Nigeria is among the top five countries that have the highest gap between people reported as diagnosed and estimated to have developed tuberculosis (TB). To bridge this gap, there is a need for ...innovative approaches to identify geographical areas at high risk of TB transmission and targeted active case finding (ACF) interventions. Leveraging community-level data together with granular sociodemographic contextual information can unmask local hotspots that could be otherwise missed. This work evaluated whether this approach helps to reach communities with higher numbers of undiagnosed TB. Methodology: A retrospective analysis of the data generated from an ACF intervention program in four southwestern states in Nigeria was conducted. Wards (the smallest administrative level in Nigeria) were further subdivided into smaller population clusters. ACF sites and their respective TB screening outputs were mapped to these population clusters. This data were then combined with open-source high-resolution contextual data to train a Bayesian inference model. The model predicted TB positivity rates on the community level (population cluster level), and these were visualised on a customised geoportal for use by the local teams to identify communities at high risk of TB transmission and plan ACF interventions. The TB positivity yield (proportion) observed at model-predicted hotspots was compared with the yield obtained at other sites identified based on aggregated notification data. Results: The yield in population clusters that were predicted to have high TB positivity rates by the model was at least 1.75 times higher (p-value < 0.001) than the yield in other locations in all four states. Conclusions: The community-level Bayesian predictive model has the potential to guide ACF implementers to high-TB-positivity areas for finding undiagnosed TB in the communities, thus improving the efficiency of interventions.
Adverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well documented. However, the actual burden has rarely been described in detail in programmatic settings. We ...investigated the occurrence of these events in the national cohort of multidrug-resistant tuberculosis (MDR-TB) patients in Nigeria.
This was a retrospective, observational cohort study, using pharmacovigilance data systematically collected at all MDR-TB treatment centers in Nigeria. Characteristics of AEs during the intensive phase treatment were documented, and risk factors for development of AEs were assessed.
Four hundred and sixty patients were included in the analysis: 62% were male; median age was 33 years Interquartile Range (IQR):28-42 and median weight was 51 kg (IQR: 45-59). Two hundred and three (44%) patients experienced AEs; four died of conditions associated with SLD AEs. Gastro-intestinal (n = 100), neurological (n = 75), ototoxic (n = 72) and psychiatric (n = 60) AEs were the most commonly reported, whereas ototoxic and psychiatric AEs were the most debilitating. Majority of AEs developed after 1-2 months of therapy, and resolved in less than a month after treatment. Some treatment centers were twice as likely to report AEs compared with others, highlighting significant inconsistencies in reporting at different treatment centers. Patients with a higher body weight had an increased risk of experiencing AEs. No differences were observed in risk of AEs between HIV-infected and uninfected patients. Similarly, age was not significantly associated with AEs.
Patients in the Nigerian MDR-TB cohort experienced a wide range of AEs, some of which were disabling and fatal. Early identification and prompt management as well as standardized reporting of AEs at all levels of healthcare, including the community is urgently needed. Safer regimens for drug-resistant TB with the shortest duration are advocated.
Adverse drug reactions are an important causes of death and account for 5–35% of hospital admissions. Operation Save the World from Adverse Drug Reactions is a drug safety surveillance programme ...developed in 2005 by the Institute of Human Virology Nigeria (IHVN) to address the under-reporting of adverse drug reaction in Nigeria, where millions of people use antiretroviral, anti-tuberculosis, and anti-malaria drugs. The drug safety surveillance programme runs in major public hospitals but is managed by the National Pharmacovigilance Center in collaboration with IHVN. The goal is to ensure public and global health, while the primary outcome is the reporting of adverse drug reactions to the Uppsala Monitoring Centre, through the Nigerian National Agency for Food and Drug Administration and Control (NAFDAC). Pharmacovigilance training and the publishing of papers are secondary outcomes.
The drug safety surveillance programme in Nigeria combines six key activities: collaboration between government and the private sector; the training of medical doctors, pharmacists, and nurses; establishment of pharmacovigilance centres in public hospitals; development of platforms for submitting individual case safety reports; the publishing of peer-review articles; and submission of individual case safety reports. To ensure sustainability, we collaborated with the Nigerian Government and research institutions, and trained only government health-care workers, who were randomly selected from a pool of applicants that applied to advertisements in three national newspapers.
