Upfill-Brown A.M.,Institute for Disease Modeling |
Lyons H.M.,Institute for Disease Modeling |
Pate M.A.,Duke University |
Shuaib F.,National Polio Emergency Operations Center |
And 7 more authors.
BMC Medicine | Year: 2014
Background: One of the challenges facing the Global Polio Eradication Initiative is efficiently directing limited resources, such as specially trained personnel, community outreach activities, and satellite vaccinator tracking, to the most at-risk areas to maximize the impact of interventions. A validated predictive model of wild poliovirus circulation would greatly inform prioritization efforts by accurately forecasting areas at greatest risk, thus enabling the greatest effect of program interventions.Methods: Using Nigerian acute flaccid paralysis surveillance data from 2004-2013, we developed a spatial hierarchical Poisson hurdle model fitted within a Bayesian framework to study historical polio caseload patterns and forecast future circulation of type 1 and 3 wild poliovirus within districts in Nigeria. A Bayesian temporal smoothing model was applied to address data sparsity underlying estimates of covariates at the district level.Results: We find that calculated vaccine-derived population immunity is significantly negatively associated with the probability and number of wild poliovirus case(s) within a district. Recent case information is significantly positively associated with probability of a case, but not the number of cases. We used lagged indicators and coefficients from the fitted models to forecast reported cases in the subsequent six-month periods. Over the past three years, the average predictive ability is 86 ± 2% and 85 ± 4% for wild poliovirus type 1 and 3, respectively. Interestingly, the predictive accuracy of historical transmission patterns alone is equivalent (86 ± 2% and 84 ± 4% for type 1 and 3, respectively). We calculate uncertainty in risk ranking to inform assessments of changes in rank between time periods.Conclusions: The model developed in this study successfully predicts districts at risk for future wild poliovirus cases in Nigeria. The highest predicted district risk was 12.8 WPV1 cases in 2006, while the lowest district risk was 0.001 WPV1 cases in 2013. Model results have been used to direct the allocation of many different interventions, including political and religious advocacy visits. This modeling approach could be applied to other vaccine preventable diseases for use in other control and elimination programs. © 2014 Upfill-Brown et al.; licensee BioMed Central Ltd.
News Article | October 28, 2016
Urges Rotarians to Remain Vigilant and Preemptive in the Fight against Poliovirus ABUJA, NIGERIA--(Marketwired - Oct 25, 2016) - Sir Emeka Offor, founder of the Sir Emeka Offor Foundation and Rotary International Polio Ambassador, issued the following letter to Rotarians to extend upon World Polio Day: One year ago, Nigeria had a zero record of any poliovirus transmission. It was an exciting time in our long and arduous history of anti-polio war. Before this, polio transmission was rampant. With Nigeria being a reservoir for the virus, the apparent uncontrolled transmission rate threatened to take a worsening turn, reaching even across national borders. Upon learning of the devastating effect of the disease on the Nigerian child, I was touched beyond imagination. I had to get involved. Thus far, my total contributions to Rotary International, which is at the forefront of the fight against polio, have exceeded $3.6 million. This includes donations to the Center for Peace & Conflict Resolution, for the safe motherhood, maternal and child health, Polio Speaking Book and disability utility tricycles. Many had labored for years before I joined Rotary, and our shared efforts paid significant dividends during 2014 and 2015. However, despite our cautious optimism, we received news this past August of three new cases of Acute Flaccid Paralysis of wild poliovirus Type 1 from Borno State. This major setback resets the timetable for the path toward polio-free certification. The new cases in Borno are a reminder that until poliovirus is completely eradicated, our children remain at risk. We must therefore not relent. There is no better time to refocus, re-strategize and fight than now. I applaud the efforts put forward by the Rotary Foundation, UNICEF, the World Health Organization and many other local and international donor organs that ceaselessly support anti-polio initiatives. The Nigerian Federal Government rolled out up to N9.8 billion to support National Primary Health Care Development Agency in its response plan to ensure that up to 56 million children are vaccinated. Volunteer Community Mobilizers have been deployed in the scale-up exercise. As we mark World Polio Day this week, I call on Rotarians in Nigeria and all over the world to stand together and invest time and resources judiciously towards the success of the End Game strategy. I urge all Rotarians to disavow complacency in our quest for a better world. Our shared commitment is of immense necessity at this time. As the Rotary International Polio Ambassador, I am convinced that we have a chance to rally each other and the nation to see that we finish what we started. We must defeat polio. The time is now. The Sir Emeka Offor Foundation is a philanthropic organization based in Abuja, FCT and Oraifite, Anambra State, Nigeria. The Foundation seeks to alleviate the suffering of the less privileged through philanthropy, and focuses primarily on giving support and hope to those in need irrespective of tribe, creed, religion and nation. The Foundation has affected the lives of many Nigerians through its domestic programs and projects, which include youth empowerment, Widows Cooperative, education, and health services and infrastructural development. For more information, visit http://sireofforfoundation.org or like us at https://www.facebook.com/siremekaofforfoundation.
