An assessment of nursing mothers' and young people's access to proprietary and patent medicine vendors' services in rural communities of south-eastern Nigeria: implication for review of national drug policy.

BACKGROUND: Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage. METHODS: A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18-20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine. RESULTS: A total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children's cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8. CONCLUSION: PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.

Iron deficiency anemia in pregnancy in Nigeria-A systematic review.

Anemia in pregnancy is a public health problem in Nigeria and it is more than likely that iron deficiency is the major cause. This study aimed to review relevant publications in order to summarize the prevalence of iron deficiency anemia, risk factors associated with iron deficiency, anemia in pregnancy as well as factors associated with compliance to routine iron therapy. MEDLINE Entrez PubMed search was performed in August 2017 and studies that investigated iron deficiency anemia in pregnancy in Nigeria from 1968 to 2017 were sought. Search keywords included "iron deficiency anemia, pregnancy, Nigeria." Only studies that provided information on the prevalence of iron deficiency anemia, risk factors associated with iron deficiency anemia and risk factors associated with compliance to routine iron therapy in pregnancy in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations, not reviews, studies conducted in Nigeria between 1968 and 2017 and studies written in the English language. A total of six relevant studies that fulfilled the study inclusion criteria were identified out of 36 studies found. All the studies reported a high prevalence of iron deficiency anemia among pregnant women and risk factors associated with iron deficiency anemia in pregnancy include multiparity, third trimester of pregnancy, and low socioeconomic status. Risk factors associated with noncompliance to routine iron therapy include poor utilization of antenatal services, low educational attainment, distance to a health facility, single or teenage pregnancy, increasing age of the pregnant women, and living in the rural areas. The prevalence of iron deficiency anemia among pregnant women was reported to be high. Awareness creation and education on the importance of family planning and proper utilization of antenatal care services should be encouraged. There should be economic empowerment of women, provision of health facilities to areas where they are absent to encourage early booking and utilization of antenatal care services.

Voluntary non-remunerated blood donation: Awareness, perception, and attitude among potential blood donors in Abakaliki, Nigeria.

BACKGROUND: Blood is the most donated tissue in medical practice and a veritable tool in many life-saving situations if used appropriately and judiciously. Despite the increased demand for blood, the supply of safe blood has been inadequate. OBJECTIVE: The aim of this study is to determine the perception and attitude toward voluntary non-remunerated blood donation among medical students in Abakaliki. SUBJECTS AND METHODS: This was a cross-sectional study carried out at Federal Teaching Hospital, Abakaliki, between October 2017 and March 2018. Stratified and simple random sampling technique was used to recruit participants from among medical students using pretested, semi-structured, self-administered questionnaire. Data were analyzed using SPSS software version 20. RESULTS: A total of 158 medical students who participated in the study were made up of 90 (57%) males and 68 (43%) females. The most prevalent age group was 20-25 years. Most of the participants, 151 (95.6%), were single. The proportion of the participants who had good knowledge about voluntary blood donation was 72.8%, while the attitudes of the respondents were positive to most aspects of blood donation considered. However, participants were found to have poor practice of voluntary blood donation as only 56 of 158 (35.4%) had ever donated blood. CONCLUSION: The majority of the participants have good knowledge and positive attitude toward voluntary non-remunerated blood donation. However, their practice of voluntary blood donation was poor. Sustained awareness creation and enlightenment is relevant to influence the masses to have better knowledge and positive attitudes toward voluntary non-remunerated blood donation with improved blood donation practices.

The potential for transmission of hospital-acquired infections by non-critical medical devices: the role of thermometers and blood pressure cuffs.

Healthcare-associated infection (HAI) is a major but often neglected public health problem. Most attention to HAI prevention is given to high-risk invasive diagnostic and therapeutic healthcare tools, while the importance of less critical tools tends to be underestimated. This study was designed to assess the potential contributory role played by thermometers and blood pressure cuffs in HAI transmission in a Nigerian teaching hospital. Analysis of swabs from thermometers and blood pressure cuffs used in the teaching hospital was conducted using standard microbiological techniques.

Soil transmitted helminth infections and schistosomiasis in school age children in sub-Saharan Africa: efficacy of chemotherapeutic intervention since World Health Assembly Resolution 2001.

Soil transmitted helminth infections (STH) and schistosomiasis constitute major public health challenges among school-age children in sub-Saharan Africa. This review assessed the efficacy of chemotherapeutic intervention in line with the World Health Assembly (WHA) resolution since the passage in 2001. Using the Medline Entrez-Pubmed search, relevant publications were identified via combinations of key words such as helminth infection, school children, chemotherapy, Africa. Albendazole, mebendazole, and praziquantel were the antihelminthic drugs most commonly evaluated. Cure rates >80% and egg reduction rates >90% were recorded in most cases of schistosomiasis using praziquantel. Albendazole was very effective against A. lumbricoides and hookworm infections with majority of the studies recording cure rates >75%, but the efficacy of the drug was poor against T. trichiura. To ensure the realization of the WHA resolution, there is need for regular treatment of school children, development of alternative antihelminthic drugs and vaccines, environmental control measures and health education.

Antibiotic susceptibility of urogenital microbial profile of infertile men in South-eastern Nigeria.

Male factors are known to contribute significantly to the infertility problem. The urogenital bacteria profile and semen quality were investigated among 160 men attending infertility clinics in South-eastern Nigeria. Both semen and urine samples were obtained from each subject and analysed according to standard techniques. A total of 16 (10%) had bacterial infection in their semen samples and individuals of older age groups were significantly affected (chi(2) = 23.18, P < 0.05). Urinary tract infection (UTI) was observed in 30.6% of subjects, with the highest rate occurring among men aged 36-40 years, but the difference was not significant (chi(2) = 7.62, P > 0.05). A total of 33.8% of the men had semen volume less than 2 ml per ejaculate, 33.8% also recorded total sperm count of <40 x 10(6) ml(-1), while 36.3% recorded sperm motility <50%. Fifty-three individuals (33.1%) had suboptimal sperm morphology (<60%), with the men aged 46-50 years old significantly affected (chi(2) = 13.03, P < 0.05). All the individuals with bacterial infection in semen also had UTI and suboptimal semen parameters. The commonest bacterial isolates were Proteus species, Staphylococcus aureus and Escherichia coli, which were resistant to most of the antibiotics assessed.

The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives.

Microbiological analysis of swabs taken from the cuffs and pocket mouths of physicians' white coats in an acute care hospital showed that 91.3% of the coats had bacterial contamination. Specifically diphtheroids, Staphylococcus aureus and Gram-negative bacilli were isolated. In contrast, comparatively lower rates of bacterial contamination were observed on the white coats (1) of visiting physicians, (2) of the medical unit compared with the rest of the hospital, (3) that were less 1 year old, and (4) that were laundered daily. Further, the white coats of physicians who wore them only when seeing patients had significantly lower bacterial contamination than white coats of physicians who wore theirs during clinical and nonclinical duties (chi(2) = 4.99, df = 1, p < .05). In particular, white-coat cuffs had a higher bacterial load than the mouths of the pockets. The bacterial isolates were resistant to nearly all of the antibiotics tested; the most effective, however, was ciproflox. Results suggest that physicians' white coats may increase nosocomial infection transmission. Proper handling of white coats by physicians and other healthcare workers could minimize cross-contamination and improve patient safety by potentially reducing nosocomial infections.

Concurrent malaria and typhoid fever in the tropics: the diagnostic challenges and public health implications.

BACKGROUND & OBJECTIVES: Malaria and typhoid fever still remain diseases of major public health importance in the tropics. Individuals in areas endemic for both the diseases are at substantial risk of contracting both these diseases, either concurrently or an acute infection superimposed on a chronic one. The objective of this report was to systematically review scientific data from studies conducted in the tropics on concurrent malaria and typhoid fever within the last two decades (1987-2007), to highlight the diagnostic challenges and the public health implications. METHODS: Using the MedLine Entrez-PubMed search, relevant publications were identified for the review via the key words Malaria and Typhoid fever, which yielded 287 entries as of January 2008. RESULTS: Most of the studies reviewed expressed concern that poor diagnosis continues to hinder effective control of concurrent malaria and typhoid fever in the tropics due to: non-specific clinical presentation of the diseases; high prevalence of asymptomatic infections; lack of resources and insufficient access to trained health care providers and facilities; and widespread practice of self-treatment for clinically suspected malaria or typhoid fever. INTERPRETATION & CONCLUSION: There were considerably higher rates of concurrent malaria and typhoid fever by Widal test compared to the bacteriological culture technique. Although culture technique remains the gold standard in typhoid fever diagnosis, Widal test is still of significant diagnostic value provided judicious interpretation of the test is made against a background of pertinent information. Malaria could be controlled through interventions to minimize human-vector contact, while improved personal hygiene, targeted vaccination campaigns and intensive community health education could help to control typhoid fever in the tropics.

Bacteriological assessment of stethoscopes used by medical students in Nigeria: implications for nosocomial infection control.

Our study assessed bacteria on swabs taken from the surface of the diaphragm of stethoscopes used by medical students in Nigeria. We found bacterial contamination on 80.1% of the stethoscopes. Staphylococcus aureus and Pseudomonas aeruginosa were major isolates. Bacterial colonization was highest among stethoscopes cleaned with only water and those never cleaned with any agent or never cleaned at all. The difference was statistically significant (chi2 = 31.9, p < .05). Stethoscopes from students who cleaned them after use on each patient and from those who practised handwashing after contact with each patient had significantly lower bacterial contamination (chi2 = 26.9; p < .05 and chi2=31.9, p < 0.05, respectively). Isolates of Staphylococcus aureus showed the highest susceptibility to antibiotics, while the most effective antibiotics were Ciproflox and Erythromycin. Integration of stethoscope care in the training curriculum of medical schools will enhance the control nosocomial infections.

Diagnosis of Plasmodium falciparum malaria in pregnancy in sub-Saharan Africa: the challenges and public health implications.

Plasmodium falciparum malaria in pregnancy is a major public health problem in sub-Saharan Africa and represents enormous diagnostic challenge. The objective of this report was to review scientific data from studies conducted in sub-Saharan Africa on the diagnosis of malaria in pregnancy within the last two decades (1987 to 2007), to highlight the challenges and the public health implications. Using the Medline Entrez-Pubmed search, relevant publications were identified for the review via combinations of key words such as Malaria, Pregnancy, and Sub-Saharan Africa, which yielded 777 entries as of September 2007. The results from the various studies were discordant, due to differences in the techniques of sample collection and analysis, based on the differences in the definition of clinical, peripheral, and placental malaria. Definitions were based on the presence of malaria parasite and/or pigments in blood smear from peripheral/placental blood, on histological placental findings, on the use of rapid diagnostic tests (RDTs) and polymerase chain reaction (PCR). Nonspecific clinical presentation of malaria, lack of efficient diagnostic facilities and trained personnel, and absence of regulatory standards for diagnostic tests, are some of the major diagnostic challenges. Increased allocation of resources to development and application of accurate diagnostics will improve malaria diagnosis in pregnancy.

Radiological features of pulmonary tuberculosis in HIV-positive and HIV-negative adult patients in south-eastern Nigeria

Pulmonary tuberculosis (PTB) is the most common clinical presentation of tuberculosis. This study was carried out to appraise the radiological features of PTB in adult HIV-positive and HIV-negative pa-tients. The chest radiographs of the patients were evaluated in the tuberculosis, leprosy, and endemic disease (TBL) clinic, Ebonyi State University Teach-ing Hospital (EBSUTH), Abakaliki, south-eastern Nigeria, from April 2004 to June 2006. Of the total of 117 individuals studied, 68 (58.1) were males and 49 (41.8%) females, indicating a male preponderance of 1.4:1. Up to 49.6% of the subjects had PTB/HIV co-infection. The highest prevalence of PTB/HIV co-infection was recorded among males aged 31­40 (12.8%), and females aged 21­30 (11.1%). The com-monest radiological features observed were cavitory lesions (64.1%), patchy opacities (44.4%), and hilar opacities (38.5%). Bilateral cavitory lesions, patchy opacities and hilar opacities were more prominent than the right-sided or left-sided ones and appeared more frequently among individuals with PTB/HIV co-infection. Perihilar patchy opacities, consolidation and pleural effusion were seen in 19.6%, 6.0%, and 4.3% of all cases, respectively. There was no statisti-cally significant difference in the association between the radiological features and patient category (χ2 = 17.74, df = 18, p = 0.47). The chest radiography re-mains an important tool in the diagnosis of PTB and will continue to provide essential information for the management and follow-up of patients

Congenital Plasmodium falciparum malaria in sub-Saharan Africa: a rarity or frequent occurrence?

It is still debatable whether congenital Plasmodium falciparum malaria is a rarity or a frequent occurrence in sub-Saharan Africa. The objective of this report is to review scientific information and findings from investigations conducted in sub-Saharan Africa on the occurrence of congenital malaria to highlight the need for development of appropriate public health policy on prevention, care, treatment, and support activities. Studies conducted in sub-Saharan Africa within the last two decades (1986 to 2006) that investigated congenital or transplacental malaria were identified using the Medline-Entrez Pubmed search and systematically reviewed. References from selected publications obtained from a Google search were also used to identify additional relevant literature for the review. Five of the studies reviewed indicated that congenital malaria is a rare event in sub-Saharan Africa with prevalence ranging from 0% to 0.7% although maternal malaria parasitemia rates of between 24.8 and 54.4% were obtained. Nine other studies noted that congenital malaria was not uncommon, with prevalence reaching up to 37%. These studies also noted high frequency of neonatal peripheral parasitemia ranging from 4.0 to 46.7%. Congenital malaria should be suspected and investigated in babies whose mothers are parasitemic, particularly if the babies are febrile.

Potential for parasite and bacteria transmission by paper currency in Nigeria.

The authors assessed the potential of Nigerian currency notes to act as environmental vehicles for the transmission of pathogenic parasites and bacteria. Currency notes obtained from four major cities in Nigeria were evaluated according to standard techniques. Fifty-four (21.6 percent [95 percent CI: 16.50-26.70]) of the first batch of 250 notes, which underwent parasitological analysis, were contaminated with enteric parasites; 133 (53.2 percent [95 percent CI: 47.02-59.39]) of the second batch of 250 notes, which underwent bacteriological analysis, were found to be contaminated with bacteria. Parasites that were isolated from the notes included Ascaris lumbricoides (8.0 percent), Enterobius vermicularis (6.8 percent), Trichuris trichiura (2.8 percent), and Taenia species (4.0 percent). Bacteria that were isolated were Streptococcus species (21.6 percent), Staphylococcus species (12.8 percent), Escherichia coli (13.2 percent), and Bacillus species (5.6 percent). Among dirty/mutilated currency notes, parasite contamination and bacterial contamination were both significantly (p < .05) more pervasive (30.6 percent and 73.8 percent, respectively) than they were among clean and mint currency notes. Lower-denomination notes were more likely to be contaminated than were higher-denomination notes, although the difference was not statistically significant (p > .05). Parasite contamination and bacteria contamination were both most frequent in notes obtained from butchers and beggars. These results suggest that currency notes may be contaminated, especially with bacteria and enteric parasites, and may serve as sources of infection. Personal hygiene to reduce risk of infection is recommended.

Lassa fever in West African sub-region: an overview.

Lassa fever is an acute viral zoonotic illness caused by Lassa virus, an arenavirus known to be responsible for a severe haemorrhagic fever characterised by fever, muscle aches, sore throat, nausea, vomiting and, chest and abdominal pain. The virus exhibits persistent, asymptomatic infection with profuse urinary virus excretion in the ubiquitous rodent vector, Mastomys natalensis. Lassa fever is endemic in West Africa and has been reported from Sierra Leone, Guinea, Liberia, and Nigeria. Some studies indicate that 300,000 to 500,000 cases of Lassa fever and 5000 deaths occur yearly across West Africa. Studies reported in English, that investigated Lassa fever with reference to West Africa were identified using the Medline Entrez-PubMed search and were used for this review. The scarcity of resources available for health care delivery system and the political instability that characterise the West African countries would continue to impede efforts for the control of Lassa fever in the sub-region. There is need for adequate training of health care workers regarding diagnostics, intensive care of patients under isolation, contact tracing, adequate precautionary measures in handling infectious laboratory specimens, control of the vector as well as care and disposal of infectious waste.

Plasmodium falciparum malaria and ABO blood group: is there any relationship?

There is increasing evidence that Plasmodium falciparum malaria is influenced by ABO blood group but the extent of association between both is yet to be well defined. Studies that investigated association between P. falciparum malaria and ABO blood group were identified using MEDLINE search and were systematically reviewed. There were apparent discrepancies and contradictions in the studies as some reported significant association between both while others observed no significant association. This outcome may reflect the complex interaction between P. falciparum malaria and the host immune responses. However, findings from all studies reviewed suggested that individuals of blood group O are relatively resistant to severe disease caused by P. falciparum infection. It was established that parasitized erythrocytes form rosettes more readily with red blood cells (RBCs) of A, B, or AB groups than with blood group O and this parasite-triggered RBC rosette formation is associated with the severity of clinical disease and with the development of cerebral malaria. Differences in rosetting ability were based on the P. falciparum strain-specific preference of rosetting with non-O blood groups and not only a phenomenon of laboratory-propagated strains, but also exist in wild clinical isolates from all major malarious areas of the world.

Mandatory pre-marital HIV testing in Nigeria: the public health and social implications.

The prevalence of HIV infection among individuals referred from faith-based organizations (FBOs) in south-eastern Nigeria for mandatory pre-marital HIV screening was determined. Of the total of 319 individuals (148 males, 171 females) screened, 25 (7.8%, 95%CI: 4.9-10.7%) were confirmed HIV-positive, comprising 13 (8.8%, 95%CI: 4.2-13.4%) males and 12 (7%, 95%CI: 3.2-10.8%) females. No significant difference was observed in the association between HIV infection and gender (chi2=0.58, df = 1, P < 0.05). The highest prevalence of HIV infection (8.9%) was recorded among individuals in the 21-30 years age category, while the least HIV infection prevalence (5.3%) was observed among persons above 40 years old. There was no significant difference in the association between HIV infection and age (chi2=0.68, df = 3, P < 0.05). Mandatory pre-marital HIV screening could generate social stigmatization and infringement of the fundamental human rights of infected individuals. Voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing are more desirable. Guidelines for the management of test-positive individuals and non-concordant couples and the safeguarding of confidentiality should be developed. Training and capacity building for religious leaders, to appropriately manage social issues associated with HIV/AIDS as it affects their organizations, are recommended.

Seroprevalence of Toxoplasma gondii infection in Kwal, a rural distriction of Plateau-Nigeria.

Toxoplasma gondii infection has become a major public health concern in recent times due to the ravaging HIV/AIDS pandemic. The seroprevalence of T. gondii infection was determined in Kwal, a rural district of Plateau-Nigeria using IgG-ELISA. Epidemiological assessment was also conducted for the purpose of establishing the infection dynamics. Antibodies to T. gondii were detected in 30 (20.8%) of the 144 individuals studied. The prevalence of infection was slightly higher amongst the males (22.0%) than the females (20.0%), individuals of age group 21-30 years had the highest prevalence of 33.3% while the least (7.4%) occurred amongst the 41-50 years age group. No significant difference was noted (p < 0.05). The seroprevalence of Toxoplasma antibodies was significantly higher amongst individuals who handle/eat rodents (29.6%) and those who constantly had contact with soil (21.2%). These were the predominant risk factors of T. gondii infection in the area. Consequently, the infection occurred most amongst farmers (25.0%). This study contributes to the development of guidelines for the prevention and management of toxoplasmosis. Results were discussed in relation to the T. gondii epidemiological factors inherent within the population studied.

Prevalence and public-health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in south-eastern Nigeria.

HIV infection and anaemia are major public-health problems in Africa and are important factors associated with an increased risk of adverse pregnancy outcomes. The objective of this study was to determine the prevalence of HIV infection and anaemia among pregnant women attending antenatal clinics in southeastern Nigeria. To achieve this, a cross-sectional survey was conducted during July 2005-June 2006 using standard techniques. Of 815 pregnant women studied, 31 (3.8%, 95% confidence interval [CI] 2.5-5.1) were HIV-positive. Maternal age and gestational age were not associated with HIV infection (p > 0.05). The prevalence of anaemia (Hb < 11.0 g/dL) was 76.9%, and 15 (1.8%, 95% CI 0.9-2.7) had severe anaemia (Hb <7.0 g/dL). A significantly higher prevalence of anaemia was observed among individuals in their second pregnancy trimester (p < 0.05) and those infected with HIV (p < 0.05). Since HIV and anaemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of HIV infection and anaemia in pregnant women.

Public health implication of bacteriuria and antibiotic susceptibility of bacteria isolates in schistosoma haematobium-infected school pupils in Southeast Nigeria.

Schistosoma haematobium infection prevalence of 57% was observed among primary school pupils, with males more infected than females (60.3% vs. 49.5%). Light infection (78.9%) was higher than heavy infection (21.1%). Prevalence of bacteriuria was 88.4% in infected individuals. Escherichia coli (20.5%), Salmonella spp (16.1%), and Staphylococcus aureus (16.1%) were major isolates. A 100% bacterial susceptibility to ciprofloxacin and taravid, was observed and up to 100% resistance with tetracycline, cotrimoxazole and nitrofuratoin. Systematic schistosomicidal/antimicrobial treatment advocated.