PROTOCOL: Water, sanitation and hygiene for reducing childhood mortality in low‐ and middle‐income countries

Respiratory tract infections and diarrhoea are the two biggest killers of children in low income contexts. They are closely related to access to, and use of improved water, sanitation and hygiene (WASH). However, there is no high quality systematic review that quantifies the effect of WASH improvements on childhood mortality. Existing systematic reviews of WASH improvements measure effects on morbidity, under the (often implicit) assumption that morbidity is closely correlated with mortality. This is at least partly because the impact evaluations on which they are based are only designed to detect changes in morbidity with statistical precision, whereas mortality is a relatively rare outcome. The proposed review will address this evidence synthesis gap, using the greater statistical power of meta-analysis to pool findings across studies

Bacteriology of Osteomyelitis at Jos University Teaching Hospital, Nigeria

This bacteriological study of osteomyelitis in our hospital was done with a view to reducing the morbidity rates associated with this disease. Clinical specimens were collected from 60 clinically diagnosed patients. The wound swabs and pus samples were inoculated onto blood agar, chocolate agar and MacConkey agar plates, while blood cultures were set up using Brain heart infusion and Thioglycollate broths. Direct Gram-stained smears were examined microscopically. The bacterial isolates were subjected to antibiotic susceptibility tests using the disc diffusion method. The prevalence of the culture-positive osteomyelitis was 70%, with the 11 – 20 year age group having the highest prevalence of 42.9%. There was no significant difference in the prevalence in relation to gender. All the blood cultures remained sterile after 7 days incubation. Overall, 76.2% of the positive cultures were from wound swabs, followed by pus samples with 23.8%. Among the isolates, Staphylococcus aureus recorded the highest prevalence of 73.8%, followed by Pseudomonas aeruginosa with 11.9%. Proteus spp., Klebsiella spp. and Escherichia coli recorded 7.1%, 4.8% and 2.4% respectively. Most of the isolates showed multiple resistance to the commonly prescribed antibiotics, except for ofloxacin that recorded 100% activity against all the isolates. Our results showed a very high rate of culture-positive osteomyelitis. Efforts should be made to start the treatment early based on culture-guided antibiotic therapy. In the absence of culture facilities, ofloxacin could be used for the empiric treatment of osteomyelitis in our community. Keywords: Osteomyelitis, Bacteriology, Antibiotics, resistance Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 19-2