DEVELOPMENT OF IMPROVED SOLID HOSPITAL WASTE MANAGEMENT PRACTICES IN A NIGERIAN TERTIARY HOSPITAL

A pre-intervention situation analysis was conducted to assess Hospital Waste Management (HWM) practices, solutions were proffered for the observed inadequacies and advocacy was made to Hospital administration for which a number of interventional measures were instituted. A post interventional survey was conducted to identify the improvements in HWM and identify areas needing further attention using a structured questionnaire to collect 300 viable samples. Overall outcome includes introduction of HWM plan, establishment of Environmental unit, procurement of waste segregation practices, double chambered incinerator while evaluation of medical and health workers’ knowledge and practices showed that 144(48%) express satisfaction with HWM.  The profession of respondents has significant effect on the knowledge about HWM while the educational qualification was not independently associated with level of satisfaction and use of personal protective equipments while handling medical waste at p=0.05. It was therefore concluded that continuous training/ capacity development and provision of waste management materials remain essential for consolidating the gains made on HWM. http://dx.doi.org/10.4314/njt.v35i3.2

Pre-donation screening of blood for transfusion transmissible infections: The gains and the pains - experience at a resource limited blood bank

Objective: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Predonation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units.Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner.Design: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for predonation testing by simple rapid  techniques and post donation screening by ELISA.Results: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Postdonation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donationtesting is relied on. More blood units were found reactive for the TTIs with the more expensive Postdonation ELISA.Conclusion: Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by postdonation ELISA testing, it is done at a compromise toblood transfusion safety.Key words: pre-donation, post-donation, TTIs screening

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

Perceived benefits of and barriers to Building Information Modelling (BIM) implementation in construction: The case of Hong Kong

BIM has experienced an increasing appeal in its adoption and implementation in the built environment worldwide in recent years. The current research study aims to identify and assess the perceived benefits of and barriers to BIM implementation in the Hong Kong construction industry. The study adopted a quantitative research design using a structured empirical questionnaire survey. Also, a comparative analysis of the perceptions of the respondents’ groupings was conducted. The major barriers to BIM adoption are related to the inherent resistance to change by construction stakeholders, inadequate organizational support and structure to execute BIM, and lack of BIM industry standards in Hong Kong. Meanwhile, the key benefits include better cost estimation and control, efficient construction planning and management, and improvement in design and project quality. Practical and insightful recommendations were suggested for policymakers, local authorities, construction firms, and other key stakeholders to increase the uptake of BIM in construction projects as well as to aid them in the quest for full adoption of BIM in the built environment. The practical implications of the research findings were also presented and discussed

Malaria parasitaemia among blood donors in Ilorin, Nigeria

Background: The prevalence of malaria parasitaemia among blood donors in Ilorin has not been documented. In this study, we determined the prevalence of malaria parasitaemia among blood donors in Ilorin, as well as, the sociodemographic and other factors associated with it.Method: This was a hospital- based cross sectional study involving 308 consenting blood donors. The sociodemographic characteristics of participants as well as blood donation history were obtained using structured questionnaires specifically designed for this purpose. Giemsastained thick and thin blood films to identify malaria parasites were performed using standard method. ABO blood grouping and haemoglobin electrophoresis tests were also done using standard methods.Results: The prevalence of malaria parasitaemia among blood donors in Ilorin was 27.3%. The parasite species found were more of Plasmodium falciparum(85.7%) than Plasmodium malariae(14.3%) . There was no age or sex difference in malaria parasitaemia. (p-value of 0.8 and 0.32 respectively). A greater proportion of blood group O individuals had malaria parasitaemia than groups A and B but this difference was not significant (p-value = 0.13). There was also no significant difference among haemoglobin genotypes.Conclusion: The prevalence of malaria parasites among blood donors in Ilorin is considerably high and lack of routine screening of blood puts recipients at risk. We recommend that routine screening for malaria parasites be commenced in our blood banks. Treatment of donor blood with riboflavin and UV light to inactivate malaria parasites and other infectious pathogens before they are transfused to patients may also be considered in our blood banks.Key words: malaria, parasitaemia, blood donors, Nigeri

Critical success factors for building information modelling (BIM) implementation in Hong Kong

Purpose – Some initiatives have been proposed and implemented to facilitate successful project delivery and improve coordination and collaboration in the design, construction and management phases of project development. Building information modeling (BIM) is one of those initiatives that, though recent, however, have made a significant impact on the construction industry in some countries. The paper aims to discuss this issue. Design/methodology/approach – This paper aims to explore the critical success factors for BIM implementation in the architecture, engineering and construction industry of Hong Kong through a mixed research method (structured empirical questionnaire survey and expert interviews). Findings – The most influential success factor relates to the client’s acceptance with BIM projects, proper organizational structure to support a BIM system within the company and financial aid from the government to set up the BIM system. The expert interviewees also stressed the need for willingness from project staff members to learn and utilize BIM. Practical implications – This study has contributed to the establishment of more practical and effective strategies for ensuring full adoption of BIM in Hong Kong. Practical recommendations for enhancing BIM adoption in the construction industry were highlighted. Originality/value – This study has established the key drivers leading to the success of BIM implementation in Hong Kong, as well as in the perspective of construction experts on how to enhance its uptake in construction projects

Reference values of haematological parameters of healthy adults in the north central zone of Nigeria

Background: Haematological parameters differ from one population to another due to several factors. To determine the clinical implication of the blood parameters of an individual in the state of health or disease, we need to have the knowledge of the normal reference range for that locality.Objectives: To determine the reference values of haematological parameters of apparently healthy adults in Ilorin.Design: A descriptive cross sectional study.Setting: Ilorin, North Central zone of NigeriaSubjects: Nine hundred and ten (443 males and 467 females) randomly selected normal, HIV negative individuals aged 18-65 yearsResults: The red blood cell count, Haemoglobin concentration, PCV and MCHC were significantly higher among males than females while the platelet count, total WBC count and absolute neutrophil count were significantly higher in females than in males. There was however no significant gender difference in the values of MCV, MCH and absolute lymphocyte count. The normal reference values obtained in this study were notably different from those that are used currently in the hospital.Conclusion: The normal reference value obtained in this study was notable different from those that are currently used in the hospital. These findings will have clinical implications regarding the adjustment of our current reference values and definitely add value to the management of patients in this part of the country

Blood utilization in elective surgical procedures in Ilorin

Blood utilization was evaluated in elective surgical procedures over a period of 6 months using different indices such as crossmatch to transfusion ratio(C/T ratio), transfusion probability (%T), and transfusion index (TI). Out of 436 units of blood crossmatched for 207 patients, only 132 were transfused with no utilization of 69.7% of crossmatched blood. In wound debridement, split thickness skin grafting (STSG), open reduction internal fixation (ORIF), mastectomy, and prostatectomy all the 3 indices showed significant blood utilization whereas in all ENT surgery utilization of blood provided was nil. This study showed that there was excessive crossmatching of blood and changing the blood ordering pattern can minimize this. Keywords: blood utilization, elective surgery The Tropical Journal of Health Sciences Vol. 13(1) 2006: 15-1

Blood donation trend in a tertiary hospital in Nigeria

Background: Voluntary donors who ought to be the main source of donor blood are relatively few in Nigeria. There is therefore a need to study current patterns of blood donation and design strategies for improvement. Objectives: To determine the types , age and sex distribution of blood donors in a tertiary Hospital in Nigeria. Method: This retrospective study was conducted in the University of Ilorin Teaching Hospital. The study covered the 5 year period from 2004-2008.Information on the types of donation and the demographic characteristics, and blood groups of donors were extracted from the donor register. Results: A total of 21694 units of blood were donated during the 5 year study period. Of these, 99% were from male and 1% from female donors. Majority of donors gave blood as family replacement donations while voluntary donations constituted 2.2% and autologous donations 0.1% of the total. Nearly half of the total number of donors and about three quarters of voluntary donors fell in the young adult age range of 20-29years. Conclusion: Voluntary blood donation which gives the safest blood is not common in Nigeria. Female donors are scarce. Youths and students in the age bracket of 20-29 years are the most appropriate targets for intensive voluntary blood donation advocacy. Key words: Blood donation, tertiary hospital, voluntary donors, female donor

Effect Of Highly Active Antiretroviral Therapy On CD4 Count And Weight In AIDS Patients Seen At The UITH, Ilorin

To determine the response on treatment-naïve HIV/AIDS patients to the Highly Active Antiretroviral Therapy (HAART) in terms of CD4 Count and Weight gain over a period of 2½ years. Patients with Acquired Immunodeficiency Syndrome (AIDS) were recruited under the Federal Government HighlyActiveAntiretroviral Therapy (HAART) programme at the University of Ilorin Teaching Hospital. The treatment regimen included Lamivudine, Starvudine and Nevirapine. The patients\' responses were evaluatedwith respect toCD4 count andweight over the period of treatment.The diagnosis ofHIV/AIDS wasmade on the basis of reactivitywith two different ELISAreagents, andCD4 countwas donewithDynalT4 Quantmethod. Theweights (kg.) of the patientswere taken atmonthly visit. The duration of treatment for the patients analysed ranged from 1 month to 14 months. Analysis of CD4 count was possible in 105 patients. The mean post treatment CD4 count and weight were significantly higher than the pre-treatment values (p < 0.001 and p < 1.01) respectively. There were significant positive correlations (p < 0.05 and p < 0.001) between increases in CD4 count and weight respectively, and duration of treatment. In eight (8) patients,CD4Count reduced or remained the same in spite of treatment. TheHAARTregime is associatedwith increase inCD4Count andweight gain.While increases in CD4 Count and weight correlated with duration of therapy, there was no correlation between CD4 Count increase andweight gain. Keywords: HIV/AIDS Antiretroviral Therapy CD4 Weight. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 312-31