Antibiotic Susceptibility of Staphylococcus Aureus in Suppurative Lesions in Imo State Teaching Hospital Orlu, Nigeria

Staphylococcus aureus, a mainly acquired hospital infection is responsible for many suppurative lesions and has demonstrated the ability of developing resistance to many antimicrobial agents leading to life threatening infections and long hospital sTo determined the prevalence and antibiotic susceptibility of Staphylococcus aureus in suppurative lesions of the surgical ward and outpatients of Imo State Teaching Hospital Nigeria.A cross-sectional study was conducted at the Hospital  to determine the prevalence and antibiotic susceptibility profiles of Staphylococcus aureus in suppurative lesions in both surgical inpatients and outpatients. Using culture techniques on MacConkey and blood agar, Staphylococcus aureus was isolated based on the colonial characteristics and confirmed by Catalase and tube Coagulase tests. The antibiotic susceptibility test was done using Kirby-Buer disk diffusion method on 4% Salt Muellar Hinton II agar for the Methicillin and non salted Muellar Hinton II agar for the other antibiotics (NCCLS M100S9).The prevalence of Staphylococcus aureus in 122 patients sampled was 59.4% for the surgical inpatients and 48.3% for outpatients giving an average prevalence of 53.9% for both groups of patients. The average antibiotic susceptibility patterns for the 8 antibiotic tested were: Ampicillin (75.0%), Chloramphenicol (34.4%), Ciprofloxacin (1.6%), Erythromycin (7.8%), Gentamycin (0%), Methicillin (1.6%), Tetracycline (45.3%) and Co-trimoxazole (50.0%). The resistance in surgical inpatients was significantly higher than outpatients (t=1299, p<0.05) and Methicillin resistance was confirmed by PCR.Staphylococcus aureus is highly prevalent and more resistant in inpatients. There is a higher risk of acquiring drug resistant staphylococcus aureus infection in inpatients of the Hospital  with a Methicillin resistance of 0% and 2.6% for out and inpatients respectively: Keywords: Staphylococcus aureus, antibiotic susceptibility, Orlu Hospital

Knowledge and misconceptions about HIV counseling and testing (HCT) among the post-conflict youths of Gulu, Northern Uganda. A prospective study design

Background: Uganda has been reported as the most successful country in Africa in reducing the prevalence of HIV/AIDS from 18% to 6.4% over the last two decades. There is evidence to suggest that despite a significant decline between 1992 and 2002, HIV prevalence has stagnated over the last 5-9 years at between 6.1 and 6.5% and it is rising in some parts of the country such as Gulu. This rise are thought to be due to the high levels of stigma and superstition preventing HIV counseling and testing (HCT). WHO reports in 2009 showed that only 20% of Uganda’s populations knew their HIV sero-status. This study was designed to find out the knowledge, misconceptions, attitude and practices of youths of Gulu about HCT. Methods: A cross-sectional study was conducted in Gulu, Pece among the youths 15 to 35 years. An in-depth interview using a questionnaire was administered to youths of Commercial Road Sub-ward. Informed consent and ethical approval was obtained and 86 respondents were interviewed. Results: Ninety three percent of respondents had knowledge about HCT and 97.7% were able to mention two or more of its benefits. Most (88.4%) agreed on public disclosure of their HIV status and 84.9% would encourage others to undertake it. Only 36.1% of respondents had undertaken HCT while the rest had not undertaken it due to fear of stigmatization. Conclusion: There is adequate knowledge, good attitude but poor practice and misconceptions to HCT. The young adults in Gulu should be supported in a special program to enable them undertake HCT and access other services for HIV/AIDS prevention.Pan African Medical Journal 2012; 12:3

Knowledge and Misconceptions about Malaria among Pregnant Women in a Post-Conflict Internally Displaced Persons' Camps in Gulu District, Northern Uganda

Background. In Uganda Malaria continues to be a major public health problem accounting for about 30–50% of all outpatient consultations and 35% of hospital admissions and a leading cause of mortality and morbidity. Pregnant women and their unborn children are vulnerable to malaria. Methods. A cross-sectional survey was conducted in 20 postconflict IDP camps of Gulu district selected randomly as clusters. 769 pregnant women were interviewed. Results. The majority of the respondents 85% have ever heard about malaria. Most (80%) 571 respondent attributed malaria to be transmitted by mosquito bites, 15 said cold weather, 53 said dirt, and 35 said not sleeping under net. Most (91%) 683 respondents mentioned that malaria was caused by mosquito, 28 mentioned cold food, 3 mentioned playing in the rain, 19 mentioned cold weather, and 6 mentioned eating mangos. Conclusion. Most pregnant women in the post conflict IDP camps have relatively high knowledge about malaria transmission, signs, symptoms, and consequences during pregnancy. However, majority of respondents had misconception about the cause of malaria while a few had misconception about the mode of malaria transmission

Nodding Syndrome and Autism Spectrum Disorder

Nodding syndrome (NS) is a devastating childhood neurological disorder seen in clusters in Eastern Africa but of uncertain nosology. It is characterized by repetitive head nodding, atonic seizures, cognitive decline, and school dropout, wasting and stunted growth and it occurs in children subject to internal displacement, food insecurity, and exposure to infectious diseases, contaminated environment and with a number of repetitive behavioral abnormalities. On the other hand autism spectrum disorders (ASD) is a group of behaviorally defined neurodevelopmental disorders with lifelong consequences. They are defined by impairments in communication and social interaction along with restrictive and repetitive behaviors. It is a complex disorder associated with a wide range of disparate and seemingly unrelated factors such as; maternal exposure to various chemical substances, maternal exposure to child abuse, maternal evidence of Diabetes, autoimmune diseases, age of either parents at conception, exposure of infants to various chemical substances, low vitamin D levels of the infant at birth, gender of the infant and a large number of genetic factors. There are a number of similarities in the clinical, biochemical and behavioral findings in children with NS and ASD

Could Nodding Syndrome (NS) in Northern Uganda be an environmentally induced alteration of ancestral microbiota?

Hippocrates stated in 460-C.370 BC that, "All diseases begin in the Gut." This statement may be beginning to have meanings in the advent of new diseases such as Nodding Syndrome (NS) and Autism Spectrum Disorder (ASD). Interestingly, a recent publication from China in the journal of microbiology in 2017 suggests that high grain diet had dynamically shifted the composition of mucosa-associated microbiota and induced mucosal Injuries in the colon of Sheep. NS is a devastating childhood neurological disorder characterized by atonic seizure, cognitive impairment, head nodding, wasting and stunted growth. In addition, NS in Northern Uganda is clustered in time (those who were in IDPs), in space (discretely observed on either sides of the two rivers of Aswa and Pager) and in person (onset mainly between the ages of 5-15 years) and therefore exhibits spatial temporality. The first case of NS was noticed in Kitgum district in 1997, one year after the reported displacement of that community into IDP. Prior to that internal displacement, there were no reported cases of NS. The same scenario occurred in the IDPs of Odek, Gulu district where the population was displaced into IDPs in 2001 and approximately a year later in 2002, cases of NS began to appear. In the IDPs, children that eventually developed NS fed nearly exclusively on food ration provided by relief agencies and roughly a year later, cases of NS began to appear. In the other East African countries, there were no reported cases of NS prior to internal displacement and dependence on food ration. The observed common factors in the three East African regions where NS occurs at endemic proportion are perhaps: Internal displacement and feeding on relief food. These researchers suggest that NS may have perhaps resulted from dietary and environmental factors during IDPs which may have been foreign to their GIT and links this observation to the concept of microbiota-gut-brain axis

HIV/AIDS STIGMATIZATION, THE REASON FOR POOR ACCESS TO HIV COUNSELING AND TESTING (HCT) AMONG THE YOUTHS IN GULU (UGANDA)

HIV/AIDS-related stigma still exists in many communities in Uganda. Stigma perpetuates discrimination and this may be a key contributor to the spread of HIV/AIDS in this country. Right from the beginning, HIV/AIDS epidemic has been accompanied with fear, ignorance and denial, leading to stigmatization and discrimination against people living with HIV/AIDS and their families. A study conducted by Uganda AIDS Commission (UAC) in Uganda indicated that 64% of the people who tested for HIV/AIDS did not disclose status to their partners due to fear of stigmatization. A cross-sectional study was conducted in Gulu District, Pece sub County among the youths 15 to 35 years old. A structured questionnaire was administered to 86 consented youths who were consecutively selected. Ethical approval was obtained from Gulu Hospital. Most youths (90%) practiced stigmatization, (93.1%) respondents had adequate knowledge on HIV counseling and testing (HCT). However, only (36.1%) had undertaken HCT and the majority did not do because of fear of stigmatization. There is sufficient knowledge, a positive attitude but a poor practice to HCT. There is high level of HIV/AIDS stigmatization among the youths

Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda

Introduction: health professions education is gradually moving away from the more traditional approaches to new innovative ways of training aimed at producing professionals with the necessary competencies to address the community health needs. In response to these emerging trends, Medical Education for Equitable Services to All Ugandans (MESAU), a consortium of Ugandan medical schools developed key competencies desirable of graduates and successfully implemented Competency Based Education (CBE) for undergraduate medical students. Objectives: to examine the current situation and establish whether assessment methods of the competencies are standardized across MESAU schools as well as establish the challenges, opportunities and lessons learned from the MESAU consortium. Methods: it was a cross-sectional descriptive study involving faculty of the medical schools in Uganda. Data was collected using focus group discussions and document reviews. Findings were presented in form of themes. Results: although the MESAU schools have implemented the developed competencies within their curricular, the assessment methods are still not standardized with each institution having its own assessment procedures. Lack of knowledge and skills regarding assessment of the competencies was evident amongst the faculty. The fear for change amongst lecturers was also noted as a major challenge. However, the institutional collaboration created while developing competencies was identified as key strength. Conclusion: findings demonstrated that despite having common competencies, there is no standardized assessment blue print applicable to all MESAU schools. Continued collaboration and faculty development in assessment is strongly recommended

TB CO-INFECTION WITH HIV/AIDS: A UNIQUE RADIOLOGICAL PRESENTATION AT LACOR HOSPITAL; A POSTCONFLICT NORTHERN UGANDA.

Background: Tuberculosis (TB) infection is thought to develop at any stage of HIV infection. Pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis are major complications in HIV/AIDS patients. Tuberculosis is still a diagnostic dilemma in low resource countries, with approximately 68.4% of all active pulmonary cases being negative for AAFBs on sputum. Additionally, it is reported that 46.7% of the active cases have disseminated TB with extra-pulmonary TB; further complicating the diagnosis in post-conflict northern Uganda. We therefore sought to clinically and radiologically characterize the various TB diagnosed in HIV/AIDS patients in this low resource and post conflict environment. Materials and Methods: A prospective cohort study was conducted on 320 sero-positive patients in Lacor Hospital. Clinical features, radiographic and ultrasonographic features of confirmed HIV sero-positive patients with suspected TB co-infection were assessed. Patients were recruited consecutively and the Chest radiographs, thoraco-lumbar and lumbar spine radiographs were taken and analyzed. Trans-thoracic ultrasonography (USS) for justified cases with pleural and pericardial effusion was conducted. FNAB and Tru-cut biopsies were performed for histological confirmation. Cases were followed-up for clinical outcomes (improvement and demise) within 2 months. The ethics and review committee of Gulu University Medical School approved the study and patients who did not meet the inclusion criteria were excluded. Data was analyzed using SPSS 13.0. Results: Atypical Chest x-ray finding included: reticulo-nodular infiltrates (69.7%); hilar and mediastinal adenopathy (40%); pleural effusion (27.5%) and miliary (20.6%). Typical Chest x-ray finding included: Apical reticulo-nodularities and fibro-cavitations (27.5%), and normal Chest x-ray (2.2%). Abdominal Ultrasonographic finding included: porta-hepatis, para-aortic and splenic hilum lymphadenopathy (15.9%); Ascitis (8.1%); TB splenitis (5.3%) and TB nephritis with peri-renal abscess (0.3%). PTB was observed in (53.4%); disseminated TB in (42.2%) and EPTB in (4.4%). Majority (81.9%) of the patients improved and was discharged on DOTS while 18.1% died. Conclusion: Imaging assessment is important adjuvant in HIV/AIDS/TB co-epidemic diagnosis. Early diagnosis and prompt management of TB co-infection ensures longer life and reduce morbidity and mortality

ASSERTIVENESS AND ATTITUDES OF HIV/AIDS ORPHANED GIRLS TOWARDS EDUCATION IN KAMPALA (UGANDA).

Whereas HIV/AIDS prevalence has been declining in Uganda from 30% to less than 10% in the last 2 decades, the number of HIV/AIDS orphaned girls in secondary schools is still high and girl children have tended to carry the heaviest burdens of family responsibilities thereby adversely affecting their assertiveness and attitudes towards education. Assertiveness is a critical life skill that enables a person to state an opinion, claim a right, or establish authority and it is important to improve attitude towards education. This study examined the relationship between assertiveness and attitude towards education of HIV/AIDS orphaned and non-orphaned adolescent school girls in Kampala. The California Psychological Inventory (CPI) Dominance (Do) Assertiveness Scale and the Attitude Scale were administered to 225 students consecutively selected from 6 secondary schools in Kampala. HIV/AIDS Orphaned girls had lower levels of assertiveness and most had a negative attitude towards education compared to non-orphaned girls. Girls orphaned to HIV/AIDS were less assertive compared to those orphaned by other causes. There was a positive relationship between assertiveness and attitude towards education among orphaned adolescent secondary school girls in Kampala. Girls orphaned to HIV/AIDS were less assertive compared to other school girls and have a poor attitude towards education

Musculoskeletal disorders among nursing staff: a comparison of five hospitals in Uganda

Abstract Introduction: Low and middle income countries have severe nursing staff shortages which is associated with risk of poor quality of patient car