Educational Interventions for Antibiotics Misuse and Self-Medication in Africa: A Systematic Review and Meta-Analysis [Protocol].

BACKGROUND: Antibiotics misuse and self-medication remains one of the most serious public health challenges globally. Persistent rise in resistant bacterial infections has been attributed to high prevalence of antibiotics misuse and self-medication. Large volume of literature has emerged describing studies that evaluate the effectiveness of various types and combinations of educational and behavior-modification techniques to reduce antibiotics misuse and self-medication. No previous systemic review has attempted to assess the quality of evidence in public domains on educational strategies aiming to reduce prevalence and improve knowledge, attitude and practice on antibiotics misuse and self-medication in Africa. This study, therefore, intends to assess the quality of evidence presented and determine the effectiveness of health education as an intervention tool for reducing prevalence and improving knowledge and attitude on antibiotics misuse and self-medication among adults in Africa. METHODS: This study will include published papers on effectiveness of health education in reducing antibiotics misuse and self-medication from 2011-2021. Systematic search for literature will be conducted according to the Preferred Reporting Item for Systematic Reviews and Meat-analysis (PRISMA) guidelines to identify published studies based on our predetermined inclusion and exclusion criteria in PubMed, EMBASE, PsychINFO, CINAHL and Web of Sciences. Two independent reviewers will assess all identified studies and another set of reviewers will extract data for analysis and evidence synthesis.

CONTEXTE: Le mauvais usage des antibiotiques et l'automédication restent l'un des plus graves problèmes de santé publique dans le monde. L'augmentation persistante des infections bactériennes résistantes a été attribuée à la prévalence élevée de l'abus d'antibiotiques et de l'automédication. Un grand nombre de publications décrivent des études qui évaluent l'efficacité de divers types et combinaisons de techniques d'éducation et de modification du comportement pour réduire l'abus d'antibiotiques et l'automédication. Aucun examen systémique antérieur n'a tenté d'évaluer la qualité des preuves dans les domaines publics sur les stratégies éducatives visant à réduire la prévalence et à améliorer les connaissances, l'attitude et la pratique sur le mauvais usage des antibiotiques et l'automédication en Afrique. Cette étude a donc pour but d'évaluer la qualité des preuves présentées et de déterminer l'efficacité de l'éducation à la santé comme outil d'intervention pour réduire la prévalence et améliorer les connaissances et l'attitude sur le mauvais usage des antibiotiques et l'automédication chez les adultes en Afrique. MÉTHODES: Cette étude comprendra les articles publiés sur l'efficacité de l'éducation sanitaire dans la réduction de la mauvaise utilisation des antibiotiques et de l'automédication entre 2011 et 2021. Une recherche systématique de la littérature sera effectuée conformément aux directives PRISMA (Preferred Reporting Item for Systematic Reviews and Meat-analysis) afin d'identifier les études publiées en fonction de nos critères d'inclusion et d'exclusion prédéterminés dans PubMed, EMBASE, PsychINFO, CINAHL et Web of Sciences. Deux examinateurs indépendants évalueront toutes les études identifiées et un autre groupe d'examinateurs extraira les données pour l'analyse et la synthèse des preuves. Mots clés: Education à la santé, Mauvaise utilisation des antibiotiques, Automédication, Examen systématique et méta-analyse, Systématique et méta-analyse.

Species Composition of Anopheles (Diptera: Culicidae) in Selected Forested Tourist Areas of Nigeria Endemic for Malaria.

The study was carried out to determine relative abundance, species diversity, of Anopheles species (Diptera: Culicidae) in selected forested areas in Cross River State, Nigeria and the prevalence of malaria infection in the specimens. Mosquitoes were collected using pyrethrum spray catch and Centre for Disease Control light traps modified with yeast and sugar to generate carbon dioxide (CO2) and identified using morphological identification keys. We used a multiplex polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) to simultaneously distinguish sibling species of the An. gambiae s.l, including separation of An. gambiae s.s. and An. coluzzii (Diptera: Culicidae). The samples were also screened for Plasmodium infection using the enzyme-linked immunosorbent assay. One hundred and four Anopheles specimens were collected during the study of which 97% was An. gambiae complex and 3% was An. rufipes (Diptera: Culicidae). Only 77% of the An. gambiae s.l. was identify to species level. The result shows that 41.6% was An. gambiae s.s. and 34.6% was An. coluzzii. No sporozoite of Plasmodium was detected in the Anopheles species. The study also found a hybrid form of An. gambiae s.s. and An. coluzzii. These findings suggest the first documented evidence of hybrid forms of An. gambiae s.s./An. coluzzii in South Eastern Nigeria although its epidemiological implication is still not clear.

Assessing agreement of hemoglobin and three- fold conversion of hematocrit as methods for detecting anemia in children living in malaria-endemic areas of Calabar, Nigeria.

BACKGROUND: One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration. AIMS: To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial. MATERIALS AND METHODS: This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman. RESULTS: The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants. CONCLUSIONS: The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.

Quality of placental RNA: Effects of explant size and culture duration.

We evaluated the impact of placental micro (≤50 mg) and macro (∼200 mg) explants, oxygen concentration and culture method on placental RNA quality after long-term culture. Our findings show that micro explants cultured at 8% oxygen have the best RNA quality and tissue structure. Macro explants were less viable after long-term culture. Macro explants and explants undergoing syncytial degeneration produced poor quality RNA and should be avoided.

Ethics of trial drug use: to give or not to give?

The 2014 outbreak of Ebola viral disease in some West African countries, which later spread to the USA and Spain, has continued to be a subject of global public health debate. While there is no approved vaccine or drug for Ebola cure yet, moral questions of bioethical significance are emerging even as vaccine studies are at different clinical trial phases. This paper, through a normative and critical approach, focuses on the question of whether it is ethical to give any experimental drugs to Ebola victims in West Africa or not. Given the global panic and deadly contagious nature of Ebola, this paper argues on three major compassionate grounds that it is ethical to use experimental drugs on the dying African victims of Ebola. Besides respecting patients and family consent in the intervention process, this paper argues that the use of Ebola trial drugs on West African population will be ethical if it promotes the common good, and does not violate the fundamental principles of transparency and integrity in human research ethics. Using Kantian ethical framework of universality as a basis for moral defense of allowing access to yet approved drugs. This paper provides argument to strengthen the compassionate ground provisional recommendation of the WHO's Strategic Advisory Group of Experts on Immunization (SAGE) on Ebola vaccines and vaccination.

Facility-Based Treatment of Under Five Diarrhoea in Cross River State: A Clinical Audit

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective; evidence- based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country.Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation.Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State; Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate; inappropriate; wrong or none; based on prescription on patients' case records.Result: Of the 370 case records audited; prescription for diarrhoea was appropriate in 40 (10.8%); inappropriate in 231 (62.4%); wrong in 82 (22.2%) and no prescription was made in 17 (4.6%).Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended

Fasting Blood Glucose Profile among Secondary School Adolescents in Ado-Ekiti, Nigeria.

Background. Over the past two decades there has been an increase in type 2 diabetes mellitus (T2DM) in children. Baseline data is needed to assess the impact of changing lifestyles on Ado-Ekiti, a previously semiurban community in Southwest Nigeria. This study was therefore conducted to assess the fasting blood glucose (FBG) of adolescents in Ado-Ekiti, Nigeria. Methodology. This was a cross-sectional study involving 628 adolescents from three different secondary schools in Ado-Ekiti, Nigeria. With parental consent, volunteers completed a structured questionnaire, and an overnight FBG was measured. Results. There were 346 males and 282 females (male : female ratio = 1.2 : 1). Their ages ranged from 10 to 19 years (mean age: 14.2 ± 1.7 years). Four hundred and forty-four (70.7%) had normal FBG, while 180 (28.7%) and 4 (0.6%) had FBG in the prediabetic and diabetic range, respectively. Female gender, age group 10-14 years, and family history of obesity were significantly associated with impaired FBG (P value <0.001, <0.001, and 0.045, resp.). Conclusion. Impaired FBG is common among secondary school adolescents and it is more prevalent among younger female adolescents (10-14 years) with positive family history of obesity.

Human chorionic gonadotrophin (HCG) stimulation test and testosterone response in children with micropenis.

BACKGROUND: Human chorionic gonadotropin (HCG) stimulation test is a reliable dynamic test for the evaluation of testicular function during childhood. A single dose of HCG injection at dose of 100 iu/kg is able to produce a progressive but modest rise in testosterone level for 72 to 120 hours in presence of a viable testicular Leydig cells. OBJECTIVE: To describe pattern of testicular response to HCG stimulation in prepubertal children with micropenis seen at a paediatric endocrinology training centre. METHODOLOGY: A retrospective review of all children seen over a fifteen months period and evaluated for micropenis using single dose HCG stimulation protocol. Information was retrieved from the clinic register and case notes of patients. Information retrieved includes age, anthropometry, associated clinical finding and results of stimulation test. Interpretation of test was as sited by Knorr and colleagues. RESULTS: Six children with micropenis had HCG stimulation test. Mean age of children was 49.9 months age range 2 months to 84 months. Base line testosterone level ranged from 0 ng/ml to 0.35 ng/ml with a mean of 0.3 ng/ml. The mean testosterone level after HCG stimulation was 1.26 ng/ml and range between 0.35 and 3.2 ng/ml. Three subjects had normal increase in testosterone level post stimulation. There was no significant increase in mean stretched penile length of 0.4 cm. CONCLUSION: HCG stimulation is an important test to determine Leydig cell function and testosterone secretion in children with micropenis. 3 (50%) including a cryptochid child showed normal rise in testosterone level post HCG stimulation. The normal response indicates a normal leydig cell function and possible presence of viable testicular tissues in the cryptochid.

Postural hypotension in type 1 diabetes: the influence of glycemic control and duration of illness.

BACKGROUND: Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub-saharan Africa where suboptimal care of DM is prevalent. AIMS: The aim of the study was to determine the prevalence of PH in young patients with type 1DM and its relationship with the duration of DM and glycemic control. SETTINGS AND DESIGN: It was a cross-sectional, case control study carried out in the pediatric out-patient clinic. MATERIALS AND METHODS: Each study participant had blood pressure (BP) measured in the supine and standing positions. Glycated hemoglobin (HbA1c) levels were determined and disease duration was documented. STATISTICAL ANALYSIS: The mean BP in the different positions was determined. The occurrence of PH, duration of disease and HbA1c levels was determined with logistic regression analysis. RESULTS: A total of 26 diabetic subjects and 26 age and sex matched controls were studied. 12 (46.2%) diabetic subjects had evidence of PH while none of the controls had PH. Diabetic subjects with PH had significantly longer duration of DM than those diabetics without PH (6.79 ± 4.81 vs. 2.83 ± 2.36, P = 0.023). The mean HbA1c level was similar in both groups of diabetic subjects (9.79 ± 2.07 vs. 9.17 ± 2.35). On logistic regression, age, duration of disease, HbA1c level and body mass index were not significant predictors of PH. CONCLUSION: PH is common in young persons with type 1 DM, with higher frequency in those with long standing disease.

Congenital cystic adenomatoid malformation of the lung: a case report and diagnostic challenges in a typical African setting.

Congenital cystic adenomatoid malformation (CCAM) of the lung an entity which results from a harmatomatous proliferation of the bronchioles constitutes 25% of the all congenital lung anomalies. Majority of cases of CCAM usually present with respiratory distress from birth, while others may present with recurrent chest infections in childhood or in adulthood. Most reports on CCAM have been on caucasian children and the diagnosis of the condition appears to be challenging unless there is a high index of suspicion. This report describes the case of a child who presented in late infancy and was initially managed as a case of hydropneumothorax, however a Computed Tomography (CT) of the chest confirmed CCAM. The diagnostic challenges is also addressed.

17 beta-hydroxysteroid dehydrogenases--their role in pathophysiology.

