Integrating syndromic case management of sexually transmitted diseases into primary healthcare services in Nigeria.

BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.

Evaluation of commercial HIV test kits used in Nigeria.

BACKGROUND: Accurate and reliable diagnosis of HIV plays a central role in any effective HIV intervention. We decided to evaluate 4 commercial HIV test kits to determine their reliability for use in developing countries. METHODS: Serum samples obtained from clients accessing tertiary health services at the STI clinic, Jos University Teaching Hospital were used to evaluate Sdbioline, Diaspot, Determine and DIALAB Elisa kits. A Western blot was used as the reference kit. RESULTS: DETERMINE kit gave 34 positive and 58 negative reactions and the positive sera were all confirmed by Western blot while DIASPOT kit gave 27 false negative results, which was at variance with the reference kit result. Other kits were SDBIOLINE with 5 false positive and DIALAB Elisa kit, which gave one false positive, and one false negative result. CONCLUSION: We conclude that Determine, SDbioline and DIALAB Elisa kits are reliable for HIV antibody testing in Nigeria and other developing countries.

The seroprevalence of cytomegalovirus antibodies among prospective blood donors in Jos.

BACKGROUND: Human cytomegalovirus, otherwise called human herpes virus type 5, is a significant cause of morbidity and mortality in pregnancy, and among immunocompromised patients like recipients of organ transplants. Cytomegalovirus is transmissible via blood transfusion, among other parenteral routes. This study therefore aims at establishing the seroprevalence of CMV antibodies among prospective blood donors in Jos. This is with a view to making recommendations on donor screening and transfusion protocols among susceptible patients. METHODS: A total of 200 prospective blood donors were recruited into the study. Screening for CMV antibodies was done using ELISA kit, manufactured by "DIALAB", Austria (www.dialb.at). RESULTS: Of the 200 prospective blood donors analysed, 184 donors were found to be positive for cytomegalovirus antibodies, representing a prevalence rate of 92%. The peak age prevalence was in the 25-29 years age range, representing 30.4%. Cytomegalovirus prevalence was lowest in the 15-19 years age range and above 50 years (1.6% each). CONCLUSION: A cytomegalovirus antibody prevalence rate of 92% indicates that screening for CMV should be included in screening algorithm for potentially susceptible recipients of blood and its products. Non infected susceptible persons should be transfused CMV negative orleucocyte depleted blood and blood products.

Distribution of Male Urethral Discharge among the Patients in Primary Health Care Centres of Jos North L.G.A.; Jos; Nigeria

Objectives: The study was to determine the distribution of male urethral discharge among the patients seen in primary health care centres of Jos North Local Government Area. Methods: Male patients with urethral discharge were recruited during their clinic days; from September 2004 to May 2006. A structured questionnaire was administered to the patients who gave their consent. Pre-treatment and post-treatment urethral samples were collected and processed according to standard laboratory procedures. Results: One hundred and seventy-six out of 200 patients completed the study. The age range and mean age of the patients were 11-60 years and 30.7 years respectively. The age decade 21-30 years constituted 100 (56.8) of 176 patients; commercial motorcyclists contributed 80 (45); the single marital status recorded 106 (60.2) while primary and secondary education status had 141 (80). Conclusion: Commercial motorcyclists recorded the highest risk of male urethral discharge; and the peak was among young adults of age decade 21-30 years; especially among the single and less educated

The Seroprevalence of Cytomegalovirus Antibodies among Prospective Blood Donors in Jos

"Background:Human cytomegalovirus; otherwise called human herpes virus type 5; is a significant cause of morbidity and mortality in pregnancy; and among immunocompromised patients like recipients of organ transplants. Cytomegalovirus is transmissible via blood transfusion; among other parenteral routes. This study therefore aims at establishing the seroprevalence of CMV antibodies among prospective blood donors in Jos. This is with a view to making recommendations on donor screening and transfusion protocols among susceptible patients. Methods: A total of 200 prospective blood donors were recruited into the study. Screening for CMV antibodies was done using ELISA kit; manufactured by ""DIALAB""; Austria (www.dialb.at) Results: Of the 200 prospective blood donors analysed; 184 donors were found to be positive for cytomegalovirus antibodies; representing a prevalence rate of 92.The peak age prevalence was in the 25-29 years age range; representing 0.4.Cytomegalovirus prevalence was lowest in the 15-19 years age range and above 50 years(1.6each). Conclusion: A cytomegalovirus antibody prevalence rate of 92indicates that screening for CMV should be included in screening algorithm for potentially susceptible recipients of blood and its products. Non infected susceptible persons should be transfused CMV negative or leucocyte depleted blood and blood products."

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria.

We investigated the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among 258 clergymen-in-training (age range 18-39 years) who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV-positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background.

Parasitic contamination of vegetables in Jos, Nigeria.

BACKGROUND: Intestinal parasites are very common in developing countries including Nigeria. There are diverse ways of their transmission; the study attempts to determine the level of intestinal parasitic contamination on vegetables sold in Jos. METHODS: Sample of 200 each of Tomatoes (Lycopersium sativus), Letus (Loctus satival) Carrot (Davcus carota L) Cabbage (Brassica Denceal) and Green leafy vegetables were analyzed using standardized Centrifugal-floatation technique methods. RESULTS: Of the 1250 samples of vegetables examined, 450 (36.0%) were positive for intestinal parasites, cabbage recorded the highest prevalence of 64% while tomatoes had the least prevalence of 20%. CONCLUSION: Vegetables in Jos are heavily contaminated with intestinal parasites and there is need for public enlightenment campaign on the danger of consuming inadequately washed and prepared vegetables.

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria

We investigated the seroprevalence of human immunodeficiency virus [HIV], hepatitis B virus [HBV] and hepatitis C virus [HCV] infection among 258 clergymen-in-training [age range 18-39 years] who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV- positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background

Nosocomial and community acquired urinary tract infections at a teaching hospital in north central Nigeria: findings from a study of 12,458 urine samples.

BACKGROUND: Urinary tract infection (UTI) is still a problem not infrequently encountered in the course of clinical practice. This study was designed to ascertain its prevalence among both the in and out-patients and the antibiotic susceptibility pattern of the isolates. METHOD: A retrospective analysis of data from all the urine samples processed at Jos university teaching hospital microbiology laboratory was undertaken for a period of 36 months (January 2000-December 2002). Samples had been collected, stored and processed by standard laboratory procedures. Results obtained were analysed using SPSS 11 statistical software and P values < 0.05 were considered significant. RESULTS: Of the 12,458 urine samples studied comprising 43% males and 57% females: the overall prevalence of UTI was found to be 22%; 7.4% among males and a higher figure of 14.6% among females, this was statistically significant (p < 0.05). The rate of nosocomial UTI was significantly higher than the community acquired type: 12.3% and 9.3% respectively (p < 0.05). The commonest nosocomial isolate was Klebsiella spp while Escherichia coli were for community acquired group. Staphylococcus aureus, Coagulase negative Staphylococcus, Proteus spp and Pseudomonas aeruginosa were also common isolates. The most effective antibiotics were Ofloxacin, Ciprofloxacin and Cefuroxime. CONCLUSION: In-patients especially should be encouraged to drink adequate water daily and practice "double urination" to reduce incidence of UTL. Ofloxacin, Ciprofloxacin and Cefuroxime should be considered first in the treatment of UTI in the absence of a susceptibility test.

Human immunodeficiency virus infection in a rural community of plateau state: effective control measures still a nightmare?

BACKGROUND: This study was designed to find out the prevalence of human immunodeficiency virus (HIV) infection in Zawan village as well as their socio-cultural practices that promote its spread. METHODS: Three hundred subjects were recruited into the study comprising 193 males and 107 females by a simple random sampling method. A structured questionnaire was administered to each respondent and 5mls of blood collected and assayed for anit-HIV antibodies. The results were analysed using statistical software Epi-Info version 6, P < 0.05 was considered significant. RESULTS: The prevalence of HIV in Zawan village was found to be 8.3% (25 out of 300) and the significant risk factors noted were--use of sharp objects, trading and the divorce/separated group, (P < 0.05). Other factors such as tattooing, male circumcision by traditional method and tonsillectomy were not found to be statistically associated with HIV infection in this community, (P > 0.05). CONCLUSION: HIV is still causing serious devastation in our rural communities. Hence government should supply affordable antiretroviral drugs to our rural dwellers, step up public enlightenment campaign and pursue with vigour the present micro-economic revival policies to alleviate abject poverty in our rural communities.

Hepatitis B virus infection in a rural settlement of northern Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been present in our communities for quite sometime now. However, majority of the people especially in rual areas are not aware of its devastating effects as adjudged by their socio-cultural practices. METHODS: Three hundred randomly selected residents of Zawan community (comprising 193 males and 107 females) were screened for hepatitis B surface antigen (HBsAg) presence in their sera. Other information was obtained with the aid of a structured questionnaire and results analysed using Epi Info 6 statistical software. RESULTS: The prevalence of HBV in Zawan village was found to be 12.6% (9% among males and 3.6% among females). The risk factors associated with HBV transmission were tonsillectomy, tattooing, use of sharp objects as well as trading. Marital status was also found to be a significant risk factor as there was a high prevalence of HBV infection among the widowed/divorced/separated group. CONCLUSION: HBV infection is endemic in our rural communities just as it is in the urban areas and efforts should be made to step up its health education campaign as well as the interventional mechanisms including immunization.

Cryptosporidium infection in undernourished children with HIV/AIDS in Jos, Nigeria

Background: AIDS and Protein energy malnutrition (PEM) severely impair the immune systemCryptosporidium has over the last two decades emerged as a life threatening disease. The study attempts to determine the prevalence of Cryptosporidium infection in malnourished children with HIV/AIDS. Method: Blood and stool samples of 52 HIV-seropositive children and another 52 HIV-sero-negative childrenaged 0-5 years were collected and screened for HIV and Cryptosporidium oocysts respectively. The sera were screened by double ELISA and the stool by the modified Ziehl-Neelsen method.Results: Out of the 52 HIV-seropositive undernourished, under-five children, none (0%) excreted Cryptosporidium oocyst in their stools while 2 (3.8%) of the control group excreted the oocyst. Conclusion: Cryptosporidium infection seems to be uncommon among undernourished under five children with HIV/AIDS in Jos

Multiple drug resistant strains of Shigella isolated in Jos, central Nigeria.

The objective of this study is to highlight the alarming rise in antimicrobial resistance among Shigella species in Jos, Plateau State. Stool samples of eight hundred and ten patients who presented at the Jos University Teaching Hospital with diarrhoea/dysentery were analysed using standard bacteriological techniques. The antimicrobial susceptibility of the isolates were determined. 25 Shigella species were isolated representing 3.1% isolation rate. The male to female ratio is 1.3:1, children aged 0-10 years constituted 16(64%) of the cases. Shigella flexneri (48%) was the most common sero-group. This was followed by S. boydii (24%), then S. sonnei (20%), and S. dysenteriae (8%). Most strains of shigella species were resistant to Ampicillin (96.0%). Chloramphenicol (96.0%), Cotrimoxazole (88%), Nalidixic acid (84%) and Tetracycline (75%). All strains were found to be sensitive to Ciprofloxacin. The drugs of choice in the treatment of Shigella infection in this environment should be Ciprofloxacin and Ofloxacin. Gentamicin was the third drug of choice its use is limited since the infection is not systemic. To avoid continuous abuse of antibiotics in our country there should be an effective legislation by the government to control the indiscriminate purchase of antibiotics.

Prevalence of cryptosporidium infection among undernourished children in Jos, Central Nigeria.

This prospective study aimed at determining the prevalence data of Cryptosporidium infection in undernourished children, its seasonality and its relative frequency in diarrhoeic stool in Jos, Central Nigeria. One hundred and seventy each of undernourished and well nourished children aged 0-5 years were recruited into the study. Stool samples and clinical data were obtained using questionnaires. Results were analysed using Chi-square test. The prevalence of the infection was found to be 4.8% and all infections occurred in diarrhoeic stool. No infection with this pathogen was recorded in the well-nourished group. There was a defined seasonality of the infection. The high prevalence suggests the importance of introducing routine screening of this group of patients for cryptosporidium infection to facilitate their management.

Antimicrobial susceptibility pattern of Neisseria gonorrhoeae isolated at the Jos University Teaching Hospital, Jos, Central Nigeria.

Widespread, inadequate and inappropriate treatment of gonococcal infections are facilitating antibiotic resistance in Jos Nigeria. We present an antimicrobial susceptibility pattern of Neisseria gonorrhoeae strains in this study. Thirty-one strains of Neisseria gonorrhoeae were isolated by inoculating swabs onto prewarmed heated blood agar and Thayer Martins medium and incubated overnight at 35 to 37 degrees C. The isolates were then screened for antimicrobial susceptibility by the disk diffusion method. About 93.6% were susceptible to azithromycin, 90.3% to ciprofloxacin, 87.1% to ceftriaxone, 80.7% and 64.3% to erythromycin and ofloxacin respectively. Less than half were each susceptible to spectinomycin (38.7%) and gentamicin (32.8%), while 12.9% and 4.6% were susceptible to tetracycline and penicillin respectively. These findings suggest that gentamicin, tetracycline and penicillin may not be recommended in this environment for treating gonococcal infections. Azithromycin, ciprofloxacin and ceftriaxone are the suggested alternatives. Prompt diagnosis, treatment and indeed continued surveillance are hereby recommended for an effective management of gonococcal infections.