Train-the-trainers intervention for national capacity building in infection prevention and control for COVID-19 in Nigeria.

Background: The first case of COVID-19 in Nigeria was reported on February 27, 2020, and over time, spread across the country leading to many healthcare worker infections. The risk of transmission of COVID-19 within healthcare facilities makes it necessary to establish infection prevention and control measures. The World Health Organisation supported the Nigeria Centre for Disease Control to conduct a train-the-trainers workshop on infection prevention and control for key healthcare workers across Nigeria. Aim/Objectives: This study aims to describe the process and results of train-the-trainers as an intervention for national capacity building in infection prevention and control for COVID-19 among healthcare workers in Nigeria. Methods: Eight-hour sessions were held over three days with face-to-face instruction and practical hands-on experience in April 2020. A total of 61 healthcare workers participated across the six geographic zones of Nigeria: North Central, North East, North West, South West, South East, and South South. The training included slide presentations, case-based scenarios, and practical hands-on sessions with plenary discussions. Pre- and post-test assessments were used to evaluate knowledge of COVID-19, triage, and infection prevention and control among healthcare workers. Finding/Results: 69 % (42) of the participants were male 31 % (19) were female, and the majority (67 %) were medical doctors. Others attending were nurses or health administrators. Of the 70 % (26) of the states with existing infection prevention and control structures within the COVID emergency response, only 40 % were functional. The average percentage of pre-test and post-test scores were 60.8 ± 13.4 and 67.8 ± 9 0.3 respectively, showing a statistically significant difference (p > 0.001) in trainee knowledge. Additionally, 70 % of participants evaluated the training workshop as "satisfactory" or higher in training format, relevance for daily clinical work, active participation, learning new concepts, and logistics. Conclusion: Nationwide infection prevention and control training is feasible during a national health crisis. Infection prevention and control is cardinal in the containment of epidemic-prone diseases like COVID-19 and is invaluable in the prevention of healthcare-associated infections in healthcare settings.

Childhood nephrotic syndrome in Enugu, Nigeria.

In a prospective study spanning 12 1/2 years (July 1983 to December 1995), 272 children with nephrotic syndrome seen at the University of Nigeria Teaching Hospital Enugu, Nigeria, were followed up and reviewed at the end of the study period. The demographic, clinical and laboratory features, response to treatment and prognosis were documented. Nephrotic syndrome made up 1.34% of all paediatric admissions. There were 164 males and 108 females giving a male to female ratio of 1.5:1. The ages ranged from 2 to 16 years, with a mean of 7.9 +/- 3.4 years and peak age of 5-7 years. The major clinical features were generalized oedema (100%), hypertension (23%), fever (20%), oliguria (10%) and cough (7%). Haematuria was present in 26%, mean serum albumin was 16 +/- 5, 1 gm/L, serum cholesterol 9.53 +/- 1.6 mmol/L Malaria parasitaemia was present in 38.7% and 9 patients (3.3%) had sickle cell disease (SS). Treatment with diuretics, pooled plasma, prednisolone or cyclophosphamide in various combination achieved 63.9% remission. Mortality was 5.5% being mainly due to chronic renal failure, hypertension and infections. The study calls for more trials in the use of steroids and cyclophosphamide in the treatment of childhood nephrotic syndrome in the tropics.

Nephrotic syndrome in Nigerian children with homozygous sickle cell disease.

Two hundred and seventy two children with the nephrotic syndrome were seen and followed up at the Paediatric Renal Unit of the University of Nigeria Teaching Hospital, Enugu over 12 1/2 year period, between June 1983 and December 1995. Of these, there were nine (3.3%) children with homozygous sickle cell disease (SS). This latter group had a mean age of 9.6 +/- 3.2 years, male to female ratio of 1:2 and serum cholesterol of 3.13 +/- 1.48 mmol/l at the time of diagnosis. The mortality rate was 55.6% in these sicklers, death occurring within one and a half to five years of diagnosis. Causes of death were attributable to sickle cell disease in 60%, renal diseases in 20%, and other causes in 20%. Renal biopsy in two of the sicklers showed membrano-proliferative glomerulonephritis (MPGN) and focal glomerulosclerosis (FGS) respectively. Homozygous sickle cell disease does seem to predispose to the development of the nephrotic syndrome and those that do develop nephrotic syndrome exhibit some special characteristics, when compared to non-sicklers with nephrotic syndrome. These include older age of onset of the nephrotic syndrome, reverse sex ratios, lower serum cholesterol, higher mortality rate and sickle cell complications rather than chronic renal failure as the major cause of death.

Pattern of drug therapy in home management of diarrhoea in rural communities of Nigeria.

