Roll out of a successful antimicrobial stewardship programme in Lagos University Teaching Hospital Nigeria using the Global-Point Prevalence Survey

Background: Antimicrobial resistance (AMR) has become a public health emergency with increasing rates and spread globally. Antimicrobial stewardship (AMS) has been advocated to reduce the burden of antimicrobial resistance, promote rational and appropriate use of antibiotics and improve clinical outcomes. Education and training are one of the AMS interventions to improve antimicrobial use. We present the roll out of a successful AMS programme with education and training using the Global-PPS as data collection tool to measure AMS interventions and impact.Methodology: This was a cross sectional study on the implementation of an AMS programme at the Lagos University Teaching Hospital. Global PPS was conducted in 2015 to collect baseline data which was used to identify targets for quality improvement in AMS and was repeated in 2017 and 2018 to measure impact of AMS interventions. AMS interventions included education, feedback of Global-PPS result and writing of the hospitalwide antibiotic policy based on the baseline data.Results: Out of the 746 inpatients surveyed, 476 (68.3%) had received at least one antimicrobial on the days of Global-PPS. The antimicrobial prescribing rates reduced significantly over the three time periods. In 2015, 82.5% were placed on antimicrobials, 65.5% in 2017 and 51.1% in 2018 (p<0.00001). The documentation of indication for treatment significantly improved from 53.4% in 2015 to 97.2% in 2018 (p<0.0001). Stop review date also significantly improved from 28.7% to 70.2% in 2018 (p<0.00001). Surgical prophylaxis for more than 24 hours reduced significantly from 93.3% in 2015 to 65.7% in 2018 (p=0.002) even though the prevalence was still high. The three most commonly administered antimicrobial groups were third generation cephalosporins, imidazole derivatives and quinolones. The most commonly prescribed antibiotics for surgical prophylaxis were ceftriaxone and metronidazole in 2015 and ceftriaxone in 2017.Conclusion: The use of education and training as AMS intervention in a limited resource setting clearly made impact on antimicrobial prescribing patterns in the hospital. Global-PPS is useful to set quality improvement targets and for monitoring, evaluation and surveillance of an AMS programme. Keywords: Antibiotic, Stewardship, Resistance, Education, Global-PP

Dental Caries Status of HIV Infected Children in Nigeria

Background: HIV positive children may be prone to developing Dental Caries due to prolonged and frequent use of sucrose containing medications and poor feeding practices. Objetive: To determine the caries status of primary and permanent dentition in HIV positive Nigerian children using dmft/DMFT indices. Methods: One hundred and twelve HIV positive children aged 4 months to 13 years attending two dedicated HIV outpatient clinics were examined for dental caries of primary and permanent dentition using the WHO criteria. Carious lesions were recorded using the dmft and DMFT indices in the primary and permanent dentition respectively. Results: Forty four [39.3%] of the 112 children examined had dental caries. mainly in the primary dentition in 96.7% of the cases. Mean dmft was 1.15±1.88, mean DMFT was 0.17±0.57. Dental caries was not significantly associated with the immune status of HIV positive children; x2= 2.58, P=0.275.Conclusions: Dental caries experience in the primary dentition of these HIV positive children was greater than in the Nigerian paediatric population. Dental caries prevalence in these HIV positive children although lower than that seen in developed countries was however higher than in other reports of healthy Nigerian children. There was no significant association between dental caries and immune status of HIV positive children.Keywords: Dental caries, HIV, Nigerian Childre

Clinical and haematological features of newborns of mothers with hypertensive disorders in pregnancy in Lagos, Nigeria

Background: Newborns of mothers with hypertensive disorders in pregnancy have an increased risk of preterm delivery, low birth weight, perinatalasphyxia and haematological derangements such as polycythaemia, thrombocytopenia and neutropenia. These morbidities are associated with  uteroplacental insufficiency. The haematological derangements however have not been studied in detail in African neonates. Objective: To determine the clinical and haematological features of newborns of hypertensive mothers Methods: Cross-sectional study involving 250 newborns; 125 newborns each of hypertensive mothers (cases), and normotensive mothers (controls). The babies were examined following delivery, their clinical data were recorded, and umbilical cord blood samples were analysed for haematological indices. Results: Preterm deliveries were significantly higher amongst infants of hypertensive mothers (31.2%)compared with controls (12.0%);p = 0.000.  Similarly, the birth weight, length and head circumference of the cases were significantly lower than the controls; p = 0.008, 0.003 and 0.004 respectively. Low fifth minute APGAR scores occurred more frequently in cases (8.0%) than controls (0.8%), p=0.010; whilst the mean haematocrit  was also significantly higher in cases than the controls, p = 0.013. The median absolute neutrophil count and platelet count were significantly lower in cases than controls; p=0.023 and 0.047 respectively. Thrombocytopenia was identified in 40.0% of the cases compared to 27.2% of the controls, p =  0.041 Conclusion: The present study has shown that newborns of hypertensive mothers have an increased risk of neonatal morbidities such as preterm birth, LBW and thrombocytopenia compared to the newborns of mothers with normal blood pressure in pregnancy, hence close attention needs to be paid to them with emphasis on their haematological system. Key words: newborn, pregnancy, hypertension, hypertensive disorders, haematological, clinical&nbsp

Experience With Hydroxy Carbamide Use; Indications, Adverse Effects And Clinical Course At A Tertiary Care Hospital In Lagos

Introduction: Sickle cell disease is the most common inherited haemoglobin disorder with the highest prevalence in Sub-saharan Africa. The clinical course of the disease has improved with newborn screening, penicillin prophylaxis and hydroxycarbamide use amongst other interventions. Despite the data on the benefit of hydroxycarbamide use, the uptake of hydroxycarbamide in poor resource  settings is still very low. Materials and Methods: This was a retrospective study at the Lagos University Teaching Hospital from January to December 2017 among children with sickle cell anemia on hydroxycarbamide. Ethical Approval was obtained from the Health, Research and Ethicscommittee of the Hospital. Statistical analysis was with SPSS version 20. Results: Atotal of 1039 children were seen in the period under review with 13.5% of them on hydroxycarbamide. The commonest  indication for hydroxycarbamide was high risk for stroke while lumbar infarction was the least common indication. Adverse effects were seen in 2.1% of the recipients and all these patients had derangements of liver function. None of the recipients had hematologic adverse effects. Conclusion: The use of hydroxycarbamide is relatively safe among children living in resource constrained settings but long term follow-up among a larger cohort is desired. Key words: Hydroxycarbamide, indications, sickle cell diseas