Open Access Case Study

Spinal Neurobrucellosis is an Unusual Cause of Nontraumatic Paraplegia in Zaria, Northern Nigeria: A report of 3 Cases and Review of Current Literature

O. R. Obiako, S. A. Abubakar, J. A. Kehinde, E. U. Iwuozo, A. U. Hamidu

International Journal of TROPICAL DISEASE & Health, Page 308-317
DOI: 10.9734/IJTDH/2013/4608

Introduction: Brucellosis is a zoonotic febrile infection common among farmers or herdsmen who come into contact with animals or animal products. Neurological complications are uncommon, but when they occur can be confused with other neurological diseases, particularly those due to tuberculosis (TB).
Aim: This report is intended to remind health workers and people living in Brucella endemic communities that spinal neurobrucellosis can mimic Potts’ disease as the cause of nontraumatic paraparesis or paraplegia.
Study Design: longitudinal case series.
Methodology: We report the cases of three patients who presented with paraplegia following months of constitutional symptoms of fever, headache, malaise and weight loss. All were exposed to cows, goats and sheep. One patient had received antituberculous therapy for 18 months with minimal recovery. Serology and neuroimaging were used to confirm the diagnosis.
Results: All patients recovered within 6 to 12 weeks of rifampicin, doxycycline, trimethoprim-sulfamethoxazole or streptomycin, but with residual paraparesis.
Conclusion: spinal neurobrucellosis can be confused with Pott’s disease (TB of the spine) with consequent poor treatment outcome.

Open Access Short Communication

MODS Culture for Primary Diagnosis of Tuberculous Meningitis and HIV-Associated Pulmonary Tuberculosis in Indonesia

Lidya Chaidir, Jessi Annisa, Sofiati Dian, David A.J. Moore, Soni Muhsinin, Ida Parwati, Ahmad Rizal Ganiem, Merry Lestari, Tina Kusumaningrum, Bachti Alisjahbana, Reinout van Crevel

International Journal of TROPICAL DISEASE & Health, Page 346-354
DOI: 10.9734/IJTDH/2013/5724

Aims: To compare the microscopic observation drug susceptibility (MODS) culture with microscopy and solid culture for diagnosis of TB meningitis and HIV-associated pulmonary tuberculosis (TB).
Study Design: Comparative study.
Place and Duration of Study: Department of Clinical Pathology, Hasan Sadikin Hospital, Bandung, Indonesia, between 2010 and 2012.
Methodology: Two groups of patients were included. The first group consisted of 167 consecutive HIV-infected patients presenting with suspected pulmonary TB. The second group consisted of 88 patients with clinical suspicion of TB meningitis. Sputum samples from HIV-associated pulmonary TB patients and cerebrospinal fluid (CSF) from patients with TB meningitis were analyzed using microscopy of Ziehl-Neelsen (ZN) stained smears, culture on solid medium (Ogawa), and MODS culture.
Results: MODS showed the highest detection rate in both patient groups. Among HIV-associated pulmonary TB patients, positivity of MODS was 31.2% compared with 26.9% for Ogawa and 20.6% for ZN. Among TB meningitis patients, positivity of MODS was 41.2% compared with 38.8% for Ogawa and 8.3% for ZN. The median time to culture positivity was significantly shorter for MODS compared to Ogawa, both for sputum (median 11 vs 21 days) and CSF (14 vs 33 days). In 14 days, MODS detected significantly more cases compared with Ogawa in both patients group (79.2% vs 2.4% and 68.6% vs 0%, respectively). Laboratory staff readily used MODS after two weeks of training.
Conclusion: We were able to implement MODS culture as a robust, sensitive, and rapid method for diagnosis of HIV-assoicated pulmonary TB and TB meningitis in a hospital setting in Indonesia. Further studies may be needed to assess the feasibility of MODS culture in other settings and assess its impact on case detection and timely treatment of both forms of TB.

Open Access Short Communication

Community Based Monitoring under National Rural Health Mission (NRHM) at Village Level in the State of Maharashtra, India

P. P. Doke, A. P. Kulkarni

International Journal of TROPICAL DISEASE & Health, Page 355-364
DOI: 10.9734/IJTDH/2013/5021

Background: Government of India, under National Rural Health Mission has established Village Health Sanitation Nutrition Committees (VHSNCs) and appointed Accredited Social Health Activists (ASHAs) in all the villages. Government of India also started Community Based Monitoring (CBM) project through Non-Governmental Organizations (NGOs). State of Maharashtra was one of the nine states selected for implementation of the pilot project.
Objectives: To assess the effect of training and implementation of CBM on Knowledge, Attitude and Practices of VHSNC members including ASHAs.
Design: It is a descriptive study using comparison group.
Settings: The study was carried out in 90 villages, 45 each from study and comparison group, in the State of Maharashtra, India.
Interventions: The study was conducted with the help of the Community Medicine Departments from nearby Medical Colleges. From each village one ASHA and three members of VHSNC were interviewed. An assessment instrument was developed having some parameters. Based upon responses to each parameter, a scoring system was also developed. Then comprehensive score was calculated for each respondent.
Main Variable: Comprehensive score obtained by the interviewed individual was studied.
Results: Only 41% ASHAs and 28% VHSNC members were trained in CBM by the concerned NGOs. The Mean score of ASHAs’ was 7.52. The mean score was 6.55 for trained members of VHSNC and 5.00 for un-trained members.
Discussion: The interviewed members were lacking in core areas. The members are not ready to take ownership and to monitor services.
Conclusions: The training and implementation of CBM did not have any difference in awareness and active participation of ASHAs. This may be due to improper coverage of training. The training helped VHSNC members in improving score but actual implementation of project did not improve the score.

Open Access Original Research Article

Assessment of Antimalarial Drug Use among the Patients in a Tertiary Hospital in Northern Part of Nigeria

Modupe I Builders, Emmanuel Ogbole, Jonah Y Peter

International Journal of TROPICAL DISEASE & Health, Page 283-291
DOI: 10.9734/IJTDH/2013/4581

Aims: To assess the pattern of antimalarial drug use among the patients attending the teaching hospital in Jos North local Government of Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: Tertiary hospital in Jos North Local Government of Plateau state of Nigeria, between July and September, 2012.
Methodology: A sample size of 441 male and female patients was selected into this study using a universal sampling. Information on the knowledge, attitudes and practices with respect to antimalarial drug use were obtained with the aid of a pre-tested interviewer-administered questionnaire. Data was analyzed using the SPSS software.
Results: Four hundred and forty one (441) patients completed the questionnaire. Respondent knowledge of malaria with respect to description of malaria decreased (42.7% to 0.2%). Almost all the patients were able to describe the causes and symptoms of malaria. One hundred and sixty nine (38.3%) frequently treated their malaria with Sulphadoxine-Pyrimethamine (SP) combination, Three hundred and eighty two (86.6%) reported to have used oral preparation, almost half of the respondents (47.6%) obtained these medications from many sources apart from hospitals, only two hundred and forty eight reported to comply to treatment. Majority of the participants always used some methods for the prevention of malaria
Conclusion: Concerted effort should be made to educate the population on malaria as well as the importance of drug adherence.

Open Access Original Research Article

Challenges of Setting up the First Stem Cell Transplant Centre in a Developing Country (Nigeria)

G. N. Bazuaye

International Journal of TROPICAL DISEASE & Health, Page 292-299
DOI: 10.9734/IJTDH/2013/4760

Hematopoietic Stem cell Transplantation (HSCT) is an approved therapy by the World Health Organization (WHO) for non-malignant and malignant disorder. This is readily assessable and available in developed countries. In 2006 a total of 50,417 first HSCT was recorded worldwide and majority was done in Europe (48%) and the America’s (36%). While only 2% in East Mediterranean and Africa.In a global perspective study the first factor for the low HSCT in poor resource country was Government health care expenditure representing 77.33% of the variance. Second factor was team density and the third Gross National Income (GNI) per capital which added another 4.41% explanation.
The first HSCT in Nigeria was done in September 2011 with several challenges in setting up a functioning unit. The challenges range from inadequate manpower compounded by brain drain of health workers. Only a Hematologist, two Nurses, two Laboratory scientists and a Hematopathologist trained for HSCT was available in Hospital. With respect to the challenges of infrastructure and equipment, a four bed isolation unit was constructed with HEPA-filtration and High-pressure machine, an Aphaeresis and platelet storage machine. Most of the supportive, diagnostic unit in the laboratory and Radio-imaging technique are below international substandard. There is need for improved laboratory culture especially for fungal and viral infections.
In selecting patients we started with a seven years old child who had severe Sickle Cell disease from a 14 years sibling donor. Also supportive care with parentheral nutrition, blood support (irradiate products), and procurement of rare drugs was a huge challenge. The cost of the first patient transplant patient was paid for by the hospital and is beyond the reach of most Nigerians. The health insurance policy of the nation is still ineffective.
Challenges in setting up the first HSCT unit in Nigeria are enormous but with a good political will from government and improved health insurance policy. HSCT could be made available, assessable and affordable to Nigerians who will require this form of therapy.

Open Access Original Research Article

Biochemical Parameters of Umbilical Cord Blood in Niger Delta, Nigeria: Towards Ensuring Efficient Cord Blood Stem Cell Transplantation

J.O. Idemudia, G. N. Bazuaye

International Journal of TROPICAL DISEASE & Health, Page 300-307
DOI: 10.9734/IJTDH/2013/4759

Aim: The aim of this study was to determine the levels of basic biochemical parameters like uric acid, potassium, sodium, bicarbonate and chloride in umbilical cord blood with a view to assess its suitability for stem cell transplantation.
Study Design: This is a cross-sectional prospective study.
Place and Duration of the Study: The study was carried out at the Departments of Obstetrics and Gynaecology, and Chemical Pathology University of Benin Teaching Hospital, Benin City Nigeria between July 2010 and March 2011.
Methodology: Cord blood from a total of 164 pregnant women (HIV, hepatitis B and C negative) who delivered in University of Benin Teaching Hospital from July 2010 to March 2011 were analyzed for some basic biochemical parameters.
Results: The levels of the biochemical parameters were sodium 135.4±6.1mmol/L (128 to 150mmol/L), potassium 7.08±1.9mmol/L (4.5 to 14.7mmol/L), bicarbonate 19.6±2.4mmol/L(14-25mmol/L), chloride 101.7±3.8mmol/L (90-109mmol/L) and uric acid 1.63±0.9mmol/L (0.19-3.09mmol/L) chloride was the most stable with a CV of 3.71% while uric acid was the least stable with a CV of 12.63%.
Conclusion: Umbilical cord blood could become an important source of stem cell in sub-sahara Africa especially with the large number of deliveries. However careful selection of quality cord blood must be enforced to avoid contaminants and haemolysis which may be responsible for the hyperkalaemia as seen in this study.

Open Access Original Research Article

Identification of the N-terminal Glycine-arginine Rich (GAR) Domain in Giardia lamblia Fibrillarin and Evidence of its Essentiality for snoRNA Binding

Sumallya Karmakar, Dibyendu Raj, Sandipan Ganguly

International Journal of TROPICAL DISEASE & Health, Page 318-327
DOI: 10.9734/IJTDH/2013/4391

Aims: Study the role of glycine-arginine rich (GAR) domain of fibrillarin in Giardia lamblia.
Study Design: Identifying a specific glycine arginine rich (GAR) sequence of Giardia fibrillarin which plays an important role in ribonucleoprotein particles complex formation with snoRNA during post transcriptional modifications of rRNA. The present study uses Electrophoretic Mobiliy Shift Assay (EMSA) to detect protein-RNA interactions. 32P labeled snoRNA incubated with purified fibrillarin or GAR domain truncated fibrillarin protein were separated by a non denaturing polyacrylamide gel where the band patterns suggested the interaction of the RNAs with both proteins.
Place and Duration of Study: Department of Parasitology, National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, between January 2011 and July 2012.
Methodology: Homology analysis of G. lamblia fibrillarin was performed with fibrillarins from Homo sapiens, Mus musculus and Arabidopsis thaliana to determine the conserved domain by ClustalW analysis. Cloning, expression and purification of fibrillarin and GAR domain truncated fibrillarin were done to study the role of GAR domain in snoRNA-fibrillarin binding by EMSA and Gradient EMSA. Immunoblot assay of purified GAR domain truncated fibrillarin was performed by using polyclonal antibody of purified recombinant giardia fibrillarin protein.
Results: Gel retardation assay showed that snoRNA does not bind with GAR domain truncated fibrillarin to form any RNP complex. Similarly in gradient EMSA the GAR domain truncated fibrillarin does not bind with any of the in vitro transcribed snoRNA even at much higher concentration than they do for full length purified recombinant fibrillarin.
Conclusion: The amino terminal conserved glycine arginine rich (GAR) domain is present in Giardia lamblia fibrillarin and is essential for binding with snoRNA of this protein.

Open Access Original Research Article

Food Borne Outbreak at a Salad Eatery, Ghana - 2009

Joyce Der, Benjamin Amanya, Francisca Dzata, Frederick Wurapa, Edwin Afari, Obeng Apori, Chima Ohuabunwo

International Journal of TROPICAL DISEASE & Health, Page 328-338
DOI: 10.9734/IJTDH/2013/5846

Aim: We investigated a foodborne outbreak to determine its magnitude, source of infection and causative agent using laboratory confirmation.
Study Design: Descriptive cross-sectional study
Place and Duration of Study: Koforidua Township of the New Juaben Municipality, Eastern Region, 5th - 8th November 2009
Methodology: A case was defined as any person presenting with abdominal cramps, diarrhea and or nausea to the Eastern Regional Hospital between 5th and 8th November, 2009 and had eaten salad from the salad eatery. All the cases that reported to the hospital were interviewed and medical records reviewed. Four stool samples, portions of the different vegetables (cabbage, carrots, green pepper and onion) used in preparing the salad and a mixed salad portion were collected for laboratory diagnosis. Environmental assessment at the salad eatery was conducted. We assessed the site were the vegetables were prepared and the transportation process of vegetables to the salad eatery.
Results: A total of 40 cases were identified with an attack rate of 0.26/1000 population with no fatalities. This was a point source outbreak with an incubation period of 7-20hours. The most affected were cases aged 21-30years (35%) and females (55%). Laboratory diagnosis confirmed Clostridium perfringens (C. perfringens) as the probable causative agent in two stool samples. C. perfringens was also confirmed in the mixed salad portion and the cabbage. The spore count for the mixed salad was 107 CFU/gram of salad and the cabbage was 109 CFU/gram of cabbage. The vegetables were washed with ordinary water only and transported to the salad eatery with poor temperature control of warm cabbage.
Conclusion: We confirmed an outbreak probably caused by C. perfringens food poisoning. The inadequate washing of vegetables and poor temperature control of warm cabbage was the probable source of the outbreak. Education of food vendors on strict food hygiene was conducted in the Koforidua Township and the inspection of food eateries re-enforced.

Open Access Original Research Article

Use of Intermittent Preventive Treatment for Malaria among Pregnant Women in Kubwa, Abuja, Nigeria

L. A. Alli, A. Y. Isah, M. A. Jamda, A. A. Adesokan

International Journal of TROPICAL DISEASE & Health, Page 339-345
DOI: 10.9734/IJTDH/2013/4868

Background and Aims of Study: Malaria in pregnancy remains one of the infectious diseases threatening the health of pregnant women and the unborn child in Africa. The use of Sulphadoxine-Pyrimethamine (SP) as intermittent preventive treatment of malaria in pregnancy (IPTp) has been shown to greatly reduce the impact of malaria in pregnancy and its complications when administered appropriately according to set protocol. The aim of this study is to ascertain the appropriate use of SP among pregnant women who received ante-natal care (ANC) and determine its relationship with feto-maternal outcome.
Place and Duration of Study: Daughters of charity Primary Health Center, Kubwa, Abuja, between January 2010 and June 2011.
Methodology: A retrospective study of 200 pregnant women, who attended ANC, delivered and followed-up to post-natal clinic at Daughters of Charity primary health centre and was administered SP between January 2010 and June 2011. Ante-natal records were retrieved and socio-demographic variable, number of doses of SP received as well as feto-maternal outcome were collected and analyzed.
Results: The use of IPTp among pregnant women in this facility is low, accounting for only 6% of the study population, while 79% were not administered IPTp throughout their pregnancy. Majority of the primigravida (61 out of 70) who were more vulnerable to malaria in pregnancy did not receive any dose of IPTp.
Conclusion: More effort is required to increase IPTp coverage in the community. This may be achieved by improving the awareness of IPTp among health care workers, pregnant women and the entire community at large

Open Access Original Research Article

Body Ailments Dietary Pattern and Nutritional Status of Elderly in Ondo State, Nigeria

I. O. Olayiwola, C. A. Olarewaju, D. A. Adelekan, Arigbede Moses, W. A. O. Afolabi

International Journal of TROPICAL DISEASE & Health, Page 365-377
DOI: 10.9734/IJTDH/2013/4035

Objective: To investigate the various body ailments both communicable and non communicable diseases in conjunction with nutritional status of elderly in Ondo state, Nigeria.
Methods: This was a random sampling of 400 elderly individuals (>60 years) living in Ondo State, Nigeria. By means of Open ended and structured questionnaire, data were collected on health, diet and Sociodemographic characteristics. There was anthropometric measurement to assess nutritional status.
Results: Most of the elderly aged 60-69 years were married and have no formal education. Most of them were from monogamy and polygamy family structure. The body ailment reported consist of body pain (28%) respiratory related complications (14%) eye ailments (11%), hypertension (8%) diabetes (3%) and musculoskeletal problems (24%) such as rheumatism, cramps and arthritis. The prevalence of self reported hypertension was 26% less in male respondents than in female respondents. The dietary pattern revealed that elderly ate from major food groups with animal protein foods (74% ate daily) but low dairy products (7% ate daily). The food habit related significantly with body ailments such as skipping meals ((c=19.2; P<0.05) and eating three times a day ((c=8.4; P<0.05).
The body Mass index classification showed more than half were in normal nutritional status (58%), but 20% underweight, 15% overweight and 7% were obese. The body ailments associated significantly with nutritional status (c=55.1; P<0.05).