Antimicrobial resistance and virulence genes of invasive Salmonella enterica from children with bacteremia in north-central Nigeria

Objectives

Bacteremia due to invasive Salmonella enterica has been reported earlier in children in Nigeria. This study aimed to detect the virulence and antibiotic resistance genes of invasive Salmonella enterica from children with bacteremia in north-central Nigeria.

Method

From June 2015 to June 2018, 4163 blood cultures yielded 83 Salmonella isolates. This is a secondary cross-sectional analysis of the Salmonella isolates. The Salmonella enterica were isolated and identified using standard bacteriology protocol. Biochemical identifications of the Salmonella enterica were made by Phoenix MD 50 identification system. Further identification and confirmation were done with polyvalent antisera O and invA gene. Antimicrobial susceptibility testing was done following clinical and laboratory standard institute guidelines. Resistant genes and virulence genes were determined using a real-time polymerase chain reaction.

Result

Salmonella typhi 51 (61.4%) was the most prevalent serovar, followed by Salmonella species 13 (15.7%), choleraesuis 8 (9.6%), enteritidis 6 (7.2%), and typhimurium 5 (6.1%). Fifty-one (61.4%) of 83 Salmonella enterica were typhoidal, while 32 (38.6%) were not. Sixty-five (78.3%) of the 83 Salmonella enterica isolates were resistant to ampicillin and trimethoprim-sulfamethoxazole, followed by chloramphenicol 39 (46.7%), tetracycline 41 (41.4%), piperacillin 33 (33.9%), amoxicillin-clavulanate, and streptomycin 21 (25.3%), while cephalothin was 19 (22.9%). Thirty-nine (46.9%) of the 83 Salmonella enterica isolates were multi-drug resistant, and none were extensive drug resistant or pan-drug resistant. A bla_TEM 42 (50.6%), floR 32 (38.6%), qnrA 24 (28.9%), tetB 20 (20.1%), tetA 10 (10.0%), and tetG 5 (6.0%) were the antibiotic resistance genes detected. There were perfect agreement between phenotypic and genotypic detection of antimicrobial resistance in tetracycline, ciprofloxacin, and chloramphenicol, while beta-lactam showed κ = 0.60 agreement. All of the Salmonella enterica isolates had the virulence genes invA, sopB, mgtC, and sip4D, while 33 (39.8%), 45 (51.8%), and 2 (2.4%) had ssaQ, spvC, and ljsGI-1, respectively.

Conclusion

Our findings showed multi-drug resistant Salmonella enterica in children with bacteremia in northern Nigeria. In addition, significant virulence and antimicrobial resistance genes were found in invasive Salmonella enterica in northern Nigeria. Thus, our study emphasizes the need to monitor antimicrobial resistance in Salmonella enterica from invasive sources in Nigeria and supports antibiotic prudence.

The risk factors and pattern of traumatic dental injuries in 10-12-year olds in Kano, Nigeria

BACKGROUND

Traumatic dental injuries (TDIs) rank among the most common conditions in children and adolescents. Nigerian dental trauma data are largely based on studies that were conducted in the southern parts of Nigeria. This study was designed to identify the risk factors and the pattern of TDIs among school-age children in northern Nigeria.

OBJECTIVES

The objective of the study was to identify the risk factors for and to determine the pattern of dental injuries among 10-12-year-old males in Kano, northern Nigeria.

MATERIALS AND METHODS

Six hundred and ninety-six 10-12-year olds were selected through a multistage sampling of school children, street children and rehabilitated children in Kano and examined for TDIs using the WHO protocols. Data analysis was carried out using SPSS version 20. Statistical significance was considered when P < 0.05.

RESULTS

Six hundred and ninety-four 10-12-year olds participated in the study; The prevalence of TDIs was 6.6%. Being a street-child was associated with 30% higher risk for dental injuries (adjusted odds ratio [aOR] = 1.3; 95% confidence interval [CI] = 0.60 - 3.1; P = 0.48), whereas living as a rehabilitated street child (aOR = 0.41; 95% CI = 0.19 - 0.88; P = 0.02) and older age were associated with a reduced risk (aOR = 0.63; 95% CI = 0.39 - 1.01; P = 0.06) to injuries. The most common type of trauma was enamel-dentine injuries or Ellis II, and the most common cause was falls. Street children and low-age groups had more single-tooth injuries (85.7% and 85.0%, respectively). The commonly injured teeth were the maxillary right and left central incisors.

CONCLUSION

Living on the street and young age were associated with the likelihood for injuries in male adolescents in Kano. The maxillary central incisors were the commonly affected teeth.

Vaccine Hesitancy and Refusal: Behavioral Evidence from Rural Northern Nigeria

It is widely believed that vaccine hesitancy is prevalent in African countries, although this belief is without rigorous evidence. Our field experiment in rural northern Nigeria behaviorally measured the prevalence of vaccine hesitancy-the non-uptake of vaccines despite their availability due to non-monetary factors directly associated with vaccination. We randomly assigned two tasks to women: answering a short survey at their house vs. additionally receiving a free tetanus vaccine by submitting a voucher. The differences in their completion rates captured vaccine hesitancy, showing the rate to be about 13%. Our study reveals that absolute refusers with negative willingness to pay (WTP) for vaccines, who are likely to have strong misperceptions or a distrust of vaccines, account for about half of vaccine hesitaters, while floating refusers with zero or weakly positive WTP, who are likely to be indifferent about vaccines, account for the other half. A simple intervention, such as a door-to-door vaccination campaign, is likely to be effective for floating refusers, while interventions for absolute refusers need to effectively change their misperceptions or distrust of vaccines.

Ways of reducing the stigma of infertility: Views of infertile women and their herbalists

This study explored the factors associated with the uptake of antenatal care services among internally displaced women (IDW) in northern Nigeria. The sample included ANC visits for 422 respondents who had a birth five years before the survey and living in the selected camps. Multinomial logistic regression was applied. Findings showed that only 28% of women visited ANC clinics for the recommended number of visits. IDW with some form of education were significantly more likely to have attended four or more ANC visits compared to the IDW with no education. Other covariates found to have a significant relationship with four or more ANC visits include, camp of displacement and access to newspaper. To improve uptake of ANC to fit the recommendations of the WHO and meet SDG3, the government and humanitarian organizations should continue to use media as a tool for advocacy in educating women on the benefits of complying with the recommended number of ANC uptake.

Factors associated with the knowledge of obstetric danger signs, and perceptions of the need for obstetric care amongst married young women in northern Nigeria

BACKGROUND

Married adolescents contribute to poor maternal health indicators in many low-and middle-income countries, where restrictive social norms hinder access to, and utilisation of maternal health services. Addressing these barriers is key to improving health outcomes of young mothers and their children.

AIM

This study assessed married young women's knowledge of obstetric danger signs and perceptions of the need to attend obstetric services.

METHODS

A cross sectional descriptive design, interviewing 1624 randomly selected married young women aged 12-25 years. Data were collected in early 2017 using an interviewer-administered questionnaire on mobile phones, and exported into a statistical software for analysis.

RESULTS

We found low levels of knowledge of danger signs, especially those pertaining to the post-partum period. Respondents' age, literacy and household wealth were significantly associated with knowledge of danger signs across the continuum of care. Awareness of danger signs during delivery, was strongly associated with perceptions of need for antenatal care (odds ratio[OR]= 2.269; p 0.05), and delivery in a health facility (OR = 1.883; P 0.05). Most respondents believed they must wait for their husband's approval to attend a health facility when in labour.

CONCLUSION

Our findings show that the low levels of knowledge of obstetric danger signs, low perceptions of the importance of facility delivery, and the need to obtain husband's permission before seeking care, are highly contextualised and reflect the socio-cultural and economic circumstances of married young women in northern Nigeria. Interventions must consider these cultural context, and include a strong male-involvement component.

Effect of performance-based financing on health service delivery: a case study from Adamawa state, Nigeria

The Nigeria State Health Investment Project (NSHIP) was implemented in three Nigerian states between 2013 and 2018. Under the NSHIP, some local government areas were randomly assigned to Performance-Based Financing (PBF) intervention while others received decentralized facility financing (DFF) for comparison. This article evaluates the effect of PBF compared with DFF on health service delivery indicators in Adamawa state, under this quasi-experimental design, using the difference-in-differences technique. The analysis used health facility monthly data collected by the Health Management Information System through the District Health Information Software 2 (DHIS2). The PBF intervention group significantly increased the quantity of most of its service delivery indicators, such as antenatal care visits and deliveries by skilled personnel compared with the comparison group (DFF) after the introduction of NSHIP, although the baseline level of service delivery between PBF and DFF health facilities was statistically identical prior to the introduction of the intervention. We also conducted robustness check analysis to confirm the effect of PBF. Overall, we found a significant positive effect of PBF on most service delivery outcomes, except full vaccinations and post-natal care. One important policy implication is that we should carefully use PBF for targeted indicators.

Women's understanding of immunization card and its correlation with vaccination behaviors

Background: Despite the proven effectiveness of vaccinations, vaccination uptake is limited in Nigeria. According to the Multiple Indicator Cluster Survey (MICS), one of the main barriers is the lack of accurate knowledge of the vaccination schedule. This study evaluates caregivers' knowledge of the vaccination schedule and their ability to read the immunization card. Methods: The study evaluated the knowledge of caregivers in 11 settlements in the Jada local government area of Adamawa State in September 2019. The change in knowledge among caregivers before and after referring to the immunization card was evaluated using a simple statistical hypothesis testing (chi-square test). We also used logistic regression analysis to evaluate the determinants of vaccination knowledge, as well as the correlation between knowledge and actual vaccination behaviors. Results: More than half of the women had correct knowledge of the vaccination schedule for critical vaccines. However, the knowledge of the caregivers did not improve after referring to the immunization card which contained the information. Caregivers who brought their children to the clinic for vaccination recently were more likely to know the vaccination schedule correctly. Accurate knowledge was highly correlated with the actual vaccination behaviors. Conclusion: Reference to the immunization card did not improve the knowledge of vaccination schedule, especially among the less-educated population. To increase the demand for vaccinations, one potential policy is to target the uneducated population and help them increase their knowledge.

Market participation, household food security, and income: The case of cowpea producers in northern Nigeria

This article evaluates the impact of cowpea market participation on household food security and income in northern Nigeria. Using household survey data from a representative sample of over 1,500 farm households and applying a combination of instrumental variable techniques and dose-response functions, we found that cowpea market participation had a statistically significant positive impact on household food security and income. Cowpea market participation increased food expenditure by 1.6% and household income by 0.7% with a 10 unit increase in the quantity of cowpea sold. These results underscore the importance of cowpea market participation for household food security and income improvement. We also found that selling cowpea to rural and urban traders significantly increased household income, food expenditure, and food security. Results show that selling cowpea to rural and urban traders increased household income by 17% and 13%, respectively. The results point to the need for an enabling policy environment and public infrastructure to enhance market participation of farmers and traders. Public infrastructure investments in the form of feeder road construction and maintenance in the distant villages are encouraged, which in the long run can translate into improved cowpea productivity and welfare of smallholder farmers.

Does Female Autonomy Affect Contraceptive Use among Women in Northern Nigeria?

Literature identified female empowerment as a predictor of positive health behaviour. However, in the context of conservative and traditional society, this is yet to be explored. This paper explores the role of female autonomy in contraceptive use among currently married women in northern Nigeria. Nationally representative Nigeria Demographic and Health Survey (NDHS, 2013) data for 18,534 currently married women in northern Nigeria was analysed. Complimentary log-logistic regression (cloglog) was used to analyse the data. Current use of modern contraceptive was 6.6% among currently married women in northern Nigeria. Results show that female autonomy was significantly associated with modern contraceptive use. Respondents' education, wealth status and desire for no more children were associated with higher contraceptive use. Despite the conservative and religious context of northern Nigeria, female autonomy significantly predicts modern contraceptive use. Thus, empowering women in northern Nigeria, especially by education, will enable them to participate in healthy contraceptive decision making.

Effect of cash incentives on tetanus toxoid vaccination among rural Nigerian women: a randomized controlled trial

Tetanus toxoid vaccination is freely available for most women in developing countries, yet maternal and neonatal tetanus are still prevalent in 13 countries, 9 of which are in sub-Saharan Africa. We evaluated whether providing cash incentives increases the uptake of tetanus toxoid vaccination among women of childbearing age in rural northern Nigeria. We randomized amounts of cash incentives to women in three groups: 5 Nigerian naira (C5), 300 naira (C300), and 800 naira (C800) (150 naira = 1 U.S. dollar). Overall, of 2,482 women from 80 villages, 1,803 (72.6%) women successfully received the vaccination (419 of 765 [54.8%] women in C5, 643 of 850 [75.7%] women in C300, and 741 of 867 [85.5%] women in C800). Women in C300 and C800 were significantly more likely to receive the vaccine than women in C5. We further found that transportation costs are one of the significant barriers that prevent women from receiving vaccination at clinics, and that cash incentives compensate for transportation costs unless such costs are large.

Contraceptive intentions of survivors of severe acute maternal morbidity in Kaduna State, Nigeria

OBJECTIVE

Intention to use modern contraception in women with severe acute maternal morbidity (SAMM) presents a window of opportunity to scale up postpartum family planning to prevent future complications. The aim of this study was to determine the factors that affect the contraceptive intentions of women who survive SAMM in Kaduna State, northern Nigeria.

METHODS

SAMM survivors aged 15-49 years were recruited after recovery and interviewed before discharge from hospital.

RESULTS

Of the 330 women studied, 246 (74.5%) had wanted the index pregnancy. Although their knowledge of modern contraception was good (89.1%), only 44.5% had ever used modern contraception. The main reason given for not wanting to use modern contraception was that God should decide on the number of children. Injectables, pills, implants and male condoms were the commonest contraceptive methods used. Of the women who gave reasons for stopping these contraceptives, the main reasons in 61% were desire to conceive and fear of side effects. The majority (72.4%) of the women wished to have more children and 69.1% intended to use contraception in the future. The husband's permission was needed by 78.2% of respondents before using contraception. The commonest reason given for not wanting to get pregnant again was to avoid complications (30.4%) and that family size had been completed (28.6%).

CONCLUSION

Male partner involvement and counselling to address religious views and fear of side effects are critical to the acceptance of postpartum family planning in SAMM survivors.

Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria

Purpose

Ensuring adequate access to skilled birth attendants during and after childbirth is a key strategy to reducing maternal and newborn mortalities. Transportation difficulties in emergency situations continue to be a significant barrier to accessing emergency obstetric care, especially in rural and hard-to-reach areas. Emergency transport schemes (ETS) have been introduced in various settings to increase access to emergency care and reduce the second obstetric delay with varying degrees of success. This qualitative study assessed the perceptions of stakeholders and beneficiaries of ETS in two states in northern Nigeria, comparing two models of ETS: one in which the ETS were introduced as a stand-alone intervention, and another in which ETS were part of a package of interventions for increasing demand and improving utilization of maternal and newborn health services.

Methods

We carried out focus group discussions with ETS drivers, mothers who delivered in the past year and utilized ETS, husbands of women who benefited from the schemes in the past year, health care providers, traditional birth attendants, and religious leaders, supplemented by in-depth interviews with program focal persons.

Results

Demand creation activities – especially working with traditional birth attendants and religious leaders – provided a strong linkage between the ETS and families of women in need of emergency transport services. Community members perceived the ETS model that included demand-generating activities as being more reliable and responsive to women’s needs.

Conclusion

ETS remain a key solution to lack of transport as a barrier to utilizing maternal and newborn health services in emergency situations in many rural and hard-to-reach communities. Programs utilizing ETS to improve access to emergency obstetric care should explore the potential of increasing their utility and reach by integrating the schemes with additional demand-side interventions, especially engagement with traditional birth attendants and religious leaders.

Programmatic implications of unmet need for contraception among men and young married women in northern Nigeria

PURPOSE

The study was designed to provide programmatic recommendations for interventions to increase contraceptive prevalence in northern Nigeria. Family-planning use in North-East and North-West regions of Nigeria has remained very low, despite years of domestic and donor investments. We examine respondents' perceptions of their own need for contraception and specifically focus on young women because of their higher risk for maternal mortality.

METHODS

In this cross-sectional study, we interviewed 1,624 married women younger than 25 years and 1,627 men married to women younger than 25 years, in Kaduna and Katsina states in northern Nigeria. We classified respondents into five categories: 1) having no real need for contraception, 2) perceiving no need for contraception, despite physical or behavioral need, 3) having met need by using a modern contraceptive method, 4) perceiving met need by employing traditional practices, and 5) having unmet need for contraception.

RESULTS

Half of female respondents had no need for contraception because they were either pregnant or desiring a pregnancy at the time of the survey. A quarter of female and male respondents were not using contraception because of their religious beliefs. Less than 2% of respondents had unmet need because of lack of availability or access, or due to poor quality of care. Men had more positive views of family planning than women.

CONCLUSION

Our findings suggest that young women in northern Nigeria would benefit from a programmatic approach that targets men, utilizes religious leaders, and addresses the prevalent religious and sociocultural norms that present barriers to contraceptive use. Such interventions have the potential to increase contraceptive prevalence more substantially, but the literature on these types of interventions in northern Nigeria is scarce. Therefore, more research is needed to identify and document what approaches work or do not work to increase contraceptive use in northern Nigeria.

Pathways to Psychiatric Care for Children and Adolescents at a Tertiary Facility in Northern Nigeria

There is limited availability of mental health services in Nigeria, and indeed most of Africa. Available services are also often under-utilized because of widespread ignorance and supernatural beliefs about the etiology of mental illnesses. The consequence, therefore, is a long and tedious pathway to care for the mentally ill, especially children and adolescents. This was a study of all new patients, aged 18 years and below, presenting over a 6 month period in 2009 (January - June) at the outpatient clinic of a tertiary psychiatric facility in northern Nigeria. A socio-demographic questionnaire was utilized, along with a record of the clinician's assessment of diagnosis for 242 patients. Subjects who had been withdrawn from school, or any previously engaged-in activity for longer than 4 weeks on account of the illness, were recorded as having disability from the illness. The children were aged 1-18 years (mean=12.3; SD=5.2) with males accounting for 51.7% (125) while 14.5% of the females (n=117) were married. Two thirds (64.5%) of the patients had been ill for longer than 6 months prior to presentation. One hundred and forty four subjects (59.5%) had received no care at all, while 36.4% had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80%), mental retardation (77.8%), epilepsy (64.1%) and psychotic disorders (50%). There is urgent need for extending mental health services into the community in order to improve access to care and increase awareness about effective and affordable treatments.