Particulate Matter (PM2.5) Characterization, Air Quality Level and Origin of Air Masses in an Urban Background in Pretoria.

Several sources have been identified as contributing to the concentration of ambient fine particulate matter, which has been associated to a variety of health issues. The chemical characteristics and sources of trace elements in PM2.5, as well as the air quality index, were investigated in this study. Twenty four-hour fine aerosol particles were collected in an urban area in Pretoria, South Africa, from April 2017 to April 2018. Eighteen trace elements were determined using an XEPOS 5 energy-dispersive X-ray fluorescence (EDXRF) spectrometer, while black and organic carbon were estimated using an optical transmissometer from the samples collected. The HYPLIT model (version 4.9) was used to estimate air mass trajectories. Health risk was calculated by comparing it to the World Health Organization's air quality index (AQI). The overall mean PM2.5 concentration of the collected sample equals 21 µg/m3. Majority of PM2.5 exceedances were reported during mid-autumn and winter seasons, as compared to daily WHO guidelines and South African standards. S had the highest concentrations, greater than 1 µg/m3. Ni, Se, Br and Sb showed they were extremely enriched, (EF > 10) and suggestive of anthropogenic or non crustal origin The 24-h PM, soot, BC and OC were significantly different by the geographical origin of air masses (p < 0.05). The AQI showed that 70% of the samples showed levels above the AQI range of good and healthy air. The findings include details on the concentration, composition, and potential sources of fine PM2.5, which is essential for policy formulation and mitigation strategies in South Africa's fight against air pollution.

Source apportionment of fine atmospheric particles using positive matrix factorization in Pretoria, South Africa.

In Pretoria South Africa, we looked into the origins of fine particulate matter (PM2.5), based on 1-year sampling campaign carried out between April 18, 2017, and April 17, 2018. The average PM2.5 concentration was 21.1 ± 15.0 µg/m3 (range 0.7-66.8 µg/m3), with winter being the highest and summer being the lowest. The XEPOS 5 energy dispersive X-ray fluorescence (EDXRF) spectroscopy was used for elemental analysis, and the US EPA PMF 5.0 program was used for source apportionment. The sources identified include fossil fuel combustion, soil dust, secondary sulphur, vehicle exhaust, road traffic, base metal/pyrometallurgical, and coal burning. Coal burning and secondary sulphur were significantly higher in winter and contributed more than 50% of PM2.5 sources. The HYSPLIT model was used to calculate the air mass trajectories (version 4.9). During the 1-year research cycle, five transportation clusters were established: North Limpopo (NLP), Eastern Inland (EI), Short-Indian Ocean (SIO), Long-Indian Ocean (LIO), and South Westerly-Atlantic Ocean (SWA). Local and transboundary origin accounted for 85%, while 15% were long-range transport. Due to various anthropogenic activities such as biomass burning and coal mining, NLP clusters were the key source of emissions adding to the city's PM rate. In Pretoria, the main possible source regions of PM2.5 were discovered to be NLP and EI. Effective control strategies designed at reducing secondary sulphur, coal burning, and fossil fuel combustion emissions at Southern African level and local combustion sources would be an important measure to combat the reduction of ambient PM2.5 pollution in Pretoria.

Clonal diversity and spatial dissemination of multi-antibiotics resistant Staphylococcus aureus pathotypes in Southwest Nigeria.

Spread of genetically diverse Staphylococcus aureus characterized with multi-antibiotic resistance and regulated by high level agr functionalities in several communities in southwest Nigeria was investigated and evaluated for infection control. Staphylococcus aureus pathotypes recovered from 256 cases including purulent pus from skin infections, soft tissue aspirates, wounds, otorrhea, eye, throat and endocervical infections were assayed for biofilm and antibiogram. Further genotyped with micro-array, mapped for geospatial distribution and evaluated for clonal diversity and functional accessory gene regulators (agr). Significant Staphylococci infection among the ages (OR:0.021, CI:0.545-1.914) and female gender with prevalence rate of MSSA (53.0%) and MRSA (1.5%) (OR:1.021, CI:0.374-1.785) were observed. More than 52.5% resistance rates to tetracycline and amoxicillin with significant median resistance were observed in all the infection cases (p = 0.001). Resistance rate of 78.8% at MIC50 32µg/ml and MIC90 128µg/ml to amoxicillin-clavulanate, and more than 40% resistance to ceftazidime, ciprofloxacin and tetracycline of MIC90 and MIC50 at 32 µg/ml were observed. Strains with multi-antibiotic resistance index above 0.83, high beta-lactamase and strong biofilm clustered into separate phylo-group. Heterogeneous t442 (wound and pus), t657 (wound), t091 (ear) and t657 (ear and wound) revealed high phylogenetic diversity. Only 4.6% pvl+ MSSA-CC1 agrI, pvl+ MSSA-CC5 (13.6%) and pvl+ MRSA-CC7 agrII (4.6%), expressed enterotoxin, leukocidins, proteases and resistance gene determinants. Livestock clonal types clustered with identified community-associated strains. Clonal dissemination of resistant pvl+ MSSA-CC1 and MRSA-CC5 encoding agr were predominant in several peri-urban communities where adequate geno-surveillance, population-target antimicrobial stewardship, extensive community structured infection control programs are needed to prevent further focal dissemination.

Active management of third stage of labor: evidence versus practice.

OBJECTIVE: To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to these definitions) with those who did not. DESIGN: Observational, cross-sectional survey. SETTING: Seven tertiary centers in southwest Nigeria. POPULATION: Women undergoing non-instrumental vaginal deliveries. METHODS: Prospective direct observations of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations. Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor. RESULTS: There was a high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL according to the ICM/FIGO definition and those who did not. CONCLUSIONS: The survey reveals substantial definition-dependent variation in the providers' adherence to recommended AMTSL practices. The clinical implications of the current practice in this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative effectiveness in the prevention of PPH.

Active management of third stage of labour: a survey of providers' knowledge in southwest Nigeria.

BACKGROUND: The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers' knowledge on the subject. OBJECTIVE: To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL. METHODS: Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria. RESULTS: Female nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19-6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21-5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05-0.39), matron (adjusted OR: 0.25; CI 0.08-0.79) or intern (adjusted OR: 0.07; CI 0.01-0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL. CONCLUSION: AMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners' adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.

Contraception usage among young adult men of a Nigerian university.

Background Family planning services recognize reproductive health as the joint responsibility of both men and women. Efforts need to be shifted to men's own sexual health in order to achieve the Millennium Development Goals (MDGs) for reduction of maternal mortality and HIV transmission. Aims To determine the methods of contraception used by young adult men and factors that influence their choice of contraceptive. Methodology A cross-sectional descriptive study was done using structured questionnaires to extract relevant information from consented young male adult between ages of 16 and 24 years of Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Nigeria. Data was coded using Microsoft Excel and was analyzed using the SPSS version 17. Results The majority of the respondents 212 (71.6%) had had sexual intercourse. Mean age at first sexual debut was 17.8 ± 2.5 years. The majority of the respondents 124 (58.5%) did not use any contraceptives during their first sexual experience and over 1/5th (21.2%) of respondents had impregnated a partner in the past with the majority, 39 (86.7%) of such pregnancies resulting in an induced abortion. Frequency of religious services attendance showed a statistically significant difference with respondents that were sexually active or had previous sex (p < 0.001). Conclusion Male involvement and education about contraceptive methods, use and consistency of contraception could have a drastic reduction in unwanted pregnancies and also a reduction in abortion complications.

Contraceptive prevalence and determinants among women of reproductive age group in Ogbomoso, Oyo State, Nigeria.

BACKGROUND: The fertility rate in Nigeria is 5.7 children per woman. The contraceptive prevalence rate has been found to be low at 15% in 2013, compared to other countries such as the US and Pakistan. OBJECTIVE: The study aimed to assess the contraceptive prevalence among women of reproductive age in Ogbomoso town, and determinants of use, with a view to make appropriate recommendations that will enhance the uptake of family planning services. MATERIALS AND METHODS: This is a descriptive cross-sectional study conducted with 560 respondents, using a multistage sampling technique. Data were retrieved using a semi-structured, pretested questionnaire. RESULTS: All the respondents were aware of contraception; however, only 49.7% (271) had ever used any method, while 25.4% (69) of the number who had ever used contraception were currently using a method. The methods being used were the traditional type (four [5.9%]), natural type (two [3.0%]), and modern type (63 [91.1%]). The predictors of contraception use included the age group of 40-49 years (odds ratio [OR] 14.1; confidence interval [CI] 3.06-73.24; P=0.0001); the married women were approximately four times more likely to use contraception than the single women (OR 4.5; CI 3.03-6.72; P<0.0001). The women with tertiary level of education were three times more likely to use contraception than those without formal education (OR 3.1; CI 1.13-9.95; P=0.0268), and the odds ratio of respondents with a positive attitude to using contraception more than those with negative attitude was 2 (OR 2; CI 1.41-2.91; P<0.0001). CONCLUSION: In light of the advantages associated with contraception use, there needs to be a conscious effort, especially among health care workers, to educate women about contraception and encourage its use.

The Prevalence, Risk Factors and Changes in Symptoms of Self Reported Asthma, Rhinitis and Eczema Among Pregnant Women in Ogbomoso, Nigeria.

BACKGROUND: Allergic disorders have become a major public health concern worldwide. No Nigerian study has examined the epidemiology of allergic diseases among women. AIM: To document the prevalence, risk factors and the changes in the symptoms of allergic disorders during pregnancy. SETTINGS AND DESIGN: Cross-sectional study conducted at the booking and antenatal clinics of LAUTECH Teaching Hospital and Millennium Development Goals (MDG) Clinic of the Comprehensive Health Center, Oja Igbo, Ogbomoso, Nigeria. MATERIALS AND METHODS: Study enrolled 432 women from two public hospitals. Sociodemographic and clinical history were obtained and allergic disorders were diagnosed using ISAAC questionnaires. RESULTS: The prevalence of wheezing, eczema and rhinitis in pregnancy are 7.5%, 4.0% and 5.8% respectively. The prevalence of wheezing and eczema was slightly higher among the pregnant in past 12 months. Wheeze worsened in 70% (18/26), improved in 15% (2/26), and stable in 15% (2/26). Eczema worsened in 50% (7/14), improved in 7.1% (1/14) and stable in 42.9% (6/14), while allergic rhinitis worsened in 50% (11/22), improved in 22.7% (5/22) and stabilized in 27.3 % (6/22). In multivariate analysis, the risk of allergic diseases in pregnancy was increase 2 times by low income earning (CI: 1.2 - 2.1, p = 0.002), low level education (OR = 0.6, CI: 0.3 - 0.9, p = 0.011) and by family history of asthma, OR-4.3, CI - 1.3 - 13.9, p = 0.015. Family history of asthma increase the chances of asthma by 18.7 times, CI-2.3 - 152.2, p = 0.006, while the odd of eczema was increased 9.1 times (CI-2.7 - 30.6, p<0.001) and 2.4 times (CI: 1.2 - 4.7, p = 0.008) by second hand home smoking and low-family income respectively. The risk of allergic rhinitis were raised 1.8 times by low family income (CI 1.1 - 2.8, p = 0.013) and 3.9 times by family history of rhinitis (OR = 3.9, CI 1.2 - 12.7, p = 0.024). CONCLUSION: Prevalence of wheezing and eczema are higher in pregnancy probably due to exacerbation induced by pregnancy. Social and genetic factors are important risk factors for allergic disorders in pregnancy.

Predictors of vaginal delivery in nulliparous mothers.

BACKGROUND: Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. MATERIALS AND METHODS: A prospective cross-sectional study was done on 286 eligible booked nulliparae in labor, to determine factors associated with vaginal delivery. Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was put at P < 0.05. RESULTS: Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; 63.9%), fetal distress (20; 27.8%), maternal distress (5; 8.0%), and rapidly developing pre-eclampsia in labor (1, 0.3%). The birth weight of the baby ranged between 2.0 and 4.5 kg with mean weight of 3.1 ± 0.4 kg. Birth weight (odd ratio [OR] = 0.40, 95% confidence interval [CI] = 0.21-0.78), fetal head engagement in early labor (OR = 10.30, 95% CI = 1.35-78.69), and maternal body mass index (BMI) (odd ratio [OR] = 2.08, 95% confidence interval [CI] = 1.03-4.20) were found to be predictors of vaginal delivery. CONCLUSION: Normal range of maternal BMI, fetal head engagement and normal range of fetal birth weight were found to be the factors associated with vaginal delivery in nulliparae. Variations in these three factors may be the underlying reason for failure to progress, which is the most common indication for caesarean section among this population of parturient.

Successful pregnancy in one horn of a bicornuate uterus.

Normal development of the female reproductive tract involves a series of complex processes characterized by the differentiation, migration, fusion, and subsequent canalization of the Müllerian system. Uterine anomalies result when these processes are interrupted. Bicornuate uterus is a unification defect of the Müllerian ducts, and it is estimated to represent 10-39% of Müllerian duct anomalies. Pregnancies in bicornuate uterus are usually considered high-risk because of association with poor reproductive outcomes, such as pregnancy loss, preterm birth, malpresentations, and fetal deformity. Routine cervical cerclage and Strassman metroplasty have been advocated as treatment for this anomaly. We report a case of successful pregnancy in one of the horns of a bicornuate uterus managed in our unit.

Polydactyly 24 in a female neonate.

Polydactyly is perhaps one of the most common congenital hand and foot anomalies. Tetrapolydactyly (polydactyly 24) is a very rare form of hand and foot anomalies. Postaxial ray polydactyly usually occurs in male blacks without associated congenital abnormalities. We report a case of postaxial ray tetrapolydactyly in a female neonate which occurred sporadically and without associated congenital abnormalities.

Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria.

BACKGROUND: Although supported by research evidence, misoprostol for induction of labour remains contentious. OBJECTIVE: To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. METHODOLOGY: Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. RESULTS: One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P>0.05). CONCLUSION: Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.