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Bajaj JS, Kassam Z, Cox IJ, et al., 2017, Fecal Microbiota Transplant From a Rational Stool Donor Improves Hepatic Encephalopathy: A Randomized Clinical Trial REPLY, HEPATOLOGY, Vol: 66, Pages: 1355-1356, ISSN: 0270-9139
Hughes T, O'Connor T, Namwat N, et al., 2017, Opisthorchiasis and cholangiocarcinoma in South East Asia: an unresolved problem, International Journal of General Medicine, Vol: 2017, Pages: 227-237, ISSN: 1178-7074
The prevalence of cholangiocarcinoma (CCA) in Southeast Asia is much higher than other areas of the world. Eating raw, fermented or undercooked cyprinid fish, infected with the liver fluke, Opisthorchis viverrini sensu lato, results in chronic biliary inflammation, periductal fibrosis, and increased cancer risk. There may be associated glomerulonephritis. The process of infection is difficult to disrupt because eating practices have proven extremely difficult to change, and the life cycle of the fluke cannot be broken due to high prevalence in canine and feline reservoir hosts. Fecal analysis and ELISA tests can be used to diagnose opisthorchiasis. Diagnosis of CCA is complex, partly due to the lack of definitive imaging characteristics and also due to the difficulty of obtaining samples for cytology or histology. This cancer has proven to be resistant to common chemotherapy treatments and so the two avenues of treatment available are surgical resection and liver transplantation, both requiring early detection of the tumor for the best chances of success. Late presentation of symptoms reduces the chances of successful surgical intervention. While liver fluke infections can be treated with praziquantel, individuals will often become re-infected, and multiple reinfections can be more harmful than a singular, long term infection. A key research need is for the detection and characterization of novel biomarkers in all parts of the carcinogenic pathway for early diagnosis.
Kim JU, Cox IJ, Taylor-Robinson SD, 2017, The Quest for Relevant Hepatocellular Carcinoma Biomarkers., Cellular and Molecular Gastroenterology and Hepatology, Vol: 4, Pages: 283-284, ISSN: 2352-345X
Mullish BH, Forlano R, Yee M, et al., 2017, Development Of An Algorithm For The Prediction Of Cardiovascular Events In Patients With NAFLD: The Role Of Mean Platelet Volume., BASL 2017 Annual Meeting
Forlano R, Mullish BH, Angkathunyakul N, et al., 2017, PWE-094 The severity of steatosis does not influence liver stiffness measurements in patients with non-alcoholic fatty liver disease, British Society of Gastroenterology Annual Meeting, Publisher: BMJ Publishing Group, Pages: A174-A174, ISSN: 1468-3288
Oleribe OO, Iyalla G, Okuro U, et al., 2017, Improving Access to HIV and Sexual Reproductive Health Services for Key Populations along Nigeria’s Transport Corridors: The STOP Project., Journal of AIDS Clinical Research & STDs, Vol: 4, ISSN: 2572-7370
Background: Despite high HIV prevalence amongst key populations in strategic travel corridors in Nigeria, there is still very low access to HIV and Sexual Reproductive Health (SRH) services. Targeting men-who-have-sex-with-men, females who sell sex, long distance truck drivers and those who live along the country’s transport corridors is vital for effective control of the HIV epidemic in Nigeria. Excellence and Friends Management Consult (EFMC) partnered with the Nigerian National Agency for the Control of AIDS (NACA) to improve access to HIV, SRH services educate and test for HIV, and offer referral/treatment to HIV-infected individuals. We report on the need, process and outcome of this project.Methods: The Strategic Travelers Outreach Program (STOP) took place between February and August 2016 in Sagamu/Ogere and Obollo-Afor travel corridors. Through community advocacy and outreach, house-to-house, door-to-door and community/office testing, key populations were provided with targeted HIV, SRH and referral services.Results: Over 50,000 people were contacted with HIV and SRH education/counselling. 19,275 (M: 10,965, 56.9%; F: 8,310, 43.1%) were tested with all receiving their results same day. General positivity rate was 1.3%: female (1.9%). Brothel-based female sex workers had higher positivity rate (3.2%). The study also revealed prostitutes did not use condoms with their husbands or long-term boyfriends and that knowledge of HIV was poor.Conclusion: The results highlight an urgent need to mobilize educational and healthcare resources to mitigate HIV transmission along these corridors. A socio-anthropological approach is required to alter long-held beliefs and change risk-seeking behavior.
