The Practice of Exclusive Breastfeeding and Its Sociodemographic Determinants amongst Nursing Mothers at a Tertiary Health Care Institution in South East, Nigeria

Background: Breastfeeding is a natural and critical act that provides nutrients and energy for the infant and young child;and through a public health intervention such as exclusive breastfeeding, it improves the survival rates of the infant. Objective: To determine the breastfeeding practices and the sociodemographic determinants of exclusive breastfeeding amongst nursing mothers present at the Imo state university teaching hospital Orlu. Methods: A cross sectional analytical study design was used that included all nursing mothers present within a 4 week study period. Data was collected using a structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant associations and binary logistic regression was used to determine sociodemographic predictors of exclusive breastfeeding practice. P value was set at 0.05 significant level. Results: While most of the respondents were aware of exclusive breastfeeding (92.5%), only 24% of the respondents were practicing exclusive breastfeeding. Work and school activities, and the feeling that breast milk was insufficient for the needs of the baby were the reasons for not practicing exclusive breastfeeding for a majority of the respondents (56.6%). Furthermore, 61% of those that were practicing non-exclusive breast feeding gave a cereal or infant formula in addition to the breast milk for 3 to 6 months. It was further revealed that there were statistically significant relationships between breastfeeding practice and maternal age (p = 0.003), level of maternal education (p = 0.005) and maternal occupation (p = 0.006). Conclusion: Understanding and taking into cognizance the sociodemographic characteristics will enable the design, and adequate delivery of appropriate and effective strategies that improve exclusive breastfeeding practice.

Assessment of Contributions of Community Tuberculosis Intervention to Tuberculosis Case Detection and Treatment Outcome in Two States in Nigeria

Background: Nigeria, one of the high burden Tuberculosis countries, has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However, low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. Materials and Method: A retrospective study with multistage sampling technique was employed to review 23,241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: The annual percentage increase for both states was 24.7%, 189.8% and 114.5% in the study group as against 5.2%, 44.6% and 65.6% in control group. Overall, 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive, while 74.8% were bacteriologically negative. Of the total 5861 cases treated, successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15, 2.95 - 3.35). Conclusion: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore, full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.

An Eight-Year Review of the Frequency and Outcome of Dog Bite and Clinical Rabies in a Teaching Hospital in North Central Nigeria

Introduction: Rabies is a neglected tropical disease that is highly fatal and yet it is under-reported in the developing countries like Nigeria. The domestic dog is the primary reservoir host as well as the most important source of infection usually conveyed by saliva through bites. Aim: This study sought to determine the frequency and outcome of dog bite injury and clinical rabies presented to the Accident and Emergency unit of Benue State University Teaching Hospital Makurdi, Benue State, Nigeria. Methods: This retrospective hospital-based study reviewed the medical records of all patients with dog bite who presented over an eight-year period from August 2014 to July 2022. Rabies virus infection was diagnosed on clinical basis. A structured proforma was used to extract relevant information and data was analysed using the statistical package for social sciences (SPSS) version 21. Result: Mean and median age was 27.03 ± 10.98 and 29 years respectively, range of 2 - 47 years and 11 (73.3%) were males. There were 15 cases of dog bite out of 17,187 patients making frequency of 1.14 per 1000 persons constituting 0.09% or about 2 cases yearly. Seven (46.7%) of this total number had clinical rabies infection with 7 (100.0%) mortality. All 7 (100.0%) with clinical rabies had a furious (encephalitic) form. Rabies immunoglobulin was prescribed in 8 (53.3%), 6 (40.0%) received them while 13 (86.7%) received post-exposure rabies vaccine. Conclusion: Dog bite is an uncommon reason for Accident and Emergency visit in our facility with male preponderance. However, about 46.7% of the dog bite victims developed clinical symptoms suggestive of furious (encephalitic) form of rabies with 100.0% fatality.

A Comparison of Clinical Features of Depressed and Non-Depressed People Living with HIV/AIDS, in Nigeria, West Africa

Objectives: Depressive disorders are a significant public health issue. They are prevalent, disabling, and often chronic, with a high economic burden to the society. Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 4 times higher than the general population. It’s still questionable whether HIV related depression is clinically different from sero-positive patients without depression. Studies comparing the clinical features of depressed and non-depressed People Living with HIV/AIDs are limited, hence the need for this study. Methods: This was a hospital based, cross sectional, descriptive study of three hundred adult HIV/AIDS patients attending the HIV clinic of Kwara State specialist hospital, Sobi, Ilorin. The PHQ-9 was administered to the respondents to screen for depression. A pre-tested PHQ-9 questionnaire was used to collect data. Subject who scored one and more were assessed clinically for depression. The three keys of social determinants of depression (SDS) were assessed and the association with depression sought. Results: One hundred and seventy (56.7%) satisfied the criteria for a depressive disorder using the PHQ-9 score. Compared to non-depressed sero-positive patients, depressed HIV patients were more likely to be female, single, unemployed, with below average year of schooling, low social economic status, low social cohesion and more stressful life events. They are more prone to hopelessness, thought of taking life and plan to commit suicide. Conclusion: These findings, show that the clinical and associated features of depression differ between depressed and non-depressed sero-positive subjects, thus requiring different management.

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes);systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes);and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.

Late Commencement of Anti-Tuberculosis Drugs in Three Directly Observed Treatment Short Course Centres in Benue State Nigeria: A Neglected Correlate of Tuberculosis Management

Background: Most researches on the correlate of Tuberculosis (TB) treatment outcomes place emphasis on sociodemographic characteristics of the patients, Human Immunodeficiency Virus status and CD4+ count of patients and nutrition among others. This study assessed the effect of delay in commencement of anti-TB regimen on the treatment outcomes of all Tuberculosis patients treated between 2011 and 2014 in three directly observed treatment short course centres in Benue State, Nigeria. Methodology: A retrospective cohort study with convenient sampling technique was used for all registered Tuberculosis patients enrolled for treatment within the reviewed period. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: Of the total 1711 cases reviewed, the males to females ratio was 3.9:1. The mean age for the males’ patients was 39.0 ± 15.3 years and the females 33.7 ± 14.2 years. Majority of the patients were new pulmonary Tuberculosis cases and they commenced their treatment after 3 weeks of diagnosis. Higher failure and death rate were reported amongst the patients who commenced their treatment late (78.7% and 42.5% respectively). The relationship between the treatment outcome and the time of commencement of anti-TB drug regimen was statistically significant (p Conclusions: Commencement of anti-TB drugs in all diagnosed Tuberculosis patients is an important correlate that must be addressed in order to achieve the global goal of reducing Tuberculosis prevalence to the level at which it will no longer constitute a public health problem in Nigeria.

Prevalence of Hypoglycaemia in Newborn at Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria

Background: Neonatal hypoglycaemia is the most common metabolic abnormality in neonates and is associated with neurological damage and death when it occurs during the first few days of life. The main objective of this study was to determine the prevalence of hypoglycaemia in the newborn and the associated maternal/neonatal risk factors. Setting and Methods: This prospective descriptive study was conducted at the labour room and the Special Care Baby Unit of Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria, between July 2017-March 2018. Results: Of the 168 neonates, 140 (83.3%) were delivered in the hospital and 28 (16.7%) were delivered outside the hospital. Hypoglycaemia was found in 19 (11.0%) of the neonates. The mean (standard deviation) of gestational age was 37.8 (3.0) weeks. 91 (54.2%) were males and 77 (45.8%) were females. Male to female ratio is 1.2:1. A significantly higher proportion of 9 (32.1%) out born compared with 10 (7.1%) of inborn, 4 (44.4%) of birth 1500 g compared with 5 (22.7%) birth weight 1500 g - 2499 g and 10 (7.3%) of birth weight ≥ 2500 g and 7 (22.6%) of babies with temperature ≤ 36.5°C compared with 7 (6.3%) of temperature 36.5°C - 37.5°C and 5 (19.2%) of temperature > 37.5°C, demonstrated hypoglycaemia respectively. Neonatal risk factors, such as, prematurity, low birth weight and respiratory distress syndrome, were significantly associated with hypoglycaemia p-value of 0.02, 0.01 and 0.00 respectively. There were no statistically significant associations between maternal risk factors and hypoglycaemia. The common presenting symptoms were jitteriness,

Obstructed labour caused by foetal congenital hydronephrosis. Trans-abdominal drainage of the hydronephrosis with resultant delivery per vagina

A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission supported by Abdominal Ultrasound revealed Bilateral Hydronephrosis which was then drained per abdomen using needle and intravenous fluid giving set with eventual relief of the obstruction and vaginal delivery of the stillborn baby.

Research Protocol： Cross-sectional Study （Survey）--The Fate of Moroccan Childhood Cancer Survivors

Background： Malignant tumors of the child represent one of the major causes of mortality in children between 1 and 14 years in the West. Young people recovering from childhood cancer may have complications related to the disease itself or treatment. Complications can be somatic, psychic or socio-occupational and familial. The current study aims to know the current status of young children treated in the oncology unit of PHOU （Pediatric Hemato-Oncology Unit）, Rabat Children Hospital is exclusively or jointly between 1978 and 2004. Material and methods： It will be a cross-sectional study conducted among childhood cancer survivors treated between 1978 and 2004 at the Pediatric Oncology Unit of Children＇s Hospital of Rabat. Medical and demographic data will be collected through questionnaires completed by phone or intemet, by the survivor, his parent or his physician. Discussion： To our knowledge, there is no previous study about the fate of Moroccan childhood cancer survivors before our study. Hence, it will be a cross-sectional study to have a quick picture on the situation in Morocco. It would be necessary to establish a follow-up strategy in Morocco.

Transgenic 4-1BBL-engineered vaccine stimulates potent Gag-specific therapeutic and long-term immunity via increased priming of CD44＋CD62Lhigh IL-7R＋ CTLs with up- and downregulation of anti- and pro-apoptosis genes

Human immunodeficiency virus type-1 （HIV-1）-specific dendritic cell （DC） vaccines have been used in clinical trials. However, they have been found to only induce some degree of immune responses in these studies. We previously demonstrated that the HIV-1 Gag-specific Gag-Texo vaccine stimulated Gag-specific effector CD8＋ cytotoxic T lymphocyte （CTL） responses, leading to completely protective, but very limited, therapeutic immunity. In this study, we constructed a recombinant adenoviral vector, adenovirus （AdV）4-1BBL, which expressed mouse 4-1BB ligand （4-1BBL）, and generated transgenic 4-1BBL-engineered OVA-Texo/4.1BSL and Gag-Texo/4.1BSL vaccines by transfecting ovalbumin （OVA）-Texo and Gag-＇rexo cells with AdV4.1BBL, respectively. We demonstrate that the OVA-specific OVA-Texo/4.ZSSL vaccine stimulates more efficient OVA-specific CTL responses （3.26%） compared to OVA-Texo-activated responses （1.98%） in wild-type C57BIJ6 mice and the control OVA-TeXO/Nu, vaccine without transgenic 4-1BBL expression, leading to enhanced therapeutic immunity against 6-day established OVA-expressing B16 melanoma BL6-1OovA cells. OVA-Texo/4.1BBL-stimulated CTLs, which have a CD44＋CD62Lhigh IL-7R＋ phenotype, are likely memory CTL precursors, demonstrating prolonged survival and enhanced differentiation into memory CTLs with functional recall responses and long-term immunity against BL6-1OovA melanoma. In addition, we demonstrate that OVA-Texo/4_ZBBL-Stimulated CTLs up- and downregulate the expression of anti-apoptosis （Bcl2110, Naipl, No13, Pak7 and Tnfrsfllb） and pro-apoptosis （Casp12, Trp63 and Trp73） genes, respectively, by RT2 Profiler PCR array analysis. Importantly, the Gag-specific Gag-Texo/4.1BBL vaccine also stimulates more efficient Gag-specific therapeutic and long-term immunity against HLA-A2/Gag-expressing B 16 melanoma BL6-1OGag/A2 cells than the control Gag-TeXO/NuH vaccine in transgenic HLA-A2 mice. Taken together, our novel Gag-Texo/4-ZBBL vaccine, which is capable of stimulating potent Gag-specific therapeutic and long-term immunity, may represent a new immunotherapeutic vaccine for controlling HIV-1 infection.

Suicidal Ideation among Depressed People Living with HIV/AIDS in Nigeria, West Africa

Objective: Transient suicide thoughts are common to some people throughout the course of HIV disease and often do not indicate significant risk of suicide. However, persistent suicidal thoughts with associated feelings of hopelessness and intent to die are very serious and must be assessed promptly and carefully. The aim of this study, therefore, was to examine the relationship between depression, hopelessness, psychosocial stressors and suicidal ideation in PLWHAs. Methods: This was a hospital based, cross sectional, descriptive study, of one hundred and seventy depressed adult HIV/AIDS patients of Kwara State Specialist Hospital, Ilorin. Depression and suicidal assessment were evaluated using the PHQ-9 scale. A score of >9 or any affirmative response to question 9 of the PHQ-9 scale necessitated suicidal risk assessment. The social determinant questionnaire was used to evaluate social cohesion and negative life events. Results: The prevalence of depression among the HIV/AID patient was 56.7%. Twenty nine (17.1%) were hopeless, twenty eight (16.5%) had at one time or the other thought of taking their lives, six (3.5%) had plan to take their lives. There was strong statistical association between depression, hopelessness (p-value = 0.000) thought of taking life (p-value = 0.000) and plan to take their lives (p-value = 0.030). Conclusion: The significant correlations between hopelessness, depression and suicidal ideation are important markers that should alert clinicians to underlying suicide risk in HIV-positive patients. In addition, low social cohesion and stressful life events were found to be risk factors for depression and suicide. Clinicians should routinely enquire about suicidality in PLWHAs to assist early diagnosis and intervention.

Moroccan Taxi Drivers Sleepiness Using Epworth Scale： A Cross-sectional Survey

Many international studies found that fatigue can be a probable major cause of truck driver accidents. The primary goal of the current study was to assess the relation between sleep disorders and accidents by using Epworth sleepiness scale. In this cross-sectional study, 300 urban and rural taxi drivers from Fez, Morocco were enrolled from January to May 2013. All participants were male and their mean age was 42.51 ± 10.81 （range 18-74） years. Their experience in driving was 8.34± 3.56 years on average; which had no significant relationship with their crash history and was not found a confounding factor in this series. The mean duration of sleep was 6.78± 1.47 h per day. The mean rate of accident was 2.78 ± 1.12 per year. The mean Epworth index was 13.23 ± 5.59. The simple linear regression showed a significant correlation between the Epworth sleepiness scale and education （P = 0.030）, age （P = 0.017）, marital status （P = 0.011）, coffee consumption （P = 0.006）, and water pipe （chicha） use （P = 0.01 ）, but there was no significant correlation with history of crash in past years. The multivariate analysis （multiple linear regressions） found a significant association between Epworth scale and age （P = 0.024）, coffee consumption （P = 0.023） and water pipe use （P = 0.027）. In Morocco where road accidents are very frequent and number of serious injuries and death is very high. This is considered as one of the major public health problems and hence public health officials, legislators and the police should collaborate in multidisciplinary approach to have effective preventives measures. This study can be the start of many debates about the most efficient preventive measure to ameliorate professional drivers＇ work condition and to reduce road accident and hence save thousands of lives from the ＂traffic war＂ in Morocco.

Moroccan Taxi Drivers Fatigue Using Pichot Questionnaire： A Cross-Sectional Survey

Studies conducted in many countries the world has shown that fatigued driving contributes to approximately 3%-30% of road accidents. We conducted this study to estimate the prevalence of fatigue among taxi drivers and to assess the determinant of fatigue among taxi drivers. In this cross-sectional study, 300 urban and rural taxi drivers from Fez, Morocco were enrolled from January to May 2013. The mean score of Pichot scale was 13.59 ± 8.23. The mean duration of sleep was 6.78 ±1.47 h per day. The mean rate of accident was 2.78 ± 1.12 per year. At the final model of the multiple linear regression we found an association statistically significant between Pichot scale and income, cardiovascular disorders, tobacco use, problems with colleagues, regularity of sleep and sleeping at the wheel. This study opened the door to many discussions about the professional drivers＇ conditions of work and we can argue that we should ameliorate the professional drivers conditions of work in Morocco.