Microbiological assessment of air-conditioners used in Calabar, Nigeria

Background: There is a rising heat level in Nigeria that has been associated with climate change which has a global reach, exposing millions of people to the risk of several health problems. Usually air conditioners are deployed in human dwellings to eradicate heat conditions but may serve as potential reservoirs of infection if not appropriately used and maintained.Aim: This study was aimed to evaluate in-use air conditioners in Calabar, Nigeria for their role in the transmission of microbial infections between April and August, 2021.Methodology: A cross sectional study was conducted to examine 100 air conditioners’ filters and 50 filtered air samples of the same air conditioners in use for potential bacterial and fungal pathogens. Each filter was wiped with sterile cotton wool swab moistened with sterile peptone water, while the filtered air samples were collected by placing the appropriate culture media plates against the air conditioner air stream in use. The culture plates were incubated at 370C for 24-48hours and one Sabouraud Dextrose agar plate at room temperature for 2-7 days. Identification of the isolates was done using standard bacteriological and mycological methods.Results: Comparatively, the filters were more significantly contaminated with bacteria 100 (100.0%) and fungi 73(73.0%), respectively (x2=62.567, P=0.00001) than the filtered air samples 24(48.0%) and 17(34.0%), respectively (x2=21.13, P=0.00001). All (100%) of the 100 air conditioner filter samples studied carried bacteria compared to 73(73.0%) which carried fungi (x2=31.12, P=0.0001). Also, air conditioner’s air stream samples carried insignificantly more bacteria 24 (48.0%) compared to fungi 17(34.0%) (x2=2.0258, P=0.1546). The most frequently encountered bacteria and fungi in the study were Bacillus species (50.8%) and Aspergillus niger (60.0%), respectively. Others were Aspergillus flavus (40.0%), Pseudomonas aeruginosa (20.2%), Staphylococcus aureus (13.7%), Klebsiella pneumoniae (9.7%), and Escherichia coli (5.6%).Conclusion: This study concludes that air conditioners in-use in Calabar can play role in the transmission and spread of air borne infections. Measures should be taken to ensure implementation of the recommended healthy, periodic cleaning and maintenance as well as from microbiological screening of in-use air conditioners

Detection of plasmid-borne NDM-1 gene in clinical isolates of Enterobacteriaceae and their carbapenem antibiogram in cross river state, Nigeria

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are considered by the World Health Organization to be a critical global health concern. New Delhi Metallo-beta-lactamase (NDM) enzymes are capable of conferring resistance to almost all β-lactam antimicrobial drugs which are often considered drugs of last resort for the treatment of serious infections. Aim: This study investigated the presence of blaNDM-1 gene on plasmids of multiple antibiotic resistant clinical isolates of Enterobacteriaceae in Cross River State, Nigeria. Methodology: Seventy-nine Enterobacteriaceae which were obtained from urine and stool samples of patients in secondary and tertiary hospitals in Cross River State, Nigeria, were identified and tested for their susceptibility to three carbapenem antibiotics. Their ability to produce carbapenemase was determined by the Modified Hodges Test (MHT), re-modified Hodges Test (rMHT) and PCR. Results: Two Klebsiella pneumoniae isolates from two separate urine samples obtained from two patients who had previously visited India, harboured the blaNDM-1 gene; both were resistant to the three carbapenems tested. Conclusion: The detection of blaNDM-1 gene in Enterobacteriaceae confirms the circulation of the gene in Calabar. It further underscores the origin of the gene and its rapid spread. This has grave public health implications for Nigeria as India remains a major medical tourism destination for Nigerians

Microbiological assessment of microphones used in churches in Calabar, Nigeria

Background: Bacteria can survive on the surface of the microscopic grooves and cracks and will go unnoticed, hence the presence of pathogenic microorganisms on the user interface of handheld microphone poses a potential public health risk. Aim: The aim of this study was to isolate and identify potential pathogenic micro-organisms associated with used microphones, between April to August, 2021 in Calabar, Nigeria. Methodology: One hundred and fifty samples were collected (75 each) from the mouthpiece (head) and handles of the various microphones from different churches in Calabar using sterile cotton wool swab moistened with sterile peptone water. Samples were inoculated on Blood agar, Cysteine Lactose Electrolyte Deficient agar and incubated at 37oC for 24 - 48 hours and also on Sabouraud’s Dextrose agar at room temperature for 2 - 7 days. Isolates were characterized macroscopically, microscopically and biochemically. Results: Overall, 96(64.0%) of the 150 samples from microphones studied yielded growth of microbes with the mouthpiece being more significantly contaminated 57(76.0%) than the handles 39(52.0%) (X2=9.375, p=0.0022). The number of microphones colonized with bacteria were significantly more 62(41.3%) than those carrying fungi 34(22.7%) (X2=7.45, p=0.0063). Staphylococcus aureus ranked highest (53.2%) among the bacterial isolates followed by Bacillus species (29.0%) and Escherichia coli (17.7%) while in the case of those colonized by fungi, Candida species ranked higher (91.2%) than Aspergillus flavus (8.8%). The distribution of microbes by church group was statistically insignificant (X2=0.508, p=0.1969). Conclusion: This study has shown that used microphones carry various microbes including potential bacterial and fungal pathogens, hence can play reservoir role in microbial infection transmission. Frequent cleaning and creation of awareness on the health hazards associated with improper use and maintenance of microphones is recommended

Morbidity pattern and outcome among under-fives at the children’s emergency room of Federal Medical Center Umuahia

Background: The patterns and outcome of under-five morbidity in health care facilities are invaluable tools that reflect the disease burden and health care needs of the children in the community. Efforts are being made over the past few years to improve child care services in our centre. A preliminary report therefore will assist in goal-targeted intervention strategies and serve as a baseline for subsequent reviews. Aim: To evaluate the morbidity pattern and outcome of under-fives at the Children’s Emergency Room of the Federal Medical Centre (FMC) Umuahia. Subjects and methods: A retrospective review of post-neonatal children aged 1 to 59 months seen over a period of five years. Information such as age, gender, month of admission, diagnosis and outcome were analyzed. Results: Of the 5,884 under-fives admitted over the study period, 56% were males with a male to female ratio of 1.2:1. The month with highest admissions was January. The leading causes of morbidity were malaria, diarrheal diseases and respiratory tract infections accounting for 79.9%. Sepsis was the most common morbidity noted among infants (p< 0.001). Mortality rate was 4%. Death rate among infants was significantly higher than in those beyond infancy, p < 0.001. Conclusion: Preventable infections are the leading causes of post-neonatal under-five morbidity in Federal Medical Centre Umuahia

Vertical Electrical Sounding for Aquifer Characterization around the Lower Orashi River Sub-Basin Southeastern Nigeria

The different aquifer units within the Lower Orashi River Sub-Basin Southeastern Nigeria were delineated using the Vertical Electrical Sounding (VES) technique. Twenty two (22) VES soundings were carried out using the ABEM SAS 4000 Terrameter. The data generated were analyzed using the Zohdy software which outputted modeled curves in terms of depth and resistivity. Six profiles were taken in the Northeast"“Southwest and Northwest"“Southeast directions to cover the entire area of study. Four to six geo-electric layers comprising the top soil, clayey sand, dry sandstone, saturated sandstone, shaley sand and sandy shale were delineated with the later usually occurring as the last layer. The third and fourth layers underlying dry sandstone form the aquiferous unit. This unit was found to have an average resistivity value range of 10.7 "“ 6060Ωm and an average thickness of 32m. It was observed that most of the aquifer units within the area are unconfined with static water level varying between 10.6 to 62.8m. Some of the aquifer units are shallow with static water level less than 40m while others are deeper with static water level occurring at over 60m below the surface. It was advised that care ought to be taken in drilling and casing at shallow aquiferous areas to maintain proper sanitary condition so as to reduce the risk of groundwater contamination

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Childhood acute glomerulonephritis in Umuahia, south eastern Nigeria

Background: Despite the declining incidence of acute glomerulonephritis (AGN) in the developed part of the world, the disease remains fairly common in low income countries with varied presentations leading to childhood mortality. Establishing the local pattern of the disease may assist in planning intervention strategies to improve disease outcome. This study aims to determine the hospital prevalence, sociodemographic characteristics, pattern of presentation and outcome of children admitted for acute glomerulonephritis in Federal Medical Centre Umuahia.Subjects and Methods: A descriptive study of all children managed for AGN over a period of six years. Relevant information were obtained and analyzed.Results: AGN accounted for 0.9% of paediatric admissions. Males accounted for 68.4% with a male to female ratio of 2:1. Their ages ranged from 2 to 15 years with a peak of 5 to 10 years. More than half of the patients (52.6%) were of low socioeconomic class. Common presenting features were oedema of varying degrees ( 94.7%) , anemia ( 6 8 . 4%) , hypertension (57.9%), fever (57.9%), oliguria (52.6%) and cola-coloured urine (36.8%). Proteinuria and haematuria were constant features while UTI was a notable co-morbidity. Complications noted were acute kidney injury, electrolyte imbalance, hypertensive encephalopathy and pulmonary edema. Mortality rate was 5.3%.Conclusion: AGN remains a cause of childhood morbidity with varied complications leading to death. However, where facilities for intervention are available outcome is generally good.Keywords: Acute glomerulonephritis, Childhood, Pattern, Outcome, Nigeri

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950�2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10�14 and 50�54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95 uncertainty interval UI 2·66�2·79) in 2000 to 2·31 (2·17�2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5�137·8) in 2000 to a peak of 139·6 million (133·0�146·9) in 2016. Global livebirths then declined to 135·3 million (127·2�144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4�27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8�67·6) in 2000 to 73·5 years (72·8�74·3) in 2019. The total number of deaths increased from 50·7 million (49·5�51·9) in 2000 to 56·5 million (53·7�59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1�10·3) in 2000 to 5·0 million (4·3�6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0�6·3) in 2000 to 7·7 billion (7·5�8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1�60·8) in 2000 to 63·5 years (60·8�66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens