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The effects of grades of coarse aggregates on the cost of concrete was studied. Several times in real life practice, the engineer at construction site is faced with the problem of not having the required grade of coarse aggregate for a given project. . This could be caused by several reasons such as; non-availability of desired grade, the different grades of coarse aggregate being obtained as a left over from a sister project, etc. In Nigeria, coarse aggregate for concrete is very expensive and thus, the engineer will think of how to use the available grade of coarse aggregate in his concrete mix design to achieve the desired results instead of discarding it. In this study, seven different grades of coarse aggregate were investigated. The fineness modulus of the fine aggregate and bulk densities of the various grades of coarse aggregate were determined. The results were used together with tables from American Concrete Institute (ACI) code to carry out concrete mix design on all the various grades of coarse aggregate to calculate the quantities of the different elements of concrete. From the mix design, the cost of the materials for producing one cubic meter of concrete was determined. The result showed that the Well graded aggregate had the highest bulk density of 1717Kg/m³ while uniformly graded retained on 10mm sieve had the least bulk density of 1580Kg/m³. Uniformly graded aggregate retained on 10mm sieve required the highest cost of N58,278.81 to produce a cubic meter of grade 25 concrete while the cost was least at N56,242.52 when uniformly graded retained on 20mm sieve and Gap-graded without 5mm size were used. This suggests that the larger the size of coarse aggregate (within the size limits studied) the less the cement paste required and hence the less the cost. [ABSTRACT FROM AUTHOR]

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. Conclusions: The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and r adiogr aphicabnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.

Over the years, the increased rate of perturbated malware based cyber-attack has presented many challenges and triggered the need for immediate solution all over the world. This was addressed in this paper development of a machine learning based fileless malware filter system for cyber security. Fileless malware which can come inform of Memory Resident Fileless malware or Windows Registry fileless malware are known to have no executable files, resides in the system memory or the windows registry. It doesn’t write any files to disk making it very challenging to detect us[1]ing traditional signature-based methods. It often leverage legitimate tools such as Windows Management Instrumentation and PowerShell to carry out its malicious activities. The methods used were data collection, data extraction, Deep Neural Network (DNN), activation function, training algorithm and classification. The methods were designed using structural and mathematical approaches which employed architectural diagrams, flow charts and self-defining equations to develop the new system. The training of the DNN was done using Gradient Descent Algorithms (GDA) to generate the malware filter algorithm. The filters were implemented with Simulink, tested and validated. The results were also evaluated using Regression (R) and Mean Square Error (MSE analyzer) and it showed R values of 0.9931 and MSE performance also recorded 0.002088Mu. This implied that the filter developed was able to detect and remove malware on the network.

Motivated by swings in the exchange rate of many developing economies which exert influence on firms’ input costs, output, stock prices, and profits, the study investigated the asymmetric reactions of stock prices and industrial output to various shocks in the exchange rate in Nigeria using a multiple threshold nonlinear autoregressive distributed lag model and high frequency series from January 1999 to December 2021. Empirical results suggest that stock prices and industrial output react asymmetrically in the opposite direction to exchange rate depreciation. It further indicates that the reactions of both stock prices and industrial output to exchange rate changes are sensitive to the size of shocks. Exchange rate shocks above the 25th percentile significantly and inversely affect both stock prices and industrial output, and the effects of exchange rate shocks on stock prices and industrial output become pernicious if above the 75th percentile. The main economic implication of the empirical finding is that in the upper quantile, both exchange rate depreciation and appreciation hurt industrial output, and hence, stock values. Thus, the multiple threshold nonlinear autoregressive distributed lag results suggest that the reactions of both stock prices and industrial output to exchange rate changes are highly sensitive to the extent of the shocks.

Energy scarcity is ubiquitous, and more acute in developing nations. Diversification of energy sources toward renewable energy is one of the world major approach in solving this problem. Thin film solar cells is universally recognized as one of the best way forward, thus investigation of low cost, non toxic inorganic materials for use in absorber and window layers in thin film photovoltaic solar cell devices will play a significant role in that regard. Thin films of antimony sulphide were grown using the solution growth technique. The films were doped with nickel impurities and annealed at annealing temperatures in the range 50 °C to 200 °C, with the annealing time fixed for 1 hour. The films were characterised using X-ray diffractometry to investigate the structural properties and UV-spectroscopy to investigate the optical properties, thus enabling to evaluate the optical constants (optical absorption coefficient, energy bandgap, refractive index, extinction coefficient, optical density, dielectric constants etc). The results from the structural analysis indicate that the films are mostly amorphous, and exhibited a polycrystalline form at an annealing temperature of 150 °C. The optical analysis show that the optical absorption coefficient were > 104 cm - 1, the energy bandgap was direct with values in the range 2.26 eV to 2.52 eV. The results of the optical studies (direct energy bandgap, values of the energy bandgap and low resistivity) indicate that the films will be utilised as window layers in solar cell devices and in other optoelectronic applications. [ABSTRACT FROM AUTHOR]

Economic activities in many sub-Saharan African (SSA) countries have weakened markedly in the last few years, with deterioration in trade balances, increasing foreign reserve depletion, and exchange rate depreciation. This situation has led to a call by the International Monetary Fund for more flexible exchange rate adjustment and even currency devaluation to reverse the economic downturn. This call for devaluation has generated controversy among economists and policymakers in these countries and has revived the need to study the effects of devaluation on economic output in SSA countries. This study therefore examines the asymmetric effects of currency devaluation as a policy shift on economic output between 1980 and 2019 in six selected SSA countries, namely Ghana, Kenya, Tanzania, Mozambique, Nigeria, and Malawi. The study employs the smooth transition regression (STR) model to determine the relative asymmetric responses of economic output to devaluation and nondevaluation regimes. The results of STR are mixed, as devaluation asymmetrically impacts positively and significantly on economic output in Ghana, Kenya, Tanzania, and Mozambique, but is insignificant in the case of Nigeria and Malawi. This mixed result suggests that the impact of currency devaluation on economic output differs across countries depending on the structure and size of the economy, the nature of goods produced, and the supportive policies in place, among other things. The policy implication of the findings is that policymakers in various countries should understand the peculiarity of core macroeconomic variables in order to design and implement robust policies.

A mechanistic based model for computing efficiency of an improved cassava attrition peeling machine was developed and evaluated in this study to enable performance predictions prior to fabrication. The model accounted for all relevant parameters affecting peeling with peeling efficiency established as a function of tuber mass, moisture content, drum speed, sphericity, peel thickness, number and surface area of peeling balls among others. The simulation model was developed using algebraic substitution/computation based algorithm. The comparative analysis validated the simulation model with the improved model's prediction error ranging from-0.006% to 0.011% resulting in over 99% prediction accuracy. Also, the simulation presented a user friendly interface that eliminated the computational rigors associated with error prone manual computations as a relief to researchers in the cassava processing sector. Hence, the improved peeling efficiency model and its simulation are recommended for developing varying capacities of cassava peelers required by end users in order to eliminate cost intensive trial and error associated with the empirical approach. [ABSTRACT FROM AUTHOR]

Seven disorders of cholesterol biosynthesis are recognized of which Smith-Lemli- Opitz syndrome (SLOS) is the most common. These disorders are associated with major developmental malformations, unusual for metabolic diseases. We reviewed the databases at the NCIMD and NCMG in order to identify all patients with inborn errors of cholesterol synthesis diagnosed in the 10 year period between June 1st 1997 and June 1st 2007. Clinical features (congenital malformations, behavioural phenotype, growth and developmental profile), biochemical features (plasma sterol profile at diagnosis), genotype, ethnic background and treatment were noted. Seven patients (age range 3-45yrs) attend the NCIMD making cholesterol pathway defects the 13th most common condition treated here. An additional 6 deceased patients were identified from the database at the NCMGs. All patients had SLOS. None of the other 6 disorders were identified. The seven patients are being treated with cholesterol supplementation in the form of a powder or egg yolk. The dose of cholesterol supplementation is titrated by monitoring growth, cholesterol and 7 dehydro-cholesterol levels and adjusting levels accordingly. There has been subjective improvement in general well-being and behaviour. Anecdotally parental perception is that supplementation has a huge beneficial effect. Cholesterol biosynthetic disorders are rare disorders in the Irish population but important to recognize as they are partially treatable. [ABSTRACT FROM AUTHOR]

Background: Little is known about community knowledge and stigma towards leprosy in endemic settings. The aim of this study was to evaluate community knowledge, attitudes and stigma towards leprosy in Nigeria., Methods: This was a mixed-methods study consisting of a quantitative cross-sectional survey of community members and qualitative focus group discussions with community members and people affected by leprosy as well as key informant interviews with healthcare workers and community leaders., Results: Of the 811 survey participants, 401 (49.4%) had a poor knowledge of leprosy that was driven by cultural beliefs, fear of its contagiousness and poor knowledge of its means of transmission. The participants reported high stigma levels with a mean score of 18.96±7.73 on the Explanatory Model Interview Catalogue Community Stigma Scale and 9.39±7.03 on the Social Distance Scale. Stigma levels were influenced by age, residence, education and knowledge of leprosy. Qualitative data suggested that community members were scared of leprosy infectiousness, and local illness concepts and misconceptions informed attitudes and behaviour towards leprosy in the community., Conclusion: Community members have a poor knowledge of, and high stigma levels towards leprosy. Culture-specific health education and behavioural change interventions are needed to address the identified gaps., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: In Nigeria, similar to many leprosy-endemic countries, leprosy is highly stigmatized. High levels of stigma among community members as well as internalized stigma among persons affected by leprosy often result in negative psychosocial consequences for those affected. To break this vicious cycle, it is important to conduct context-specific behavioral change activities. Although written material has been successful in improving knowledge and perception, it is not suitable for populations with low educational levels. Audio-delivered interventions are likely to be more suitable for people who are illiterate. This study proposes to assess the impact of an audio-delivered intervention on the perception (knowledge, attitudes, and beliefs) of community members with regard to leprosy in Nigeria., Objective: This study aims to assess the impact of audio-delivered and written health education on the perception of leprosy. Specific objectives are to (1) investigate the perception (local beliefs, knowledge, and attitudes) of community members toward leprosy and persons affected by leprosy; (2) investigate whether there is a difference in impact on perception between participants who have received audio-delivered health education and those who have received written health education, with specific reference to gender differences and differences between rural and urban areas; and (3) assess the impact of the participatory development of the audio-delivered and written interventions on empowerment and internalized stigma of persons affected by leprosy who developed the interventions. Additionally, we will translate and cross-culturally validate 4 study instruments measuring outcomes in 2 major Nigerian languages., Methods: We will use a mixed methods, cross-sectional study design for the intervention development and a 3-arm cluster randomized controlled trial for its implementation and evaluation, comprising (1) baseline assessments of knowledge, attitudes, perceptions, and fears of community members, to develop the audio-delivered content and written material, and the self-esteem and internalized stigma of persons affected by leprosy; and (2) participatory development of the audio-delivered content and written material by persons affected by leprosy and the pilot and implementation of the interventions. This will be done among different groups (selected using cluster randomization) that will be compared (control group, audio-intervention group, and written material group) to evaluate the intervention and the impact of developing the intervention on the persons affected., Results: This study was funded in June 2022, and community member participant recruitment started in January 2023. Baseline data collection was completed by May 2023 (n=811). Participatory cocreation of the audio and written health education content began in July 2023, and the materials are currently under development. Study results are expected in September 2024., Conclusions: Study findings will contribute to developing evidence-based, context-specific behavioral change interventions, which are critical to addressing stigma in many leprosy-endemic communities where leprosy is highly stigmatized, and contribute toward global triple zero leprosy efforts., Trial Registration: Pan African Clinical Trial Registry PACTR202205543939385; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23667., International Registered Report Identifier (irrid): DERR1-10.2196/53130., (©Ngozi Murphy-Okpala, Tahir Dahiru, Anna T van ’t Noordende, Carolin Gunesch, Joseph Chukwu, Charles Nwafor, Suleiman Hudu Abdullahi, Chukwuma Anyaike, Ugochinyere Angelic Okereke, Anthony Meka, Chinwe Eze, Okechukwu Ezeakile, Ngozi Ekeke. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 24.01.2024.)

Background: The Pulmonary Embolism Severity Index (PESI) is a validated tool to predict 30-day all-cause mortality in patients with acute pulmonary embolism (PE) but includes only clinical variables., Aims: We aimed to determine the effectiveness of PESI extended with an echocardiographic parameter., Methods: This cross-sectional observational study included consecutive patients with acute PE diagnosed with computed tomography pulmonary angiography., Results: Of 117 subjects (57 men, 48.7%), at a median age of 69 (59-80) years, 16 patients died during the 30-day follow-up. Six modified models of PESI with an additional single echocardiographic parameter were created, which increased the predictive value of PESI (area under the curve [AUC] 0.8608): tricuspid annular plane systolic excursion (TAPSE) <18 mm, right ventricular (RV) free wall longitudinal strain (RVFWLS) >-23%, 60/60 sign, RV global longitudinal strain (RVGLS) >-16%, pulmonary ejection acceleration time (AcT) <67 ms, and thrombus in right heart cavities (AUC 0.8657 to 0.8976, respectively, all markers P <0.001). TAPSE, AcT, RVFWLS, and RVGLS showed significant correlations with the PESI score, but not a thrombus in the right heart cavity or the 60/60 sign. As PESI adjuncts, they independently predicted fatal outcomes: thrombus with hazard ratio (HR) 10.04 (95% confidence interval [CI], 2.81-37.12; P <0.001) and the 60/60 sign with HR 4.07 (95% CI, 1.27-12.81; P <0.001)., Conclusions: The quantitative echocardiographic parameters of RV systolic function and pulmonary artery blood flow are associated with the PESI score and thus increase its predictive value to a limited extent. PE- specific findings: a thrombus in the right heart cavity and the 60/60 sign are effective adjuncts to the PESI score.

The fight against malaria is a continuum as the epidemic is not abating. For proper deployment of tools in the fight against malaria, an assessment of the situation is necessary. This work assessed the level of antimalarial drug treatment failure in Ebonyi State, Nigeria. Both survey and in vitro analyses were adopted. The survey was used to obtain qualitative information from both the malaria subjects and the pharmacies where antimalarial drugs are sourced. The results from the survey were complemented by an in vitro assay of the level of active pharmaceutical ingredients (APIs) in the commonly used artemisinin combination in Nigeria; artemether/lumefantrine. Results from the survey revealed that artemisinin combination therapies (ACTs) remain the mainstay in the treatment of malaria, even though other non-artemisinin drugs are still used. It also revealed that many patients still self-medicate, although, this may not be connected to the treatment failure seen among some malaria subjects. The in vitro assay showed that ACT contains the right quantity of APIs. Further surveillance is, therefore, necessary to understand the real cause of treatment failure among malaria subjects in Nigeria.

The global burden of malaria seems unabated. Africa carries the greatest burden accounting for over 95% of the annual cases of malaria. For the vision of a world free of malaria by Global Technical Strategy to be achieved, Africa must take up the stakeholder's role. It is therefore imperative that Africa rises up to the challenge of malaria and champion the fight against it. The fight against malaria may just be a futile or mere academic venture if Africans are not directly and fully involved. This work reviews the roles playable by Africans in order to curb the malaria in Africa and the world at large., (© 2022 Egwu CO et al.)

Diabetes mellitus (DM) underscores a rising epidemic orchestrating critical socio-economic burden on countries globally. Different treatment options for the management of DM are evolving rapidly because the usual methods of treatment have not completely tackled the primary causes of the disease and are laden with critical adverse effects. Thus, this narrative review explores different treatment regimens in DM management and the associated challenges. A literature search for published articles on recent advances in DM management was completed with search engines including Web of Science, Pubmed/Medline, Scopus, using keywords such as DM, management of DM, and gene therapy. Our findings indicate that substantial progress has been made in DM management with promising results using different treatment regimens, including nanotechnology, gene therapy, stem cell, medical nutrition therapy, and lifestyle modification. However, a lot of challenges have been encountered using these techniques, including their optimization to ensure optimal glycemic, lipid, and blood pressure modulation to minimize complications, improvement of patients' compliance to lifestyle and pharmacologic interventions, safety, ethical issues, as well as an effective delivery system among others. In conclusion, lifestyle management alongside pharmacological approaches and the optimization of these techniques is critical for an effective and safe clinical treatment plan.

This protocol describes a study in which we would assess the effect of using community lay counselors, self-help groups (SHGs), and trained frontline health workers to reduce mental disorders and improve quality of life (QOL) of persons affected by leprosy or Buruli ulcer (BU). A cluster randomized controlled study design will be employed. The study will involve persons affected by leprosy or BU. Ten local government areas (clusters) with the highest number of notified leprosy or BU cases between 2014 and 2018 in Southern Nigeria will be purposively selected. The clusters will be randomized into intervention and control groups using a computer-generated list of random numbers. At baseline, data were collected using the following validated questionnaires, Patient Health Questionnaire, Generalized Anxiety Disorder questionnaire, Stigma Assessment and Reduction of Impact Scale, World Health Organization QOL BREF and Warwick-Edinburgh Mental Well-being scale among persons affected by leprosy or BU. The intervention will last for 2 years and will involve use of community lay counselors, SHGs, and appropriately trained frontline health workers in reducing mental disorders and improving QOL of persons affected by leprosy or BU. This project postulates that the reduction of burden of mental health problems and improved QOL among persons affected by leprosy or BU could be achieved through a holistic approach involving SHGs, appropriately trained community opinion leaders, and general health-care workers as well as a functional referral system. If successful, the model will be integrated into the activities of the National Tuberculosis and Leprosy Control Programme and scaled up nationwide. Trial registration: ISRCTN Registry: ISRCTN 83649248. https://trialsearch. who.int/Trial2.aspx? TrialID % ISRCTN83649248 Prospectively registered., Competing Interests: None

Malaria burden has severe impact on the world. Several arsenals, including the use of antimalarials, are in place to curb the malaria burden. However, the application of these antimalarials has two extremes, limited access to drug and drug pressure, which may have similar impact on malaria control, leading to treatment failure through divergent mechanisms. Limited access to drugs ensures that patients do not get the right doses of the antimalarials in order to have an effective plasma concentration to kill the malaria parasites, which leads to treatment failure and overall reduction in malaria control via increased transmission rate. On the other hand, drug pressure can lead to the selection of drug resistance phenotypes in a subpopulation of the malaria parasites as they mutate in order to adapt. This also leads to a reduction in malaria control. Addressing these extremes in antimalarial application can be essential in maintaining the relevance of the conventional antimalarials in winning the war against malaria.

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level., Methods: We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods., Results: The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels 'high' and 'low' were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators., Conclusion: There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies., Competing Interests: The authors have declared that no competing interests exist.

Background: This study examines the global media framing of coronavirus disease 2019(COVID-19) to understand the dominant frames and how choice of words compares in the media. Periods of health crisis such as the outbreak of coronavirus pandemic add to the enormous burden of the media in keeping people constantly informed. Extant literature suggests that when a message is released through the media, what matters most is not what is said but how it is said. As such, the media could either mitigate or accentuate the crisis depending on the major frames adopted for the coverage. Methods: The study utilises content analysis. Data were sourced from LexisNexis database and two websites that yielded 6145 items used for the analysis. Nine predetermined frames were used for the coding. Results: Human Interest and fear/scaremongering frames dominated the global media coverage of the pandemic. We align our finding with the constructionist frame perspective which assumes that the media as information processor creates 'interpretative packages' in order to both reflect and add to the 'issue culture' because frames that paradigmatically dominate event coverage also dominate audience response. The language of the coverage of COVID-19 combines gloom, hope, precaution and frustration at varied proportions. Conclusion: We conclude that global media coverage of COVID-19 was high, but the framing lacks coherence and sufficient self-efficacy and this can be associated with media's obsession for breaking news. The preponderance of these frames not only shapes public perception and attitudes towards the pandemic but also risks causing more problems for those with existing health conditions due to fear or panic attack., (© 2020 The Author(s).)

Multidrug-resistant tuberculosis (MDR-TB) is presently a major public health threat. MDR-TB patients face diverse financial and psychosocial difficulties. Researchers conducted in-depth interviews based on interview guides with 42 participants. Data were analyzed using categorization, coding, generation of themes, and thematic memo writing. The key findings were as follows: Out of the 42 patients, 30 (71.4%) were males and 12 (28.6%) were females. All patients received financial stipends for transport and monthly social support. The patients however needed more financial support than they received (suggesting high unmet financial needs). Patients suffered depressive mood before and during treatment but received inadequate mental health/psychosocial care and treatment. Patients developed hearing impairment as a major adverse drug reaction, but the care and treatment they received were inadequate. In conclusion, the programmatic support provided for MDR-TB patients' financial and mental health/psychosocial needs and auditory drug side effects fell short of their need. Programmes for control of MDR-TB should increase budgetary allocations and ramp up mechanisms for provision of mental health/psychosocial support and care/treatment for drug side effects., (© 2019 John Wiley & Sons, Ltd.)

Introduction: Diabetes mellitus (DM) and tuberculosis (TB) are of great public health importance globally, especially in Sub-Saharan Africa. Tuberculosis is the third cause of death among subjects with non-communicable diseases. DM increases risk of progressing from latent to active tuberculosis. The study aimed to ascertain yield of TB cases and the number needed to screen (NNS) among DM patients., Material and Methods: Across-sectional study was conducted at 10 health facilities with high DM patient load and readily accessible DOTS center in 6 states of southern region of Nigeria over aperiod of 6 months under routine programme conditions. All patients who gave consent were included in the study. Yield and NNS were calculated using an appropriate formula., Results: 3 457 patients were screened with amean age (SD) of 59.9 (12.9) years. The majority were male, 2 277 (65.9%). Overall prevalence of TB was 0.8% (800 per 100 000). Sixteen (0.5%) were known TB cases (old cases). There were 221 presumptive cases (6.4%) out of which 184 (83.3%) were sent for Xpert MTB/Rif assay. Eleven (0.3%) new cases of TB were detected, giving additional yield of 40.7% and the number needed to screen (NNS) of 315. All the 11 patients were placed on anti-TB treatment., Conclusions: The prevalence of TB among DM patients was higher than in the general population. The yield was also good and comparable to other findings. This underscores the need for institute active screening for TB among DM patients. Further stu-dies are recommended to identify associated factors to guide policy makers in planning and development of TB-DM integrated services.

Background: Contextualising evidence to inform policy-making is increasingly recognised as key to developing and implementing effective health policies. Creating a one-stop shop for evidence is an approach that can facilitate timely access to the best evidence to inform policy decisions. We report outcomes after implementation of the Policy Information Platform (PIP), a pilot one-stop evidence repository in Nigeria designed to alleviate barriers to accessing policy-relevant knowledge., Methods: This cross-sectional study involved five phases, namely (1) consultation with Nigerian policy-makers to identify priority policy issues, areas of health policy information needs, and challenges and capacity constraints in accessing evidence for policy-making; (2) a stakeholder engagement workshop to formally launch the PIP; (3) extraction of data and other information from scientific articles, policy briefs, evaluation reports, grey literature and health policy documents relevant to policy-making in Nigeria (identified by Google and PubMed searches and by examination of websites of relevant Nigerian government ministries, agencies and parastatals), for use in developing the PIP website; (4) promotion of the PIP in national and state health policy meetings; and (5) evaluation of the PIP using a stakeholder survey questionnaire distributed via email and critical appraisal of the grey literature included in the PIP using the authority, accuracy, coverage, objectivity, date and significance (AACODS) checklist., Results: Priority policy areas identified by policy-makers were disease control and prevention, population health issues and health administration. Challenges identified by policy-makers were a lack of adequate capacity to access policy-relevant evidence and transform the evidence into policy. Policy-makers suggested using systematic reviews, policy briefs and rapid response mechanisms and involving policy-makers in research as ways of increasing evidence uptake for policy. A total of 126 policy-relevant, peer-reviewed scientific articles, 85 health policy documents and 201 policy-relevant grey literature documents were selected for inclusion in the PIP. Of the 195 individuals contacted via email to evaluate the PIP, 31 (15.9%) provided a response. Respondents noted that the PIP facilitated access to information based on local evidence and context-sensitive data. Barriers identified included lack of knowledge about the PIP and limited capacity of end-users to use the data compiled in the platform., Conclusion: An easily accessible one-stop shop of policy-relevant evidence can considerably improve policy-makers' access to evidence for use in policy-making and practice.

Objectives: To describe the trend of leprosy case notification among children from 2002 to 2012 in Southern Nigeria. 2. To identify the challenges faced by the children suffering from leprosy., Design: A retrospective descriptive desk analysis of leprosy case notification data for children from 0 to 14 years in 14 states in Southern Nigeria. Secondly, a cross sectional study of all children currently undergoing leprosy treatment in three selected clusters (referral centres) in Southern Nigeria. A questionnaire-based interview was used to identify the challenges faced by the children with leprosy., Results: Notified cases of leprosy among children in southern Nigeria decreased from 110 cases in 2002 to 64 cases in 2012. The median child proportion and MB proportion were 7.0% and 80.5% respectively. Two children (with WHO Grade 2 Disability) interviewed had great difficulty with their education and social life. Others were able to cope well in school and suffered no discrimination probably because their disease remained undisclosed to and unrecognised by the teachers. The school teachers were reportedly unable to recognise the symptoms/signs of leprosy in seven out of the 10 cases. Eight of the child leprosy cases were initially misdiagnosed at peripheral hospitals. The diagnostic delay ranged from 5 to 48 (with a median of 36) months. Notably, five out of the 10 children interviewed reported a positive household contact history., Conclusion: Notwithstanding the decline in leprosy case-notification in southern Nigeria over the past decade, transmission of the infection appears to be on-going as evidenced by the considerable number of child cases. Innovative approaches in case-finding including school-based activities and robust 'family-contact' management are recommended to address long diagnostic delays and lingering stigma.

Unlabelled: The objective of this study was to compare the first afebrile seizure management with internationally recognized standards in an Irish tertiary pediatric setting. Twenty-one management standards were derived from a combination of British (NICE 2004) and North American (AAN 2003) guidelines. Cases of first afebrile seizure presenting to a pediatric emergency department between July 2007 and June 2010 were assessed against the standards. On completion, the standards developed were presented to the relevant stakeholders, a nurse-developed parental advice sheet was introduced, and a re-audit was performed from July 2010 to June 2011. Forty children were identified in the initial audit period (A1) and 41 over the re-audit (A2). No case achieved full compliance with the devised standards in the audit period. A median compliance score of 15 (range 5-20) was achieved in A1 and 17 (range 11-21) in A2 [mean rank 31.93 versus 49.85; p(1,1) < 0.0001]. Optimal compliance (total score of ≥17) with devised standards was achieved in 6/40 patients in A1 and in 21/41 patients in A2 [χ (2) = 11.95; p(1,1) = 0.001]., Conclusion: We demonstrated an initial lack of compliance with international guidelines on management of a common medical presentation, first afebrile seizure, and demonstrated that improvements can be achieved by identification of appropriate standards and critical appraisal of the compliance with these standards through both formal and informal education.

Weight gain caused by antiepileptic drugs (AEDs) constitutes a serious problem in the management of people with epilepsy. AEDs associated with weight gain include sodium valproate, pregabalin and vigabatrin. Excessive weight gain can lead to non-compliance with treatment and to an exacerbation of obesity-related conditions. The mechanisms by which AEDs cause weight gain are not fully understood. It is likely that weight change induced by some AEDs has a genetic underpinning, and recent developments in DNA sequencing technology should speed the understanding, prediction and thus prevention of serious weight change associated with AEDs. This review focuses on the biology of obesity in the context of AEDs. Future directions in the investigations of the mechanism of weight change associated with these drugs and the use of such knowledge in tailoring the treatment of specific patient groups are explored.

With an annual new case detection of 4000 people, a Grade 2 disability rate of 12%, and nearly 10% child ratio among new cases, leprosy remains a disease of public health importance in Nigeria. Faced with the reality of low endemicity; a declining budgetary allocation to leprosy control; and a pervasive loss of expertise; it is necessary for Nigeria to re-organise its leprosy control services to further reduce the burden of the disease and ensure quality care to people affected by leprosy.

Background: The WHO has estimated that there are about 1300 million smokers globally and about 75 of these are in the developing countries. It is also predicted that if the current pattern of smoking continues, by 2020, there will be 10 million tobacco-related deaths annually worldwide and seven million (70%) of these deaths will occur in the developing countries. The objective of the study was to assess the cigarette smoking pattern and associated factors among male students in public secondary schools in Anambra State., Methods: The setting was public secondary schools in Anambra State. The study was in April 2008. It was a cross-sectional survey involving six schools, selected by multistage sampling technique. Eight hundred and fifty male students participated in the study. A semistructured self-administered questionnaire was used. Qualitative data were collected using focus group discussion (FGD)., Results: The mean age of respondents was 16 +/- 2.1 years. The ever-smoked and current smoking prevalence were 13.1% and 8.7% respectively. Mean age of commencement of cigarette smoking 13.7 +/- 2.6 years. Among smokers, 37.8% were dai smokers. Television (40.7%) and radio (33.3%) were the main sources of advertisement. Peer influence (34.2%) was the main reason for uptake of cigarette smoking. Major reason for not smoking among non-smokers was health concerns (57.9%). There were significant associations between smoking status and age of respondents (2 = 25.08; P = < 0.05), father's smoking status (2 = 158.77, P < 0.05), awareness of health hazards of smoking (2 = 5.13, P = 0.023) and advertisement on television (2 = 4.05, P = 0.044) and billboards (2 = 44.39, P < 0.05)., Conclusion: Cigarette smoking prevalence among secondary school boys in Anambra State is high. Health education and strict implementation of anti-smoking policies of the federal government of Nigeria is recommended.