Molecular signatures define subtypes of auditory afferents with distinct peripheral projection patterns and physiological properties.

Type I spiral ganglion neurons (SGNs) are the auditory afferents that transmit sound information from cochlear inner hair cells (IHCs) to the brainstem. These afferents consist of physiological subtypes that differ in their spontaneous firing rate (SR), activation threshold, and dynamic range and have been described as low, medium, and high SR fibers. Lately, single-cell RNA sequencing experiments have revealed three molecularly defined type I SGN subtypes. The extent to which physiological type I SGN subtypes correspond to molecularly defined subtypes is unclear. To address this question, we have generated mouse lines expressing CreERT2 in SGN subtypes that allow for a physiological assessment of molecular subtypes. We show that Lypd1-CreERT2 expressing SGNs represent a well-defined group of neurons that preferentially innervate the IHC modiolar side and exhibit a narrow range of low SRs. In contrast, Calb2-CreERT2 expressing SGNs preferentially innervate the IHC pillar side and exhibit a wider range of SRs, thus suggesting that a strict stratification of all SGNs into three molecular subclasses is not obvious, at least not with the CreERT2 tools used here. Genetically marked neuronal subtypes refine their innervation specificity onto IHCs postnatally during the time when activity is required to refine their molecular phenotype. Type I SGNs thus consist of genetically defined subtypes with distinct physiological properties and innervation patterns. The molecular subtype-specific lines characterized here will provide important tools for investigating the role of the physiologically distinct type I SGNs in encoding sound signals.

Parent-Youth Sexual Discussion and its Association with Sexual Activity among Undergraduates in a Nigerian University.

BACKGROUND: Parents play a significant role in the sexual orientation and behaviours of their children. Lack of communication between parents and their children about sexual matters may contribute to engagement of young people in risky sexual behaviours. OBJECTIVES: To assess the pattern of parent-youth sexual discussions and its association with sexual activity among unmarried undergraduates in a Nigerian university. METHODS: A descriptive cross-sectional study was conducted among 400 undergraduates aged 15-24 years in a tertiary institution in Ogun state, Nigeria. A structured selfadministered questionnaire was used for data collection. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. The level of significance was set at p <0.05. RESULTS: Parent-youth discussions on sexual issues had occurred in 225 (56.2%) of the respondents, with mothers being more involved than fathers; onset was at secondary school level in nearly three-fifths. There was no statistically significant relationship between parent-youth sexual discussions and engagement in sexual intercourse (p = 0.666); however, parental visit(s) on campus was associated with a significant reduction in sexual intercourse (p = 0.006). CONCLUSION: Engagement of youths in sexual discussions by their parents is still low and such discussions are often not impactful in preventing pre-marital sex. Parental supervisory visits for undergraduates on campus may be helpful in consolidating the desired effect of such sexual discussions, and should be encouraged.

CONTEXTE: Les parents jouent un rôle important dans l'orientation et les comportements sexuels de leurs enfants. Le manque de communication entre les parents et leurs enfants sur les questions sexuelles peut contribuer à l'engagement des jeunes dans des comportements sexuels à risque. OBJECTIFS: Évaluer le modèle de discussions sexuelles entre parents et enfants et son association avec l'activité sexuelle chez les étudiants célibataires de premier cycle d'une université nigériane. MÉTHODES: Une étude descriptive transversale a été menée auprès de 400 étudiants de premier cycle âgés de 15 à 24 ans dans un établissement d'enseignement supérieur de l'État d'Ogun, au Nigeria. Un questionnaire structuré auto-administré a été utilisé pour la collecte des données. Les données ont été analysées à l'aide du logiciel SPSS (Statistical Package for the Social Sciences) version 21.0. Le niveau de signification a été fixé à p <0,05. RÉSULTATS: Des discussions entre parents et jeunes sur les questions sexuelles ont eu lieu chez 225 (56,2%) des répondants, les mères étant plus impliquées que les pères ; elles ont eu lieu au niveau de l'école secondaire chez près de trois cinquièmes des répondants. Il n'y avait pas de relation statistiquement significative entre les discussions sexuelles entre parents et jeunes et l'engagement dans des rapports sexuels (p = 0,666) ; cependant, la visite des parents sur le campus était associée à une réduction significative des rapports sexuels (p = 0,006). CONCLUSION: L'engagement des jeunes dans des discussions sexuelles avec leurs parents reste faible et ces discussions n'ont souvent pas d'impact sur la prévention des rapports sexuels avant le mariage. Les visites de supervision parentale pour les étudiants de premier cycle sur le campus peuvent être utiles pour consolider l'effet désiré de ces discussions sexuelles, et devraient être encouragées. Mots clés: Discussion sexuelle entre parents et jeunes, rapports sexuels, étudiants de premier cycle, jeunes.

Spatial Distribution of COVID-19 in Nigeria.

BACKGROUND: The first reported case of the novel coronavirus (COVID 19) in Nigeria was on the 27th of February 2020. Since then, the country has witnessed a steady increase in the number of patients confirmed with the disease. As of April 27th 2021, a total of 164,756 confirmed COVID-19 cases were notified making it the fifth-highest number of cases in the African region. This study aims to determine the spatial distribution of COVID-19 in Nigeria, identify clusters and determine factors associated with COVID-19. METHODS: The study used secondary data of COVID-19 cases notified in each of the 36 states and the Federal Capital Territory between 27th February and 9th June, 2020. The Global and Local Moran'sItest were used to identify significant spatial clusters. The negative binomial regression model was used to identify factors associated with COVID-19 and p d" 0.05 was regarded as statistically significant. RESULTS: The Local Moran I identified Lagos State as the significant cluster for COVID-19 in Nigeria at p<0.05. Higher GDP per capita and lower literacy rates were significantly associated with COVID-19 cases reported by the states while population density, BCG coverage and average temperature were not significantly associated. CONCLUSION: The study identified Lagos State as the hotspot for the COVID-19 pandemic in Nigeria. The states with lower literacy rate and higher GDP per capita reported a higher number of COVID-19 cases. Proactive measures are needed to control of the infection in Lagos state while improving the literacy about the disease transmission and control measures.

CONTEXTE: Le premier cas signalé du nouveau coronavirus (COVID 19) au Nigeria a eu lieu le 27 février 2020. Depuis lors, le pays a connu une augmentation constante du nombre de patients confirmés atteints de la maladie. Au 27 avril 2021, un total de 164 756 cas confirmés de COVID-19 ont été notifiés, ce qui en fait le cinquième plus grand nombre de cas dans la région africaine. Cette étude vise à déterminer la distribution spatiale du COVID-19 au Nigeria, à identifier les clusters et à déterminer les facteurs associés au COVID-19. MÉTHODES: L'étude a utilisé des données secondaires de cas de COVID-19 notifiés dans chacun des 36 États et le Territoire de la capitale fédérale entre le 27 février et le 9 juin 2020. Les tests Global et Local de Moran I ont été utilisés pour identifier des clusters spatiaux importants. Le modèle de régression binomiale négative a été utilisé pour identifier les facteurs associés au COVID-19 et p 0,05 a été considéré comme statistiquement significatif. RÉSULTATS: Le Moran local I a identifié l'État de Lagos comme le cluster significatif pour COVID-19 au Nigeria à p<0,05. Un PIB par habitant plus élevé et des taux d'alphabétisation plus faibles étaient significativement associés aux cas de COVID-19 signalés par les États, tandis que la densité de population, la couverture en BCG et la température moyenne n'étaient pas significativement associées. CONCLUSION: L'étude a identifié l'État de Lagos comme le point chaud de la pandémie de COVID-19 au Nigéria. Les États ayant un taux d'alphabétisation plus faible et un PIB par habitant plus élevé ont signalé un nombre plus élevé de cas de COVID-19. Des mesures proactives sont nécessaires pour contrôler l'infection dans l'État de Lagos tout en améliorant les connaissances sur la transmission de la maladie et les mesures de contrôle. Mots-clés: COVID-19, Nigeria, SARS-CoV-2, clusters spatiaux, épidémiologie spatiale, statistiques spatiales.

Preparation of the intact rodent organ of Corti for RNAscope and immunolabeling, confocal microscopy, and quantitative analysis.

This protocol describes the preparation of the mouse organ of Corti for RNAscope, immunolabeling, confocal microscopy, and quantitative image analysis to examine transcript and protein localization, sensory hair cells, and synapses. This protocol can be applied to mice and other rodents (juvenile and adult) and can be adapted for other techniques, including electrophysiology and RNA sequencing. This protocol features minimal tissue processing to preserve viability for downstream assays, while isolating the organ of Corti is the most challenging step. For additional details on the use and execution of this protocol, please refer to McLean et al. (2009); Schuth et al. (2014); Lingle et al. (2019); Pyott et al. (2020).

Volume gradients in inner hair cell-auditory nerve fiber pre- and postsynaptic proteins differ across mouse strains.

In different animal models, auditory nerve fibers display variation in spontaneous activity and response threshold. Functional and structural differences among inner hair cell ribbon synapses are believed to contribute to this variation. The relative volumes of synaptic proteins at individual synapses might be one such difference. This idea is based on the observation of opposing volume gradients of the presynaptic ribbons and associated postsynaptic glutamate receptor patches in mice along the pillar modiolar axis of the inner hair cell, the same axis along which fibers were shown to vary in their physiological properties. However, it is unclear whether these opposing gradients are expressed consistently across animal models. In addition, such volume gradients observed for separate populations of presynaptic ribbons and postsynaptic glutamate receptor patches suggest different relative volumes of these synaptic structures at individual synapses; however, these differences have not been examined in mice. Furthermore, it is unclear whether such gradients are limited to these synaptic proteins. Therefore, we analyzed organs of Corti isolated from CBA/CaJ, C57BL/6, and FVB/NJ mice using immunofluorescence, confocal microscopy, and quantitative image analysis. We find consistent expression of presynaptic volume gradients across strains of mice and inconsistent expression of postsynaptic volume gradients. We find differences in the relative volume of synaptic proteins, but these are different between CBA/CaJ mice, and C57BL/6 and FVB/NJ mice. We find similar results in C57BL/6 and FVB/NJ mice when using other postsynaptic density proteins (Shank1, Homer, and PSD95). These results have implications for the mechanisms by which volumes of synaptic proteins contribute to variations in the physiology of individual auditory nerve fibers and their vulnerability to excitotoxicity.

Epidemiology of Coronavirus Disease (COVID-19) in Nigeria

In late December 2019, there was an outbreak of a new Coronavirus infection in Wuhan, Hubei Province, China, which caused acute respiratory syndrome of unknown aetiology. The World Health Organization (WHO) named the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) or COVID-19 and declared the infection a pandemic on the 11th of March 2020. The first case of COVID-19 in Nigeria was reported on the 27th of February 2020 and since then the numbers of confirmed cases has been on the increase, at least in Nigeria. With no vaccine or cure in sight, only public health measures that include personal protective measures, physical distancing, environmental and travel-related measures have been recommended to mitigate and contain the spread of the disease. There is need to make testing for COVID-19 widely available so that the true burden of the infection will be described. This step should assist policy makers in making evidence-based decisions in the prevention and control of the disease

Altered cochlear innervation in developing and mature naked and Damaraland mole rats.

Compared to many other rodent species, naked mole rats (Heterocephalus glaber) have elevated auditory thresholds, poor frequency selectivity, and limited ability to localize sound. Because the cochlea is responsible for encoding and relaying auditory signals to the brain, we used immunofluorescence and quantitative image analysis to examine cochlear innervation in mature and developing naked mole rats compared to mice (Mus musculus), gerbils (Meriones unguiculatus), and Damaraland mole rats (Fukomys damarensis), another subterranean rodent. In comparison to mice and gerbils, we observed alterations in afferent and efferent innervation as well as their patterns of developmental refinement in naked and Damaraland mole rats. These alterations were, however, not always shared similarly between naked and Damaraland mole rats. Most conspicuously, in both naked and Damaraland mole rats, inner hair cell (IHC) afferent ribbon density was reduced, whereas outer hair cell afferent ribbon density was increased. Naked and Damaraland mole rats also showed reduced lateral and medial efferent terminal density. Developmentally, naked mole rats showed reduced and prolonged postnatal reorganization of afferent and efferent innervation. Damaraland mole rats showed no evidence of postnatal reorganization. Differences in cochlear innervation specifically between the two subterranean rodents and more broadly among rodents provides insight into the cochlear mechanisms that enhance frequency sensitivity and sound localization, maturation of the auditory system, and the evolutionary adaptations occurring in response to subterranean environments.

Sodium-activated potassium channels shape peripheral auditory function and activity of the primary auditory neurons in mice.

Potassium (K+) channels shape the response properties of neurons. Although enormous progress has been made to characterize K+ channels in the primary auditory neurons, the molecular identities of many of these channels and their contributions to hearing in vivo remain unknown. Using a combination of RNA sequencing and single molecule fluorescent in situ hybridization, we localized expression of transcripts encoding the sodium-activated potassium channels KNa1.1 (SLO2.2/Slack) and KNa1.2 (SLO2.1/Slick) to the primary auditory neurons (spiral ganglion neurons, SGNs). To examine the contribution of these channels to function of the SGNs in vivo, we measured auditory brainstem responses in KNa1.1/1.2 double knockout (DKO) mice. Although auditory brainstem response (wave I) thresholds were not altered, the amplitudes of suprathreshold responses were reduced in DKO mice. This reduction in amplitude occurred despite normal numbers and molecular architecture of the SGNs and their synapses with the inner hair cells. Patch clamp electrophysiology of SGNs isolated from DKO mice displayed altered membrane properties, including reduced action potential thresholds and amplitudes. These findings show that KNa1 channel activity is essential for normal cochlear function and suggest that early forms of hearing loss may result from physiological changes in the activity of the primary auditory neurons.

Changes in spontaneous movement in response to silent gaps are not robust enough to indicate the perception of tinnitus in mice.

Approaches to identify the perception of tinnitus in various animal models have been difficult to apply to mouse. As a result, mice have been underutilized to investigate the cellular, molecular, and genetic mechanisms underlying tinnitus. A recent study in guinea pigs identified a novel spontaneous behavior (unconditioned response), changes in movement during silent gaps, that identified a subgroup of animals presumably with tinnitus. Guinea pigs identified with tinnitus failed to "freeze" in response to silent gaps in sound. In the hope of developing a rapid and reliable assay for mice, we used a similar approach. C57BL/6J mice underwent three trials in which spontaneous movement was video recorded in the presence of white noise interrupted with six silent gaps. Movement metrics included velocity and body movement. Before the third trial, mice underwent either sham or noise exposure to induce hearing loss and tinnitus. Auditory brainstem responses before and after noise trauma confirmed normal hearing in sham-treated animals and hearing loss in the noise-exposed cohort. No differences in the various movement metrics were detected during the silent gaps either before or after sham/noise exposure. Variability in spontaneous movement both before and after sham/noise exposure was substantially greater in mice compared to guinea pigs. Thus, this assay is not sufficiently statistically powerful to identify changes in movement that might indicate tinnitus perception in mice. Previous observations also reported increased movement overall in guinea pigs identified as suffering tinnitus. In contrast, mice showed no statistically significant differences in movement between the three trials. Despite our results, other unconditioned (as well as conditioned) behaviors should be examined in mice to test their utility to detect changes that indicate the perception of tinnitus. Such assays are essential to accelerate the use of mouse models in tinnitus research.

The afferent signaling complex: Regulation of type I spiral ganglion neuron responses in the auditory periphery.

The spiral ganglion neurons (SGNs) are the first action potential generating neurons in the auditory pathway. The type I SGNs contact the sensory inner hair cells via their peripheral dendrites and relay auditory information to the brainstem via their central axon fibers. Individual afferent fibers show differences in response properties that are essential for normal hearing. The mechanisms that give rise to the heterogeneity of afferent responses are very poorly understood but are likely already in place at the peripheral dendrites where synapses are formed and action potentials are generated. To identify these molecular mechanisms, this review synthesizes a variety of literature and comprehensively outlines the cellular and molecular components positioned to regulate SGN afferent dendrite excitability, especially following glutamate release. These components include 1) proteins of the SGN postsynapses and neighboring supporting cells that together shape glutamatergic signaling, 2) the ion channels and transporters that determine the intrinsic excitability of the SGN afferent dendrites, and 3) the neurotransmitter receptors that extrinsically modify this excitability via synaptic input from the lateral olivocochlear efferents. This cellular and molecular machinery, together with presynaptic specializations of the inner hair cells, can be collectively referred to as the type I afferent signaling complex. As this review underscores, interactions of this signaling complex determine excitability of the SGN afferent dendrites and the afferent fiber responses. Moreover, this complex establishes the environmental milieu critical for the development and maintenance of the SGN afferent dendrites and synapses. Motivated by these important functions, this review also indicates areas of future research to elucidate the contributions of the afferent signaling complex to both normal hearing and also hearing loss.

Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding.

BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Comparison of statistical models used for assessing factors associated with infant mortality in Nigeria

Background: Infant mortality is a public health concern especially in developing countries, particularly Nigeria. Different models had been used independently to identify factors associated with infant mortality. Some of the used models sometimes violate the underlying assumption for the models. This study was designed to compare the models that have been previously used and identify the appropriate model using standard model selection criteria to analyse risk factors for infant mortality in Nigeria.Methods: The study utilised 2008 Nigeria Demographic and Health Survey (NDHS) data with a sample size of 7107. The NDHS was a stratified two-stage cluster design where a questionnaire was used to collect data on the birth history of women aged 15-49 years. The models employed for this study were: Logit, Probit and Clog-log. The model selection criteria were Akaike Information Criterion (AIC), Residual Deviance and Vuong test. The model with the smallest criteria was considered to be the best fit.Results: The results showed that Infant Mortality in Nigeria can be appropriately modelled by Clog-log model. The models and corresponding AIC values were: Logit (6171.1), Probit (6212.6) and Clog-log (6126.6). The residual deviance included: Logit (6135.1), Probit (6176.6) and Clog-log (6090.6). Clog-log had the smallest AIC and residual deviance values; hence, it was of the best fit. Home delivery and delivery by professionals had negative significant associations with infant mortality while women's education (primary/no education) and birth order had positive significant association, (p < 0.05). Conclusion: The best model for infant mortality evaluation in Nigeria was Clog-log. Generally, improved women's education would significantly reduce Infant Mortality in Nigeria

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children. METHODS: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013. RESULTS: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1-4 years and 186 (58.1%) 5-14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05). CONCLUSION: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.

Contexte : Le virus de l'immunodéficience humaine (VIH) et la tuberculose (TB) sont les causes majeures de décès dû à une maladie infectieuse dans le monde. L'Organisation Mondiale de la Santé estime que la prévalence du VIH parmi les enfants atteints de TB dans des pays à prévalence modérée à élevée va de 10% à 60%. Cette étude a eu pour but de déterminer l'accès aux services VIH pour les enfants coinfectés par TB-VIH.Méthodes : Une revue rétrospective des données d'enfants ayant eu un diagnostic de TB dans l'état de Lagos au Nigeria entre le 1e janvier 2012 et le 31 décembre 2013.Résultats : Un total de 1199 enfants âgés de 0 à 14 ans ont eu un diagnostic de TB. Parmi eux, 1095 (91,3%) ont eu un test VIH, dont 320 (29,2%) ont été positifs. Le ratio garçon/fille de coinfection TB-VIH a été de 1:0,9. Sur les 320 enfants coinfectés TB-VIH, 57 (17,8%), 86 (26,9%) et 186 (58,1%) respectivement avaient <1 an, 1­4 ans et 5­14 ans. Sur les 320 enfants coinfectés TB-VIH, 186 (58,1%) ont débuté le cotrimoxazole (CPT) tandis que 151 (47,2%) étaient sous traitement antirétroviral (ART). La mise sous ART n'a pas été significativement plus élevée dans les structures où les services TB-VIH se trouvaient au même endroit (P > 0,05).Conclusion : La mise sous CPT et ART a été faible. Il est nécessaire d'intensifier les efforts d'amélioration de l'accès aux services VIH à Lagos, Nigeria.

Marco de referencia: La infección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB) son las principales causas de muerte por enfermedad infecciosa en todo el mundo. La Organización Mundial de la Salud considera que la prevalencia de infección por el VIH en los niños con TB de los países con prevalencia moderada o alta oscila entre 10% y 60%. El presente estudio tuvo por objeto determinar el acceso de los niños coinfectados por el VIH y la TB a los servicios relacionados con el VIH.Método: Se llevó a cabo un examen retrospectivo de los datos sobre los niños con diagnóstico de TB en el estado de Lagos en Nigeria del 1° de enero del 2012 al 31 de diciembre del 2013.Resultados: Se estableció el diagnóstico de TB en 1199 niños de 0 a 14 años de edad, de los cuales 1095 contaban con una prueba diagnóstica del VIH (91,3%) y 320 habían obtenido un resultado positivo (29,2%). La proporción entre el sexo masculino y femenino fue 1:0,9 en los niños coinfectados. De los 320 casos de coinfección, 57 eran menores de un año de edad (17,8%), 86 tenían entre 1 y 4 años (26,9%) y 186 entre 5 y 14 años de edad (58,1%). De los 320 niños coinfectados, se inició tratamiento preventivo con cotrimoxazol (CPT) en 186 (58,1%) y 15 niños comenzaron el tratamiento antirretrovírico (ART) (47,2%). La aceptación del ART no fue significativamente más alta en los establecimientos donde los servicios contra la TB y el VIH compartían la ubicación (P > 0,05).Conclusión: La aceptación del CPT y el ART fue baja. Es preciso intensificar las iniciativas tendentes a mejorar el acceso a los servicios relacionados con el VIH de Lagos, en Nigeria.

Prevalence of vulvovaginal candidiasis among women with diabetes mellitus in Ibadan, Oyo State, Nigeria

Background: Diabetes mellitus predisposes to both bacterial and fungal infections, including Candida species. Hitherto, Candida albicans has been identified as the most common opportunistic pathogen among patients with diabetes mellitus. More recently, Non-Candida albicans Candida (NCAC) species are increasingly recognized as the cause of candida infections.Objective: To determine the prevalence of vulvovaginal candidiasis (VVC) as well as the species of Candida frequently identified among women with diabetes mellitus in Ibadan, Nigeria.Methods: A cross-sectional study of 213 women diagnosed with diabetes mellitus was carried out in 2010. Direct microscopy and fungal cultures of high vaginal swabs were done using Sabouraud--Dextrose Agar and ChromAgar.Results: The prevalence of VVC among 213 women with diabetic mellitus was 18.8% (40/213). The predominant Candida species isolated were Candida glabrata (30.0%), C. albicans and C. tropicalis (17.5%) each and C. Gulliermondii (15.0%). Diabetic women had higher rates of moderate and heavy growth of Candida density. Twenty-nine (72.5%) patients with candidiasis were symptomatic and the most common symptom was vulval/vaginal itching 48.3% (14/29.Conclusion: This study put the prevalence rate of VVC among women with diabetes mellitus in Ibadan at 18.8%. The most common Candida species isolated was C.glabrata and majority of the patients were symptomatic

Public-private mix for TB and TB-HIV care in Lagos, Nigeria.

SETTING: Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. OBJECTIVE: To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. DESIGN: A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. RESULTS: A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. CONCLUSION: There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.

HIV sero-prevalence among children diagnosed with TB in Nigeria.

A total of 76 children diagnosed with TB were screened for HIV. Eight (10.5%) were found to be HIV seropositive.

Identifying the training needs of traditional birth attendants.

With the aid of pre-tested, structured, interview questionnaires, 51 traditional birth attendants (TBAs), identified by their certificate of traditional midwifery, were assessed for their knowledge about the care given in pregnancy, labour, and the postnatal period, beliefs and delivery practices including child care, and their attitude towards orthodox midwifery. A total of 22 (43.1%) so identified were found to be practicing traditional midwifery as a full-time job, while 29 (56.9%) were practising on a part-time basis, doing other jobs such as farming and trading. Twenty-two (51.2%) of the male TBAs practised traditional midwifery as a full-time job, while the remaining 21 (48.8%) practised traditional midwifery part-time, along with farming occupation. All the female TBAs practised traditional midwifery part-time with their main occupation such as trading. There was no significant difference between the mean age of male compared with female respondents (59.3+/-15.1 vs. 54.6+/-15.9 years; P = 0.43). Harmful traditional practices, practices that may need verification and areas where training is needed are highlighted. The importance of registration and active supervision of their practices were discussed. The skills that need to be stressed include identification of danger signs in pregnancy and prompt referral of maternal complications. The essence of registration for monitoring of their activities cannot be overemphasized. Findings also revealed that appropriate training could expand their roles in primary health care programmes.

Treatment outcome of TB/HIV positive and TB/HIV negative patients on directly observed treatment, short course (DOTS) in Sagamu, Nigeria.

OBJECTIVE: The World Health Organisation marked 10 years of implementation of Directly Observed Treatment short course (DOTS). One key factor affecting the success of the DOTS strategy is the rising HIV prevalence among TB patients. The study was embarked upon to compare the treatment outcome of TB/HIV positive and TB/HIV negative patients in Sagamu, Nigeria. METHODS: A prospective study of 353 smear positive TB patients aged 15 years and above who were registered for 8 months anti-tuberculosis (DOTS) therapy between January 2001 and December 2003 at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Treatment outcome indicators of cure, default, transfer to another district and death were assessed in relation to the HIV status of the patients. RESULTS: There were 353 eligible patients of which 58 (16.4%) were HIV positive. The clinical symptoms and signs of TB were similar in both HIV positive and negative TB patients. The cure rate was 76.8%.patients. The cure rate was significantly lower in HIV infected compared with non-HIV infected TB patients (60.3% v 80.0%;p = 0.0001). However, among survivors it was not significant (71.4% v 82.5%; p = 0.07). Overall mortality was 5.1% which was significantly higher in HIV positive compared to HIV negative TB patients (15.5% v 3.1%; p = 0.00007). On the whole, 17% defaulted treatment and 1.1% failed treatment. These were however not significantly related to HIV status. CONCLUSION: The cure rate in this study is still lower than the recommended 85% target by the WHO. Mortality rate in TB/HIV positive patients was higher than in HIV negative patients. The option of a community based TB programme using volunteers or family members to supervise administration of anti-TB drugs so as to ensure adherence to TB treatment may be considered.

Knowledge and use of the partograph among healthcare personnel at the peripheral maternity centres in Nigeria.

In an attempt to evaluate the contributory factors to the high frequency of referred cases in obstructed labour at the State's referral hospital, a questionnaire-based survey of 396 maternity care-providers from 66 randomly selected peripheral delivery units in Ogun State, Nigeria was conducted over a 2-month period, to evaluate their knowledge and use of the partograph. The majority of the personnel were nurses/midwives (45.5%) and community health extension workers (CHEW) (42.7%). Of the 216 personnel (54.5%) who were aware of the partograph, 36 (16.7%), 119 (55.5%) and 61 (28.2%) demonstrated poor, fair and good levels of knowledge, respectively. No junior CHEW had a satisfactory knowledge of the partograph. Only 39 (9.8%) of all the personnel routinely employed the partograph for labour management and almost half of these individuals had a poor level of knowledge. Efforts to limit the frequency of referred cases of established obstructed labour to the State's referral hospital should include training of care-providers at the peripheral delivery units, especially junior personnel in the effective use of the partograph, in addition to employing quality assurance measures to check inappropriate use.

Pre- and post-directly observed treatment era in the management of TB: a teachiing hospital experience.

The study evaluated the effect of implementing the directly observed treatment (DOT) programme for the treatment of TB in a teaching hospital setting in Nigeria. A significant increase in treatment completion rate and reduction in mortality was observed. The expansion of the DOT programme is desirable to stem the increasing TB epidemic in the country.