Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State.

BACKGROUND: 71% of countries in the World Health Organisation's (WHO's) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO's mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs). METHODS: We followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016. RESULTS: In its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%). CONCLUSION: The case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.

Feeding behavior analysis of the soybean aphid (Hemiptera: Aphididae) on resistant soybean 'Dowling'.

Soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), is an exotic pest of soybean, Glycine max (L.) Merr., in North America. Plant resistance to the soybean aphid was recently discovered in 'Dowling' soybean in 2005. Dowling exhibits strong antibiotic effects on the soybean aphid by limiting colonization and effectively controlling aphid population development during all soybean growth stages. In addition, aphids feeding on Dowling experienced significantly reduced survival, longevity, and fecundity and increased developmental times. An assessment of soybean aphid feeding behavior was compared on Dowling and the susceptible check 'Glenwood' by using the electrical penetration graph technique. The effects of plant resistance on aphid feeding behavior were analyzed by comparing the amount of time soybean aphid spent feeding on various plant tissues on resistant and susceptible plants. There was no significant difference in the initial time for the aphid to begin probing on resistant and susceptible plants indicating no adverse effect of plant exterior on the soybean aphid attempting to feed. However the time from the beginning of plant penetration by the stylets to the first phloem sieve element phase was significantly different. In aphids that successfully reached phloem on Dowling, the time taken to reach this phase was triple the time of aphids reaching the phloem sieve element on the susceptible line. In addition, the total number of probing events and the duration of nonprobing were not significantly different between Dowling and Glenwood. When comparing feeding between lines, a greater proportion of aphids showed ingestion of xylem when feeding on Dowling, whereas successful feeding on phloem on Dowling was significantly shorter than when feeding on the susceptible line. Therefore, the antibiotic effect of Dowling resistance seems to reside at the level of the phloem sieve element, prohibiting the aphid from successfully exploiting phloem, and as a consequence the aphid abandons the Dowling plant or dies of inadequate nutritional intake.

Diploid males sire triploid daughters and sons in the parasitoid wasp Cotesia vestalis.

In the Hymenoptera, males develop as haploids from unfertilized eggs and females develop as diploids from fertilized eggs. In species with complementary sex determination (CSD), however, diploid males develop from zygotes that are homozygous at a highly polymorphic sex locus or loci. We investigated mating behavior and reproduction of diploid males of the parasitoid wasp Cotesia vestalis (C. plutellae), for which we recently demonstrated CSD. We show that the behavior of diploid males of C. vestalis is similar to that of haploid males, when measured as the proportion of males that display wing fanning, and the proportion of males that mount a female. Approximately 29% of diploid males sired daughters, showing their ability to produce viable sperm that can fertilize eggs. Females mated to diploid males produced all-male offspring more frequently (71%) than females mated to haploid males (27%). Daughter-producing females that had mated to diploid males produced more male-biased sex ratios than females mated to haploid males. All daughters of diploid males were triploid and sterile. Three triploid sons were also found among the offspring of diploid males. It has been suggested that this scenario, that is, diploid males mating with females and constraining them to the production of haploid sons, has a large negative impact on population growth rate and secondary sex ratio. Selection for adaptations to reduce diploid male production in natural populations is therefore likely to be strong. We discuss different scenarios that may reduce the sex determination load in C. vestalis.

Complementary sex determination in the parasitoid wasp Cotesia vestalis (C. plutellae).

In the Hymenoptera, single locus complementary sex determination (sl-CSD) describes a system where males develop either from unfertilized haploid eggs or from fertilized diploid eggs that are homozygous at a single polymorphic sex locus. Diploid males are often inviable or sterile, and are produced more frequently under inbreeding. Within families where sl-CSD has been demonstrated, we predict that sl-CSD should be more likely in species with solitary development than in species where siblings develop gregariously (and likely inbreed). We examine this prediction in the parasitoid wasp genus Cotesia, which contains both solitary and gregarious species. Previous studies have shown that sl-CSD is absent in two gregarious species of Cotesia, but present in one gregarious species. Here, we demonstrate CSD in the solitary Cotesia vestalis, using microsatellite markers. Diploid sons are produced by inbred, but not outbred, females. However, frequencies of diploid males were lower than expected under sl-CSD, suggesting that CSD in C. vestalis involves more than one locus.

Single-locus complementary sex determination absent in Heterospilus prosopidis (Hymenoptera: Braconidae).

