Lassa Fever Infection among Healthcare Workers during the 2018 Outbreak in Nigeria

Introduction: Healthcare workers (HCWs) are potentially exposed to infection during viral hemorrhagic fever outbreaks. In the wake of 2018, Nigeria experienced an unprecedented surge in cases of Lassa fever (LF), which affected HCWs. To guide infection prevention and control (IPC) strategies in similar settings, we characterize HCWs' infection and describe the gaps in IPC standards and practices during the outbreak. Methods: Data was collected using a structured questionnaire, interview, and review of case notes of 21 HCW with laboratory-confirmed Lassa fever who were treated at the Irrua Specialist Teaching Hospital (ISTH) Irrua and the Alex-Ekwemen Federal Teaching Hospital, Abakaliki (AEFETHA), between 1st January and 27th May 2018. Information collected was the patients' socio-demographic characteristics, date of potential exposure and onset of illness, nature, and type of exposure, clinical features, outcome, use of personal protective equipment (PPE), and personnel IPC training and were analyzed using descriptive statistics with Microsoft Excel. Results: The study included 21 HCWs, and 12 (57.14%) were doctors. The case fatality rate was 23%. Nearly two-thirds (62%) of the HCWs could describe a likely procedure leading to their exposure and infection. Among 13 HCWs, 85% had multiple blood and body fluids exposure, while 15% had needle stick injury or scalpel cut. About one-fifth of the participants had received some IPC training. Conclusion: Limited IPC adherence and inappropriate risk assessment were identified as factors leading to Lassa fever exposure and infection among HCWs. There is an urgent need to provide IPC training for all HCWs and to ensure an adequate supply of IPC materials to all healthcare facilities as part of emergency preparedness, especially in LF endemic areas

Medication management of hypertension and diabetes mellitus at two referral health institutions in Bayelsa State, Nigeria: a prospective study

Despite the call for timely diagnosis and management of hypertension (HTN) and diabetes mellitus (DM), recent developments in outcomes of their medication management in concerned patients remain largely unimpressive. This study is aimed at assessing the impact of pharmacist-led health educational intervention on outcomes of medication management as well as drug utilization among hypertensive and/or diabetic patients attending clinics at the Federal Medical Center and Niger Delta University Teaching Hospital in Bayelsa State, Nigeria. Following ethical approval, 430 hypertensive and/or diabetic patients were recruited and studied prospectively. Their blood pressure (BP), fasting plasma glucose (FPG), and drug utilization pattern (DUP) were first assessed after which patient- and healthcare professional- (comprising Physicians, Pharmacists, and Nurses) focused health-educational intervention was done. Subsequently, they were followed up for a period of 10 months. The parameters (including BP, FPG, DUP, and prevalence of resistant HTN) for those patients (n = 307) not lost to follow-up were determined and compared with their pre-intervention data. Data generated were analyzed using descriptive statistics, Student t-test, Fisher’s Exact and Chi-square tests. A 2-tailed p-value < 0.05 was considered significant. In this study, 66.1, 26.1, and 7.8% of the cohort had HTN alone, comorbid HTN and diabetes, and diabetes alone, respectively. Proportion of hypertensive patients with controlled BP increased from 31.5% before intervention to 51.2% after intervention (p < 0.0001) while the prevalence of resistant HTN reduced from 34.6% to 27.9% correspondingly. There was no significant difference in the proportion of diabetic patients with controlled FPG before and after intervention (p > 0.05). Diuretics (37.8% vs. 31.4%), calcium channel blockers (23.9% vs. 22.0%), and angiotensin converting enzyme inhibitors (16.4% vs. 16.4%) were the most prescribed antihypertensive drugs both pre- and postintervention, respectively. The most prescribed antidiabetic agents were the biguanides (52.6% vs 54.1%) and sulphonylureas (36.8% vs 37.3%), before and after intervention, respectively. The health educational intervention adopted in the study improved outcomes of medication therapy among the hypertensive patients but not in the diabetics. Diuretics and the biguanide (metformin) were the most prescribed drugs for HTN and diabetics, respectively.Keywords: Blood pressure, hyperglycemia, health-educational intervention, Niger Delt

Prevalence of Lassa virus among rodents trapped in three South-South States of Nigeria

Background & objectives: Lassa fever has been endemic in Nigeria since 1969. The rodent Mastomys natalensis has been widely claimed to be the reservoir host of the Lassa virus. This study was designed to investigate the dis- tribution of species of rodents in three states (Edo, Delta and Bayelsa) of Nigeria and to determine the prevalence of Lassa virus amongst trapped rodents in the selected states. Methods: Rodents were trapped during November 2015 to October 2016 from the three states in South-South re- gion of Nigeria. Total RNA was extracted from the blood collected from the trapped rodents. Reverse transcription polymerase chain reaction (RT-PCR) was used to confirm the presence of Lassa virus in the rodents. Results: The results revealed that six species of rodents were predominantly present in these geographical locations. Mus musculus (39.4%) had the highest prevalence, closely followed by Rattus rattus (36.1%), R. fuscipus (20.3%), M. natalensis (2%), Myosoricinae soricidae (1.2%) and R. norvegicus (1%). The overall positivity (carrier rate) of Lassa virus was 1.6% amongst the 1500 rodents caught in the three states. In Edo and Delta States, the RT-PCR results showed presence of Lassa virus in R. rattus, M. musculus and M. natalensis. On the other hand, only M. na- talensis was detected with the virus, amongst the species of rodents caught in Bayelsa State. M. natalensis recorded the highest Lassa virus among rodents trapped in Edo (87%), Delta (50%) and Bayelsa (11%) States respectively. Interpretation & conclusion: The rather low Lassa virus positive among rodents in Bayelsa State of Nigeria may explain the absence of reports of outbreak of Lassa fever over the past 48 yr in the state. The results also confirmed that apart from Mastomys natalensis, other rodents such as Rattus rattus and Mus musculus may also serve as res- ervoirs for Lassa virus. From the findings of this cross-sectional study, it was concluded that a more comprehensive study on rodents as reservoir host, need to be undertaken across the entire states of Nigeria, for better understanding of the epidemiology and endemicity of Lassa fever

Financial perspective of private pharmacies in Tehran (Iran); is it a lucrative business?

<p>Abstract</p> <p>Background and purpose of the study</p> <p>Pharmacies as direct providers of medicine and pharmaceutical services to patients have an important role in the health status of a society. The assessment of their financial situations by healthcare policy makers is necessary to prevent any negative effects on population's health. In this study we aim to analyze the financial status of pharmacies in Tehran, Iran.</p> <p>Methods</p> <p>This study is a cross-sectional study based on a survey. Two-hundred and eighty-eight private community daytime pharmacies in Tehran were selected by random sampling. We used two questionnaires to collect data regarding cost, expense and income factors of private pharmacies and the significance of each of them from these selected pharmacies. The data was collected in 2011 from Tehran pharmacies. Profitability of pharmacies in Tehran, Iran was calculated in its current situation and then estimated for three defined scenarios: 1. The dispensing fee is omitted (ceteris paribus), 2. Pharmacies are prohibited from selling hygienic & cosmetic products (ceteris paribus), 3. Scenarios 1 and 2 together (ceteris paribus). These data were analyzed by using SPSS and descriptive-analytic statistics.</p> <p>Results</p> <p>About 68% of interviewees responded to our questionnaires. Our analysis indicated that the average annual costs (and expenses), income and profits of pharmacies are 73,181; 106,301; and 33,120 United States Dollar (USD), respectively. The analysis indicated that omission of dispensing fee (scenario 1) and prohibition of pharmacies from selling hygienic & cosmetic products (scenario 2) would decrease income of pharmacies to 18438 and 14034 USD/year, respectively. According to respondents, the cost (or expense) of properties and buildings, energy, taxes, delays in reimbursement by insurance companies, and renting the place of pharmacy could be considered as cost factors and prescription medicines, OTC medicines, dispensing fees, hygienic & cosmetic products, and long-term payment to pharmaceutical distribution companies as income factors, which have significant effects on a pharmacy's economy.</p> <p>Major conclusions</p> <p>According to the results of this study, regarding the pharmacies' cost (and expenses) and incomes, the omission of dispensing fees for prescriptions has considerable negative effects on the profitability of pharmacies and likely on society's health.</p