Enrolment, Attrition and Graduation of the Girl Child in Public Junior Secondary Schools in South West Nigeria, 1996-2006

The study examined the enrolment, attrition and graduation of the girl child in Junior Secondary Schools in South West Nigeria from 1999 to 2006 during which five cohorts were produced. This is against the backdrop of the launching of the Universal Basic Education (UBE) Programme of the Federal Government of Nigeria in 1999, a programme that is designed not only to ensure that the child acquires basic skills in life but also to redress the gender imbalance in the Nigerian educational landscape and therefore ensure greater female participation in national development. Relevant data were collected through a Records Observation Format from 72 Junior Secondary Schools purposively selected from the urban and rural areas of the six States that constitute South West Nigeria namely Ekiti, Lagos, Ogun, Ondo, Oshun and Oyo States. Data collected were subjected to the t-test statistical analysis in consonance with the hypotheses formulated to guide the study. Results indicate no significant difference between enrolment and graduation in both urban and rural areas at 0.05 significant level indicating that the UBE programme is probably on course with respect to participation of the girl child. Among the recommendations are that brilliant but indigent female students be offered bursary and scholarship awards and that gender specific laws be enacted to protect female children from abuse and exploitation in order to ensure and assure their education

Prevalence of Hepatitis C virus and HIV among adults presenting for health screening in Lagos

Background: Hepatitis C virus is an important cause of chronic liver disease with 71 million people worldwide living with chronic HCV infection as at 2015. Nigeria has the second largest burden of HIV in Africa, with 3.2 million Nigerians living with HIV/AIDS in 2016. Most people infected with the hepatitis C virus are asymptomatic and often unaware of their infection. This study was conducted to determine the prevalence of and risk factors for HCV and HIV infections among apparently healthy individuals in Lagos.Materials and methods: This was a retrospective study in which the prevalence of hepatitis C virus antibodies and HIV was determined among apparently healthy individuals who presented for health screening at a private laboratory facility in Lagos from May 2014 to June 2016. The health records of those who met the inclusion criteria were systematically reviewed to extract demographic and clinical information including age, sex, history of blood transfusion, alcohol use, surgery and results of serological tests for antibodies to hepatitis C virus and HIV.Results: Out of 1379 apparently healthy individuals included in the study, 60.1% were male. The prevalence rate of hepatitis C virus (HCV antibody) and HIV were 0.7% and 2% respectively. Hepatitis C virus infection was not significantly associated with history of blood transfusion, alcohol use, prior surgery and age. HIV infection was significantly associated with only prior history of surgery (OR 4.72, p=0.02).Conclusion: In this study of apparently healthy Nigerians, the prevalence rates of HCV and HIV were low, no documented HCV-HIV co-infection and surgery was a risk factor for HIV infection. Screening of healthy individuals for HIV and HCV infection is very importConclusion:ant to determine those who are infected and need to access treatment

Histologic Analysis of Gynaecologic Lesions in Nigerians

Background: Gynaecological neoplasms are a cause of significant morbidity and mortality in females all over the world.Objective: To determine the pattern of gynaecological lesions seen in Me Cure Healthcare, Lagos  Nigeria.Design: A descriptive retrospective study.Setting: Histopathology section of Me Cure Healthcare Limited from August 2009 to August 2014.Subjects: Histopathological reports and paraffin sections of gynaecologic lesions/ specimens which were diagnosed by Me Cure Healthcare.Results: A total of 691 gynaecologic specimens were received. The youngest patient was 14 years, while the oldest patient was 79 years with a mean age of 40.47 years and Std of ± 10.59. Eighty three percent  of specimens were benign neoplastic lesions, while 5.9% of specimens were malignant neoplastic   lesions. Uterine leiomyomas were the most common lesions and majority of them were seen in age  groups 30-39 and 40-49 years. Simple endometrial hyperplasia without atypia accounted for most   endometrial lesions (52,3%) and were seen more in age groups 30-39 and 40-49 years. Most ovarian  lesions (45.9%) were non neoplastic cysts and seen more in age groups 20-29 and 30-39 years. The  cancers seen were those of the cervix (56.1%), endometrium (22%), ovary (14.6%), uterus (4.9%) and choriocarcinoma (2.4%) in that order. Cervical cancer was seen in 36.5% of cervical lesions and involved mainly age groups; 30-39 years, 50-59 years and 60-69 years (each of these age groups had five cases). The mean age for cases of cancer of the cervix was 50 years Std ± 13.0 and all the age groups except 10-19 years were involved.Conclusion: Benign lesions were the most common with uterine leiomyoma accounting for most of them, while cervical carcinoma was the the common gynaecological cancer. Endometrial cancer cases were noted to be on the rise

A Wee Evaluative Study of the Academic Orientation of Lagos State Junior Secondary School Teachers

This study investigated the academic orientation of Junior Secondary School teachers in Lagos, Nigeria, using 384 participants that were sampled from the States’ six Educational Districts. It focused on the quality, magnitudes and differences existing among teachers on the basis of their discipline and the Education District where they teach. Academic orientation for teachers in Arts/Religion Departments was found to be slightly higher than for all other Departments. Teachers in Educational District 5 had the highest mean, followed closely by Educational District 6. The range of scores for all the districts was 0.55, SD=0.261. In general, the classification of ratings of teachers’ academic orientation yielded a value of 5.03, which, by the rating scale of COC-B, the instrument that was used for data gathering, translate to “fair” performance. Using Multivariate analysis of Variance to test the hypothesis for the study, no statistically significant difference was observed in the academic orientation of Lagos State Junior Secondary School teacher irrespective of their discipline and the educational district where they work. It is suggested that attention be paid to the retraining of teachers, and that prospective teachers be trained before they take on the job if teachers would be expected to fulfil their roles in the transformation agenda of this nation. Keywords:  Academic orientation; conceptual orientation; subject-matter specialist

Gastrointestinal stromal tumor of the anal wall in a Nigerian

Documented reports of gastrointestinal stromal tumors (GIST) are relatively few in the sub-Saharan continent. The body of evidence points towards anal wall involvement being a rarity indeed. In this article we document a 61 year old Nigerian man who presented with bleeding per rectum and in whom the histological features (including immunohistochemistry) of the biopsied anal lesion was GIST.Key words: Gastrointestinal stromal tumors (GIST), anal wall, immunohistochemistry, Nigeri

Prevalence and risk factors of acute gastroenteritis caused by Rotavirus among children in tertiary hospitals, southeastern Nigeria

Background: Diarrhea is a worldwide problem and rotavirus is the commonest viral etiologic agent. In Nigeria, diarrhea causes more than 315,000 deaths of preschool-age children annually. In Ebonyi State, it is among the leading causes of pediatric emergency visits and one of the major causes of infant morbidity and mortality. This study was aimed at determining the prevalence and associated risk factors of acute gastroenteritis due to rotavirus infection among under-five children in Abakaliki, Ebonyi state. Methodology: This was a cross-sectional study of 275 children under 5 years of age hospitalized for acute watery diarrhea, who were consecutively recruited into the study. Stool samples were collected from each child for rotavirus antigen detection using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic information of each child and selected risk factors were collected using structured questionnaire. Data analysis was done on SPSS software version 20.0, and association of demographic characteristics and risk factors with rotavirus diarrhoea was measured using Chi-square test, odds ratio (and 95% confidence interval). Significant value was set at p < 0.05. Results: The prevalence of rotavirus diarrhea among children under 5 years of age in this study was 26.5% (73/275). Aside from educational level of the mothers, there was no significant association between any of the sociodemographic characteristics and prevalence of rotavirus diarrhoea (p>0.05). Although the prevalence of diarrhoea in the children was lower with the use of maize gruel (pap) as weaning feed (26.3%, 71/270) compared to the use of other complementary feeding such as ‘Cerelac’ and ‘NAN’ (40%, 2/5), this association did not reach a significant level(OR=0.5352, 95% CI=0.0875-0.3270, p=0.6110), probably due to the small number of children weaned using other complementary feeds. Conclusion: The relatively high prevalence of rotavirus diarrhea in children under 5 years of age in this study is an indication of the need for the parents/guardians of these children to improve child feeding hygiene

Evaluation of procalcitonin as a biomarker of bacterial sepsis in adult population in a tertiary healthcare facility in Lagos, Nigeria

Background: Prompt antibiotic treatment of sepsis improves the outcome, but dependence on clinical diagnosis for empiric therapy leads to overuse of antibiotics which in turn promotes the emergence of antibiotic resistance. Blood culture takes time and molecular diagnosis may not be available or affordable. The use of procalcitonin (PCT) as a biomarker to guide antibiotic therapy in adults is less established compared to children. This study was therefore designed to evaluate the usefulness of PCT as a biomarker to aid early commencement of antibiotics among adult patients with sepsis in a tertiary healthcare facility in Lagos, Nigeria. Methodology: Three hundred patients with clinical diagnosis of sepsis made by the managing physicians were recruited for the study. Criteria used for clinical diagnosis of sepsis include tachycardia, tachypnea, fever or hypothermia and presence of leukocytosis, bandemia or leucopenia. The patients were selected using systematic consecutive sampling methods. A sepsis work-up including quick sequential organ failure assessment (qSOFA), white blood cell count (WCC), aerobic blood culture and estimation of serum PCT levels were done for all the participants. Data were analysed using the Statistical Package for Social Sciences (SPSS) for windows version 25.0. Sensitivity, specificity, positive, and negative predictive values, accuracy and likelihood ratio of PCT against blood culture, WCC and qSOFA score were determined. Association between variables was measured using Fisher exact test (with Odds ratio and 95% confidence interval). P-value ˂0.05 was considered statistically significant. Results: There were 127 (42.3%) males and 173 (53.7%) females with the mean age of 44.9±14.5 years. Majority (96.2%, n=75/78) of the patients who were culture positive for bacterial pathogens had PCT level ≥10ng/ml, which showed statistically significant association of bacteraemia with PCT level (OR=1362.5, 95% CI=297.9-6230.5, p˂0.0001). At PCT cut-off value of 0.5ng/ml, the negative predictive value of 100% almost confirms absence of systemic bacterial infection. The high sensitivity, specificity, positive predictive value, negative predictive value,accuracy and likelihood ratio of 94.9%, 98.6%, 96.2%, 98.2%, 97.7%, and 69.9 respectively recorded at PCT level of 10ng/ml indicates that this cut-off level is strongly diagnostic of systemic bacterial infection. Conclusion: In this study, we observed that PCT levels were significantly higher in patients with positive culture (bacteraemia) and PCT was able to differentiate bacterial sepsis from non-bacterial infections. The findings of this study support the usefulness of PCT as a biomarker for early diagnosis of systemic bacterial infections in adult patients.   French title: Évaluation de la procalcitonine en tant que biomarqueur de la septicémie bactérienne chez la population adulte dans un établissement de soins de santé tertiaires à Lagos, au Nigeria Contexte: Un traitement antibiotique rapide de la septicémie améliore les résultats, mais la dépendance au diagnostic clinique pour le traitement empirique conduit à une surutilisation des antibiotiques qui à son tour favorise l'émergence de la résistance aux antibiotiques. L'hémoculture prend du temps et le diagnostic moléculaire peut ne pas être disponible ou abordable. L'utilisation de la procalcitonine (PCT) comme biomarqueur pour guider l'antibiothérapie chez l'adulte est moins établie que chez l'enfant. Cette étude a donc été conçue pour évaluer l'utilité de la PCT en tant que biomarqueur pour faciliter le début précoce des antibiotiques chez les patients adultes atteints de septicémie dans un établissement de soins de santé tertiaire à Lagos, au Nigeria. Méthodologie: Trois cents patients avec un diagnostic clinique de septicémie posé par les médecins traitants ont été recrutés pour l'étude. Les critères utilisés pour le diagnostic clinique du sepsis comprennent la tachycardie, la tachypnée, la fièvre ou l'hypothermie et la présence d'une leucocytose, d'une bandémie ou d'une leucopénie. Les patients ont été sélectionnés à l'aide de méthodes d'échantillonnage consécutifs systématiques. Un bilan de septicémie comprenant une évaluation séquentielle rapide des défaillances d'organes (qSOFA), une numération des globules blancs (WCC), une hémoculture aérobie et une estimation des taux sériques de PCT a été effectué pour tous les participants. Les données ont été analysées à l'aide du package statistique pour les sciences sociales (SPSS) pour Windows version 25.0. La sensibilité, la spécificité, les valeurs prédictives positives et négatives, la précision et le rapport de vraisemblance de la PCT par rapport à l'hémoculture, le WCC et le score qSOFA ont été déterminés. L'association entre les variables a été mesurée à l'aide du test exact de Fisher (avec rapport de cotes et intervalle de confiance à 95 %). La valeur P ˂0,05 a été considérée comme statistiquement significative. Résultats: Il y avait 127 (42,3%) hommes et 173 (53,7%) femmes avec un âge moyen de 44,9±14,5 ans. La majorité (96,2%, n=75/78) des patients dont la culture était positive pour les agents pathogènes bactériens avaient un taux de PCT ≥ 10ng/ml, ce qui a montré une association statistiquement significative de la bactériémie avec le taux de PCT (OR=1 362,5, IC à 95%=297,9-6230.5, p˂0.0001). À la valeur seuil PCT de 0,5ng/ml, la valeur prédictive négative de 100% confirme presque l'absence d'infection bactérienne systémique. La sensibilité élevée, la spécificité, la valeur prédictive positive, la valeur prédictive négative, l'exactitude et le rapport de vraisemblance de 94,9%, 98,6%, 96,2%, 98,2%, 97,7% et 69,9 respectivement enregistrés au niveau PCT de 10 ng/ml indiquent que cette réduction- hors niveau est fortement le diagnostic d'une infection bactérienne systémique. Conclusion: Dans cette étude, nous avons observé que les taux de PCT étaient significativement plus élevés chez les patients ayant une culture positive (bactériémie) et que la PCT était capable de différencier la septicémie bactérienne des infections non bactériennes. Les résultats de cette étude confirment l'utilité de la PCT en tant que biomarqueur pour le diagnostic précoce des infections bactériennes systémiques chez les patients adultes

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

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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