MEDICAL OUTREACH AND IMPROVED ACCESS TO SPECIALIST SERVICES FOR THE RURAL COMMUNITY OF BAUCHI STATE, NIGERIA: THE REQUIREMENTS FOR SUSTAINABILITY.

Introduction: The West African College of Physicians (Nigeria) conducted its Annual General and Scientific Meeting (AGSM) in Bauchi State, Nigeria on 11th-15th of July, 2023. The theme of the AGM is HEALTH-RELATED SDGs IN NIGERIA: THE PROGRESS SO FAR. The sub- themes included challenges of health care in the face of Disaster and the menace of brain drain on health care manpower and medical education. Part of the activities for the AGSM was a medical outreach conducted at Durum community of Bauchi LGA, Bauchi State on Saturday, 8th July, 2023 between 8:00AM to 5:00PM at Durum primary school premises. Objectives: We examined the role of specialist medical outreach in supporting primary health care services and overcoming the barriers to health care faced by the rural dwellers and also examined issues affecting sustainability. Methods: Durum community was chosen from the list of 3 rural communities submitted to the Local Organizing Committee (LOC). A community entry was conducted to the relevant stakeholders. A descriptive cross-sectional design was used for the study. A semi-structured data form was used to collect information from 1062 participants. The activities included health talk and consultations on common health problems in the community as well as referral services. Relevant screenings tests for HBV, HCV, DM, Kidney diseases (Urinalysis), HIV and Tuberculosis were conducted. Medications for common diseases affecting the community were prescribed by the Doctors and dispensed during the outreach. The data were analyzed using SPSS version 26 at 5% significance level and 95% confidence interval. Results: A total of 1,062 filled forms were retrieved. The results show that majority of the participants are females 615(58%) while 447(42%) are males. Half of the respondents are illiterate 526(50%) and only 1%(11) attended tertiary institution. Majority are unemployed 646(61%) and only 1%(13) are civil servants. The commonest existing chronic medical conditions among the participants are hypertension 43(4%) and diabetes 15(1%). The commonest presenting complaints of the respondents are fever 404(38%), headache 170(16%), cough 53(%), dizziness 53(5%), skin rashes 43 (4%), abdominal pain 159 (15%), diarrhoea 53(5%) and vaginal discharge 127(12%). Regarding medical check-up, 481(45%) of the respondents have never ever had a medical check-up. 44(4%) had a check-up in the last preceding month, 41(4%) had check-up in the last preceding week, 40(4%) had check up in the last 6 months, while 34(3%) had check-up in the last one year. 84(42%) and 81(41%) among those tested had positive results for hepatitis B and C respectively and were counseled and referred. None tested positive for Tuberculosis and 1(1%) tested positive for HIV among those screened. 301(80%) among those tested had positive results for malaria and were counseled and offered treatment. The commonest health problems in the community were malaria (41%), enteric fever (26%), PUD/Dyspepsia (19%), UTI (9%) and skin diseases (5%). Conclusions: The study found out that half of the participants are illiterate and unemployed. The commonest health problems in the community were malaria, enteric fever, PUD/Dyspepsia, UTI, skin diseases, Hepatitis B & C. Thus, we recommend that the Primary Health Care Centre in the community should continue to provide the basic health services to the community. The Drug Revolving Fund (DRF) of the facility should be upgraded with relevant drugs and medical consumables at an affordable cost and a Doctor should be posted to the centre on temporary basis. These require the support of Ward Development Committee, Department of Primary Health Care of Bauchi Local Government Area, Bauchi State Primary Health Care Development Agency and the Bauchi State Ministry of Health. In addition, the State Government should improve the allowances for the health care personnel working in the rural areas and support the community in educational enrollment and poverty alleviation as well as collaborating with health institutions like the WACP in providing quality services to the State.

Hepatitis B vaccination status among health workers in Nigeria: a nationwide survey between January to June 2021.

BACKGROUND: Hepatitis B vaccination is the most important preventive measure against Hepatitis B viral (HBV) infection. Vaccination against HBV infection among healthcare workers is important because of their daily exposure to patients' body fluids and the possible risk of transmission to other patients. Hence, this study assessed the risk of hepatitis B infection, vaccination status and associated factors among healthcare workers in six geopolitical zones of Nigeria. METHODS: A nationwide cross-sectional study was conducted between January and June 2021 using electronic data capture techniques to enroll 857 healthcare workers (HCWs) in regular contact with patients and their samples through a multi-stage sampling method. RESULTS: The participants' mean (SD) age was 38.7 (8.0) years, and 453 (52.9%) were female. Each of the six geopolitical zones in Nigeria had a fair representation, with a range of 15.3 to 17.7% of the study population. The majority (83.8%) of healthcare workers in Nigeria knew that they were at an increased risk of being infected by their work. Also, 72.2% knew that if infected, there was a high risk of liver cancer in later life. Many participants (642 [74.9%]) responded that they consistently applied standard precautions, such as hand washing, gloves, and face masks while attending to patients. Three hundred and sixty (42.0%) participants were fully vaccinated. Of the 857 respondents, 248 (28.9%) did not receive any dose of the hepatitis B vaccine. Factors that were associated with not being vaccinated included age less than 25 [adjusted odds ratio (AOR) 4.796, 95% CI 1.119 to 20.547, p = 0.035], being a nurse (AOR 2.346, 95% CI 1.446 to 3.808, p = 0.010), being a health attendant (AOR 9.225, 95% CI 4.532 to 18.778, p = 0.010), and being a healthcare worker from the Southeast (AOR 2.152, 95% CI 1.186 to 3.904, p = 0.012) in Nigeria. CONCLUSION: This study showed a high level of awareness of the risks associated with hepatitis B infection and suboptimal uptake of the hepatitis B vaccine among healthcare workers in Nigeria.

Citrobacter freundii: A Cause of Cardiac Tamponade and Empyema Thoracis in a Nigerian Child.

Citrobacter infection is an uncommon but serious, difficult to treat infection associated with high mortality. Accumulation of pus or fluid in a pericardial space causes restriction of cardiac filling and consequent decrease in cardiac output. We herein report Citrobacter freundii, a rare infectious cause of this uncommon disorder. Our patient is a 10yr old male referred with complaints of cough productive of mucoid sputum and associated chest pain of two weeks duration, difficulty in breathing and orthopnoea for one week. He was acutely ill looking in respiratory distress with tachypnoea and tachycardia. Blood pressure was normal with pulsus alternans, there was increased jugular venous pressure, diffused apex beat and distant heart sounds with pericardial rub. Retroviral screening and gene Xpert for Mycobacterium tuberculosis were negative. Chest radiograph showed enlarged heart of "water bottle" appearance with cardiothoracic ratio of 0.77 and right sided pleural effusion which was drained. Transthoracic Echocardiogram confirm pyopericardium with multiples echoes in cardiac temponade. Echo-guided percutaneous pericardiocentesis yielded 600mls of purulent aspirates. Citrobacter freundii Sensitive to gentamycin, co-amoxiclav but resistant to cefuroxime and cefixime was cultured from pericardial aspirates and sputum. Patient recovered fully after pericardiocentesis and intravenous antibiotics. In this case report, we describe Citrobacter freundii causing cardiac temponade and empyema in a Nigerian immunocompetent child which to our knowledge has thus far not been reported. Pyopericardium may follow rare causes as Citrobacter freundii which require high index of suspicion.