Prevalence of HBsAg Among Prospective Blood Donors and Pregnant Women in Kebbi State, Nigeria

This study was aimed at determining the prevalence of Hepatitis B surface antigen (HBsAg) among prospective blood donors and pregnant women in Kebbi State, Nigeria. Three hundred and sixty one (361) apparently healthy prospective blood donors were recruited and screened for HBsAg using HBsAg rapid test kit. Those that tested positive for HBsAg (16.6%) were further assessed for liver function. The prevalence by gender was 23.4% and 13.1% for male and female subjects respectively. Prevalence by the three senatorial zones of the state is in the order Kebbi South (21.8%) > Kebbi North (15.1%) > Kebbi Central (13.6%). Subjects within the age group 26-30 years had the highest HBsAg prevalence of 20.9% compared to the other age groups. Single males have higher prevalence (26.1%) of HBV infection than their married counterparts (16.7%). Local government workers had highest prevalence (29.2%) followed by self-employed (27.6%) and then state government employees (14.3%). In females, occupational exposure (healthcare worker) and polygamy are risk factors with highest prevalence of 40.0% and 23.2% respectively. The levels of serum liver enzymes and bilirubin were significantly higher (p < 0.05) in HBsAg positive subjects compared to the HBsAg negative subjects. The reverse was, however, the case for albumin. Our result suggests that Kebbi State is one of the HBsAg hyper-endemic areas in Nigeria.Keywords: Hepatitis B, Prevalence, Liver function test, Kebbi State

Lessons on small towns water and sanitation reforms in Jigawa state, Nigeria

The paper attempts to discuss the Jigawa state’s attempt at implementing its WASH (Water Supply Sanitation and Hygiene) policy on small towns which had led to not only improvement in access to water and sanitation but had empowered communities to take strategic decisions on options and tariff which ordinarily would have been impossible due to political pressure. The challenges of implementation include dealing with a large number of small towns (about 400 WCAs (Water Consumers Associations)) and strengthening the WCAs to move from the nurturing state to self reliance. Donor agencies have played proactive roles in supporting the small town reforms. One lesson is that for access in water and sanitation to be improved, policies need to focus more on small towns but these communities will need to be nurtured to address cost recovery and supported through structures at state level like STOWA (Small Towns Water Supply and Sanitation Agency) in Jigawa state and at Local Government levels like the proposed Local Government WASH departments.. The next step of whether the WCAs can delegate responsibility of water supply operation to local private operators, remains to be seen

Assessing the impacts of various street-level characteristics on the burden of urban burglary in Kaduna, Nigeria

Evidence suggests that crimes committed in urban environments are geographically concentrated across a range of scales, and that the variation in rates of crime within an urban space is significantly dependent on the physical environment as well as the situation in which the crime takes place. However, these assertions are typically drawn from environmental criminological studies that have focussed on Euro-American cities and western intellectual perspectives. We seek to move beyond these by focussing on a second-tier city in sub-Saharan Africa (Kaduna, Nigeria), a context for which very little literature exists. This paper therefore examines the association between a range of street characteristics and the risk of residential burglary in Kaduna for the first time. It describes a methodology for conducting a household crime victimisation survey in Nigeria, and then aggregating the information to a street-level to perform a population-based ecological study. It integrates street network analysis and statistical modelling techniques in order to provide novel estimates for factors that may increase the risk of burglary such as street accessibility metrics (e.g. connectivity, betweenness and closeness centrality), segment length, socioeconomic status and business activities. Finally, the article provides a discussion on the plausibility and implication of findings within the sub-Saharan African context

Knowledge and acceptability of prenatal diagnosis among pregnant women attending antenatal clinic in a tertiary health institution in Sokoto, Nigeria

Background: Technology and advances in research have made it possible for the fetus to become a patient whose illness can be investigated, diagnosed and treated in utero. The study was aimed at assessing the knowledge and acceptability of prenatal diagnosis among pregnant women.Methods: This was a cross-sectional study carried out between December 2016 and March, 2017. Pregnant women attending antennal care clinic at the Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH) were recruited via convenient sampling method using semi-structured interviewer questionnaire.Results: A total of 417 pregnant women were interviewed. The mean maternal age was 28.35±5 years with a range between 17 to 45 years. Up to 188 (69.10%) had at least secondary school level of education. There was an overall poor knowledge of prenatal diagnosis, as 406 (97.36%) had little to no idea. There was statistically significant association between knowledge and educational status at p value- 0.0001. Majority, 353 (87.8%) will accept prenatal diagnosis if offered. There was also statistically significant association between educational status and acceptability as well as knowledge of prenatal diagnosis at p value- 0.001 and 0.001 respectively. The noninvasive method, ultrasound was the most preferred by the majority, 332 (84.3%). Termination of pregnancy as an option of management in fetal abnormality was acceptable by up to 2/3 (63.1%) of the respondents.Conclusions: The knowledge of prenatal diagnosis among the respondents was generally poor. The identifiable factor that determined knowledge and acceptability of prenatal diagnosis was level of education

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries