for a variety of reasons that includes language barriers, lack of writing skills and motivation, limited budgetary support and lack of effective mentorship. This outline the need for different approaches to continuous improving the publication, such scientific writing mentorship for non-English FELTP residents.


Assuntos
Epidemiologia/educação , Idioma , Editoração/estatística & dados numéricos , Pesquisa/educação , Educação Baseada em Competências , Humanos , Laboratórios , Mentores , Moçambique , Publicações Periódicas como Assunto/estatística & dados numéricos , Saúde Pública
9.
Pan Afr Med J ; 33(Suppl 2): 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404295

RESUMO

Introduction: Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods: Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results: Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion: Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.


Assuntos
Fortalecimento Institucional , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Laboratórios/organização & administração , Técnicas de Laboratório Clínico , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Libéria/epidemiologia
10.
BMC Infect Dis ; 19(1): 746, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455256

RESUMO

BACKGROUND: Antimicrobial resistance is one of the most serious public health threats of the twenty-first century. The implementation of AMR surveillance in Zimbabwe is limited. However, data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (i.e., from 73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that Zimbabwe is affected by AMR. This study was done to determine the magnitude of AMR in Harare and determine the trends of AMR to first-line and to last-resort antibiotics and make recommendations to mitigate the problem. METHODS: A retrospective record review of data collected from the microbiology department at a private laboratory between January 2012 and December 2017 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates. Microsoft Excel 2016 was used to plot trends from 2012 to 2017 and Epi Info™7 was used for statistical analysis. RESULTS: A total of 23,432 isolates, of 12 medically important bacteria were analysed. Forty-three percent of the isolates were from urines, 36.7% were from pus swabs and 7% were from blood. The most common pathogen was Escherichia coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoea (0.2%). Resistance was highest to ampicillin followed by penicillin, both ranging between 70 and 100% over the six years. Statistically significant increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant E. coli and Streptococcus pneumonia and third generation cephalosporin-resistant E. coli. There was an increase in resistance to last-line antibiotics i.e., fluoroquinolone-resistant Salmonella spp. and carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, methicillin-resistant S. aureus showed a decreasing trend. CONCLUSIONS: There is a high burden of drug resistance to common antibiotics in Harare and an emergence of resistance to last-line antibiotics.


Assuntos
Bactérias/efeitos dos fármacos , Infecções Bacterianas/microbiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Ampicilina/farmacologia , Antibacterianos/farmacologia , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Cefalosporinas/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Zimbábue/epidemiologia
11.
BMC Health Serv Res ; 19(1): 454, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277655

RESUMO

BACKGROUND: Visual inspection with acetic acid and cervicography (VIAC) is a method used to screen for cervical cancer. VIAC can be used as part of a "see and treat" strategy. Nine Harare city council health facilities offer VIAC free of charge with the aim of reducing morbidity and mortality from cervical cancer. Between 2014 and 2016, the number of women utilising VIAC dropped by 35%. We analysed records of clients who utilise VIAC at Harare city health facilities to characterise women accessing VIAC and their outcomes to make recommendations for improving the services. METHODS: We conducted a descriptive cross-sectional study using data collected for the Harare city VIAC program. We analysed all records of clients who utilised VIAC services at nine Harare city health facilities from 1 May 2012 to 31 December 2016. RESULTS: We analysed 46,217 records, the median age of the clients was 34 years [Q1 = 27: Q3 = 42]. Of the 46,217 clients screened, 3001 (6.5%) were VIAC positive, and 512 (1.1%) had suspicious of cancer lesions. The prevalence of VIAC positive ranged from 58 to 74 per 1000-screened clients over the 5 years. The prevalence of suspected cancer ranged from 9 to 14 per 1000-screened clients, and there was a general decrease in the prevalence between 2012 and 2016. Of the 3513 clients with VIAC positive or had suspicious of cancer lesions, 2090 (74.1%) did not receive treatment at the site where the screening took place. CONCLUSION: The majority of women who are accessing VIAC services in Harare are middle-aged, multiparous and married women. There is a treatment gap at most of the VIAC centres such that clients are referred to other centres for management. The objective of "see and treat" is not being realised.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Estudos Transversais , Análise de Dados , Assistência à Saúde , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem , Zimbábue/epidemiologia
12.
BMJ Glob Health ; 4(4): e001427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354972

RESUMO

In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.

13.
Pan Afr Med J ; 32: 61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223353

RESUMO

Introduction: globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. Methods: a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. Results: we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). Conclusion: the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cachimbos de Água/estatística & dados numéricos , Fumar/epidemiologia , Tabaco , Adolescente , Adulto , Cidades , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Uganda/epidemiologia , Adulto Jovem
14.
Pan Afr Med J ; 32(Suppl 1): 9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949284

RESUMO

Introduction: Despite the availability of vaccines, pertussis outbreaks still occur in developing countries. In December 2015 we investigated a pertussis outbreak in Kaltungo, Nigeria to identify determinants of infection and institute control measures. Methods: We enrolled 155 cases and 310 unmatched controls. We defined cases as residents of Kaltungo with paroxysmal or whooping cough lasting 2 weeks with or without vomiting and randomly selected neighborhood controls. Using structured questionnaire, we collected data on socio-demographics, clinical and risk factors. We collected twelve nasopharyngeal swabs for laboratory analysis using Polymerase Chain Reaction. Results: Median age was 24 months (range 1-132 months) for cases and 27 months (range 1-189 months) for controls. Female cases and controls were 86 (55.5%) and 150 (48.4%) respectively. A total of 83 (56.6%) cases were in age group 12-59 months. Age-specific-attack-rate was 83/1,786 (4.7%); Age-specific-case-fatality-rate was 21/83 (25.3%); Age-specific-proportional-mortality-ratio was 21/24 (87.5%). A total of 61 (39.4%) zero doses and 30.1% Pentavalent dropouts were documented. Multivariate analysis revealed parental refusal (adjusted OR = 27.8; CI = 8.8-87.7), contact with a case (AOR = 7.9, CI = 4.3-14.7, P = 0.000), belonging to the Muslim faith (AOR = 2.0; CI = 1.1-3.5) and having mothers with informal education only (AOR = 4.7, CI-2.6-8.4) as independent predictors of pertussis infection. Conclusion: Sub-optimal vaccination due to parental refusal and informal education of mothers were major determinants of pertussis infection. We conducted awareness campaigns of key immunization messages targeted at the informal education sector. We ensured appropriate case management, contact vaccination and health education in public gatherings, worship places and schools.


Assuntos
Surtos de Doenças , Vacina contra Coqueluche/administração & dosagem , Cobertura Vacinal , Coqueluche/epidemiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Escolaridade , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Nigéria/epidemiologia , Fatores de Risco , Inquéritos e Questionários , Vacinação/estatística & dados numéricos , Recusa de Vacinação/estatística & dados numéricos , Coqueluche/prevenção & controle
15.
Pan Afr Med J ; 32(Suppl 1): 12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949286

RESUMO

Introduction: Road traffic accidents are leading cause of injuries and deaths globally. Low income economies are the most affected. Most causes of RTA are predictable and preventable. This study describes trends and causes of road traffic accidents in Anambra State, South Eastern Nigeria. Methods: We conducted a retrospective study of road traffic accidents from 2010 to 2014. Data were obtained from the Federal Road Safety Commission, Anambra State Command. Information extracted included sex, age, cause of accidents, number of people and type of vehicles involved. Cases were recorded as fatal if any victim died, serious if any victim was hospitalized for more than 24 hours and minor if any victim was hospitalized for less than 24 hours. Causes of accidents were classified into human, mechanical, and climatic factors. Univariate analysis to generate frequencies and proportions was conducted using Microsoft Office Excel 2007. Results: A total of 1,141 road traffic accidents consisting 271 fatalities, 652 serious and 218 minor cases were recorded in Anambra State from 2010-2014. Seven thousand, four hundred and forty-four persons involving 1,816 vehicles were involved in RTA that resulted in 448 deaths and 2,785 injuries. More deaths 348 (77%) and injuries 2009 (72%) occurred more in males than females. Major causes of road traffic accidents were loss of vehicle control 256 (17%) and speed violation 207 (14%). There was an increased number of persons involved in RTA in 2014 (1,842) compared with 2010 (299). In all, 3,233 casualties (deaths and injuries) and crashes (fatal, serious and minor) were recorded out of which 900 (27.8%) casualties and 294 (9.1%) crashes occurred in 2013. Conclusion: Leading causes of road traffic accidents are human factors; speed violation, loss of vehicle control and dangerous driving which are sadly preventable. Sensitization and enforcement of safe road principles among commercial vehicles and car drivers will help curb this menace. Government at all levels should implement strong policies aimed at reducing the speed of vehicles on roads.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/tendências , Adulto , Condução de Veículo/normas , Criança , Feminino , Hospitalização/tendências , Humanos , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos
16.
Pan Afr Med J ; 32(Suppl 1): 14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949288

RESUMO

Introduction: Intimate Partner Violence (IPV) is an under-reported public health problem. This study determined the prevalence of IPV and types of IPV, complications and factors associated with IPV among women accessing health services. Methods: we conducted a cross-sectional survey of 702 women accessing maternal and child health services in Enugu State, Nigeria using multi-stage sampling technique. Quantitative data was collected using semi-structured questionnaire, qualitative data by key informant interview (KII). We analysed data using descriptive statistics, bivariate and multivariate logistic regression analysis. The level of statistical significance was set at p-value < 0.05. Qualitative data was analysed using thematic content analysis. Results: mean age of respondents was 27.71 ± 5.14 years and 654 (93.2%) were married. Prevalence of IPV, a year before last pregnancy, was 307 (43.7%) and during last pregnancy was 261 (37.2%). Frequent involvement in physical fights with other men, controlling behaviour and younger aged partners (< 40 years) were independent predictors of IPV experience both before and during pregnancy. Independent predictors of IPV experience before and during pregnancy were younger aged partners (< 40 years). [Adjusted Odds Ratio AOR 1.72; 95% confidence interval (CI) = 1.17, 2.53], partner having controlling behaviour AOR 2.24; 95% C.I=1.51-3.32) and Partner's frequent involvement in physical fights (AOR 2.29; 95% C.I = 1.43-3.66). Having a male child and married/cohabiting were protective against violence. KII revealed poverty, lack of education and infidelity as common triggers of IPV. Conclusion: the prevalence of IPV and types of IPV was high and the predisposing factors of IPV in Enugu were multifactorial. Couple counselling sessions that focus on non-violence conflict resolution techniques is crucial to end IPV.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Parceiros Sexuais , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Análise Multivariada , Nigéria/epidemiologia , Gravidez , Prevalência , Fatores de Proteção , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
17.
Pan Afr Med J ; 32(Suppl 1): 3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984325

RESUMO

Introduction: Treatment success requires both a sustainable supply of Antiretroviral Therapy (ART) to clinics and lifelong adherence to treatment by patients. Poor adherence to medication may lead to treatment failure as a result of developing HIV resistance strains. Based on WHO 2014 guideline, over 26 million people will be additionally enrolled globally. Optimal treatment requires identification of patients with suboptimal adherence for targeted intervention. The aim of the study was to determine the predictors of non-adherence to ART. Methods: An unmatched 1:2 case-control study with 68 cases using simple random sampling. A case was defined as an ART patient who failed to achieve increase in CD4 count of 100cell/mm3 in one year. Controls are those with adequate immunological response. Questionnaires were administered for socio-demographic and adherence-related information. Bivariate and multivariable logistic regression was done using Epi Info at 95% Confidence Interval (CI) and precision of 5%. Results: A total of 204 patients were enrolled, mean age of cases was 36 (Standard Deviation Sd=8.8), n=68 and controls 37 (Sd=9.8), n=136. Of enrollees, 69.6% (142) were females. Mean duration on ART was 4.9 years for cases and 4.5 years for controls (standard deviation = ± 2.2 years). The commonest reason for missing drugs was forgetfulness (58% cases). On multivariate analysis, having formal education (Adjusted Odds Ratio [aOR] = 3.03, 95% CI = 1.5-6.0) and income above minimum wage, (aOR = 2.38, 95% CI = 1.06-4.76) were independently associated with non-adherence. The commonest reason for missing drugs was forgetfulness (58% cases). Conclusion: In conclusion, educated people and those with higher income were more likely to be non-adherent and should be the focus of adherence counseling. Some form of reminders like use of telephone should be adopted to address forgetfulness.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Adulto , Estudos de Casos e Controles , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nigéria , Centros de Cuidados de Saúde Secundários , Fatores de Tempo
18.
Pan Afr Med J ; 32(Suppl 1): 6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984327

RESUMO

Introduction: human cytomegalovirus (CMV) has remained a cause of morbidity and mortality in pregnancy and immunocompromised patients. CMV is transmissible through blood transfusion. We conducted a descriptive, cross-sectional study to assess blood donor safety and to determine the prevalence and associated factors for CMV infection among blood donors in Minna, Nigeria. Methods: all consenting blood donors were screened for CMV antibodies (IgM and IgG) using ELISA kit and haematological indices using a haematological analyzer. We administered structured questionnaires to obtain socio-demographic and socio-economic data. Data were subjected to univariate, bivariate and multivariate statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p < 0.05. Results: a total of 345 participantswere recruited, the majority were males 336 (97.4%). Monthly earnings of majority of the blood donors, 136 (40.6%) ranged from ₦18,000 to ₦35,000. The prevalence of CMV infection was 96.2%. The prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6%. Most of the study participants, 274 (79.4%) were family replacement donors. The majority of the blood donors 195 (56.5%) were anaemic (PCV < 36, Hb < 12g/dl). Those with positive CMV were more likely to be of high-income level (OR = 0.32, P = 0.04). Conclusion: the seroprevalence of CMV was high with a significant proportion of donors capable of transmitting CMV infection to blood recipients. The majority of the blood donors were anaemic. High income level is associated with CMV infection. Quality of screening for anemia be improved.


Assuntos
Anticorpos Antivirais/sangue , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue , Infecções por Citomegalovirus/epidemiologia , Adulto , Anemia/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Renda/estatística & dados numéricos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
19.
Pan Afr Med J ; 32(Suppl 1): 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984328

RESUMO

Introduction: tuberculosis (TB) is the commonest opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. World Health Organization (WHO) recommends 85% treatment success rate for all TB cases as an indicator of TB control. The study aimed at determining TB treatment success rate among TB-HIV co-infected patients and identifying predictors of successful treatment among patients in TB treatment sites in Abeokuta, Nigeria. Methods: it was a cross-sectional study among HIV-TB co-infected patients in the two major health facilities in Abeokuta, Nigeria. Socio-demographic characteristics with treatment history were obtained using a semi-structured questionnaire. Sputum samples were collected and tested for acid-fast bacilli (AFB) using a standard method according to national guideline for TB treatment to determine treatment success rate. Treatment success was defined as any HIV positive patient with a diagnosis of TB by acid-fast bacilli (AFB) smear positivity at diagnosis, who after 6 months of complete treatment becomes smear negative. Adjusted odds ratio was used to identify independent predictors of successful treatment outcome with confidence interval set at 95% and level of significance set at P < 0.05. Results: a total of 109 HIV-TB co-infected patients were enrolled for this study. Fifty-nine (54.1%) were females, 106 (97.3%) were newly treated for TB. Eighty-five (78.0%) were treated in a private health facility. A total of 91 had successful treatment outcome with a treatment success rate (TSR) of 83.5%. Eleven (10.1%) died, 5 (4.6%) defaulted, 1 (0.9%) failed treatment, 1 (0.9%) was transferred out. Successful treatment was associated with being newly registered (i.e. receiving TB treatment under the DOTS program for the first time), receiving TB treatment for the first time (adjusted OR = 18, 95%CI: 1.5-482.3) and being treated at a private health facility (adjusted OR = 14.1, 95%CI 4.27-48.4). Conclusion: treatment success rate of TB among HIV-TB co-infected patients in this study slightly falls below the WHO target. Registration status and health facility type were predictors of treatment outcome among study patients. Patients and healthcare workers in public facilities were educated on HIV-TB co-infection management.


Assuntos
Antituberculosos/administração & dosagem , Coinfecção , Infecções por HIV/complicações , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Criança , Estudos Transversais , Terapia Diretamente Observada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Escarro/microbiologia , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
20.
Pan Afr Med J ; 32(Suppl 1): 11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984330

RESUMO

Introduction: Sub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas. Methods: We conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection. Results: We screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection. Conclusion: Interplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Estudos Transversais , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Adulto Jovem
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