Bajaj JS, Kassam Z, Fagan A, et al., 2017, Fecal Microbiota Transplant from a Rational Stool Donor Improves Hepatic Encephalopathy: A Randomized Clinical Trial., Hepatology, Vol: 66, Pages: 1727-1738, ISSN: 0270-9139
Recurrent hepatic encephalopathy (HE) is a leading cause of readmission despite standard of care (SOC) associated with microbial dysbiosis. Fecal microbiota transplantation (FMT) may improve dysbiosis; however, it has not been studied in HE. We aimed to define whether FMT using a rationally-derived stool donor is safe in recurrent HE compared to SOC alone. An open-label, randomized clinical trial with a 5 month follow-up in outpatient cirrhotic men with recurrent HE on SOC was conducted with 1:1 randomization. FMT-randomized patients received 5-days of broad-spectrum antibiotic pre-treatment then a single FMT enema from the same donor with the optimal microbiota deficient in HE. Follow-up occurred on days 5, 6, 12, 35 and 150 post-randomization. The primary outcome was safety of FMT compared to SOC using FMT-related serious adverse events (SAE). Secondary outcomes were AEs, cognition, microbiota and metabolomic changes. Participants in both arms were similar on all baseline criteria and were followed till study-end. FMT with antibiotic pre-treatment was well-tolerated. Eight (80%) SOC participants had a total of 11 SAE compared to two (20%) FMT participants with SAEs (both FMT-unrelated, p=0.02). Five SOC and no FMT participants developed further HE (p=0.03). Cognition improved in FMT, but not SOC group. MELD score transiently worsened post-antibiotics, but reverted to baseline post-FMT. Post-antibiotics, beneficial taxa and microbial diversity reduction occurred with Proteobacteria expansion. However, FMT increased diversity and beneficial taxa. SOC microbiota and MELD score remained similar throughout. CONCLUSIONS: FMT from a rationally selected donor reduced hospitalizations, improved cognition and dysbiosis in cirrhosis with recurrent HE.
Bajaj JS, Kassam Z, Fagan A, et al., 2017, Fecal microbiota transplant using a precision medicine approach is safe, Associated with lower hospitalization risk and improved cognitive function in recurrent hepatic encephalopathy, International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Publisher: ELSEVIER SCIENCE BV, Pages: S49-S49, ISSN: 0168-8278
Oleribe O, Kumar V, Awosika-Olumo A, et al., 2017, Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria, Pan African Medical Journal, Vol: 26, ISSN: 1937-8688
INTRODUCTION: Immunization is the world's most successful and cost-effective public health intervention as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013. METHODS: A quantitative analysis of the 2013 NDHS dataset was performed. Ethical approvals were obtained from Walden University IRB and the National Health Research Ethics Committee of Nigeria. The dataset was downloaded, validated for completeness and analyzed using univariate, bivariate and multivariate statistics. RESULTS: Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination, and 29% never received any vaccination. Immunization coverage was significantly associated with childbirth order, delivery place, child number, and presence or absence of a child health card. Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Paternal education, occupation, and age were also significantly associated with coverage. Respondent's age, educational attainment and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis. CONCLUSION: The study highlights child, parental and socioeconomic barriers to successful immunization programs in Nigeria. These findings need urgent attention, given the re-emergence of wild poliovirus in Nigeria. An effective, efficient, sustainable, accessible, and acceptable immunization program for children should be designed, devel
Forlano R, Maurice J, Mullish BH, et al., 2017, The severity of steatosis does not influence liver stiffness measurements in patients with Non-Alcoholic Fatty Liver Disease, International Liver Conference, Publisher: Elsevier, Pages: S586-S587, ISSN: 0169-5185
Bajaj JS, Kassam Z, Fagan A, et al., 2017, FECAL MICROBIOTA TRANSPLANT USING A PRECISION MEDICINE APPROACH IS SAFE, ASSOCIATED WITH LOWER HOSPITALIZATION RISK AND IMPROVED COGNITIVE FUNCTION IN RECURRENT HEPATIC ENCEPHALOPATHY, Digestive Disease Week, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S906-S906, ISSN: 0016-5085
Shariff MIF, Kim JU, Ladep NG, et al., 2017, The plasma and serum metabotyping of hepatocellular carcinoma in a Nigerian and Egyptian cohort using proton nuclear magnetic resonance spectroscopy, Journal of Clinical and Experimental Hepatology, Vol: 7, Pages: 83-92, ISSN: 0973-6883
