An intervention study investigating the effectiveness of contextualizing multimodal strategy on improving hand hygiene at a tertiary hospital in Nigeria.

BACKGROUND: Hand hygiene (HH) is a proven low-cost means to curtail the problem of hospital-acquired infection (HAI). However, a low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria. METHODS: This was an intervention study conducted utilizing mixed methods to investigate the effectiveness of the World Health Organization (WHO) multimodal strategy to improve the HH compliance rate of doctors at ABUTH Zaria. The study was conducted between June and August 2022 and included delivering a behavioural change HH workshop to doctors followed by data collection in the surgical wards that had received environmental modification through the provision of an alcohol-based hand rub (ABHR), HH posters and nurses for visual and/or verbal reminders. RESULTS: The cumulative HH compliance rate was 69% (n=1774) and was significantly different from the baseline HH compliance rate of 17.1% (confidence interval 45.5 to 57.7, p<0.001). Observed HH was highest in the ward with both visual and verbal reminders (78%) and lowest (59%) where neither visual nor verbal reminders were provided (n=444 per ward). All respondents reported motivation to perform HH with the presence of ABHR. CONCLUSIONS: The WHO multimodal strategy is good for enhancing HH among health workers in the context of low- and middle-income countries. More research is needed to understand how much of a reduction in HAI is directly associated with efficient HH by health workers.

Evaluation of knowledge and awareness of invasive fungal infections amongst resident doctors in Nigeria.

INTRODUCTION: it has been estimated that about 11.8% of the Nigerians suffer serious fungal infections annually. A high index of suspicion with early diagnosis and institution of appropriate therapy significantly impacts on the morbidity and mortality of invasive fungal infections (IFIs). METHODS: we conducted a cross-sectional multicentre survey across 7 tertiary hospitals in 5 geopolitical zones of Nigeria between June 2013 and March 2015. Knowledge, awareness and practice of Nigerian resident doctors about the diagnosis and management of invasive fungal infections were evaluated using a semi-structured, self-administered questionnaire. Assessment was categorized as poor, fair and good. RESULTS: 834(79.7%) of the 1046 participants had some knowledge of IFIs, 338(32.3%) from undergraduate medical training and 191(18.3%) during post-graduate (specialty) residency training. Number of years spent in clinical practice was positively related to knowledge of management of IFIs, which was statistically significant (p < 0.001). Only 2 (0.002%) out of the 1046 respondents had a good level of awareness of IFIs. Only 4(0.4%) of respondents had seen > 10 cases of IFIs; while 10(1%) had seen between 5-10 cases, 180(17.2%) less than 5 cases and the rest had never seen or managed any cases of IFIs. There were statistically significant differences in knowledge about IFIs among the various cadres of doctors (p < 0.001) as level of knowledge increased with rank/seniority. CONCLUSION: knowledge gaps exist that could militate against optimal management of IFIs in Nigeria. Targeted continuing medical education (CME) programmes and a revision of the postgraduate medical education curriculum is recommended.

Antimicrobial prescription pattern in a tertiary hospital

Background: Antimicrobials are nonreplaceable in the treatment of bacterial infections and thus should be used judiciously. In Nigeria, there is currently no restriction on the prescription and sale of antimicrobials. This study was conducted to assess the antimicrobial prescription pattern of physicians at a tertiary hospital in Northwestern Nigeria. Materials and Methods: A point prevalence survey was carried out among all inpatients at Ahmadu Bello University Teaching Hospital in June 2015. Those receiving an antimicrobial agent during the survey period were included in the study while patients admitted on the day of the survey were excluded from the study. Data were obtained using a structured interviewer­administered questionnaire and abstraction from patient records. Information obtained included demographic data, antimicrobial agents prescribed, indication for treatment, laboratory data, and stop/review dates of prescriptions. Data were analyzed using SPSS version 20.0. Results: Twenty­three wards with a total number of 318 inpatients were enlisted. Of these, 210 (66%) patients were on treatment with antimicrobials. Male: female ratio of patients on antimicrobials was 1.2:1, and age of respondents ranged from 1 day (0.0027 years) to 75 years. The overall antimicrobial prevalence rate was 210 (66%) with surgical prophylaxis 100 (47.6%) as the most common indication. Overall, 332 antimicrobials were prescribed with cephalosporins as the most common class prescribed 96 (28.9%). Majority of the prescriptions (328, 98.8%) were based on empirical treatment, 288 (86.7%) were open prescriptions, and only 4 (1.2%) were according to treatment guidelines. Conclusion: The high prevalence of antimicrobial use highlights the need for an antimicrobial stewardship program in this facility

Predictors of insecticidal net use among internally displaced persons aged 6-59 months in Abuja, Nigeria.

INTRODUCTION: Malaria is the commonest cause of morbidity and mortality among displaced populations especially children in endemic countries. Nigeria, an endemic country, has had increase in internally displaced persons (IDP) due to insurgency. utilization of long-lasting insecticidal nets (LLIN) is a key strategy employed to achieve global targets of malaria elimination and its effectiveness is determined by utilization, coverage and maintenance. We determined the coverage and utilization of LLIN among children aged 6-59 months at IDP camps and its predictors. METHODS: A cross-sectional study was conducted among children aged 6-59 months at the three IDP camps in Abuja. We collected data on socio-demographic characteristics, LLIN ownership and utilization using computer-aided interview, complemented by direct observation of nets. We defined universal LLIN coverage as the proportion of households with one LLIN to two persons and utilization as an eligible child sleeping under the LLIN the night preceeding the survey. Bivariate analysis was done at p < 0.25 and logistic regression at 5% level of significance. RESULTS: Overall, 393 children were enrolled with mean age of 33.3 ± 17.4 months, 51.6% were female. Household LLIN ownership was 76.7.5%, universal coverage 11.2% and utilization 89.7%. Independent predictors of LLIN utilization were LLIN hung at sleeping area (adjusted OR: 99.9, CI: 22.7 - 438.8) and type of camp site (adjusted OR: 8.2, CI: 2.5 - 27.4). CONCLUSION: LLIN utilization was high in these IDP camps despite low coverage. LLIN distribution and hanging campaigns are recommended to reduce malaria transmission in the IDP camps.