Seroprevalence of antibodies to herpes simplex virus 1 and 2 in patients with HIV positive from Ebonyi State, Nigeria: a cross-sectional study

OBJECTIVES

To assess the seroprevalence of herpes simplex virus (HSV) types 1 and 2 in patients infected with HIV in Nigeria.

DESIGN

Cross-sectional design from January to June 2019.

SETTING

Federal Teaching Hospital, Ebonyi State, Nigeria.

PARTICIPANTS

A total of 276 patients with HIV were analysed using ELISA method for the presence of HSV-1 and HSV-2 specific IgG antibodies.

OUTCOMES

Fisher's exact test was used to determine the association between the seroprevalence of HSV and demographic variables (statistically significant=p value ≤0.05).

RESULTS

Totally, 212 (76.8%) and 155 (56.2%) patients with HIV were seropositive for HSV-1 and HSV-2 IgG antibodies, respectively. The seroprevalence of HSV-1 was significantly higher than the HSV-2 in patients with HIV (p value <0.0001). HSV-1 and HSV-2 seroprevalence were higher in patients aged more than 30 years. The seroprevalence of HSV-1 was significantly higher (p=0.01) in females (82.4%, 131/159) than males (69.2%, 81/117), but there was no significant difference in seroprevalence of HSV-2 in females (57.9%, 92/159) compared with males (53.8%, 63/117) (p=0.51). Professional drivers had a higher seroprevalence of HSV-1 and HSV-2 and there was a significant association between the occupation and the HSV-1 and HSV-2 seropositivity (p>0.05). The seroprevalence of HSV-1 was significantly higher in the singles (87.4%, 90/103) than the married patients with HIV (p=0.001). However, HSV-2 seroprevalence was significantly higher in the married patients with HIV (63.6%, 110/173) (p=0.001).

CONCLUSIONS

Prevalence of 76.8% for HSV-1 and 56.2% for HSV-2 among patients with HIV was seen. The HSV-1 was significantly higher in the singles while HSV-2 seroprevalence was significantly higher in the married patients with HIV with HSV-1 and HSV-2 coinfection rate of 7.6%. This study became very imperative to provide an important insight into the hidden dynamics of HSV infections.

Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria

Background

Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria.

Methods

The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada.

Results

At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful).

Conclusion

The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.

Potential risk of induced malaria by blood transfusion in South-eastern Nigeria

Induced malaria by blood transfusion is a potential health hazard but is often neglected in many malaria endemic areas. Standard parasitological technique was used to determine the prevalence of malaria among blood donors in the South-eastern Nigeria. Of the total 325 blood donors (310 males and 15 females) screened, 133 (40.9%, CI 95%: 35.6-46.2%) were infected with malaria parasite, 78 (58.6%) had 1-10 parasites per 100 thick film fields ('+' or 4-40 parasites per mm3) while 55 (41.4%) had 11-100 parasites per 100 thick film fields ('++' or 41-400 parasites per mm3). P. falciparum was identified in all the infected cases, however 3 (2.3%) persons had mixed infection with P. malariae. Males were more infected (41.3%, CI 95%: 35.8-46.8%) than females (33.3%, CI 95%: 9.4-57.2%). The infection decreased with age with highest prevalence of 48.5% among those aged 20-25 years. The infection significantly varied with age but not with sex (P<0.05). Individuals with blood group B were slightly more infected (42.1%, 95%CI., 19.6-64.6%) than those of groups O (41.0%,CI 95%: 35.3-46.7%) and A (40.0%, CI 95%: 20.8-59.2%) but there was no significant difference (P < 0.05). Highest prevalence of infection was recorded in the month of April corresponding to the onset of the wet season. An overhaul of existing blood donation policies in many health facilities in the sub-Saharan Africa to incorporate malaria screening is advocated. Curative antimalarial drugs followed by prophylactic drugs should be given to all recipients of Parasitized blood.

Immunological and epidemiological evaluation of EBV infections among HIV-1 infected individuals in Abakaliki, Nigeria supports the potential use of neutrophils as a marker of EBV in HIV disease progression and as useful markers of immune activation

Human herpesvirus 4 which is commonly known as Epstein-Barr virus (EBV) is one of the opportunistic pathogens that affect human immunodeficiency virus (HIV) infected individuals and it is the leading cause of death and cancer in humans. The study was designed to evaluate the prevalence of EBV among HIV-1 infected individuals in Abakaliki metropolis, Ebonyi State, Nigeria. A total of 91 HIV-1 infected individuals were collected from Mile 4 Hospital, Abakaliki, Ebonyi State, Nigeria. ELISA was used to determine the Epstein-Barr Nuclear Antigen (EBNA) IgG and IgM antibodies. Full blood count (FBC), white cell count (WBC) and differential counts were also determined using standard hematological methods. Of the 91 serum samples obtained from HIV-1 infected individuals, 87(95.6%) and 20(22.0%) samples were found to be positive for EBVNA IgG and IgM antibody respectively. All the age groups had significant IgG prevalence, but age groups ≤ 20 years, and ≥ 41 had the highest prevalence while age group 21-30 years was found to have a less rate of prevalence. Also, the highest seropositivity for IgM antibodies was observed in the age group 31-40 years (32.4%) while the age groups ≤20 years (0.0%) is the lowest. However, these differences were not statistically associated with PVL and EBVNA IgG (p = .4311) and IgM antibodies (p = .4861).Higher seropositivity of EBVNA IgG occurred among those with PVL 41-10,000 copies/mL (100.0%) and PVL 10,001 copies/mL and above (100.0%) compared to those with PVL less than or equal to 40 copies/mL (95.0%). While regarding EBVNA IgM antibodies, higher seropositivity of EBVNA IgM occurred among those with PVL less than or equal to 40 copies/mL (25.0%) compared to those with PVL 41-10,000 copies/mL (20.0%) and PVL 10,001 copies/mL and above (8.3%). There was a significant difference in Neutrophils p < .026 between the mean of females and males (40.9 ± 11.7 and 36 ± 31.1) infected with EBV IgM in HIV individuals. There was also a significant positive correlation between CD4 counts and the WBC, Lymphocytes, Eosinophils and the neutrophil among the HIV-1 individuals used for this study. The correlations observed between both CD₄⁺ count and neutrophil support the potential use of neutrophils as a marker of EBV in HIV disease progression and as useful markers of immune activation.

Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop

Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers’ ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.

Promoting Evidence to Policy Link on the Control of Infectious Diseases of Poverty in Nigeria: Outcome of A Multi-Stakeholders Policy Dialogue

BACKGROUND

In Nigeria, malaria, schistosomiasis and lymphatic filariasis are among infectious diseases of poverty (IDP) with severe health burden and require effective policy strategies for their control. In this study, we investigated the value of policy brief and policy dialogue as excellent policymaking mechanisms that enable policymakers to adapt effective evidence informed policy for IDP control.

METHODS

A policy brief was developed on the control of malaria, schistosomiasis and lymphatic filariasis and subjected to deliberations in a one-day multi-stakeholder policy dialogue held in Ebonyi State Nigeria. A modified cross sectional intervention study design was used in this investigation. Structured pre-tested questionnaires were used to evaluate the policy brief document and policy dialogue process at the end of the policy dialogue.

RESULTS

Forty-seven policymakers participated in the dialogue. An analysis of the response on the policy brief regarding context, different features of the problem; policy options and key implementation considerations indicated the mean ratings (MNRs) mostly ranged from 6.40-6.85 on 7 point scale. The over-all assessment of the policy brief had MNR at 6.54. The analysis of the response on the policy dialogue regarding the level of priority of policy issue, opportunity to discuss different features of the problem and options for addressing the problem, and the MNRs mostly ranged from 6.50-6.82. The overall assessment of the policy dialogue had MNR at 6.72.

CONCLUSION

Policy dialogues can allow research evidence to be considered together with views, experiences and tacit knowledge of policymakers and can enhance evidence-to-policy link.

Enhancing the Capacity of Policy-Makers to Develop Evidence-Informed Policy Brief on Infectious Diseases of Poverty in Nigeria

BACKGROUND

The lack of effective use of research evidence in policy-making is a major challenge in most low- and middle-income countries (LMICs). There is need to package research data into effective policy tools that will help policy-makers to make evidence-informed policy regarding infectious diseases of poverty (IDP). The objective of this study was to assess the usefulness of training workshops and mentoring to enhance the capacity of Nigerian health policy-makers to develop evidence-informed policy brief on the control of IDP.

METHODS

A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point Likert scale according to the degree of adequacy; 1 = "grossly inadequate," 4 = "very adequate" was employed. The main parameter measured was participants' perceptions of their own knowledge/understanding. This study was conducted at subnational level and the participants were the career health policy-makers drawn from Ebonyi State in the South-Eastern Nigeria. A one-day evidence-to-policy workshop was organized to enhance the participants' capacity to develop evidence-informed policy brief on IDP in Ebonyi State. Topics covered included collaborative initiative; preparation and use of policy briefs; policy dialogue; ethics in health policy-making; and health policy and politics.

RESULTS

The preworkshop mean of knowledge and capacity ranged from 2.49-3.03, while the postworkshop mean ranged from 3.42-3.78 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 20.10%-45%. Participants were divided into 3 IDP mentorship groups (malaria, schistosomiasis, lymphatic filariasis [LF]) and were mentored to identify potential policy options/recommendations for control of the diseases for the policy briefs. These policy options were subjected to research evidence synthesis by each group to identify the options that have the support of research evidence (mostly systematic reviews) from PubMed, Cochrane database and Google Scholar. After the evidence synthesis, five policy options were selected out of 13 for malaria, 3 out of 10 for schistosomiasis and 5 out of 11 for LF.

CONCLUSION

The outcome suggests that an evidence-to-policy capacity enhancement workshop combined with a mentorship programme can improve policy-makers' capacity for evidence-informed policy-making (EIP).

Public health implication of bacteriuria and antibiotic susceptibility of bacteria isolates in schistosoma haematobium-infected school pupils in Southeast Nigeria

Schistosoma haematobium infection prevalence of 57% was observed among primary school pupils, with males more infected than females (60.3% vs. 49.5%). Light infection (78.9%) was higher than heavy infection (21.1%). Prevalence of bacteriuria was 88.4% in infected individuals. Escherichia coli (20.5%), Salmonella spp (16.1%), and Staphylococcus aureus (16.1%) were major isolates. A 100% bacterial susceptibility to ciprofloxacin and taravid, was observed and up to 100% resistance with tetracycline, cotrimoxazole and nitrofuratoin. Systematic schistosomicidal/antimicrobial treatment advocated.

Potential for parasite and bacteria transmission by paper currency in Nigeria

The authors assessed the potential of Nigerian currency notes to act as environmental vehicles for the transmission of pathogenic parasites and bacteria. Currency notes obtained from four major cities in Nigeria were evaluated according to standard techniques. Fifty-four (21.6 percent [95 percent CI: 16.50-26.70]) of the first batch of 250 notes, which underwent parasitological analysis, were contaminated with enteric parasites; 133 (53.2 percent [95 percent CI: 47.02-59.39]) of the second batch of 250 notes, which underwent bacteriological analysis, were found to be contaminated with bacteria. Parasites that were isolated from the notes included Ascaris lumbricoides (8.0 percent), Enterobius vermicularis (6.8 percent), Trichuris trichiura (2.8 percent), and Taenia species (4.0 percent). Bacteria that were isolated were Streptococcus species (21.6 percent), Staphylococcus species (12.8 percent), Escherichia coli (13.2 percent), and Bacillus species (5.6 percent). Among dirty/mutilated currency notes, parasite contamination and bacterial contamination were both significantly (p < .05) more pervasive (30.6 percent and 73.8 percent, respectively) than they were among clean and mint currency notes. Lower-denomination notes were more likely to be contaminated than were higher-denomination notes, although the difference was not statistically significant (p > .05). Parasite contamination and bacteria contamination were both most frequent in notes obtained from butchers and beggars. These results suggest that currency notes may be contaminated, especially with bacteria and enteric parasites, and may serve as sources of infection. Personal hygiene to reduce risk of infection is recommended.

Mandatory pre-marital HIV testing in Nigeria: the public health and social implications

The prevalence of HIV infection among individuals referred from faith-based organizations (FBOs) in south-eastern Nigeria for mandatory pre-marital HIV screening was determined. Of the total of 319 individuals (148 males, 171 females) screened, 25 (7.8%, 95%CI: 4.9-10.7%) were confirmed HIV-positive, comprising 13 (8.8%, 95%CI: 4.2-13.4%) males and 12 (7%, 95%CI: 3.2-10.8%) females. No significant difference was observed in the association between HIV infection and gender (chi2=0.58, df = 1, P < 0.05). The highest prevalence of HIV infection (8.9%) was recorded among individuals in the 21-30 years age category, while the least HIV infection prevalence (5.3%) was observed among persons above 40 years old. There was no significant difference in the association between HIV infection and age (chi2=0.68, df = 3, P < 0.05). Mandatory pre-marital HIV screening could generate social stigmatization and infringement of the fundamental human rights of infected individuals. Voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing are more desirable. Guidelines for the management of test-positive individuals and non-concordant couples and the safeguarding of confidentiality should be developed. Training and capacity building for religious leaders, to appropriately manage social issues associated with HIV/AIDS as it affects their organizations, are recommended.

Lassa fever in West African sub-region: an overview

Lassa fever is an acute viral zoonotic illness caused by Lassa virus, an arenavirus known to be responsible for a severe haemorrhagic fever characterised by fever, muscle aches, sore throat, nausea, vomiting and, chest and abdominal pain. The virus exhibits persistent, asymptomatic infection with profuse urinary virus excretion in the ubiquitous rodent vector, Mastomys natalensis. Lassa fever is endemic in West Africa and has been reported from Sierra Leone, Guinea, Liberia, and Nigeria. Some studies indicate that 300,000 to 500,000 cases of Lassa fever and 5000 deaths occur yearly across West Africa. Studies reported in English, that investigated Lassa fever with reference to West Africa were identified using the Medline Entrez-PubMed search and were used for this review. The scarcity of resources available for health care delivery system and the political instability that characterise the West African countries would continue to impede efforts for the control of Lassa fever in the sub-region. There is need for adequate training of health care workers regarding diagnostics, intensive care of patients under isolation, contact tracing, adequate precautionary measures in handling infectious laboratory specimens, control of the vector as well as care and disposal of infectious waste.

Western blot-indeterminate results in Nigerian patients HIV serodiagnosis: the clinical and public health implication

The clinical and public health implication of HIV Western blot (WB) indeterminate results is yet to be appraised in sub-Saharan Africa, including Nigeria. Using HIV Tri Line Test enzyme-linked immunosorbent assay (ELISA), 1286 patients (600 males and 686 females; age range, 5-60 years) with symptoms suggestive of HIV infection were screened. A total of 1020 (79.3%, 95% confidence interval [CI] 76.8-81.5) of the patients comprising of 514 (85.7%) males and 506 (73.8%) females were HIV seropositive and the difference was statistical significantly (chi(2) = 5.72, df = 1, p < 0.05). Western blot analysis of sera from the 1020 HIV-seropositive individuals using the BIO-RAD NEW LAV-BLOT I specifying World Health Organization (WHO) interpretive criteria, confirmed the HIV serostatus of 815 (79.9%, 95% CI, 77.4-82.4) of them with 205 (20.1%, 95% CI, 17.6-22.6) individuals having indeterminate results consisting of either; 1 env +/- gag +/- pol, gag + pol, gag only or pol only. Of these, 102 (19.8%) were males and 103 (20.4%) were females. Patients aged 11-20 years old recorded the highest percentage of indeterminate results (31.7%, 95% CI, 20.2-43.2) while those aged 21-30 years recorded the least (14.2%, 95% CI, 10.6-17.8) and the difference was statistically significant (chi(2) = 15.73, df = 5, p < 0.05). Result confirmed the limitation of Western blot assays in HIV confirmatory serodiagnosis. After obtaining HIV indeterminate Western blot result, clinicians should consider the total profile for the patient, reassess risk factors for HIV infection, perform a HIV retesting at 3-month intervals for 6 months or use an alternate HIV antibody confirmatory assay and running antibody tests for other human retroviruses.

Potential risk of induced malaria by blood transfusion in South-eastern Nigeria

Induced malaria by blood transfusion is a potential health hazard but is often neglected in many malaria endemic areas. Standard parasitological technique was used to determine the prevalence of malaria among blood donors in the South-eastern Nigeria. Of the total 325 blood donors (310 males and 15 females) screened, 133 (40.9%, CI 95%: 35.6-46.2%) were infected with malaria parasite, 78 (58.6%) had 1-10 parasites per 100 thick film fields ('+' or 4-40 parasites per mm3) while 55 (41.4%) had 11-100 parasites per 100 thick film fields ('++' or 41-400 parasites per mm3). P. falciparum was identified in all the infected cases, however 3 (2.3%) persons had mixed infection with P. malariae. Males were more infected (41.3%, CI 95%: 35.8-46.8%) than females (33.3%, CI 95%: 9.4-57.2%). The infection decreased with age with highest prevalence of 48.5% among those aged 20-25 years. The infection significantly varied with age but not with sex (P<0.05). Individuals with blood group B were slightly more infected (42.1%, 95%CI., 19.6-64.6%) than those of groups O (41.0%,CI 95%: 35.3-46.7%) and A (40.0%, CI 95%: 20.8-59.2%) but there was no significant difference (P<0.05). Highest prevalence of infection was recorded in the month of April corresponding to the onset of the wet season. An overhaul of existing blood donation policies in many health facilities in the sub-Saharan Africa to incorporate malaria screening is advocated. Curative antimalarial drugs followed by prophylactic drugs should be given to all recipients of parasitized blood.

Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos, Nigeria

Information is very scarce on the prevalence of hepatitis-B virus (HBV) infection among blood donors and patients with human immunodeficiency virus (HIV) infection in Nigeria. Hepatitis-B surface antigen (HBsAg) ELISA was used to determined the prevalence of HBsAg among 175 blood donors (aged 20-40 years) and 490 HIV-infected patients (aged 17-60 years) in Jos, Nigeria. Twenty-five (14.3%) of the blood donors and 127 (25.9%) of the HIV-infected individuals were HBsAg seropositive, indicating a higher HBV infection among HIV-infected persons than among healthy blood donors. A slightly higher HBsAg seroprevalence was recorded in the males (14.6%) than females (12.9%) of the blood donors. Among the HIV-infected patients, the males had considerably higher HBsAg seroprevalence than the females (31.8 vs 22.1%) with the highest prevalence of HBsAg occurring in the 51-60 years age group (44%), followed by those of 31-40 years (28.2%). Results confirmed the high endemicity of HBV infection in Jos, Nigeria and the significantly greater prevalence of HBV infection among HIV-infected patients than among blood donors.

Public expenditures and health care in Africa

Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of health care. Analyzing information from five Sub-Saharan African countries, namely Botswana, Burkina Faso, Cameroon, Ethiopia and Senegal, we investigate the impacts of shifting expenditure patterns and levels on the process of providing health services as well as on delivery of health care. The country analyses indicate that in addition to the level of public spending, the expenditure mix (i.e. salaries, drugs, supplies etc.), the composition of the health infrastructure (hospitals, clinics, health posts etc.), community efforts, and the availability of private health care all influence health care delivery. Consequently, per capita public expenditure (the most important indicator in a number of related studies) alone as a measure of the availability of health care and especially for cross-country comparisons is inadequate. Reductions in government resources for health care often result in less efficient mixing of resources and hence less health care delivery, in quality and quantity terms. With the recent trends in health care spending in Africa there should be greater effort to increase the efficient use of these increasingly scarce resources, yet the trend in resource mix has been in the opposite direction. Given the input to public health care of local communities, as well as the provision of private health care, it would seem that government spending on health care should be counter-cyclical, i.e. government health spending should accelerate during periods of economic down turns. Such counter-cyclical spending would tend to offset the difficulties facing local communities and the declining ability of individuals to pay for private health care. Recommending counter-cyclical health spending may seem wishful, but it points up the necessity of understanding what is likely to happen to health care in African countries in the face of economic difficulties, and particularly in the face of fiscal austerity.