Tertiary Health Facility Research Articles

C-reactive protein and neutrophil-to-lymphocyte ratio as key inflammatory indicators in the diagnosis of cervical necrotizing fasciitis

Background Cervical necrotizing fasciitis (CNF) is a life-threatening bacterial infection with a diagnostic challenge. Currently, there is insufficient evidence on the diagnostic accuracy of inflammatory indicators in CNF. Objective This study aims to identify key inflammatory indicators and assess their diagnostic accuracy for CNF. Methods A diagnostic case-control study was conducted at a tertiary healthcare facility from January 2020 to December 2023. Laboratory data from patients with CNF and non-CNF at admission were evaluated. Key inflammatory indicators were identified through consistent outcomes from multivariable logistic regression and receiver operating characteristic curves analyses. The diagnostic accuracy of these indicators, with the results of combined tests, were calculated. Results CNF was confirmed in 21 of the 67 patients investigated. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) were identified as key inflammatory indicators, with sensitivities of 0.905 and 0.810, and specificities of 0.870 and 0.913, respectively, at CRP threshold of 165.0 mg/L and NLR of 15.8. Combining CRP and NLR in parallel and serial tests increased sensitivity to 0.952 and specificity to 1.0, respectively. Conclusions and significance CRP and NLR have been verified as key inflammatory indicators with satisfactory diagnostic abilities for CNF diagnosis, providing a strong foundation for future studies.

Diabetes and Depression: Cross-Sectional Study Among Patients in a Tertiary Healthcare Facility in Accra, Ghana

Diabetes and Depression: Cross-Sectional Study Among Patients in a Tertiary Healthcare Facility in Accra, Ghana

Intracorporeal anastomosis in minimally invasive right hemicolectomy: a nationwide survey of the Korean Society of Coloproctology.

We investigated the current practices and perceptions of colorectal surgeons in South Korea regarding intracorporeal ileocolic anastomosis (IIA) in minimally invasive right hemicolectomy (RHC). Members of the Korean Society of Coloproctology (KSCP) participated in an online survey encompassing demographic information, surgical experiences, methods for IIA, and advantages, barriers, and perceptions of IIA. We performed a statistical analysis of survey results. Among the 1,074 KSCP members contacted, 178 responded to the survey. Most respondents were males aged 40-49 years with >10 years of experience who were affiliated with a tertiary healthcare facility. One hundred fifty-six respondents had performed <100 colorectal cancer surgeries annually. Fifty-nine respondents reported experiences of the IIA technique in minimally invasive RHC. Most respondents favored the isoperistaltic side-to-side (S-S) anastomosis and stapled S-S anastomosis, hand-sewn closure for the common channel, and the periumbilical area for primary specimen extraction. Respondents with IIA experience emphasized the reduction in postoperative complications as the primary reason for performing IIA, whereas respondents without IIA experience cited the lack of benefits as the main deterrent. Respondents commonly cited concerns regarding anastomotic leakage and intraabdominal contamination as the primary reasons for not performing IIA. Respondents with IIA experience demonstrated a more positive response towards attempting or transitioning to IIA than those without. Respondents with IIA experience prioritized self-sufficiency, whereas respondents without IIA experience prioritized proctorship and discussions of the initial cases. Measures to standardize the IIA technique and appropriate training programs must be implemented to enhance its use in minimally invasive RHC.

Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities.

Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP). Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020. Fifty-four referral level facilities in Nigeria. Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery. Descriptive statistics and multilevel mixed-effects logistic regression models. Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes. Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82-2.12; p < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06-1.32; p = 0.002), primary level of education (OR 1.20, 95% CI 1.03-1.4; p < 0.002), nulliparity (OR 1.21, 95% CI 1.12-1.31; p < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21-1.52; p < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15-1.38; p < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13-1.31; p < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders. Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are poor with about a quarter developing complications and about 1 in 10 having stillbirths.

Association of vitamin D status and vitamin D receptor polymorphism in diabetic foot ulcer patients: A prospective observational study in a South-Indian tertiary healthcare facility.

Objective of the study was to find the association of vitamin D receptor (VDR) polymorphisms (Fokl, Taql and Apal) with vitamin D levels in diabetic foot ulcer (DFU) patients in South India. In this case-control study, plasma vitamin D levels and VDR genotype frequencies of 70 cases (DFU patients) were compared with 70 diabetic (diabetes mellitus [DM] [non-DFU]) patients and 70 apparently healthy controls (HC) from South India. Plasma vitamin D levels were measured using the ELISA technique, and genotyping of VDR polymorphisms was carried out using real-time polymerase chain reaction. Logistic regression was used to find the association between DFU versus HC and DFU versus DM traits. Association analysis was performed based on additive, dominant and recessive models with age and gender as covariates. A 45.7% of DFU patients have sufficient vitamin D levels than 48.6% and 40% of DM patients and HC, respectively. Linkage disequilibrium analysis for DFU versus HC and DFU versus DM traits shows that single nucleotide polymorphisms (SNPs) Taq1 (rs731236) and Apal (rs7975232) are in strong linkage disequilibrium in DFU patients. The alleles and genotype frequencies were similar in all three groups. Although the additive model does not show statistical significance, age and sex correlate with the three SNPs (Fokl, Taql and Apal). No association was found between VDR gene polymorphisms and vitamin D levels in DFU patients in Southern India. On the other hand, age and sex correlate with the three SNPs.

Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India.

In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process. This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests. The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions. Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers. Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al. Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740.

Knowledge, Attitude, and Practice (KAP) Study of Egyptian physicians towards HIV infection: a multicentre study.

In Egypt, there is a paucity of new data regarding awareness of HIV/AIDS among physicians. This study aimed to assess the level of awareness, attitude, practice, and knowledge of a sample of Egyptian physicians regarding HIV regarding natural history, epidemiology, and virology, method of transmission, clinical manifestations, diagnosis, prevention, and management. Sixty-eight Egyptian physicians were enrolled in an observational analytic multicenter cross-sectional KAP study in Egyptian tertiary health care facilities covering different localities, including New Valley University, Assiut University, South Valley University, Helwan University, Alexandria University, Aswan University, and Al-Azhar University. The attitude of physicians towards the privacy of persons living with HIV, was the one with the highest percentage 85.3%. On the other hand, respondents think that only 25% of physicians do not stigmatize HIV patients. Moreover, only 25% of the study group do not stigmatize persons living with HIV. The highest proportion of favorable practice was 39.7% and the lowest was 17.6%. With regard to their knowledge about HIV, the lowest proportion of correct answers to a question was 4.4%, and the highest proportion was 92.6%. Most of the enrolled physicians were found to have a moderate knowledge score, 49/68 (72%). There was a significant difference between different specialties regarding knowledge scores. There are some knowledge gaps among a sample of Egyptian physicians with regard to HIV/AIDS. In addition, Egyptian physicians may have a moderate degree of undesirable attitude and practice toward HIV/AIDS.

Prevalence of rectal carbapenem resistant Enterobacterales carriage among patients attending healthcare facilities in Ibadan, Nigeria: a descriptive study

BackgroundCarbapenem Resistant Enterobacterales (CRE) infections are increasingly associated with or directly responsible for morbidity and mortality from bacterial infections in sub-Saharan Africa where there are limited antibiotic options. CRE rectal colonization of patients in healthcare facilities provides a reservoir of these organisms and could potentially cause invasive infections in these settings. The prevalence of rectal carriage among patients attending healthcare facilities in Nigeria has not been previously described. We set out to assess the prevalence of rectal CRE carriage and their antibiotic susceptibility patterns among patients attending healthcare facilities in Nigeria.MethodsA descriptive cross-sectional study was carried out from December 2021 to September 2022 in Ibadan, in which patients attending primary, secondary and tertiary healthcare facilities were screened for rectal carriage of CRE by microscopy, culture and sensitivity of rectal swab specimens.ResultsA total of 291 patients were screened; 45 (15.5%), 66 (22.7%) and 180 (61.8%) at primary, secondary and tertiary healthcare facilities, respectively. All but one of them had received a third-generation cephalosporin or carbapenem in the preceding 30 days. The mean age was 28.8 years and 55.7% were male. Overall, 51 (17.5%) participants had CRE colonization, with 5(11.1%), 9(13.6%) and 37(20.6%) at primary, secondary and tertiary healthcare facilities, respectively (p = 0.243). Regarding antimicrobial susceptibility, 43(84.3%) CRE isolates were resistant to at least 3 different classes of antibiotics while two Escherichia coli isolates were resistant to all 5 classes of antibiotics tested. The lowest rates of CRE resistance were to tigecycline (6, 11.5%) and colistin (8, 15.7%).ConclusionsIn this first study on CRE colonization in Nigeria, we found that a substantial proportion of patients in three levels of healthcare facilities had rectal carriage of CRE, including pan-resistant isolates. Active surveillance and appropriate infection prevention and control practices (IPC) need to be urgently strengthened to mitigate the risk of active CRE infection.Trial registrationNot applicable.

Resistant C. albicans implicated in recurrent vulvovaginal candidiasis (RVVC) among women in a tertiary healthcare facility in Kumasi, Ghana

BackgroundVulvovaginal candidiasis is a common fungal infection that affects the female lower genital tract. This study determined the major risk factors associated with vulvovaginal infection (VVI) in the Ashanti region of Ghana and also determined the antifungal resistance patterns of Candida albicans isolates to some antifungals.MethodsThree hundred and fifty (350) high vaginal swab (HVS) samples were collected from women who presented with signs and symptoms of VVI. A structured questionnaire was administered to one hundred and seventy-two (172) of the women. HVS samples were cultured on Sabouraud dextrose agar with 2% chloramphenicol. The polymerase chain reaction was employed to confirm C. albicans. Antifungal susceptibility testing was performed and the susceptibility of C. albicans isolates to fluconazole, clotrimazole, amphotericin B, nystatin, miconazole and 5-flurocytosine were assessed.ResultsVaginal infection was most prevalent amongst females in their reproductive age (21 to 30 years; 63.0%). The study found a significant association between vaginal infections and some risk factors such as sexual practices (p < 0.001), antibiotic misuse (p < 0.05), poor personal hygiene (p < 0.005) and birth control methods (p < 0.049). Out of the 350 HVS samples collected, 112 yielded yeast cells with 65 (58%) identified as C. albicans. The C. albicans isolates were resistant to 5’ flucytosine (100%), fluconazole (70%), voriconazole (69.2%), miconazole (58.5%) and nystatin (49.2%). C. albicans isolates were more susceptible to amphotericin B (53.8%) and clotrimazole (45.1%), although an appreciable number of isolates showed resistance (46.1% and 52.3%, respectively).ConclusionThere should be nationwide education on all associated risk factors of VVI. Also, use of the various antifungal agents in vaginal candidiasis should proceed after antifungal susceptibility testing to ensure efficacious use of these agents.

Pattern of Bacterial Flora and Effect of Disinfection on Fingerprinting Biometric Devices at a Tertiary Care Health Facility: An Interventional Study.

Introduction Recently, many public and private sector institutions and hospitals have installed biometric fingerprint devices for attendance purposes. This step is taking us toward modernization but biometric devices have their cons and pros; if not sterilized at regular intervals, then it may be a potent cause of transmission of various infections. Many studies have reported the presence of coagulase-negative Staphylococcus aureus (CONS), methicillin-resistant Staphylococcus aureus (MRSA), Escherichiacoli, Pseudomonas, and others. Aim To study the pattern of bacterial flora and the effect of disinfection on fingerprinting biometric devices at a tertiary care health facility. Materials andmethods A total of 138 biometric devices were used, out of which 105 were frequently (at least 50 uses per day) used and functional. So, 105 samples were collected on day zero (baseline), of which 43 and 62 were from clinical and non-clinical groups, respectively. The devices were disinfected with isopropyl alcohol (w/v 70%) and subsequent samples were taken on day 1 (after 24 hours) and day 7. The samples were collected and transported to the microbiology lab for culture and incubation. Statistical analysis was performed usingSPSS software version 25 (IBM Corp., Armonk, NY) employing chi-square, Cochran's Q test, and post hoc test. A p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant. Results At baseline (day 0), bacterial growth was observed in 13 (38%) devices from the clinical group and 10 (20%) from the non-clinical group. After disinfection with 70% isopropyl alcohol, bacterial growth was reduced by 83% on day 1 but increased by 82% on day 7. These changes were statistically significant (p ≤ 0.05). Conclusion The present study concluded the definite presence of bacterial flora on the biometric fingerprint devices which are prone to carry and transmit microorganisms indirectly from person to person. The surface of biometric fingerprinting devices should be disinfected daily. If not possible, it should be done on an average of every third day to control and minimize the transmission of microorganisms.

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

Building an antimicrobial stewardship model for a public-sector hospital: a pre-implementation study.

Introduction. Antimicrobial resistance (AMR) is recognized as an important global health risk, associated with increased mortality, morbidity and healthcare costs. Antimicrobial stewardship (AMS) involves a coherent set of processes that promote the rational use of antimicrobials.Gap statement. An AMS programme should be adapted and developed according to the available resources of a facility. This requires an analysis of the core AMS elements that are already in place and the resources available.Aim. This study aimed to assess the readiness of a tertiary healthcare facility and staff towards implementing an antimicrobial stewardship programme (ASP).Methodology. This study focused on two aspects during an AMS pre-implementation phase. A situational or strengths, weaknesses, opportunities, and threats analysis was conducted based on (1) a questionnaire on attitudes and perceptions of pharmacists, clinicians and nurses towards AMR and AMS and (2) a situational analysis on the readiness of the facility.Results. The questionnaire, which was available for completion between September 2021 and December 2021, was sent to a total of 3100 healthcare professionals (HCPs). Thirty-two (1.0 %) HCPs comprising 2 pharmacists, 16 clinicians and 14 nurses completed the questionnaire. Of the total participants, 31 (96.9 %) viewed AMR as a problem in South African hospitals and 29 (90.6 %) perceived AMR as a problem at their facility. The majority (n = 29, 90.6 %) of the participants were familiar with the term AMS, and 26 (81.3 %) participants agreed to willingly participate in any initiatives involving antimicrobial use at the facility. The situational analysis depicted existing strengths in terms of AMS structures such as the formation of an AMS committee and information and technology systems at the HCP's disposal. Weaknesses included the limited number of AMS activities being carried out and poor participation from HCPs within the AMS team.Conclusion. A pre-implementation phase in the building of an ASP can greatly assist in finding gaps for improvement, which can then be addressed in the implementation phase. Furthermore, the pre-implementation phase provides a baseline to measure improvements once the implementation phase has been instituted.

A comparative assessment of CD4 recovery in a cohort of patients on different HAART regimens in a Nigerian tertiary healthcare facility

A comparative assessment of CD4 recovery in a cohort of patients on different HAART regimens in a Nigerian tertiary healthcare facility

Analysis of Health Workers’ Use of Libraries and Digital Platforms in Accessing and Sharing Health Information in Tanzania

Background Health information comprises valuable data and knowledge that supports healthcare delivery. Although libraries and digital platforms are valuable for providing health information, there is a lack of documentation regarding their use by health workers in Tanzania. This study sought to analyze health workers’ use of libraries and digital platforms to access and share health information. Method A cross-sectional study using a mixed research approach was conducted from August to September 2022 at primary, secondary, and tertiary health facilities in Kilimanjaro and Mbeya regions. Semi-structured questionnaires and interviews were used to collect data from 500 health workers from all selected health facilities in all regions. IBM SPSS version 21 was used to analyze quantitative data, while thematic analysis was used to analyze qualitative data. Results Very few health workers (32.6%) used libraries while lack of physical libraries, limited time, and use of mobile phones hindered health workers from using libraries to access and share health information. Most of the health workers (56%) used digital platforms to access and share health information. Insufficient skills, lack of internet connectivity, and high cost of internet bundles limited health workers from utilizing digital platforms for accessing and sharing health information. Conclusion Many health workers do not use libraries and digital platforms to access and share health information. As a result, efforts should be made to increase the use of libraries and digital platforms among health workers to increase access to reliable and relevant health information to improve the quality of healthcare services.

Profile of Patients With Obstructive Sleep Apnea: An Initial Experience in a Tertiary Health Facility.

Introduction Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with increasing prevalence worldwide. The disease is, however, underdiagnosed in many resource-limited countries, especially in sub-Saharan Africa with unknown prevalence. Study aim The aim of this study was to determine the demographic and clinical characteristics, as well as measured sleep study parameters of suspected OSA patients. Methods The study was a retrospective review of the clinical characteristics and home sleep study reports of patients seen at the respiratory and sleep clinic from January 2020 to June 2022. Descriptive statistics such as means, medians, and percentages were employed to summarize the data using tables and graphs. Spearman correlation coefficient and Fisher's exact test were used to determine associations between the variables. Findings The study participants were predominantly male, and 64.7% were ≥50 years of age. Approximately 76% of the cases had moderate-to-severe OSA based on the apnea-hypopnea index (AHI) scores with a mean BMI of 38.4kg/m2 and 43.1kg/m2, respectively (p=0.013), and a mean STOP-BANG score of 5.2 and 6.2, respectively (p <0.001). There was a positive correlation between AHI scores and BMI of the patients (r=0.252, p=0.003), as well as with their STOP-BANG scores (r=0.436, p< 0.001). Oxygen desaturation index (ODI) parameters of participants also positively correlated with the AHI scores (r=0.872, p<0.001). Conclusion The proportion of patients with moderate-to-severe OSA was high. Obesity was significantly associated with AHI scores, which also positively correlated with the STOP-BANG and ODI scores. These results suggest that the burden of OSA, which is closely linked with obesity, could be underestimated in Ghana and requires epidemiological studies in the very near future to clearly define and anticipate its impact on the health economy of Ghana.

Evaluating the Prevalence and Clinical Significance of Fetal Posterior Cerebral Artery Variants via Magnetic Resonance Imaging: Insights From a Tertiary Healthcare Facility in Tamil Nadu.

Introduction The prevalence and clinical significance of fetal posterior cerebral artery (FPCA) variants are studied using magnetic resonance imaging (MRI) at Saveetha Medical College. This research focuses on the fetal origin of the posterior cerebral artery (PCA), a condition where the posterior communicating artery (PComA) is larger than the P1 segment of the PCA, affecting cerebral hemodynamics and associated with various cerebrovascular pathologies. Materials and methods This retrospective analysis employed MRI records from the Department of Radio Diagnosis at Saveetha Medical College, conducted between January 2013 and December2023. The study included patients undergoing MRI for various neurological indications, with specific imaging protocols including T1- and T2-weighted sequences, diffusion-weighted imaging, and magnetic resonance angiography (MRA). Results The study confirmed a prevalence rate of FPCA variants within the expected range of 20%-30%. MRI findings were systematically analyzed by experienced radiologists to assess the presence and characteristics of FPCA variants. The relationship between these variants and clinical symptoms was explored, revealing significant correlations that emphasize the variants' impact on patient outcomes, particularly in the context of cerebrovascular events. Conclusion The study underlines the importance of recognizing FPCA variants due to their significant implications in neurovascular health and cerebrovascular accident (CVA) outcomes. These variants alter cerebral hemodynamics and can complicate neurosurgical and diagnostic procedures. Therefore, personalized treatment and management strategies are crucial for optimizing patient care.

Glycated Hemoglobin as a Screening Tool in the Diagnosis of Diabetes Mellitus among Adult Patients in a Tertiary Health Facility in Port Harcourt, Niger Delta Region of Nigeria

