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.     

Neo‐adjuvant Capecitabine Chemotherapy in Women with Newly Diagnosed Locally Advanced Breast Cancer in a Resource‐poor Setting (Nigeria): Efficacy and Safety in a Phase II Feasibility Study

The majority of clinical trials of neo‐adjuvant therapy for breast cancer have been conducted in resource‐rich countries. We chose Nigeria, a resource‐poor country, as the major site for a phase II feasibility open‐label multicenter clinical trial designed to evaluate the efficacy, safety, and tolerability of neo‐adjuvant capecitabine in locally advanced breast cancer (LABC). Planned treatment consisted of 24 weeks of capecitabine at a dose of 1,000 mg/m² twice daily (2,000 mg/m² total per day). The primary endpoints were overall, partial, complete clinical response rate (OCR, PCR, CCR) and complete pathologic response (cPR). A total of 16 patients were recruited from August 2007 to April 2010. The study was terminated early as a result of slow accrual. After the first three cycles of therapy, PCR were seen in five of 16 patients (31%; 95% CI 11–59%). Of the remaining 11 patients, eight had no response (NR) or stable disease (SD), and three had progressive disease (PD). Seven patients proceeded with further therapy of which had SD. OCR at the end of eight cycles was 44% (95% CI 20–70%). Clinical response and radiologic response by ultrasonomammography were highly concordant (spearman correlation 0.70). The most common adverse effect was Grade 1 hand–foot syndrome, which was seen in 75% of patients. Despite several limitations, we successfully carried out this phase II feasibility study of neo‐adjuvant capecitabine for LABC in Nigeria. Capecitabine monotherapy showed good overall response rates with minimal toxicity and further studies are warranted.     

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.     

Antioxidant activity in HIV and malaria co-infected subjects in Anambra State,southeastern Nigeria

ObjectiveTo determine the antioxidant status of HIV and malaria co-infected participants.MethodsBlood samples collected from the 193 randomly recruited participants were used for HIV screening, Plasmodium falciparum antigen screening, malaria parasite density count, CD4⁺ T cell count, glutathione reductase, glutathione peroxidase and total antioxidant status measurement. Standard laboratory methods were used for the analysis.ResultsThe results showed that glutathione reductase, glutathione peroxidase, total antioxidant status and CD4⁺ T cell count were significantly lowered in symptomatic HIV participants with and without malaria co-infection (P<0.01) in each case compared with control participants. Also, glutathione reductase, glutathione peroxidise, total antioxidant status and CD4⁺ T cell count were significantly lowered in asymptomatic HIV participants with and without malaria co-infection (P<0.05) in each case, compared with control participants without malaria. Similarly, these antioxidants were significantly lowered in control participants with malaria infection (P<0.05) compared with control participants without malaria. The malaria parasite density in symptomatic HIV infected participants was negatively associated with glutathione reductase (r = ?0.906, P<0.01), glutathione peroxidase (r = ?0.719, P<0.01) and total antioxidant status (r = ?0.824, P<0.01).ConclusionsThe antioxidant activity was affected in HIV infected participants with malaria co-infection. Malaria co-infection in HIV seems to exert additional burden on antioxidants. This calls for concern in malaria endemic areas with increasing prevalence of HIV infection.     

Effect of kolanut on the pharmacokinetics of the antimalarial drug halofantrine

Objective To study the effect of the concomitant consumption of kolanut, a caffeine-containing nut, on the pharmacokinetics of halofantrine. Methods A single dose of 500 mg halofantrine hydrochloride was orally administered either alone or concomitant with 12.5 g kolanut to 15 healthy male volunteers in a Latin-square randomized crossover design with a wash-out period of 6 weeks between treatments. Blood samples were collected and analyzed by HPLC for halofantrine and the active metabolite N-desbutylhalofantrine. Results Concomitant intake of kolanut with halofantrine significantly decreased C_max and AUC of both halofantrine and the metabolite desbutylhalofantrine, while no significant effect was observed for t _max and t _1/2 of the compounds. In the case of halofantrine, C_max decreased from 179 ± 119 to 98 ± 32 ng/ml, and the AUC was reduced from 17,450 ± 4,611 to 11,821 ± 4,069 ng·h/ml. C_max of desbutylhalofantrine decreased from 124 ± 41 to 62 ± 23 ng/ml and the AUC from 13,341 ± 4,749 to 7,359 ± 3,018 ng·h/ml when kolanut was co-administered. Conclusions Co-administration of halofantrine and kolanut caused a significant decrease in the plasma concentrations of halofantrine and the active metabolite desbutylhalofantrine probably during adsorption of the drug due to complex formation. This indicates that caution should be exerted when the drug is taken together with caffeine-containing nutrients.     

Novel solidified reverse micellar solution-based mucoadhesive nano lipid gels encapsulating miconazole nitrate-loaded nanoparticles for improved treatment of oropharyngeal candidiasis

Objective: To develop and evaluate solidified-reverse-micellar-solution (SRMS)-based oromucosal nano lipid gels for improved localised delivery of miconazole nitrate (MN).

Methods: Phospholipon^® 90G and Softisan^® 154 (3:7) were used to prepare SRMS by fusion. Solid lipid nanoparticles (SLNs, 0.25–1.0% w/w MN) formulated with the SRMS by high shear homogenisation were employed to prepare mucoadhesive nano lipid gels. Physicochemical characterisation, drug release in simulated salivary fluid (SSF) (pH 6.8) and anti-candidal activity were carried out.

Results: The SLNs were spherical nanoparticles, had mean size of 133.8?±?6.4 to 393.2?±?14.5?nm, low polydispersity indices, good encapsulation efficiency (EE) (51.96?±?2.33–67.12?±?1.65%) and drug loading (DL) (19.05?±?2.44–24.93?±?1.98%). The nano lipid gels were stable, spreadable, pseudoplastic viscoelastic mucoadhesive systems that exhibited better prolonged release and anti-candidal properties than marketed formulation (Daktarin^® oral gel) (p?Conclusion: This study has shown that SRMS-based nano lipid gels could be employed to prolong localised oromucosal delivery of MN.