Schistosomiasis is a neglected tropical disease. Sub-Saharan Africa accounts for 93% of the world's 207 million schistosomiasis cases. Urogenital schistosomiasis and malaria are both public health problems in Nigeria, where they are endemic. We determined the co-prevalence of urogenital schistosomiasis and malaria in schoolchildren and assessed its implication on anaemia and malnutrition. This cross-sectional study was conducted amongst primary schoolchildren in the Warwade, Saya Saya and Jigawar Daha villages of Nigeria. Urine samples were collected to detect Schistosoma haematobium eggs, and finger prick blood was used for haemoglobin concentration and malaria diagnosis. Nutritional status was assessed using anthropometric measurements and a pre-tested questionnaire. The overall prevalence and density of S. haematobium were 27.7% and 9 eggs/10 ml, respectively, with significant differences between villages and sexes. The prevalence of malaria and infection density was 10.4% and 330 mps/jl, respectively. Co-infection prevalence was 3.3%. Anaemia prevalence was 66%, with significant variation across villages and between sexes. Prevalence of stunting, underweight, and wasting was 41.7%, 46%, and 29.7%, respectively. Mean haemoglobin concentrations in Plasmodium and children co-infected with urogenital schistosomiasis were significantly lower than those who were negative for the infection. No significant association was observed between malnutrition and single or co-infection of urogenital schistosomiasis and malaria. After adjusting for variables associated with anaemia, village of residence remained a significant predictor of anaemia. Water contact activities, such as fishing, swimming, and irrigation, emerged as independent risk factors of S. haematobium infection. SIGNIFICANCE: Urogenital schistosomiasis and malaria infections are prevalent in communities around Warwade dam in Dutse, Nigeria, and cause anaemia. Continuous monitoring, proper treatment and regular intervention is desirable in the communities.

ABSTRACT Improving basic capacities for regulation of medicines and health technologies through regulatory systems strengthening is particularly challenging in resource-constrained settings. “Regionalization”—an approach in which countries with common histories, cultural values, languages, and economic conditions work together to establish more efficient systems—may be one answer. This report describes the Caribbean Regulatory System (CRS), a regionalization initiative being implemented in the mostly small countries of the Caribbean Community and Common Market (CARICOM). This initiative is an innovative effort to strengthen regulatory systems in the Caribbean, where capacity is limited compared to other subregions of the Americas. The initiative’s concept and design includes a number of features and steps intended to enhance sustainability in resource-constrained contexts. The latter include 1) leveraging existing platforms for centralized cooperation, governance, and infrastructure; 2) strengthening regulatory capacities with the largest potential public health impact; 3) incorporating policies that promote reliance on reference authorities; 4) changing the system to encourage industry to market their products in CARICOM (e.g., using a centralized portal of entry to reduce regulatory burdens); and 5) building human resource capacity. If implemented properly, the CRS will be self-sustaining through user fees. The experience and lessons learned thus far in implementing this initiative, described in this report, can serve as a case study for the development of similar regulatory strengthening initiatives in resource-constrained environments.

RESUMEN El mejoramiento de la capacidad básica para la reglamentación farmacológica mediante el fortalecimiento de los sistemas de reglamentación plantea un reto especialmente difícil en contextos de escasos recursos. Una posible solución radica en la “regionalización”, proceso según el cual países con un mismo legado histórico, cultural y lingüístico y con situaciones económicas semejantes colaboran entre sí con objeto de establecer sistemas más eficientes. En el presente informe se describe el Sistema de Reglamentación del Caribe (SRC), iniciativa de regionalización que se está poniendo en marcha en los países de la Comunidad y el Mercado Común del Caribe (CARICOM), pequeños en su mayoría. La iniciativa representa una medida innovadora por fortalecer los sistemas de reglamentación en el Caribe, donde la capacidad existente es más modesta que en otras subregiones de las Américas. En el concepto y diseño de la iniciativa hay elementos y pasos destinados a fomentar la sostenibilidad en contextos de escasos recursos. Estos consisten en aprovechar las plataformas ya existentes para la cooperación, gobernación e infraestructura centralizadas; fortalecer las capacidades de reglamentación que puedan tener la mayor incidencia sobre la salud pública; incorporar políticas que fomenten la confianza en los organismos de reglamentación; modificar el sistema para alentar a la industria a comercializar sus productos en el CARICOM (por ejemplo, utilizando un punto de entrada centralizado para aligerar las cargas reglamentarias); y fortalecer la capacidad en materia de recursos humanos. Si se pone en práctica adecuadamente, el SRC se financiará a sí mismo con las cuotas de los usuarios. La experiencia y las enseñanzas extraídas hasta el momento con la puesta en marcha de esta iniciativa, que se describen en el presente informe, pueden ser útiles como estudio de caso para la formulación de iniciativas afines orientadas a fortalecer la capacidad de reglamentación en entornos de pocos recursos.

BACKGROUND: Warfarin is the most frequently used oral anticoagulant worldwide and it is the oral anticoagulant of choice in South Africa for reducing thrombosis-related morbidity and mortality. However, the safety and efficacy of warfarin therapy depends mainly on careful monitoring and maintenance of the international normalised ratio (INR) within an optimal therapeutic range. AIM: The aim of this study was to describe the profile and the anticoagulation outcomes of patients on warfarin therapy in a major warfarin clinic in the Western Cape Province of South Africa. SETTING: Victoria Hospital - a district hospital in Cape Town. METHODS: A cross sectional review of clinical records of patients on warfarin therapy who attended the INR clinic from 01 January 2014 to 30 June 2014 was done. Data analysis was done with STATA to generate appropriate descriptive data. RESULTS: Our study showed that atrial fibrillation (AF) was the commonest indication for warfarin use in this study and hypertension was the commonest comorbidity among these patients. Only 48.5% achieved target therapeutic range; 51.5% were out-of-range. There was a significant association between alcohol consumption and poor anticoagulation outcomes (p-value < 0.022). Anticoagulation outcomes were better among the older age groups, male patients and in those with AF. The prevalence of thrombotic events while on warfarin treatment was 2.2%, while prevalence of haemorrhagic events was 14%. Most of the patients with bleeding events were on concurrent use of warfarin and other medications with potential drug interactions. CONCLUSION: In our study, patients who achieved target therapeutic control were less than the acceptable 60%.

OBJECTIVE: To devise a flowchart suitable for assessing risk of trichomoniasis, chlamydia and gonorrhoea in an adolescent population, not all of whom will be sexually experienced or currently in a relationship. METHODS: The data used to derive the flowchart were generated from cross-sectional microbiological surveys of girls aged 14-19 years in Port Harcourt, Nigeria. The flowchart screened on the basis of: (i) sexual experience; (ii) recent sexual activity; (iii) a positive urine leukocyte esterase (LE) test; and (iv) among LE negatives, a history of malodorous/pruritic discharge. FINDINGS: Using this flowchart, we found that 26.2% of all adolescents screened would receive treatment for cervicitis and vaginitis. Chlamydial, gonococcal, and trichomonal infections were correctly diagnosed in 37.5%, 66.7%, and 50 % of the cases, respectively. CONCLUSION: Although the flowchart is more suitable for an adolescent population than the vaginal discharge algorithm used in syndromic management protocols, it still lacks precision and needs adapting to local settings.

OBJETIVO: Elaborar un diagrama adecuado para evaluar el riesgo de tricomoniasis, clamidiasis y gonorrea en una población de mujeres adolescentes, no todas las cuales habían tenido experiencias sexuales o mantenían en ese momento una relación. MÉTODOS: Los datos empleados para elaborar el diagrama se obtuvieron a partir de estudios microbiológicos transversales de muchachas de 14 a 19 años de Port Harcourt (Nigeria). En el diagrama se hace un cribado teniendo en cuenta (i) la experiencia sexual; (ii) la actividad sexual reciente; (iii) la eventual positividad de la prueba de la esterasa leucocitaria (EL) en orina; y (iv), entre los casos EL-negativos, los antecedentes de flujo maloliente o pruriginoso. RESULTADOS: De todas las adolescentes sometidas a ese cribado, el 26,2% recibieron tratamiento contra una cervicitis o vaginitis, y las infecciones por clamidias, gonococos y tricomonas fueron diagnosticadas correctamente en el 37,5%, 66,7%, y 50% de los casos, respectivamente. CONCLUSIÓN: Tratándose de una población de adolescentes, el diagrama es preferible al algoritmo para flujo vaginal empleado en los protocolos de manejo sindrómico, pero adolece aún de imprecisión y ha de ser adaptado a las condiciones locales.

OBJECTIF: Mettre au point un algorithme adapté à l’évaluation du risque de trichomonase, de chlamydiose et de gonococcie dans une population d’adolescentes qui n’ont pas toutes une expérience sexuelle ou ne sont pas engagées présentement dans une relation. MÉTHODES: Les données utilisées pour construire l’algorithme proviennent d’enquêtes microbiologiques transversales chez des adolescentes de 14 à 19 ans habitant Port Harcourt (Nigéria). Les différents points de l’algorithme portent sur: i) l’expérience sexuelle; ii) l’activité sexuelle récente; iii) untest urinaire positif pour la leucocyte estérase (LE); iv) parmi les adolescentes LE négatives, un antécédent de pertes vaginales nauséabondes ou prurigineuses. RÉSULTATS: Parmi l’ensemble des adolescentes examineés, 26,2% ont reçu un traitement pour une cervicite ou une vaginite ; les affections à Chlamydia, à gonocoques et à trichomonas ont été correctement diagnostiquées dans respectivement 37,5 %, 66,7% et 50% des cas. CONCLUSION: Si cet algorithme est mieux adapté à une population d’adolescentes que l’algorithme pour les pertes vaginales utilisé dans les protocoles de prise en charge syndromique, il manque encore de précision et a besoin d’être adapté aux conditions locales.