Open Access Commentary

Maximizing Benefits to Mothers and Newborn: an Ethical Analysis of Issues in Newborn Health Program Design

Rashed Shah

International Journal of TROPICAL DISEASE & Health, Page 956-962
DOI: 10.9734/IJTDH/2014/11179

This paper highlights on the aspects of bioethics principle of beneficence and equal value of human lives and the concept of distributive justice, mothers and women as seen through the lens of community based newborn health programs in developing countries. The Interagency Group of Safe Motherhood reveals a major reason for what women continue to die from pregnancy related disease is that they are discriminated and that the severe neglect of women’s health is a violation of their human rights. Following the bioethics principle of beneficence and to value the equal worth of human lives and the concept of distributive justice, all women including adolescents and pregnant women in same community must have been focused and addressed through a newborn health program. Even within a context with scarce resources, we need to remember that cost sharing and investment on maternal care, particularly antenatal counseling and delivery assistance, helps increasing newborn survival. Estimated over half of costs of newborn health program needs to be invested in maternal health aspects, to ensure effective successful program implementation to improve newborn survival.

Open Access Original Research Article

The Association between Hepatitis B Virus and Non Hodgkin’s Lymphoma in Sudanese Patients in Gezira State Sudan

Nagla Gasmelseed, Afrah Awad Elsir, Ahmed Elhaj Mohamed

International Journal of TROPICAL DISEASE & Health, Page 860-868
DOI: 10.9734/IJTDH/2014/10180

The incidence of non-Hodgkin lymphoma (NHL) is steadily increasing worldwide. According to the Globocan 2008, NHL is ranked as the 12th most common cancer worldwide and the 4th most common cancer in Sudan. Sudan is endemic with hepatitis B virus (HBV) infection.
Objectives: The objective of this study was to identify the association between NHL and HBV infection in Sudanese patients, Gezira State.
Methods: This was cross sectional case-control study was conducted at the, National Cancer Institute (NCI) University of Gezira, during the period from 2007 to 2008. A total of 81 non-Hodgkin lymphoma patients and 95 hospitals based controlled of matched age and sex, were included in the study. All patients and control had their serum screened for the presence of HBsAg by ELISA and HBV DNA was tested using polymerase chain reaction (PCR). The Statistical Program for Social Science (SPSS16.0) was used for all statistical analyses, and test of significance.
Results: The mean age of NHL patients was 37.9±23.6 years with a range (1-85 years). Male to female ratio was 1.9 to 1. There were different types of NHL in this study with the majority being B-cell lymphoma 70.4% (57/81), 49.38% (40/81 ) were positive by PCR, while controls 20/95 (21.05%) with significant difference between cases and controls (P<0.05). There was a significant association between B-cell subtype and HBV by both serological and molecular methods (OR= 6.5 95% CI: 1.3 - 32.5) and (OR= 3.6 95% CI: 0.8 – 07.4).
Conclusion: This study concludes that there is a significant association between HBV and the development of NHL in Sudanese patients in Gezira State the finding provides evidence supporting the hypothesis that HBV infection may have an association with the development of NHL patients.

Open Access Original Research Article

Differentials and Correlates of Infants Mortality in Nigeria: A Comparative Survival Analysis between North East and South West Nigeria

Fagbamigbe Adeniyi Franics, Alabi Olalere

International Journal of TROPICAL DISEASE & Health, Page 869-886
DOI: 10.9734/IJTDH/2014/9597

Aims: Infant mortality rate (IMR) is not only used as a demographic measure, but also as an important health indicator of a society as well as a measure of its living standard worldwide. The Nigeria Demographic and Household Survey (NDHS) declared a wide difference in the IMR among geographical zones in Nigeria with widest gap between the North East (NE) and South West (SW). This study assessed the differences in IMR viz-a-viz socio-demographic, sexual and reproductive factors and also determined factors affecting the IMR in the two zones.
Place of Study: Rural and Urbanlocations across the NE and SW Nigeria
Study Design: We used a nationally representative cross sectional data from the NDHS 2008 survey.Our analysis was based on the 23,995 and 11,546 births during five years preceding data collection from women aged 15-49 years in NE and SW Nigeria respectively.
Methods: We censored the children who have not had their first birthday as of the day of interview and estimated the IMR with Life tables using West Models. Other analysis were carried out with descriptive statistics, bivariate and multivariate cox regression models at 5% significance level.
Results: About 3 of every four NE children are from rural areas compared with 47.4% in SW, while nearly 78% of NE children are from mothers without formal education the rate was 20.9% in the SW. The IMR among children from teenager mothers was 121 and 82 per 1000 live births in NE and SW respectively, 87 for urban NE, 52 for urban SW, 115 for rural NE, and 66 for rural SW. In the NE, children from rural areas were about 30% times more likely than children from urban areas to die before their first birthday (HR=1.3 95% CI:1.1-1.6)while in the SW they were 40% times more likely to die (HR=1.6 95% CI:1.1-2.4). Children from wealthiest homes in the NE had lower IMR than children from wealthiest homes in the SW (37 vs 55) but wealth quintiles were not significant to IMR in the SW.
Conclusion: The prevailing trend of early marriage, non-education, delayed initiation of breastfeeding, unsafe drinking water, unemployment and poverty among others should be averted so as to improve child survival in the Nigeria especially in the North East.

Open Access Original Research Article

Low Prevalence of Plasmodium vivax - Plasmodium falciparum Mixed - Infection in Patients from Central and Eastern Part of Sudan: Implication for Case Management in Sudan

Albadawi A. Talha, Sakineh Pirahmadi, Elgaily M. Elgaily, Sedigheh Zakeri, Bakri Y. M. Nour

International Journal of TROPICAL DISEASE & Health, Page 887-895
DOI: 10.9734/IJTDH/2014/10916

Accurate diagnosis of malaria parasite species is crucial for rational treatment that is a key success for a malaria control and elimination programmes. The main objective of this investigation was to correct species identification and re-assessment of diagnosis method in central and eastern part of Sudan. The blood samples were collected from 71 febrile cases infected with P. vivax in Eastern and Central Sudan, diagnosed by light microscopy and also by nested-PCR assay, using 18S small sub-unit ribosomal RNA (ssrRNA) gene.
The nested-PCR were detect 92.9% (66/71) and 2.8% (2/71) P. vivax and P. falciparum mono-infection, respectively. Based on microscopy method, the level of mixed - Infection was zero; however, nested-PCR assay detected 4.2% (3/71) mixed infections in collected samples. In detecting P. vivax infection, microscopy had high sensitivity (97%) and specificity (50%). In conclusion, the present data point to the need of improving microscopy diagnosis method in malaria endemic region and also suggest that although molecular techniques are not practical for diagnosis of P. vivax and P. falciparum mixed infections in any areas; these could be used to collect epidemiological facts for control and elimination of the disease in Sudan.

Open Access Original Research Article

Awareness and Knowledge of HIV Counselling and Testing among Undergraduate University Students in Lagos, Nigeria

S. O. Akodu

International Journal of TROPICAL DISEASE & Health, Page 896-904
DOI: 10.9734/IJTDH/2014/10903

Background: HIV counselling and testing (HCT) is a key strategic entry point to prevention, treatment, care and support services.
Aim: The study aimed at determining the awareness of HIV counselling and testing among undergraduate university students in Lagos, Nigeria.
Methods: The study was a descriptive cross-sectional one conducted in May 2010 among students recruited from seven faculties within two of the campuses of Lagos State University, Ojo and Ikeja campuses.
Results: The level of awareness of HIV counselling and testing before the survey was high among both male and female respondents. The knowledge about HIV counselling and testing was poor irrespective of their Faculty of study.
Conclusion: Level of awareness of HIV counselling and testing seems to be high among undergraduate students in Lagos. However, the knowledge about HIV counselling and testing is still poor, even among medical students.

Open Access Original Research Article

Knowledge and Practice Pattern of Malaria Prevention and Control in Pregnancy by Healthcare Providers within the Context of Focused Antenatal Care in Enugu State, Nigeria

U. Igboeli Nneka, O. Adibe Maxwell, C. Aguwa Nze

International Journal of TROPICAL DISEASE & Health, Page 905-916
DOI: 10.9734/IJTDH/2014/10598

Aim: To assess the knowledge and practice pattern of malaria prevention and control in pregnancy by healthcare providers within the context of focused antenatal care.
Study Design: A prospective cross-sectional survey study.
Place and Duration of Study: Health facilities from the three levels of care in Enugu, Southeast Nigeria, between July to September, 2011.
Methodology: Data collection was with a pre-tested structured questionnaire administered to the healthcare providers that were directly involved in antenatal care services. They consisted of 113 respondents (Doctors, Pharmacists and Nurses). The questionnaire elicited information on their knowledge about malaria, treatment and prevention practices.
Results: Many providers had high knowledge of malaria in pregnancy. Malaria diagnosis was mainly by symptom recognition 102 (90.3%). Treatment of uncomplicated malaria was mainly with Artemisinin-Combination Therapies (ACTs) both in the 1st 43 (38.1%), 2nd and 3rd 55 (48.7%) trimesters. Severe malaria was also treated with ACTs 24 (24.8%) by majority of the providers. Quinine was used by only few providers in treating 1st trimester uncomplicated malaria 8 (7.1%) and severe malaria 19 (16.8%). Sulphadoxine-Pyrimethamine (SP) was mostly used by the providers 88 (77.9%) for malaria prevention while proguanil 29 (25.4%) was usually given as an alternative to SP. SP was given by directly-observed treatment by 55.8% of the providers while only 18.6% actually withheld folic acid supplementation for the recommended two weeks following SP administration. Other antenatal care (ANC) - MIP integrated services rendered by the providers were Iron folate supplementation 90 (79.6%), Insecticide-Treated-Nets (ITNs) Provision 87 (77.0%) and Deworming 30 (26.5%).
Conclusion: The level of knowledge on malaria in pregnancy was high among the providers. However, there was sub-optimal delivery of current best practices, especially in the area of drug prescriptions for both treatment and prevention. Multiple strategies are required to improve healthcare providers’ practices in MIP prevention and control.

Open Access Original Research Article

Serum Iron Status and Haematological Profiles in Adult Nigerian Sickle Cell Anaemia Patients

J. A. Olaniyi, K. S. Akinlade, A. D. Atere, O. G. Arinola

International Journal of TROPICAL DISEASE & Health, Page 917-927
DOI: 10.9734/IJTDH/2014/8985

Background: Sickle cell anaemia (SCA) patients are prone to require long-term frequent blood transfusion because of chronic haemolysis and overlapping hyper-haemolysis. Hence, they become vulnerable to iron overload and its complications. On the other hand, iron deficiency has been documented among un-transfused SCA cases. Thus, there is a need to effectively and efficiently determine iron status of SCA patients.
Objective: We investigated whether adult SCA patients in steady state (SSt) or those with vaso-occlusive crisis (VOC) have significantly different iron status viz-a-viz Serum Iron (SI), Serum Ferritin (SF), Total Iron Binding Capacity (TIBC), Transferrin (TRF), percentage TFS and haematological parameters when compared with age and sex-matched controls.
Materials and Methods: Ninety subjects, comprising 30 SCA patients in SSt, 30 SCA patients with VOC and 30 HbAA, ethnicity, age and sex-matched controls (NC), were consecutively recruited. Serum samples were analysed for SF, TRF and TIBC using ‘WATER’ HPLC 616 and 626; SI was determined using the Atomic Absorption Spectroscopic (AAS) method. Haematological parameters were determined using a Sysmex Kx21 auto-analyser.
Results: The SCA groups (VOC and SSt) had significantly lower SI, SF, TRF and TIBC compared to the control group. The VOC group had a significantly lower mean ferritin level but higher SI, TRF and percentage TFS levels compared to SSt group. The MCV, MCH (in SSt group) were significantly lower while MCHC was significantly higher in the SCA groups compared to the NC group. Using the normal ranges for all parameters, all parameters were within normal for the controls while TIBC was below normal and percentage TFS was higher in SCA groups. Percentage TFS was significantly higher in VOC compared to SSt group.
Conclusions: The study reported lower SI and TRF, lower MCV and MCH, below normal TIBC, within normal Ferritin but elevated WBC and platelet counts, elevated percentage TFS (more elevated in VOC than SSt) and higher MCHC in SCA patients. The use of percentage TFS as a marker of VOC is suggested.

Open Access Original Research Article

Association of Enterococcus faecalis with Different Forms of Dental Diseases among Patients Visiting a Tertiary Hospital in Ekiti State, Nigeria

O. M. David, I. B. Fakayode, O. Famurewa

International Journal of TROPICAL DISEASE & Health, Page 928-935
DOI: 10.9734/IJTDH/2014/5024

Aims: The implication of Enterococcus faecalis in dental infections is rising and resistance to common antibiotics continues to rise globally as well. In this study, the association of E. faecalis with different forms of dental infections was investigated and the antibiotic resistance profile of the isolates was determined.
Place and Duration of Study: The samples were collected from a tertiary health institution in Ekiti State, transferred to the Department of Microbiology, Ekiti State University, Ado-Ekiti, Nigeria and processed immediately. This study was carried out between June, 2009 and March, 2010.
Methodology: Oral interview was conducted among the patients in order to collect relevant data while sterile culturette was used to collect the samples after proper diagnoses, plated and incubated appropriately using standard microbiological techniques. The susceptibility of the isolates to commonly and frequently used antibiotics was determined by the disc diffusion method on Müller-Hinton agar.
Results: Overall, 46.0% of the subjects had dental infections The subjects with dental infections were 46.60% males and 53.40% females. Students accounted for 58.25% of the total subjects followed by traders with 16.50%. Enterococcus faecalis was isolated from 52.08% of the students, 22.92% traders and 4.17% of the farmers. The highest occurrence (37.86%) of dental infection was recorded among patients within the age bracket 21 and 30 years while dento-aveola abscess (DAA) followed by dental caries (DC) were the predominant dental infections recorded in that order. A total of 46.60% of the dental infections were colonized by E. faecalis that were mostly resistant to amoxicillin (93.90%) and cloxacillin (92.68%). Resistance to the fluoroquinolones tested was relatively low, ranging from 8.54 to 25.61% in spafloxacin and perfloxacin, respectively whilst it was 1.22% to vancomycin among the isolates.
Conclusion: The isolates were resistant to common antibiotics tested, however, vancomycin proved to be the most effective in the inhibition of the isolates.

Open Access Original Research Article

Prevalence of Hypertension and Associated Risk Factors in Adults from a Semi Urban District in Ghana: A Population Based Survey

Joseph K. L. Opare, Nicole Probst-Hensch, Edwin Afari, Axel Hoffmann, Christian Schindler, Fred Wurapa, Chima Ohuabunwo, Samuel Sackey, David Mensah, Olivia Serwaa

International Journal of TROPICAL DISEASE & Health, Page 936-946
DOI: 10.9734/IJTDH/2014/7844

Objectives: Given the paucity of community based surveys on hypertension and other non-communicable diseases in the Akwapim North District (AKND) of Ghana’s Eastern-Region (ER), we conducted a population survey to determine the prevalence of hypertension and its associated determinants.
Methods: We recruited 519 adults age ≥ 25years in a multi-stage sample of enumeration centres over a one-month period. We measured body weight, waist and hip circumference, height, blood pressure (BP) and obtained demographic and risk factor information. Univariate and bivariate-analysis determined the prevalence of hypertension, significant difference and predictors of known risk factors (p <0.05).
Results: Among the 519 participants, 62.8% were women. The mean age and body mass index (BMI) were 48.6±16.8 years and 23.2±5.2 kg/m2 respectively. Prevalence of hypertension was 32.2% with a male-to-female distribution of 27.5% and 35.0% respectively. The prevalence of alcohol use was high at 65.6% (340/519). Age and waist circumference were predictors of diastolic BP.
Conclusions: There is a high prevalence of hypertension in the AKND of Ghana. Stakeholders should structure interventions on hypertension to promote healthier-lifestyles.

Open Access Original Research Article

Variation of CD4+ T-Lymphocyte Counts and Transaminases in HIV and HIV/HBV Co-infected Patients on Therapy at Nylon Hospital Douala, Cameroon

Jules Clement Nguedia Assob, John Ngunde Palle, Dickson Shey Nsagha, Sandrine Donfack Mewoabi, Edward Chongsi Mbukam

International Journal of TROPICAL DISEASE & Health, Page 947-955
DOI: 10.9734/IJTDH/2014/9662

Objective: This study was aimed at determining the prevalence of Hepatitis B and associated risk factors such as CD4+ counts variation and liver enzymes among HIV co– infected patients and those with HIV mono-infections only.
Design and Methods: Three hundred and fourteen (314) HIV patients took part in this cross sectional case control study. Socio-demographic information and history of exposure to risk factors such as scarification, blood transfusion, and unprotected sexual intercourse and alcohol consumption, were obtained through a well-structured questionnaire. Serological tests were done to determine the presence of Hepatitis B (HB) surface Antigen, liver enzymes’ activities were estimated and CD4+ cell counts evaluated using standard laboratory methods.
Results: Out of the 314 HIV patients, 20 (6.4%) tested positive for hepatitis B surface antigen (HBsAg) while 294 (93.6%) were negative. Most HIV patients co–infected with HBV were in the age group 31 to 45 years. There was no significant variation when co-infection and mono-infection groups were compared based on age and sex (p=0.7405 and p=0.3361). More males, 7 (2.23%) against 2 (0.64%) females (P=0.02) co–infected with HBsAg had a CD4+ cell counts in the range 201-350cells/µL. No significant difference of liver transaminases (SGPT and SGOT) levels between mono and co-infection groups (P>0.05) was observed. No association of HBsAg with observed risk factors among HIV patients was noted.
Conclusion: The study concluded that the prevalence of hepatitis B among HIV patients was 6.4% with majority of the patients having CD4+ cell counts within 201-350. The liver function parameters (transaminases) were not affected with HIV/HBV co-infection.