Case fatality rate and burden of snakebite envenoming in children - A systematic review and meta-analysis.

Snakebite is a major public health problem with an estimated global burden of 5 million people per annum. Data on snakebite envenoming in children are very limited and is unclear whether there is a significant difference in severity between adults and children. We therefore conducted a meta-analysis of observational studies on snakebite in children to obtain a more precise estimate of case fatality rate (CFR) as well as to explore the differences in outcome between children and adults. Studies from all over the world reported until the end of February 2023 were included. Analysis was conducted consistent with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria. Estimates were obtained from Random Effects Model (REM). Sub-analysis was conducted for studies from sub-Saharan Africa (SSA) to provide estimates for the continent. Adverse outcomes comprising composite endpoints (CE), defined as fatality and or complications, were compared between children and adults in sub-analysis of studies reporting on both groups. The annual burden and fatality of snakebite envenoming were derived based on lifetime prevalence of bite, meta-analysis estimates, and other data inputs. The pooled estimate of the CFR from 35 studies included worldwide was 1.98% [95%CI:1.38-2.58%] while the estimates from 6 studies within SSA was 2.43% (95%CI:0.67-4.20%). The odds of adverse outcomes were 2.52 times higher in children compared to adults. The estimated annual burden was 178,491 cases with 4346 deaths among children in SSA. These estimates compare favorably to those reported in the literature.

Gram-negative bacilli are a major cause of secondary pneumonia in patients with pulmonary tuberculosis: evidence from a cross-sectional study in a tertiary hospital in Nigeria.

Background: This study was aimed at describing the profile of bacterial aetiology of secondary pneumonia in pulmonary tuberculosis (PTB) patients. Methods: A 22-month analysis of patients with PTB and secondary bacterial pneumonia was conducted. Data on isolates recovered and the antimicrobial susceptibility profile were recorded. Results: Of the 141 patients, there were 79 (56%) males and the mean age was 35.98±15.93. Gram-negative bacilli were isolated with equal frequency as Streptococcus pneumoniae (63 [44.7%]). Most of the isolates tested were sensitive to levofloxacin, ceftriaxone or chloramphenicol. Conclusion: Gram-negative bacilli are a major cause of pneumonia in patients with PTB on treatment.

Role of GeneXpert MTB/Rif Assay in Diagnosing Tuberculosis in Pregnancy and Puerperium.

Presentation of tuberculosis (TB) in pregnancy may be atypical with diagnostic challenges. Two patients with complicated pregnancy outcomes, foetal loss and live premature delivery at 5 and 7 months of gestation, respectively, and maternal loss, were diagnosed with pulmonary TB. Chest radiography and computed tomography showed widespread reticuloalveolar infiltrates and consolidation with cavitations, respectively. Both patients were Human Immunodeficiency Virus (HIV) seronegative and sputum smear negative for TB. Sputum GeneXpert MTB/Rif (Xpert MTB/RIF) was positive for Mycobacterium tuberculosis. To strengthen maternal and childhood TB control, screening with same-day point-of-care Xpert MTB/RIF is advocated among both HIV positive pregnant women and symptomatic HIV negative pregnant women during antenatal care in pregnancy and at puerperium.

A Multi-Site Knowledge Attitude and Practice Survey of Ebola Virus Disease in Nigeria.

BACKGROUND: The 2014 Ebola Virus Disease (EVD) outbreak was characterised by fear, misconceptions and irrational behaviours. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform implementation of effective control measures. METHODS: Between July 30th and September 30th 2014, we undertook a cross sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) among adults of the general population and healthcare workers (HCW) in three states of Nigeria, namely Bayelsa, Cross River and Kano states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorised as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. RESULTS: Out of 1035 study participants with median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross River and Kano states respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%) and 49.95% (37.50%) respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%) and 252 (24.35%) had good KAP of EVD defined using 80%, 90% and 70% score cut-offs respectively. Independent predictors of good knowledge of EVD were being a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting 'moderate to high fear of EVD' (OR-2.15, 95% CI-(1.47-3.13) and 'willingness to modify habit' (OR-1.68, 95% CI-1.23-2.30). CONCLUSION: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to implement public sensitization programmes that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

Pattern of antibiotic prescription and resistance profile of common bacterial isolates in the internal medicine wards of a tertiary referral centre in Nigeria.

Indiscriminate and excessive use of antibiotics is the major driver to the development of bacterial resistance, which is now a global challenge. Information regarding antibiotic use in Nigerian hospitals is lacking. This study examined the pattern of antibiotic prescription in a tertiary hospital in Nigeria. In a retrospective survey, case records of patients who were admitted into the medical wards over a 6-month period were reviewed. A pre-formed questionnaire was administered that sought information such as sociodemographic data, drug data, basis of prescription and other relevant information on all patients who received antibiotics. Data were analysed using SPSS for Windows v.16. Of 412 patients admitted into the internal medicine ward during the study period, 202 (49.0%) received antibiotics, of whom 125 (61.9%) received more than one antibiotic. Overall there were 334 antibiotic prescriptions. Community-acquired pneumonia (67/202; 33.2%) was the leading cause of antibiotic prescription, and ceftriaxone (132/334; 39.5%) was the most commonly prescribed antibiotic. The parenteral route was the commonest route of administration (270/334; 80.8%) and most of the prescriptions were empirical (323/334; 96.7%). Antimicrobial resistance among common bacterial isolates was noted. Inappropriate antibiotic prescription is common. There was frequent use of third-generation cephalosporins as empirical therapy, with de-escalation in only a handful of cases. This highlights the need for introduction of antibiotic guidelines.