RESUMO
Background: There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes. Methods: This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software. Results: The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis. Conclusion: The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.
RESUMO
Blood, stool and urine samples were collected from 100 patients diagnosed as having typhoid in 5 hospitals in Akwa Ibom State and analyzed for the presence of Salmonella species and other bacteria. Of the 100 blood samples screened, 55 (55%) were positive with the Widal test and 39 (39%) were positive on blood culture. Thirteen (14.1%) out of 92 urine samples were positive for bacterial growth, while 22 (26.8%) of the stool cultures were positive out of the 82 samples screened. Those within the age range 11-20 years old were infected most frequently (33%), followed by the age range 21-30 (19%) and 41-50 (18%) years old. Those in the age range of 0-2 years old (4%) were least infected. Female subjects were more infected than males. The commonest organisms isolated from the blood samples were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus vulgaris, Streptococcus faecalis, Salmonella paratyphi and Salmonella typhi. S. aureus, S. epidermidis, E. coli, K. aerogenes, S. faecalis, Proteus mirabilis and P. aeruginosa were isolated from urine, while those isolated from stool were S. aureus, E. coli, S. typhi, S. paratyphi, Shigella sp, K. pneumoniae, P. vulgaris, P. aeruginosa and Vibrio cholerae 01. The isolates were sensitive to peflacine, ceftazidine, ciprofloxacin, ceftriaxone, cefotaxime and chloramphenicol. These antibiotics are recommended as the drugs of choice in therapy. The results suggest the existence of symptomless carriers of enteric fever bacilli in the state. This is worrisome, since some of the S. typhi isolates exhibited multiple resistance to commonly used antibiotics.
