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Khader Y, Jeong D, Odume B, Chukwuogo O, Dim C, Useni S, Okuzu O, Malolan C, Kim D, Nwariaku F, Nwokoye N, Gande S, Nongo D, Eneogu R, Odusote T, Oyelaran S, Chijioke-Akaniro O, Nihalani N, Anyaike C, Gidado M. Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions. JMIR Public Health Surveill 2023; 9:e40311. [PMID: 36753328 PMCID: PMC9947752 DOI: 10.2196/40311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/07/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots. OBJECTIVE We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. METHODS KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study. RESULTS During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively. CONCLUSIONS Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.
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Affiliation(s)
| | - Dohyo Jeong
- University of Texas, Dallas, TX, United States
| | - Bethrand Odume
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | | | - Cyril Dim
- College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Sani Useni
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Okey Okuzu
- InStrat Global Health Solutions, Abuja, Nigeria
| | - Chenchita Malolan
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Fiemu Nwariaku
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nkiru Nwokoye
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Stephanie Gande
- Technical Division, KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Debby Nongo
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Rupert Eneogu
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Temitayo Odusote
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Salewa Oyelaran
- Office of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and Tuberculosis, United States Agency for International Development, Abuja, Nigeria
| | - Obioma Chijioke-Akaniro
- National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Federal Ministry of Health, Abuja, Nigeria
| | | | - Chukwuma Anyaike
- National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Mustapha Gidado
- Program Management Unit, KNCV Tuberculosis Foundation, Hague, Netherlands
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Otu A, Okuzu O, Effa E, Ebenso B, Ameh S, Nihalani N, Onwusaka O, Tawose T, Olayinka A, Walley J. Training health workers at scale in Nigeria to fight COVID-19 using the InStrat COVID-19 tutorial app: an e-health interventional study. Ther Adv Infect Dis 2021; 8:20499361211040704. [PMID: 34457270 PMCID: PMC8385598 DOI: 10.1177/20499361211040704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. Methods: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated information about COVID-19 to frontline health workers and epidemic response officers across 25 states of Nigeria. The potential effectiveness of this app in training frontline health workers was assessed through online pre- and post-tests and a survey. Results: A total of 1051 health workers from 25 states across Nigeria undertook the e-learning on the InStrat COVID-19 training app. Of these, 627 (57%) completed both the pre- and post-tests in addition to completing the training modules. Overall, there were statistically significant differences between pre- and post-tests knowledge scores (54 increasing to 74). There were also differences in the subcategories of sex, region and cadre. There were higher post-test scores in males compared with females, younger versus older and southern compared with northern Nigeria. A total of 65 (50%) of the participants reported that the app increased their understanding of COVID-19, while 69 (53%) stated that they had applied the knowledge and skills learnt at work. Overall, the functionality and usability of the app were satisfactory. Conclusion: Capacity building for epidemic control using e-health applications is potentially effective, can be delivered at minimal cost and service disruption and can serve as a tool for capacity building in similar contexts.
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Affiliation(s)
- Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Emmanuel Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | | | - Obiageli Onwusaka
- Foundation for Healthcare Innovation and Development, Calabar, Cross River State, Nigeria
| | | | | | - John Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Abstract
The original treatment indicated for those suffering from neurotic anxiety was to employ psychotherapy to facilitate changes in behavior and coping with stressful events. A spectrum of somatic treatments "from cathartics and emetics to opium and "strengthening tonics", from atropine and digitalis to potassium bromide and chloral hydrate, from barbiturates to benzodiazepines", to serotonergics, came to be used as well [1]. The Food and Drug Administration originally approved many gamma-aminobutyric acid (GABA) facilitating drugs since the 1960s for anxiety treatment. The 1980s evidenced the approval of a few serotonergic treatments that cornered the prescribing market and the front line of most treatment protocols. More recently, GABAergic drugs are making a return in the treatment of anxiety disorders. The following paper details the pharmacodynamic history of treating anxiety and also updates the reader as to the newer GABA-based approaches mentioned above.
