Nasal carriage of meticillin-resistant Staphylococcus aureus among children living with HIV attending Infectious Diseases Clinics in Kano, Nigeria.

Background: Children living with HIV (CLWH) are at risk of colonisation and infection with meticillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates from CLWH with bloodstream infections in Kano were MRSA. Aim: To estimate the prevalence of nasal colonisation with S. aureus and MRSA in CLWH in Kano State and to determine associated risk factors. Methods: A cross-sectional study was performed in the infectious diseases clinics of two public hospitals in Kano involving 214 CLWH/caregiver pairs. Children were selected from clinic registers by simple random sampling and an interviewer-administered questionnaire used to elicit factors associated with MRSA carriage from the caregivers. Clinical records were reviewed for patients' medical histories. Standard laboratory techniques were used to isolate S. aureus from nasal swabs collected from CLWH. MRSA was detected using the cefoxitin disc diffusion method and PCR for mecA gene detection. We measured the prevalence of S. aureus and MRSA carriage in the CLWH and calculated adjusted odds ratios (AOR) for factors associated with MRSA. Results: Nasal S. aureus carriage in CLWH was 18.7% (40/214). Cefoxitin disc diffusion identified 6/214 (2.8%) of CLWH were MRSA carriers, while PCR identified that 9/214 (4.2%) of CLWH were MRSA carriers. Recent hospitalisation (AOR: 61.04; 95% CI: 9.01-413.38) and recent antibiotic therapy (AOR: 7.52; 95% CI: 1.07-52.95) were independent risk factors for MRSA colonisation. Conclusions: The rate of MRSA nasal colonisation among CLWH in Kano was similar to that reported in other studies in Africa. Infection prevention and control measures including MRSA screening and decolonisation, as well as education for CLWH and their carers should be introduced to reduce MRSA spread.

Performance of COVID-19 case-based surveillance system in FCT, Nigeria, March 2020 -January 2021.

INTRODUCTION: The emergence of novel SARS-CoV-2 has caused a pandemic of Coronavirus Disease 19 (COVID-19) which has spread exponentially worldwide. A robust surveillance system is essential for correct estimation of the disease burden and containment of the pandemic. We evaluated the performance of COVID-19 case-based surveillance system in FCT, Nigeria and assessed its key attributes. METHODS: We used a cross-sectional study design, comprising a survey, key informant interview, record review and secondary data analysis. A self-administered, semi-structured questionnaire was administered to key stakeholders to assess the attributes and process of operation of the surveillance system using CDC's Updated Guidelines for Evaluation of Public Health Surveillance System 2001. Data collected alongside surveillance data from March 2020 to January 2021 were analyzed and summarized using descriptive statistics. RESULTS: Out of 69,338 suspected cases, 12,595 tested positive with RT-PCR with a positive predictive value (PPV) of 18%. Healthcare workers were identified as high-risk group with a prevalence of 23.5%. About 82% respondents perceived the system to be simple, 85.5% posited that the system was flexible and easily accommodates changes, 71.4% reported that the system was acceptable and expressed willingness to continue participation. Representativeness of the system was 93%, stability 40%, data quality 56.2% and timeliness 45.5%, estimated result turnaround time (TAT) was suboptimal. CONCLUSION: The system was found to be useful, simple, flexible, sensitive, acceptable, with good representativeness but the stability, data quality and timeliness was poor. The system meets initial surveillance objectives but rapid expansion of sample collection and testing sites, improvement of TAT, sustainable funding, improvement of electronic database, continuous provision of logistics, supplies and additional trainings are needed to address identified weaknesses, optimize the system performance and meet increasing need of case detection in the wake of rapidly spreading pandemic. More risk-group persons should be tested to improve surveillance effectiveness.

Pattern and Predictors of Tobacco Use Among Undergraduates in Three Tertiary Institutions in North-Western Nigeria.

BACKGROUND: Tobacco use is associated with medical, social and economic problems. There is paucity of data on tobacco use among undergraduates in northern Nigeria. This study assessed pattern and predictors of tobacco use among undergraduates in Zaria, North-western Nigeria. METHOD: It was a cross-sectional study of undergraduates in three tertiary institutions. Multi-stage sampling technique was used to select 1,080 undergraduates. Data was collected using a questionnaire adapted from Global Adult Tobacco Survey and Global Youth Tobacco Survey. Bi-variate analysis was used to identify independent variables showing statistically significant association with current tobacco use. These were entered into step-wise logistic regression. RESULTS: Their median age was 24 years (range:15-47). Prevalence of current tobacco use was 27.0%. About 58.7% smoked tobacco daily and 40.0% used smokeless tobacco daily. Commonest places where tobacco was used were off campus accommodation (30.2%), social center (30.2%) and bar or club (28.1%). Predictors of tobacco use were being a male [2.64(1.82-3.84)], married [2.33(1.49-3.70)], experiencing tobacco promotional activity [1.56(1.12-2.17)], willing to use promotional objects [2.06(1.35-3.14)], using of promotional objects [2.74(1.90-3.96)], and exposure to secondhand smoke [14.10(4.16-47.81)]. Predictors of non-use of tobacco were spending two years or less awaiting university admission [0.65 (0.46-0.91)], parents currently together [0.48(0.33-0.69)], and supporting ban on tobacco [0.34 (0.23-0.48)]. CONCLUSION: Prevalence of tobacco use and expenditure on tobacco were high. University authorities should commence programs to identify tobacco users and encourage cessation. The findings also highlight the need to establish effective tobacco surveillance system that includes students of tertiary institutions.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012-2019: a secondary data analysis.

BACKGROUND: Nigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. METHODS: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019. RESULTS: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases. CONCLUSIONS: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Prevalence, patterns and correlates of smokeless tobacco use in Nigerian adults: An analysis of the Global Adult Tobacco Survey.

INTRODUCTION: The global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts. METHODS: We conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data. RESULTS: The prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56). CONCLUSION: The prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey.

Comparative assessment of infection prevention and control practice among maternity unit health workers in public and private secondary health facilities in Kaduna state, Nigeria

Objectives: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. Material and Methods: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. Results: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. Conclusion: IPC practice especially among public HF workers was poor. Keywords: Hospital-acquired infection, Infection prevention and control, Maternity unit, Practice

Prevalence and Factors Associated with Neonatal Sepsis in a Tertiary Hospital, North West Nigeria.

CONTEXT: Neonatal sepsis is an important cause of morbidity and mortality of newborns, especially in developing countries. AIMS: Our study determined the prevalence of neonatal sepsis and its predisposing factors among neonates admitted in Ahmadu Bello University Teaching Hospital (ABUTH). SETTINGS AND DESIGN: This was a cross-sectional descriptive study conducted in ABUTH. SUBJECTS AND METHODS: The data were abstracted from the case notes of neonates admitted from May 2017 to May 2018. A pretested pro forma was used to abstract the data. STATISTICAL ANALYSIS USED: Odds ratios and multivariate logistic regression were used to determine the factors associated with neonatal sepsis among the study population. RESULTS: The prevalence of neonatal sepsis was 37.6%. Escherichia coli was the most commonly isolated organism. Neonates 0-7 days of age were 2.8 times less likely to develop neonatal sepsis than older neonates. Babies born with an Apgar score of <6 within the 1st min were 2.4 times more likely to develop neonatal sepsis than those whose Apgar score was higher. Neonates of mothers who had urinary tract infection during pregnancy were 2.3 times more likely to have had sepsis and those whose mothers had premature rupture of membranes were 4.6 times more likely. CONCLUSIONS: The prevalence of neonatal sepsis was high among the neonates studied. Neonatal and maternal factors were associated with sepsis in the neonates. These findings provide guidelines for the selection of empirical antimicrobial agents in the study site and suggest that a continued periodic evaluation is needed to anticipate the development of neonatal sepsis among neonates admitted.

Knowledge and risk perception towards Lassa fever infection among residents of affected communities in Ebonyi State, Nigeria: implications for risk communication.

BACKGROUND: Lassa fever (LF) is an epidemic-prone zoonotic disease prevalent in Nigeria and Ebonyi State is a high burden area in Nigeria. Low risk perceptions have been reported to prevent appropriate preventive behaviours. We investigated the knowledge and risk perception of residents towards LF and determined the factors influencing their risk perception in communities that have reported confirmed cases of LF. METHODS: We conducted a cross-sectional study in the affected wards in Abakaliki Local Government Area (LGA). We interviewed 356 adult respondents recruited across 6 settlements in 3 of the affected wards through multistage sampling technique. Information on participants' knowledge of LF, their risk perception using the health belief model as well as factors influencing risk perception were obtained. We estimated the proportions of respondents with good knowledge and high risk perceptions. We also explored the relationship between risk perception, knowledge and sociodemographic characteristics using Chi Square and logistic regression at 5% level of significance. RESULTS: The mean age of the participants was 33.3 ± 12.2 years, 208 (63.2%) were females, 230 (69.9%) were married and 104 (31.6%) had attained tertiary education. Though 99.1% were aware of LF infection, 50.3% among them had poor knowledge of LF symptoms and risk factors, 92.9% had high risk perception of severity, 72.4% had a high feeling of susceptibility towards LF infection, 82.5% had a high perceived self-efficacy towards LF infection, 63.5% had a low perceived benefit of LF preventive practices and 31.8% had high perceived barrier towards LF preventive practices. Good knowledge of LF was the only significant factor influencing risk perception; perceived severity: (COR: 3.0, 95%CI: 1.2-7.8), perceived susceptibility (AOR: 2.0, 95%CI: 1.25-3.3) and perceived benefit (COR: 2.1, 95%CI: 1.3-3.3). CONCLUSIONS: Good knowledge of LF influences risk perception towards LF which has great import on LF preventive practices. A gap exists in the content and acceptance of LF risk communication information in the LGA. There is a need to review the risk communication messages in the state towards LF in the community with special focus on the males and younger population.