Volume-12, Issue-8, August 2026

Abstract

Background: Human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains the leading cause of death among people living with HIV in sub-Saharan Africa. Where CD4 testing is unavailable, a chest X-ray must substitute for flow cytometry. We developed and internally validated a Radiographic Severity Score (RSS) to identify HIV-positive patients with advanced immunosuppression using plain-film radiography. 
Methods: Cross-sectional diagnostic accuracy study of 242 HIV-positive adults with newly diagnosed pulmonary TB at two sites in southern Nigeria (2017–2018). Two radiologists independently scored films using the RSS (12 zones, weighted for severity). Discriminative accuracy, calibration, and inter-reader reliability were assessed. 
Results: Of 242 enrolled, 228 had complete data. Mean RSS was 2.2±1.5 (CD4 <100 cells/µL), 3.4±1.7 (CD4 100–199 cells/µL), 4.8±1.9 (CD4 200–349 cells/µL), and 6.1±1.8 (CD4≥350 cells/µL). The stepwise gradient was significant (Spearman rho =+0.72, p <0.001). At threshold RSS ≤4: AUC=0.84 (95% CI 0.76–0.92), sensitivity 68.3%, specificity 80.0%, PPV 79.5%, NPV 69.4%. Inter-reader agreement was almost perfect (Cohen kappa =0.81, ICC=0.92). 
Conclusion: The RSS is a simple bedside tool for identifying HIV-positive patients with CD4 <200 cells/µL in settings without same-day CD4 testing. In this Nigerian cohort, the RSS demonstrated strong discriminative accuracy (AUC 0.84) and almost perfect inter-reader reliability (kappa 0.81). However, external validation in independent cohorts is required before the RSS can be recommended for widespread implementation in TB-HIV integrated programmes 

Keywords: Tuberculosis, Pulmonary; HIV Infections; CD4 Lymphocyte Count; Radiography, Thoracic; Sensitivity and Specificity; Nigeria.

References

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Abstract

A health impact study was conducted in the Nkoabang neighborhood of the Nkolafamba commune from January to March 2026 to assess the health risks associated with using drinking water without prior treatment. The approach used combined individual questionnaires, focus groups, and direct observations among 45 individuals. Regarding gender and occupation, the respondents consisted of 58% women and 42% men; and 44% civil servants, 22% traders, 18% informal workers, 11% unemployed, and 5% others, respectively. Regarding water consumption aspects, the population generally uses well water (protected and/or unprotected), boreholes, and rivers for domestic activities; and drinking water from boreholes, wells, and mineral water. Notably, 70% of the population is unaware of the microbiological quality and does not treat the water (minimal chlorination, filtration, boiling). Furthermore, wastewater and solid waste are discharged into the environment without prior treatment by 49% of the population. The waterborne diseases identified in this locality include typhoid, gastroenteritis, diarrhea, and amoebas. Faced with this situation, 87% of the population mainly resorts to self-medication through the use of antibiotics, consisting mostly of Amoxicillin 22%, Ciprofloxacin 20%, Ofloxacin 18%, Cotrimoxazole 11%, certain antiparasitic drugs 11%, and alternative treatments such as medicinal plants. 

Keywords: Health risk, drinking water, prior treatment, waterborne diseases, Nkoabang.

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