Laboratory Diagnostic Capacity for Fungal Infections in Nigerian Tertiary Hospitals: A Gap Analysis Survey.

BACKGROUND: An estimated 11.8% of Nigerians suffer from invasive fungal infections (IFIs) yearly. Laboratory capacity to diagnose IFIs in Nigeria has not been objectively assessed. OBJECTIVE: To identify the gaps in laboratory capacity for diagnosis of IFIs in Nigerian tertiary hospitals. METHODS: Clinical microbiologists in Nigerian tertiary hospitals were invited to partake in a 21-item online survey via a professional chat group and email. A descriptive crosssectional study of survey responses was conducted. Frequencies were computed for microscopy, culture, antifungal sensitivity, and non-culture based diagnostic modalities. FINDINGS: Respondents were from 22 tertiary hospitals spread across the six geo-political zones of Nigeria. Gaps identified include absence of mycology laboratory/bench in 5/22 (22.7%), no access to a biosafety cabinet in 5/22 (22.7%), lack of laboratory scientists formally trained in mycology in 9/22 (40.9%), lack of participation in external quality assurance in all (100%), lack of automated blood culture facilities in 9/22 (40.9%), no yeast identification beyond germ tube test in12/22 (54.5%), and no anti-fungal sensitivity testing in 17/22 (77.3%). Galactomannan, cryptococcal antigen lateral flow assay and latex agglutination tests are used in 1(4.5%), 3 (13.6%) and 5 (22.7%) centres respectively; antigen/antibody based non-culture diagnostics were totally absent in 12/22 (54.5%) hospitals. CONCLUSION: Nigerian tertiary hospitals have gaps in the laboratory capacity to diagnose invasive fungal infections despite the significant size of the population at risk of these life-threatening infections in the country. Economically feasible diagnostic solutions and models as well as capacity building are urgently required.

CONTEXTE: On estime que 11,8% des Nigérians souffrent d'infections fongiques invasives (IFI) chaque année. La capacité des laboratoires à diagnostiquer les IFI au Nigéria n'a pas été objectivement évaluée. OBJECTIF: Identifier les lacunes dans la capacité des laboratoires pour le diagnostic des IFI dans les hôpitaux tertiaires Nigéria. METHODES: Les microbiologistes cliniques des hôpitaux tertiaires nigérians ont été invités à participer à une enquête en ligne de 21 éléments via un groupe de discussion professionnel et par courrier électronique. Une étude transversale descriptive des réponses à l'enquête a été menée. Les fréquences ont été calculées pour la microscopie, la culture, la sensibilité antifongique et les modalités de diagnostic non basées sur la culture. RESULTATS: Les répondants provenaient de 22 hôpitaux tertiaires répartis dans les six zones géopolitiques du Nigéria. Les lacunes identifiées incluent l'absence de laboratoire / banc de mycologie dans 5/22 (22,7%), pas d'accès à une armoire de biosécurité dans 5/22 (22,7%), le manque de scientifiques de laboratoire formellement formés en mycologie dans 9/22 (40,9%), manque de participation à l'assurance qualité externe dans tous (100%), manque d'installations d'hémoculture automatisées dans 9/22 (40,9%), pas d'identification de levure au-delà du test sur tube germinatif dans 12/22 (54,5%), et pas d'antifongique test de sensibilité en 17/22 (77,3%). Le galactomannane, le dosage à flux latéral de l'antigène cryptococcique et les tests d'agglutination au latex sont utilisés respectivement dans 1 (4,5%), 3 (13,6%) et 5 (22,7%) centres; les diagnostics sans culture basés sur l'antigène / anticorps étaient totalement absents dans 12/22 (54,5%) hôpitaux. CONCLUSION: Les hôpitaux tertiaires Nigéria ont des lacunes dans la capacité des laboratoires à diagnostiquer les infections fongiques invasives malgré la taille importante de la population à risque de ces infections potentiellement mortelles dans le pays. Des solutions et des modèles de diagnostic économiquement réalisables ainsi que le renforcement des capacités sont nécessaires de toute urgence. MOTS CLÉS: Infections fongiques, Laboratoires, Nigéria, Hôpital tertiaire.

Aerobic Exercise Improves Quality of Life and CD4 Cell Counts in HIV Seropositives in Nigeria.

BACKGROUND: Studies that examine the effectiveness of exercise on quality of life and CD4 cells of HIV population are not easily available in developing countries. PURPOSE: This study was therefore aimed at investigating the effect of 12 weeks aerobic exercise on quality of life and CD4 cells of HIV seropositives in Nigeria. METHODS: Using convenient sampling, 91 volunteer and willing HIV infected persons were enrolled in the study. Based on inclusion criteria, 82 were eligible for the study, and randomly assigned to control and experimental groups. After determining the baseline values of the variables, the experimental group participated in moderate intensity aerobic exercise for 12 weeks. Weekly lectures were organized for the control group. Attrition rate of 22% was recorded at the end the study, leaving 32 participants in each group. The variables were re-assessed at the end of the Descriptive statistic summarized the socio-demographic characteristics of the participants. Paired Student t-test and Student t-test for two independent samples analyzed the significant difference in mean values of the variables. RESULTS: Mean ages in years of the control and experimental groups were39.38 10.03 and 40.84 ± 10.05 respectively, and that of the 64 participants was 39.57±10.13. There was significant improvement (p < 0.05) in the variables between pre- and post-tests in the experimental group. There was insignificant change (p > 0.05) in the four domains of quality of life of the participants, and significant reduction (p < 0.05) in the other four domains of this variable between pre- and post-tests in the control group, in CD4 cell counts, significant improvement was recorded. The variables at the end of the study showed significant difference (p < 0.05) between both groups. CONCLUSION: Quality of life and CD4 cells of HIV seropositives in the experimental group improved significantly after 12 weeks moderate intensity aerobic exercise.