The Prevalence and Risk Factors Associated with Nasal Methicillin- Resistant Staphylococcus Aureus Colonization among Children in a Tertiary Hospital in Nigeria

BACKGROUND: Nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization is of public health concern due to increased risk of developing invasive infections and the therapeutic challenges. This concern is more among the vulnerable group. We determined the prevalence and associated risk factors of MRSA nasal carriage among children in a tertiary hospital in Nigeria.METHOD: We conducted a hospital-based, cross-sectional study among 300 children attending the outpatient clinic of a tertiary hospital recruited through systematic sampling technique. An interviewer-administered, structured questionnaire was used to obtain sociodemographic characteristics and exposure factors. Nasal swabs samples were collected and inoculated on mannitol salt agar and subcultured on nutrient agar to isolate Staphylococcus aureus. We used the conventional Polymerase Chain Reaction (PCR) technique to detect the presence of mecA gene for MRSA. We calculated the prevalence, prevalence odds ratio to determine risk factors for MRSA acquisition at 5% level of significance.RESULTS: The median age was 1.7 years (6 months-16 years). Males accounted for 60.7%, and 75% of the participants were under 5 years. Staphylococcus aureus colonization was found in 36.3% of the participants while 5.3% of the participants had MRSA identified by detecting the mecA gene. History of recent surgery in the last six months was the only independent predictor of nasal MRSA colonization among the participants (aOR=12.5; 95%CI: 2.7-50.0.)CONCLUSION: The high prevalence of MRSA colonization observed among the children in this study suggests the need to consider screening children with history of previous surgery as infection control and prevention intervention for MRSA

COVID-19 pandemic waves: how prepared is West Africa for managing a high COVID-19 caseload? Urgent actions needed

The ECOWAS Region and the world have learnt a lot in the last year and a half concerning the pandemic. As the pandemic continues to evolve, the region needs to put together all these lessons in other to better protect its people, rebuild its economy and strengthen the regional health security for better regional prosperity. We reviewed the response mounted by the region from January 2020 to July 2021 and the existing body of knowledge. We recommend that the region quickly increase the COVID-19 immunization coverage, sustain the enhance genomic surveillance, improve testing and the strengthen point of entry surveillance

Pattern and determinants of self-medication among pregnant women attending antenatal clinics in primary health care facilities in Ogbomoso, Oyo State, Nigeria

Introduction: Self medication in pregnancy has continued to be on the front burner of the global public health discourse due to the increased incidence of abortion, foetal malformation and antimicrobial resistance that were found to be associated with it. Inspite of this burden, in Nigeria, most studies on self-medication were conducted on the general population with only a few carried out among pregnant women. Therefore, this study was carried out to determine the prevalence and factors associated with self-medication among pregnant women in Oyo State. Methods: The study was a hospital-based cross-sectional survey. A multi-stage sampling technique was used to select 347 pregnant women who attended antenatal clinics at 56 primary health care facilities in Ogbomoso. A semi-structured, interviewer-administered questionnaire was used to obtain information on the practice of self-medication. Data were analyzed using SPSS version 25; bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of self-medication in pregnancy. The level of statistical significance was set at p < 0.05. Results: The mean age of the respondents was 27.0 ± 6 years. The majority (76.6%) of the respondents had poor knowledge of self-medication. About half of the respondents self-medicated with the analgesics (83.1%), antibiotics (66.7%) and antimalarial drugs (28.9%). Nausea and vomiting (90.4%), diarrhoea (67.8%), back pain (62.1%) and fever (28.8%) were the common medical problems. The main reasons for self-medication were previous experience with the drugs (50.9%), the suggestion by family about the drugs (45.2%) and advice from the community pharmacists (31.6%). The proportion of the respondents who used herbal concoction was 30.0% and the reasons given for the herbal use were low cost (47.6%) and perceived efficacy (42.9%). The proportion of pregnant women who gave a history of abnormality in the previously born baby (ies) was 13.0%. Cleft lip (66.7%) was the most prevalent abnormality. The determinants of self-medication were age (aOR: 0.7, 95% CI: 0.33- 0.97), education (aOR: 0.7, 95% CI: 0.49 - 0.99), confidence in other health workers' prescription (aOR: 0.4, 95% CI: 0.15 –0.88), relief from discomfort (aOR: 2.8, 95% CI: 1.46 –5.42) and suggestion by families (aOR: 3.6, 95% CI: 1.62 – 8.05). Conclusion: The prevalence of self-medication was high and was more pronounced among married, urban dwellers and those with post-basic education including the respondents aged 25 years and above. This may be explained by the higher proportion of the respondents with poor knowledge of self-medication. Health education, especially during antenatal clinics, on the dangers associated with selfmedication in pregnancy, is therefore recommended

