On the Efficiency of Financial Intermediation in Nigeria’s Growth Performance: A Two Stage Least Square Approach

We test the efficiency of financial intermediation in Nigeria’s economic growth performance using the Two Stage Least Square (TSLS) technique of regression analysis. Relying on a tripartite simultaneous equation regression model, the results show that financial intermediation process in Nigeria has been partly effective but sub-optimal. Evidence from the structural parameter estimates indicate that low savings coupled with poor credit support to the real sector attenuated the growth effect of financial intermediation in Nigeria. This is attributable to high interest spread, low per capita income, poor banking habit and high inflation, among others. It is recommended that the devices for improving financial intermediation and Nigeria’s growth performance are to set a positive and moderate interest rate, increase the volume of deposit, increase bank branches, increase income per capita and continue with liberalization

The Growth Implication of Trade Liberalization in West Africa

This study empirically investigates the growth implication of trade liberalization in twelve West African (WA) countries using time series data for the period of 1970-2011. Relying on a Vector error correction model (VECM), our result indicates that trade orientation (trade policy variable) investment rate and exports shocks have significant positive impact on growth in 8 out of 12 WA economies. This suggests that it is possible to stimulate economic growth in some African countries through an outward-looking strategy of export expansion. We, thus, conclude that WA economies can vigorously pursue trade liberalization in order to enhance their growth performance. The caveat is that this would require a refocusing of domestic production capacity to commodity lines that overlap those of the trading partners, especially those of the OECD nations, so as to be able to garner the benefits derivable from liberal trade policy

The Growth Implication of Trade Liberalization in West Africa

This study empirically investigates the growth implication of trade liberalization in twelve West African (WA) countries using time series data for the period of 1970-2011. Relying on a Vector error correction model (VECM), our result indicates that trade orientation (trade policy variable) investment rate and exports shocks have significant positive impact on growth in 8 out of 12 WA economies. This suggests that it is possible to stimulate economic growth in some African countries through an outward-looking strategy of export expansion. We, thus, conclude that WA economies can vigorously pursue trade liberalization in order to enhance their growth performance. The caveat is that this would require a refocusing of domestic production capacity to commodity lines that overlap those of the trading partners, especially those of the OECD nations, so as to be able to garner the benefits derivable from liberal trade policy

Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria

BACKGROUND: The staphylococci are implicated in a variety of human infections; however, many clinical microbiology laboratories in Nigeria do not identify staphylococci (in particular coagulase negative staphylococci - CNS) to the species level. Moreover, data from multi-centre assessment on antibiotic resistance and epidemiology of the staphylococci are not available in Nigeria. This study investigated 91 non-duplicate staphylococcal isolates obtained from the microbiology laboratories of eight hospitals in Nigeria during the period January to April 2010. METHODS: Identification and antibiotic susceptibility testing was performed using the VITEK 2 system, detection of resistance genes by PCR, and molecular characterization was determined by SCCmec typing, spa and multilocus sequence typing (MLST). RESULTS: All the isolates were susceptible to mupirocin, tigecycline, vancomycin and linezolid, but 72.5% of CNS and 82.3% of Staphylococcus aureus were resistant to cotrimoxazole, while multiresistance was observed in 37 of the 40 CNS isolates. Untypeable SCCmec types (ccrC/Class A mec and ccr-negative/Class C2 mec gene complex) in two methicillin-resistant S. aureus (MRSA) were identified. Additionally, ccr-negative/Class A mec and ccr type 4/Class C2 mec gene complex was detected in one isolate each of S. sciuri and S. haemolyticus, respectively. The S. aureus isolates were classified into 21 spa types including two new types (t8987, t9008) among the methicillin-susceptible S. aureus (MSSA) isolates. Two (CC8-SCCmecnon-typeable and CC88-SCCmec IV) and four (CC8-SCCmec III/IV/V; CC30-SCCmec II/III; CC88-SCCmec IV; and ST152-SCCmecnon-typeable) MRSA clones were identified in Maiduguri (North-East Nigeria) and South-West Nigeria, respectively. The proportion of Panton-Valentine leukocidin (PVL)-positive MSSA was high (44.4%) and 56.3% of these strains were associated with sequence type (ST) 152. CONCLUSIONS: The identification of multiresistant mecA positive S. haemolyticus and S. sciuri from clinical samples indicates that characterization of CNS is important in providing information on their diversity and importance in Nigeria. There is the need to develop new SCCmec classification methods for non-typeable methicillin-resistant staphylococci, and to curtail the spread and establishment of the S. aureus ST152 clone in Nigeria. The study presents the first report of a PVL-positive ST152-SCCmecnontypeable MRSA and SCCmec typing of methicillin-resistant CNS in Nigeria

Isolation and Immunological Detection of Mycobacterium Tuberculosis from HIV and Non-HIV Patients in Benue State, Nigeria

BACKGROUND: Immunological techniques are important tools for tuberculosis epidemiology; although its use is underutilized in Nigeria. In this study, we report the epidemiological outlook of Mycobacterium tuberculosis among HIV patients in Benue State, Nigeria.METHODS: Sputum samples were collected from 425 suspected TB patients from July 2016 to February 2018 and subjected to acid-fast microscopy, GeneXpert MTB/RIF, processed using NALC-NaOH and cultured on Lowenstein-Jensen media. The isolates obtained were identified by SD-Bioline® assay.RESULTS: The prevalence of TB by acid-fast microscopy was 35(15.9%). The prevalence of TB by acid-fast bacilli was significantly (χ2 = 8.458; P = 0.003) highest among the 15-34 years age group (22.0%) compared with other age groups. TB prevalence was significantly (χ2 = 4.751; P = 0.029) higher among patients from rural areas than those from urban center (23.8% vs 14.1%). GeneXpert assay detected 64(15.1%) TB cases of which patients from rural areas had significantly (χ2 = 8.104; P = 0.017) higher prevalence of TB than patients from urban areas (23.8% vs 12.9%). The overall rifampicin resistance TB was 3.1%. Also, patients from rural areas had significantly (χ2 = 10.625; P = 0.005) higher rifampicin resistance compared with patient from urban areas (8.3% vs 1.3%). Of the 126(29.7%) mycobacterial isolates, 42(33.33%) were identified as MTBC and 84 (66.67%) as NTM by SD-Bioline®assay.CONCLUSIONS: The study revealed that Mycobacterium tuberculosis infection is still a major public health problem, with relatively high prevalence rate of rifampicin resistance among HIV positive patients. Further studies are needed for early detection and treatment intervention necessary for infection control

Antibiotic resistance and molecular epidemiology of Staphylococcus aureus in Nigeria

<p>Abstract</p> <p>Background</p> <p><it>Staphylococcus aureus </it>is an important pathogen causing a wide range of infections in the hospital and community setting. In order to have adequate information for treatment of <it>S. aureus </it>infections, it is crucial to understand the trends in the antibiotic-resistance patterns. In addition, the occurrence and changes in types of <it>S. aureus</it>, clonal identities, and their geographic spread is essential for the establishment of adequate infection control programmes. In this study, 68 <it>S. aureus </it>isolates obtained from clinical and non-clinical sources in Nigeria between January and April 2009 were characterized using phenotypic and molecular methods.</p> <p>Results</p> <p>All the <it>S. aureus </it>isolates were susceptible to teicoplanin, vancomycin, phosphomycin, fusidic acid, rifampicin, daptomycin, mupirocin, linezolid and tigecycline. Sixteen percent of the isolates were resistant to oxacillin, while 55% and 72% of isolates were resistant to tetracycline and trimethoprim/sulphamethoxazole (cotrimoxazole), respectively (Table <tblr tid="T1">1</tblr>). There was excellent correlation between the broth microdilution assay and detection of antibiotic resistance genes by the multiplex PCR, in the determination of <it>S. aureus </it>resistance to erythromycin, gentamicin, methicillin and tetracycline. A total of 28 <it>spa </it>types were identified in the study, and the predominant <it>spa </it>type among the methicillin-susceptible <it>S. aureus </it>(MSSA) isolates was t084 (13 isolates). The t037-ST241-SCC<it>mec</it>III type was the only clone identified in Maiduguri (North-East Nigeria) while in South-West Nigeria, diversity among the MRSA isolates (t451-ST8-SCC<it>mec</it>V; t008-ST94-SCC<it>mec</it>IV; t002-ST5-SCC<it>mec</it>V; t064-ST8-SCC<it>mec</it>V) was observed. The toxin genes <it>seh </it>and <it>etd </it>were detected in isolates affiliated with clonal complexes CC1, CC80 and sequence type ST25, respectively. The proportion of PVL-positive isolates among MSSA was high (40%). Most of the PVL-positive MSSA isolates were obtained from wound infections and associated with clonal complexes CC1, CC30, CC121 and with sequence type ST152.</p> <tbl id="T1"> <title> <p>Table 1</p> </title> <caption> <p>Antibiotic resistance profile of <it>S. aureu</it><it>s </it>(MSSA and MRSA) from Nigeria</p> </caption> <tblbdy cols="4"> <r> <c> <p/> </c> <c cspan="3" ca="left"> <p><b>Number (%) of resistant isolates among</b>:</p> </c> </r> <r> <c ca="left"> <p><b>Antibiotic</b></p> </c> <c ca="left"> <p><b>MSSA</b></p> <p><b>(n = 57)</b></p> </c> <c ca="left"> <p><b>MRSA</b></p> <p><b>(n = 11)</b></p> </c> <c ca="left"> <p><b>Total</b></p> <p><b>(n = 68)</b></p> </c> </r> <r> <c cspan="4"> <hr/> </c> </r> <r> <c ca="left"> <p>Penicillin</p> </c> <c ca="left"> <p>49 (86)</p> </c> <c ca="left"> <p>11 (100)</p> </c> <c ca="left"> <p>60 (88.2)</p> </c> </r> <r> <c ca="left"> <p>Oxacillin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>11 (100)</p> </c> <c ca="left"> <p>11 (16.2)</p> </c> </r> <r> <c ca="left"> <p>Teicoplanin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Vancomycin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Gentamicin</p> </c> <c ca="left"> <p>1 (1.8)</p> </c> <c ca="left"> <p>9 (81.8)</p> </c> <c ca="left"> <p>10 (14.7)</p> </c> </r> <r> <c ca="left"> <p>Tetracycline</p> </c> <c ca="left"> <p>27 (47.4)</p> </c> <c ca="left"> <p>11 (100)</p> </c> <c ca="left"> <p>38 (55.9)</p> </c> </r> <r> <c ca="left"> <p>Ciprofloxacin</p> </c> <c ca="left"> <p>12 (21.1)</p> </c> <c ca="left"> <p>8 (72.7)</p> </c> <c ca="left"> <p>20 (29.4)</p> </c> </r> <r> <c ca="left"> <p>Moxifloxacin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>7 (63.6)</p> </c> <c ca="left"> <p>7 (10.3)</p> </c> </r> <r> <c ca="left"> <p>Trimethoprim/sulfamethoxazole</p> </c> <c ca="left"> <p>39 (68.4)</p> </c> <c ca="left"> <p>10 (90.9)</p> </c> <c ca="left"> <p>49 (72.1)</p> </c> </r> <r> <c ca="left"> <p>Phosphomycin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Fusidic acid</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Erythromycin</p> </c> <c ca="left"> <p>2 (3.5)</p> </c> <c ca="left"> <p>6 (54.5)</p> </c> <c ca="left"> <p>8 (11.8)</p> </c> </r> <r> <c ca="left"> <p>Clindamycin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>6 (54.5)</p> </c> <c ca="left"> <p>6 (8.8)</p> </c> </r> <r> <c ca="left"> <p>Rifampicin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Daptomycin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Mupirocin</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Linezolid</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> <r> <c ca="left"> <p>Tigecycline</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> <c ca="left"> <p>0 (0)</p> </c> </r> </tblbdy> </tbl> <p>Conclusions</p> <p>The use of phenotypic and molecular methods provided useful information on antibiotic resistance and molecular diversity of <it>S. aureus </it>in Nigeria. The high proportion of PVL-positive MSSA isolates affiliated to various clonal complexes and detected in all the health institutions is a major concern, both as a source of severe infections and as a potential reservoir that could lead to the emergence of PVL-positive MRSA. This study presents the first baseline information on the nature of the antibiotic resistance genes from <it>S. aureus </it>isolates in Nigeria. There is the need to curtail the spread and establishment of MRSA and PVL-positive MSSA clones in Nigerian health care institutions.</p

Diagnostic performance of GeneXpert and Ziehl-Neelson microscopy in the detection of tuberculosis in Benue State, Nigeria

Background: Accurate and timely diagnosis of tuberculosis (TB) is key to effective treatment and management. This study was designed to compare the diagnostic performance of GeneXpert and Ziehl-Neelson (ZN) microscopy test using culture as the reference.Methods: Cross-sectional study was conducted in a tertiary hospital to compare the performance of GeneXpert and ZN test among HIV and non-HIV patients. Sputum samples were collected from 261 suspected TB patients and analyzed in the laboratory using GeneXpert, ZN test and culture. Statistical analysis included calculation of sensitivity, specificity, positive predictive value and negative predictive value. X2 was used to compare the outcome of diagnostic test and demographic variables. p-value &lt; 0.05 was considered significant.Results: Comparison of TB prevalence among urban versus rural areas using the three diagnostic tests are: ZN test: 32 (12.3%) vs 16 (6.1%; X2 7.63, P = 0.007); GeneXpert: 63 (16.1%) vs 20 (7.7%, X2 9.01, P = 0.003) and culture: 22 (8.4%) vs 10 (3.8% X2 4.44, P = 0.05). Also, prevalence of TB was significantly (P &lt; 0.05) higher among HIV negative 25 (9.6%) than HIV positive 23 (8.8%) patients. The overall prevalence of rifampicin resistance was 12 (4.60%). Out of 261 sputum samples examined for TB, 48 (18.38%) tested positive by ZN test, 62 (23.76%) by GeneXpert and 32 (12.26%) by culture. Two out of 32 samples that tested positive by culture were negative by GeneXpert. GeneXpert had higher sensitivity (93.75%) than ZN test (50.00%). However, they had equal specificity (86.03%). The sensitivity and specificity of ZN and GeneXpert among HIV patients was 58.33% (95% CI = 29.66–84.83) and 79.31% (95% CI; 69.24–87.26) and 91.67% (95% CI 61.51–99.79) and 80.67 (95% CI; 70.58–88.17) while among HIV negative patients; ZN test and GeneXpert assay had 45.00% (23.05–68.45) and 90.14% (84.04–94.50) and 95.00% (75.13–99.87) and 89.44% (83.13–93.96), respectively.Conclusion: GeneXpert demonstrated higher level of performance than ZN microscopy. We recommend the use of GeneXpert for diagnosis of TB in Benue State and Nigeria in general for effective treatment and management of tuberculosis.Keywords: Diagnostic performance, GeneXpert MTB/Rif, Ziehl-Neelson, Tuberculosis, HI

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Factors associated with preventive behaviors, anxiety among healthcare workers and response preparedness against COVID-19 outbreak: A one health approach

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) is the causative agent of COVID-19. This study aimed to assess the preventive behavior, and responses to national preparedness and response readiness to the COVID-19 outbreak by Healthcare workers in Nigeria. Methods: A cross-sectional survey of 1200 HCW was carried out, three hundred and forty-six (346) responded to the online questionnaire on demographic characteristics, national preparedness, and preventive behavior towards COVID-19 by HCWs. Descriptive analysis of variables in the form of tables and graphs was carried out. A binary logistic regression analysis was applied and expressed as odds ratio (OR) at a 95% confidence interval (C·I) and p-value of 0.05 as significant values. Results: Of the (346) HCWs, 249 (72.0%) were males, 214 (61.8%) belong to the age group 30–39 years, age group of between 20 and 49 years were more likely to be anxious about been infected of SARS-CoV-2. HCWs in the S.E. region were 35 times more likely to use a face mask (OR 35.0; 95% C·I 3.48–370.41; P = 0.0003), and 140 (40.5%) of the HCWs supported one health approach for containing the spread of COVID-19. HCWs were anxious (OR = 5.885; 95% C·I: 1.634–20.973; p = 0.007) about their families becoming infected with SARS-CoV-2 because of their occupation. Conclusion: The national preparedness and response to the COVID-19 outbreak in Nigeria were below expectations. Healthcare workers were worried about infection with SARS-CoV-2. One health approach is recommended for the fight against the infectious disease of animal origin like COVID-19

Lymphatic filariasis among the Yakurr people of Cross River State, Nigeria

<p>Abstract</p> <p>Background</p> <p>In order to initiate a disease elimination programme for lymphatic filariasis based on mass drug administration, a proper understanding of the geographical distribution and degree of risk is essential.</p> <p>Methods</p> <p>An investigation of lymphatic filariasis due to <it>Wuchereria bancrofti</it> was carried out among 785 people in four communities of Yakurr Local Government Area of Cross River State, Nigeria between March and August, 2009. Finger prick blood smear samples collected from the subjects were examined for <it>W. bancrofti</it> using standard parasitological protocol. The subjects were also screened for clinical manifestations of lymphatic filariasis.</p> <p>Results</p> <p>Of the 785 persons examined, 48 (6.1%) were positive for microfilariae in their thick blood smear. There was a significant difference in the prevalence of lymphatic filariasis among the various age groups (P < 0.01) although peak prevalence occurred between 41 – 60 years. There was no significant difference in prevalence and density with respect to sex (P > 0.05). The overall mean microfilarial density of the infected individuals was 5.6mf/50 μl. There was a significant variation (P < 0.01) in mean microfilarial density within the communities, ranging from 4.7 to 6.4 mf/50 μl. The only clinical sign found in the study area was lymphoedema of the leg recording 2 (0.3%) prevalence.</p> <p>Conclusions</p> <p>The National Lymphatic Filariasis Elimination Programme should intervene by expanding the distribution of albendazole and ivermectin to all endemic areas including Yakurr Local Government Area of Cross River State, Nigeria.</p