Linking communities and health facilities to improve child health in low resource settings: a systematic review

Community-facility linkage interventions are gaining popularity as a way to improve community health in low-income settings. Their aim is to create/strengthen a relationship between community members and local healthcare providers. Representatives from both groups can address health issues together, overcome trust problems, potentially leading to participants' empowerment to be responsible for their own health. This can be achieved via different approaches. We conducted a systematic literature review to explore how this type of intervention has been implemented in rural and low or lower-middle income countries, its various features and how/if it has helped to improve child health in these settings. Publications from three electronic databases (Web of Science, PubMed, Embase) up to 03/02/2022 were screened, with 14 papers meeting the inclusion criteria (rural setting in low/lower-middle income countries, presence of a community-facility linkage component, outcomes of interest related to under-five children's health, peer-reviewed articles containing original data written in English). We used Rosato's integrated conceptual framework for community participation to assess the transformative and community empowering capacities of the interventions, and realist principles to synthesize the outcomes. The results of this analysis highlight which conditions can lead to success of this type of intervention: active inclusion of hard-to-reach groups, involvement of community members in implementation's decisions, activities tailored to the actual needs of interventions' contexts, and usage of mixed methods for a comprehensive evaluation. These lessons informed the design of a community-facility linkage intervention and offer a framework to inform the development of monitor and evaluation plans for future implementations.

FEEDING PRACTICES AND NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN A PERI-URBAN SETTING IN IBADAN, SOUTHWEST NIGERIA: A COMPARATIVE CROSS-SECTIONAL STUDY

Background

Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential. This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan.

Methods

We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers' sociodemographic details, 24-hour dietary recall of the child's feeding, and anthropometric measurements were obtained.

Results

Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father's education, caregiver's occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 - months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings.

Conclusion

Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

FEEDING PRACTICES AND NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN A PERI-URBAN SETTING IN IBADAN, SOUTHWEST NIGERIA: A COMPARATIVE CROSS-SECTIONAL STUDY

Background

Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential. This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan.

Methods

We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers' sociodemographic details, 24-hour dietary recall of the child's feeding, and anthropometric measurements were obtained.

Results

Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father's education, caregiver's occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 - months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings.

Conclusion

Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

Genetic Epidemiology and Associated Diseases of APOL1: A Narrative Review

BACKGROUND

The Apolipoprotein 1 (APOL1) protein is a product of the human APOL1 gene located on chromosome 22q13.1 and performs functions including lipid transport and metabolism, programmed cell death, autophagy and innate immunity against intracellular pathogens. It is unique among its gene family in its possession of a signal peptide that confers on it the ability for export out of the cell and into the blood stream. The aim of this review is to explore the genetic epidemiology and biology of the APOL1 gene, describe its association with different renal and extra-renal disorders and highlight the timelines of the discoveries of the various associations.

METHODS

A literature search was carried out using combination of terms including "apolipoproteins", "apolipoprotein L", "APOL1", "genetics of APOL1", "Chronic Kidney Disease (CKD) and APOL1"," APOL1 and associated diseases" covering the period January 1990 to April 2020.

RESULTS

High frequency of the APOL1 gene arose as a result of natural selection in East and West Africa, regions endemic for Trypanosoma brucei infection. High frequencies are also reported among individuals of African ancestry in North America. APOL1 G1 and G2 variants protect against Trypanosoma brucei rhodesiense having overcome their virulence through the serum trypanolytic factor. Although protective against infection from trypanosomes, these alleles have also been shown to increase the risk of several disorders including various forms of chronic kidney diseases, schizophrenia, stroke, cancer, and pre - eclampsia.

CONCLUSION

The elucidation of the APOL1 gene has deepened understanding of racial disparities in health and disease. Growing understanding of the genetics and functions of APOL1 has potential to enhance translational benefits for development of new biomarkers, preventive and therapeutic interventions in the context of precision medicine.

Five traditional Nigerian Polyherbal remedies protect against high fructose fed, Streptozotocin-induced type 2 diabetes in male Wistar rats

BACKGROUND

This present study sought to assess the modulatory effects of five Nigerian traditional polyherbal in high fructose-fed, streptozotocin-induced (HF-STZ) Type 2 diabetes (T2D) in rats. T2D was achieved via fructose feeding (20%^W/V) ad libitum for 2 weeks and streptozotocin (STZ, 40 mg/kg) (15th Day) intraperitoneally.

METHODS

Seventy-two hours after STZ injection, fourty-eight diabetic rats were divided into eight of 6 rats/group: Diabetic normal untreated, glibenclamide (GBLI, 0.07 mL/kg) or yoyo (YB, 0.43), ruzu (RB, 0.08), fajik (FJB, 0.20), oroki (OB, 0.16), and fidson (FB, 0.43)/ mL/kg bitters respectively. Controls normal and diabetic untreated groups received intragastric carboxylmethylcellulose (CMC, 1 mL/kg) for eleven days.

RESULTS

T2D was characterized in rats by an increased (p < 0.001-0.05) blood glucose levels (BGL), total cholesterol, triglycerides, low-density lipoprotein and alanine aminotransferase compared with control CMC group. Similarly, hepatic and pancreatic malondialdehyde (MDA) were increased by 180 and 97% respectively. Polyherbal treatments demonstrated efficacies on BGL as follow: YB (55.6%, 160.7 mg/dL); RB (59.7%, 145.2 mg/dL); FJB (59.8%, 243.4 mg/dL); OB (60.8%, 194.5 mg/dL) and FB (61.3%, 203.3 mg/dL) respectively by day 11 (versus GBLI, 65.1%) compared with control untreated diabetic rats. Also, elevated TC, LDL cholesterol, ALT were lowered (p < 0.05) by YB, FJB, and FB respectively in rats. YB, FJB, and OB lowered MDA levels in treated rats. Further, YB, RB, FJB and FB restored changes in liver, and pancreas histopathology. Predominant non-polar bioactive include oleic, hexadecanoic, octadecanoic among others following gas chromatography-mass spectrophotometry analyses.

CONCLUSION

Overall, these present results demonstrate anti-hyperglycemic potentials, although with cautions, of some polyherbal in T2D rats, which may, in part, be antioxidants mediated.

Oxygen for children and newborns in non-tertiary hospitals in South-west Nigeria: A needs assessment

BACKGROUND

Oxygen is important for the treatment of hypoxaemia associated with pneumonia, malaria, and other medical, obstetric, and surgical conditions. Access to oxygen therapy is limited in many of the high mortality settings where it would be of most benefit.

METHODS

A needs assessment of 12 non-tertiary hospitals in south-west Nigeria, assessing structural, technical and clinical barriers to the provision of safe and effective oxygen therapy.

RESULTS

Oxygen supply was reported to be a major challenge by hospital directors. All hospitals had some access to oxygen cylinders, which were expensive and frequently ran out. Nine (75%) hospitals used oxygen concentrators, which were limited by inadequate power supply and lack of maintenance capacity. Appropriate oxygen delivery and monitoring devices (nasal prongs, catheters, pulse oximeters) were poorly available, and no hospitals had clinical guidelines pertaining to the use of -oxygen for children. Oxygen was expensive to patients (median US$20/day) and to hospitals. Estimated oxygen demand is reported using both a constant mean-based estimate and adjustment for seasonal and other variability.

CONCLUSIONS

Making oxygen available to sick children and neonates in Nigerian hospitals will require: improving detection of hypoxaemia through routine use of pulse oximetry; improving access to oxygen through equipment, training, and maintenance structures; and commitment to building hospital and state structures that can sustain and expand oxygen initiatives.

Factors influencing extract of Hibiscus sabdariffa staining of rat testes

Some plant extracts can be used in biology and medicine to reveal or identify cellular components and tissues. We investigated the effects of time and concentration on staining of histological sections of rat testes by an acidified extract of Hibiscus sabdariffa. An ethanolic extract of H. sabdariffa was diluted using 1% acetic acid in 70% ethanol to stain histological sections of testes at concentrations of 0.2, 0.1 and 0.05 g/ml for 5, 10, 15, 30, 45 and 60 min. The sections of testes were stained deep red. The staining efficiency of H. sabdariffa was greater at a high concentration and required less time to achieve optimal staining. H. sabdariffa is a strongly basic dye that can be used for various diagnostic purposes. Staining time and concentration must be considered to achieve optimal results.

Frequency of twinning in southwest Nigeria

BACKGROUND:

In the human species, twin is a type of multiple birth in which the mother gives birth to two offspring from the same pregnancy. The occurrence and frequency of twinning, however, varies across human populations. The maternal age, socio-environmental factors, increase in the use of contraceptives, the race of human population, increase in the spontaneous abortion rate, and seasonal variations are among the factors that could influence twinning rate. Information on twinning rates in southwest Nigeria is limited.

AIMS:

This study presents information on the frequency of twinning, as well as its analysis by maternal age, in four urban settings in southwest Nigeria. This is with the aim of extending current knowledge on the frequency of twinning in southwest Nigeria and contributing to the demographic studies in the country.

MATERIALS AND METHODS:

Data on single births and twin births from January 1995 to December 2004 were collected from the Oyo State General Hospital (OSGH), Wesley Guild Hospital (WGH), Obafemi Awolowo University Teaching Hospital (OAUTH), and Ekiti State Specialist Hospital (ESSH) in Ogbomoso, Ilesa, Ile-Ife, and Ado-Ekiti respectively. These were analyzed by year and maternal age groups of 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years according to the standard method.

RESULTS:

A frequency of twin births of 46.5 per 1000 deliveries and 46.2 per 1000 deliveries was recorded for Ilesa and Ile-Ife respectively. The frequency recorded for Ogbomoso and Ado-Ekiti was 38.5 and 22.1 per 1000 deliveries respectively. The overall average frequency of 40.2 per 1000 deliveries for the four hospitals ranks among the highest recorded rates of twin births in the world. The maternal age group of 25-29 years had the highest occurrence of twin births, while the lowest was recorded in the 45-49 years age group.

CONCLUSION:

This analysis reveals high incidence of twinning in the studied areas and supports previous assertion that the southwestern part of Nigeria has the highest twinning rate in the country and in the whole world. It is our opinion that diet, maternal history of twinning, and some socio-environmental factors may have influenced the results.

Effect of defatted methanolic extract of Holarrhena floribunda leaves in sodium arsenite-induced clastogenecity in Wistar albino rats

This study examined the effect of defatted methanolic extract of Holarrhena floribunda leaves on sodium arsenite-induced clastogenecity and toxicity in male wistar rats. Animals were randomly allotted into six groups of five rats each and treated as follows; Group A (sodium arsenite (NaAsO3)), Group B (100 mg/kg extract), Group C (100 mg/kg extract plus NaAsO3), Group D (200 mg/kg extract), Group E (200 mg/kg extract plus NaAsO3) and Group F had distilled water. Sodium arsenite (2.5 mg/kg) was given intraperitoneally once per week. The extract was administered through oral gavage for 28 consecutive days. Clastogenecity was evaluated by studying micronuclei formation in polychromatic erythrocytes cells (PCEs) in the bone marrow. Plasma levels of Gamma Glutamyl Transferase (ãGT), Aspartate Amino Transferase (AST), Alanine Amino Transferase (ALT) were determined. Hepatic Reduced Glutathione (GSH), Superoxide Dismutase (SOD), Catalase (CAT), protein and lipid peroxidation were determined. Liver histopathological evaluation was also carried out.The results obtained show that NaAsO3-induced micronuclei formation in PCEs was reduced at 100 and 200 mg/kg of the extract by 7.7% and 38.5% respectively while elevated plasma ãGT and ALT levels were significantly ameliorated (P<0.001). There was no significant difference in plasma AST levels and hepatic SOD activities in all the treated groups as compared with the control. Sodium arsenite-induced reduction of GSH concentration was elevated by the extract at 100 and 200 mg/kg by 18.5% and 11.9% respectively. The reduction of CAT activity by NaAsO3 was also ameliorated at 200 mg/kg extract by 23.3%. The extract at 100 mg/kg significantly reduced NaAsO3-induced lipid peroxidation by 16.4% (P < 0.05). Histological examinations showed that the extract at 100 mg/kg protected NaAsO3-induced liver damage. This study revealed that the leaf extract has potential to ameliorate clastogenecity and toxicity induced by sodium arsenite in rats.

Cytotoxic and genotoxic effects of aqueous extracts of five medicinal plants on Allium cepa Linn

The cytotoxic and genotoxic effects of aqueous extracts of five medicinal plants: Azadirachta indica (A. Juss), Morinda lucida (Benth.), Cymbopogon citratus (DC Stapf.), Mangifera indica (Linn.) and Carica papaya (Linn.) was evaluated using the Allium cepa assay. The extracts were prepared with tap water as practised locally. Onion bulbs were exposed to 1, 5, 10, 25 and 50%; and 1, 2.5, 5, 10 and 20% concentrations (v/v) of each of the extracts for macroscopic and microscopic analyses, respectively. There was concentration-dependent and statistically significant (P<0.05) inhibition of root growth by the extracts when compared with the control. The EC(50) obtained for decoctions of Azadirachta indica. Cymbopogon citratus, Mangifera indica and Carica papaya were 0.6, 3.0, 1.4 and 0.8%, respectively. It was 2.6 and 0.8% for the squeezed extracts of Azadirachta indica and Morinda lucida, respectively. All the tested extracts were observed to have mitodepressive effects on cell division and induced mitotic spindle disturbance in Allium cepa. These results suggest an inhibitory, mitodepressive and turbagenic activities of the aqueous extracts on Allium cepa.

Human sex ratio at birth in South West Nigeria

BACKGROUND:

Human sex ratio at birth differs from one population to the other. This variation has been attributed to cultural practices, seasonal variation, small-family size policy and sex selective technology. Information on secondary sex ratio in Nigeria is limited.

AIMS AND OBJECTIVE:

To analyzed human sex ratio at birth for samples of the Nigerian population in 4 urban settings in Southwest Nigeria, in order to know the trend and to compare the findings with those of previous reports.

MATERIALS AND METHODS:

Data were collected from Obafemi Awolowo University (OAU) teaching hospital at Ile Ife and Wesley Guild hospital at Ilesa, Osun state; General hospital at Ogbomoso, Oyo state and Ekiti state specialist hospital at Ado-Ekiti, Ekiti state. The data consisted of 35 209 live single births recorded between 1995 and 2004. Each set of data was analyzed to determine the sex ratio by year, month and quarterly values. Chi-square analysis was used to determine the deviation of the sex ratios for the years from the average value.

RESULTS:

The annual average ratios of 104.7:100, 102.8:100, 98.9:100 and 100.8:100 were recorded for OAU teaching hospital, Wesley Guild Hospital, General Hospital and Ekiti State specialist hospital, respectively. When pooled together, the average ratio was 102.7:100. This shows some bias for male births. Data also indicates more male birth in the rainy season, suggesting a seasonal variation of sex ratio.

CONCLUSION:

These findings are representative of the populations in southwest Nigeria and are comparable to values obtained for other regions in Nigeria and other populations of African origin.

Landfill leachate-induced toxicity in mice

Microbial, plant and studies in aquatic animals have shown that landfill leachate is toxic. However, more information about its effects in terrestrial animals is required. As a part of ongoing research into the toxic effects of landfill leachate in Nigeria, we evaluated the acute effects of raw and simulated leachates from Abadina, Orita-Aperin and Oworonsoki dump sites, all in Southwest Nigeria, in mice. Raw leachates were obtained directly from the dumps while the simulated leachates were obtained from the solid wastes in the laboratory by using the ASTM method. The samples were designated Abadina raw leachate (ARL), Orita-Aperin raw leachate (OARL) and Oworonsoki raw leachate (OWRL); and Abadina simulated leachate (ASL), Orita-Aperin simulated leachate (OASL) and Oworonsoki simulated leachate (OWSL). Their physico-chemical properties were determined in accordance with standard analytical methods. Young male mice (12-15 wk) weighing 24-31 g were exposed to 1%, 5%, 10%, 25%, 50% and 100% concentrations of each test samples for 5 consecutive days and were observed for a period of 96 h for toxic response. Mortality recorded at different times for each sample at the various concentrations was mostly within the last 48 h of the exposure period. The LC50 obtained are 100% for both ARL and OARL, and 50% for OWRL; and 83.50% and 50% for ASL and OWSL, respectively. It was indeterminate for OASL. Apart from this, other toxic effects like weight loss, sluggishness, loss of hair and reduced food intake were observed. The investigated samples were ranked as OWRL > OWSL > ASL > OARL > ARL > OASL. The observed effects were due to the toxic constituents present in the leachate samples. This suggests that the mixtures have the potential to cause harmful effect to public health and our environment through seepage into ground or surface water.