Medical students' perceptions regarding antibiotics use and antimicrobial resistance in Ebonyi State, Nigeria

Background and Objectives: Medical students as future doctors have important roles to play in the control of antimicrobial resistance. The aim of this study was to assess the perceptions of medical students regarding antibiotics use and antimicrobial resistance in Ebonyi State, Nigeria.Methods: A cross-sectional survey was conducted among all the 184 fifth and sixth year medical students in Ebonyi State University, Nigeria using semi-structured, self-administered questionnaires. Proportions, chi square and logistic regression were estimated with Epi Info version 7.2 at 5% level of significance.Results: Respondents were mostly males (62.5%), aged 20-29 years (68.9%) with 60.9% of them in final year. Majority (85.9%) had used antibiotics in the last one year. Most (78.3%) rated themselves to have adequate knowledge on antibiotic use and resistance but only 40.2% respondents had positive perception towards antibiotic use and resistance. Similarly, only 46.7% agreed that hand washing was important in controlling antimicrobial resistance. Majority (53.3%) believed that antibiotics were safe drugs and should be used commonly while only 50.5% disagreed with use of antibiotics as first line treatment for sore throat. Desire for more education on antimicrobial resistance and use was a significant predictor of positive perception (OR 0.36, 95% CI; 0.15-0.87; P=0.024)Conclusions: There was poor perception towards antibiotic use and resistance in spite of the high rates of antibiotic consumption and self-rated knowledge on antimicrobial use. There is need for reorientation of medical students' perceptions towards antibiotic usage and the role of infection control in curbing antimicrobial resistance.Keywords: antibiotic use, antimicrobial resistance, perception, medical students, Nigeri

Prevalence and factors associated with dengue fever among febrile patients attending secondary health facilities in Kano metropolis, Nigeria

Background: The Nigeria Centre for Disease Control (NCDC) has categorized dengue fever as a priority epidemic-prone disease. Kano metropolis is a hub for international trade and has seen rapid population growth with unplanned urbanisation. This provides the right environment for dengue virus transmission and spread. Most fevers in Nigeria and Kano in particular are treated as malaria or typhoid. This study aimed to determine the prevalence and factors associated with dengue fever and dengue-malaria co-infection among febrile patients in Kano metropolis. Methodology: We conducted a hospital-based cross-sectional study among febrile patients attending secondary health facilities in Kano metropolis. We used multistage sampling technique to recruit 440 participants into the study. An interviewer administered structured questionnaire was used to collect participants’ information, while blood was screened for malaria using rapid diagnostic test (RDT) kit and tested for dengue fever using an ELISA kit for dengue IgM. Data was cleaned and analysed using Microsoft Excel 2016 and Epi Info version 7.2 to calculate frequencies, proportions and odds ratios. Results: The median age of participants was 24 years (IQR= 13-36 years) while the age-group most represented was the 10-19 years’ age group with 97 (22.9%) participants. Males constituted 257 (60.6%) while most were single 238 (56.1%). Dengue IgM was positive for 332 (78.3%), while malaria RDT was positive for 81 (19.1%) and 67 (15.8%) were positive for both. Those aged above 25 years were less likely to present with dengue fever (OR=0.6; 95% CI=0.33-0.97). Dengue fever contributes a high percentage to febrile illnesses seen in Kano metropolis. Significant proportions of febrile patients have both dengue and malaria co-infection. None of the participants had dengue as a presumptive diagnosis. Conclusion: These findings imply dengue fever should feature as a prominent differential for febrile illnesses and dengue screening tests should be made available for all cases seen in Kano. Keywords: seroprevalence; dengue fever; RDT; secondary health facilities; Nigeria French Title: Prévalence et facteurs associés à la dengue chez les patients fébriles fréquentant les établissements de santé secondaires de la métropole de Kano, au Nigéria Contexte: Le Nigeria Center for Disease Control (NCDC) a classé la dengue parmi les maladies à tendance épidémique prioritaires. La métropole de Kano est une plaque tournante du commerce international et a connu une croissance démographique rapide avec une urbanisation imprévue. Cela fournit le bon environnement pour la transmission et la propagation du virus de la dengue. La plupart des fièvres au Nigeria et à Kano en particulier sont traitées comme le paludisme ou la typhoïde. Cette étude visait à déterminer la prévalence et les facteurs associés à la dengue et à la co-infection dengue-paludisme chez les patients fébriles de la métropole de Kano. Méthodologie: Nous avons mené une étude transversale en milieu hospitalier auprès de patients fébriles fréquentant des établissements de santé secondaires de la métropole de Kano. Nous avons utilisé une technique d'échantillonnage en plusieurs étapes pour recruter 440 participants dans l'étude. Un questionnaire structuré administré par un intervieweur a été utilisé pour collecter les informations des participants, tandis que le sang a été testé pour le paludisme à l'aide d'un kit de test de diagnostic rapide (TDR) et testé pour la dengue à l'aide d'un kit ELISA pour les IgM de la dengue. Les données ont été nettoyées et analysées à l'aide de Microsoft Excel 2016 et d'Epi Info version 7.2 pour calculer les fréquences, les proportions et les rapports de cotes. Résultats: L'âge médian des participants était de 24 ans (IQR=13-36 ans) tandis que le groupe d'âge le plus représenté était le groupe d'âge 10-19 ans avec 97 (22,9%) participants. Les hommes en constituaient 257 (60,6%) tandis que la plupart étaient célibataires 238 (56,1%). Les IgM de la dengue étaient positives pour 332 (78,3%), tandis que les TDR du paludisme étaient positifs pour 81 (19,1%) et 67 (15,8%) étaient positifs pour les deux. Les personnes âgées de plus de 25 ans étaient moins susceptibles de présenter une fièvre dengue (OR=0,6; IC à 95%=0,33-0,97). La dengue contribue à un pourcentage élevé des maladies fébriles observées dans la métropole de Kano. Des proportions significatives de patients fébriles présentent une co-infection à la fois par la dengue et le paludisme. Aucun des participants n'avait de dengue comme diagnostic présumé. Conclusion: Ces résultats impliquent que la dengue devrait apparaître comme un différentiel important pour les maladies fébriles et des tests de dépistage de la dengue devraient être disponibles pour tous les cas observés à Kano. Mots-clés: séroprévalence; la fièvre de la dengue; RDT; établissements de santé secondaires; Nigeri

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

No Abstract

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.Peer reviewe

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations