Awareness and knowledge of scabies and ringworm among parents of school-age children in Calabar, Cross River State, Nigeria: Implications for prevention of superficial skin infestations.

Context: Risk factors for the persistence of superficial skin infestations are prevalent in humid tropical environments, which are favorable for breeding of the causative vector mite Sarcoptes scabiei (ectoparasite) and dermatophyte fungi. Aim: This study aimed at assessing the awareness and knowledge of childhood scabies and ringworm infestations among parents in Calabar, a highly humid rainforest tropical environment. Settings and Design: Cross-sectional study design and systematic random sampling were used to recruit school-age children in selected primary schools in Calabar. Materials and Methods: Researcher-driven administration of a structured questionnaire was conducted to obtain quantitative data from parents of recruited children. Statistical Analysis Used: : Chi-square was used to assess factors associated with ever hearing or seeing scabies and ringworm infestations. Statistical significance was set at P < 0.05. Results: One hundred and eighty-two (56.7%) and 218 (67.9%) of the respondents had heard of or seen scabies and ringworm infestation. Among respondents that were aware of scabies, 53.3% knew of the cause, 50.5% were aware of the risk factors while 68.1% and 78.0% knew their treatment and prevention, respectively; 98.6%, 60.6%, 76.6%, and 80.7% of respondents knew the cause, risk factors, treatment, and prevention of ringworm infestation, respectively. Fathers with at least secondary school literacy level and sharing beds were significantly associated with awareness of scabies. Conclusion: There is a suboptimal level of awareness and knowledge of two of the most common superficial skin infestations among parents of primary school children in the study setting. There is a need to redouble our effort at sensitization of parents toward improved awareness of these common infestations.

Résumé Contexte: Les facteurs de risque de persistance des infestations cutanées superficielles sont prévalents dans les environnements tropicaux humides, favorables à la reproduction du vecteur responsable, la gale Sarcoptes scabiei (ectoparasite), et des champignons dermatophytes. Objectif : Cette étude visait à évaluer la sensibilisation et les connaissances des parents de Calabar, un environnement tropical de forêt équatoriale très humide, concernant la gale et les infestations à la teigne chez les enfants. Cadre et conception : Une étude transversale et un échantillonnage systématique ont été utilisés pour recruter des enfants d'âge scolaire dans des écoles primaires sélectionnées à Calabar. Méthodes et matériel: Une administration dirigée par le chercheur d'un questionnaire structuré a été réalisée pour obtenir des données quantitatives auprès des parents des enfants recrutés. Analyse statistique utilisée: Le test du chi carré a été utilisé pour évaluer les facteurs associés à la connaissance de la gale et des infestations à la teigne. La signification statistique a été fixée à P < 0,05. Résultats: Cent quatre-vingt-deux (56,7 %) et 218 (67,9 %) des répondants avaient entendu parler ou vu une infestation de gale et de teigne. Parmi les répondants qui étaient au courant de la gale, 53,3 % connaissaient la cause, 50,5 % étaient conscients des facteurs de risque, tandis que 68,1 % et 78,0 % connaissaient respectivement leur traitement et leur prévention. De même, 98,6 %, 60,6 %, 76,6 % et 80,7 % des répondants connaissaient respectivement la cause, les facteurs de risque, le traitement et la prévention de l'infestation à la teigne. Les pères ayant au moins un niveau d'alphabétisation au niveau secondaire et partageant des lits étaient significativement associés à la connaissance de la gale. Conclusion: Il existe un niveau sous-optimal de sensibilisation et de connaissance de deux des infestations cutanées superficielles les plus courantes parmi les parents d'enfants d'école primaire dans le cadre de l'étude. Il est nécessaire de redoubler d'efforts pour sensibiliser les parents afin d'améliorer la connaissance de ces infestations courantes. Mots-clés: Infestations cutanées, gale, teigne, connaissance, parents, enfants d'âge scolaire, Nigeria.

Soil-transmitted helminth infection among school-age children in Ogoja, Nigeria: implication for control.

The study aimed at assessing the prevalence and risk factors of soil-transmitted helminthiases among school-aged children in Ogoja Local Government Area, Cross River State. Fecal samples were collected from 504 participants and analyzed using the Kato-Katz technique and modified Baermann technique for identifying larvae of Strongyloides. A total of 232 (46.0%) samples were positive for soil-transmitted helminths. The overall prevalence of Ascaris lumbricoides, hookworm, Trichuris trichiura, and Strongyloides stercoralis were 14.1%, 16.5%, 2.6%, and 12.9% respectively. The prevalence of infections were higher among males (46.6%) than females (45.4%). Overall, parasitic infection was higher in the 5-7-year age group (65.6%) than in the other age groups (p = 0.000). Infection intensities of A. lumbricoides (84.00 EPG) (p = 0.044) and T. trichiura (96.00 EPG) (p = 0.041) were higher in school-age children aged 14-16 years. A. lumbricoides and hookworm co-infection (8.7%) was the most common mixed infection and was significantly higher in males than females. School-aged children who did not have prior knowledge about soil-transmitted helminth infections, the habit of drinking water without boiling, open defecation, use of pit latrine, and children who did not have toilet facilities in school were significantly associated with soil-transmitted helminthiases. There was a significant relationship between washing hands after using the toilet, the habit of putting on footwear outside the house, and soil-transmitted helminth infection. In addition to preventive chemotherapy, control measures should focus on health education, providing clean drinking water, proper disposal of human excreta and sewage, and environmental hygiene.

Current epidemiology of histoplasmosis in Nigeria: A systematic review and meta-analysis.

Introduction: Histoplasmosis commonly occurs in the advanced HIV disease population and also in immunocompetent individuals. Previous reviews and recent studies highlight several cases of histoplasmosis reported in Nigeria. We aimed to describe the current epidemiology of histoplasmosis in Nigeria and the need for active surveillance in the at-risk populations. Methods: Literature searches for all publications on histoplasmosis in Nigeria were performed using online databases including Google scholar, PubMed and African Journal online. The following search terms: 'histoplasmosis' and 'Nigeria', AND/OR 'Histoplasma and Nigeria' were used. No limitations on the date or other search criteria were applied, to avoid the exclusion of articles on histoplasmosis in Nigeria. All publications on histoplasmosis outside Nigeria were excluded. Results: Our review identified a total of 231 cases of histoplasmosis reported from Nigeria: 128 were from individual case reports and case series while 103 were cases from two observational studies. Of the 231 cases, 97 (42.0%) were from South West Nigeria, 66 (28.6%) were from South-South Nigeria, 24 (10.4%) were from North West, 22 (9.5%) from North Central Nigeria, 17 (7.4%) from South East Nigeria and 5 (2.2%) from the North East. Based on Nigeria's current population size of 216,953,585 the burden of histoplasmosis per 100,000 inhabitants was estimated to be 0.1%. The sheer number of cases detected in recent observational studies compared with individual case reports and series reported over a longer duration of 6 decades suggests gross under-reporting of histoplasmosis in Nigeria. Conclusion: Histoplasmosis is not an uncommon clinical entity in Nigeria. Histoplasmosis case finding should be improved by training and retraining healthcare professionals and providing much-needed diagnostic capacity and infrastructure across health facilities in Nigeria.

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria.

Background: Several case reports abound in literature about cases of histoplasmosis misdiagnosed as tuberculosis (TB). Nigeria is one of the highest TB-burdened countries, but data on histoplasmosis in Nigeria are sparse in the literature. The aim of this research was to investigate patients with presumptive pulmonary TB in Calabar, Nigeria, for histoplasmosis. Methods: This was a descriptive cross-sectional study of 213 participants with presumptive diagnosis of pulmonary TB between April 2020 and March 2021. Urine samples were collected from selected patients for Histoplasma antigen test using enzyme immunoassay kits, while sputum samples were collected for GeneXpert test for confirmed diagnosis of TB and conventional polymerase chain reaction (PCR) for the diagnosis of histoplasmosis. Results: Of the 213 participants enrolled into the study, 94 subjects (44.1%) were confirmed TB patients, 75 (35.2%) were human immunodeficiency virus (HIV) positive, 41 (19.2%) had advanced HIV disease (AHD), and 138 (64.8%) were HIV negative. Twenty-seven of the 213 participants were Histoplasma positive by antigen test and/or PCR, giving an overall prevalence rate of 12.7%. The prevalence of histoplasmosis among confirmed TB patients (7.4% [7/94]) was significantly lower than in unconfirmed TB patients (16.8% [20/119]) (P = .04). Participants on anti-TB therapy also had a significantly lower rate of histoplasmosis compared to those not on anti-TB drugs (P = .00006). The internal transcribed spacer (ITS) sequencing of the Histoplasma revealed a closely relatedness to Histoplasma capsulatum. Conclusions: Histoplasmosis is not uncommon among presumptive TB patients. There should be proper microbiological investigation of patients presenting with symptoms suggestive of TB to exclude cases of histoplasmosis.

Evaluation of pulmonary tuberculosis case detection improvement with the deployment of XpertMTB/Rif in the tuberculosis control program of cross River State, Nigeria.

OBJECTIVE/BACKGROUND: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl-Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program. MATERIALS AND METHODS: Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif. RESULTS: A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4-89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively). CONCLUSION: The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients.

Evaluation of rifampicin resistance and 81-bp rifampicin resistant determinant region of rpoB gene mutations of Mycobacterium tuberculosis detected with XpertMTB/Rif in Cross River State, Nigeria.

OBJECTIVE/BACKGROUND: World Health Organization tuberculosis (TB) indices from 2014 to 2016 showed that Nigeria had the 6th highest prevalence, 4th highest incidence, and the highest mortality rate globally. In efforts to improve TB care, the XpertMTB/Rif (GeneXpert) technology, Cepheid, Sunnyvale, California, USA, which has revolutionized TB detection with concomitant rifampicin-resistance molecular detection, was introduced in Cross River State, South-South Nigeria, in 2014. The GeneXpert uses molecular beacons to detect five overlapping 81-bp regions in the rpoB gene known as the Rifampicin Resistant Determinant Region (RRDR). These probes are represented as Probe A (507-511), Probe B (512-518), Probe C (518-523), Probe D (523-529), and Probe E (529-533). Mutations in this region have been shown to account for about 93% of resistance to rifampicin, which is the most important drug in tuberculosis treatment. The objective of this study was to determine the frequency of rifampicin resistance and the commonly associated probes for various rpoB gene mutations within the 81-bp RRDR of Mycobacterium tuberculosis in Cross River State, Nigeria. METHOD: We collated and analyzed data from the 10 Xpert MTB/Rif sites in Cross River State from June 2014 to June 2016 and determined the frequency of mutations associated with different probes designated A-E, which represent the RRDR of rpoB gene. All centers use XpertMTB/Rif version G4. RESULT: In total, 973 tuberculosis cases were detected from 4671 cases tested. Rif resistance was detected in 6.0% (58/973) of cases. Probe E mutations were the most common, seen in 60.3% (35/58); followed by Probe D, 17.2% (10/58); and Probe B, 13.8% (8/58). Probe A occurred in 3.4% (2/58). No Probe C mutation was seen. Multiple mutation combinations involving probes B and D occurred in 3.4% (2/58), while one isolate had triple site mutations involving A, D, and E. One isolate that at initial testing showed a Probe A mutation displayed a Probe D mutation when tested in another site prior to treatment enrollment. CONCLUSION: In our setting, 6.0% of tuberculosis isolates are rifampicin resistant. Mutations associated with probe E commonly due to codon 531 are the most predominant cause of rifampicin resistance. Mutations at probe C (codons 518-523) were uncommon. A change in mutation may have occurred in one of the patients.

Bacterial contamination in a special care baby unit of a tertiary hospital in Jos, Nigeria.

Background: Nosocomial infections pose a great challenge on healthcare systems. Although surfaces in neonatal wards, umbilical stump wounds and catheter are responsible for a high number of nosocomial infections due to bacteria. The aim of this study was to determine the bacterial profile of air and surface contamination in the special care baby unit of a tertiary hospital in Jos, Nigeria. Methods: Surface and air samples were cultured and antibiotic susceptibility of isolated bacteria were determined. Results: The bacterial profile of air and surface samples showed that Klebsiella was the most common bacteria followed by Staphyllococcus; while the least was Escherichia. Most of the bacteria were isolated from the out-born term area of the special care baby unit. All the bacteria isolated were susceptible to ceftriaxone and meropenem. Conclusion: This study showed that all areas of the special care baby unit of the hospital have bacterial, indicating that these are a potential source of cross-infection from healthcare workers to the neonatal patients.