Abstract:

Background: Guyana has the third highest incidence and rate of death from cervical cancer in the Western Hemisphere. The are several predisposing factors including HPV infection, early age of menarche, young age of first sexual experience and first full term pregnancy, multiple sexual partner, smoking, low socioeconomic status,.

Aim: to determine the common risk factors for cervical cancer among women attending the GPHC VIA clinic

Methodology: A Self-Administered pretested and validated questionnaire which seeks to identify common risk factors for cervical factors among all women between the ages of 16 and 35 that attended The VIA Clinic at GPHC. Data was collected during a 1 week period Monday to Thursday (VIA Clinic Days) , a total of 48 women participated in the Study.

Results: There was a 60% response to the study. 25% were of the low socioeconomic status. Only 18.7% of women had a papanicolaou smear in the last three years. 31.25% had a positive family history of cancer (breast and cervical). 18.8% had menarche before the age of 12 years. 95% of the women were sexually active with 47.9% having had their first sexual intercourse between the ages of 17-20. 21.7% of women had multiple sex partners and practice unprotected sexual intercourse . In addition a little less that half of the participants consumed a low fruit diet and a significant majority ate smoked and canned foods regularly

Conclusion: Lack and irregular use of condoms at every coitus, multiple partners, inadequate diet among others were the main factors that predisposes the women to become infected with the human papilloma virus and subsequently development of cervical cancer .

References:

[1.] Matti Lehtinen, TapioLuostarinen, Linda D. Youngman, Tarja Antila, Joakindillner, Timo Hakulinen, PenttiKoskela, Per Lenner and Goran Hallman; Low levels of serum vitamin A and E in blood and subsequent risk for cervical cancer: Interaction with HPV seropositivity; Nutrition and Cancer 34(2) 229-234 – 1999.

[2.] Yvonne N Flores, PhD, David M Bishai, MD, Keerti V Shah, MD, Eduardo Lazcano-Ponce, D en C, Attila Lörincz, MD, Mauricio Hernández, PhD, Daron Ferris, MD, Jorge Salmerón; Risk factors for cervical cancer among HPV positive women in Mexico; Salud Publica Mex 2008;50:49-58.

[3.] Weekly Epidemiological Record, 5/17/2002, Vol. 77 Issue 20, p167, 2p, Cervical cancer, oral contraceptives and parity

[4.] Alliance for Cervical cancer prevention (ACCP); Cervical Cancer Prevention Fact Sheet – May 2004

[5.] WHO - HPV Information Center; Human Papillomavirus and Cervical Cancer Summary Report Guyana; updated year 2007

[6.] Goodarz Danaei, Stephen Vander Hoorn, Alan D Lopez, Christopher J L Murray, MajidEzzati, and the Comparative Risk Assessment collaborating group ; Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors

[7.] Giuliano AR, Siegel EM, Roe DJ, Ferreira S, Baggio ML, Galan L, Duarte-Franco E, Villa LL, Rohan TE, Marshall JR, Franco EL; Ludwig-McGill HPV Natural History Study; Dietary intake and risk of persistent human papillomavirus (HPV) infection

[8.] Sedjo RL, Roe DJ, Abrahamsen M, Harris RB, Craft N, Baldwin S, Giuliano AR; Vitamin A, carotenoids, and risk of persistent oncogenic human papillomavirus infection

[9.] Center for Disease Control and prevention Fact sheet for public health personnel; Male latex condoms and sexually transmitted infections, June 2000

[10.] Herrero, Rolando, Reeves, William C., Brinton, Louise A., Garcia, Mariana, Brenes, Maria M., Gaitan, Eduardo, Tenorio, Francisco, Rawls, William E., de Britton, Rosa C.

[11.] Herrero, Rolando, Reeves, William C., Brinton, Louise A., Garcia, Mariana, Brenes, Maria M., Gaitan, Eduardo, Tenorio, Francisco, Rawls, William E., de Britton, Rosa C; Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population; J.P Lippincott company 1990

[12.] Atiene S. Sagay, Godwin E. Imade, Viola Onwuliri, Daniel Z. Egah, Matthew J. Grigg, Jonah Musa, Tom D. Thacher, James O. Adisa, Malcolm Potts and Roger V. Short: Genital Tract Abnormalities among Female Sex Workers

[13.] Who Douche with Lemon/Lime Juice in Nigeria: Afr J Reprod Health 2009;

[14.] Quinn, M., et al., Cancer Trends in England & Wales 1950-1999. Vol. SMPS No. 66. 2001: TSO.

[15.] U.S National cancer institute Factsheet, Heterocyclic amines in cooked meats.

[16.] United States Business And Finance, Article – Study links BPA to increased risk of prostate cancer by Kara Sissell.

[17.] Environmental Working Group, A Survey of Bisphenol A in U.S. Canned Foods, March 2006

[18.] Chemical Week, Article – Plastic Additives Bisphenol A linked to Breast Cancer, June 8, 2005 pg 43

[19.] V. Sasongkoa, Y. Jayasinghe MBBS FRANZCOG, EE. Moore MS, PhDb, S. Grover MD FRANZCOGa, S. Tabrizi PhD, S. Garland MD FRCPA FAChSHM FRANZOG, Ad Eundem (Senior Author) and Early Onset Cervical Cancer Study

Abstract:

Introduction: HBV and Syphilis share certain epidemiological characteristics and route of transmission with HIV, and co-infections are not uncommon. Against the backdrop of the need for understanding of the risk factors as a cornerstone for designing effective prevention and control interventions, this research determined the prevalence and some determinants of co-infection of hepatitis and syphilis among PLHIVs.

Methods: Descriptive cross sectional study among 350 PLHIVs seen at the General Hospital Calabar selected using multistage sampling method. Disease screenings were done using standard techniques. Data was analyzed using the SPSS software version 17.0.

Results: Prevalence of HBV and Syphilis were 0.014% and 0.086%, with co-infection rate of 1 out of 351 cases. Co-infections was not statistically significantly associated with any of the diseases (X² of 3.013 and p value of 0.006) despite only 205(58.3%) having low estimated sexual risk scores.

Conclusion: Though co-infection prevalence rate is low, HBV and syphilis screening should be included in pre-HAART care, and towards encouragement of sexual behavioural change among PLHIVs.

Key words: PLHIVs, Co-infections, Prevalence, Syphilis, HBV.

References:

[1]. Okocha EC, Oguejiofor CO, Odenigbo CU, Okonkwo UC, and  Asomugha L. Prevalence of hepatitis B surface antigen seropositivity among HIV-infected and non-infected individuals in Nnewi, Nigeria. Niger Med J. 2012 Oct-Dec; 53(4): 249–253.

[2]. Carmen Pittman, Sabrina Plitt, Ted Birse, Karen Doucette, Barbara Romanowski, Rya Cooper, et al. Prevalence and correlates of HIV and hepatitis B virus coinfection in Northern Alberta. Can J Infect Dis Med Microbiol. 2014 Spring; 25(1): e8–e13.

[3]. Goyal Ankur, Goyal Sapna,¹Lal Ankit, and Agrawal Arti. Very low prevalence of hepatitis B and C Co-infection in HIV-positive medical inpatients in a tertiary care hospital in Agra (UP), Northern India. Indian J Sex Transm Dis. 2012 Jul-Dec; 33(2): 147–148.

[4]. Silverman JG, Decker MR,  Gupta J, Dharmadhikari A, Seage GR and Raj A.Syphilis and Hepatitis B Co-infection among HIV-Infected, Sex-Trafficked Women and Girls, Nepal. Emerg Infect Dis. 2008 Jun; 14(6): 932–934.

[5]. Saravanan S, Velu V, Kumarasamy N, Nandakumar S, Murugavel KG, Balakrishnan P, et al. Coinfection of Hepatitis B and Hepatitis C Virus in HIV-Infected Patients in South India. World J Gastroenterol. 2007; 7:5015–20. [PMC free article] [PubMed]

[6]. Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006; 44:S6–9. [PubMed]

[7]. McGovern B. The epidemiology, natural history and prevention of hepatitis B: Implications of HIV coinfection. Antivir Ther. 2007;12(Suppl 3):H3–13. [PubMed]

[8]. Spradling P, Richardson J, Buchacz K, et al. Prevalence of chronic hepatitis B virus infection among patients in the HIV Outpatient Study 1997–2007. J Viral Hepatol. 2010; 17:879–86. [PubMed]

[9]. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. The Lancet. 2002; 360(9343):1347–60. doi: 10.1016/s0140-6736(02)11403-6

[10]. Ocama P, Opio CK, Lee WM. Hepatitis B virus infection: Current status. Am J Med. 2005; 118:1413? [PubMed]

[11]. McGovern BH, Sherman KE. Epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV infected patient. In: Thomas D, editor. 2009.

[12]. Puoti M, Airoldi M, Bruno R, Zanini B, Spinetti A, Pezzoli C, et al. Hepatitis B virus coinfection in human immunodeficiency virus infected subjects. AIDS Rev. 2002; 4:27. [PubMed]

Abstract:

Background: The field of transfusion medicine has encountered a huge problem in providing safe blood and blood products; therefore there is a need to improve testing for Transfusion transmitted Diseases (TTDs) and the selection of blood donors.

Objective: The objective of the present study was to estimate the prevalence of TTIs among healthy blood donors.

Methods: A total of 12,326 healthy blood donors reporting to our blood bank in Nnamdi Azikiwe University Teaching Hospital, Nnewi, were screened for Hepatitis B surface Antigen (HBsAg), Hepatitis C virus (HCV), Human Immunodeficiency virus (HIV) and Venereal Disease Research Laboratories (VDRL) tests.

Results: A total of 12,326 healthy blood donors aged 18-60 years were screened for TTIs. Out of these 333 donors (2.7%) were seropositive for HBsAg,219 (1.8%) were seropositive for HIV,195 (1.6%) were seropositive for HCV and 57 (0.5%) had shown sero positivity for syphilis. More male donors 660 (5.4%) were infected with TTIs than female donors 144(1.2%).The prevalence of TTIs in this study showed higher prevalence among donors 18 – 40 years of age (5.3%) compared to 41-60 years of age group. The rate of co infectivity in our study was 0.3% (33/12,326.

Conclusion: This study reflects that blood transfusion is one of the risk factors of spread of TTIs especially in developing countries where rapid test-based screening protocol tends to be used increasingly in blood banks. Therefore, proper donor selection and public awareness campaign targeting communities in poor countries will be an important measure to curb the spread of TTIs through blood transfusion.

Keywords: transfusion; HIV; HBV; HCV; syphilis; seroprevalence

References:

[1]. World Health Organization (WHO) Hepatitis B. Fact sheet Number 204.

[2]. United Nation Program on HIV/AIDS (UNAIDS). Global Factsheet; World AIDS day getting to Zero.

[3]. World Health Organization (WHO) Global Health Observatory Data Repository Data on the size of the HIV/AIDS epidemic: Prevalence of HIV 1 among adults.

[4]. Mujeeb SA, Kausar A, Khalid M. Seroprevalence of HBV, HCV, and HIV infection among college going voluntary donors. J Pak Med Assoc 2000; 50:269-70

[5]. Manzoor I, Hashmi N, Daud S: Seroprevalence of transfusion transmissible infections (TTIS) in blood donors. Biomedical 2009, 25:154-158.

[6]. EL-Gilany AH and EL-Fedawy. Blood borne infections among student voluntary blood donors in Mansoura University, Egypt. East Mediterr Health J. 2006 Nov; 12(6):742-8.

[7]. Moore A et al. Estimated risk of HIV transmission by blood transfusion in Kenya. Lancet. 2001 Aug 25; 358(9282):657-60.

[8]. Sentjens R et al. Prevalence and risk factors of HIV infection in blood donors and various population subgroups in Ethiopia. Epidemiol Infect. 2002 Apr; 128(2):221-8.

[9]. Schreiber GB, MP Busch, SH Kleinman, JJ Korelitz. The risk of transfusion transmitted viral infections- The retrovirus epidemiology donor study. N Engl J Med. 1996 Jun 27; 334(26):1685-90.

[10]. Isselbacher KJ, JR Wands, 1991. Neoplasms of the Liver, In Harrison’s principles of Internal Medicine. 12th Ed. New York

[11]. Ejele OA, Erhabor O, Nwauche CA. The risk of transfusion-transmissible viral infections in the Niger-Delta area of Nigeria. Sahel Medical Journal. 2005; 8(1):16-19

[12]. Bhatti FA et al. Anti-hepatitis B core antigen testing, viral markers, and occult hepatitis B virus infection in Pakistani blood donors: implication for transfusion practice. Transfusion. 2007; 47(1):74-79. This article on PubMed

[13]. Abdalla F, Mwanda FO,Rana W. Comparing walk-in and call-responsive donors in a national and a private hospital in Nairobi. East Afr Med J. 2005 Oct;82(10):531-5.

[14]. Matee MI et al. Prevalence of transfusion-associated viral infections and syphilis among blood donors in Muhimbili Medical Centre, Dar es Salaam, Tanzania. East Afr Med J. 1999 Mar; 76(3):167-71.

[15]. Alavian SM and Fallahian F. Epidemiology of Hepatitis C in Iran and the world. ShirazE-Medical Journal. Oct-2009;10(4)

[16]. Elfaki AM, Eldour AA and Elsheikh NM. Sero-prevalence of immunodeficiency virus, hepatitis B and C and syphilis among blood donors at ElObeid Teaching Hospital, West Sudan. Sudan Journal of Medical Sciences. 2008;3 (4):333-338

[17]. Erhabor O, Nwoka E, and Adias TC. Seroprevalence of Treponema palladium infection among blood donors in a resource-poor setting in the Niger Delta of Nigeria. Africa Sanguine.2007; 10(1):19-21

[18]. Zohreh A, Mazyar G, Bashir H, Sherun A and Seyed MA. Zero prevalence of syphilis among blood donors in Tehran, Iran. Transf Today. 2005; 64:24

[19]. Adjei AA, Kudzi W, Armah H and Adiku T. Prevalence of antibodies to syphilis among blood donors in Accra, Ghana. Jpn J Infect Dis. 2003 Aug; 56(4):165-7.

Abstract:

The antimicrobial activity of the ethanol extracts of two Nigerian chewing sticks (Terminalia glaucescens and Zanthoxylum zanthoxyloides) against oral bacteria and fungi isolates implicated in dental caries were assessed. The aim of the study is to isolate microbial organisms associated with dental caries and to assess the antimicrobial activity of the ethanol extracts of Zanthoxylum zanthoxyloides and Terminalia glaucescens stem used as chewing sticks. The dental extracts from 20 (twenty) patients with clinical features of dental caries were collected from School of dental technology and therapy clinic, Trans-ekulu, Enugu. The patients comprised of 8 males and 12 females with ages ranging from 16-40 years. The disc diffusion method was used in evaluating sensitivity to the extracts and it was observed that all the isolates were sensitive to T. glaucescens at different levels of concentration with a MIC and MBC of 6.25mg/ml for S. pyogenes. The isolated and tested dental pathogens were Escherisia coli, Pseudomonas aerugenosa, Streptococcus mutans, Streptococcus pyogenes, Staphylococcus aureus and Candida albicans. However, of the all the isolates E. coli proved resistant to Z. zanthoxyloides extract. Conventional antibiotics were used as positive control while distilled water was used as negative control.

The ability of T. glaucescens and Z. zanthoxyloides extracts to inhibit the growth of the bacteria and fungi in this study is an indication that the plant can be used as a source for antimicrobial agent in the formulation of toothpaste and mouth wash, thus justifying the use of the plant locally as chewing sticks.

References:

[1]. Akande, J.A. and Hayashi, Y. (1998). Potency of extract contents from selected tropical chewing sticks against Staphylococcus aureus and Staphylococcus auricularis. World Journal of Microbiology and Biotechnology, 14: 235-238.

[2]. Barry, A.L. and Thornsberry, C.P. (1991). Susceptibility Tests: Diffusion Test Procedures. In: Balows A, editor. Manual of Clinical Microbiology. 5th ed. Boston: Asm International; pp. 1117–25.

[3]. Fejerskov, O. R. and Kidd, E.N. (2003) .Dental caries: the disease and its clinical management. 1st ed. London: Wiley-Blackwell.

[4]. Fudulu, S.O. (1975). Antimicrobial properties of the buffer extracts of chewing sticks used in Nigeria. Planta medica; 27: 123-126.

[5]. Holding J.A. and Colee, J.G.(1971). “Routine biochemical tests,” in Methods in Microbiology, vol. 6, pp. 592–599.

[6]. Holt, J. G., Kreig, N. R., Sneath, P., Staley, J. and Williams, S.(1994).Bergey's Manual of Determinative Bacteriology. 9^th Edition.Williams & Wilkins, Baltimore. Pp. 65-73.

[7]. Kleinberg, I. (2002) .“A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to Streptococcus mutans and the specific-plaque hypothesis,” Critical Reviews in Oral Biology and Medicine, vol. 13, no. 2, pp. 108–125.

[8]. Ogundiya, M.O., Kolapo, A . L., Okunade, M .B. and Adejumobi, E. (2014). Evaluation of Phytochemical Composition and Antimicrobial Activity of Terminalia glaucescens Against Some Oral Pathogens. Advances Natural & Applied Sciences, 2(2): 89-93.

[9]. Pretorius, J.C., Magama, S. and Zietsman, P.C. (2003).Growth Inhibition of Plant Pathogenic Bacteria and Fungi by Extracts from Selected South African Plant Species. South African. Journal of Botany, 20: 188-192.

[10]. Schaeken, J.M., Van der Hoeven, J.S. and Franken, H.C.(1986). “Comparative recovery of Streptococcus pyogenes on five isolation media, including a new simple selective medium,” Journal of Dental Research, vol. 65, no. 6, pp. 906–908.

[11]. Wolinsky, L.E. and Sote, E.O. (1984). Isolation of natural plaque-inhibiting Substances from Nigerian chewing sticks. Caries Research, 18:216-225.

Abstract:

Background: Infant mortality is a global problem which the Millennium Development Goals has aimed to reduce by two-third by the year 2015. Several studies have linked social, behavioral and environmental factors to increased infant mortality rates in the past. The objective of this study was to review the existing literature on the effects of socio-behavioral and environmental factors affecting infant mortality.

Methods: A search of the literature was carried out. The search was conducted using web browsers like Google scholar, Pub Med, Medline and sociological abstracts. The articles were chosen when they were found to be relevant and were reviewed accordingly. Initially, the search was limited to recent articles not earlier than year 2000. But, when enough materials were not found, the search was extended to older articles because they were found to be highly relevant for the study.

Findings: This review revealed that social factors such as poverty, household income, mother’s economic status, nature of care for infants, maternal age, breastfeeding, birth orders, birth intervals, place of delivery, income inequality, social policies, health scheme, mother’s education and postnatal care were found to affect infant mortality. Similarly, environmental factors such as poor residential conditions, nature of water supply, particulate matter air pollution, poor sanitation, heavy metal poisoning and household environmental characteristics were found in the literature to be linked to infant mortality. Behaviors of pregnant women like cigarette smoking, alcohol drinking, sedentary lifestyle, weight gain, utilization of prenatal care facilities and exercises were found to be closely related to infant mortality.

Conclusion: It was concluded that many social, environmental and behavioral factors exist in the literature which were found to affect infant mortality. The knowledge of these factors should be utilized by both governmental and non-governmental organizations in the world to swing into action of arresting and preventing the menace of increasing infant mortality especially in the underdeveloped and developing countries.

Key words: Infant mortality, Social factors, Behavioral factors, Environmental factors.

References:

[1] G.O. Ayenigbara and V.B. Olorunmaye,‘Investigating the Causes of Infant Mortality in Akoko South-west Local Government Area of Ondostate, Nigeria’, Public Health Research (2012),Vol.2, No. 6, pp. 180-184.

[2] D. Umbersonand J.K. Montex, ‘Social Relationships and Health: A Flashpoint for Health Policy’, Journal of Health and Social Behavior.(2010),Vol.51 No. 1.

[3] A Peggy ‘Stress and Health: Major Findings and Policy implications’ Journal of Health and Social Behavior(2010),Vol.51 No. 1.

[4] M, Claeson,E.R. Boss, T. Mawji, I. Pathmanathan, ‘Reducing child Mortality in India in the new millennium’, Bull World Health Organ(2000),Vol.78, pp. 1192-1199.

[5] N.N. Manisha , W. Premila and A Proochita, ‘ Impact of non-health policies on infant mortality through the social determinants pathway’, Bulletin of the World Health Organization(2011), Vol.89 pp. 778-778.

[6] A.O Adepoju, O. Akanni and A.O.Falusi, ‘ Determinants of Child Mortality in Rural Nigeria’, World Rural Observations(2012), Vol.4 No. 2 pp. 38-45.

[7] C.K. Ajaero and O.I. Owoh,, ‘The Pattern and Determinants of Infant Mortality in Rural Nigeria’, Innovare Journal of Social Sciences(2013),Vol.1 No.1.

[8] E.M. Hisham and O. Clifford, ‘Socioeconomic Determinants of Infant Mortality in Kenya: Analysis of Kenya DHS’, Journal of Humanities and Social Sciences (2008), Vol.2, No.2.

[9] K. Daniel and S. Adrianna, ‘The Social Determinants of infant Mortality and Birth Outcomes in Western Developed Nations: A Cross-Country Systematic Review’, Int J Environ Res Public Health(2013), Vol. 10, No. 6, pp. 2296-2335.

[10] R.A. Bello and A.I. Joseph, ‘Determinants of Child Mortality in Oyo state, Nigeria’, African Research Review (2014), Vol. 8, No. 1, pp. 252-272.

[11] A. Davis, ‘Home Environmental Health Risks’, OJIN: The Online Journal Issues in Nursing(2007),Vol. 12, No. 2.

[12] R. Warren, B. Walker and V.R. Nathan, ‘Environmental factors influencing public health and medicine: Policy implications’, J Natl Med Assoc.(2002),Vol. 94, No. 4, pp. 185-193.

[13] K. Olden and S.L. White, ‘Health-related disparities: influence of environmental factors’, Med Clin North Am.(2005), Vol. 89, No. 4, pp. 721-38.

[14] A.W. Patricia, ‘Role of the environment in the decline of infant mortality: an analysis of the 1911 census of England and Wales’, Journal of Biosocial Science(2008), Vol. 18, No. 4, pp. 457-470.

[15] M. Patel, ‘Effects of the health service and environmental factors on infant mortality: the case of Sri Lanka’, Journal of Epidemiology and Community Health(1980), Vol. 34, pp. 76-82.

[16] K. Reinhard, R. Isabelle, M. Sylvia, S. Joel, K. Michal and K. Nino,‘Air pollution attributable post neonatal infant mortality in U.S. metropolitan areas: a risk assessment stud’, Environmental Health: A Global access Science Source (2004), Vol. 3, No.4.

[17] T.J. Woodruff, L.A. Darrow and J.D. Parker, ‘Air pollution and post neonatal infant Mortality in the United States, 1999-2002’, Environ Health Perspect. (2008),Vol. 116, No. 1, pp. 110-115.

[18] M.C. Godson and M.J. Nnamdi, ‘Environmental Determinants of Child Mortality in Nigeria’, Journal of Sustainable Development(2012), Vol. 5, No. 1.

[19] S.C. Gray, E.E. Sharon, D.S. Bradley and L.M. Marie, ‘Assessing the impact of race, social factors and air pollution on birth outcomes: a population-based study’, Environmental Health(2014), Vol. 13, No.4.

[20] Health and Behavior: The interplay of Biological, Behavioral and Societal Influences, NCBI resources (2001),www.ncbi.nih.gov/books/NBK43744.

[21] P.M. Lantz, S.H. James, M.L. James, R.W. David, P.M. Richard and C. Jieming, (1998). ‘Socioeconomic Factors, Health Behaviors and Mortality: results From a Nationally Representative Prospective study of U.S. Adults’, JAMA(1998), Vol. 279, pp. 1703-1708.

[22] G.M. Zahid, ‘Mother’s Health-Seeking Behavior and Childhood Mortality in Pakistan’ The Pakistan Development Review(1996), Vol. 35, No. 4, pp. 719-731.

[23] B.K. Finch, R. Frank and R.A. Hummer, ‘Racial/ ethnic disparities in infant mortality: the role of behavioral factors’ Soc. Biol.(2000), Vol. 47, No. 3-4, pp. 244-263.

[24] D.D. Reidpath, and P. Allotey, ‘Infant Mortality rate as an indicator of population health’J Epidemiol Community Health (2003), Vol. 57, pp. 344-346.

[25] P.M. Insel and W.T. Roth, 10th ed., Care Concepts in Health, New York, McGraw Hill (2006).

[26] G.W. Marsden, ‘Infant Mortality in Europe: Implications for the United States. Statement to the National Commission to Prevent Infant Mortality’, Journal of Public Health Policy(1998), Vol. 9, pp. 473-484.

[27] C. Reza, A. Ali, H.E. Mohammad, H.N. Kourosh, M. Majid, A. Elham, E. Rasool, S. Mohsen and S. Mohammad, ‘Important Risk Factors of Mortality among Children Aged 1-59 Months in Rural Areas of Shahroud, Iran: A Community-based Nested Case-Control Study’, Int J Prev Med.(2012), Vol. 3, No. 12, pp. 875-879.

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Abstract:

Objective: This paper evaluates HIV sero-positivity among Multi- Drug Resistance Tuberculosis adult patients at Ndola Central Hospital, Ndola, Zambia.

Research question: How many patients who were admitted at Ndola Central Hospital had HIV / MDR- TB co-infections, and how many died?

Method: A Retrospective Cohort study using the existing data and laboratory results in patient files and MDR TB register (sampling frame) were reviewed for all MDR TB patients whose culture and drug susceptibility test done at Ndola Central Hospital were assessed for HIV sero-status from January 2010 to June 2014. Review of records was done from 15/08//2014 to 22//o8/14 and sample comprised of 114 records which were available during the stated period using convenient sampling. A semi-structured questionnaire was used for data collection on the existing data base on patient’s file and MDR- TB patient register. Data analyzed using Epi data version 3 and bivariate analysis.

Results: The study revealed that 68.1% of the MDR TB patients were males, compared to 31.9% females; however there was no association between MDR TB and sex. The study showed that 42% of the respondents with MDR TB were co-infected with HIV. It also revealed that mortality among HIV / MDR TB co-infected patients was 36% and those negative accounted 12.7% showing an association between HIV sero status and MDR TB co-infection mortality.

Conclusion: HIV / MDR TB co-infection is a major public health problem needing urgent interventions, and proper treatment options for policy direction.

Keywords: Evaluation, HIV / MDR-TB co-infection, Ndola, Zambia.

References:

[1]. Nathason E va 2010 et al MDR Tuberculosis- critical steps for prevention and control.

[2]. "UNAIDS Report on the Global AIDS Epidemic 2012", UNAIDS, 2012 www.unaids.org/en/resources/campaigns/20121120_globalreport2012/

[3]. Personal communication

[4]. Suchindran, S. "Is HIV infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review" PLoS one, May 2009, 4(5): e5561http://www.plosone.org/article/

[5]. Global Tuberculosis Control 2012", WHO, Geneva, 2012 www.who.int/tb/publications/global_report/

[6]. "UNAIDS and the Stop TB Partnership join forces to stop HIV/TB deaths", UNAIDS, 2012 www.unaids.org/

[7]. Remarks by Nelson Mandela: "Confronting the Joint HIV/TB Epidemics", XV International AIDS Conference, Bangkok, 2004 http://quod.lib.umich.edu/c/cohenaids/

[8]. "Frequently asked questions about TB and HIV", WHO, Geneva www.who.int/tb/challenges/hiv/faq/en/

[9]. Luetkemeyer, A. "Tuberculosis and HIV", HIVInSite, http://hivinsite.ucsf.edu/

[10]. Mayer, K. "Synergistic Pandemics: Confronting the Global HIV and Tuberculosis Epidemics" Clinical Infectious Diseases, 2010, Volume 50, Supplement 3, S67 http://cid.oxfordjournals.org/content/50/Supplement_3/"

[11]. "Tribute to Winston", Action www.action.org/blog/post/tribute_to_winstone

[12]. "The Global Plan to Stop TB", WHO, Geneva, 2011, 12www.stoptb.org/global/plan/Personal communication

[13]. Mayer, K. "Synergistic Pandemics: Confronting the Global HIV and Tuberculosis Epidemics" Clinical Infectious Diseases, 2010, Volume 50, Supplement 3, S67 http://cid.oxfordjournals.org/content/50/Supplement_3/"

[14]. Mwiinga V. 2014: prevalence of Multi Drug Resistance Tuberculosis at Ndola Central Hospital (NCH) among Adults, Ndola, Zambia.(un published)

[15]. "Frequently asked questions about TB and HIV", WHO, Genevawww.who.int/tb/challenges/hiv/faq/en/

[16]. Bond V., Chileshe M. Magazi B. Zambart Project: Zambia and South Africa ; Final working report February 2009, Renewal program. WHO (2005).

[17]. WHO (2007) (WHO, United nation joint programme on HIV / AIDS. Guidance on provider initiated HIV testing and counseling in health facilities. Geneva.

[18]. Manda SOM, Masenyetse LJ, Lancaster JL , van der Walt ML (2013) Risk of Death among HIV Co-Infected Multidrug Resistant Tuberculosis Patients, Compared To Mortality in the General Population of South Africa. J AIDS Clinic Res S3:007. doi: 10.4172/2155-6113.S3-007

[19]. Deivanayagam CN1, Rajasekeran S, Venkantesan R, Mahilmaran A, Ahmed PR, Annadurai S, Kumar S, Chandrasekar C, Ravichandran N, Penicillaiah R, (2002) Prevalence of acquired MDR TB & HIV co-infection. www.ncbi.nlm.nih.gov/pubmed/12437236

[20]. WHO Global Tuberculosis Report 2014 Supplement DRUG-RESISTANT TUBERCULOSIS SURVEILLANCE & RESPONSE

[21]. 21. WHO (2012) Global TB control, Geneva. www.who.int/tb/publications/global report

[22]. UNAIDS: 27-29 May (2014) Public-Private mix. Model for the sustainability of successful TB control initiatives

[23]. UNAIDS (2014) Twin epidemic HIV & TB co-infection

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[25]. Ndola Central Hospital: MDR TB WARD; HMIS 2009 TO 2014: CASES of MDR TB patients who were admitted at NCH.

[26]. MOH: The National tuberculosis and leprosy program. TB manual 3^rd edition.

[27]. PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/24215798

[28]. DOI: http://dx.doi.org/10.1016/j.tube.2013.08.009 Home » Citations » Journal of AIDS & clinical research » Risk of Death among HIV Co-Infected Multidrug Resistant Tuberculosis Patients, Compared To Mortality in the General Population of South Africa.

Abstract:

Introduction: According to the WHO, malnutrition remains the biggest contributor to child mortality with 6 million children dying from hunger each year. In 2010, protein energy malnutrition was estimated to have resulted in 600 000 deaths from 883000 deaths, in 1990 another 8400 deaths resulted from iodine and iron deficiency.

The general objective of the study was to find out if mothers of the under-fives leaving in the Bamendakwe Health Area are knowledgeable of the preventive measures against malnutrition.

Materials & Methods: A descriptive cross-sectional design was employed in which a structural questionnaire was used for the collection of primary data from a sample of mothers with under-five children on their knowledge in the prevention of malnutrition.

Results: Results obtained show that feeding a child with a balanced diet will help prevent malnutrition in children less than 5 years.

Discussion: Mothers lacked the means to prevent malnutrition, lacked the knowledge of different foods to feed the child to prevent malnutrition. Ignorance and poverty are associated with malnutrition; according to Kammann (2003), ignorance, lack of adequate funds, unemployment leads a deficit in the means to purchase the right kind of foods rich in proteins.

Conclusion: Malnutrition remains a serious paediatric problem in the under-fives as mothers’ deficit on balanced dieting can result to malnutrition.

Key words: Malnutrition, Marasmus, Kwashiorkor, Health education, Balanced Diets, Breastfeeding, Sanitation, Behaviour Change Communication

References:

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Abstract:

Childhood diseases, pediatric cancer burden, Baptist Hospital Mutengene, Cameroon.

The pattern of disease burden has changed worldwide in past decades. Non communicable diseases, including cancers, are the main cause of mortality and morbidity in both high income countries (HICs)and low and middle income countries (LMICs). Pediatric oncology is not seen as a child health priority in most LICs like Cameroon amongst many others where pediatric cancer data are fragmented. The objective of this study was to generate data on childhood diseases at Baptist Hospital Mutengene(BHM) and to measure the burden attributed to pediatric cancerusing incidence, mortality, cancer related admission and quality of life in cancer survivors in order to guide resource allocation to the pediatric ward. A retrospective cohort study and a secondary data analysis were conducted from 2006 to 2013. Communicable diseases (malaria, chest infection and diarrhea) constitute the main burden of childhood diseases at BHM based on incidence and mortality. Pediatric cancers led by Burkitt lymphoma are contributing to an extent to the burden of childhood diseases with a proportionate incidence of 1 to 2 cases per 1000 per year and an admission rate of 31.8 per 1000 per year. 26 (13%) of 193 Burkitt lymphoma patients suffered a disability in the course of their illness and treatment and 2 (7.6% of the 26 but 1% of the 193) had a permanent disability due to Burkitt lymphoma, the leading pediatric cancer at BHM .Pediatric cancers contribute to increasing the burden of childhood diseases at BHM based on incidence, admission rate and quality of life of cancer survivors.

References:

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[9]. Enow-Orock G. E, Pondy A, Doumpe P, Koki N, Lemerle J(2012).A pediatric oncology group pilot study on childhood cancers at the Chantal Biya Foundation Yaounde, Cameroon: Report of 350 cases. Scientific research and essays Vol. 7(25), pp. 2237-2241, 5 July, 2012. Available online at http://www.academicjournals.org/SRE

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[17]. Bonita R, BeagleholeR,KjellströmT (2006). Measuring health and disease Chapter 2, Basic epidemiology 2^ndedition. World Health Organization

[18]. Stefan DC, Baadjes B, Kruger M (2014).Incidence of childhood cancer in Namibia-the need for registries in Africa.The Pan African Medical Journal. 2014;17:191. Permanent link: http://www.panafrican-med journal.com/content/article/17/191/full. Doi:10.11604/pamj.2014.17.191.3830

[19]. UNAIDS 2014 PROGRESS REPORT ON THE GLOBAL PLAN towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive

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[21]. Hesseling PB.(2012). The SIOP Burkitt lymphoma pilot study in Malawi. Medical and pediatric oncology 200; 34:142

Abstract:

This study on perceptions, practices, and levels of physical activity (PA) promotion by nurses and physicians in Kanye health facilities is a quantitative cross-sectional research. The population comprised 220 prospective respondents (205 nurses and 15 physicians). Of those who agreed to participate, data were collected using a self-administered structured questionnaire after a pilot study. Simple random sampling was used in data collection. Data were analyzed using STATA. Findings were presented in the form of tables and graphs. Results showed 98.4% perceive PA as promoting health, while 92.3% said PA promotion is a daily duty of nurses and physicians. Of the total respondents, 61.3% were engaged in PA. A major finding of this research is that 89.2% of respondents perceive that PA promotion should be a requirement for contemporary health facilities. Results showed that a good number of respondents (67.6%) reported that they promote physical activity. Thus, hypothesis number two that there is a high proportion of nurses and physicians who do not promote PA was rejected at 0.05 level of significance. The study recommended the inclusion of PA promotion and skills in the curriculum of nurses and physicians.

Key words: physical activity (PA), PA promotion, general practice, moderate-intensity PA, engaged in PA.

References:

[1]. Conn, S.V. (2004). Anxiety outcomes after physical activity interventions – meta-analysis findings. Nursing research 59(3), 224-231.

[2]. World Health Organisation (2004). Global Strategy on Diet, Physical Activity and Health. Geneva.

[3]. Donaldson (2009). www.dh.gov.uk/publications

[4]. Fallon, A. E. and Hausenblas, A. H. (2004). Trans-theoretical Model: is termination applicable to exercise? American Journal of Health Studies

[5]. Finn, K., Johannsen, N., and Specker, B. (2002). Factors associated with preschool children. Journal of of Pediatrics. Iowa: Mosby.

[6]. Fox, K., Biddle, S., Edmunds, L., Bowler, I., and Killoran, A. (1997). Physical activity promotion through primary health care in England. British Journal of General Practice 47, pp. 367-369.

[7]. Hagberg (2005). Updated physical activity guidelines 2007. Atlanta: American College of Sports Medicine

[8]. Family Heritage Books (2001). Radiant Living, Simple Steps to Health and Happiness.

[9]. Lim, K., and Taylor, L. (2005). Factors associated with physical activity among older people – A population-based study. Preventive Medicine 40, pp. 33-40.

[10]. Wildwood: Project Restore. Ludington, A. & Diehl, H. (2000). Health Power, Health by Choice Not Chance. Hagerstown: Review and Herald.

[11]. Ribera, A. P., McKenna, J. and Riddock, C. (2005). Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system. The European Journal of Public Health 15 (6), 569-575.

[12]. US Department of Health and Human Services (1996). Physical activity and health: A report of the Surgeon General. Atlanta: Department of Health and Human Services, Centres for Disease Prevention Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, the President’s Council on Physical Fitness and Sports.

[13]. Guallar-Castillon, P., Lopez Garcia, E., Lozano, Palacios, L., et al (2002) The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women. Int J Obes 26, 247-242.

[14]. Epstein, L. H. (1998). Integrating theoretical approaches to promote physical activity. Am J Prev Med 15, 257-265.

[15]. Sparling, P.B., Owen, N., Lambert, E.V., Haskel, W. L. (2000). Promoting physical activity: the new imperative for public health. Health education research 15(3), 367-376.

[16]. Harrabi, I., Maatoug, J., Gaha, M., Kebaili, R., Gaha, R., and Ghannem, H. (2009). School-based intervention to promote healthy lifestyles in Sousse, Tunisia. Indian Journal of Community Medecine 35(1), 94-99.

[17]. Hancock, T. (2007). The Ottawa Charter for health promotion: A critical reflection background to the 19^th IUHPE World conference on health promotion and health education, “Health promotion comes of age: Research, policy, & practice for the 21^st century.” Supplement, www.iuhpe.org

[18]. Lobelo, F., Duperly, and Frank (2009). Physical activity habits of doctors and medical students influence their counselling practices. British Journal of Sports Medecine 43, 89-92.

[19]. Robertson, M.C., Devlin, N., Gardner, M.M., and Campbell, A. J. (2001). Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls – two: controlled trial in multiple centres. The Journal of the royal society for the promotion of health 121, 143-143

[20]. Rollo, I. (2004). Understanding the role of exercise in health promotion. Nursing Time. (100), 37, p. 36.

[21]. Elley, R. C., Kerse, N., Arroll, B., Robinson, E. (2003). Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. British Medical Journal 326, 793

[22].Chiverton, P. A., Votava, K. M. and Tortoretti, D.M. (2003). The future role of nursing in health promotion. American Journal of health promotion 18 (2), 192-194.

[23].McKenna, J., Naylor, P.J., and McDowell, N. (1998). Barriers to physical activity promotion by general practitioners and practice nurses. British Journal of sports Medicine 32, 242-247.

[24].McKenna, J., Naylor, P.J., and McDowell, N. (1997). Factors that influence practice nurses to promote physical activity. British Journal of Sports Medicine 31, 308-313.

[25].Ryan, M. K. (2008). Health promotion of faculty and staff: the school nurse’s role. The Journal of school nursing 24(4), 183-189.

[26].U.S. Department of health and human services, Centres for disease control and prevention, National centre for chronic disease prevention and health promotion, and the President’s council on physical fitness and sports (1999). Physical activity and health, a report of the Surgeon General Executive Summary. Atlanta: National centre for chronic disease prevention and health promotion.

[27].Steptoe, Doherty, Kendrick, Rink, and Hilton (1999). Attitudes to cardiovascular health promotion among general practitioners and practice nurses. Family practice 16 (2), 158-163.

[28].Ptlotnikoff, R.C., Taylor, L.M., Wilson, P.M., Courneya, K.S., Sigal, R.J., Birkett, N., Raine, K., and Svenson, L.W. (2006). Factors associated with physical activity in Canadian adults with diabetes. Medical Science Sports Exercise 38(8), pp. 1526-1534.

[29].www.who.iint World Health Organisation (2006).. Working Together – The World Health.

Abstract:

Study aimed at determining prevalence of Multi Drug Resistance Tuberculosis at Ndola Central Hospital among Adults, Ndola, Zambia.

A retrospective cohort study review was conducted among adult MDR-TB patients at Ndola Central Hospital from 15^th August to 22^nd August 2014. All records for MDR TB patients from MDR TB ward were reviewed (January 2010 up to June 2014). Sample size was 114, Convenient sampling was done using MDR- TB treatment register and laboratory results. Data was analyzed using Epi Data version 3, and Pearson Chi square. The findings revealed that 48.2% of the patients with MDR TB had sputum positive results for culture, compared to 6.6% whose sputum was negative. The study also found that, of all (114) MDR TB patients who were admitted in MDR TB ward at Ndola Central Hospital, only 44% had Multi drug resistance , 33% had Mono resistance, while 22.6% had Poly resistance. The findings revealed that 29.8% were new cases, 23.7% treatment failure, and 4.9% relapse. Discussion of findings shows that; almost 50% of the respondents had MDR TB which was confirmed by sputum culture results and others had poly resistance and mono resistance. The respondents were either new cases, treatment failure or relapse cases, which showed that there could be other factors associated with drug resistance.

Conclusion: prevalence rate of MDR TB was 44% and is major threat for TB control measures and proper treatment options.

Keywords: Prevalence, MDR-TB Resistance, Ndola, Zambia.

References:

[1]. WHO (2014): Global Tuberculosis Report 2014. WHO Library Cataloguing-in-Publication Data. ISBN 978 92 4 156480 9

[2]. Dalton Dr Tracy Dalton, Peter Cegielski, MD,Somsak Akksilp, MD, Luis Asencios, MPH, Janice Campos Caoili, MD, Prof Sang-Nae Cho, PhD, Vladislav V Erokhin, MD, Julia Ershova, PhD, Ma Tarcela Gler, MD, Boris Y Kazennyy, MD, Hee Jin Kim, MD, Kai Kliiman, MD, Ekaterina Kurbatova, MD, Charlotte Kvasnovsky, MD, Vaira Leimane, MD, Martie van der Walt, PhD, Laura E Via, PhD, Grigory V Volchenkov, MD, Martin A Yagui, MD, Hyungseok Kang, MD, (2012) The Global PETTS ; 1406-17; “prevalence of and risk factors for resistance to second line drugs in people with multi drug resistance tuberculosis in eight countries. A prospective cohort study” the Lancet 380(9851)

[3]. Scientific Facts on drug resistance Tuberculosis (http:// www.greenfacts.org/en/tuberculosis/1-2-mdr-tb-xdr.htm)

[4]. Farmer Paul (2001) “The major infectious diseases in the world- to treat or not to treat?” New England journal of medicine 345 (3): 208-10.

[5]. Blower SM, Chao T, Modeling the emergency of the ‘hot zones’: Tuberculosis and amplification dynamics of the drug dynamics of drug resistance. Nat med 2004 ;10 (10): 1111-6

[6]. Mirsaedi SM, Tabasi P, Khoshnood K, Pooramir, M V, Rowhani- Rahbar A, Mansoori S D (2005); Treatment of multiple drug resistance tuberculosis MDR – TB in Iran. Int/ infect dis 2005;9;(6):317-22

[7]. CDC June 1992/ 41(RR-11); 59-71 management of persons exposed to multidrug resistant tuberculosis. Recommendations and reports.

[8]. WHO multi drug and extensively drug resistant to Tb (m/xdr-Tb): 2010 Global report on surveillance and response 2010.

[9]. Nathason Eva Eva Nathanson, M.Sc., Paul Nunn, F.R.C.P., Mukund Uplekar, M.D., Katherine Floyd, Ph.D., Ernesto Jaramillo, M.D., Ph.D., Knut Lönnroth, M.D., Ph.D., Diana Weil, M.Sc., and Mario Raviglione, M.D. 2010 MDR Tuberculosis- critical steps for prevention and control. N Engl J Med 2010; 363:1050-1058September 9, 2010DOI: 10.1056/NEJMra0908076

http://heraf.or.ke/Africa/xdr-and-mdr-tb-in-kenya.html

[10]. Weyner Karin 2003 MDR-TB in South Africa: New Strategies and policies, MCR Unit for Tb operational and policy Research. Pretoria.

[11]. MOH : The National TB/Leprosy Control Programme; Guidelines for the Programmatic Management of Drugs- Resistant Tuberculosis, Draft Copy.

[12]. Kapata N., Chanda-Kapata P, Bates M, Mwaba P, Cobelens F, Grobusch MP, Zumla A. (2013) Multi Drug Resistant TB in Zambia: a review of national data from 2001 to 2011.

[13]. Ndola Central Hospital: MDR TB WARD;HMIS 2009 TO 2014 : CASES of MDR TB admitted

[14]. Surveillance and DOTs Implementation in Zambia; 2006 Data.

[15]. Fantahun Biadglegne1,2,3,4*, Ulrich Sack3,4 and Arne C Rodloff (2014): Multidrug-resistant tuberculosis in Ethiopia: efforts to expand diagnostic services, treatment and care http://www.aricjournal.com/content/3/1/3. Retrieved on 28/11/15.

[16]. World Health Organization(2013): Global Tuberculosis control. Geneva: World Health Organization; 2013. (http://www.who.int/tb/data).

Abstract:

Objective: To determine the prevalence rate of Human Immuno-deficiency Virus(HIV) among tuberculosis (TB) patients in a general hospital in Lagos, Nigeria.

Methods: This is a cross-sectional study. Demographic information was retrieved from the register of TB patients, HIV testing was done through rapid testing and confirmation by the hospital laboratory. Descriptive statistics was used to get the characteristics of the study participants. Bivariate analysis was performed for estimation of odd ratio (OR) and 95% confidence interval (CI). Chi square was utilized for the determination of the relationships that exists between study variables. P-values <0.05 were considered significant.

Results: All the 130 patients gave consent to be tested for HIV. Eighty-eight (88) of the patients were male representing 67.7% of the patients and 85.4% of the patients had sputum smear positive pulmonary tuberculosis (TB) while the rest were sputum smear negative, 20 (15.4%) were HIV-positive. HIV prevalence among male patients was 13.6% (p value=0.42), but 19.1% (p value=0.42)among female patients. Prevalence of HIV among sputum smear positive pulmonary TB patients was 13.5% (p value=0.15) and 26.3% (p value=0.15) among sputum smear negative patients.

Conclusions: This study revealed that HIV prevalence is higher among pulmonary TB patients than among the general population in Nigeria. It further lays credence to the close link that exists between active TB and HIV/AIDS infection in Nigeria, and the higher proportion of sputum smear negativity is found in HIV positive patients. There is a need therefore for a program to address HIV/TB co-infection.

Keywords: Tuberculosis, HIV, co-infection, Lagos, Nigeria.

References:

[1]. Akinleye, O.M., Alo, O.G., Salami, O.O., Alaka-Coker, A.A., Idris, M.G. and Onyeoghani, N. (2015). Tuberculosis and HIV co-infection among patients attending directly observed treatment short course (DOTS) in Lagos, Nigeria. Archives of Applied Science Research, 2015, 7 (7):69-74.

[2]. Barnes, P.F., Bloch, A.B., Davidson, P.T., Snider, D.E. (1991). Tuberculosis in patients with human immunodeficiency virus infection. N. Engl. J. Med. 1991;324:1644-1650.

[3]. Daniel, O.J., O.T. Oladapo, A.A. Salako, C.A. Iyaniwura and F.A. Oluwole, 2005. Gender and TB/HIV co-infection: Presentation and treatment outcome in Nigeria. Nig. Med. Practitioner, 47: 58-60.

[4]. Erhabor,O., Jeremiah, Z.A., Adias, A.C. and Okere, C.E. (2010). The prevalence of human immunodeficiency virus infection among TB patients in Port Harcourt Nigeria, HIV/ AIDS—Research and Palliative Care, Vol. 2, 2010, pp. 1-5.

[5]. Global HIV/AIDS Initiative Nigeria (2010). GHAIN support to TB-HIV integration: End of project monograph. Accessed on 28^th August, 2015 at: http://www.fhi360.org/sites/default/files/media/documents/GHAIN%20support%20to%20TB-HIV%20integration.pdf

[6]. Hasnain, J., Memon, G.N., Memon, A., Channa, A.A., Creswell, J. and Shah, S.A. (2012). Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan. BMJ Open 2012; 2:e001677. doi: 10.1136/bmjopen-2012-001677

[7]. Knox, G. and R. Guglielmo, R. (2006). Global report on TB and HIV: New analysis of TB/HIV epidemics in Bangladesh. Brazil, Nigeria, Tanzania and Thailand, Press Release.

[8]. Onubogu, C.C., Kunle-Ope, C.N., Onyejepu, N., Nwokoye, N.N., Raheem, T.Y., Igbasi, U.T., Tochukwu, N.E., Omoloye, R.M., Ejezie, C.O., Musa, A.Z., Odunukwe, N.N., Onwujekwe, D.I., and Idigbe, E.O. (2010). Prevalence of tuberculosis and human immunodeficiency virus (TB/HIV) co-infections amongst patients with bronchopulmonary disorders in Lagos. African Journal of Microbiology Research Vol. 4(18), pp. 1904-1908, 18 September, 2010 Accessed online on 27^th August, 2015 at: http://www.academicjournals.org/ajmr ISSN 1996-0808.

[9]. Nwachukwu, N.C., Orji, I.K., Okereke, H.C. (2009). Epidemiology of tuberculosis in some parts of Abia State, Federal Republic of Nigeria. Asian J. Epidem., 2: 13-17.

[10]. Nwobu GO, Okodua MA, Tatfeng YM. Comparative Study Of HIV Associated Pulmonary Tuberculosis In Chest Clinics From Two Regions Of Edo State, NigeriaOnline J Health Allied Scs. 2004;3:4

[11]. Odaibo, G.N., Okonkwo, P., Lawal, O.M., and Olaleye, D.O. (2013). HIV infection among newly diagnosed TB patients in southwestern Nigeria:A multi-DOTS centre study. World Journal of AIDS (3):2, pp154-159. Accessed on 28^th August at: (http://www.scirp.org/journal/wja)

[12]. Odaibo, G.N., Gboun, M.F., Ekanem, E.E., Gwarzo, S.N., Saliu. I., Egbewunmi, S.A., Abebe, E.A. and Olaleye. D.O (2006). HIV infection among patients with PTB in Nigeria,” African Journal of Medicine and Medical Sciences, 2006, (35), pp. 93-98.

[13]. Raizada N., Chauhan L.S., Khera A., Khera, A., Sokhey, J., Wares, D.F., Sahu, S.. Thakur, R., & Dewan, P.K. (2008). HIV seroprevalence among Tuberculosis patients in India, 2006–2007. PLoSOne 2008;3:e2970. doi:10.1371/journal.pone.0002970.

[14]. Tadese, S., and Tadese, T. (September, 2013). HIV co-infection among tuberculosis patients in Dabat, northwest Ethiopia. Journal of Infectious Diseases and Immunity. Vol. 5(3), pp 29-32. DOI 10.5897/JIDI2013.0117

[15]. Taura, W.D., Sale, I.T., and Mohammed, Y. (2008). The prevalence of tuberculosis in patients attending the infectious diseases hospital Kano, Nigeria. Int. Jor. P. App. Sci., 2: 63-69.

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