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Background Rapid diagnostic tests are frequently used in healthcare settings across Nigeria for diagnosis of Plasmodium falciparum malaria, which is the commonest form of malaria in the country. In this study, the performance of a rapid diagnostic test (RDT) was compared with expert microscopy using the polymerase chain reaction (PCR) as the reference standard in a tertiary hospital in Jos, Nigeria. Methods This study was a prospective, cross-sectional, hospital-based study. A total of 200 participants of all ages presenting to Jos University Teaching Hospital with a history of fever or an axillary temperature of >37.5°C were recruited. Blood specimens were collected and malaria testing was done using RDT, microscopy and PCR. Results The prevalence of malaria in this study was 17%, 15% and 13% by PCR, microscopy and RDT, respectively. Compared with microscopy, RDT had lower sensitivity of 75% (95% CI: 56.60-88.54) vs 88.24% (95% CI: 72.55-96.70), lower specificity of 98.80% (95% CI: 95.72-99.85) vs 100.0% (95% CI: 97.80-100.0), lower positive predictive value 92.31 (95% CI: 74.89-97.97) vs 100 (95% CI: 98.0-100.0), and lower negative predictive value 95.35 (95% CI: 91.83-97.39) versus 97.65 (95% CI: 94.30-99.05). Conclusion The diagnostic performance of expert microscopy was better than RDT in the diagnosis of Plasmodium falciparum malaria. Quality assurance procedures such as using expert microscopy to cross-check a proportion of RDT negative results in patients with clinical features of malaria is desirable.

Background The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. Methods An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. Results The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88). Conclusions Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.

Background: Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. Methods: This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. Results: A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. Conclusions: The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.

Background and ObjectivesMeasuring head circumference (HC) of newborns is an important tool for evaluating intra-uterine brain development. HC reference charts currently in use in Nigeria are not representative of the local population. We thus present locally derived HC reference data for Nigerian infants at birth.Subjects and MethodsWe reviewed birth records of all infants at the Jos University Teaching Hospital (JUTH) over a 10 year period from January 2006. JUTH is a tertiary care center offering obstetric services to a large population of women in Jos and its environs. All births with gestational age between 28 and 42 weeks were included in the study. STATA version 14 was used to calculate gestational age associated HC percentile measurements.ResultsWe included 18 282 babies to generate the reference values. The mean HC value was 34.4 ± 2.1 cm (M = 34.6 ± 2.16 cm, F = 34.1 ± 2.02 cm, p ConclusionsThe use of our locally derived HC reference values could be more appropriate in defining normal head growth in Nigerian infant populations thereby improving newborn care.

Lassa fever (LF) outbreaks in Nigeria mostly occur in rural areas and during the dry season, peaking between December through February. Fever is a cardinal presenting feature among the myriad manifestations of LF. Thirty four patients with clinical diagnosis of LF were analyzed. However, only 11 (32%) LASV infections were confirmed by RT-PCR. The 2016 LF outbreak showed a preferential urban occurrence and a high case fatality. Fever (≥38°C) was not detected in over a fourth of the patients at the time of examination. Bleeding diathesis was the most common presentation while abdominal pain and headache were present in more than half of the confirmed cases. Changes in the geographical distribution and clinical presentation may have implications for disease control efforts and the risk of transmission, both locally and internationally. In order to guide interventions, public health authorities should be aware that the epidemic patterns may be changing.

The association of Zika virus (ZIKV) infection with congenital malformation and neurological sequelae has brought significant global concern. Consequently, the World Health Organization (WHO) declared it "a public health emergency of International concern" on 1 February, 2016. A critical review of its pathogenesis would lead to a better understanding of the clinical features and the neurological complications. This review is based on literature search in PubMed/Medline, Google Scholar and the WHO, http://www.who.int. This include all relevant articles written in English published through June 2018, with subject heading and keywords such as Zika, ZIKV, Zika pathogenesis, diagnosis of Zika, Zika Nigeria, Zika Africa and Zika resource-limited settings. Following ZIKV infection, viraemia ensues targeting primarily the monocytes for both the Asian and African strains. ZIKV infection by an African strain appears to be more pathogenic, in early pregnancy tends to result in spontaneous abortion. Whereas an Asian strain tends to be less pathogenic and more chronic, this allows the pregnancy to continue, ultimately resulting in congenital malformations. There is no routine laboratory diagnosis of ZIKV infection in resource-constrained countries. Serologic tests should be interpreted with caution since there can be cross-reactivity with other flaviviruses, especially in Africa where the burden of infection with flaviviruses is comparatively high. There is a paucity of well-equipped laboratories for comprehensive ZIKV diagnosis. It is imperative to strengthen the health systems, improve health workforce and diagnostic capacity of such settings.

Nosocomial infections pose a great challenge on healthcare systems. Although surfaces in neonatal wards, umbilical stump wounds and catheter are responsible for a high number of nosocomial infections due to bacteria. The aim of this study was to determine the bacterial profile of air and surface contamination in the special care baby unit of a tertiary hospital in Jos, Nigeria.Surface and air samples were cultured and antibiotic susceptibility of isolated bacteria were determined.The bacterial profile of air and surface samples showed that Klebsiella was the most common bacteria followed by Staphyllococcus; while the least was Escherichia. Most of the bacteria were isolated from the out-born term area of the special care baby unit. All the bacteria isolated were susceptible to ceftriaxone and meropenem.This study showed that all areas of the special care baby unit of the hospital have bacterial, indicating that these are a potential source of cross-infection from healthcare workers to the neonatal patients.

Background Zika virus (ZIKV) has been known for decades in Africa but contemporary data is lacking at large. Objectives To describe the seroepidemiology of ZIKV in North Central Nigeria. Study design We performed a cross-sectional study at six health care facilities in North Central Nigeria from January to December 2016. Detection of ZIKV antibodies was done using an anti-ZIKV recombinant non-structural protein 1 (NS1)-based ELISA. A colorimetric assay to detect ZIKV neutralizing antibodies was used on ELISA reactive and randomly selected ELISA non-reactive samples. ZIKV real-time RT-PCR was done on a subset of samples. Results A total of 468 individual samples were included with almost 60% from pregnant women. Using NS1-based ELISA, an anti-ZIKV positive rate of 6% for IgM and 4% for IgG was found. Pregnant women showed anti-ZIKV positive rates of 4% for IgM and 3% for IgG. None of the ZIKV antibody positive samples tested ZIKV RT-PCR positive. An association with male sex was found for anti-ZIKV IgG ELISA positivity (prevalence ratio 3.49; 95% confidence interval: 1.48–8.25; p = .004). No association with pregnancy, yellow fever vaccination or malaria was found for anti-ZIKV IgM or IgG positivity. ZIKV neutralizing antibodies were detected in 17/18 (94%) anti-ZIKV NS1 positive/borderline samples and in one sample without detectable ZIKV NS1 antibodies. Partial ZIKV E gene sequence was retrieved in one sample without ZIKV antibodies, which clustered within the West African ZIKV lineage. Conclusions Our results show a largely ZIKV immunologically naive population and reinforce the importance of ZIKV surveillance in Africa.

Background In Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic. Methodology Blood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears. Results The prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result. Conclusion Although the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.

We compared two techniques for CD4 T-lymphocyte counting: flow cytometry (Cyflow) and magnetic beads (Dynabead). Similar results with good correlation were obtained from the 40 adult blood samples counted ( P = 0.057, r = 0.93). The Cyflow technique is more precise and cost-effective than the Dynabead method ($3 to $5 versus $12 to $22 per test, respectively), since as many as 200 samples can be measured per day.

Vaginal douche products have been associated with cervical cancer. We examined female sex workers (FSWs) in Nigeria who douche with lemon or lime juice and compared the findings with that of nonusers. We obtained Pap smears and performed colposcopy of the vulva, vagina and cervix. A total of 374 FSWs comprising 81 Lemon users (LUs) and 293 non lemon users (NLUs) were examined. Their mean age was 27.8 +/- 6.7 (range 16-63) years. At colposcopy, 17 (4.5%) had genital warts [LUs 5 (6.2%); NLUs 12 (4.1%); p=0.43], 61 (16.3%) had suspected squamous intraepithelial lesions (SILs) [LUs 17 (21.0%); NLUs 44 (15.0%); p=0.20] and 65 (17.4%) had other findings. Pap smear cytology showed that 87 (24.6%) had SILs [LUs 26 (33.3%); NLUs 61 (22.1%); p=0.03]. Lemon/lime use was associated with cervical dysplasia after controlling for HIV status (Adjusted OR=1.8; 95% CI, 1.0-3.0). Our data suggests an association between the practice of douching with citrus juice and cervical dysplasia.

While resistance to older antimalarials is increasingly common, newer antimalarials are still not widely available or affordable in much of Africa. Older antimalarials used in combination might be adequately effective in treating uncomplicated malaria. The objective of this study was to determine whether the combination of sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) is superior to SP alone in the treatment of uncomplicated Plasmodium falciparum malaria in Nigerian patients. We recruited subjects with malaria, defined as the presence of fever and parasitemia2,000/microL, from the outpatient department of a Nigerian teaching hospital. We alternately assigned 280 subjects to receive SP with or without CQ. We assessed clinical and parasitologic responses on days 1, 2, 3, 7, and 14. A total of 114 in the SP + CQ group and 116 in the SP group completed the study. By day 3, 97 (75%) in the SP + CQ group and 52 (42%) in the SP group had cleared their parasitemia (P0.001); by day 14, 112 (98%) and 67 (58%), respectively, had cleared their parasitemia (P0.001). By day 3, 82 (63%) in the SP + CQ group and 20 (16%) in the SP group were symptom free (P0.001). When a modified World Health Organization clinical classification system was used, adequate clinical response occurred in 99 (87%) and 61 (53%) of those in the SP + CQ and SP groups, respectively. RI, RII, and RIII resistance to SP + CQ was 7.9%, 3.5%, and 1.8%, respectively, whereas resistance to SP was 23%, 17%, and 5%, respectively. Combined SP + CQ is superior to SP alone for treatment of uncomplicated malaria in Nigerian patients and may prolong the usefulness of these readily available and affordable drugs.

Background In Plasmodium falciparum-infected children, the relationships between blood cell histopathology, blood plasma components, development of immunocompetence and disease severity remain poorly understood. Blood from Nigerian children with uncomplicated malaria was analysed to gain insight into these relationships. This investigation presents evidence for circulating neutrophil extracellular traps (NETs) and antinuclear IgG antibodies (ANA). The presence of NETs and ANA to double-stranded DNA along with the cytokine profiles found suggests autoimmune mechanisms that could produce pathogenesis in children, but immunoprotection in adults. Methods Peripheral blood smear slides and blood samples obtained from 21 Nigerian children under six years of age, presenting with uncomplicated malaria before and seven days after initiation of sulphadoxine-pyrimethamine (SP) treatment were analysed. The slides were stained with Giemsa and with DAPI. Levels of the pro-inflammatory cytokines IFN-γ, IL-2, TNF, CRP, and IL-6, select anti-inflammatory cytokines TGF-β and IL-10, and ANA were determined by immunoassay. Results The children exhibited circulating NETs with adherent parasites and erythrocytes, elevated ANA levels, a Th2 dominated cytokine profile, and left-shifted leukocyte differential counts. Nonspecific ANA levels were significant in 86% of the children pretreatment and in 100% of the children seven days after SP treatment, but in only 33% of age-matched control samples collected during the season of low parasite transmission. Levels of ANA specific for dsDNA were significant in 81% of the children both pre-treatment and post treatment. Conclusion The results of this investigation suggest that NET formation and ANA to dsDNA may induce pathology in falciparum-infected children, but activate a protective mechanism against falciparum malaria in adults. The significance of in vivo circulating chromatin in NETs and dsDNA ANA as a causative factor in the hyporesponsiveness of CpG oligonucleotide-based malaria vaccines is discussed.

Objective: To describe the use of lemon/lime juice for douching by female sex workers (FSWs) and family planning clients (FPCs) in Jos, Nigeria. Method: A total of 300 sexually active women comprising 200 FSWs and 100 FPCs were interviewed in June 2004 to determine the mode and rationale for the use of lemon/lime juice for sex. Result: Majority of the women 167/300 (55.7%, 95% CI = 50–61%) i.e. 163/200 (81.5%, 95% CI=75–87%) FSWs, 4/100 (4%, 95% CI=1–10%) FPCs used vaginal lemon/lime douches. Lime juice was used by 105/167 (62.8%, 95% CI=55–70%), lemon juice by 30/167 (18%, 95% CI=12–25%) or a mixture by 18/167 (10.8%, 95% CI=7–25%). The juice was used either neat 44/167 (26%, 95% CI=20–34%) or diluted in water 75/167 (45%, 95% CI=37–53%) either before or after sex. Nineteen per cent (32/167) found the juice painful. Over half of the women believed that it protected them from pregnancy and/or sexually transmitted infections; they did not know their HIV status. Eighty-six per cent would recommend it to others, and 71% would be willing to take part in a study to evaluate its safety and efficacy. Conclusion: Lemon and lime juice are widely used for douches among women at high risk of HIV transmission. There is an urgent need to determine whether or not this practice promotes or prevents HIV infection.

BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses from eight PHCs were trained on this new strategy. The training included: identification of STDs use of flow charts patient education and counseling clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training about 731 clients were attended to 451 (61.7%) had signs and symptoms of various STDs (genital discharge genital ulcer genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.