AIDS mortality in a tertiary health institution: A four-year review

Africa contains 70% of adults and 80% of children living with AIDS in the world and has buried 75% of the 21.8 million worldwide who have died of AIDS since the epidemic began. Nigeria, the most populous country in Africa, has 5.8% of her adult population having HIV infection at the end of 2003. We reviewed the causes of death among AIDS patients in Aminu Kano Teaching Hospital Kano, Nigeria over four years. Four-hundred-fifty-five (9.9%) of the 4,574 adult medical admissions were due to HIV/AIDS-related diagnosis. HIV/AIDS admissions increased progressively from 45 cases in 2001 to 174 in 2004. HIV/AIDS caused 176 deaths over the period giving an HIV-related mortality of 38.7%. This also showed a gradual increase from 24 deaths in 2001 to 61 deaths in 2004. The most common causes of death were tuberculosis (33.4%), septicemia (23.8%), advanced HIV disease (9.1%), meningitis (7.4%), other pulmonary infections (5.1%) and Kaposi's sarcoma (4.5%). The present dismal situation of patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed. With the introduction of affordable highly active antiretroviral therapy (HAART) in several centers in Nigeria, it is hoped that infected patients can be made to live longer.     

Waiting time for emergency abdominal surgery in Zaria,Nigeria

Background

Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention.

Patients and Method

We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted.

Results

There were 488 patients, mean age 32 ±1.7SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 ± 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay.

Conclusion

Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.     

Ocular immunity to Staphylococcus aureus

Staphylococcus aureus is an important cause of infectious disease of the eye and hypersensitivity lesions of the cornea including phlyctenules and catarrhal infiltrates. Because little is known about ocular immunity to S. aureus, we measured antibody levels to ribitol teichoic acid, the major antigenic determinant of S. aureus, in rabbit serum and tears using an enzyme-linked immunosorbent assay after immunization with S. aureus antigens using the following routes: intradermal injection of cell wall mixed with complete Freund's adjuvant, subconjunctival injection of cell wall mixed with complete Freund's adjuvant, topical application of cell wall to the eye, and topical application of viable S. aureus to the eye. All four immunization groups showed an IgG antibody response to ribitol teichoic acid in serum and tears with the highest titers in serum found after intradermal immunization with cell wall and the highest titers in tears found after topical application of S. aureus. All four immunization routes showed an IgA antibody response to ribitol teichoic acid in tears with the highest titers found after subconjunctival immunization with cell wall. There was no IgA response to ribitol teichoic acid in serum in any group. The results of this study suggest that ocular immune responses to S. aureus may be influenced by exposure to staphylococcal antigens not only in the external eye but also at sites remote from the eye.     

Polymorphonuclear neutrophil chemotaxis induced and inhibited by Bacteroides spp.

A possible virulence factor for Bacteroides subcutaneous abscesses has been found. The effect of Bacteroides culture filtrate and outer membrane on chemotaxis of rabbit peritoneal polymorphonuclear (PMN) neutrophils was assayed in Boyden chambers and via exocytosis of N-acetyl-beta-glucosaminidase. Both Bacteroides culture filtrate and outer membrane elicited some chemotaxis, as measured in the Boyden chamber; however, they had little effect upon exocytosis in cytochalasin B-treated PMN neutrophils. In the presence of serum complement, they completely abolished PMN neutrophil movement in the Boyden chamber assay, yet they gave a definite positive response for the exocytosis assay in the presence of serum complement or activated complement fragment.     

Assessment of unmet needs to address noncompliant households during polio supplemental immunization activities in Kaduna state, 2014–2016

Background

Despite concerted global efforts being made to eradicate poliomyelitis, the wild poliovirus still circulates in three countries, including Nigeria. In addition, Nigeria experiences occasional outbreaks of the circulating vaccine-derived poliovirus type 2 (cVDPV2). Vaccine rejection by caregivers persists in some parts of northern Nigeria, which compromises the quality of supplemental immunization activities (SIAs). In 2013, the Expert Review Committee (ERC) on polio recommended innovative interventions in all high-risk northern states to improve the quality of SIA rounds through innovative interventions. The study assessed the impact of using unmet needs data to develop effective strategies to address noncompliant households in 13 high-risk Local government areas (LGAs) in Kaduna state, Nigeria.

Methods

A retrospective study was conducted in noncompliant communities using unmet needs data collated from 2014 to 2016. Household-based noncompliance data collated from tally sheets between 2013 and 2016 was also analyzed to assess the impact of unmet needs data in addressing noncompliance households in high-risk communities in Kaduna state. A structured interview was used to interview caregivers by the application of an unmet needs questionnaire, a quantitative study that assesses caregiver perception on immunization and other unmet needs which, if the gaps were addressed, would allow them to accept immunization services. Interventions include siting of temporary health camps in noncompliant communities to provide free medical consultations, treatment of minor ailments, provision of free antimalaria drugs and other essential drugs, and also referral of serious cases; intervention of religious and traditional leaders, youth against polio intervention, and the use of attractive bonuses (sweets, balloons, milk) during SIAs were all innovations applied to reduce noncompliance in households in affected communities as the need for eradication of polio was declared as a state of emergency. Outcomes from the analyses of unmet needs data were used to direct specific interventions to certain areas where they will be more effective in reducing the number of noncompliant households recorded on the tally sheet in each SIA round. Hence, seven immunization parameters were assessed from the unmet needs data.

Results

Overall, 54% of the noncompliant caregivers interviewed were ready to support immunization services in their communities. The majority of caregivers were also willing to vaccinate their children publicly following unmet needs interventions that were conducted in noncompliant communities. The trend of noncompliant households decreased by 79% from 16,331 in September 2013 to 3394 in May 2016.

Conclusions

Unmet needs interventions were effective in reducing the number of noncompliant households recorded during SIA rounds in Kaduna State. Hence, unmet needs intervention could be adapted at all levels to address challenges faced in other primary healthcare programs in Nigeria.

     

Environmental,economic and socio-cultural risk factors of recurrent seasonal epidemics of cerebrospinal meningitis in Kebbi state,northwestern Nigeria: a qualitative approach

Background

Kebbi State remains the epicentre of the seasonal epidemic meningitis in northwestern Nigeria despite interventions. In this setting, no previous study has been conducted to understand the risk factors of the recurrent meningitis epidemics using qualitative approach. Consequently, this study intends to explore and better understand the environmental, economic and socio-cultural factors of recurrent seasonal epidemic meninigitis using a qualitative approach.

Methods

We conducted in-depth interview (40 IDIs) and focus group discussions (6 FGDs) in two local government areas (LGAs) in Kebbi State, Northwestern Nigeria to understand the environmental, economic and socio-cultural factors of recurrent meningitis outbreaks. Routine surveillance data were used to guide the selection of settlements, wards and local government areas based on the frequency of re-occurrences and magnitude of the outbreaks.

Results

The discussions revealed certain elements capable of potentiating the recurrence of seasonal meningitis epidemics. These are environmental issues, such as poorly-designed built environment, crowded sleeping and poorly ventilated rooms, dry and dusty weather condition. Other elements were economic challenges, such as poor household living conditions, neighbourhood deprivation, and socio-cultural elements, such as poor healthcare seeking behaviour, social mixing patterns, inadequate vaccination and vaccine hesitancy.

Conclusion

As suggested by participants, there are potential environmental, socio-cultural and economic factors in the study area that might have been driving recurrent epidemics of cerebrospinal meningitis. In a bid to addressing this perennial challenge, governments at various levels supported by health development partners such as the World Health Organisation (WHO), United Nation Habitat, and United National Development Programme can use the findings of this study to design policies and programmes targeting these factors towards complementing other preventive and control strategies.

     

Towards an effective poliovirus laboratory containment strategy in Nigeria

Background

The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world free of wild poliovirus transmission when no wild virus has been found in at least 3 consecutive years, and all laboratories possessing wild poliovirus materials have adopted appropriate measures of containment. Nigeria has made progress towards poliomyelitis eradication with the latest reported WPV type 1 on 21 Aug 2016 after 2?years without any case. This milestone achievement was followed by an inventory of biomedical laboratories completed in November 2015 with the destruction of all identified infectious materials. This paper seeks to describe the poliovirus laboratory containment process in Nigeria on which an effective containment system has been built to minimize the risk of virus re-introduction into the population from the laboratories.

Methods

A national survey of all biomedical facilities, as well as an inventory of laboratories from various sectors, was conducted from June–November 2015. National Task Force (NTF) members and staff working on polio administered an on-site questionnaire in each facility. Laboratory personnel were sensitized with all un-needed materials destroyed by autoclaving and incineration. All stakeholders were also sensitized to continue the destruction of such materials as a requirement for phase one activities.

Results

A total of 20,638 biomedical facilities were surveyed with 9575 having laboratories. Thirty laboratories were found to contain poliovirus or potentially infectious materials. The 30 laboratories belonged to the ministries of health, education, defence and private organizations.

Conclusions

This article is amongst the first in Africa that relates poliovirus laboratory containment in the context of the tOPV-bOPV switch in alignment with the Global Action Plan III. All identified infectious materials were destroyed and personnel trained to continue to destroy subsequent materials, a process that needs meticulous monitoring to mitigate the risk of poliovirus re-introduction to the population.

     

Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study

BackgroundBreast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia.Patients and MethodsA 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant.ResultsOverall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91).ConclusionThe majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.