Knowledge, attitude and practice of infection prevention and control among healthcare workers: one year after an outbreak of nosocomial Lassa fever in a tertiary hospital in southeast Nigeria

Background: With the rise in cases of Lassa fever in recent times in West Africa, the healthcare setting continues to pose significant risk especially among healthcare workers (HCWs) for diseases like Lassa fever that are transmitted via contact with blood and other body fluids. We therefore assessed the knowledge, attitude and practice (KAP) of infection prevention and control (IPC) one year after an outbreak of nosocomial transmission of Lassa fever in the study hospital. Methodology: A cross-sectional study of HCWs was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, a tertiary hospital designated for Lassa fever treatment in southeast Nigeria. A total of 631 HCWs selected by systematic random sampling were surveyed using self-administered questionnaire to determine the KAP of IPC. Data analysis was done with EPI INFO version 7.2 and Microsoft Excel 2016, and Chi square statistic was used to examine relationship between variables at 5% level of significance. Results: Only 287 (51.1%) of the 562 respondent HCWs had good knowledge of IPC, 442 (78.6%) had good attitude towards IPC, and 268 (47.7%) had good practice of IPC. Socio-demographic predictors of IPC knowledge included being a medical laboratory scientist (AOR=0.5; 95% CI=0.29-0.83; p=0.009), tertiary education level (AOR=7.0; 95% CI=1.11-44.60; p=0.038), and work experience of ≥ 7 years (AOR=2.3; 95% CI=1.47-3.57; p<0.001). Male gender (AOR=1.9; 95% CI=1.06-3.42; p=0.031), nurse professional (AOR=6.5; 95% CI=2.67-15.81; p<0.001) and work experience of ≥ 7 years (AOR=2.5; 95% CI=1.37-4.54; p=0.003) were predictors of good attitude towards IPC. Also, nurse professional (AOR=3.1; 95% CI=1.79-5.20; p<0.001) and married status (AOR=1.6; 95% CI=1.05-2.55; p=0.028) were predictors of good practice of IPC among the respondents. Conclusions: The study demonstrated that knowledge and practice of IPC was low in the study location despite the interventions that had been instituted to improve the IPC framework. Therefore, there is need to adapt approaches that will influence behavior change towards IPC in the course of the in-service trainings being conducted in the hospital.

Birth preparedness and complication readiness among women of reproductive age group in Abakaliki, Southeast Nigeria.

BACKGROUND: Birth preparedness and complication readiness (BPCR) reduces delays in obstetric care, improves health-seeking behavior during an obstetric emergency, and improves knowledge on danger signs of pregnancy. AIMS: To assess the knowledge, perception, and practice of women on BPCR. SUBJECTS AND METHODS: This was a cross-sectional study conducted at Federal Teaching Hospital in Ebonyi state, Nigeria at the postnatal ward from June to December 2016. Women who delivered were recruited consecutively on discharge from the postnatal ward. Their knowledge, perception, and practice of BPCR in the last pregnancy were sought. Information obtained were analyzed using 2008 Epi-info™ software version 3.5.1 (Atlanta Georgia USA). RESULT: A total of 438 of 445 questionnaires were correctly filled and analyzed giving a response rate of 98.4%. Most of the women knew about birth preparedness 384 (87.7%) and complication readiness 348 (79.5%). A significant number of women did not access antenatal care within the first trimester 236 (53.9%), did not know that family planning is important in BPCR 216 (49.3%), and did not identify means of transport in the event of emergency 354 (80.8%). No provision of blood during antenatal care for the blood banking system was a common finding 258 (58.9%). In multivariate logistic regression analysis, choosing a health care provider was a common finding among literate mothers (OR = 2.8,95% CI = 1.02,7.72), woman within 25-29 years (OR = 1.09, 95%CI = 1.02,1.16), and multiparas (OR = 0.82, 95% CI = 0.67,0.99). CONCLUSION: There is increased knowledge and awareness of BPCR but the comprehensive components and practices of BPCR are still not optimal in our setting.

Ruptured ectopic in heterotopic pregnancy: Management and spontaneous vertex delivery of a live baby at term.

Spontaneous heterotopic pregnancy is an uncommon clinical condition in which there is a simultaneous development of intrauterine and extrauterine pregnancies. It is a life-threatening emergency when the ectopic ruptures. We present Mrs. EC, a 27-year-old G1P0 + 0 with a family history of multiple gestations who had a heterotopic pregnancy at a gestational age of 7 weeks. She presented with features of threatened miscarriage at early pregnancy with an ultrasound confirmation of intrauterine pregnancy. The diagnosis of ruptured ectopic pregnancy coexisting with intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Thereafter, pregnancy was carried to term, and she delivered a live male baby that weighed 3.0 kg. Heterotopic pregnancy should be sort for in all pregnancies during the early scan, especially in those with predisposing factors for multiple gestations and risk factors for ectopic gestation. A high index of suspicion is necessary for making a diagnosis in women with intrauterine pregnancy, with or without symptoms of ectopic gestation, and irrespective of the existence of risk factors for ectopic pregnancy.

The prevalence of osteoporosis among antenatal clinic attendees in a rural mission hospital in South-East Nigeria.

INTRODUCTION: Osteoporosis is a global public health problem characterized by reduction of bone mineral density (BMD). This study aimed to assess the prevalence of osteoporosis among antenatal clinic attendees in a rural Southeastern hospital. MATERIAL AND METHODS: This was a cross-sectional study of booking Antenatal Clinic Attendees at Mile 4 Catholic Hospital, Abakaliki, between October 2014 and February 2015. The study participants were selected through systematic random sampling. The BMD of the right calcaneal bone of the participants was measured using the OsteoPro, a Quantitative ultrasound scan. RESULTS: A total of 327 eligible women participated in the study. The average age of the participants was 29 ± 4.5 years. The average parity was 2 ± 1.6 childbirths. The mean T-score was -1.19 ± 4.9. Osteoporosis and osteopenia were recorded in 119 women (36.4%) and 56 women (17.1%), respectively, whereas 152 (46.5%) were within normal range. History of regular exercise by the respondents is statistically significant on the reduction of osteopenia and osteoporosis (P ≤ 0.05). The history of ever use of calcium supplementation by the study participants in the index pregnancy did not have any significant effect on the reduction of osteoporosis. CONCLUSION: There is a high prevalence of osteoporosis among pregnant women in Southeast Nigeria. This may be due to the predominant poor adherence and low dose of calcium supplementation among pregnant women in this environment. Therefore, there is an urgent need for sensitization on this public health problem.

Fitz-Hugh-Curtis syndrome: An incidental diagnostic finding in an infertility workup.

A case of Fitz-Hugh-Curtis syndrome in a 32-year-old para 1+1 is reported. She presented with inability to conceive of 4 years duration. Her husband's semen analysis was within normal range. She had a hysterosalpingogram that showed bilateral tubal blockage and clinical assessment showed right sided abdominal tenderness, cervical excitation tenderness, and adnexa tenderness. The endocervical swab test for Chlamydia trachomatis was a positive. Laparoscopy and dye test showed adhesion bands on the under surface of the liver (the violin string appearance). She recovered well postoperatively. The couple received ofloxacin and metronidazole for 2 weeks. Literatures on Fitz-Hugh-Curtis syndrome presentation, pathogenesis, and management were reviewed.

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Background: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking