Prevalence of Group B Streptococcus Colonization among Pregnant Women and Feto-Maternal Outcomes in a Tertiary Health Institution, North-Western Nigeria

Background: Group B Streptococcus (GBS) infection is a major cause of bacterial infections in the peri-natal period. These include amnionitis, urinary tract infections and endometritis. At birth, 50-60% of the neonates born to colonized mothers have positive cultures taken from mucus membranes and the skin. Aim: The aim of this study is to determine prevalence of GBS colonization and compare the maternal and perinatal outcomes among GBS positive and GBS negative women within 7 days postpartum. Methodology: This was a longitudinal study among pregnant women between 35-37 weeks gestation attending antenatal clinic at Usman Danfodiyo University Teaching Hospital, Sokoto. Vaginal and rectal swabs were taken from the participants and cultured for growth of Group B Streptococcus within 24 hours. The participants were followed up to 7 days post-delivery with their newborns to determine the maternal and early neonatal outcomes. Results: One hundred and eighty five (185) women were recruited and 159 (85.9%) participants were available for follow-up to determining feto-maternal outcomes. Among the participants, 3.8% (7) had GBS vaginal colonization. There was no single case of early neonatal infection, intensive neonatal resuscitation nor neonatal mortality among both GBS positive and GBS negative women. Conclusion: It has been found that the prevalence of maternal GBS colonization during pregnancy was low and neither GBS colonization nor GBS non-colonization was associated with poor maternal or poor fetal outcomes.

Emergency Contraceptives: Knowledge, Attitude and Prescription Practice of Primary Healthcare workers in Sokoto Metropolis, Northwest Nigeria.

Background: Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. About thirty percent of all pregnancies, and 61% of all unintended pregnancies, ended in an induced abortion in Nigeria, and many women with unwanted pregnancies decide to end them by abortion. Healthcare providers' knowledge and attitude towards emergency contraception is very important for dissemination of awareness, consumer acceptance and use of contraceptives, as health care workers interact with large numbers of women and are reliable sources of information. This study aimed to assess healthcare workers' emergency contraception knowledge, attitude and prescription practice. Materials and Methods: The study was a cross-sectional study. Healthcare workers providing services in Primary Health care facilities of Sokoto metropolis were studied. Using formula for sample size estimation for crosssectional study, a total of 419 respondents were recruited into the study using systematic sampling technique. The instrument of data collection was a structured interviewer administered questionnaire and data was collected by means of Open Data Kit for android App and analysed using IBM SPSS statistical software package version 23. Univariate and bivariate analysis were conducted; level of significance was set at 5%. Results: Few (39.9%) respondents knew that Intra uterine contraceptive devices can be used for emergency contraception, only 15.4% knew how emergency contraceptives work. Most (75.4%) believed that emergency contraceptives should be available only on prescription; and 30.5% felt that emergency contraceptive pills promote irresponsible behaviour. More than half of the respondents (56.5%) had prescribed within the last one month, 48.7% of them prescribed less than 5 times within the month. Only 27(8.0%) have ever prescribed emergency contraceptive pills in advance of need. Conclusion: The study respondents had good knowledge of emergency contraceptives, albeit, with some misconceptions, they also demonstrated good attitude, however, the prescription practice was fair.

Post-operative Experience following Caesarean Section in a Nigerian Obstetric Population

Background: Caesarean section is the most significant obstetrics operative intervention globally. Good postoperative experience after caesarean section is important because there is need for the mother to recover from surgery and take care of her baby. The aim of this study was to assess the experience of women that had caesarean section in the first 24 hours postoperatively. Materials/methods: This was a cross-sectional study conducted among women that had elective and emergency caesarean section. They were followed up to 24 hours post-operative. The primary outcome measures were pain score and satisfaction. Secondary outcome measures were time of mobilization, time of commencement of oral feeds and time of initiation of breastfeeding. Data analysis was carried out using Statistical Package for Social Sciences version 22. Results: The median pain scores among those that had emergency and elective caesarean section ranged between 2 and 3 at all points of pain assessment. The satisfaction was good among 66.1% that had emergency caesarean section and 71.2% among those that had elective caesarean section. However, the difference was not statistically significant (χ2 = 0.546, p = 0.761). More than 90% of the participants that had either emergency or elective caesarean section did not ambulate within the first 24 hours after caesarean section and there was no association between the time of ambulation and the type of caesarean section (χ2 = 0.005, p = 0.941). Conclusion: The participants had adequate pain relief and majority were satisfied with the pain relief. However, the optimum satisfaction was not achieved. The participants did not ambulate early and did not initiate breast-feeding early. Recommendation: Further research is recommended to assess other factors that affect patient's satisfaction and ambulation so as to improve on patient's postoperative care.

Phenotypic Detection of Methicillin and Inducible Clindamycin Resistant Staphylococcus Aureus: An Effort to Combat Antimicrobial Resistance and Improve Patient Safety in Gombe, Nigeria

Introduction: Antimicrobial resistance (AMR) is a major threat to patient safety. Methicillin and inducible clindamycin resistant Staphylococcus aureus are important multidrug resistant organisms (MDROs). Timely reporting of MDROs is necessary for rational antibiotic prescription and in combating AMR. We present the prevalence and distribution of Methicillin and inducible clindamycin resistant (iCR) isolates of Staphylococcus aureus from Gombe Nigeria. Materials and Methods: This descriptive cross-sectional study included 260 isolates of Staphylococcus aureus from clinical specimens in Federal Teaching Hospital Gombe (FTHG). Isolates identification was done using conventional biochemical methods. Methicillin resistance was detected by cefoxitin disc diffusion method while iCR isolates by erythromycin and clindamycin disc approximation test (D-test). Data analysis was done using SPSS version 23.0. Results: Methicillin resistant Staphylococcus aureus (MRSA) was detected in 178 (68.5%) isolates while 214 (82.3%) were iCR (D-test positive). Among the MRSA, 87.1% were also iCR while 72.4% of the iCR isolates were MRSA. There was significant association between MRSA and iCR (p = 0.03), MRSA and clindamycin resistance (p = 0.05) and MRSA and erythromycin resistance (p < 0.01). Conclusion: Prevalence of MDR Staphylococcus aureus is high in Gombe Nigeria. Antimicrobial stewardship programme (ASP) and good Infection Prevention and Control (IPC) are necessary in combating AMR and improving patient safety.

Descriptive Characterisation of Suspected Measles Cases in Sokoto State 2010 -2016: A Secondary Data Analysis

Background: Measles is a disease with worldwide distribution; however, control efforts have substantially altered the global distribution. The incidence has decreased considerably in regions where routine vaccination is strong; however, this is not the case in developing countries like Nigeria. This study aims to describe the distribution of measles cases in Sokoto state in time, place and person. Methods: Descriptive analyses of measles surveillance data between 2010 and 2016 was carried out to describe the epidemiology of measles in Sokoto State in Time, Place and Person. Microsoft Excel and IBM SPSS were used to analyse the data. We reported frequencies and proportions; cross-tabulations and chi-square tests were used to find associations between variables. Results: A total of 13974 suspected cases of measles were line-listed between January 2010 and June 2016. Overall, 11008 (78.8%) were below five years, and 7421 (53.1%) were males. A majority, 12896 (92%), of the suspected measles cases were reported in the first half of each year of evaluation. Gwadabawa Local Government Area (LGA) recorded the highest measles cases, 1881 (14%). Ten thousand and twenty-seven (71.8%) of suspected measles cases did not receive the measles vaccine. The overall Case Fatality Rate (CFR) was 0.9%. However, Bodinga LGA had the highest CFR of 4%. Only 605(4%) suspected measles cases were tested for Measles IgM. One hundred and twenty-five (0.9%) deaths were recorded. Factors significantly associated with deaths are measles vaccination status (p = 0.001) and admission status (p < 0.001). Conclusion: There is the persistence of measles over the period affecting primarily children below five years with a low CFR. However, a majority of the children did not receive their measles vaccine. Based on this finding, measles will remain a public health problem unless significant efforts are put into place to increase vaccination coverage.

Influence of Camel Milk on the Antibacterial Activity of Ciprofloxacin

Background: Despite the availability of more researched and formulated orthodox medicines, traditional medicines remain the main source of therapy for the majority of people worldwide with some patrons concurrently using both forms unaware of the unwanted effects that may occur. Camel milk is often used alone or in combination with other orthodox medications to treat diseases. The study aimed to investigate the influence of camel milk on the antibacterial activity of ciprofloxacin. Materials and methods: The in vitro antibacterial activity of camel milk escalating doses (30μL, 100μL and 300μL) alone and in combination with Ciprofloxacin escalating doses (2mcg, 5mcg, 15mcg) against some clinical bacterial isolates (Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Serratia marcescens) was determined using the Agar-well diffusion method. Result: Camel milk escalating doses alone showed dose-dependent antibacterial effect against all the test bacteria. However, combinations of the camel milk escalating doses and ciprofloxacin escalating doses respectively produced an antagonistic effect against all the test organisms. Conclusion: Fresh camel milk possesses antibacterial activity against Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens and Staphylococcus aureus but is not recommended for combination with ciprofloxacin to treat infections caused by the above organisms.

A Rare Case of Generalized Tetanus Complicating Breast Cancer: A Consequence of Harmful Cultural Practices.

Tetanus infection is a public health disease and is still a cause of high morbidity and mortality in developing countries compared to the developed countries of the world. Apart from the traditional risk factors for tetanus, ignorance and harmful cultural practices greatly increase the risk and poor outcomes of tetanus in our country. We report this case of fatal generalized tetanus infection from necrotic fungating tumour following application of traditional herbal medication to highlight the link between a non-communicable disease, an infectious disease and poor health seeking behaviour in a global health context. We also reviewed similar cases reported in the literature. Patient consent was sought for before her death and patient confidentiality was assured.

Studies on the Antiulcer Activity of the Chloroform Fraction of Balanites aegyptiaca Stem Bark Extract

Background: Balanites aegyptiaca L. Delile (Zygophyllaceae) is a perennial tree found mostly in the desert environments. Decoctions of its stem barks are used traditionally in northern Nigeria to treat wounds, ulcers and stomach ailments. Other ethnomedicinal uses include: treatment of malaria, pain and fever. The aim of this study was to evaluate the antiulcer activity of the chloroform stem bark extract of Balanites aegyptiaca in Wistar rats. Materials and methods: Acute toxicity study on the chloroform fraction of the stem bark extract of Balanites aegyptiaca was carried out using the OECD 425 guidelines at a limit dose of 3000 mg/kg. Phytochemical analysis of the fraction was carried out to detect the presence of alkaloids, tannins, flavonoids, steroids, carbohydrates, saponins and glycosides using standard procedures. The antiulcer activity of the fraction was evaluated in ethanol and indomethacin-induced ulcer models in rats. Rats were allotted into five groups (n=5). Group 1 received 10% Tween 20 (1 ml/kg), group 2 received standard drug, omeprazole (20 mg/kg), and groups 3-5 were the extract groups and received 125, 250 and 500 mg/kg, p.o. respectively of the chloroform fraction of Balanites aegyptiaca. The mean ulcer indices were assessed and the percentage ulcer inhibition calculated. Results: At the limit dose of 3000 mg/kg the fraction of Balanites aegyptiaca did not produce any mortality or observable signs of toxicity in the rats. The phytochemical analysis showed the presence of flavonoids, saponins and steroids. The fraction at the doses of 250 and 500 mg/kg caused a significant (p<0.05) reduction in mean ulcer indices in the ethanol and indomethacin-induced ulcer models when compared to the control. Conclusion: Our study showed that the chloroform fraction of the stem bark extract of Balanites aegyptiaca possesses antiulcer activities. Further studies are needed to isolate the active constituents.

Prevalence of Hospital Associated Infections and Health Care Workers Compliance with Hand Hygiene Practices in a Tertiary Hospital in Sokoto, Nigeria

Background: Hospital associated infections (HAIs) remain a significant cause of morbidity and mortality. And despite the simplicity of hand hygiene practice, an important preventive measure that has been proven to reduce the risk of acquiring and transmitting HAIs, Health care workers (HCW) compliance with the recommendations is of serious concern. Aim: The aim of this study was to determine the prevalence of hospital associated infections and HCWs compliance with hand hygiene practice in a tertiary hospital. Methods and material: This was a hospital-based descriptive cross-sectional study among 110 patients on admission selected using universal sampling, and 377 HCWs selected using a multistage sampling technique. Data collected with self-administered questionnaire for HCWs, interviewer-administered proforma for the patients and data extraction sheet for laboratory analysis. Data analyzed for descriptive statistics using SPSS version 20.0. Results: Patients' mean age was 32.8, IQR: 10.5-37.9 years. Majority, 56(50.9%) were females; Hausa/Fulani, 91(82.7%) and 37(33.6%) had only Qur'anic education while only 20(18.2%) had tertiary education. Health care workers' mean age was 31.8 5.3 years. Majority 227(60.2%) are females, and 267(71.8%) of the participants have received training on hospital infection control. Overall prevalence of HAIs was 42.7%, highest in surgical unit. Commonest HAIs being blood stream infections, and the least, Health Care Associated Pneumonia. Most of the infections were due to Staphylococcus aureus, 22(46.8%) and Pseudomonas aeruginosa, 14(29.8%). Highest hand hygiene practice was reported after contact with body fluid and highest non-compliance reported was before touching patient. Hand hygiene compliance rate was 49.6% and main reasons to non-compliance were high work load, lack of running water and soap, and regular use of hand gloves. Conclusions: Prevalence of HAIs was reportedly high, and low hand hygiene compliance and rate despite majority of the HCWs having received training on Hospital infection control. To reduce the prevalence and the associated burden of HAIs, there is need to put in measures to improve compliance to quality hand hygiene practice by health workers.

PATTERN AND PREDICTORS OF SUBSTANCE USE AMONG IN-SCHOOL ADOLESCENTS: A COMPARISON OF PUBLIC AND PRIVATE SECONDARY SCHOOLS IN GOMBE LGA, GOMBE STATE, NIGERIA.

Background: Substance use is a Public Health problem with significant negative consequences on the physical, psychological and mental health of individuals with worse effects among adolescents. The objective of this study was to determine and compare the pattern and predictors of substance use among in-school adolescents in Public and Private secondary schools in Gombe LGA, Gombe State. Methods: It was a comparative cross-sectional study. Multistage sampling technique was used to select participants from both comparison groups. Data was collected using a pretested self-administered questionnaire. All data generated were collated and analysed using the IBM Statistical Package for Social Sciences (SPSS) version 23. Results: The proportion of students engaged in substance use were 17.9% and 18.9% in private and public secondary schools respectively, this was not statistically significantly different (P-value 0.830). There was a statistically significant difference in the level of health risk associated with substance use among respondent in public and private schools (P value 0.008). Furthermore, respondents in public schools who almost never participated in religious activities and those who occasionally participated in religious activities had 4.2 and 3.5 times more odds respectively of using substances compared to those who almost always participated in religious activities p value 0.007 (CI 1.497-12.008) and p value 0.008 (CI 1.398-9.183) respectively. In both schools, those who had friends that used substances were more likely to use them p value <0.001(OR 0.99; CI 0.039-0.232) for private and p value <0.001 (OR 0.108; CI 0.048-0.245) for public schools. Conclusion: This study has therefore implied that there is no difference in the proportion and pattern of substance use by adolescents in both private and public secondary schools, however, the level of health risk is more among those in private schools.