Missile injuries to the external genitalia: a five year experience in Maiduguri, North Eastern Nigeria

Background: There is a tremendous increase in violence as a result of the insurgency that is currently afflicting our region. Injuries from Gunshot and improvised explosive devices (IEDS) are quite common and the external genitalia is longer exempted from such injuries.Methods: The study reviewed all patients with missile injuries to the external genitalia managed in the University of Maiduguri Teaching Hospital (U.M.T.H) between January 2011 and December 2015. Results: A total of 51 patients had injuries to the external genitalia. Seven were excluded for incomplete data and 44 patients were analyzed. Age ranged from 5-70 years with a mean of 32.75 years and a male to female ratio of 10:1.  The peak age group was 30-39 years accounting for 31.82%. The injuries were scrotal 65.91%, and penis 20.45%. Procedures done were wound debridement in all patients, and delayed primary closure in 43.18%. The outcome was satisfactory in terms of cosmesis, erectile and voiding functions.Conclusions: Genital missile injuries are on the increase with militarization of civilian population. Goals of treatment still remain cosmesis, preservation of erectile and voiding function

Iatrogenic ureteric injuries in open abdominopelvic surgery: a five year experience in Maiduguri, North Eastern Nigeria

Background: Ureteric injuries during open abdominopelvic procedures though rare, are often associated with high morbidity and mortality especially when they present late. Late presentation is the norm as most injuries occurred during non-urological procedures and patients subsequently referred to urologist.Methods: The study reviewed iatrogenic ureteric injuries managed by the urology unit in the University of Maiduguri Teaching Hospital between January 2011 and December 2015.Results: A total of 19 patients (23 injured ureters), age ranged from 9 to 70 years, with a mean of 38.42 years and Female to male ratio of 2.17:1. Clinical features were renal failure with anuria in 21.05% and leakage of urine in 57.89%. Duration of symptoms ranged from 5 to 39 days. Injuries were sustained during caesarean section in 36.84% and retroperitoneal tumour resection in 31.58%. Pattern of injuries were left ureter in 39.13%, right in 26.08%, and bilateral in 4 patients 21.05% of patients- accounting for 34.78% of injuries. Procedures done were uretero-neocystostomy in 60.87% ureters and Boari flap with Psoas hitch in 17.39%. Post-operative complications were, surgical site infection 15.79% and urosepsis in 26.34%. Mortality was 15.79%.Conclusions: Iatrogenic ureteric injuries though rare are associated with high morbidity and mortality. Early detection especially during surgery and immediate repair will reduce morbidity and mortality. Keywords:

Compliance with Guidelines for Treatment of Staphylococcus aureus Bacteremia is Associated with Decreased Mortality in Patients Hospitalized for Community-Acquired Pneumonia with Staphylococcus aureus Bacteremia

Introduction: Staphylococcus aureus bacteremia has a minimum treatment duration of two weeks, while S. aureus community-acquired pneumonia (CAP) treatment is at least five days. Treatment failure, persistent bacteremia, and recurrence are common among patients with community-acquired S. aureus bacteremia. There is conflicting information in the current Infectious Diseases Society of America (IDSA) guidelines for the treatment of S.aureus bacteremia patients with CAP. Therefore, the appropriate treatment duration and modality for S. aureus CAP with bacteremia is unclear. The objective of this study was to compare outcomes among patients with S. aureus CAP and bacteremia treated in compliance versus non-compliance with IDSA S. aureus bacteremia guidelines. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) study database. Logistic regression was used to compare outcomes. Results: A total of 117 patients with S. aureus CAP and bacteremia were included in the study. Compliance with S. aureus bacteremia guidelines was documented in 67 patients, and non-compliance was documented in 50 patients. Compliance with IDSA S. aureus bacteremia guidelines resulted in a decrease in odds of re-hospitalization of 30% after adjusting for confounding variables between the compliant and non-compliant groups (adjusted odds ratio (aOR) 0.70 [95% CI 0.29–1.70]; P=0.42). The 30-day mortality for the compliant group was 6% and for the non-compliant group was 10%; P=0.576. The 1-year mortality for the compliant group was 19% and for the non-compliant group was 44%; P=0.011. Conclusion: The present study demonstrated that when treated in compliance with IDSA guidelines for S. aureus bacteremia, there was decreased 1-year mortality for patients hospitalized for S. aureus CAP with bacteremia. In this case, the IDSA S. aureus bacteremia guidelines recommend treating uncomplicated S. aureus bacteremia with CAP for at least two weeks of antimicrobials and at least four weeks of antimicrobials for complicated S. aureus bacteremia with CAP

Comparative analysis on the effect of heavy metals: a case study of selected states in Nigeria

In the toxicological aspect, uncontrolled amount of heavy metals is deadly, to the environment and its inhabitants. To complicate issues, reviewed work has revealed that technological advancement is one of the key sources of heavy metals. This can lead to outbreak of diseases, decrease of life span, cancer, and other related effects. Providing sustainable environment, the concentration of these metals need to be periodically regulated. This research studies the effect of some selected heavy metals (Fe, Cd, Cu, Ni, Cr, Pb, Zn and Mn) in Kano State Nigeria, using Atomic Absorption spectroscopy (AAS). The results were compared with other related work conducted in some states across Nigeria (Akwa Ibom, Kwara, Kaduna, and Bauchi States) and standard international values (WHO, FAO, SEPA and US EPA). The parameters analysed were; Concentration, Bioaccumulation (Plant concentration factor –PCF), Transfer factor (TF), Daily Intake of Metals (DIM), and Health Risk Index (HRI). Statistical package (SPSS) was used, to establish the relationship between these metals in all the sites. The result showed that there were substantial absorption of these metals by the plants and the consumers. Children were more exposed than adults in terms of DIM and the HRI. The comparison showed sequential order in the parameters investigated. All the biological samples exhibited Phytoremediation quality with the TF>1, this will aid in having sustainable environment to the resident and citizen of the state in particular and the nation in general, as well as serving as an impetus for the initiation of safe comprehensive remedy of the subject matter. The PCF for all the samples varied across states and plants.Keywords: AAS, Adults, ANOVA. Children, Concentration, DIM, HRI, PCF, Phytoremediatio

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study.

INTRODUCTION: The early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast feeding of newborns in public primary healthcare facilities (PHCs) in Northeast Nigeria, to influence the planning of programmes targeted at improving newborn care in the region. METHOD: We used an explanatory mixed-method approach. We conducted case observation of childbirths and newborn care for the quantitative arm, and interviewed mothers and birth attendants 1 hour after childbirth for the qualitative arm. The analysis for the quantitative arm was done with SPSS V.23. For the qualitative arm, we transcribed the audio files, coded the texts and categorised them using thematic analysis. RESULT: We observed 393 and 27 mothers for the quantitative and qualitative arms of the study, respectively. The quantitative arm shows that 39% of mothers did not breastfeed their newborns within 1 hour of birth. The qualitative arm shows that 37% of mothers did not breastfeed within 1 hour of birth. Themes that describe the barriers to early breast feeding in public PHCs are: birth attendants' unwillingness or inability to accommodate mothers' safe traditional practices, ineffective rooming-in practices, staff shortages, lack of privacy in the lying-in ward and poor implementation of visiting-hour policy in public PHCs. The pregnant women denied safe traditional birth practices like chanting, praying or reading religious books during delivery are five times more likely not to breastfeed newborns within the first hour of birth (relative risk=4.5, 95% CI 1.2-17.1) compared with pregnant women allowed these practices. CONCLUSION: Stakeholders must increase their focus on improving breastfeeding practices in public PHCs. Instituting policies that protect mothers' privacy and finding innovative ways to accommodate and promote safe traditional practices in the intrapartum and postpartum period in PHCs will improve the early breast feeding of newborns in these PHCs

"Their own project for their own people": Community participation in the Village Health Worker Scheme in Gombe State, Nigeria

Background Maternal mortality in Nigeria, at 560 deaths per 100,000 live births, remains stubbornly high and contributes to lack of progress towards the Sustainable Development Goals. In Gombe State, remote rural communities’ limited access to health services, hampers universal coverage. Low adult literacy restricts efforts to increase community participation for health, particularly among women. To help achieve universal coverage in services to improve the wellbeing of pregnant women, mothers and newborns, the Gombe State Primary Health Care Development Agency (SPHCDA) introduced in 2016 an innovative practice: the Village Health Worker (VHW) Scheme, supported by Society for Family Health (SFH). VHWs, a new cadre of trained, volunteer community-based female health workers, connect the community to health care services by promoting uptake of services, providing basic preventive care, and referring women with pregnancy or postpartum complications and sick newborns. Community participation, particularly through engagement with the Ward Development Committees (WDCs), incorporates community accountability for sustainable universal coverage. Methods To evaluate the scheme’s reach, we are analysing quantitative data from annual household surveys, starting in 2017. To evaluate its responsiveness to community needs and understand the scheme’s scalability and sustainability we are conducting qualitative interviews with community members, VHWs, supervisors, implementers and the donor every six months. Working with all stakeholders we use these quantitative and qualitative data to identify and plan for course correction opportunities. Results After six months of implementation, 24% of households reported at least one VHW visit. Only 5% of wards in the State reported coverage over 50%, while a quarter of wards reported coverage of less than 15%. In response, the SPHCDA and implementers are tailoring health service delivery to address these challenges. A key finding for the scheme’s scalability and sustainability is the high level of community engagement through WDCs’ willingness to support it, by sensitising husbands and families about how VHWs serve their community. Yet challenges remain for resourcing, recruitment, adequate VHW supervision and attrition of VHWs, through marriage, return to education or other employment opportunities. Discussion / Conclusions The reach of the VHW scheme showed variability by geographic area, coverage being lowest in hard to reach areas. Community involvement and State engagement are key contributions to the scheme’s scalability and sustainability. This poster presents useful insights for policy makers and others in LMICs seeking to encourage community participation to create universal coverage of health services

'A seamless transition': how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria.

Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme's sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents' accounts, six key actions emerged as essential in promoting the VHW Scheme's sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial

Outbreak of measles in Sokoto State North-Western Nigeria, three months after a supplementary immunization campaign

BackgroundWorldwide, measles infects about 20 million people with about 200,000 deaths annually. On February 12, 2016 an outbreak of measles was reported from Sokoto state, Nigeria.AimsA team of Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) Residents was sent to confirm the existence of the outbreak, describe the socio-demographic characteristics and identify risk factors for the outbreak.MethodsWe defined cases according to the World Health Organization (WHO) criteria. We conducted an unmatched case-control study and descriptive study. We actively searched for cases across local government areas (LGAs) of the state, and administered questionnaires to parents of affected children. We analyzed the data using Epi-Info 7 and Microsoft Excel 2013.ResultsA total of 979 cases were recorded. Median age was 36 months with age range of 3–168 months. Ten deaths were recorded with a Case Fatality Rate (CFR) of 1.02 per cent. About 76.51 per cent of cases were under-five years of age. The outbreak spanned over a period of 10 weeks. Twenty-two out of 23 LGAs were affected. Eighty-nine cases (9.1 per cent) had their blood sample taken for laboratory confirmation, where 21 (23.6 per cent) tested positive for measles.A total of 238 respondents were interviewed; 128 cases and 110 controls. Mothers’ education (OR: 2.9, 95 per cent CI: 1.4–5.9), immunization status of children (OR: 2.0, 95 per cent CI: 1.1–3.4), and fathers’ occupation (OR: 0.2, 95 per cent CI: 0.1–0.5), are the factors that affect measles infection among children in the state.ConclusionOur investigation confirmed a measles outbreak in Sokoto state. Though with a low CFR, the majority of deaths occur in children are factors that adversely affect development of measles in Sokoto state

Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study.

OBJECTIVES: This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN: Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING: Gombe state, Northeast Nigeria. PARTICIPANTS: Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS: Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES: Eighteen indicators of maternal and newborn healthcare. RESULTS: Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS: This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings

Human rights, health and the state in Bangladesh

BACKGROUND: This paper broadly discusses the role of the State of Bangladesh in the context of the health system and human rights. The interrelation between human rights, health and development are well documented. The recognition of health as a fundamental right by WHO and subsequent approval of health as an instrument of welfare by the Universal Declaration of Human Rights (UDHR) and the International Covenant on Social, Economic and Cultural Rights (ICSECR) further enhances the idea. Moreover, human rights are also recognized as an expedient of human development. The state is entrusted to realize the rights enunciated in the ICSECR. DISCUSSION: In exploring the relationship of the human rights and health situation in Bangladesh, it is argued, in this paper, that the constitution and major policy documents of the Bangladesh government have recognized the health rights and development. Bangladesh has ratified most of the international treaties and covenants including ICCPR, ICESCR; and a signatory of international declarations including Alma-Ata, ICPD, Beijing declarations, and Millennium Development Goals. However the implementation of government policies and plans in the development of health institutions, human resources, accessibility and availability, resource distribution, rural-urban disparity, the male-female gap has put the health system in a dismal state. Neither the right to health nor the right to development has been established in the development of health system or in providing health care. SUMMARY: The development and service pattern of the health system have negative correlation with human rights and contributed to the underdevelopment of Bangladesh. The government should take comprehensive approach in prioritizing the health rights of the citizens and progressive realization of these rights