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Willet V, Dixit D, Fisher D, Bausch DG, Ogunsola F, Khabsa J, Akl EA, Baller A. Summary of WHO infection prevention and control guideline for Ebola and Marburg disease: a call for evidence based practice. BMJ 2024; 384:2811. [PMID: 38408787 PMCID: PMC10897755 DOI: 10.1136/bmj.p2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
| | - Devika Dixit
- World Health Organization, Geneva, Switzerland
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel G Bausch
- FIND, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
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Luedtke S, Wood C, Olufemi O, Okonji P, Kpokiri EE, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa A, Ekumankama C, Theophilus A, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Birjovanu G, Lefevre C, Petrou S, Ogunsola F, Kostkova P. Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study. Antimicrob Resist Infect Control 2023; 12:141. [PMID: 38053212 PMCID: PMC10699010 DOI: 10.1186/s13756-023-01342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.
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Affiliation(s)
- Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Caroline Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chibuzo Ekumankama
- Department of Ophthalmology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ayibanoah Theophilus
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Infectious Diseases Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Stylianos Petrou
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
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Balogun M, Akodu B, Shoemaker D, Yesufu V, Onyenwenyi A, Udeh R, Ezeaka C, Ayankogbe O, Ogunsola F. A blended curriculum to improve student community health officers' competencies in newborn infection prevention and control. Ann Med 2023; 55:2205167. [PMID: 37103887 PMCID: PMC10142393 DOI: 10.1080/07853890.2023.2205167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Infections contribute significantly to neonatal mortality in Nigeria. Community health officers (CHOs) provide maternal, newborn and child health services at the primary health care level. However, newborn infection prevention and control (NB-IPC) is not included in their current training curriculum, which has little innovation in teaching methods. This study assessed the effectiveness of a blended curriculum on NB-IPC in improving the competencies of student CHOs. METHODS This pre- and post-test study was conducted in the CHO training school of Lagos University Teaching Hospital (LUTH), which has 70 students enrolled. We developed and implemented a blended curriculum on NB-IPC using Kern's six-step framework. Twelve videos were recorded of content experts teaching various aspects of NB-IPC and were watched online or downloaded by students. Two interactive practical sessions were held in class. Pre- and post-course assessment of knowledge was with multiple choice questions, attitude with a Likert scale, and skills with an objective structured clinical examination (OSCE). Course satisfaction was also assessed with a validated scale. Paired t-test was used to determine mean differences at a significance level of 0.05. RESULTS The mean knowledge score of students increased from 10.70 (95% confidence interval (CI): 10.15-11.24) pre-course out of a possible score of 20 to 13.25 (95%CI: 12.65-13.84) post-course (p < 0.001). Mean attitude score increased from 63.99 (95%CI: 62.41-65.56) out of a possible score of 70 to 65.17 (95%CI: 63.68-66.67) (p = 0.222). The mean OSCE score increased from 21.27 (95%CI: 20.20-22.34) out of a possible score of 58.5 to 34.73 (95%CI: 33.37-36.09) (p < 0.001). Mean post-course satisfaction score of students was 127.84 (95%CI: 124.97-130.89) out of a possible score of 147. CONCLUSION The new curriculum on NB-IPC improved the competencies of student CHOs in LUTH and they were highly satisfied. The blended curriculum may be a feasible addition to learning in CHO schools across Nigeria.Key messageA blended curriculum on NB-IPC involving video teaching is effective in improving the competencies of student CHOs.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos state, Nigeria
| | - Babatunde Akodu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos state, Nigeria
| | - Diane Shoemaker
- Foundation for Advancement of International Medical Education and Research, Philadelphia, USA
| | - Victoria Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos state, Nigeria
| | | | - Roseline Udeh
- Community Health Officers' Training School, Lagos University Teaching Hospital, Pakoto, Ogun state, Nigeria
| | - Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos state, Nigeria
| | - Olayinka Ayankogbe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos state, Nigeria
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos state, Nigeria
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Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria. Infect Agent Cancer 2023; 18:68. [PMID: 37915091 PMCID: PMC10619301 DOI: 10.1186/s13027-023-00550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. METHODS We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. RESULTS A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. CONCLUSION ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria.
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Ali J Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV Clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kirsten Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N Christian
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olugbenga A Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Demirkan B Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Brian T Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Chad J Achenbach
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert L Murphy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Oladele RO, Ettu AO, Medugu N, Habib A, Egbagbe E, Osinaike T, Makanjuola OB, Ogunbosi B, Irowa OO, Ejembi J, Uwaezuoke NS, Adeleke G, Mutiu B, Ogunsola F, Rotimi V. Antibiotic Guidelines for Critically Ill Patients in Nigeria. West Afr J Med 2023; 40:962-972. [PMID: 37768104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients. METHODS A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members. RESULTS Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole. CONCLUSION Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs.
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Affiliation(s)
- R O Oladele
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - A O Ettu
- Lagos State Health Service Commission, Lagos 102273, Nigeria
| | - N Medugu
- Nile University of Nigeria, Abuja, Nigeria. +234-8059083612
| | - A Habib
- Bayero University Kano, Kano State, Nigeria
- Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - E Egbagbe
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - T Osinaike
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O B Makanjuola
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - B Ogunbosi
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O O Irowa
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - J Ejembi
- Ahmadu Bello University, Zaria, Kaduna State, Nigeria
- Ahmadu Bello University Teaching Hospital, Kaduna State, Nigeria
| | | | - G Adeleke
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - B Mutiu
- Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - F Ogunsola
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - V Rotimi
- Center for Infection Control and Patient Safety
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6
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Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and Survival outcomes of HIV-associated cervical cancer in Nigeria. medRxiv 2023:2023.08.08.23293820. [PMID: 37609183 PMCID: PMC10441483 DOI: 10.1101/2023.08.08.23293820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. Results A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+). The HIV+/ICC) patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC+) (P<0.001. Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV+/ICC+ diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC+. The HIV-/ICC+ women had better OS compared to HIV+/ICC+ participants (p=0.018), with 12-month OS 84.1% (95%CI: 75% - 90%) and 67.6% (95%CI: 42%-84%) respectively. Conclusion ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Francis A. Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Ali J. Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kristen Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N. Christian
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Nigeria
| | - Olugbenga A. Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Godwin E. Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Nigeria
| | - Alani S. Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Nigeria
| | - Demirkan B. Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Brian T. Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Chad J. Achenbach
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Nigeria
| | - Robert L. Murphy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A. Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Odukoya OO, Odediran OO, Rogers CR, Ogunsola F, Okuyemi KS. Exploring the barriers and facilitators towards physical activity among church members in Lagos, Nigeria: a qualitative study. Afr Health Sci 2023; 23:572-581. [PMID: 38223576 PMCID: PMC10782367 DOI: 10.4314/ahs.v23i2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Physical inactivity is substantially linked to the rise in the global burden of non-communicable diseases. Faith-based organizations are recognized as potential partners for sustainable health interventions. Objective This study aims to explore the facilitators and barriers towards physical activity among adult church members in Lagos, Nigeria. Methods Sixteen focus group discussions (n-163) were conducted among adult male and female church members in twelve Anglican churches. The discussions were audio-taped, transcribed verbatim and analysed along with the field notes for themes using sequential approach with the aid of the Dedoose® software. Results Individual facilitators of PA included self-discipline, and personal habits. Individual barriers were laziness, ill-health, fear of injury and pre-existing health conditions. Organizational facilitators included biblical verses promoting PA, while deterring factors were lack of safe spaces for PA and poor knowledge among church leadership. The community-level facilitators included pro-physical activity cultural practices, while the prevailing practice hiring house-helps, high costs of gym membership and gender norms discouraging men from participating in household chores served as deterring community-level factors. Environmental facilitators were the availability of safe spaces for PA while deterring factors were city living and high traffic density. Conclusion Several multi-level factors influence physical activity among church members. While it is pertinent to address personal factors, family and community factors also promote PA, therefore, group-level interventions may be warranted. Strategies that address the socio-cultural norms that serve as barriers to PA should also be included in the design of church-based PA programmes.
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Affiliation(s)
- Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos& Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Omoladun Olukemi Odediran
- Department of Community Health and Primary Care, College of Medicine, University of Lagos& Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Charles R Rogers
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Folasade Ogunsola
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Kolawole S Okuyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos& Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
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Paintsil E, Alimi Y, Abdulaziz M, Ogbuagu O, Ogunsola F, Kessy SJ, Horsney E, Lee C, Brundney K, Okwor T, Kabwe P, Waheed A, Vondran A, Bigirimana R, Ilesanmi O, Nsubuga DN, Raji T, Mankoula W, Ihekweazu C, Nkengasong J. A continent-wide effort and solidarity at curbing COVID-19 pandemic: the Africa task force for novel coronavirus (AFTCOR) infection prevention and control technical working group's experience. BMC Public Health 2023; 23:893. [PMID: 37189137 PMCID: PMC10184057 DOI: 10.1186/s12889-023-15706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
A continent-wide Africa Task Force for Coronavirus with its six technical working groups was formed to prepare adequately and respond to the novel Coronavirus disease (COVID-19) outbreak in Africa. This research in practice article aimed to describe how the infection prevention and control (IPC) technical working group (TWG) supported Africa Centre for Disease Control and Prevention (Africa CDC) in preparedness and response to COVID-19 on the continent. To effectively address the multifaceted IPC TWG mandate of organizing training and implementing rigorous IPC measures at healthcare service delivery points, the working group was sub-divided into four sub-groups-Guidelines, Training, Research, and Logistics. The action framework was used to describe the experiences of each subgroup. The guidelines subgroup developed 14 guidance documents and two advisories; all of which were published in English. In addition, five of these documents were translated and published in Arabic, while three others were translated and published in French and Portuguese. Challenges faced in the guidelines subgroup included the primary development of the Africa CDC website in English, and the need to revise previously issued guidelines. The training subgroup engaged the Infection Control Africa Network as technical experts to carry out in-person training of IPC focal persons and port health personnel across the African continent. Challenges faced included the difficulty in conducting face-to-face IPC training and onsite technical support due to the lockdown. The research subgroup developed an interactive COVID-19 Research Tracker on the Africa CDC website and conducted a context-based operation and implementation research. The lack of understanding of Africa CDC's capacity to lead her own research was the major challenge faced by the research subgroup. The logistics subgroup assisted African Union (AU) member states to identify their IPC supply needs through capacity building for IPC quantification. A notable challenge faced by the logistics subgroup was the initial lack of experts on IPC logistics and quantifications, which was later addressed by the recruitment of professionals. In conclusion, IPC cannot be built overnight nor can it be promoted abruptly during outbreaks of diseases. Thus, the Africa CDC should build strong national IPC programmes and support such programmes with trained and competent professionals.
