Muhammad Balogun

Psychosocial burden of caregivers of children attending Sickle Cell Clinic, Lagos, Nigeria, 2014

Introduction : sickle Cell Disease (SCD) is the most common genetic disorder amongst the black people and one of the major chronic non-communicable diseases affecting children. Nigeria accounts for more than 100,000 new births annually. The impact on the family is worse in developing countries because of inadequate social welfare and poor access to health care services. Our objectives were to determine the knowledge and attitude of caregivers of children with SCD towards the disease and the associated psychosocial burden.

Seroprevalence of rubella-specific antibodies and factors associated with its transmission among children aged 0-10 years, in Jos, Nigeria, 2016

Introduction : rubella infection during early pregnancy may result in congenital rubella syndrome (CRS), stillbirth or miscarriage. Children often are the source of infection to their mothers. Routine rubella vaccination is yet to be introduced in Nigeria. We determined the sero-prevalence of rubella-specific antibodies in school children 0 - 10 years and factors associated with its transmission in Jos. Methods : we conducted a cross-sectional study. We recruited children aged 0 - 10 years from five and 17 schools in Jos North and Jos South Local Government Areas (LGAs) respectively using a modified cluster sampling. Blood sample was collected from each child and analyzed for rubella IgG and IgM using ELISA. We administered a structured questionnaire to obtain socio-demographic and risk factors information from the participants. We conducted univariate, bivariate and multivariate analysis to determine proportions and significant factors at 95% confidence interval. Results : a total of 405 children were studied with a mean age of 6.3 years (SD ± 2.5), and 220 (54.3%) were females. Rubella IgG was positive in 336 (83.0%) of children while only 9 (2.2%) children were positive for IgM. None of the children had ever received rubella vaccine. On bivariate analysis, age ≥5 years, [OR (CI) 1.8 (1.0 - 3.1)], lack of western education, [OR (CI) 2.3 (1.2 - 4.3)] and residence in Jos North [OR (CI) 10.4 (3.2 - 33.9)] were significantly associated with rubella sero-positivity. On multivariate analysis, only residence in Jos North was significantly associated with rubella seropositivity. OR (CI) 10.4 (2.4 - 43.9). Conclusion : a large proportion of children were still susceptible to rubella virus infection. Children above five years, lack of western education and living in Jos North LGA were risk factors for rubella sero-positivity. Parents were enlightened on dangers of CRS and the need for rubella vaccine. The result of the study was shared with Plateau State to encourage fast tracking of introduction or rubella vaccination in Nigeria.

Prevalence of hypertension among patients with type 2 diabetes in Dutse, Jigawa State, 2015

Introduction : preventing complications is of paramount importance in the management of patient diagnosed with diabetes mellitus. High blood pressure (hypertension) is a risk factor for various diabetic complications. About 22 percent of the world population suffered from hypertension. In 2014, Africa has the highest prevalence of hypertension (30% for both sexes). The American Diabetes Association describe the combination of hypertension and type 2 diabetes as a lethal condition that increases person’s risk of having a heart attack or stroke. The aim of this study was to determine the prevalence of hypertension among patients with type 2 diabetes. Methods : we conducted a cross sectional study followed by a case-control study. For the cross sectional study, 385 type 2 diabetic patients attending Rasheed Shekoni Specialist Hospital, Dutse, were enrolled. For the case-control study, 80 patients were gender-matched with 80 controls. Probability sampling technique was used. Systolic and diastolic blood pressure, fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) were measured. Multivariate analysis was done with confidence interval set at 95%. Results : thirty five percent of the studied diabetics were hypertensive while only 23.75% of the controls were hypertensive. Mean FBG for the diabetic and control subjects were 9.32 and 4.18 mmol/L respectively. There was statistically significant difference (p 2 = 4.1, p 0.05). Furthermore, the risk of being hypertensive among the diabetic subject with poor glycaemic control was 1.4 times higher compared to that of those with good glycaemic control. Conclusion : one third of the diabetic patients in north-western Nigeria is hypertensive. A vigilant blood pressure check, coupled with efficient glycaemic control is therefore important in management of type 2 diabetic patient especially in those that are above forty years of age.

Epidemiological and demographic profile of patients with Noma in Nigeria, 1999 - 2015

Introduction : noma (Cancrum oris) is a severe acute gangrene of the tissues of the mouth and face that kills or disfigures its victims. Although rarely reported in developed countries, it is prevalent in sub-Saharan Africa. The incidence in Nigeria is estimated at 6.4 per 1000 children. We described the epidemiology and demographic characteristics of Noma surgical patients in Nigeria from 1999 to 2015. Methods : we conducted a retrospective descriptive study using two data sources. We obtained data on Noma surgical patients for 1999-2015 from Noma Children’s Hospital, Sokoto, Nigeria. Variables analyzed were age, sex, nationality, and location of patients. In addition, we reviewed the 2013 Nigeria Demographic and Health Survey to identify demographic characteristics of location of patients. Results : a total of 1,182 Noma surgical patients were reported with a mean age of 22.4 ± 13.4 years. Those of age group 10-14 years were 209 (17.7%) and constituted majority of patients. Males were 670 (56.7%). Nigerians were 1170 (99.0%) out of which 909 (77.0%) came from five states. There is no access to improved drinking water in 78.1% of households in Kebbi. There is no practice of principles of infant and young child feeding in 99% of households in Zamfara. In Sokoto, 78.5% of females six years and above have no education. In Kano, 74.7% of children had not received measles immunization. In Katsina, 80.2% of households do not have soap and water for hand washing. Conclusion : most patients came from five states in Northwest Nigeria. Northwest Nigeria has demographic risk factors that promote Noma. Access to safe drinking water, good child feeding practices, education of people to improve health seeking behavior, supplementary immunization and good oral and general hygiene should be improved in these areas.

Prevalence of confirmed malaria and uptake of malaria control intervention services among antenatal care attendees in Kaduna State, Nigeria: 2011 - 2016

Introduction : malaria threatens the lives of pregnant mothers, fetuses, and infants. Approximately 25 million pregnant women are at risk of Plasmodium falciparum Malaria in Africa and it contributes to an estimated 11% maternal mortality. Control efforts have reduced Malaria prevalence over the years, yet Nigeria suffers the highest global burden, with approximately 51 million cases and 207,000 deaths annually. We described the trend of Malaria among women attending Antenatal Care (ANC) clinic and their access to preventive intervention services. Methods : descriptive study design was used. Malaria transmission is mesondemic in Kaduna State and intervention funding are provided by government and non-governmental organizations, such as Global Fund. We retrieved the State Malaria data from District Health Information System (DHIS2). Data was analyzed with MS Excel 2013 to determine the prevalence and trend of confirmed Malaria cases among ANC attendees, their access to Intermittent Preventive Treatment (IPT2) and Long Lasting Insecticidal Nets (LLINs). Results : confirmed Malaria among ANC attendees rose from 9% in 2011 to 14 % in 2012. Proportion of confirmed malaria among ANC attendees then dropped from 2013 (5.76%) but spiked in 2015 (5.6%). There was a steady decline in the trend from 2011 to 2016. Only 14% of all ANC attendees received LLINs from 2011 to 2016 with the lowest proportion (2%) in 2011 and the highest (20%) in 2014. The average IPT2 uptake over the review period was about 21% (target 100%), with a low of 3% in 2011 and a high of 22% in 2015. Inconsistencies were observed in the ANC data for the year 2013. Conclusion : prevalence of confirmed Malaria reduced among ANC attendees in Kaduna State with increase in LLIN coverage. Despite the progress made, the State is yet to meet the LLIN and IPT2 uptake targets of the National Malaria Control Program for pregnant women. We recommended that the State government should ensure constant availability of intervention commodities to increase LLIN and IPT2 uptake as well as improved supportive supervision to ensure quality data in the State.

Assessment of possible healthcare associated infection pathogens at a military hospital, Lagos State, Nigeria, November, 2015

Introduction : healthcare associated infection (HCAI) are infections among patients in hospital setting that become manifest only after 48hrs of hospital stay, which are caused by pathogens acquired in healthcare settings. Usually, HCAI are infections of urinary tract, surgical wounds, and the lower respiratory tract. They are a major cause of death and increased morbidity in hospitalized patients. In November, 2015, we assessed the prevalence of possible nosocomial pathogens at a military hospital in Lagos State, Nigeria. Methods : hospital areas such as theatre, treatment room, nurses’ station, male surgical ward, vital signs room, accident and emergency room, labour room, and post-natal ward were randomly sampled for the survey. We collected swabs specimens from specific sites such as table tops, faucets, door handles, beddings and equipment using sterile swab sticks. The swabs were inoculated on nutrient, chocolate and McConkey agar plates and incubated at 37⁰C for 24hrs. We characterized isolates by Gram reaction and biochemical methods. Results : out of the 83 sites cultured, 31(37.3%) yielded significant growth. Organisms isolated include Staphylococcus epidermidis (32.2%), Staphylococcus aureus (22.6%), Escherichia coli (12.9%), Klebsiella pneumoniae (9.7%), Streptococcus pyrogenes (9.7%), Aspergillus spp. (9.7%) and Proteus mirabilis (3.2%) were isolated. These isolates were from sterile and non-sterile sites, fomites and hospital equipment. Non-sterile sites were less likely to have microbial growth when compared with sterile sites; (Odds ratio: 0.78, CI: 0.20 - 3.03). However, this association was not statistically significant. Conclusion : possible pathogens for HCAI were isolated from vital sections of the hospital. Organisms isolated pose risk to sterile procedures and patients care with attendant burden on their recovery. We educated the hospital community on the importance of hand washing with soap and recommended adherence to regular sterilization and disinfection procedures of relevant sites where patient care is administered towards reduction of healthcare associated pathogens.

Trends and patterns of pertussis morbidity and mortality in Bauchi State, Nigeria: 2011 - 2015

Introduction : globally, there are estimated 16 million pertussis cases and about 195,000 deaths occur in children every year. Despite generally high coverage with childhood pertussis vaccines globally, pertussis is one of the leading causes of vaccine-preventable deaths worldwide. Most deaths occur in young babies who are either unvaccinated or incompletely vaccinated. In Nigeria national estimate for DPT coverage in 2013 was 38% and State level coverage ranged from 3% - 76% across 20 northern states. Pentavalent vaccine was the most effective means of preventing Pertussis and is given in three doses at 6 weeks, 10 weeks and 14 weeks of age. We analyzed five-year pertussis morbidity and mortality trend from Bauchi State. Methods : Bauchi State is situated in the north eastern geopolitical zone having 20 Local Government Areas. We retrieved and analyzed Integrated Disease Surveillance and Response (IDSR) monthly records of pertussis cases and deaths in Bauchi State over a five-year period (2011-2015). The IDSR data are collected from health facilities across the state by all the 20 LGA disease surveillance and notification officers routinely, and sent to the state where it is collated, analyzed and sent to the Federal Ministry of Health and other relevant stakeholders. Univariate analysis was carried out using Microsoft office excel to calculate rates. Results : occurrence of cases of pertussis in Bauchi State decline from an attack rate of 0.025% in 2011 to 0.005% in 2015. Highest number of cases was recorded between the months of October and September. Children age 12 - 59 months were the most affected followed by those aged 5-9 years, while neonates were the least affected and it has been observed that all age groups were affected. Pertussis death was only recorded in 2012 (CFR 0.3%) and 2014 (CFR 0.1%) out of the five years under review. Conclusion : children 12 - 59 months are the most affected age group and pentavalent vaccine coverage is still low, we therefore recommended periodic catch up immunization with pentavalent vaccine to children older than one year of age.

Outbreak of poliomyelitis in a previously Polio-Free State in Nigeria, 2013

Introduction : globally, Nigeria is one of the three polio endemic countries. Taraba State reported two confirmed wild polio virus type 1 (WPV 1) cases between April-May, 2013. The cases were in settlements 2 - 3 kilometers apart. The state last reported WPV 1 in 2008. We conducted an outbreak investigation of Poliomyelitis to determine the factor(s) that contributed to the re- emergence of WPV 1 and to assess the extent of spread of the cases.

Evaluation of malaria surveillance system in Ogun State, Nigeria: 2011 - 2015

Introduction : an estimated 3.2 billion people worldwide are at risk of having Malaria and sub-Saharan Africa carries the highest burden. Nigeria has 97% of her population at risk of Malaria and accounts for 32% of global Malaria deaths. Ogun State is endemic for Malaria with a prevalence of 62.7%. Effective Malaria Surveillance System is crucial to the control and elimination of Malaria. We evaluated the Malaria Surveillance System in Ogun State to describe its attributes. Methods : we evaluated the system using the “Centers for Disease Control’s updated Guidelines for Evaluating Public Health Surveillance Systems, 2001”. We did a retrospective review of Malaria specific data in Integrated Disease Surveillance and Response (IDSR) case summary forms from 2011 to 2015. We conducted descriptive analysis of cases using Microsoft Excel. Six key stakeholders were interviewed and a semi-structured questionnaire was administered to the 40 surveillance officers (SOs) in the State. Results : thirty-seven (93%) of the SOs reported that changes in the data capture tools and case management have been accommodated. Case definitions were understood by 40 (100%) of the SOs. Thirty-five (88%) of the SOs reported that the system was simple. All the Stakeholders interviewed and 38 (95%) of the SOs reported that the system was acceptable. Data was essentially from public health facilities excluding those from tertiary and private health facilities and thus not representative. Thirty-five (88%) SOs reported that data quality was enhanced by quarterly supportive supervision. There was late reporting among 100 (20%) of the 477 health facilities. Only 60% of the health facilities reports were timely which is below the State’s 80% target. Conclusion : malaria surveillance system in Ogun State is simple, flexible, and acceptable. The data from the system is not representative .We recommended involvement of the tertiary and private health facilities in the State to enhance representativeness and improve data quality.

Evaluation of acute flaccid paralysis surveillance system, Sokoto State, Nigeria: 2012 - 2016

Introduction : Nigeria is one of the three countries where transmission of wild polio virus (WPV) still occurs. Transmission occurs only in the northern part of the country. We evaluated the Acute Flaccid Paralysis (AFP) Surveillance system to assess the attributes of the system in Sokoto State, Northern Nigeria.