Publications by authors named "Garba Iliyasu"

33 Publications

Snakebite envenoming in different national contexts: Costa Rica, Sri Lanka, and Nigeria.

Toxicon X 2021 Jul 25;9-10:100066. Epub 2021 May 25.

Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University, Kano, Nigeria.

Snakebite envenoming is a neglected tropical disease that predominantly affects impoverished rural communities in sub-Saharan Africa, Asia, and Latin America. The global efforts to reduce the impact of this disease must consider the local national contexts and, therefore, comparative studies on envenomings in different countries are necessary to identify strengths, weaknesses and needs. This work presents a comparative analysis of snakebite envenomings in Costa Rica, Sri Lanka, and Nigeria. The comparison included the following aspects: (a) burden of envenomings, (b) historical background of national efforts to confront envenomings, (c) national health systems, (d) antivenom availability and accessibility including local production, (e) training of physicians and nurses in the diagnosis and management of envenomings, (f) prevention campaigns and community-based work, (g) scientific and technological platforms in these topics, and (h) international cooperation programs. Strengths and weaknesses were identified in the three contexts and several urgent tasks to improve the management of this disease in these countries are highlighted. This comparative analysis could be of benefit for similar studies in other national and regional contexts.
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http://dx.doi.org/10.1016/j.toxcx.2021.100066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175406PMC
July 2021

Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria.

Antimicrob Resist Infect Control 2021 04 30;10(1):73. Epub 2021 Apr 30.

Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria.

Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.

Methods: In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert's scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model.

Results: A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.

Conclusions: Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria's NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.
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http://dx.doi.org/10.1186/s13756-021-00940-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086089PMC
April 2021

Determinants of loss to follow-up among people living with HIV on antiretroviral therapy in Nigeria.

Afr J AIDS Res 2021 Mar;20(1):93-99

Department of Medicine, College of Health Sciences, Bayero University, Kano, Nigeria.

: Considerable success has been recorded in the global fight against the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Retention in care is the key to the attainment of set goals in the fight against the disease. We aim to determine the factors associated with loss to follow-up (LTFU) among people living with HIV on antiretroviral therapy (ART) in a limited resource setting.: This was a retrospective cohort study that included adult patients who accessed ART at the study site between January 2005 and October 2018. A multivariate logistic regression model was used to obtain adjusted odds ratios and 95% confidence intervals of independent determinants of LTFU.: Of the 8 679 patients included in the study, 3 716 (43%) were males, 4 009 (46%) were enrolled during the years 2005 to 2008, 8 421 (97%) spent less than two hours travelling from their residence to the treatment centre, and 3 523 (41%) had their first-line ART regimen changed. Among the characteristics that determine LTFU were male patients (OR = 1.167, 95% CI: 1.071-1.272), and World Health Organization clinical stage 3 (OR = 2.091, 95% CI: 1.485-2.944).: In our study, male gender, enrolment year 2005 to 2008, no change in first-line ART and nevirapine-based therapy were more likely to be associated with LTFU.
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http://dx.doi.org/10.2989/16085906.2021.1874444DOI Listing
March 2021

Knowledge, attitude and practice survey of COVID-19 pandemic in Northern Nigeria.

PLoS One 2021 14;16(1):e0245176. Epub 2021 Jan 14.

Infectious and Tropical Diseases Unit, College of Health Sciences, Bayero University, Kano, Kano State, Nigeria.

Background: A pandemic of coronavirus disease 2019 (COVID-19) emerged and affected most of the world in early 2020. To inform effective public health measures we conducted a knowledge, attitude and practice (KAP) survey among a Hausa Muslim society in Nigeria in March 2020.

Methods: The study is an analytic cross-sectional survey with questionnaires administered to the general population including Health Care Workers (HCW) in Kano, Nigeria. Participants were recruited by convenience sampling following informed consent. The percentage of KAP scores were categorized as good and poor. Independent predictors of good knowledge of COVID 19 were ascertained using a binary logistic regression model.

Results: The questionnaire was administered among urban 32.8%, peri-urban dwellers 32.4%, and to online participants 34.8%. The peri-urban and urban participants were given paper questionnaires. There were 886 study participants with mean age 28.58yrs [SD:10.25] (Interquartile range [IQR]:22yrs-32yrs), males 55.4% with 57.3% having had or were in tertiary education. Most participants were students 40% and civil servants 20%. The overall mean [standard deviation (SD)] for knowledge, attitude and practice scores expressed in percentage was 65.38%[SD15.90], 71.45% [SD14.10], and 65.04% [SD17.02] respectively. Out of the respondents, 270(30.47%) had good knowledge (GK), 158(17.8%) had good attitude (GA), and 230(25.96%) had good practice (GP) using cut-off scores of 75%, 86.5%, and 75% respectively. Over 48% did not agree COVID-19 originated from animals while 60% perceived the pandemic to be due to God's punishment. Also, 36% thought it was a man-made virus. When rating fear, most respondents [63.5%] had marked fear i.e. ≥ 7 out of 10 and 56% admitted to modifying their habits recently in fear of contracting the virus. As regards attitude to religious norms, 77.77% agreed on cancellation of the lesser pilgrimage as a measure to curb the spread of the disease while 23.64% admitted that greater pilgrimage (Hajj) should proceed despite the persistence of the ongoing pandemic. About 50% of the respondents insisted on attending Friday congregational prayers despite social distancing. One in four people still harbored stigma towards a person who has recovered from the virus. 28% felt some races are more at risk of the disease though 66% mentioned always practicing social distancing from persons coughing or sneezing. Almost 70% of respondents said they were willing to accept a vaccine with 39% saying they would be willing to pay for it if not publicly funded. In univariate analysis increasing age and having been ever married were associated with GK while tertiary education was associated with GA [Odds Ratio; 95% Confidence Interval] 2.66(1.79-3.95). Independent positive predictors of GK were those who were or had ever been married, those who had marked fear of COVID-19, and had modified their habits in the last three months. Those who had non-tertiary education and had the questionnaire administered as paper rather than online version had GK but age was not a predictor.

Conclusion: Knowledge of transmission and preventive measures should be improved in the general population cognizant of cultural norms and Islamic practices. The study highlights the importance of considering belief systems and perception in developing control measures against COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245176PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808653PMC
February 2021

A descriptive study of smear negative pulmonary tuberculosis in a high HIV burden patient's population in North Central Nigeria.

PLoS One 2020 1;15(9):e0238007. Epub 2020 Sep 1.

Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.

Tuberculosis (TB) is a serious disease of public health concern, mainly in low- and middle-income countries. Most of these countries have challenges in diagnosis and treatment of TB in people with smear-negative pulmonary tuberculosis (SNPTB), which remains a significant public health challenge because of the global burden of the disease. We evaluated the epidemiology and clinical presentation of SNPTB in a cohort of patients with high HIV burden. The study was a cross-sectional study among patients with SNPTB in four major hospitals that care for TB/HIV patients in north-central Nigeria. All patients 18 years and above who were newly diagnosed as SNPTB, or patients with SNPTB who had not taken TB drugs for up to 2 weeks irrespective of their HIV status were recruited. Demographic data (sex, age), smoking status, and medical history (clinical form of TB, symptoms at admission, diagnostic methods, presence of comorbidities, prior TB treatment) were obtained using a semi-structured questionnaire. Detailed clinical examination was also done on all the study subjects. Baseline results of packed cell volume, HIV test and sputum acid fast bacilli done during TB screening were retrieved from the patients' case notes and recorded. Also, the base line Chest X-ray films taken during TB screening were reviewed and reported by two radiologists blinded to each other's reports. The Xpert MTB/RIF tests and sputum culture (using LJ medium) were done in a TB reference laboratory. A total of 150 patients with SNPTB were studied. Majority of the patients were female 93 (62%). The median age of the patients was 36.5 years with greater percentage of the patients within the ages of 25-44 years 92 (61.3%). Twenty-two (14.7%) of the patients had previous TB treatment. History of cigarette smoking was obtained in only 7(4.7%) of the patients while 82 (64.1%) were HIV positive. All the patients had a history of cough for over a period of at least three weeks, while, 27 (18%) reported having hemoptysis. About 87 (58%) had fever and 110 (73.7%) had anemia, while weight loss and night sweat were reported in 98(65.3%) and 82 (54.7%) of the patients respectively. Chest x rays were reported as typical of TB in only 24 (16%) of the patients. Of the 150 sputa sample analyzed, 21/150 (14.0%) and 22/150 (14.7%) where Gene Xpert and sputum culture positive respectively. The sensitivity and specificity of Gene Xpert assay were 81.8% (18/22; 95% CI 61.5 to 92.7%) and 97.4% (112/115; 95% CI 92.6 to 99.1%), respectively. The study found cough, fever and anemia to be the commonest presentation in patient with SNPTB in a high HIV burden patient's population. There is also relatively high culture positivity among the patients. This underscores the need to expand the facilities for culture and confirmation in TB centers across the country.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238007PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462271PMC
October 2020

Evaluation of GeneXpert MTB/RIF as a diagnostic tool in patients with sputum smear-negative TB in a high HIV burden region in Nigeria.

Trans R Soc Trop Med Hyg 2020 09;114(9):690-692

Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Nigeria.

Background: There are challenges in the diagnosis of TB in people with smear-negative pulmonary TB (SNPTB) in resource-limited settings. We evaluated the diagnostic usefulness of Xpert MTB/RIF compared with TB culture among SNPTB.

Methods: The study was a cross-sectional study among patients with SNPTB. The Xpert MTB/RIF tests and sputum culture (using Lowenstein-Jensen medium) were performed. Sensitivity and specificity were calculated.

Results: Of 150 patients studied, the sensitivity and specificity of GeneXpert MTB/RIF were 81.8 and 97.4%, respectively.

Conclusion: The sensitivity and specificity of Xpert MTB/RIF assay was comparative with culture in SNPTB patients.
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http://dx.doi.org/10.1093/trstmh/traa019DOI Listing
September 2020

Posttraumatic stress disorder and psycho-social impairment following snakebite in Northeastern Nigeria.

Int J Psychiatry Med 2021 Mar 26;56(2):97-115. Epub 2020 Mar 26.

Infectious and Tropical Diseases Unit, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.

Background: Snakebite is a major public health problem among impoverished rural populations causing considerable morbidity and mortality in West Africa. Despite the huge burden of snakebite in this region, psycho-social impairment following snakebite has not been evaluated. In this study, we assessed for features of posttraumatic stress disorder and psycho-social impairment among rural snakebite victims in Northeastern Nigeria.

Methods: Individuals with previous snakebite managed in our facility, defined as exposed to snakebite, and their matched relatives not exposed to snakebite were invited to participate in the study following community mobilization. A retrospective cohort study was conducted evaluating the presence of psycho-social functioning, posttraumatic stress disorder, quality of life, social disability, cognitive impairment, and psychological morbidity using standard tools administered by the investigators, trained nurses, and community health workers.

Results: The prevalence of features of posttraumatic stress disorder among those exposed to snakebite compared to those not exposed to snakebite was 43% and 28%, respectively (risk ratio = 1.53; 95% confidence interval: 1.04-2.24; p = 0.024). Subjects exposed to snakebite had significantly poorer quality of life score in the psychological and social domains (p < 0.05). Other psycho-social complications associated with snakebite were impaired family/school functioning and psychological morbidity. No difference in cognitive functioning was observed between the two groups.

Conclusions: Snakebite is complicated by features of posttraumatic stress disorder, poor quality of life, and psycho-social impairments in northeastern Nigeria. Detection, monitoring, and appropriate management interventions should be provided and made more accessible to snakebite victims to ameliorate mental and psychological impairment.
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http://dx.doi.org/10.1177/0091217420913400DOI Listing
March 2021

Hepatitis B vaccine knowledge and self-reported vaccination status among healthcare workers in a conflict region in northeastern Nigeria.

Ther Adv Vaccines Immunother 2020 16;8:2515135519900743. Epub 2020 Jan 16.

Department of Medicine, Bayero University Kano, Kano, Nigeria.

Background: Hepatitis B virus (HBV) infection is highly endemic in Nigeria. The primary objective of this study is to describe the knowledge, self-reported vaccination status, and intention of healthcare workers to receive hepatitis B vaccine at a tertiary referral center in conflict-ravaged northeastern Nigeria.

Methods: This was cross-sectional analytical study among medical practitioners, nurses, laboratory workers, health attendants, pharmacists, and radiographers working at Federal Medical Center Nguru, Yobe State. Written informed consent was obtained from all study participants. Data were obtained using questionnaires and entered into a Microsoft Excel spreadsheet, cleaned and analyzed using JMP Pro software.

Results: Of the 182 participants, we found that 151 (82.97%), 81 (44.51%), 85 (46.70%), and 33 (18.13%) had good knowledge of HBV, good knowledge of hepatitis B vaccine, were vaccinated against HBV by the least dose, and had a complete hepatitis B vaccination status, respectively. The lack of availability of the vaccine was the main reason for not receiving the vaccine among the unvaccinated 36/91 (39.56%), followed by not knowing where to access the vaccine 19/91 (20.88%).

Conclusion: The study highlights the need for strategies to ensure the availability of hepatitis B vaccine in conflict settings and need for vaccinology training given the suboptimal level of awareness and uptake of the hepatitis B vaccine among the healthcare workers.
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http://dx.doi.org/10.1177/2515135519900743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966246PMC
January 2020

Superbugs-related prolonged admissions in three tertiary hospitals, Kano State, Nigeria.

Pan Afr Med J 2019 9;32:166. Epub 2019 Apr 9.

Department of Microbiology and Immunology, Faculty of Biomedical Sciences Kampala International University Western Campus, Ishaka Bushenyi, Uganda.

Introduction: Superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria.

Methods: A descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for spp and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method.

Results: One hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (NIs) were caused by Gram-negative bacteria, predominantly Escherichia coli, spp, spp, spp and spp. In-vitro antibiotic susceptibility test revealed that were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem.

Conclusion: Superbugs (Acinetobacter species) significantly contributed to delayed hospital admissions through observed 100% resistance to used antibiotics. The healthcare managers of these hospitals and the ministry of health need to take measures against this resistant bacteria ( spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.
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http://dx.doi.org/10.11604/pamj.2019.32.166.18481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607235PMC
July 2019

Cost of Illness of Diabetic Foot Ulcer in a Resource Limited Setting: A Study from Northwestern Nigeria.

J Diabetes Metab Disord 2018 Dec 4;17(2):93-99. Epub 2018 Aug 4.

1Department of Medicine, College of Health Science, Bayero University, Kano, PMB 3011 Nigeria.

Introduction: Diabetic foot ulcer is a major complication of diabetes with a high economic cost of managing. Data from resource limited setting will bring to light how patients in these localities suffer financially in addition to poverty and lack of health insurance. This study estimated cost of illness among patients with diabetic foot ulcer in northwestern Nigeria.

Methods: It was a hospital based cross-sectional study. Questionnaire was used to take the bio data and medical history. Direct medical, direct non-medical and indirect cost were estimated.

Result: Majority of the patients were males with the mean age of 59.3 ± 15.1 yrs. About 60% of the patients earn less than $100 monthly. The total cost of illness of diabetic foot ulcer was estimated at $140,735.56 (median = $1381.55[IQR 1002.42-]). Direct cost of illness was $107,797.06 (median = $1023.27[IQR 773.93-1568]), while the indirect cost was $32,938.49 (median = $209.90[IQR 128.74-357.08]). Out of pocket payment accounted for 90% of the payment.

Conclusion: The cost of diabetic foot ulcer is very exorbitant and the patients affected are mostly poor, unemployed and the breadwinners of their families.
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http://dx.doi.org/10.1007/s40200-018-0344-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405375PMC
December 2018

Occurrence of hypocortisolism in HIV patients: Is the picture changing?

Ghana Med J 2018 Sep;52(3):147-152

Infectious Disease unit, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Background: The occurrence of endocrine diseases in people who are infected with HIV is traditionally thought to occur in the setting of AIDS with opportunistic infections and malignancies. However, recent studies find the correlation between hypocortisolism and stage of HIV (CD4 count and WHO clinical stage) inconsistent.

Methods: This descriptive cross-sectional study included three hundred and fifty (350) consecutive patients with HIV infection. They were interviewed, and subsequently underwent laboratory evaluation for the detection of hypocortisolism. Blood samples for serum cortisol estimation were taken at baseline and at 30 minutes following the administration of 1µg of tetracosactrin (Synacthen). In addition, the patients had blood samples taken at 0 minutes (baseline) for CD4+ lymphocyte cell counts.

Results: At baseline, 108 (30.9%) participants had serum cortisol levels below 100 µg/L with a median value of 55.48 µg/L (11.36-99.96 µg/L), but only 57 (16.3%) study participants had stimulated serum cortisol levels below 180 µg/L with median of 118 µg/L (19.43-179.62). There was no significant difference in the occurrence of clinical features between participants with low and normal serum cortisol, nor WHO clinical stage, CD4 count and ART regimen. The occurrence of hypocortisolism was higher among participants who had been on ART for a longer period of time.

Conclusion: There is a high prevalence of hypocortisolism among HIV patients by biochemical testing, especially those who have been on ARVs for a longer duration. Hypocortisolism cannot be predicted based on the participants' WHO clinical stage of disease, CD4 cell count, or the treatment regimen.

Funding: Personal Funds.
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http://dx.doi.org/10.4314/gmj.v52i3.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303552PMC
September 2018

Snakebite burden in Sub-Saharan Africa: estimates from 41 countries.

Toxicon 2019 Mar 27;159:1-4. Epub 2018 Dec 27.

Infectious & Tropical Diseases Unit, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria. Electronic address:

There is no reliable estimate of burden of snakebite-envenoming (SBE) in Sub-Saharan Africa (SSA). We derived from a meta-analysis the burden of SBE related deaths, amputations and Post-Traumatic Stress Disorder (PTSD) in 41 countries in SSA. The annual burden was estimated at 1.03 million DALYs (95% Confidence Interval: 0.80-1.28 million DALYs). This is similar to or higher than the burden of many Neglected Tropical Diseases (NTDs) and the finding advocates for a commensurate resources allocation towards control of SBE.
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http://dx.doi.org/10.1016/j.toxicon.2018.12.002DOI Listing
March 2019

Status of antimicrobial stewardship programmes in Nigerian tertiary healthcare facilities: Findings and implications.

J Glob Antimicrob Resist 2019 06 14;17:132-136. Epub 2018 Dec 14.

School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa; Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK. Electronic address:

Objectives: The problem of antimicrobial resistance (AMR) is increasing worldwide, with health-related and economic consequences. This is a concern in Africa, including Nigeria, the most populous country in Africa, with its high rates of infectious diseases. Approaches to reducing AMR include instigating antimicrobial stewardship programmes (ASPs) in hospitals. Currently, no information is available regarding the extent of ASPs in Nigerian hospitals. Consequently, the objective was to address this starting in tertiary hospitals.

Methods: This was a cross-sectional, questionnaire-based study among tertiary healthcare facilities. Tertiary hospitals were chosen initially since if there are concerns in these training hospitals, such concerns will likely to be exacerbated in other hospitals.

Results: Completed questionnaires were received from 17 of 25 tertiary healthcare facilities across five of the six geopolitical regions of Nigeria. Ten (59%), four (24%), two (12%) and one (6%) respondents were in internal medicine, infectious diseases, medical microbiology and clinical pharmacology, respectively. Only six healthcare facilities (35%) had a formal organisational structure and a team responsible for ASP. Facility-specific treatment recommendations, based on local AMR patterns, were available in only four facilities (24%). Policies on approval for prescribing specified antimicrobials and formal procedures for reviewing their appropriateness after 48h were present in only two facilities (12%). A cumulative antimicrobial susceptibility report for the previous year was available in only two facilities (12%), and only one facility routinely monitored antimicrobial use.

Conclusion: Significant inadequacies in the availability of ASPs were observed. This needs to be urgently addressed to reduce AMR rates in Nigeria.
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http://dx.doi.org/10.1016/j.jgar.2018.11.025DOI Listing
June 2019

Laboratory-confirmed hospital-acquired infections: An analysis of a hospital's surveillance data in Nigeria.

Heliyon 2018 Aug 2;4(8):e00720. Epub 2018 Aug 2.

Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.

Objective: Hospital-acquired infections (HAI) are a global problem and a major public health concern in hospitals throughout the world. Quantification of HAI is needed in developing countries; hence we describe the results of a 2-year surveillance data in a tertiary hospital in Nigeria.

Methodology: This study is a 2-year review using secondary data collected at a tertiary referral center in northwestern Nigeria. The data was collected using surveillance forms modeled based on the Centre for Disease Control (CDC) protocol. Descriptive statistics were used to present results as frequencies and percentages.

Result: 518 patients developed HAI out of 8216 patients giving an overall prevalence of 6.3%. The mean age of the patients was 35.98 years (±15.92). Males constituted 281 (54.2%). UTI 223 (43.1%) was the most prevalent HAI. Overall, 207 (40.0%) was the most frequent isolates followed by 80 (15.4%). There was a high prevalence of cloxacillin resistant (67.9%) and gram-negative rods resistant to third-generation cephalosporins. Trimethoprim-sulfamethoxazole resistance across the board was more than 90%.

Conclusion: There is a high burden of HAI especially UTI in our hospital with resistance to commonly used antibiotics documented.
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http://dx.doi.org/10.1016/j.heliyon.2018.e00720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072901PMC
August 2018

Post-exposure prophylaxis following occupational exposure to HIV and hepatitis B: an analysis of a 12-year record in a Nigerian tertiary hospital.

J Infect Prev 2018 Jul 17;19(4):184-189. Epub 2017 Dec 17.

Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.

Background: Healthcare workers (HCWs) have an increased risk of occupational exposure to blood-borne pathogens.

Aims/objectives: We aim to examine the utilisation and outcome of post-exposure prophylaxis (PEP) for both HIV and hepatitis B (HBV) among HCWs.

Methods: This was a retrospective study conducted in a tertiary hospital in North-Western Nigeria. We reviewed data on HIV or HBV PEP given to HCWs between 2004 and 2016.

Results: A total of 115 HCWs presented for PEP during the study period. Intern doctors were the most exposed group (40/115; 34.8%). There were 86/115 (74.8%) needle stick exposures. While 53/115 (46.1%) of the sources of exposure were HIV-positive, 9/115(7.83%) were HBV-positive. Zidovudine-based regimen (40/70) was the most commonly prescribed. No seroconversion occurred among those that completed PEP treatment and follow-up.

Discussion: No seroconversion occurred among those that received either or both HIV and HBV PEP and completed PEP treatment.
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http://dx.doi.org/10.1177/1757177417746733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039908PMC
July 2018

Gram-negative bacilli are a major cause of secondary pneumonia in patients with pulmonary tuberculosis: evidence from a cross-sectional study in a tertiary hospital in Nigeria.

Trans R Soc Trop Med Hyg 2018 05;112(5):252-254

Department of Medicine, College of Health Science, Bayero University, Kano, Nigeria.

Background: This study was aimed at describing the profile of bacterial aetiology of secondary pneumonia in pulmonary tuberculosis (PTB) patients.

Methods: A 22-month analysis of patients with PTB and secondary bacterial pneumonia was conducted. Data on isolates recovered and the antimicrobial susceptibility profile were recorded.

Results: Of the 141 patients, there were 79 (56%) males and the mean age was 35.98±15.93. Gram-negative bacilli were isolated with equal frequency as Streptococcus pneumoniae (63 [44.7%]). Most of the isolates tested were sensitive to levofloxacin, ceftriaxone or chloramphenicol.

Conclusion: Gram-negative bacilli are a major cause of pneumonia in patients with PTB on treatment.
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http://dx.doi.org/10.1093/trstmh/try044DOI Listing
May 2018

A prospective study of hospital-acquired infections among adults in a tertiary hospital in north-western Nigeria.

Trans R Soc Trop Med Hyg 2018 01;112(1):36-42

Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Nigeria.

Background: Hospital-acquired infections (HAIs) are an important cause of morbidity and mortality. This study examined the epidemiology, clinical outcomes and microbiological profile of HAIs.

Methods: This prospective study was carried out on patients identified to have developed HAIs while admitted to the medical wards, surgical wards, dialysis unit and intensive care unit (ICU) of the hospital. Patients were recruited consecutively until the target study population was reached. A clinical evaluation and relevant laboratory investigations were carried out.

Results: A total of 100 patients who had 144 episodes of HAIs were studied. Rates of HAIs were 7.16%, 18.63% and 1.75% in the medical wards, ICU and surgical wards, respectively. The most common HAI was urinary tract infection caused by Escherichia coli. High-level resistance to commonly prescribed antibiotics, especially ampicillin and ceftriaxone, was observed among causative bacteria.

Conclusion: The burden of HAIs is high and similar to other parts of Nigeria. There is a need for continued surveillance of HAIs in all the wards of the hospital in order to fully describe the extent of the problem.
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http://dx.doi.org/10.1093/trstmh/try020DOI Listing
January 2018

COMMUNITY ACQUIRED PNEUMOCOCCAL PNEUMONIA IN NORTHWESTERN NIGERIA: EPIDEMIOLOGY, ANTIMICROBIAL RESISTANCE AND OUTCOME.

Afr J Infect Dis 2018 15;12(1):15-19. Epub 2017 Nov 15.

Department of medicine, College of Health Sciences, Bayero University Kano. Kano, Nigeria.

Background: Pneumococcus is the leading cause of community acquired pneumonia (CAP) worldwide, and the leading cause of mortality. Pneumococcal pneumonia is poorly studied in Nigeria. We describe the epidemiology including associated co-morbidities and outcome of pneumococcal pneumonia in North-western Nigeria.

Material And Methods: We conducted a prospective, hospital based study on patients with community acquired pneumococcal pneumonia. Detailed clinical evaluation and relevant laboratory investigations were carried out. Susceptibility test to commonly used antibiotics was carried out on all confirmed pneumococcal isolates. In hospital mortality was recorded. Analysis was carried out using descriptive statistics with differences and relationships were determined using Chi square and Fisher's exact tests as appropriate, with p < 0.05 regarded as significant.

Results: Of the one hundred and twenty-five (125) patients with pneumococcal pneumonia were studied. The mean age of the patients was 41.3years (± 16.84), and 69/125(55.2%) were males. Co-morbidities were observed in 63/125 (53.8%) of the patients. Resistance to commonly used antibiotics was observed. Overall in-hospital mortality was 9/117(7.8%). HIV (OR=2.081; 95%CI 1.651-3.237), age ≥65years (OR=5.947; 95%CI3.581-17.643), and CURB-65 score of ≥ 3 (OR=2.317; 95%CI1.734-4.719) were independent predictors of mortality.

Conclusion: Pneumococcal pneumonia is the commonest cause of CAP in North-western Nigeria with relatively high mortality. There is need to strengthened the vaccination policy targeting at risk adult population in Nigeria.
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http://dx.doi.org/10.21010/ajid.v12i1.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733253PMC
November 2017

Adherence to HIV Postexposure Prophylaxis in a Major Hospital in Northwestern Nigeria.

Infect Control Hosp Epidemiol 2018 02 2;39(2):247-248. Epub 2018 Jan 2.

2Infectious and Tropical Diseases Unit,Department of Medicine,College of Health Sciences,Bayero University Kano,Nigeria.

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http://dx.doi.org/10.1017/ice.2017.276DOI Listing
February 2018

Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt.

PLoS One 2017 30;12(11):e0188595. Epub 2017 Nov 30.

Infectious & Tropical Diseases Unit, College of Health Sciences, Bayero University, Kano, Nigeria.

Background: Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children.

Objective: To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination.

Methods: We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$.

Results: At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly cost-effective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi.

Conclusion: Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0188595PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708681PMC
December 2017

Metabolic syndrome among HIV infected patients: A comparative cross sectional study in northwestern Nigeria.

Diabetes Metab Syndr 2017 Nov 5;11 Suppl 1:S523-S529. Epub 2017 Apr 5.

Infectious Disease Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria. Electronic address:

Introduction: The increasing availability of antiretroviral drugs has made HIV-positive patients to live longer, and conditions that are associated with longevity such as metabolic syndrome and other cardiovascular related conditions have become relevant in them. This is less well studied among African populations. Therefore the study aimed at estimating and comparing the prevalence of and associated risk factors for the metabolic syndrome (MS) among African HIV infected patients.

Method: In this comparative cross-sectional study, we analyzed the data of 300 participants matched for age and gender who satisfied the inclusion criteria with half of the subjects on HAART, while the other half was HAART naïve. The MS was diagnosed using ATP-III criteria.

Results: The mean age of the patients was 34.8±9.9years. The majority of the patients were females 64%. The prevalence of MS among HAART-exposed patients was found to be 19.3%, while it was 5.3% among HAART naïve patients (p=0.001). Raised triglyceride and elevated blood pressure were the criteria with the highest occurrence among HAART-exposed, 82.8% for each. Advanced age, longer duration of HIV diagnosis and HAART exposure, increased BMI, weight gain after HAART exposure, exposure to PIs and increased mean CD4 cell count were found to be significantly associated with MS (p<0.05). However, only age (OR 4.3, 95% CI 1.6-11.8, p=0.005) and BMI (OR 4.2, 95% CI 1.5-11.9, p=0.007) were found to be independently associated with the development of MS.

Conclusion: Exposure to HAART particularly protease inhibitor based regimen increases the risk of MS among HIV-infected patients.
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http://dx.doi.org/10.1016/j.dsx.2017.03.046DOI Listing
November 2017

Prevalence and genetic determinant of drug-resistant tuberculosis among patients completing intensive phase of treatment in a Tertiary Referral Center in Nigeria.

Int J Mycobacteriol 2017 Jan-Mar;6(1):47-51

Department of Medicine, College of Health Sciences, Bayero University, Kano, Nigeria.

Background: Drug-resistant tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Despite the high prevalence of primary DR-TB, its routine screening prior to the treatment is not performed in public hospitals in Nigeria. Data regarding drug resistance and its genetic determinant among follow-up patients with TB are lacking in Nigeria. Hence, the aim of this study was to determine the prevalence and genetic determinant of drug resistance among the follow-up patients with TB in a tertiary hospital in Nigeria.

Materials And Methods: This was a cross-sectional, laboratory-based study conducted on 384 sputum samples collected from consented follow-up patients with TB. Standard microbiology methods (Ziehl-Neelsen staining and microscopy) and polymerase chain reaction (PCR; line probe assay [LIPA]) were used to analyze the collected samples. Pearson's Chi-square test was used to analyze the generated data.

Results: Out of 384 sputum samples analyzed for Mycobacterium tuberculosis and DR-TB, 25 (6.5%) tested positive for acid-fast bacilli. These samples were subjected to PCR (LIPA), of which 18 (72%) tested positive for DR-TB. Of these 18 samples, mutations conferring resistance to rifampicin (rpoB) and isoniazid (katG and/or inhA) were detected in 12 (66.7%) and 6 (33.3%) samples, respectively. Transmission dynamics of DR-TB was not significantly (P > 0.05) dependent on demographic characteristics.

Conclusion: There is a need to strengthen the laboratory capacity for the diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.
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http://dx.doi.org/10.4103/2212-5531.201883DOI Listing
July 2018

Emergence and control of epidemic meningococcal meningitis in sub-Saharan Africa.

Pathog Glob Health 2017 Feb 12;111(1):1-6. Epub 2017 Jan 12.

b Infectious Disease Unit, Department of Medicine, College of Health Science , Bayero University Kano , Kano , Nigeria.

For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.
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http://dx.doi.org/10.1080/20477724.2016.1274068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375607PMC
February 2017

Initiation of antiretroviral therapy based on the 2015 WHO guidelines.

AIDS 2016 11;30(18):2865-2873

aHealth Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, New York, USA bInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda cInfectious and Tropical Diseases Unit, College of Health Sciences, Bayero University Kano dDepartment of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.

Objective: In 2015, the WHO recommended initiation of antiretroviral therapy (ART) in all HIV-positive patients regardless of CD4 cell count. We evaluated the cost-effectiveness of immediate versus deferred ART initiation among patients with CD4 cell counts exceeding 500cells/μl in four resource-limited countries (South Africa, Nigeria, Uganda, and India).

Design: A 5-year Markov model with annual cycles, including patients at CD4 cell counts more than 500 cells/μl initiating ART or deferring therapy until historic ART initiation criteria of CD4 cell counts more than 350 cells/μl were met.

Methods: The incidence of opportunistic infections, malignancies, cardiovascular disease, unscheduled hospitalizations, and death, were informed by the START trial results. Risk of HIV transmission was obtained from a systematic review. Disability weights were based on published literature. Cost inputs were inflated to 2014 US dollars and based on local sources. Results were expressed in cost per disability-adjusted life years averted and measured against WHO cost-effectiveness thresholds.

Results: Immediate initiation of ART is associated with a cost per disability-adjusted life years averted of -$317 [95% confidence interval (CI): -$796-$817] in South Africa; -$507 (95% CI: -$765-$837) in Nigeria; -$136 (-$382-$459) in Uganda; and -$78 (-$256-$374) in India. The results are largely driven by the impact of ART on reducing the risk of new HIV transmissions.

Conclusions: In HIV-positive patients with CD4 counts above 500 cells/μl in the four studied countries, immediate initiation of ART versus deferred therapy until historic eligibility criteria are met is cost-effective and likely even cost-saving over time.
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http://dx.doi.org/10.1097/QAD.0000000000001251DOI Listing
November 2016

Nosocomial infections and resistance pattern of common bacterial isolates in an intensive care unit of a tertiary hospital in Nigeria: A 4-year review.

J Crit Care 2016 08 28;34:116-20. Epub 2016 Apr 28.

Infectious Disease Unit, Department of medicine, College of Health Science, Bayero University Kano, PMB 3011, Kano, Nigeria. Electronic address:

Introduction: Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria.

Method: Case records of patients who were admitted into the intensive care unit over a 4-year period were retrospectively reviewed. A preformed questionnaire was administered, and data on clinical and microbiological profile of patients with documented infection were obtained.

Results: Eighty-our episodes of nosocomial infections were identified in 76 patients. Road traffic accident (29/76, 38.2%) was the leading cause of admission. The most common infections were skin and soft tissue infections (30/84, 35.7%) followed by urinary tract infection (23/84, 27.4%). The most frequent isolates were Staphylococcus aureus (35/84, 41.7%), Klebsiella pneumoniae (18/84, 21.4%), and Escherichia coli (13/84, 15.5%). High rate of resistance to cloxacillin (19/35, 54.3%) and cotrimoxazole (17/26, 65.4%) was noted among the S aureus isolates. All the Enterobacteriaceae isolates were susceptible to meropenem, whereas resistance rate to ceftriaxone was high (E coli, 55.6%; K pneumoniae, 71.4%; Proteus spp, 50%).

Conclusion: Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.
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http://dx.doi.org/10.1016/j.jcrc.2016.04.018DOI Listing
August 2016

Adult Loa loa Filarial Worm in the Anterior Chamber of the Eye: A First Report from Savanna Belt of Northern Nigeria.

PLoS Negl Trop Dis 2016 Apr 7;10(4):e0004436. Epub 2016 Apr 7.

Infectious Disease Unit, Department of Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano State, Nigeria.

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http://dx.doi.org/10.1371/journal.pntd.0004436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824396PMC
April 2016

Knowledge and practices of infection control among healthcare workers in a Tertiary Referral Center in North-Western Nigeria.

Ann Afr Med 2016 Jan-Mar;15(1):34-40

Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.

Background: Healthcare acquired infections (HCAIs) otherwise call nosocomial infection is associated with increased morbidity and mortality among hospitalized patients and predisposes healthcare workers (HCWs) to an increased risk of infections. The study explores the knowledge and practices of infection control among HCW in a tertiary referral center in North-Western Nigeria.

Materials And Methods: This is a cross-sectional study. A self-administered structured questionnaire was distributed to the study group (of doctors and nurses). Data on knowledge and practice of infection control were obtained and analyzed. Study population were selected by convenience sampling.

Results: A total of 200 responses were analyzed, 152 were nurses while 48 were doctors. The median age and years of working experience of the respondents were 35 years (interquartile range [IQR] 31-39) and 7 years (IQR 4-12), respectively. Most of the respondents 174/198 (87.9%) correctly identified hand washing as the most effective method to prevent HCAI, with nurses having better knowledge 139/152 (91%) (P = 0.001). Majority agreed that avoiding injury with sharps 172/200 (86%), use of barrier precaution 180/200 (90%) and hand hygiene 184/200 (92%) effectively prevent HCAI. Only 88/198 (44.4%), 122/198 (61.6%), and 84/198 (42.4%) of the respondents were aware of the risks of infection following exposure to human immunodeficiency virus, hepatitis B virus and hepatitis C virus-infected blood, respectively. About 52% of doctors and 76% of nurses (P = 0.002) always practice hand hygiene in between patient care.

Conclusion: Gaps have been identified in knowledge and practice of infection control among doctors' and nurses' in the study; hence, it will be beneficial for all HCW to receive formal and periodic refresher trainings.
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http://dx.doi.org/10.4103/1596-3519.161724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452692PMC
July 2016

Effect of distance and delay in access to care on outcome of snakebite in rural north-eastern Nigeria.

Rural Remote Health 2015 22;15(4):3496. Epub 2015 Nov 22.

Department of Medicine, College of Health Sciences, Bayero University, Nigeroa.

Introduction: Snakebite envenoming is a major cause of morbidity and mortality in rural areas of the tropics. Timely administration of effective antivenom remains the mainstay of management.

Methods: The study was a quantitative descriptive study aimed at exploring the causes and effects of delay, distance and time taken to access care on snakebite outcomes in Nigeria. All prospective snakebite victims reporting to Kaltungo General Hospital were enrolled. Data on demography, date and time bitten, date and time admitted, site of bite, circumstances of snakebite, responsible snake, clinical features, 20-minute whole-blood clotting test, antivenom administered and outcome were recorded. Delay arising from use of traditional first aid (TFA), time elapsed from snakebite to presentation and the shortest distance from bite location to the hospital was calculated or obtained using a global positioning system.

Results: The association between delay before hospital presentation and poor outcome was not statistically significant, even though there was a 2% higher likelihood of poor outcome among those with a 1-hour delay compared to those without delay (odds ratio 1.02, 95% confidence interval 1.00-1.03). There was no difference in distance from bite location to hospital between those with a poor outcome (74) compared to those with a good outcome (325). Those with a poor outcome had more severe envenomation requiring more antivenoms and longer hospital stays. Given poor access to antivenom therapy at distant locations ≥100 km, victims were more likely to use TFA such as black 'snake' stone, with consequent prolonged delays. Antivenoms should be more readily available at distant places.

Conclusions: Community education on avoiding potentially harmful TFA and prompt access to care is recommended. There is a need to provide snakebite care to multiple peripheral, relatively more rural inaccessible areas.
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August 2016

Role of GeneXpert MTB/Rif Assay in Diagnosing Tuberculosis in Pregnancy and Puerperium.

Case Rep Infect Dis 2015 3;2015:794109. Epub 2015 Aug 3.

Infectious & Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, PMB 3452, Kano 700233, Kano State, Nigeria ; College of Health Sciences, Bayero University, Kano, PMB 3011, Kano 700241, Kano State, Nigeria.

Presentation of tuberculosis (TB) in pregnancy may be atypical with diagnostic challenges. Two patients with complicated pregnancy outcomes, foetal loss and live premature delivery at 5 and 7 months of gestation, respectively, and maternal loss, were diagnosed with pulmonary TB. Chest radiography and computed tomography showed widespread reticuloalveolar infiltrates and consolidation with cavitations, respectively. Both patients were Human Immunodeficiency Virus (HIV) seronegative and sputum smear negative for TB. Sputum GeneXpert MTB/Rif (Xpert MTB/RIF) was positive for Mycobacterium tuberculosis. To strengthen maternal and childhood TB control, screening with same-day point-of-care Xpert MTB/RIF is advocated among both HIV positive pregnant women and symptomatic HIV negative pregnant women during antenatal care in pregnancy and at puerperium.
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http://dx.doi.org/10.1155/2015/794109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538769PMC
September 2015
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