Search

BackgroundMany patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed.MethodsWe searched four databases from inception to April 27, 2020, without language restrictions (PROSPERO: CRD42018100004). We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random-effects meta-analysis to obtain pooled estimates stratified by passive and active case finding.ResultsOur search identified 1799 studies, of which 18 studies with 14527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 38.4-56.7) in passive and 92.7% (95% CI 83.1-97.0) in active case finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. Past history of tuberculosis was documented in only 55% of studies, with just five out of 18 reporting any alternative diagnoses.DiscussionNearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs.FundingNIHR, UK MRC

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa.

Cardiovascular disease (CVD) is a common cause of morbidity/mortality in patients with type 2 diabetes mellitus (T2DM). Echocardiography can detect changes in cardiac geometry/function before overt CVD symptoms. This study aimed to evaluate left ventricular (LV) geometry and function in normotensive/hypertensive patients with T2DM without overt cardiac symptoms. A cross-sectional study in which fifty normotensives and fifty hypertensive adults with DM without overt cardiac symptoms were enrolled from the cardiology/diabetes clinics of Jos University Teaching Hospital (JUTH) in a simple random manner. Relevant history, physical examination and biochemical investigations were performed. 12-lead electrocardiography and echocardiograph assessment of LV geometry and function were also performed. Data was analyzed using Epi-info 7 statistical software; p value < 0.05 was considered significant. There were 27 females and 29 females in both groups. The prevalence of abnormal LV geometry was 36.0%, 95% CI 33.2-38.8% and 58.0%, 95% CI 55.2-60.8% in the normotensive and hypertensive groups respectively, P=0.028. Similarly, the prevalence of LV dysfunction was 38.0%, 95%CI 35.2-40.8% and 62.0%, 95%CI 59.2-64.8% respectively, P=0.017. The independent predictors of LV dysfunction were found to be duration of diabetes (OR 7.74, 95%CI 4.46-10.46), duration of hypertension ≥5years (OR 4.15, 95%CI 4.01-9.27), smoking (OR 4.34, 95%CI 1.32-6.23), body mass index ≥25 (OR 5.53, 95%CI 1.38-2.09) and glycosylated haemoglobin ≥7 (OR 7.11, 95%CI 2.15-0.81). There is high prevalence of LV dysfunction/abnormal LV geometry in T2DM patients without overt cardiac symptoms; co-morbid hypertension worsens these abnormalities. Early and periodic echocardiography is recommended with appropriate intervention in these patients.

Urban cities in sub-Saharan Africa (SSA) are faced with ambient air pollution. This is an important public health problem with models and limited monitoring data indicating high concentrations of pollutants such as fine particulate matter (PM2.5). Going through most global air quality index maps, however, information about ambient pollution from SSA is scarce. We evaluated the feasibility and practicality of longitudinal measurements of ambient PM2.5 using low-cost air quality sensors (Purple Air-II-SD) across thirteen locations in seven countries in SSA. Devices were used to gather data over a 30-day period with the aim of assessing the efficiency of its data recovery rate and identifying challenges experienced by users in each location. The median data recovery rate was 94% (range: 72% to 100%). The mean 24-hour concentration measured across all sites was 38 µg/m3 with the highest PM2.5 period average concentration of 91 µg/m3 measured in Kampala, Uganda and lowest concentrations of 15 µg/m3 measured in Faraja, The Gambia. Kampala-Uganda and Nnewi-Nigeria recorded the longest periods with concentrations>250µg/m3. Power outages, SD memory card issues, internet connectivity problems and device safety concerns were important challenges experienced when using Purple Air-II-SD sensors. Despite some operational challenges, this study demonstrated that it is reasonably practicable and feasible to establish a network of low-cost devices to provide data on local PM2.5 concentrations in SSA countries. Such data are crucially needed to raise public-, societal and policymaker awareness about air pollution across SSA.

Ambient air pollution in urban cities in sub-Saharan Africa (SSA) is an important public health problem with models and limited monitoring data indicating high concentrations of pollutants such as fine particulate matter (PM2.5). On most global air quality index maps, however, information about ambient pollution from SSA is scarce. We evaluated the feasibility and practicality of longitudinal measurements of ambient PM2.5 using low-cost air quality sensors (Purple Air-II-SD) across thirteen locations in seven countries in SSA. Devices were used to gather data over a 30-day period with the aim of assessing the efficiency of its data recovery rate and identifying challenges experienced by users in each location. The supplementary files for the write-up of the above is deposited here on Zenodo.

Objectives:The objective of this study is to determine the prevalence of hypertension and other co-morbid CVD in adults with COPD, associated factors and the impact of CVD on outcomes (hospitalizations and mortality) over 600 days.Methods:A cohort study carried out in JUTH, Nigeria. 82 adults with C

Occupational exposures to blood borne pathogens including HIV have been well studied. However, limited studies exist about the utilization of post exposure prophylaxis and follow-up in Nigeria. The objectives of the study were to describe the characteristics of occupational exposure to HIV, the utilization of post exposure prophylaxis (PEP) among health workers, and the proportion of exposed health workers reporting for follow-up three months after exposure. A cross sectional descriptive study involving ninety three health workers was carried out at a general hospital located in an urban area in North Central zone of Nigeria. A simple random sampling technique was used. The prevalence of occupational exposure, utilization of post exposure prophylaxis and follow-up rate were assessed using self administered questionnaire. Data analysis was done using SPSS version 16 and descriptive analysis was carried out. It was reported that, 73.1% of respondents at least one or more occupational exposures to HIV and other blood borne pathogens through accidental needle injury/prick, blood splash on a fresh wound or conjunctiva exposure in the last one year. Needle stick injury occurred in 83.8% of all respondents who had occupational exposures. 8.8% of exposed respondents commenced post exposure prophylaxis with two-thirds completing the post exposure prophylaxis regimen. Only one (25%) of those who completed the regimen reported for follow-up. Occupational exposures to HIV are common among health workers. The rates of utilization of post exposure prophylaxis and follow-up were low. DOI: http://dx.doi.org/10.3126/ijosh.v3i1.6635 International Journal of Occupational Safety and Health, Vol 3 No 1 (2013) 11-17

Background Prompt treatment of malaria following adequate diagnosis helps to reduce morbidity and mortality in children. Lack of resources and adequate manpower in developing countries make malaria microscopy difficult. The Rapid Diagnostic Test kit (RDT) remains unpopular despite its availability and ease of use because of lack of local research on its effectiveness leading to over-prescription of Artemisinin Combination Therapy (ACT).