Background: Panton-Valentine Leukocidin (PVL) is one of the major virulence factors known to be associated with invasive, life-threatening Staphylococcus aureus ( S. aureus ) soft tissue infections. Several studies have shown that methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are carriers of the lukSF-PV ; however, data describing their prevalence and distribution in the Nigerian setting are sparse in the literature, and thus informed the need for the current study. Objective: We aimed to detect mecA and analysed the risk factors associated with lukSF-PV -producing S. aureus wound infections. Design: This was a single-centre hospital-based descriptive cross-sectional study conducted between March 2019 and September 2019 at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methods: Aspirates from participants with soft tissue infections were cultured, and all isolates of S. aureus were tested for the presence of lukSF-PV using endpoint polymerase chain reaction. The mecA was also detected, and antibiotic susceptibility testing was performed. Results: Eighty S. aureus isolates were identified from 360 participants. Of the eighty, 47 (58.8%) were MRSA and 10 (12.5%) were lukSF-PV -producing S. aureus strains. Of the ten, six were MSSA and four were MRSA, but the difference was not statistically significant. A significant association was observed between lukSF-PV -producing S. aureus- infected wounds and recurrent skin infections ( p = 0.024), as well as working in a day care nursery home ( p = 0.0008). The majority of S. aureus isolates were susceptible to tigecycline (76%) and vancomycin (76%), followed by susceptibility to linezolid (72.5%), quinupristin/dalfopristin (67.2%), levofloxacin (38.6%) and erythromycin (11.7%). Conclusion: The prevalence of PVL-positive S. aureus strains causing soft tissue infections in our setting is seemingly high. There is a need for active surveillance of this gene in patients presenting with S. aureus soft tissue infections in our setting, ensure antibiotic susceptibility testing, evaluate the impact of these strains on clinical outcomes and prevent the spread of lukSF-PV -positive S. aureus strains.

Panton-Valentine Leukocidin (PVL) is one of the major virulence factors known to be associated with invasive, life-threatening Staphylococcus aureus (S. aureus) soft tissue infections. Several studies have shown that methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are carriers of the lukSF-PV; however, data describing their prevalence and distribution in the Nigerian setting are sparse in the literature, and thus informed the need for the current study. We aimed to detect mecA and analysed the risk factors associated with lukSF-PV-producing S. aureus wound infections. This was a single-centre hospital-based descriptive cross-sectional study conducted between March 2019 and September 2019 at the University of Calabar Teaching Hospital, Calabar, Nigeria. Aspirates from participants with soft tissue infections were cultured, and all isolates of S. aureus were tested for the presence of lukSF-PV using endpoint polymerase chain reaction. The mecA was also detected, and antibiotic susceptibility testing was performed. Eighty S. aureus isolates were identified from 360 participants. Of the eighty, 47 (58.8%) were MRSA and 10 (12.5%) were lukSF-PV-producing S. aureus strains. Of the ten, six were MSSA and four were MRSA, but the difference was not statistically significant. A significant association was observed between lukSF-PV-producing S. aureus-infected wounds and recurrent skin infections (p = 0.024), as well as working in a day care nursery home (p = 0.0008). The majority of S. aureus isolates were susceptible to tigecycline (76%) and vancomycin (76%), followed by susceptibility to linezolid (72.5%), quinupristin/dalfopristin (67.2%), levofloxacin (38.6%) and erythromycin (11.7%). The prevalence of PVL-positive S. aureus strains causing soft tissue infections in our setting is seemingly high. There is a need for active surveillance of this gene in patients presenting with S. aureus soft tissue infections in our setting, ensure antibiotic susceptibility testing, evaluate the impact of these strains on clinical outcomes and prevent the spread of lukSF-PV-positive S. aureus strains.

Background: Globally, 296 million people were infected by hepatitis B in 2019, with 1.1 million deaths. Africa is one of the endemic regions. Good knowledge and awareness of hepatitis B remain pivotal to the biosafety of medical students. This study sought to determine the levels of knowledge and awareness of hepatitis B among students of Pamo University of Medical Sciences (PUMS), Port Harcourt, Nigeria, and the predicting factors associated with this knowledge and awareness. The is with the aim of providing recommendations for improving and sustaining biosafety levels for medical and other health-related students of the University. Methodology: The study was a descriptive cross-sectional design conducted amongst 528 randomly selected medical students of PUMS, Port Harcourt, Nigeria. Structured questionnaires were interviewer-administered to collect socio-demographic information and participants’ responses to questions on knowledge and awareness of hepatitis B. Data were analysed using SPSS version 26.0 and relationships of socio-demographic characteristics and predictive factors with knowledge and awareness of hepatitis B were tested using binary logistic regression analysis with p value for statistical significance set at <0.05. Results: A total of 528 students participated in the study, 202 (38.3%) males and 326 (61.7%) females. Most participants (296, 56.1%) were between 15-19 years of age with mean age of 19 ±2.43 years. The mean (±SD) of participants responses with good knowledge of hepatitis B was 249±121.5 while for good awareness, it was 181±88.3. The percentage average for good knowledge and good awareness was 47.2% and 34.2% respectively, with positive correlation between knowledge and awareness of hepatitis B (r=0.720, p<0.0001). Age was significantly associated with participants percentage average knowledge (OR=0.77, 95% CI 0.70-0.84, p<0.0001) and awareness of hepatitis B (OR=0.84, 95%CI 0.78-0.90, p=0.004). No other factor was significantly associated with knowledge and awareness of hepatitis B except Ijaw tribe (OR=0.4, 95%CI 0.24-0.66, p=0.034) and attendance of Federal Government College (OR=0.4, 95% CI 0.24-0.68, p=0.046). Conclusion: The percentage average good knowledge of 47.2% and awareness of 34.2% for hepatitis B in this study are low, although most participants in the study were between the ages of 15-19 years and in their first and second year of study. This gives room for improvement in knowledge and awareness of hepatitis B with progression in age and year of training. Good knowledge and awareness of hepatitis B are central to the biosafety of medical students. It is recommended that the National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) review the current medical school curriculum to increase the teaching of medical and health-related students that will impact more on knowledge and awareness of infectious diseases and infection prevention and control. French title: Connaissance et sensibilisation à l'hépatite B parmi les étudiants de l'Université des sciences médicales de Pamo (PUMS), Port Harcourt, État de Rivers, Nigéria Contexte: Dans le monde, 296 millions de personnes ont été infectées par l’hépatite B en 2019, avec 1,1 million de décès. L'Afrique fait partie des régions endémiques. Une bonne connaissance et sensibilisation à l’hépatite B reste essentielle à la biosécurité des étudiants en médecine. Cette étude visait à déterminer les niveaux de connaissance et de sensibilisation à l'hépatite B parmi les étudiants de l'Université des sciences médicales de Pamo (PUMS), à Port Harcourt, au Nigeria, ainsi que les facteurs prédictifs associés à ces connaissances et sensibilisation. L'objectif est de fournir des recommandations pour améliorer et maintenir les niveaux de biosécurité pour les étudiants en médecine et dans d'autres domaines liés à la santé de l'Université. Méthodologie: L'étude était une conception transversale descriptive menée auprès de 528 étudiants en médecine sélectionnés au hasard au PUMS. Port Harcourt, Nigéria. Des questionnaires structurés ont été administrés par l'intervieweur pour recueillir des informations sociodémographiques et les réponses des participants aux questions sur la connaissance et la sensibilisation à l'hépatite B. Les données ont été analysées à l'aide de SPSS version 26.0 et les relations entre les caractéristiques sociodémographiques et les facteurs prédictifs avec la connaissance et la sensibilisation à l'hépatite B. ont été testés à l’aide d’une analyse de régression logistique binaire avec une valeur de p pour la signification statistique fixée à <0,05. Résultats: Au total, 528 étudiants ont participé à l'étude, 202 (38,3%) hommes et 326 (61,7%) femmes. La plupart des participants (296, 56,1%) étaient âgés de 15 à 19 ans, avec un âge moyen de 19±2,43 ans. La moyenne (± ET) des réponses des participants ayant une bonne connaissance de l'hépatite B était de 249±121,5 tandis que pour une bonne connaissance, elle était de 181±88,3. Le pourcentage moyen de bonne connaissance et de bonne sensibilisation était respectivement de 47,2% et 34,2%, avec une corrélation positive entre la connaissance et la sensibilisation à l'hépatite B (r=0,720; p<0,0001). L'âge était significativement associé au pourcentage de connaissances moyennes des participants (OR=0,77; IC à 95% 0,70-0,84; p<0,0001) et à la connaissance de l'hépatite B (OR=0,84; IC à 95% 0,78-0,90; p=0,004). Aucun autre facteur n'était associé de manière significative à la connaissance et à la sensibilisation à l'hépatite B, à l'exception de la tribu Ijaw (OR=0,4; IC à 95% 0,24-0,66; p=0,034) et de la fréquentation du Collège du Gouvernement Fédéral (OR=0,4; IC à 95% 0,24-0,68; p=0,046). Conclusion: Le pourcentage moyen de bonnes connaissances de 47,2% et de sensibilisation de 34,2 % à l'hépatite B dans cette étude est faible, bien que la plupart des participants à l'étude étaient âgés de 15 à 19 ans et en première et deuxième années d'études. Cela laisse place à une amélioration des connaissances et de la sensibilisation à l’hépatite B avec une progression en âge et en année de formation. Une bonne connaissance et sensibilisation à l’hépatite B est essentielle à la biosécurité des étudiants en médecine. Il est recommandé que la Commission Nationale des Universités (NUC) et le Conseil Médical et Dentaire du Nigéria (MDCN) réexaminent le programme actuel des facultés de médecine afin d'accroître l'enseignement aux étudiants en médecine et dans les domaines de la santé, ce qui aura davantage d'impact sur la connaissance et la sensibilisation aux maladies infectieuses. et la prévention et le contrôle des infections.

Background: Severe infections caused by carbapenem-resistant Enterobacteriaceae (CRE) have mortality rate exceeding 50%. On the strength of this, this study sought to determine the prevalence of urinary tract infection (UTI) in pregnancy caused by CRE and associated risk factors in University of Calabar Teaching Hospital (UCTH), Nigeria, with the aim of making recommendations that can stem the tide of UTI caused by this bacterial strain in the hospital.Methodology: This was a descriptive cross-sectional study of 349 consecutively selected pregnant women attending antenatal clinic of UCTH, Calabar, Nigeria, between September 2020 and August 2021. Demographic/ clinical data and risk factors were collected with semi-structured interviewer-administered questionnaire. Voided mid-stream urine (MSU) sample was collected from each participant and transported to the medical microbiology laboratory of the hospital for microbiological analysis using conventional culture and biochemical identification methods. Antimicrobial susceptibility test (AST) on each isolate was performed by the disk diffusion technique against selected antibiotics. Phenotypic carbapenemase production from presumptive carbapenem resistant isolates following AST was confirmed by the modified Hodge test (MHT). Data analysis was done on SPSS version 19.0. Association of risk factors with prevalence of UTI caused by CRE was determined using Chi square or Fisher Exact test, with p<0.05 considered statistically significant.Results: The prevalence of UTI among the pregnant women was 10.0% (35/349), with prevalence of 6.6% for Escherichia coli (23/349) and 3.5% (12/349) for Klebsiella pneumoniae. Antibiotic susceptibility test result showed that piperacillin-tazobactam was the most active antibiotic in vitro, with 82.9% isolates sensitive to it while sensitivity to imipenem (60.0%) and meropenem (40.0%) was low. A total 17 (48.6%) of the 35 isolates were resistant to carbapenems in the AST and 12 (34.3%) were carbapenemase-producing strains on MHT while 5 (14.3%) were non-carbapenemase-mediated resistance (NCMR). None of the demographic characteristics or risk factors analysed was significantly associated with UTI caused by CRE in the pregnant women (p>0.05).Conclusion: To stem the rising trend of UTIs in pregnancy caused by carbapenem resistant uropathogens,pregnant women receiving antenatal care in UCTH, Calabar should be routinely screened for UTI and offeredappropriate treatment if indicated based on microbiological test results. Contexte: Les infections graves causées par des entérobactéries résistantes aux carbapénèmes (CRE) ont un taux de mortalité supérieur à 50 %. Forte de ces éléments, cette étude a cherché à déterminer la prévalence des infections des voies urinaires (IVU) pendant la grossesse causée par la CRE et les facteurs de risque associés à l'hôpital universitaire de Calabar (UCTH), au Nigeria, dans le but de formuler des recommandations qui peuvent endiguer la marée d'infections urinaires causées par cette souche bactérienne à l'hôpital. Méthodologie: Il s'agit d'une étude transversale descriptive portant sur 349 femmes enceintes sélectionnées consécutivement fréquentant la clinique prénatale de l'UCTH, Calabar, Nigeria, entre septembre 2020 et août 2021. Les données démographiques/cliniques et les facteurs de risque ont été collectés à l'aide d'un questionnaire semi-structuré administré par un intervieweur. Un échantillon d'urine mi-jet (MSU) a été collecté auprès de chaque participant et transporté au laboratoire de microbiologie médicale de l'hôpital pour analyse microbiologique à l'aide de méthodes de culture et d'identification biochimiques conventionnelles. Le test de sensibilité aux antimicrobiens (AST) sur chaque isolat a été réalisé par la technique de diffusion sur disque contre des antibiotiques sélectionnés. La production phénotypique de carbapénémase à partir d'isolats présumés résistants aux carbapénèmes après AST a été confirmée par le test de Hodge modifié (MHT). L'analyse des données a été effectuée sur SPSS version 19.0. L'association des facteurs de risque avec la prévalence des infections urinaires causées par la CRE a été déterminée à l'aide du test du Chi carré ou de Fisher Exact, avec p <0,05 considéré comme statistiquement significatif. Résultats: La prévalence des infections urinaires chez les femmes enceintes était de 10,0% (35/349), avec une prévalence de 6,6% pour Escherichia coli (23/349) et de 3,5% (12/349) pour Klebsiella pneumoniae. Les résultats du test de sensibilité aux antibiotiques ont montré que l'association pipéracilline-tazobactam était l'antibiotique le plus actif in vitro, avec 82,9% des isolats qui y étaient sensibles, tandis que la sensibilité à l'imipénème (60,0%) et au méropénème (40,0%) était faible. Au total, 17 (48,6%) des 35 isolats étaient résistants aux carbapénèmes dans l'AST et 12 (34,3%) étaient des souches productrices de carbapénémase sur MHT, tandis que 5 (14,3%) étaient des souches non médiées par la carbapénémase (NCMR). Aucune des caractéristiques démographiques ou des facteurs de risque analysés n'était associée de manière significative aux infections urinaires causées par la CRE chez les femmes enceintes (p>0,05). Conclusion: Pour endiguer la tendance croissante des infections urinaires pendant la grossesse causée par des uropathogènes résistants aux carbapénèmes, les femmes enceintes recevant des soins prénatals à l'UCTH de Calabar devraient être systématiquement dépistées pour les infections urinaires et se voir proposer un traitement approprié si cela est indiqué sur la base des résultats des tests microbiologiques.

