Prevalence and antimicrobial resistance pattern of coagulase negative Staphylococci isolated from pigs and in-contact humans in Jos Metropolis, Nigeria

The nasal carriage and antibiotic susceptibility pattern of coagulase negative  staphylococci (CoNS) isolates from healthy pigs and in-contact humans were  investigated in 300 pigs and 101 in-contact humans from pig farms and abattoir. The results indicate that 13.2% (53/401) of the isolates were CoNS species based on confirmatory test with Microgen biochemical kit and were further subjected to antibiotic susceptibility testing. Nine CoNS species were identified; S. haemolyticus (n = 10), S. simulans (n =5), S. chromogen (n = 9), S. warneri (n =5), S. xylosus (12), S. epidermidis (n = 5), S. schleiferi (n = 5) and S. hominis (n = 2). Overall, resistance to beta-lactams was the most observed; 79.2% of the isolates were resistant to penicillin while 11.3% and 7.5% were respectively resistant to oxacillin and cefoxitin, respectively.  Resistance to 2 or more antimicrobial agents was observed in 39.6% (21/53) of the CoNS isolates. All the isolates were resistant to at least one antimicrobial agent except for gentamicin. Multidrug resistant CoNS are common colonizers of apparently healthy pigs and in-contact humans in the study area with S. xylosus and S. haemolyticus being the major species detected.Key words: Antibiotics, CoNS, pigs, humans

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95 uncertainty interval 2·9�3·0) for men and 3·5 years (3·4�3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78�0·92) and 1·2 years (1·1�1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Morbidity and complications of diabetes mellitus in children and adolescents in Ghana: study design and rationale

Background:Diabetes is associated with premature morbidity and mortality from its many complications. There is limited data on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa. Objective:The study aims to: i) determine the burden and related factors of chronic diabetes complications, and non-diabetes ocular conditions in children and adolescents and ii) the quality of life (QoL) of the participants compared to healthy controls. Methods:After ethics approval from all the participating institutions, and written informed consent or assent, a cohort of children and adolescents (4 – 19 years) with diabetes was recruited from health facilities from two cities in Ghana, Accra (Korle Bu Teaching Hospital) and Cape Coast (Cape-Coast Teaching Hospital). Demographic, medical history, anthropometric measurements and laboratory characteristics were collected, and the participants screened for microvascular and macrovascular complications as well as non-diabetic ocular disease. QoL questionnaires were administered to participants, their care givers and controls. Participants were followed up annually to determine the natural history and trends in the above conditions. The statistical package for social sciences (SPSS Version 25.0) will be used for data analysis. Continuous and categorical data will be presented as mean and standard deviation (SD) and as percentages (%), respectively. T-test and ANOVA will be used to compare means and Chi-square for categorical data. Correlation, regression and logistic regression will be employed to establish linear associations and causal associations as appropriate. Relative risk and Odds ratios will be used to estimate risk. Quality of life (QoL) outcomes in Ghanaian children and adolescents with diabetes mellitus compared with caregivers and healthy controls will be assessed using the PedsQL™ inventory. Significance will be set at α=0.05. Results:The study was approved by the Ethical and Protocol Review Committee of the College of Health Sciences, University of Ghana (protocol identification number: MS-Et/M.12-P4.5/2013-2014) and received funding support from University of Ghana Research Fund (large multi-disciplinary grant). Data collection started from August 2017 to September 2019. Currently, patient recruitment, clinical examinations, and some laboratory analysis have been completed. A total of 59 children and adolescents with diabetes mellitus have been recruited. Blood samples are stored at -80 degrees Celsius for analysis. Data has been captured to date and analysis is currently underway. Investigators are planning to submit results for publication by October, 2020. Conclusions:The prevalence, natural history, trends in diabetic complications and non-diabetic ocular disease, and quality of life will be provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes

Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the global burden of disease study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd