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BACKGROUND: Carbapenem Resistant Enterobacterales (CRE) infections are increasingly associated with or directly responsible for morbidity and mortality from bacterial infections in sub-Saharan Africa where there are limited antibiotic options. CRE rectal colonization of patients in healthcare facilities provides a reservoir of these organisms and could potentially cause invasive infections in these settings. The prevalence of rectal carriage among patients attending healthcare facilities in Nigeria has not been previously described. We set out to assess the prevalence of rectal CRE carriage and their antibiotic susceptibility patterns among patients attending healthcare facilities in Nigeria. METHODS: A descriptive cross-sectional study was carried out from December 2021 to September 2022 in Ibadan, in which patients attending primary, secondary and tertiary healthcare facilities were screened for rectal carriage of CRE by microscopy, culture and sensitivity of rectal swab specimens. RESULTS: A total of 291 patients were screened; 45 (15.5%), 66 (22.7%) and 180 (61.8%) at primary, secondary and tertiary healthcare facilities, respectively. All but one of them had received a third-generation cephalosporin or carbapenem in the preceding 30 days. The mean age was 28.8 years and 55.7% were male. Overall, 51 (17.5%) participants had CRE colonization, with 5(11.1%), 9(13.6%) and 37(20.6%) at primary, secondary and tertiary healthcare facilities, respectively (p = 0.243). Regarding antimicrobial susceptibility, 43(84.3%) CRE isolates were resistant to at least 3 different classes of antibiotics while two Escherichia coli isolates were resistant to all 5 classes of antibiotics tested. The lowest rates of CRE resistance were to tigecycline (6, 11.5%) and colistin (8, 15.7%). CONCLUSIONS: In this first study on CRE colonization in Nigeria, we found that a substantial proportion of patients in three levels of healthcare facilities had rectal carriage of CRE, including pan-resistant isolates. Active surveillance and appropriate infection prevention and control practices (IPC) need to be urgently strengthened to mitigate the risk of active CRE infection. TRIAL REGISTRATION: Not applicable.
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Antibacterianos , Enterobacteriaceae Resistentes a los Carbapenémicos , Portador Sano , Infecciones por Enterobacteriaceae , Instituciones de Salud , Recto , Humanos , Nigeria/epidemiología , Masculino , Femenino , Adulto , Estudios Transversales , Recto/microbiología , Prevalencia , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Portador Sano/epidemiología , Portador Sano/microbiología , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Antibacterianos/farmacología , Adulto Joven , Persona de Mediana Edad , Adolescente , Pruebas de Sensibilidad Microbiana , Carbapenémicos/farmacologíaRESUMEN
BACKGROUND: Treatment options are limited for TB/HIV-coinfected children who require PI-based ART. Rifabutin is the preferred rifamycin for adults on PIs, but the one study evaluating rifabutin with PIs among children was stopped early due to severe neutropenia. METHODS: We evaluated rifabutin safety and plasma pharmacokinetics among coinfected children 3-15 years of age receiving rifabutin 2.5 mg/kg daily with standard doses of lopinavir/ritonavir. The AUC0-24 at 2, 4 and 8 weeks after rifabutin initiation was described using intensive sampling and non-compartmental analysis. Clinical and laboratory toxicities were intensively monitored at 12 visits throughout the study. RESULTS: Among 15 children with median (IQR) age 13.1 (10.9-14.0) years and weight 25.5 (22.3-30.5) kg, the median (IQR) rifabutin AUC0-24 was 5.21 (4.38-6.60) µg·h/mL. Four participants had AUC0-24 below 3.8 µg·h/mL (a target for the population average exposure) at week 2 and all had AUC0-24 higher than 3.8 µg·h/mL at the 4 and 8 week visits. Of 506 laboratory evaluations during rifabutin, grade 3 and grade 4 abnormalities occurred in 16 (3%) and 2 (0.4%) instances, respectively, involving 9 (60%) children. Specifically, grade 3 (n = 4) and grade 4 (n = 1) neutropenia resolved without treatment interruption or clinical sequelae in all patients. One child died at week 4 of HIV-related complications. CONCLUSIONS: In children, rifabutin 2.5 mg/kg daily achieved AUC0-24 comparable to adults and favourable HIV and TB treatment outcomes were observed. Severe neutropenia was relatively uncommon and improved with ongoing rifabutin therapy. These data support the use of rifabutin for TB/HIV-coinfected children who require lopinavir/ritonavir.
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Coinfección , Infecciones por VIH , Tuberculosis , Adolescente , Adulto , Niño , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Lopinavir/efectos adversos , Rifabutina/efectos adversos , Ritonavir/efectos adversos , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológicoRESUMEN
BACKGROUND: TB is the leading cause of death among HIV-infected children, yet treatment options for those who require PI-based ART are suboptimal. Rifabutin is the preferred rifamycin for adults on PI-based ART; only one study has evaluated its use among children on PIs and two of six children developed treatment-limiting neutropenia. METHODS: Since 2009, rifabutin has been available for HIV/TB-coinfected children requiring PI-based ART in the Harvard/APIN programme in Nigeria. We retrospectively analysed laboratory and clinical toxicities at baseline and during rifabutin therapy, and examined HIV/TB outcomes. RESULTS: Between 2009 and 2015, 48 children received rifabutin-containing TB therapy with PI (lopinavir/ritonavir)-based ART: 50% were female with a median (IQR) baseline age of 1.7 (0.9-5.0) years and a median (IQR) CD4+ cell percentage of 15% (9%-25%); 52% were ART experienced. Eighty-five percent completed the 6 month rifabutin course with resolution of TB symptoms and 79% were retained in care at 12 months. Adverse events (grade 1-4) were more common at baseline (27%) than during rifabutin treatment (15%) (Pâ=â0.006). Absolute neutrophil count was lower during rifabutin compared with baseline (medianâ=â1762 versus 2976 cells/mm3, respectively), but only one instance (2%) of grade 3 neutropenia occurred during rifabutin treatment. CONCLUSIONS: With clinical and laboratory monitoring, our data suggest that rifabutin is a safe option for TB therapy among children on PI-based ART. By contrast with the only other study of this combination in children, severe neutropenia was rare. Furthermore, outcomes from this cohort suggest that rifabutin is effective, and a novel option for children who require PI-based ART. Additional study of rifabutin plus PIs in children is urgently needed.
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Antibióticos Antituberculosos/uso terapéutico , Coinfección/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Lopinavir/uso terapéutico , Rifabutina/uso terapéutico , Ritonavir/uso terapéutico , Tuberculosis/tratamiento farmacológico , Antibióticos Antituberculosos/administración & dosificación , Antibióticos Antituberculosos/efectos adversos , Terapia Antirretroviral Altamente Activa , Biomarcadores , Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Infecciones por VIH/virología , Humanos , Masculino , Estudios Retrospectivos , Rifabutina/administración & dosificación , Rifabutina/efectos adversos , Resultado del Tratamiento , Tuberculosis/microbiologíaRESUMEN
The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital, Ibadan, Nigeria from 2006-2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital, Ibadan, Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients' demographic characteristics remained virtually the same over time, there was significant decline in the prevalence of baseline opportunistic infections (2006-2007=55.2%; 2011-2013=38.0%). Overall, 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex, HIV encephalopathy, low CD4 count (< 50 cells), and anaemia. To reduce early mortality, community education should be promoted, timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients.
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Infecciones por VIH/mortalidad , Adulto , Fármacos Anti-VIH/administración & dosificación , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Adulto JovenRESUMEN
Objectives: This study aims to provide lacking data on antibiotics and treatment strategies used in the management of carbapenem-resistant Enterobacteriaceae (CRE) infections in Nigeria. Methods: A cross-sectional study was carried out at the University College Hospital in Ibadan. CRE isolated from routine culture of specimens from hospitalized patients from December 2021 to September 2022 was identified. Treatment information and other data were collected from the patients' medical records. Results: The hospital laboratory isolated CRE from 55 patients during the study period and 27 (49.1%) of them had data available for the study. The most frequently isolated CRE was Klebsiella spp. (13 of 27, 48.1%). Of the 24 patients who received empiric antibiotics, only two (8.3%) of their CRE isolates were susceptible. After receiving culture results, 18 (66.7%) patients were treated with at least one antibiotic, to which resistance was documented. Only three (11.1%) patients overall commenced or remained on an antibiotic, to which their CRE isolate was susceptible. Conclusions: Despite culture data, we found a high prevalence of drug-pathogen mismatch in CRE treatment, including new or persistent use of antibiotics, to which resistance was documented. Antimicrobial stewardship efforts need to be strengthened to specifically address CRE treatment and effective antibiotics need to be made accessible.
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OBJECTIVE: To evaluate the performance of Xpert Mycobacterium Tuberculosis/rifampicin (MTB/RIF) Ultra (Ultra) for diagnosis of childhood tuberculosis (TB) within public health systems. METHODS: In this cross-sectional study, children aged <15 years with presumptive pulmonary TB were consecutively recruited and evaluated for TB at tertiary-level hospitals in Benin, Mali, and Ghana. Bivariate random-effects models were used to determine the pooled sensitivity and specificity of Ultra against culture. We also estimated its diagnostic yield against a composite microbiological reference standard (cMRS) of positive culture or Ultra. RESULTS: Overall, 193 children were included in the analyses with a median (interquartile range) age of 4.0 (1.1-9.2) years, 88 (45.6%) were female, and 36 (18.7%) were HIV-positive. Thirty-one (16.1%) children had confirmed TB, 39 (20.2%) had unconfirmed TB, and 123 (63.7%) had unlikely TB. The pooled sensitivity and specificity of Ultra verified by culture were 55.0% (95% confidence interval [CI]: 28.0-79.0%) and 95.0% (95% CI: 88.0-98.0%), respectively. Against the cMRS, the diagnostic yield of Ultra and culture were 67.7% (95% CI: 48.6-83.3%) and 70.9% (95% CI: 51.9-85.8%), respectively. CONCLUSION: Ultra has suboptimal sensitivity in children with TB that were investigated under routine conditions in tertiary-level hospitals in three West African countries.
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Antibióticos Antituberculosos , Mycobacterium tuberculosis , Tuberculosis , Niño , Femenino , Humanos , Masculino , Antibióticos Antituberculosos/farmacología , Antibióticos Antituberculosos/uso terapéutico , Estudios Transversales , Ghana/epidemiología , Mycobacterium tuberculosis/genética , Rifampin/farmacología , Rifampin/uso terapéutico , Sensibilidad y Especificidad , Esputo/microbiología , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/tratamiento farmacológicoRESUMEN
Publications on COVID-19's impact on the global tuberculosis burden are from adult cohorts, pediatric data are lacking for inform decision. We compared the TB trends in southern Nigerian children in the pre-COVID-19 and COVID-19 era. This was a retrospective, cross-sectional study of early morning sputum/gastric washing or stool samples from children with presumptive TB evaluated using GeneXpert in a tertiary hospital from January 2016 to May 2022. Of the 20 589 persons screened for presumed TB in the pre-COVID-19 and the COVID-19 era, only 1104 (88.7%) of 1245 children had complete data for analysis. In the COVID era, a significantly higher number of children were presumed to have TB 755 (68.4%), P < .001. The overall incidence of MTB detected by Xpert MTB/RIF during the study period was 6.4% (71/1104). The incidence of MTB in the pre-COVID-19 era was 24/349 (6.9%), which was slightly higher than the COVID-19 era (47/755; 6.2%), P > .05). The annual trends of MTB detected peaked in 2019 [18/115; 15.7%] in the pre-COVID-19 era, then plummeted to 12/228 (5.3%) in 2020 in the COVID-19 era, and reached its all-time low of 6/160 (3.8%) in the first half of 2022, (P < .001). The overall incidence of Rifampicin-resistant TB (RR-TB) was 2.8% among the MTB detected cases and all occurred in the COVID-19 era. This study found a significant decline in MTB diagnosis and in the emergence of RR-TB in the COVID-19 era. This necessitates re-prioritizing worldwide efforts to manage childhood tuberculosis, including increased testing, if the aim of eliminating tuberculosis by 2035 is to be met.
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Introduction: Diarrhoea can be debilitating in young children. Few aetiological investigations in Africans living with human immunodeficiency virus (HIV) have been performed since antiretrovirals became widely available. Methods: Stool specimens from children with diarrhoea living with HIV, and HIV-uninfected controls, recruited at two hospitals in Ibadan, Nigeria, were screened for parasites and occult blood, and cultured for bacteria. Following biochemical identification of at least five colonies per specimen, diarrhoeagenic Escherichia coli and Salmonella were confirmed by PCR. Data were line-listed and comparisons were made using Fisher's Exact test. Results: Only 10 children living with HIV could be enrolled during the 25-month study period and 55 HIV-uninfected children with diarrhoea were included for comparison. The most common pathogens overall were enteroaggregative E. coli (18/65, 27.7%), enteroinvasive E. coli (10/65, 15.4%), Cryptosporidium parvum (8/65, 12.3%) and Cyclospora cayetanensis (7/65, 10.8%). At least one pathogen was detected from seven of ten children living with HIV and 27 (49.1%) HIV-uninfected children. Parasite detection was associated with HIV positive status (p=0.03) with C. parvum specifically recovered more commonly from children living with HIV (p=0.01). Bacterial-parasite pathogen combinations were detected in specimens from four of ten children living with HIV but only 3(5.5%) HIV-uninfected children (p=0.009). Stools from five of ten children living with HIV and 7(12.7%) HIV-negative children (p = 0.014) contained occult blood. Discussion: Even though children living with HIV present infrequently to Ibadan health facilities with diarrhoea, their greater propensity for mixed and potentially invasive infections justifies prioritizing laboratory diagnosis of their stools.
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Criptosporidiosis , Cryptosporidium , Infecciones por VIH , Parásitos , Animales , Humanos , Niño , Lactante , Preescolar , Escherichia coli/genética , VIH , Nigeria/epidemiología , Diarrea/microbiología , Bacterias , Heces/microbiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiologíaRESUMEN
Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0-15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.
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Antibióticos Antituberculosos , COVID-19 , Infecciones por VIH , Mycobacterium tuberculosis , Tuberculosis , Masculino , Humanos , Niño , Preescolar , Femenino , Rifampin/farmacología , Rifampin/uso terapéutico , Mycobacterium tuberculosis/genética , Estudios Retrospectivos , Antibióticos Antituberculosos/farmacología , Antibióticos Antituberculosos/uso terapéutico , Pandemias , Farmacorresistencia Bacteriana , Sensibilidad y Especificidad , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Esputo/microbiología , Prueba de COVID-19RESUMEN
A retrospective study of 2764 patients was conducted at an HIV clinic in Nigeria to evaluate retention in care in patients treated for TB. At 6 and 12 months after commencement of TB treatment, 1842(66.6%) and 1624(58.8%) participants remained in care. Of the 922 and 1140 not in care at 6 and 12 months, 814(88.3%) and 1006(88.2%) respectively were lost to follow-up (LTFU). VL < 1000copies/ml was associated with higher odds of retention in care at 6 and 12 months (OR = 2.351 and 2.393) than VL > 1000 copies/ml. HAART use was associated with high likelihood of being in care at 12 months (OR = 3.980). CD4 counts of 200-350 and >350 cells/mm3 were associated with increased odds of remaining in care at 12 months compared with CD4 < 200 cells/mm3 (p = 0.005 and p = 0.001). Targeted interventions such as early HAART and close follow-up for high risk groups are likely to improve retention in care.
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Infecciones por VIH , Retención en el Cuidado , Tuberculosis , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Nigeria/epidemiología , Estudios Retrospectivos , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiologíaRESUMEN
Introduction: Alterations in blood glucose levels are common and an important determinant of a patient's admission outcomes, point-of-care glucometers, which are affected by a variety of factors, are increasingly used in clinical care. In this study we compared blood glucose levels determined by two commonly used glucometers (One Touch® and Accu-check®) with those of a standard laboratory method and determined the effect of haematocrit on glucose readings. Methods: Blood glucose levels were measured with One Touch® and Accu-Check® glucometers and the glucose oxidase method at the same time in 295 children aged 0 to 15 years over a 6-month period. Bland-Altman and correlation analysis were used to explore biases among the three methods. For all statistical tests, a p-value of less than 0.05 was considered statistically significant. Results: Most were males (51.2%) and the median (range) age was 1 year (1 day, 12 years). There was a significant correlation between each of the glucometer methods and laboratory blood sugar, and the correlation between the two glucometers was strong and significant. This correlation remained statistically significant even after controlling for haematocrit values. There was an acceptable level of bias (3.9 mg/dL) between the One Touch® and Accu-check® glucometers, but each had a remarkably large bias compared with the glucose oxidase method. Conclusion: The use of a tested glucometer in clinical settings can aid in rapid decision-making, but there is a need to periodically cross-check with the glucose oxidase method in the laboratory to optimise treatment outcomes for children with dysglycaemia.
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Background: Vaccination has been described as the most critical tool to end the COVID-19 pandemic and to save lives and livelihoods. This study aimed to evaluate the spectrum of adverse events following immunization with the COVID-19 AstraZeneca/Oxford vaccine in Ibadan, southwestern Nigeria. Methodology: A cross-sectional study. Adults aged ≥ 18 years who had received the Astra-Zeneca/Oxford COVID-19 vaccine at selected COVID-19 vaccination centres across three Local Government Areas in Ibadan, SW Nigeria were interviewed by means of a structured questionnaire to determine the spectrum of adverse events following immunisation (AEFI). Results: We enrolled 369 adults; 179 males and 190 females, with a mean of age of 37.8 ±12.0 years. Three hundred and thirty-two (90.0%) of the subjects experienced one or more AEFI. Of the total AEFIs reported, the most frequent were headache 225 (21.1%), fatigue/tiredness 186 (17.4%), pain at the injection site 99 (9.3%) and myalgia 97(9.1%). Nine in ten (96.4%) of these AEFIs occurred within 48 hours post-vaccination. Higher severity of adverse events score (p=0.049) and multiple AEFIs (p=0.01) were associated with the first dose of the vaccine. There were severe AEFI in 1.2 % (95% CI: 0.3-.9.0%) of the respondents. Presumed or confirmed COVID 19 infection before vaccination increased the odds of AEFI (OR 7.0, 95% CI: 1.8-27.8). Conclusion: Our study showed a high frequency of AEFI among recipients of the Astra Zenecca/Oxford vaccine in Ibadan. Majority of the AEFIs are mild and self-limiting. Previous infection with COVID-19 appears to increase the risk of AEFI.
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Background: The COVID 19 pandemic has had its impact on tuberculosis notification, incidence, and management, particularly in the context of rifampicin-resistant TB. We set out to determine the trends in rifampicin resistant tuberculosis between the pre-COVID and COVID era in a resource-constrained setting. Methods: This was a retrospective review of single early morning sputum from presumed tuberculosis between January 2016 and May 2022 in a regional TB referral and treatment centre in South-western, Nigeria. We used a molecular beacon to detect Mycobacterium tuberculosis (MTB) and mutations in the rpoB gene using a real-time polymerase chain reaction (PCR). Results: We analyzed 19,892 of 20,589 presumptive TB with complete data. Most subjects were in the age group 18-45 years (10,594; 53.3 %) and were males (11,492; 57.8 %). Of the 19,892 presumptive TB, 4,526 (22.8 %) were in pre-COVID-19 era (Jan 2016-December 2019) and 15,366 (77.2 %) cases were in COVID-19 era (Jan 2020-May 2022). The MTB notification declined during the COVID-19 era compared with the pre-COVID-19 era (10.5 % vs 12.9 %, p < 0.001). The annual prevalence of MTB rose from 5.6 % (2016) to a peak of 23.2 % in 2019 (pre-COVID-19 era), followed by a decline to 12.8 % in 2020 and 8.6 % in 2022 (COVID-19 era), p = <0.001). The overall incidence of RR-TB was 3.8 %. The incidence of RR was higher during pre-COVID-19 than the COVID-19 era, 9.5 % vs 2.5 %, p = <0.001. The incidence of RR-TB declined substantially from 28.0 % in 2016 to 1.6 % in 2021 but rose exponentially to 5.4 % in 2022. After controlling for confounders, only the pre-COVID-19 status was associated with increased odds for RR (adjusted odds ratio 3.3, 95 % confidence interval, 2.049, 5.421). Conclusion: This study found a progressive decline in MTB notification since the COVID-19 pandemic's outbreak. Furthermore, RR-TB notification decreased gradually in the pre-COVID-19 era, with a resurgence in 2022. In the era of COVID-19, there is an urgent need to increase intervention efforts in order to halt the decline in MTB detection rates and the resurgence of RR-TB.
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Introduction: the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored. Methods: using a cross sectional survey, a pre-tested and validated questionnaire on a "Google form" was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test. Results: among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH. Conclusion: vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.
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Vacunas contra la COVID-19 , COVID-19 , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Estudios Transversales , Femenino , Humanos , Masculino , Nigeria/epidemiología , Vacilación a la VacunaciónRESUMEN
BACKGROUND: Discharged against medical advice (DAMA) is a risk factor that often leads to adverse outcomes and hospital readmissions in neonatal units. A few studies have shown that spiritual/faith-based interventions (FBIs) tend to have a lower incidence of DAMA compared with public hospitals. Perhaps, a holistic approach to patient care that addresses the spiritual needs, the soul and the body component of a being in this setting may account for the observed lower incidence of DAMA. Limited randomized control trials (RCTs) exist on FBIs with regard to DAMA in the published literature. This study seeks to compare the effectiveness of FBI, social support, religiosity, and types of FBI on neonatal DAMA against standard of care in tertiary hospitals in Nigeria. METHODS: This RCT will be conducted in two public tertiary teaching hospitals in two of the six geopolitical zones in Nigeria. The sociodemographic and clinical details of all patients admitted to the neonatal wards during the study period will be documented. Study participants will be selected through a multistage sampling technique. Subjects will be randomized and allocated to treatment and control arms having the established baseline measure of social support and religiosity. Ethical approval was obtained from the State Research Ethics Review Committee. A written informed consent will be obtained from the parents/caregivers prior to patient enrolment. The study will be conducted in line with the Declaration of Hesinki 2000. Appropriate statistical tools will be used for data collection and analysis. DISCUSSION: The outcome of this analysis will give insights into the effectiveness of FBI on DAMA. It will also predict the effect of the mediators of parents/caregivers' religiosity, spirituality, forms of FBI, the religious sect of parents/caregivers, and social support on the rate of DAMA on neonatal admission in tertiary hospitals in Nigeria. This could help Public Health Institutions and Governments make decisions about the determinants of neonatal DAMA and how to mitigate such outcomes. It is hoped that the evidence from this study may guide policy formulation and guidelines on enhancing hospital retention of sick neonates until they are fit for discharge. TRIAL REGISTRATION: This study was registered at the Pan Africa Clinical Trial Registry (PACTR202102670906630).
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Consejo , Alta del Paciente , Hospitalización , Humanos , Recién Nacido , Nigeria , Padres , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
INTRODUCTION: There are few studies describing colonisation with extended spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE) among children in sub-Saharan Africa. Colonisation often precedes infection and multi-drug-resistant Enterobacterales are important causes of invasive infection. METHODS: In this prospective cross-sectional study, conducted between April and June 2017, 200 children in a tertiary academic hospital were screened by rectal swab for EBSL-PE and CRE. The resistance-conferring genes were identified using polymerase chain reaction technology. Risk factors for colonisation were also evaluated. RESULTS: Overall, 48% (96/200) of the children were colonised with at least one ESBL-PE, 8.3% (8/96) of these with 2 ESBL-PE, and one other child was colonised with a CRE (0.5% (1/200)). Common colonising ESBL-PE were Klebsiella pneumoniae (62.5%, 65/104) and Escherichia coli (34.6%, 36/104). The most frequent ESBL-conferring gene was blaCTX-M in 95% (76/80) of the isolates. No resistance- conferring gene was identified in the CRE isolate (Enterobacter cloacae). Most of the Klebsiella pneumoniae isolates were susceptible to piperacillin/tazobactam (86.2%) and amikacin (63.9%). Similarly, 94.4% and 97.2% of the Escherichia coli isolates were susceptible to piperacillin/tazobactam and amikacin, respectively. Hospitalisation for more than 7 days before study enrolment was associated with ESBL-PE colonisation. CONCLUSION: Approximately half of the hospitalised children in this study were colonised with ESBL-PE. This highlights the need for improved infection prevention and control practices to limit the dissemination of these microorganisms.
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Antibacterianos/farmacología , Proteínas Bacterianas/genética , Infección Hospitalaria/diagnóstico por imagen , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/clasificación , beta-Lactamasas/genética , Proteínas Bacterianas/metabolismo , Niño , Preescolar , Infección Hospitalaria/microbiología , Estudios Transversales , Farmacorresistencia Bacteriana Múltiple , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Femenino , Hospitalización , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos , Factores de Riesgo , Sudáfrica , Centros de Atención Terciaria , beta-Lactamasas/metabolismoRESUMEN
The burden of severe hearing impairment is increasing with two-thirds of these hearing impaired people residing in developing countries. Newborn hearing screening helps to identify early, babies who need intervention in order to prevent future disability. Neither universal nor targeted hearing screening programme is available in Nigeria. Objectives: This study was carried out to assess the prevalence of hearing impairment among high-risk newborns in UCH and the associated risk factors. Materials and Methods: Two hundred one newborns in the neonatal unit of UCH with risk factors for hearing impairment had hearing screening done using automated auditory brainstem response (AABR) at 30, 45, and 70 dB at admission and discharge, and those that failed screening at discharge were rescreened at 6 weeks post-discharge. Results: Eighty-three (41.3%) and 32 (15.9%) high-risk newborns failed at admission and discharge screening respectively, and 19 (9.5%) still failed at follow up screening. The majority of hearing loss at follow up was bilateral (94.7%) and severe (52.6%). The risk factors associated with persistent hearing loss at follow up were acute bilirubin encephalopathy (RR = 11.2, CI: 1.4-90.6), IVH (RR = 8.8, CI: 1.1-71.8), meningitis (RR = 4.8, CI: 1.01-29), recurrent apnoea (RR = 2.7, CI: 1.01-7.3), severe perinatal asphyxia NNE III (RR = 7, CI: 2.4-20.2). Conclusion: Severe and bilateral hearing impairment is a common complication among high risk newborns in UCH persisting till 6 weeks post-neonatal care. Severe perinatal asphyxia with NNE III, ABE, IVH, meningitis and administration of amikacin for more than 5 days were significant risk factors. We recommend that SCBU graduates with these risk factors should have mandatory audiologic evaluation at discharge.
RESUMEN
INTRODUCTION: This study describes the epidemiologic features and clinical course of children with blood transfusion-associated HIV infection (TAHI) in Ibadan, Nigeria. METHODOLOGY: All children diagnosed to have TAHI at the University College Hospital, Ibadan, were studied and compared with children who acquired HIV vertically using the pediatric HIV database in the hospital. RESULTS: Transfusion-associated HIV infection accounted for 14 (2.3%) of the 597 children diagnosed to have HIV infection between January 2004 and December 2011. The mean age at diagnosis of TAHI was 10.2 years and that of vertically acquired HIV infection was 3.9 years ( P < .001). In 9 cases, blood transfusion took place in private hospitals and in 5 cases in public hospitals. Median interval between infection and diagnosis of AIDS was 84 months in cases with TAHI and 48 months in vertically acquired cases ( P = .542). CONCLUSION: Optimal blood safety practices are advocated for prevention of TAHI in Nigeria.
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Infecciones por VIH/transmisión , Reacción a la Transfusión/epidemiología , Adolescente , Seguridad de la Sangre , Transfusión Sanguínea/estadística & datos numéricos , Niño , Preescolar , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Nigeria/epidemiologíaRESUMEN
BACKGROUND: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. OBJECTIVES: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. METHODS: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. RESULTS: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). CONCLUSION: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.