The WHO atlas for female-genital schistosomiasis: Co-design of a practicable diagnostic guide, digital support and training.

Up to 56 million young and adult women of African origin suffer from Female Genital Schistosomiasis (FGS). The transmission of schistosomiasis happens through contact with schistosomiasis infested fresh water in rivers and lakes. The transmission vector is the snail that releases immature worms capable of penetrating the human skin. The worm then matures and mates in the blood vessels and deposits its eggs in tissues, causing urogenital disease. There is currently no gold standard for FGS diagnosis. Reliable diagnostics are challenging due to the lack of appropriate instruments and clinical skills. The World Health Organisation (WHO) recommends "screen-and-treat" cervical cancer management, by means of visual inspection of characteristic lesions on the cervix and point-of-care treatment as per the findings. FGS may be mistaken for cervical cancer or sexually transmitted diseases. Misdiagnosis may lead to the wrong treatment, increased risk of exposure to other infectious diseases (human immunodeficiency virus and human papilloma virus), infertility and stigmatisation. The necessary clinical knowledge is only available to a few experts in the world. For an appropriate diagnosis, this knowledge needs to be transferred to health professionals who have minimal or non-existing laboratory support. Co-design workshops were held with stakeholders (WHO representative, national health authority, FGS experts and researchers, gynaecologists, nurses, medical doctors, public health experts, technical experts, and members of the public) to make prototypes for the WHO Pocket Atlas for FGS, a mobile diagnostic support tool and an e-learning tool for health professionals. The dissemination targeted health facilities, including remote areas across the 51 anglophone, francophone and lusophone African countries. Outcomes were endorsed by the WHO and comprise a practical diagnostic guide for FGS in low-resource environments.

Contributory Factors to Successful Tuberculosis Treatment in Southwest Nigeria: A Cross-Sectional Study.

Tuberculosis (TB) is one of the oldest human diseases, and preventing treatment failure is critical. This is because TB cases pose a risk to the immediate and remote communities due to the potential for spread, particularly for multidrug-resistant (MDR) strains that have been associated with higher morbidity and mortality rates. Hence, this study looked at the factors that influence TB treatment outcomes in Southwest Nigeria. We conducted a cross-sectional study with 712 TB patients from 25 directly observed treatment short course (DOTS) centers, out of which 566 (79.49%) were new treatment cases, and 102 (14.33%) were retreatment cases. The outcome variable was computed into successful treatment where 'Yes' was assigned to TB treatment completed and cured, and 'No' was assigned to all the remaining outcomes following the standard TB definition. Independent variables included in the analysis were the patient's socio-demographic characteristics (such as age, sex, distance from the facility, marital status, family type, education, and computed socioeconomic status from modified DHS household assets), clinical and facility parameters (such as the HIV status, facility of access to healthcare, healthcare workers attitudes, services offered at the facility, appearance of the facility, number of people seeking care and waiting time at the facility). Bivariate analysis showed that HIV status (OR: 3.53, 95% CI: 1.83-6.82; p = 0.001), healthcare worker attitude (OR: 2.13, 95% CI: 1.21-3.74; p = 0.01), services offered at the facility (OR: 0.67, 95% CI: 0.49-0.92; p = 0.01), appearance of facility (OR: 0.67, 95% CI: 0.46-0.98; p = 0.04), and number of people seeking care (OR: 2.47, 95% CI: 1.72-3.55; p = 0.001) were associated with higher odds of successful treatment outcome with statistical significance. After multivariate analysis, reactive HIV status (aOR: 3.37, 95% CI: 1.67-6.80; p = 0.001), positive attitude of healthcare workers (aOR: 2.58, 95% CI: 1.36-4.89; p = 0.04), excellent services offered at the healthcare facility (aOR: 0.53, 95% CI: 0.36-0.78; p = 0.001) and few people seeking care (aOR: 2.10, 95% CI: 1.21-3.84; p = 0.001) became independent significant determinants of successful treatment outcome. The study concluded that reactive HIV status, positive attitude of healthcare workers, few people seeking healthcare, and excellent service provided were all factors that contributed to successful treatment outcomes.

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria.

BACKGROUND: The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010-2016 in Lagos, Nigeria. METHODS: Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. RESULTS: A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014-2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. CONCLUSION: Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.

Outcomes in Malnourished Children at a Tertiary Hospital in Swaziland after Implementation of the World Health Organization Treatment Guidelines

Background. Swaziland adopted the World Health Organization (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007; with the aim of reducing high case fatality rates for childhood malnutrition. However; no follow-up studies have been conducted to determine the reduction in these rates after implementation of the guidelines.Objectives. To determine the case fatality rate for childhood malnutrition after implementation of the WHO treatment guidelines.Methods. A retrospective observational study was undertaken. Demographic; anthropometric and clinical characteristics and outcomes for all children aged under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 were recorded and analysed. Results. Of the 227 children who met the study inclusion criteria; 179 (64.6) were severely malnourished and 98 (35.4) had moderate malnutrition; 111 children died during admission; giving an overall case fatality rate of 40.1. Mortality was significantly higher among severely malnourished children than among those with moderate malnutrition (46.9 v. 27.6) (odds ratio (OR) 3.0; 95 confidence interval (CI) 1.7 - 5.3). Co-morbid pneumonia and gastroenteritis were significant predictors of mortality (OR 2.0; 95 CI 1.2 - 3.4 and OR 1.9; 95 CI 1.1 - 3.2; respectively). Conclusion. Case fatality rates for childhood malnutrition remain high despite adoption of the WHO treatment guidelines. There is a need for periodic clinical audits and mortality review meetings to reduce deaths from childhood malnutrition so as to meet the WHO mortality target of less than 5 and improve child survival