Optimizing PSMA scintigraphy for resource limited settings - a retrospective comparative study.

BACKGROUND: PSMA PET/CT is the most sensitive molecular imaging modality for prostate cancer (PCa), yet much of the developing world has little or no access to PET/CT. [99mTc]Tc-PSMA scintigraphy (PS) is a cheaper and more accessible gamma camera-based alternative. However, many resource-constrained departments have only a single camera without tomographic or hybrid imaging functionality, and camera time is frequently in high demand. Simplifying imaging protocols by limiting the field of view (FOV) and omitting SPECT/CT or even SPECT may provide a partial solution. The aim was thus to determine the adequacy of PS planar-only and/or SPECT-only imaging protocols with a limited FOV. METHODS: The scans of 95 patients with histologically proven PCa who underwent PS with full-body planar and multi-FOV SPECT/CT were reviewed. The detection rates for uptake in the prostate gland/bed and in metastases were compared on planar, SPECT, and SPECT/CT. The agreement between modalities was calculated for the detection of metastases and for staging. The impact of imaging a limited FOV was determined. RESULTS: Pathological prostatic uptake was seen in all cases on SPECT/CT (excluding two post-prostatectomy patients), 90.3% of cases on SPECT, and 15.1% on planar images (p < 0.001). Eleven (11.7%) patients had seminal vesicle involvement on SPECT/CT, which was undetectable/indistinguishable on planar images and SPECT. The agreement between modalities was moderate to good (κ = 0.41 to 0.61) for the detection of nodal metastases, with detection rates that did not differ significantly (SPECT/CT = 11.6%, SPECT = 8.4%, planar = 5.3%). Detection rates for bone metastases were 14.7% (SPECT/CT) and 11.6% (SPECT and planar). Agreement between modalities for the detection of bone metastases was good (κ = 0.73 to 0.77). Three (3.1%) patients had visceral metastases on SPECT/CT, two of which were detected on SPECT and planar. There was good agreement between modalities for the TNM staging of patients (κ = 0.70 to 0.88). No metastatic lesions were missed on the limited FOV images. CONCLUSION: When PS scintigraphy is performed, SPECT/CT is recommended. However, the lack of SPECT/CT capabilities should not preclude the use of PS in the presence of limited resources, as both planar and SPECT imaging are adequate and will correctly stage most PCa patients. Furthermore, time-based optimisations are achievable by limiting the FOV to exclude the distal lower limbs.

Data analytics-based evaluation of blood indices and adaptation of medicated and non-medicated broiler chickens under humid tropical conditions.

The growth performance and blood indices of medicated and non-medicated broiler chickens have been the subject of this research coupled with a paucity of comparative information on what can actually happen to broiler chickens if not medicated when reared under humid tropical conditions. One hundred unsexed day-old broilers were randomly and equally allotted into two treatment groups of TM (medicated) and TN (non-medicated) in a completely randomized design each treatment with five replicates having ten birds each. The birds were reared on deep litter system for 56 d which was divided into two phases of 28 d each (starter and finisher), during which data were collected with respect to daily feed intake, final body weight, body weight gained (BWG), mortality rate while blood analysis was carried out on 28th and 56th d for starter and finisher phases, respectively. Non-medicated group served as control. Feed conversion ratio (FCR) and feed conversion efficiency (FCE), were later calculated. Data collected were subjected to analysis of variance statistically. There was no significant difference between the medicated and non-medicated broilers for daily feed intake, final body weight, and BWG and also for the blood parameters investigated at starter phase. However, at finisher phase, no significant difference was observed in the daily feed intake of Tm and Tn but there was significant (P < 0.05) difference in the final body weight, BWG, FCR, FCE, and mortality rate between the two groups. Birds on Tm attained higher weight significantly (P < 0.05) than those on TN. BWG, FCR, and FCE followed the same trend and also the mortality rate. White blood cells count of TN was higher significantly (P < 0.05) than TM while TM birds recorded higher packed cell volume, red blood counts, and hemoglobin concentration (Hb) significantly (P < 0.05) than TM birds. Effect of medication was much noticeable at finisher phase as it improved the growth rate though mortality rate was close to that of TN group. These results suggest that broilers can be produced free of medication with good feeding without loss of birds while the growth rate can be enhanced with the use of prebiotics and prebiotics.

Poultry fecal imagery dataset for health status prediction: A case of South-West Nigeria.

Feces is one quick way to determine the health status of the birds and farmers rely on years of experience as well as professionals to identify and diagnose poultry diseases. Most often, farmers lose their flocks as a result of delayed diagnosis or a lack of trustworthy experts. Prevalent diseases affecting poultry birds may be quickly noticed from image of poultry bird's droppings using artificial intelligence based on computer vision and image analysis. This paper provides description of a dataset of both healthy and unhealthy poultry fecal imagery captured from selected poultry farms in south-west of Nigeria using smartphone camera. The dataset was collected at different times of the day to account for variability in light intensity and can be applied in machine learning models development for abnormality detection in poultry farms. The dataset collected is 19,155 images; however, after preprocessing which encompasses cleaning, segmentation and removal of duplicates, the data strength is 14,618 labeled images. Each image is 100 by 100 pixels size in jpeg format. Additionally, computer vision applications like picture segmentation, object detection, and classification can be supported by the dataset. This dataset's creation is intended to aid in the creation of comprehensive tools that will aid farmers and agricultural extension agents in managing poultry farms in an effort to minimize loss and, as a result, optimize profit as well as the sustainability of protein sources.

Enhancing poultry health management through machine learning-based analysis of vocalization signals dataset.

Population expansion and rising consumer demand for nutrient-dense meals have both contributed to an increase in the consumption of animal protein worldwide. A significant portion of the meat and eggs used for human consumption come from the poultry industry. Early diagnosis and warning of infectious illnesses in poultry are crucial for enhancing animal welfare and minimizing losses in the breeding and production systems for poultry. On the other hand, insufficient techniques for early diagnosis as well as infectious disease control in poultry farms occasionally fail to stop declining productivity and even widespread death. Individual physiological, physical, and behavioral symptoms in poultry, such as fever-induced increases in body temperature, abnormal vocalization due to respiratory conditions, and abnormal behavior due to pathogenic infections, frequently represent the health status of the animal. When birds have respiratory problems, they make strange noises like coughing and snoring. The work is geared towards compiling a dataset of chickens that were both healthy and unhealthy. 100 day-old poultry birds were purchased and split into two groups at the experimental site, the poultry research farm at Bowen University. For respiratory illnesses, the first group received treatment, whereas the second group did not. After that, the birds were separated and caged in a monitored environment. To eliminate extraneous sounds and background noise that might affect the analysis, microphones were set a reasonable distance away from the birds. The data was gathered using 24-bit samples at 96 kHz. For 65 days, three times per day (morning, afternoon, and night) of audio data were continually collected. Food and water are constantly provided to the birds during this time. During this time, the birds have constant access to food and water. After 30 days, the untreated group started to sound sick with respiratory issues. This information was also noted as being unhealthy. Chickens' audio signals were recorded, saved in MA4, and afterwards converted to WAV format. This dataset's creation is intended to aid in the design of smart technologies capable of early detection and monitoring of the status of birds in poultry farms in a continuous, noninvasive, and automated way.

Morphometric analysis of schistosome eggs recovered from human urines in communities along the shoreline of Oyan River Dam in Ogun State, Nigeria.

There are growing concerns that communities characterized with surface water, where both humans and livestock interact for agricultural, domestic, cultural and recreational purposes, are likely to support hybridization between schistosome species infecting humans and livestock. This study therefore investigated the morphometrics of schistosome eggs recovered from human urine samples in four schistosomiasis endemic communities (Imala-Odo, Abule-Titun, Apojula and Ibaro-Oyan) along the banks of Oyan River Dam in Ogun State, Nigeria. Recovered eggs were counted, photographed, and measured with IC Measure™ for total length, maximum width and a ratio of egg shape. A total of 1984 Schistosoma eggs were analysed. Two major egg morphotypes were identified: the first represented 67.8% of the eggs, with the typical round to oval shape and mean length and width of 166 µm, 66.8 µm, respectively; the second represented 32.2% of the eggs and are more elongated, with a mean length of 198 µm, and width of 71.3 µm. Our results revealed significant variations in sizes of the schistosome eggs recovered (length: t = -35.374, degrees of freedom (df) = 1982, P = 0.000; weight: t = -10.431, df = 1982, P = 0.000), with the atypical shaped eggs appearing more elongated than expected. These eggs might represent individuals with some degree of contribution from Schistosoma bovis or possibly other Schistosoma species known to be present in Nigeria. Hence, this observation calls for further molecular studies to establish the genetic information about the miracidia from both atypical and typical eggs. It is also important to establish the presence of bona fide S. bovis infection in cattle and vector snails in the presumptive areas of hybridization.

SARS-CoV-2 vaccination site as possible pitfall on somatostatin receptor imaging.

SARS-CoV-2 (COVID-19) vaccination numbers are globally increasing. Therefore, an increased chance exists that patients undergoing Peptide Receptor Radionuclide Therapy (PRRT) or diagnostic radionuclide imaging for Neuroendocrine Tumours (NETs) may have recently received vaccination. We report the imaging findings of two NETs patients, A-following [177Lu] Lu-DOTATATE PRRT post therapy planar scintigraphy and single photon emission computed tomography with computed tomography (SPECT/CT), and B-following [68 Ga]Ga-DOTA-NOC positron emission tomography with computed tomography (PET/CT) respectively. Both studies were done few days after COVID-19 vaccination. Patient A showed a new focus of uptake in the left deltoid muscle; and Patient B showed uptake in the left deltoid and a left axillary lymph node. Nuclear Physicians need to be aware of pitfalls with somatostatin receptor radionuclide imaging post-vaccination to ensure accurate interpretation, as well as dosimetric considerations with vaccine-related post-therapy uptake.

A medical percussion instrument using a wavelet-based method for archivable output and automatic classification.

There is no standard instrument for carrying out medical percussion even though the procedure has been in continuous use since 1761. This study developed one such instrument. It generates medical percussion sounds in a reproducible manner and accurately classifies them into one of three classes. Percussion signals were generated using a push-pull solenoid plessor applying mechanical impulses through a polyvinyl chloride plessimeter. Signals were acquired using a National Instruments USB 6251 data acquisition card at a rate of 8.192 kHz through an air-coupled omnidirectional electret microphone located 60 mm from the impact site. Signal acquisition, processing, and classification were controlled by an NVIDIA Jetson TX2 computational device. A complex Morlet wavelet was selected as the base wavelet for the wavelet decomposition using the maximum wavelet energy method. It was also used to generate a scalogram suitable for manual or automatic classification. Automatic classification was achieved using a MobileNetv2 convolutional neural network with 17 inverted residual layers on the basis of 224 × 224 x 1 images generated by downsampling each scalogram. Testing was carried out using five human subjects with impulses applied at three thoracic sites each to elicit dull, resonant, and tympanic signals respectively. Classifier training utilized the Adam algorithm with a learning rate of 0.001, and first and second moments of 0.9 and 0.999 respectively for 100 epochs, with early stopping. Mean subject-specific validation and test accuracies of 95.9±1.6% and 93.8±2.3% respectively were obtained, along with cross-subject validation and test accuracies of 94.9% and 94.0% respectively. These results compare very favorably with previously-reported systems for automatic generation and classification of percussion sounds.

Factors contributing to the duration of postpartum abstinence among Nigerian women: semi-parametric survival analysis.

BACKGROUND: The duration of postpartum abstinence is on the decrease but has not been met with increased uptake of contraceptive in Nigeria. This imbalanced transition could result in shorter birth intervals and worsen maternal and child health outcomes. There is a paucity of information on the duration and predictors of time to end of postpartum abstinence in Nigeria. This study was aimed at understanding the time to end of postpartum abstinence and factors predicting the duration in Nigeria. METHODS: The NDHS 2013 data was used. Data of all women who had ever given birth were included. The time to end of postpartum abstinence was censored among currently breastfeeding mothers. The Kaplan Meier Product Limit method was used to estimate the survival and hazard function while the Cox regression was used to fit a model for time to end of postpartum abstinence at 5% significance level. Data were weighed and provisions were made for multicollinearity. RESULTS: The overall average duration of postpartum abstinence in Nigeria is 3 month. In all, 58% ended postpartum abstinence within the first three months while 18%, 10%, and 14% ended it within 4-6 months, 7-12 months and after one year respectively. Postpartum abstinence did not last beyond 3 months among 83% of the women in the North-West region, compared with 23% in the North Central region, and 34% in the South East. The Muslims had the highest proportion of women who ended postpartum abstinence within the first three months after delivery at 72% compared with Catholic women (31%). The median time to end of postpartum abstinence was lowest (2 months) among women from North West, Muslims, in poorest wealth quintiles and those with no education. The "hazard" of earlier resumption of sexual activity after birth was over 3 times more likely among women in the North West than those in the North Central (aHR = 3.09, 95% CI: 2.95-3.24). Women using contraceptives had a 40% hazard of ending postpartum abstinence earlier. Rural women were 7.6% times less likely to end postpartum abstinence compared to their urban counterpart. Women from rich households have an excess risk of 14% to end postpartum abstinence early compared to women from poor households. CONCLUSION: Women of reproductive age in the North West, who are Muslims and with no education are at higher risk of ending postpartum abstinence early. Hence, policymakers and reproductive health stakeholders should design effective intervention targeted at this group of women as a means of controlling fertility.

Comparative Analgesic Effects of Ibuprofen, Celecoxib and Tramadol after third Molar Surgery: A Randomized Double Blind Controlled Trial.

BACKGROUND: This study compared the effects of ibuprofen, celecoxib and tramadol on pain after surgical extraction of impacted mandibular third molars. PATIENTS AND METHODS: This double blind randomized controlled trial recruited 135 healthy subjects who required surgical extraction of impacted mandibular third molars, with a mean age of 26.51 ± SD 6.29 years. The subjects were randomized into three equal groups and given appropriate doses of each drug immediately after extraction. They continued the drugs up to 48 hours after extraction. Postoperative pain intensity was self-recorded by subjects at 4, 8, 16, 24 and 48 hours after extraction, using visual analogue scale (VAS). Data analysis involved descriptive statistics, 2-sample Wilcoxon Mann-Whitney U test and Kruskal Wallis rank test. Statistical analysis was done using intention-to-treat analysis. The mean VAS at each point of postoperative pain assessment was compared using one way analysis of variance (ANOVA) among the three groups. Statistical significance was inferred at p < 0.05. RESULTS: The mean VAS score of the celecoxib group (32.35± SD 23.96) at 4 hours was the lowest among the three groups. This was followed by the ibuprofen group with mean VAS score of 38.96 ± SD 22.30. Whereas, the subjects in tramadol group experienced the highest VAS score (53.31 ± SD 23.30) at 4 hours. There was statistically significant difference in the mean VAS scores at 4 hours after extraction when the three groups were compared (p = 0.0039). Celecoxib group also had the lowest mean VAS scores at 8 hours, 24 hours and 48 hours after the extraction. None of the subjects in the ibuprofen and celecoxib groups reported any adverse effect of the analgesics, whereas 47.61% of the tramadol group did. CONCLUSION: Celecoxib was the most effective analgesic of the three studied drugs in controlling postoperative pain after mandibular third molar extraction in our subjects. It was closely followed by ibuprofen while tramadol was found to be the least effective. CLINICAL SIGNIFICANCE: The outcomes of this study suggest that celecoxib can be prescribed for effective control of postoperative pain after third molar surgery especially in patients with peptic ulcer disease who will not tolerate the adverse effect of traditional nonsteroidal anti-inflammatory drugs. It also shows that ibuprofen can be an analgesic of choice for patients who are not at risk of gastrointestinal complications of nonsteroidal anti-inflammatory drugs (NSAIDs). Tramadol could be considered for patients with milder postoperative pain after third molar surgery.

Molecular approaches to the identification of Bulinus species in south-west Nigeria and observations on natural snail infections with schistosomes.

The current study considers the distribution of a small sample of 138 Bulinus snails, across 28 localities within eight Nigerian states. Snails were identified using a combination of molecular methods involving both DNA sequencing of a partial cytochrome oxidase subunit 1 (cox1) fragment and restriction profiles obtained from ribosomal internal transcribed spacer (its) amplicons. The results showed that the majority of Bulinus samples tested belonged to the species Bulinus truncatus while only two were Bulinus globosus. The use of RsaI restriction endonuclease to cleave the ribosomal its of Bulinus, as a method of species identification, was adopted for the majority of samples, this being a quicker and cheaper method better suited to small laboratory environments. Polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat within each of the collected Bulinus samples was employed to determine the extent and distribution of infected snails within the sample areas. Successful amplification of the Dra1 repeat demonstrated that 29.7% of snails were infected with schistosomes. Sequencing of the partial schistosome its from a small subset of snail samples suggested that some snails were either penetrated by both Schistosoma haematobium and Schistosoma bovis miracidia or hybrid miracidia formed from the two species.

Urinary schistosomiasis transmission in Epe, an urban community of Southwest Nigeria.

BACKGROUND: A survey of Schistosoma haematobium infection in Epe, an urban community in Lagos State, Southwest Nigeria, was carried out to ascertain the possibility that schistosomiasis, otherwise considered a rural disease, could reach urban populations. MATERIALS AND METHODS: About 100 ml of voided urine samples from 200 pupils aged 6-13 years [109 (54.5%) males and 91 (45.5%) females], attending an Anglican primary school, Ebute Afuye, and a community primary school, Erepoto, were examined parasitologically for hematuria and S. haematobium ova following informed consent obtained from their parents/guardians. All samples were screened using polymerase chain reaction (PCR) amplification of the schistosome Dra1 gene. Fourteen Bulinus snails collected from the two sites, Ebute Afuye (6) and Erepoto (8), were screened for schistosome infection by the PCR amplification of the schistosome Dra1 gene. PCR-RFLP of the snails' its region was analyzed for species identification and a subregion of the cox1 gene from four infected snails (two from each site) was amplified and sequenced. RESULTS: In the Anglican primary school, Ebute Afuye, and community primary school, Erepoto, 16% and 29% were positive for hematuria, and 16% and 17% had schistosome ova, respectively. PCR analysis showed that 57% and 40% were positive for the infection in Anglican primary school, Ebute Afuye, and community primary school, Erepoto, respectively. PCR screening of the snails confirmed that four from Ebute Afuye and three from Erepoto were infected with schistosomes. PCR-RFLP showed that all the 14 snails were Bulinus truncatus while phylogenetic analysis of the sequenced partial cox1 gene corroborated the PCR-RFLP results. CONCLUSIONS: There was a high prevalence of S. haematobium infection among the participants detected by PCR, which was able to detect infection in cases otherwise shown to be negative by hematuria. We also observed that B. truncatus is one of the snail species responsible for the transmission of urinary schistosomiasis in the Epe community. For national control programs, it is very important that trends in the prevalence and intensity of schistosomiasis in urban cities be monitored.

Squamous cell abnormalities in exfoliated cells from the urine of Schistosoma haematobium-infected adults in a rural fishing community in Nigeria.

Schistosoma haematobium infection is endemic in Nigeria, with substantial transmissions in all the states of the federation and a high prevalence rate in schools. Literature has linked bladder cancer, mostly squamous cell type, with long-term S. haematobium infections. The objective of this descriptive study was to screen exfoliated cells in the urine of S. haematobium-infected patients for squamous cell abnormalities through cytopathological examinations. Study participants were drawn from Imala Odo, a community near Oyan Dam in Abeokuta North Local Government Area, Ogun state, Southwest Nigeria. Due to a considerable day-to-day variation of S. haematobium eggs in urine, 3 rounds of 200 ml of urine samples were collected on 3 different days from 32 infected patients and 10 uninfected controls and examined. Cytological preparations of the infected 15 males and 8 females and 10 controls (5 males and 5 females) were screened for squamous cell abnormalities. Severely dysplastic to frankly malignant squamous cells were observed in 1 (3.1%) male and 2 (6.3%) females, while no abnormality was observed in the controls.

Detection of schistosomes polymerase chain reaction amplified DNA by oligochromatographic dipstick.

The applications of highly specific and sensitive molecular techniques based on polymerase chain reaction (PCR) have constituted a valuable tool for the diagnosis of schistosomiasis and also for the detection of schistosome infections in the snail intermediate hosts. The common method of detecting PCR amplicons is gel electrophoresis in the presence of ethidium bromide, a carcinogen, which is followed by UV transillumination. Other methods, which are available for detecting PCR products, are real-time PCR, PCR-enzyme-linked immunosorbent assay (PCR-ELIZA) and mass spectrometry but they are cumbersome while they are sometimes complex and expensive. Therefore, a simple method of PCR product detection would be a welcome idea and a most valuable tool particularly in disease endemic countries with limited research facilities and resources. In this study, we applied a simple and rapid method for the detection of Schistosoma haematobium and Schistosoma mansoni PCR amplified DNA products using oligochromatographic (OC) dipstick. The amplicons are visualized by hybridization with a gold conjugated probe, while a control for the chromatographic migration is incorporated in the assay. The lower detection limit observed was 10fg of genomic DNA from each of the two species, while the dipstick was also specific for each of the species used in this study.

Sociocultural aspects of mass delivery of praziquantel in schistosomiasis control: the Abeokuta experience.

BACKGROUND: Schistosomiasis is a public health problem in Nigeria. Although there is an ongoing national program for its control, disease control programs in other countries have shown the need to understand the sociocultural aspects of disease transmission, prevention, and treatment in endemic communities before control efforts are undertaken. OBJECTIVE: To describe sociocultural factors that influence the distribution process of praziquantel for the mass treatment of schistosomiasis infection. METHODS: Data for the study were collected through focus group discussions held separately with adult males and females, male and female adolescents (13-19 years), and male and female children (5-12 years). In-depth interviews were similarly held with the drug distributors of praziquantel for mass treatment and with community/opinion leaders of six hyperendemic communities in Ogun State, Southwest Nigeria on mass treatment using praziquantel. These focus group discussions and in-depth interviews were held both before and following the drug distribution. The data were analyzed using the textual analysis program, Textbase Beta. RESULTS: Following a 3-week period of mass treatment in six communities, we observed an increased awareness of rivers/streams as a source of schistosomiasis. In addition, the communities reported overwhelming support for the mass treatment after receiving treatment. The reasons for this acceptance appear to include the perceived efficacy of praziquantel against the disease and its availability free of charge. The drug's distributors adhered to the originally specified systems-based protocol for mass treatment in only two of the six communities. The systems-based protocol adhered to strict distribution through primary health centers and schools. The four other communities used a community-based approach for mass treatment with praziquantel and attained greater coverage of treatment as a result. CONCLUSION: Obtaining community support and involvement before the implementation of mass treatment of schistosomiasis with praziquantel contributes to an effective treatment strategy for this disease. A detailed assessment of a community's health needs, before the initiation of the control efforts against endemic infections, should be undertaken.

Height as a substitute for weight for estimating praziquantel dosage.

The study evaluated height and weight measurements of 750 school children from five rural communities in western Nigeria. The measurements were taken by 12 trained community members designated as distributors in determining treatment dose with praziquantel for these children. A very strong correlation value, r=0.97, was obtained for the weight of treated children measured by the distributors and the research team. The distributors obtained a correlation coefficient value of r=0.87 on weight and height measurements, showing that height can be used by community distributors in lieu of weight for correct dose determination.

An assessment of parent-child communication on sexuality in lagos, Nigeria.

This study is the first phase of a project designed to help parents acquire skills necessary for comfortable and effective communication about adolescents' sexuality. It assessed parent-child communication on sexuality among the in-school adolescents in Lagos, Nigeria. It was observed that a high proportion of the adolescents interviewed receive information on sexuality from friends and the mass media and also communicate more with their friends on sexuality than with their parents.

Knowledge and practices of traditional birth attendants in prenatal services in Lagos State, Nigeria.

A questionnaire-based study was conducted on 189 Traditional Birth Attendants (TBAs) on their knowledge and practices in prenatal services. Only 86 (45.5%) of them associated cessation of menstrual period with pregnancy while others use mystic power 46 (24.3%), early morning sickness, pallor of conjunctiva and reaction to herbs 56 (29.6%) to detect pregnancy. Fundal height n=76 (40.2%), palpation n=82 (43.4%), special soaps and soups n=52 (27.5%) and special devices n=8 (4.2%) are used to determine stages of pregnancy. Foetal health status is determined by regular foetal movements n=95 (50.3%), mystic power n=15 (8%), soap n=2 (1.1%), special concoction 9 (4.8%), health status of mother n=67 (35.4%) and foetal heart beat n=24 (12.7%). Ninety seven (51.3%) of them used herbal treatment, 77 (40.7%) used incantations, 189 (100%) used special soaps as their main methods of delivery, while only 18 (9.5%) of respondents refer difficult cases to hospitals. Instruments used for separating cord were blade 123 (65.1%) and scissors 40 (21.1%). Symptoms recognized by the TBAs as signs of complications in pregnancy were dizziness, swollen feet, pallor, tiredness, absent foetal movement, loss of appetite, heaviness, pain in back/stomach/side, weight loss, vomiting, bleeding, fever/malaria, head ache, bad dream, premature or delayed labour. Although some of them recognized some danger signs in pregnancy and labour, only very few would refer difficult cases for emergency obstetric interventions. Clear protocols for management and referral, which are necessary for improved maternal survival, should be provided through regular training of the TBAs.

Effectiveness of different approaches to mass delivery of praziquantel among school-aged children in rural communities in Nigeria.

Schistosomiasis is hyperendemic in Nigeria. The national policy on schistosomiasis control has adopted praziquantel as the main drug of use in the control strategy aimed at reducing morbidity. However, the best delivery channel for praziquantel in schistosomiasis control in Nigeria is yet to be determined. This study assessed different channels for praziquantel delivery in a mass treatment effort. Three groups, each of two communities, were assigned to one of the following three channels: health facility (HF), school, and community for mass delivery of praziquantel to school-aged children. Distributors were trained on all aspects of praziquantel distribution and sufficient praziquantel tablets were provided for the drug distribution within 3 weeks following which an evaluation of the drug distribution by the different treatment channels was conducted. Overall, the community channel of delivery achieved the best coverage of 72.2% (range: 69-73%) compared to 44.3% (range: 39.5-62%) and 28.5% (range: 26.3-74.5%) for the HF and school channels, respectively. Community channel of praziquantel delivery as shown in this study ensures good coverage of both in and out-of-school children.