Abstract Background: The prevalence of diabetes mellitus (DM) has been increasing worldwide, especially in Nigeria. However, it remains underdiagnosed in many people with the disease. There is a need for early detection and treatment of the populations that are at risk to prevent or reduce complications. There is a paucity of Nigerian studies documenting the performance of the glycated hemoglobin (HbA1c) test in diagnosing DM. This, therefore, informed our decision to embark on this study. Objective: The objective of this study was to assess the role of the HbA1c in the diagnosis of DM at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a descriptive cross-sectional study, in which 400 subjects were evaluated for the presence of glucose intolerance. Two hundred patients with hypertension and 200 nonhypertensives patients were screened for DM. A structured questionnaire was administered to the recruited subjects, and their blood samples were collected for HbA1c and fasting plasma glucose. The detection of DM using the two different screening tests was determined. The sensitivity and specificity were calculated. Results: The mean age of the hypertensive subjects was 48 ± 10 years, whereas that of the nonhypertensive subjects was 46 ± 10 years. The frequency of diabetes in the study population by the HbA1c was 7.8%, whereas it was 25.3% by the oral glucose tolerance test (OGTT) (P &lt; 0.001). The frequency of prediabetes was 25.3% by the HbA1c as compared to 20.5% by the OGTT (P &lt; 0.001). The sensitivity of the HbA1c test for the diagnosis of diabetes was 62.5%, whereas the specificity was 99.7%. Conclusions: This study shows that there was a significant difference in the diagnostic performance of the HbA1c test compared to the OGTT; HbA1c test was less accurate and more likely to miss some diagnoses.

Descriptive, Hospital-Based, 10-Year Study of Malaria Transmission in Goa, a Southwest Indian State in the Malaria Elimination Phase.

The South Asia International Center of Excellence for Malaria Research, an NIH-funded collaborative program, investigated the epidemiology of malaria in the Indian state of Goa through health facility-based data collected from the Goa Medical College and Hospital (GMC), the state's largest tertiary healthcare facility, between 2012 and 2021. Our study investigated region-specific spatial and temporal patterns of malaria transmission in Goa and the factors driving such patterns. Over the past decade, the number of malaria cases, inpatients, and deaths at the GMC decreased significantly after a peak in 2014-2015. However, the proportion of severe malaria cases increased over the study period. Also, a trend of decreasing average parasitemia and increasing average gametocyte density suggests a shift toward submicroscopic infections and an increase in transmission commitment characteristic of low-transmission regions. Although transmission occurred throughout the year, 75% of the cases occurred between June and December, overlapping with the monsoon (June-October), which featured rainfall above yearly average, minimal diurnal temperature variation, and high relative humidity. Sociodemographic factors also had a significant association with malaria cases, with cases being more frequent in the 15-50-year-old age group, men, construction workers, and people living in urban areas within the GMC catchment region. Our environmental model of malaria transmission projects almost negligible transmission at the beginning of 2025 (annual parasitic index: 0.0095, 95% CI: 0.0075-0.0114) if the current control measures continue undisrupted.

Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study.

Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575]with delivery of LBW children. Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

Awareness and Perception of Physical Activity among Nigerian Pregnant Women Attending Primary and Tertiary Health Facilities: A Comparative Study

Background: Despite the benefits of physical activity (PA) during pregnancy, expectant women are not meeting the exercise recommendations. This may be connected with their level of awareness, perception, and attitude to physical exercise. Objective: To assess and compare the awareness and perception of pregnant women about PA at primary and tertiary health care facilities (PHC and THC) in a local government in Nigeria. Methods: A comparative, cross-sectional study recruited 502 pregnant women from six selected health facilities (250 PHC vs 252 THC). Their perception and awareness of PA were assessed using an interviewer-administered questionnaire. Results: Pregnant women accessing care in THC have a higher level of awareness than PHC attendees (60.7% vs 34.4%; p = 0.001). Women accessing care at PHC had a better perception of PA (67.2%) than women assessing care at THC 55.2% (p = 0.006). Age and occupation were significantly associated with awareness of PA among participants in PHC, while only occupation was significantly associated with THC. Age, occupation, and number of children alive were significant predictors of awareness of PA; in contrast, age, education, monthly income, and number of pregnancies were the predictors of perception of PA among the PHC participants. Conclusion: Awareness of PA was good in the tertiary facility but poor in PHC, while perception of PA was good in both facilities. Women, irrespective of parity, should be inspired to exercise as women who habitually exercise are more likely to continue during pregnancy.