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Mortality and loss to programme before antiretroviral therapy among HIV-infected children eligible for treatment in The Gambia, West Africa
Okomo Uduak,Togun Toyin,Oko Francis,Peterson Kevin
AIDS Research and Therapy , 2012, DOI: 10.1186/1742-6405-9-28
Abstract: Background HIV infection among children, particularly those under 24 months of age, is often rapidly progressive; as a result guidelines recommend earlier access to combination antiretroviral therapy (cART) for HIV infected children. Losses to follow-up (LTFU) and death in the interval between diagnosis and initiation of ART profoundly limit this strategy. This study explores correlates of LTFU and death prior to ART initiation among children. Methods The study is based on 337 HIV-infected children enrolled into care at an urban centre in The Gambia, including those alive and in care when antiretroviral therapy became available and those who enrolled later. Children were followed until they started ART, died, transferred to another facility, or were LTFU. Cox proportional hazards regression models were used to determine the hazard of death or LTFU according to the baseline characteristics of the children. Results Overall, 223 children were assessed as eligible for ART based on their clinical and/or immunological status among whom 73 (32.7%) started treatment, 15 (6.7%) requested transfer to another health facility, 105 (47.1%) and 30 (13.5%) were lost to follow-up and died respectively without starting ART. The median survival following eligibility for children who died without starting treatment was 2.8 months (IQR: 0.9 - 5.8) with over half (60%) of all deaths occurring at home. ART-eligible children less than 2 years of age and those in WHO stage 3 or 4 were significantly more likely to be LTFU when compared with their respective comparison groups. The overall pre-treatment mortality rate was 25.7 per 100 child-years of follow-up (95% CI 19.9 - 36.8) and the loss to programme rate was 115.7 per 100 child-years of follow-up (95% CI 98.8 - 137). In the multivariable Cox proportional hazard model, significant independent predictors of loss to programme were being less than 2 years of age and WHO stage 3 or 4. The Adjusted Hazard Ratio (AHR) for loss to programme was 2.06 (95% CI 1.12 – 3.83) for being aged less than 2 years relative to being 5 years of age or older and 1.92 (95% CI 1.05 - 3.53) for being in WHO stage 3 or 4 relative to WHO stage 1 or 2. Conclusions Earlier enrolment into HIV care is key to achieving better outcomes for HIV infected children in developing countries. Developing strategies to ensure early diagnosis, elimination of obstacles to prompt initiation of therapy and instituting measures to reduce losses to follow-up, will improve the overall outcomes of HIV-infected children.
Pre-treatment mortality and loss-to-follow-up in HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients eligible for antiretroviral therapy in The Gambia, West Africa
Toyin Togun, Ingrid Peterson, Shabbar Jaffar, Francis Oko, Uduak Okomo, Kevin Peterson, Assan Jaye
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-24
Abstract: All HIV-infected patients aged 15 years or older eligible for ART between June 2004 and September 2009 were included in the analysis. Assessment for eligibility was based on the Gambia ART guideline. Survival following ART-eligibility was determined by Kaplan-Meier estimates and predictors of pre-treatment mortality determined by Cox proportional hazard models.Overall, 790 patients were assessed as eligible for ART based on their clinical and/or immunological status among whom 510 (64.6%) started treatment, 26 (3.3%) requested transfer to another health facility, 136 (17.2%) and 118 (14.9%) were lost to follow-up and died respectively without starting ART. ART-eligible patients who died or were lost to follow-up were more likely to be male or to have a CD4 T-cell count < 100 cells/μL, while patients in WHO clinical stage 3 or 4 were more likely to die without starting treatment. The overall pre-treatment mortality rate was 21.9 deaths per 100 person-years (95% CI 18.3 - 26.2) and the rate for the composite end point of death or loss to follow-up was 47.1 per 100 person-years (95% CI 41.6 - 53.2). Independent predictors of pre-treatment mortality were CD4 T-cell count <100 cells/μL (adjusted Hazard ratio [AHR] 3.71; 95%CI 2.54 - 5.41) and WHO stage 3 or 4 disease (AHR 1.91; 95% CI 1.12 - 3.23). Forty percent of ART-eligible patients lost to follow-up seen alive at field visit cited difficulty with the requirement of disclosing their HIV status as reason for not starting ART.Approximately one third of ART-eligible patients did not start ART and pre-treatment mortality rate was found high among HIV infected patients in our cohort. CD4 T-cell count <100 cells/μL is the strongest independent predictor of pre-treatment mortality. The requirement to disclose HIV status as part of ART preparation counselling constitutes a huge barrier for eligible patients to access treatment.It is estimated that nearly 37% of people eligible for Antiretroviral therapy (ART) in sub-Sahara A
Treatment outcomes among HIV-1 and HIV-2 infected children initiating antiretroviral therapy in a concentrated low prevalence setting in West Africa
Uduak Okomo, Toyin Togun, Francis Oko, Kevin Peterson, John Townend, Ingrid Peterson, Assan Jaye
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-95
Abstract: All treatment naive HIV-infected children who initiated cART according to the WHO ART guidelines for children between October 2004 and December 2009 were included in the analysis. Kaplan-Meir estimates and sign-rank test were used to investigate the responses to treatment.65 HIV-1 and five HIV-2 infected children aged？<？15？years were initiated on cART over this time period. HIV-1 infected children were treated with a combination of Zidovudine or Stavudine？+？Lamivudine？+？Nevirapine or Efavirenz while children with HIV-2 were treated with Zidovudine？+？Lamivudine？+？ritonavir-boosted Lopinavir. HIV-1 infected children were followed-up for a median (IQR) duration of 20.1？months (6.9 – 34.3), with their median (IQR) age at treatment initiation, CD4% and plasma viral load at baseline found to be 4.9？years (2.1 – 9.1), 13.0% (7.0 – 16.0) and 5.4 log10 copies/ml (4.4 – 6.0) respectively. The median age at treatment initiation of the five HIV-2 infected children was 12？years (range: 4.6 – 14.0) while their median baseline CD4+ T cell count and HIV-2 viral load were 140 cells/mm3 (Range: 40 – 570 cells/mm3) and 4.5 log10copies/mL (Range: 3.1 - 4.9 log10copies/mL) respectively.Among HIV-1 infected children <5？years of age at ART initiation, the median (IQR) increases in CD4% from baseline to 12, 24 and 36？months were 14% (8 – 19; P？=？0.0004), 21% (15 – 22; P？=？0.005) and 15% (15 – 25; P？=？0.0422) respectively, while the median (IQR) increase in absolute CD4 T cell count from baseline to 12, 24 and 36？months for those ≥5？years at ART initiation were 470 cells/mm3 (270 – 650; P？=？0.0005), 230 cells/mm3 (30 – 610; P？=？0.0196) and 615 cells/mm3 (250 – 1060; P？=？0.0180) respectively. The proportions of children achieving undetectable HIV-1 viral load at 6-, 12-, 24- and 36？months of treatment were 24/38 (63.2%), 20/36 (55.6%), 8/22 (36.4%) and 7/12 (58.3%) respectively. The probability of survival among HIV-1 infected children after 12？months on ART was 89.9% (95% CI 78.8 – 95.3). C
Bacterial Isolates and Antibiotic Sensitivity among Gambian Children with Severe Acute Malnutrition
Uduak A. Okomo,Danlami Garba,Augustin E. Fombah,Ousman Secka,Usman N. A. Ikumapayi,Jacob. J. Udo,Martin O. C. Ota
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/825123
Abstract: Background. Establishing the pattern of infection and antimicrobial sensitivities in the local environment is critical to rational use of antibiotics and the development of management algorithms. Methods. Morbidity history and physical examination of 140 children with severe acute malnutrition were recorded. Their blood, stool, and urine samples were cultured and antibiotic sensitivity patterns determined for any bacterial pathogens isolated. Results. Thirty-eight children had a pathogen isolated from blood culture, 60% of which were considered contaminants. Coagulase negative staphylococcus was the predominant contaminant, while the major causes of bacteraemia were nontyphoidal Salmonella (13%), S. pneumoniae (10%), and E. coli (8%). E. coli accounted for 58% of the urinary isolates. No pathogen was isolated from stool. In vitro sensitivity by disk diffusion showed that 87.5% of the isolates were sensitive to ampicillin and/or gentamicin and 84.4% (27/32) to penicillin and/or gentamicin. Conclusions. A combination of ampicillin and gentamicin provides adequate antibiotic cover for severely malnourished children in The Gambia.
Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study
Martin Meremikwu, Uduak Okomo, Chukwuemeka Nwachukwu, Angela Oyo-Ita, John Eke-Njoku, Joseph Okebe, Esu Oyo-Ita, Paul Garner
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-55
Abstract: To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State.Audit of 665 patient records at six private and seven government health facilities in 2003.Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%), sulphadoxine-pyrimethamine (22.7%) or artemisinin derivatives alone (15.8%). Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5%) were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments.Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.The Nigerian government has recently changed its policy guidelines for treating uncomplicated malaria to artemether-lumefantrine or amodiaquine plus artesunate replacing monotherapy with chloroquine and sulfadoxine-pyrimethamine (SP). The policy change became necessary because the therapeutic efficacy of chloroquine and SP had deteriorated [1]. Any introduction of new treatments will require evidence from audit to understand current prescribing practices, and training to provide guidance [2]. The success of a new treatment policy would depend on the adherence of health providers and patients to the recommendations [3], and, in Nigeria, as in many other countries, there is a powerful pharmaceutical industry that aims to influence prescribing in both the private and public sector. Clinicians in the private sector are often thought to use more irrational treatments than in the public sector. In Nigeria, the priva
Bacterial Isolates and Antibiotic Sensitivity among Gambian Children with Severe Acute Malnutrition
Uduak A. Okomo,Danlami Garba,Augustin E. Fombah,Ousman Secka,Usman N. A. Ikumapayi,Jacob. J. Udo,Martin O. C. Ota
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/825123
Abstract: Background. Establishing the pattern of infection and antimicrobial sensitivities in the local environment is critical to rational use of antibiotics and the development of management algorithms. Methods. Morbidity history and physical examination of 140 children with severe acute malnutrition were recorded. Their blood, stool, and urine samples were cultured and antibiotic sensitivity patterns determined for any bacterial pathogens isolated. Results. Thirty-eight children had a pathogen isolated from blood culture, 60% of which were considered contaminants. Coagulase negative staphylococcus was the predominant contaminant, while the major causes of bacteraemia were nontyphoidal Salmonella (13%), S. pneumoniae (10%), and E. coli (8%). E. coli accounted for 58% of the urinary isolates. No pathogen was isolated from stool. In vitro sensitivity by disk diffusion showed that 87.5% of the isolates were sensitive to ampicillin and/or gentamicin and 84.4% (27/32) to penicillin and/or gentamicin. Conclusions. A combination of ampicillin and gentamicin provides adequate antibiotic cover for severely malnourished children in The Gambia. 1. Introduction Severe acute malnutrition (SAM) results from a relatively short duration of nutritional deficit that is often complicated by marked anorexia and concurrent infective illness [1]. Globally, comorbidities such as diarrhoea, pneumonia, and malaria, which result from a relatively defective immune status, remain the major causes of death among children with SAM [2]. Children with complications require hospital care due to the attendant high risk of mortality [3]. The high prevalence of bacteraemia, urinary tract infections, diarrhea, and pneumonia among children with severe malnutrition [4–7] coupled with an atypical clinical presentation of sepsis justifies the routine use of empirical antibiotic treatment in the initial phase of inpatient management as recommended by WHO [8, 9]. However, the choice of antibiotics has to be guided by locally prevalent pathogens and their antibiotic susceptibility patterns. There are few local studies on the spectrum of bacterial isolates affecting malnourished children and their antibiotic sensitivity since the HIV pandemic [10]. The objectives of this study were to evaluate the prevalence of acute bacterial infections and their antibiotic sensitivity in children aged 6–59 months with SAM admitted to the paediatric ward of the Medical Research Council (MRC) Unit’s hospital, Fajara, The Gambia. 2. Methods 2.1. Study Design and Participants In this prospective study, children with SAM
Design and Evaluation of a User Interface for an Autonomous Agricultural Sprayer  [PDF]
Uduak Edet, Franklin Ogidi, Daniel Delmar Mann
Agricultural Sciences (AS) , 2022, DOI: 10.4236/as.2022.132016
Abstract: This paper describes the design and evaluation of a user interface for a remotely supervised autonomous agricultural sprayer. The interface was designed to help the remote supervisor to instruct the autonomous sprayer to commence operation, monitor the status of the sprayer and its operation in the field, and intervene when needed (i.e., to stop or shut down). Design principles and guidelines were carefully selected to help develop a human-centered automation interface. Evaluation of the interface using a combination of heuristic, cognitive walkthrough, and user testing techniques revealed several strengths of the design as well as areas that needed further improvement. Overall, this paper provides guidelines that will assist other researchers to develop an ergonomic user interface for a fully autonomous agricultural machine.