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Affiliation(s)
- T L Schwartz
- Psychiatry Department, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. The authors undertook a comprehensive literature review in order to provide a better understanding of novel treatment options in regards to alleviating weight gained by use of antidepressants, antipsychotics, and mood stabilizers. There are no agents for management of this weight gain approved by the Food and Drug Administration (FDA), and existing studies on options are mainly uncontrolled, small-scale projects with limited power to produce coherent conclusions. There is a clear need for larger studies on existing options, and future psychotropics without these side-effects are currently in the pipeline.
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Affiliation(s)
- T L Schwartz
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, NY 13210, USA.
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment, but consensus shows that weight gain is prominent. The present review looked at the aetiology and cause of weight gain associated with psychotropic use and presents hypotheses as to why patients gain weight on antipsychotics, mood stabilizers and antidepressants. It is found that most psychotropic medications induce some weight gain, and clinicians are encouraged to utilize active interventions to alleviate the weight gain in order to prevent more serious obesity related comorbidities.
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Affiliation(s)
- S Virk
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the aetiology of this weight gain and the potential treatments being used to alleviate this side-effect. We found solid evidence that weight gain is often associated with the mood stabilizers, and antipsychotics and antidepressants. Only few weight neutral or weight loss producing psychotropics are available, and weight gain, outside of an immediate side-effect, may generate secondary side-effects and medical comorbidity. Weight gain may cause hypertension, diabetes, osteoarthritis, sedentary lifestyle, coronary artery disease, etc. Given the likelihood of inducing weight gain with psychotropic medications and the longitudinal impact on physical health, a thorough literature review is warranted to determine the epidemiology, aetiology and treatment options of psychotropic-induced weight gain.
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Affiliation(s)
- T L Schwartz
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, NY 13210, USA.
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Bajaj P, Nihalani N, Shah N, Desai N, Shinde V, Raut N. Reemergence of positive symptoms of schizophrenia during the course of treatment with risperidone. Indian J Psychiatry 1999; 41:96-9. [PMID: 21455369 PMCID: PMC2962850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Thirty patients suffering from schizophrenia (diagnosed as per DSM-IV criteria), for more than 2 years and having predominant negative symptoms were started on risperidone (2-10 mg/day) and were followed up over a period of 16 weeks. The improvement was assessed using PANSS (Positive and Negative Syndrome Scale).During this 16 weeks follow up, it was interestingly noted that though there was a significant improvement in negative symptoms in all the patients, in 7 patients there was a reemergence of positive symptoms. Four patients had increase in rating on suspiciousness and hostility and two patients reported auditory hallucinations. One patient developed delusions and conceptual disorganization along with suspiciousness and hostility.
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Affiliation(s)
- P Bajaj
- PRIYA BAJAJ, MBBS., Senior Resident, L.T.M. Medical College and L.T.M. General Hospital, Sion, Mumbai-400 022
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Kale K, Nihalani N, Karnik N, Shah N. Postpartum psychosis in a case of sheehan's syndrome. Indian J Psychiatry 1999; 41:70-2. [PMID: 21455357 PMCID: PMC2962287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This case report describes a case of a 23 years old female who presented with clinical features of postpartum psychosis (Psychotic disorder not otherwise specified, DSM-IV). On investigation she was found to be suffering from Sheehan's syndrome (postpartum pituitary infarction). It was interesting to note that all the clinical features of Sheehan's syndrome and psychosis improved with hormone replacement therapy and she did not require treatment with antipsychotic medications.
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Affiliation(s)
- K Kale
- KEDAR KALE, M.B.B.S., Resident Medical Officer, Department of Psychiatry, L.T.M. Medical College & L.T.M. General Hospital, Mumbai 400 022
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Nihalani N, Dalvi M, Awana S, Shah N. Gender identity disorder : a report of three cases. Indian J Psychiatry 1998; 40:386-8. [PMID: 21494506 PMCID: PMC2966693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gender Identity Disorder (GID) is a complex problem. This report describes three cases of GID with more or less similar clinical presentation. It was interesting to note that inspite of the similarity in their early clinical features, their own approach towards their illness, the reaction of the family members and the outcome were different. The report also highlights the need for different therapeutic approaches required in the individual cases.
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Affiliation(s)
- N Nihalani
- NIKHIL NIHALANI, M.B.B.S., Resident Medical Officer, Department of Psychiatry, L.T.M Medical College & L.T.M. General Hospital, Mumbai - 400 022
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