Microbial Contamination of Locally Produced Cheese and Determination of their Antimicrobial Potential in Nigeria

The high consumptionrate of soft cheese and manner of cheese production in Nigeria prompted the need to determine the microbial quality and  antimicrobial properties of locally produced cheese in Nigeria. A total of 20 cheese samples were obtained from different points in 4 cities in southern Nigeria, 5 cheeses per city. They were investigated for some physico-chemical properties, isolation and microbial counts and determination of antimicrobial potential. There was no significant variation in the  composition of physic-chemical properties of cheese samples from various cities except for the acidity of cheese sample obtained from Ilorin. All the 20 samples (100%) yielded low level of lactic acid bacteria (LAB) with counts ~ 103. Escherichia coli or Klebsiella species were constantly isolated in all the cheese samples. Similarly, yeast and Aspergillus species were isolated either alone or in a mixed culture. The result showed increase in total bacteria count from the point of production to the hawkers.  Antimicrobial potential was not found in cheese against the  microorganisms used in the study. The study identified local cheese (‘wara’) as a high risk food in Nigeria due to the high rate of contamination since they are ready-to-eat food item and no antimicrobial property detected in the soft cheese.Key Words: Cheese; Bacteria; Fungi; Nigeria, Susceptibility Le taux de fromage à pâte molle et les modalités de production de  fromage au Nigeria à forte consommation a incité la nécessité de déterminer la qualité microbienne et propriétés antimicrobiennes de  fromage produit localement au Nigeria. Un total de 20 échantillons de fromage ont été obtenues à partir de différents points dans 4 villes au sud du Nigeria, 5 fromages par ville. Ils ont été étudiés pour certaines  propriétés physico-chimiques, l'isolement et les numérations microbiennes et détermination du potentiel antimicrobien. Il n'y avait aucune variation significative dans la composition des propriétés physico- chimiques des échantillons de fromage à partir de différentes villes à l'exception de l'acidité de l'échantillon obtenu à partir de fromage de la ville d’Ilorin. Tous les 20 échantillons (100%) ont donné un faible niveau de bactéries lactiques (LAB) avec environs 103 espèces. Escherichia coli ou Klebsiellaont été constamment isolés dans tous les échantillons de fromage. De même, des espèces de levures et d'Aspergillus ont été isolés soit seuls, soit dans une culture mixte. Le résultat a montré l’augmentation des bactéries totales compté du point de production aux colporteurs. Potentiel antimicrobien n'a pas été trouvé dans le fromage contre les micro-organismes utilisés dans l'étude. L'étude a identifié fromage local (' wara ‘) comme un aliment à haut risque au Nigeria en raison du taux élevé de contamination, car ils sont prêts à consommer l'aliment et aucune  propriété antimicrobienne détecté dans le fromage à pâte molle.Mots clés: Fromage; bactéries; champignons; Nigeria, sensibilit

Effect of Hepatitis-B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) share similar routes of transmission, making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naïve patients and investigate the effect of co-infection on CD4 count and liver function.Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy- naive HIV-infected individuals. The CD4 count, Hepatitis B surface antigen, Serum albumin, total Protein, and liver  enzymes were determined using standard techniques.Results: The prevalence of HIV and HBV co-infection was 37%. The mean serum ALT and ALP were significantly higher in the co- infected patients (P-values <0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT, AST and ALP of mono and coinfected patients with CD4 count<200/μl were significantly higher than those with count ≥ 200 cells/μl. (pvalue of <0.01). The mean ALT and  AST of the co - infected patients and all patients with CD4 count <200 cells/μl were higher than the normal reference range.Conclusion: Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count <200 cells/μl are likely to result in abnormal ALT and AST. We recommend those co-infected patients and those with CD4 count <200 cells/μl should be given non-hepatotoxic antiretroviral drug.Keywords: HIV, Hepatitis B, CD4 count, liver function, co-infectio

Safety in the workplace: The burden and pattern of markers of Hepatitis B virus infection in routine blood samples in haematology laboratory at Irrua, Edo, Nigeria

Hepatitis B virus [HBV] infection is a worldwide problem resulting in many deaths yearly from cirrhosis and liver cancer. Regrettably also, healthcare workers get exposed to blood-borne pathogens, including hepatitis B virus at work. HBV infection in immuno-competent hosts results in acute fulminant illness which may be fatal, partially resolved to become chronic, or completely resolved. HBV immunization in the country cover neonates and health workers leaving many people uncovered. Lack of monitoring and confirmation of successful HBV immunization in heath workers reduces coverage in this group leaving many susceptible to HBV infection at work. We aimed to determine the magnitude of this risk for occupational exposure to HBV infection. We therefore analyzed sixty nine routine blood samples coming to our Haematology laboratory at Irrua, Edo, Nigeria, using the five parameter hepatitis B virus kit manufactured by Micropoint Diagnostics USA. Results showed that HBsAg, Ant-HBs, HBeAg, Anti-HBe and Anti-HBc were reactive in 11.6%, 23%, 1.4%, 7% and 7% of our study samples indicating that the burden of HBV infectivity is high. We recommend active monitoring and routine confirmation of successful HBV immunization in health workers with expansion of the program to cover more of our population.Keywords: Chronic HBV Infection, Occupational exposure, Immunization, Management of Chronic HBV infectio

Quality of care: Ensuring patient safety in blood transfusion in Irrua, Edo State Nigeria

Blood transfusion can be very beneficial and life saving to patients; though it carries with it the risk of Transfusion Transmissible Infections [TTIs] likes the Human Immuno deficiency Virus [HIV], Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Syphilis. Unfortunately, many hospitals in Nigeria are unable to undertake adequate donor-blood screening for TTIs using the ELISA Technique, owing to lack of facilities, manpower and/or funding. As our center partners with the National Blood Transfusion Service [NBTS] for screening with ELISA, we set out to determine the prevalence of the TTIs among blood donors in order to underscore the desirability of optimal screening of blood and partnering with the NBTS to improve blood safety. Donor blood units were sent to the NBTS for rescreening with ELISA technique, after we had screened for the TTIs using rapid kits. We then reviewed the results of 613 donors over two years to determine the prevalence of TTIs among donors. Overall results showed that 86 (13.6%) was reactive for one or two of the TTIs: HIV 23(3.6%); HBV 41 (6.5%); HCV 17 (2.7%) and Syphilis 5(0.8%). Our findings suggest that screening donor blood with rapid kits only is froth with dangers to the patient; hence hospitals lacking the capacity to screen with ELISA should partner with the NBTS.Keywords: Blood Safety, ELISA Screening, Rapid Kit Screening, TTIs, NBT

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an