A comparison of cervical smear adequacy using either the cytobrush or the Ayre spatula: a practice audit

Background: To obtain an adequate cervical (Papanicolaou) smear, the transformation zone, including the squamo-columnar junction, should be sampled as carcinoma develops preferentially in this transformation zone. The Ayre spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency, including the cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre spatula as opposed to the cytobrush. Methods: This was a retrospective analytical study. One sampler, an experienced general practitioner, took the smears in the period 1990 to 2004. Initially, the Ayre spatula was used to consecutively sample the cervix and thereafter, a cytobrush alone was used. Two groups were thus formed for comparison. The presence of endocervical cells was accepted as an indicator of an adequate smear. A Cusco speculum was used to visualize the cervix. The sample was smeared onto a slide and fixated with an alcohol aerosol spray. Results: A total of 4561 smears were taken and 247 had no endocervical cells. A further 34 smears were classified as unsatisfactory due to the presence of degeneration (19), insufficient squamous cells (7), inflammatory exudate (4), excess blood (3) and/or a thick slide (1).The cytobrush group was similar demographically to the Ayre spatula group: 1981 (99%) and 2490 (98%) respectively were non pregnant; 67 (3%) and 110 (4%) were nulliparous, 1008 (50%) and 1370 (54%) were para 1 – 5, and 931 (46%) and 1075 (42%) were para 6 or more; 0 (0%) and 2 (0.1%) were aged between 10 – 19 years, 1496 (75%) and 2012 (78%) between 20 – 49, and 510 (25%) and 541 (21%) were aged 50 years or more. Of 2006 smears taken with a cytobrush, 1955 (97.5%) contained endocervical cells compared with 2325 (91%) of 2555 smears taken with an Ayre spatula. The difference was significant with an Odds Ratio of 4.56 (95% Confidence Interval 3.42-6.42). Conclusion: The cytobrush is significantly more efficacious than the Ayre spatula in obtaining adequate cervical smears. Use of the cytobrush will ensure less repeat smears with a consequent reduction in workload for samplers and laboratories. Although very few smears lacked sufficient squamous cells (an indicator of adequate ectocervical sampling), current best practice is that the cytobrush be used together with a wooden spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone. For full text, click here: South African Family Practice2006;48(9): 15-15

Screening for gestational diabetes: evaluation of prevalence in age-stratified subgroups at Central hospital Warri Nigeria

Background: The prevalence of gestational diabetes depends on the method of diagnosis as well as ethnic background. Maternal age has also been identified as a factor, but has not been given much attention. The notion of gestational prediabetes has also speculated, but is equally yet to be a focus in discussion. Aim: This work aimed at evaluating the screening for gestational diabetes in Central Hospital, Warri; to determine prevalence of gestational diabetes in the general population and in stratified age groups. The other objective was to investigate the effectiveness and use of the methods of diagnosis. Materials and Methods: This was a retrospective review of laboratory data of de-identified antenatal patients. Hospital records of gestational diabetes from 2013 to 2015 were obtained from the Central Hospital, Warri. Data collected included age of the de-identified patients, blood glucose results and whether the test was fasting or random. Other information was the month/year of test. A total of 3 589 results were analyzed. Results: Averaged prevalence of 5.85% is identified. Fasting blood sugar (FBS) measurement was used more and it also identified more positives (9%) compared to random blood sugar (<2%). On a dichotomous age group, prevalence of gestational diabetes appeared low in women below 25 years compared to those ≥26 years old. In a more stratification of age groups, potential antepartum prediabetes in pregnancy was lower in women above 40 years old relative to the younger age subpopulations (p < 0.000001). No significant variation was observed in level of usage of either method between months/years. Conclusion:  There is an ongoing good practice of using affordable screening test, which is FBS. The significant finding was that there may be up to 9% prevalence of GDM and that this number may erroneously be lower if random blood glucose measurement is used. Another worthy observation was that the prevalence in stratified age groups was non-directional, especially as prediabetes appears higher in the younger age subpopulation

Utilization of insecticide treated nets against malaria among pregnant women in Southern Nigeria

Malaria remains one of the most important causes of maternal and child morbidity and mortality in sub-Saharan African, despite the availability of effective intervention. Pregnant women are susceptible to symptomatic malaria due to the invasion of the placenta by Plasmodium. There are public health endeavours in promoting use of insecticide treated nets (ITNS), but there is dearth of data on effectiveness of such endeavour. This narrative review looks briefly at the historical background of use of ITNS against malaria, Government policy and program evaluation process on free ITNS for vulnerable groups, relevance of knowledge in use of insecticide treated nets among pregnant mothers, and the role of attitude and practice on effective use of ITNS in prevention of malaria. There is evidence that relatively few people in high-risk regions access and use ITNS. The low utilization of ITNs attributable to perceived cost, inability to adjust to size of the beds, and side-effects heat and ventilation when slept under it

World diabetes day 2017 focus: antepartum hyperglycaemia (or gestational prediabetes) is more in women below 40 years

Prediabetes is a state of hyperglycaemia that is above normal, but below blood glucose threshold for diabetes mellitus. As part of the theme for World Diabetes Day of 2017, it has been articulated by the International Diabetes Federation, that up to 16% of births may be affected by this condition and it is estimated that 50% of the affected antenatal patients are under 30 years old. The notion of gestational prediabetes, hyperglycaemia in pregnancy as a clinical condition is yet to be seriously discussed in regards to prediabetes in pregnancy. Instead, it seems to be subsumed in the discourse of gestational diabetes mellitus. This subsuming position is evident in the fact that even in discussion of management challenges of the ‘hyperglycaemia in pregnancy’ condition, blood glucose thresholds for gestational diabetes refers to higher versus lower cut-offs, but never refers to prediabetes

Public risk perception and behaviours towards COVID-19 during the first and second waves in Nigeria: a secondary data analysis

Objectives To describe changes in public risk perception and risky behaviours during the first wave (W1) and second wave (W2) of COVID-19 in Nigeria, associated factors and observed trend of the outbreak. Design A secondary data analysis of cross-sectional telephone-based surveys conducted during the W1 and W2 of COVID-19 in Nigeria. Setting Nigeria. Participants Data from participants randomly selected from all states in Nigeria. Primary outcome Risk perception for COVID-19 infection categorised as risk perceived and risk not perceived. Secondary outcome Compliance to public health and social measures (PHSMs) categorised as compliant; noncompliant and indifferent. Analysis Comparison of frequencies during both waves using χ2 statistic to test for associations. Univariate and multivariate logistic regression analyses helped estimate the unadjusted and adjusted odds of risk perception of oneself contracting COVID-19. Level of statistical significance was set at p<0.05. Results Triangulated datasets had a total of 6401 respondents, majority (49.5%) aged 25–35 years. Overall, 55.4% and 56.1% perceived themselves to be at risk of COVID-19 infection during the W1 and W2, respectively. A higher proportion of males than females perceived themselves to be at risk during the W1 (60.3% vs 50.3%, p<0.001) and the W2 (58.3% vs 52.6%, p<0.05). Residing in the south-west was associated with not perceiving oneself at risk of COVID-19 infection (W1—AOdds Ratio (AOR) 0.28; 95%CI 0.20 to 0.40; W2—AOR 0.71; 95%CI 0.52 to 0.97). There was significant increase in non-compliance to PHSMs in the W2 compared with W1. Non-compliance rate was higher among individuals who perceived themselves not to be at risk of getting infected (p<0.001). Conclusion Risk communication and community engagement geared towards increasing risk perception of COVID-19 should be implemented, particularly among the identified population groups. This could increase adherence to PHSMs and potentially reduce the burden of COVID-19 in Nigeri

Antibiotic resistance profiles and relatedness of enteric bacterial pathogens isolated from HIV/AIDS patients with and without diarrhoea and their household drinking water in rural communities in Limpopo Province South Africa

Antibiotic resistance profiles and the correlation of enteric bacterial pathogens from HIV positive individuals with and without diarrhoea and their household drinking water were determined using the KirbyBauer disk diffusion and polymerase chain reaction methods respectively. The sef gene of Salmonella enteritidis was amplified with the primer pair sefA-1 and sefA-2. The fliC gene of Salmonella typhimurium was amplified with the primer pair flicA-1 and flicA-2. Heat-labile toxin (LT) primers (Lta and LTb) were used to amplify Escherichia coli isolates and VirA1 and VirA2 for the Vir A gene of Shigella dysenteriae. Results of antibiotic resistance profiles of enteric bacterial pathogens isolated from stool samples of HIV positive and negative individuals with and without diarrhea and their household drinking water showed very similar drug resistance patterns. Over 90% of all the organisms isolated from the various study cohorts showed resistance to penicillin, cloxacillin and amoxicillin. Conversely, almost all the organisms were sensitive to ciprofloxacin, gentamycin, meropenem and imipenem. About 50% of E. coli isolated from the various study cohorts showed multiple antibiotic resistance to penicillin, amoxicillin, ampicillin, erythromycin, tetracycline, doxycycline and cotri-moxazole ( PR, AR, APR, ER, TR, DXTR, and TSR ) whereas less than 10% resistance was consistently reported for ofloxacin, gentamycin, meropenem cefotaxime, cefuroxime and imipenem ( OFXS, GMS, MEMS, CTXS, CXMS and IMIS ). The majority of Salmonella and Shigella isolates from all the groups were sensitive to ciprofloxacin, gentamicin, amikacin, meropenem, imipenem, nalidixic acid, kanamycin, piperacillin-tazo bactam, cefuroxime, doxycyclin, cefepime and ceftazidime (CIPS, GMS, AKS, MEMS, IMIS, NAS, KNS, DXTS, CXMS, CPMS, CAZS and PTZS). For Campylobacter, over 30% of the isolates were resistant to erythromycin, ampicillin, tetracycline,cotrimoxazole and ceftazidime (ER, APR TSR and CAZR) whereas over 85% were susceptible to ciprofloxacin, ofloxacin, gentamycin, amikacin, mero-penem, and nalidixic acid (CIPS, OFXS, GMS, AKS,MEMS and NAS). In addition to penicillin, amoxicillin, ampicillin and erythromycin, Aeromonas and Plesiomonas spp were more resistant to chloramphenicol, but were susceptible to ciprofloxacin, gentamycin, amikacin, meropenem, imipenem and nalidixic acid (CIPS, GMS, AKS, MEMS, IMIS and NAS). Polymerase Chain Reaction (PCR) experiments using targeted species genes of S. enteritidis, S. typhimurium, E. coli, Sh. dysenteriae showed that isolates from stool samples of HIV positive and HIV negative individuals with and without diarrhoea were also present in the household drinking water of the same study cohorts, suggesting that drinking water may have been the sources of the organisms in stool sample. Furthermore, by showing that the primers were able to amplify the genes in both clinical and environmental isolates, the link between the virulence of the pathogens was established

Determination of capture barrier energy of the e-center in palladium Schottky barrier diodes of antimony-doped germanium by varying the pulse width

Please read abstract in the article.The National Research Foundation (NRF) of South Africahttp://iopscience.iop.org/journal/2053-1591am2020Physic

Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study

Objective: Despite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria. Design Retrospective cohort study. Setting: COVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control. Participants: Individuals who were investigated for SARSCoV-2 using real-time PCR testing during the study period 27 February–8 June 2020. Methods: COVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs. Results: A total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95%CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84). Conclusion: The significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals

Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

Background South Africa has implemented a community health programme delivered by community health workers (CHWs) to strengthen primary healthcare services. Provision of community Human Immunodeficiency Virus (HIV) services constitutes an important component of this programme. To support effectiveness, we assessed fidelity of HIV programme implementation by CHWs from the community’s perspective in a rural South African setting. Methods A cross-sectional study was conducted targeting 900 randomly selected households in twelve wards of two sub-districts (Greater Giyani and Greater Letaba) of Mopani District (Limpopo Province, South Africa). Questionnaires were administered to the traditionally most appropriate adult member of the household. Included were questions related to the four standard components to measure implementation fidelity against local guidelines: coverage, frequency, duration and content of HIV programme implementation. Results Participants were enrolled at 534 households; in most other cases there was nobody or no adult member at home (n = 291). Reported coverage of 55% (141/253) and a frequency of 47% (66/140) were higher in Greater Giyani as compared to Greater Letaba (44%; 122/278 and 29%; 33/112, respectively, p = 0.007 for both comparisons). Coverage was not associated with the distance from the participant’s household to the facility (p = 0.93). Duration of programme delivery was reported to be high, where all CHW visits (253/253; 100%) were conducted within the last 6 months and the content delivered was adequate (242/253; 96%). Individuals reporting a CHW visit were more likely to know their HIV status than those not visited (OR = 2.0; 95% CI 1.06–3.8; p = 0.032). Among those visited by the CHW discussion of HIV was associated with knowing the HIV status (OR = 2.2; 95% CI 1.02–4.6; p = 0.044); in particular for women (OR = 2.9; 95% CI 1.5–5.4; p = 0.001). Conclusions This study demonstrates promising HIV programme implementation fidelity by CHWs in rural South Africa. Programme coverage and frequency should be improved whilst maintaining the good levels of duration and content. Resource investment, strengthening of operational structure, and research to identify other facilitators of programme implementation are warranted to improve programme effectiveness and impact