A Review and Analysis of Outcomes from Prevention of Mother-to-Child Transmission of HIV Infant Follow-up Services at a Pediatric Infectious Diseases Unit of a Major Tertiary Hospital in Nigeria: 2007-2020.

BACKGROUND AND OBJECTIVE: Above 90% of childhood HIV infections result from mother-to-child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria. METHODS: This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client's folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status. RESULTS: Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never-breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.

Multi-Antibiotic Resistance and Factors Affecting Carriage of Extended Spectrum ß-Lactamase-Producing Enterobacteriaceae in Pediatric Population of Enugu Metropolis, Nigeria.

Extended-spectrum ß-lactamase (ESBL)-producing organisms have become a serious challenge in healthcare delivery globally. The prevalence of ESBL carriage in healthy and sick children in Enugu, Nigeria, was bacteriologically investigated in this study. Four hundred and twenty-two biological samples (mid-stream urine and feces) were bacteriologically analyzed. The isolates were screened for ESBL production using Clinical and Laboratory Standards Institute (CLSI) breakpoints. The suspected ESBL producers were confirmed using double disc synergy test method. Out of the 162 isolates screened, 32 (19.8%) were confirmed as ESBL positive, with a prevalence of 25.32% among sick children in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu and 13.89% in apparently healthy children in a community setting. Klebsiella spp. and Escherichia coli had the highest prevalence of 34.6% and 28.6%, respectively; Citrobacter spp. and Enterobacter spp. were 18.2% and 16.7%, respectively. The ESBL positive isolates were resistant to sulfamethoxazole/trimethoprim (100%), tetracycline (100%), kanamycin (96.9%), nitrofurantoin (84.4%), ciprofloxacin (68.6%), and chloramphenicol (62.5%) but susceptible to meropenem (100%), colistin (56.3%), and gentamicin (50%). Klebsiella spp. had the highest ESBL occurrence among sick children while E. coli had the highest ESBL occurrence among healthy children in Enugu. All ESBL-positive isolates were multiply resistant to conventional antibiotics. The emergence and spread of ß-lactamase-producing Enterobacteriaceae in hospital and community environments highlight the possibility for an infection outbreak if not checked.

Determinants of academic performance in medical students: evidence from a medical school in south-east Nigeria.

BACKGROUND: Medical education is considered one of the toughest college degrees to acquire. Exploring the factors that determine good academic performance in medical school will help in the planning of curriculum and assist students to navigate through medical school more effectively. METHODS: This cross-sectional and descriptive study enrolled 145 second year clinical students (500 level) of the Enugu State University of Science and Technology in south-east Nigeria using purposive and convenient sampling method. It assessed factors that predicted good academic performances in surveyed students. RESULTS: Medical students without membership in any campus group, those that receive(s) less than ten thousand naira (≈US$27) every month as upkeep allowance, those admitted through the University Matriculation Examination, and students who visit their families on a weekly basis were more likely to have better academic performances than those in corresponding categories. Of these significant predictors of good academic performance, mode of admission into medical school (Rs=-0.310 P=0.001) and monthly allowance students got for upkeep (Rs=-0.281 P=0.001) had the strongest correlation with good academic performances. CONCLUSION: Our study identified factors that correlate with academic performances among medical students. We propose frequent appraisal of these factors and support system that will help improve performance in these students.

Awareness, gender variations, consequences of sexual risk behavior and adopted solutions among senior secondary schools adolescents in Owerri, Nigeria

In our area, there is dearth of accurate sex education that could equip adolescents in making informed decisions on sexual issues. This scenario has been linked to a high prevalence of sexual risk behaviors, consequences and poor choices with regard to solutions. Objective: To determine the awareness, gender variations, consequences of sexual risk behavior, and adopted solutions among senior secondary school adolescents in Owerri, Nigeria. Methodology: This was a cross sectional survey of 384 in-school adolescents in Owerri, Nigeria, selected using a multistage sampling technique. Data were collected using pretested self-administered semi- structured questionnaires. Data were analyzed using SPSS v.22 (p<0.05). Results: The majority of adolescents, i.e. 306 (82.5%), were aware of sexual risk behaviors, 340 (91.6%) had received some sex education, and 296 (79.8%) were aware of contraceptives. Key sources of information on sexuality were schools and parents. In total, 54 (14.1%) participants were sexually active, 12 (22.2%) reported ever having an STI, and 9 (75%) had been treated in hospital. Also, 8 (14.8%) of the 54 had dealt with a pregnancy; 7 (87.5%) had undergone an abortion, 3 (42.9%) in a hospital. Sexual risk behaviors among males were associated with age (p=0.002), school type (p=0.002), and alcohol intake (p=0.000), while the residence of the parents had a stronger influence among females (p=0.014). Conclusions: This study found high awareness of sexual issues, mainly sourced from schools and parents. Associations were made between sexual risk behaviors and gender differences (age, school type, and alcohol intake in males, parental residence among females). The consequences of sexual risk behaviors were early pregnancy and STIs, with poor solutions adopted.