Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players’ capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players’ support largely depends on how well the reform aligns with political structures and current institutional practices.     

Serological response of cattle following Brucella abortus strain 19 vaccination and simultaneous administration of levamisole

The serological response of heifers to injection with Brucella abortus strain 19 vaccine and simultaneous administration of levamisole hydrochloride were compared with those of heifers inoculated with Brucella abortus strain 19 vaccine alone. The Rose Bengal, serum agglutination, complement fixation and Coombs' antibovine globulin tests were used to measure the humoral responses for a period of sixteen weeks after vaccination. The results indicated that antibody titres in the heifers injected with levamisole and the vaccine were moderately elevated. It was suggested that the heightened antibody titres were possibly mediated through helper T-cells and macrophages. The significance of using levamisole as an adjuvant with Brucella abortus strain 19 vaccine in cattle is briefly discussed.     

Effect of Vaccine Direct Delivery (VDD) on vaccine stockouts and number of vaccinations: Case study from Bauchi State,Nigeria

ObjectiveVaccine stockouts are prevalent in Africa. Despite the importance of this as a barrier to universal vaccination coverage, rigorous studies looking at ways to reduce vaccine stockouts have been limited. We causally evaluated the effect of Vaccine Direct Delivery (VDD), an intervention to ensure the vaccine stock availability at health facilities, on the reduction of stockouts in Bauchi state, Nigeria.MethodsEmploying the interrupted time-series method, we evaluated the change in the occurrence of vaccine stockouts before and after the introduction of VDD in July 2015. We used health facility level data from January 2013 to December 2018 among 175 facilities in Bauchi state, collected through the District Health Information Software 2 (DHIS2) for monthly information on stockouts and stock balances in all the health facilities in Nigeria. Data were analyzed using Stata 15 SE. To validate the causal relationship between VDD and vaccine stockouts, we conducted two sets of robustness checks. First, we evaluated the effect of VDD on the stockouts of other commodities. Second, we compared the trend of the prevalence of vaccine stockouts among health facilities between Bauchi state where VDD was introduced and another state (Adamawa state) where VDD was never introduced.ResultsAfter the introduction of VDD, vaccine stockouts in Bauchi state decreased by 9 percentage points on average, and they have been decreasing monthly by 0.4 percentage points more than pre-VDD. In Adamawa state, where VDD was never introduced, the prevalence of vaccine stockouts did not change over time. In Bauchi state after VDD introduction, the stock balances of target vaccines all increased, and the number of vaccinations carried out increased in neighboring health facilities.ConclusionsVDD intervention resulted in a significant reduction of vaccine stockouts as well as in an increase in the number of vaccinations performed. However, we should consider how to improve the system to provide vaccination service to the population in a sustainable way.     

Support and unmet needs of patients undergoing multidrug-resistant tuberculosis (MDR-TB) treatment in southern Nigeria

Multidrug-resistant tuberculosis (MDR-TB) is presently a major public health threat. MDR-TB patients face diverse financial and psychosocial difficulties. Researchers conducted in-depth interviews based on interview guides with 42 participants. Data were analyzed using categorization, coding, generation of themes, and thematic memo writing. The key findings were as follows: Out of the 42 patients, 30 (71.4%) were males and 12 (28.6%) were females. All patients received financial stipends for transport and monthly social support. The patients however needed more financial support than they received (suggesting high unmet financial needs). Patients suffered depressive mood before and during treatment but received inadequate mental health/psychosocial care and treatment. Patients developed hearing impairment as a major adverse drug reaction, but the care and treatment they received were inadequate. In conclusion, the programmatic support provided for MDR-TB patients' financial and mental health/psychosocial needs and auditory drug side effects fell short of their need. Programmes for control of MDR-TB should increase budgetary allocations and ramp up mechanisms for provision of mental health/psychosocial support and care/treatment for drug side effects.     

Endemicity of vesical schistosomiasis in the Ebonyi Benue river valley,south eastern Nigeria

The investigation on the prevalence of patent and clinically severe infections with Schistosoma haematobium was carried out amongst inhabitants of Ebonyi Benue river valley, South Eastern Nigeria between August 2000 and June 2001. The inhabitants are predominantly farmers. Of the 3296 subjects examined from 15 randomly selected villages in the valley, 776 (23.5%) were excreting the eggs of S. haematobium in their urine. Infection rates varied between 18.9% and 30.6%. The severity of infection calculated by arithmetic mean egg counts (AMEC) and geometric mean egg counts (GMEC) varied significantly between the age groups and the villages (P < 0.05). The prevalence and severity of infection increased with age from 0 to 25 years and decreased thereafter. Symptoms associated with the disease include visible hematuria (63.1%), suprapubic pain (10.3%) and stranguary (9.9%). While 65 positive persons had more than one symptom, 64 of the positive persons had no noticeable symptoms. Visible hematuria showed moderate sensitivity and high specificity for the disease. Female genital schistosomiasis (FGS) of the lower reproductive tract was recorded in 19 females of child bearing age that complained of severe suprapubic pain. Eight snail species were recorded in the stagnant ponds and both Bulinus globosus and B. truncatus were infected with schistosome cercariae. The factors contributing to these observations and feasible control measures are discussed.     

