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Background: Tuberculosis (TB) coexists with other non-communicable diseases (NCDs), including Diabetes Mellitus (DM). Smoking increases the risk of TB as well as DM. Health systems are poorly prepared in many low middle income countries (LMICs) and are currently facing the "triple burden of smoking, TB, and DM" that drives these countries into the vicious cycle of poverty. Methods: A cross-sectional study method was carried out to assess the proportion of TB care centers that included integration measures for diabetic care as well as those providing DM care that included integration measures for TB. A list of 49 health care centers in Lagos offering TB care and managing Diabetes patients were recruited. A focus Group Discussion(FGD) and Individual interviews were conducted to investigate health care providers ' knowledge, attitudes and practices and the barriers encountered in the process of integrating TB and DM care. Results: Out of the 49 health care centres recruited in this study, 6% of health care units are aware of a surveillance to screen for diabetes in tuberculosis patients, while 2% of health facilities confirmed awareness of a surveillance to screen for tuberculosis in diabetes patients. 91% of health centres either verified the lack of or no understanding of monitoring of both diseases. The percentage of health facilities that have existing guideline on TB and DM screening was evaluated, it was perceived that 8% of health facilities had implemented a guideline to screen for DM in TB patients, while 4% of these Care Centres have implemented a guideline for diabetes patients to be screened for TB. Conclusion TB/DM integrative screening, treatment and management could be better attained if both co-morbidities integration program is initiated in the healthcare centres and policies of western states and Nigeria as a whole.

BackgroundSince insecticides are commonly used in agriculture/cultivation and in vector control, they are frequently found in agricultural water bodies, where mosquito larvae are exposed. Although their concentration is often so low as not to kill the larvae, they affect the development of the mosquitoes. In particular, their effects may be transmitted to adults to influence their characteristics of life-history and their vectorial competence for arboviruses infection and malaria. Such effects on vectorial competence of sub-lethal doses of insecticides are likely to be related to their impact on immune response. Insecticide exposure influences the immune response of insects in several ways. Organophosphates and organochlorines affect the number of hemocytes (for phagocytosis) However, it is not known whether larvae exposure will impact the immune response of adults.MethodAssessment of the bio-efficacy and residual activities of insecticides sprayed, wall surface using CDC wall cone bioassay test. Entomological indices with Anopheles species collection was measured to determined vectorial involvement and residual bio-efficacy of of Inesfly 5AIGR/ Inesfly 5AIGRNG insecticidal paints on Adult Anopheles gambiae complex mosquitoes on treated wall surfaces in at both communities (Masaka and Gidan Zakara) from January to April and May through June, 2018. A bio-assay cone test was carried out at various wall surfaces/height treated with above named insecticidal paints at parameters of 0.5meter, 1meter, and 1.5meter respectively.ResultIn both communities the knockdown/mortality threshold fluctuates (94%-99%.) indicating the state of resistance and susceptible, however, in the month of May and June at Gidan-Zakara, the knockdown/mortality of mosquitoes after 24hrs was 90%-100%.The seasonal abundance of mosquito population was generally observed to decrease between the month of January through April, 2018 and increases during the onset of rains in the months of April through June, 2018. There was no significance difference in the seasonal abundance of mosquitoes and the efficacy of Inesfly 5AIGR and Inesfly 5AIGRNG insecticide paints (F= 0.958> 0.435 and F 1.515>0.293. Similarly no significant difference in the residual efficacy and the malaria vector mortality (F=2.286>0.183) and in June (F1.549>0.287). The residual Inesfly paints were effective, given that 98%-100% malaria vector were susceptible. ConclusionThe malaria vectorial competence of Anopheles species were 98% - 100% susceptible to residual ‘1NESFLY’ paints (5AIGR and 5AIGRNG) at various wall parameters of 0.5meters, 1meter and 1.5meters in the studied communities in central Nigetia. It is also imperative to state that the trial paints were in compliance with animals and human tolerance levels/standards during the during the trial periods, and fulfils the WHO criteria of insecticidal bio-efficacy (mortality >80%).

Background Available evidence indicates that the various stages of the malaria parasite life cycle have specific immune responses. The pro-inflammatory cytokines tend to play an important role in preventing malaria and killing the parasites. Furthermore, the relative levels of pro-and anti-inflammatory cytokines are essential mediators of malaria anemia production and outcomes. Natural human immune responses to malaria recognize extracellular sporozoites and merozoites, both of which have surface-exposed antigens, and which are currently being developed for various vaccines. Methods A total of four hundred sixty- two (462) participants were tested for Plasmodium falciparum. The procedure employed were parasite staining using World Health Organization parasitology laboratory protocol [Microscopy] of Giemsa staining and Enzyme linked immunosorbent assay [ELISA]. Results The subjects in this study showed high levels of INF-γ and TNF-α which decreases with increased malaria severity and high parasite density. These results suggest that INF-γ cytokine and TNF-α may contribute to protection against severe malaria anaemia and parasite clearance. Conversely, infected participants showed higher levels of IL-10, which decreases with severe malaria parasite, furthermore IL-10 levels correlated with parasite density. These findings suggest that higher levels of anti-inflammatory cytokines, especially IL-10 levels may contribute to pathogenesis of complicated malaria by inhibiting the INF-γ and TNF-α production. Conclusion Molecular biological and other serological analysis are needed to elucidate the implication of these cytokines and other pro-inflammatory cytokines as IL-17, IL-21 and IL-22 in the responses to malaria and consequently their involvement in malaria vaccine construct/development as well as other therapeutics for the treatment and elimination of the malaria parasite in our environment.

Call for closure of Folateng private wards in public hospitals in southern Gauteng To the Editor: The facilities available in southern Gauteng for severely ill patients with diseases related to internal medicine are currently under severe pressure. Central and regional hospitals in this region have frequently had to close to admissions because their bed occupancies have exceeded 100%. This problem started in 2013 and has become progressively worse. The reasons for this crisis are not difficult to understand: (i) there is a very high burden of illness in the population served by these public hospitals, including communicable (HIV/AIDS, tuberculosis) and non-communicable (cardiac, pulmonary, metabolic, oncological) diseases; (ii) Gauteng is the most populous province of South Africa, with just over 12 million people; and (iii) despite this ever-increasing burden of illness, a decision was taken some years ago to close a number of public health facilities such as Hillbrow and Kempton Park hospitals. In addition, a significant number of public healthcare beds were privatised for use by patients with medical aids-Folateng private wards. It is no wonder that our existing public hospitals are overwhelmed. The Department of Medicine at Chris Hani Baragwanath Academic Hospital in Johannesburg has a bed capacity of 730, with bed occupancy of over 90%. We admit over 100 patients a day, and not infrequently have more patients than available beds. The result is that very sick people are kept waiting on chairs for long periods of time. The nurses, the doctors and the support services are frequently overstretched, resulting in suboptimal service delivery. This is a totally unacceptable situation that needs a strategic solution.

The South African population is suffering from an obesity epidemic. Sleep-disordered breathing (SDB), which includes obstructive sleep apnoea and obesity hypoventilation syndrome, is closely related to obesity. SDB may have serious health consequences if not asked about when taking a history related to sleep and sleep-deprivation symptoms. Unfortunately, a formal polysomnogram is available to very few patients who need the diagnosis confirmed. However, taking a sleep history, measuring the haemoglobin level and using a much smaller device in the comfort of a patient's bed can obviate the need for formal polysomnography.

Background: Substantial evidence exists that quitting smoking after a cancer diagnosis can result in improved treatment efficacy and safety, decreased risk of recurrence and second primary cancers, and lower mortality. Based on this evidence, Cancer Care Ontario (CCO) implemented a smoking cessation program for new ambulatory cancer patients in Ontario's 14 Regional Cancer Centers (RCCs) in 2014. Implementation is monitored centrally by CCO using performance indicators and monthly discussions with regional champions. Significant variation in implementation processes and performance metrics amongst RCCs highlighted a need for quality improvements. Method: Funding received from the Canadian Partnership Against Cancer enabled CCO to undertake a series of initiatives to enhance provider and patient education and to standardize processes. Based on program learnings and emerging evidence, the program model was revised from 5As (Ask, Advise, Assess, Assist, Arrange) to 3As (Ask, Advise, Act), and site-specific recommendations were provided to support consistency in implementation. Patient-facing materials, an on-line learning module, scripts and videos were developed to educate healthcare providers and patients on the health benefits of smoking cessation in order to improve rates of screening and referrals to cessation services. Importantly, two performance indicators have been included on CCO's Regional Scorecard, which measures performance against targets and determines an RCC's overall performance ranking within the province. Result: Performance on the Tobacco Use Screening indicator (proportion of new cancer patients screened for tobacco use) was 42.0% across Ontario in April 2015 when first included on the Scorecard. By March 2017, performance had improved to 62.7%, with significant improvements seen among the lowest-performing RCCs. The Accepted a Cessation Referral indicator (proportion of tobacco users who accepted referral to cessation services) improved only modestly from 19.7% in Q1 of 2016/17 to 23.4% in Q4. This indicator will be added to the Regional Scorecard starting in 2017/18. Both indicators are discussed at the quarterly performance reviews with the Regional Vice-Presidents responsible for cancer services. In 2016/17, lung cancer patients accounted for the largest percentage of current users of tobacco by tumor site (21.9%); in addition, almost a quarter of all patients accepting a referral (24.3%) were lung cancer patients. Conclusion: The CCO performance Scorecard is a strong driver of quality improvement. CCO is encouraged by regional enthusiasm to adopt the refined 3As model, and anticipates further improvements in the performance metrics, especially in the number of tobacco users who accept referral to cessation services.

Background Hepatitis C virus is an RNA virus of the flaviviridae family and appears to have humans and chimpanzees as the only species susceptible to its infection [1]. Infection is often asymptomatic but once established, chronic infection can lead to scarring of the liver (fibrosis) and advanced scarring (cirrhosis) which is generally apparent after many years [2]. It is a major and growing public health problem that can easily lead to chronic liver disease, cirrhosis and hepatocellular carcinoma [3]. Methods This study was conducted on one hundred and thirty (130) pregnant women of reproductive age (15 – 45 years) who were randomly selected at National hospital Abuja. 5 ml of blood was obtained from study participants for rapid HCV screening and malaria thick films and thin films for parasite densities and parasite species identification. Result The preponderance of HCV was 130 (17.1%), malaria (49.4%) and HCV and malaria co-infection was (10.9%), of the hundred and thirty (130) samples obtained from pregnant women in the Abuja National Hospital. Conclusion The sero-prevalence of HCV infection and its infectivity is high in central Nigeria. This study findings guide the want for routine HCV and malaria screening among pregnant women at some stage in antenatal care within the region and Nigeria. It also form a base for continual education campaign about HCV amongst rural/Urban pregnant mothers/women and food vendors in central states and other parts of Nigeria. Those efforts will guarantee top of the line and better outcome for excellent health care delivery for the expecting mothers and other health care providers in our hospitals.