Neonatal Sepsis: Etiology, Antimicrobial Susceptibility, and Treatment Outcomes in a Tertiary Hospital in Jos, Nigeria

IntroductionNeonatal sepsis is a systemic illness that occurs in newborns. It is a leading cause of neonatal morbidity and mortality globally. The aim of this study is to determine the burden of neonatal sepsis and assess the challenges of diagnosis among neonates hospitalized at the newborn unit of a tertiary care hospital in northern Nigeria.MethodsMembers of the study team extracted clinical and laboratory data from the medical records for all babies admitted to the hospital with neonatal sepsis between January 2015 and December 2019 using a standardized case report form.ResultsA total of 227 (39.5%) were found to have had suspected neonatal sepsis based on clinical presentation. Of these, 134 (59.0%) were male, 59 (26.0%) were preterm, and 93 (41.0%) were hospitalized within the first 24 hours of life. The majority were outborn, 148 (65.2%), and 147 (64.8%) had early-onset neonatal sepsis. Only 10 (4.4%) of these babies had blood cultures done; of these, only one was positive for Staphylococcus aureus. The duration of admission was > 7 days in 45.4% of the babies; the parents of 11.5% of the babies signed against medical advice and discharged, and 13.7% died.ConclusionThe prevalence of suspected neonatal sepsis in our hospital is high, but the rate of blood culture diagnosis is unacceptably low. There is an urgent need for improved laboratory support, including the routine availability of blood cultures and other markers of neonatal sepsis.

Background : Sepsis neonataroum is an important factor for morbidity and mortality in neonates. The incidence of neonatal bacterial sepsis depends on geographic area and may vary from country to country as well as within the same country.Objective: To identify the percentage of neonatal septicemia confirmed by positive blood cultures among 664 neonates admitted in neonatal care unit, and to identify the bacterial agents causing early and late neonatal sepsis and their antimicrobial susceptibility, and the outcome from neonatal septicemia. Patients and methods: The total number of patients(with clinical signs and symptoms suggesting sepsis) collected from neonatal care unit of ALKadimiya Teaching hospital from the 1st of January to the end of october 2011 were 664 neonates, and only 105 neonates who show signs and symptoms suggestive of septicemia that were confirmed by a positive blood culture were enrolled in this study. Data were collected include :Gestational age, Birth weight , Gender, Onset of sepsis, Place of delivery and also we followed up the subjects and recorded the outcome till discharge.Results: In this prospective study and from 664 neonate were admitted (total number of admission), positive blood cultures were obtained for 105 neonates (15.8%). Gram negative bacteria were the commonest causative agent in both early (66.7%) and late (56.9%) onset sepsis. Among neonates with sepsis, 33 patients (31.4%) had early onset and 72 patient (68.6%) had late-onset neonatal sepsis. The susceptibility of the isolated causative agent to selected antibiotics were the same in early and late onset sepsis. Over 70% of gram negative bacilli were resistant to both ampicillin and cloxacillin but show variable sensitivity to gentamicine and cefotaxime. Most of the isolated gram positive bacteria were sensitive to ampicillin, cloxacillin and cefotaxime but highly resistant to gentamicin. The death rate was 20.9%. Early onset sepsis, male gender, gestational age less than 37 weeks and birth weight less than 2500 gm were found to be significantly associated with death.Conclusions: Gram negative bacteria were the main cause of early and lateonset neonatal sepsis in our center and many of these isolated bacteria were resistant to the used antibiotics. Low birth weight neonates <2500 gm, gestational age < 37weeks, male gender and early onset sepsis were significantly associated with death. The death rate due to neonatal sepsis was higher compared with the other studies.
 Recommendations: Proper antenatal care and optimal obstetric management in early detection and treatment of mothers at risks together with minimizing invasive procedures of infants as much as possible and ideal nursery setup which includes adequate space for care of infants and aseptic equipments for monitoring.

Retinal vascular occlusions are the second most common retinal vascular diseases following diabetic retinopathy. They are associated with several systemic and ocular pathologies and are significant causes of visual loss. This study aims to determine the prevalence, pattern and risk factors for retinal vascular occlusions in a tertiary hospital in Jos, Nigeria. A retrospective review of all cases of retinal vascular occlusions seen in the eye clinic from January 2011 to December 2014 was carried out. The patients were identified from the clinic register and their case folders retrieved. The following data were then extracted from the files; patients' age, sex, presenting visual acuity, presence of any systemic disorders and type of retinal vascular occlusion. Data analysis was done using Epi Info 7. Three thousand eight hundred and twenty one new patients were seen during the study period and there were 52 (1.36%) cases of retinal vascular occlusions. Only the case files of 44 (84.6%) patients were available and were analysed. These were made up of 17 (39%) males and 27 (61%) females. These had a total of 46 retinal vascular occlusions made up of 37 (80.4%) retinal vein occlusions, 8 (17.4%) central retinal artery occlusions and a case (2.2%) of combined central retinal artery and vein occlusion. Hypertension and diabetes were the most common systemic risk factors while glaucoma was the most common ocular association. Retinal vascular occlusions are uncommon in our centre but lead to severe visual loss and are associated with significant systemic pathologies.

Background Kaposi’s sarcoma became prevalent with the appearance of human immune deficiency virus (HIV) in the 1980s. However, the widespread use of the highly active antiretroviral therapy (HAART) reduced its prevalence in communities with good access to the antiretroviral drugs. The objective of this study was to determine the prevalence and predictors of Kaposi’s sarcoma among persons receiving HIV care at a tertiary hospital in Jos, Nigeria. Methods The study used a cross-sectional study design, based on secondary data related to patients who had received HIV care between January 2004 and December 2017. Logistic regression was then used to determine the variables that were predictors of Kaposi’s sarcoma risk. Results The prevalence of Kaposi’s sarcoma among the patients was 1.2% (95% confidence interval, CI=1.06-1.34). Patients whose baseline viral loads were higher than 10,000 copies/mm3 were three times more likely to develop Kaposi’s sarcoma than those with lesser viral load (OR: 3.13, CI: 2.19-4.47). Gender, duration of HAART and education had modifying effect on the Kaposi’s sarcoma risk. Conclusions Kaposi’s sarcoma is a substantial public health problem among the HIV population in Jos. Universal access to HAART by the Federal Government of Nigeria and its partners is recommended to reduce its prevalence. In addition, education, skill acquisition and income generating programs should be targeted at girls and women by governments and other stakeholders in order to reduce the inequality that worsens their vulnerability to HIV infection and Kaposi’s sarcoma.

Aim Despite effective antihypertensive medications, poor medication adherence and retention in care contribute to uncontrolled blood pressure. This study aimed to assess the effect of text message reminders on medication adherence and retention in care among hypertensive patients in a tertiary hospital in Jos, Nigeria. Materials and methods This were a hospital-based quasi-experimental study. Hypertensive patients in the Cardiology (intervention group) and Nephrology (control group) clinics of Jos University Teaching Hospital, selected through a multi-stage sampling technique, had their treatment adherence and retention in care assessed at pre- and post-intervention period of six months. Data collected using a semi-structured interviewer-administered questionnaire were analysed using the Statistical Product and Services Solution version 23. McNemar’s test was used to assess effects of text message reminders on treatment adherence and retention in care. A p-value < 0.05 was considered statistically significant. Results At baseline, treatment adherence was 40.5% and 46.0% in the intervention and control groups respectively with the odds of adherence in the intervention group being 0.8 times that of the control group (95% C.I. = 0.48–1.31). Retention in care was 91.3% and 96.9% in the intervention and control groups respectively with the odds of retention in the intervention group being 0.34 times that of the control group (95% C.I. = 0.11–1.11). Post intervention, treatment adherence was 47.8% and 34.2% in the intervention and control groups respectively with the odds of treatment adherence in the intervention group being 1.77 times the odds of adherence in the control group (95% C.I. = 0.95–3.28). Retention in care was 60.9% and 63.3% in the intervention and control groups respectively. Conclusion Low treatment adherence and high retention rates were recorded among hypertensive patients. Text message reminders improved adherence but decreased retention, highlighting the need to optimize their use to improve both outcomes at Jos University Teaching Hospital.

Diet is a crucial aspect of diabetes management and healthy eating is one of the main focus in preventing type 2 diabetes mellitus. Despite mounting evidence of the role of the dietary approach in the management of diabetes mellitus, studies still show low adherence to dietary recommendations. This study aimed at assessing the dietary knowledge, attitudes, and practices of type 2 diabetes mellitus patients in two tertiary hospitals in Jos, Nigeria. This was a descriptive cross-sectional study among 448 type 2 diabetic patients using systematic random sampling. Quantitative data was collected using a self- administered questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 20. A 95% confidence interval was used and a probability value of P≤0.05 was considered statistically significant. The study revealed that dietary knowledge of type 2 diabetic patients attending tertiary health care facilities in Jos, Nigeria was poor, their attitudes were positive, but they had poor dietary practices. A significant association was observed between marital status (P=0.022), religion (P=0.003), education level (P=0.000), employment status (P=0.000), family history (P=0.012), and dietary knowledge. This study highlights the importance of proper health education as this could possibly improve dietary knowledge, dietary practices that potentially change patient outcomes.

Rapid diagnostic tests are frequently used in healthcare settings across Nigeria for diagnosis of Plasmodium falciparum malaria, which is the commonest form of malaria in the country. In this study, the performance of a rapid diagnostic test (RDT) was compared with expert microscopy using the polymerase chain reaction (PCR) as the reference standard in a tertiary hospital in Jos, Nigeria. This study was a prospective, cross-sectional, hospital-based study. A total of 200 participants of all ages presenting to Jos University Teaching Hospital with a history of fever or an axillary temperature of >37.5°C were recruited. Blood specimens were collected and malaria testing was done using RDT, microscopy and PCR. The prevalence of malaria in this study was 17%, 15% and 13% by PCR, microscopy and RDT, respectively. Compared with microscopy, RDT had lower sensitivity of 75% (95% CI: 56.60-88.54) vs 88.24% (95% CI: 72.55-96.70), lower specificity of 98.80% (95% CI: 95.72-99.85) vs 100.0% (95% CI: 97.80-100.0), lower positive predictive value 92.31 (95% CI: 74.89-97.97) vs 100 (95% CI: 98.0-100.0), and lower negative predictive value 95.35 (95% CI: 91.83-97.39) versus 97.65 (95% CI: 94.30-99.05). The diagnostic performance of expert microscopy was better than RDT in the diagnosis of Plasmodium falciparum malaria. Quality assurance procedures such as using expert microscopy to cross-check a proportion of RDT negative results in patients with clinical features of malaria is desirable.

Background Chronic leukemia is the most common leukemia subtype seen among adults in Jos, Nigeria, with few reported isolated cases of ocular morbidity. There are no published comprehensive data on adult leukemic ophthalmopathy from this region. Aim The aim of this study was to determine the prevalence, pattern, and causes of visual impairment (VI) among adult patients with chronic leukemia in Jos, North-Central Nigeria. Patients and methods The study included adult patients diagnosed with either chronic myeloid leukemia or chronic lymphocytic leukemia, confirmed by bone marrow biopsy, in two tertiary hospitals in Jos, North-Central Nigeria, between January 2016 and June 2017. Visual acuity was assessed and categorized using the International Classification of Diseases. Detailed ocular examination was carried out and causes of vision loss were noted. Results A total of 104 eyes of 52 patients were examined within the study period. The mean age of the patients was 45±17.7 years, and 35 (67.3%) patients were males. The majority (63.4%) of the participants had chronic myeloid leukemia. Ocular disorders were present in 32 (61.5%) of all patients, and 10 (19.2%) patients were visually impaired. Of these, nine (90.0%) had moderate VI due to refractive errors, cataract, glaucoma, and disk swelling; and one (10.0%) person was bilaterally blind from exudative retinal detachment and vitreous hemorrhage. Only 27% of all causes of VI were leukemia specific and included disk swelling, exudative retinal detachment, and vitreous hemorrhage. Conclusion Although ocular disorders were frequent among adults with chronic leukemia in Jos, the magnitude of vision loss from chronic leukemia-specific ocular disorders was low.

Radio-diagnostic staff are expected to always and routinely adorn a form of radiation monitoring device to enable objective monitoring of the exposure to each individual with such monitoring aimed at checking any ill effects of radiation. This cross-sectional study aimed at comparing the utilization of radiation monitoring devices among radio-diagnostic staff was conducted in 2 tertiary hospitals and 2 secondary hospitals in Jos, Plateau State, Nigeria between August 2019 and October 2019. Consenting staff of radio-diagnostic departments of the 4 hospitals filled up a self-administered questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. A total of 60 staff: 51(85%) in the tertiary, and 9 (15%) in the secondary hospitals participated in the study. A positive attitude to the proper use of radiation monitoring device was found to be higher among staff in the tertiary hospitals (44/51; 86.3%) compared to those in the secondary hospitals (7/9; 77.8%); χ2=0.4332, p=0.510. Statistically significant association was established between age of staff and attitude to use of the monitoring device in tertiary facilities: χ2= 9.379, p=0.05, and also between age of staff, years in service and years in the department and the practical usage of the radiation monitoring device among the staff of the secondary hospitals: χ2= 9.000, p=0.029; χ23.937, p=0.047; χ23.937, p=0.047 respectively. The utilization of radiation monitoring devices among the radio-diagnostic staff in Jos was predominantly positive. Age of the staff, years in service as well as years in the present department were significant associations to utilization of radiation monitoring devices among staff across the two hospital categories.

Background: Hypothermia on admission in neonatal units is a well-recognized contributor of neonatal mortality and morbidity. This study aimed to identify risk factors for hypothermia on admission in a resource-poor setting which will help provide targeted preventive interventions. Methods: A retrospective cross-sectional descriptive study was conducted from July 1, 2020 to January 31, 2022. A total of 567 neonates were included in the study, data were collected from the unit electronic database. The axillary temperature of each neonate was measured using a digital thermometer at the point of admission. Bivariate and multiple logistic regressions were used to assess associated risk factors. Results: The prevalence of admission hypothermia (AH) in the study population was 42.4% with mild and moderate hypothermia accounting for 46.3% and 53.7%, respectively. Maternal ages 20–29 years (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.09–0.93) and 30–39 years (aOR 0.27, 95% CI 0.08–0.88) and primary education (aOR 0.44, 95% CI 0.21–0.92) were associated with reduced risk of AH. Age <24 h (aOR 3.61, 95% CI 1.70–7.66), gestational age 28–32 weeks (aOR 3.90, 95% CI 1.41–10.79) and 33–36 weeks (aOR 2.835, 95% CI 1.52–5.28), admission weight <2.5 kg (aOR 2.01, 95% CI 1.18–3.43), and cold season (aOR 1.85, 95% CI 1.06–3.14) were associated with increased risk of AH. Mortality in those with AH was 3 folds (crude odds ratio 3.38, 95% CI 1.6–6.82). Conclusion: Hypothermia on admission is common in neonates in resource-poor settings. Training of newborn care-providers in maintaining thermoneutral environment and temperature at delivery and postnatal periods will be a cost-effective intervention in reducing neonatal mortality.

BACKGROUND Nosocomial infections pose a great challenge on healthcare systems. Although surfaces in neonatal wards, umbilical stump wounds and catheter are responsible for a high number of nosocomial infections due to bacteria. The aim of this study was to determine the bacterial profile of air and surface contamination in the special care baby unit of a tertiary hospital in Jos, Nigeria. METHODS Surface and air samples were cultured and antibiotic susceptibility of isolated bacteria were determined. RESULTS The bacterial profile of air and surface samples showed that Klebsiella was the most common bacteria followed by Staphyllococcus; while the least was Escherichia. Most of the bacteria were isolated from the out-born term area of the special care baby unit. All the bacteria isolated were susceptible to ceftriaxone and meropenem. CONCLUSION This study showed that all areas of the special care baby unit of the hospital have bacterial, indicating that these are a potential source of cross-infection from healthcare workers to the neonatal patients.

BackgroundNeonatal sepsis is a significant cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as pathogens of bacterial sepsis and antibiotic sensitivity pattern can considerably vary in different settings. This study was conducted at Bugando Medical Centre (BMC), Tanzania to determine the prevalence of neonatal sepsis, predictors of positive blood culture, deaths and antimicrobial susceptibility, thus providing essential information to formulate a policy for management of neonatal sepsis.MethodsThis was a prospective cross sectional study involving 300 neonates admitted at BMC neonatal unit between March and November 2009. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method.ResultsAmong 770 neonates admitted during the study period; 300 (38.9%) neonates were diagnosed to have neonatal sepsis by WHO criteria. Of 300 neonates with clinical neonatal sepsis 121(40%) and 179(60%) had early and late onset sepsis respectively. Positive blood culture was found in 57 (47.1%) and 92 (51.4%) among neonates with early and late onset neonatal sepsis respectively (p = 0.466). Predictors of positive blood culture in both early and late onset neonatal sepsis were inability to feed, lethargy, cyanosis, meconium stained liquor, premature rupture of the membrane and convulsion. About 49% of gram negatives isolates were resistant to third generation cephalosporins and 28% of Staphylococcus aureus were found to be Methicillin resistant Staphylococcus aureus (MRSA). Deaths occurred in 57 (19%) of neonates. Factors that predicted deaths were positive blood culture (p = 0.0001), gram negative sepsis (p = 0.0001) and infection with ESBL (p = 0.008) or MRSA (p = 0.008) isolates.ConclusionOur findings suggest that lethargy, convulsion, inability to feed, cyanosis, PROM and meconium stained liquor are significantly associated with positive blood culture in both early and late onset disease. Mortality and morbidity on neonatal sepsis is high at our setting and is significantly contributed by positive blood culture with multi-resistant gram negative bacteria.

Malaria was thought to be rare in neonates. However, recent studies report increasing prevalence in neonates. Clinical features of neonatal malaria have also not been adequately reported. This study was undertaken to assess the prevalence, clinical features and outcome of malaria in neonates admitted into two tertiary hospitals in Jos, Plateau State. All consecutive neonates aged 0 - 28 days admitted into the neonatal units of Jos University Teaching Hospital and Bingham University Teaching Hospital, Jos were recruited into the study. Giemsa stained blood films of the neonates were examined by trained microscopists. Neonates with malaria had presenting clinical features recorded and treated with amodiaquine (1st line) and quinine (2nd line). Clinical features and parasitaemia were monitored for 14 days for outcome. Of the 301 neonates enrolled, 16 had malaria parasitaemia giving a prevalence of 5.3%. Congenital malaria accounted for 87.5% of cases of neonatal malaria. Plasmodium falciparum mono-infection was responsible for all the cases of malaria. ITN use in pregnancy offered some protection against neonatal malaria (CI=0.2 - 0.7). The median parasite density was 255 (72, 385) parasites/μl. Fever was significantly present in 10 (66.7%) of the cases (p=0.03). Fifteen of the 16 neonates had clinical and parasitological cure on treatment with amodiaquine. One treatment failure had cure after retreatment with quinine. There was no mortality in all 16 neonates treated for malaria. Malaria is not rare in neonates on admission in Jos. Fever is the commonest clinical feature of neonatal malaria. Amodiaquine provided effective treatment of malaria in neonates in Jos.

Neonatal sepsis is one of the significant causes of morbidity and mortality in neonates, especially in developing countries. This study investigates the species distribution and antimicrobial susceptibility pattern of agents causing neonatal sepsis in a northern hospital in Vietnam. Materials and methods. All in-term neonates treated at the Neonatal Center, National Children’s Hospital, Vietnam between December 2019, and April 2021 who met the clinical criteria for sepsis and positive blood cultures were enrolled. Species identification and antimicrobial susceptibility testing were performed with Vitek 2 Compact (bioMerieux, France). Results. Eighty-five neonates were included with the majority of cases being early-onset sepsis (61.2%, 95% CI: 50.6–71.8%). Gram-negative, Gram-positive, and fungal isolates constituted 50.6%, 40%, and 9.4%, respectively. The most common agent was Staphylococcus aureus (28.2%) followed by Klebsiella pneumoniae and Escherichia coli (16.5% each). For those with bacteriological sepsis, Gram-negative pathogens were predominant in early-onset sepsis whereas Gram-positive pathogens were predominant in late-onset sepsis (75.0% (33/44) vs 69.7% (23/33), p 0.001). Antibiotic resistance was common among bacterial isolates, but antifungal resistance was not detected among isolates of Candida sp. Vancomycin and fluoroquinolone were very effective against Gram-positive organisms while piperacillin + tazobactam, aztreonam, and ertapenem were potent drugs against Gram-negative organisms. Conclusion. Routine investigation of microbial profiles and antimicrobial susceptibility patterns is essential to guiding strategies for the choices of empirical antimicrobials.

Background: Postpartum depression (PPD) is of public health importance. Estimation of it occurrence in other parts of the developed world showed prevalence rates of approximately 10%–25%. Previous prevalence studies in crisis-ridden areas showed prevalence rates ranging from 28% to 58%. However, since the entrenchment of relative peace in Jos, Nigeria there has not been any other study to the best of the authors' knowledge. Aim: The aim of the present study was to determine the prevalence of PPD in a postethno-religious crisis period among women attending the Postnatal and Children's welfare clinic in a tertiary hospital, Jos, Nigeria. Materials and Methods: In total, 550 women were recruited in a cross-sectional study that involved a two-stage procedure in a Tertiary Hospital in Jos, Nigeria. The Edinburgh Postnatal Depression Scale questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis were used. Results: A weighted prevalence of 21.8% of PPD was found among the participants. Age (P