Occurrence of high level methicillin resistance Staphylococcus aureus in patients from health facilities in Akwa Ibom State, Nigeria

Background:Methicillin resistant S. aureus(MRSA) has become a major public health predicament worldwide. This is owing to its involvement in the evolution of MDR strains and difficulty in therapeutic management of infected patients. This study was conducted to investigate the prevalence of methicillin resistance Staphylococcus aureusamong patients in two health facilities in Akwa Ibom State, Nigeria.Materials and Methods:Clinical isolates of patients from University of Uyo Teaching Hospital (UUTH), Uyo and General Hospital, Ikot Abasi (GHIA) were investigated based on the strategic location of the hospitals. The study design was a descriptive cross-sectional study. Three hundred clinical samples were collected from male and female in and out-patients of all ages and processed using standard bacteriological methods. Detection of Staphylococcus aureusand MRSAstrains were done according to standard protocols while antibiotic susceptibility testing of MRSAisolates was conducted using Kirby-Bauer disc diffusion method and interpreted following the CLSI 2021 guidelines. Results:The prevalence of MRSAstrains in this study was 42.9%. Majority of patients with MRSAwere from UUTH (44%) closely followed by patients from GHIA(40%). High antibiotics resistant rates of MRSAwere recorded for ampicillin (96.6%), ciprofloxacin (73.3%), erythromycin (63.3%) and cotrimoxazole (60%). Gentamicin and ceftriaxone sensitivity rates were 53.3% and 63.4%, respectively. Conclusion:Health facilities in the state should institute effective antimicrobial stewardship, intensify surveillance and screening of Staphylococcus aureusfor MRSAstrains to guard against dissemination of multidrug resistant strains in both hospital and community settings because of the clinical implications

Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique / Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique. Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et de dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie. Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post traumatique. Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

ntroduction: Post-traumatic stress disorder following a road accident has both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of this disorder, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya

Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Occurrence of high level methicillin resistance Staphylococcus aureusin patients from health facilities in Akwa Ibom State, Nigeria

Background:Methicillin resistant S. aureus(MRSA) has become a major public health predicament worldwide. This is owing to its involvement in the evolution of MDR strains and difficulty in therapeutic management of infected patients. This study was conducted to investigate the prevalence of methicillin resistance Staphylococcus aureusamong patients in two health facilities in Akwa Ibom State, Nigeria.Materials and Methods:Clinical isolates of patients from University of Uyo Teaching Hospital (UUTH), Uyo and General Hospital, Ikot Abasi (GHIA) were investigated based on the strategic location of the hospitals. The study design was a descriptive cross-sectional study. Three hundred clinical samples were collected from male and female in and out-patients of all ages and processed using standard bacteriological methods. Detection of Staphylococcus aureusand MRSAstrains were done according to standard protocols while antibiotic susceptibility testing of MRSAisolates was conducted using Kirby-Bauer disc diffusion method and interpreted following the CLSI 2021 guidelines. Results:The prevalence of MRSAstrains in this study was 42.9%. Majority of patients with MRSAwere from UUTH (44%) closely followed by patients from GHIA(40%). High antibiotics resistant rates of MRSAwere recorded for ampicillin (96.6%), ciprofloxacin (73.3%), erythromycin (63.3%) and cotrimoxazole (60%). Gentamicin and ceftriaxone sensitivity rates were 53.3% and 63.4%, respectively. Conclusion:Health facilities in the state should institute effective antimicrobial stewardship, intensify surveillance and screening of Staphylococcus aureusfor MRSAstrains to guard against dissemination of multidrug resistant strains in both hospital and community settings because of the clinical implications.

Sepsis et choc septique en réanimation à Brazzaville (Congo) / Sepsis and septic shock in polyvalent intensive care at Brazzaville (Congo)

Objectifs. Décrire les aspects cliniques, bactériologiques et évolutifs du sepsis et du choc septique dans le service de réanimation polyvalente du CHUB. Patients et méthodes. Il s'agit d'une étude transversale, monocentrique et descriptive, durant 12 mois, incluant les patients âgés d'au moins 18 ans admis en réanimation polyvalente pour un sepsis ou choc septique. Les variables épidémiologiques, cliniques, bactériologiques et évolutives ont été analysées avec Excel 2019. Résultats. 56 patients ont été retenus (20,7%). Leur âge moyen était de 43,1 ± 17,9 ans (extrêmes de 18 et 84 ans), avec 66,1% des hommes. Le foyer infectieux initial était péritonéal (64,3 %). À l'admission, le nombre médian de défaillances d'organes par patient était de trois (maximum 5). Les défaillances rénale (71,4%), hépatique (69,6%) et hémodynamique (62,5%) étaient les plus représentées. Le taux de réalisation du bilan bactériologique était de 35,7% : hémoculture (10,7%), uroculture (14,3%), porte d'entrée infectieuse (7,1%). La durée d'hospitalisation des patients sortis vivants était de 8,1 ± 6,3 jours (extrêmes de 2 et 31 jours). Le taux de mortalité était de 57,1%. Les décès survenaient au-delà de 24 h d'hospitalisation (75%), chez des patients avec comorbidités (65,6%), porte d'entrée péritonéale (59,4%), et défaillances hémodynamique (81,2%) et rénale (75%). Conclusion. Les prévalences du sepsis et du choc septique dans notre série sont superposables à celles de la littérature. Le taux de réalisation des bilans bactériologiques reste faible. La mortalité du sepsis demeure très élevée.

Introduction. No accurate data on sepsis and septic shock in intensive care unit (ICU) in the Republic of Congo are available. The aim of the study was to describe the course of patients with sepsis and/or septic shock in the polyvalent ICU of the University Teaching Hospital of Brazzaville. Patients and methods. This was a cross-sectional, monocentric and descriptive study, lasting 12 months, including patients aged at least 18 years admitted to ICU for sepsis or septic shock. The clinical presentation, the bacteriological findings and the outcome were analyzed with Excel 2019. Results. 56 patients were selected (20.7%). The average age was 43.1 ± 17.9 years (extremes 18 and 84 years), with 66.1% of men. The initial infection was peritoneal (64.3%). At admission, the median number of organ failures per patient was three (maximum 5). Renal (71.4%), hepatic (69.6%) and hemodynamic (62.5%) failures were the most common. Bacteriological assessment rate was 35.7%: blood culture (10.7%), urine culture (14.3%). The duration of hospitalization of alive patients was 8.1 ± 6.3 days (extremes 2 and 31 days). The mortality rate was 57.1%. Deaths occurred beyond 24 hours of hospitalization (75%), in patients with comorbidities (65.6%), peritonitis (59.4%), hemodynamic (81.2%) and renal (75%) failures. Conclusion. The prevalence of sepsis and septic shock in our study is comparable to other published series. The bacteriological assessments rate is still low. The mortality is very high.

Exploring a community's understanding of HIV vaccine-induced seropositivity in a South African research setting

Background. The high HIV prevalence and incidence in South Africa makes it suitable for recruitment of participants for large-scale HIV preventive vaccine trials. However, fear of vaccine-induced seropositivity (VISP) may be a barrier for community acceptability of the trial, for volunteers to participate in HIV preventive vaccine trials and for uptake of an efficacious vaccine. Prior to 2015, when the first phase 1 safety HIV vaccine trial was undertaken at Setshaba Research Centre, Soshanguve, the local community stakeholders and healthcare workers were naive about HIV vaccine research and HIV preventive vaccines. Objective. To explore knowledge and perceptions regarding VISP among community stakeholders and healthcare workers in peri-urban Soshanguve, Tshwane.Methods. Using a quantitative-qualitative mixed-methods study design, surveys (n=50) and in-depth interviews (n=18) were conducted during July - August 2015. Participants included community stakeholders, community advisory board members and healthcare workers, who were >18 years old and had attended community educational workshops during September 2014 - May 2015. Audio recordings of interviews were transcribed verbatim and coded using content thematic analysis. Data were further analysed by sex, age and educational level.Results. Of a maximum score of 2 on knowledge on VISP, the 50 survey participants (mean age 33.78 years; 45 females) obtained an average of 0.88 (44%). Of 17 in-depth interviewees (one interview could not be transcribed; mean age 30.9 years; 12 females), 8 (47%) displayed some knowledge about VISP, of whom only 5 defined VISP correctly. Women were more knowledgeable about VISP than men; 5 of 12 women (42%) came close to defining VISP correctly, while none of the 5 men did so. The main fear of trial participation expressed by most participants (n=6) was testing HIV-positive as a result of the vaccine. While some participants believed that the community's perceptions of VISP would negatively affect HIV vaccine trial support and recruitment efforts, others noted that if trial participants understand the concept of VISP and are part of support groups, then they would have the information to combat negative attitudes within their community. Conclusion. Most participants had an inaccurate and incomplete understanding of VISP. Many feared testing HIV-positive at clinics; therefore, education on improving a basic understanding of how vaccines work and why VISP occurs is essential. In addition, assessing participant understanding of HIV testing, transmission and VISP is critical for recruitment of participants into HIV vaccine trials and may improve acceptability of an HIV preventive vaccine

Evaluate the incidence, topography, management, and outcomes in patients with polytrauma in the Suez Canal and Sinai areas

Introduction: The global prevalence of trauma-related mortality ranges from 2% to 32%; however, In Egypt, it reaches 8%. Trauma chiefly affects people in the productive age group; seriously ill patients with multiple injuries present with various levels of polytrauma. Application of incorrect triage systems and improperly trained trauma teams increase mortality and morbidity rates in non-dedicated institutions; however, these rates can decrease with appropriate infrastructure. This study aimed to improve the quality of care for patients with polytrauma through improved knowledge of the different severity levels of polytrauma and defined databases, using a suitable triage trauma system, well-trained trauma team, and appropriate infrastructure. Methods: This observational cross-sectional study was conducted at the emergency department (ED), over a study period of 7 months, from August 10, 2019, to March 09, 2020. This study included 458 patients with polytrauma who had met the inclusion and exclusion criteria and attended the ED of Suez Canal University Hospital. Results: The incidence of trauma among all emergency cases in the ED was 5.3%. However, most multiple injuries are mild, accounting for 44.4%, while 27.3% of the cases had life-threatening injuries. Moreover, 41.9% of the patients were managed non-operatively, whereas 58.1% of the patients required surgical interventions. Concerning the outcome, 56% and 6.9% of patients with and without life-threatening injuries respectively, died. Conclusion: Facilities of the highest quality should be available for patients with polytrauma, especially those with life-threatening injuries. In addition, training emergency medical service staff for trauma triage is essential, and at least one tertiary hospital is required in every major city in the Suez Canal and Sinai areas to decrease trauma-related mortality.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

Background: Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives: To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results: Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion: The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Association of intestinal helminthic infection and nutritional status of primary school children in Gombe State, Nigeria

Background: Intestinal helminthic infections are among the commonest infections worldwide. It often affects the poorest communities and has similar geographic distribution with malnutrition. Intestinal helminthic infection contributes to undernutrition through subtle reduction in digestion and absorption of food, chronic inflammation and loss of nutrients. The objective of this study is to determine the prevalence of intestinal helminthic infection and its relationship with nutritional status of primary school children in Gombe, Gombe State, Nigeria. Methodology: This was a cross sectional study of 350 pupils selected through multistage random sampling technique from 24 primary schools in Gombe, Gombe State, Nigeria from July 2018 to January 2019. Demographic information including age, gender, height, and weight were collected from each participant with a designed collection form. The data were analysed using SPSS version 24.0, and presented as frequency distribution and mean ± SD. The Chisquare test (with Odds ratio and 95% confidence interval) was used to test for association between prevalence of helminthiasis and factors such as gender, age group and school type. A p value of less than 0.05 was considered statistically significant at 95% confidence interval. Results: The prevalence of intestinal helminthic infection was 23.7% (83/350). Eighty (96.4%) of the 83 infected pupils were in public schools while only 3 (3.6%) were in private schools (p<0.001). The prevalence of helminthiasis was significantly higher in underweight pupils (34%, OR=2.113, p=0.0065)) and significantly lower (5.4%, OR=0.1637, p=0.0037) in overweight pupils while the prevalence was not significantly associated with normal weight (p=0.5482) or obesity (p=1.000). Conclusions: Intestinal helminthic infection is a public health problem in children with adverse significant relationship with nutritional status. Provision of toilet facilities in schools and periodic de-worming of pupils aimed at reducing loss of nutrients from intestinal helminthiasis are recommended.

Dental caries risk assessment in primary school children aged 11 to 12 years: Case of Nyarugenge District, Rwanda

Background Dental caries in children is a public health concern affecting 60-90% of children worldwide. Dental caries perturbs children's eating ability, school performance as well as overall quality of life. This study aimed to determine the prevalence of dental caries and its risk factors among children aged 11 to 12 years in Nyarugenge District in Kigali, Rwanda. Methods The cross-sectional analytical study design involved 400 children from Nyarugenge district. By stratified sampling, we selected Gitega and Butamwa primary schools and used systematic sampling to choose the pupils into the sample. An interview and oral examination were performed. Descriptive statistics and logistic regression were done. Results Dental caries was observed in 25.5% of children. Deep pits and fissures carried a two-fold risk of getting dental caries than children without deep pits and fissures (OR = 2.4, 95% CI = [1.5; 4.0], P-value < 0.001). Dental plaque was identified as a risk factor for getting dental caries (OR=2.2, 95% CI = [1.2; 3.3], P-value: 0.01). Conclusion Dental caries is a public health concern associated with poor oral hygiene, deep pit, and fissures among children aged 11 to 12 years old. Oral hygiene education, application of ART, and regular screening programs are in need.

Prevalence of non-communicable diseases among HIV positive patients on antiretroviral therapy at a tertiary health facility in Makurdi, north-central, Nigeria

Human immunodeficiency virus (HIV) treatment program has grown exponentially in Nigeria largely due to improved Antiretroviral therapy (ART) regimen which has changed the course of HIV/AIDs by enabling patients to live longer, raising concern of the co-existence of HIV with other chronic illnesses, notably non communicable diseases (NCDs). This study determined the prevalence of hypertension and diabetes mellitus among HIV positive patients in a tertiary institution in Makurdi, North-central Nigeria.Methods: A cross-sectional study was conducted at the ART clinic among clients ≥ aged 21 years old living with HIV /or enrolled between October 2022, and March 30, 2023. The clients' information was extracted from the register using a Proforma and all the clients who had attended their follow up clinic visit within the study period were included in the study. Data was analyzed using SPSS version 21.0. Categorical data were presented as frequencies and percentages. Results: Among the 491 patients, 404 (82.3%) had HIV only and 87 (17.7%) had HIV and at least one comorbidity, namely DM and/or HTN. Hypertension was the most prevalent comorbidity affecting 15.5% of the patients while 1.0% of them were diabetic. The middle aged (30-49) patients, females (63.2%) had the highest prevalence of comorbidities and some of those with normal weight (35.6%) also had the highest prevalence of NCDs.Conclusion: Non-communicable diseases are common among people living with HIV. There is need to encourage early diagnosis and treatment of non-communicable diseases in HIV positive patients in Nigeria.

Sex-related differential prevalence of central obesity in diabetes mellitus: a multi-centred survey in North-Central Nigeria

Contrary to the old dictum that central obesity is more common among men than women, recent reports have shown a gradual reversal of this trend, as suggested by some studies. Objective: To compare the prevalence of central obesity among men and women with Diabetes mellitus in NorthCentral Nigeria. Methods: This multi-centred, cross-sectional study was conducted across 20 hospitals in Abuja, Nasarawa State, and Niger State, involving 1040 participants. Some obesity indices (body mass index, waist circumference and waist-toheight ratio) were measured. Results: The prevalence of central obesity (waist circumference criterion) was significantly higher in the females compared to male participants (89.6% vs 51.6%, χ2 = 1231.37, p<0.001), similar to the prevalence determined by waistheight ratio criterion (female vs male, 88.8% vs 71.5%, χ2 = 58.83, p<0.001). Following correction for age, duration of diabetes mellitus, blood pressure, blood glucose, and glycated haemoglobin using logistic regression, female gender remained a significant determinant of central obesity (OR = 2.76, 95% CI 1.81-3.83, p = 0.004). Conclusion: The prevalence of central obesity was higher among women than men in a cross-section of patients with diabetes mellitus in North-Central Nigeria

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde, Cameroon

Background. The COVID-19 pandemic has added an additional burden in countries with already fragile health systems. Our objective was to determine the prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde. Methods. A descriptive cross-sectional study was conducted at the Jordan Medical Services for 8 weeks from April 19 to June 13, 2021, i.e., during the second wave in Cameroon. For the 86 patients with suspected malaria, nasopharyngeal and blood samples were taken for SARS-CoV-2 antigen and anti-SARS-CoV-2 IgG and IgM using the STANDARD TM Q COVID-19 Ag kit from SD BIOSENSOR, Korea, 2020 and Standard TM Q COVID 19 Ac IgG/IgM kit from SD BIOSENSOR, Korea, 2020 respectively. Confirmation of malaria was done by microscopic examination of stained blood smears. Results. Malaria was confirmed in 20.9% (18) of cases. The prevalences of COVID-19 and COVID-19/malaria co-infection were 8.1% and 0.9% respectively. Of the 25.6% (54) of patients with anti-COVID-19 IgM, no positive microscopic cases were found. On the other hand, a little more than half of the patients had IgG antibodies against COVID-19 whether they had a positive thick drop or not (56.0% (42/75) and 52.2% (71/136) respectively). Conclusion. In case of suspicion of malaria in a malaria area, it seems important to consider COVID-19 as a differential diagnosis.

Introduction. La pandémie de la COVID-19 a ajouté un fardeau supplémentaire dans les pays aux systèmes de santé déjà fragiles. Objectif : déterminer la prévalence et la séroprévalence de la COVID-19 en cas de suspicion du paludisme au cours de la deuxième vagueà Yaoundé. Méthodologie. Une étude transversale descriptive a été menée au Centre Médical le Jourdain pendant 8 semaines du 19 Avril au 13 Juin 2021 soit durant la deuxième vague au Cameroun. Pour les 86 patients avec suspicion de paludisme, des prélèvements nasopharyngé et sanguins ont été réalisés pour la recherche d'antigène du SRAS- CoV 2 et des IgG et IgM anti-SARS-CoV-2 grâce aux kits STANDARDTM Q COVID-19 Ag de SD BIOSENSOR, Corée, 2020 et StandardTM Q COVID 19 Ac IgG/IgM de SD BIOSENSOR, Corée, 2020 respectivement. La confirmation du paludisme a été faite grâce à l'examen microscopique des étalements de sang colorés. Résultats. Le paludisme était confirmé dans 20,9% (18) des cas. Les prévalences de la COVID-19 et de la coïnfection COVID19/Paludisme étaient de 8,1% et de 0,9% respectivement. Sur les 25,6% (54) des patients avec des IgM anti-COVID-19, aucun cas de microscopie positive n'a été retrouvé. Par ailleurs un peu plus de la moitié des patients avaient des anticorps IgG anti-COVID-19 qu'ils aient une goutte épaisse positive ou pas soit 56,0% (42/75) et 52,2% (71/136) respectivement. Conclusion. En cas de suspicion du paludisme en zone impaludée, il parait non négligeable de considérer la COVID-19 comme un diagnostic différentiel.

Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia

Background. Healthcare workers (HCWs) can play a significant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke. Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia. Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated. Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) system-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC. Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the delivery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.

Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Molecular and serological pattern of Toxoplasma gondii among rural population in four regions of Gabon

Toxoplasma gondii is an obligatory intracellular parasite that causes a zoonotic disease capable of infecting nearly all warm-blooded hosts, including humans. However, reports on the molecular prevalence of T. gondii in humans are rare in Gabon. The present study aimed to evaluate the serological and molecular prevalence of T. gondii among apparently healthy rural populations in four regions of Gabon. This study included six hundred blood samples from the Interdisciplinary Center for Medical Research (CIRMF) bank, including 300 women and 300 men living in 111 villages. Blood samples were screened using enzyme-linked fluorescent assay (ELFA), while buffy coat samples were analyzed using PCR analyses. Of the 600 samples screened, 548 (91.3%) showed IgG antibodies against T. gondii; 11 (2%) had both IgG and IgM. Among the 548 positive samples, 155 (28%) had higher IgG titers (>300 UI/ml), and 49 of them (31.6%) were detected with T. gondii DNA. The present findings on human toxoplasmosis in Gabon suggest that at an older age, reactivation of old infections seems more frequent than new infections, as indicated by the presence of T. gondii using PCR among elevated IgG subjects without IgM. Further studies should be performed to identify the genotypes of T. gondii that infect humans in Gabon.

Sedentariness and overweight in relation to mortality in Sub-Saharan Africa. A Mediation analysis based on the WHO-Global Health Observatory Data Repository

Aims: The aim of the study was to investigate the complex mediation analysis between physical inactivity and overweight in relation to mortality. Methods: The study is based on public data collected by the Global Health Observatory (GHO) of the World Health Organisation. Results: We showed that the median early mortality attributable to NCDs during the period 2016 - 2019 in both men and women all together was 23.2% (5th to 95th range = 17.2, 35.6) while that in men alone was 25.1% (16.5, 45.7) and that of women was 22.0% (17.0, 27.9). When considering regional early NCDs mortality for both men and women, a systematically high median was observed in Southern Africa (28.7% (22.2, 43.8)) and a low median in Eastern Africa (21.1% (17.15, 27.3)). The analysis of the overall relation between physical inactivity, overweight and early mortality due to NCDs revealed a statistical significance of the direct association between physical inactivity and early mortality due to NCDs. Conclusion: Our findings revealed three main epidemiological and public health concerns. First, an early mortality attributable to NCDs in a range of about 20% to 30% across the SSA regions for both sexes were observed. Second, there was a direct effect between physical inactivity and early NCDs mortality as well as for the indirect effect mediated by overweight. Finally, a percentage point decrease of physical inactivity prevalence and overweight could effectively generate a reduction of mortality due to NCDs. Future studies are needed to confirm the scientific evidence observed in this study. Such studies should be based on observation of individual subjects, adopt a longitudinal design, and collect information that evaluate the complex relation between physical inactivity and early NCDs mortality, along with the role of overweight as a possible mediator.