A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia.

BACKGROUND: The purpose of this study was to compare the performance of heat and moisture exchanger filters with heated humidifying systems in the mechanical ventilator circuit on the incidence of ventilator-associated pneumonia (VAP) and bacterial colonization. METHOD: Two hundred and forty-three consecutive patients who required mechanical ventilation for 48 hours or more in the adult intensive care unit were randomized to either a heat and moisture exchanger (HME) or a heated humidifying breathing circuit. RESULTS: The VAP rate among the group with HME was 11.4%; the rate among the group with heated humidifying system (HHS) was 15.8%. The difference was not statistically significant. Approximately 68% of the patients in the HME group had no pathogen isolated compared with 50% of the patients in the HHS group. This difference was statistically significant (P =.006). However, the distribution of the pathogens among those patients who had the isolated pathogens was mostly identical in the 2 groups. CONCLUSION: Even though the study did not find HME to be significantly advantageous over the HHS, in as much as VAP rate is concerned, other advantages such as reduced nurses workload, reduced financial cost, and better safety made HME a more favorable device for use in our adult intensive care unit.

Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis.

The diagnostic value of Brucella ELISA IgG and IgM has been evaluated in patients with brucellosis. Serum samples and blood cultures were collected from 83 patients with brucellosis. The sera were tested by Brucella ELISA for Brucella IgM and IgG antibodies. All 44 controls were negative for IgG and IgM. Brucella melitensis was isolated from blood cultures of 30/83 (36.1%) patients. Among the 30 bacteremic patients, 24 (80%) had an increased IgM titer of > or = 200. Of the 53 non-bacteremic patients, 41 had IgM titer > or = 200, while 22 had IgG titer of > or = 1,600. The ELISA IgM and IgG tests achieved a specificity and sensitivity of 100% and 96% respectively, while the positive and negative predictive values were 100% and 94% respectively. The Brucella ELISA is a reliable and sensitive test in the diagnosis of brucellosis. The test is rapid, easy to perform and can be automated.

Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk.

BACKGROUND: To measure rates of incisional surgical site infection (ISSI) after cesarean section (CS) and to assess risks for infection. METHODS: Prospective surveillance for ISSI at a 540-bed hospital in Saudi Arabia by using Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance (NNIS) system risk index. RESULTS: Seven hundred thirty-five CSs were studied from September 1998 to July 1999; 72% were emergency procedures, despite a 95% rate of antenatal care. The overall ISSI rate was 2.8% (95% confidence interval [CI], 1.7%-4.3%). The rate for NNIS risk category 0 was 2.4% (95% CI, 1.3%-4.2%; n = 536) and for category 1 was 4.1% (95% CI, 1.8%-8.6%; n = 170). In the multivariate analysis, the only independent risks for ISSI were duration of surgery (OR = 1.01; 95% CI, 1.00-1.03; P =.02) and no antibiotic prophylaxis (OR = 3.09; 95% CI, 1.10-9.11; P =.04). Antibiotic prophylaxis was inconsistently administered among both emergency and elective CS. Infection control procedures were inadequate in the obstetric suite operating room. CONCLUSIONS: Despite deficient infection control practices in the setting described, ISSI rates after CS were judged "acceptable" compared with NNIS benchmark rates. This was attributed to prescribing antibiotic prophylaxis for patients at low risk as well as high risk of infection.

The cost-saving potential of prevaccination antibody tests when implementing a mass immunization program.

A seroprevalence study of hepatitis A virus (HAV), hepatitis B virus (HBV), and varicella-zoster virus (VZV) was carried out among Saudi Arabian National Guard soldiers with the objective of determining the cost-saving potential of prevaccination antibody tests when implementing an immunization program for the soldiers. A systematic sampling of 450 blood samples from 1,350 soldiers who donated blood at our hospital was carried out. Antibody tests were performed using the enzyme-linked immunosorbent assay method. The seropositivity rates for antibodies to HAV, HBV, and VZV were 97.5, 17.8, and 88.5%, respectively. Comparing the cost of prevaccine screening with that of universal vaccination, it was estimated that savings of 76 and 32% could be effected for HAV and VZV. Conversely, screening for HBV before immunization could increase the cost of vaccinating against the disease by 49%. A seroprevalence study could be a useful cost-saving approach to a mass immunization program against endemic, natural immunity-conferring diseases.

Circadian rhythm of granulocyte-macrophage colony-stimulating factor in normal subjects and neutropenic hospitalised patients.

BACKGROUND: Granulocyte-macrophage colony-stimulating factor (GM-CSF), one of the haemopoietic growth factors, has rarely been detected in human serum. It has, therefore, been suggested that a paracrine model can explain its behaviour where the substance is produced and acts locally. An alternative explanation might be due to blood sampling time with GM-CSF concentrations undetectable at the nadir of secretion. HYPOTHESIS: We hypothesised that endogenous production of GM-CSF in humans is subject to diurnal rhythm. METHODS: Blood samples were obtained from 17 healthy individuals and 17 neutropenic hospitalised patients with haematological malignancies on myelosuppressive therapy at 6, 12, 18 and 24 hours. In the neutropenic patients, samples were collected at the nadir of the neutrophil count (ANC < 0.2 x 109/L). Serum was assayed for GM-CSF levels using an enzyme-linked immunosorbent assay method. RESULTS: There were significant differences in the mean levels of GM-CSF within the two groups (P < 0.001). In normal subjects, peak GM-CSF levels were reached at six hours (mean = 10.1 pg/ml). Peak levels were reached in hospitalised neutropenic patients at 18 hours (mean = 13.7 pg/ml). The difference between the peak GM-CSF levels in the two groups was not significant (P = 0.11). On factorial design analysis, there was a significant interaction between the time of blood collection and the subject groups (P < 0.001). CONCLUSIONS: Our data are consistent with a diurnal secretion pattern for GM-CSF in both normal and neutropenic patients. As this finding might have practical implications, including timing of administration of GM-CSF in neutropenic patients, further studies are suggested.

The incidence and risk factors of ventilator-associated pneumonia in a Riyadh hospital.

We report the incidence of, and risk factors for, ventilator-associated pneumonia (VAP) at the King Fahad National Guard Hospital. Of the 202 patients studied, 41 (25.2%) had VAP. The incidence density was 16.8/1,000 person-days of ventilation. Variables significantly associated with VAP were serious injury from motor-vehicle accident, enteral feeding, and length of ventilation. The avoidance of unnecessary enteral nutrition could help to reduce VAP.

Comparative study of Amplicor polymerase chain reaction and ligase chain reaction for direct detection of M.tuberculosis in clinical specimens.

Full text is available as a scanned copy of the original print version.

Epidemiology of hepatitis E virus in male blood donors in Jeddah, Saudi Arabia.

To our knowledge, only a few epidemiological reports on the prevalence of hepatitis E antibodies in Saudi blood donors have been published. Men of several nationalities, donating blood at King Khalid National Guard Hospital (Jeddah, Saudi Arabia) were selected (n = 593) for this study examining the seroprevalence of hepatitis E virus (HEV) in the local male donor population and testing the relationship of the antibody to HEV (anti-HEV) to donor characteristics using Odds Ratio (OR) and Chi-square statistic. The prevalence of anti-HEV in the group examined was 16.9 per cent (100/593). The seroprevalence for Saudi donors was 14.8 per cent compared with 33.3 per cent for non-Saudis of Middle Eastern origin. Donors who were 40 yr and over had significantly higher seroprevalence than those donors who were 30 yr or younger (OR = 2.5, p = 0.006). There was a significant association between anti-HEV and anti-HCV with donors who were positive to anti-HCV having about 5 times the risk of HEV than those who were anti-HCV negative (p = 0.02). These findings demonstrate the high seroprevalence rate of anti-HEV among male blood donors in Saudi Arabia.

Infant feeding practices, socio-economic conditions and diarrhoeal disease in a traditional area of urban Ilorin, Nigeria.

A cross-sectional study involving 771 children under the age of one year, was carried out in a traditional area of urban Ilorin, Nigeria, to determine how socio-economic conditions and feeding practices relate to diarrhoeal disease among infants. After adjustment has been made (through logistic regression) for covariates, five factors had significant association with diarrhoeal disease. These are the age of the child, parity, mother's education, availability of household kitchen and the feeding of semi-solid food to the infants. The lowest diarrhoeal rate occurred in infants aged 0-3 months while the highest rate occurred among infants seven to nine months old (Odds Ratio = 4.2). Children who were of the fifth or higher birth order had significantly higher risk of diarrhoea when compared with those who were of the first or second birth order (OR = 1.62; P < 0.05). Children of mothers with secondary education had significantly higher risk of diarrhoea compared with children of illiterates (OR = 1.9; P < 0.05). Households that had no kitchen had significantly higher risk of infantile diarrhoea than households with kitchen facilities (P < 0.01). Finally, infants receiving semi-solid food had higher risk of diarrhoea compared to those children not receiving semi-solid food (P < 0.05). Diarrhoeal disease awareness campaign to educate mothers on the dangers of childhood diarrhoea and how to prevent it, through proper hygiene, especially, food hygiene, is advocated.

PIP: A cross-sectional study of all 771 infants younger than 1 year of age in households in an impoverished ward in Ilorin, Nigeria, investigated the interrelationships among infant feeding practices, socioeconomic conditions, and diarrheal disease during the 1988 dry season. Although almost all infants were being breast-fed, 83.1% of 0-3 month olds were also receiving bottle feeds and 73% of 10-12 month olds were receiving solid foods. Logistic regression analysis identified 5 variables that were significantly associated with diarrheal disease: child's age (p 0.01), parity (p 0.05), mother's education (p 0.05), household availability of a kitchen (p 0.01), and the feeding of semi-solid foods (p 0.05). The highest prevalence of diarrhea was found among infants 7-9 months of age and the lowest among those 0-3 months (odds ratio (OR), 4.2). Children of the fifth or higher birth orders had a higher risk of diarrhea than first- and second-born children (OR, 1.62). Infants of mothers with a secondary education had a significantly greater diarrhea prevalence than those of illiterate mothers (OR, 1.9). In households with a kitchen, the diarrhea prevalence was lower than in those without such a facility (OR, 0.6). Finally, diarrhea prevalence was significantly lower among children yet to receive semi-solid foods than in those already eating such foods (OR, 0.5). These findings indicate a need for a diarrhea awareness campaign to educate mothers on the need for proper hygiene.

Psychosocial correlates of alcohol, tobacco and cannabis use amongst secondary school students in Ilorin, Nigeria.

The psychosocial correlates of alcohol, cigarette and cannabis use were examined in a population of secondary school students in Ilorin, Nigeria, using a 117-items substance use questionnaire. Current alcohol use was found to be significantly associated with urban location of schools, self-reported study difficulty, self-reported poor mental health and having fathers who are highly skilled professionals. Current cigarette use was found to be positively correlated with rural location of school, male sex, older age group and self-reported poor mental health. Lifetime cannabis use was found to be significantly associated with male sex, self-rated poor academic performance and self-reported poor mental health. Perceived availability of alcohol, cigarette and cannabis by the respondents was found to be related to the rate of use of these drugs while perceived harmfulness did not appear to serve as a sufficient deterrent against substance use in the student population. These findings indicate the need for preventive strategies that emphasize school based drug education programmes, parent and teacher education, and national health policies that control availability and accessibility to these substances by Nigerian youths.

The use of sedative-hypnotic drugs in a university hospital in Saudi Arabia.

Sedative-hypnotic drugs (SHD) involve mainly benzodiazepines and barbiturates. For nonhospitalized patients, they are mostly prescribed by general practitioners to patients who are physically ill. In hospitals, most of the patients receiving these drugs are psychiatric patients. This study aims at describing patterns of prescribing these drugs in Saudi Arabia that may be different from that in other countries due to greater legal restriction on psychotropic medications in general. It is a retrospective analysis of charts of the first 100 patients admitted to King Khalid University Hospital (KKUH) from 1 January 1989 to the medical, surgical, psychiatric, and obstetric and gynecology wards. The results are compared to a methodologically similar study from Canada. Generally, SHDs were more frequently prescribed in Canada than in Saudi Arabia. Most of the SHDs were prescribed in the surgical ward and most of the indications in both studies were medical. These and other findings are discussed in the context of cultural aspects in Saudi Arabia.

Pattern of substance use amongst secondary school students in Ilorin, northern Nigeria.

One thousand and forty one Senior secondary School Students in Ilorin, Kwara State, Nigeria were surveyed using a 117-items self-administered substance use questionnaire in May 1988. Males constituted 56.6% and Females 43.5% of the study population. The mean age was 16.8 years (S.D. 1.84). The most currently used substances were found to include salicylate analgesics (56.2%), antibiotics (23.6%), stimulants (21.6%), alcohol (12.0%) and cigarette (4.4%). Current use of alcohol, antibiotics and salicylate analgesic was significantly more common in the rural school. Current use of cigarette and cannabis occurred significantly more in the male population while no significant sex differences were noted for the other drugs surveyed. For many students, initiation into substance use started at primary school level. The need to monitor the pattern of substance use at all levels of our educational system (primary, secondary and post-secondary) and to develop adequate preventive programmes for the student population was emphasized.

Psychosocial correlates of alcohol, tobacco and cannabis use: findings from a Nigerian university.

The possible correlates of alcohol, tobacco and cannabis use were investigated in a survey conducted among undergraduate students of the University of Ilorin, Nigeria. Factors that emerged as common correlates to the three substances investigated were peer influence, self-reported poor mental health, religiousity, parental/guardian supervision, perceived availability and perceived harmfulness. In addition, drinking and smoking were found to be commoner among the male sex and among respondents who reported study difficulty. There was also a significant positive relationship between cannabis use and a polygamous family background and belonging to an older age group. Although the data used in the analysis is limited due to its cross-sectional nature, the observations made are useful enough for the formulation of primary prevention strategies. A further and more elaborate longitudinal study is, however, suggested.

Evaluation of a face-to-face weaning food intervention in Kwara State, Nigeria: knowledge, trial, and adoption of a home-prepared weaning food.

This paper reports on the evaluation of a pilot intervention which used nutrition education techniques to introduce a fortified, home-prepared weaning food (eko ilera, or 'pap for health') in 12 communities in Kwara State, Nigeria, from June to August, 1988. The recipe added toasted cowpea flour, red palm oil, and sugar to increase the energy and protein density of the traditional maize or sorghum starch porridge used for weaning from 38 to 85 kcal and 0.8 to 2.0 g protein per 100 g. A stratified, random sample of participating (n = 295) and non-participating (n = 301) mothers from the same communities were interviewed from 2 to 8 weeks following the completion of the intervention, and their rates of knowledge, trail, and adoption of eko ilera were evaluated. Of the participating mothers, 57% (95% CI: 51%, 63%) knew the modified recipe, 48% (43%, 54%) tried it, and 17% (12%, 21%) adopted it with the intention of using it in the future. Only 2% (1%, 7%) of non-participating mothers knew about the recipe. Multivariate analyses indicated that the mothers' level of education and their perception of the cost and length of preparation time of the recipe were significantly associated with its adoption. The intervention was successful in using face-to-face nutrition education methods to introduce eko ilera to mothers in this region of Nigeria and to encourage its trial and adoption.

Diarrhoeal disease morbidity, risk factors and treatments in a low socioeconomic area of Ilorin, Kwara State, Nigeria.

A 12-month diarrhoeal disease surveillance was carried out in a sample of 351 children under 3 years of age in a low-income traditional area of Ilorin, Nigeria to determine whether sociodemographic characteristics, including age of the child, sex, parity, mother's education, occupation, mother's age and household kitchen, were associated with the incidence of acute diarrhoea. Bivariate and multivariate analyses were used to determine association. Results indicated that only the age of the child and the type of kitchen used by the household had a significant association with diarrhoea. Diarrhoeal incidence decreases with the child's age while households with a private kitchen had a significantly lower incidence rate than those without a kitchen. This finding emphasises the importance of good hygiene in reducing the risk of having diarrhoea. Three common treatments applied by mothers are ORS (used in 14.8% of diarrhoea days), antibiotics (54.5%) and local herbs (27.7%). The younger a child is the more likely that ORS and antibiotics will be administered during diarrhoea. About 53% of the antibiotic use was by self medication while 40% were prescribed by the clinics. The need for educational campaigns to discourage the inappropriate use of antibiotics was emphasised.

Development of a nutritionally adequate and culturally appropriate weaning food in Kwara State, Nigeria: an interdisciplinary approach.

A nutrition education program was undertaken in Kwara State, Nigeria to improve infant feeding practices and nutritional status of weaning-aged children. A series of ethnographic, market survey, epidemiological, dietary, clinical, and communications research studies were implemented to develop a culturally acceptable, yet nutritionally adequate, weaning food. A premise of the project was that the development and introduction of any new weaning food should be based upon ingredients available in the community and to households, at a low cost and with minimum preparation time, and that would be culturally acceptable by mothers for feeding young children. Initially, research was conducted to define the problem in both nutritional and anthropological terms. Data was collected to describe: (1) present patterns of infant feeding and their determinants; and (2) dietary intake and nutritional status of infants in the intervention area. This paper focuses on the process of defining the problem and developing an intervention from an interdisciplinary perspective. The development of the new weaning food, Eko-Ilera, a fortified pap based on the traditional weaning food, is described.

Sociodemographic and clinical factors affecting recognition of childhood diarrhea by mothers in Kwara State, Nigeria.

Early diagnosis of infant and child diarrhea by family members is the key to timely treatment. Factors that influence the caregiver's recognition of diarrhea have not been systematically studied, but may include characteristics of the caregiver, the child, or the illness itself. This paper examines the relationships between the caregivers' diagnoses of diarrhea during the previous 24 hr and the reported frequency and consistency of their children's bowel movements during the same period of time, using information from a representative sample of 2655 children less than 3 years of age in Kwara State, Nigeria. Diarrheal point prevalence based on maternal diagnosis (10.0%) was about half that based on the clinical criteria of three or more liquid or semi-liquid stools (18.8%). Only 36% of the mothers recognized a recent episode of diarrhea defined by the clinical criteria. Mothers were more likely to recognize diarrhea when a greater number of stools of watery consistency were excreted or when the stools contained blood or mucus. Mothers were least likely to recognize diarrhea when the child was a girl or less than 2 months of age. These results suggest that cross-cultural comparisons of diarrheal rates should use consistent, objective evidence of illness to compare rates rather than maternal diagnosis alone. Also, diarrheal disease control programs should explore those factors affecting recognition of illness in local contexts to assure that treatment recommendations can be applied in a timely fashion.

Effect of diarrhoea on dietary intake by infants and young children in rural villages of Kwara State, Nigeria.

Community-based, quantitative studies of dietary intake by 5- to 28-months-old Nigerian children were conducted during episodes of diarrhoea and subsequent convalescent and healthy periods. Energy intakes during diarrhoea (85.3 kcal/kg per d) were slightly lower than during health (95.9 kcal/kg per d, P less than 0.05), using paired analysis of intra-individual differences. When intake was disaggregated by food source, no differences by illness status were found in energy intake from breast milk or liquid pap. There were no differences in frequency or duration of breastfeeding by illness status, but pap was provided more frequently and in smaller amounts during illness. Energy intake from other foods, including solids, was greater during health than diarrhoea (P less than 0.05) with an increase in number of servings per day. There was no evidence of caretakers either withholding food during illness or providing extra food during the convalescent phase. The magnitude of illness-associated differences in these children's daily intake was small relative to the deficit in their intakes, even on healthy days, when compared to the amounts recommended for this age group.

Contraceptive knowledge and practices in Ilorin, Nigeria: 1983-88.

This report describes changes in knowledge and use of contraceptives in Ilorin, Nigeria between 1983 and 1988, a period marked both by dramatic changes in Nigeria's economic climate, as a result of the decline in the value of oil exports, and by considerable increases in public programs aimed at promoting the use of family planning and reducing fertility. The report is based on the analysis of two surveys of married women aged 15-35 years who lived in the city of Ilorin. By 1988, knowledge of modern methods of contraception had become virtually universal in Ilorin, even among women with no education and among those living in the poorest areas of the city. Current use of contraceptives had also increased considerably since 1983, reaching prevalence rates of 15 percent among women with primary education, 20 percent among those with secondary education, and 40 percent among those with postsecondary education. Each of these groups of women experienced at least a doubling of contraceptive prevalence between 1983 and 1988. Although use among uneducated women was still low in absolute terms (prevalence of 4.5 percent), these women also experienced a substantial relative increase in use.

PIP: Changes in knowledge and use of contraceptives in Ilorin, Nigeria between 1983 and 1988 are reported. During these 5 years there have been dramatic changes in economic climate, and much increase in public programs promoting family planning and reduced fertility. The results of a 1983 survey of married women aged 15-35 years show that while knowledge of contraceptive methods was high, current use was very low. Traditional birth spacing methods were declining, and fertility was very high. A 2nd survey similar to the 1983 survey, was undertaken in 1988 to look into fertility changes and its determinants including contraceptive knowledge and use, breastfeeding, and postpartum abstinence, and to improve understanding of reproductive behavior. The 1988 survey covers married women aged 15-49 and men currently married to women of these ages. Knowledge of contraception was almost universal among women with more than a primary education and in medium and high socioeconomic areas. The most dramatic increase took place in knowledge of the most effective contraceptives increased between 1983 and 1988. Large relative increases took place among those with no education, with ever-use increasing from 1.9% in 1983 to 9.7% in 1988. Among the women with no education, current use increased from 0.8% in 1983, to 4.5% in 1988. In the other 3 education classifications, use increased from 4.4% to 15.2% among those with a primary education; from 10.7% to 20.0% among those with a secondary education. The same pattern of substantial increase in shown when use is analyzed by area of residence. There was a shift to more effective methods in 1988. Most women 1st used contraceptives during the 5-year period, 1983-1988 and obtained their method from hospitals or clinics although some went to pharmacies.

Child mortality in a Nigerian city: its levels and socioeconomic differentials.

Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country.