The effects of different storage temperature conditions on the infectivity of Trypanosoma brucei in mice in Southeastern Nigeria

The effects of storing Trypanosoma brucei in different temperature conditions were studied using 55 adult female albino mice weighing between 18 and 33 g. The mice were divided into six groups. Groups 2–6 comprised ten mice each while group 1 comprised five mice and served as the control. Groups 2–6 were each further subdivided into two sub-groups of five mice each. Storage temperature conditions were room temperature (25–28 °C) (bench) and refrigeration temperature (4 °C). The onset of parasitaemia and packed cell volume were monitored. Groups 1–6 were infected intraperitoneally with 1.0?×?10⁶ trypanosomes at 0, 3, 6, 9, 12 and 24 h, respectively, following blood sample collection and storage. It was observed that the parasites in both temperature conditions were all active till the 9th hour of storage. However, the parasites stored at room temperature (bench) were sluggish and weak compared to the very active parasites in the group stored in the refrigerator by the 12th and 24th hours of storage. A pre-patent period of 4–8 days was recorded for all infected mice despite their storage condition. Surprisingly, the parasites in both storage conditions irrespective of time of infection produced patent infections. However, the pre-patent periods were highest for mice infected at both 12 and 24 h of storage. There were no significant differences (p?<?0.05) in the mean packed cell volume between groups infected with blood stored at either temperature prior to infection irrespective of the time of infection. We therefore conclude that trypanosomes in blood samples are infective for up to 24 h either at room temperature or at the refrigeration temperature (4 °C). Even so, for optimum infectivity, the infected blood should be used for infection within 9 h of collection.     

Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu,Nigeria: a prospective,comparative study

IntroductionFolic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis.AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype.MethodThis study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment.ResultsThe median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001).ConclusionMedian red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state.     

Differentiation of Brucella abortus and Yersinia enterocolitica serotype 09 infections: use of lymphocyte transformation test

Cell-mediated immune responses in cattle infected with Brucella abortus Strain 544, cattle infected with Yersinia enterocolitica serotype 09 and non exposed cattle were studied by an in vitro whole-blood lymphocyte stimulation procedure. A soluble Brucella polypeptide containing some lipopolysaccharide prepared from Brucella abortus strain 99 was used as antigen while Concanavalin A was used as mitogen. Results were assayed for (6-3H) thymidine incorporation into deoxyribonucleic acid. All the cattle from which Brucella abortus was recovered developed very high lymphocyte transformation responses while cattle infected with Yersinia enterocolitica 09 and non exposed cattle did not develop high lymphocyte stimulation reactions. The animals infected with Yersinia enterocolitica 09 were strongly positive to the Rose Bengal, serum agglutination, Complement fixation and Coombs' antibovine globulin tests. One lactating cow infected with Yersinia enterocolitica 09 was positive to the Brucella milk ring test. It was concluded that the lymphocyte stimulation assay could be used to differentiate bovine brucellosis from yersiniosis.     

Comparative study of depression in hospitalized and stable heart failure patients in an urban Nigerian teaching hospital

OBJECTIVE: There are conflicting reports about the presence of depression in Black patients with heart failure (HF). We therefore evaluated the pattern of depression among hospitalized and stable HF patients in a homogenous Black population. METHOD: Patients hospitalized for new or decompensated HF were assessed. The Zung Self-Rating Depression Scale (SDS) questionnaire was administered to the subjects who were subsequently interviewed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). Stable HF patients at the outpatient clinic were used as controls. RESULTS: There were 123 hospitalized and 82 stable outpatients. Depression was present in 67% of hospitalized patients and 30.50% of the outpatients (P<.0001, using the SDS indexed scores). Stratifying the SDS indexed scores showed that 45.50%, 19.60% and 1.80% of the hospitalized patients compared with 26.80%, 3.70% and 0% of the outpatients had mild, moderate and severe depression (P=.007 and P=.001), respectively. The HDRS assessment showed that 63.40% of the hospitalized patients and 28.0% of the stable outpatients had significant depression (P<.0001). CONCLUSION: Depression affects two thirds of hospitalized urban Nigerian HF patients compared to one third of stable outpatients with HF. The prevalence of depression is similar to the prevalence among European and North American samples.