Context: Risk factors for the persistence of superficial skin infestations are prevalent in humid tropical environments, which are favorable for breeding of the causative vector mite Sarcoptes scabiei (ectoparasite) and dermatophyte fungi. Aim: This study aimed at assessing the awareness and knowledge of childhood scabies and ringworm infestations among parents in Calabar, a highly humid rainforest tropical environment. Settings and Design: Cross-sectional study design and systematic random sampling were used to recruit school-age children in selected primary schools in Calabar. Materials and Methods: Researcher-driven administration of a structured questionnaire was conducted to obtain quantitative data from parents of recruited children. Statistical Analysis Used: Chi-square was used to assess factors associated with ever hearing or seeing scabies and ringworm infestations. Statistical significance was set at P < 0.05. Results: One hundred and eighty-two (56.7%) and 218 (67.9%) of the respondents had heard of or seen scabies and ringworm infestation. Among respondents that were aware of scabies, 53.3% knew of the cause, 50.5% were aware of the risk factors while 68.1% and 78.0% knew their treatment and prevention, respectively; 98.6%, 60.6%, 76.6%, and 80.7% of respondents knew the cause, risk factors, treatment, and prevention of ringworm infestation, respectively. Fathers with at least secondary school literacy level and sharing beds were significantly associated with awareness of scabies. Conclusion: There is a suboptimal level of awareness and knowledge of two of the most common superficial skin infestations among parents of primary school children in the study setting. There is a need to redouble our effort at sensitization of parents toward improved awareness of these common infestations.

Background: Despite various chemotherapy efforts and national-level regulations implemented by the Nigerian government and health sector stakeholders, Schistosoma infections persist as a public health issue. Objective: This study assessed schistosomiasis prevalence among school-aged children in Ogoja Local Government Area, Cross River State, and identified risk factors for the disease. Methods: Urine and faecal samples were examined using microscopy involving centrifugation and Kato-Katz techniques respectively. Results: The overall prevalence of schistosomiasis was 9.7% (49/504). The prevalence of schistosomiasis was 10.8% and 8.7% among females and males, respectively. Schistosoma haematobium infection was higher in the 14-16 year age group (12.7%). Overall mean parasite load for urogenital schistosomiasis was 6.40 eggs/10 mL of urine and 36.00 eggs per gram (EPG) for intestinal schistosomiasis. Infection with schistosomiasis was higher among those who had not heard about schistosomiasis (17.8%) (p=0.000) and who did not know the cause of the infection (12.4%) (p=0.002). Swimming/bathing in open water (OR = 1.199), fetching water from streams/rivers (OR = 1.202), parents/guardians who had no formal education (OR = 2.722) and unemployment (OR = 2.904) were risk factors significantly associated with schistosomiasis (p P<0.05). Conclusion: Although intensities of infections were generally low, prompt integrated control efforts are still required to lower helminth infection in the study area.

The diagnosis of disseminated histoplasmosis remains a challenge particularly in developing countries chiefly due to the low number of required skilled personnel and poor accessibility to diagnostic tools. While culture remains the gold standard in the diagnosis of disseminated histoplasmosis, it requires a period of 1 to 6 weeks of incubation to achieve growth, thus delaying the initiation of treatment. Histoplasma antigen detection is an alternative diagnostic method but has not gained routine utility in resource-limited settings probably due to high cost. Molecular techniques have also been shown to have high sensitivity in the diagnosis of disseminated histoplasmosis but they are very expensive and not easily affordable. Besides the above techniques, Histoplasma can also be detected on peripheral blood film but this is not routinely utilized in the diagnosis of disseminated histoplasmosis. The purpose of this review is to demonstrate the use of peripheral blood film or blood smear as a diagnostic tool for disseminated histoplasmosis in resource-limited settings where classical diagnostic methods are not readily available. We highlight fifty-eight case reports of disseminated histoplasmosis diagnosed on peripheral blood film. Of the 58, 53 (91.4%) were confirmed by classical diagnostic methods, 62.3% (33/53) by culture, 56.6% (30/53) by histopathology, 32.1% (17/53) by serology, 13.2% (7/53) by molecular detection and 3.8% (2/53) by cytology. Blood smears should be done in every patient being evaluated for disseminated histoplasmosis. It is yet an important tool for the diagnosis of disseminated histoplasmosis and is affordable. Comparative studies elucidating the performance of peripheral blood film in the diagnosis of disseminated histoplasmosis against a culture standard should be carried out.

Artemisinin drug resistance is one of the major reasons for malaria treatment failures in the sub-Saharan African countries where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated malaria. The occurrence of single nucleotide polymorphisms (SNPs) is found to correlate with antimalarial drug resistance. With artemisinin, the SNPs occurs at the Kelch 13-propeller gene locus on chromosome 13. The artemisinin drug resistance surveillance strategy involves continuous monitoring of Kelch 13-propeller biomarker to detect emergence of mutations which could herald drug resistance in the region. In this narrative review paper, we examined existing literature to bridge the knowledge gap and accentuate the importance of routine surveillance for artemisinin resistance in sub-Saharan Africa. We conducted our search on PubMed database and Google Scholar to identify peer-reviewed articles, reports, and abstracts on artemisinin drug resistance using the following keywords; ‘artemisinin drug resistance’, ‘antimalarial drug resistance’, ‘artemisinin-based combination therapy’, ‘Kelch 13-propeller’, ‘K13- propeller gene’, and ‘K13 molecular marker’. The review provided pertinent information on artemisinin derivatives, artemisinin-based combination therapy, molecular action of artemisinin, definition of artemisinin resistance, genetic basis of artemisinin drug resistance and discovery of Kelch 13, and the importance of artemisinin resistance surveillance. Molecular surveillance can provide healthcare policy makers a forecast of impending threats to malaria treatment. This is more so when drugs are in combination therapy, for instance, molecular surveillance can give a hint that one drug is failing despite the fact that in combination, it is still apparently clinically effective.

Introduction: Histoplasmosis commonly occurs in the advanced HIV disease population and also in immunocompetent individuals. Previous reviews and recent studies highlight several cases of histoplasmosis reported in Nigeria. We aimed to describe the current epidemiology of histoplasmosis in Nigeria and the need for active surveillance in the at-risk populations. Methods: Literature searches for all publications on histoplasmosis in Nigeria were performed using online databases including Google scholar, PubMed and African Journal online. The following search terms: 'histoplasmosis' and 'Nigeria', AND/OR 'Histoplasma and Nigeria' were used. No limitations on the date or other search criteria were applied, to avoid the exclusion of articles on histoplasmosis in Nigeria. All publications on histoplasmosis outside Nigeria were excluded. Results: Our review identified a total of 231 cases of histoplasmosis reported from Nigeria: 128 were from individual case reports and case series while 103 were cases from two observational studies. Of the 231 cases, 97 (42.0%) were from South West Nigeria, 66 (28.6%) were from South-South Nigeria, 24 (10.4%) were from North West, 22 (9.5%) from North Central Nigeria, 17 (7.4%) from South East Nigeria and 5 (2.2%) from the North East. Based on Nigeria's current population size of 216,953,585 the burden of histoplasmosis per 100,000 inhabitants was estimated to be 0.1%. The sheer number of cases detected in recent observational studies compared with individual case reports and series reported over a longer duration of 6 decades suggests gross under-reporting of histoplasmosis in Nigeria. Conclusion: Histoplasmosis is not an uncommon clinical entity in Nigeria. Histoplasmosis case finding should be improved by training and retraining healthcare professionals and providing much-needed diagnostic capacity and infrastructure across health facilities in Nigeria.

Abstract Background Several case reports abound in literature about cases of histoplasmosis misdiagnosed as tuberculosis (TB). Nigeria is one of the highest TB-burdened countries, but data on histoplasmosis in Nigeria are sparse in the literature. The aim of this research was to investigate patients with presumptive pulmonary TB in Calabar, Nigeria, for histoplasmosis. Methods This was a descriptive cross-sectional study of 213 participants with presumptive diagnosis of pulmonary TB between April 2020 and March 2021. Urine samples were collected from selected patients for Histoplasma antigen test using enzyme immunoassay kits, while sputum samples were collected for GeneXpert test for confirmed diagnosis of TB and conventional polymerase chain reaction (PCR) for the diagnosis of histoplasmosis. Results Of the 213 participants enrolled into the study, 94 subjects (44.1%) were confirmed TB patients, 75 (35.2%) were human immunodeficiency virus (HIV) positive, 41 (19.2%) had advanced HIV disease (AHD), and 138 (64.8%) were HIV negative. Twenty-seven of the 213 participants were Histoplasma positive by antigen test and/or PCR, giving an overall prevalence rate of 12.7%. The prevalence of histoplasmosis among confirmed TB patients (7.4% [7/94]) was significantly lower than in unconfirmed TB patients (16.8% [20/119]) (P = .04). Participants on anti-TB therapy also had a significantly lower rate of histoplasmosis compared to those not on anti-TB drugs (P = .00006). The internal transcribed spacer (ITS) sequencing of the Histoplasma revealed a closely relatedness to Histoplasma capsulatum. Conclusions Histoplasmosis is not uncommon among presumptive TB patients. There should be proper microbiological investigation of patients presenting with symptoms suggestive of TB to exclude cases of histoplasmosis.

Aim: Bloodstream infections are a major cause of morbidity and mortality worldwide. The prevalence of causative microorganisms varies from one geographical region to another. This study was aimed at determining the etiological agents prevalent in our environment and their susceptibility profile. Study design: This is a retrospective study carried out at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methodology: Blood culture results of patients documented over a two-year period were retrieved and analyzed. Blood culture positive isolates were detected using conventional method and Oxoid signal blood culture systems. Antimicrobial sensitivity tests were carried out by Kirby-Bauer disc diffusion method. Methicillin resistance in Staphylococcus aureus and coagulase negative Staphylococcus species (CoNS) was detected by disk diffusion method using 30 µg cefoxitin disk. ESBL production was detected by phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: A total of 413 blood culture antimicrobial susceptibility test results were analyzed, of which 116 (28.09%) were identified as culture positive. Sixty-nine (59%) of the positive isolates were from female patients. Out of 116 positive cultures, 58.62% (68/116) were Gram positive organisms, 40.52% (47/116) were Gram negative organisms, non albicans Candida accounted for 0.86% (1/116). Staphylococcus aureus (n=41, 35.3%) was the predominant isolate and showed high sensitivity to levofloxacin (100%), Linezolid (100%) and Amikacin (100%). Twelve isolates of S. aureus were methicillin resistant, while 1 isolate was inducible clindamycin resistant. Of the 116 isolates identified in this study, forty-three (43) were multidrug resistant with highest number of multidrug resistant isolates from Staphylococcus aureus (n=20). 21.28% (n=10) of the Gram-negative isolates were positive for extended spectrum beta lactamases. Conclusion: A high rate of antimicrobial resistance is observed among microorganisms causing blood stream infections. This emphasizes the need for antimicrobial sensitivity testing in the management of blood stream infections.

Background: Diarrhea claims the lives of more children than malaria, HIV and measles combined. Prompt identification of symptoms of diarrhea by Caregivers and timely commencement of oral rehydration therapy using oral rehydration solution (ORS) or appropriate home available fluids are recommended corrective measures. Diarrhea is the second chief cause of mortality among under-five children in the world. This study was to ascertain the basic knowledge of childhood diarrhea and the health- seeking practices among caregivers of under-five children in Calabar- South, Calabar, Nigeria within the limits of available sanitation and public health-seeking facilities. Materials and Methods: Six wards were chosen from the 12 wards in the study area by casting lot. Ten streets were randomly selected from each of the 6 wards. Eleven compounds were selected randomly per street to give a total of 660 compounds. A household with an under-five child or children was randomly selected per compound and therefore 660 Caregivers were enlisted on giving consent. Semi-structured questionnaires were used to collect data from respondents. Results: In this study, 638 (98.2%) of respondents had good basic knowledge of childhood diarrhea in under-five children, 12 (1.8%) had fair basic knowledge, no group was rated as having poor basic knowledge. Occurrence of childhood diarrhea was marginally higher among respondents with good knowledge of diarrhea (50.3%) than respondents with fair basic knowledge, (50%). In practice during advent of childhood diarrhea, some caregivers chose to seek health-care from traditional healers 6.1% (19), churches 1.9% (6), pharmacies 16.9% (53), patent drug stores 18.8% (59), hospital, 14.3% (45), or self medication at home 42% (132). Conclusion: Although most Caregivers possessed good basic knowledge of childhood diarrhea, there were constrains translating this knowledge into intervention practices due to inadequate presence. of social amenity framework in the study area. Government and non Governmental authorities should make provision of social amenities such as hospitals, pipe borne water, waste disposal facilities, power supply, water drainages etc, a priority. These findings might be attributed to inadequate availability of social amenity framework comprising primary healthcare centers and community pharmacy, pipe borne water system, water-closet toilet system, public garbage disposal dumps planned water drainage system etc, thus constraining translation of knowledge to diarrhea intervention practices.

Background: Diarrhoea is currently the second leading cause of childhood mortality globally, after pneumonia. It accounted for 9% of all under-five deaths which was greater than the mortality arising from malaria, HIV and measles combined. The under-five mortality has continued to spike despite medical intervention protocols.This study was therefore designed to assess Caregivers’ knowledge of environmental sanitation and hygiene practices in the prevention of acute diarrhoea among under-five children in Calabar-South, Cross River State, Nigeria. Materials and method: A Caregiver who met the inclusion criteria was enlisted as respondent from each of the 660 households to give a total of 660 respondents. Structured questionnaires were administered to the respondents to collect data. Answers to the questions were numerically weighted and summed up to breakpoints used in categorising the respondents’ knowledge of environmental sanitation and hygiene practices into poor, fair and good knowledge. Results: Six hundred and fifty (650) respondents completed the interview. Male under-five children were 352 (54.2%) and females 298 (45.8%).Child’s age and male sex were statistically significant predictors of occurrence of childhood diarrhoea. Occurrence of acute diarrhoea in under-five children was greatest among children 13 24 months149 (67.1%) and male under-five children 196 (55.7%) compared to female under-five children 131 (44.0%). Occurrence of diarrhoea reduced with improved Caregivers’ knowledge of environmental sanitation and hygiene practices. Occurrence of diarrhoea was also observed to reduce with improved educational status and income of Caregivers.

