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Changing patterns of cataract services in North-West Nigeria: 2005-2016.

ABSTRACT: This study was conducted to assess the impact of the eye care programme on cataract blindness and cataract surgical services in Sokoto, Nigeria over a 12 year period 2005-2016.Data from the 2005 population based cross-sectional study of blindness in Sokoto state was re-analysed to obtain baseline estimates of the prevalence of cataract blindness and cataract surgical coverage for persons 50 years and over in Wurno health zone. A population based survey of a representative sample of persons 50 years and over in Wurno health zone was conducted in July 2016. Data on eye health workforce, infrastructure and cataract surgical services between 2005 and 2016 were analysed from relevant documents.In 2005 the unadjusted prevalence of bilateral cataract blindness (<3/60) in people 50 years and over in Wurno health zone was 5.6% (95% CI: 3.1, 10.1). By 2016 this had fallen to 2.1% (95% CI 1.5%, 2.7%), with the age-sex adjusted prevalence being 1.9% (95% CI 1.3%, 2.5%). The CSC for persons with visual acuity <3/60, <6/60, <6/18 for Wurno health zone was 9.1%, 7.1% and 5.5% respectively in 2005 and this had increased to 67.3%, 62.1% and 34.7% respectively in 2016. The CSR in Sokoto state increased from 272 (1005 operations) in 2006, to 596 (2799 operations) in 2014. In the 2005 survey, couching (a procedure used by traditional practitioners to dislocate the lens into the vitreous cavity) accounted for 87.5% of all cataract interventions, compared to 45.8% in the 2016 survey participants. In 2016 18% of eyes having a cataract operation with IOL implantation had a presenting visual acuity of <6/60 (poor outcome) with the main causes being postoperative complications (53%) and uncorrected refractive error (29%).Between 2005 and 2016 there was a doubling in cataract surgical rate, a 7 times increase in cataract surgical coverage (<3/60), and a decrease in cataract blindness and the proportion of eyes being couched. However, there remains a high prevalence of un-operated cataract in 2016 indicating a need to further improve access to affordable and good quality cataract surgical services.

SUBMITTER: Muhammad N

PROVIDER: S-EPMC5560675 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:IntroductionChild mortality has been linked to infectious diseases, malnutrition and lack of access to essential health services. We investigated possible predictors for death and patients lost to follow up (LTFU) for paediatric patients at the inpatient department (IPD) and inpatient therapeutic feeding centre (ITFC) of the Anka General Hospital (AGH), Zamfara State, Nigeria, to inform best practices at the hospital.MethodsWe conducted a retrospective cohort review study using routinely collected data of all patient admissions to the IPD and ITFC with known hospital exit status between 2016 and 2018. Unadjusted and adjusted rate ratios (aRR) and respective 95% confidence intervals (95% CI) were calculated using Poisson regression to estimate the association between the exposure variables and mortality as well as LTFU.ResultsThe mortality rate in IPD was 22% lower in 2018 compared to 2016 (aRR 0.78; 95% CI 0.66-0.93) and 70% lower for patients coming from lead-affected villages compared to patients from other villages (aRR 0.30; 95% CI 0.19-0.48). The mortality rate for ITFC patients was 41% higher during rainy season (aRR 1.41; 95% CI 1.2-1.6). LTFU rates in ITFC increased in 2017 and 2018 when compared to 2016 (aRR 1.6; 95% CI 1.2-2.0 and aRR 1.4; 95% CI 1.1-1.8) and patients in ITFC had 2.5 times higher LTFU rates when coming from a lead-affected village.ConclusionsOur data contributes clearer understanding of the situation in the paediatric wards in AGH in Nigeria, but identifying specific predictors for the multifaceted nature of mortality and LTFU is challenging. Mortality in paediatric patients in IPD of AGH improved during the study period, which is likely linked to better awareness of the hospital, but still remains high. Access to healthcare due to seasonal restrictions contributes to mortalities due to late presentation. Increased awareness of and easier access to healthcare, such as for patients living in lead-affected villages, which are still benefiting from an MSF lead poisoning intervention, decreases mortalities, but increases LTFU. We recommend targeted case audits and qualitative studies to better understand the role of health-seeking behaviour, and social and traditional factors in the use of formal healthcare in this part of Nigeria and potentially similar settings in other countries.

Project description:IntroductionIn Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.MethodsA cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants' maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of <0.05 and confidence interval (CI ≠ 0).ResultsThe study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04).ConclusionsParticipants' willingness to pay for cataract surgery in outreach Sites is much lower than the surgery's actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility.

Project description:BackgroundAlthough anthrax is endemic in Lesotho, limited information is available on the patterns of the disease among livestock animals. This study investigated temporal patterns of anthrax outbreaks and cases among livestock animals in Lesotho.MethodsSecondary data of anthrax outbreaks reported to the Department of Livestock Services between January 2005 and December 2016 was used for this study. Proportions of anthrax outbreaks and cases, and their corresponding 95% confidence interval were calculated and compared across year, season, month and region using the Chi-square or Fisher's exact test. The autoregression model was used to evaluate annual trends of anthrax outbreaks and cases.ResultsA total of 38 outbreaks were reported in the Lowlands districts of Lesotho. District was significantly (p<0.0001) associated with outbreaks and cases, with the highest proportions of outbreaks (52.6%) and cases (70.2%) reported in Maseru. Significantly (p = 0.0004) higher proportions of anthrax outbreaks (78.9%) and cases (95.1%) were reported in the rainy-hot season compared to the dry-cold season. Five hundred and twenty-six (n = 526) anthrax cases were reported with significantly (p<0.0001) higher proportion of cases (70.3%) in cattle compared to other species. Higher proportion of anthrax cases (35.9%) were reported in 2008 and during the months of February (30.8%) and April (30.2%). There was no significant annual trend in anthrax outbreaks (r = 0.0282; p = 0.6213) and cases (r = 0.0873; p = 0.3512) over the study period.ConclusionThe burden of anthrax in Lesotho is significantly higher in cattle. Anthrax outbreaks occur only in the lowland districts and follow a seasonal pattern. Therefore, more effort should be targeted at curbing the disease in cattle and the lowlands districts. Furthermore, there should be heightened monitoring of cases in the rainy season to ensure that resultant carcasses are disposed of appropriately to minimise future outbreaks.

Project description:BACKGROUND:Although anthrax occurs globally, the burden of the disease remains particularly high in Africa. Furthermore, the disease anthrax has significant public health and economic implications. However, sufficient attention has not been given to the geographic distribution of anthrax outbreaks and cases in Lesotho. Therefore, this study investigates the spatial patterns of anthrax outbreaks and cases among livestock in Lesotho from 2005 to 2016. METHODS:A cross-sectional study design was adopted to realise the objectives of this study using retrospective data of anthrax outbreaks and cases recorded by the Department of Livestock Services (DLS) between 2005 and 2016. Anthrax outbreaks were geo-coded at village level and aggregated at district level. Proportions and 95% CI of anthrax outbreaks and cases by village and district were calculated. Cartographic maps displaying the distribution of anthrax outbreaks and cases at village and district level were constructed. RESULTS:A total of 38 outbreaks were reported over the study period, and they were clustered in the Lowlands districts of Lesotho. Most outbreaks (52.6%, 20/38) in livestock were reported in the Maseru district. The Leribe district reported the lowest proportions of outbreaks (5.3%, 2/38) and cases (0.6%, 3/526). At the village level, 18% (7/38) of outbreaks were in Maseru Urban, followed by Ratau (16%, 6/38) and Mofoka (13%, 5/38). The Maseru district reported the highest (1.3%, 369/29,070) proportion of cases followed by Mafeteng (0.9%, 73/8530). The village with the most cases was Kolo (10.5%, 21/200), followed by Thaba-Chitja (7.7%, 33/430). CONCLUSION:Anthrax outbreaks and cases exclusively occur in the Lowlands districts of Lesotho, with villages such as Mahobong, Pitseng, Kolo, and Thaba-Chitja having a higher risk of anthrax disease. Findings of the present study have serious public health implications in light of the fact that between 2003 and 2008 Lesotho's main abattoir was closed; hence, most of the meat in Lesotho was imported and/or sourced from the informal slaughter facilities. Much larger studies are needed to further investigate factors contributing to spatial disparities in anthrax outbreaks and cases observed in this study. Findings of the present study can be used to guide the formulation of a policy on prevention and control of anthrax in Lesotho.

Project description:Coral reefs of the North Indo-West Pacific provide important ecosystem services to the region but are subjected to multiple local and global threats. Strengthening management measures necessitate understanding the variability of larval connectivity and bridging global connectivity models to local scales. An individual-based Lagrangian biophysical model was used to simulate connectivity between coral reefs for three organisms with different early life history characteristics: a coral (Acropora millepora), a sea urchin (Tripneustes gratilla), and a reef fish (Epinephelus sp). Connectivity metrics and reef clusters were computed from the settlement probability matrices. Fitted power law functions derived from the dispersal kernels provided relative probabilities of connection given only the distance between reefs, and demonstrated that 95% of the larvae across organisms settled within a third of their maximum settlement distances. The magnitude of the connectivity metric values of reef cells were sensitive to differences both in the type of organism and temporal variability. Seasonal variability of connections was more dominant than interannual variability. However, despite these differences, the moderate to high correlation of metrics between organisms and seasonal matrices suggest that the spatial patterns are relatively similar between reefs. A cluster analysis based on the Bray-Curtis Dissimilarity of sink and source connections synthesized the inherent variability of these multiple large connectivity matrices. Through this, similarities in regional connectivity patterns were determined at various cluster sizes depending on the scale of interest. The validity of the model is supported by 1) the simulated dispersal kernels being within the range of reported parentage analysis estimates; and, 2) the clusters that emerged reflect the dispersal barriers implied by previously published population genetics studies. The tools presented here (dispersal kernels, temporal variability maps and reef clustering) can be used to include regional patterns of connectivity into the spatial management of coral reefs.

Project description:This study examined pyrethroid resistance intensity and mechanisms in Culex quinquefasciatus (Say) (Diptera: Culicidae) populations from Jigawa, North-West Nigeria. Resistance statuses to permethrin, lambda-cyhalothrin and alphacypermethrin were determined with both WHO and CDC resistance bioassays. Synergist assay was conducted by pre-exposing the populations to Piperonyl butoxide (PBO) using the WHO method. Resistance intensities to 2x, 5x and 10x of diagnostic concentrations were determined with the CDC bottle method. Species analysis and presence of knockdown mutation (Leu-Phe) were done using Polymerase Chain Reaction (PCR). Results showed that Cx. quinquefasciatus was the only Culex spp. present and "Kdr-west" mutation was not detected in all analyzed samples. Using WHO method, Cx. quinquefasciatus resistance to permethrin was detected in Dutse (12.2%) and Kafin-Hausa (77.78%). Lambda-cyhalothrin resistance was recorded only in Kafin-Hausa (83.95%) with resistance suspected in Ringim (90%). Resistance to alphacypermethrin was recorded in all locations. Pre-exposure to PBO led to 100% mortality to alphacypermethrin and lambda-cyhalothrin in Ringim while mortality to permethrin and alphacypermethrin in Dutse increased from 12.2% to 97.5% and 64.37% to 79.52% respectively. Using CDC bottle bioassay, resistance was also recorded in all populations and the result shows a significant positive correlation (R2 = 0.728, p = 0.026) with the result from the WHO bioassay. Results of resistance intensity revealed a very high level of resistance in Kafin-Hausa with susceptibility to lambda-cyhalothrin and alphacypermethrin not achieved at 10x of diagnostic doses. Resistance intensity was also high in Dutse with susceptibility to all insecticides not achieved at 5x of diagnostic doses. Widespread and high intensity of resistance in Cx. quinquefasciatus from North-West Nigeria is a major threat to the control of diseases transmitted by Culex and other mosquito species. It is a challenge that needs to be adequately addressed so as to prevent the failure of pyrethroid-based vector control tools.

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Changing patterns of cataract services in North-West Nigeria: 2005-2016.

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