Impact of Introducing Integrated Quality Assessment for Tuberculosis and Malaria Microscopy in Kano; Nigeria

Background: The World Health Organization (WHO) has recommended the integration of malaria microscopy quality assessment (QA) with that of other microscopically diagnosed diseases; but there is no evidence that it has been attempted. We assessed the feasibility of linking malaria microscopy into the existing tuberculosis (TB) microscopy QA system in Kano; Nigeria. Methodology: Five TB microscopy centres were selected for implementing the integrated TB and malaria microscopy QA scheme in the state. A model system was designed for selecting and blinded rechecking of TB and malaria slides from these laboratories. Supervision and evaluation was conducted at 3-month intervals for 24 months. Results: TB microscopy QA was strengthened in four laboratories. Full integration of the QA for TB and malaria microscopy was achieved in two laboratories; and partial malaria microscopy results. At the final assessment; 100specificity was achieved for TB microscopy results in four laboratories. There was an increased concordance rate and decreased false positivity and false negativity rates of TB microscopy results in all five laboratories. Conclusions: It is feasible to integrate the QA system and training for TB and malaria microscopy for assessing and improving quality of both services. However; the integrated system needs testing in different settings in order to be able to develop sound recommendations to guide the complex scaling-up process

Urinary Schistosomiasis in the Danjarima Community in Kano; Nigeria

Background: Studies in northern Nigeria have suggested a linear relationship between urinary schistosomiasis and individual water-related activities. Knowledge of the perceptions of the local populace about schistosomoasis and of gender and cultural restrictions could be beneficial to control programmes. We studied the prevalence of urinary schistosomoasis and the socio-demographic factors associated with the disease in Danjarima community of Kano; northern Nigeria. Methodology: A cross-sectional survey involving 890 subjects was conducted in the community. Urine samples were collected and examined for ova of Schistosoma haematobium using sedimentation technique. A semi-structured questionnaire was administered to the subjects in order to determine their knowledge and perceptions about urinary schistosomiasis in relation to their cultures. Results: Eggs of S. haematobium were demonstrated in 370 (41.6) of the urine sampled examined. The highest prevalence rate of 54.4infection with S. haematobium was recorded in Zaura sub-village while the lowest rate of 6.4was observed in Sabon-Fegi. More males (55.9) were infected than females (3.7) and the difference between the infection rate in males and females was statistically significant (P = 0.01). The age group 10 to 14 years recorded the highest rate of infection (P = 0.05) in both males (80.9) and females (10.3). Conclusion: The lack of adequate perception on the cause of urinary schistosomiasis and exposure to water bodies were responsible for the high prevalence of infection in Danjarima

Recurrent cholera epidemics in Kano--northern Nigeria.

OBJECTIVES: The study examined the factors associated with recurrent cholera epidemics in Kano State of Northern Nigeria, the management of the epidemics and health outcomes. METHODS: Using epidemiological data from the Public Health Department of the Kano State Ministry of Health, the study examined the frequency and geographical distribution of the epidemics for the period 1995 to 2001; procedures for detection; control measures as well as results of biological and bacteriological testing of water from different sources. Mapping and testing for significance of faecal contamination of water sources were done. RESULTS: The number of cholera cases in the city was 2 630; 847 and 2 347 in 1995/6, 1997 and 1999 respectively. The State Epidemiological Unit which is responsible for surveillance detected epidemics using set thresholds and activated multi-sectoral emergency responses. Control measures encompassed accurate diagnosis at the reference laboratory, Kaduna; registration of cases; case management and public health measures targeting personal hygiene and water treatment. The cholera epidemics attracted worldwide attention with emergency responses from many agencies including WHO, UNICEF and Medicens Sand Frontiers (MSF). Case fatality rates decreased from 15% in 1995/6 to 5% in 1997 and 2% in 1999. The organism responsible for all the outbreaks was Vibrio cholerae, el-tor of inaba serotype. Water contamination of all sources was the principal cause of the epidemics. There were statistically significant differences in levels of faecal contamination of water sources, wells being most affected, followed by piped water, chi2 = 11.556, (p < 0.02). Bore holes were relatively safer sources of water. Point source epidemics always started from Kano City before fanning out to the rest of the State. CONCLUSION: Multi-sectoral Epidemic Preparedness and Response (EPR) approaches have contributed to the reduction in case fatality rates over the years and should be sustained. However, in order to prevent future cholera epidemics, there is need to introduce intervention measures that address the root problems of poor sanitation and unsafe water supplies.