Enhancing health policymakers' information literacy knowledge and skill for policymaking on control of infectious diseases of poverty in Nigeria

Background

In Nigeria, one of the major challenges associated with evidence-to-policy link in the control of infectious diseases of poverty (IDP), is deficient information literacy knowledge and skill among policymakers. There is need for policymakers to acquire the skill to discover relevant information, accurately evaluate retrieved information and to apply it correctly.

Objectives

To use information literacy tool of International Network for Availability of Scientific Publications (INASP) to enhance policymakers'' knowledge and skill for policymaking on control of IDP in Nigeria.

Methods

Modified "before and after" intervention study design was used in which outcomes were measured on target participants both before the intervention is implemented and after. This study was conducted in Ebonyi State, south-eastern Nigeria and participants were career health policy makers. A two-day health-policy information literacy training workshop was organized to enhance participants" information literacy capacity. Topics covered included: introduction to information literacy; defining information problem; searching for information online; evaluating information; science information; knowledge sharing interviews; and training skills.

Results

A total of 52 policymakers attended the workshop. The pre-workshop mean rating (MNR) of knowledge and capacity for information literacy ranged from 2.15-2.97, while the post-workshop MNR ranged from 3.34-3.64 on 4-point scale. The percentage increase in MNR of knowledge and capacity at the end of the workshop ranged from 22.6%-55.3%.

Conclusion

The results of this study suggest that through information literacy training workshop policy makers can acquire the knowledge and skill to identify, capture and share the right kind of information in the right contexts to influence relevant action or a policy decision.     

Genetic bottlenecks, perceived racism, and hypertension risk among African Americans and first-generation African immigrants

The complexity of factors influencing the development of hypertension (HTN) in African Americans has given rise to theories suggesting that genetic changes occurred due to selection pressures/genetic bottleneck effects (ie, constriction of existing genetic variability) over the course of the slave trade. Ninety-nine US-born and 86 African-born health professionals were compared in a cross-sectional survey examining genetic and psychosocial predictors of HTN. We examined the distributions of three genetic loci (G-protein, AGT-235, and ACE I/D) that have been associated with increased HTN risk. There were no significant differences between US-born African Americans and African-born immigrants in the studied genetic loci or biological variables (eg, plasma renin and angiotensin converting enzyme activity), except that the AGT-235 homozygous T genotype was somewhat more frequent among African-born participants than US-born African Americans. Only age, body mass index, and birthplace consistently demonstrated associations with HTN status. Thus, there was no evidence of a genetic bottleneck in the loci studied, ie, that US-born African Americans have different genotype distributions that increase their risk for HTN. In fact, some of the genotypic distributions evidenced lower frequencies of HTN-related alleles among US-born African Americans, providing evidence of European admixture. The consistent finding that birthplace (ie, US vs Africa) was associated with HTN, even though it was not always significant, suggests potential and unmeasured cultural, lifestyle, and environmental differences between African immigrants and US-born African Americans that are protective against HTN.     

Western blot-indeterminate results in Nigerian patients HIV serodiagnosis: the clinical and public health implication

The clinical and public health implication of HIV Western blot (WB) indeterminate results is yet to be appraised in sub-Saharan Africa, including Nigeria. Using HIV Tri Line Test enzyme-linked immunosorbent assay (ELISA), 1286 patients (600 males and 686 females; age range, 5-60 years) with symptoms suggestive of HIV infection were screened. A total of 1020 (79.3%, 95% confidence interval [CI] 76.8-81.5) of the patients comprising of 514 (85.7%) males and 506 (73.8%) females were HIV seropositive and the difference was statistical significantly (chi(2) = 5.72, df = 1, p < 0.05). Western blot analysis of sera from the 1020 HIV-seropositive individuals using the BIO-RAD NEW LAV-BLOT I specifying World Health Organization (WHO) interpretive criteria, confirmed the HIV serostatus of 815 (79.9%, 95% CI, 77.4-82.4) of them with 205 (20.1%, 95% CI, 17.6-22.6) individuals having indeterminate results consisting of either; 1 env +/- gag +/- pol, gag + pol, gag only or pol only. Of these, 102 (19.8%) were males and 103 (20.4%) were females. Patients aged 11-20 years old recorded the highest percentage of indeterminate results (31.7%, 95% CI, 20.2-43.2) while those aged 21-30 years recorded the least (14.2%, 95% CI, 10.6-17.8) and the difference was statistically significant (chi(2) = 15.73, df = 5, p < 0.05). Result confirmed the limitation of Western blot assays in HIV confirmatory serodiagnosis. After obtaining HIV indeterminate Western blot result, clinicians should consider the total profile for the patient, reassess risk factors for HIV infection, perform a HIV retesting at 3-month intervals for 6 months or use an alternate HIV antibody confirmatory assay and running antibody tests for other human retroviruses.     

Mandatory pre-marital HIV testing in Nigeria: the public health and social implications

The prevalence of HIV infection among individuals referred from faith-based organizations (FBOs) in south-eastern Nigeria for mandatory pre-marital HIV screening was determined. Of the total of 319 individuals (148 males, 171 females) screened, 25 (7.8%, 95%CI: 4.9-10.7%) were confirmed HIV-positive, comprising 13 (8.8%, 95%CI: 4.2-13.4%) males and 12 (7%, 95%CI: 3.2-10.8%) females. No significant difference was observed in the association between HIV infection and gender (chi2=0.58, df = 1, P < 0.05). The highest prevalence of HIV infection (8.9%) was recorded among individuals in the 21-30 years age category, while the least HIV infection prevalence (5.3%) was observed among persons above 40 years old. There was no significant difference in the association between HIV infection and age (chi2=0.68, df = 3, P < 0.05). Mandatory pre-marital HIV screening could generate social stigmatization and infringement of the fundamental human rights of infected individuals. Voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing are more desirable. Guidelines for the management of test-positive individuals and non-concordant couples and the safeguarding of confidentiality should be developed. Training and capacity building for religious leaders, to appropriately manage social issues associated with HIV/AIDS as it affects their organizations, are recommended.     

Potential for parasite and bacteria transmission by paper currency in Nigeria

The authors assessed the potential of Nigerian currency notes to act as environmental vehicles for the transmission of pathogenic parasites and bacteria. Currency notes obtained from four major cities in Nigeria were evaluated according to standard techniques. Fifty-four (21.6 percent [95 percent CI: 16.50-26.70]) of the first batch of 250 notes, which underwent parasitological analysis, were contaminated with enteric parasites; 133 (53.2 percent [95 percent CI: 47.02-59.39]) of the second batch of 250 notes, which underwent bacteriological analysis, were found to be contaminated with bacteria. Parasites that were isolated from the notes included Ascaris lumbricoides (8.0 percent), Enterobius vermicularis (6.8 percent), Trichuris trichiura (2.8 percent), and Taenia species (4.0 percent). Bacteria that were isolated were Streptococcus species (21.6 percent), Staphylococcus species (12.8 percent), Escherichia coli (13.2 percent), and Bacillus species (5.6 percent). Among dirty/mutilated currency notes, parasite contamination and bacterial contamination were both significantly (p < .05) more pervasive (30.6 percent and 73.8 percent, respectively) than they were among clean and mint currency notes. Lower-denomination notes were more likely to be contaminated than were higher-denomination notes, although the difference was not statistically significant (p > .05). Parasite contamination and bacteria contamination were both most frequent in notes obtained from butchers and beggars. These results suggest that currency notes may be contaminated, especially with bacteria and enteric parasites, and may serve as sources of infection. Personal hygiene to reduce risk of infection is recommended.     

HIV infection in hospitalized children with endemic diseases in Abakaliki, Nigeria: the role of clinically directed selective screening in diagnosis

The increasing prevalence of HIV infection in Nigeria, its similar manifestations with endemic diseases and limited facilities for screening calls for judicious HIV testing. Children aged one month to 15 years admitted into the paediatric ward of the Ebonyi State University Teaching Hospital between January 2000 and September 2001 for various endemic diseases were reviewed retrospectively. Eight clinical risk factors commonly associated with HIV infection and endemic diseases present either singly or in combination, were reviewed to determine whether they could help to predict HIV infection and at what level and finally help formulate criteria for selective screening of HIV infection. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of the 282 children reviewed 31 (11.0%) were HIV positive giving a sero-prevalence rate of 4.1% of total admission. The HIV seropositive rate was highest in oral candidiasis (OC) (38.2%), followed by severe malnutrition (SM) (33.8%) then generalized lymphadenopathy (GLN) (31.4%).The presence of SM, GLN, OC and chronic dermatitis were highly significant independent risk factors for predicting HIV seropositivity (p<0.05). A marked shift towards the likelihood of HIV sero-positivity in the presence of at least two of the eight risk factors was documented. Children with two risk factors present had a 9.1 times more risk of being HIV sero-positive compared with those who had only one risk factor present (chi(2)=11.6, p=0.0007, OR = 9.1, 95% Cl = 2.5-32.8). Thirteen children (41.9%) representing a vast majority of HIV-positive children showed evidence of at least two of the eight clinical risk factors. As the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increase significantly (p<0.0001). Our study shows that clinically-directed selective screening in the presence of at least two risk factors should be carried out which does have a practical role in early diagnosis of HIV infection in a resource-poor setting.     

Secondary structure peptide mimetics: design, synthesis, and evaluation of beta-strand mimetic thrombin inhibitors

Constrained dipeptide mimetic templates were designed to mimic the secondary structure of peptides in a beta-strand conformation. Two templates corresponding to the D-Phe-Pro portion of the thrombin inhibitor D-Phe-Pro-ArgCH2Cl were synthesized and converted into nine alpha-ketoamide and alpha-ketoheterocycle inhibitors of thrombin. Additionally, a template corresponding to L-Phe-Pro was synthesized and converted to a thrombin inhibitor. The in vitro inhibition of thrombin by these compounds was determined, and those corresponding to the D-Phe-Pro were found to be more potent inhibitors than the L-Phe-Pro mimetic. The alpha-ketoamides were found to be more potent than the alpha-ketoheterocycles but had much slower on rates. By comparison of a series of alpha-ketoamide analogues, it is apparent that the there is a preference for binding of bulky hydrophobic substituents in the P' portion of the thrombin active site. Three of the inhibitors (MOL098, MOL144, and MOL174) were screened against a series of coagulation and anticoagulation enzymes and found to be selective for inhibition of the coagulation enzymes. Two of the inhibitors were tested in in vitro models of intestinal absorption and found to have low absorption potential. The compounds were then tested in vivo in both rats and primates, and one of them (MOL144) was approximately 25% absorbed in both species. This study has delineated the synthesis of constrained dipeptide beta-strand mimetics and validated the potential for compounds of this type as potent thrombin inhibitors and possible drug leads.