Antibiotic resistant pattern of environmental isolates of Listeria monocytogenes from Ado-Ekiti, Nigeria

Incidence of Listeria monocytogenes in cow manure, agricultural soil, and common vegetables sold in major markets in Ado-Ekiti, Nigeria was determined. Antibiotic resistant pattern of the isolates wasexamined by paper disk assay. A total of 196 environmental samples were cultured on a selective medium out of which 153 (78.1%) were positive for L. monocytogenes. Erythromycin was the mosteffective antibiotic against the isolates with the least resistance (28.1%) while chloramphenicol proved to be least effective with resistant of 52.29%. The multiple-antibiotic resistant pattern of the isolates showed augumentin/amoxicillin (33.3%),  lugumentin/erythromycin (24.18%), and cotrimoxazole/ chloramphenicol/amoxicillin (28.8%) to be most prominent. The least value was observed in cloxacilin/cotrimoxazole/gentamycin with 15.34%. The modal values of the Minimum Inhibitory Concentrations(MICs) of the antibiotics to the isolates range between 4.0 and >16.0 ìg/ml. cotrimoxazole and gentamicin recorded the highest MIC compared with other antibiotics

Bacteriological, physicochemical and mineral studies on Awedele spring water and soil samples in Ado Ekiti, Nigeria

Enterococci abound in faeces, survive long outside the enteric environment and possess unique ability to acquire and transfer antibiotic resistance. Recent studies have identified Enterococci as a relevant indicator of water quality. The current study focused on the prevalence of antimicrobial resistant forms of Enterococcus species isolated from Awedele spring water in Ekiti State Nigeria. The bacteriological and physicochemical quality of the water samples was also assessed. The mineral content of the adjacent soil samples was also determined. Antibiotic resistance among isolated Enterococcus species was highest to penicillin as all isolates demonstrated complete resistance to the antibiotics. Prevalence of gentamycinresistant enterococci was lowest (48%). Mean total bacterial and enterococcus count ranged from 1.8 x104 to 8.6 x 104 cfu/ml and 1.5 x 105 to 4.0 x 105 cfu/ml respectively. While calling for an improved data capturing system for drinking water surveillance in developing nations, the study highlights the need for continuous efforts aimed at instigating the required hygiene behavioral change among residents of rural settlements in the developing world

Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

Background: Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. Methods: A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Results: Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit. Conclusions: This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Prevalence of Sexually Transmitted Infections and Sexual Practices of Out of School Youths in Border Town Markets in Lagos and Ogun State

People under the age of twenty five make up forty three percent of the world population; most young people do not have access to appropriate information about sexuality and do not know how to protect themselves from sexually transmitted infections, including HIV, or unintended pregnancy. Universal access to reproductive health education and services are important in achieving the millennium development goals. A cross sectional study was carried out among youths working in two border town markets to determine the prevalence sexually transmitted infections and their sexual practices. Calculated minimum sample size of 240 was used, data was collected with pretested interviewer administered questionnaire using systematic random sampling method. Analysis was done with Epi info version 3.5.1, test of association was carried out using chi square at p value &lt; 0.05. The mean age was 19.72+3.06, majority were females and overall 70% (165) of the respondents had stopped schooling. Among the females, 8.4% stopped schooling because they got pregnant. Only 4.2% knew the meaning of safer sex, more than half of the respondents have had sex in the past, by 19years of age about 80% were sexually experienced, among the sexually experienced youths 18.3% had symptomatic STIs in the past. For youths that were currently sexually active, 42.9% had sex with casual partners, 22.4% were consistent condom users while one third had multiple sex partners. Education was a significant predictor of condom use and receiving sexuality education while males were more likely to have multiple partners and symptomatic STIs was commoner among respondents with multiple partners. The high prevalence of symptomatic STIs among the youths in border markets in this study was not surprising in view of the poor practice of safer sex and early age of sexual debut. There is need for community based outreach sexuality education based education and services targeted at adolescents and young people, family life education curriculum should be implemented in all secondary schools.Nigerian Medical Practitioner Vol. 62 No 5-6, 201

The Effects of Health Education on Sexual Behavior and Uptake of HIV Counseling and Testing Among out of School Youths in a Nigerian Border Market

Background: This intervention study assessed the effectiveness of health education and provision of free Human Immunodeficiency Virus (HIV) counseling and testing services on sexual behavior and uptake of HIV counseling and testing (HCT) among out of school youths (15 24yrs) in a Nigerian border town market using Seme border as the study group and IdiIroko border as the control group.Methodology: One in two systematic sampling techniques was used for selecting 120 respondents in each border town market. Data was collected using a standardized validated questionnaire.Result: Both groups had similar demographic pattern, mean age of the respondents was 19 years while mean age at sexual debut was 16 years. Condom use increased from 60% to 74%, consistency of use from 15% to 19% while multiple partners decreased from 26% to 19%. Relationship was demonstrated between sexual debut and regular attendance at religious activities, alcohol consumption, having sex and multiple sexual partners. Statistically significant increase in number of youths who had done HCT post intervention from 18%to 59% (P = 0.05) was also observed.Conclusion: Provision of accessible youth friendly voluntary counseling and testing VCT services at the border as well as health education for out of school youths will help in improving uptake of VCT services and condom use among those that are sexually active

Sexually transmitted infections: Prevalence, knowledge and treatment practices among female sex workers in a cosmopolitan city in Nigeria

Sexually transmitted infections constitute economic burden for developing countries, exposure to causative agents is an occupational hazard for female sex workers. Targeted interventions for this population can reduce the incidence and prevalence of sexually transmitted infections including human immunodeficiency virus, but barriers exists which can hinder effective implementation of such programs. This descriptive cross sectional study sought to assess the prevalence, knowledge and treatment practices of sexually transmitted infections among brothel based female sex workers Three hundred and twenty three consenting female sex workers were surveyed using pre tested, interviewer administered questionnaires. More than half of the respondents (54.2%) had poor knowledge of symptoms of sexually transmitted infections. Only 13.9% were aware that sexually transmitted infections could be asymptomatic. The self reported prevalence of symptomatic sexually transmitted infections was 36.5%. About half of those with sexually transmitted infectionss sought treatment in a hospital or health centre while 32.5% from a patent medicine vendor. Most respondents (53.8%) mentioned the perceived quality of care as the main reason for seeking treatment in their chosen place. More of the respondents with good knowledge of sexually transmitted infections  reported symptoms compared to those with fair and poor knowledge. The knowledge of sexually transmitted infections among these female sex workers is poor and the prevalence is relatively high. Efforts to improve knowledge promote and encourage preventive as well as effective treatment practices must be made for this population.RésuméLes infections sexuellement transmissibles constituent un fardeau économique pour les pays en développement et l'exposition aux agents pathogènes est un risque professionnel pour les prostituées. Les interventions qui visent cette population peuvent réduire l'incidence et la prévalence des infections sexuellement transmissibles, y compris le virus de l'immunodéficience humaine, mais il existe des obstacles qui peuvent entraver la mise en oeuvre effective de ces programmes. Cette étude descriptive transversale a cherché à évaluer les pratiques de la prévalence, la connaissance et le traitement des infections sexuellement transmissibles chez les prostituées qui pratiquent leur métier dans des bordels. Trois cent vingt-trois prostituées consentants ont été interrogées àl'aide des questionnaires déjà testés et administrés par l’intervieweur. Plus de la moitié des interviewées (54,2%) avaient une mauvaise connaissance des symptômes des infections sexuellement transmissibles. Seulement 13,9% étaient au courant que les infections sexuellement transmissibles peuvent être asymptomatiques. La prévalence des symptômes d'infections sexuellement transmissibles auto signalés était de 36,5%. Environ la moitié de ceux qui sont atteints des infections sexuellement transmissibles ont recherché un traitement dans un centre hospitalier ou dans un centre de santé tandis que 32,5% le recherchaient auprès d'unvendeur des médicaments brevetés. La plupart des interviewées (53,8%) ont mentionné la qualité perçue des soins comme la principale raison pour se faire soigner dans les lieux choisis. Beaucoup d’interviewées qui ont une bonne connaissance des infections sexuellement transmissibles ont signalé des symptômes par rapport à ceux qui les connaissent passablement ou mal. La connaissance des infections sexuellement transmissibles chez les prostituées est mauvaise et la prévalence est relativement élevée. Il faut faire des efforts pour améliorer les connaissances, pour promouvoir et pour encourager la prévention ainsi que les pratiques de traitement efficaces à l’intérêt de cette population.Keywords: Symptomatic STIs, Patent medicine vendor, Brothel