African Journals Online
Journal of the Nigerian Association of Infection Control

Volume 3 No.2 2000
Abstracts

Hepatitis B Knowledge in Lagos, Nigeria: Implications for Prevention and Control

¹O.O. Odusanya, ²C.A. Onykwere

¹Department of Community Health & Primary Care

²Department of Medicine, Lagos State University College of Medicine

Correspondence: O.O. Odusanya

ABSTRACT

A cross-sectional study was conducted to determine the knowledge of, attitudes to and practice concerning hepatitis B in Lagos, Nigeria. A self-administered questionnaire was used as survey instrument. Three hundred and seventy eight respondents participated in the survey, were selected through a multi-staged random sampling method. Only 222/378 (58.7%) had ever heard of hepatitis B; only 31.5% knew that it was a viral infection and less than a third knew about modes of transmission or complications while 27% were aware the disease was preventable through vaccination. Two respondents (0.5%) were vaccinated against hepatitis B. Knowledge about the disease was poor as only 98 respondents (27%) had adequate knowledge on the subject (at least 50% of the study scores). Age, gender and education qualifications did not have any significant association with knowledge on hepatitis B (p>0.05). Low knowledge about hepatitis B is evident in the community and remains a barrier to the control of the disease.

Investigation of Different Water Sources as a Possible Cause of Cholera Outbreak in Lagos in 1997

¹I. N. Idika, ¹R. A. Audu, ¹K. S. Oyedeji, ¹R. Iyanda and ²C. A. Egbom
¹Nigerian Institute of Medical Research, P.M.B. 2013 Yaba, Lagos, Nigeria
²Federal Public Health Laboratory Yaba, Lagos, Nigeria
Correspondence: I. N. Idika

ABSTRACT

Cholera still remains one of the major causes of high morbidity and mortality in developing countries. In Nigeria this has been attributed to poor health management response to outbreaks. So during a cholera outbreak in Lagos state in October 1997, water samples were examined to identify the epidemic strain and determine the antibiotic susceptibility patterns of any Vibrio cholerae isolated.

Twenty-four water samples from various sources (wells, taps, boreholes and packaged water) from the affected areas were processed using alkaline peptone water and thiosulphate citrate bile salt agar. Various biochemical and serological tests were used for identification.

Vibrio cholerae, 01 serogroup, Ogawa serotype and EI-Tor biotype was isolated from 20.8% of the water samples tested. These isolates showed multiple resistance to antibiotics particularly tetracycline but were susceptible to the cephalosporins. Eleven other water samples (45.8%) showed growth of Enterococcus faecalis while two others (8.3%) grew diptheroids. Samples from Ikeja area (control) showed no bacterial growth.

This study isolated a V. cholerae that was the same as the strain reported in previous cholera outbreaks in Nigeria. Isolation of other faecal bacteria suggests faecal pollution of water sources in the areas studied.

Age-Appropriate Immunization Coverage in a Rural Community in Edo State, Nigeria

O. O. Odusanya
Department of Community Health & Primary Care, Lagos State University College of Medicine, P.M.B. 21266, Ikeja

ABSTRACT

Although assessing immunization status at a single point in time (such as 24 months) is a useful marker for national vaccination coverage, it does not provide sufficiently detailed information to identify and understand the intricacies of age-appropriate immunization coverage in a defined geographical area.

In two separate studies up to 45% of children were not up-to-date with their immunization at 24 months of age while delay at the first immunization has been shown to be a strong independent predictor of failure to be completely immunized. Furthermore, vaccination rates may lag for several years before disease incidence increase making susceptible populations difficult to identify in the absence of effective programme evaluation.

Therefore it is important to bench mark the proportion of children under one year who are immunized at the recommended age. This is because for many of these illness, children are susceptible to the infections should they be immunized later than when recommended.

We conducted a secondary analysis on immunization data collected from a rural community, Sabongidda-Ora in Edo State, Nigeria to determine the proportion of children who were immunized at the recommended age. The primary data was collected as a population based immunization coverage assessment using standardized methods. There were 229 children in the original survey. Only children (n=110) whose vaccination cards had information on date of birth and date of vaccination were included in the secondary analysis. This was to allow for computation of actual ages at which each antigen was received.

A child was considered immunized at the recommended age if the vaccine was given not later than 30 days after it was due. This follows the guidelines of the American Paediatric Association. Frequency distribution of variables were produced.

The proportion of children who received the antigens at the recommended ages is shown on Table 1. The proportion as well as the mean period of vaccination shows a wide fluctuation. For BCG, the range of vaccination was 0-225 days of life while for DPT1, it was from 4-32 weeks. Only 26% of the children received all their vaccines within the recommended period. The age-appropriate rates are much lower than was observed for the entire cohort.

These results show that the proportion of children who were vaccinated within 30 days of their being eligible to receive the vaccines was rather small and unsatisfactory. The proportion of children who were not up-to-date with their immunization in this study is similar to the rates reported by other researchers.

Thus there may be large numbers of children who are susceptible to these infections due to the deferment of their vaccination. For example a child who fails to be vaccinated at nine months of age may suffer an attack of measles at 12 months of age with serious complications.

In conclusion, age-appropriate immunization rates were found to be low amongst a subset of children living in a rural Nigeria community. We suggest that immunization coverage rates be detailed enough to include age-appropriate analyses while health education campaigns be mounted to motivate mothers to bring their children early in life for vaccination.

The Effect of Various Brands of Chloroxylenol disinfectants on Some Common Hospital PAthogens

*F. T. Ogunsola, **C. N. Akujobi, ***K. C. Iregbu and
*O. O.Oduyebo
*Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Arab, Lagos, Nigeria
***Department of Medical Microbiology and Parasitology National Hospital for Women and Children, Abuja

Correspondence: F. T. Ogunsola

ABSTRACT

Suspension and surface viability tests were carried out to determine the effects of various brands of chloroxylenol disinfectants on clinically important nosocomial gram negative and gram-positive organisms. Dettol and morigard brands of chloroxylenol inhibited gram-positive organisms at a dilution of 1 in 50. Tiscol brand of chloroxylenol achieved the same effect at 1 in 30. All the disinfectants had much less activity against the gram negative organisms tested, inhibiting them only in the undiluted form, though Pseudomonas aeruginosa was not inhibited even by the undiluted Tiscol.

The presence of organic matter resulted in a slight loss of activity, thus, raising the required inhibitory concentration of Dettol and Morigard on the gram-positive organisms to 1 in 40. When all organisms were exposed to recommended dilutions of disinfectants for 10, 30, 60 and 90 minutes on a glass tile at room temperature, dettol and morigard inhibited all organisms, including P aeruginosa at, a minimum contact time of 10 minutes while Tiscol inhibited only gram positives at 30 minutes but could not inhibit gram negative organisms even at 90 minutes.

Apart from having a different recommended dilution from dettol and morigard, Tiscol was also observed to have a lower activity, although they were all stated to have about the same concentration. In Nigeria, there is need for manufacturers to be able to sustantiate the activity of their products and also for the relevant government agencies to adequately control monitoring of disinfectants in the market.

A Comparative Study on the Antimicrobial Susceptibility Patterns of Klebsiella and Enterobacter Species from the Lagos University Teaching Hospital

I. E. Abe-Aibinu, V. Ohaegbulam and T. O. Odugbemi
Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria

Correspondence: I. E. Abe-Aibinu

ABSTRACT

This paper sets to differentiate between Klebsiella and Enterobacter spp. Identification and to compare their antimicrobial susceptibility patterns at Lagos University Teaching hospital, a tertiary health institution.

From March to July 1998, a total of 300 clinical specimens were processed in the Medical Microbiology Laboratory of Lagos University Teaching Hospital (LUTH). Isolates were obtained from urine and swabs of wounds, ear, throat and eye. Identification was carried out by conventional methods and antimicrobial susceptibility was investigated by disk diffusion method. All isolates were tested for beta-lactamase production.

The 300 clinical samples processed yielded a total of 185 species of both Klebsiella (105 isolates) and Enterobacter (80 isolates). All isolates from both species were highly susceptible to amikacin, ceftazidime, ceftriaxone, aztreonam and nalidixic acid (70%). However, ofloxacin and norfloxacin were observed to be more effective on Klebsiella spp (90-93%) than on Enterbacer spp (70-75%). Sixty-three percent of Klebsiella spp and 52.2% of Enterobacter spp were susceptible to Gentamicin. The gentamicin-resistant klebsiella spp were from urine samples while the gentamicin-resistant Enterobacter spp were obtained from wound swabs. Isolates of both species were in general, highly resistant (80%) to cotrimoxazole, tetracycline and amoxicillin-clavulanic acid.

Ninety-four per cent of Klebsiella spp and 91% of Enterobacter spp produced beta-lactamase. Multi-resistant strains of these organisms appear to be endemic in the Lagos University Teaching Hospital, though there was no evidence of any outbreak of infections caused by these organisms in this study. The result of this study will be helpful in the empiric therapy of infections caused by Klebsiella and Enterobacter spp. In the long run, continuous surveillance of antimicrobial resistance in these organisms should aid in the development of a sound antibiotic policy in the hospital.

Key Words: Klebsiella spp, Enterobacter spp, Comparative, Antibiotic Susceptibility.

Reservoirs of Nosocomial Pathogens at a University Teaching Hospital In Nigeria

F. T. Ogunsola, P. C. Utulu, O. Mabayoje, T. Odugbemi and A.F.B. Mabadeje
Department of Medical Microbiology and Parasitology,
Department of Medicine
Department of Pharmacology
College of Medicine, University of Lagos, P.M.B 12003.

Correspondence: F. T. Ogunsola

SUMMARY

Two hundred and seventy seven microorganisms were isolated between February and August 1998 from surgical and medical wards including the haemodialysis unit and microbiology laboratory of a University Teaching Hospital in Lagos, Nigeria. Environmental Contamination was high. Medical and surgical wards accounted for the highest contamination rates of 67% and 63% respectively; followed by the microbiology laboratory, 48% and the Haemodialysis unit, 30%. Within the wards, the areas most contaminated were the
sinks, bedpans, wastebins, mattresses and toilet seats, Staphylococcus aureus was the most commonly isolated organism with a prevalence rate of 39.3% closely followed by Klebsiella pneumoniae, 24.6%. Others were coagulase-negative Staphylococci, 13.7%; Escherichia coli, 8.3% Pseudomonas aeruginosa, 9.0%, Proteus mirabilis, 1.8%; Citrobacter freundii, 1.1%; Proteus vulgaris, 0%; Salmonella paratyphi A, 0.7%; Enterobacter aerogenes, 0.4% and Salmonella typhi, 0.4%. Antibiograms of the isolates suggested three clusters of Staphylococcus aureus, groups SA1, SA2 and SA3. The largest group SA!, present in the Medical wards, Surgical wards, Microbiology laboratory and the haemodialysis unit, was Methicillin-sensitive. SA2 was present in only the medical and surgical wards while SA3 was only found in the surgical wards. Two clusters each, KP1 and KP2 of Klebsiella pneumoniae and EC1 and EC2 of Escherichia coli were obtained while there was only one cluster, PA1, of Pseudomonas aeruginosa. KP1, EC1 and PA1 were found in all the wards. Lack of adequate running water and poor environmental sanitation were major contributory factors to the high contamination rates.

Evaluation Of Blood Collected From Clinically Diagnosed Typhoid Fever Patients In
The Metropolis Of Lagos, Nigeria

¹K. O. Akinyemi, ¹A. O. Oyefolu, ²E. O. Omonigbehin,
²K. A. Akinside and ³A. O. Coker
¹Department of Microbiology, Lagos State University (LASU) Ojo, P.M.B. 1087, Apapa, Lagos, Nigeria.
²Genetic Division, Nigerian Institute for Medical Research (NIMR), Yaba, Lagos, Nigeria.
³Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Idi-Araba, P.M.B. 12003, Lagos, Nigeria (E-mail:[email protected])

Correspondence: K. O. Akinyemi (e-mail:[email protected])

SUMMARY

Over a period of 15 months, a total number of 635 clinically diagnosed typhoid fever patients and 100 healthy volunteers attending some public and government recognized health institutions in Lagos metropolis were bled and screened for Salmonella agglutin is, malaria parasitaemia and bacterial culture.

Out of the 635 patients, 505 (79.5%) were positive for Widal agglutination test using 1:160 as the cut-off antibody titre as determined in the screened sera of the healthy volunteers. Blood culture revealed that 216 (42.8%) bacterial pathogens were isolated from the Widal positive patients yielded out of which 101 (46.8%) isolates were of Salmonella sp. And 115 (53.2%) isolates of other bacteria of the family enterobacteriaceae. Among the Salmonella sp., 68(67.3%), 17(16.8%) and 16(15.8%) were S. typhi, S. paratyphi and S. arizonae respectively while the other enteric pathogens had 31 (27.0%), 29(25.2%), 23(20.0%), 14(12.2%), 10(8.7%), 5(4.3%) and 3(2.6%) isolates for Proteus sp., Klebsiella sp., Shigella sp., Pseudomonas aeruginosa, Escherichia coli, Haffinia sp. and Citrobacter sp. respectively. Malaria parasitaemia was demonstrated in the blood of 188 (37.2%) of Widal positive patients.

Our findings implied that a positve Widal agglutination test of a clinically diagnosed patient does not necessarily confirm a true S.typhi and S. paratyphi infections since other enteric bacteria as well as malaria parasites mimics both the 'O' and 'H' Salmonellae-antigens that form the core of Widal agglutination test kits. We therefore suggest the culturing of blood samples from all clinically suspected cases of typhoid and paratyphoid fever irrespective of the Widal agglutination antibody titre, so also is the necessity of performing malaria-parasite test particularly, in the malaria endemic regions of the globe, before proceeding on any antimicrobial therapy.

This suffice to say that exclusive reliance on serology for the diagnosis of this febrile disease can be misleading as individuals with preaxial are assumed and erroneously treated for typhoid fever based on single Widal agglutination test, whereas potential fatal illness such as malaria and other parasitaemia, non-typhoid salmonellosis, endocarditis and other gastro-intestinal infections may have been responsible.

We are therefore, through our findings, of the opinion that bacteriological confirmation of typhoid fever cases remains the most definitive diagnostic procedure particularly in Nigeria.

Key Words: Typhoid and paratyphoid fever, Widal agglutination test, culture, S.typhi, S. paratyphi, malaria paradise.