Antimicrobial resistance (AMR) is a global problem compromising the effective treatment of infectious diseases. The World Health Organization (WHO) is encouraging and promoting awareness creation ...among health workers as one of its strategies to reduce the rate of emergence and transmission of AMR. Available data on the prescribing behavior of healthcare workers (HCWs) in Nigeria remains incomplete. This study was designed to provide an up-to-date estimate of the knowledge, attitude and antibiotic prescribing behavior of HCWs in Nigeria.
This is a cross-sectional study. Self-administered questionnaires were distributed to healthcare workers selected from six states, one each from the 6 geopolitical zones in Nigeria. A multi-stage sampling technique was used to reflect the three tiers of healthcare: primary, secondary and tertiary levels. Quantitative data was summarized using descriptive statistics. All data analysis was done using the Statistical package for social sciences version 26.0.
Of the 420 questionnaires distributed, 358 (85.2%) responded. The mean year of practice of the respondents was 9.32 ± 7.8 years. About a half (50.3%) agreed that their prescribing behavior could promote antimicrobial resistance. 49.2% had a good knowledge of AMR and physicians had significantly better knowledge than other HCWs (X
= 69.59, P < 0.001). Several participants prescribed antibiotics for common viral infections such as sore throats (75.7%), measles (37.7%), common cold and flu (21.2%). Over 60.3% admitted prescribing antibiotics just to be on the safe side. In general, 70.9% of the respondents frequently or moderately use practice guidelines while 25.7% often apply the delayed antibiotic prescription (DAP) strategy to reduce antimicrobial prescription.
This study reveals an overall moderate level of knowledge of AMR and attitude towards minimizing the emergence of antimicrobial resistance though this did not translate significantly to practice. Further efforts must be made in order to improve rational prescription of antimicrobials among HCWs in Nigeria.
One of the objectives of the Global Action Plan by the World Health Organization (WHO) to contain antimicrobial resistance (AMR), is to improve global awareness through effective communication and ...education. Comprehensive information on the level of awareness of AMR among Nigerian public is deficient. This study was therefore designed to assess the current level of awareness and knowledge of the Nigerian public of AMR.
Pre-tested and validated questionnaire was used to obtain information from the general public across the six geopolitical zones (North Central, North East, North West, South East, South South and South West) in Nigeria. Multi-stage sampling was used to select one state from each zone and respondents were selected through a multi-stage sampling technique. Responses to eight questions were used to grade the level of knowledge categorized as poor, fair and good. Collation and analysis of data were performed at the Microbiology Department of the Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria, using SPSS version 24.0.
Questionnaires from 482 respondents comprising 242 (50.2%) females and 240 (49.8%) males from six states (Lagos, Ebonyi, Delta, Plateau, Borno and Jigawa) were analyzed. Of the 482 respondents, 322 (66.8%) had taken antibiotics in the last six months out of which 31.3% were without prescription. 26.1% of respondents believe they don't need to complete the dosage as long as they feel better. Although 272(56.5%) of the respondents were familiar with the term "antibiotic resistance", only 40(8.3%) had good knowledge of AMR. A majority (76.6%) believed that they were powerless to stop the spread of AMR. There was no association between the gender of respondents and knowledge of AMR (p = 0.13). However, respondents from Ebonyi and Delta states in southern Nigeria were more likely to have good knowledge of AMR (X
= 53.22, P < 0.0001). The respondents in the urban area had a higher score for knowledge level compared to the rural dwellers, though this was not statistically significant within and across states.
This survey provides an insight into the level of AMR awareness and antibiotic use in the wider Nigeria public. Our findings show that about a third of the general public consume antibiotics obtained without prescription. There is an overall poor understanding of antimicrobial resistance and/or proper use of antibiotics among respondents. It is critical that more holistic public enlightenment programs are carried out to increase awareness of AMR and promote responsible use of antibiotics.
HIV and tuberculosis (TB) are risk factors for non-communicable chronic lung disease (CLD). Despite the high prevalence of these infections in West Africa, there are no studies that compare CLD ...between people with HIV and HIV-negative populations in this setting. This study sought to quantify the contribution of HIV and TB infection in addition to conventional CLD risk factors, such as tobacco and biofuel exposure, to CLD in urban West Africa.
A multi-centre cross-sectional study was conducted in three community clinics in Lagos, Nigeria between 2018 and 2019.
Spirometry, questionnaires and clinical records were used to estimate prevalence of CLD and association with risk factors.
In total, 148 HIV-negative individuals and 170 HIV-positive individuals completed the study. Current cigarette (11 of 318, 3.5%) and lifetime domestic biofuel (6 of 318, 1.8%) exposures were low. Airway obstruction (33 of 170, 19.4% vs. 12 of 148, 8.1%, P = 0.004) and CLD (73 of 170, 42.9% vs. 34 of 148, 23%, P < 0.0001) were more prevalent in people with HIV compared with the HIV-negative group. HIV infection odds ratio 2.35 (1.33, 4.17), P = 0.003 and history of TB odds ratio 2.09 (1.04, 4.20), P = 0.038 were independently associated with increased risk of CLD.
HIV and TB far outweigh conventional risk factors, including tobacco and domestic biofuel exposure, as drivers of non-communicable CLD in urban West Africa. Current global policy for CLD may have limited impact on CLD in this setting. Enhanced prevention, diagnosis and management strategies for incident HIV and TB infections are likely to have a significant impact on long-term lung health in sub-Saharan Africa.
In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven ...effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria.
Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses.
This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment.
ClinicalTrials.gov ( NCT04704336 ). Registered on 11 January 2021.
Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are ...avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of
pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world's population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.
Tuberculosis (TB) remains a major public health challenge in Nigeria with a minimum yield of various TB control efforts due to sociocultural determinants of health including TB‐associated stigma. ...Therefore, to achieve the Sustainable Development Goal targets for TB control, an understanding and reduction in TB‐associated stigma is necessary. The study aims to explore the perspective of community members and investigate the possible ways of mitigating TB‐associated stigma in rural and urban areas in Lagos State, Nigeria. Eight focus group discussions (FGD) were conducted among eight homogenous groups of participants living in the community in rural and urban areas of Lagos state who were stratified by gender, between July and November 2017. Analysis of data was done using the modified grounded theory. A total of 86 participants took part in the FGDs. There were various stigmatising behaviours towards people infected with TB in rural and urban communities studied. This includes: Not willing to eat with people suffering from TB, withdrawal from TB patients in social gatherings, verbal abuse of TB patients and refusing to visit their houses because of their illness. There were also misconceptions about the cause of TB in our study which includes spiritual attack, ingestion of cat hair and inhalation of dust. However, participants in the study believed that mitigating the effect of TB‐associated stigma will require adequate community education on TB, provision of financial and emotional support to the patients, as well as the involvement of community leaders in TB control activities and stigma reduction interventions. TB‐associated stigma exists in rural and urban communities, with a lack of appropriate knowledge of TB and fear of infection as a major determinant in rural and urban areas respectively. Health education and sensitisation about TB, with community leaders as champions could help to mitigate the effect of TB‐associated stigma.
Background. Tuberculosis (TB) is an important public health concern in Nigeria. TB-associated stigma could lead to delayed diagnosis and care, treatment default, and multidrug resistance. ...Understanding of TB-associated stigma is therefore important for TB control. The study is aimed at determining and comparing the knowledge, attitude, and determinants of TB-associated stigma. Methodology. This was a comparative cross-sectional study among adults in urban and rural areas of Lagos State, Nigeria. Respondents were selected through a multistage sampling technique and interviewed using a semistructured questionnaire, which contained the Explanatory Model Interviewed Catalogue (EMIC) stigma scale. IBM SPSS Statistics Software package version 20 was used for analysis. Results. A total of 790 respondents were interviewed. High proportions of respondents in rural and urban areas were aware of TB (97.5% and 99.2%, respectively). Respondents in the urban areas had overall better knowledge of TB compared to the rural areas (59.4% vs. 23%; p<0.001), while respondents in the rural areas had a better attitude to TB (60.5% vs. 49.9%; p=0.002). The majority of respondents in rural and urban areas had TB-associated stigma (93% and 95.7%, respectively). The mean stigma score was higher in the urban compared to rural areas (17.43±6.012 and 16.54±6.324, respectively, p=0.046). Marital status and ethnicity were the predictors of TB-associated stigma in the rural communities (AOR-0.257; CI-0.086-0.761; p=0.014 and AOR–3.09; CI-1.087-8.812; p=0.034, respectively), while average monthly income and age of respondents were the predictors of TB-associated stigma in urban areas (AOR–0.274; CI–0.009-0.807; p=0.019 and AOR-0.212; CI–0.057-0.788; p=0.021, respectively). Conclusion. TB-associated stigma is prevalent in both rural and urban areas in this study. There is therefore a need to disseminate health appropriate information through the involvement of the community. Also, innovative stigma reduction activities are urgently needed.
To present management challenges, surgical technique, and outcome associated with penoscrotal reconstruction in patients with giant scrotal lymphedema in sub-Saharan Africa.
A prospective study of ...all patients who had penoscrotal reconstruction for giant scrotal lymphedema at our university teaching hospital between January 2003 and December 2012 was carried out. Patients' preoperative clinical evaluation findings, operative technique, and postoperative course were reviewed after obtaining ethical approval and informed consent from the patients.
Nineteen patients with giant scrotal lymphedema presented to us during the period of study; out of which, 11 had surgical excision and were studied. Their mean age and median duration of symptoms were 48.5 years and 11.5 years respectively. They all had surgical reconstruction using modified Charles procedure by the same combined team of urologists and plastic surgeons. Scrotal hematoma (27.3%) and superficial surgical site infection (18.2%) were complications encountered postoperatively. One patient (9.1%) had recurrence within 24 months, requiring repeat excision.
Giant scrotal lymphedema poses severe physical challenge to the sufferer. Surgery remains the only hope to reduce penoscrotal size. Combined effort of urologic and plastic surgeons is essential for reconstruction.
While the effect of HIV infection on some maternal outcomes is well established, for some others there is conflicting information on possible association with HIV. In this study we investigated ...pregnancy and neonatal outcome of HIV positive women in large HIV treatment centre over a period of 84 months. They were managed according to the Nigerian PMTCT protocol. Adverse obstetric and neonatal outcome were observed in 48.3% HIV positives compared 30.3% to the negatives (OR: 2.08; CI: 1.84-2.34). Low birth weight (OR:2.95; CI:1.95-3.1), preterm delivery (OR:2.05;CI:1.3-3.1), perinatal death (OR:1.9;CI:1.3-3.2), and spontaneous abortion (OR:1.37; CI:1.1-2.3) were factors found to be independently associated with HIV. Low CD4 count (OR: 2.45; CI: 1.34- 4.56) and opportunistic infections (OR: 2.11; CI: 1.56-3.45) were to be associated with adverse obstetric and neonatal outcome. This study confirms the association of HIV, severe immunosuppression and opportunistic infection and adverse obstetric and neonatal outcome. Alors que l'effet de l'infection par le VIH sur certains résultats maternels sont bien établis, pour certains d'autres, il ya des informations contradictoires sur l'association possible avec le VIH. Dans cette étude, nous avons étudié la grossesse et l'état néonatal des femmes séropositives dans un grand centre de traitement du VIH au cours d'une période de 84 mois. Elles étaient prises en charge selon le protocole nigérian de PTME. On a remarqué des résultats obstétricaux et néonatals Indésirables chez 48,3% des séropositives par rapport à 30,3% pour les négatifs (OR: 2,08, IC: 1,84 à 2,34). Le faible poids de naissance (OR: 2,95, IC : 1,95-3,1), l'accouchement prématuré (OR: 2,05, IC : 1,3-3,1), la mortalité périnatale (OR: 1,9, IC : 1,3-3,2), et l'avortement spontané (OR: 1,37 IC :1,1-2 3) étaient des facteurs qui seraient associés de façon indépendante avec le VIH. Les femmes qui ont un faible taux de CD4 (OR: 2,45, IC: 1,34 à 4,56) et les infections opportunistes (OR: 2,11, IC : 1,56-3 .45) devaient être associées aux résultats obstétricaux et néonatals défavorables. Cette étude confirme l'association entre le VIH, l'immunosuppression sévère et l'infection opportuniste, les résultats obstétricaux et néonatals défavorables.
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