Yaws is a disease caused by the bacteria Treponema pallidum subspecies pertenue, which is most commonly seen among children below 15 years. In the twentieth century yaws was endemic in Nigeria but ...eradication strategies markedly reduced the disease burden. Currently there is minimal data on the ongoing transmission of yaws in Nigeria, despite reports of confirmed yaws cases in neighbouring West African countries.
We conducted both community and school-based active yaws case search among school-aged children in southeast Nigeria. Children were screened by trained community volunteers. Suspected yaws cases were clinically reviewed and tested using rapid diagnostic serological tests.
Between February and May 2021, up to 28 trained community volunteers screened a total of 105,015 school children for yaws. Overall, 7,706 children with various skin lesions were identified. Eight (8) suspected cases of yaws were reported, reviewed and screened, but none was confirmed using rapid diagnostic tests. The four most common skin conditions identified were scabies (39%), papular urticaria (29%), tinea corporis (14%) and tinea capitis (12%).
No case of yaws was confirmed in this large population of children in south-east Nigeria. Continuous community awareness and yaws case finding activities have been recommended across Nigeria.
A major challenge to TB control globally is low case detection, largely due to routine health facility-based passive case-finding employed by national TB control programs. Active case-finding is a ...risk-population-based screening approach that has been established to be effective in TB control. This intervention aimed to increase TB case detection in hard-to-reach areas in southern Nigeria.
Using a descriptive cross-sectional design, we conducted implementation research in 15 hard-to-reach riverine local government areas with historically recognized low TB case notification rates. Individuals with TB symptoms were screened using multiple strategies. Data were collected quarterly over a 4-year period using reporting tools and checklists. Descriptive analysis was done with Microsoft Excel spreadsheet 2019.
A total of 1,089,129 individuals were screened: 16,576 in 2017; 108,102 in 2018; 697,165 in 2019; and 267,286 in 2020. Of those screened, 24,802 (2.3%) were identified as presumptive TB, of which 88.8% were tested and 10% were diagnosed with TB (0.23% of those screened). TB notifications more than doubled, increasing by 183.3% and 137.5% in the initial implementation and scale-up, respectively. On average, 441 individuals needed to be screened to diagnose 1 TB case. The cases, predominantly males (56.1%) and aged 15 years and older (77.4%), comprised 71.9% bacteriologically confirmed drug-sensitive TB, 25.8% clinically diagnosed drug-sensitive TB, and 2.3% drug-resistant cases. Detection sources included community outreach (1,786), health facilities (505), people living with HIV (57), and household contacts of bacteriologically confirmed TB cases (123). Remarkably, 98.1% of diagnosed TB cases commenced treatment.
We found a significant yield in TB case notifications, more than doubling the baseline figures. Given these successful results, we recommend prioritizing resources to support active case-finding strategies in national programs, especially in hard-to-reach areas with high-risk populations, to address TB more comprehensively.
Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these ...lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria.
A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed.
Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus.
Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country.
Background
Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. ...We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria.
Methods
This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients’ clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected.
Results
Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003).
Conclusions
Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria.
Buruli ulcer (BU), also known as Mycobacterium ulcerans disease, is the third most common mycobacterial disease worldwide. Although BU disease has been diagnosed among Nigerians in neighbouring West ...African countries, data on the burden of the disease in Nigeria itself are scanty. This study aimed to assess the magnitude and epidemiology of BU in the South South region of Nigeria.
We conducted a cross-sectional survey in the Ogoja territory (comprising 31 communities). We undertook sensitisation programmes centred on BU in 10 of the communities. Participants were asked to identify community members with long-standing ulcers, who were then invited for evaluation. We also contacted traditional healers to refer their clients who had non-healing ulcers. All suspected cases had a full clinical evaluation and laboratory testing. Confirmed cases were given treatment in a referral hospital in the territory.
We diagnosed 41 clinical BU cases; 36 (87.8 %) of which were confirmed by quantitative polymerase chain reaction (qPCR). These 36 PCR-confirmed cases were diagnosed in a total population of 192,169 inhabitants. Therefore, the estimated crude prevalence of BU was 18.7 per 100,000 population, varying from 6.0 to 41.4 per 100,000 in the districts surveyed. The majority (66.7 %) of the cases were females. About 92 % of the BU lesions were located on the patients' extremities. No differences were observed between the sexes in terms of the location of the lesions. The age of the patients ranged from four to 60 years, with a median age of 17 years. All 35 (100 %) patients who consented to treatment completed chemotherapy as prescribed. Of the treated cases, 29 (82.9 %) needed and received surgery. All cases healed, but 29 (82.9 %) had some limitations in movement. Healing with limitations in movement occurred in 18/19 (94.7 %) and 8/10 (80.0 %) of patients with lesions >15 cm (Category III) and 6-15 cm in diameter (Category II), respectively. The median duration of treatment was 130 (87-164) days for children and 98 (56-134) days for adults (p = 0.15).
In Nigeria, BU is endemic but its severity is underestimated-at least in the study setting. There is a need to identify and map BU endemic regions in Nigeria. A comprehensive BU control programme is also urgently needed.
The economic burden of Buruli ulcer for patients has not been well-documented. This study assessed the costs of Buruli ulcer care to patients from the onset of illness to diagnosis and to the end of ...treatment.
This was a cross-sectional cost of illness study conducted among patients with Buruli ulcer in four States in Nigeria between July and September 2015. A structured questionnaire was used to collect data on the patients' characteristics, household income and out-of-pocket costs of care.
Of 92 patients surveyed, 54 (59%) were older than 15years, 49 (53%) were males, and 86 (93%) resided in a rural area. The median (IQR) direct medical and non-medical cost per patient was US$124 (50-282) and US$3 (3-6); corresponding to 149% and 4% of the patients' median monthly household income, respectively. The overall direct costs per patient was US$135 (58-327), which corresponded to 162% of median monthly household income, with pre-diagnosis costs accounting for 94.8% of the total costs. The direct costs of Buruli ulcer care were catastrophic for 50% of all patients/households - the rates of catastrophic costs for Buruli ulcer care was 66% and 19% for patients belonging to the lowest and highest income quartiles, respectively.
Direct costs of Buruli ulcer diagnosis and treatment are catastrophic to a substantial proportion of patients and their families.
The Soil Moisture Active Passive (SMAP) mission is one of the first Earth observation satellites being developed by NASA in response to the National Research Council's Decadal Survey. SMAP will make ...global measurements of the soil moisture present at the Earth's land surface and will distinguish frozen from thawed land surfaces. Direct observations of soil moisture and freeze/thaw state from space will allow significantly improved estimates of water, energy, and carbon transfers between the land and the atmosphere. The accuracy of numerical models of the atmosphere used in weather prediction and climate projections are critically dependent on the correct characterization of these transfers. Soil moisture measurements are also directly applicable to flood assessment and drought monitoring. SMAP observations can help monitor these natural hazards, resulting in potentially great economic and social benefits. SMAP observations of soil moisture and freeze/thaw timing will also reduce a major uncertainty in quantifying the global carbon balance by helping to resolve an apparent missing carbon sink on land over the boreal latitudes. The SMAP mission concept will utilize L-band radar and radiometer instruments sharing a rotating 6-m mesh reflector antenna to provide high-resolution and high-accuracy global maps of soil moisture and freeze/thaw state every two to three days. In addition, the SMAP project will use these observations with advanced modeling and data assimilation to provide deeper root-zone soil moisture and net ecosystem exchange of carbon. SMAP is scheduled for launch in the 2014-2015 time frame.
Whereas research on caregiving is well documented, less is known about gender inequalities in caregiver stress, coping mechanisms, and health outcomes, all of which may vary by race, ethnicity, and ...socioeconomic status. This scoping review investigated racial and ethnic disparities using the Stress Process Model among male caregivers. Several databases were searched including Academic Search Premier, Medline Complete, APA PsycInfo, CINHAL, Google, ProQuest, and Web of Science. Included were peer-reviewed articles in English, published from 1990 to 2022. A total of nine articles fulfilled inclusion criteria. Most of the articles indicated that compared to White male caregivers, African American male caregivers provided more hours of care, assisted with more activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and experienced more financial stress. In terms of coping style, one study found African American male caregivers, compared to White male caregivers, held negative religious beliefs. Another study showed that they were at a higher risk for stroke than their White counterparts. The search revealed a dearth of studies on racial disparities in stress, coping, and health outcomes among male caregivers. Further research is needed on the experiences and perspectives of male minority caregivers.
Electronic waste (e-waste) or discarded electronic devices that are unwanted, not working, or have reached their end of life pose significant threats to human and environmental health. This is a ...major concern in Africa, where the majority of e-waste is discarded. In the year 2021, an estimated 57.4 million metric tons of e-waste were generated worldwide. Globally, COVID-19 lockdowns have contributed to increased e-waste generation. Although Africa generates the least of this waste, the continent has been the dumping ground for e-waste from the developed world. The flow of hazardous waste from the prosperous 'Global North' to the impoverished 'Global South' is termed "toxic colonialism". Agbogbloshie, Ghana, an e-waste hub where about 39% of e-waste was treated, was listed among the top 10 most polluted places in the world. The discard of e-waste in Ghana presents an issue of environmental injustice, defined as the disproportionate exposure of communities of color and low-income communities to pollution, its associated health and environmental effects, and the unequal environmental protection provided through policies. Despite the economic benefits of e-waste, many civilians (low-income earners, settlers, children, and people with minimal education) are exposed to negative health effects due to poverty, lack of education, and weak regulations. We critically examine the existing literature to gather empirical information on e-waste and environmental injustice. Comprehensive policies and regulations are needed to manage e-waste locally and globally.
Research on amphibian parasites has been on the increase because of the noticeable decline of amphibians. Studies on these parasites have been limited to their prevalence and infection patterns, and ...there is still a dearth of knowledge on the phenotypic variations. To characterise and investigate the genetic variability and relatedness of amphibian nematode parasites, two nematode parasites-suspected Cosmocerca sp. and suspected Rhabdias sp.-of the toad Schlerophrys regularis were investigated. One hundred and sixty-eight S. regularis were collected from three study areas: Ikorodu, Ojota and Badagry. Intestines were dissected to obtain the enteric parasites, and lungs were washed in saline solution. Parasites were labelled according to the location of collection (Badagry 5A-5I, Ikorodu 5J-5O, Ojota 5P and 5S) and were then preserved for further identification. Eighteen parasites were identified morphologically using standard keys and by amplification of the 18S small subunit (SSU) ribosomal DNA sequence. Phylogenetic analysis was done using the Neighbour-Joining method. From the sequence homology and phylogenetic analysis, the suspected Cosmocerca sp. shared the closest genetic relatedness with Aplectana chamaeleonis isolate AC3 with 100% similarities while the suspected Rhabdias sp. shared the closest genetic relatedness with Rhabditoides regina isolate DF5012 with 100% similarities. Based on location, four Aplectana chamaeleonis (5E, 5F, 5G, 5H) and five Rhabditoides regina (5A, 5B, 5C, 5D, 5I) were from Badagry, four Aplectana chamaeleonis (5J, 5M, 5N, 5O) and two Rhabditoides regina (5K, 5L) from Ikorodu, one Aplectana chamaeleonis (5S) and two Rhabditoides regina (5P, 5Q) from Ojota. We report that Rhabditoides regina, a parasite known to be associated with insects, was recovered in the lungs of toads. Further investigations to resolve the complexities of superfamily Cosmocercoidea are recommended. Relatedness was not influenced by collection location as parasites were not unique to a specific environment.
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