BackgroundDrug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.MethodsFollowing GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009–2013 and tested for first- and second-line drug resistance.ResultsFrom the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.ConclusionsWest African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.

BackgroundThe Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.ObjectiveTo describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship.MethodsThe SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit.ResultsThere was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit.ConclusionThe SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops.

The antimicrobial activity of extracts of twelve Nigerian medicinal plant species and a "wonder cure" concoction [Epa-Ijebu]; used in traditional medicine for the treatment of tuberculosis and cough were screened for activity against Mycobacterium tuberculosis isolated from tuberculosis patient sputum and the control strains of M. tuberculosis (H37RV). Both ethanolic and aqueous solution of the extract of Allium ascalonicum, Terminalia glaucescens, Allium cepa and Securidaca longepedunculata (ethanolic extract only) at 0.05g/ml as well as aqueous solution of "wonder cure" concoction at same concentration inhibited the growth of M. tuberculosis. However at lower concentration of 0.2 µg/ml (critical proportion level of the control drug (isoniazide), M. tuberculosis was resistant to both aqueous and ethanolic extracts of the plants as well as the aqueous solution of the wonder-cure concoction. The phytochemical analysis of the plant extract and the Epa-Ijebu showed the presence of bioactive compounds: tannin, flavonoid, alkaloids, phlobatannin, anthocyanin, reducing sugar, saponin and anthraquinone. Our results offer a scientific basis for the traditional use of aqueous and ethanolic extracts of Allium ascalonicum, Terminalia glaucescens, Allium cepa, Securidaca longepeducunlata (ethanolic extract only) and aqueous solution of the "wonder cure" concoction at higher concentration against M. tuberculosis. However local herbs such as Nicotiana tabacum, Allium sativum, Aframomum melegueta, Aprus precatorius, Xylopia aethiopica, Tetrapleura tetraptera, Crinium jagus, and Garcinia kola were ineffective.

BackgroundProficiency testing (PT) is a means of verifying the reliability of laboratory results, but such programmes are not readily available to laboratories in developing countries. This project provided PT to laboratories in Nigeria.ObjectivesTo assess the proficiency of laboratories in the diagnosis of HIV, tuberculosis and malaria.MethodsThis was a prospective study carried out between 2009 and 2011. A structured questionnaire was administered to 106 randomly-selected laboratories. Forty-four indicated their interest in participation and were enrolled. Four rounds of pre-characterised plasma panels for HIV, sputum films for tuberculosis and blood films for malaria were distributed quarterly by courier over the course of one year. The results were returned within two weeks and scores of ≥ 80% were reported as satisfactory. Mentoring was offered after the first and second PT rounds.ResultsAverage HIV PT scores increased from 74% to 95% from the first round to the third round, but decreased in the fourth round. For diagnosis of tuberculosis, average scores increased from 42% in the first round to 78% in the second round; but a decrease to 34% was observed in the fourth round. Malaria PT performance was 2% at first, but average scores increased between the second and fourth rounds, culminating in a fourth-round score of 39%. Many participants requested training and mentoring.ConclusionsThere were gross deficiencies in the quality of laboratory services rendered across Nigeria. In-country PT programmes, implemented in conjunction with mentoring, will improve coverage and diagnosis of HIV, tuberculosis and malaria.

Background Multidrug-resistant tuberculosis (MDR-TB) remains a clear threat to TB control. There is a paucity of data A32