17 beta-Hydroxysteroid dehydrogenases (17HSDs) regulate the biological activity of sex steroid hormones in a variety of tissues by catalyzing the interconversions between highly active steroid hormones, e.g. estradiol and testosterone, and corresponding less active hormones, estrone and androstenedione. Epidemiological and endocrine evidence indicates that estrogens play a role in the etiology of breast cancer, while androgens are involved in mechanisms controlling the growth of normal and malignant prostatic cells. Using LNCaP prostate cancer cell lines, we have developed a cell model to study the progression of prostate cancer. In the model LNCaP cells are transformed in culture condition into more aggressive cells. Our data suggest that substantial changes in androgen and estrogen metabolism occur in the cells, leading to increased production of active estrogens during the process. In breast cancer, the reductive 17HSD type 1 activity is predominant in malignant cells, while the oxidative 17HSD type 2 mainly seems to be present in non-malignant breast epithelial cells. Deprivation of an estrogen response by using specific 17HSD type 1 inhibitors is a tempting approach in treating estrogen-dependent breast cancer. Our recent studies demonstrate that in addition to sex hormone target tissues, estrogens may be important in the development of cancer in some other tissues previously not considered to be estrogen target tissues, such as the gastrointestinal tract.

17 beta-hydroxysteroid dehydrogenases and cancers.

17 beta-Hydroxysteroid dehydrogenases (17HSDs) catalyze the interconversions between active 17 beta-hydroxysteroids and less-active 17-ketosteroids thereby affecting the availability of biologically active estrogens and androgens in a variety of tissues. The enzymes have different enzymatic properties and characteristic cell-specific expression patterns, suggesting differential physiological functions for the enzymes. Epidemiological and endocrine evidence indicate that estrogens play a key role in the etiology of breast cancer while androgens are involved in mechanisms controlling the growth of prostatic cells, both normal and malignant. Recently, we have developed, using LNCaP prostate cancer cell lines, a cell model to study the progression of prostate cancer. In the model LNCaP cells are transformed in culture condition to more aggressive cells, able to grow in suspension cultures. Our results suggest that substantial changes in androgen and estrogen metabolism occur in the cells during the process. These changes lead to increased production of active estrogens during transformation of the cells. Data from studies of breast cell lines and tissues suggest that the oxidative 17HSD type 2 may predominate in human non-malignant breast epithelial cells, while the reductive 17HSD type 1 activity prevails in malignant cells. Deprivation of an estrogen response by using specific 17HSD type 1 inhibitors is a tempting approach to treat estrogen-dependent breast cancer. Our recent studies demonstrate that in addition to sex hormone target tissues, estrogens may be important in the development of cancer in some other tissues previously not considered as estrogen target tissues such as colon. Our data show that the abundant expression of 17HSD type 2 present in normal colonic mucosa is significantly decreased during colon cancer development.

Prostate specific antigen in the Nigerian African.

The biological characteristics of prostate-specific antigen were studied in the Nigerian African. Two hundred and fourteen persons were selected for the study. The group was made up of 59 apparently healthy men (age range 22-76 years), 58 men (age range 40-91 years) who had biopsy proven diagnosis of cancer of the prostate gland, 81 men (age range 46-87 years) who had biopsy proven benign prostatic hypertrophy (BPH) and 16 women (age range 23-47 years). Their median ages were 53 years, 66 years, 66 years and 27 years, respectively. The median PSA value among the control population was 0.7 ug/L (range 0.1-4.3 ug/L) and 98.3% of them had PSA of less than 4 ug/L. No person below 50 years of age had PSA value greater than 2 ug/L. There was a significant correlation between age and serum PSA value over the entire age range (r = 0.523; P = 0.001). In the female study group, 4(25%) had detectable values the cause of which could not be determined. The median PSA value among the BPH patients was 8.5 ug/L (range 0.2-350 ug/L). In this group 37% of them had values below 4 ug/L and 54.3% of them had values less than 10 ug/L. Among the patients who had cancer of the prostate gland the median PSA value was 92.6 ug/L and the mode was greater than 350 ug/L (32% of the patients); 10% and 20% of them had values below 4 ug/L and 10 ug/L respectively. It is concluded that the trend is the same as in the studies and there is the need for prostate gland volume studies and evaluation of women who have detectable PSA values.

Validity of the GHQ-30 in a Nigerian medical outpatient clinic.

Basic mental health vital statistics are scarce in developing countries. Scarcer still are validated psychological survey instruments which can be used in these settings. A method of dealing with such scarcity is through the validation of instruments developed elsewhere. One such instrument is Goldberg GHQ-30. The 30-item General Health Questionnaire was used by the authors as a screening instrument for emotional disorder in a general medical outpatient clinic. The GHQ-30 misclassified 32.3% of the respondents, a majority of whom were false-positives. There is a tendency for the misclassified respondents to suffer from chronic physical ailments, and to be older. The GHQ-30 appears not to have high specificity (65%) and sensitivity (73%). The predictive value (53.3%) of a positive finding by this screening instrument in this population is also low. Informed consent was obtained from participating subjects.

Plasma vitamin C (ascorbic acid) levels in asthmatic children.

Plasma concentration of ascorbic acid was determined in fifty-one asthmatic children and a group of matched controls. The mean ascorbic acid level of 0.54 mg/100 ml among the asthmatics was significantly lower than a mean of 0.84 mg/100 ml for controls (P less than 0.001). Ascorbic acid level was directly related to the socio-economic class (SC) since asthmatic children from SC I, II and II had significantly higher ascorbic acid levels than those from SC IV and V. There was however, no relationship between the plasma ascorbic acid level and atopy, frequency of asthmatic attacks over the previous 12 months and the duration of asthma. It is postulated that if plasma ascorbic acid level was related to the susceptibility to viral respiratory tract infections, the observed low level of the vitamin in the asthmatics would make them more liable to such infections which are capable of precipitating acute asthmatic attacks. Confirmation of our results would indicate the need for regular ascorbic acid supplement in some children with bronchial asthma.

Serum alpha 1-antitrypsin levels in asthmatic children.

Serum levels of alpha 1-antitrypsin (AAT) were determined by an enzymatic assay method in fifty-five asthmatic children and in the same number of controls. The mean AAT level was significantly lower in asthmatics (1.65 mumol/min/ml) than in controls (2.0 mumol/min/ml) (P less than 0.02). A significantly higher proportion of asthmatics than controls (P less than 0.05) had levels below 2.1 mumol/min/ml which is the lower limit of normal, thus suggesting a higher prevalence of partial (heterozygous) AAT deficiency in the asthmatics. There was no relationship between the mean AAT levels and age, duration of asthma or frequency of asthmatic attacks. Although there is some controversy about the relationship between heterozygous AAT deficiency and pulmonary disease, severe (homozygous) AAT deficiency has been linked with emphysema which is also a complication of asthma. There was however, no evidence of emphysema in either the asthmatic child or the control who had no detectable serum AAT. There were three asthmatics whose chest radiographs showed hyperinflation, but had a mean AAT level that was not significantly different from that in those without such changes. Further studies, including phenotype determination in a larger group of asthmatic children, are required in order to determine the prevalence of both homozygous and heterozygous AAT deficiencies which may be risk factors in the development of emphysema and other pulmonary complications of asthma.

Serum IgG, IgA and IgM in asthmatic children.

Serum levels of immunoglobulins G, A and M were determined in forty-five asthmatic children and in the same number of controls. Mean IgG and IgA levels in the asthmatics were not significantly different from those in the controls. Conversely, mean IgM values in female controls and all the controls taken as a group, were significantly higher than those in their asthmatic counterparts. There was no relationship between severity of asthma and the mean levels of the various immunoglobulins. However, the mean IgG value in asthmatic children with positive skin sensitivity tests was significantly higher than the mean value in those who had negative reactions. It is concluded that the serum levels of these immunoglobulins are of limited value in either the diagnosis of asthma or in the grading of its severity.