Oral Activated Charcoal Prevents Experimental Cerebral Malaria in Mice and in a Randomized Controlled Clinical Trial in Man Did Not Interfere with the Pharmacokinetics of Parenteral Artesunate
J. Brian de Souza,Uduak Okomo,Neal D. Alexander,Naveed Aziz,Benjamin M. J. Owens,Harparkash Kaur,Momodou Jasseh,Sant Muangnoicharoen,Percy F. Sumariwalla,David C. Warhurst,Stephen A. Ward,David J. Conway,Luis Ulloa,Kevin J. Tracey,Brian M. J. Foxwell,Paul M. Kaye,Michael Walther
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0009867
Abstract: Safe, cheap and effective adjunct therapies preventing the development of, or reducing the mortality from, severe malaria could have considerable and rapid public health impact. Oral activated charcoal (oAC) is a safe and well tolerated treatment for acute poisoning, more recently shown to have significant immunomodulatory effects in man. In preparation for possible efficacy trials in human malaria, we sought to determine whether oAC would i) reduce mortality due to experimental cerebral malaria (ECM) in mice, ii) modulate immune and inflammatory responses associated with ECM, and iii) affect the pharmacokinetics of parenteral artesunate in human volunteers.
Proximate Composition and Phytochemical Constituents of Aspilia africana (Pers) C. D. Adams & Tithonia diversifolia (Hemsl) A. Gray STEMS (Asteraceae)
Uduak Essiett*, Emana Akpan
Indian Journal of Pharmaceutical and Biological Research , 2013,
Abstract: Proximate composition and phytochemical constituents of stems of A. africana and T. diversifolia(Asteraceae) were investigated. The stems of these species contain anti-oxidant, anticancer, anti-tumor,anti-viral, anti-inflammatory and anti-allergic properties which cures malaria, skin diseases, athlete’s foot,asthma, gonorrhoea and to stop bleeding. The stems of these two species revealed the presence offlavonoids, tannins, saponins and cardiac glycosides. The proximate analysis of the stems of A. africanaand T. diversifolia showed the moisture content of 15.7% and 20.6%, total ash of 6.10% and 6.55%, acidinsoluble ash of 0.55% and 0.33%, sulphated ash of 18.8% and 14.0%, protein content of 7.87% and9.62%, fat of 3.68% and 4.21%, fibre of 12.30% and 15.82%, carbohydrate of 75.97% and 70.35%, volatileether soluble of 7.33% and 1.66%, water soluble of 3.33% and 0.33% and diluted alcohol soluble of 5.33%and 5.66%. The results of this study suggest the popular use of A. africana and T. diversifolia in herbalmedicine.
Exchange Rate Fluctuations, Delivery of Foreign Exchange Services and Economic Growth in Nigeria
Anthonia Uduak Ubom
- , 2018, DOI: 10.5923/j.ijfa.20180702.02
Abstract: In this paper, the relationship between exchange rate fluctuations,delivery of foreign exchange services and economic growth in Nigeria was examined. Major problems identified were that over some years now, exchange rate among the major traded currency (dollar) and the naira has fluctuated significantly thereby affecting the delivery of market transactions (spot and forward). The forward transaction is very low compared to the spot transaction. These subsequently led to reduction in the economic growth of Nigeria, measured in terms of growth rate of gross domestic product among others. On these grounds, this work was aimed at establishing relationships that exist between the dutch auction, interbank, bureau de change exchange rates, values of spot and forward transactions and growth rate of gross domestic product (gdpr), unemployment rate (uner) and s per capita income (pci) in Nigeria from the year 2010 to 2016. The expost facto research design was used and the research methods were descriptive and analytical in nature. Tool of analysis was the Ordinary Least Square (OLS) multiple regression model. It was discovered among others that, inverse relationship exists between gdpr, interbank exchange rates and values of spot transactions, between unemployment rates and interbank exchange rates and between per capita income and dutch auction, bureau de change exchange rates, values of the spot and forward transactions. Also, positive corelation exist between gdpr, dutch auction and bureau de change exchange rates. On these grounds, it was concluded that the variables of exchange rate fluctuations, delivery of foreign exchange services affect economic growth both positively and negatively. On the bases of these, it was recommended among others that market participants should undertake forward transactions to serve as an insurance cover for their spot transactions, exchange rate between the naira and the United States dollar be reduced to the barest minimum to encourage producers who sourced raw materials externally to continue/remain in business. This will cut down the rates of unemployment and per capita income will improve
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