Investing in life saving vaccines to guarantee life of future generations in Africa.

The World Health Organization's Regional Offices for Africa and for the Eastern Mediterranean in conjunction with the African Union and the Government of Ethiopia hosted a ministerial conference on immunization in Africa from 24 to 25 February 2016 in Addis Ababa, Ethiopia under the theme "towards universal immunization coverage as a cornerstone for health and development in Africa". The conference brought together African leaders - including health and finance ministers, and parliamentarians thus creating a powerful platform for governments to demonstrate their commitment to advancing universal access to immunization on the continent in line with the Global Vaccine Action Plan. The event also brought together advocates, technical experts, policymakers, partner agencies, donors and journalists to examine how best to drive forward immunization across Africa, ensuring every child has access to the vaccines they need. Key points highlighted throughout conference were: universal access to immunization is at the forefront of enabling Africa to reach its full potential - by improving health, driving economic growth and empowering future generations; it is one of the most cost-effective solutions in global health, with clear benefits for health and development; and immunization brings economic benefits too, reducing health care costs and increasing productivity. At the close of the conference, 46 African countries signed a historic ministerial declaration on "Universal Access to Immunization as a Cornerstone for Health and Development in Africa" signaling fierce determination among African leaders to secure the health and prosperity of their societies through immunization.

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.

Enhancing access to immunization services and exploiting the benefits of recent innovations in the African region.

The African Regional Office of the World Health Organization (WHO AFRO) organized the annual regional conference on immunization (ARCI) from 10 to 12 December 2012 in Dar es Salaam, Tanzania, under the theme, "Innovations, access and the right of all to vaccines". The meeting reviewed the status of immunization in the region and identified all innovations, strategies and technologies available and how these could be fully utilized to enhance the access and the rights of all to vaccines. Over 50 oral presentations were made in plenary and parallel sessions of the conference which was attended by over 200 participants drawn from national immunization programs, academia, public health experts and immunization partners. In addition there were 40 poster presentations. This manuscript summarizes of the meeting, highlighting the innovations in immunization being piloted or scaled-up, their impact and suggesting ways to further improve immunization service delivery for the eradication, elimination and control of vaccine-preventable diseases in the region.

Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria?

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P < 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.

The rapid monitoring of ivermectin treatment: will school-based surveys provide the answer?

The data on ivermectin-treatment coverage recorded in household surveys sometimes conflict with those recorded in school-based surveys or in the relevant treatment registers maintained by community-directed distributors (CDD). An attempt has now been made, in two sites in Nigeria (Enugu and Kaduna states) and one in Sudan (Abu Hamad province), to determine how well these three sets of data are correlated (and to explore the effectiveness of several alternative channels for the delivery of treatment-monitoring forms to schools). Using a cross-sectional approach, data were collected from primary schools, households and treatment registers. Calculation of Pearson's correlation coefficients (r) indicated that, overall, the data from the household surveys were very similar to those collected using the school-based strategy (r=0.66; P<0.0001) or from the treatment registers of the CDD (r=0.86; P<0.0001). The information recorded in the CDD registers also closely matched that recorded in the school-based surveys (r=0.67; P<0.0001). These encouraging results for the pooled data masked some inter-site differences. The correlation between the household-survey and treatment-register data was, for example, only good in Enugu (r=0.89; P<0.001), and was too weak to be statistically significant in Abu Hamad or Kaduna. Although the results of the school-based survey in Kaduna also did not closely correlate with those of the corresponding household survey (r=0.10; P=0.71), the household survey at this site was probably not conducted as well as those at the two other sites. In general, it appears that school-based surveys are an effective means of monitoring community coverage with ivermectin, rapidly, accurately and at relatively low cost. It is therefore recommended that school-based methods of monitoring of coverage are adopted by programme managers.

Onchocerciasis in pre-primary school children in Nigeria: lessons for onchocerciasis country control programme.

There is limited data on the prevalence of onchocerciasis in young children in Nigeria, partly because treatment with the effective drug Ivermectin has been contra-indicated in children less than 5. As the risk of complications of onchocerciasis is related to duration and intensity of infection, it would be beneficial to know the prevalence in young children for design of control programmes. A study was therefore undertaken to determine the prevalence of onchocerciasis in 642 children 0-4 years old in a rain forest endemic community in South East Nigeria. The overall onchocerciasis prevalence (positive skin snips) for children 0-4 years old in three Local Government Areas in Enugu State, Eastern Nigeria was 15.7% with no significant difference in infection rates between male and female children. There was no detectable infection in children less than 1 year old. Characteristic onchocercal rash was identified in 11.1% of the children and presence of typical onchocercal subcutaneous palpable nodules in 4.6%. Total prevalence for adults in the same population was found to be 26.9%. This indicates that in onchocerciasis endemic communities, everybody may be at risk of infection irrespective of age.

Urinary schistosomiasis among school children in Nigeria: consequences of indigenous beliefs and water contact activities.

A study of urinary schistosomiasis in Umueze-Anam, Anambra State, Nigeria, showed a Schistosoma haematobium infection of 26% (85) among school children with no significant difference by sex except when age as a variable is introduced. Eleven percent (37) of the 333 children were positive for haematuria; all these 37 children lived within 1.0 km of the water sources. Of the 85 infected children, swimming and laundering accounted for 65% and 48% of all water contact activities, for boys and girls respectively. One-third of the 230 adults interviewed believed haematuria to be a venereal disease and 20% thought it was a sign of maturity. Individual perception of causation and seriousness of haematuria differed by level of education and by sex. Less than 2% of the respondents knew that snails transmitted the disease. The effects of social restrictions on the epidemiology of infection is discussed.

Factors Associated with the use of SSS Among Mothers in Nsukka Zone of Enugu State, Nigeria.

The study was designed to identify factors influencing mothers' use of SSS in the management of diarrhoea in children. A survey questionnaire was used and a total of 652 mothers drawn from both rural and urban communities were interviewed. The two perceptual factors, perceived seriousness of diarrhoea and perceived efficacy of salt sugar solution (SSS) were found to relate significantly with SSS use. Similar associations were found between knowledge of SSS preparation and beliefs about diarrhoeal illness causation. Of the three demographic factors tested, only one, education, showed potential for influencing SSS use. Religion and residence (rural, urban) were not found to be predictors of SSS use. The positive association of clinic use (as measured by place where the mother gave birth to her last child) with SSS points to the need to improve the quality of facility-based health education with special focus on improving knowledge of SSS preparation procedures and perception of SSS efficacy.