Between 2004 and 2016, Nigeria's National Pharmacovigilance Center received 16 500 individual case safety reports out of 80 000 adverse drug reaction reporting forms. The number of health-care workers who were trained in the reporting of adverse drug reactions was fewer than 300 and there was no training model during this time. However, between 2014 and 2018 when Operation Save the World from Adverse Drug Reactions was introduced and implemented, more than 5000 individual case safety reports, with more than 40 000 reactions were submitted. Furthermore, more than 3000 health-care workers have been trained in the reporting of adverse drug reactions, and a Structured Pharmacovigilance and Training Initiative (SPHARTI) model has been developed, with two peer-reviewed articles published. Serious adverse drug reactions, such as bilateral gynaecomastia, violent psychiatric disorders, and Stevens-Johnson syndrome have also been reported.
The drug safety surveillance programme Operation Save the World from Adverse Drug Reactions has increased the reporting of adverse drug reactions in Nigeria and increased the critical mass of qualified health-care workers trained in the reporting of adverse drug reactions. The strength of the programme is in the combination of the six key activities. Challenges remain in establishing causality of the reported reactions and operating the programme at primary health centres.
US PEPFAR.
Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the ...elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting.This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index BMI ≥30 kg/m2) and the prespecified potential risk factors.Of the 134,652 in HIV cohort, 19,566 (14.5%) were EPLHIV: 12,967 (66.3%) were normal weight (18.5 ≤ BMI < 25), 4548 (23.2%) were overweight (25 ≤ BMI < 30), while 2,051 (10.5%) were obese (BMI ≥30). The average age the normal weight (57.1; standard deviation 6.6) and the obese (56.5; standard deviation 5.5) was similar. We observed that being an employed (relative risk RR 1.71; 95% confidence interval CI 1.48-2.00; P < .001), educated (RR 1.93; 95% CI 1.54-2.41; P < .001), and presence of hypertension (RR 1.78; 95% CI 1.44-2.20; P < .001), increased the risk of obesity. Also, being male (RR 0.38; 95% CI 0.33-0.44; P < .001), stages III/IV of the World Health Organization clinical stages of HIV (RR 0.58; 95% CI 0.50-0.68; P < .001), tenofovir-based regimen (RR 0.84; 95% CI 0.73-0.96, P < .001), and low CD4 count (RR 0.56; 95% CI 0.44-0.71; P < .001) were inversely associated with obesity.This study demonstrates that multiple factors are driving obesity prevalence in EPLHIV. The study provides vital information for policy-makers and HIV program implementers in implementing targeted-interventions to address obesity in EPLHIV. Its findings would assist in the implementation of a one-stop-shop model for the management of HIV and other comorbid medical conditions in EPLHIV.
Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and ...regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria.
A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants.
Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed.
Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings.
The purpose of this study was to understand the effects of access to health insurance on the healthcare-seeking behavior of the population in four suburban communities in Rivers State, Nigeria. The ...conceptual framework of the study is based on Anderson’s behavioral model of health services use. The study looked at how access to health insurance affects the healthcare seeking behavior and the preventive care seeking behavior of the study population. Two-hundred and seventy participants were surveyed using the Health Care Access and Utilization Survey (HCAUS) questionnaire. Data were analyzed using descriptive statistics (frequencies and percentages) and bivariate logistic regression. Respondents with health insurance had a higher statistically significant proportion for having access to health care compared to respondents without health insurance (38.18% vs. 11.16%; p=0.001). Respondents with health insurance were 4.92 times more likely to have access to health care compared to respondents without health insurance (OR=4.92; p=0.001; 95% CI: 2.47-9.80). Respondents with access to health insurance had a higher statistically significant proportion for seeking of preventive care compared to respondents without access to health insurance (23.64% vs. 12.09%; p=0.05). The analysis showed that respondents who currently have access to health insurance were 2.25 times more likely to seek preventive care compared to respondents without access to health insurance (OR=2.25; p=0.05; 95% CI: 1.06-4.74). The findings in this study may help health policy advocates, formulators, and implementers design effective, universal, and affordable health insurance programs for poor and vulnerable communities where finance is still a major barrier to healthcare access.
African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network ...(SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans.
Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation.
We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping.
Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.
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