Despite promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs), there remains limited knowledge on how to implement ASPs in peculiar settings for a more elaborate ...impact. This study explored prescriber experiences and perceptions of the usefulness, and feasibility of strategies employed for the implementation of antimicrobial stewardship (AMS) interventions as well as challenges encountered.
This is a cross-sectional mixed-method survey of prescribers' perspective of the facilitators and barriers of implementing ASP. The quantitative approach comprised of a semi-structured questionnaire and data collected were analyzed using SPSS version 26 while the qualitative approach used focus group discussions followed by content analysis.
Out of the thirty people that participated in the workshop, twenty-five completed the questionnaires which were analyzed. The respondents included 15 (60.0%) medical doctors and 10 (40.0%) pharmacists. The mean age of the respondents was 36.39±7.23 years with mean year of practice of 9.48±6.01 years. Majority of them (84.0%) were in a position to provide input on the implementation of AMS in their facilities, although their managements had the final decision. The pharmacists (100%) were more likely to agree that antibiotic resistance was a problem for their practice than the medical doctors (78.6%) while equal number (80.0%) of respondents (pharmacists and medical doctors) believed that inappropriate prescribing was a problem. Having a specialized and dedicated team with effective monitoring was recognized as crucial for effective ASP while inadequate personnel was identified as a major barrier. We identified stakeholder's engagement, policies and regulation, as well as education as themes for improving AMS in the country.
The results gave insight into the prescribers' perspective on the facilitators and barriers to antimicrobial stewardship; challenges and possible solutions to implementing ASPs in health facilities in Lagos State. We further identified pertinent contextual factors that need to be addressed when developing ASPs in healthcare facilities in a resource-poor setting.
Healthcare workers (HCWs) are disproportionately infected with SARS-CoV-2 when compared to members of the general public; estimating the seroprevalence of SARS-CoV-2 antibody and SARS-CoV-2 infection ...rate among HCWs is therefore crucial. This study was carried out in four health facilities in Lagos Nigeria to determine the prevalence of IgG antibodies (seroprevalence) and SARS-CoV-2 active infection rate via a positive rtPCR result, the cross-sectional study was conducted between December 2020 and July 2021. Nasopharyngeal and blood samples were collected from HCWs and screened for SARS-CoV-2 infection using the rtPCR technique and antibody using the Abbott anti-SARS-CoV-2 IgG CMIA assay, respectively. Demographic and occupational exposures data were obtained and analysed using descriptive and inferential statistics, variables significant via inferential statistics were subjected to a multivariate analysis. A total of 413 participants were enrolled, with a mean age in years of 38.4±11.0. The seroprevalence was 30.9% (115/372) while 63/395 (15.9%) were actively infected with the virus. HCWs whose job role had direct contact with patients had a higher percentage of SARS-CoV-2 infection when compared with those not in direct contact, also being a health care worker was significantly associated with getting a positive COVID-19 PCR result. In conclusion the SARS-CoV-2 seroprevalence seen in this study was higher than national serosurvey estimates indicating HCWs are at higher risk of COVID-19 infection when compared to the general public. Vaccination and effective implementation of infection control measures are important to protect HCWs.
Real-world data on vaccine-elicited neutralising antibody responses for two-dose AZD1222 in African populations are limited. We assessed baseline SARS-CoV-2 seroprevalence and levels of protective ...neutralizing antibodies prior to vaccination rollout using binding antibodies analysis coupled with pseudotyped virus neutralisation assays in two cohorts from West Africa: Nigerian healthcare workers (n = 140) and a Ghanaian community cohort (n = 527) pre and post vaccination. We found 44 and 28% of pre-vaccination participants showed IgG anti-N positivity, increasing to 59 and 39% respectively with anti-receptor binding domain (RBD) IgG-specific antibodies. Previous IgG anti-N positivity significantly increased post two-dose neutralizing antibody titres in both populations. Serological evidence of breakthrough infection was observed in 8/49 (16%). Neutralising antibodies were observed to wane in both populations, especially in anti-N negative participants with an observed waning rate of 20% highlighting the need for a combination of additional markers to characterise previous infection. We conclude that AZD1222 is immunogenic in two independent West African cohorts with high background seroprevalence and incidence of breakthrough infection in 2021. Waning titres post second dose indicates the need for booster dosing after AZD1222 in the African setting despite hybrid immunity from previous infection.
Abstract Aim This study was undertaken to determine the prevalence of Bacterial Vaginosis (BV), Trichomonas Vaginalis (TV) co-infection, and the antibacterial sensitivity profile of bacterial ...isolates. Methods The study was a cross-sectional study of 232 pregnant women on a routine antenatal visit between April 2019 and Sept. 2020, at Amukoko clinic in Lagos, Nigeria. The gynaecologist conducted the clinical examination on each patient looking for vaginal discharge and its consistency/homogeneity, colour and odour. Two High Vaginal Swab (HVS) samples were taken from every patient and a semi-structured questionnaire was used to gather the socio-demographic, practices/attitudes, and clinical information of each participant. One sample was employed for wet preparation to identify the TV and BV diagnosis using Amsel’s criteria and Whiff’s test. The second sample was used for bacterial culture and antibiogram was conducted using the disc diffusion technique. The Clinical Laboratory Standard Institutes’ (CLSI) interpretative criteria were used to categorise the results. Results The mean age of the clients was 28.11 ± 7.08 years of age. The majority (88%) were aged 15–35 years. Only 81 (34.9%) had microbial organisms isolated or seen from their specimens and 19 (8.2%) of such were classified as having BV (Bacteriods or Gardnerella isolated). Of the 81 infected, 33 (40.8%) had only bacterial infection, 36 (44.4%) had TV alone and 12 (14.8%) had bacteria co-infected with TV. From the clinical records, the population that was classified as having UTI or vaginitis was only 46 (20.7%) The study observed age (15–35 years) related association between vaginosis/ TV co-infection (X 2 = 7.9; P = 0.005). Participants with symptoms of vaginitis or UTI (mainly E. coli & pseudomonas spp. isolated), BV/co-infection with TV significantly associated with female traders (X 2 = 8.5; P = 0.003) and were more associated with those from polygamous relationships (X 2 = 18.79, P = 0.0001). Women in their 3 rd and 2 nd . trimester were more significantly associated with vaginal infection (X 2 = 9.47, P = 0.002; X 2 = 4.79, P = 0.029) respectively. The Pseudomonas showed susceptibility to ciprofloxacin (CIP) and cefuroxime (CXM). While, E. coli isolates were susceptible to cefepime, ciprofloxacin, and imipenem. Conclusion There is a relatively low prevalence of BV and flagellate co-infection in the community studied. Recommendation We recommend screening of antenatal women with underlying symptoms for BV and flagellates co-infection to avoid its progression to vaginitis.
•No formal ASP in place in 80% of healthcare facilities, and only six facilities had an AMS team.•No dedicated financial support in any facility and limited IT resources especially in primary and ...secondary facilities.•Only two facilities (8%) perform prospective audit and feedback and 28% monitor adherence to guidelines.•No private healthcare facility produced a cumulative antimicrobial susceptibility or AMS annual report for previous year.•Tracking was generally poor in healthcare facilities with ASPs, with only monitoring of adherence to treatment guidelines.
Optimising antibiotic use in healthcare settings through antimicrobial stewardship programmes (ASPs) is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antimicrobial resistance. This needs assessment was designed to provide the current status of ASPs in healthcare facilities in Lagos State and identify gaps for future interventions.
A descriptive cross-sectional survey was conducted using a self-administered questionnaire to ascertain the extent and nature of ongoing ASPs among selected healthcare facilities and identify gaps for future interventional studies.
Of 32 questionnaires distributed, 25 (78%) were completed and returned from three tertiary, six secondary, eleven primary and five private healthcare facilities. The mean years of practice of respondents was 13.96 ± 7.8 years (2–31 years). Six facilities (24%) had a team responsible for ASP operating at varying degrees of capacity, while five (20%) had a formal ASP. All six facilities with an antimicrobial stewardship (AMS) team had a medical doctor as the team lead, and 5 (20%) also had a pharmacist involved in implementation efforts. Routine pre-authorisation for specific antibiotic was performed in six facilities (24%), four of which monitor pre-authorisation interventions. Only two facilities (8%) performed prospective audit and feedback for specific antibiotic agents. Private healthcare facilities were more likely to have information technology (IT) capability to support the needs of AMS activities.
This study revealed minimal ASP activities in healthcare facilities in Lagos State and highlighted possibilities of leveraging on available IT resources for a co-ordinated AMS strategy.
This paper maps the US presidential terms with price dynamics in US stock markets by focusing on the S&P500 index. Fractional integration techniques, which are more general than other standard ...methods, are used and the results obtained produce interesting findings. It was found that during the second presidential terms, S&P500 stock market is less efficient and present higher degrees of persistence in its volatility. This is observed independently of the political affiliations of the president in power. The volatility, in general, reflects the spillover of economic excesses at the end of the first presidential term when seeking re‐election into the second term in office. Expansionary monetary and fiscal policies at the end of the first term may create disequilibria in the economy which are amplified in the second term through a transmission mechanism resulting in contractionary interventionist policies in a situation where no incentive for re‐election exists by the incumbent. The existence of stock's price cycles as induced by US presidential terms contradicts market efficiency theory but this helps investors decisions.
Population-based study is known to be a very essential type of study during and after a pandemic or epidemic, as it provides crucial information on the incidence, prevalence, and risk factors of the ...disease in question. There has been limited information about the challenges faced in conducting such surveys in Nigeria. In this paper, we will share our experience, and describe the challenges faced in conducting a population-based seroepidemiological study of COVID-19 in Lagos, Nigeria. Some challenges were peculiar to specific Local Government Areas (LGAs) while others were general. The challenges include general misconceptions of community members about health research, difficulties in mapping houses, planning for data collection, standardizing data collection, working in hard-to-reach communities when resources were limited as well as difficulty in collection of blood and naso-oropharyngeal swabs. Ways of overcoming these problems, lessons learnt, and recommendations are hereby discussed.
Background
A common complication of any respiratory disease by a virus could be a secondary bacterial infection, which is known to cause an increase in severity. It is, however, not clear whether the ...presence of some opportunistic pathogens called pathobionts contributes to the severity of the disease. In COVID-19 patients, undetected bacterial co-infections may be associated with the severity of the disease. Therefore, we investigated the implications of bacterial co-infections in COVID-19 cases.
Results
This is a cross-sectional study that involved archived specimens collected from nasopharyngeal samples of 150 people for COVID-19 screening in Lagos. DNA extraction from the samples was carried out to determine the presence of five respiratory bacterial pathogens using nested real-time PCR, and data were analysed using the Chi-square test. Of the 150 samples collected, 121 (80.7%) were positive for SARs-CoV-2 infection and 29 were negative. The proportion of patients with bacteria co-infection in COVID-19-negative, asymptomatic, and mild cases were 93.1%, 70.7%, and 67.5%, respectively. There was no statistically significant difference between mild COVID-19 conditions and bacteria co-infection (
p
= 0.097). There was also no significant difference in the nasal carriage of
Staphylococcus aureus
,
Mycoplasma pneumoniae
, and
Haemophilus
spp. However, there was a statistically significant increase in the carriage of
Moraxella catarrhalis
and
Chlamydophila pneumoniae
among COVID-19-negative patients when compared with the positive patients (
p
value = 0.003 and 0.000 for
Moraxella catarrhalis
and
Chlamydophila pneumoniae
, respectively).
Conclusions
The current study shows that bacterial co-infection and superinfection with COVID-19 are not associated with mild and asymptomatic COVID-19 cases in our setting. However, given the high prevalence of
Staphylococcus aureus
and
Mycoplasma pneumoniae
among the mild COVID-19 cases seen in this study, early diagnosis and treatment of these bacterial co-infections are still encouraged to mitigate the effect on the severity of COVID-19.
Background. The objective of this study was to describe the prevalence and clinical features of coronavirus disease 2019 (COVID-19) among children (≤18 years) evaluated for Severe Acute Respiratory ...Syndrome Coronavirus 2 (SARS-CoV-2) infection at a testing centre in Lagos, Nigeria. Methodology. This was a retrospective study. Data on the sociodemographic, clinical characteristics and SARS-CoV-2 results of participants at a modified drive-through centre for COVID-19 test sample collection over four months were retrieved from the electronic medical records (EMR). Data obtained were analyzed using SPSS version 22.0. Results. A total of 307 children (≤18 years) were evaluated in this review. The prevalence of SARS-CoV-2 infection among the paediatric population was 16.3%. The median age (interquartile range (IQR)) was 9 (4–14) years. Common symptoms reported by the positive cases were fever (40.0%), cough (32.9%), sore throat (17.1%), and runny nose (15.7%). The majority of the positive cases had mild symptoms. Fever and sore throat were associated with the positive cases. Conclusion. Fever and sore throat were associated with SARS-CoV-2 infection among our cohort which buttresses the need for a high level of suspicion and clinical acumen in the management of common febrile diseases in paediatric settings.
There is low LARC uptake in Nigeria and not much is documented about Nigerian women's preferences for these products and how these preferences affect women's choices. Therefore, the purpose of this ...study is to provide empirical evidence on the decision-making behavior of Nigerian women regarding LARCs. Three hypothetical LARCs were presented. Informed by results obtained from the review of relevant literature and focus group discussion held with selected family planning services providers, the identified attributes were effect on weight, cost, LARC effectiveness and effect on bleeding patterns, each at three levels. A d-optimal design was used to construct nine choice sets. An additional choice set was included to conduct the test-retest stability test. The choice sets and other socio-demographic questions formed the discrete choice experiment questionnaire. A random sample of 150 eligible women was selected from women who enrolled and attended family planning clinics in public healthcare facilities in Ibadan, Nigeria through a three-stage sampling technique. Mixed logit modeling was used to obtain estimates of the parameters and willingness to pay (WTP) for each attribute was calculated. The test-retest stability result showed that 76.7% of the respondents responded in a consistent and rational manner. The women preferred LARCs that have no effect on their weights compared to LARCs that cause either slight weight loss or gain. Also, they preferred LARCs that offer 1/1000 level of effectiveness in a year. The most preferred attribute level, ‘women experience infrequent bleeding’, increases WTP by NGN 13,984.584 (USD 33.68) while the least preferred level, ‘women experience frequent/prolonged bleeding’, has a negative mean WTP (-NGN 19,598.378 (-USD 47.20)) indicating dispreference for the level. Furthermore, women derived higher utilities from very cheap LARCs. Evidence-based information on women's preferences regarding LARC usage would help policymakers in the deployment of strategies that would ensure that preferred LARCs are procured and made readily available to women.
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