Hygiene practices in abattoir and slaughter slab, determinants and assessment of abattoir and slaughter slab facilities in Abakaliki, Ebonyi State South-East Nigeria

Background: Workers in slaughterhouses engaging in unhygienic practices create conducive environments for zoonoses and meat contamination. Knowledge of hygiene practices and their determinants provides evidence for the design of targetedinterventions.Objectives: We investigated knowledge and determinants of hygiene practices among workers in slaughterhouses and assessed slaughterhouse facilities in Abakaliki.Methods: Workers in the Central Meat Market abattoir and Slaughter slab Abakaliki were interviewed in a cross-sectional quantitative study to ascertain their knowledge and hygiene practices while abattoir facilities were assessed using a checklist. Associations were analysed with Chi-square while predictors were determined using binary logistic model.Results: We interviewed 188 workers 75.5% and 85.6% of whom had good knowledge and good hygiene practices respectively. However, hand-washing before and after handling meat (44.1%), cleaning work surfaces with soap and water (45.2%) and sanitary disposal of waste (6.9%) were suboptimal. Knowledge of good hygiene practice was a predictor of good hygiene practice (AOR: 4.6, 95% CI: 2.0-11.3, p=0.001). Well water and borehole were present in both slaughterhouses and cold rooms were available in Central Meat market abattoir.Conclusions: The level of good knowledge was high and this was a determinant of good hygienic practices. Training on hygiene practices is recommended to prevent meat contamination and zoonoses. Keywords: Knowledge; Hygiene Practices; Abattoir; Slaughter slab; Determinants; Ebonyi; Nigeria

Knowledge and practices of foodstuff traders on Lassa fever and rodent control in Izzi Local Government Area, Ebonyi State, Nigeria

Introduction: Lassa fever (LF) could be transmitted through food contamination with excreta or body fluids of infected Mastomys natalensis. Foodstuff markets in rural areas are usually rodent infested with possibility of foodstuff contamination with Lassa virus. We assessed the knowledge and practices of foodstuff traders on LF and rodent control in rural markets. Methods: A cross-sectional study was carried out in three rural markets in Ebonyi State in 2017. We administered questionnaire on 111 respondents selected via multi-stage sampling. Knowledge of LF and rodent control practices were assessed using cut-off of 75% and their relationship with socio-demographic characteristics were explored using crude odds ratio and logistic regression. Results: Mean age of respondents was 33.6±9.2 years, majority were females 67/111 (60.4%), married 81/111 (73.0%) and had secondary education 45/111 (40.5%). Although all respondents had heard of LF, 34/111 (30.6%) knew any symptom of LF, 51/111 (46.0%) knew any route of transmission, 24/111 (21.6%) knew any practices exposing one to LF infection, and 40/111 (36.0%) knew any preventive measures against LF infection. Fifty-two percent of respondents covered their wares, 57/111 (51.4%) blocked rodent access into their shops, while 16/111 (14.4%) used chemical agents to control rats. None used traps/cats for rodent control. Overall, 32/111 (28.8%) respondents had good knowledge of LF and 15/111 (13.5%) had good practice of rodent control. Conclusion: Many foodstuff traders had poor knowledge of LF and poor practices of rodent control. These traders should be targeted for sensitization on LF and rodent control to minimize contamination of foodstuff

Preparedness and perception of graduates and trainees of Nigeria Field Epidemiology and Laboratory Training Program towards participation in COVID-19 outbreak response

Introduction: Health workforce is one of the six building blocks of a resilient health system and is key to outbreak control. We assessed preparedness and perception of graduates and trainees of Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) towards participation in COVID-19 response. Methods: A cross-sectional study was carried out among 231 respondents. Respondents were graduates and trainees of NFELTP. Electronic self-administered questionnaire was used to collect information from the respondents. We described binary variables using frequencies and percentages; and normally distributed continuous variables using means and standard deviations. Responses to open-ended questions were analyzed in themes. Results: Many respondents (68.4%) had undergone at least one training on COVID-19 surveillance (72.2%), infection prevention and control (63.9%), risk communication (38.6%) and sample collection (31.7%). Respondents had previously participated in outbreaks of 27 health-related events especially Lassa fever, poliomyelitis, measles, cholera and yellow fever. Respondents were willing to be engaged in the response (86.6%), despite its novelty, although, 33.8% expressed apprehension for being infected in the course of response to COVID-19 outbreak, while 52.8% mentioned feeling safe in participating in the response. Conclusion: NFELTP trainees and graduates should be continuously engaged in outbreak response activities to enhance capacity of Nigerian health workforce

Patterns of Antimicrobial Use in a Specialized Surgical Hospital in Southeast Nigeria: Need for a Standardized Protocol of Antimicrobial Use in the Tropics

Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost‑effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria. Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4. Results: A total of 127 inpatients  participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients. Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics. Keywords: Antimicrobial protocol in surgery, antimicrobial resistance, antimicrobial stewardship, prophylactic antibiotic

Awareness, knowledge, risk perception and uptake of maternal vaccination in rural communities of Ebonyi State, Nigeria

Introduction: Knowledge and uptake of maternal vaccination has been reported to be low in low- and middle-income countries. Objectives: To determine the knowledge, uptake and determinants of uptake of maternal vaccination among women of childbearing age. Methods: A cross sectional study was done among 607 women of childbearing age selected from rural communities in Ebonyi State using multi-staged sampling technique. A pretested, interviewer administered questionnaire was used. The proportion of maternal vaccination uptake and predictors of uptake was determined at 5% level of significant using multiple logistic regression model. Results: Most of the respondents (39.9%) were in the 15-24 years age group. Only 1.3% and 41.5% were knowledgeable and had received any form of maternal vaccines respectively. The main reasons adduced for non-receipt of the vaccine was lack of information (65.8%) and not being pregnant (23.5%). Pregnancy was the predictor for uptake of maternal vaccine among the study population. Conclusions: There was low level of knowledge and uptake of maternal vaccine among rural women and a myth that the vaccine is only given when pregnant. This calls for increase targeted enlightenment of rural women on maternal vaccine in order to improve uptake. Keywords: Maternal vaccination; rural communities; Nigeria

Descriptive epidemiology and mortality risk factors of COVID-19 outbreak in Delta State, Nigeria, March - August 2020

Introduction: The highly contagious Coronavirus Disease 2019 (COVID-19) was first confirmed in Nigeria on February 27, 2020. In Delta State, the first COVID-19 case was recorded on April 7, 2020, which spread across the state. We characterized the COVD-19 pandemic in Delta State in terms of person, place, and time, and determined the risk factors for COVID-19 mortality. Methods: We conducted a retrospective analysis of COVID-19 pandemic in Delta State between March 23 to August 17, 2020. We obtained line-lists of 5,917 COVID-19 patients, cleaned and analyzed sociodemographic, clinical characteristics and outcome variables using IBM SPSS Statistics 25. We calculated frequencies, proportions, mean and standard deviation (SD). Bivariate and multivariate logistics regression analysis were conducted to determine the risk factors of COVID-19 mortality, adjusted-odds-ratios were reported at 95% confidence interval and p-value set at 5% significance level. Results: From March-August 2020, 1,605 confirmed COVID-19 cases and 47 deaths (case-fatality-rate 2.9%) were recorded. Majority were aged 20-39 years 675 (42.1%) while 1,064 (66.3%) were males (mean age 39±15years). Persons aged ≥60years were more likely to die from COVID-19 than younger cases (aOR: 11.0; 95% CI: 4.9-24.4) while Symptomatic positive cases at time of test were more likely to die than those who were not (aOR: 3.2; 95% CI: 1.3-7.5). Conclusion: Males in the youthful age-group were mostly affected. Independent predictors of mortality were being elderly or symptomatic at time of testing. Strengthening case management to target symptomatic patients and intensifying sensitization activities targeting youthful males and elderly persons, are important to reduce mortality

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