Dalhatu Araf Specialist Hospital Research Articles

Factors Affecting Uptake and Utilization of Insecticide Treated Net Among Women of Reproductive Age (15 – 49 years) Group Attending Antenatal Clinics in Nasarawa State Nigeria

Background: Vector control is the main path to preventing and reducing malaria transmission. The ownership and use of Insecticide-Treated Nets (ITNs) is the core vector control method and a proven intervention for the control and elimination of malaria in several malaria-endemic countries. This study determined the factors affecting the uptake and utilization of ITN by women in their reproductive age group in Nasarawa State Nigeria. Methods : A descriptive cross sectional study among women of reproductive age group (15 – 49 years) attending Ante Natal Clinic at the Dalhatu Araf Specialist Hospital Lafia, General Hospital Akwanga and Medical Centre Mararaba Gurku in Nasarawa State Nigeria. An interviewer administered questionnaire was used after obtaining an informed consent. Ethical approval was gotten from the state research ethics committee. Data analysis was done using SPSS version 23.0. Results: The mean age of this study population was 27.9 ± 10.6 years. Of the total number of 772 participants in this study, a larger chunk of 707 (91.6%) have heard of insecticide treated net. In addition, most 538 (69.7%) participants said healthcare workers emphasizes the use of insecticide treated net during their antenatal care visits. More than half of the participants, 432 (56.0%) owned an ITN at home. Utilization of insecticide treated nets showed that, 451 (58.4%) sleeps under an insecticide treated net, with 334 (74.1%) of these sleeping under it daily. Reasons for not using ITN for some were; due to heat 137 (30.4%), due to smell 83 (18.3%) and others for no good reason 86 (19.1%) respectively. Beliefs about usefulness of ITN showed 320 (71.0%) felt it is very good and useful in preventing malaria. Conclusions: Most participants are aware of ITN. More than half owned (56%) and sleeps (58.4%) under the ITN. About 71% believed ITN is useful in preventing mosquito bites and malaria. Reasons for declining using ITN among some were due to the ITN’s heat and smell. While more than two-third felt ITN is useful in preventing mosquito bites and malaria. Keywords: Factors, Insecticide Treated Nets, Uptake, Utilization. DOI: 10.7176/JHMN/92-06 Publication date: August 31 st 2021

Compliance to treatment regimen among diabetic patients at Dalhatu Araf Specialist Hospital Lafia, Nigeria

Compliance to treatment regimen among diabetic patients at Dalhatu Araf Specialist Hospital Lafia, Nigeria

Burden and risk factors of preterm birth in Nasarawa State, North Central, Nigeria: A five-year case review

Background: Preterm birth has been on the increase globally and accounting for morbidities and mortalities. Preterm delivery referred to the birth of a newborn prior to thirty seven completed gestational weeks. There is dearth of knowledge on the burden of preterm birth in this state. This study therefore determined the burden of preterm deliveries in Nasarawa State, evaluate the risk factors and identify the outcome of such deliveries. Methods: A descriptive cross-sectional study of all preterm delivered from the 1st of January 2014 to the 31st of December 2013 at the Dalhatu Araf Specialist Hospital (DASH) Lafia, General Hospital Akwanga and Medical Centre Mararaba Gurku in the Southern, Northern and Western senatorial zones of Nasarawa State respectively. Data was analyzed using SPSS version 20. Results: The mean age of mothers of preterm in this study is 26.5±5.7 years. More than three-quarter of preterm birth in Nasarawa State were at the DASH Lafia. The prevalence of preterm birth and admissions were 1.5% and 10.8% respectively. One in four of the preterm were either late preterm or extreme preterm. Singleton gestation accounted for 82.1% of the preterm births while 75.6% of such deliveries where through the vaginal mode of deliveries. Risk factors for preterm deliveries were multiple gestation, antepartum haemorrhage (placenta previa), premature rupture of membrane and previous preterm delivery. Deaths among the preterm was 11% in this study. Conclusion: The burden of preterm births in this study is comparable to other centre in same region. Half of the preterm were either late or extreme preterm. Risk factors for preterm deliveries were placenta previa, premature rupture of membrane, multiple gestation and previous preterm child birth. Death was recorded in one out of every nine preterm

Open Surgery for Urinary Stones in a Resource Poor Setting: A Look at Dalhatu Araf Specialist Hospital, Lafia, Nigeria

Urinary stone disease has afflicted humankind since antiquity[1]. It remains a common urological condition worldwide, including in our environment[2]. Although open surgery was previously the main option for stone removal, advances in technology mean that treatment is now largely through minimally invasive surgery, as recommended by a number of urological guidelines[3,4]. Unfortunately, at our centre, we still treat urinary stones solely through open surgery, mostly because we lack endoscopic equipment. In addition, most of our patients, even if referred to facilities where endoscopic management is possible, cannot afford the cost of treatment.

Antimicrobial activity of Ricinus comunis, Swietenia mahogani and Crusentia cujete ethanol extracts against multidrug resistant pathogens, recovered from a hospital environment

Medicinal plants have been used as effective approaches to manage multidrug resistant pathogens, including infectious agents that cause nosocomial infections. This study aimed to investigate the antimicrobial potentials of ethanolic extracts of Ricinus comunis, Swietenia mahogani and Crusentia cujete against five multidrug resistant nosocomial pathogens namely; Staphylococcus aureus, Pseudomonas sp., Klebsiella sp., Escherichia coli and Candida sp., which were isolated from hospital fomites. Using standard microbiological methods, fomite swab samples from ward beddings and door handles from the casualty, women, and children ward of Dalhatu-Araf Specialist Hospital, Lafia, Nigeria, were assessed. A total of 251 microbial isolates, consisting of 8 bacterial and 6 fungal genera were recovered. The highest frequency of microbial pathogens was recorded in the casualty unit (98[39%]), followed by the women’s unit (90[36%]), while the children’s ward (63[25%]) was the least contaminated. S. aureus (25[42%]) and Aspergillus sp. (43[72%]) were the most isolated bacteria and fungi; respectively, while Salmonella sp. (7[12%]) and Trichoderma sp. (9[15%]) were the least isolated. However, there were no significantly statistical differences across wards and microbial isolates. The five selected isolates were tested for in vitro susceptibility against several standard antibiotics to check their multiple drug resistance. The tested microorganisms exhibited various levels of multidrug resistance patterns except for Candida sp. which was resistant to two classes of antibiotics (azole group and griseofulvin). On the other hand, Klebsiella sp. was resistant to eight antibiotics of four classes. The ethanolic leaf extract of C. cujete was more effective against all the selected microbial pathogens, while the bark extract of S. mahogani was substantially effective. R. comunis exhibited no inhibitory potential against any of the tested pathogens. All the plant extracts were not as effective against the tested microorganisms as the conventional antibiotics that were used as positive controls. Results obtained indicate the risk of nosocomial infections caused by multidrug resistant pathogens originating from the hospital environment. Good hygienic practices, public awareness on nosocomial infections and further research into ethnomedicine are hereby recommended.

Multidrug resistant Escherichia coli among patients with gastrointestinal tract infections seeking health care services at Lafia, Nigeria

Gastrointestinal tract (GIT) in human plays an important role in providing habitat to various microbial communities including numerous prokaryotic cells numbering over 100 trillion. This study was aimed at accessing the multidrug resistance (MDR) of E. coli among patients with GIT infections seeking health care at Dalhatu Araf Specialist Hospital (DASH), Lafia, Nasarawa state, Nigeria. A total of one hundred and fifty (150) stool samples were collected using sterile sample containers from patients with symptoms of GIT infections in search of medical care in this hospital. The samples collected were processed using standard microbiological methods. Out of the total samples collected, 35.3% (53/150) revealed the presence of E. coli whereas 64.7% did not. Extended spectrum beta-lactamases (ESBL) were found in 45.3% of E. coli obtained in this study, which were further used for the antimicrobial susceptibility test. E. coli were more resistant to ampicillin (75.51%), followed by amoxycillin/clavulanic acid (61.22%) and were least resistant to imipenems (12.25%). In conclusion, MDR E. coli producing ESBL are abundant among patients with GIT infections visiting DASH, Lafia. Thus, it is important to determine the genes responsible for this MDR as well as dissemination of adequate information to the masses visiting the hospital for treatment on the possible effects caused by the antibiotics abuse
 Keywords: Escherichia coli, Multiple-Drug Resistance, Antimicrobial, Gastrointestinal tract, Extended Spectrum Beta-Lactamases, Microbiological methods

Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

Background: Nephrotic syndrome is a clinical condition caused by alteration of glomerular membrane permeability resulting in a net loss of protein, and vitamin D binding proteins in urine leading to hypoalbuminaemia and hypocalcaemia. A positive correlation between serum albumin and ionized calcium in childhood nephrotic syndrome has been described but the correlation between total serum calcium or corrected serum calcium and serum albumin has not been extensively described.Methods: This study was carried out at Dalhatu Araf Specialist Hospital, Lafia Nigeria. Fifteen children with idiopathic nephrotic syndrome were recruited consecutively as the cases, 15 age and gender matched healthy children were recruited as the controls. Total serum calcium and albumin was assayed in all these children. Corrected serum calcium was calculated for the cases. Tests of correlation was carried out to see if there was any relationship between corrected or total serum calcium and serum albumin.Results: The mean total serum calcium and serum corrected calcium levels in the cases was 2.04±0.34 mmol/l and 2.5 mmol/l respectively. The mean total serum calcium was 2.12±0.32 mmol/l for the controls. The mean serum albumin level was 14.7±4.1 g/l and 34.6±2.7 mmol/l for the cases and controls respectively. A negative and weak correlation was found between serum albumin and corrected serum calcium and a similar negative correlation between serum albumin and total serum calcium.Conclusions: The common reports of a positive correlation between serum ionized calcium and serum albumin cannot be applied to total or corrected serum calcium and serum albumin.

Facility-Based Newborn Deaths at a Referral Tertiary Hospital in North-Central Nigeria during the Sustainable Development Goal Era: A Retrospective Cohort Analysis.

Nigeria has the largest number of global under-five deaths and almost half of these occur in the newborn period in an almost 50:50 ratio across hospital facilities and communities. We examine and describe risk factors for newborn mortality at a busy neonatal unit of a referral tertiary hospital in North-central Nigeria. We conducted a retrospective cohort analysis of all newborn admissions to the Dalhatu Araf Specialist Hospital between September 2018 and March 2020. We determined the newborn mortality rate (NMR) and case fatality rates (CFRs) for individual diagnostic categories and determined risk predictors for mortality using cox-proportional hazard models. Of 1171 admitted newborn infants, 175 (14.9%) died with about half of these occurring within 24 h of admission. Extremely low birth weight infants and those with congenital anomalies had the highest CFRs. Identified risk factors for mortality were age at admission [adjusted hazard ratio (AHR): 0.996, 95% CI: 0.993-0.999], admitting weight (AHR: 0.9995, 95% CI: 0.9993-0.9997) and home delivery (AHR: 1.65, 95% CI: 1.11-to 2.46). Facility-based newborn mortality is high in North-central Nigeria. Majority of these deaths occur within the first 24 h of admission, signifying challenges in acute critical newborn care. To improve the current situation and urgently accelerate progress to meet the sustainable development goal NMR targets, there is an urgent need to develop human and material resources for acute critical newborn care while encouraging facility-based delivery and decentralizing existing newborn care. Lay summaryNigeria now has the greatest number of deaths in children below the age of five globally. Almost half of these occurred in the newborn period and these deaths occur within hospital facilities and also in communities in an almost 50:50 ratio. As such, the country might not attain global newborn mortality rates that were set as targets for the sustainable development goals (SDGs). In this article, we examine and describe the risk factors for newborn deaths occurring at a typical newborn unit in North-central Nigeria. During the period under review, we found that about 175 (14.9%) died and about half of these deaths occurred within 24 h of admission. Extremely small babies and those who were born with physical defects had the highest death rates. Older babies and those who weighed more at admission had decreased risks of dying while being delivered at home increased the risk of death. Hospital newborn deaths remain high in North-central Nigeria and the pattern of early admission deaths signifies challenges in stabilizing critically ill newborn infants. There is an urgent need to develop human and material resources for acute critical newborn care while encouraging institutional delivery and decentralizing of existing newborn care.

Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, Management, and Outcome.

Objective:To determine the presentation, management, and outcome of cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria.Materials and Methods:This is a retrospective study conducted at Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Information of patients who presented with cryptorchidism to the hospital from January 2015 to January 2020 was retrieved from the folders and analysed.Results:A total of 37 patients were studied during the study period. Only three (8.1%) presented and had correction before/at the age of two. A majority of patients (91.9%) presented after the age of two; 78% of the testes were palpable. The condition was unilateral in 30 patients (81.1%) and bilateral in seven patients (18.9%). Laparoscopy was used in one (2.7%) patient. A majority (51.4%) of the testes were in the inguinal canal, 29.7% at the external ring, 13.5% at the internal ring, and 5.4% within the abdomen. Orchidopexy was performed for 41 undescended testes and orchidectomy for three atrophic testes. There was a good outcome in 93.2% of the surgical corrections. Scrotal haematoma developed following two orchidopexies and one (2.2%) testis retracted.Conclusion:Cryptorchidism is a common anomaly in urology. The correction of cryptorchidism at the appropriate age is indicated to optimise testicular function, potentially reduce and/or facilitate the diagnosis of testicular malignancy, provide cosmetic benefits, and prevent complications such as a clinical hernia or torsion. Education of parents, traditional birth attendants, midwives, and doctors in our environment is required to ensure earlier presentation and treatment.

The role of short message services (SMS) on childhood immunization in a tertiary health facility in Nasarawa State

Background: Immunization has remained the most cost effective strategy of reducing global childhood deaths and disabilities. The diseases and illnesses targeted by the process of vaccination to achieving immunization are termed Vaccine Preventable Diseases (VPD). Vaccine preventable diseases constitute a major burden to under-five morbidity and mortality in developing countries like Nigeria.This key strategy is being hindered by factors such as forgetfulness and accessibility challenges among others. This study seeks to evaluate the place of using remindersin the form ofShort Message Services (SMS) and or phone calls in improving health seeking behavior through immunization.
 Materials and Methods: A questionnaire based cross sectionalstudies was carried out between 1st of July to the 31st of December 2019 on the Children Medical Wards of the DalhatuAraf Specialist Hospital. The role of SMS and preference of care-givers between SMS and phone calls on immunization activities was determined. Data analyses were done using the Statistical Package for Social Sciences (SPSS) version 20.
 Results: The mean age of mothers in this study is 27.58±5.82 years, as most mothers (58.5%) were aged between 21-30 years. Almost all of the responders in this study were married except two (one single mother and a widow respectively). More than 90% had a phone. In spite of this, one fifth of the mothers agreed to have missed immunization at some point. Most (82.2%) of the responders believed using SMS as a reminder will reduce the rate of missed immunization. Loss of immunization cards and forgetfulness were the leading reasons for missed immunization in this study.
 Conclusions: Most mothers in the present study believed SMS will reduce the rate of missed immunization and preferred it to phone calls.

Antimicrobial Resistance Profile and Detection of Extended Spectrum and Amp C β-Lactamase Resistance Genes in Escherichia coli Isolated from Diarrheic Children in Lafia, Nasarawa State, Nigeria

Aims: This study evaluated the presence of extended spectrum β-lactamase (ESBL) and AmpC β-lactamase resistance genes in E. coli from stool of diarrheic children in some hospitals in Lafia metropolis, Nigeria.
 Methodology: A total of 70 stool samples of children were obtained from Dalhatu Araf Specialist Hospital, Lafia, M & D Hospital, Olivet Medical Centre and Sandaji Medical Centre, Lafia. Escherichia coli were isolated and identified using standard microbiological methods. Antimicrobial susceptibility of the isolates was tested using Clinical and Laboratory Standards Institute (CLSI) method. The phenotypic detection of ESBL and AmpC β-lactamase production in some antibiotic resistant isolates were carried out using disc method. The molecular detections of ESBL and AmpC resistance genes were carried out using Polymerase Chain reaction (PCR) method.
 Results: Of the 70 samples, the occurrence of E. coli was 100%. The isolates were highly resistant to ampicillin (97.14%), ciprofloxacin (90.00%), sulfamethoxazole/trimethoprim (84.29%), streptomycin (78.57%), amoxicillin/clavulanic acid (70.00%); moderate to gentamicin (38.57%), ceftazidime (37.14%) and cefotaxime (30.00%); and less resistant to cefoxitin (15.71%) and imipenem (8.57%). Twenty-one (30.00%) isolates were jointly resistant to both cefotaxime and ceftazidine. Of this number, 66.67% (14/21) were phenotypically confirmed ESBL producers; and the occurrences of ESBL resistance genes were: 7.14% (SHV), 42.86% (CTX-M) and 50.00% (TEM). Out of 11isolates resistant to cefoxitin, 4(36.36%) were phenotypically confirmed as AmpC β-lactamase producers; and the occurrence of AmpC genes were: 50.00% (CIT), 25.00% (FOX) and 25.00% (MOX).
 Conclusion: The isolates were least resistant to imipenem and cefoxitin and highly resistant to ampicillin, ciprofloxacin and sulfamethoxazole/trimethoprim. TEM and CTX-M ESBL genes were more frequent than SHV. CIT AmpC gene was more frequent than FOX and MOX.

Multidrug Resistance and Plasmid Profile of Staphylococcus Aureus and Escherichia Coli Isolated From Patients Attending Urology Clinic, Dalhatu Araf Specialist Hospital (DASH) Lafia, Nasarawa State, Nigeria

Multidrug Resistance and Plasmid Profile of Staphylococcus Aureus and Escherichia Coli Isolated From Patients Attending Urology Clinic, Dalhatu Araf Specialist Hospital (DASH) Lafia, Nasarawa State, Nigeria

Assessment of the Nutritional Status of Under-Five Years (6–59 Months) Children Attending Dalhatu Araf Specialist Hospital Lafia, Nasarawa State, Nigeria

Abstract Objectives Malnutrition is a major public health challenge in developing countries and as such the nutritional status of children serve as an indicator to rate the overall well-being of a society. In this study, we assessed the nutritional status of under-five children attending Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Methods After ethical clearance, 165 under five children were randomly recruited into the study. The socio-demographic and nutritional information of the children and mother were obtained using structured questionnaires. Anthropometric assessment was done on each child and blood samples analyzed using standard biochemical techniques. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results Out of the 165 children recruited for this study, 51.5% were males. 41.2% of the children showed prevalence of Global Malnutrition, 15.8% and 25.5% indicated moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) respectively. 66.1% of the children had Mid-upper arm circumference (MUAC) measures in the normal range of 12.5–14.6 cm. There is a significant relationship between nutritional knowledge of the mother, socioeconomic status, child feeding practices, and the nutritional status of their children (P < 0.05). The biochemical parameters studied reported that average PCV (33.32 ± 4.49) and total protein (34.53 ± 13.26 g/L) were lower than the normal range, glucose (4.52 ± 0.97 mmol/L) and Calcium (2.14 ± 0.25 mmol/L) were within the normal range and Albumin (64.16 ± 16.87 g/L) was above the normal range. Conclusions This study has successfully revealed the nutritional status of under five years children in Nasarawa State, Nigeria. Our findings have critical implications for intervention initiatives among children in Nigeria. Funding Sources Self funded.

Characterization and Plasmid Profile of Resistant Klebsiella pneumoniae Isolates in Patients with Urinary Tract Infection in Nasarawa State, Nigeria

Klebsiella pneumoniae has been identified as an urgent threat to human health based on its increasing antimicrobial resistance to the beta-lactamases and Carbapenemases. The pathogen has become a threat to both patients and healthcare providers as its incidence is on the increase, becoming a major global healthcare issue. The study was aimed at characterizing and determining the plasmid profile of resistant Klebsiella pneumoniae isolates from urinary tract of patients at Dalhatu Araf Specialist Hospital Lafia, Nasarawa State, Nigeria. Early morning mid-stream urine samples were collected from patients with urinary tract infections between April and May, 2019 and Klebsiella pneumoniae characterized on the basis of its antibiotic resistance pattern, and the plasmid DNA profile determined. Thirty-eight strains of resistant Klebsiella pneumoniae were obtained of which 33 showed resistance to more than three antibiotics. About 51.1% of the isolates were resistant to Tetracycline, while the isolates were least resistant to Azithromycin and Cefotaxime (30.3%) respectively. Klebsiella pneumoniae isolates showed 32 different resistance patterns, 24 of the strains had the capacity to produce Extended Spectrum Beta-lactamases enzymes: CTX-M 24(72.7%), SHV 19(57.6%) and TEM 16(48.5%) respectively. All the resistant Klebsiella pneumoniae isolated had the same plasmid size of 48.5 kilobases and only 1 plasmid each though they all obtained a multiple antibiotic resistance (MAR) index > 0.2. The study concluded that Klebsiella pneumoniae harbours genes which confer antibiotic resistance on the isolates. The study exposes further the challenge of antibiotic resistance and need for concerted effort at stopping the challenge of drug resistance.
 Int. J. Appl. Sci. Biotechnol. Vol 8(1): 21-28

Incidence and <i>in vitro</i> susceptibility profile of <i>Plasmodium falciparum</i> isolates to antimalarial agents in Lafia, Nigeria

Malaria burden has been reported to be wide spread worldwide. The level of Plasmodium species resistance to recommended antimalarial drugs has also been reported to be on the increase. Thus It is necessary to monitor antimalarial drugs’ efficacy and the intensity of malaria in Nigeria. This study was designed to determine the incidence of malaria and the susceptibility of Plasmodium falciparum isolates from patients of Dalhatu Araf Specialist Hospital Lafia to reported prescribed Antimalarials in Lafia. A retrospective study was carried out to know the pattern of antimalarial drug prescriptions, age and gender of malaria patients for 2014, 2015 and 2016. The antimalarial susceptibility of Plasmodium falciparum was also carried out by the method used by Peletiri et al., 2012. The observed Malaria prevalence was 5.9%, 4.4% and 4.8% for 2014, 2015 and 2016 respectively. The incidences of malaria among different age groups were 19.07%, 15.86%, and 44.30% for 0-5 years, 6-18 years and 19 years above respectively. Malaria was observed higher in females 58.2%, than male 41.1%. Antimalarial drug prescription was basically Artemisinin combination therapy 88.67%. Out of the 91 Plasmodium falciparum isolates evaluated, 32 (35.16%) were resistant to piperaquine, 26 (28.57%) were resistant to artesunate, 25 (27.00%) were resistant to chloroquine, 16 (17.58%) were resistant to Lumefantrine and 10 (10.99%) were resistant to artemether. This study gives current information on the incidence of reported malaria and antimalarial susceptibility pattern of Plasmodium falciparum Isolates in Lafia Nigeria. Keywords: Plasmodium falciparum, Artesunate, Artemether, Chloroquine, Lumefantrine, Piperaquine.

Predictors of pediatric HIV disclosure among caregivers of HIV positive children attending special treatment clinic in dalhatu araf specialist hospital, Lafia, Nigeria.

HIV-infected children now live longer due to the availability of HIV counseling, testing, and treatment with highly active antiretroviral treatment (HAART). Efforts to help these children to know about the HIV infection and their status are important steps toward long-term disease management. This study was conducted to determine the factors associated with pediatric HIV disclosure among caregivers of children attending Special Treatment Clinic at Dalhatu Araf Specialist Hospital, Lafia. This was a descriptive cross-sectional study conducted among 160 caregivers of children attending the Special Treatment Clinic (STC) at DASH, Lafia, selected by systematic random sampling technique. Interviewer administered structured questionnaire was used to collect data, while bivariate and multivariate analyses were done with the Epi Info version 7. Pediatric HIV disclosure rate in this study was 33.8%. The mean age at pediatric HIV disclosure was 9.85 ± 1.86 years. The independent predictors for pediatric HIV disclosure following logistic regression were child's age, 10-14 years (AOR = 4.46; 95%CI 1.47-13.61), child knowledge of caregivers' HIV status (AOR = 51.18; 95%CI 13.40-195.66), and caregivers' age ≥40 years (AOR = 3.58; 95%CI 1.25-11.74). The pediatric HIV disclosure was low in this study due to the caregivers' and their wards' factors. Health care workers need to intensify health education on the benefit of pediatric HIV disclosure at the STC clinic.

Seroprevalence of hepatitis B virus infection among pregnant women attending antenatal clinic in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State

Context: Hepatitis B virus (HBV) infection is a cause of chronic liver disease, causing cirrhosis and hepatocellular carcinoma, and pregnant women are not spared. Perinatal transmission is a significant way that the disease is spread from mother to children who will eventually become adults and chronic carriers. This study sought to determine the burden of the disease among pregnant women.Aims: To estimate the prevalence and investigate possible factors associated with HBV infection among pregnant women attending antenatal clinics in DASH, Lafia.Settings and Design: A hospital-based descriptive cross-sectional survey conducted at the Obstetrics and Gynecology Department of DASH, Lafia, NasarawaMethods and Material: Around 200 pregnant women who attended the ANC clinic were consecutively enrolled, their venous blood samples collected, and hepatitis B profile was carried out using commercially available rapid chromatographic kitsStatistical Analysis Used: Data were collected by trained data collectors using a proforma, then entered into a predesigned program in the Epi-info version 3.5.4 (CDC, Atlanta, Georgia, USA) and analyzed.Results: The seroprevalence of HBV infection was high (8%) and there were no statistically significant associations between the infection and the investigated sociodemographic and other risk factors.Conclusions: The study showed that HBV is hyperendemic in this region, and antenatal screening for this virus is desirable to avert its sequelae in both mothers and their newborn babies.

An insight into Ribavirin post-exposure prophylaxis for Lassa fever infection prevention amongst health-care workers in a specialist hospital in North-Central Nigeria

Background: Oral ribavirin is used as standard post-exposure prophylaxis (PEP) in preventing the nosocomial spread of Lassa fever (LF) in outbreaks. This study sought to have an insight into the incidence and case fatality rate of Lassa fever infections, assess the biosocial data and outcome of the healthcare workers who received ribavirin PEP and determine the adverse effects associated with ribavirin PEP therapy at the Dalhatu Araf Specialist Hospital Lafia Nasarawa State Nigeria. Methods: This was a prospective study done between January 2017 to December 2018. Data on biosocial, details of exposure to the Lassa virus, the dosage of ribavirin therapy, adverse effects and outcomes were obtained. Results: The incidence of LF infection was 16% of all suspected cases, with a case fatality rate of 57.1%. General body weakness 30 (44.8%) and loss of appetite 25(37.2%) were the common adverse drug effects reported. The majority of the healthcare workers, 66 (98.5%) remained asymptomatic for secondary LF infection after completion of their oral ribavirin PEP, only, 1 (1.5%) became symptomatic for secondary LF infection, and expired on the sixth-day post-needlestick exposure. Conclusion: Lassa fever infection is common in Nasarawa State, and it is associated with a high case fatality rate. Healthcare workers on duty are at risk of being exposed when adherence to infection prevention and control is inadequate. Oral ribavirin PEP therapy was found to have a low adverse effect profile and efficacious in the prevention of symptomatic secondary LF infection.

Phenotypic Detection of Extended Spectrum Beta-lactamase Resistance of Escherichia coli from Patients Attending Selected Healthcare Facilities in Nasarawa State, Nigeria

Aims: This study investigated the phenotypic detection of extended spectrum beta-lactamase resistance of diarrheagenic E. coli isolated from diarrheic patients attending some major health facilities in Nasarawa State, Nigeria.
 Place and Duration of Study: Department of Microbiology, Nasarawa State University, P.M.B 1022, Keffi, Nasarawa State, Nigeria; between December, 2017 to March, 2019.
 Methodology: A total of 207 confirmed E. coli isolates from loose stool samples of patients with suspected cases of diarrhea (69 from Federal Medical Centre Keffi [MCK] 69 from General Hospital Akwanga [GHA] and 69 from Dalhatu Araf Specialist Hospital Lafia [DASHL]) were included in this study.
 Results: E. coli was isolated and identified using standard microbiological methods. The antibiotic susceptibility testing for the isolates was carried out and interpreted in accordance with Clinical and Laboratory Standards Institute protocol. Phenotypic detection of ESBL production in isolates resistant to ciprofloxacin, cefotaxime and ceftazidime) was carried out using double disc synergy test. The occurrence of E. coli was 100% in all the hospitals. Age groups 0-5 and 6-10 years have the highest occurrence than age group 35 – >45 years. Isolates from DASHL were more resistant to amoxicillin/clavulanic acid (86.9%), Streptomycin (75.0%) and sulphamethoxazole/trimethoprim (68.1%), isolates from FMCK were more resistant to amoxicillin/clavulanic acid (84.1%), sulphamethoxazole/trimethoprim (69.6%), isolates from GHA were more resistant to amoxicillin/clavulanic acid (85.5%) and sulphamethoxazole/trimethoprim (73.0%). Multiple antibiotic resistance (MAR) was observed with the order of occurrence: FMCK (98.6%) > DASHL (92.8%) > GHA (89.9%). The most common MAR index of 0.2 in DASHL was 0.4 (20.3%); FMCK was 0.4 (15.9%) and GHA was 0.3 (17.4%). The order of occurrence of classes of antibiotic resistance in E. coli isolates in DASHL was MDR (84.0%) ˃ XDR(7.2%) > PDR and NMDR (4.3%); in FMCK was MDR (91.3%) ˃ XDR(4.3%) ˃ NMDR (2.9%) and PDR(1.4%); and in GHA was MDR (88.8%) ˃ NMDR(5.8%) > XDR and PDR(2.9%). Detection rate of ESBL was 53.6% (30/207), distributed in relation to the location as DASHL (60.0%), FMCK (50.0%) and GHA (52.6%).
 Conclusion: Most of the isolates from the study locations were antibiotic resistance. Further studies on molecular detection of ESBL, diversity and characterization of the E. coli into pathotypes are ongoing.

Molecular Diversity and Extended Spectrum Beta-lactamase Resistance of Diarrheagenic Escherichia coli from Patients Attending Selected Health Care Facilities in Nasarawa State, Nigeria

Aims: This study investigated the molecular diversity and extended spectrum beta-lactamase resistance of diarrheagenic E. coli isolated from patients attending selected healthcare facilities in Nasarawa State, Nigeria.
 Place and Duration of Study: Department of Microbiology, Nasarawa State University, P.M.B 1022, Keffi, Nasarawa State, Nigeria; between December 2017 and June, 2019.
 Methodology: A total of 207 confirmed E. coli isolates (using standard microbiological methods) from loose stool samples of patients with suspected cases of diarrhea (69 from Federal Medical Centre Keffi [MCK] 69 from General Hospital Akwanga [GHA] and 69 from Dalhatu Araf Specialist Hospital Lafia [DASHL]) were included in this study.
 Results: Phenotypic detection of ESBL production by β-lactam resistant isolates was done using double disc synergy test. Molecular detection of ESBL genes in phenotypically confirmed ESBL producers was done using Polymerase Chain Reaction. Out of 56 isolates jointly resistant to cefotaxime and/or ceftazidime and ciprofloxacin from DASHL, FMCK and GHA, 53.6% (30/56) were ESBL producers, distributed in relation to the hospitals as follows: blaCTX-M in DASHL was 6(66.7%), FMCK was 11(100.0%), and GHA was 10(100.0%); blaSHV in DASHL was 8(88.9%), FMCK was 7(63.6%), and GHA was 10(100.0%), and blaTEM in DASHL was 9(100.0%), FMCK was 10(90.9%), and GHA was 10(100.0%). Also, the occurrence of blaSHV was 100.0% in GHA but 88.9% in DASHL. The detection DEC was high in DASHL (88.9%) but low inGHA (58.8%). The occurrence of ETEC was high in GHA (60.0%) while EAEC was also high in FMCK (81.8%) and GHA (70.0%). The isolates were distributed into strain A – J based on RFLP pattern and the occurrence of strain A was high in GHA (70.0%) but low in DASHL (33.3%).
 Conclusion: Most of the isolates were both diarrheagenic and ESBL resistant, and the predominant ESBL and pathotypes genes were blaCTX-M, blaTEM and EAEC. Further studies on molecular detection of sub-types of ESBL and sequencing of diarrheagenic pathotypes genes should be carried out.