Adokiya M.N.,University of Heidelberg |
Adokiya M.N.,University for Development Studies |
Awoonor-Williams J.K.,Ghana Health Service |
Barau I.Y.,National Primary Health Care Development Agency |
And 2 more authors.
BMC Public Health | Year: 2015
Background: Well-functioning surveillance systems are crucial for effective disease control programs. The Integrated Disease Surveillance and Response (IDSR) strategy was developed and adopted in 1998 for Africa as a comprehensive public health approach and subsequently, Ghana adopted the IDSR technical guidelines in 2002. Since 2012, the IDSR data is reported through the new District Health Information Management System II (DHIMS2) network. The objective was to evaluate the Integrated Disease Surveillance and Response (IDSR) system in northern Ghana. Methods: This was an observational study using mixed methods. Weekly and monthly IDSR data on selected infectious diseases were downloaded and analyzed for 2011, 2012 and 2013 (the years before, of and after DHIMS2 implementation) from the DHIMS2 databank for the Upper East Region (UER) and for two districts of UER. In addition, key informant interviews were conducted among local and regional health officers on the functioning of the IDSR. Results: Clinically diagnosed malaria was the most prevalent disease in UER, with an annual incidence rate close to 1. Around 500 suspected HIV/AIDS cases were reported each year. The highest incidence of cholera and meningitis was reported in 2012 (257 and 392 cases respectively). Three suspected cases of polio and one suspected case of guinea worm were reported in 2013. None of the polio and guinea worm cases and only a fraction of the reported cases of the other diseases were confirmed. A major observation was the large and inconclusive difference in reported cases when comparing weekly and monthly reports. This can be explained by the different reporting practice for the sub-systems. Other challenges were low priority for surveillance, ill-equipped laboratories, rare supervision and missing feedback. Conclusions: The DHIMS2 has improved the availability of IDSR reports, but the quality of data reported is not sufficient. Particularly the inconsistencies between weekly and monthly data need to be addressed. Moreover, support for and communication within the IDSR system is inadequate and calls for attention. © 2015 Adokiya et al.
Abimbola S.,National Primary Health Care Development Agency
MEDICC Review | Year: 2011
The benefits of an interconnected world for health care remain untapped. As a result of the politics of inequality between rich and poor countries, one or a few health systems are set up as models. Every country, irrespective of political or economic status, should be open to learning from others to build relevant and cost-effective systems. To combat the current global challenge of chronic noncommunicable diseases, poor countries have the advantage of flexible health systems that are veritable laboratories of health systems research. Not only can research conducted in these health systems help harness the potential of mobile communication technologies and informal health providers, it can also help rich country health systems adapt to meet the chronic disease challenge.
Ukwaja K.N.,Federal Teaching Hospital |
Alobu I.,Ministry of Health |
Abimbola S.,National Primary Health Care Development Agency |
Hopewell P.C.,San Francisco General Hospital
Infectious Diseases of Poverty | Year: 2013
Background: Studies on costs incurred by patients for tuberculosis (TB) care are limited as these costs are reported as averages, and the economic impact of the costs is estimated based on average patient/household incomes. Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups. Thus, the extent to which TB expenditures risk sending households into, or further into, poverty and its determinants, is unknown. We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria. Methods: Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State, Nigeria. Using household direct costs and income data, we analyzed the incidence of household catastrophic payments using, as thresholds, the traditional >10% of household income and the ≥40% of non-food income, as recommended by the World Health Organization. We used logistic regression analysis to identify the determinants of catastrophic payments. Results: Average direct household costs for TB were US$157 or 14% of average annual incomes. The incidence catastrophic payment was 44%; with 69% and 15% of the poorest and richest household income-quartiles experiencing catastrophic activity, respectively. Independent determinants of catastrophic payments were: age >40 years (adjusted odds ratio [aOR] 3.9; 95% confidence interval [CI], 2.0, 7.8), male gender (aOR 3.0; CI 1.8, 5.2), urban residence (aOR 3.8; CI 1.9, 7.7), formal education (aOR 4.7; CI 2.5, 8.9), care at a private facility (aOR 2.9; 1.5, 5.9), poor household (aOR 6.7; CI 3.7, 12), household where the patient is the primary earner (aOR 3.8; CI 2.2, 6.6]), and HIV co-infection (aOR 3.1; CI 1.7, 5.6). Conclusions: Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care. Financial and social protection interventions are needed for identified at-risk groups, and community-level interventions may reduce inefficiencies in the care-seeking pathway. These observations should inform post-2015 TB strategies and influence policy-making on health services that are meant to be free of charge. © 2013 Ukwaja et al.; licensee BioMed Central Ltd.
Negin J.,University of Sydney |
Cumming R.,University of Sydney |
de Ramirez S.S.,Johns Hopkins University |
Abimbola S.,National Primary Health Care Development Agency |
Sachs S.E.,Columbia University
Tropical Medicine and International Health | Year: 2011
Objective To expand the evidence base on the prevalence of non-communicable disease (NCD) risk factors in rural Africa, in particular among older adults aged 50 and older. Methods Cross-sectional study in three rural sites in Malawi, Rwanda and Tanzania. One person was interviewed from each of 665 households selected through a stratified random sampling procedure across the three sites. The questionnaire included socio-demographic characteristics, smoking and alcohol intake as well as a food frequency questionnaire. Results Smoking rates among older men and women were higher than among adults under 50. While only 2.3% of women under 50 were current smokers, 21.0% of older women smoked (P<0.0001). Among men, 19.0% of men under 50 smoked versus 36.6% of older men (P=0.001). Alcohol consumption among older women aged 50 and older (45.0%) was more common (P=0.005) than among women under 50 (27.6%). Examining a set of five risk factors, more men aged 50 and older (49.5%) had two or more risk factors than men under 50 (25.5%) (P<0.0001). Similarly, 52.0% of women aged 50 and older had two or more risk factors, versus 24.1% of women under 50 (P<0.0001). Conclusion Contrary to what is seen in developed country settings, this study reveals high rates of smoking and alcohol consumption among men and women aged 50years and older in rural Africa that puts them at risk of NCDs. The health of older adults in rural Africa has been neglected, and these findings highlight the importance of reaching out to older adults with messaging regarding diet, smoking, alcohol use and general health. © 2011 Blackwell Publishing Ltd.
Mangal T.D.,Imperial College London |
Aylward R.B.,WHO |
Mwanza M.,WHO |
Gasasira A.,WHO |
And 3 more authors.
The Lancet Global Health | Year: 2014
Background: The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world's cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical efficacy estimates for the oral poliovirus vaccines (OPV) currently in use. Methods: We used acute flaccid paralysis (AFP) surveillance data from Nigeria collected between January, 2001, and December, 2012, to estimate the clinical efficacies of all four OPVs in use and combined this with vaccination coverage to estimate the effect of the introduction of monovalent and bivalent OPV on vaccine-induced serotype-specific population immunity. Vaccine efficacy was determined using a case-control study with CIs based on bootstrap resampling. Vaccine efficacy was also estimated separately for north and south Nigeria, by age of the children, and by year. Detailed 60-day follow-up data were collected from children with confirmed poliomyelitis and were used to assess correlates of vaccine status. We also quantitatively assessed the epidemiology of poliomyelitis and programme performance and considered the reasons for the high vaccine refusal rate along with risk factors for a given local government area reporting a case. Findings: Against serotype 1, both monovalent OPV (median 32·1%, 95% CI 26·1-38·1) and bivalent OPV (29·5%, 20·1-38·4) had higher clinical efficacy than trivalent OPV (19·4%, 16·1-22·8). Corresponding data for serotype 3 were 43·2% (23·1-61·1) and 23·8% (5·3-44·9) compared with 18·0% (14·1-22·1). Combined with increases in coverage, this factor has boosted population immunity in children younger than age 36 months to a record high (64-69% against serotypes 1 and 3). Vaccine efficacy in northern states was estimated to be significantly lower than in southern states (p≤0·05). The proportion of cases refusing vaccination decreased from 37-72% in 2008 to 21-51% in 2012 for routine and supplementary immunisation, and most caregivers cited ignorance of either vaccine importance or availability as the main reason for missing routine vaccinations (32·1% and 29·6% of cases, respectively). Multiple regression analyses highlighted associations between the age of the mother, availability of OPV at health facilities, and the primary source of health information and the probability of receiving OPV (all p<0·05). Interpretation: Although high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery. Funding: Bill & Melinda Gates Foundation Vaccine Modeling Initiative, Royal Society. © 2014 Mangal et al.
Negin J.,University of Sydney |
Abimbola S.,University of Sydney |
Abimbola S.,National Primary Health Care Development Agency |
Marais B.J.,University of Sydney
International Journal of Infectious Diseases | Year: 2015
Knowledge that older people are vulnerable to develop tuberculosis is rarely considered in developing country settings. According to 2010 Global Burden of Disease estimates, the majority of tuberculosis-related deaths occurred among people older than 50; most in those aged 65 and above. Older people also contribute a large proportion of Disability-Adjusted Life Years (DALYs); 51% of tuberculosis DALYs occurred in patients aged 50 years and older in East Asia. Tuberculosis age distributions in Africa have been severely skewed by the human immunodeficiency virus (HIV) epidemic, but emerging data suggest increasing disease burdens among older people. Older adults are more likely to develop extra-pulmonary and atypical forms of disease that are often harder to diagnose than conventional sputum smear-positive pulmonary tuberculosis. Their care is complicated by more frequent drug-related adverse events and increased co-morbidity, which may prove difficult to manage in regions where health resources are already constrained. Health systems will have to confront the challenge of an ageing global population and the integrated services required to address their health needs. © 2014 The Authors.
Jimoh L.,Duke University |
Pate M.A.,Duke University |
Pate M.A.,National Primary Health Care Development Agency |
Lin L.,Duke University |
Schulman K.A.,Duke University
International Journal of Medical Informatics | Year: 2012
Purpose: To investigate the potential of information and communication technology (ICT) adoption among maternal and child health workers in rural Nigeria. Methods: A prospective, quantitative survey design was used to collect data from quasi-randomly selected clusters of 25 rural health facilities in 5 of the 36 states in Nigeria over a 2-month period from June to July 2010. A total of 200 maternal and child health workers were included in the survey, and the data were analyzed using a modified theory of acceptance model (TAM). Results: There was no significant difference between ICT knowledge and attitude scores across states. There were significant differences in perceived ease of use (P<.001) and perceived usefulness scores (P=.001) across states. Midwives reported higher scores on all the constructs but a lower score on endemic barriers (which is a more positive outcome). However, the differences were only statistically significant for perceived usefulness (P=.05) and endemic barriers (P<.001). Regression analysis revealed that there was no interaction between worker group and age. Older workers were likely to have lower scores on knowledge and attitude but higher scores on perceived ease of use and perceived usefulness. Lastly, we found that worker preference for ICT application in health varied across worker groups and conflicted with government/employer priorities. Conclusions: Although the objective of this study was exploratory, the results provide insight into the intricacies involved in the deployment of ICT in low-resource settings. Use of an expanded TAM should be considered as a mandatory part of any pre-implementation study of ICT among health workers in sub-Saharan Africa. © 2012 Elsevier Ireland Ltd.
Jenkins H.E.,Imperial College London |
Aylward R.B.,World Health Organization |
Gasasira A.,WHO Nigeria |
Donnelly C.A.,Imperial College London |
And 9 more authors.
New England Journal of Medicine | Year: 2010
Background: The largest recorded outbreak of a circulating vaccine-derived poliovirus (cVDPV), detected in Nigeria, provides a unique opportunity to analyze the pathogenicity of the virus, the clinical severity of the disease, and the effectiveness of control measures for cVDPVs as compared with wild-type poliovirus (WPV). Methods: We identified cases of acute flaccid paralysis associated with fecal excretion of type 2 cVDPV, type 1 WPV, or type 3 WPV reported in Nigeria through routine surveillance from January 1, 2005, through June 30, 2009. The clinical characteristics of these cases, the clinical attack rates for each virus, and the effectiveness of oral polio vaccines in preventing paralysis from each virus were compared. Results: No significant differences were found in the clinical severity of paralysis among the 278 cases of type 2 cVDPV, the 2323 cases of type 1 WPV, and the 1059 cases of type 3 WPV. The estimated average annual clinical attack rates of type 1 WPV, type 2 cVDPV, and type 3 WPV per 100,000 susceptible children under 5 years of age were 6.8 (95% confidence interval [CI], 5.9 to 7.7), 2.7 (95% CI, 1.9 to 3.6), and 4.0 (95% CI, 3.4 to 4.7), respectively. The estimated effectiveness of trivalent oral polio vaccine against paralysis from type 2 cVDPV was 38% (95% CI, 15 to 54%) per dose, which was substantially higher than that against paralysis from type 1 WPV (13%; 95% CI, 8 to 18%), or type 3 WPV (20%; 95% CI, 12 to 26%). The more frequent use of serotype 1 and serotype 3 monovalent oral polio vaccines has resulted in improvements in vaccine-induced population immunity against these serotypes and in declines in immunity to type 2 cVDPV. Conclusions: The attack rate and severity of disease associated with the recent cVDPV identified in Nigeria are similar to those associated with WPV. International planning for the management of the risk of WPV, both before and after eradication, must include scenarios in which equally virulent and pathogenic cVDPVs could emerge. Copyright © 2010 Massachusetts Medical Society.