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Aim: The aim of this study was to determine the prevalence of GBS serotype distribution in Jos University Teaching Hospital. Materials and Methodology: This was a hospital based descriptive cross-sectional study of 300 women receiving health care at the Jos University Teaching Hospital between July 2017 and November 2017. Systematic sampling technique was employed in recruiting consenting subjects for this study. High vaginal and anorectal swabs were collected from each subject after obtaining their consent by signing a structured consent form. The identified Streptococcus agalactiae (GBS) isolates were serotyped using immuLex strep-B antisera from SSI Diagnostica, 2 Herredysvejen, DK-3400 Hillerod Demnark to identify the different serotypes. The results obtained were computed using SPSS version 21. Results: A total of 300 women obtaining health care in Jos University Teaching Hospital (JUTH) were enrolled in this study between the months of July, 2017 and November, 2017. In all, vaginal and anorectal swabs were taken from 200 pregnant women and 100 non-pregnant women. The age range of the study population was between 16 years to 48 years with a mean age of 31.9 year (SD ± 6.6). The prevalence rate among the study population was 6.3%. The colonization rate among pregnant and non-pregnant women was 6.5% and 6.0% respectively with no significant statistical difference. Serotype Ia was the commonest isolate responsible for 42.1% of the GBS isolates. Serotype III accounted for 31.6% of the isolates, followed by serotype V (15.8%). Serotype II was less common, responsible for only 10.5%. Conclusion: This study showed that GBS colonization rate among the study population was 6.3%. Approximately, 6.5% and 6.0% prevalence rate were found among pregnant and non-pregnant women respectively. Of all the GBS isolates, serotypes Ia, II, III, and serotype V were isolated with serotype Ia being the most prevalent serotype. This knowledge of serotype distribution will help in instituting serotype specific GBS vaccines for the prevention of GBS diseases in Jos.

Aim: The aim of this study was to determine the prevalence of GBS colonization among HIV positive and HIV negative pregnant women in relation to CD4 cell counts. Materials and Methodology: This was a hospital based descriptive cross-sectional study of 200 pregnant women (100 HIV positive and 100 HIV negative) and 100 non-pregnant women (50 HIV positive and 50 HIV negative) obtaining health care at the Jos University Teaching Hospital between July 2017 and November 2017. Systematic sampling technique and written informed consent were used in recruiting subjects for this study. High vaginal and anorectal swabs were collected from each subject after filling a structured questionnaire. CD4 cell count was also done for all the HIV positive patients at Aids Prevention Initiative in Nigeria (APIN) of Jos University Teaching Hospital (JUTH). The results from the laboratory analysis of the specimens were computed using SPSS version 21. Results: A colonization rate of 7.3% was observed in HIV positive patients compare to 5.3% in HIV negative. The different in colonization rate between the two groups was not statistically significant (X2 = 0.507; P = 0.477) (Table 1). In pregnant women living with HIV, colonization rate was 8.0% compare to 5.0% observed in non-pregnant women living with HIV. This however, was not statistically significant (Table 2) (χ2 = 0.013; P = 0.908). HIV positive subjects with low CD4 counts (

Purpose: Knowledge of the prevalence of HPV infection among adolescents is essential to determining the best age for introduction of HPV vaccine, monitoring vaccine efficacy and giving insight into determinants of persistent high-risk HPV infection, a necessary cause of cervical cancer. Yet, there’s been limited studies in low-and-middle-income countries.Methods: In this cross-sectional study, we randomly selected 205 girls, aged 9–20 years, from 10 schools. We obtained informed consent and assent, collected data and trained participants who self-collected vaginal samples using swab stick. We genotyped HPV using SPF10-DEIA/LiPA25 and analyzed data using Stata 14®.Results: The mean (SD) age of the girls was 14.9 (2.3) years. We found HPV in 13.2% of vaginal swabs. The earliest age at which anyHPV and hrHPV infections were detected was 10 and 12 years respectively. The prevalence of any HPV peaked at 16 and 17 years, hrHPV at 16 years, lrHPV at 17 and 18 years and multiple hrHPV 18 years of age. The prevalence of hrHPV infection was 1.5% among the 9–12 years age group, 2.9% among 13–16 years and 3.4% among 17–20 years old. The commonest hrHPV types detected were 52 (3.9%), 18 (1.5%) and 51 (2.4%). The most common lrHPV types was 6 (2.9%).Conclusion: The prevalence of HPV infection in these urbanized young girls in Nigeria is high and commences after 9 years of age. HPV vaccination in this population should start at 9 years of age or younger to prevent establishment of persistent HPV infection.

Background The success of any tuberculosis (TB) control/intervention programme hinges on the understanding of transmission dynamics of TB within that setting. However, there is paucity of data in high disease burdened countries like Nigeria on the associated risk factors of childhood TB and this supports the need for this research. Objective This study was undertaken to determine the prevalent associated risk factors of childhood pulmonary TB in a high diseased burdened setting. Subjects and method We carried out a cross sectional study among children aged 18 months to 15 years in six selected health facilities in Nasarawa State, Nigeria. The subjects were screened for pulmonary TB using chest X-ray, sputum or gastric aspirate acid-fast bacilli microscopy and mycobacterium culture. They were also screened for HIV infection. Detailed information was taken regarding history of contact with adult TB source case, house-hold contact, duration of contact, house-hold size, number of people sleeping in a room, cross ventilation, BCG immunization, socio-economic, educational and HIV status of parents, and ingestion of unpasteurized milk and chronic illness other than TB. The subjects had physical examination for BCG scar and nutritional status. Results A total of 150 subjects were selected for the study with mean age of 9.12 ± 4.66 years and median age of 10.0 years. The prevalence of definite TB cases found among them was 32% which is 5.5 times higher than the reported national average. The risk factors associated with pulmonary TB include lower socioeconomic status (79.2%), history of contact with an adult TB case source (72.9%), overcrowding (72.9%), absence of cross ventilation (68.8%), ingestion of unpasteurized milk (45.8%) and severe malnutrition among children under five using MUAC parameter (12.5%). The most significant independent predictors of TB in children were absence of cross ventilation (OR = 3.27), contact with adult source case (OR = 2.91) and overcrowding (OR = 2.30). Conclusion Absent of cross ventilation, contact with adult source case and overcrowding are the most significant predictors of pulmonary TB in children. Although ingestion of unpasteurized milk is a significant predictor and important source of TB, it is not a major source of TB transmission when compared to contact with adult source case (Open TB).

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.

Extended Spectrum Beta Lactamase (ESBL) producing Escherichia coli is a global cause of life threatening infections. We determined the presence of ESBL and carbapenemase production in clinical isolates of E. coli and their antibiotic susceptibility. Clinical isolates of community and hospital acquired E. coli from 220 patients seen at a tertiary hospital were evaluated. Antibiotic susceptibility testing was by the modified Kirby-Bauer protocol while ESBL production was determined by the Double Disk Synergy Test (DDST). Carbapenem resistance was confirmed by the Modified Hodge Test. Of the 220 isolates, 122 (55.5%) were from females; 41 (18.6%) were ESBL positive. About 90% of the ESBL producing isolates were resistant to nine of the 15 antimicrobial agents tested. However, only one (2.4%) of the 41 ESBL producing isolates exhibited carbapenem resistance. The ESBL negative isolates were susceptible to Meropenem (100%), Cefepime (97.8%), Ceftriaxone (96.6%) and Cefotaxime (96.6%). All the ESBL producing isolates harbored detectable plasmids with sizes ranging from 2322 to 23,130 base pairs. Our findings show that although multidrug resistant ESBL producing E. coli are prevalent in both the hospital and the community in this environment, carbapenem resistance is still low. We recommend that institutions develop guidelines for the early phenotypic detection of ESBLs and carbapenem resistance.

Background: Group B Streptococcus agalactiae (GBS) has been established as a normal flora of the gastrointestinal tract from where it continually colonizes the vagina and serves as a potential cause of neonatal infections. This necessitated this study to determine the carriage rate among pregnant women. Aim: The aim of this study was to determine the anogenital colonization and antibiotic susceptibility of Streptococcus agalactiae isolates from women receiving health care at the Jos University Teaching Hospital (JUTH). Materials and Methodology: This was a hospital based descriptive cross-sectional study of 200 pregnant women and 100 non-pregnant women attending antenatal clinic (ANC) and Gynaecology clinic at the Jos University Teaching Hospital respectively, between July 2017 and November 2017. High vaginal and anorectal swabs were collected from the subjects. The specimens were cultured and antibiotic susceptibility testing of the GBS isolates determined. The results obtained were analyzed using SPSS version 21. Results: The age range (standard deviation) of the pregnant women was between19-48(±7.2) years with an average age of 31.2 years. The overall prevalence rate of GBS among the study participants was 6.3%. Pregnant and non-pregnant women were positive in 6.5% and 6.0% respectively. The highest colonization rate was found in the maternal age-group 16-20years (11.1%), followed by age-group>40years (10.0%). Low colonization rate of 2.2% was observed among maternal age group 36-40years.Of the 100 non-pregnant women recruited as control for this study, they had age range of 16 years to 48 years with a mean age of 33.4 years (SD ± 6.1). Approximately, 6.0% of the 100 non-pregnant women enrolled were cultured positive for GBS colonization. There was no statistically significance between GBS colonization between the pregnant and non-pregnant women. All the Isolates were sensitivity to penicillin, erythromycin, and clindamycin while 5.3% were resistant to ampicillin, 10.5% to ceftriaxone and 21.1% to vancomycin. Conclusion: This study showed that GBS colonization rate among the study population was 6.3%. Approximately, 6.5% and 6.0% prevalence rate was found among pregnant and non-pregnant women respectively. All the isolates were sensitive to penicillin, erythromycin and clindamycin. A total of 21.5% of the isolates were resistant to vancomycin. Ceftriaxone and ampicillin resistant was demonstrated in 10.5% and 5.3% respectively. Keywords: Streptococcus agalactiae , colonization rate, pregnant women, antibiotic susceptibility

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.

Malaria was thought to be rare in neonates. However, recent studies report increasing prevalence in neonates. Clinical features of neonatal malaria have also not been adequately reported. This study was undertaken to assess the prevalence, clinical features and outcome of malaria in neonates admitted into two tertiary hospitals in Jos, Plateau State. All consecutive neonates aged 0 - 28 days admitted into the neonatal units of Jos University Teaching Hospital and Bingham University Teaching Hospital, Jos were recruited into the study. Giemsa stained blood films of the neonates were examined by trained microscopists. Neonates with malaria had presenting clinical features recorded and treated with amodiaquine (1st line) and quinine (2nd line). Clinical features and parasitaemia were monitored for 14 days for outcome. Of the 301 neonates enrolled, 16 had malaria parasitaemia giving a prevalence of 5.3%. Congenital malaria accounted for 87.5% of cases of neonatal malaria. Plasmodium falciparum mono-infection was responsible for all the cases of malaria. ITN use in pregnancy offered some protection against neonatal malaria (CI=0.2 - 0.7). The median parasite density was 255 (72, 385) parasites/μl. Fever was significantly present in 10 (66.7%) of the cases (p=0.03). Fifteen of the 16 neonates had clinical and parasitological cure on treatment with amodiaquine. One treatment failure had cure after retreatment with quinine. There was no mortality in all 16 neonates treated for malaria. Malaria is not rare in neonates on admission in Jos. Fever is the commonest clinical feature of neonatal malaria. Amodiaquine provided effective treatment of malaria in neonates in Jos.

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 and Aims: Neonatal sepsis is an important cause of morbidity and mortality in Nigeria and in most parts of the world. Consequently, we determined the prevalence of the common bacterial pathogens of neonatal sepsis, their antibiotic susceptibility profiles, antibiotic regimen used in treatment and their clinical outcomes in a resource limited environment. Study Design: This was a prospective cross sectional study. Place and Duration of Study: Study was conducted in the Special Care Baby Unit (SCBU), Original Research Article Onyedibe et al.; BJMMR, 7(7): 567-579, 2015; Article no.BJMMR.2015.363 568 Department of Paediatrics and the Department of Medical Microbiology of Jos University Teaching Hospital (JUTH), Jos, Nigeria between May to December 2011. Methodology: Biological samples were collected from 218 neonates suspected of sepsis (119 male, 99 female). The WHO and the Integrated Management of Childhood Illnesses (IMCI) criteria for suspicion of sepsis were used to select subjects into the study. Samples were processed and analyzed by standard methods in the microbiology laboratory. Antibiotic susceptibility testing was done. The antibiotic regimen used for therapy and subsequent clinical outcomes were documented. Results: Prevalence of culture proven sepsis was 34.4% (75/218). The common isolates were Klebsiella pneumoniae (32%), Staphylococcus aureus (30.7%) and Escherichia coli (10.7%). More than 60% of the K. pneumoniae isolates were resistant to the antibiotics tested. The E. coli and Enterobacter isolates were 100% sensitive to meropenem. The Gram positive isolates were most sensitive to ciprofloxacin (85%). Resistance of S. aureus was 6% to cefotaxime and 61% to ampicillin. A total of 173 (79.4%) neonates were discharged home, 15 (6.8%) were discharged against medical advice and 30 (13.8%) died on admission. The antibiotic regimen with the least mortality was a combination of ciprofloxacin and gentamicin. Conclusion: The cultures in this study showed variable antibiogram with complicated patterns of resistance. In all cases of suspected neonatal sepsis, we recommend culture and sensitivity tests to identify the causative pathogen and initiate specific antibiotic therapy. However, cefotaxime in combination with gentamicin is recommended as first line empirical therapy.

BACKGROUND: Candida albicans are widely isolated fungal yeast agents from clinical samples. Several storage methods for fungi have evolved overtime and they are not without setbacks. Preservation method is critical for research,training and teaching.In resource–poor setting,the method to employ must be cheap and easy to maintain with minimal risk of contamination as well as degeneration of the organisms.We thus,set out to study the stability of Candida albicans over long and short term storage in a resource-limited setting.METHODS: One hundred Candida albicans strains isolated from patients with vulvovaginal candidiasis and oral candidiasis were preserved in triplicates using sterile distilled water,Chromagar plate,mineral oil overlay and brain heart infusion broth plus 10% glycerol at -20OC.Recovery rates were determined at six months,12 months and 18 months by sub-culturing onto sabouraud dextrose agar.RESULT: The recovery rate of C. albicans was 100% for all the preservation methods used during the six months storage,mineral oil overlay and brain heart infusion broth plus 10% glycerol for the 12months storage,and only the brain heart infusion broth plus 10% glycerol during the 18months storage.CONCLUSION: Candida albicans can be preserved over long period of time in resource- limited setting where power supply is erratic using brain heart infusion broth plus 10% glycerol at -20OC and mineral oil overlay technique whereas for short term preservation, sterile distilled water and taped culture plates technique can be used. Preservation of Candida albicans isolates in resource- limited setting over short or long term period is possible and affordable depending on the technique employed.KEYWORDS: Candida albicans, preservation, sterile distilled water, Chromagar plate, mineral oil overlay, brain heart infusion broth.

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.

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 parasitemia > 2,000/μL, 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 (P < 0.001); by day 14, 112 (98%) and 67 (58%), respectively, had cleared their parasitemia (P < 0.001). By day 3, 82 (63%) in the SP + CQ group and 20 (16%) in the SP group were symptom free (P < 0.001). 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.

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.

Zika virus disease has resonated great concern globally. The World Health Organization declared it “a public health emergency of International concern” on 1st February, 2016. The recent outbreaks have become a major challenge due to a drift from its earlier known benign exanthematous spectrum to a causal link to microcephaly. Historically, the name Zika virus comes from the Zika Forest of Uganda. It was first identified in 1947 among Rhesus Macaque sub-population. Two genetically distinct isolates have been well characterized; the Asian and African strains. This virus is spread by bites of day-time-active Aedes mosquitoes; the Aedes aegypti and Aedes albopictus. Zika Virus appears to spread along a narrow equatorial belt of Africa to Asia through the Pacific Ocean to French Polynesia, New Caledonia (southwest Pacific Ocean), the Cook Islands (south Pacific), and Easter Island (a Chilean territory in Polynesia), and most recently to Mexico, Central America, the Caribbean, and South America, where today has assumed a pandemic proportion.Up to eighty percent of infections are asymptomatic. Symptomatic infections are characterized by a self-limiting febrile illness and maculopapular rash, arthralgia, conjunctivitis, back pain and mild headaches. Maternal Zika viral load is thought to be a significant risk factor to fetal infection leading to invasion of either trophoblasts or placental cells or both through maternal decidua. Zika viral RNA proteins and associated extensive selective tissue injuries have been demonstrated in the brains and spinal cords of abortuses. Diagnosis of Zika virus is essentially based on viral RNA detection from clinical specimens. Currently, licensed preventive medicines or vaccines are unavailable. With the wide spate of recent outbreaks and consequent neurologic morbidity and mortality, there is need for deployment of point-of-care equipment for screening of pregnant women in our environment. This is an ambitious call for advocacy by all relevant health care providers.Keywords: Zika Virus, disease outbreaks, microcephaly, Aedes mosquitoes

71Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria, 2Faculty of Medical Sciences, University of Jos, Jos,Plateau State, Nigeria, 3Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria, 4Leptospirosis Unit, Central DiagnosticsLaboratories National Veterinary Research Institute, Vom, Plateau State, Nigeria, 5Department of Infectious Diseases, Brighton and Sussex University Hospital, Brighton,Southeast England, United Kingdom, 6Global Health Programme, Brighton and Sussex University, Brighton, Southeast England, United Kingdom, 7Royal TropicalInstitute, KIT Biomedical Research, WHO/FAO/OIE and National Collaborating Center for Reference and research on Leptospirosis, Meibergdreef, Amsterdam, TheNetherlands

Background: The deployed artemether–lumefantrine (AL) and artesunate–amodiaquine (AA) medicines are known to be gametocytocidal. Continuous monitoring of their efficacies is imperative for malaria elimination interventions. To compare gametocytocidal clearance by AL versus AA. Materials and Methods: Data on demographics, anthropometry measures and gametocytes densities of 111 of 114 Human Immunodeficiency Virus (HIV) sero-negative children aged 6–59 months with uncomplicated Plasmodium falciparum malaria mono-infection, who participated in a drug therapeutic efficacy testing, were extracted. Patients who had severe malnutrition, other causes of common childhood fevers and use of antimalarial medicines in the preceding 1 week were excluded from the study. Study participants who met the enrolment criteria and gave written informed parental consent were randomized to receive AL or AA according to the manufacturer’s instructions. Clinical and parasitological evaluations were performed on D0, D1, D2, D3, D7, D14, D21 and D28. Analysis was restricted to 111 participants who completed the study. Results: Twelve (10.8%) patients had gametocytes on D0. Six (5.4%) study participants were in the AL treatment arm and 6 (5.4%) participants were in the AA treatment arm (P = 0.32). Gametocyte clearance time (GCT)AL was 104 h and (GCT)AA was 152 h (P = 0.44). Conclusion: AL and AA demonstrated comparable gametocytocidal activity in North-Central Nigeria. There is a need for continuous monitoring of the efficacies of these artemisinin-based combination therapies to keep track with the emergence of resistant Plasmodium gametocyte isolates in Nigeria.

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.

In most parts of the world, female sex workers (FSW) have been among the groups most vulnerable to and most affected by HIV. The data on HIV infection among FSW is very scanty in North central of Nigeria. OBJECTIVE To examine factors contributing to the spread of the HIV epidemic among FSW participating in a program for the prevention of transmission of HIV at the Jos University Teaching Hospital (JUTH) Jos, Plateau State Nigeria. METHODS: A total of 500 FSW were interviewed, but only 307 consented to give their blood samples to be tested for HIV and Syphilis and genital specimens were collected from them, analyzed for other sexually transmitted infections (STIs). Information about sociodemographic characteristics, sexual behaviors, knowledge about HIV and other STIs, HIV risk perception and history of STI-related symptoms were also documented. RESULT: The prevalence of HIV was 57.3% (176/307). HIV –1, HIV-1&2 and HIV-2 accounted for 96.0%, 2.3% and 1.7% respectively. Their mean age was 24.5 + 5.5years.The FSW within age groups 20-24 and 25-29 years were more affected with prevalence rates of 39.4% and 35.5%, respectively. In addition, those with genital symptoms and STIs during the last 12 months had increased risk of HIV by 68.6 (pValue

No Abstract Available Journal of Medicine in the Tropics Vol.5(2) 2003: 53-57

No Abstract Journal of Medicine in the Tropics Vol.4(2) 2002: 35 - 40

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.

A retrospective study of the results of Ziehl-Nelsen stained smears was carried out over a 9-year period, from 1988 to 1997 (excluding 1989 for non availability of records). This was to ascertain the current trend of tuberculosis in our community especially with the increasing incidence of HIV and AIDS. In all, 17,377 patients results were reviewed. The ages of the patients ranged from 1 to 86 years, with a mean of 29.29 years. Males accounted for 51.8% (9001), while the females were 48.2% (8376) of cases reviewed. The prevalence of AFB smear-positive cases was 11.9% (2074)/17337) more in the age group 10-49 years. Among the 2074 smear positive patients, 1363 (65.7%) were males while 711 (34.3%) were females with a M: F ratio of 2:1. The prevalence was also greater in in-patients (60.9%) when compared with out-patients (39.1%). The annual prevalence was higher in the late 80s and early 90s compared with mid- and late- 90s. For the effective control of Tuberculosis, diagnosis especially sputum smear microscopy and treatment using DOTS approach should be free. Key Words: Tuberculosis, laboratory report, AFB. Nigerian Medical Practitioner 46(2) 2004: 33-35

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.