Open Access Original Research Article

Assessment of Knowledge about Schistosomiasis among Paddy Rice Farmers in Doho and Kibimba, Eastern Uganda

Imran Ejotre, Sarah Nachuha, Polycarp M. Mwima

International Journal of TROPICAL DISEASE & Health, Page 1209-1217
DOI: 10.9734/IJTDH/2014/12579

Aim: To assess knowledge levels on schistosomiasis in farmers and laborers working in paddy rice fields in eastern Uganda.
Study Design: A cross-sectional survey among farmers practicing paddy rice farming in Doho and Kibimba.
Place and Duration of Study: The study was carried out in April 2014 in Doho and Kibimba rice schemes, eastern Uganda.
Methodology: Unequal number of respondents was interviewed and these were selected purposively. Ninety samples (90) were used, 50 from Doho and 40 from Kibimba. A chi-squared test was used to test schistosomiasis knowledge differences among respondents between schemes.
Results: A chi squared test indicated that there were significant differences in the number of people who had suffered from schistosomiasis at Doho and Kibimba rice schemes (P<0.001). For example Four percent (4%) of respondents in Doho indicated to have suffered from schistosomiasis at one time while 35% interviewed at Kibimba scheme had suffered from this disease. Although there were variations in the proportions of respondents on the rest of the knowledge items between the two sites, these variations were not statistically significant (P<0.05). About 63% of respondents in Kibimba scheme declared to have received schistosomiasis education from the Ministry of health officers. On the contrary, 80% of respondents in Doho scheme indicated that they have not received any schistosomiasis training/education of any kind.
Conclusion: Schistosomiasis is prevalent amongst paddy rice farmers in Doho and Kibimba schemes. Although the farmers at Kibimba were more sensitized about this disease, this did not have a significant effect on the level of knowledge about the farmers in the two schemes. We recommend that a much more intensive study supported by laboratory test be done to comprehensively bring out the magnitude of the disease and its impacts in order to inform policy and management decisions by government and respective public and private stakeholders.

Open Access Original Research Article

The Effectiveness of De-stigmatising Interventions

Silatham Sermrittirong, Wim H. Van Brakel, J. F. G. Bunders-Aelen, Gomes Unarat, Pojana Thanyakittikul

International Journal of TROPICAL DISEASE & Health, Page 1218-1232
DOI: 10.9734/IJTDH/2014/13296

Aims: This study on leprosy was conducted to assess the effectiveness of the de-stigmatising interventions which were launched by three different groups of people.
Study Design: Cross-sectional survey.
Place and Duration of Study: Raj Pracha Samasai Institute and Chaiyaphum province, Thailand, May 2013.
Methodology: The study was done in three districts of Chaiyaphum province, Thailand. Community members and health workers were interviewed using the Explanatory Model Interview Catalogue (EMIC) scale. Frequency tables were used to describe the percentage of respondents who perceived stigma. A p-value of <0.05 was considered indicative of a statistically significant difference. A t-test was applied to compare between the mean EMIC score of community members and health workers before and after interventions.
Results: It was found that de-stigmatising interventions involving affected persons resulted in a measurable reduction of perceived stigma related to leprosy among community members and health workers. In the area of a self-help group (SHG) significant reductions were found in the mean EMIC score after interventions. There was no reduction of negative attitudes and perceived stigma either among community members or health workers in the area where de-stigmatising interventions were launched by a formal health care group. A high percentage of people with perceived stigma were still found in all areas (ranging from 77 to 85 %).
Conclusion: Involving the community and people affected themselves in de-stigmatising interventions, and tailor-made education are keys to success in reducing stigma related to leprosy. Sustaining of the intervention is important to ensure a gradual reduction of stigma in the long run.

Open Access Original Research Article

Barriers to HIV Treatment Adherence: Findings from a Treatment Center in South-South, Nigeria

O. Maduka, C. I. Tobin-West

International Journal of TROPICAL DISEASE & Health, Page 1233-1244
DOI: 10.9734/IJTDH/2014/12186

Aims: Non-adherence to treatment represents a significant challenge to anti-retroviral treatment goals. This study aimed to identify and explore perceived barriers to adherence in non-adherent HIV patients attending the University of Port Harcourt Teaching Hospital.
Study Design: This was a descriptive, cross-sectional study of HAART experienced patients who had less than 95% adherence to their HAART medication.
Place and Duration of Study: The study was carried out between May and June 2011 at the Antiretroviral treatment center of the University of Port Harcourt Teaching Hospital in the Southern part of Nigeria
Methodology: Data collection was via quantitative and qualitative methods. A structured interviewer administered questionnaire adapted from the Adult Antiretroviral Clinical Trials Group (AACTG) study was used to identify barriers to adherence. In addition, four focus group discussions (FGDs) were held with 27 purposively selected participants. Quantitative data was analyzed with SPSS version 18, while the FGDs were analyzed using thematic content analysis.
Results: Ninety-six (96) patients, 39 (40.6%) males and 57 (59.4%) females with median age of 35.5 years participated in the study. Identified barriers to adherence included; being away from home during medication times 41 (42.7%), being busy with other things 35 (36.5%), forgetfulness 33 (34.4%), running out of pills 25 (26%), difficulty taking pills at specified times 25 (26.0%), the need to avoid side effects 16 (16.7%), and lack of a social support system 15 (15.6%). Barriers identified by the FGDs were fear of taking HIV drugs in front of others, sharing drugs with infected spouse, alcohol use, financial challenges, poor understanding about the effects of the drugs, forgetfulness, long clinic hours and poor attitude of health workers.
Conclusion: Adherence counseling, use of reminder systems and treatment supporters are useful Public Health interventions for improving adherence and should be integrated into service delivery at this and other centers. In addition, better organization of the clinic, increasing staff strength and training will go a long way to address these barriers. Decentralization of HIV treatment centers to secondary and primary health facilities needs consideration.

Open Access Original Research Article

Pattern of Antimicrobial Resistance of Escherichia coli from Healthy Adults in Amassoma, South-South Nigeria

Adebola Onanuga, Ebiladei Berefagha

International Journal of TROPICAL DISEASE & Health, Page 1245-1253
DOI: 10.9734/IJTDH/2014/12715

Aim: To investigate the antimicrobial resistance profile of faecal Escherichia coli to common antimicrobial agents in healthy adults in Amassoma, South Southern Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Pharmaceutical Microbiology and Biotechnology, Niger Delta University, Bayelsa State, between February and June 2010.
Methodology: The stool samples collected were inoculated and screened for E. coli using standard microbiological protocols. The antimicrobial susceptibility test of the isolates was done using disc diffusion technique.
Results: A total of 110 (84.6%) E. coli isolates were obtained from all the samples comprising 38 (34.5%) from the villagers and 72 (65.5%) from the University students. The overall resistance profiles of all the isolates were: ampicillin-95.5%, tetracycline-72.7%, augmentin-70.9%, co-trimoxazole-54.5%, cefuroxime-44.5%, chloramphenicol-39.1%, nalidixic acid-30.0%, nitrofurantoin-28.2%, ceftazidime-15.5%, ciprofloxacin-14.5%, gentamicin-10.0% and ofloxacin-4.5%. The isolates from the villagers exhibited significantly higher resistances to some of the antibiotics than those from the students (P<0.05). The prevalence of multiple drug resistance among all the isolates was 76 (69.1%).
Conclusion: The observed high level of multiple drug resistance among the flora of healthy individuals call for measures to control the sales of antimicrobial agents in this country as a strategy toward the containment of antibiotic resistance.

Open Access Original Research Article

Thrombocytopenia in Egyptian Patients with Hepatitis C Virus Treated with Standard of Care Therapy: A Cohort Study

Eman Medhat, Gamal Esmat, Mohamed Seif, Mohammed El-Beshlawy, Raghda Marzaban, Zeinab Zakaria, Fatma Abuliela

International Journal of TROPICAL DISEASE & Health, Page 1254-1267
DOI: 10.9734/IJTDH/2014/12875

Background and Study Aims: Thrombocytopenia (TP) in chronic hepatitis C virus (HCV) is a common finding either directly due to viral infection of platelets or indirectly due to immune alteration triggered by the virus, the consequences of HCV- induced cirrhosis and portal hypertension, or induced by Interferon (IFN), the corner element of the standard of care (SOC) therapy for HCV. This study aimed to evaluate TP in patients with chronic HCV, and to evaluate the mutual effect between SOC and TP.
Methods: The study was conducted on 209 patients with chronic HCV from Railway Hospital, Cairo. Patients were divided into two groups, Group (I): 144 patients who received SOC therapy, and Group (II): 65 patients who did not receive therapy. All patients were subjected to clinical examination, laboratory investigations, abdominal ultrasonography, and liver biopsy.
Results: TP was a common finding (60/209; 28.7%), more in group I (33/ 60; 55%, mean= 124.8±16.2/ml), and was significantly worse in group II (mean= 99.7±36.3/ml, p=0.008). Along the course of treatment, 2 significant drops of platelet count took place, nadirs at W8 and W24. TP was significantly related to hepatitis activity and hepatic synthetic function, and not related to the viral load. Four cases developed severe TP, only 1 of them continued therapy on IFN dose reduction.
Conclusions: TP is a common complication among HCV patients and along its SOC therapy, particularly influenced significantly by splenomegaly and advanced fibrosis.

Open Access Original Research Article

Tetanus Toxoid Immunization Coverage in Federal Medical Centre, Umuahia, Abia State, South East Zone, Nigeria

H. I. Nwokeukwu, A. U. Ukegbu, U. Emma- Ukaegbu, K. C. Nwogu, N. Nwankwo, D. Osunkwo, E. Ajuogu

International Journal of TROPICAL DISEASE & Health, Page 1268-1277
DOI: 10.9734/IJTDH/2014/12189

Background: Tetanus toxoid immunization is given to pregnant women and women of child bearing age to prevent neonatal tetanus and maternal tetanus. The tetanus toxoid vaccine is given five times to women of child bearing age. If the vaccination is given with correct dose, through the right route of administration and completely the woman will be protected for life/ all child bearing years. It was therefore necessary to find out the tetanus toxoid coverage in such tertiary health institution where many pregnant women attend and immunization is given.
Objective: To determine the tetanus toxoid coverage in the health facility.
Methods: Records of the data management tools of Tetanus Toxoid (TT) immunization were checked and data collected. The data was collected from tetanus toxoid register in the immunization unit of Federal medical centre, Umuahia. Data was analyzed with Excel and Epi info.
Results: The health facility summary form showed steady increase in coverage rate for TT1 and TT2 pregnant women only from 2006(33%, 28%) to 2012(64%, 50%) except 2010(37%, 29%) where it reduced. The dropout rate of TT1/TT2 ranged from 14% in 2011 to 28% in 2009. The dropout rate in 2012 was 22%. In immunization register 2006-2009, those that competed (took TT1 to TT5) ranged from 10%-16%.However, those that started in 2010 to 2012 were not expected to have taken up to TT5 due to interval of administration
Conclusion: The coverage rate of TT was low with highest coverage rate in 2012 and there was also high dropout rate. This showed that many pregnant women are still not immunized with TT and some that started did not get the second dose indicating no protection.

Open Access Original Research Article

Urogenital Schistosomiasis among Fulani Pastoralists in Rivers State

N. Eze Chinwe, P. I. Agi

International Journal of TROPICAL DISEASE & Health, Page 1278-1286
DOI: 10.9734/IJTDH/2014/8778

Aim: To determine the distribution and endemicity of Urogenital schistosomiasis infection among Fulani Pastoralists in their various bush encampments in Rivers State, Nigeria.
Study Design: Cross –sectional, descriptive study.
Place and Duration of Study: Rivers State, Nigeria, between November 2009 and January 2011.
Methodology: Urine samples were collected from 593 Fulani pastoralists from six bush encampments and examined for schistosome eggs using centrifugation method. The number of eggs obtained per 10ml of urine specimen was counted and quantified as intensity of infection. Egg counts were reported according to the following categories. Light infection ≤50eggs/10ml of urine, moderate infection- ≥50≤100 eggs/10ml of urine, heavy infection- ≥100 eggs/10ml of urine of urine. Urine samples were tested for proteinuria and haematuria using commercial reagent strips capable of detecting urinary blood, protein and other parameters.
Results: Of the 593 Fulani pastoralists who were investigated, 394(66.4%) were infected with a mean overall intensity of 83.3±2.0 eggs/10ml of urine. The herdsmen in Eleme and Oyigbo bush encampments had the highest prevalence of 91(81.3%) and 77(76.2%) respectively with a mean intensity of 96.1±4.0 and 93.1±5.1 eggs/10ml urine. There were significantly more infected males than the females (p<0.05). The subjects aged 21-30 years had the highest prevalence 92 (76.0%) with heavy intensity of infection (25.0%). About 169(42.9%) of infected Fulani’s excreted ≥50≤100 eggs/10ml of urine while 132(33.5%) excreted ≥100 eggs/10ml of urine. Haematuria was recorded in 444(74.9%) with majority observed in 31-40 years age group while 427(72.0%) tested positive for proteinuria.
Conclusion: The results revealed high prevalence and intensity rates of Schistosoma haematobium among the Fulani herdsmen. Since such herdsmen are always on the move in search of greener pastures they would always pollute water bodies and thus serve as source of transmission to neighbouring communities. Health education campaigns by health workers as well as intensified integrated control measures are advocated.

Open Access Original Research Article

Dietary Pattern and Antioxidants Levels in Patients with Simple Goiter and Thyroid Cancer

K. S. Adedapo, K. A. Ogunwale, A. A. Musa, O. Olufemi

International Journal of TROPICAL DISEASE & Health, Page 1287-1297
DOI: 10.9734/IJTDH/2014/13218

Background /Aims: Oxidative stress has been implicated in the pathogenesis of thyroid cancer and simple goiter among other diseases however; there has not been a direct comparison of the severity of the stress factor in these two conditions in relation to their dietary pattern in our environment.
Objective: This study assessed oxidative stress indices, antioxidant status and dietary pattern in thyroid cancer and simple goiter compared with the controls.
Study Design: This is a case-control study.
Place and Duration of Study: Study groups were recruited from the Departments of Surgery and Nuclear medicine of University of Ilorin teaching hospital, Ilorin, Kwara State and University College Hospital, Ibadan, Oyo State respectively between March 2013 and September 2013.
Materials and Methodology: A total number of one hundred and five (105) age matched participants consisting of 88 females and 17 males were recruited for this study. They were divided into 3 groups; Group one 35 participants with thyroid cancer and group two, 35 participants with simple goiter and group three, 35 control participants. Plasma levels malondialdehyde (MDA), hydrogen peroxide (H2O2) and total plasma peroxide (TPP) were determined by colorimetric methods. Antioxidant status was determined by measuring total antioxidant potential (TAP), glutathione peroxidase (GPx), Superoxide dismutase (SOD), reduced glutathione (GSH), glutathione-s-transferase (GST) by colorimetric methods. Selenium (Se) was determined by atomic absorption spectrophotometry (AAS).Oxidative stress index (OSI) was measured and all values expressed as mean ± SD, while frequency of intake of various dietary sources of the participants were collated.
Results: TAP, SOD, GPx, GSH and GST (antioxidants) levels in group 1 (552.17±74.67; 1.30±0.32; 1.91±0.23; 4.47±0.59; 0.92±0.25; 1.28±0.04 respectively) were significantly lower than group 3 (933.51±80.15; 2.85±0.39; 5.40±0.76; 8.34±1.12; 2.11±0.31). While the mean plasma levels of antioxidants in group 2 (704.74±62.22; 2.01±0.27; 4.62±0.89; 6.19± 0.56; 1.47± 0.14 and 1.40±0.04) were significantly higher than that of group 1. However, significant increase was observed in mean levels of oxidative stress markers; TPP, MDA, H2O2 and OSI, in group 1 (16.24±2.52, 13.88±2.95, 13.52±6.91 and 2.93±1.40 respectively) compared to group 3 (4.57±1.32, 3.22±1.20, 3.01±0.86 and 0.48±0.14). Oxidative stress markers in group 2 (9.79±1.40, 5.90±1.13, 3.81±1.40 and 1.62±0.23) were significantly lower than group 1. A p - value <0.05 was considered significant. Majority of the control participants consumed fruits and vegetables (sources of exogenous antioxidants) regularly more than the test groups
Conclusion: The study reported higher oxidative stress markers; oxidative stress index and lower antioxidant status in study subjects compared to controls .Oxidative stress appeared more marked in thyroid malignancy than the benign thyroid disease state. Adequate intake of fresh fruits and vegetables could be beneficial for thyroid cancer patients.