Occurrence of malaria and utilization of antimalaria preventive measures amongst pregnant women attending Ajeromi- Ifelodun General Hospital, Lagos State, Nigeria

Malaria in Pregnancy poses a serious health problem both for the mother and her unborn baby and this can be prevented with the use of Intermittent Preventive Treatment with sulphadoxine pyrimethamine (IPTp-SP), Long Lasting Insecticidetreated Nets (LLIN) and other preventive measures. This cross-sectional survey was carried out among pregnant women attending Ajeromi Ifelodun General Hospital between August 2013 and February 2014. A total of 414 pregnant women (with mean age of 29±8.7) in their first (84), second (124) and third (206) trimesters were recruited for this study. Blood samples for making both thin and thick smears were collected and semi-structured questionnaires administered to the respondents. The questionnaire probed into their knowledge on cause of malaria, the preventive measures taken against mosquito bite, use of IPTp-SP, possession and use of LLIN. The overall prevalence of malaria due to Plasmodium falciparum is 24 (5.8%) out of which 13 were primigravid, 5 were secundi-gravid, and 6 were multigravida with no significant difference (P>0.05) amongst them. Two hundred and eighty-six (69.1%) pregnant women had good knowledge of the cause of malaria. 164 (39.6%) of the sampled population had a tertiary education while 182 (44.0%) had secondary education, 124 (30.4%) were traders and 80(19.6%) were civil servants. Preventive measures claimed to be adopted by the respondents in avoiding mosquito bites include the use of LLIN (62.6%), insecticides sprays (36.2%), and locally adopted measures (1.5%). The number of respondents who had not availed themselves of IPTp-SP was significantly higher 258 (62.3%) compared to those who had (P<0.05). It was observed that educational status had no significant effect on the knowledge of the cause of malaria in sample population (p>0.05). The findings of this study reveal that there is a good knowledge on the cause of malaria among pregnant women but low use of IPTp-SP. In order to meet the new target of reaching an elimination stage set by the World Health Organization, factors responsible for the low use of these preventive measures should be investigated and quickly addressed so as to reduce both maternal and child morbidity/mortality resulting from malaria infection.Keywords: Malaria, Pregnant women, Prevention, Intermitent preventive treatment, Sulphadoxine-pyrimethamine, Longlasting Insecticide treated ne

Genetic diversity of Plasmodium falciparum among pregnant women in south-west Nigeria

Pregnancy-associated malaria (PAM) is a major public health concern and an important contributor to maternal and foetal mortality in sub-Saharan Africa. Understanding of the biological basis of malaria in pregnancy was recently advanced by the discovery that susceptibility to PAM is not solely dependent on pre-exposure or gravidity. It was hypothesize in this study that PAM is difficult to diagnose in pregnant women who are multigravidae due to antibodies acquired from previous infections coupled with the extensive genetic diversity of the parasite. This cross-sectional study was carried out to assess the extent of genetic diversity of P. falciparum isolates among pregnant women attending antenatal care in Lagos, Nigeria between August 2013 and February 2014. A total of 414 pregnant women in their first (84), second (124) and third (206) trimesters were recruited for this study. Blood spots were made from P. falciparum positive blood samples and the parasite deoxyribonucleic acid was extracted for merozoite surface proteins 1 and 2 genotyping. The prevalence of FC27 allele type from pregnant women isolate was higher (33.3%) than that from non-pregnant women (29.2%). The multiplicity of infection with P. falciparum in both groups was low. The findings indicate a low level of P. falciparum diversity among pregnant women but there is need for year-round surveillance especially during the peak malaria transmission.Keywords: Genetic diversity; Plasmodium falciparum; merozoite surface proteins

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien\u2013Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9\ub72 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4\u20137) and 7 (6\u20138) days respectively (P &lt; 0\ub7001). There were no significant differences in rates of readmission between these groups (6\ub76 versus 8\ub70 per cent; P = 0\ub7499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0\ub790, 95 per cent c.i. 0\ub755 to 1\ub746; P = 0\ub7659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34\ub77 versus 39\ub75 per cent; major 3\ub73 versus 3\ub74 per cent; P = 0\ub7110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P &lt; 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement