Impact of Agricultural Input Supply on Agricultural Growth in Nigeria

Improving the production capacity of agriculture in Nigeria through agricultural input supply is an important policy goal in a country where agriculture represents an important sector in the economy. The agricultural sector provides livelihood to a significant portion of Nigerian population, especially in rural areas, where poverty is more pronounced. Thus, a growing agricultural sector contributes to both overall growth and poverty alleviation. The study specifically examined the effects of agricultural input supply on agricultural growth in Nigeria from 1990 to 2017. The objective of this study is to examine agricultural input supply in Nigeria and its implications on the growth of agricultural growth in Nigeria. The study used time series data covering 1986-2016 obtained from FAOSTAT, World Development Indicator and Central Bank of Nigeria data base. This study utilized Auto-Regressive Distributed Lag (ARDL) approach to investigate the variables. The finding of the study shows that there is co-integration between the variables. The result of the study shows that gross capital formation and Fertilizer supply to agriculture were significant in influencing agricultural growth in Nigeria with coefficient values of (-0.002468), and (0.001506), with P-values of (0.0222) and (0.0171) respectively. Given the robust nature of the result, it is evident that agricultural input supply contributes in great measure to agricultural growth in Nigeria. The study then conclude that agricultural input is essential for the growth of agricultural sector in Nigeria and recommend that given the lean resources available to government, attention should be given to the inputs that contributes significantly to the growth of the sector

Pattern of bacterial pathogens of acute Otitis media in a tertiary hospital, South Western Nigeria

Introduction: Otitis media was reasonably prevalent prior to the use of antibiotics for treatment. In Nigeria, hospital incidence reports indicate that chronic suppurative Otitis media is the commonest. Complications that usually arise as a result of untreated Otitis media are meningitis, brain abscess, keratoma, otosclerosis, and hearing loss. The study aimed at providing information on the pattern of bacterial pathogens of acute Otitis media in LAUTECH Teaching hospital, Osogbo, Nigeria.Methods: It was a cross-sectional study involving patients with acute Otitis media attending ENT clinic at LAUTECH Teaching Hospital, Osogbo, Nigeria. Ear swabs were collected from the patients after informed consent. The samples were inoculated on general and selective laboratory media. Bacterial pathogens were isolated and identified. Antibiotic susceptibility testing was performed on each of the bacterial isolates using modified Kirby Bauer disk diffusion.Results: There were 115 isolates from 98 patients with acute Otitis media. Gram negative bacteria constituted 66.7% of the isolates. The most common organism was Pseudomonas aeruginosa (34.8%). Others were Staphylococcus aureus (30.4%), Proteus spp (15.7%), Klebsiella spp (11.3%), Escherichia coli (2.6%) and few Fungi (4.1%). Antibiotics sensitivity results of the isolates showed high resistance against most readily available antibiotics. The cumulative resistance of all the bacteria isolates to Augmentin was 89%, gentamicin 80%, ciprofloxacin 34% and ceftazidime 10%. About 88% of the Gram positive bacteria were resistant to penicillin G, amoxicillin, cotrimoxazole, and erythromycin. While 100% of the Gram negative bacteria were resistant to cotrimoxazole, tetracycline, and chloramphenicol. However, commonly isolated organisms were highly susceptible to few 3rd-generation cephalosporins especially ceftriaxone and ceftazidime.Conclusion: Based on the result of this study, it is suggested that knowledge of antibiotic profile of etiological agents in Otitis media would be of great advantage in reducing the morbidity and mortality associated with Otitis media.Keywords: Otitis media, Bacterial agents, Antibiotic resistanc

Impact of Agricultural Input Supply on Agricultural Growth in Nigeria

Improving the production capacity of agriculture in Nigeria through agricultural input supply is an important policy goal in a country where agriculture represents an important sector in the economy. The agricultural sector provides livelihood to a significant portion of Nigerian population, especially in rural areas, where poverty is more pronounced. Thus, a growing agricultural sector contributes to both overall growth and poverty alleviation. The study specifically examined the effects of agricultural input supply on agricultural growth in Nigeria from 1990 to 2017. The objective of this study is to examine agricultural input supply in Nigeria and its implications on the growth of agricultural growth in Nigeria. The study used time series data covering 1986-2016 obtained from FAOSTAT, World Development Indicator and Central Bank of Nigeria data base. This study utilized Auto-Regressive Distributed Lag (ARDL) approach to investigate the variables. The finding of the study shows that there is co-integration between the variables. The result of the study shows that gross capital formation and Fertilizer supply to agriculture were significant in influencing agricultural growth in Nigeria with coefficient values of (-0.002468), and (0.001506), with P- values of (0.0222) and (0.0171) respectively. Given the robust nature of the result, it is evident that agricultural input supply contributes in great measure to agricultural growth in Nigeria. The study then conclude that agricultural input is essential for the growth of agricultural sector in Nigeria and recommend that given the lean resources available to government, attention should be given to the inputs that contributes significantly to the growth of the sector

Nosocomial infections and the challenges of control in developing countries.

Nosocomial infection is a recognized public health problem world-wide with a prevalence rate of 3.0-20.7% and an incidence rate of 5-10%. It has become increasingly obvious that infections acquired in the hospital lead to increased morbidity and mortality which has added noticeably to economic burden. However, after about three decades of nosocomial infection surveillance and control world-wide, it still remains an important problem for hospitals today. Studies have shown that most hospitals in developing countries especially Africa, have no effective infection control programme due to lack of awareness of the problem, lack of personnel, poor water supply, erratic electricity supply, ineffective antibiotic policies with emergence of multiply antibiotic resistant microbes, poor laboratory backup, poor funding and non-adherence to safe practices by health workers. It is recommended that the cost of hospital infection control programme should be included in the health budget of the country and fund allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks. There is need for adequate staffing and continuous education of staff on the principles of infection control, especially hand washing which is the single most important effective measure to reduce the risks of cross infection.

Assessment of selected liver enzyme activity in patients with rifampicin-resistant tuberculosis receiving treatment at a tertiary healthcare facility, southwest Nigeria

Background: Several anti-tuberculous drugs have been effective in the treatment and management of drugsensitive and -resistant tuberculosis (TB). While these drug combinations have proven to be highly active against tubercle bacilli, side effects and toxicity may occur with tendency to interrupt or discontinue therapy, resulting in poor compliance. The objective of this study is to assess hepatotoxic potentials of anti-TB drugs among patients with rifampicin-resistant TB (RRTB) undergoing treatment at the directly observed treatment short-course (DOTS) clinic of Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria. Methodology: This was a prospective study of 40 patients with RRTB on second-line anti-TB therapy including bedaquiline, moxifloxacin, prothionamide, ethambutol, pyrazinamide, isoniazid and clofazimine. RRTB was diagnosed by sputum smear AFB microscopy and Xpert MTB/RIF assay at the TB laboratory of Bowen University Teaching Hospital, Ogbomoso, Nigeria. Forty gender and age-matched apparently healthy persons were used as control. Venous samples (~5ml) were collected from each participant at baseline (prior to commencement of anti-TB therapy) and after completion of 9-11 months therapy, as well as from the controls. Plasma was separated by centrifugation and the activity of ALT, AST and ALP was measured by spectrophotometric analysis, while total protein and albumin levels were determined using routine methods. Data were presented as mean±SD and analysed using SPSS version 21.0. Comparison of the mean enzyme activity at baseline and after completion of therapy as well as with the control was done with unpaired ‘t’ test, and ‘p’ (two tail) value less than 0.05 was considered statistically significant. Results: The age range of the 40 RRTB patients is 20-67 years (mean age 45.50±10.1 years) while the age range of the 40 controls is 21-65 years (mean age 45.70±12.10 years). The male to female ratio is 1.2:1 for the patients and 1:1 for the control. There is statistically significant increase in post-therapy plasma activity of ALT (p<0.0001), AST (p<0.0001), ALP (p<0.0001), and total protein level (p=0.0086) compared to the baseline, while plasma albumin level decreased significantly post-therapy (p=0.007). Although there is no significant difference in the baseline activity of ALT (p=0.4936) and AST (p=0.2539) for the RRTB patients compared to the control, post-treatment activity of ALT (p<0.0001) and AST (p<0.0001) in RRTB patients were significantly higher than in apparently heathy controls. Conclusion: The activity of the liver enzymes (AST and ALT) reported among RRTB patients in our study are within the normal reference range for persons above 18 years of age, indicating a non-hepatotoxic effect of the anti-TB drugs. However, statistically significant increase in these enzyme activities in the patients’ posttreatment compared to the baseline, and to apparently healthy controls, indicates that the drugs may be potentially hepatotoxic on prolonged usage.   French title: Évaluation de l'activité des enzymes hépatiques sélectionnées chez les patients atteints de tuberculose résistante à la rifampicine recevant un traitement dans un établissement de soins de santé tertiaires, dans le sud-ouest du Nigeria Contexte: Plusieurs médicaments antituberculeux se sont révélés efficaces dans le traitement et la prise en charge de la tuberculose pharmacosensible et résistante. Bien que ces combinaisons de médicaments se soient avérées très actives contre les bacilles tuberculeux, des effets secondaires et une toxicité peuvent survenir avec une tendance à interrompre ou à interrompre le traitement, entraînant une mauvaise observance. L'objectif de cette étude est d'évaluer les potentiels hépatotoxiques des médicaments antituberculeux chez les patients atteints de tuberculose résistante à la rifampicine (RRTB) qui suivent un traitement à la clinique DOTS (Traitement de courte durée directement observé) de l'Université de technologie de Ladoke Akintola (LAUTECH), Hôpital, Ogbomoso, Nigéria Méthodologie: Il s'agissait d'une étude prospective de 40 patients atteints de RRTB sous traitement antituberculeux de deuxième ligne comprenant la bédaquiline, la moxifloxacine, le prothionamide, l'éthambutol, le pyrazinamide, l'isoniazide et la clofazimine. La RRTB a été diagnostiquée par microscopie AFB des frottis d'expectoration et test Xpert MTB/RIF au laboratoire de la tuberculose de l'hôpital universitaire de Bowen, à Ogbomoso, au Nigeria. Quarante personnes apparemment en bonne santé appariées selon le sexe et l'âge ont été utilisées comme contrôle. Des échantillons veineux (~5ml) ont été prélevés sur chaque participant au départ (avant le début du traitement antituberculeux) et après la fin du traitement de 9 à 11 mois, ainsi que sur les témoins. Le plasma a été séparé par centrifugation et l'activité de l'ALT, de l'AST et de l'ALP a été mesurée par analyse spectrophotométrique, tandis que les taux de protéines totales et d'albumine ont été déterminés à l'aide de méthodes de routine. Les données ont été présentées sous forme de moyenne ± ET et analysées à l'aide de SPSS version 21.0. La comparaison de l'activité enzymatique moyenne au départ et après la fin du traitement ainsi qu'avec le contrôle a été effectuée avec un test «t» non apparié, et une valeur «p» (deux queues) inférieure à 0,05 a été considérée comme statistiquement significative. Résultats: La tranche d'âge des 40 patients RRTB est de 20 à 67 ans (âge moyen 45,50±10,1 ans) tandis que la tranche d'âge des 40 témoins est de 21 à 65 ans (âge moyen 45,70±12,10 ans). Le ratio hommes/femmes est 1.2:1 pour les patients et 1:1 pour le contrôle. Il y a une augmentation statistiquement significative de l'activité plasmatique post-thérapie de l'ALT (p<0,0001), de l'AST (p<0,0001), de l'ALP (p<0,0001) et du taux de protéines totales (p=0,0086) par rapport à la ligne de base, tandis que l'albumine plasmatique le niveau a diminué significativement après le traitement (p=0,007). Bien qu'il n'y ait pas de différence significative dans l'activité de base de l'ALT (p=0,4936) et de l'AST (p=0,2539) pour les patients atteints de RRTB par rapport au groupe témoin, l'activité post-traitement de l'ALT (p<0,0001) et de l'AST (p<0,0001) chez les patients RRTB étaient significativement plus élevés que chez les témoins apparemment en bonne santé. Conclusion: L'activité des enzymes hépatiques (AST et ALT) rapportée chez les patients atteints de RRTB dans notre étude se situe dans la plage de référence normale pour les personnes de plus de 18 ans, indiquant un effet non hépatotoxique des médicaments antituberculeux. Cependant, une augmentation statistiquement significative de ces activités enzymatiques chez les patients après le traitement par rapport à la ligne de base et à des témoins apparemment sains, indique que les médicaments peuvent être potentiellement hépatotoxiques en cas d'utilisation prolongée

Underutilization of the Clinical Microbiology Laboratory by Physicians in Nigeria

Background: Clinical laboratories are critical to correct diagnosis of medical conditions to ensure appropriate management. Point prevalence survey (PPS) of antimicrobial use and resistance performed in Nigeria in 2015 and 2017 showed high rates of antibiotic use, but poor laboratory utilization for definitive diagnosis of the infections for which the antimicrobials were prescribed. This study investigated the reasons for clinicians‟ poor utilization of the clinical laboratory for definitive diagnosis and treatment of infections.Methods: A cross sectional survey of clinicians attending the 2018 annual scientific conference and general meeting of the National Postgraduate Medical College of Nigeria (NPMCN) in Owerri, Southeastern Nigeria, was conducted using self-administered structured questionnaire to obtain information on the sub-optimal utilization of the clinical microbiology laboratory. Results: Of 283 respondents, 14.8% were general practitioners and 85.2% were specialists who have been in practice for a median period of 20 years (range 3 – 48 years). The specialists included surgeons (26%), family physicians (19.8%), internists (14.3%), pathologists (13.9%), paediatricians (8.8%), obstetricians and gynecologists (8.1%), community medicine physicians (6.2%), and dental surgeons (2.6%). Majority of the respondents (90.8%) work in public, 88.3% work in tertiary and 9.9% in secondary care hospitals. For diagnosis of infections, 16% and 49.8% reported using laboratory “always” and “very often” respectively. Among these, the most commonly utilized investigations were microscopy, culture and sensitivity (62.4%), DNA detection (18.3%), GeneXpert for tuberculosis (17.2%), and antigen detection (16.7%). Among clinicians that “hardly make use” of the laboratory, their reasons for non-use were; clinical diagnosis being sufficient (39.7%), delayed results (17.2%), having knowledge of „potent‟ antibiotics (15.5%), lack of access to microbiology laboratory (13.8%), absence of pathologists to assure quality of tests (12.1%), and no need of the laboratory to manage patients with infections (8.6%).Conclusion: These findings indicate that poor use of the microbiology laboratory seems mainly associated with perception and attitude of the physicians to the relevance of the laboratory, and perceived inadequacy of microbiology practice in some others. There is need to raise physicians‟ awareness on the relevance and what constitutes optimal use of the clinical microbiology laboratory for accurate diagnosis of infections and appropriate antimicrobial use.Key words: utilization, microbiology laboratory, diagnosis, antimicrobials, infectious disease

Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

Background: Antimicrobial resistance (AMR) is a major clinical challenge globally. It is mainly a consequence of inappropriate prescribing and use of antibiotics. Antimicrobial stewardship (AMS) ensures that antibiotics are prescribed and used appropriately. This study assessed AMS practice in selected Nigerian hospitals.Methodology: This was a cross sectional survey of 20 Federal, State and Private tertiary hospitals randomly selected from the six geopolitical zones of Nigeria. Using an adapted WHO tool on AMS, data were collected from each hospital as regard the existence of AMS committee, Accountability and Responsibility, AMS actions, Education and Training, Monitoring and Evaluation, Infection Prevention and Control (IPC) practice, facilities to support AMS, and challenges to AMS implementation. Gaps and challenges to the implementation of the AMS among the hospitals were identified.Results: Only 6 (30%) of the 20 hospitals had AMS committees while 2 (10%) had any evidence of leadership commitment to AMS. All the hospitals had laboratory facilities to support culture and sensitivity testing. There were no regular AMS-related education or training, monitoring, evaluation or reporting activities in the hospitals, except in 7 (25%) that had participated in the global point prevalence survey (Global-PPS) of antimicrobial use and resistance being hosted by the University of Antwerp, Belgium. Challenges impeding AMS activities included lack of human and financial resources, prescribers’ opposition, lack of awareness and absence of AMS committees. Most of the gaps and challenges bordered on seeming lack of knowledge and inadequate communication among prescribers and other stakeholders.Conclusion: There is need for intense education and training activities for prescribers and other stakeholders, including but not limited to hospital administrators. Keywords: Survey, Antimicrobial Stewardship, Antimicrobial Resistance; Nigeria   French title: Mise en œuvre de la gestion des antimicrobiens dans les hôpitaux Nigérians: lacunes et défis Contexte: La résistance aux antimicrobiens (RAM) est un défi clinique majeur à l'échelle mondiale. C'estprincipalement une conséquence d'une prescription et d'une utilisation inappropriées d'antibiotiques. La gestion des antimicrobiens (AMS) garantit que les antibiotiques sont prescrits et utilisés de manière appropriée. Cette étude a évalué la pratique de l'AMS dans certains hôpitaux Nigérians. Méthodologie: Il s'agissait d'une enquête transversale de 20 hôpitaux tertiaires fédéraux, d'État et privéssélectionnés au hasard dans les six zones géopolitiques du Nigéria. À l'aide d'un outil OMS adapté sur l'AMS, des données ont été collectées auprès de chaque hôpital en ce qui concerne l'existence d'un comité AMS, la responsabilité et la responsabilité, les actions AMS, l'éducation et la formation, le suivi et l'évaluation, la  pratique de prévention et de contrôle des infections (IPC), les installations pour soutenir l'AMS. et les défis de la mise en œuvre de l'AMS. Les lacunes et les défis liés à la mise en œuvre de l'AMS parmi les hôpitaux ont été identifiés. Résultats: Seuls 6 (30%) des 20 hôpitaux avaient des comités AMS tandis que 2 (10%) avaient des preuves d'engagement du leadership envers l'AMS. Tous les hôpitaux disposaient d'installations de laboratoire pour soutenir la culture et les tests de sensibilité. Il n'y avait pas d'activités régulières d'éducation ou de formation, de suivi, d'évaluation ou de rapportage liées à la MGS dans les hôpitaux, sauf dans 7 (25%) qui avaient participé à l'enquête mondiale sur la prévalence ponctuelle (Global-PPS) de l'utilisation et de la résistance aux  antimicrobiens organisée par l'Université d'Anvers, Belgique. Les défis entravant les activités de l'AMS  comprenaient le manque de ressources humaines et financières, l'opposition des prescripteurs, le manque de sensibilisation et l'absence de comités AMS. La plupart des lacunes et des défis se limitaient à un manque apparent de connaissances et à une communication inadéquate entre les prescripteurs et les autres intervenants.Conclusion: Des activités d'éducation et de formation intensives sont nécessaires pour les prescripteurs et autres intervenants, y compris, mais sans s'y limiter, les administrateurs d'hôpitaux. Mots clés: enquête, gestion des antimicrobiens, résistance aux antimicrobiens; Nigeria   &nbsp

Corrigendum: Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

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Catheter Associated Urinary Tract Infection: Aetiologic Agents and Antimicrobial Susceptibility Pattern in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

The objective of this study was to identify microbial pathogens associated with bacteriuria and UTI in patients with indwelling urethral catheters and determine their susceptibility patterns to commonly used antimicrobial agents in our institution. Catheter urine and catheter tip specimens of all the patients were analyzed by microscopy and culture on Blood, MacConkey and CLED agar plates. Pure colonies of isolated organism were biochemically characterized and disc diffusion antibiotic susceptibility was performed on each bacterial isolate. The commonest indication for catheterization is benign prostatic hyperplasia (BPH, 62.3%). One hundred and eight patients (88.5%) were urine culture positive for microbial pathogens with 126 microbial isolates while 14 (11.5%) were bacteriologically sterile. Ninety two of those positive (85.1%) each had one organism recovered, 14 (13.0%) had two organisms recovered and 2 (1.9%) had 3 organisms recovered. Klebsiella spp were the commonest pathogen isolated with 46 (36.6%), followed by Pseudomonas spp 34 (27.0%), Escherichia coli 26 (20.6%), Staphylococcus aureus 12 (9.5%), Proteus mirabilis 4 (3.2%), Candida albicans 4 (3.2%) and coagulase negative staphylococci 2 (1.6%). The in vitro antibiotic susceptibility pattern of the Gram negative organisms showed high resistance to commonly used antibiotics such as ampicillin (100%), gentamicin (90.9%), tetracycline (89.1%), cotrimoxazole (87.3%), cefuroxime (81.1%), nalidixic acid (87.3%), nitrofurantoin (67.3%), colistin (63.7%), perfloxacin (65.5%) and ciprofloxacin (56.4%). Staphylococcus aureus isolates were also resistant to penicillin (100%), gentamicin (100%), cotrimoxazole (100%), chloramphenicol (100%), cloxacillin (83.3%), tetracycline (83.3%), erythromycin (66.7%) and cefuroxime (66.7%). Only perfloxacin (66.7% sensitivity) and ciprofloxacin (83.3% sensitivity) appear effective. We conclude that catheter-associated UTI in our institution is caused by multi-resistant microbial pathogens which has occurred consequent on prophylactic antibiotic therapy administered after catheterization. Emphasis should be placed on good catheter management rather than the use of prophylaxis, to reduce the incidence of catheter associated UTI

Short Communication: Laboratory survey of extended spectrum beta-lactamase producing enterobacteriaceae in clinical infections among hospitalised patients at LAUTECH Teaching Hospital, Ogbomoso, Nigeria

Background: The extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae are a major public health threat globally, causing both community and healthcare associated infections (HAIs). Due to multi-resistant nature of these strains, infections caused by them are associated with treatment failure, high mortality, and increased healthcare costs. This laboratory survey determined the prevalence of infections caused by ESBLproducing enterobacteriaceae in LAUTECH Teaching Hospital, Ogbomoso Methodology: Over three years (January 2016 to December 2018), non-duplicate clinical samples (sputum, blood, urine, and wound swabs) collected from hospitalised patients with suspected clinical infections were routinely processed at microbiology laboratory of our hospital for aerobic culture and isolation of enterobacteriaceae. Antibiotic susceptibility of each isolate to routinely used antibiotics was determined by the disk diffusion method and ‘double disk’ synergy test was used to routinely confirm ESBL production. Demographic and clinical data were extracted from the requisition form.Results: Of the total 4,198 hospitalised patients over the three year period, 1,222 (29.1%) had clinical infections, out of which 689 (16.4%) were laboratory confirmed. Enterobacteriaceae were isolated from 343 patients (prevalence rate, 8.2%) while ESBL producers were isolated from 46 (prevalence rate, 1.1%). The most frequent enterobacteriaceae were Klebsiella spp (54.5%) and Escherichia coli (35.9%) recovered mainly from urinary tract infection (UTI, 45.2%), skin and soft tissue infection (SSTI, 27.9%) and lower respiratory tract infection (LRTI, 17.5%) but ESBL producers were frequently associated with osteomyelitis (50%), LRTI (18.3%) and SSTI (14.6%). The ESBL producers were all resistant to ampicillin, cefotaxime, ceftazidime, cefepime, gentamicin, and ciprofloxacin but susceptible to imipenem. The non-ESBL producers were comparatively less resistant with 43.8%, 34.3%, 29%, 35%, 43%, 37%, and 4% resistant to ampicillin, cefotaxime, ceftazidime, cefepime, gentamicin, ciprofloxacin and imipenem respectively.Conclusion: The prevalence of clinical infections among hospitalised patients in our facility is high but the rate of ESBL-producing enterobacteriaceae is relatively low. In spite of this, there is need for continuous surveillance of ESBL and other antibiotic resistant pathogens as part of the infection prevention and control (IPC) programme, with implementation of measures that will reduce the incidence of these infections in our hospital.Keywords: Laboratory survey; hospitalised patients; ESBL; multidrug resistanc