Barriers in determining prevalence of type 2 diabetes mellitus among postpartum GDM: The research and retraining needs of healthcare professionals.

AIM: A large percentage of gestational diabetes (GDM) are undiagnosed, and prevalence of postpartum type 2 diabetes (T2DM) is unknown, especially in developing countries. This study assessed barriers to GDM diagnosis and postpartum follow-up; to determine educational needs. MATERIALS AND METHODS: This was a clinical observational study of records and procedures of antenatal services at two hospitals. Laboratory and medical records were reviewed for availability of data on anthropometrics, blood glucose, gestational age, urinalysis, and lipid profile for GDM register. Antenatal clinic protocol was observed for GDM diagnosis. BMI was derived and data were analyzed using SPSS version 20. RESULTS: Critical barriers attributable to health systems included lack of screening for blood sugar as part of routine antenatal protocol, and lack of GDM registers at both facilities. There was 6.5% registration of pregnancies in first trimester, 22% pre-pregnancy obesity, and 2.6% high blood pressure. Positive glucosuria cases were not followed-up for GDM diagnosis. CONCLUSIONS: There is neither concerted effort to diagnose GDM, nor systematic records of screening and postpartum follow-up. The gap in diabetology knowledge and practice calls for re-training of antenatal healthcare professionals. GDM screening checklist needs to be established and positive results entered into GDM registers for proper management during and after delivery.

Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years' summary and future direction.

OBJECTIVE: The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings were reviewed. The objective is to summarize research outcomes and itemize limitations as they constitute basis of future directions. RESULTS: Affordability and availability are major confounding behavioural change wheel factors in the rural community. 4.9% prevalence of prediabetes, which may be lower or non-significantly different in urban areas. Hyperglycaemia co-morbidity with dyslipidaemia (5.0%), obesity (3.1%) and hypertension (1.8%) were observed. Limitation of the study includes participants being mostly over 60 years old, which has created impetus for the Global Alliance on Chronic Diseases agenda on vulnerability of older adults to diabetes being a new direction of the collaboration. Other directions in Australia and Nepal focus on patients with chronic kidney disease with or without cardiovascular complications. This report highlights the need to translational research.

Development of public health program for type 1 diabetes in a university community: preliminary evaluation of behavioural change wheel.

BACKGROUND: Diabetes mellitus, including type 1 is a global public health problem among the young persons. While public health campaign and screening program is a potential strategy, but communication skills, knowledge and opinion of the healthcare personnel are indicated as variables that can impact patient's education, which will lead to better outcome of care. Thus, in designing or planning a program for public health, workforce development considers opinion and behavioural change wheel of prospective personnel. OBJECTIVE: The purpose of this preliminary study was to evaluate if a university academic department has the behavioural change wheel to function as workforce infrastructure for an envisioned program. METHOD: Survey of knowledge, attitude and practice (KAP) of a university community regarding diabetes type 1 was performed. The KAP were translated into behavioural change wheel comprising capacity, motivation and opportunity (CMO). RESULTS: There are baseline indications of the behavioural change wheel potential of the public health department to run a T1D screening program. The number of participants who knew someone with T1D was significantly higher than the subgroup with no such knowledge (p<0.0004) and this improved when age factor is considered (p<0.00005). CONCLUSION: While the public health department of a university community has the behavioural change wheel or CMO to develop a workforce infrastructure for T1D screening program, the experience that comes with age of lecturers will be an important factor to enable such program to succeed.

Prevalence of intestinal parasitic and bacterial pathogens in diarrhoeal and non-diarroeal human stools from Vhembe district, South Africa.

In the present study, a cross-sectional survey of intestinal parasitic and bacterial infections in relation to diarrhoea in Vhembe district and the antimicrobial susceptibility profiles of isolated bacterial pathogens was conducted. Stool samples were collected from 528 patients attending major public hospitals and 295 children attending two public primary schools and were analyzed by standard microbiological and parasitological techniques. Entamoeba histolytica/E. dispar (34.2%) and Cryptosporidium spp. (25.5%) were the most common parasitic causes of diarrhoea among the hospital attendees while Giardia lamblia (12.8%) was the most common cause of diarrhoea among the primary school children (p < 0.05). Schistosoma mansoni (14.4%) was more common in non-diarrhoeal samples at both hospitals (16.9%) and schools (17.6%). Campylobacter spp. (24.9%), Aeromonas spp. (20.8%), and Shigella spp. (8.5%) were the most common bacterial causes of diarrhoea among the hospital attendees while Campylobacter (12.8%) and Aeromonas spp. (12.8%) were most common in diarrhoeal samples from school children. Vibrio spp. was less common (3% in the hospitals) and were all associated with diarrhoea. Antimicrobial resistance was common among the bacterial isolates but ceftriaxone (91%) and ciprofloxacin (88.6%) showed stronger activities against all the organisms. The present study has demonstrated that E. histolytica/dispar, Cryptosporidium, Giardia, and Cyclospora are common parasitic causes of diarrhoea in Vhembe district while Campylobacter spp. and Aeromonas are the most common bacterial causes of diarrhoea in Vhembe district of South Africa.

Prevalence, haemolytic and haemagglutination activities and antibiotic susceptibility profiles of Campylobacter spp. isolated from human diarrhoeal stools in Vhembe District, South Africa.

Campylobacter species are increasingly being recognized as agents of gastroenteritis worldwide. However, data on the pathogenic characteristics of the organism isolated in rural communities in South Africa are lacking. In this study, the prevalence of Campylobacter spp. from diarrhoeal stools, haemolytic and haemagglutinating activities of the isolates, and antibiotic susceptibility profiles, including minimum inhibitory concentration (MIC) patterns to different antibiotics, were determined using the standard microbiological techniques. Campylobacter spp. were isolated from individuals of all age-groups; however, the infection rate was higher among individuals aged less than two years (30.4%). Of 115 Campylobacter strains isolated, polymerase chain reaction (PCR) analysis indicated that 98 (85%) were C. jejuni, while 17 (15%) were C. coli. Seventy-one (62%) of the strains showed haemolysis on human blood, and 80% agglutinated human blood, whereas 22.6% were beta-lactamase-positive. Resistance to antimicrobials, such as erythromycin, ciprofloxacin, vancomycin, and fusidic acid, was high. Increased resistance to macrolide and quinolone antibiotics poses major risks for treatment failure. Haemolytic and haemagglutinating activities may be useful in preliminary characterization of pathogenic strains in settings where Campylobacter-associated infections are common.

Prevalence, pathogenesis, antibiotic susceptibility profiles, and in-vitro activity of selected medicinal plants against Aeromonas isolates from stool samples of patients in the Venda region of South Africa.

The prevalence, pathogenic indices, such as haemolytic and haemagglutinating activities, antibiograms, and in-vitro activities of local medicinal plants against Aeromonas isolates in Vhembe district of Limpopo province, South Africa, were studied using standard microbiological methods. In total, 309 diarrhoeic stool samples were collected from patients attending five health centres in the region during December 2004-May 2005. Aeromonas species were identified using the API 20E system. The haemagglutinating and haemolytic activities of isolates on human, sheep, pig and chicken red blood cells were investigated. Antibiotic susceptibility profiles of the isolates to several antibiotics and in-vitro activity of local medicinal plants were also ascertained using previously-reported schemes. Results showed that 104 (33.6%) of the 309 samples were positive for Aeromonas species, of which 89 (85.6%) were Aeromonas hydrophila, 12 (11.5%) A. sobria, and three (2.9%) A. caviae. All strains of A. hydrophila and A. caviae produced haemolysis on sheep blood, while eight of the 12 A. sobria strains were haemolytic on sheep blood. The haemolytic activities of the isolates were variable on other red blood cells tested. High level of resistance was observed to amoxicillin and ampicillin, followed by cefuroxime (79%), chloramphenicol (74%), and erythromycin (65%). The carbapenems were the most active drugs with only 7% resistance to meropenem and 11% to imipenem. About 12% of the isolates were resistant to ciprofloxacin. The extracts of three of seven medicinal plants tested showed inhibitory activity against all Aeromonas isolates; these included acetone and hexane extracts of Pterocarpus angolensis, Syzygium cordatum, and Zornia milneana. The results suggest a high prevalence of Aeromonas species in the region. The isolates demonstrated multiple resistant profiles to different antibiotics tested. Some local medicinal plants were inhibitory to Aeromonas isolates, indicating a potential role in the management of Aeromonas-related infections. Structural elucidation of the active components may pave the way for the discovery of candidate templates for eventual drug design. Most isolates possessed important virulence characteristics based on their haemolytic and haemagglutinating ability. However, the genetic characterization of the isolates will further confirm their pathogenicity and the origin of multiple antibiotic resistance.

Storage of breast milk: effect of temperature and storage duration on microbial growth.

OBJECTIVE: To study the effect of storage duration at varying temperature ranges, the pattern of microbial isolates and the quantity of colony-forming units (CFU) on expressed breast milk. DESIGN: Cross sectional study. SETTING: Bacteriology laboratory, University of Zimbabwe in Parirenyatwa Hospital, Harare. MAIN OUTCOME MEASURES: The temperature, storage duration and types of micro-organisms in freshly expressed breast milk. RESULTS: Freshly expressed human breast milk contained microbial non-pathogens of skin flora. There was no growth of organisms in stored breast milk after four hours, eight hours, 24 hours and 72 hours storage duration at temperature ranges 0 to 4 degrees C (freezing temperature), 4 to 10 degrees C (refrigerator temperature), 15 to 27 degrees C (room temperature) and 30 to 38 degrees C (high temperature) respectively. Growth was detected after the storage durations and organisms isolated were both pathogens and non-pathogens with low counts. Average colony counts was (CFU < 200). CONCLUSION: The study revealed that storage duration for expressed breast milk should not exceed 24 hours in refrigerator temperature (4 to 10 degrees C), eight hours at room temperature (15 to 27 degrees C) and four hours at high temperature (30 to 38 degrees C). Although freezing temperature (0 to 4 degrees C) seemed safest for breast milk storage, short-term storage in a freezer is not recommended due to likely the hazards of the thawing process.

Bacteriological examination of milk and milk products sold in Harare.

A study to assess the bacteriological quality of milk and ice cream was conducted using the direct plate count method and the methylene blue dye reduction test. A total of 105 milk and 95 ice cream samples were obtained form two factories (depots) and distributing supermarkets (outlets) in Harare. Under the methylene blue test, all milk and ice cream samples passed the hour and 2 hour tests respectively. However, 99% of the milk and 69% of the ice cream samples reduced the dye after 5.5 and 4 hrs respectively. The results from the direct plate counts revealed the presence of both pathogens and non-pathogens. The median plate counts in the milk and ice cream were found 400 cfu / ml and 100 cfu / ml respectively. Organisms isolated in both samples and in all outlets were similar, these included Bacillus spp. Coagulase Staphlococcus spp., microcuccus spp., Steptococcus spp., Diphthroids, Fusiform bacterial Klebsiella spp., and Citrobacter spp. No significant differences were found in the plate counts of the samples obtained from the depots and outlets for the milk (P = 0.542, df = 1)) and ice cream samples (P = 0.377, df = 1). Results further revealed that there was no significant difference in isolates obtained form strawberry ice cream (0.0096). The study has therefore, revealed that milk and milk product sold in various outlets in Harare contained a variety of bacteria of public health importance and also that the methylene blue dye reduction test is not reliable for the detection of bacterial contaminants in dairy products. It is thus suggested that the use of methylene blue dyes be adapted in combination with other tests such as the plate count in assessing bacterial contaminants in milk products.

The bactericidal effect of normal human serum samples from various blood groups against local isolates of Staphylococcus aureus.

The sensitivity of staphylococcus aureus isolated in Ekpoma, Edo State, Nigeria, to the bactericidal activity of normal human sera from different blood groups ("A", "B", "AB", "O") was determined using the microtitre plate method. Results obtained revealed that S. aureus was sensitive to pooled serum samples of blood groups "B", "AB", and "O", each accounting for 60.7 per cent, 50.5 per cent and 53.5 per cent respectively, but resistant to blood group "A" with a sensitivity value of 43.3 per cent. This finding which is of clinical importance shows the differences of serum batctericidal activity of normal human sera from different blood group against S. aureus.

The bactericidal Effect of Normal Human Serum Samples from Various Blood Groups against Local Isolates of Staphloccus aureus

"The sensitivity of staphylococcus aureus isolated in Ekpoma; Edo State; Nigeria; to the bactericidal activity of normal human sera from different blood groups (""A""; ""B""; ""AB""; ""O"") was determined using the microtitre plate method. Results obtained revealed that S. aureus was sensitive to pooled serum samples of blood groups ""B""; ""AB""; and ""O""; each accounting for 60.7 per cent; 50.5 per cent and 53.5 per cent respectively; but resistant to blood group ""A"" with a sensitivity value of 43.3 per cent. This finding which is of clinical importance shows the differences of serum batctericidal activity of normal human sera from different blood group against S. aureus."

Antibiograms and plasmids of Staphylococcus aureus and coagulase negative staphylococci isolated from different clinical sources.

OBJECTIVES: To ascertain the antibiotic resistance patterns and plasmids of Staphyl coccus aureus and coagulae negative staphylococci isolated from different clinical specimens in Lagos, Nigeria. DESIGN: Prospective study involving the screening of specimens of blood, urine, skin and soft tissue infections, vagina, urethra, eye, ear, nose, pleural fluid and seminal fluid obtained from patients attending the Lagos University Teaching Hospital (LUTH) and Providence Hospital Diagnostic Laboratories, Lagos, Nigeria. SETTING: A laboratory based study conducted in the Microbiology Unit, University of Lagos and the National Institute for Medical Research (NIMR) Lagos, Nigeria. The patients were from different communities in Lagos. SUBJECTS: A total of 200 patients that were positive for the presence of S. aureus and coagulase negative staphylococci (CONS) were employed in the study. MAIN OUTCOME MEASURES: Frequency of isolation of S. aureus and coagulase negative staphylococci (CONS) from the different clinical specimens determination of their resistance profile using standard techniques for the isolation of both organisms and the Kirby-Bauer disc diffusion method for antibiotic testing. RESULTS: All the S. aureus and CONS isolates were sensitive to novobiocin and ofloxacin. Ninety eight (80 pc) of S. aureus isolates were resistant to tetracycline (Tet), 73 (60 pc) to Streptomycin (Str), and 49 (40 pc) to Chloramphenicol (Chl). All the S. aureus isolates were resistant to Penicillin (P) and only two (2 pc) and four (three pc) were resistant to Cefuroxime (Cxm) and Ceftriasone (Cro) in that order. Twenty six (21 pc) of S. aureus isolates were resistant to Methicillin. For CONS, 92 pc were resistant to Penicillin, 47 (60 pc) to streptomycin and 40 (51 pc) to tetracycline. Nineteen (24 pc) were resistant to Methicillin. Further antibiotic sensitivity results revealed the following patterns: 87 (71 pc) and 29 (36 pc) of S. aureus and CONS respectively showed P RTet"R, pattern of resistance. The resistance pattern PREryRGmRCazRCxmR was shown by only one (17 pc) of S. aureus and none (Opc) of CONS. Only 59% and four pc of S. aureus and CONS isolates showed resistance pattern ChlREryR, CazR respectively. Results of plasmid profiles showed that 48 (96 pc) of 50 S. aureus and 26 (87 pc) of 30 CONS isolates harboured one or more plasmids of molecular sizes ranging from 1.0 Kb to 19.5 Kb. Nine (19 pc) of 48 S. aureus and three (12 pc) of CONS isolates showed plasmid identity. CONCLUSION: We assert that although isolates of S. aureus and CONS showed multiple antibiotic resistance which could be plasmid mediated, only about five pc of both organisms showed resistance pattern ChlREryRCazRTetRCxmRSxtRGmR and EryRGmRCazRCxmR and this is of chemotherapeutic importance. Both organisms, were highly sensitive to Ceftriazone, Ceforoxime and Gentamicin. The high levels of resistance of many antibiotics may be attributable to indiscriminate use or antibiotic abuse in the community.

Anti-Plesiomonas shigelloides agglutinating and complement-fixing antibody titres in normal individuals and diarrhoeal patients in Edo State, Nigeria.

One hundred patients with diarrhoea and 50 asymptomatic individuals attending various hospitals in Edo State, Nigeria, were screened for serum complement-fixing and agglutinating antibodies to Plesiomonas shigelloides using the complement-fixation and agglutination tests. Seventy (70%) of the 100 patients and 20 (40%) of the 50 asymptomatic individuals had detectable complement-fixing antibodies at titres ranging from 1:32 to 1:128 and 1:8 to 1:32 respectively. Results suggest that cases of diarrhoea in this environment may be due to P. shigelloides, but the demonstration of antibodies in asymptomatic individuals show that they also have serum antibodies against P. shigelloides. The exclusive use of antibody responses in the diagnosis of P. shigelloides infections should, therefore, be interpreted with caution.

Antibiogram of bacterial isolates from cases of otitis media and lower respiratory tract infections.

A total of one hundred and two cases of otitis media were screened for the isolation of bacterial flora of ears. Out of this, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae accounting for 41.2%, 25.5% and 13.3% respectively were isolated. A further two hundred and four sputum samples from cases of lower respiratory tract infections were screened. Moraxella catarrhalis, S. aureus, S. pneumoniae and H. influenzae constituting 20.9%, 37%, 30% and 21% were isolated in that order. Thirty-one point seven percent of the Moraxella catarrhalis isolates were beta-lactamase positive. Beta-lactamase M. catarrhalis were resistant to penicillin and ampicillin while the non-beta-lactamase producers were sensitive to these antimicrobial agents. However, both beta-lactamase producers and non-producers were resistant to trimethoprim but sensitive to erythromycin, tetracycline and amoxycillin. Staphylococcus aureus, S. pneumoniae and H. influenzae was also sensitive to penicillin while S. pneumoniae was also sensitive to erythromycin and H. influenzae to chloramphenicol.

Evaluation of the pathogenicity and virulence of Yersinia species isolated in Edo and Delta States of Nigeria.

Sixteen isolates of four species of Yersinia comprising five of Yersinia enterocolitica and Yersinia fredricksenii, four of Yersinia intermedia and two of Yersinia kristensenii isolated from domestic and wild animals in villages in Edo and Delta States, Nigeria, were evaluated for their pathogenicity using laboratory animal models and virulence characteristics tests which included autoagglutinability, calcium dependency for growth, heat-stable enterotoxin production and conjunctivities in guinea pig eye. Results obtained revealed that Yersinia enterocolitica isolates were enteropathogenic as demonstrated by the production of diarrhoea and eventual recovery from faeces, spleen and liver of the infected animals. Three (60%) (2 serotypes 0:3 and 1 serotype 0:8) of the five Yersinia enterocolitica isolates were lethal to the animals. Other Yersinia isolates (Yersinia kristensenii, Yersinia fredricksenii and Yersinia intermedia) were uniformly non pathogenic to the animals. However, a strain of Yersinia intermedia isolate produced diarrhoea in the inoculated animals and caused lethality in guinea pigs and mice, but was negative for autoagglutination test, calcium dependency, conjunctivities, and positive for heat-stable enterotoxin production. We are of the view that this strain may be another Yersinia intermedia--like bacterium, previously isolated in Nigeria. Results therefore, suggest an emergence of a pathogenic Yersinia intermedia species in this environment.

HIV seropositivity among female prostitutes and nonprostitutes: obstetric and perinatal implications.

Serum samples totaling 600 were obtained from female prostitutes (300) resident in different hotels in Lagos, Nigeria and nonprostitutes (300) attending different health centers for routine check-up in Lagos, Nigeria. Sera obtained were screened for the prevalence of HIV seropositivity among prostitutes in comparison with nonprostitutes by the enzyme linked immunosorbent assay (ELISA) using the Abbott test kits as recommended by the manufacturers. Positive sera were subjected to confirmatory testing using the Western Blot test-New Lav Blot I and II. Our results revealed that of the 300 prostitutes and nonprostitutes screened, 50 (16.67%) and 6 (2%) were HIV seropositive, respectively, and the difference was statistically significant (P < 0.01). For antibody to HIV-1, 44 (88%) and 5 (83%) of the positive cases recorded among prostitutes and nonprostitutes were seropositive. Four (8%) and one (16.67%) of the positive cases were HIV-2 seropositive for prostitutes and nonprostitutes, respectively. Only 2 (4%) of the positive samples from prostitutes showed reactivities with HIV-1 and HIV-2 (simultaneous infection or dual reactivity). Incidence of the dual reactivity was not recorded among the nonprostitutes screened. This study is expected to provide baseline data on HIV seropositivities among prostitutes and nonprostitutes in Nigeria. The biomedical application of this study is that it will also serve as strong evidence to indicate the high prevalence of HIV seropositivity among prostitutes in order to attract government intervention to step-up control measures.