In the haplodiploid Hymenoptera, haploid males arise from unfertilized eggs, receiving a single set of maternal chromosomes while diploid females arise from fertilized eggs and receive both maternal and paternal chromosomes. Under single-locus complementary sex determination (sl-CSD), sex is determined by multiple alleles at a single locus. Sex locus heterozygotes develop as females, while hemizygous and homozygous eggs develop as haploid and diploid males, respectively. Diploid males, which are inviable or sterile in almost all cases studied, are therefore produced in high frequency under inbreeding or in populations with low sex allele diversity. CSD is considered to be the ancestral form of sex determination within the Hymenoptera because members of the most basal taxa have CSD while some of the more derived groups have other mechanisms of sex determination that produce the haplo-diploid pattern without penalizing inbreeding. In this study, we investigated sex determination in Heterospilus prosopidis Viereck, a parasitoid from a relatively primitive subfamily of the Braconidae, a hymenopteran family having species with and without CSD. By comparing sex ratio and mortality patterns produced by inbred and outbred females, we were able to rule out sl-CSD as a sex determination mechanism in this species. The absence of sl-CSD in H. prosopidis was unexpected given its basal phylogenetic position in the Braconidae. This and other recent studies suggest that sex determination systems in the Hymenoptera may be evolutionary labile.

Population structure, mating system, and sex-determining allele diversity of the parasitoid wasp Habrobracon hebetor.

Besides haplo-diploid sex determination, where females develop from fertilized diploid eggs and males from unfertilized haploid eggs, some Hymenoptera have a secondary system called complementary sex determination (CSD). This depends on genotypes of a 'sex locus' with numerous sex-determining alleles. Diploid heterozygotes develop as females, but diploid homozygotes become sterile or nonviable diploid males. Thus, when females share sex-determining alleles with their mates and produce low fitness diploid males, CSD creates a genetic load. The parasitoid wasp Habrobracon hebetor has CSD and displays mating behaviours that lessen CSD load, including mating at aggregations of males and inbreeding avoidance by females. To examine the influence of population structure and the mating system on CSD load, we conducted genetic analyses of an H. hebetor population in Wisconsin. Given the frequency of diploid males, we estimated that the population harboured 10-16 sex-determining alleles. Overall, marker allele frequencies did not differ between subpopulations, but frequencies changed dramatically between years. This reduced estimates of effective size of subpopulations to only N3 approximately 20-50, which probably reflected annual fluctuations of abundance of H. hebetor. We also determined that the mating system is effectively monogamous. Models relating sex-determining allele diversity and the mating system to female productivity showed that inbreeding avoidance always decreased CSD loads, but multiple mating only reduced loads in populations with fewer than five sex-determining alleles. Populations with N3 less than 100 should have fewer sex-determining alleles than we found, but high diversity could be maintained by a combination of frequency-dependent selection and gene flow between populations.

Constrained oviposition and female-biased sex allocation in a parasitic wasp.

In haplodiploid organisms such as parasitic wasps, substantial oviposition by females without sperm is predicted to cause mated females to bias their offspring sex ratios towards daughters. The effect of the production of sons by unmated and sperm-depleted (constrained) females on sex allocation by mated females was studied in two populations of the parasitic wasp Bracon hebetor over 3 years. B. hebetor females who depleted their sperm reserves from prior matings rarely remated and became constrained to produce only sons. Constrained females readily oviposited and produced clutches similar in size to those produced by mated females. Although the fraction of constrained females in the population varied considerably between sites and sampling dates, it was usually high enough to favor the production of female-biased sex ratios by mated females. Mated females consistently produced female-biased sex ratios. However, we found no evidence that the sex ratios produced by mated females from the field shifted in relation to the proportion of constrained females in the population. Females held with males or held in isolation also produced female-biased sex ratios. These findings suggest that, in B. hebetor, mated females produce sex ratios that reflect the average fraction of constrained females over evolutionary time.

Infeccion intrahospitalaria por Klesbsiella pneumoniae en un brote de sepsis en recien nacidos. / Cross infection due to Klebsiella pneumoniae in an outbreak of sepsis in newborn infants

1. Se estudiaron 17 recien nacidos desde el punto de vista clinico y bacteriologico, que presentaban signos clinicos de sepsis entre abril y septiembre de 1978, y cuyo agente aislado en todos los casos fue Klebsiella pneumoniae. 2. El cuadro clinico se inicio en promedio a los 7.5 dias de vida. Cuatro de los recien nacidos tenian antecedentes de rotura prematura de membranas. No hubo relacion entre las infecciones del embarazo y la sepsis del recien nacido. El 53% nacieron por cesarea. 3. El 53% fue pretermino,el 70% conmenos de 2.500 gr y el 47% con scores de Apgar al minuto igual o menor de 5. 4. El cuadro clinico se manifesto en el 47% con hepatomegalia, el 70% con palidez terrosa, el 53% hipoactividad el 41% con deshidratacion e ictericia, el 35% con apnea. 5. Se aislo Klebsiella pneumoniae en personal y ambiente. 6.A todas las cepas se les practico estudio de sensibilidad a los antibioticos, encontrandose 3 grupos claramente definidos. 7. La mortalidad fue de 41%