Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel's diagnostic criteria

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV, selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using with complete Amsel's clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH > 4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test). Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV by the Amsel's criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups 20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X 2=28.063, p=0.0001). Prevalence of BV was significantly higher in single (unmarried) pregnant women (45.5%, X 2=4.038, p=0.045), women with primary school education level (66.7%, X 2=14.530, p=0.001), unemployed women (36.1%, X 2=13.278, p=0.0013), and nulliparous women [36.4%, X 2 (for trend) = 4.805, p=0.0274), while there was no significant difference in the prevalence of BV with relation to trimester of pregnancy (X 2=2.750, p=0.253). Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate interventions to prevent adverse pregnancy outcomes

Prevalence and Pattern of Soil Transmitted Helminths (Sths) among Primary School Children at Nnewi, Nnewi- North Local Government Area, Anambra State, Nigeria

Soil Transmitted Helminths (STHs) are of great Public Health importance. The present study was designed to evaluate the prevalence and pattern of STHs among Primary School Children at Nnewi, Nnewi North Local Government Area of Anambra State, Nigeria. 250 school children aged 1-12 years were randomly recruited from 5 major primary schools at Nnewi between January and June 2017. 95 (38%) were males while 155 (62%) were females. Stool samples were collected using universal sterile containers and examined microscopically using saline floatation method. Out of the 250 pupils examined, 105 (42%) were positive for at least one STH. 40 (42.1%) of the males examined were positive while 65 (41.9%) of the females were positive. There was no significant difference between sexes (P > 0.05). Children aged 1-5 years had the highest prevalence (62.2%), followed by those aged 6-8 years (33.3). Children aged 9-12 years had the least prevalence. Prevalence was significantly different between the different age groups (P < 0.05). Among the STHs isolated, Ascaris lumbricoides was the most prevalent (22%), followed by Hookworm (14%). The least prevalent was Trichuris trichiura (6%). No case of mixed infection was detected. The study concludes that STHs are of immense public Health importance in primary School children at Nnewi and efforts should be intensified to promote health education, personal hygiene and sanitation and regular deworming of school children.

Assessment of School Health Instruction Implementation in Primary Schools in a Local Community in South-East Nigeria: A Comparative Study between Private and Public Schools.

Schools have the responsibility to educate their students and encourage them to live healthy and hygienic behavior. This descriptive cross-sectional study aimed to determine the status of the school health instruction in 56 randomly selected schools in Nnewi North Local Government area of Anambra state using the school health program evaluation scale. It also assessed the extent of implementation of provisions of school health instruction in these schools. Forty six (78.6%) of the 56 schools surveyed had adequate implementation of school health instruction. The proportion of school that met the requisite score (16) for adequate implementation of school health instruction was not significantly different between private and public schools [24(73%) vs. 20(87%), P=0.389]. There was also no significant difference in mean scores attained for school health instruction between private and public schools (17.6±4.4 vs. 17.6±3.6; P=0.939). Private school had more non classroom related heath activity compared to public schools (75.8% vs. 21.7%, P=0.000) while public schools, had significantly more qualified health instructors, ten (43.5%) compared to private schools six (18.2%), P=0.040. Training and retraining of primary school teachers coupled with effective school health policies would be essential in ensuring adequate and optimal implementation of school health instructions in primary schools.

Adverse Drug Reaction Reporting by Different Categories of Healthcare Workers in Nnewi, Nigeria: Awareness, Knowledge and Attitudes.

Aim: To determine the level of awareness, knowledge and attitudes among health workers in different settings of health care in Nnewi, Nigeria towards the reporting of adverse drug reactions (ADRs). Methods: A descriptive cross-sectional study of 372 health workers in different health facilities in Nnewi North LGA of Anambra state, Nigeria was done. The participants were doctors, pharmacists and nurses, selected using multistage sampling technique. Data collection employed pretested, self-administered structured questionnaires. Data was analysed using statistical package for social sciences version 17. Chi-square test for proportions was used to document statistical significance among variables. A p value of < 0.05 was considered significant. Results: Two hundred and fifty five (68.5%) were females and 117 (31.5%) were males. This comprises 241 (64.8%) nurses/related cadres, 109 (29.3%) doctors and 22 (5.9%) pharmacists. Majority of them, 221 (59.4%) were not aware of the existence of the national ADR reporting scheme/guideline. The Pharmacists were more aware compared to other health professionals (P=.000). Respondents from tertiary health facility showed greatest awareness (43.2%). A total of 131 (35.2%) respondents have knowledge of the criteria for reporting ADR though it does not have a relationship with profession (P=.71) and does not depend on the level of the health facility where one worked (P=.30). Conclusion: This study showed poor awareness, knowledge gaps and poor attitude to ADR reporting across the professional groups. There is need for regular sensitization, training and retraining as well as attitudinal changes of health care providers to ADR reporting.

Infant Feeding Practices and Growth Pattern in the First Six Months of Life: A Cross-Sectional Study of Babies Attending the Infant Welfare Clinic of the Nnamdi Azikiwe University Teaching Hospital.

Background: Malnutrition which mostly is a consequence of improper feeding practices has been shown to contribute to over 50% of under-5 mortality. This means that appropriate age-specific nutritional prescription is the surest way of significantly shrinking childhood mortality especially in sub-Saharan Africa. Aim: This cross-sectional descriptive and analytical study aims to determine the relationship between different infant feeding practices and the nutritional status of apparently healthy infants below six months of age attending the infant welfare clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Methods: Mother infant pairs attending the infant welfare clinic that meets the inclusion criteria were consecutively enrolled over a six months period. Results: Four hundred infants were enrolled for this study. Educational level (P=0.003), socioeconomic class (P=0.010), occupation (P=0.025) and infants age (P=0.001) significantly determined exclusive breast feeding (EBF) practice. Exclusively breast feed infants showed higher weight and length indices for age and sex compared to infants in other feeding group (P=0.001). Significantly lower proportion of infants in the EBF group (1.9%) compared to infants in the predominant breast feeding (PBF) 5.2% and complementary breast feeding (CBF) 9.7% feeding group showed evidence of under-weight (P=0.015). Binary logistic regression analysis showed that EBF infants were 0.12 and 0.51 times less likely to be under-weight (OR 0.12; CI 0.02-0.93) and stunted (OR 0.51; CI 0.27-0.96) respectively. Conclusion: Since malnutrition is a major contributor to neonatal and infant’s mortality in Africa, the campaign for EBF practice should not only be sustained but further strengthened as a way of halting and possibly reversing the gloomy trend.

Determinants of Post-Caesarean wound Infection in Nnewi, Nigeria.

Background: Delivery by caesarean section has been reported as the single most important risk factor for maternal wound infection. Wound infection is not only a leading cause of prolonged hospital stay but a major cause of widespread aversion to caesarean delivery in developing countries. Despite all these, the determinants of post-caesarean wound infection in Nnewi have remained largely uninvestigated. Objective: This study was to determine the factors that predispose to post- caesarean wound infection at a tertiary institution in a developing country. Design: This was a cross sectional study. Place and Duration of Study: Labour ward, Theatre and Post natal ward of NAUTH Nnewi between April to November 2012. Methodology: All women who had caesarean section, met the inclusion criteria and gave consent were included in the study. They were divided into two groups (Group A and Group B) each comprising 60 women. Group A comprised women who had emergency caesarean section, while those in group B had elective caesarean section. The outcome of their post-caesarean wound was assessed. Statistical analysis (Logistic regression) of identified risk factors in patients who developed wound infection was performed at a 95% confidence interval. Results: The incidence of post caesarean wound infection was 12.5%. While the infection rate was twelve (20.0%) among women who had emergency caesarean section, it was 3 (5.0%) among those who had elective caesarean section. The identified independent risk factors for wound infections were the duration of membrane rupture more than 24 hours (OR=0.11: 95% CI 0.03- 0.47: P =0.003), labour duration more than 12 hours (OR =0.07: 95% CI 0.01-0.32: P =0.001) and the use of subumbilical, midline incision (OR=0.21: 95% CI 0.05-0.91). Conclusion: The post caesarean wound infection rate in NAUTH was high. Efforts should be geared towards the prevention of prolonged labour by health education, early intervention and use of partograph. Timely intervention for prolonged rupture of membranes would drastically reduce the incidence of wound infection in our area.

Catheter-Associated Urinary Tract Infection Following Caesarean Section in Nnewi, Nigeria: A Prospective Comparative Study.

Background: Urinary tract catheterization is a major risk factor for urinary tract infections (UTIs). Catheter associated urinary tract infections (CAUTIs) still remain a major reservoir of antibiotic resistant pathogens with attendant increase in morbidity and mortality. Objective: To determine and compare the incidence of catheter associated urinary tract infections following immediate and 24-hour postoperative removal of urethral catheters for caesarean section. Design: The study was a prospective, comparative study. Place and Duration of Study: Labour ward, Theatre and Postnatal wards of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi between August 2012 to April 2013. Methodology: The study involved 156 women admitted for caesarean section where the urethral catheters were removed 24-hour post operatively (group A) or immediately after caesarean section (group B). Urine samples were collected. Outcome measures included pre-operative and 72 hour postoperative urine microscopy, culture and sensitivity, urinary frequency, dysuria, urgency, fever and duration of hospital stay. The patients’ data were coded, computed and analyzed using SPSS version 16. A P-value of <0.05 was considered significant. Results: Of the 79 patients in group A, 9 (11.4%) had significant bacteriuria in the 72 hour post operative urine culture while 5 (6.5%) had significant bacteriuria in group B, (OR=1.85: 95% CI 0.59-5.80, P=0.28). The overall incidence of catheter associated urinary tract infection in NAUTH was 14(9.0%). Escherichia coli were mostly isolated 4 (44.4%). The lowest level of resistance was seen with Amoxycillin- clavulanic acid (Augmentin). Conclusion: The present study showed that significant bacteriuria in Group A almost double the incidence in Group B, however, the difference was not statistically significant. Further studies should be carried out to compare catheterization with non- catheterization for caesarean section.