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Borno, Adamawa, Yobe States Declare End of Cholera Outbreaks

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In a synchronized event, the Commissioners of Health in Borno, Adamawa and Yobe States recently declared the end of the Cholera outbreak. It has been over two weeks since the last cases of Cholera were detected and as required by epidemiological protocols and standards, when the number of suspected cases in an epidemic area significantly declines and all samples from suspected cholera cases test negative for a minimum period of two weeks, the outbreak is considered controlled.

Following the intense outbreak response which was led and coordinated by the Nigerian Government with support from the World Health Organization (WHO), the last cases of cholera were reported in Borno state on 14 December 2018, while Adamawa and Yobe states reported their last cases on 23 November and 04 December 2018 respectively indicating an end of the outbreaks according to epidemiological standards.

Since the outbreaks of cholera were declared in each of the states at different times in 2018, close to 11,000 cases including 175 deaths with a case fatality ratio of 2.1% were reported across the three states as of 15th January 2019.

WHO Emergency manager for the North East Nigeria, Dr Collins Owili explained that the outbreaks affected close to 11,000 people across 28 Local Government Areas (LGAs) with Borno contributing 58%, Adamawa, 25% and Yobe state 17%.

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“Atypical of cholera outbreaks, suspected cases were reported in early February 2018 from three wards in Kukawa LGA, Borno state,” said Owili. “Similarly, in Yobe state, on the 28th of March 2018, an outbreak of cholera was confirmed by the Honourable Commissioner for Health after samples collected from Gashua town in Bade LGA, tested positive to the bacteria vibrio cholerae. While, in Adamawa, cases were reported in Mubi north and South as early as 17 May 2018.”

In an address to the media on the official closure of the outbreak in Maiduguri, Borno state, the Commissioner for Health, represented by the Permanent Secretary, Alhaji Bukar Mustapha Allau commended WHO’s technical leadership and coordination of the health sector response.

Allau disclosed that 15 LGAs of Borno state accounted for 6,367 reported cases of cholera in 2018, with 73 associated deaths indicating a case fatality ratio (CFR) of 1.15%. According to him, “Jere LGA with 2,482 cases, Maiduguri Municipal Council with 1,556 and Ngala LGA with 1,052 contributed 80% of all reported cases in the state. Other LGAs that reported various cases include Magumeri Konduga, Kwaya-Kusar, Chibok, Shani, Damboa, Kaga, Askira-Uba, Bama, Dikwa, Guzamala and Kala/Balge.”

He commended the multi-sectoral approach, swift response and effective health partner coordination by all health partners as soon as the outbreak was confirmed.

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n Yola, Adamawa state, the Commissioner for Health, Dr Fatima Atiku-Abubakar explained that WHO’s robust surveillance activities including early detection, timely reporting and coordinated response guided interventions and helped in controlling the spread of the outbreaks which reached 2, 755 cases including 43 deaths as of 23 November 2018.

Her counterpart in Yobe state, Dr Muhammed Bello Kawuwa, stated that WHO’s strategic community surveillance even in difficult to reach locations, effective health partner coordination and capacity building of health workers enabled timely control of the outbreaks.

Yobe state reported more than 1,800 cases with 61 associated deaths, giving a Case Fatality Rate (CFR) of 3.36% with 591 cases reported from Gulani LGA, 485 cases from Gujba LGA and 489 cases from Damaturu LGA. In Fune LGA, 181 cases were reported and 67 cases were reported in Potiskum LGA.

Although, cholera outbreaks are endemic in North East Nigeria, the outbreaks have remained persistent following the disruption of healthcare services as a result of the ongoing insurgency in the region. More than 1.7 million people have been internally displaced in Borno, Adamawa and

Yobe states, and thus, rendered vulnerable to communicable disease infections especially cholera, Yellow fever and meningitis. Through its health emergencies programme, WHO is coordinating 45 health sector partners to respond to multiple as well as concurrent outbreaks of diseases in the region.

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WHO recommends dolutegravir as preferred HIV treatment option in all populations

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Based on new evidence assessing benefits and risks, the World Health Organization (WHO) recommends the use of the HIV drug dolutegravir (DTG) as the preferred first-line and second-line treatment for all populations, including pregnant women and those of childbearing potential.

Initial studies had highlighted a possible link between DTG and neural tube defects (birth defects of the brain and spinal cord that cause conditions such as spina bifida) in infants born to women using the drug at the time of conception. This potential safety concern was reported in May 2018 from a study in Botswana that found 4 cases of neural tube defects out of 426 women who became pregnant while taking DTG. Based on these preliminary findings, many countries advised pregnant women and women of childbearing potential to take efavirenz (EFV) instead.

New data from two large clinical trials comparing the efficacy and safety of DTG and EFV in Africa have now expanded the evidence base. The risks of neural tube defects are significantly lower than what the initial studies may have suggested.

The guidelines group also considered mathematical models of the benefits and harms associated with the two drugs; the values and preferences of people living with HIV, as well as factors related to implementation of HIV programmes in different countries, and cost.

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DTG is a drug that is more effective, easier to take and has fewer side effects than alternative drugs that are currently used. DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to EFV and nevirapine-based regimens. In 2019, 12 out of 18 countries surveyed by WHO reported pre-treatment drug resistance levels exceeding the recommended threshold of 10%.

All of above findings informed the decision to update the 2019 guidelines.

In 2019, 82 low- and middle-income countries reported to be transitioning to DTG-based HIV treatment regimens. The new updated recommendations aim to help more countries improve their HIV policies.

As for any medications, informed choice is important. Every treatment decision needs to be based on an informed discussion with the health provider weighing the benefits and potential risks.

WHO also stresses the importance of providing information and options to help women make an informed choice. To this end WHO has convened an advisory group of women living with HIV from diverse backgrounds to advise on policy issues related to their health, including sexual and reproductive health. WHO highlights the need to continually monitor the risk of neural tube defects associated with DTG.

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Two-thirds of Global South hypertension sufferers missing treatment – study

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Healthcare in low- and middle-income countries is poorly prepared for the increasing number of people with high blood pressure, with more than two-thirds of people affected going without treatment – a new study reveals.

Researchers studied health data for one million people in the Global South, discovering that less than half of those affected are diagnosed with high blood pressure or hypertension. Of these patients, only 30% are treated and only 10% have the disease under control.

The research team analysed the healthcare of hypertension in 44 countries. Using a cascade of care approach, which looked at the numbers of people with hypertension who had been screened, diagnosed, treated, and controlled, they determined how well the health systems of the various countries are treating people with hypertension.

University of Birmingham researchers worked with colleagues at the Harvard T.H. Chan School of Public Health, the University of Göttingen and the Medical Faculty of Heidelberg, publishing their findings in The Lancet.

Justine Davies, Professor of Global Health at the University of Birmingham’s Institute of Applied Health Research, comments: “Hypertension, or high blood pressure, is known from other studies to be prevalent in lower and middle income countries.

“Our research adds by showing that care in these countries is not able to match the number of people who need treatment. This is a particular problem as without treatment there is a considerable risk of complications – including stroke and death.

“It is not all bad news though. We found that some countries – like Costa Rica, Bangladesh, Brazil, Ecuador, Kyrgyzstan and Peru – are doing much better than expected, and it is important to look in more depth at those countries and learn from their success.”

The group carried out its research using surveys including the World Health Organisation’s STEPS survey – which uses a uniform approach to obtain data on established risk factors.

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“Our study shows not only that care for hypertension in these countries is severely inadequate, but also where exactly patients are being lost in the treatment system,” says Pascal Geldsetzer, postdoctoral research fellow at Harvard T.H. Chan School of Public Health and first author of the study.

Dr. Mary Mayige, Principle Research Scientist at the National Institute for Medical Research in Tanzania and co-author of the study, commented: “There is an urgent need to strengthen the healthcare system for chronic disease care in low income countries. This includes improving information systems and increased financing to ensure universal access across the continuum from preventive interventions to tertiary health care services.”

Researchers firstly determined how many people suffered from high blood pressure. Based on this, they determined how many of these patients were examined, diagnosed and treated each time. Finally, they analysed how many patients successfully controlled the disease with medication.

“High blood pressure can be treated relatively well and cheaply, but undiagnosed or untreated hypertension represents a considerable risk for the people affected,” says Sebastian Vollmer, Professor of Development Economics at the University of Göttingen.

“High blood pressure is one of the major widespread diseases in the Global South and increasingly common as populations in these countries age. This study provides important insights for policy-makers about where in the treatment chain for hypertension the greatest problems currently lie,” adds Till Bärnighausen, Professor of Global Health at Heidelberg University Hospital and the Medical Faculty of Heidelberg.

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Environmental Sanitation Law: Oyo Govt. Seals 6 Shops, Canteen, Butcher’s Stand In Ibadan 

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At least six shops,  including a food canteen and a butcher’s shop were sealed on Thursday along Old Ife road and Gbagi area in Ibadan, the Oyo state capital for flouting the State’s environmental Sanitation and Waste Management Law.

 

The act was in accordance with the recent agreement made by Stakeholders during an advocacy programme on environmental laws organised by Oyo State Government to leverage on  environmental laws in its bid to ensure a healthy and safe environment.

 

Oyo State government held a stakeholders advocacy meeting on Tuesday 16th July at the House of Chiefs in Ibadan, where various groups and government representatives deliberated on ways forward to put a stop to indiscriminate waste disposal, where participants charged the Seyi Makinde-led administration to step up enforcement exercise among other solutions to the menace of filthy environment.

 

The Director of Environmental Health Officers for the Ministry of Environment and Water Resources, Sanitarian Olusoji Oyewole  who led the enforcement team during the weekly environmental sanitation within Ibadan environs, said it was surprising that despite the campaign efforts of the present administration against the scourge of filth and maintenance of healthy and safe environment, some shop owners were still violating the environmental regulation.

 

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He further warned traders, shop owners, motorists and the general public to desist from violating the sanitation laws which include dumping of refuse indiscriminately, construction of shanties on drainage, display of wares and food items at the road set back and under high – tension wires among others as mobile court would soon be established to prosecute  residents that violate environmental sanitation law in the state

 

“It is disheartening that despite the efforts of the State government to bring to a halt, the culture of filth through indiscriminate refuse dumping, lackadaisical attitude to environmental exercise on Thursdays and other regulations, some are still found doing same.

 

“All these regulations are for our own good. We will spend less on maintenance of our health and you will see that the government’s strive to make the State an investor friendly will be successful.

 

“The mobile court that will see to immediate dispensation of justice to environmental

 

Mr. Oyewole therefore enjoined all and sundry to embrace cleaningness as environmental issue is a collective responsibility.

 

 

 

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