A prospective study was carried out in 72 rural communities in Nigeria to determine the pattern of drug therapy and other treatment modalities in case management of diarrhoea at home. The communities were selected using the cluster-sampling technique, and the survey was carried out using the standard methodology of WHO/CDD diarrhoea case management and morbidity. A total of 9,293 children aged less than 5 years were studied, of which 488 had diarrhoea in the preceding 24 hours of the medical examination. Oral rehydration salts (ORS) solution and drugs were used by 20.1%, of the children ORS alone by 2.7%, home-based fluids alone by 21.7%, drugs and salt-sugar solution (SSS) by 31.8%, and drugs and other home-based fluids by 23.7%. The drug-use rate was 75.6%, and polypharmacy occurred in 56.9%. The injection-use rate was 18.4%. Antibiotics (40.3%), antiprotozoals (24.6%), and antidiarrhoeals (15.3%) were the main groups of drugs used. The government doctors, health workers, pharmacists, and patent medicine dealers were the main sources of prescription and supply of drugs. The village health workers, traditional birth attendants, and traditional doctors, who together provided significant proportion of these functions, are an important group requiring training.

Experience with ventriculo peritoneal shunts at the University of Nigeria Teaching Hospital, Enugu.

In a study of 212 children at the University of Nigeria Teaching Hospital, Enugu who received ventriculo peritoneal shunt for hydrocephalus over a 13-year period (1977-1989, 14 had infected shunts and one developed shunt nephritis. Staphylococcus aureus was responsible for 36.4% of the positive cultures and was responsible for the only case of shunt nephritis. This is about the fourth case of shunt nephritis associated with Staphylococcus aureus shunt infection, in the literature. The pertinent features of this case were intraventricular haemorrhage as the cause of the hydrocephalus, frequent revision of shunts before the onset of nephritis and full recovery following intravenous antibiotic therapy and reimplantation of a new shunt.

Serum vitamin A levels of preschool children in a Nigerian rural community.

A study was carried out to determine the serum vitamin A levels of 250 preschool children in a rural community in eastern Nigeria. The children were aged between 2 months and 5 years and comprised 117 boys and 133 girls. A total of 23 (9.2%) children had 'deficient levels' (< 10 micrograms/dl) and 41 (16.4%) had 'low levels' (< 20 micrograms/dl) according to the Interdepartmental Committee on Nutrition for National Defence criteria for the interpretation of serum vitamin A levels. The sex distribution showed that 14 (11.97%) boys and nine (6.77%) girls had deficiency levels. A history of night blindness was obtained in six (3.7%) of 162 children aged 3-5 years.

Ventriculo peritoneal shunts in children. A ten year experience at the University of Nigeria Teaching Hospital, Enugu-Nigeria.

In a ten year period (1977--1986) one hundred and fifty children with hydrocephalus who received ventriculo-peritoneal shunt as their modality of treatment were followed up. Seventy-one per cent of these children were neonates and infants, the majority of them presenting within the first 3 months of onset of symptoms and signs. The major causes of hydrocephalus in these children were congenital malformations, meningitis, tumours and trauma. Pudenz shunt systems were favoured in the 1977--81 period, while 1982--86 period witnessed an upsurge of self devised catheters because of dwindling national economy. The latter were cheaper and more readily available. Apart from blockage of shunts which occurred more in self devised catheters, the performance of these catheters in terms of shunt infections and other complications were same in both self devised and conventional catheters. The main complications encountered were blockage and infection of the shunts, while rare complications included migration and extrusion of shunts to and from the peritoneal cavity, CSF ascites and recurrent abdominal cysts.

Glomerular filtration rate in healthy Nigerian children and in children with sickle cell anaemia in a steady state.

In a prospective study, the glomerular filtration rate (GFR) of 365 Nigerian children aged 4-14 years was determined at the University of Nigeria Teaching Hospital, Enugu. The subjects were made up of 305 healthy children and 60 children with sickle cell anaemia in a steady state. For the healthy children who served as controls, the mean (SD) GFR was 112 (35)ml/min/1.73m2, there being no sex difference. The peak GFR was recorded in boys at 9 years and girls at 13 years. In the children with sickle cell anaemia in a steady state, the mean (SD) GFR was 111 (36), a figure similar to that of normal controls.

Splenectomy in Nigerian children with sickle cell anaemia.

A total of 4359 children with sickle cell anaemia were treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria in an eight year period 1979-1986. Of this number 4 children with hypersplenism associated with intractable complaints were offered splenectomy as the treatment of choice. Following splenectomy they had improved haematological indices and general wellbeing, but splenectomy did not abolish abdominal or bone pain crises. This study emphasizes that though splenectomy could be of beneficial effect on carefully chosen cases of hypersplenism, it has not become a major form of therapy for the majority of children with sickle cell anaemia in Nigeria.

Influence of birthweight and social status on cordblood cholesterol in full term Nigerian neonates.

In a study on the influence of birth weight and social status on cord blood cholesterol, it was found that the serum cholesterol level at birth for full term babies from Eastern Nigeria is 2.71 +/- 0.42 mmol/l with a range of 1.90-3.58 mmol/l. This is higher than the figure obtained from Ibadan babies in Western Nigeria. There was no correlation between birthweight and serum cholesterol for term babies, coefficient of correlation being +0.138. Social status of parents did not influence cholesterol level at birth.