Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria.

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Genital mycoplasma infections among women in an urban community of northern Nigeria: do we need to search for them?

METHODS: To determine the incidence of genital Mycoplasma infection among females in Jos. High vaginal swab (HVS) and or Endocervical swab (ECS) samples were obtained from 476 females undergoing vaginal examinations along with other females who volunteered to enroll in the study Samples were processed using standard laboratory procedures for the isolation of Mycoplasma species while information such as age, marital status, occupation and other clinical data were obtained using a questionnaire. The results obtained were analysed using SPSS 11.0 statistical methods and P values = or < 0.05 were considered significant. RESULTS: The overall incidence of genital Mycoplasma infection was found to be 29.6% (n=141); M. hominis, 12.1% (n=57); U. urealyticum 9.4% (n=45); mixed infection, 6.7% (n=32), and other Mycoplasmas, 1.4% (n= 7). Majority of the isolates were from those aged 20-35 years old (most sexually active group); 83% (n=52) of those who presented with vaginal discharge were infected with Mycoplasma spp. (P< 0.05); also, the incidence of infection among the separated/divorce/widowed group was significantly higher than the married group (P<0.05). CONCLUSION: Mycoplasmas are common genital organisms, hence should be sought out for from ECS probably on routine basis for suspected genital tract infections.

Outcome of directly observed therapy short course (DOTS) regimen in a rural community of the Nigerian Niger Delta.

BACKGROUND: [corrected] The objective of this retrospective study was to evaluate the outcome of directly observed therapy short course (DOTS) application in a Nigerian rural community. METHODS: A retrospective study of all the records of DOTS at the centre from January 2001 to December 2005 was compiled and features such as: age, gender, drugs used, and outcome of treatment (defaulted, cured, died, or developed multidrug resistant-TB) were considered. Also the different personnel and infrastructure at the centre for the programme were also assessed. Results were analysed using Epi Info 6 statistical software, and P values < 0.05 were considered significant. RESULTS: Two hundred and seventy four (274) cases of pulmonary TB were registered at the centre during the study period, consisting of 100 (36.5%) females and 174 (63.5%) males with a statistically significant gender difference (P<0.001). The age range with the highest number of pulmonary tuberculosis cases was 31-40 years (24.8%; n=68), and the age range with the lowest number was 71 years and above (1.1%; n=3). Treatment outcome showed that 84.7% (n=232) completed treatment with cure; 2.5% (n=7) developed multidrug resistance at completion of treatment; 5.5% (n=15) defaulted; 3.3% (n=9) died in the course of treatment, and treatment in 11 people was still ongoing. CONCLUSION: The outcome of DOTS in the present study was impressive, and the programme should be extended to other rural communities; however, more efforts should be made towards the tracing of defaulters.

Intestinal parasitism, potable water availability and methods of sewage disposal in three communities in Benue State, Nigeria: a survey.

BACKGROUND: To assess the level of parasite burden in a village community and the predisposing factors. METHODS: Two hundred subjects each were recruited from three communities- Tyogbenda, Jato-Aka and Adikpo during an episode of free medical outreach. A simple random sampling method was adopted and a questionnaire was interviewer administered on relevant aspects of basic hygiene such as- sources of water supply, methods of domestic sewage disposal and frequency of hand washing. Stool samples were collected and tested and findings analysed using appropriate statistical methods, p values < 0.05 were considered significant. RESULTS: The prevalence of intestinal parasites in Tyogbenda, Jato-Aka and Adikpo communities was found to be 71.5%, 65.5% and 40.5% respectively. Ascaris lumbricoides was the commonest parasite in the three centres (34.5%, 28.5% and 19.0% respectively for Tyogbenda, Jato-Aka and Adikpo communities). Other parasites identified were- Entamoeba histolytica, Entamoeba coli, Hookworm. Enterobius vermicularis, Strongyloides stercoralis, Schistosoma mansoni and Trichuris trichura. Multiple parasitic infestation was common in the communities where quality of water supply and methods of sewage disposal facilities were below standard. CONCLUSION: The prevalence of intestinal parasitism is still high in Nigerian rural communities. The present resolve by the federal ministry of water resources to supply potable water to all Nigerian rural communities should be sustained. Furthermore, a health education program should be properly constituted and integrated into the present primary health care policy for the country.