Background: Species of Enterobactericeae elaborate extended spectrum β-lactamases(ESBL), which areenzymes that confer resistance to third generation cephalosporins and aztreonam but inhibited by βlactamase inhibitors, like clavulanic acid. Studies have reported association betweenESBLproductionand multidrug resistance to other classes of antibiotics like aminoglycosides and ampicillins.This development is disturbing, given that cefotaxime– gentamicinor ampicillin-gentamicin combinations are readily the empirical regimens for suspected neonatal sepsis. Treatment of ESBLinfections, posed serious therapeutic challenges, resulting in increasing treatment failures. The purpose of this study is to establish if correlation exists between maternal vagina colonization with ESBLproducing Enterobacteriaceae in pregnancy and ESBLearly onset neonatal sepsis ( EONS) using E.coli and K .pneumoniae as surrogates. Materials and Methods: The study was conducted in May, 2015. Maternal high vagina swabs (HVS) and baby’s blood cultures were evaluated for surrogates of E. coli, Enterobacteriaceae and Gram negative bacilli respectively. Antibiogram, ESBL confirmation and plasmid DNA analysis were performed on these isolates. Mother-to-newborn transmission of sepsis was evaluated ,by comparing antibiogram and plasmid DNA profiles of mother and her baby’s isolates. A similarity in these parameters between a mother and her newborn was considered a motherto-newborn transmission of blood borne infection. Results: ESBL was detected in 16.0% of the maternal vagina isolates and 19.3% of the babies suspected of sepsis. Percentage Mother-to-newborn transmission of ESBL-sepsis was 0.6%. This was not statistically significant to establish a correlation between maternal ESBLcolonization in pregnancy and ESBLearly onset neonatal sepsis. Conclusion: There is no correlation between maternal vagina colonization with ESBL-producing Enterobacteriaceae in pregnancy and ESBL-early onset neonatal sepsis.

Background Leprosy, also referred to as Hansen’s disease is an ancient disease caused by Mycobacterium tuberculosis. It could be debilitating if attention is delayed.In 1998, Nigeria had harmoniously achieved thenational elimination benchmark of ≤ 1 case of leprosy per 10,000 population as set by WHO but soon after resurgence of the disease set in, for lack of sustained infection prevention and control structures and grassroots sensitization.This study is aimed at finding the knowledge of leprosy among the people of Ikun community in Biase –West Development Area of Cross River State of Nigeria. The outcome will dictate appropriate interventions with a view to enhancing knowledge and curtailing myths and misconceptions towards leprosy in Ikun community. Materials and Methods Semi-structured questionnaires, with each question assigned weighted score. were used to collect data, A respondent level of knowledge about leprosy was categorized into Poor knowledge or Good knowledge based on percentage correct response to questions raised in the questionnaire. A respondent was rated as having Good knowledge of leprosy if he or she answered ≥75% of the questions correctly or having Poor knowledge where he or she answered <75% of the questions raised in the questionnaire correctly. Results Two hundred and ninety four respondents participated in this study,137 (46.6%) males and 157(53.4%) females. Majority 119(40.5%) were in the age bracket of 31-40years of age. Two hunded(68%) were married, 55(18.7%) unmarried while 39(13.3%) were minors. Respondents were mostly farmers 115(39.2%). One hundred and eighty (61.3%) of the respondents had poor knowledge of leprosy whereas 114(38.7%) had good knowledge . Conclusion There is poor basic knowledge of leprosy in the study area, particularly in the aspects of cause of the disease, transmission and presentation. This, if not addressed would lead to a build up of misconceptions and myths against individuals with the condition. There is strong need for health education and grassroots sensitization in the study area.

Background: The most important risk factor to developing UTI is the presence of an indwelling urethral catheter. Eighty percent of nosocomial UTI was reported to be caused by urethral catheterization. UTIs in health care institutions and in those with frequent antibiotic exposures were frequently caused by multi- drug resistant pathogens. This study sought to determined the antibiogram of isolates from catheterized patients with UTIs with a view to establishing if there were justifications for empiric treatment of this condition in the study area in the absence of quality antibiotic formulary. Materials and Methods: Interviewer administered questionnaires were used to collect socio-demographic data. Specimens were cultured on 5% sheep blood agar (SBA), MacConkey and sabouraud dextrose agar plates and incubated at 37°c for 24 hours in ambient air. Significant bacteriuria was determined on growths from SBA. Growths were identified using standard biochemical techniques. Results: The study established 74.3% (52) prevalence of CAUTIs amongst catheterized patients in the study area with 29 (41.4%) female dominance. Imipenem (93.9%) recorded the highest percentage susceptibility, followed by Amikacin (91.8%) and Piperacillin/ tazobactam (88.8%). E. coli 17(32.7%) was the dominant isolate. Extended spectrum β-lctamase prevalence was 23(44.2%) and MRSA 2(3.8%). There was significant statistical relation between ESBL production and resistance to other classes of antibiotics. Conclusion: There is high percentage prevalence of multidrug resistance (MDR) among isolates of CAUTIs in the study area. We therefore advocate laboratory based prescription practice and de-emphasized empiric treatment pending when there would be in a quality drug formulary founded on regular resistance surveillance.

Background: Negative attitude and stigma against leprosy patients constrain them to resort to concealing their status thus resulting in delayed detection, treatment, complications and perpetuation of the condition in the locality. This study was aimed at finding out the prevailing attitude and stigma toward leprosy in the community with a view to addressing the fueling factors. Materials and Methods: It was descriptive cross sectional study. Semi-structured interviewer administered questionnaires were used for data collection. Explanatory Model Interview Catalogue (EMIC), was used to grade stigma against leprosy amongst participants. Answers to questions in the questionnaire were assigned scores which were summed up into percentage breakpoints. A respondent was interpreted as having favorable or unfavorable attitude to leprosy depending on his or her percentage sum of score. Stigma was categorized based on the sum of an individual’s EMIC score as high, moderate or low level of stigma. Data were analyzed using SPSS version 20. Results: The study revealed that only 44(15%) of respondents had favorable attitude towards leprosy whereas 250(85%) had unfavorable attitude towards this group. Attitude to leprosy was observed to be significantly related to age and sex of respondent, religion and ethnicity, p-value< 0.05. EMIC profile of the study respondents revealed that 47(16%) demonstrated low stigma, 81(28%) demonstrated moderate stigma and 166(56%) demonstrated high stigma towards leprosy. There was no statistically significant relationship between stigma and socio-demographic variables. Conclusion: Misunderstanding and misconceptions about leprosy and leprosy patients is still well rooted in the norms and culture of the people of Ikun, breeding negative attitude and stigma toward leprosy. Vigorous leprosy awareness programs structured along the lines of attitude-stigma influencing socio-demographic variables, with emphasis on the cause, transmission, diagnosis and treatment of leprosy will help to stem the tide of myths and misconceptions.

Background: Diarrhea claims the lives of more children than malaria, HIV and measles combined. Prompt identification of symptoms of diarrhea by Caregivers and timely commencement of oral rehydration therapy using oral rehydration solution (ORS) or appropriate home available fluids are recommended corrective measures. This study was to ascertain the basick nowledge of childhood diarrhea and the health-seeking practices among caregivers of under-five children in Calabar- South, Calabar, Nigeria. Materials and Methods: Six wards were chosen from the 12 wards in the study area by casting lot. Ten streets were randomly selected from each of the 6 wards. Eleven compounds were selected randomly per street to give a total of 660 compounds. A household with an under-five child or children was randomly selected per compound and therefore 660 Caregivers were enlisted on giving consent. Semi-structured questionnaires were used to collect data from respondents. Results: In this study, 638 (98.2%) of respondents had good basic knowledge of childhood diarrhea in under-five children, 12 (1.8%) had fair basic knowledge, no group was rated as having poor basic knowledge. Occurrence of childhood diarrhea was marginally higher among respondents with good knowledge of diarrhea (50.3%) than respondents with fair basic knowledge, (50%). In practice during advent of childhood diarrhea, some caregivers chose to seek health-care from traditional healers 6.1% (19), churches 1.9% (6), pharmacies 16.9% (53), patent drug stores 18.8% (59), hospital, 14.3% (45), or self medication at home 42% (132). Conclusion: Although most Caregivers possessed good basic knowledge of childhood diarrhea, there were constrains translating this knowledge into intervention practices due to inadequate presence. Of social amenity framework in the study area. Government and non Governmental authorities should make provision of social amenities such as hospitals, pipe borne water, waste disposal facilities, power supply, water drainagesetc, a priority.

DOI: 10.21276/sjams.2018.6.10.94 Abstract: Considering that body surface colonization of the new born by multi-drug resistant bacterial strains could predispose to early onset neonatal sepsis (EONS) this study was embarked upon at the Lagos University Teaching Hospital (LUTH), Lagos to investigate the percentage body surfaces colonization of the newborn and the vagina of their respective mothers by extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE). The study also evaluated the percentage of babies so colonized, who manifested with signs and symptoms of sepsis in the first 7 days of postnatal life. The antibiotic susceptibility, resistance patterns and risk factors for ESBLcolonization of the newborn in pregnancy were also determined. This investigation was conducted amongst 350 newborn babies delivered in the labour wards of LUTH, Lagos and their mothers, between January 2014 and May, 2015. Structured questionnaires were used to collect mothers’ socio-demographic data. The body surfaces swabs from the newborns and maternal high vagina swabs were cultured and isolates were tested both for antibiotic susceptibility and ESBL production. The babies whose body surfaces were colonized by Enterobacteriaceae were monitored for the first 7 days of postnatal life for signs and symptoms of EONS. Multivariate logistic regression model was constructed to determine the risk factors for newborn ESBL-PE colonization. A total of 243 (69.4%) babies were colonized by Enterobacteriaceae, 187 (53.4%) were non-ESBL-PE, 56 (16%) of the Isolates were conformed ESBL-PE. Out of the 56 confirmed cases ESBL-PE, 11 (19.6%) on postnatal monitoring, manifested with signs and symptoms of EONS. Maternal vagina ESBL-PE colonization in pregnancy was an independent risk factor for neonatal colonization (p<0.05). ESBL-production was associated with cross resistance to other antibiotic classes. Antenatal screening of pregnant women for vaginal colonization with ESBLPE is recommended. Further research to determine if a correlation exists between vaginal ESBL-PE in pregnancy and EONS should be encouraged.

Objective/Background: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl–Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program. Materials and Methods: Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif. Results: A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4–89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively). Conclusion: The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients.