Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria - A multi-facility study of 34 tertiary hospitals.

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria ­ A multi-facility study of 34 tertiary hospitals

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Land use/land cover and climate change interaction in the derived savannah region of Nigeria.

The interaction of land use/land cover (LULC) and climate change, to a large extent, involves anthropogenic activities. This study was carried out in the derived savannah of Nigeria, a delicate, transition ecological zone between the rainforest and savanna zones where the interaction of LULC and climate change could be well appreciated. Using the remote sensing and GIS, Land Change Modeler (LCM), and multivariate geostatistics tools, the study evaluated coupled interaction between LULC and climate change and assessed the changes in the land use/land cover patterns for the periods 1972, 1986, 2002, and 2019. It also evaluated the present (1941-2019) and future (2020-2050) variability in rainfall patterns and made an attempt to predict the interaction between LULC and climate change in future climate. The results suggest that the urban (built-up) area, waterbody, woodland, and farmland experienced a rapid increase of about 2,400%, 583%, 277%, and 32%, respectively, while the forest cover lost about 39% between 1972 and 2019. Furthermore, the study predicted 46% and 29% reduction in the forested area between 2002 and 2050 and 2019 and 2050, respectively. The study concludes that rainfall will be the major driver of LULC change within the study area under a future climate.

Knowledge of human immunodeficiency virus post-exposure prophylaxis among doctors in a Nigerian tertiary hospital.

BACKGROUND: The mainstay of prevention of occupationally-acquired HIV infection is compliance with universal precautions. Appropriate post-exposure prophylaxis is an integral part of prevention, control and workplace safety. This study was undertaken to assess the level of knowledge of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among doctors in Federal Medical Centre, Gombe, Nigeria. MATERIALS AND METHODS: Ethical committee approval for the conduct of the study was obtained. Questionnaires were served to all cadres of doctors from house officers to consultants; it was completed and returned on anonymous basis. RESULTS: Sixty six (88.0%) of the 75 distributed questionnaires were returned completed and formed the basis of further analysis. The overall knowledge level of post-exposure prophylaxis against human immunodeficiency virus infection was very low. About 62.1% are aware of the existence of PEP policy in the hospital. The level of knowledge concerning the high-risk fluid and three drugs used in PEP is high. Over 90% are not aware of the risk of sero-conversion following significant needle-sticks injury and mucous membrane exposure. The study also revealed poor knowledge concerning actions to be taken, how soon to commence the PEP treatment and the duration of medication following needle stick injury. More than 50% of the surveyed doctors had experienced significant exposure to potentially infective materials and none reported or sought PEP advice. CONCLUSION: There is the need to educate the doctors and other health workers about the PEP guideline policy, what to do in the event of injury, whom to contact and the importance of seeking urgent advice following injury or exposure.

Knowledge of Human Immunodeficiency Virus Post-Exposure Prophylaxis among Doctors in a Nigerian Tertiary Hospital

Background: The mainstay of prevention of occupationally-acquired HIV infection is compliance with universal precautions. Appropriate post-exposure prophylaxis is an integral part of prevention; control and workplace safety. This study was undertaken to assess the level of knowledge of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among doctors in Federal Medical Centre; Gombe; Nigeria. Materials and Methods: Ethical committee approval for the conduct of the study was obtained. Questionnaires were served to all cadres of doctors from house officers to consultants; it was completed and returned on anonymous basis. Results: Sixty six (88.0) of the 75 distributed questionnaires were returned completed and formed the basis of further analysis. The overall knowledge level of post-exposure prophylaxis against human immunodeficiency virus infection was very low. About 62.1are aware of the existence of PEP policy in the hospital. The level of knowledge concerning the high-risk fluid and three drugs used in PEP is high. Over 90are not aware of the risk of sero-conversion following significant needle-sticks injury and mucous membrane exposure. The study also revealed poor knowledge concerning actions to be taken; how soon to commence the PEP treatment and the duration of medication following needle stick injury. More than 50of the surveyed doctors had experienced significant exposure to potentially infective materials and none reported or sought PEP advice. Conclusion: There is the need to educate the doctors and other health workers about the PEP guideline policy; what to do in the event of injury; whom to contact and the importance of seeking urgent advice following injury or exposure

Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases.

BACKGROUND: Fractures in the proximal or distal third of the femoral shaft or those with severe comminution are known to be less suitable for intramedullary nailing with Kuntscher nail. With the introduction of interlocking intramedullary nailing the problems of rotational malalignment and shortening that accompany such fractures are now less common. At the National Orthopaedic Hospital Igbobi, Interlocking Intramedullary Nailing was introduced as a form of surgical treatment for fractures of the femur, our initial experience in this type of intramedullary nailing form the basis of this report. METHOD: This is a retrospective study of all cases of fractured femur that were treated with locked intramedullary nailing between March 2002 and September 2003. RESULTS: During a 19-month period, 19 patients with 19 fractures were treated for fracture of the femoral shaft with locked intramedullary nailing using the Russell-Taylor (18 fractures) and Grosse-Kempf (1 fracture) nails. Thirteen fractures (68.5%) had comminution of the Winquist-Hansen type III and IV 12 of which were statically locked. There were three intra-operative technical problems including the case of a subtrochanteric fracture, where the nail missed the medullary canal of the proximal segment. There were 2 cases of superficial wound infection, which responded to local wound care and antibiotics. Although limb length discrepancy and rotational mal-alignment were not assessed routinely during the follow-up of patients, no symptomatic malrotation was recorded. Sixteen out of the 19 patients were available for follow-up for an average period of 11 months. All these cases progressed to union, without the need for dynamization in statically locked fixations. CONCLUSION: In spite of the initial problems encountered with this relatively new procedure in our centre, we were able to achieve a reasonably good result in addition to supporting the notion that dynamization of a statically locked nail is not always necessary for healing of fractures.

Prognostic factors in the management outcome of carcinoma of the larynx in Lagos.

This is a retrospective analysis on the prognostic factors in the management outcome of clinically and histologically diagnosed carcinoma of larynx seen in Lagos University Teaching Hospital between 1996-1999. Various prognostic factors have been documented as determinants on the probable outcome of carcinoma of the larynx, such as duration of symptoms, smoking, medical status of the patient, degree of differentiation, size and site of tumour and presence of cervical lymph node. Thirty-six patients between 1996-1999 were reviewed, with a male to female ratio of 11:1, and peak age group of occurrence in 50-59 years, majority (86.12%) of which were non-smokers who presented in varied degrees of airway obstruction necessitating pre-treatment tracheostomy in 70% of the patients with more than 50% presenting within 3-6 months of onset of initial symptom. The tumours were staged clinically and histology revealed well differentiated T3 glottic tumour without any clinically palpable neck node in more than 50% of the patients which should predict a better outcome. But the interplay of many prognostic variables like pre-treatment tracheostomy and its attendant complications, supposed biological aggressive tumour in a non-smoker, coupled with treatment biased by patients, high costs of treatment, logistics and poor follow up compliance, resulted in poor outcome of our management.

Characterization of Aeromonas spp. isolated from humans with diarrhea, from healthy controls, and from surface water in Bangladesh.

Aeromonas isolates from patients with diarrhea in Bangladesh (n = 69), from healthy controls (n = 11), and from surface water (n = 40) were analyzed with respect to their hybridization groups (HGs) by the aid of fatty acid methyl ester (FAME) characterization and DNA fingerprinting by AFLP, biochemical phenotypes (Phe-nePlate [PhP] types), and the production of hemolysin and cytotoxin. The aim of the investigation was to find out whether certain strains carrying virulence factors predominated among patient isolates. According to FAME and/or AFLP analysis, most human isolates were allocated to DNA HGs 4 (Aeromonas caviae) and 1 (A. hydrophila). Most environmental strains were allocated to HG8 (A. veronii biogroup sobria) and HG4 (A. caviae), and only one was of HG1. According to PhP typing, the diversity among patient isolates was lower than that among other strains, and two dominating PhP types (types BD-1 and BD-2) were identified in 29 and 30% of the patient isolates, respectively. PhP type BD-1 was also common among the environmental isolates, whereas PhP type BD-2 was only identified in two of the other isolates. Twenty-five of 26 isolates belonging to HG1 were of the same PhP type (BD-2), whereas isolates of other common HGs were more diverse according to their PhP types. Hemolytic and cytotoxin-producing strains occurred more frequently among the environmental isolates than among patient isolates. However, the hemolytic and cytotoxic activities among human isolates was strongly correlated to the HG1/BD-2 type, which, in addition, showed high cytotoxin titers (median values, 1/512 compared to 1/128 for cytotoxin-positive isolates belonging to other types). Thus, the HG1/BD-2 type may represent a pathogenic A. hydrophila type that is able to produce diarrhea in humans.

Prevalence, antimicrobial properties and beta-lactamase production of haemolytic enterobacteria in patients with diarrhoea and urinary tract infections in Legos, Nigeria.

OBJECTIVE: To determine the prevalence, antimicrobial properties and beta-lactamase production of haemolytic enterobacteria in patients with diarrhoea and urinary tract infections in Lagos, Nigeria. DESIGN: Hospital based prospective study. SUBJECTS: Total of 324 patients comprising 194 diarrhoeal and 130 urinary tract infection (UTI) cases. MAIN OUTCOME MEASURES: Production of haemolysms. beta-lactamase and antibiograms of isolates. RESULTS: 186 (57.41 pc) of the 324 clinical specimens screened were positive for enterobacteria, out of which 29 (15.59 pc) were haemolytic. Proteus vulgaris (2.78 pc) Klebsiella spp. (1.85pc). Escherichia coli (1.23 pc). Pseudomonas spp. (0.93 pc). Yersinia enterocolitics and Morganella morganii (0.62 pc). Salmonella spp. Vibrio cholerae and Proteus mirabilis (0.31pc) were the haemolytic enterobacteria Isolated. The susceptibilities of haemolytic bacteria to eight antibotics determined by disc-agar diffusion technique revealed that all 29 (100 pc) haemolytic isolates were sensitive to gentamycin and streptomycin but showed varied susceptibilities to the other drugs. Eleven (37.9 pc) of the 29 isolates produced beta-lactamase. CONCLUSION: We conclude that gentamycin and streptomycin are effective drugs against haemolytic isolates from diarrhoea and UTI cases.

Prevalence of human immunodeficiency virus (HIV) antibodies in tuberculosis patients in Lagos, Nigeria.

To establish the prevalence of HIV antibodies in patients with pulmonary tuberculosis, 536 new cases presenting with symptoms of bronchopulmonary disorders were randomly selected from the six referral chest clinics in Lagos and screened for tuberculosis and HIV infections. Sputum and serum samples were obtained from all the patients. The sputum samples were examined for acid-fast bacilli (AFB) by both microscopy and culture. The sera were screened for HIV-1 and HIV-2 antibodies by ELISA and confirmed by Western blot (WB). Of the 536 cases studied, 188 (35%) were positive for AFB while 13 (2.4%) were seropositive for HIV. Correlation between the AFB and HIV results revealed that 10 (5.3%) of the 188 AFB positives were also seropositive for HIV as compared to 3 (0.9%) in the 348 AFB negative cases. The difference in the HIV seroprevalence rates in the two groups was statistically significant (P < 0.001). The recorded higher frequency of HIV infections in the AFB positives strongly suggested some level of interaction between TB and HIV infections in Lagos. Infections with HIV-2 were more prevalent than HIV-1 in the patients with HIV and TB. No case of dual infection with HIV-1 and HIV-2 was recorded in this group of patients. However, in the 3 HIV-seropositive patients within the control group (non-tuberculosis patients), 2 (67%) were positive for both HIV-1 and HIV-2 while 1 (33%) was positive for HIV-2 only. Mycobacterium tuberculosis (70%), M. avium (20%) and M. kansasii (10%) were the mycobacteria strains isolated from the HIV/TB infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasmid screening amongst Aeromonas species and Plesiomonas shigelloides isolated from subjects with diarrhoea in Lagos, Nigeria.

Fifty-three Aeromonas strains and 16 Plesiomonas shigelloides isolated from subjects with diarrhoea in Lagos were screened for the presence of plasmids. Nine (17%) of the Aeromonas strains and one (6.3%) of the P. shigelloides harboured one or more plasmids, ranging in size from 2.4 to 16.8 MDa. As has been documented in other enteropathogens, the possibilities are that these plasmids code for some factors to enhance the virulence of their hosts.

Correlation between human and animal bio-serogroups of Campylobacter isolates in Nigeria.

Campylobacter enteritis is endemic in Nigeria as in most other developing countries of the world. This paper examines the common biotypes and serogroups of Campylobacter in human and animal isolates. The observed correlation suggests a possible animal to human route of infection in Nigeria. Implications on preventive and control measures are discussed.

Biochemical characteristics and a simple scheme for the identification of Aeromonas species and Plesiomonas shigelloides.

The biochemical characteristics of 55 strains of Aeromonas spp. and 16 P. shigelloides of human faecal origin were examined. Results of tests for the production of oxidase, acid from xylose, dulcitol, adonitol, mannitol, or inositol; greenish pigmentation on nutrient agar, and growth in 6.5% NaCl broth were found to be specific and reproducible. However, other tests such as haemolysis on blood agar (BA), production of DNase, amylase, ornithine or lysine decarboxylase; citrate utilization and the methyl red, Voges-Proskauer (MRVP) varied with different strains. On the basis of our results, we propose a simple scheme for the preliminary identification of Aeromonas and Plesiomonas isolates in laboratories with limited resources. We hope that other laboratories will evaluate it to determine its validity.

Occurrence of Aeromonas species and Plesiomonas shigelloides in patients with and without diarrhoea in Lagos, Nigeria.

The prevalence of Aeromonas spp. and Plesiomonas shigelloides was determined in patients attending the enteric laboratory of the Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Nigeria. During the 12-month study (October 1986-September 1987), Aeromonas spp. were isolated from 53 (2.26%) of 2350 patients with diarrhoea and only 2 (0.4%) of 500 patients without diarrhoea (p less than 0.01). Similarly, P. shigelloides was isolated from 16 (0.68%) patients with diarrhoea and none of the controls (p greater than 0.05). The seasonality, age and sex distribution of diarrhoea associated with Aeromonas spp. and P. shigelloides in this study were similar to those of diarrhoea associated with other recognised enteropathogens in Nigeria. Both species may play a role in the aetiology of acute diarrhoeal disease in that environment.

Characterization and antibiotic sensitivity of Campylobacter jejuni and Campylobacter coli isolated from children at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

One hundred and thirteen rectal swabs and 87 faecal samples obtained from the Paediatric casualty of the Lagos University Teaching Hospital, Lagos, Nigeria were processed for Campylobacter jejuni/coli. Twenty-two (11%) of the specimens were positive for C. jejuni. Biotyping results showed that nine (41%) and eight (36%) belonged to C. jejuni biotypes I and II respectively, while three (14%) and two (9%) belonged to C. coli biotypes I and II. Serotyping results revealed that C. jejuni biotypes I and II and C. coli biotypes I and II belonged to different serotypes with serotypes A9 and A36 being the most prevalent. In-vitro antibiotic sensitivity testing using the disc method showed that 18 (82%) of the Campylobacter jejuni/coli isolates were sensitive to erythromycin and nalidixic acid, while 16 (73%) were sensitive to streptomycin. All were resistant to penicillin, while four (18%) and six (27%) were sensitive to tetracycline and cloxacillin respectively. We therefore recommend the use of erythromycin and streptomycin for cases of Campylobacter enteritis requiring antimicrobial therapy in Lagos, Nigeria.

Antimicrobial resistance patterns and plasmids of enteropathogenic Escherichia coli isolated in Nigeria.

In an epidemiological study of enteropathogenic Escherichia coli, 102 strains were isolated from patients seen at the University Teaching Hospital in Lagos. The most common serotype encountered was 055 followed by 026. Antimicrobial susceptibility testing and plasmid profiling of the strains were done. All the strains were sensitive to colistin, nalidixic acid, nitrofurantoin, cefotaxime, amikacin, and augmentin. Of the 102 strains, 47 (46%) were resistant to one or more of the following antimicrobial agents: Co-trimoxazole, tetracycline, ampicillin, streptomycin, sulphonamide and a combination of ampicillin with sulbactam. All the strains that were resistant to any antimicrobial agents were also resistant to tetracycline. Seventy-two strains (70.6%) harbored plasmid whose molecular weights ranged from 0.8 to 120 x 10(6) daltons. The majority of the plasmid were smaller than 6 x 10(6); 90% of strains carrying plasmid ranging in size from 2 to 6 x 10(6) daltons and 50 to 70 x 10(6) daltons were resistant to one or more antimicrobial agents. Transformation and conjugation experiment showed that about 57% of the resistant strains carried R plasmid. Plasmid-determined resistance to tetracycline, ampicillin, streptomycin and sulphonamide was found.

Biotype and serogroup distribution of Campylobacter isolates from children in Nigeria.

A total of 101 Campylobacter isolates from Nigerian children with or without gastroenteritis were biotyped and serogrouped by using the Lior typing schemes (H. Lior, J. Clin. Microbiol. 20:636-640, 1984; H. Lior, D. L. Woodward, J. A. Edgar, L. J. Laroche, and P. Gill, J. Clin. Microbiol. 15:761-768, 1982). Fifty-three (52.5%) of the isolates were Campylobacter jejuni biotype I, 29 (28.7%) were C. jejuni biotype II, 10 (9.9%) were Campylobacter coli biotype I, and 9 (8.9%) were C. coli biotype II. Serogroup 36 was the most common (20.7%) in this study, in contrast with serogroup 1 (18.5%) earlier reported from Canada (Lior et al., J. Clin. Microbiol. 15:761-768, 1982).