Pathology as a profession: contribution of undergraduate training on choice of career among final year students of a medical school in north central Nigeria.

BACKGROUND: The choice of pathology as a profession by would be resident doctors, will, to a large extent depend on the amount of knowledge acquired on the subject at the undergraduate level. METHODS: A questionnaire was self administered to final year medical students of University of Jos shortly after the completion of the final written paper in medicine in September 2005; meant to elicit their views on choosing patology as a profession after graduation. RESULTS: Eighty-five students enrolled comprising 65 (76.5%) males and 20 (23.5%) females Ninety six percent of the students were between 26 and 30 years. Those who found Pathology interesting were 76.5%; 18.8% picked pathology as their career of first choice after graduation 5.9%, 3.5% and 5.9% as 2nd, 3rd and 10th choices repectively. Among the pathology disciplines, 8.2%, 4.7%, 3.5% and 2.4% would specialize in Histopathology, Haematology, Chemical Pathology and Medical Microbiology respectively. The students generally complained of inadequate time and exposure during the postings as well as the difficulty in understanding Medical Microbiology. CONCLUSION: More time should be allocated to the teaching of Pathology at the undergraduate level. Learning enhancing aids should be introduced such as: regular practical demonstrations, audio-visual teaching aids, computer assisted programs and the establishment of pathology museums in the medical schools across the country.

Human immunodeficiency virus infection in a rural community of plateau state: effective control measures still a nightmare?

BACKGROUND: This study was designed to find out the prevalence of human immunodeficiency virus (HIV) infection in Zawan village as well as their socio-cultural practices that promote its spread. METHODS: Three hundred subjects were recruited into the study comprising 193 males and 107 females by a simple random sampling method. A structured questionnaire was administered to each respondent and 5mls of blood collected and assayed for anit-HIV antibodies. The results were analysed using statistical software Epi-Info version 6, P < 0.05 was considered significant. RESULTS: The prevalence of HIV in Zawan village was found to be 8.3% (25 out of 300) and the significant risk factors noted were--use of sharp objects, trading and the divorce/separated group, (P < 0.05). Other factors such as tattooing, male circumcision by traditional method and tonsillectomy were not found to be statistically associated with HIV infection in this community, (P > 0.05). CONCLUSION: HIV is still causing serious devastation in our rural communities. Hence government should supply affordable antiretroviral drugs to our rural dwellers, step up public enlightenment campaign and pursue with vigour the present micro-economic revival policies to alleviate abject poverty in our rural communities.

Nosocomial and community acquired urinary tract infections at a teaching hospital in north central Nigeria: findings from a study of 12,458 urine samples.

BACKGROUND: Urinary tract infection (UTI) is still a problem not infrequently encountered in the course of clinical practice. This study was designed to ascertain its prevalence among both the in and out-patients and the antibiotic susceptibility pattern of the isolates. METHOD: A retrospective analysis of data from all the urine samples processed at Jos university teaching hospital microbiology laboratory was undertaken for a period of 36 months (January 2000-December 2002). Samples had been collected, stored and processed by standard laboratory procedures. Results obtained were analysed using SPSS 11 statistical software and P values < 0.05 were considered significant. RESULTS: Of the 12,458 urine samples studied comprising 43% males and 57% females: the overall prevalence of UTI was found to be 22%; 7.4% among males and a higher figure of 14.6% among females, this was statistically significant (p < 0.05). The rate of nosocomial UTI was significantly higher than the community acquired type: 12.3% and 9.3% respectively (p < 0.05). The commonest nosocomial isolate was Klebsiella spp while Escherichia coli were for community acquired group. Staphylococcus aureus, Coagulase negative Staphylococcus, Proteus spp and Pseudomonas aeruginosa were also common isolates. The most effective antibiotics were Ofloxacin, Ciprofloxacin and Cefuroxime. CONCLUSION: In-patients especially should be encouraged to drink adequate water daily and practice "double urination" to reduce incidence of UTL. Ofloxacin, Ciprofloxacin and Cefuroxime should be considered first in the treatment of UTI in the absence of a susceptibility test.

Bacteriology of urinary tract infection among patients with acquired immunodeficiency syndrome in Jos, Nigeria.

BACKGROUND: The study was set to find out the bacterial agents causing urinary tract infection (UTI) in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Two hundred patients with AIDS on admission at the Jos University Teaching Hospital (JUTH) were recruited into this study. Urine sample was collected from each patient and processed. Other information was obtained with protocol questionnaire. The results were analyzed using Epi Info 6. RESULTS: The prevalence of UTI in AIDS patients was found to be 24% and control 10.6%. Escherichia coli were the commonest Gram-negative isolate followed by Klebsiella species. Enterococcus species was the commonest Gram-positive organism. CONCLUSION: There should be extreme caution whenever the need arises to catheterize AIDS patients.

Hepatitis B virus infection in a rural settlement of northern Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been present in our communities for quite sometime now. However, majority of the people especially in rual areas are not aware of its devastating effects as adjudged by their socio-cultural practices. METHODS: Three hundred randomly selected residents of Zawan community (comprising 193 males and 107 females) were screened for hepatitis B surface antigen (HBsAg) presence in their sera. Other information was obtained with the aid of a structured questionnaire and results analysed using Epi Info 6 statistical software. RESULTS: The prevalence of HBV in Zawan village was found to be 12.6% (9% among males and 3.6% among females). The risk factors associated with HBV transmission were tonsillectomy, tattooing, use of sharp objects as well as trading. Marital status was also found to be a significant risk factor as there was a high prevalence of HBV infection among the widowed/divorced/separated group. CONCLUSION: HBV infection is endemic in our rural communities just as it is in the urban areas and efforts should be made to step up its health education campaign as well as the interventional mechanisms including immunization.

Multiple resistant Pseudomonas aeruginosa in contemporary medical practice: findings from urinary isolates at a Nigerian University Teaching Hospital.

Pseudomonas aeruginosa is a bacterium that is often encountered in urinary tract infection (UTI) worldwide and has shown varied antibiotic susceptibility patterns. This study was therefore designed to ascertain the antibiotic susceptibility patterns of the organism in Jos. Data on antimicrobial susceptibility of P. aeruginosa generated from urine samples by the Microbiology laboratory of Jos University Teaching Hospital (JUTH) was compiled for a period of three years (July 2001-June 2004). Additional information was obtained from the records department of the hospital. Samples were collected, stored and processed using standard laboratory procedures. The rate of isolation of P. aeruginosa from urine samples was found to be 4.6% (n=127) from 12,458 samples. From male population 34% (n=43) were isolated and 66 % (n=84) were recovered from females population with a significant (P < 0.05) gender difference. All the 100 % isolates of P. aeruginosa were resistant to penicillin, cloxacillin, tetracycline, nitrofurantoin and nalidixic acid. while 67% were sensitive to augmentin, sensitivity to ofloxacin was 92%, ciprofloxacin 92% and cefuroxime (86%). The resistance pattern of P. aeruginosa from urine against antibiotics was extremely high. Prophylactic antibiotic medication against UTI should be carefully weighed against this undesirable possible outcome (resistance). Susceptibility testing should be adopted as a basic routine laboratory procedure in hospitals and clinics in order to guide appropriately on the right choice of antibiotics. Finally, ofloxacin, ciprofloxacin, and cefuroxime should be considered on isolation of P. aeruginosa from UTI, especially in the absence of a sensitivity report as well as for prophylactic options.