Open Access Case Study

Dengue with Scrub Typhus Coinfection in Northern India

Vishal Singh, Satish Chandra Mishra, Nikesh A. Agarwal, Binod B. Raut, Pulkit Singh

International Journal of TROPICAL DISEASE & Health, Page 58-62
DOI: 10.9734/ijtdh/2020/v41i230256

Background: Amongst the many vector and water-borne diseases prevalent in tropics, dengue occupies a prominent place. Dengue epidemics are frequent and at times, during such epidemic, coinfections may occur causing diagnostic dilemmas.

Case Report: A 36 years old lady, from a rural background, presented during the 2019 dengue epidemic with fever, vomiting, and non-colicky abdominal pain. The evaluation showed hepatosplenomegaly, leukocytosis, and thrombocytopenia. The investigations confirmed the diagnosis and she was treated conservatively as a case of dengue with warning signs. A longer than anticipated duration of fever and clinical deterioration prompted reassessment, which revealed the presence of an eschar over the right upper thigh. The Weil-Felix test using Proteus OX-K stain was positive at a titer of 1:320. Following treatment with oral doxycycline, she showed rapid defervescence and clinical improvement.

Conclusions: Coinfection with scrub typhus is rare with dengue. If left untreated, it adversely affects the outcome. The key to diagnosing such coinfections includes a high index of suspicion, repeated clinical examination, and the knowledge of local endemicity.

Open Access Original Research Article

Molecular Epidemiology of Plasmodium falciparum Chloroquine Resistance Transporter Genes among School Children in Kwara State, Southwestern Nigeria

A. O. Oluwasogo, H. O. Ismail, D. A. Pelumi

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/ijtdh/2020/v41i230249

Background: Plasmodium falciparum existence continues to develop resistance to conventional antimalaria drugs in malaria endemic areas. Plasmodia often prevent drugs from interacting with the target site, hence, developing resistance to antimalaria drugs. Mutations in the Plasmodium falciparum chloroquine resistance transporter (Pfcrt), are the major determinant of chloroquine resistance in human malaria parasite.

Methodology: Malaria infection, Pfcrt and Pfmdr1 genes of isolates among school students within the age range of 11-22 years from four selected rural communities of Kwara state were studied. One hundred and eighty seven subjects (187) were selected for the study. Blood samples were collected by finger prick method for malaria screening. Nested PCR and restriction fragment length polymorphism (RFLP) were done to detect alleles of pfcrt at codon 76 and pfmdr1 at codon 86. DNA of isolates was appropriately extracted from the filter paper blots using the methanol fixation method. Logistic regression was performed on the binary observations obtained while linear regression was conducted on the fifty (50) subjects that tested positive to malaria.

Results: Out of 187 subjects screened, 26.7% (50) were positive to P. falciparum. Highest malaria parasite count of 36.4% was recorded in 14-16 years age group while 20-22 years age group had the least malaria parasite count (15.4%). The result of the studied isolates indicated that out of 50 isolates analyzed for Pfcrt gene, wild type alleles accounted for 32% (16) while mutant alleles accounted for 68% (34). Alakuko Community accounted for the least number of T76 mutant alleles 10% (5) while Apado community recorded the highest number of T76 mutant gene 22% (11). For Pfmdr1 gene analysis at codon 86, isolates from Apado community showed the highest mutant type alleles (Y86) of 22% (11), while Igbonla community in Ifelodun local government had the least mutant alleles, 6% (3).

Conclusion: The overall result revealed existence of mutant alleles in both the Pfcrt and Pfmdr1 genes which was higher than the wild type gene in both cases. The presence of chloroquine resistance genes among the studied population implies that alternative antimalaria drugs should be designed by pharmaceutical industry.

Open Access Original Research Article

Health Insurance and Healthcare Quality: A Comparative Study between Insured and Uninsured Patients at a Teaching Hospital in Northeast Nigeria

O. E. Daramola, A. F. Oderinde, C. M. Anene, J. M. Abu, T. M. Akande

International Journal of TROPICAL DISEASE & Health, Page 13-19
DOI: 10.9734/ijtdh/2020/v41i230250

Objective: Patients’ perception of the quality of care is essential in assessing health services and feedbacks from patient satisfaction surveys are useful in healthcare quality improvements.

Methods: A descriptive cross-sectional study was done to evaluate satisfaction with the quality of care among insured patients under the National Health Insurance Scheme (NHIS) and uninsured (Out-of-Pocket paying) patients at University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, Nigeria. Data were collected from 115 respondents from each group selected by systematic random sampling; using self-administered questionnaires. Analysis was done using IBM SPSS Statistics 20.0.

Results: The overall mean satisfaction for the uninsured group (73.1 ± 7.2) was higher than that of the insured group (71.2 ± 7.5). However, the difference was not statistically significant, p = 0.063. The observed satisfaction levels in the various areas of services accessed among the insured and uninsured group in this study are comparable, except for the significant differences observed in satisfaction with hospital facilities and the availability of prescribed drugs, suggesting the need for the improvement of hospital facilities and availability of drugs.

Conclusion: Despite complaints about the NHIS, it is still generally preferred to out-of-pocket payment by both groups. Therefore, more efforts should be made to expand the population coverage of health insurance to allow the inclusion of more people, while the need for continuous improvement of quality health services cannot also be overemphasized.

Open Access Original Research Article

Middle-age Spread of Overweight and Obesity in Ghana; Myth or Reality? Evidence from WHO SAGE Wave 2 Data

Michael Rockson Adjei, Janet Vanessa Baafi, Salifu Bawa, Felicia Amoo-Sakyi, Paulina Clara Appiah, Kwabena Twum-Nuamah, Gifty Amugi, Kofi Issah, Timothy Sewornu Letsa, George Mensah, Richard Biritwum, Alfred Edwin Yawson

International Journal of TROPICAL DISEASE & Health, Page 20-28
DOI: 10.9734/ijtdh/2020/v41i230251

Aims: The aim of this study is to describe the age-related risk of overweight/obesity among Ghanaians using data from the WHO Study on global AGEing and adult health (SAGE) Wave 2.

Study Design: Cross sectional study.

Place and Duration of Study: Ghana; 2014-2015.

Methodology: Primary study variables were extracted onto Microsoft Excel 14.0 spreadsheet. Secondary variables were generated through grouping, recategorization and combination of primary variables. Descriptive statistics were calculated for age and BMI. Associations between respondents’ characteristics and BMI were evaluated with chi square(χ2) and odds ratio (OR) at 95% confidence level.

Results: Data of 1322 respondents were included in data analysis. In all, 520 (39.3%) of the respondents were overweight/obese and nearly half (46.62%) were middle-aged adults. Middle-aged adults were nearly twice as likely to be overweight/obese compared with old adults (AOR=1.62; CI: 1.25-2.10) and the risk was higher for middle-aged females (AOR=2.38; CI: 1.84-3.09). Overall, being middle-aged (OR=1.73; CI: 1.35-2.21); living in an urban community (OR=2.01; CI: 1.61-2.52); being a female (OR=2.69; CI: 2.1-3.44); not engaging in regular physical activity (OR=1.49; CI: 1.18-1.88); and being an occasional drinker of alcoholic beverage (OR=1.58; CI: 1,12-2.22) were significantly associated with overweight/obesity.

Conclusion: Obesity/overweight are lifestyle driven phenomenon and can be controlled by risk modification. Public sensitization, imposition of special taxes on sugary beverages, promotion of healthy local staples and creation of enabling community environments to encourage physical activity may be useful approaches in controlling the epidemic.

Open Access Original Research Article

Socioeconomic Factors and Cultural Practices Influencing the Resurgence of Bedbugs (Cimex hemipterus): A Case of Nakuru Town, Kenya

Muriithi Dennis, Mogere Dominic, Kariuki John, Shire Abdirazak, Kingóri Samuel

International Journal of TROPICAL DISEASE & Health, Page 29-38
DOI: 10.9734/ijtdh/2020/v41i230252

Bedbugs are parasitic insects that feed mostly on blood (human). Cimex hemipterus commonly known as the Tropical bedbug resurge in warmer climates like Africa, Asia and America. Over the years bedbug infestation has remained a major public health concern among the residents of Nakuru Town Kenya. The purpose of this study was to determine socioeconomic factors and cultural practices that influence the resurgence of bedbugs in Nakuru Town, Kenya.

This study adopted analytic epidemiological study design and used cross sectional descriptive survey for data collection. It was conducted in seven estates in Nakuru Town, Kenya with an estimated population of 32,856 in a period of seven months. Cluster sampling was used to sample the households in the estates with the study surveillance being done in four hundred and twenty two (422) households whereas 57% and 43% of the participants were male and female respectively.

The main source of income among the respondents was self-employment with only 27% of the participants being employed. According to the findings of this study 31% of the residents were earning between 5000 and 10000 with only 4% of their monthly income been allocated to healthcare. The current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. Cultural beliefs like witchcraft are limiting the eradication of bedbugs and leads to the resurgence in some of the households.

In conclusion, the current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. The findings of this study will be used to inform the policy makers in the Nakuru County government on measures to be taken to improve the socioeconomic status of its residents so that in the future residents are empowered to eradicate the bedbugs.

Open Access Original Research Article

Drug Resistant Tuberculosis in Oyo State, Nigeria: A Retrospective Study

Stephen Oluwasegun Adetunji

International Journal of TROPICAL DISEASE & Health, Page 39-45
DOI: 10.9734/ijtdh/2020/v41i230253

Aim: The focus of this work was to evaluate the prevalence of rifampicin resistant tuberculosis in Oyo State, Nigeria.

Study Design:  A cross sectional retrospective study

Place and Duration of Study: St Mary’s Catholic Hospital, Ibadan, Nigeria, between October 2016 and March 2018

Methodology: In this study, 1044 patients diagnosed in the GeneXpert laboratory was conducted using the laboratory register. The age, gender, HIV Status, MTB analysis results and resistance to rifampicin were collected and analyzed.

Results: Of the 1044 tested, 177 (17%) tested positive for TB while 19 (10.7%) of the 177 were resistant to rifampicin. Fourteen (73.7%) of the 19 were male and 5 (26.3%) were female. Fourteen (73.7%) of the 19 fell between 21 - 40 years of age. Seven (36.8%) of the 19 resistant to rifampicin were HIV positive. Of the total 1044 patients tested, 601 (57.6%) were females and 443 (44.4%) were male.

Conclusion: This study showed that rifampicin resistant tuberculosis is high in Nigeria especially among the economically productive age group in the country. More attention should be committed to quick accessibility of diagnosis, treatment and monitoring by the policymakers.

Open Access Original Research Article

Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

M. U. Ibekwe, Paul Ni

International Journal of TROPICAL DISEASE & Health, Page 46-52
DOI: 10.9734/ijtdh/2020/v41i230254

Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstruction which commonly occurs in this population, can pose serious challenges in this age group.

Aim: To study the pattern and aetiology of acute upper airway obstruction in the paediatric age group in University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management.

Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15 years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study.

Data obtained were analyzed with the IBM statistical package for social sciences SPSS version 20. Results were presented in simple descriptive forms with tables.

Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%).

Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.

Open Access Original Research Article

Identification of Cryptosporidium parvum Oocysts among Hospitalized Children under-5years in Northeastern Nigeria

Umoru M. Askira, T. M. Isyaka, A. B. Samaila, Tijjani Isa, M. Muhammad Ibrahim, U. T. Hadiza, Haruna B. Ali, M. Usman

International Journal of TROPICAL DISEASE & Health, Page 53-57
DOI: 10.9734/ijtdh/2020/v41i230255

Cryptosporidium parvum is among the major pathogens causing diarrheal diseases in children. It is of major public health significance due to its low infectious dose and its oocysts are highly resistant to chlorination, common household disinfectants and survive long periods in the environment. This study was designed to evaluate the occurrence of Cryptosporidium parvum oocysts in stool of hospitalized children under-5 years. One hundred and fifty (150) stool samples were collected from one hundred and fifty children (Male:Female = 1:1.08, Mean Age±S.D=22.08 months ± 21.02) and were processed using the modified Ziehl-Nelson method for identification of protozoan oocysts. Out of the one hundred and fifty (150) stool samples analyzed, 16 tested positive to oocysts of C. parvum, which gives a parasite prevalence rate of 10.7%. This was observed to be higher among male patients (52.0%) and children between the age 32-41 months (31.3%). Parasite prevalence in relation to age of patients was statistically not significant (X2=0.105, DF=1, P-value = 0.74591, p<0.05). Other intestinal protozoan parasites identified include Entamoeba histolytica (1.33%) and Giardia lamblia (2.60%).