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Tuberculosis and Humans, Till Death Do Us Part?

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Tuberculosis
  • Tuberculosis and Humans, Till Death Do Us Part?

Tuberculosis (TB) is the leading infectious cause of death globally, accounting for over one billion deaths in the last two centuries. The disease appears to have stuck with humans since ancient times as compelling evidence and anecdotes abound from India and China, incidentally the countries with the highest burden of the disease.

About 30 years ago, an Egyptian mummy was re-subjected to another rounds of tests, with improved performance characteristics; Mycobacterium tuberculosis was identified in her lungs, bones and gall bladder; she died in Thebes, around 600 BC. Fast forward to 2017, the World Health Organisation (WHO) reported that 10 million people developed TB across all countries of the world, and 1.6 million people died from the disease; this is in spite of almost a century of widespread use of the Bacillus Calmette-Guerin (BCG) vaccine.

However, the TB bug appears to always be a step ahead and has successfully evaded every attempt to eradicate it, thus sustaining the coerced matrimony it has established with humans.

Dr Tunde Olayanju

Dr Tunde Olayanju

Several international agencies have risen to the challenge and donated generously to the fight against TB, thousands of dollars in aids and research grants have been committed to vaccines and drugs development, the outcomes are largely incommensurate with the vast monetary investment. The WHO’s “stop TB strategy” (2006-2015) has given birth to the “end TB strategy” (2015-2035) while the United Nations’ Millennium Development Goals (MDG; 2000-2015) has metamorphosed into Sustainable Development Goals (SDG; 2015-2030), both with pragmatic intentions to fight the TB scourge. Governments of different countries have also spent substantial proportion of their health budgets to support prevention, diagnosis, and treatment of TB in different capacities. However, the TB bug appears to always be a step ahead and has successfully evaded every attempt to eradicate it, thus sustaining the coerced matrimony it has established with humans.

Not only has TB refused to go away, it has evolved over the years, altering its genome to procreate strains that are resistant to drug treatment. That becomes a bigger challenge because TB drug development appeared to have been banished into a limbo for over 40 years, while the bug had a field day playing hide and seek with the available drugs. There is currently a wide spectrum of resistance ranging from monoresistant TB, through a multidrug resistant (MDR) TB stage, to a group of strains referred to as extensively drug resistant (XDR) TB. The cascade snowballs progressively based on the number of important drugs the bug has developed resistance to, and there appears to be no end in sight. A totally drug resistant (TDR) TB has been described in literatures, and cases have been reported in India, Iran and South Africa, other authors referred to these strains as incurable (XXDR)TB; although this is not yet a conventional classification, only for technical reasons.

Rather than wait for people to present at hospitals with chronic coughs, haemoptysis and weight loss, pro-active institutions now intervene in communities, screening large number of people who would otherwise not go to the clinics, with WHO-recommended rapid diagnostic (WRD) kits, and the detection rate of active TB in those apparently healthy people has been alarming. The implication of this finding is that hospital reported incidence rate may just be a tip of the iceberg. Sadly, there has been several reported cases of primary infection by drug-resistant strains, as evidenced by whole genome sequencing showing downstream cases with identical sequencing profile and resistant-encoding mutations to index cases. Most of the affected people had been in contact with the index cases who probably had failed treatment or are battling with a recurrence. Furthermore, health care workers who are directly involved in patient care now bear a huge brunt of nosocomial transmission, and this trend has been widely reported.

Although sputum culture still retains a high sensitivity in detecting the TB bug, the caveat for a relatively high bacillary load is a major limitation in immunocompromised individuals. However, the use of urinary Lipoarabinomannan (LAM) is becoming more popular as a dependable point-of-care testing (POCT) platform in sputum smear negative patients, especially in HIV-coinfection which is very common in TB patients. Xpert Ultra has also been developed with improved assay chemistry to boost the diagnostic accuracy of gene Xpert, an automated polymerase chain reaction based rapid test for detecting TB and rifampicin resistance. Furthermore, Line Probe Assay (LPA), a rapid molecular test has been approved to not only detect TB, but also to detect resistance to major first and second line drugs, thus enhancing the early diagnosis of drug resistant TB.

These are all impressive innovations aiming to improve clinical approach to the management of TB, but will this bug ever bulge? There is hardly any known anti-TB drug currently in use, that the bug has not developed a pathway to evade. Certain countries have even made it mandatory to conduct an extended drug susceptibility testing before commencing treatment in TB patients. This is in a bid to ensure patients are getting drugs to which the bugs will respond, rather than empirically loading them with drugs which are though potent, unfortunately, ineffective in patients with resistant strains. There are already reports of resistance to novel and repurposed anti-TB drugs like bedaquiline, linezolid and delamanid even when so many countries have not been able to procure them because of the cost. If and when such countries finally muscle their ways into the elitists’ group to access the so-called novel drugs, the bug may just be far gone, as usual, one step ahead and we are back to square one.

Will TB always win over humans? Maybe there are things we could do differently or possibly just improve on. Is it possible to cast the net of diagnosis wider, for instance by intensifying effort at screening beyond pre-employment tests? The market women, artisans, prisoners and close contacts of TB patients are potential targets for active case finding to enhance early detection and possible disease containment. Treatment programs could also be strengthened, with tighter control on admission policy, directly observed treatment and antibiotic stewardship. At least 20 clinical trials are currently at various stages of completion on the registry, the regimens with proven efficacy could be fast-tracked and given early approval.

Maybe it’s also time to fully embrace Host Directed Therapy (HDT) using autophagy inducing drugs; Alternate Day Fasting (ADF) has also been recommended as a physiological way of inducing autophagy. Improving infection control measures in treatment centres would also go a long way in protecting health care workers.

Bearing in mind that vaccination has helped in the past to eliminate killer diseases and that concerted efforts and political will recently produced a potential cure for Ebola, governments and non-governmental organisations could do more to finance TB related research. More so, that human migration across continents is not likely to stop anytime soon

Dr. Olatunde Olayanju writes from Oyo State, Nigeria and can be reached via holatundey@yahoo.com.

CEO/Founder Investors King Ltd, a foreign exchange research analyst, contributing author on New York-based Talk Markets and Investing.com, with over a decade experience in the global financial markets.

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Oyo Begins Training of 3,300 Youths in Agribusiness

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Governor Seyi Makinde of Oyo State

The Oyo State Government has signed a memorandum of understanding with the CSS Global Integrated Farms in Nasarawa State to train 3,300 youths from the state on agriculture and agribusiness.

The state governor, Seyi Makinde, made this disclosure at the Stakeholders Consultative Meeting on the 2022 Budget, noting that the move is part of measures being taken by his administration to address the challenges of youth unrest and youth unemployment.

He equally explained that the state government’s decision to reconstruct the Oyo-Iseyin federal road was borne out of the need to prevent the state’s investments in the Fashola Agribusiness Hub from becoming a waste as a result of lack of road access.

A statement by the Chief Press Secretary to the governor, Mr Taiwo Adisa, quoted him as explaining that the training will have 150 participants per batch and that the first batch is to begin training this week.

“I am happy to tell you that we just signed an MoU with CSS Farms in Nasarawa State to assist us in training 3,300 youths in agriculture and agribusiness.

“The training will last two weeks. The first set will start on August 1, and there will be 150 participants for every batch. By the end of August, we would have trained 600 of them.”

Governor Makinde, who stated that his administration will do everything to ensure that youths in the state are meaningfully engaged, said he has also instructed the local governments to set up Direct Labour Agencies, which would absorb the youths to engage in minor construction and other works.

He said: “Our youths have to be meaningfully engaged and we will continue to strive. What I asked them to do in each local government is to set up a Direct Labour Agency, in which a certain amount of money will be earmarked for them every month.

“They will be the ones to be doing culverts, fixing street lights, channelisation of drainages and we have an arrangement with the local government chairmen. As soon as we put the new cabinet in place, I assure you that whoever becomes the new Commissioner for local government matters will drive the process.”

The governor equally said that his administration has been investing heavily in sports development in order to take youths off the streets, saying the investments in the Lekan Salami Stadium and other sporting facilities will soon pay off.

“Some of us have talked about our troublesome youths who are disturbing the peace of our environments because they have nothing doing. This is why the Oyo State Government has committed resources of about N6bn to remodel the Lekan Salami Stadium, not only for football but for other sporting activities.

“We have to be patient with the government so that we don’t lose focus. What you are doing at the community level and what we are doing at the state level, what we need to do is to consolidate, which is the only way we can develop the talents in our communities. We should not relent.

“So, I also want to urge our local government chairmen and chairpersons to develop their programmes to ensure they utilise the sports facilities we have put in place.”

While stating that the state is set to flag off the Oyo-Iseyin Road once it obtains the written approval, Governor Makinde said: “I went to Abuja to meet with the Minister of Works and Housing, Babatunde Raji Fashola. We are hell-bent on the reconstruction and rehabilitation of Oyo-Iseyin road even though it is a federal road.

“This is because we are investing a lot of money in the Fashola farm estate there. If we don’t fix that road, all of that money will go to waste.

“I am happy to report that the Minister was gracious and has given his verbal go-ahead. He asked us to come with the document and it will be signed.”

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US Congress Puts On Hold Proposed Arms Sales, Pressures Biden to Reassess US-Nigeria Relations Over Human Rights Record

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Soldier

United States lawmakers have begun to mount pressure on President Joe Biden over concerns about Nigeria’s human rights records.

Already, a proposed sale of 12 attack aircraft and 28 helicopter engines worth $857 million has been put on hold.

Democrats and Republicans on the Senate Foreign Relations Committee have delayed clearing a proposed sale of 12 AH-1 Cobra attack helicopters and accompanying defence systems to the Nigerian military, pausing a deal worth some $875 million, according to U.S. officials and congressional aides familiar with the matter.

In addition to the helicopters, the proposed sale included 28 helicopter engines produced by GE Aviation, 14 military-grade aircraft navigation systems made by Honeywell, and 2,000 advanced precision kill weapon systems—laser-guided rocket munitions, according to information sent by the State Department to Congress and reviewed by Foreign Policy, a US-based magazine.

It said the behind-the-scenes controversy over the proposed arms sale illustrated a broader debate among Washington policymakers over how to balance national security with human rights objectives.

It said the hold on the sale also showcased how powerfully the US lawmakers wanted to push the Biden administration to rethink the country’s relations with Africa’s most populous nation amid overarching concerns that Nigerian President Muhammadu Buhari was drifting towards authoritarianism as his government has been besieged by multiple security challenges, including a jihadist insurgency.

Foreign policy observed that Western governments and international human rights organisations had ramped up their criticisms of the Nigerian government, particularly, in the wake of its ban on Twitter, systemic corruption issues, and the Nigerian military’s role in deadly crackdowns on protesters after widespread demonstrations against police brutality last year.

Chairman of the Senate Foreign Relations Committee, Senator Bob Menendez, called for a “fundamental rethink of the framework of our overall engagement” with Nigeria during a Senate hearing with U.S. Secretary of State Antony Blinken in June.

Both Menendez and Senator Jim Risch, the top Republican on the Senate Foreign Relations Committee, have therefore placed a hold on the proposed arms sale, according to multiple U.S. officials and congressional aides familiar with the matter, who spoke to Foreign Policy on the condition of anonymity.

The details on the proposed sale were first sent by the US State Department to Congress in January before then former US Vice President Joe Biden was inaugurated as president, according to officials familiar with the matter.

Nigeria has relied on US arms sales in the past to help address multiple security challenges, including the 12-year insurgency by Boko Haram militants in the country’s northeast, a spate of high-profile kidnapping-for-ransom campaigns targeting schoolchildren in the country’s North-west, and deadly clashes between the country’s semi-nomadic herders and farmers fueled by climate change and environmental degradation of the country’s arable land.

The State Department, it was said, described the US-Nigeria relationship as “among the most important in sub-Saharan Africa” and had provided limited funding for various military training and education programmes.

Some experts said the United States should hit the pause button on major defence sales until it could make a broader assessment of the extent to which corruption and mismanagement hobble the Nigerian military and whether the military was doing enough to minimise civilian casualties in its campaign against Boko Haram and other violent insurrectionists.

“There doesn’t have to be a reason why we don’t provide weapons or equipment to the Nigerian military,” said Judd Devermont, Director of the Africa programme at the Center for Strategic and International Studies, a think tank.

Continuing, he added, “But it has to be done with an assessment of how it will actually, one, change the direction of conflict in Nigeria, and, two, that they will use it consistent with our laws. In both cases, it’s either a question mark or a fail. There is a culture of impunity that exists around abuses by the military,” said Anietie Ewang, the Nigeria researcher at Human Rights Watch.

Ewang cited the Nigerian military’s killing of unarmed protesters during the country’s massive #EndSARS demonstrations against police corruption and brutality last year as well as cases documented by human rights organisations of abuses in the military’s campaign against Boko Haram.

“I’m sure it’s a difficult situation. There are so many conflicts springing up across the country now. The authorities, I presume, are trying to do the best they can to save lives and properties. But this must be done in accordance with human rights standards. You can’t throw one out just to be able to achieve the other.”

Nigerian Embassy in Washington did not, however, return a request for comment, foreign policy claimed.

In the past, the Nigerian military had dismissed reports of human rights abuses by its soldiers as baseless and accused human rights groups of undermining the military’s resolve to combat terrorism.

But the United States had scrubbed proposed arms sales to Nigeria in the past on a case-by-case basis.

Former US President Barack Obama’s administration cut back arms sales to Nigeria over concerns about civilian casualties and human rights abuses, including blocking a 2014 sale of Cobra helicopters by Israel to Nigeria.

During that time, US officials reportedly voiced concerns that Boko Haram had infiltrated the Nigerian military—an accusation that provoked indignation from the Nigerian government.

These moves severely strained US-Nigeria relations, with Buhari accusing Obama of having unintentionally “aided and abetted” extremist groups by refusing to expand military cooperation and arms sales.

In late 2017, then US President Donald Trump’s administration agreed to sell the Nigerian government 12 A-29 Super Tucano warplanes, resurrecting a proposed sale the Obama administration froze after the Nigerian Air Force bombed a refugee camp that January.

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Over 1M Nigerians Have Completed Online Voters Card Pre-Registration – INEC

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INEC-PVC- Investors King

The Independent National Electoral Commission (INEC) affirmed that over 1 million additional voters have completed their online pre-registration for the ongoing nationwide Continuous Voter Registration (CVR) within the last four weeks across the country.

INEC’s national commissioner, and chairman, Information and Voter Education Committee, Festus Okoye, said this through a statement released in Abuja on Monday.

Of the 1 million new eligible voters, 259,450 people have completed their registration in Osun State and it is currently been followed by Edo state with 98,286 new voters.

These two states were closely followed by Anambra state with 65,014, followed by Bayelsa with 63,250, and later Lagos State with 61,991, this came as Yobe with 1,893, followed by Sokoto State with 2,453, Jigawa 2,593, and Zamfara with 2,769 were some of the least stare registered.

The state’s distribution of the online fresh registration released by INEC in Abuja on Monday showed the weekly update provided by INEC for week four which also reveals that the commission received 1,135,395 applications.

The figure of the total applications received includes those for voter transfer, requests for replacement of Permanent Voter Cards, and update of voter information record, etc.

According to the commission, the distribution of the 1,135,395 total applications by age group showed that 740,063 of them were youths between the ages of 18 to 34 years.

The applications from the middle-aged of between 35 to 49 years old were 278,042; the elderly from 50 to 69 years were 102,578; while the old from 70 years and above were 14,712

The distribution by occupation indicated that artisan constituted 75,877 of the total applications; farming/fishing – 81,096; public servants -25,298; business -230,551; house wives -25,816; students 355,227; civil servants 44,093; traders 97,624; others/not specified 199,813.

Also, the distribution by gender showed that females constituted 492,449 of the received applications while males were 642,946 as well as showed that 12,274 of the applicants indicated to be persons living with disabilities.

Okoye, providing an update on the online pre-registration which started nationwide on June 28, disclosed that the commission, also on Monday, commenced physical registration at its 811 state and local government area offices nationwide.

According to the statement, “As of 7 am today, Monday, July 26, the number of new registrants has risen to 1,006,661. The detailed distribution of the registrants by age, State/FCT, gender, occupation, and disability for week four of the exercise has been uploaded on the commission’s website and social media platforms.

“However, the distribution by age still shows that 740,063 (or 73.5 percent) are young Nigerians between the ages of 18 and 34. As earlier announced by the commission, physical or in-person registration begins today, Monday, July 26 at our 811 state and local government area offices nationwide.

“The exact locations of the designated centers have already been uploaded to our website and social media platforms. For further details, citizens are encouraged to contact our state offices through the dedicated telephone numbers provided in the uploaded publication.

“‘Nigerians who pre-registered online can now complete their registration at those centers based on scheduled appointments. In addition, other Nigerians who prefer to register physically/in person can now do so at those centers.

“Both online pre-registration and physical/in-person registration will continue simultaneously until the suspension of the CVR exercise on June 30, 2022, to enable the commission to clean up the data and compile the voters’ register for the 2023 General Election.”

Okoye appealed to all citizens who wished to register to approach any of INEC’s state or local government area offices nationwide to do so, as the commission entered the next phase of the CVR exercise.

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