Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria.

BACKGROUND: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. METHODS: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. RESULTS: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. CONCLUSIONS: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

EAONO/JOS classification for acquired cholesteatoma: evaluating the impact of the number of affected sites on treatment and outcomes.

PURPOSE: The European and Japanese system for cholesteatoma classification proposed an anatomical differentiation in five sites. In stage I disease, one site would be affected and in stage II, two to five. We tested the significance of this differentiation by analyzing the influence of the number of affected sites on residual disease, hearing ability and surgical complexity. METHODS: Cases of acquired cholesteatoma treated at a single tertiary referral center between 2010-01-01 and 2019-07-31 were retrospectively analyzed. Residual disease was determined according to the system. The air-bone gap mean of 0.5, 1, 2, 3 kHz (ABG) and its change with surgery served as hearing outcome. The surgical complexity was estimated regarding the Wullstein's tympanoplasty classification and the procedure approach (transcanal, canal up/down). RESULTS: 513 ears (431 patients) were followed-up during 21.6 ± 21.5 months. 107 (20.9%) ears had one site affected, 130 (25.3%) two, 157 (30.6%) three, 72 (14.0%) four and 47 (9.2%) five. An increasing number of affected sites resulted in higher residual rates (9.4-21.3%, p = 0.008) and surgical complexity, as well poorer ABG (preoperative 14.1 to 25.3 dB, postoperative 11.3-16.8 dB, p < 0.001). These differences existed between the means of cases of stage I and II, but also when only considering ears with stage II classification. CONCLUSION: The data showed statistically significant differences when comparing the averages of ears with two to five affected sites, questioning the pertinence of the differentiation between stages I and II.

Seroprevalence of Hepatitis B and C Virus Infections among Healthcare Seekers at a Tertiary Health Facility in North-Central Nigeria: A Retrospective Study.

BACKGROUND: Hepatitis B and C viral infections are among the common infectious diseases with global public health importance. Nigeria is among the countries identified to be hyper-endemic for hepatitis B virus (HBV) infection. This study aimed to determine the seroprevalence of HBV and hepatitis C virus (HCV) infections among healthcare seekers at Bingham University Teaching Hospital, Jos, Nigeria, to increase awareness among the populace and sensitize public health stakeholders. METHODS: A retrospective study that involved data abstraction from the medical laboratory records of patients seeking care at Bingham University Teaching Hospital. The information collected included screening results for HBsAg and anti-HCV. Data were analyzed using SPSS version 24. RESULTS: A total of 186 patients were screened for HBV infection and 96 were screened for HCV infection. The mean ages and standard deviations were 36.2 ± 15.05 years and 37.2 ± 14.48 years for those screened for HBV and HCV, respectively. The seroprevalence rate of HBV infection was 14.0% while the rate for HCV infection was 10.4%. Males had a higher HBV seroprevalence of 9.1% than females with 4.9%. For HCV seroprevalence, females recorded a higher prevalence of 6.2% compared to their male counterparts who had 4.2%. Among those screened for HBV, the young adult age group had the highest prevalence rate of 10.2%, while for the HCV screen the middle-aged group had the highest prevalence rate of 6.2%. These were, however, not statistically significant (p > 0.05). CONCLUSION: This study has shown that both HBV and HCV infections are hyper-endemic. There is a need to intensify awareness campaigns and improve the implementation of preventive and management strategies for HBV and HCV infections.

CONTEXTE: Les infections virales par les virus de l'hépatite B et C font partie des agents infectieux courants des problèmes de santé mondiale. Le Nigeria fait partie des pays identifiés comme hyperendémiques pour l'infection par le virus de l'hépatite B (VHB). Cette étude visait à déterminer la séroprévalence des infections par le VHB et le virus de l'hépatite C (VHC) parmi les demandeurs de soins de santé à l'Hôpital Universitaire Bingham, Jos, Nigeria, afin d'accroître la sensibilisation parmi la population et de sensibiliser les intervenants en santé publique. MÉTHODES: Une étude rétrospective impliquant l'abstraction des données à partir des dossiers de laboratoire médical des patients cherchant des soins à l'Hôpital Universitaire Bingham, Jos. Les données collectées étaient leurs résultats de dépistage de l'AgHBs et de l'anti-VHC. Les données ont été analysées à l'aide du logiciel SPSS version 24. RÉSULTATS: Un total de 186 patients ont été dépistés pour une infection par le VHB et 96 pour une infection par le VHC. Leur âge moyen et leurs écarts-types étaient respectivement de 36,2 ± 15,05 ans et 37,2 ± 14,48 ans pour ceux dépistés pour le VHB et le VHC. Le taux de séroprévalence de l'infection par le VHB était de 14,0 % et celui pour l'infection par le VHC était de 10,4 %. Les hommes avaient une séroprévalence plus élevée du VHB de 9,1 % que les femmes avec 4,9 %. Pour la séroprévalence du VHC, les femmes ont enregistré une prévalence plus élevée de 6,2 % par rapport à leurs homologues masculins qui avaient 4,2 %. Parmi ceux dépistés pour le VHB, le groupe d'âge des jeunes adultes présentait le taux de prévalence le plus élevé de 10,2 %, tandis que pour le dépistage du VHC, le groupe d'âge des adultes d'âge moyen présentait le taux de prévalence le plus élevé de 6,2 %. Cependant, ces données n'étaient pas statistiquement significatives (p = > 0,05). CONCLUSION: Cette étude a montré que les infections par le VHB et le VHC sont hyper-endémiques. Il est nécessaire d'intensifier les campagnes de sensibilisation et d'améliorer la mise en œuvre de stratégies préventives et de gestion des infections par le VHB et le VHC. MOTS-CLÉS: Séroprévalence, AgHBs, anti-VHC, Demandeurs de soins de santé, établissement de santé, Jos.

Prevalence of vaginal HPV infection among adolescent and early adult girls in Jos, North-Central Nigeria.

PURPOSE: Knowledge of the prevalence of HPV infection among adolescent and early adult girls is essential to determining the best age for the introduction of HPV vaccine, monitoring vaccine efficacy, and giving insight into determinants of persistent high-risk HPV infection, a necessary cause of cervical cancer. Yet, there have been limited studies of HPV infection among adolescent and early adult girls in low-and-middle-income countries. METHODS: In this cross-sectional study, we randomly selected 205 girls, aged 9-20 years, from 10 schools in central Nigeria. We obtained informed consent and assent, collected data, and trained participants to self-collect vaginal samples using swab stick. We genotyped HPV using SPF10-DEIA/LiPA25 and analyzed data using Stata 14®. RESULTS: The mean (SD) age of the girls was 14.9 (2.3) years. We found HPV in 13.2% of vaginal swabs. The earliest age at which anyHPV and hrHPV infections were detected was 10 and 12 years respectively. The prevalence of any HPV peaked at 16 and 17 years, hrHPV at 16 years, lrHPV at 17 and 18 years and multiple hrHPV 18 years of age. The prevalence of hrHPV infection was 1.5% among the 9-12 years age group, 2.9% among 13-16 years and 3.4% among 17-20 years old. The commonest hrHPV types detected were 52 (3.9%), 18 (1.5%) and 51 (2.4%). The most common lrHPV types was 6 (2.9%). CONCLUSION: The prevalence of HPV infection in these urbanized young girls in Nigeria is high and commences after 9 years of age. HPV vaccination in this population should start at 9 years of age or younger to prevent the establishment of persistent HPV infection.

Burden of COVID-19 Pandemic on Adolescents' Quality of Life: A Cross-Sectional Study among Secondary School Students in North-Central Nigeria.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) has caused millions of mortalities globally. Although the prevalence and fatality rates of COVID-19 among adolescents is low, its impact on their health-related quality of life (HRQoL) is not adequately known. This study was carried out to determine the burden COVID-19 pandemic has on the HRQoL of adolescents. METHODS: A cross-sectional descriptive study was carried out among adolescents in public and private secondary schools in Jos North Local Government Area of Plateau State. A multistage sampling technique was employed to select the schools and recruit the participants in April/May 2021. Data was collected using a self-administered questionnaire containing the participants' socio-demographic characteristics, questions on being burdened by COVID-19 pandemic, and the KIDSCREEN-10 tool for assessing the HRQoL. The data was analyzed using SPSS version 25.0 and a p-value of < 0.05 was regarded as significant. RESULTS: A total of 405 adolescents participated in the study with a mean age of 14.6 ± 2.06 years. Majority (52.8%) of the participants were girls. More than half (53.3%) of the participants reported being burdened by the COVID-19 pandemic. Also, 45.7% of the participants experienced a lower HRQoL. There was a statistically significant association between being burdened by the COVID-19 pandemic and their HRQoL (χ2 = 7.108, p = 0.01). In addition, the participants' HRQoL was significantly associated with their age (χ2= 5.112, p = 0.02). CONCLUSION: This study highlights the significant burden of COVID-19 pandemic on adolescents' wellbeing. Therefore, there is the need to intensify health intervention strategies among adolescents to reduce the physical, emotional, and mental burden imposed by the COVID-19 pandemic in order to optimize their quality of life.

CONTEXTE: La maladie de coronavirus 2019 (COVID-19) a causé des millions de décès dans le monde. Bien que la prévalence et les taux de mortalité du COVID-19 chez les adolescents soient faibles, son impact sur leur qualité de vie liée à la santé (QVLS) n'est pas suffisamment connu. Cette étude a été menée pour déterminer le poids de la pandémie de COVID-19 sur la QVLS des adolescents. MÉTHODES: Une étude descriptive transversale a été menée parmi les adolescents des écoles secondaires publiques et privées de la région de Jos North Local Government Area de l'Etat du Plateau. Une technique d'échantillonnage à plusieurs degrés a été utilisée pour sélectionner les écoles et recruter les participants en avril/mai 2021. Les données ont été collectées à l'aide d'un questionnaire auto-administré contenant les caractéristiques sociodémographiques des participants, des questions sur le fardeau que représente la pandémie de COVID-19, et l'outil KIDSCREEN-10 pour évaluer la qualité de vie. Les données ont été analysées à l'aide de SPSS version 25.0 et une valeur p < 0,05 a été considérée comme significative. RÉSULTATS: Un total de 405 adolescents ont participé à l'étude avec un âge moyen de 14,6 ± 2,06 ans. La majorité (52,8%) des participants étaient des filles. Plus de la moitié (53,3%) des participants ont déclaré être accablés par la pandémie de COVID-19. En outre, 45,7 % des participants ont connu une baisse de leur qualité de vie. Il y avait une association statistiquement significative entre le fait d'être accablé par la pandémie de COVID-19 et leur QVLS (χ2 = 7,108, p = 0,01). De plus, la QVLS des participants était significativement associée à leur âge (χ2 = 5,112, p = 0,02). CONCLUSION: Cette étude met en évidence le poids important de la pandémie de COVID-19 sur le bien-être des adolescents. Il est donc nécessaire d'intensifier les stratégies d'intervention sanitaire auprès des adolescents pour réduire le fardeau physique, émotionnel et mental imposé par la pandémie de COVID-19 afin d'optimiser leur qualité de vie. Mots clés: Adolescents, École secondaire, COV ID-19, Qualité de vie liée à la santé (QVLS), Jos.

Severe Chest Injury Revisited - An Analysis of The Jos University Teaching Hospital Trauma Registry.

BACKGROUND: Chest injury remains a major source of morbidity and mortality in trauma as approximately two-thirds of all severe traumas involve the chest. OBJECTIVE: To determine the changes in the profile management and outcome of severe chest injury in Jos University Teaching Hospital, Jos, Nigeria. MATERIALS AND METHODS: This is an analysis of the Trauma Registry of Jos University Teaching Hospital-a prospectively gathered database. Patients' entries with severe chest injuries for 7 years, from January 2012 to December 2018, were entered into a database and analyzed using the Epi Info Statistical Software, using simple statistics. RESULTS: In all, 162 patients presented with severe chest injury over a 7-year period, of whom 78 (48.1%) had polytrauma, while 84 (51.9%) had isolated chest injury. There were 139 males and 23 females, giving male: female ratio of 6:1. Over 95 (58.6%) of them were between 20 and 39 years. Blunt injury was predominant, constituting 66.7%. Motor vehicular crash was the most common mechanism of injury constituting 87 (53.7%), while gunshot injuries were responsible for 34 (21%). In managing these severe chest injuries, 146 (90%) of the patients had closed-chest tube thoracostomy as the definitive treatment, while 16 (9.9%) had thoracotomy. The mean and median duration of hospital stay was 13.3 and 10 days, respectively. The commonest complication was wound infection in 8 (4.9%) patients and a mortality of 5.9%. CONCLUSION: Blunt chest injury remains the commonest mechanism of chest injury but with an increasing proportion of penetrating injuries affecting predominantly young males. Most severe chest injury patients survive with simple interventions of resuscitation, and closed-chest tube thoracostomy for definitive treatment.

Monitoring communication with patients: analyzing judgments of satisfaction (JOS).

Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.

Otomycosis in Jos: Predisposing factors and Management.

BACKGROUND: Otomycosis is a challenging and frustrating common Otologic condition to both patients and managing clinician. This fungal infection most often involves the squamous epithelium of the external auditory canal and is; characterized by pruritus, occasional otalgia and hypoacusis. OBJECTIVES: To highlight the predisposing factors and management of Otomycosis in our center. STUDY DESIGN: Retrospective review of 35 patients with a clinical diagnosis of otomycosis treated from January 2012 to March 2013. SETTING: The study was carried out at the Jos University Teaching Hospital, in the outpatient clinic of the department of Ear Nose Throat & Head. PARTICIPANTS: Thirty-five patients diagnosed with otomycosis had their medical data analyzed for this study. INTERVENTION: Antifungal eardrop was used for dressing the ears. RESULT: 35 patients were seen within 15 months period (Jan. 2012- Mar. 2013). There were 11 males: 24 females given a gender ratio of 1:2.1. The commonest age group involved was 41-50(25.71%). There were 13, 10 and 6 cases of right, left and bilateral cases of Otomycosis m respectively. 16 cases were seen during the wet season and 19 cases during the dry season. In terms of occupation, house wives and civil servants constitute 28.60 and 17.15 % respectively. Diabetic mellitus was noted in1 (2.86%) patient. CONCLUSION: The predisposing conditions for Otomycosis are present in Jos environment and can usually be diagnosed by clinical examination. This study suggested that otomycosis found are predominantly unilateral, more common in older age group, in female mainly housewives, civil servants and Candida species is the most common causative organism implicated in causation of otomycosis and treated with clotimazole containing drugs. Discontinuation of antifungal agent is most appropriate in antibiotic induced otomycosis.

BODY WEIGHT CHANGES IN WOMEN USING IMPLANON IN JOS, NIGERIA.

BACKGROUND: The fear of weight gain is one of the adverse events that make women to discontinue Implanon® (etonorgestrel) contraceptive. Black women are more prone to gain weight with the use of such progestogen-only contraceptives than women of other racial groups. The weight of women is also an important consideration since it influences the concentration of the active drug and may predispose to failure at a higher weight profile.Information on weight changes with the use of etonorgestrel implant is scarce in our sub-region. We therefore explored the direction and extent of weight changes among women in different weight categories and determined the predictors of the final body weight during use of Implanon®. MATERIALS AND METHOD: This was a retrospective study of all women that accepted implanon at the Family Planning Unit of the Jos University Teaching Hospital, Jos Nigeria from March 2007 to March 2014. Data analysis was carried out using Stata version 12.1. The socio-demographic data and reproductive histories were extracted from the records and the duration of use of the implant, reasons for discontinuation and the initial weight and at follow up were analysed. RESULTS: Over 99% of the women who had Implanon® were parous and the commonest contraceptive they had used previously was the injectables. However, almost a quarter (22.8%) were accepting Implanon® as their first ever contraceptive method. The mean baseline weight was 64.4 ± 12.1 kg and the median weight was 63.0 kg. The average months of use of Implanon® in this study was 27 months and there was a mean increase in body weight of 2.5 kg during the study. However, there was a broad variability in the individual change in body weight with about 38.6% losing weight or not having any net weight change. Over three-fifths (61.4%) of the women had a net weight gain while using Implanon®. Of these women, 36.0% gained 1-5 kg, 19.2% gained 6-10 kg, 4.2% gained 11-15 kg and 2.0% gained more than 16 kg with the maximum gain at 26 kg. The mean weight changes were 0.8 kg, 1.6 kg, 3.2 kg and 3.3 kg respectively for the first, second, third and fourth years of Implanon® use respectively. Implanon® was removed on account of weight gain in 3.8% of those women who had removed the implant. There was no statistically significant difference in weight gain among the different weight categories: women who had an initial weight above 90 kg gained less than 1 kg compared to those who had normal weight (for this study <70 kg) at the baseline that gained on average more than 2.0 kg. The most significant predictor of the final body weight with Implanon® use was the initial body weight which predicts it in 83.5% of the time (p-value 0.000, CI 0.99, 1.05). CONCLUSION: There was a broad variability in weight changes with the use of Implanon® and the initial body weight is the most significant predictor of the final body weight. Therefore implanon can be used by women of all weight categories including those considered to be obese.

Parental Knowledge of HPV Infection, Cervical Cancer and the Acceptance of HPV Vaccination for their Children in Jos, Nigeria.

Background: Despite the high prevalence of human papillomavirus (HPV) infections and cervical cancer in Nigeria, the utilization of the HPV vaccine as a highly effective preventive measure remains low. The aim of this study was to find out if parental knowledge of HPV infection and cervical cancer influenced the acceptance of HPV vaccines for their 9-14-year-old children. Materials and Methods: This was a cross-sectional survey of 509 parents comprising 262 fathers and 247 mothers in 8 randomly selected communities in Jos, Plateau State Nigeria. A pretested semi-structured investigator-administered questionnaire, without identifiers, was used to collect information on parental knowledge of HPV, cervical cancer, HPV vaccine and its acceptance for their 9-14-year-old children. The data were analysed using SPSS version 23.0. Bivariate analysis was done using chi-square statistical test. Point estimates with corresponding 95% confidence interval (CI) were estimated with a value of P ≤ 0.05 was considered as statistically significant. Results: Five hundred and nine parents were interviewed. The mean age of the respondents was 43.7 ± 9.43 years. Most of the participants (86.1%) had formal education from primary to tertiary level. Only 1.60%, 11.60% and 1.62% of respondents had knowledge of HPV, cervical cancer and HPV vaccines respectively, whereas 67.8% of parents were willing to pay for the cancer-preventing HPV vaccines out-of-pocket. There was no statistically significant associations between parental level of education (P = 0.056), parental knowledge of cancer of cervix (P = 0.483), religion of parents (P = 0.324) and the acceptance of HPV vaccination for their children. There was a statistically significant association between parental willingness to pay for HPV vaccines if not offered free (P = 0.001) with acceptance of vaccination. Vaccine acceptability was associated with positive attitude towards the vaccine (odds ratio [OR] = 4.178; 95% CI, 1.714-10.180; P = 0.002), whereas parental knowledge of HPV, cervical cancer and HPV vaccine did not show significant association with acceptability of HPV vaccination for their children. Conclusion: Despite poor parental knowledge of HPV infection and cervical cancer, there was high acceptability of HPV vaccination for their children. HPV vaccination was acceptable to parents regardless of educational level or religion. Parents in Jos communities seems to have much faith in preventive vaccines as advertised by the health authorities. Accordingly, efforts should be geared towards ensuring availability, affordability and the provision of basic information regarding HPV vaccination in Northern Nigeria.

Remedying the Metamemory Expectancy Illusion in Source Monitoring: Are there Effects on Restudy Choices and Source Memory?

Metamemory monitoring, study behavior, and memory are presumably causally connected. When people misjudge their memory, their study behavior should be biased accordingly. Remedying metamemory illusions should debias study behavior and improve memory. One metamemory illusion concerns source memory, a critical aspect of episodic memory. People predict better source memory for items that originated from an expected source (e.g., toothbrush in a bathroom) rather than an unexpected source (e.g., shampoo in a kitchen), whereas actual source memory shows the opposite: an inconsistency effect. This expectancy illusion biases restudy choices: Participants restudy more unexpected than expected source-item pairs. The authors tested the causal relationships between metamemory and source memory with a delay and a source-retrieval attempt between study and metamemory judgment to remedy the expectancy illusion and debias restudy choices. Debiased restudy choices should enhance source memory for expected items, thereby reducing the inconsistency effect. Two groups studied expected and unexpected source-item pairs. They made metamemory judgments and restudy choices immediately at study or after delay, restudied the selected pairs, and completed a source-monitoring test. After immediate judgments, participants predicted better source memory for expected pairs and selected more unexpected pairs for restudy. After delayed judgments, participants predicted a null effect of expectancy on source memory and selected equal numbers of expected and unexpected pairs. Thus, the expectancy illusion was partially remedied and restudy choices were debiased. Nevertheless, source memory was only weakly affected. The results challenge the presumed causal relationships between metamemory monitoring, study behavior, and source memory.

Detection of CTX-M and SHV Genes in Extended Spectrum Beta-Lactamase Producing Klebsiella Pneumoniae and Pseudomonas Aeruginosa in a Tertiary Hospital in North-central Nigeria.

Background: Antimicrobial resistance (AMR) is an emerging threat to global health security. Globally, an estimated 700,000 deaths are attributed to AMR annually. Annual deaths due to AMR are projected to reach 10 million by 2050 if current trends persist. Extended Spectrum ß-Lactamases (ESBLs) have the ability to hydrolyse penicillins, cephalosporins up to the third generation, and monobactams, but not ß-lactamase inhibitors such as clavulanic acid. ESBLs undergo continuous mutation, leading to the development of new enzymes with over 400 different ESBL variants described. This study aimed to detect selected CTX-M genes, SHV,and TEM genes in Extended Spectrum Beta-Lactamase producing Klebsiella pneumoniae and Pseudomonas aeruginosa in Jos, Nigeria. Methodology: A total of 110, non-replicated isolates of Klebsiella pneumonia and 125 isolates of Pseudomonas aeruginosa were identified phenotypically from clinical specimens of patients at a tertiary hospital in Jos, North-central Nigeria. The isolates were screened for ESBL production using the disk diffusion method of the Clinical Laboratory Standard Institute (CLSI) breakpoints. Phenotypic confirmation of ESBL production was done using the double-disc synergy test. Multiplex PCR was used to detect ESBL genes. Results: Fifty (45.5%) of the 110 isolates of Klebsiella pneumoniae and 9(7.2%) of the 125 isolates of Pseudomonas aeruginosa were ESBL-positive. Typing of 20 representative ESBL isolates (17 Klebsiella and 3 Pseudomonas spp) showed the presence ofblaCTX-M1, blaCTX-M9, and blaSHV genes in these isolates. All 20 (100%) isolates had the blaCTX-M1 gene. The blaSHV gene was detected in 16(80%) while CTX-M9 was detected in 6(30%) of the isolates studied. Conclusion: The study showed that there is a high prevalence of ESBL genes among isolates ofKlebsiella pneumoniae and Pseudomonas aeruginosa in North-central Nigeria. This emphasizes the need for continuous surveillance and coordinated infection prevention and control to curtail its spread.

Predictors of tuberculosis knowledge among mothers of under-fives, seen at Bingham University Teaching Hospital, Jos Nigeria.

INTRODUCTION: Globally, tuberculosis still remains a disease of public health concern and accounts for high morbidity and mortality particularly in developing countries, where it is fuelled by a number of factors. METHODOLOGY: Through a cross-sectional descriptive study, this study aims to determine the predictors of knowledge about TB among 261 mothers of children under 5 years of age attending Child Welfare Clinic, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria. RESULTS: The mean age of the mothers was 31.54 ± 5.28 years, and 249 (98.4%) aware of TB. About two-third having sufficient knowledge and positive attitude regarding TB. Significant statistical association was found between knowledge and attainment of post-secondary education (OR 4.0; 95% CI 12.09, 7.63; p Ë‚ 0.001), monthly income ≤ 25,000 naira (OR 2.18; 95% CI 1.02, 4.65; p = 0.042), monthly income > 51,000 naira (OR 3.24; 95% CI 1.43, 7.31; p = 0.005), women engaged in business (OR 0.43; 95% CI 0.22, 0.83; p = 0.012) and possessing positive attitude (OR 3.87; 95% CI 2.16, 6.93; p ˂ 0.001) in the univariate analysis. However, in the multivariate logistic regression, it was only attitude that was found to be a predictor of TB knowledge of mothers. CONCLUSIONS: TB knowledge among the mothers was high, only attitude regarding thoughts and beliefs about TB was found as an independent predictor of TB knowledge. With the positive influence of attitude on knowledge among the mothers, it is recommended that this be strengthened for sustenance to prevent further infection.

Inadvertent Extended use of ImplanonR Contraceptive Implants by Clients in Jos, Nigeria: An Interesting Finding.

Background: Contraceptive implants are popular methods among women accessing family planning in Jos. Women appear to be using these methods for longer periods despite adequate counselling including the use for a maximum period prescribed by the manufacturers. Methodology: This was a retrospective, cross sectional study of all clients who had ImplanonR classic removed between May 2006 and December 2019. The register of acceptors of the implant was retrieved and relevant variables collated and analyzed for age, duration of use of the implant and the indication for removal. The data was analyzed using the Stata statistical software version 14, College Station, Texas, USA. Results: A total of 1,805 implants were inserted, when all of them would have been removed, only 596(33%) were documented to have been removed. The mean age of the clients was 31.031 ± 5.56 years, range 18-51 years. The mean duration of use of ImplanonR was 29.370 ± 11.756 months, range 0.5-72months. About 83(13.9%) implants were used beyond the expected duration of use of 36 months. By the 3rd, 4th, and 5th years, 86.1%, 97.5% and 99.2% had had the implants removed. Clients used the method beyond the stipulated expiration of the implants, up to twice the period expected. There was no failure or pregnancy recorded. Conclusion: About one-sixth of women extended the use of ImplanonR implants. This may be more as only 33.0% of them returned for removal at the facility where it was inserted. However, there was no pregnancy recorded in this group of women despite the extended duration of use.

Comparative Assessment of the Implementation of Integrated Disease Surveillance and Response in Public and Private Health Facilities in Jos North Local Government Area of Plateau State, Nigeria.

Background: Due to the continuous increase in the spread of epidemic-prone diseases and the associated morbidity and mortality, integrated disease surveillance and response (IDSR) was introduced as the main strategy in resource-poor settings for the detection and notification of these diseases. Integrated disease surveillance is a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviors of interest. Methods: : A comparative cross-sectional study was conducted between March and July 2018 among selected public and private health facilities in Jos North Local Government Area (LGA), Plateau State. Quantitative data were collected with the aid of a semi-structured interviewer-administered questionnaire and facility-based checklist. Data were analyzed using SPSS version 23. Statistical significance level was set at P ≤ 0.05 at a 95% confidence level. Results: A.total of 126 health workers were studied. IDSR-trained health personnel was found in 52.7% of the public health facilities compared with only 16.7% of the private health facilities studied (P < 0.001). Awareness of IDSR was higher in the public health facilities than in the private ones (P < 0.001). IDSR implementation was poorer in the private health facilities 40.7% compared with 76.4% in public health facilities (P < 0.001). Evidence of previous disease notification and reporting was seen only in 33.3% and 16.7% of public and private health facilities, respectively (P < 0.001). Conclusion: This study revealed that awareness and attitude of health workers in public health facilities in Jos North were higher than that of those in private health facilities and there is the sub-optimal implementation of IDSR among the health workers in Jos North LGA, especially among the private health facilities.

RésuméContexte: En raison de l'augmentation continue de la propagation des maladies à potentiel épidémique et de la morbidité et de la mortalité associées, la surveillance intégrée des maladies et la riposte (IDSR) ont été introduites comme principale stratégie dans les milieux pauvres en ressources pour la détection et la notification de ces maladies. La surveillance intégrée des maladies est une combinaison de systèmes actifs et passifs utilisant une infrastructure unique qui recueille des informations sur plusieurs maladies ou comportements d'intérêt. Méthodes: Une étude transversale comparative a été menée entre mars et juillet 2018 auprès d'établissements de santé publics et privés sélectionnés dans la zone de gouvernement local (LGA) de Jos North, dans l'État du Plateau. Les données quantitatives ont été recueillies à l'aide d'un questionnaire semi-structuré administré par un enquêteur et d'une liste de contrôle basée sur l'établissement. Les données ont été analysées à l'aide de la version 23 de SPSS. Le niveau de signification statistique a été fixé à P ≤ 0,05 à un niveau de confiance de 95 %. Résultats: Au total, 126 agents de santé ont été étudiés. Le personnel de santé formé par l'IDSR a été trouvé dans 52,7 % des établissements de santé publics, contre seulement 16,7 % des établissements de santé privés étudiés (P < 0,001). La sensibilisation à la SIMR était plus élevée dans les établissements de santé publics que dans les établissements privés (P < 0,001). La mise en oeuvre de la SIMR était plus faible dans les établissements de santé privés, 40,7 % contre 76,4 % dans les établissements de santé publics (P < 0,001). Des preuves de notification et de notification antérieures de la maladie n'ont été observées que dans 33,3 % et 16,7 % des établissements de santé publics et privés, respectivement (P < 0,001). Conclusion: Cette étude a révélé que la sensibilisation et l'attitude des agents de santé dans les établissements de santé publics de Jos North étaient plus élevées que celles des établissements de santé privés et qu'il existe une mise en oeuvre sous-optimale de la SIMR parmi les agents de santé de Jos North LGA, en particulier parmi les les formations sanitaires privées. Mots-clés : surveillance intégrée des maladies et mise en oeuvre de la riposte, zone de gouvernement local de Jos North, établissements de santé publics et privés.

Congenital cholesteatoma assessment based on staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society.

OBJECTIVE: We aimed to assess the clinical characteristics of extent patterns in congenital cholesteatoma, based on the Japan Otological Society (JOS) staging system. METHODS: This was a retrospective chart review that included 80 ears of 80 patients with congenital cholesteatoma who underwent primary surgery at a tertiary academic medical center. The main characteristics and outcomes reviewed were sex, age, clinical background, surgical method, and stage classification according to two staging classifications: the criteria advocated by JOS and Potsic staging system. RESULTS: The age at the time of surgery ranged from 1 to 35 years (average 8.4 years), and there were 54 men and 26 women. According to the JOS staging system, 12 ears were Stage Ia (15%), 7 ears were Stage Ib (9%), 1 ear was Stage Ic (1%), 59 ears were Stage II (74%), and 1 ear was Stage III (1%). In the study of postoperative residual recurrence, there were 4 cases after the primary operation and 3 cases after the staged operation. All 3 ears with residual disease after planned surgery were cholesteatomas that extended to all the tympanomastoid space. CONCLUSION: We consider the JOS staging system to be more suitable, in terms of anatomical classification and surgical procedure selection for comparison between Europe, the United States, and Asia. Specifically, it was advantageous that the PTAM classification and the S classification are associated with surgical procedure selection and postoperative course.

Limitations of non-echo planar diffusion weighted magnetic resonance imaging (non-EPI MRI) in cholesteatoma surveillance after ossicular chain reconstruction. A prospective study.

OBJECTIVE: Non-echo planar diffusion weighted magnetic resonance imaging is a reliable surveillance tool of residual cholesteatoma nowadays. It is not known whether the material of the ossicular chain prosthesis modifies the sensitivity and specificity of MRI in these cases. The aim of the study was to compare the sensitivity, specificity and a localization-specific accuracy of non-EPI DW MRI sequences for residual cholesteatoma in the following 3 subgroups: patients with titanium ossicular prosthesis (group T), with autologous cortical bone columella (group A) or without any reconstruction (group WR) of hearing bones. METHODS: This prospective study covered 28 cases with cholesteatoma of the middle ear undergone second-look surgery, who had preoperative PROPELLER DW-MRI. Surgical findings were compared to the results of the DWI-MRI. RESULTS: The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were: 0.76-0.8-0.76-0.8. Group T, group A and group WR sensitivity was 0.83-0.6-1, specificity: 0.75-0.75-0.85, PPV: 0.83-0.75-0.66, NPV: 0.75-0.6-1. Overall accuracy was 0.78. Size of missed cholesteatoma was 2-4 mm (mean: 2.66±1.15). CONCLUSIONS: Various materials are suitable for ossicular chain reconstruction. The poor detectability of residual or recurrent cholesteatoma in the middle ears reconstructed with autologous bony prosthesis may still claim second-look surgery instead of the usage of non- EPI DWI sequences independently in these patients.

Pregnancy and Birth Outcomes Among Women on Antiretroviral Therapy: A Long-term Retrospective Analysis of Data from a Major Tertiary Hospital in North Central Nigeria.

BACKGROUND AND OBJECTIVE: Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria. METHODS: This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. Abstracted data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05. RESULTS: Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ2 [(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030.

The Rise and Fall of Female Sterilization in Jos, Nigeria: A Cause for Concern.

BACKGROUND: Female sterilization is a permanent form of contraception offered to women who have completed their family size. Other methods are all temporary and meant to be reversible. A high-quality female sterilization service was introduced in Jos with the assistance of training in counseling and minilaparotomy under local anesthesia in May 1985. After training, female sterilization became available for couples desiring it on completion of family size. MATERIALS AND METHODS: This was a retrospective study of all clients who had female sterilization for contraception between 1985 and 2019. The clinic register was retrieved and evaluated for acceptances of all contraceptive methods within the period and trends observed. RESULTS: Over the 35 years, a total of 29,167 new clients accepted modern family planning methods. Out of these, a total of 5167 were female sterilizations, constituting 17.7% of the new acceptors. The temporary methods of contraception constituted 82.3%. The other methods used were the intrauterine device 8357 (28.7%), the oral pills 5125 (17.6%), the injectables 5235 (17.9%), and the contraceptive implants 5283 (18.1%). Although female sterilization was 4th among the five methods studied, there was however a gradual decline in its acceptance from a peak of 36.1% in 1992 to 1.4% in the year 2018. CONCLUSION: The acceptance of female sterilization rose to a peak in 1992 and declined to the lowest level in 2018, occasioned in part by the introduction of varieties of contraceptive implants providing long acting, reversible, and cheap contraception.

Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria.

Background: Epistaxis, though a mere nuisance can have life-threatening consequences. This first study from Jos on epistaxis aims to determine its sociodemographic characteristics, causes, the treatment modalities and the predictors of patient outcome. Study Design: A retrospective chart review. Methods: Health records of patients that met the inclusion criteria for epistaxis at the Jos University Teaching Hospital, Jos, Nigeria, between February 2011 and December 2015 were retrieved manually using standardized codes in the International Classification of Diseases 10th revision and studied for age, gender, associated comorbidities, treatment modalities offered, and outcome of treatment. Results: We managed 154 patients. Records of 92 patients were retrievable aged between 1 and 85 years (Mean = 37.7; standard deviation ± 16.2) with male to female ratio of 2.3:1. Patients in the third decade were the largest group. The most common cause was idiopathic. Anterior nasal bleeding occurred in 51.1%, posterior nasal bleeding in 34.8%. Conservative management was effective in 84.8%. Etiological factors other than chronic liver disease and otolaryngological malignancies showed statistically significant association with good patient outcomes (P = 0.013, P = 0.044, and P = 0.026, respectively). A mortality rate of 5.4% was recorded. Conclusion: Epistaxis of idiopathic origin occurring mostly in young males is the most common with most resolving on conservative management. Early hospital presentation, normal blood pressure at presentation and all management modalities were positive predictors of outcome in our patients.

RésuméContexte: Epistaxis, bien qu'une simple nuisance peut avoir des conséquences mortelles. Cette première étude de Jos sur l'épistaxis vise à déterminer ses caractéristiques sociodémographiques, ses causes, les modalités de traitement et les prédicteurs de l'issue du patient. Conception de l'étude: Une revue rétrospective des dossiers. Méthodes: Les dossiers médicaux des patients répondant aux critères d'inclusion de l'épistaxis au Jos University Teaching Hospital, Jos, Nigéria, entre février 2011 et décembre 2015 ont été récupérés manuellement à l'aide de codes normalisés dans la 10e révision de la Classification internationale des maladies. , les comorbidités associées, les modalités de traitement offertes et les résultats du traitement. Résultats: Nous avons géré 154 patients. Les dossiers de 92 patients étaient récupérables entre 1 et 85 ans (moyenne = 37,7; écart-type = +16,2) avec un ratio hommes / femmes de 2,3: 1. Les patients de la troisième décennie étaient le groupe le plus important. La cause la plus fréquente était idiopathique. Saignement nasal antérieur est survenu chez 51,1%, saignement nasal postérieur chez 34,8%. La gestion conservatrice était efficace dans 84,8%. Des facteurs étiologiques autres que la maladie hépatique chronique et les tumeurs malignes otolaryngologiques ont montré une association statistiquement significative avec de bons résultats pour les patients (P = 0,013, P = 0,044 et P = 0,026, respectivement). Un taux de mortalité de 5,4% a été enregistré. Conclusion: L'épistaxis d'origine idiopathique survenant principalement chez les jeunes hommes est le plus commun avec le plus de résolution sur la gestion conservatrice. La présentation hospitalière précoce, la pression artérielle normale à la présentation et toutes les modalités de prise en charge ont été des prédicteurs positifs des résultats chez nos patients.