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Affiliation(s)
- Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Yewande Alimi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Onyema Ogbuagu
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Suzan Joseph Kessy
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Emilio Horsney
- UK Public Health Rapid Support Team, Public Health England, London, UK
| | | | - Karen Brundney
- Columbia University Irving Medical Center, New York City, USA
| | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Patrick Kabwe
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ariyo Waheed
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anna Vondran
- Infection Control African Network, Cape Town, South Africa
| | - Radjabu Bigirimana
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Olayinka Ilesanmi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
| | | | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wessam Mankoula
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Kessy SJ, Gon G, Alimi Y, Bakare WA, Gallagher K, Hornsey E, Sithole L, Onwekwe EVC, Okwor T, Sekoni A, Vahanian A, Vorndran A, Niyoyitungira T, Raji T, Ihekweazu C, Abdulaziz M, Ogunsola F. Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa During COVID-19. Glob Health Sci Pract 2023; 11:GHSP-D-22-00051. [PMID: 37116932 PMCID: PMC10141425 DOI: 10.9745/ghsp-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/14/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Strengthening infection prevention and control (IPC) capacity was identified as a key intervention to prepare African Union member states to curb the COVID-19 pandemic. As part of the Africa Taskforce for Coronavirus, which helped implement the Africa Joint Continental Strategy for COVID-19 Outbreak response, the IPC Technical Working Group (IPC TWG) was convened to coordinate the development of IPC core components for preparedness, response, and recovery from COVID-19. As part of the IPC TWG's work, the Africa Centres for Disease Control and Prevention, in collaboration with the Infection Control Africa Network, delivered virtual IPC training sessions targeted to African Union member states. We aimed to undertake a process evaluation of this training to inform and improve both ongoing and future programming. METHODS The scope of the evaluation was agreed upon through discussion with the training organizers and advisory members and a design workshop. A mixed-methods approach was used; data collection was partly prospective and partly retrospective due to the rapid start of some of the training activities. Existing available data included: usage analytics, the content of questions posed during the webinar and community of practice, and participant feedback survey results. In addition, in-depth qualitative interviews were conducted with a sample of webinar participants. RESULTS The rapid development of this training was efficient and responsive. The training reached more than 3,000 participants across the 2 rounds, but the numbers varied substantially by location. Participants engaged well during the question period during each webinar, but the asynchronous community of practice was less utilized during the evaluation time frame. Many participants appreciated the African focus of the webinars and gave positive feedback on the practical and context-specific content. CONCLUSIONS The move toward online training provides an important opportunity to improve IPC across the African continent.
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Affiliation(s)
| | - Giorgia Gon
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yewande Alimi
- Africa Centres for Disease Control, Addis Ababa, Ethiopia
| | | | | | | | - Lizzi Sithole
- Infection Control Africa Network, Cape Town, South Africa
| | | | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Anna Vorndran
- Infection Control Africa Network, Cape Town, South Africa
| | | | - Tajudeen Raji
- Africa Centres for Disease Control, Addis Ababa, Ethiopia
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Zheng Y, Silas O, Musa J, Qu Y, Gao T, Kim K, Joyce B, Wang J, Gursel D, Fatimah A, Imade G, Akanmu A, Wei JJ, Kocherginsky M, Kim KY, Wehbe F, Achenbach C, Anorlu R, Simon M, Sagay A, Ogunsola F, Murphy R, Hou L. Abstract 3021: Epigenetic signatures of virus-associated cervical cancer in women living with HIV. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Low- and middle-income countries are facing a high health burden of cervical cancer (CC). The situation is worsened by a high prevalence of human immunodeficiency virus (HIV). We aim to identify epigenetic signatures to help understand the virus-associated pathways underlying CC development, which is fundamental to developing effective CC screening tools or therapeutic approaches for women living with HIV.
Methods: We recruited a total of 365 Nigerian women with mean age of 52 (239 HIV+ and 126 HIV-; 98 without CC, 106 with cervical lesions, and 161 with CC). DNA methylation profiling in cervical tissue samples was performed using Illumina EPIC array covering over 860K methylation sites. The epigenetic signatures were identified among HIV+ women through epigenome-wide association study comparing CC vs. CC-free (Bonferroni adjusted p <0.05), which were further validated by comparing: 1) pairs of tumor and adjacent normal samples; and 2) pairs of cervical lesions and adjacent normal samples. The comparisons were adjusted for age, BMI, education, employment, parity, study site, and technical batch variables. We then compared the identified signatures between HIV+ and HIV- among CC women to delineate the role of HIV. We constructed a methylation risk score (MRS) using the signatures, and we performed receiver operating characteristic (ROC) analysis to evaluate the performance of distinguishing across cancer statuses (CC, cervical lesions, CC-free).
Results: We identified 46 differentially methylated markers (p-value ranging from 5.7e-8 to 2.4e-19) in HIV+ CC women. The effect sizes among the 46 markers in the paired tumor-normal analysis and the paired lesion-normal analysis were highly correlated with the CC vs. CC-free analysis (r=0.99 and r=0.95, respectively) with smaller magnitudes (1.8 and 4.3 times smaller, respectively). Gene ontology and Reactome pathway enrichment analysis revealed that these 46 markers were enriched in genes involving activation of PI3K/AKT/mTOR signaling network (e.g., RPTOR, HDAC3, MAPKAP1), which plays a crucial role in virus/host crosstalk and virus-induced carcinogenesis. The PI3K/AKT/mTOR signaling cascade suppressors, including gene PRDM8, were silenced by promoter hypermethylation among HIV+ CC women (p=4.3e-12). These epigenetic changes, however, were not observed in CC women without HIV. In an independent dataset, MRS was the lowest in women without CC (2.3±2.1), followed by women with cervical lesions (4.9±1.1), and the highest in CC women (9.6±3.9) (p-trend < 2e-16). The MRS achieved areas under the ROC curve = 0.93 and 0.88 in distinguishing CC and cervical lesions from CC-free among HIV+ women, respectively.
Conclusion: HIV may communicate with cervical cells and promote CC through epigenetic activation of PI3K/AKT/mTOR signaling pathway. Our epigenetic signatures may serve as novel biomarkers for CC early detection and treatment for women living with HIV.
Citation Format: Yinan Zheng, Olugbenga Silas, Jonah Musa, Yishu Qu, Tao Gao, Kyeezu Kim, Brian Joyce, Jun Wang, Demirkan Gursel, Abdulkareem Fatimah, Godwin Imade, Alani Akanmu, Jian-Jun Wei, Masha Kocherginsky, Kwang-Youn Kim, Firas Wehbe, Chad Achenbach, Rose Anorlu, Melissa Simon, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Epigenetic signatures of virus-associated cervical cancer in women living with HIV [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3021.
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Affiliation(s)
- Yinan Zheng
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | | | | | - Yishu Qu
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Tao Gao
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Kyeezu Kim
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Brian Joyce
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Jun Wang
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Demirkan Gursel
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Jian-Jun Wei
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | | | - Kwang-Youn Kim
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Firas Wehbe
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Chad Achenbach
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | | | - Melissa Simon
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | | | | | - Robert Murphy
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- 1Northwestern Univ. Feinberg School of Medicine, Chicago, IL
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Balogun M, Olubodun T, Ubani O, Yesufu V, Sekoni A, Ogunsola F. Clients' Perception of Maternal, Newborn and Child Health Services received before and during the COVID-19 Outbreak in Nigeria's Epicenter. West Afr J Med 2023; 40:262-268. [PMID: 37017366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND Since the emergence of COVID-19, countries have implemented measures to limit spread, which include movement restrictions. These measures led to poor or inadequate delivery of many health services, including maternal, neonatal and child health (MNCH) services. This study assessed clients' perception of routine MNCH services received from government health care facilities before and during the COVID-19 outbreak in Lagos, Nigeria's epicenter. METHODS This was a cross-sectional descriptive study conducted among 1241 women of reproductive age selected by multistage sampling who had just received MNCH services across 12 primary, secondary or tertiary health facilities. Data was collected using interviewer-administered questionnaires and analyzed using STATA version SE15.1. RESULTS Before the COVID-19 outbreak, about half of the women perceived waiting time (50.7%), attention given to patients (53.0%), and respect given to patients (55.7%) as somewhat satisfactory. Fiftyfour percent of respondents said access to water was somewhat satisfactory. During the outbreak, 51.0% of the respondents said waiting time at the health facilities was shorter while over a third said attention given to patients (35.8%) and respect given to patients (35.8%) was better. Half of the respondents (50.7%) said access to water remained the same while 47.7% said it was better. Forty-one percent of respondents said overall quality of services became better during the outbreak. CONCLUSION To strengthen health systems for MNCH, the government should provide adequate water supply, optimal sanitation and hygiene facilities. Training of staff in provision of patient friendly MNCH services will go a long way to ensure sustained improvement in quality and also perception of care.
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Affiliation(s)
- M Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos State, Nigeria
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - T Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Center Abeokuta, Ogun State, Nigeria.
| | - O Ubani
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - V Yesufu
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos State, Nigeria
| | - A Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos State, Nigeria
| | - F Ogunsola
- Department of Medical Microbiology, College of Medicine of the University of Lagos, Idi-Araba, Lagos State, Nigeria
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12
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Odukoya O, Molobe I, Olufela O, Oluwole E, Yesufu V, Ogunsola F, Okuyemi K. Exploring church members' perceptions towards physical activity, fruits and vegetables consumption, and church's role in health promotion: implications for the development of church-based health interventions. J Public Health Afr 2023; 14:2112. [PMID: 36798843 PMCID: PMC9926555 DOI: 10.4081/jphia.2023.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background The study explored the perceptions of church members towards physical activity (PA), the consumption of fruits and vegetables (FV), and the church's role in health promotion prior to the development of a church-based intervention for physical activity and fruit and vegetable consumption in Lagos, Nigeria. Method Sixteen focus group discussions (FGD) and eleven key Informant Interviews (KII) were conducted. Eight FGDs among adults and four among the youth and the elderly church members. Key informant interviews were held among church leaders and members of the church medical advisory. Study findings were categorized under thematic headings. Based on the data analysis, several key themes were identified: the knowledge of the concept of health and common health problems, opinions of physical activity, opinions of healthy eating and fruit and vegetable consumption, types and attitudes towards existing church-based health programs and the role of the church in health promotion and church-based health programs. Within each theme, several childthemes were noted such as the challenges with fruit and vegetable consumption, biblical support for physical activity and fruit & vegetable consumption, the role of the church leaders, program sustainability and barriers to participation. Results The participants perceived health not only as the absence of disease but as general well-being of the body and soul. Health was also related to the ability to perform religious activities. Common health problems included a mix of communicable and non-communicable diseases. They are aware that physical activity, fruits and vegetables are essential for healthy living. The youth saw it as a means of improving their physical appearance however the elderly expressed concerns about the possibility of associated trips and falls. Overall, they viewed fruits and vegetables as healthy foods while processed western foods were perceived as unhealthy. Fruits and vegetables were seen as beneficial primarily to aid food digestion, boost immunity, improve youthfulness, aid weight control and to prevent chronic disease. The study participants agreed that the church, as an institution, has a significant role to play in promoting the health of her members. Instituted health committees embedded within existing church structures often lead church-based health-promoting activities and are imperative for sustainability. Types of health programs included health talks, screening programs for common NCDs, sport competitions, distributions of FV during church ceremonies such as harvests, Lenten seasons, Love feasts and church bazaars. Health outreaches were seen as a means of evangelism, and it was unanimously agreed that the Bible supports PA and healthy eating. Generally, the respondents had positive attitudes towards church-based health programs and they advised that future programs include the use of technology and should be integrated into existing church activities to improve participation. The participants also noted that the opinion of the church leaders influences the behaviours of church members and their support is critical in the development and implementation of church-based health programs. Conclusion Church members are aware that physical activity and the consumption of fruits and vegetables are important for healthy living and expressed support for church-based health programs. They believe that the Bible supports the promotion of PA and FV consumption as healthy behaviours. Program integration, the use of technology and support of church leaders and existing church medical advisory groups are imperative for developing and sustaining church-based health programs.
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Affiliation(s)
- Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria,Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria. 234-8023200770.
| | - Ikenna Molobe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Oridota Olufela
- Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Esther Oluwole
- Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Victoria Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Folasade Ogunsola
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Akiyode-Afolabi A, Ogwezzy-Ndisika A, Christian E, Okonkwo A, Klein K, Brown S, Kamau N, Murphy R, Hou L, Ogunsola F. Harnessing student involvement: Perspectives from building infrastructure for sexual harassment prevention and response at the University of Lagos, Nigeria. J Glob Health 2022; 12:03075. [PMID: 36520549 PMCID: PMC9754064 DOI: 10.7189/jogh.12.03075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | | | - Kate Klein
- Northwestern University, Evanston, Illinois, USA
| | - Sarah Brown
- Northwestern University, Evanston, Illinois, USA
| | - Ngoki Kamau
- Northwestern University, Evanston, Illinois, USA
| | | | - Lifang Hou
- Northwestern University, Evanston, Illinois, USA
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Odukoya OO, Odediran O, Rogers CR, Ogunsola F, Okuyemi KS. Barriers and Facilitators of Fruit and Vegetable Consumption among Nigerian Adults in a Faith-Based Setting: A Pre-Intervention Qualitative Inquiry. Asian Pac J Cancer Prev 2022; 23:1505-1511. [PMID: 35633531 PMCID: PMC9587891 DOI: 10.31557/apjcp.2022.23.5.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Inadequate consumption of fruit and vegetable is a risk factor for morbidity and mortality associated with non-communicable diseases (NCDs). An understanding of the barriers and facilitators to consumption is important for effectiveness of intervention in Africa. We present insights among church members before developing a church-based multi-component intervention to address the inadequate consumption of fruit and vegetable. METHODS We conducted eighteen focus group discussions among 163 church members. All discussions were audio-taped, transcribed verbatim, and were analyzed for thematic content. RESULTS We identified five main themes; Personal: awareness and knowledge of benefits, choice, habits, and curiosity, dietary restrictions and gastrointestinal symptoms following fruit and vegetable consumption. Familial: practices promoting the ready availability of fruit and vegetables in the home or habits that encourage children to eat vegetables as they transition into adulthood, pre-existing health problems of family members and the long preparation time of some traditional vegetables. Socio-cultural: Cultural practices that encourage F&V consumption, the high cost of fruits and vegetables, alternatives foregone, and cultural taboos. Environmental: inadequate farmland and storage facilities, seasonality of several fruit and vegetables, and sharp practices of force-ripening with chemicals. Church-related: inadequate space provided by the church for arable cultivation and lack of knowledge of the benefits among church leaders, church activities that involve serving fruits and vegetables and the biblical support for the consumption of fruits and vegetables. CONCLUSION It is essential to leverage practices that promote fruit and vegetable intake and address barriers mentioned by the participants when designing such interventions.
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Affiliation(s)
- Oluwakemi O Odukoya
- Public Health Physician, Department of Community Health and Primary Care, College of Medicine, University of Lagos& Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Omoladun Odediran
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
| | - Charles R Rogers
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, 375 Chipeta Way, Suite A, UT 84108, USA
| | - Folasade Ogunsola
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Kolawole S Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, 375 Chipeta Way, Suite A, UT 84108, USA
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Sekoni A, Tun W, Dirisu O, Ladi-Akinyemi T, Shoyemi E, Adebajo S, Ogunsola F, Vu L. Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: the Nigerian experience. BMC Public Health 2022; 22:33. [PMID: 34991535 PMCID: PMC8734127 DOI: 10.1186/s12889-021-12378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Self-care health interventions are innovative approaches for improving health and achieving the sustainable development goals (SDGs). Men who have sex with men (MSM) have been disproportionately affected by Human Immunodeficiency Virus (HIV). In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using key opinion leaders (KOLs) to distribute HIVST (HIV self-test) kits to MSM. This qualitative survey used a combination of in-depth interviews (IDI) with HIVST users and focus group discussions (FGDs) with KOLs to collect data three months after the distribution of the test kits by the KOLs. Thematic analysis of the data was carried out. Result Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications required for KOLs to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST. Conclusion This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage for ensuring that HIV self-test kit is utilized and HIV positive individuals are linked to treatment and care in homophobic environments. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12378-0.
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Affiliation(s)
- Adekemi Sekoni
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi Araba, Lagos, PMB: 12003, Nigeria.
| | - Waimar Tun
- HIV and AIDS Program, Population Council, Washington, DC, 20008, USA
| | - Osasuyi Dirisu
- HIV and AIDS Program, Population Council, Utako, Abuja, 900108, Nigeria
| | - Temitope Ladi-Akinyemi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi Araba, Lagos, PMB: 12003, Nigeria
| | - Elizabeth Shoyemi
- HIV and AIDS Program, Population Council, Yaba, Lagos, 100001, Nigeria
| | - Sylvia Adebajo
- HIV and AIDS Program, Population Council, Utako, Abuja, 900108, Nigeria
| | - Folasade Ogunsola
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi Araba, Lagos, PMB: 12003, Nigeria
| | - Lung Vu
- HIV and AIDS Program, Population Council, Washington, DC, 20008, USA
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Wood CE, Luedtke S, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa AO, Ekumankama CB, Ogunsola F, Okonji P, Kpokiri EE, Ayibanoah T, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Soriano D, Birjovanu G, Lefevre C, Olufemi O, Kostkova P. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac044. [PMID: 35445194 PMCID: PMC9015911 DOI: 10.1093/jacamr/dlac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.
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Affiliation(s)
- Caroline E. Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
- Corresponding author. E-mail: ; @PattyKostkova, @UCL_dPHE, @AnwarMusahAM, @LASUOfficial, @UnilagNigeria, @ekpoks, @suluedt, @DrCaroline_Wood
| | - Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Oludotun Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Folasade Ogunsola
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E. Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Theophilus Ayibanoah
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Delphine Soriano
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
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Abayomi A, Balogun MR, Bankole M, Banke-Thomas A, Mutiu B, Olawepo J, Senjobi M, Odukoya O, Aladetuyi L, Ejekam C, Folarin A, Emmanuel M, Amodu F, Ologun A, Olusanya A, Bakare M, Alabi A, Abdus-Salam I, Erinosho E, Bowale A, Omilabu S, Saka B, Osibogun A, Wright O, Idris J, Ogunsola F. From Ebola to COVID-19: emergency preparedness and response plans and actions in Lagos, Nigeria. Global Health 2021; 17:79. [PMID: 34243790 PMCID: PMC8267235 DOI: 10.1186/s12992-021-00728-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lagos state is the industrial nerve centre of Nigeria and was the epicentre of the 2014 Ebola outbreak in Nigeria as it is now for the current Coronavirus Disease (COVID-19) outbreak. This paper describes how the lessons learned from the Ebola outbreak in 2014 informed the emergency preparedness of the State ahead of the COVID-19 outbreak and guided response. DISCUSSION Following the Ebola outbreak in 2014, the Lagos State government provided governance by developing a policy on emergency preparedness and biosecurity and provided oversight and coordination of emergency preparedness strategies. Capacities for emergency response were strengthened by training key staff, developing a robust surveillance system, and setting up a Biosafety Level 3 laboratory and biobank. Resource provision, in terms of finances and trained personnel for emergencies was prioritized by the government. With the onset of COVID-19, Lagos state was able to respond promptly to the outbreak using the centralized Incident Command Structure and the key activities of the Emergency Operations Centre. Contributory to effective response were partnerships with the private sectors, community engagement and political commitment. CONCLUSION Using the lessons learned from the 2014 Ebola outbreak, Lagos State had gradually prepared its healthcare system for a pandemic such as COVID-19. The State needs to continue to expand its preparedness to be more resilient and future proof to respond to disease outbreaks. Looking beyond intra-state gains, lessons and identified best practices from the past and present should be shared with other states and countries.
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Affiliation(s)
- Akin Abayomi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | | | - Munir Bankole
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Bamidele Mutiu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - John Olawepo
- School of Public Health, University of Nevada, Las Vegas, USA
| | - Morakinyo Senjobi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Lanre Aladetuyi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Akinsanya Folarin
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Madonna Emmanuel
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Funke Amodu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Adesoji Ologun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abosede Olusanya
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Moses Bakare
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abiodun Alabi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Ismail Abdus-Salam
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Eniola Erinosho
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abimbola Bowale
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Sunday Omilabu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Babatunde Saka
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
- Global Emerging Pathogens Treatment Consortium, Lagos, Nigeria
| | - Akin Osibogun
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Ololade Wright
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Jide Idris
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
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Zheng Y, Hawkins C, Okeke E, Duguru M, Odeghe E, Lesi O, Qu Y, Kim K, Joyce B, Wang J, Roberts L, Gursel D, Fatimah A, Akanmu A, Imade G, Wei JJ, Kocherginsky M, Kim KY, Odukoya O, Adeyemo W, Wehbe F, Achenbach C, Sagay A, Ogunsola F, Murphy R, Hou L. Abstract 83: Blood-Based Circulating Cell-Free DNA Epigenetic Age Is Accelerated Among HIV-Infected Patients with Hepatocellular Carcinoma in Nigeria. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Hepatocellular Carcinoma (HCC) is the leading cause of cancer-related mortality in Nigeria. HIV and viral hepatitis B (HBV) and C (HCV) co-infection are common in Nigeria that significantly accelerates liver disease progression including HCC. Aging-related DNA methylation signatures obtained in liquid biopsy, such as circulating cell-free DNA (ccfDNA) extracted from serum/plasma are promising minimally-invasive biomarkers that may inform HIV-associated HCC. We examined the epigenetic age acceleration (EpiAgeAccel) in ccfDNA in HCC patients with HIV.
Methods: The study included three groups of participants: a) HIV positive with HCC (n=7); b) HIV positive and cancer-free (n=45); and c) HIV negative with HCC (n=33). Epigenetic age was estimated by Horvath's calculator using genome-wide ccfDNA methylation data profiled by Illumina EPIC array. EpiAgeAccel was computed as the residuals of a linear model of epigenetic age on chronological age, namely the unexplained portion of epigenetic age by chronological age. We used multiple linear regression to compare EpiAgeAccel between HIV/HCC groups, adjusting for sex, age, education, alcohol intake, and HBV/HCV infection.
Results: Among HIV positive participants, there was a higher percentage of men (57% vs. 22%, p<0.001), HBV infection (29% vs. 11%, p=0.004), and HCV infection (57% vs. 2%, p<0.001) in the HCC group compared to the cancer-free group. EpiAgeAccel was 4.8 years higher in HIV positive patients with HCC compared to cancer-free HIV positives (p=0.02). Among HCC patients, EpiAgeAccel was 2.1 years higher in HIV positives compared to HIV negative but not statistically significant.
Conclusion: Epigenetic age in ccfDNA is accelerated in HIV-positive HCC patients. EpiAgeAccel measured in ccfDNA may be developed into a surrogate biomarker for minimally invasive HCC detection among HIV-infected patients in low- and middle-income countries.
Citation Format: Yinan Zheng, Claudia Hawkins, Edith Okeke, Mary Duguru, Emuobor Odeghe, Olufunmilayo Lesi, Yishu Qu, Kyeezu Kim, Brian Joyce, Jun Wang, Lewis Roberts, Demirkan Gursel, Abdulkareem Fatimah, Alani Akanmu, Godwin Imade, Jian-Jun Wei, Masha Kocherginsky, Kwang-Youn Kim, Oluwakemi Odukoya, Wasiu Adeyemo, Firas Wehbe, Chad Achenbach, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Blood-Based Circulating Cell-Free DNA Epigenetic Age Is Accelerated Among HIV-Infected Patients with Hepatocellular Carcinoma in Nigeria [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 83.
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Zheng Y, Musa J, Kim K, Qu Y, Joyce B, Wang J, Gursel D, Silas O, Fatimah A, Imade G, Akanmu A, Wei JJ, Kocherginsky M, Kim KY, Wehbe F, Achenbach C, Anorlu R, Simon M, Sagay A, Ogunsola F, Murphy R, Hou L. Abstract 76: Global LINE-1 Hypomethylation as Novel Biomarker for Cervical Cancer in Nigerian Women Living with HIV. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Nigeria faces a high health burden of cervical cancer (CC), which is worsened by high prevalence of human immunodeficiency virus (HIV) infection. Repetitive elements (RE) are DNA sequences that occur in multiple copies throughout the human genome. HIV infection can lead to RE hypomethylation that causes genome instability, an event often seen in the early phase of tumorigenesis. We aim to examine global RE hypomethylation as a novel epigenetic biomarker for CC among HIV-positive women in Nigeria.
Methods: This study involved three groups of women: a) HIV-positive with CC (n=39); b) HIV-positive and cancer-free (n=52); and c) HIV-negative with CC (n=23). We estimated three types of global RE methylation in cervical tissue using genome-wide methylation data: long interspersed nuclear elements (LINE-1), Alu, and human endogenous retrovirus (HERV). We used multiple linear regression adjusting for age, education, parity, employment, cancer stage, body mass index, and sample batch to compare the biomarkers across the HIV/ICC groups and paired t-test to compare 26 pairs of tumor vs. surrounding normal tissues, stratified by HIV status. Receiver operating characteristic curve (ROC) and area under the ROC (AUC) were used to examine the diagnostic value.
Results: Among HIV-positive women, all 3 global RE methylation biomarkers were hypomethylated in CC compared to cancer-free (LINE-1: mean difference [MD]=-0.049, p-value=2.9e-8; Alu: MD=-0.011, p-value=2.0e-4; HERV: MD=-0.013, p-value=1.7e-6). Paired analyses showed a larger, more significant MD in HIV-positive stratum than HIV-negative, especially LINE-1 (MD=-0.048 vs. -0.020, p-value=0.004 vs. 0.254). LINE-1 achieved the highest AUC (0.85, 95% CI: 0.76-0.95) in distinguishing tumor tissue from normal tissue among HIV-positive women, followed by HERV (0.82, 95% CI: 0.73-0.92) and Alu (0.60, 95% CI: 0.47-0.72).
Conclusion: Global LINE-1 hypomethylation may serve as a novel biomarker for CC screening and early detection for women living with HIV in low- and middle-income countries.
Citation Format: Yinan Zheng, Jonah Musa, Kyeezu Kim, Yishu Qu, Brian Joyce, Jun Wang, Demirkan Gursel, Olugbenga Silas, Abdulkareem Fatimah, Godwin Imade, Alani Akanmu, Jian-Jun Wei, Masha Kocherginsky, Kwang-Youn Kim, Firas Wehbe, Chad Achenbach, Rose Anorlu, Melissa Simon, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Global LINE-1 Hypomethylation as Novel Biomarker for Cervical Cancer in Nigerian Women Living with HIV [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 76.
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Musa J, Kim K, Zheng Y, Qu Y, Joyce B, Wang J, Travis L, Gursel D, Silas O, Abdulkareem F, Imade G, Akanmu A, Wei JJ, Kocherginsky M, Kim KY, Wehbe F, Achenbach C, Anorlu R, Simon M, Sagay A, Ogunsola F, Murphy R, Hou L. Abstract 71: Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Invasive cervical cancer (ICC) is one of the HIV-associated cancers with a high burden in Nigeria. ICC occurs at relatively younger age in HIV infected women, with HIV known to promote aging and related diseases, including cancer. DNA methylation changes with increasing age, various health-related exposures, and age-related health outcomes, suggesting a role of DNA methylation in biological aging and disease. We sought to understand the effect of HIV infection on epigenetic age acceleration (EpiAgeAccel) in Nigerian women with ICC.
Methods: Epigenetic age (EpiAge) was estimated by Horvath's calculator using genome-wide methylation data in 116 cervical tissue samples from three groups of women: a) HIV positive with ICC (n=39); b) HIV positive and cancer-free (n=53); and c) HIV negative with ICC (n=24). EpiAgeAccel was computed as the regression residuals of EpiAge against chronological age (ChronAge), representing the independent deviation of EpiAge from ChronAge. We compared EpiAgeAccel across the 3 HIV/ICC groups using multiple linear regressions adjusting for ChronAge, education, parity, employment, cancer stage, body mass index, and study site. Among the ICC women, we compared EpiAgeAccel between 26 tumor tissues and their surrounding normal tissues using paired t-tests, stratified by HIV status.
Results: EpiAgeAccel among HIV positive women with ICC was 4.5 years higher than HIV positive and cancer-free women (p=0.019). We did not find substantial differences in EpiAgeAccel between HIV-positive women with ICC and HIV-negative women with ICC. EpiAgeAccel was 7.9 and 2.9 years higher in tumor tissues compared to the surrounding normal tissues among HIV positive women (p=0.021) and negative women (p=0.295), respectively.
Conclusion: EpiAge is accelerated in cervical tissue of HIV-infected women with ICC. EpiAgeAccel may be a potential biomarker for ICC screening and early detection for women living with HIV in low- and middle-income countries.
Citation Format: Jonah Musa, Kyeezu Kim, Yinan Zheng, Yishu Qu, Brian Joyce, Jun Wang, Lois Travis, Demirkan Gursel, Olugbenga Silas, Fatimah Abdulkareem, Godwin Imade, Alani Akanmu, Jian-Jun Wei, Masha Kocherginsky, Kwnag-Youn Kim, Firas Wehbe, Chad Achenbach, Rose Anorlu, Melissa Simon, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 71.
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Affiliation(s)
- Jonah Musa
- 1University of Jos,
- 2Northwestern University,
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Zheng Y, Hawkins C, Okeke E, Lesi OA, Qu Y, Roberts LR, Gursel D, Abdulkareem FB, Akanmu A, Imade G, Wei JJ, Kocherginsky M, Kim KY, Adeyemo WL, Wehbe FH, Achenbach C, Sagay A, Ogunsola F, Murphy R, Hou L. Acceleration of blood-based circulating cell-free DNA epigenetic age among HIV-infected patients with hepatocellular carcinoma in Nigeria. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16137 Background: Hepatocellular Carcinoma (HCC) is the leading cause of cancer-related mortality in Nigeria. HIV and viral hepatitis B (HBV) and C (HCV) co-infection are common in Nigeria that significantly accelerates liver disease progression including HCC. Aging-related DNA methylation signatures obtained in liquid biopsy, such as circulating cell-free DNA (ccfDNA) extracted from serum/plasma are promising minimally-invasive biomarkers that may inform HIV-associated HCC. We examined the epigenetic age acceleration (EpiAgeAccel) in ccfDNA in HCC patients with HIV. Methods: The study included three groups of participants: a) HIV positive with HCC (n=7); b) HIV positive and cancer-free (n=45); and c) HIV negative with HCC (n=33). Epigenetic age was estimated by Horvath’s calculator using genome-wide ccfDNA methylation data profiled by Illumina EPIC array. EpiAgeAccel was computed as the residuals of a linear model of epigenetic age on chronological age, namely the unexplained portion of epigenetic age by chronological age. We used multiple linear regression to compare EpiAgeAccel between HIV/HCC groups, adjusting for sex, age, education, alcohol intake, and HBV/HCV infection. Results: Among HIV positive participants, there was a higher percentage of men (57% vs. 22%, p<0.001), HBV infection (29% vs. 11%, p=0.004), and HCV infection (57% vs. 2%, p<0.001) in the HCC group compared to the cancer-free group. EpiAgeAccel was 4.8 years higher in HIV positive patients with HCC compared to cancer-free HIV positives (p=0.02). Among HCC patients, EpiAgeAccel was 2.1 years higher in HIV positives compared to HIV negative but not statistically significant. Conclusions: Epigenetic age in ccfDNA is accelerated in HIV-positive HCC patients. EpiAgeAccel measured in ccfDNA may be developed into a surrogate biomarker for minimally invasive HCC detection among HIV-infected patients in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | - Yishu Qu
- Northwestern University, Chicago, IL
| | | | - Demirkan Gursel
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Jian-Jun Wei
- Department of Pathology, Northwestern University, Feinberg Medical School, Chicago, IL
| | | | | | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Chad Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Lifang Hou
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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22
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Musa J, Kim K, Zheng Y, Travis LB, Gursel D, Silas OA, Abdulkareem FB, Imade G, Akanmu A, Wei JJ, Kocherginsky M, Kim KY, Wehbe FH, Achenbach C, Anorlu R, Simon MA, Sagay A, Ogunsola F, Murphy R, Hou L. Accelerated epigenetic age among HIV-infected Nigerian women with invasive cervical cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17504 Background: Invasive cervical cancer (ICC) is one of the HIV-associated cancers with a high burden in Nigeria. ICC occurs at relatively younger age in HIV infected women, with HIV known to promote aging and related diseases, including cancer. DNA methylation changes with increasing age, various health-related exposures, and age-related health outcomes, suggesting a role of DNA methylation in biological aging and disease. We sought to understand the effect of HIV infection on epigenetic age acceleration (EpiAgeAccel) in Nigerian women with ICC. Methods: Epigenetic age (EpiAge) was estimated by Horvath’s calculator using genome-wide methylation data in 116 cervical tissue samples from three groups of women: a) HIV positive with ICC (n=39); b) HIV positive and cancer-free (n=53); and c) HIV negative with ICC (n=24). EpiAgeAccel was computed as the regression residuals of EpiAge against chronological age (ChronAge), representing the independent deviation of EpiAge from ChronAge. We compared EpiAgeAccel across the 3 HIV/ICC groups using multiple linear regressions adjusting for ChronAge, education, parity, employment, cancer stage, body mass index, and study site. Among the ICC women, we compared EpiAgeAccel between 26 tumor tissues and their surrounding normal tissues using paired t-tests, stratified by HIV status. Results: EpiAgeAccel among HIV positive women with ICC was 4.5 years higher than HIV positive and cancer-free women (p=0.019). We did not find substantial differences in EpiAgeAccel between HIV-positive women with ICC and HIV-negative women with ICC. EpiAgeAccel was 7.9 and 2.9 years higher in tumor tissues compared to the surrounding normal tissues among HIV positive women (p=0.021) and negative women (p=0.295), respectively. Conclusions: EpiAge is accelerated in cervical tissue of HIV-infected women with ICC. EpiAgeAccel may be a potential biomarker for ICC screening and early detection for women living with HIV in low- and middle-income countries.
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Affiliation(s)
- Jonah Musa
- University of Jos, Jos, Plateau, Nigeria
| | | | | | | | - Demirkan Gursel
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Jian-Jun Wei
- Department of Pathology, Northwestern University, Feinberg Medical School, Chicago, IL
| | | | | | | | - Chad Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Melissa A. Simon
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Lifang Hou
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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23
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Zheng Y, Musa J, Joyce BT, Wang J, Gursel D, Silas OA, Abdulkareem FB, Imade G, Akanmu A, Wei JJ, Kocherginsky M, Kim KY, Wehbe FH, Achenbach C, Anorlu R, Simon MA, Sagay A, Ogunsola F, Murphy R, Hou L. Global line-1 hypomethylation as novel biomarker for cervical cancer in Nigerian women living with HIV. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17513 Background: Nigeria faces a high health burden of cervical cancer (CC), which is worsened by high prevalence of human immunodeficiency virus (HIV) infection. Repetitive elements (RE) are DNA sequences that occur in multiple copies throughout the human genome. HIV infection can lead to RE hypomethylation that causes genome instability, an event often seen in the early phase of tumorigenesis. We aim to examine global RE hypomethylation as a novel epigenetic biomarker for CC among HIV-positive women in Nigeria. Methods: This study involved three groups of women: a) HIV-positive with CC (n=39); b) HIV-positive and cancer-free (n=52); and c) HIV-negative with CC (n=23). We estimated three types of global RE methylation in cervical tissue using genome-wide methylation data: long interspersed nuclear elements (LINE-1), Alu, and human endogenous retrovirus (HERV). We used multiple linear regression adjusting for age, education, parity, employment, cancer stage, body mass index, and sample batch to compare the biomarkers across the HIV/ICC groups and paired t-test to compare 26 pairs of tumor vs. surrounding normal tissues, stratified by HIV status. Receiver operating characteristic curve (ROC) and area under the ROC (AUC) were used to examine the diagnostic value. Results: Among HIV-positive women, all 3 global RE methylation biomarkers were hypomethylated in CC compared to cancer-free (LINE-1: mean difference [MD]=-0.049, p-value=2.9e-8; Alu: MD=-0.011, p-value=2.0e-4; HERV: MD=-0.013, p-value=1.7e-6). Paired analyses showed a larger, more significant MD in HIV-positive stratum than HIV-negative, especially LINE-1 (MD=-0.048 vs. -0.020, p-value=0.004 vs. 0.254). LINE-1 achieved the highest AUC (0.85, 95% CI: 0.76-0.95) in distinguishing tumor tissue from normal tissue among HIV-positive women, followed by HERV (0.82, 95% CI: 0.73-0.92) and Alu (0.60, 95% CI: 0.47-0.72). Conclusions: Global LINE-1 hypomethylation may serve as a novel biomarker for CC screening and early detection for women living with HIV in low- and middle-income countries.
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Affiliation(s)
| | - Jonah Musa
- University of Jos, Jos, Plateau, Nigeria
| | | | - Jun Wang
- Northwestern University, Chicago, IL
| | - Demirkan Gursel
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Jian-Jun Wei
- Department of Pathology, Northwestern University, Feinberg Medical School, Chicago, IL
| | | | | | | | - Chad Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Melissa A. Simon
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Lifang Hou
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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24
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Balogun M, Banke-Thomas A, Sekoni A, Boateng GO, Yesufu V, Wright O, Ubani O, Abayomi A, Afolabi BB, Ogunsola F. Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey. PLoS One 2021; 16:e0251382. [PMID: 33961682 PMCID: PMC8104439 DOI: 10.1371/journal.pone.0251382] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria's epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction. METHODS This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction. RESULTS About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients' satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients' satisfaction score (ß = 1.80, 95%CI: 1.10-2.50). CONCLUSION The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, United States of America
| | - Victoria Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Ololade Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Osinachi Ubani
- Lagos State Primary Health Care Board, Yaba, Lagos, Nigeria
| | - Akin Abayomi
- Lagos State Ministry of Health, Ikeja, Lagos, Nigeria
| | - Bosede B. Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
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25
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Hou L, Mehta SD, Christian E, Joyce B, Lesi O, Anorlu R, Akanmu AS, Imade G, Okeke E, Musah J, Wehbe F, Wei JJ, Gursel D, Klein K, Achenbach CJ, Doobay-Persaud A, Holl J, Maiga M, Traore C, Sagay A, Ogunsola F, Murphy R. Impact of the COVID-19 pandemic on global health research training and education. J Glob Health 2020; 10:020366. [PMID: 33214886 PMCID: PMC7648891 DOI: 10.7189/jogh.10.020366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Supriya D Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elizabeth Christian
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Brian Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Olufunmilayo Lesi
- Department of Medicine, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Alani Sulaimon Akanmu
- Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, and College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Godwin Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Edith Okeke
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Jonah Musah
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Firas Wehbe
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Demirkan Gursel
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kate Klein
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Chad J Achenbach
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ashti Doobay-Persaud
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jane Holl
- Biological Sciences Division, University of Chicago, Chicago, Illinois, USA.,School of Professional Studies, Northwestern University, Chicago, Illinois, USA
| | - Mamoudou Maiga
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Cheick Traore
- University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Atiene Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert Murphy
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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26
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Oladele R, Ogunsola F, Akanmu A, Stocking K, Denning DW, Govender N. Opportunistic fungal infections in persons living with advanced HIV disease in Lagos, Nigeria; a 12-year retrospective study. Afr Health Sci 2020; 20:1573-1581. [PMID: 34394217 PMCID: PMC8351866 DOI: 10.4314/ahs.v20i4.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Nigeria has a large estimated burden of AIDS-related mycoses. We aimed to determine the proportion of patients with AIDS-related opportunistic fungal infections (OFIs) at an urban antiretroviral treatment (ART) centre in Nigeria. Methods A retrospective analysis of a cohort of ART-naïve, HIV-infected patients, assessed for ART eligibility and ARTexperience at the PEPFAR outpatient clinic at Lagos University Teaching Hospital over a 12-year period (April 2004-February 2016) was conducted. Results During this period, 7,034 patients visited the clinic: 4,797 (68.2%) were female; 6161 patients had a recorded baseline CD4 count, and the median CD4 count was 184 cells/µl (IQR, 84–328). A baseline HIV-1 viral load (VL) was recorded for 5,908 patients; the median VL was 51,194 RNA copies/ml (IQR, 2,316–283,508) and 6,179/7046(88%) had initiated ART. Some 2,456 (34.9%) had a documented opportunistic infections, of whom 1,306 (18.6%) had an opportunistic fungal infection. The total number of OFI episodes was 1,632: oral candidiasis (n=1,473, 90.3%), oesophageal candidiasis (n=118; 8%), superficial mycoses (n=23; 1.6%), Pneumocystis pneumonia (PJP) (n=13; 0.8%), and cryptococcal meningitis(CM) (n=5; 0.4%). 113 (1.6%) were known to have died in the cohort. Conclusion Approximately 1 in 5 HIV-infected patients in this retrospective cohort, most of whom had initiated ART, were clinically diagnosed with an OFI. Improved access to simple accurate diagnostic tests for CM and PJP should be prioritised for this setting.
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Affiliation(s)
- Rita Oladele
- University of Lagos College of Medicine, Medical Microbiology & Parasitology
| | | | | | - Katie Stocking
- University Hospital of South Manchester NHS Foundation Trust
| | - David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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27
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Tagbo BN, Bancroft RE, Fajolu I, Abdulkadir MB, Bashir MF, Okunola OP, Isiaka AH, Lawal NM, Edelu BO, Onyejiaka N, Ihuoma CJ, Ndu F, Ozumba UC, Udeinya F, Ogunsola F, Saka AO, Fadeyi A, Aderibigbe SA, Abdulraheem J, Yusuf AG, Sylvanus Ndow P, Ogbogu P, Kanu C, Emina V, Makinwa OJ, Gehre F, Yusuf K, Braka F, Mwenda JM, Ticha JM, Nwodo D, Worwui A, Biey JN, Kwambana-Adams BA, Antonio M. Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine. Clin Infect Dis 2020; 69:S81-S88. [PMID: 31505626 PMCID: PMC6736152 DOI: 10.1093/cid/ciz474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.
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Affiliation(s)
- Beckie N Tagbo
- Institute of Child Health, University of Nigeria Teaching Hospital, Ituku-Ozalla, and.,Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State
| | - Rowan E Bancroft
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Iretiola Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital.,Department of Paediatrics, College of Medicine, University of Lagos
| | | | - Muhammad F Bashir
- Department of Paediatrics, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | | | | | - Namadi M Lawal
- Department of Disease Control and Immunization, National Primary Health Care Development Agency, Abuja
| | - Benedict O Edelu
- Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State
| | - Ngozi Onyejiaka
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Chinonyerem J Ihuoma
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | | | - Uchenna C Ozumba
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | - Frances Udeinya
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Aishat O Saka
- Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital
| | - Abayomi Fadeyi
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Kwara
| | - Sunday A Aderibigbe
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Kwara
| | - Jimoh Abdulraheem
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Kwara
| | - Adamu G Yusuf
- Medical Microbiology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | - Peter Sylvanus Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Philomena Ogbogu
- Department of Medical Microbiology, University of Benin Teaching Hospital
| | - Chinomnso Kanu
- Department of Community Health, University of Benin Teaching Hospital, and
| | - Velly Emina
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Nigeria
| | - Olajumoke J Makinwa
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Florian Gehre
- Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State.,Department of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Kabir Yusuf
- Department of Disease Control and Immunization, National Primary Health Care Development Agency, Abuja
| | | | - Jason M Mwenda
- WHO Regional Office for Africa WHO/AFRO, Republic of Congo, Brazzaville
| | | | | | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Joseph N Biey
- WHO Regional Office for Africa WHO/AFRO, Republic of Congo, Brazzaville
| | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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28
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Sopeyin A, Hornsey E, Okwor T, Alimi Y, Raji T, Mohammed A, Moges H, Onwuekwe EVC, Minja FJ, Gon G, Ogbuagu O, Ogunsola F, Paintsil E. Transmission risk of respiratory viruses in natural and mechanical ventilation environments: implications for SARS-CoV-2 transmission in Africa. BMJ Glob Health 2020; 5:bmjgh-2020-003522. [PMID: 32863269 PMCID: PMC7462043 DOI: 10.1136/bmjgh-2020-003522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Respiratory viruses can be transmitted through contact, droplet and airborne routes. Viruses that are not naturally airborne may be aerosolised during medical procedures and transmitted to healthcare workers. Most resource-limited healthcare settings lack complex air handling systems to filter air and create pressure gradients that are necessary for minimising viral transmission. This review explores the association between ventilation and the transmission of respiratory viruses like SAR-CoV-2. When used appropriately, both natural and mechanical ventilation can decrease the concentration of viral aerosols, thereby reducing transmission. Although mechanical ventilation systems are more efficient, installation and maintenance costs limit their use in resource-limited settings, whereas the prevailing climate conditions make natural ventilation less desirable. Cost-effective hybrid systems of natural and mechanical ventilation may overcome these limitations.
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Affiliation(s)
- Anuoluwapo Sopeyin
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emilio Hornsey
- UK Public Health Rapid Support Team, PUblic Health England, London, UK
| | - Tochi Okwor
- Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Yewande Alimi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Abdulaziz Mohammed
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Hiwot Moges
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Frank J Minja
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giorgia Gon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Onyema Ogbuagu
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Akoka, Nigeria
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA .,Departmemt of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
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29
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Mehtar S, Wanyoro A, Ogunsola F, Ameh EA, Nthumba P, Kilpatrick C, Revathi G, Antoniadou A, Giamarelou H, Apisarnthanarak A, Ramatowski JW, Rosenthal VD, Storr J, Osman TS, Solomkin JS. Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases. Int J Infect Dis 2020; 100:123-131. [PMID: 32712427 PMCID: PMC7378004 DOI: 10.1016/j.ijid.2020.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/26/2022] Open
Abstract
Surgical site infection (SSI) rates in low- and middle-income countries (LMICs) range from 8 to 30% of procedures, making them the most frequent healthcare-acquired infection (HAI) with substantial morbidity, mortality, and economic impacts. Presented here is an approach to surgical site infection prevention based on surveillance and focused on five critical areas identified by international experts. These five areas include 1. Collecting valid, high-quality data; 2. Linking HAIs to economic incapacity, underscoring the need to prioritize infection prevention activities; 3. Implementing SSI surveillance within infection prevention and control (IPC) programs to enact structural changes, develop procedural skills, and alter healthcare worker behaviors; 4. Prioritizing IPC training for healthcare workers in LMICs to conduct broad-based surveillance and to develop and implement locally applicable IPC programs; and 5. Developing a highly accurate and objective international system for defining SSIs, which can be translated globally in a straightforward manner. Finally, we present a clear, unambiguous framework for successful SSI guideline implementation that supports developing sustainable IPC programs in LMICs. This entails 1. Identifying index operations for targeted surveillance; 2. Identifying IPC “champions” and empowering healthcare workers; 3. Using multimodal improvement measures; 4. Positioning hand hygiene programs as the basis for IPC initiatives; 5. Use of telecommunication devices for surveillance and healthcare outcome follow-ups. Additionally, special considerations for pediatric SSIs, antimicrobial resistance development, and antibiotic stewardship programs are addressed.
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Affiliation(s)
- Shaheen Mehtar
- Infection Control Africa Network, Cape Town, South Africa
| | - Anthony Wanyoro
- Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya
| | - Folasade Ogunsola
- Infection Control African Network, College of Medicine, University of Lagos, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery National Hospital, Abuja, Nigeria
| | - Peter Nthumba
- Clinical Epidemiologist and Plastic Surgeon, AIC Kijabe Hospital, and GCB, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | | | - Gunturu Revathi
- Microbiology Laboratory, Aga Khan University Hospital, Nairobi, Kenya
| | | | | | | | - John W Ramatowski
- International Federation for Infectious Diseases, Boston, United States
| | | | - Julie Storr
- Consultant with S2 Incorporated, Geneva, Switzerland
| | - Tamer Saied Osman
- Global Disease Detection, US Naval Medical Research Unit 3, Cairo, Egypt
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Tartari E, Hopman J, Allegranzi B, Gao B, Widmer A, Cheng VCC, Wong SC, Marimuthu K, Ogunsola F, Voss A. Perceived challenges of COVID-19 infection prevention and control preparedness: A multinational survey. J Glob Antimicrob Resist 2020; 22:779-781. [PMID: 32659504 PMCID: PMC7351656 DOI: 10.1016/j.jgar.2020.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/24/2020] [Accepted: 07/04/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ermira Tartari
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - Joost Hopman
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedetta Allegranzi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Bin Gao
- Infectious Disease Unit, Tianjin 4th Centre Hospital, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong, China
| | - Shuk Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong, China
| | - Kalisvar Marimuthu
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore; National Centre for Infectious Diseases, Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria; Infection Control Africa Network, Cape Town, South Africa
| | - Andreas Voss
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands; REshape Center for Innovation, Radboudumc, Nijmegen, The Netherlands.
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Wood C, Kostkova P, Olufemi O, Soriano D, Ogunsola F, Lefevre-Lewis C, Kpokiri E, Shallcross L. Understanding non-compliance with surgical antibiotic prophylaxis prescribing guidance, in Nigeria. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Antimicrobial Resistance is a prominent worldwide threat that is increasing in low-to-middle income countries. Good antibiotic stewardship (AMS) improves compliance with evidence-based antimicrobial prescribing guidelines but just 4% of LMICs have national AMS initiatives in place and only 15% have national policies. As high as 20-50% of surgical antibiotic prophylaxis prescription in Nigeria is thought to be non-compliant. Behaviour change theories can structure our understanding of why poor compliance occurs and can facilitate development of effective interventions to improve it.
Methods
The Theoretical Domains Framework (TDF; Michie et al. 2009) was used to develop an online survey and interview schedule for focus group discussions. Audio recordings were transcribed and analysed by two researchers using thematic analysis, TDF and the COM-B model of behaviour change (Michie et al. 2010).
Results
60 surgeons (59% male; 43% surgical consultant; 5-10 yrs experience) from Lagos University Teaching Hospital, Lagos University College of Medicine and Niger Delta University Teaching Hospital completed the survey. A sub-group of 14 surgeons (79% male; 86% surgical consultant; 10-15 yrs experience) participated in three focus groups. Whilst compliance with guidance was generally considered desirable, surgeons reported translating guidance to Nigerian practice and context was often difficult, time-consuming and restricted by not having access to recommended antibiotics.
Conclusions
Behaviour change theory can be used to further our understanding of key barriers and facilitators to non-compliance with surgical antibiotic prophylaxis prescribing guidance, amongst surgeons in Nigeria. This presentation will conclude with discussion of how findings from this project are being used to develop a cost-effective, scalable, decision-support smartphone app for prescribing behaviour change.
Key messages
Behaviour change theory can be used effectively to further understanding of barriers and facilitators to Nigerian surgeons’ non-compliance with surgical antibiotic prophylaxis prescribing guidance. We must form a comprehensive understanding of factors (social & environmental) driving non-compliant attitudes and behaviours, before creating interventions to change prescribing behaviour.
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Affiliation(s)
- C Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - P Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - O Olufemi
- Lagos University College of Medicine, Lagos University, Lagos, Nigeria
| | - D Soriano
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - F Ogunsola
- Lagos University College of Medicine, Lagos University, Lagos, Nigeria
| | - C Lefevre-Lewis
- UCL Centre for Behaviour Change, University College London, London, UK
| | - E Kpokiri
- Antimicrobial Resistance Centre, LSHTM, London, UK
| | - L Shallcross
- Institute of Health Informatics, University College London, London, UK
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Balogun M, Meloni ST, Igwilo UU, Roberts A, Okafor I, Sekoni A, Ogunsola F, Kanki PJ, Akanmu S. Status of HIV-infected patients classified as lost to follow up from a large antiretroviral program in southwest Nigeria. PLoS One 2019; 14:e0219903. [PMID: 31344057 PMCID: PMC6657856 DOI: 10.1371/journal.pone.0219903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/04/2019] [Indexed: 11/19/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a term used to classify patients no longer being seen in a clinical care program, including HIV treatment programs. It is unclear if these patients have transferred their care services elsewhere, died, or if there are other reasons for their LTFU. To better understand the status of patients meeting the criteria of LTFU, we traced a sample of HIV-infected patients that were LTFU from the Lagos University Teaching Hospital (LUTH) antiretroviral program. Methods We conducted a cross-sectional study of HIV-infected adult patients who enrolled for care between 2010 and 2014 at LUTH and were considered LTFU. Patients with locator information were traced using phone calls. Face-to-face interviews were used to collect data from successfully traced and consenting participants. Predictors of LTFU from LUTH, disengagement from care and willingness to re-engage in care in LUTH were assessed. Results Of 6108 registered patients, 3397 (56%) were LTFU and being unmarried was a predictor of being LTFU from LUTH. Of 425 patients that were traced, 355 (84%) were alive and 70 (16%) were dead. Two hundred and sixty-eight patients consented to interviews; 96 (35.8%) of these had transferred to another clinic for care while 172 (64.2%) were disengaged from care. More than half (149/268; 55.6%) were not on antiretroviral therapy (ART). Some of the primary reasons for LTFU were; long distance to clinic (56%) and feeling healthy (6.7%). Predictor of disengagement from care within the interviewed cohort was not having started ART. The predictors of willingness to re-engage in care included, not having started ART, male sex and longer duration in HIV care prior to LTFU. Conclusion Most of the interviewed cohort that was LTFU were truly disengaged from care and not on ART. Interventions are required to address processes of re-engagement of patients that are LTFU.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
- * E-mail:
| | - Seema Thakore Meloni
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | | | - Alero Roberts
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Ifeoma Okafor
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Phyllis J. Kanki
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Sulaimon Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine of the University of Lagos, Lagos, Nigeria
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Sam-Agudu NA, Paintsil E, Aliyu MH, Kwara A, Ogunsola F, Afrane YA, Onoka C, Awandare GA, Amponsah G, Cornelius LJ, Mendy G, Sturke R, Ghansah A, Siberry GK, Ezeanolue EE. Building Sustainable Local Capacity for Global Health Research in West Africa. Ann Glob Health 2016; 82:1010-1025. [PMID: 28314488 DOI: 10.1016/j.aogh.2016.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Global health research in resource-limited countries has been largely sponsored and led by foreign institutions. Thus, these countries' training capacity and productivity in global health research is limited. Local participation at all levels of global health knowledge generation promotes equitable access to evidence-based solutions. Additionally, leadership inclusive of competent local professionals promotes best outcomes for local contextualization and implementation of successful global health solutions. Among the sub-Saharan African regions, West Africa in particular lags in research infrastructure, productivity, and impact in global health research. OBJECTIVE In this paper, experts discuss strategies for scaling up West Africa's participation in global health evidence generation using examples from Ghana and Nigeria. METHODS We conducted an online and professional network search to identify grants awarded for global health research and research education in Ghana and Nigeria. Principal investigators, global health educators, and representatives of funding institutions were invited to add their knowledge and expertise with regard to strengthening research capacity in West Africa. FINDINGS While there has been some progress in obtaining foreign funding, foreign institutions still dominate local research. Local research funding opportunities in the 2 countries were found to be insufficient, disjointed, poorly sustained, and inadequately publicized, indicating weak infrastructure. As a result, research training programs produce graduates who ultimately fail to launch independent investigator careers because of lack of mentoring and poor infrastructural support. CONCLUSIONS Research funding and training opportunities in Ghana and Nigeria remain inadequate. RECOMMENDATIONS We recommend systems-level changes in mentoring, collaboration, and funding to drive the global health research agenda in these countries. Additionally, research training programs should be evaluated not only by numbers of individuals graduated but also by numbers of independent investigators and grants funded. Through equitable collaborations, infrastructure, and mentoring, West Africa can match the rest of Africa in impactful global health research.
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Affiliation(s)
- Nadia A Sam-Agudu
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Department of Paediatrics, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, TN; Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Awewura Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Gladys Amponsah
- School of Anaesthesia, Ridge Regional Hospital, Accra, Ghana
| | | | | | - Rachel Sturke
- Division of International Policy, Planning, and Evaluation and Center for Global Health Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, Legon, Ghana
| | | | - Echezona E Ezeanolue
- School of Community Health Sciences, University of Nevada, Las Vegas, NV; College of Medicine, University of Nigeria, Enugu, Nigeria
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Okwor TJ, Tobin-West C, Oduyebo O, Anayochukwu-Ugwu N, Adebola O, Shuaib F, Idigbe O, Ogunsola F. Identifying infection prevention and control gaps in healthcare facilities operating in Rivers state during the EVD outbreak in Nigeria 2014. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474878 DOI: 10.1186/2047-2994-4-s1-o11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Marais F, Minkler M, Gibson N, Mwau B, Mehtar S, Ogunsola F, Banya SS, Corburn J. A community-engaged infection prevention and control approach to Ebola. Health Promot Int 2015; 31:440-9. [PMID: 25680362 DOI: 10.1093/heapro/dav003] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.
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Affiliation(s)
- Frederick Marais
- Department of Health, Western Cape Government: Health, 8 Riebeek Street, Cape Town, South Africa Division of Community Health, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
| | - Meredith Minkler
- School of Public Health, University of California Berkeley, 50 University Hall, Berkeley, CA 94720-7360, USA
| | - Nancy Gibson
- Department of Family Medicine, CIET, McGill University, 5858 Ch. De la Côte-des-Neiges, 3rd Floor, Montreal, QC H3S 1Z1, Canada
| | - Baraka Mwau
- Urban/Regional Planning and Development, Nairobi, Kenya
| | - Shaheen Mehtar
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg 7505, Cape Town, South Africa Infection Control Africa Network, Tygerberg 7505, Cape Town, South Africa
| | - Folasade Ogunsola
- The Nongoma Clinic and Emma Thompson Nursing Home, Main Street, Kenema, Nongoma, South Africa
| | - Sama S Banya
- City and Regional Planning and Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA
| | - Jason Corburn
- City and Regional Planning and Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA
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Balogun M, Sekoni A, Meloni ST, Odukoya O, Onajole A, Longe-Peters O, Ogunsola F, Kanki PJ. Trained community volunteers improve tuberculosis knowledge and attitudes among adults in a periurban community in southwest Nigeria. Am J Trop Med Hyg 2014; 92:625-32. [PMID: 25510722 DOI: 10.4269/ajtmh.14-0527] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nigeria has the world's 10th largest tuberculosis (TB) burden. Targeted community-based interventions can potentially help reduce TB incidence. We designed an intervention in a periurban community where 10 community volunteers were trained to provide community TB education and also detect and refer TB suspects to a nearby clinic. To determine the effect of the intervention on knowledge, attitude, and preventive practices of TB, we compared results from a pre-intervention survey with those of a post-intervention survey. Pre-intervention, respondents had a mean knowledge score of 10.6 ± 7.0 of a possible 34, a mean attitude score of 5.8 ± 3.3 of a possible 10, and a mean practice score of 5.3 ± 1.4 of a possible 7. The intervention significantly increased the mean knowledge score to 16 ± 5.4 (P < 0.001) and mean attitude score to 7.0 ± 1.8 (P < 0.001); however, there was no statistically significant difference in the mean practice score. Eight TB suspects were referred to the clinic, and one suspect was subsequently diagnosed with TB. The use of trained community volunteers to share information on TB improved the overall knowledge and attitudes of respondents. Continued empowerment of the community should be encouraged to promote TB prevention and care.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Seema Thakore Meloni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adebayo Onajole
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Olukemi Longe-Peters
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Folasade Ogunsola
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Phyllis J Kanki
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
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Olaleye DO, Odaibo GN, Carney P, Agbaji O, Sagay AS, Muktar H, Akinyinka OO, Omigbodun AO, Ogunniyi A, Gashau W, Akanmu S, Ogunsola F, Chukwuka C, Okonkwo PI, Meloni ST, Adewole I, Kanki PJ, Murphy RL. Enhancement of health research capacity in Nigeria through north-south and in-country partnerships. Acad Med 2014; 89:S93-7. [PMID: 25072590 PMCID: PMC5207797 DOI: 10.1097/acm.0000000000000353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Research productivity in Sub-Saharan Africa has the potential to affect teaching, student quality, faculty career development, and translational country-relevant research as it has in developed countries. Nigeria is the most populous country in Africa, with an academic infrastructure that includes 129 universities and 45 medical schools; however, despite the size, the country has unacceptably poor health status indicators. To further develop the research infrastructure in Nigeria, faculty and research career development topics were identified within the six Nigerian universities of the nine institutions of the Medical Education Partnership Initiative in Nigeria (MEPIN) consortium. The consortium identified a training model that incorporated multi-institutional "train-the-trainers" programs at the University of Ibadan, followed by replication at the other MEPIN universities. More than 140 in-country trainers subsequently presented nine courses to more than 1,600 faculty, graduate students, and resident doctors throughout the consortium during the program's first three years (2011-2013). This model has fostered a new era of collaboration among the major Nigerian research universities, which now have increased capacity for collaborative research initiatives and improved research output. These changes, in turn, have the potential to improve the nation's health outcomes.
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Affiliation(s)
- David O Olaleye
- Dr. Olaleye is professor of virology, Department of Virology, and former dean, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Odaibo is a reader, Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Prof. Carney is assistant provost for graduate and professional studies and associate professor of health studies, Chicago State University, Chicago, Illinois. Dr. Agbaji is senior lecturer, Department of Medicine, Jos University Teaching Hospital and University of Jos, Jos, Nigeria. Dr. Sagay is professor of obstetrics and gynecology, Faculty of Medical Sciences, Jos University Teaching Hospital, Jos, Nigeria. Dr. Muktar is senior lecturer in hemato-oncology/retrovirology, Department of Hematology and Blood Transfusion, Ahmadu Bello University, and consultant hematologist, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Dr. Akinyinka is provost and professor of pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Omigbodun is professor of obstetrics and gynecology and former provost, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Ogunniyi is professor of neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Gashau is chief consultant physician, University of Maiduguri Teaching Hospital, Borno, Maiduguri, Nigeria. Dr. Akanmu is professor of hematology and blood transfusion, College of Medicine, University of Lagos, Lagos, Nigeria. Dr. Ogunsola is professor of medical microbiology and provost, College of Medicine, University of Lagos, Lagos, Nigeria. Dr. Chukwuka is senior lecturer and consultant respiratory physician, College of Medicine, University of Nigeria, Enugu, Nigeria. Dr. Okonkwo is CEO, AIDS Prevention Initiative in Nigeria LLC, Abuja, FCT Territory, Nigeria. Dr. Meloni is research associate, Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Mass
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Shittu A, Oyedara O, Abegunrin F, Okon K, Raji A, Taiwo S, Ogunsola F, Onyedibe K, Elisha G. Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria. BMC Infect Dis 2012; 12:286. [PMID: 23121720 PMCID: PMC3529121 DOI: 10.1186/1471-2334-12-286] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 10/29/2012] [Indexed: 01/13/2023] Open
Abstract
Background The staphylococci are implicated in a variety of human infections; however, many clinical microbiology laboratories in Nigeria do not identify staphylococci (in particular coagulase negative staphylococci - CNS) to the species level. Moreover, data from multi-centre assessment on antibiotic resistance and epidemiology of the staphylococci are not available in Nigeria. This study investigated 91 non-duplicate staphylococcal isolates obtained from the microbiology laboratories of eight hospitals in Nigeria during the period January to April 2010. Methods Identification and antibiotic susceptibility testing was performed using the VITEK 2 system, detection of resistance genes by PCR, and molecular characterization was determined by SCCmec typing, spa and multilocus sequence typing (MLST). Results All the isolates were susceptible to mupirocin, tigecycline, vancomycin and linezolid, but 72.5% of CNS and 82.3% of Staphylococcus aureus were resistant to cotrimoxazole, while multiresistance was observed in 37 of the 40 CNS isolates. Untypeable SCCmec types (ccrC/Class A mec and ccr-negative/Class C2 mec gene complex) in two methicillin-resistant S. aureus (MRSA) were identified. Additionally, ccr-negative/Class A mec and ccr type 4/Class C2 mec gene complex was detected in one isolate each of S. sciuri and S. haemolyticus, respectively. The S. aureus isolates were classified into 21 spa types including two new types (t8987, t9008) among the methicillin-susceptible S. aureus (MSSA) isolates. Two (CC8-SCCmecnon-typeable and CC88-SCCmec IV) and four (CC8-SCCmec III/IV/V; CC30-SCCmec II/III; CC88-SCCmec IV; and ST152-SCCmecnon-typeable) MRSA clones were identified in Maiduguri (North-East Nigeria) and South-West Nigeria, respectively. The proportion of Panton-Valentine leukocidin (PVL)-positive MSSA was high (44.4%) and 56.3% of these strains were associated with sequence type (ST) 152. Conclusions The identification of multiresistant mecA positive S. haemolyticus and S. sciuri from clinical samples indicates that characterization of CNS is important in providing information on their diversity and importance in Nigeria. There is the need to develop new SCCmec classification methods for non-typeable methicillin-resistant staphylococci, and to curtail the spread and establishment of the S. aureus ST152 clone in Nigeria. The study presents the first report of a PVL-positive ST152-SCCmecnontypeable MRSA and SCCmec typing of methicillin-resistant CNS in Nigeria.
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Affiliation(s)
- Adebayo Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Giwa F, Olayinka A, Ogunsola F. Seroprevalence of poliovirus antibodies amongst children in Zaria, Northern Nigeria. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Aibinu I, Pfeifer Y, Peters F, Ogunsola F, Adenipekun E, Odugbemi T, Koenig W. Emergence of bla(CTX-M-15), qnrB1 and aac(6')-Ib-cr resistance genes in Pantoea agglomerans and Enterobacter cloacae from Nigeria (sub-Saharan Africa). J Med Microbiol 2011; 61:165-167. [PMID: 21921107 DOI: 10.1099/jmm.0.035238-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- I Aibinu
- Institute for Medical Microbiology, OVGU, Magdeburg, Germany.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Y Pfeifer
- Nosocomial Infections, Robert Koch Institute, Wernigerode, Germany
| | - F Peters
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - F Ogunsola
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - E Adenipekun
- Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - T Odugbemi
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - W Koenig
- Institute for Medical Microbiology, OVGU, Magdeburg, Germany
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Aibinu IE, Pfeifer Y, Ogunsola F, Odugbemi T, Koenig W, Ghebremedhin B. Emergence of -lactamases OXA-10, VEB-1 and CMY in Providencia spp. from Nigeria. J Antimicrob Chemother 2011; 66:1931-2. [DOI: 10.1093/jac/dkr197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Feldblum PJ, Halpern V, Lie CC, Obunge O, Ogunsola F, Ampofo W, Opoku K. What predicts non-retention in microbicide trials? Contemp Clin Trials 2011; 32:512-6. [PMID: 21382512 DOI: 10.1016/j.cct.2011.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 02/04/2011] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Poor retention can reduce study power and thwart randomization, possibly resulting in biased estimates of effect. Some HIV prevention trials conducted in developing countries have been challenged by high loss to follow-up. Identifying factors associated with non-retention could lead to recruitment of women more likely to remain in the trial, potentially yielding greater efficiency and validity. METHODS We summarized retention rates and, using Cox regression, evaluated factors associated with non-retention in four trials of two candidate vaginal microbicides (1% C31G or SAVVY® and 6% cellulose sulfate or CS) conducted in multiple sub-Saharan African countries. We defined retention as completion of the trial, including those with an HIV outcome. Non-retention comprised participants randomized to a study arm who were either lost to follow-up or discontinued prior to infection with HIV. RESULTS 7,367 women were enrolled and randomized in the four trials; 7,086 are included in this analysis. 1,514 (21.4%) participants were either lost to follow-up or had early discontinuation. In the final Cox model, the following baseline factors were associated with non-retention: younger age (hazard ratio [HR] = 0.95); less education (HR = 0.97); condom use at last sex (HR = 1.18); larger number of sex acts in a typical week (HR = 1.01); and baseline candidiasis or bacterial vaginosis (HR = 1.12). CONCLUSIONS Younger and less educated women were more difficult to retain in these microbicide trials. But these same traits may be associated with higher HIV infection rates. Enhanced retention methods focused on those at highest risk of non-retention and possibly infection will optimize study efficiency and validity.
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Fashae K, Ogunsola F, Aarestrup FM, Hendriksen RS. Antimicrobial susceptibility and serovars of Salmonella from chickens and humans in Ibadan, Nigeria. J Infect Dev Ctries 2010; 4:484-94. [DOI: 10.3855/jidc.909] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 10/31/2022] Open
Abstract
Background: This study determines the prevalence and antibiotic resistance of Salmonella serovars from humans and chickens in Ibadan, Nigeria, in 2004-2007. Methodology: A total of 991 blood samples were collected from patients in 2004 to 2005 and 641 fecal samples were collected from poultry farms in 2007. All Salmonella isolates were serotyped and tested for antimicrobial susceptibility. Results: Thirty-nine (4%) Salmonella isolates were obtained from human blood and 70 (11%) from chicken fecal samples. The human isolates revealed nine different serovars; 82% were non-typhoidal Salmonella and 18% were (S. Typhi). The majority of serovars from humans were S. Enteritidis (33%), S. Dublin (18%), and S. Typhimurium (18%). Resistance to chloramphenicol, sulfamethoxazole, trimethoprim, and ampicillin ranged from 36% to 59% for the human isolates. Eight different serovars were obtained from chickens; S. Virchow (71%) predominated. A high frequency (87%) of reduced susceptibility to ciprofloxacin was observed among the chicken isolates. A high frequency of resistance to tetracycline (93%), nalidixic acid (81%), and sulfamethoxazole (87%) was observed. Rare serovars such as S. Apapa, S. Mouschaui, S. Jukestown, S. Oritamerin, and S. Onireke were isolated from both humans and chickens. Identical serovars were not found among human and chicken isolates. Conclusions: This study indicates that chickens are not a reservoir of Salmonella causing bacteraemia among humans in Ibadan, Nigeria. Studies locating the reservoirs responsible for invasive salmonellosis in humans are needed. Controls and targeted interventions against S. Virchow and the frequent occurrence of antimicrobial resistance in chickens should be initiated to prevent the spread of this serovar.
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Halpern V, Obunge O, Ogunsola F, Otusanya S, Umo-Otong J, Wang CH, Mehta N. Interim data monitoring to enroll higher-risk participants in HIV prevention trials. BMC Med Res Methodol 2009; 9:44. [PMID: 19549331 PMCID: PMC2708194 DOI: 10.1186/1471-2288-9-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 06/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower-than-expected incidence of HIV undermines sample size calculations and compromises the power of a HIV prevention trial. We evaluated the effectiveness of interim monitoring of HIV infection rates and on-going modification of recruitment strategies to enroll women at higher risk of HIV in the Cellulose Sulfate Phase III study in Nigeria. METHODS We analyzed prevalence and incidence of HIV and other sexually transmitted infections, demographic and sexual behavior characteristics aggregated over the treatment groups on a quarterly basis. The site investigators were advised on their recruitment strategies based on the findings of the interim analyses. RESULTS A total of 3619 women were screened and 1644 enrolled at the Ikeja and Apapa clinics in Lagos, and at the Central and Peripheral clinics in Port Harcourt. Twelve months after study initiation, the overall incidence of HIV was less than one-third of the pre-study assumption, with rates of HIV that varied substantially between clinics. Due to the low prevalence and incidence rates of HIV, it was decided to close the Ikeja clinic in Lagos and to find new catchment areas in Port Harcourt. This strategy was associated with an almost two-fold increase in observed HIV incidence during the second year of the study. CONCLUSION Given the difficulties in estimating HIV incidence, a close monitoring of HIV prevalence and incidence rates during a trial is warranted. The on-going modification of recruitment strategies based on the regular analysis of HIV rates appeared to be an efficient method for targeting populations at greatest risk of HIV infection and increasing study power in the Nigeria trial. TRIAL REGISTRATION The trial was registered with the ClinicalTrials.gov registry under #NCT00120770 http://clinicaltrials.gov/ct2/show/NCT00120770.
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Affiliation(s)
- Vera Halpern
- Family Health International, Research Triangle Park, NC, USA.
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Halpern V, Ogunsola F, Obunge O, Wang CH, Onyejepu N, Oduyebo O, Taylor D, McNeil L, Mehta N, Umo-Otong J, Otusanya S, Crucitti T, Abdellati S. Effectiveness of cellulose sulfate vaginal gel for the prevention of HIV infection: results of a Phase III trial in Nigeria. PLoS One 2008; 3:e3784. [PMID: 19023429 PMCID: PMC2582655 DOI: 10.1371/journal.pone.0003784] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 10/29/2008] [Indexed: 11/25/2022] Open
Abstract
Background This trial evaluated the safety and effectiveness of 6% cellulose sulfate vaginal gel in preventing male-to-female vaginal transmission of HIV, gonorrhea and chlamydial infection. Methods This Phase III, double-blind, randomized, placebo-controlled trial was conducted between November 2004 and March 2007 in Lagos and Port Harcourt, Nigeria. We enrolled 1644 HIV-antibody negative women at high risk of HIV acquisition. Study participants were randomized 1∶1 to cellulose sulfate or placebo and asked to use gel plus a condom for each act of vaginal intercourse over one year of follow-up. The participants were evaluated monthly for HIV, gonorrhea and chlamydial infection, and for adverse events. Results The trial was stopped prematurely after the data safety monitoring board of a parallel trial concluded that cellulose sulfate might be increasing the risk of HIV. In contrast, we observed fewer infections in the active arm (10) than on placebo (13), a difference that was nonetheless not statistically significant (HR = 0.8, 95% CI 0.3–1.8; p = 0.56). Rates of gonorrhea and chlamydial infection were lower in the CS group but the difference was likewise not statistically significant (HR = 0.8, 95% CI 0.5–1.1; p = 0.19 for the combined STI outcome). Rates of adverse events were similar across study arms. No serious adverse events related to cellulose sulfate use were reported. Conclusions Cellulose sulfate gel appeared to be safe in the evaluated study population but we found insufficient evidence that it prevented male-to-female vaginal transmission of HIV, gonorrhea or chlamydial infection. The early closure of the trial compromised the ability to draw definitive conclusions about the effectiveness of cellulose sulfate against HIV. Trial Registration ClinicalTrials.gov NCT00120770
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Affiliation(s)
- Vera Halpern
- Family Health International, Research Triangle Park, North Carolina, United States of America.
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