Single Dose Versus 72-Hour Course of Ceftriazone for Antibiotic Prophylaxis in Preventing Post-Caesarean Wound Infection: A Randomized Control Trial.

Background: Single dose antibiotic prophylaxis has been established as the standard for prevention of post-caesarean wound infection in most developed centers across the world. However, this is not the case in most developing countries including Nigeria where various multiple dose regimens are still being used due to paucity of locally generated evidence, and anecdotal suggestions of a higher risk of infectious morbidity in our environment. Objectives: This study was aimed to determine whether there was a significant difference in the incidence of post-caesarean section wound infection between a single dose and a 72-hour course of intravenous ceftriazone for antibiotic prophylaxis in selected patients undergoing both elective and emergency caesarean section. Materials and Methods: A randomized controlled trial was carried out among 170 consenting parturients scheduled for elective or emergency caesarean section who met a set out selection criteria, between January and June 2016. They were divided randomly into two equal groups, A and B, of 85 each using the Windows WINPEPI software version 11.65 (Copyright J.H. Abrahamson, 22 Aug 2016) for randomization. Group A patients received a single dose of 1 g, whereas Group B patients were given a 72-hour course (1 g daily) of intravenous ceftriazone. The primary outcome measure was the incidence of clinical wound infection. The secondary outcome measures were the incidences of clinical endometritis and febrile morbidity. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences version 21. Results: The overall incidence of wound infection was 11.2%; Group A had 11.8%, and Group B had 10.6%. Endometritis was 20.6%; Group A had 20% and Group B had 21.2%. Febrile morbidity was 4.1%; Group A had 3.5% and Group B had 4.7%. There was no statistically significant difference in the incidence of wound infection (relative risk [RR] = 1.113; 95% confidence interval [CI] = 0.433, 2.927; P = 0.808), endometritis (RR = 0.943; 95% CI = 0.442, 1.953; P = 0.850), and febrile morbidity (RR = 0.745, 95% CI = 0.161, 3.415; P = 0.700) between the two groups. Group A showed similar risk of developing wound infection compared to Group B (P > 0.05). Conclusion: There was no significant difference in post-caesarean wound infection and other infectious morbidity between patients that received a single dose, and those that received a 72-hour course of ceftriazone for antibiotic prophylaxis. This suggests that single dose antibiotic prophylaxis with ceftriazone is similar to multiple dose regimens in efficacy with likely cost-effective advantage.

Objective structured clinical examination vs traditional clinical examination: An evaluation of students' perception and preference in a Nigerian medical school.

BACKGROUND: Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5(th) and 6(th) year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE). MATERIALS AND METHODS: A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE. RESULTS: There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26-30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5(th) and 6(th) year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students' personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5(th) and 6(th) year students and between males and females. CONCLUSION: Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.

Community-level distribution of misoprostol to prevent postpartum hemorrhage at home births in northern Nigeria.

In Nigeria, most deaths due to postpartum hemorrhage (PPH) occur in the absence of skilled birth attendants. A study using community mobilization and the training of community drug keepers to increase access to misoprostol for PPH prevention was conducted in five communities around Zaria in Kaduna State, Nigeria. Community-oriented resource persons (CORPs) and traditional birth attendants (TBAs) recruited and counseled pregnant women on bleeding after delivery, the importance of delivery at a health facility, and the role of misoprostol. Drug keepers stored and dispensed misoprostol during a woman's third trimester of pregnancy. TBAs and CORPs enrolled 1,875 women from January through December 2009. These results are based on 1,577 completed postpartum interviews. Almost all women delivered at home (95%) and skilled attendance at delivery was low (7%). The availability of misoprostol protected 83% of women who delivered at home against PPH who otherwise would not have been protected. Policymakers working in similar contexts should consider utilizing commuity-level distribution models to reach women with this life-saving intervention.