Carbapenem resistance associated with coliuria among outpatient and hospitalised urology patients.

The World Health Organization in 2017 listed carbapenem resistant Enterobacteriaceae (CRE) with critical priority for research. A research to assess carbapenem resistant Escherichia coli (CREc) in coliuria among the outpatients and inpatients of a tertiary health institution was carried out using conventional methods, polymerase chain reaction, Sanger sequencing, and bioinformatics. There were 39 positive coliuria cases from the urine samples collected from a total of 126 patients with various genitourinary diseases. The E. coli enumeration (log10 CFU/mL) revealed that 82.1% (n = 32) of the samples showed significant coliuria, 12.8% (n = 5) showed non-significant coliuria while 5.1% (n = 2) showed indeterminate coliuria even when repeated. Significantly higher numbers (p > 0.05) of the sampled inpatients yielded positive coliuria (57.9%) than the outpatients. Though there were significantly more (P > 0.05) urology female patients (n = 77) than male (n = 49), coliuria was more prevalent in sampled male patients (34.9%) than female (28.6%). Highest prevalence of coliuria was observed among the age range (18-30) years. Selected CREc that was sequenced and the sequences submitted to GenBank of National Center for Biotechnological Information (NCBI) were Escherichia coli AYO-WINI111 and Escherichia coli AYO-WINI112 with accession number MT735391 and MT735392, respectively. High resistance was observed against ertapenem (53%), imipenem (62%), meropenem (48%), and doripenem (47%), while 7%-22% of the isolates showed phenotypic intermediate carbapenem resistance. Critically dangerous CREc are harboured by large number urology patients in the study area, depicting the need for more attention in the management of the condition, as CREc are close to achieving totally antibiotic resistance.

Phenotypic Characterization and Antibiotic Susceptibility Profile of Coagulase Positive Staphylococci from The External Surfaces of Hospital Cockroaches (Periplaneta americana)

A study to phenotypically characterize and determine the antibiogram of coagulase positive Staphylococci (CoPS) from the external surfaces of hospital cockroaches (Periplaneta americana) was conducted using standard microbiological methods. Out of the 50 cockroaches collected from various hospitals in Uyo, sixty-two percent (n = 31) had coagulase positive Staphylococci which consisted of Staphylococcus aureus (44.0 %; n = 22) and Staphylococcus intermedius (18.0 %; n = 9). The CoPS isolates showed 100% resistance to Penicillin, Tetracycline, Clindamycin and 80.6% sensitivity to Amoxicillin-clavulanate. The CoPS showed multiple antibiotic resistances to ≥ 3 antibiotics, with 60 % exhibiting resistance to 6 antibiotics. Out of the 80 % (n = 31) of the multidrug resistant CoPS that were sensitive to Amoxicillin-clavulanate, none of them showed production of beta lactamase. The cockroaches bore multiple antibiotic resistant CoPS on their external surfaces and their contact can initiate contamination of patients' food. Pest control measures in hospital are hereby recommended to minimize cockroach related infections

Resistotyping and extended-spectrum beta-lactamase genes among Escherichia coli from wastewater treatment plants and recipient surface water for reuse in South Africa.

The spread of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli has increased in different environments. This study aimed to evaluate the patterns of antibiotic resistance and ESBL genes among E. coli isolates collected from wastewater and recipient surface water in South Africa. Fifteen samples containing nine wastewater and six river water samples were collected from a local wastewater treatment plant. The E. coli isolates were detected using standard microbiology methods. Antibiotic susceptibility testing was performed using disc diffusion agar. The occurrence of bla CTX-M, bla SHV and bla TEM ESBL genes was investigated by PCR. Exactly 140 isolates were selected from the primary enumeration plates with a log10 CFU/mL count that ranged from 4.1 to 4.2 (influent), 4.2 to 4.5 (biofilter) and 2.5 to 3.3 (effluent). The wastewater effluent showed an impact on the receiving water environment, as the treatment efficiency was 92% and the downstream log10 CFU/mL count (range, 3.6-3.8 log10 CFU/mL) was higher than the upstream count (range, 3.3-3.6 log10 CFU/mL). Antibiotic testing results showed that 40% to 100% of E. coli isolates were resistant to ampicillin, penicillin, tetracycline and cefotaxime but susceptible to imipenem, meropenem and ciprofloxacin. A total of 40 studied isolates (28.6%) had both the bla TEM and bla CTX-M genes, while no bla SHV was detected. The wastewater treatment plants contributed multidrug-resistant ESBL-producing E. coli isolates that can be potential environmental health risks. Regular monitoring policies are recommended to prevent the spread of antibiotic resistance in the region.

Drivers of cervical cancer screening uptake in Ibadan, Nigeria.

Despite the empirical evidence that cervical cancer screening has been a successful public health initiative to secondarily prevent the incidence and mortality from cervical cancer in developed nations, majority of women of sub-Saharan root, Nigeria inclusive, do not utilize this essential health service. This study/article contributes to the empirical literature on the drivers of cervical cancer screening utilization within Nigeria context. The paper investigates the determinants of cervical cancer screening utilization among both working class women and women involved in trading activities in Oyo state, Nigeria. The statistical estimations find strong support for attitudinal correlates, perceived seriousness and family history as drivers of utilization of cervical cancer screening. While only 13.5% of respondents reported to have ever utilized the screening test, majority had positive attitude towards the screening. The screening uptake among the women could improve, if necessary barriers are addressed. The paper highlights policy recommendations for enhancing organized screening guidelines in a developing country.

Concentration and reduction of antibiotic residues in selected wastewater treatment plants and receiving waterbodies in Durban, South Africa.

In the province of KwaZulu-Natal, South Africa the incidence of resistant tuberculosis, upper respiratory tract diseases as well as diarrhoeal and parasitic infections is high. Treatment of these diseases with antibiotics is partly reflected by the excretion of the respective antibiotics and their subsequent occurrence in wastewater. Their quantitative reduction in wastewater treatment reflects their potential environmental as well as human impact, the latter due to the use of the recipient water for domestic purposes and for irrigation. Information of the occurrence and reduction of different classes of antibiotics in wastewater treatment is sparse, especially the particle bound fraction of these. Due to this, analyses of aqueous and particle bound antibiotics in untreated wastewater of four selected wastewater treatment plants (WWTPs) and their receiving water bodies was carried out in Durban, South Africa. The treatment step especially considered was the biological one, represented by activated sludge and trickling filters. The treatment further included secondary clarifiers and final chlorine disinfection. Composite samples were collected during the period February 2017 to May 2017 and analysed with online solid phase extraction - high performance liquid chromatography mass spectrometry (SPE-HPLC-MS). For the 13 assessed antibiotics, the limit of detection (LOD) and the limit of quantification (LOQ) ranged from 0.07 to 0.33 ng L-1 and 0.23 to 1.09 ng L-1 respectively, while the total percentage recovery was in the range of 51 to 111%. The percentage of individual antibiotics bound to the particulate fraction normally lost by sample (influent) filtration, if not analysed in parallel, was in the range of 2.6%-97.3% (n = 32). In this fraction (sludge from centrifuge sample), the concentration of bound antibiotics of all the target antibiotics were detected in the influent of all WWTP in concentration ranges between 1.3 ng L-1 (Azithromycin; AZI) to 81,748 ng L-1 (Ciprofloxacin; CIP). The antibiotics with the highest median concentrations in receiving water bodies of the respective WWTP were; Sulfamethoxazole; SUL (239 ng L-1) WWTP "K", Ciprofloxacin; CIP (708 ng L-1) WWTP "S" and Albendazole; ALB (325 ng L-1 and 683 ng L-1) WWTP "P" and "I" respectively. The overall percentage removal efficiency for the four WWTPs ranged from 21% to 100%. The biological treatment steps, activated sludge and trickling filters, were effective in removing antibiotics especially with the trickling filter and the impact of the sedimentation stage after activated sludge treatment.

Identification of antibiotics in wastewater: current state of extraction protocol and future perspectives.

The release and occurrence of antibiotics in the aquatic environment has generated increased attention in the past few decades. The residual antibiotic in wastewater is important in the selection for antimicrobial resistance among microorganisms and the possibility of forming toxic derivatives. This review presents an assessment of the advancement in methods for extraction of antibiotics with solid phase extraction and liquid-liquid extraction methods applied in different aquatic environmental media. These advanced methods do enhance specificity, and also exhibit high accuracy and recovery. The aim of this review is to assess the pros and cons of the methods of extraction towards identification of quinolones and sulphonamides as examples of relevant antibiotics in wastewater. The challenges associated with the improvements are also examined with a view of providing potential perspectives for better extraction and identification protocols in the near future. From the context of this review, magnetic molecular imprinted polymer is superior over the remaining extraction methods (with the availability of commercial templates and monomers), is based on less cumbersome extraction procedures, uses less solvent and has the advantage of its reusable magnetic phase.

Job satisfaction and retention of midwives in rural Nigeria.

BACKGROUND: Nigeria is one of the 57 countries with a critical shortage of human resources for health, especially in remote rural areas and in northern states. The National Midwifery Service Scheme (MSS) is one approach introduced by the Government of Nigeria to address the health workforce shortage in rural areas. Since 2009, unemployed, retired and newly graduated midwives are deployed to primary health care (PHC) facilities in rural areas of Nigeria. These midwives form the mainstay of the health system at the primary health care level especially as it relates to the provision of skilled attendance at birth. This study followed up and explored the job satisfaction and retention of the MSS midwives in three Northern states of Nigeria. METHODS: this was a descriptive study. Data were collected using a mixed method approach which included a job satisfaction survey, focus group discussions (FGDs) and exit interviews to explore job satisfaction and retention factors. All 119 MSS midwives deployed by the National Primary Health Care Development Agency between 2010 and 2012 to the 51 Partnership for Reviving Routine Immunisation- Maternal and Child Health (PRRINN-MNCH) programme targeted PHC facilities were included in the study. RESULTS: MSS midwives were very satisfied with from the feeling of caring for women and children in the community (4.56), with the chance to help and care for others (Mean 4.50), the feeling of worthwhile accomplishment from doing the job (Mean 4.44) and the degree of respect and fair treatment they received from more senior staff and/or supervisor (Mean 4.39). MSS midwives were least satisfied with the lack of existence of a (established) career ladder (Mean 2.5), availability of promotional opportunities within the scheme (Mean 2.66), safety of accommodation (Mean 3.18), and with 'the degree to which they were fairly paid for what they contribute to the health facility' (Mean 3.41). When asked about future career plans, 38% (n=33) of the MSS midwives planned to leave the scheme within two years, of which 16 (18%) wanted to leave within one year. However, 39% of the midwives (n=34) indicated that they would be happy to continue working even after the scheme has ended. Of these 34 participants, 18 would like to continue working in the same facility where they are now whereas the remaining 16 would like to continue working in the north but not in the facility where they are working currently. Eight themes on job satisfaction and retention emerged from the FGDs conducted with current midwives, whereas six themes emerged from the exit interviews from midwives who have left the scheme. CONCLUSION: the MSS programme is a short-term solution to increase SBA coverage in rural Nigeria. MSS midwives were dissatisfied with the short term contract, lack of career structure, irregular payment, poor working condition, inadequate supervision and poor accommodation being offered by the programme, which all contribute to poor retention of MSS midwives. IMPLICATIONS FOR POLICY AND PRACTICE: midwives׳ job satisfaction and retention are critical to improving the health of mothers and their newborn. Poor job satisfaction and retention therefore requires improvements in financial and non-financial incentives, health systems, supportive supervision, ensuring job security and a career structure for midwives working in rural health facilities. Initiating effective strategies to motivate and increase the retention of rural health workers is important for Nigeria to achieve the Millennium/Sustainable Development Goals.

Skilled birth attendance-lessons learnt.

To reduce the horrific maternal mortality figures that we have globally especially in resource poor countries, there was a global commitment to reduce maternal mortality by three-quarters by 2015 using 1990 as a baseline. To measure the achievement of this goal, two indicators: maternal mortality ratio and proportion of births attended by skilled attendance were selected. To ensure skilled attendance at birth for all women, the international community set a target of 80% by 2005, 85% by 2010 and 90% coverage by 2015. However, in 2008 only 65.7% of all women were attended to by a skilled attendant during pregnancy, childbirth and immediately postpartum globally with some countries having less than 20% coverage. With the global human resource crisis, achieving this target is challenging but possible. This paper provides a narrative review of the literature on the skilled birth attendance strategy identifying key challenges and lessons learnt.

A community-based investigation of the avoidable factors of maternal mortality in Nigeria: the pilot experience

"Background: Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals. However; because measuring maternal mortality is difficult and complex; reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult in some countries. Reliable baseline data are crucial to effectively track progress and measure that targets or goals of reducing maternal mortality have been met. Objectives:The objectives of this pilot study were: to test adequacy of research instruments; to improve research techniques; to determine an appro- priate workload; to determine the time required for interviews; and to assess the feasibility of a (full-scale) study/ survey. Methods:This pilot study was conducted between 11th April and 22nd April 2005. 420 houses were visited and interviews of 420 respondents between the ages of 15-49 were conducted in a randomly pre-selected Local Government Area of Oyo state using a structured instrument developed using the principles of the Sisterhood Method. Results:There was willingness of the public to participate in the study. The response rate was 100.There was no issue raised as regards the structure;wording and translation of the question- naire.This pilot study uncovered local political problems and other issues that may be encountered during the main study. Conclusions:The pilot raised a number of fundamental issues related to the process of designing the research instrument; identifying and recruiting Data Collectors; training and supervision of Data Collectors and the research project; gaining access to respondents and obtaining support and approval from ""gate- keepers"".This paper highlights the lessons learned and reports practical issues that occurred during pilot study."

5-yearly monitoring of trends of substance use among secondary school students in Ilorin, Nigeria, 1988-1998.

This report describes the trends of substance use among youths by comparing data collected among senior secondary school students in Ilorin metropolis, Kwara State, Nigeria at 5-yearly intervals (1988-1998). In 1998, data were collected from 750 senior secondary school students from six secondary schools in the study area using a self-report 117-item questionnaire based on the World Health Organization (WHO) guidelines for student substance-use surveys. Substances investigated in the survey were alcohol, cigarettes, cannabis, strong and mild stimulants, hypnosedatives, antibiotics, cocaine, heroin, organic solvents and hallucinogens. These data were compared with similar ones collected from students with similar characteristics, and from the same six schools in 1988 and 1993. It was found that high use substances were mild stimulants, antibiotics and alcohol, while cigarettes, cannabis, heroin and cocaine remained low-use substances. Most current users of all the substances were occasional users, except for cigarettes and cannabis where more frequent (daily and weekly) usage was reported. There was also a significant increase in the use of alcohol, organic solvents, mild stimulants and hypnosedatives, and a significant reduction in cigarette smoking over the three data waves. No gender difference was recorded for alcohol, hypnosedatives and cocaine use in the three data waves. It was concluded that although some substances recorded significant increases in their usage over the three data waves, the current use rates were still generally low and comparable to those of other Nigerian studies. Substances used were those employed mainly for study purposes (mild stimulants and hypnosedatives), and most students used the substances only on occasional basis. Nonetheless, in view of the rapidly changing socio-economic life of Ilorin City, it has become imperative to continue with the 5-yearly monitoring of trends.

Teenage prostitution--child abuse: a survey of the Ilorin situation.

In the light of civilization that has come to erode some of the sexual constraints in the traditional African society's opennes today toward sexuality and sexual expression, adolescents commence sexual activity at an increasing earlier age and the average marriage come much later. It is therefore not surprising that an increasing proportion of adolescents in Nigeria are engaging in teenage prostitution. This study is an attempt to conduct a general survey into the nature of teenage prostitution in Nigeria and to provide information on the prevalence, factors, trends and characteristics of teenage prostitution. A semi-structured questionnaire was administered to 150 known teenage prostitutes. Among other things the finding suggest that childhood sexual abuse perhaps leads to prostitution. Half of the sample used in the study had their first sexual experience early in life, and about the same number lived with their parents when they began prostituting. Implications of the findings were discussed and suggestions made for further research.