BACKGROUND/AIMS: Previous studies have observed disturbances in the (1)H nuclear magnetic resonance (NMR) blood spectral profiles in malignancy. No study has metabotyped serum or plasma of hepatocellular carcinoma (HCC) patients from two diverse populations. We aimed to delineate the HCC patient metabotype from Nigeria (mostly hepatitis B virus infected) and Egypt (mostly hepatitis C virus infected) to explore lipid and energy metabolite alterations that may be independent of disease aetiology, diet and environment. METHODS: Patients with HCC (53) and cirrhosis (26) and healthy volunteers (19) were recruited from Nigeria and Egypt. Participants provided serum or plasma samples, which were analysed using 600 MHz (1)H NMR spectroscopy with nuclear Overhauser enhancement spectroscopy pulse sequences. Median group spectra comparison and multivariate analysis were performed to identify regions of difference. RESULTS: Significant differences between HCC patients and healthy volunteers were detected in levels of low density lipoprotein (P = 0.002), very low density lipoprotein (P < 0.001) and lactate (P = 0.03). N-acetylglycoproteins levels in HCC patients were significantly different from both healthy controls and cirrhosis patients (P < 0.001 and 0.001). CONCLUSION: Metabotype differences were present, pointing to disturbed lipid metabolism and a switch from glycolysis to alternative energy metabolites with malignancy, which supports the Warburg hypothesis of tumour metabolism.
Burstow N, Mohamed Z, Gomaa AI, et al., 2017, Hepatitis C treatment: where are we now?, International Journal of General Medicine, Vol: 10, Pages: 39-52, ISSN: 1178-7074
Chronic hepatitis C infection affects millions of people worldwide and confers significant morbidity and mortality. Effective treatment is needed to prevent disease progression and associated complications. Previous treatment options were limited to interferon and ribavirin regimens, which gave low cure rates and were associated with unpleasant side effects. The era of direct acting antiviral (DAA) therapies began with the development of the first-generation of NS3/4A protease inhibitors (PI) in 2011. They vastly improved outcomes for patients, particularly those with genotype 1 infection, the most prevalent genotype globally. Since then a multitude of DAAs have been licensed for use and outcomes for patients have improved further, with fewer side effects and cure rates approaching 100%. Recent regimens are interferon-free, and in many cases, ribavirin-free and involve a combination of DAA agents. This review summarises the treatment options currently available and discusses potential barriers that may delay the global eradication of hepatitis C.
Itzhaki RF, Lathe R, Balin BJ, et al., 2017, Microbes and Alzheimer's Disease, Advances in Alzheimer's Disease, Vol: 5, Pages: 3-8, ISSN: 2210-5727
Mohamed Z, Mbwambo J, Rwegasha J, et al., 2017, High prevalence of chronic hepatitis C in injecting drug users in Tanzania, East Africa: a neglected burden of disease, International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Publisher: ELSEVIER SCIENCE BV, Pages: S416-S416, ISSN: 0168-8278
Itzhaki RF, Lathe R, Balin BJ, et al., 2017, Microbes and Alzheimer's Disease, HANDBOOK OF INFECTION AND ALZHEIMER'S DISEASE, Editors: Miklossy, Publisher: IOS PRESS, Pages: 3-8, ISBN: 978-1-61499-705-4
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Oleribe OO, Salako B, Okeke EN, et al., 2016, Engaging currently available tested and proven strategies to tackle hepatitis B viral epidemic: the HBV-4-pronged approach (HBV4PA), Journal of Public Health and Epidemiology, Vol: 8, Pages: 337-342, ISSN: 2141-2316
Hepatitis B viral (HBV) infection is a major world problem and is a key contributing factor to the worldwide incidence of hepatocelullar carcinoma, especially in sub-Saharan Africa. However, although hepatitis B treatment is available and effective, it is out of the reach of the common person. Many have, because of cost of treatment, succumbed to the chronic effects of HBV infection, such as liver cirrhosis and primary liver cancer. In this article, we make a case for the provision of free antiviral drugs to chronically-infected HBV patients by expanding the current HIV services to HBV-infected individuals using the PMTCT model. This, when implemented, will save lives, prevent unnecessary and escalating health expenditure and ensure sustainable development.
Elgharably A, Gomaa AI, Crossey M, et al., 2016, Hepatitis C in Egypt – Past, Present and Future, International Journal of General Medicine, Vol: 2017, ISSN: 1178-7074
Hepatitis C viral infection is endemic in Egypt with the highest prevalence rate in the world. It is widely accepted that the implementation of mass population anti-schistosomal treatment involving administration of tartar emetic injections (between the 1950s to the 1980s) led to widespread infection. What is less well known, however, is that these schemes were implemented by the Egyptian Ministry of Health on the advice of the World Health Organisation. There has been a spectrum of treatments to target the public health disaster represented by the hepatitis C problem in Egypt: from the use of pegylated-Interferon to the recent use of direct acting antiviral drugs. Some new treatments have shown greater than 90% efficacy. However, cost is a key barrier to access of these new medicines. This is coupled with a growing population, limited resources and a lack of infection control practices which mean Egypt still faces significant disease control issues today.
Karanjia RN, Crossey MME, Cox IJ, et al., 2016, Hepatic steatosis and fibrosis: Non-invasive assessment, World Journal of Gastroenterology, Vol: 22, Pages: 9880-9897, ISSN: 1007-9327
Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and noninvasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.
Taylor-Robinson SD, Oleribe OO, 2016, Famine and Disease in Nigerian Refugee Camps for Internally Displaced Peoples: A Sad Reflection of Our Times, QJM-an International Journal of Medicine, Vol: 109, Pages: 831-834, ISSN: 1460-2725
Nigeria is Africa’s most populous country with over 180 million inhabitants. Its history has been marred by ethnic and religious conflict, typified by the Biafran war of 1967-1970 and the recent Boko Haram insurgency. As a result of the latter conflict, there are hundreds of thousands of internally-displaced people living in refugee camps with little or no resources. Starving children are commonplace in what is one of the world’s largest oil producing nations. In this article, we examine the consequences of the current crises, and the efforts of the current government, non-governmental organisations and outside agencies to solve the current healthcare inequalities in a resource-rich, but currently disorganised country.
Rice SJ, Albani VJ, Fattakhova GE, et al., 2016, Cost and utility estimates for patients at different stages in the natural history of Primary Biliary Cirrhosis (PBC) from the UK-PBC Cohort, 67th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD), Publisher: WILEY-BLACKWELL, Pages: 850A-851A, ISSN: 0270-9139
McPhail MJW, Montagnese S, Villaneuva M, et al., 2016, Urinary metabolic profiling by 1H NMR spectroscopy in patients with cirrhosis may discriminate overt but not covert hepatic encephalopathy, Metabolic Brain Disease, Vol: 32, Pages: 331-341, ISSN: 1573-7365
To date urinary metabolic profiling has been applied to define a specific metabolic fingerprintof hepatocellular carcinoma on a background of cirrhosis. Its utility for the stratification of othercomplications of cirrhosis, such as hepatic encephalopathy (HE), remains to be established. Urinaryproton nuclear magnetic resonance (1H-NMR) spectra were acquired and NMR data from 52 patientswith cirrhosis (35 male; 17 female, median (range) age [60 (18-81) years]) and 17 controls werecompared. A sub-set of 45 patients (33 male; 12 female, [60 (18-90) years, median model for end stageliver disease (MELD) score 11 (7-27)]) were fully characterised by West-Haven criteria, PsychometricHepatic Encephalopathy Score (PHES) and electroencephalogram (EEG), and defined as overt HE(OHE, n=21), covert HE (cHE, n=7) or no HE (n=17). Urinary proton nuclear magnetic resonance (1HNMR)spectra were analysed by partial-least-squares discriminant analysis (PLS-DA). The resultsshowed good discrimination between patients with cirrhosis (n=52) and healthy controls (n=17)(R2X=0.66, R2Y=0.47, Q2Y=0.31, sensitivity-60%, specificity-100%) as the cirrhosis group hadhigher 1-methylnicotinamide with lower hippurate, acetate, phenylacetylglycine and N-methyl nicotinicacid levels. While patients with OHE could be discriminated from those with no HE, with higherhistidine, citrate and creatinine levels, the best models lack robust validity (R2X=0.65, R2Y=0.48,Q2Y=0.12, sensitivity-100%, specificity-64%) with the sample size used. Urinary 1H-NMR metabolicprofiling did not discriminate patients with cHE from those without HE, nor discriminate subjects onthe basis of PHES/EEG result or MELD score. In conclusion, patients with cirrhosis showed differenturinary 1H-NMR metabolic profiles compared to healthy controls and those with OHE may bedistinguished from those with no HE although larger studies are required. However, urinary 1H-NMRmetabolic profiling did not discriminate patients with differing grades of
Grover VP, Southern L, Dyson JK, et al., 2016, Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging, Alimentary Pharmacology & Therapeutics, Vol: 44, Pages: 936-945, ISSN: 1365-2036
Background: Brain change can occur in primary biliary cholangitis (PBC), potentially as a result of cholestatic and/or inflammatory processes. This change is linked to systemic symptoms of fatigue and cognitive impairment. Aim: To identify whether brain change occurs early in PBC. If the change develops early and is progressive, it may explain the difficulty in treating these symptoms. Methods: Early disease brain change was explored in 13 patients with newly diagnosed biopsy-proven pre-cirrhotic PBC using magnetization transfer, diffusion-weighted imaging and 1H magnetic resonance spectroscopy. Results were compared to 17 healthy volunteers. Results: Cerebral magnetization transfer ratios were reduced in early PBC, compared to healthy volunteers, in the thalamus, putamen and head of caudate with no greater reduction in patients with greater symptom severity. Mean apparent diffusion coefficients were increased in the thalamus only. No 1H magnetic resonance spectroscopy abnormalities were seen. Serum manganese levels were elevated in all PBC patients, but no relationship was seen with imaging or symptom parameters. There were no correlations between neuroimaging data, laboratory data, symptom severity scores or age. Conclusions: This is the first study to be performed in this pre-cirrhotic patient population and we have highlighted that neuroimaging changes are present at a much earlier stage than previously demonstrated. The neuroimaging abnormalities suggest that the brain changes seen in PBC occur early in the pathological process, even before significant liver damage has occurred. If such changes are linked to symptom pathogenesis, this could have important implications for the timing of second-line-therapy use.
Grover VP, McPhail M, Wylezinska M, et al., 2016, A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy, Metabolic Brain Disease, Vol: 32, Pages: 77-86, ISSN: 1573-7365
The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50% of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA.
Lemoine MN, Shimakawa Y, Njie R, et al., 2016, Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study, Lancet Global Health, Vol: 4, Pages: e559-e567, ISSN: 2214-109X
BackgroundDespite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment.MethodsBetween Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western Gambia were offered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also offered to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited for a comprehensive liver assessment and were offered treatment according to international guidelines. We defined linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012 European Association for the Study of the Liver guidelines.FindingsHBsAg screening was accepted by 5980 (weighted estimate 68·9%, 95% CI 65·0–72·4) of 8170 adults from 27 rural and 27 urban communities and 5559 (81·4%, 80·4–82·3) of 6832 blood donors. HBsAg was detected in 495 (8·8%, 7·9–9·7) individuals in communities and 721 (13·0%, 12·1–13·9) blood donors. Prevalence was higher in men (239 [10·5%, 8·9–12·1] of 2328 men vs 256 [7·6%, 6·5–8·7] of 3652 women; p=0·004) and middle-aged participants. Linkage to care was high in the communities, with 402 (81·3%) of 495 HBsAg-positive individuals attending the clinic. However, only 300 (41·6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those
Oleribe OO, Eziome IP, Oladipo O, et al., 2016, Industrial Action by Healthcare Workers in Nigeria in 2013 - 2015: An Inquiry into Causes, Consequences and Control. A Cross-sectional Descriptive Study., Human Resources for Health, Vol: 14, ISSN: 1478-4491
Abstract: Background: Healthcare worker strikes involving all categories of healthcare workers are common in Nigeria. The purpose of this study was to identify the root cause(s) of healthcare worker strikes, the effect on the health system and possible solutions to prevent, or at least reduce industrial actions.Methodology: A cross-sectional descriptive survey approach was used. A self-administered questionnaire was administered between February and March, 2015. Data were analyzed using Epi DataTM and SPSS 21. Results: A total of 150 healthcare workers participated in the study, of which 62 (41.3%) were males, 86 (57.3%) married, 90 (60.0%) Christians, and 119 (79.3%) were graduates, and about half of the participants earned less than N129,000.00 (US$737.00) per month. Less than half of the participants (43.6%) supported industrial actions. Poor healthcare leadership and management were cited as the most common (92%), as well as the most important (43.3%) cause of healthcare worker strikes in Nigeria. Other cited causes were a demand for higher salaries and wages (82%), infrastructural issues (63.3%) and inter-personal issues (61.3%). Only 2.0% rated current health care management as excellent, while 24.0% rated it as very good. Several strategies were cited towards improving healthcare management.Conclusion: The findings of this study differ from previous studies that identified demand for increased salaries and wages as the commonest cause of healthcare worker strikes in Nigeria. Training doctors in health management and leadership, towards building skilled physician-leaders, is a strategy that is long overdue in Nigeria.
Oleribe OO, Oladipo OA, Ezieme IP, et al., 2016, From decentralization to commonization of HIV healthcare resources: Keys to reduction in health disparity and equitable distribution of health services in Nigeria, Pan African Medical Journal, Vol: 24, ISSN: 1937-8688
Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities.This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.
Oleribe OO, Taylor-Robinson SD, 2016, Before Sustainable Development Goals (SDG): why Nigeria failed to achieve the Millennium Development Goals (MDGs)., Pan African Medical Journal, Vol: 24, Pages: 156-156, ISSN: 1937-8688
World leaders adopted the UN Millennium Declaration in 2000, which committed the nations of the world to a new global partnership, aimed at reducing extreme poverty and other time-bound targets, with a stated deadline of 2015. Fifteen years later, although significant progress has been made worldwide, Nigeria is lagging behind for a variety of reasons, including bureaucracy, poor resource management in the healthcare system, sequential healthcare worker industrial action, Boko Haram insurgency in the north of Nigeria and kidnappings in the south of Nigeria. The country needs to tackle these problems to be able to significantly advance with the new sustainable development goals (SDGs) by the 2030 target date.
Adler M, Larocca L, Trovato FM, et al., 2016, Evaluating the risk of hepatocellular carcinoma in patients with prominently elevated liver stiffness measurements by FibroScan: a multicentre study, HPB, Vol: 18, Pages: 678-683, ISSN: 1365-182X
Background and aimsThere are limited data on the significance of liver stiffness measurements (LSM) by transient elastography in the upper extreme end of the measurable spectrum. This multicentre retrospective observational study evaluated the risk of hepatocellular carcinoma (HCC) in patients with LSM ≥20 kPa.Methods432 cirrhosis patients with LSM ≥20 kPa between June 2007 and October 2015 were retrospectively followed-up through electronic records.ResultsA minimum 1-year follow-up was available for 278 patients (177 men; average age 57, range 18–84). LSM ranged from 20.0 to 75.0 kPa (mean 34.6 kPa). Cumulative incidences of HCC were 19 (6.8%), 30 (10.8%) and 41 (14.7%) at 1, 2 and 3 years, respectively. HCC was associated with age (p = 0.003), higher LSM (p = 0.005) and viral aetiology (p = 0.007). Patients were divided into 4 groups based on LSM at entry: 20–25 kPa (n = 74); 25–30 kPa (n = 62); 30–40 kPa (n = 75); >40 kPa (n = 67). Compared to the 20–25 kPa group, the 30–40 kPa group had a hazard ratio (HR) of 3.0 (95% CI, 1.1–8.3; p = 0.037), and the >40 kPa group had a HR of 4.8 (95% CI, 1.7–13.4; p = 0.003).ConclusionsThis study shows an association between LSM at the upper extreme and HCC risk. Physicians may find this beneficial as a non-invasive dynamic approach to assessing HCC risk in cirrhosis patients.
Asavarut P, Norsworthy PJ, Cook J, et al., 2016, Diet and disease: transgressing boundaries between science and society - understanding neglected diseases through the lens of cultural studies and anthropology, Medical Humanities, Vol: 42, Pages: 181-183, ISSN: 1473-4265
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