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Background: Multi drug resistant bacterial agents that contaminate seafood cause several diseases in humans and are widely documented as a global public health challenge. Methods: This study evaluated the microbiological and antimicrobial resistance genes profiles of bacterial Isolates from shellfish vended at Iko and Douglas Creeks of Cross River State, Nigeria. A total of 540 shellfish (117 clams, 88 oysters, 136 periwinkles) samples were collected from various vendor at the two Creeks were analyzed. The samples were processed using standard microbiological methods to identify bacterial pathogens. Antimicrobial susceptibility was assayed using the Kirby-Bauer disk diffusion method. Isolates were screened for antimicrobial resistant genes using polymerase chain reaction. Results: Overall, a total of 135 bacteria isolates were identified. The most common isolate was Alcaligenes species 53(39.2%) followed by Pseudomonas species 44(32.6%), Providencia species 25(18.5%), Vibrio species 6(4.4%), and Paenalcaligenes species 7(5.2%). The isolates showed varying susceptibilities to Imipenem (36%) and amikacin (28%) but were all resistant to Trimethoprim-Sulfamethoxazole. Fifty-three isolates had a multiple antibiotic resistance index (MARI) of ≥0.9 - 1.0. Most of the bacterial isolates were detected with TEM genes (82.2%), SHV (51.8%,), VIM (50.3%) resistance genes. None of the isolates expressed Veb gene. Only 40.7% of the isolates expressed QnrB gene while none expressed QnrA and QnrS. Conclusion: The detection of these multidrug resistant clinically relevant bacterial species suggests a significant linkage of commonly consumed seafood in the community and environmental spread of MDR bacteria.

Background: Biofilm production caused by bacteria plays a vital role in catheter associated urinary tract infection (UTI) or bacteriuria being responsible for persistence and recurrent infection. Biofilms forming bacteria are difficult to eradicate due to antimicrobial resistance to the commonly used antibiotic. Biofilms are currently estimated to be responsible for over 65% of nosocomial infections and 80% of microbial infections. This study aimed to perform biofilm detection on uropathogenic bacterial isolates among fistula patients attending National Obstetric Fistula centre Ningi and investigate the antimicrobial susceptibility pattern. Methods: A total of 217 strains of significant bacteriuria were isolated from vesico vaginal fistula (VVF) patients. A cross sectional study was conducted at the hospital. The urine samples were collected and cultured on CLED and blood agar media while confirmation was done using their biochemical reaction. The detection of biofilms formation on the isolates was performed using tube adherence and Congo red agar method. Antimicrobial susceptibility testing was carried out by disc diffusion method on Muller Hinton agar. Results: Out of 217 significant bacteriuria isolated, 38 strains produced biofilms;28 strains tested positive on tube adherence method while 15 strains were positive on Congo red agar method. Bacteria that produced biofim showed multiple drug resistance compared to the platonic bacterial cells. All the biofilm producers showed 100% resistant to septrin, ampiclox, gentamycin and amoxicillin. There was no significant value between tube adherence and Congo red agar method with P value > 0.05. Conclusion: Biofilm detection should form part of routine testing while antimicrobial susceptibility testing is paramount on better choice of antibiotic therapy for proper management to reduce economic lost, treatment failure and drug resistance.

Background: Multi drug resistant bacterial agents that contaminate seafood cause several diseases in humans and are widely documented as a global public health challenge. Methods: This study evaluated the microbiological and antimicrobial resistance genes profiles of bacterial Isolates from shellfish vended at Iko and Douglas Creeks of Cross River State, Nigeria. A total of 540 shellfish (117 clams, 88 oysters, 136 periwinkles) samples were collected from various vendor at the two Creeks were analyzed. The samples were processed using standard microbiological methods to identify bacterial pathogens. Antimicrobial susceptibility was assayed using the Kirby-Bauer disk diffusion method. Isolates were screened for antimicrobial resistant genes using polymerase chain reaction. Results: Overall, a total of 135 bacteria isolates were identified. The most common isolate was Alcaligenes species 53(39.2%) followed by Pseudomonas species 44(32.6%), Providencia species 25(18.5%), Vibrio species 6(4.4%), and Paenalcaligenes species 7(5.2%). The isolates showed varying susceptibilities to Imipenem (36%) and amikacin (28%) but were all resistant to Trimethoprim-Sulfamethoxazole. Fifty-three isolates had a multiple antibiotic resistance index (MARI) of ≥0.9 - 1.0. Most of the bacterial isolates were detected with TEM genes (82.2%), SHV (51.8%,), VIM (50.3%) resistance genes. None of the isolates expressed Veb gene. Only 40.7% of the isolates expressed QnrB gene while none expressed QnrA and QnrS. Conclusion: The detection of these multidrug resistant clinically relevant bacterial species suggests a significant linkage of commonly consumed seafood in the community and environmental spread of MDR bacteria.

Antibiotic resistant bacteria pathogens remain the leading cause of shellfish borne diseases and a major health threat to humans worldwide. The objectives of this study were to isolate, identify, and determine the antibiotic resistance patterns of Gram-negative bacteria from shellfish. We analyzed a total of 540 shellfish (117 clams, 88 oysters, and 136 periwinkles) samples collected from different vendors at Iko and Douglas Creeks in Akwa Ibom State, South-South Nigeria. Conventional cultural techniques, morphological, biochemical characteristics, and PCR amplification were used to identify the bacterial isolates. Antibiotic susceptibility tests (Kirby-Bauer disk diffusion method) and ESBL phenotype (disk) of the isolates were performed. One hundred and thirty-five (135) Gram-negative bacteria comprising 5 genera and 14 species were detected at a prevalence of: Alcaligenes faecalis TRB-7 38 (28.2%), Pseudomonas oryzihabitans strain KCB005 16 (11.9%), Paenalcaligenes retgerii strain B5 12 (8.9%) Pseudomonas aeruginosa JB2 10 (7.4%), Providencia stuartii DMC-28b 9 (6.7%), Alcaligenes species TLT151 8 (5.9%), Pseudomonas aeruginosa CIFRI DTSB1 7 (5.2%), Paenalcaligenes species UN24 7 (5.2%), Alcaligenes faecalis BT10 7 (5.2%), Vibrio species strain PrVy108 6 (4.4%), Pseudomonas xiamenensis C10-2 5 (3.7%), Providencia vemicola Bu15_38 4 (2.9%), Pseudomonas anguillisceptica 4029 3 (2.2%), and Pseudomonas aeruginosa N15-01092 3 (2.2%). All tested isolates showed various degrees of resistance to the thirteen antimicrobials evaluated. High levels of resistance (100%) to cefepime and imipenem were expressed by all isolates except the Providencia species. For the EBSL indicators, all isolates apart from Alcaligenes species were resistant (100%) to ceftriaxone. All Vibrio species were susceptible to norfloxacin, nalidixic acid, and ceftazidime. The identification of antibiotic resistant Gram-negative bacteria (GNARB) from shellfish in this study highlights the risk of disseminated multi-drug resistance—a serious public health concern.

Aims: This study evaluated the presence of extended spectrum β-lactamase (ESBL) and AmpC β-lactamase resistance genes in E. coli from stool of diarrheic children in some hospitals in Lafia metropolis, Nigeria. Methodology: A total of 70 stool samples of children were obtained from Dalhatu Araf Specialist Hospital, Lafia, M & D Hospital, Olivet Medical Centre and Sandaji Medical Centre, Lafia. Escherichia coli were isolated and identified using standard microbiological methods. Antimicrobial susceptibility of the isolates was tested using Clinical and Laboratory Standards Institute (CLSI) method. The phenotypic detection of ESBL and AmpC β-lactamase production in some antibiotic resistant isolates were carried out using disc method. The molecular detections of ESBL and AmpC resistance genes were carried out using Polymerase Chain reaction (PCR) method. Results: Of the 70 samples, the occurrence of E. coli was 100%. The isolates were highly resistant to ampicillin (97.14%), ciprofloxacin (90.00%), sulfamethoxazole/trimethoprim (84.29%), streptomycin (78.57%), amoxicillin/clavulanic acid (70.00%); moderate to gentamicin (38.57%), ceftazidime (37.14%) and cefotaxime (30.00%); and less resistant to cefoxitin (15.71%) and imipenem (8.57%). Twenty-one (30.00%) isolates were jointly resistant to both cefotaxime and ceftazidine. Of this number, 66.67% (14/21) were phenotypically confirmed ESBL producers; and the occurrences of ESBL resistance genes were: 7.14% (SHV), 42.86% (CTX-M) and 50.00% (TEM). Out of 11isolates resistant to cefoxitin, 4(36.36%) were phenotypically confirmed as AmpC β-lactamase producers; and the occurrence of AmpC genes were: 50.00% (CIT), 25.00% (FOX) and 25.00% (MOX). Conclusion: The isolates were least resistant to imipenem and cefoxitin and highly resistant to ampicillin, ciprofloxacin and sulfamethoxazole/trimethoprim. TEM and CTX-M ESBL genes were more frequent than SHV. CIT AmpC gene was more frequent than FOX and MOX.

This study investigated the antimicrobial resistance profile and presence of plasmid-mediated quinolone resistance (PMQR) genes in Salmonella typhi from patients attending selected general hospitals in Abuja municipal, Nigeria. Four hundred stool samples from patients with suspected typhoid fever were collected from Asokoro General Hospital Abuja (AGH), Garki Hospital Abuja (GHA), Maitama General Hospital Abuja (MGHA) and Wuse General Hospital Abuja (WGHA) and S. typhi was isolated and identified using standard microbiological methods. Antimicrobial susceptibility testing of the isolates was carried out using Clinical and Laboratory Standards Institute (CLSI) method. Molecular detection of PMQR genes in the ciprofloxacin-resistant isolates was carried out using Polymerase Chain Reaction (PCR) method. The overall occurrence of the isolates was 13.3% (53/400), with the highest hospital-related occurrence at WGHA (18.0%). The occurrence was highest at age 21-30yrs in AGHA (20.0%), GHA (33.3%) and WGHA (45.0%). The occurrence was higher in females at AGHA (12.7%) and GHA (16.0%); but higher in males at MGHA (11.4%) and WGHA (18.2%). Resistance to ciprofloxacin was the least at 30.2%, distributed as follows: AGHA (20.0%), GHA (35.7%), MGHA (36.4%) and WGHA (27.8%). The most common resistance phenotype was: NA-S-XT-AMC-TE-CRO-C-CN with overall occurrence of 9.4% (5/53) observed in AGH (10.0%), GHA (16.7%) and MGHA (18.2%) but not in WGHA. All (100%) isolates were multiple antibiotic resistance (MAR) isolates, with MAR indices above 0.2; and the commonest MAR index of 0.6 (30.0%) in AGHA, 0.8 (35.7%) in GHA; 0.8 (45.6%) in MGHA, and was 0.7 (38.9%) in WGHA. Multidrug resistance (MDR) was the commonest at 96.2% (51/53), with occurrences in the selected hospitals as follows: AGHA (90.0%), GHA (100.0%) and MGHA (100.0%) and WGHA (94.4%).The PMQR genes detected had overall frequency in the order: aac(6′)-Ib-cr (50.0%) >qnrB (37.5%) >qnrS (18.8%); qnrS was absent in AGHA and WGHA. The genes co-existed with one another with the qnrB+ aac(6′)-Ib-cr combination, present in isolates from all the hospitals, being the most common at (31.3%). Ciprofloxacin was the most effective antibiotic against the isolates; most isolates were MAR with prior exposure to antibiotics; most isolates were MDR and the ciprofloxacin-resistant isolatesharbored qnrS, qnrB and aac(6′)-Ib-cr PMQR genes, with aac(6′)-Ib-cr being the most prevalent.

in 1988 the World Health Assembly set an ambitious target to eradicate Wild Polio Virus (WPV) by 2000, following the successful eradication of the smallpox virus in 1980. South Sudan and the entire African region were certified WPV free on August 25, 2020. South Sudan has maintained its WPV free status since 2010, and this paper reviewed the country's progress, outlined lessons learned, and describes the remaining challenges in polio eradication.secondary data analysis was conducted using the Ministry of Health and WHO polio surveillance datasets, routine immunisation coverage, polio campaign data, and surveys from 2010 to 2020. Relevant technical documents and reports on polio immunisation and surveillance were also reviewed. Data analysis was conducted using EPI Info 7 software.administrative routine immunisation coverage for bivalent Oral Polio Vaccine (OPV) 3rd dose declined from 77% in 2010 to 56% in 2020. In contrast, the administrative and post-campaign evaluation coverage recorded for the nationwide supplemental polio campaigns since 2011 was consistently above 85%; however, campaigns declined in number from four in 2011 to zero in 2020. Overall, 76% of notified cases of Acute Flaccid Paralysis (AFP) received three or more doses of the oral polio vaccine. The Annualized Non-AFP rate ranged between 4.0 to 5.4 per 100,000 under 15 years populations, and stool adequacy ranged from 83% to 94%.South Sudan's polio-free status documentation was accepted by the ARCC in 2020, thereby enabling the African Region to be certified WPV free on August 25, 2020. However, there are concerns as the country continues to report low routine immunisation coverage and a reduction in the number of polio campaigns conducted each year. It is recommended that the country conduct high-quality nationwide supplemental polio campaigns yearly to achieve and maintain the required herd immunity. It invests in its routine immunisation program while ensuring optimal AFP surveillance performance indicators.

Aims: This study investigated the phenotypic detection of extended spectrum beta-lactamase resistance of diarrheagenic E. coli isolated from diarrheic patients attending some major health facilities in Nasarawa State, Nigeria. Place and Duration of Study: Department of Microbiology, Nasarawa State University, P.M.B 1022, Keffi, Nasarawa State, Nigeria; between December, 2017 to March, 2019. Methodology: A total of 207 confirmed E. coli isolates from loose stool samples of patients with suspected cases of diarrhea (69 from Federal Medical Centre Keffi [MCK] 69 from General Hospital Akwanga [GHA] and 69 from Dalhatu Araf Specialist Hospital Lafia [DASHL]) were included in this study. Results: E. coli was isolated and identified using standard microbiological methods. The antibiotic susceptibility testing for the isolates was carried out and interpreted in accordance with Clinical and Laboratory Standards Institute protocol. Phenotypic detection of ESBL production in isolates resistant to ciprofloxacin, cefotaxime and ceftazidime) was carried out using double disc synergy test. The occurrence of E. coli was 100% in all the hospitals. Age groups 0-5 and 6-10 years have the highest occurrence than age group 35 – >45 years. Isolates from DASHL were more resistant to amoxicillin/clavulanic acid (86.9%), Streptomycin (75.0%) and sulphamethoxazole/trimethoprim (68.1%), isolates from FMCK were more resistant to amoxicillin/clavulanic acid (84.1%), sulphamethoxazole/trimethoprim (69.6%), isolates from GHA were more resistant to amoxicillin/clavulanic acid (85.5%) and sulphamethoxazole/trimethoprim (73.0%). Multiple antibiotic resistance (MAR) was observed with the order of occurrence: FMCK (98.6%) > DASHL (92.8%) > GHA (89.9%). The most common MAR index of 0.2 in DASHL was 0.4 (20.3%); FMCK was 0.4 (15.9%) and GHA was 0.3 (17.4%). The order of occurrence of classes of antibiotic resistance in E. coli isolates in DASHL was MDR (84.0%) ˃ XDR(7.2%) > PDR and NMDR (4.3%); in FMCK was MDR (91.3%) ˃ XDR(4.3%) ˃ NMDR (2.9%) and PDR(1.4%); and in GHA was MDR (88.8%) ˃ NMDR(5.8%) > XDR and PDR(2.9%). Detection rate of ESBL was 53.6% (30/207), distributed in relation to the location as DASHL (60.0%), FMCK (50.0%) and GHA (52.6%). Conclusion: Most of the isolates from the study locations were antibiotic resistance. Further studies on molecular detection of ESBL, diversity and characterization of the E. coli into pathotypes are ongoing.

Aims: This study investigated the molecular diversity and extended spectrum beta-lactamase resistance of diarrheagenic E. coli isolated from patients attending selected healthcare facilities in Nasarawa State, Nigeria. Place and Duration of Study: Department of Microbiology, Nasarawa State University, P.M.B 1022, Keffi, Nasarawa State, Nigeria; between December 2017 and June, 2019. Methodology: A total of 207 confirmed E. coli isolates (using standard microbiological methods) from loose stool samples of patients with suspected cases of diarrhea (69 from Federal Medical Centre Keffi [MCK] 69 from General Hospital Akwanga [GHA] and 69 from Dalhatu Araf Specialist Hospital Lafia [DASHL]) were included in this study. Results: Phenotypic detection of ESBL production by β-lactam resistant isolates was done using double disc synergy test. Molecular detection of ESBL genes in phenotypically confirmed ESBL producers was done using Polymerase Chain Reaction. Out of 56 isolates jointly resistant to cefotaxime and/or ceftazidime and ciprofloxacin from DASHL, FMCK and GHA, 53.6% (30/56) were ESBL producers, distributed in relation to the hospitals as follows: blaCTX-M in DASHL was 6(66.7%), FMCK was 11(100.0%), and GHA was 10(100.0%); blaSHV in DASHL was 8(88.9%), FMCK was 7(63.6%), and GHA was 10(100.0%), and blaTEM in DASHL was 9(100.0%), FMCK was 10(90.9%), and GHA was 10(100.0%). Also, the occurrence of blaSHV was 100.0% in GHA but 88.9% in DASHL. The detection DEC was high in DASHL (88.9%) but low inGHA (58.8%). The occurrence of ETEC was high in GHA (60.0%) while EAEC was also high in FMCK (81.8%) and GHA (70.0%). The isolates were distributed into strain A – J based on RFLP pattern and the occurrence of strain A was high in GHA (70.0%) but low in DASHL (33.3%). Conclusion: Most of the isolates were both diarrheagenic and ESBL resistant, and the predominant ESBL and pathotypes genes were blaCTX-M, blaTEM and EAEC. Further studies on molecular detection of sub-types of ESBL and sequencing of diarrheagenic pathotypes genes should be carried out.

Limited treated options to Salmonellosis exist due to the emergence of extended spectrum beta lactamases (ESBLs). This study determined the prevalence of common ESBL genes (blaSHV, blaCTX-M, blaOXA) and profiled their antimicrobial resistance drug pattern. A descriptive cross-sectional study that involved 16 Salmonella enterica isolates from diarrhoeic children at the University of Calabar Teaching Hospital and 39 isolates from healthy birds in poultry farms within the Calabar metropolis. Standard disc diffusion method determined antimicrobial susceptibility while Polymerase Chain Reaction (PCR) using specific primers identified the beta-lactamase genes. All 55 isolates phenotypically demonstrated ESBL production. All 55 salmonella isolates were resistant to Cefotaxime and Nalixidic acid. All the clinical isolates were susceptible Ciprofloxacin and Norflaxacin. The poultry isolates however exhibited varied degrees of resistance to Ciprofloxacin and Norflaxacin. All 55 Salmonella isolates carried the blaSHV genes, blaCTX-M gene (94.5%) blaOXA gene (18.2%). Molecular characterization identified the blaSHV gene as the most prominent. This study provides relevant data that would help in the implementation of policies regarding the use of antimicrobial agents in clinical and veterinary settings as well provide antimicrobial treatment guidelines that would strengthen infection control processes. Key words: Salmonella enterica, Antimicrobial-resistance, ESBL-genes, Poultry-sources.

This study investigated the co-carriage of plasmid mediated quinolone resistance (PMQR) and extended spectrum beta-lactamase (ESBL) producing lactose non-fermenting (LNF) Enterobacteriaceae isolated from poultry birds. This was a descriptive cross-sectional study carried out between September, 2016 and March, 2017. The Kirby-Bauer disk diffusion method was used to determine the antimicrobial susceptibility patterns. ESBL screening disc kit was used to detect ESBL activities. Detection of ESBL and PMQR genes was carried out by means of polymerase chain reaction. In total, 207 LNF Enterobacteriaeae isolates were recovered from the cloacal swabs of poultry birds within the Calabar Metropolis. ESBL-producing isolates were 162 (78.3%) while fluroquinolone resistant isolates were 194 (93.7%). Among the ESBL-producing isolates, resistance to Ciprofloxacin, Norfloxacin, Levofloxacin, Ofloxacin and Nalidixic acid was 55 (34.2%), 26 (16.1%), 35 (21.7%), 50 (31.1%), and 162 (100%), respectively. About 65% of the quinolone resistant isolates were positive for at least one of the PMQR and ESBL genes in this study. Strict antimicrobial screening, surveillance of resistant isolates as well as the judicious practice of antimicrobial administration in the poultry setting with special emphasis on fluoroquinolones is advised given the high prevalence of co-existent ESBL and PMQR genes. Key words: LNF enterobacteriaeae, Extended spectrum beta-lactamases, quinolone resistance

Background:Yellow Fever is an acute viral hemorrhagic disease endemic in tropical Africa and Latin America and transmitted through infected mosquitoes. The renewed onset of yellow fever outbreaks in Nigeria followed a global trend of reports and from other African countries marking the emergence of yellow fever as a brand-new re-emerging global threat in 2016 with giant outbreaks of yellow fever reports in Angola and the Democratic Republic of Congo. Nigeria has been battling successive yellow fever resurgence since September 2017. Yellow Fever disease has no cure, but control is through vaccination and vector control. Eliminating Yellow fever Epidemic (EYE) strategy to improve high risk countries’ prevention, preparedness, detection, management and response to yellow fever outbreaks was developed by WHO in 2017 and launched in Nigeria in April 2018. Yet, poor vaccination coverage continues to be a cause for concern.Materials and Methods:We conducted a retrospective cross-sectional study that examines the resurgence of Yellow fever cases and outbreaks from 2013-2020 in Oyo State, Nigeria. The Yellow Fever data for both surveillance and immunization were the focus of the review. Surveillance data were retrieved from the State’s database reported by all 33 LGAs, maintained by the State and supported by the World Health Organization at the Zonal and State levels. The immunization data were retrieved from District Health Information Software (DHIS_2). The proportion of LGAs reporting at least one case of suspected yellow fever with blood specimen, and the number of suspected cases reported for each year within the period under review was measured. We also assessed the trend of confirmed cases, and the incidence per 100,000 population. Also, suspected cases of yellow fever were categorized into four age groups and their vaccination status assessed. The State’s annual administrative vaccination coverage for yellow fever vaccine was compared with the number of confirmed cases for each year.Results:The proportion of LGAs reporting at least a case of suspected yellow fever, with blood sample collected, ranged from 6.1% to 84.9% between 2014 and 2020 while a total of 9 confirmed (8 cases) and probable (1 case) cases of yellow fever were recorded. However, there were no confirmed cases from the year 2013 to 2016, including 2018 but upward trend of incidence of the disease per 100,000 population from 0% in 2013 through 2018, to 3.5% in 2019 and then to 5.6% in 2020 was observed. 93 of 240 (39%) suspected yellow fever cases reported during the given period were observed to have received yellow fever vaccine Conclusion: In conclusion, the resurgence of yellow fever cases in the State reiterate the State being high risk for yellow fever transmission and underline the need for viable interventions such as environmental hygiene to rid the environment of the disease vector’s ecological niche and improving vaccination coverage to provide population immunity.

Background: Schistosomiasis is a Neglected Tropical Disease (NTD) that constitutes a public health problem in Sub-Saharan Africa (SSA), including Nigeria. There is need for updated information on the extent of the disease burden at community level to facilitate effective prioritization and monitoring of the disease. Methods: A cross-sectional study was conducted among school-aged children in Obudu Local Government Area (LGA), one of the 18 LGAs in Cross River State, Southern Nigeria. Seven schools from seven communities were randomly selected for this study. A total of 1,113 urine samples obtained from school-aged children were screened for Schistosoma haematobium (S. haematobium) eggs using standard parasitological method of diagnosis. Proteinuria and hematuria were evaluated using reagent test strips. Results: In this study, 153 (13.7%) children were infected with S. haematobium. More males (86 or 14.7%) were infected than females (67 or 12.7%); the differences were not statistically significant. The overall geometric mean intensity of infection was 13.3 eggs/10ml of urine. Females (13.69 eggs/10ml of urine) had the highest intensity of infection than males (12.91eggs/10ml of urine). Prevalence of hematuria was 152 (13.7%) (95% C.I. = 10.649 – 18.751%) while the prevalence of proteinuria was 172 (15.5%) (95% C.I. = 5.162 – 38.712%). Prevalence of infection significantly (p

Background The year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity. Methods We evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers. Results Penta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation. Conclusions The systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.

This study investigated the antimicrobial resistance profile of Escherichia coli from urine of patients with suspected urinary tract infections (UTIs) in selected general hospitals in Abuja Municipal, Nigeria. Four Hundred and Thirty urine samples were collected between September 2017 and May 2018 from patients attending Asokoro General Hospital (AGH), Garki Hospital Abuja (GHA) and Wuse General Hospital (WGH); and E. coli was isolated and identified by culture, microscopy and biochemical tests. The overall occurrence of E. coli was 52 (12.1%). The occurrences in relation to the hospitals were of the order: GHA (14.7%) > WGH (12.6%) > AGH (9.0%). The highest (50%) occurrence was at age 41-50 years in WGH, and the lowest (4.3%) was at age 31-40 years in AGH. More females than males harboured the bacteria in all the hospitals. Isolates from AGH showed highest (100.0%) resistance to Sulphamethoxazole/Trimethoprim but least (0.0%) resistance to Ciprofloxacin. Isolates from GHA showed the highest resistance to Cefotaxime and Streptomycin (95.2%) but least (23.8%) to Gentamicin and Imipenem. Isolates from WGH showed highest (88.8%) resistance to Amoxicillin/Clavulanic Acid but least (16.7%) to Sulphamethoxazole/Trimethoprim. The commonest antibiotic resistance phenotype in AGH was Amoxicillin/Clavulanic Acid-Streptomycin-Cefotaxime-Ceftazidime-Imipenem-Ampicillin (3.9%); in GHA was Amoxicillin/Clavulanic Acid-Streptomycin-Sulphamethoxazole/Trimethoprim-Cefotaxime-Ceftazidime-Ampicillin (7.7%); and in WGH was Amoxicillin/Clavulanic Acid-Streptomycin-Cefotaxime-Cefotaxime-Ceftazidime-Imipenem-Ampicillin (3.9%). All the isolates had MAR indices above 0.2; the most common index in AGH was 0.4 (at 30.8%), GHA was 0.7 (at 33.3%) and WGH was 0.7 (at 27.8%). The commonest class of antibiotic resistance was MDR with the order of occurrence as: GHA (92.2%) > WGH (77.7%) > AGH (76.6%). Ciprofloxacin, gentamicin and imipenem were the most effective antibiotics in the study location. However, MAR indices in this study have shown that the isolates originated from an environment where antibiotics are freely available and misused/abused. Hence, there is a need for greater monitoring of antibiotic supplies and use.

Objective: This study focuses on the reverse cold chain system of stool sample management from cases reported to the AFP surveillance system between 2010 and 2015. Through the distribution of their NPEV isolation rates, we identify lapses in the reverse cold chain management and provide recommendations that should help improve the reverse cold chain system and the AFP surveillance system in general as Nigeria once again matches towards a polio free certification. Methods: A descriptive retrospective study was conducted using AFP surveillance data routinely collected between January 2010 and December 2015 by the Disease Surveillance and Notification Officers (DSNOs) in Nigeria and the WHO accredited Polio Laboratories. All AFP cases reported to the Disease Surveillance network during this period from all the states were included in the study. EPIINFO—veritable customized software was used to run queries on the access database and obtain the specific data sets required. Results: A total of 52,879 AFP cases were reported from 2010-2015, in which 7288 non-polio enteroviruses were isolated. NPEV isolation rate ranged from 10.8% in the southeast to 20.3% in the northeast with the states in the northern geopolitical zones having higher NPEV rates in comparison to the states in the southern geopolitical zones. The WHO Polio laboratory in Ibadan serves twenty-seven states in the country; the average non-polio AFP rate among states served by this laboratory is 11.7% from a total of 4012 AFP cases recorded. The WHO Polio laboratory in Maiduguri recorded 3276 with an average non-polio AFP rate of 19.2%. Conclusion: Though the country’s NPEV isolation rate remain slightly higher above the 10% recommended by WHO, steps should be taken to enhance the reverse cold-chain system particularly in the southern states. This would increase confidence in the AFP surveillance system in Nigeria as she proceeds once again towards complete polio eradication and meeting certification standards.

Background The globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone. Methods This was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOC Results The switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%). Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428). Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker. Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored. Conclusion The Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised.

Introduction: Enteropathogenic Escherichia coli (EPEC) causes infectious diarrhea among children in developing countries. However, in Nigeria, due to limited laboratory resources, the genetic diversity of its virulence factors, which include intimin subtypes, remains undefined. Methodology: EPEC isolates from diarrheic children 60 months of age and younger in Abuja, Nigeria, were analyzed. Polymerase chain reaction (PCR) for EPEC virulence gene, Hep-2 cell adherence, and serotyping were performed. EPEC strains were further subtyped by PCR for the identification of intimin subtype genes α (alpha), β (beta), γ1 (gamma-1), and έ (epsilon). Antibiotic resistance and extended-spectrum beta-lactamase (ESBL) production was determined by Clinical and Laboratory Standards Institute guidelines. Results: Overall, 18 (4.5%) out of 400 children with acute diarrhea had EPEC infection. Typical EPEC (tEPEC) strains were detected in 14 (3.5%), whereas 4 (1.1%) were atypical EPEC (aEPEC). A total of 15 (83.3%) of the EPEC isolated belonged to β intimin subtype gene, while the remaining 3 EPEC isolates possessed the intimin έ subtype. No α and γ intimin subtypes were detected. Traditional EPEC serotypes O114:H14 were detected only in tEPEC strains. Marked resistance to β-lactam agents were observed but no ESBL-producing tEPEC or aEPEC was detected. Conclusions: This is the first report of intimin subtype genes in Abuja, Nigeria. EPEC isolates of diverse serotypes resistant to β-lactam antimicrobial agents were observed. These data will be useful in facilitating the characterization of intimin variants of EPEC and some Shiga toxin-producing E. coli (STEC) in humans and other animal species.

The wide use of antibiotics to treat urinary tract infection (UTIs) caused by bacteria is compromised by the development of resistance mechanisms in bacteria. This study evaluated the antibiotic resistance inEscherichia colifrom urine of patients with suspected UTI in Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Four hundred urine samples of suspected UTI patients were collected andE. coliwas isolated and identified using standard microbiological methods. Antimicrobial Susceptibility Testing for the isolates was carried out and interpreted as described by the Clinical and Laboratory Standards Institute (CLSI). The occurrence of the bacterium was 14.5 % (58/400). The occurrence was higher in female (15.8 %) than the male (12.5 %); and highest at > 50 years (31.8 %). The isolates were more resistant to ampicillin (79.3 %), streptomycin (62.0 %) and cefoxitin (58.6 %) but less resistant to gentamicin (15.8 %), imipenem (18.9 %) and amoxicillin/clavulanic acid (27.6 %). The occurrence of multi-drug resistance (MDR) isolates was 87.9%. The antibiotics namely gentamicin, imipenem and amoxicillin/clavulanic acid were very effective against the isolates and most of the isolates were MDR. There is thus a need for the hospital to limit its antibiotic use in the light of these observations.

Objectives To demonstrate the immunity status of children with non-polio acute flaccid paralysis (NP AFP) reported through the AFP surveillance system in the South–South region of Nigeria. Study design A retrospective study was conducted using AFP surveillance data collected routinely between January 2011 and December 2014 by the Disease Surveillance Department of the regional health service and the World Health Organization (WHO)-accredited regional reference polio laboratory. All cases of AFP reported to the Disease Surveillance Network from all six zones during this period were included in the study. Methods In total, 5111 cases of AFP in children aged ≤15 years were reported between 2011 and 2014. These cases were investigated and verified by WHO surveillance officers using a standard questionnaire, which captured the number of doses of oral polio vaccine (OPV) received by the child. Two stool samples were collected for each case, 24–48 h apart, within 14 days of the onset of paralysis, and transported to the national polio laboratory under reverse cold chain storage. Data retrieved were stored in an AFP database hosted by the WHO server. EPIINFO software was used to query the database and extract the information required for analysis in this study. Results The percentage of children who had received at least three doses of OPV (which serves as a threshold to measure immunity status) decreased from 87% in 2011 to 82% in 2014. The percentage of children who had not received any doses of OPV decreased from 2% in 2011 to 1% in 2014. Forty-eight percent of the children who had not received any doses of OPV were aged Conclusion Given the decrease in OPV immunity status, the region risks re-introduction of poliovirus. Swift steps should be taken to improve the immunization coverage, which would boost immunity status in Nigeria.

The uptake of Routine immunization services continues to decline in Oyo State despite best efforts to improve Routine Immunization (RI) services. This study aims to investigate the root cause of poor routine immunization uptake in the State using Ibadan north and Kajola Local Government Areas (LGAs) as sentinel study sites in Oyo state, Nigeria. A cross-sectional Community survey was conducted between 26th-30th November 2018 using structured questionnaires uploaded onto Open Data Kit-collect (ODK) mobile software in the 2 LGAs namely Kajola and Ibadan North LGAs, Oyo state. Majority of the respondents Local Immunization Officers, RI Focal Persons, Other Health Workers and Community Members were fully aware of RI services, its benefits/importance and were mostly satisfied with the services they received at their community health facility. However, 95% of the respondents stated that they were not part of the RI planning processes in their communities neither were they actively involved in selecting the date, time or venue for RI in their communities. Also 76% of the respondents stated that Health workers neither rescheduled RI sessions for missed children neither did they visit /track the missed children. Functional Village Development Committees (VDCs) and updated Reaching Every Ward (REW) micro-plan was not present in 67% and 62% of the visited facilities respectively. World Health Organization (WHO) was mostly responsible for funding of immunization activities. Funding and poor engagement with members of the communities have been discovered to be a major contributing factor to poor immunization uptake in these LGAs. We advise that this gap be bridged for the purposes of improved RI uptake in the state.

A weak AFP surveillance system constitutes a major threat to Nigeria’s polio free certification status. This study investigates the factors that have affected AFP surveillance, case detection along the international border settlements of Oyo state, Nigeria. A cross-sectional survey was conducted between 26th-31th December 2018 using structured questionnaires uploaded onto Open Data Kit-collect (ODK) mobile software in 4 LGAs in Oyo state. Overall, 427 respondents (community members=420, community informants=7) participated in this study. On the average, 10% and 46% of the community members and informants could identify the various aspects of the AFP case definition. Majority of the community members weren’t aware of AFP surveillance neither were they aware of their AFP focal person/DSNO or where to report AFP cases. Barriers to case reporting include, irregular movements of commercial vehicles, swampy roads during rainy seasons, rocky roads during dry seasons; poor communication networks; and poor modes of transportation. The accessibility and difficulty of terrain along these international boarders has greatly hindered surveillance activities in their corresponding communities. If steps are taken to improve accessibility in such areas, we believe that AFP case detection and reporting would also improve.

Background The containment of poliovirus infectious/potentially infectious materials in all biomedical facilities in Nigeria remain crucial to maintaining gains recorded towards polio eradication. Activities involved in the Nigerian Poliovirus type 2-laboratory containment survey in line with the 3rd Global Action Plan III (GAP III) for poliovirus containment are documented in this study. Through these activities, the overall preparedness for poliovirus eradication in Nigeria is assessed. Method A cross-sectional survey was conducted from 19th September-31st October 2016 using structured Laboratory survey and inventory (LSI) questionnaires uploaded onto the SPSS software package in 560 biomedical facilities classified either as high risk or medium risk facilities across the 6 zones in Nigeria. Results In total, 560 biomedical facilities were surveyed in Nigeria in conformity with the GAP III. In total, 86% of the facilities surveyed were with laboratories while 14% were without laboratories. Twelve laboratories with poliovirus potentially infectious materials were identified in this exercise. In total, 50% of the 12 laboratories were under the ministry of education for research purposes. While 33% were among those laboratories surveyed in the phase 1a exercise without any recorded inventory, but have acquired some since the phase 1a survey. A total of 13,484 poliovirus infectious materials were found in the 12 laboratories. Only 8% of the materials were immediately destroyed while the remaining materials (62%) were found in Oyo and Borno states scheduled for destruction within 3–4 months according to WHO protocol for destruction of poliovirus infectious materials. Conclusion This study has revealed the successful containment of all poliovirus infectious materials in the laboratories surveyed. It has also revealed some surveillance gaps. We recommend that the surveillance system be improved to maintain the gains from the containment exercise and avoid reintroduction of infectious materials into biomedical facilities. This reduces the chances of viral reintroduction to the population in general.

In this present paper, we proposed and formulated a quantitative approach to parametric identifiability of dual HIV-parasitoid-pathogen infectivity in a novel 5-dimensional algebraic identifiability HIV dynamic model, as against popular 3-dimensional HIV/AIDS models. In this study, ordinary differential equations were explored with analysis conducted via two improved developed techniques—the method of higher-order derivatives (MHOD) and method of multiple time point (MMTP), with the later proven to be more compatible and less intensive. Identifiability function was introduced to these techniques, which led to the derivation of the model identifiability equations. The derived model consists of twelve identifiable parameters from two observable state variables (viral load and parasitoid-pathogen), as against popular six identifiable parameters from single variable; also, the minimal number of measurements required for the determination of the complete identifiable parameters was established. Analysis of the model indicated that, of the twelve parameters, ten are independently identifiable, while only the products of two pairs of the remaining parameters ( and ) are identifiable. Validation and simulations of the model outcome were examined using well-known Runge-Kutter of order of precision 4, in Mathcad surface, with each parameter viewed as unknown and results discussed in stratified trend, which simplified the sequence of magnitude of the identifiable parameters. By the result, identifiable parameters were established which were core to a 5-D dual HIV dynamic model. Therefore, the study though centered on dual HIV-pathogen infectivity, its adoption for other nonlinear dynamic models was readily achievable.

Multiplicity of new cases of HIV/AIDS and its allied infectious diseases daunted by lack of proper parametric estimation necessitated this present work. Formulated using ordinary differential equation was a five-dimensional (5D) differential mathematical model with which compatibility of optimal control strategy for dual (viral load and parasitoid-pathogen) infectivity in the blood plasma was investigated. Discretization method indicated the incompatibility of the model due to large error derivatives. The study using numerical method established treatment set point with which we explored the variation of predominant model parameters and thereof investigated the maximization of uninfected healthy CD4 T cell count as well as the de-replication of viruses following the consistent administration of reverse transcriptase inhibitor from set point. Presented was a series of numerical calculations obtained using well-known Runge-Kutter of order of precision 4, in Mathcad platform. Analysis of simulated parameters showed that distortion of replication viruses and de-transmutation of susceptible CD4 T cells by viruses via chemotherapy led to restoration and gradual increase of healthy blood plasma, with near zero declination of both viral load and parasitoid-pathogen within chemotherapy validity time frame. The model was worthy in the study of treatment analysis of dual HIV—pathogen infection and thereof recommended for other related dual infectious diseases.

International audience; Introduction: Escherichia coli are frequently isolated from diarrheic children in the Federal Capital Territory Abuja, Nigeria, but their virulent properties are not routinely evaluated. Therefore, the etiology of childhood diarrheal disease attributable to diarrheagenic Escherichia coli (DEC) in Abuja, Nigeria remains unknown. Methodology: Stool specimens from 400 acute diarrheic children between 0 and 60 months of age were studied. E. coli strains isolated were evaluated by polymerase chain reaction (PCR) for nine virulence genes and HEp-2 cell adherence to detect and identify five distinct diarrheagenic E. coli categories. Results: Diarrheagenic E. coli was detected in 51 (12.8%) of the diarrheic children. The observed DEC pathotypes were enteropathogenic E. coli (EPEC) in 18 (4.5%) children, enterotoxigenic E. coli (ETEC) in 16 (4.0%), enteroaggrative E. coli (EAEC) in 8 (2.0%), enterohaemorrhagic E. coli (EHEC) in 6 (1.5%), and enteroinvasive E. coli (EIEC) in 3 (0.8%). Four (1.0 %) EPEC strains with only the eae+ gene that adhered diffusely to HEp-2 cell were identified as atypical EPEC. All the DEC categories except atypical EPEC were identified in children between 6 and 12 months of age. Conclusions: This study underscores the need for routine evaluation of diarrheic children for virulence properties of infectious DEC. Atypical EPEC are emerging among the DEC pathotypes isolated from childhood acute gastroenteritis in Abuja, Nigeria.

Background: Heat-labile (LT) and heat-stable (ST) toxin variants of enterotoxigenic Escherichia coli (ETEC) are enterotoxins associated with diarrhea among children in Abuja, Nigeria. Enterotoxigenic Escherichia coli is also known as a major etiological agent of diarrheal disease among travelers in developing countries. Continuous identification of commonly expressed bacterial components of ETEC can help extend the protective spectra of future candidate ETEC vaccines in Nigeria. Objectives: This study aimed to provide new insights into the distribution patterns of enterotoxins, colonization factor antigens (CFA phenotypes), and serotypes and to determine the antimicrobial susceptibility patterns of ETEC strains from children with acute diarrhea in Abuja, Nigeria. Methods: Escherichia coli strains, isolated from the stool samples of children aged 0 - 60 months, were tested via polymerase chain reaction, ganglioside GM1 ELISA assay, hemagglutination assay, HEp-2 cell adherence assay, dot blot technique, and disc diffusion method for antimicrobial resistance. Results: Rnterotoxigenic Escherichia coli was detected in 16 (4.0%) out of 400 children with acute diarrhea. The toxigenic genotypes expressed by ETEC strains included LT toxin gene 6 (37.5%), ST toxin gene 6 (37.5%), and ST/LT gene 4 (25.0%). The CF phenotypes with major expression included CS2 (25.0%), CS3 (12.5%), and CFA1 (6.3%), with a probability value below 0.05 (P < 0.05). However, no CFA/CS was detected in 56.3% of ETEC strains. Multidrug resistance pattern of nalidixic acid-ciprofloxacin-amoxicillin-augmentin-cephalexin-cefuroxime was observed in 19% of ETEC strains. The most prevalent ETEC serotype was O8: H9 (n, 5). Based on the findings, ETEC infection peaked to 7.2% in July. Conclusion: Although ST and LT toxins seem to have equal distributions in the analyzed population, continuous identification of CFA phenotypes and toxins is necessary for the evaluation of ETEC vaccines in Nigeria.

Introduction: In Nigeria, acute gastroenteritis in children under five years of age is a major cause of mortality and morbidity; identification and characterization of microbial agents of acute gastroenteritis, including Salmonella , remains a powerful tool for effective management, surveillance, and control. Methodology: Diarrheal stool samples were directly plated onto differential and selective media to isolate Salmonella. Extended-spectrum beta-lactamases were screened using the double disk diffusion technique and by PCR targeting the bla TEM and bla CTX-M genes. Pulsed-field gel electrophoresis (PFGE) was performed usingthe PulseNet Canada Laboratory protocol for molecular subtyping using the restriction enzymes Xba I and Bln I. Results: The serotypes identified were Salmonella enterica serovar Zanzibar (n = 5), Salmonella Brancaster (n = 3), and one isolate of Salmonella Enteritidis (phage type 1). The following levels of resistance were found among the Salmonella strains: amoxicillin, five strains (55.6%); amoxicillin-clavulanic acid, two strains (22.2%); cephalexin, five strains (55.6%); and cefuroxime, five strains (55.6%). Intermediate resistance was found in five strains (55.6%) only to amoxicillin-clavulanic acid. All isolates were susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone, and no ESBL-producing Salmonella were detected. Conclusions: Our findings demonstrated the involvement of three Salmonella serovars in acute gastroenteritis; resistance to penicillins and cephalosporins was common.

Background: Acute Flaccid Paralysis (AFP) was adopted by World Health Organization (WHO) in 1988 as a key pillar used in monitoring progress towards the global polio eradication initiative. High quality AFP surveillance is essential to support this global initiative. We applied recently developed case verification methods for the quantitative evaluation of AFP cases reported to the surveillance systems to evaluate the quality of AFP reports in Akwa Ibom State, Nigeria. Objectives: The aim of this study is to identify the demographic, clinical and epidemiological attributes and quality of acute flaccid paralysis surveillance. Methods: All AFP cases reported in children 0 - 14 years during January 2006 to December 2012 were investigated and verified by WHO surveillance officers, using standard questionnaire. Two stool samples 24 - 48 hours apart from a total of 1184 AFP cases were collected within 14 days of onset of paralysis with the prior oral/verbal informed consent and transported to the national polio laboratory under reverse cold chain. Result: In all, 885/1184 representing 75% of the AFP cases reported were verified by WHO officers in the period under review. Overall, 534/885 (60.3%) of AFP cases had more than >3 doses of Oral Polio Vaccine (OPV), while 196/885 (22.2%) received 3 dose of OPV and 128/885 (14.5%) received between 1 - 2 doses of OPV. It was interesting that 27/885 (3%) never received OPV before. Overall, 743/885 (84.0%) were reported within ≤14 days of paralysis onset, while 142/885 (16%) were reported after ≥14 days of paralysis onset. In total, 797/885 (90.1%) of cases were found to have fever at the onset of paralysis; paralysis was found to be asymmetric in 805/885 (91%). Wasting or diminished muscle tone was observed in 34.0% of cases verified, while deep tendon reflexes were good (normal) in 79% of cases. Gullain-Barre syndrome was observed in 50.9% of the reported cases followed by injection neuritis (25.0%) and transverse myelitis (2.0%). However, other causes recorded 22.1%. The legs (90.2%) are the parts of the body mostly affected, while arm recorded 9.8% of the AFP cases reported and verified. Conclusions: The result of this study indicates that the characterization of AFP cases reported to the surveillance network could provide better understanding of age, and sex distribution, common clinical causes of AFP and impact of distance to health facilities on the health seeking behaviours of AFP cases.

Objective: This study seeks to evaluate the prevalence of Salmonella producing ESBLs strains by phenotypic methods and their profile of drug resistance amongst patients with diarrhoea due to gastroenteritis and enteric Fever in Calabar, Nigeria. Methods: Stool samples were collected from 256 patients in Calabar with diarrhoea due to enteric fever and gastroenteritis. They were examined for Salmonella infection. Isolation and detection of Salmonella species was done following the standard ISO 6579:2002/Amd2007 method. Modified double disc synergy and phenotypic confirmatory tests were used to determine ESBL-producing Salmonella species. Results: Salmonella isolates were recovered from 44 (17.2%) stool samples; 24 (9.4%) were ESBLs producers and 20 (7.8%) were non-ESBLs producers. Eight (33.3%) and 3 (15.0%) strains of both ESBL producing and nonESBL producing respectively, demonstrated resistance against 7 of the 8 antibiotics used in this study. Resistance against 3rd generation cephalosporin was observed in 34 (77.3%) of the Salmonella strains against ceftazidime, 26 (59.1%) against cefotaxime while all 44 (100%) Salmonella strains were resistant against ceftriaxone. Conclusion: The presence of ESBL Salmonella amongst isolated strains should not be overlooked. We recommend continuous surveillance of antimicrobial resistant strains and the rational use antimicrobials agents

We evaluated the malaria burden in randomly selected pregnant women (PW) attending antenatal clinics in Abuja, Nigeria, to establish an association between pregnancies, malaria. Structured questionnaire was administered by the ante-natal nursing staff and a research assistant. In total, 1400 pregnant women were screened between April and Sep- tember 2004, and capillary blood samples were obtained and screened for malaria parasites in thin blood films and quanti- tative buffy coat analysis (QBC). In total, 1035 (73.9%) pregnant women were positive for Plasmodium falciparum; of which 578 (55.8%) were primigravidae; 299 (28.9%) second gravidae; and 158 (15.3%) were multigravidae, while 297 (28.7) were in their first trimester, 311 (30%) were in their second trimester, and 427 (41.3%) were in their third trimester. The highest prevalence of malaria parasite (31.6%) was found in those aged 26-30 years while the lowest prevalence (2.9%) occurred in those aged 41-46 years. Socio economically, prevalence of malaria parasite is highest in non- automobile owners 84.4%, 66% in those with monthly income less than $100, and those living in vegetable thatched houses had 46.0%, while the lowest incidence (15.6%) was found in automobile owners. Of the 760 pregnant women who sought malaria treatment only 278 (34.2%) seek intervention in hospitals, while 59.4% got treatment outside the hospital or were on self medication. This study demonstrated a high prevalence of malaria in the population evaluated, and there- fore underlines the need for urgent intervention through capacity building, implementation of intermittent preventive treat- ment (IPT), use of insecticides treated-nets (ITN) and effective case management of malaria illness. The delivery of these interventions through ante-natal clinics in Nigeria is highly critical and needs to be encouraged; strategies that encourage pregnant women to attend antenatal clinics early and consistently need to be developed. It is also important to develop coherent and effective policies and tools to tackle malaria and poverty.

Summary Objectives Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. Methods A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. Results Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. Conclusions The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities.

In view of the need for environmental management, waste recycling and alternative energy resources, there has been on-going work on biogas production with a locally fabricated digester in Akwa Ibom State of Nigeria. The first result shows that 0.032 m3 of biogas was produced from 180l of poultry manure mixed with same volume of moisture in 16 days. Using the same concentration of cow dung in a repeat experiment, 0.015 m3 of biogas was produced in 7 days. There was interruption in the gas production in the second case due to excessive wetness of weather. Further investigation indicated that the volume of gas evolved might also depend on the ambient temperature as shown in the second experiment. A maximum volume of 0.006 m3 was got for the maximum temperature 51 °C and a minimum volume of 0.00 m3 got for the minimum temperature of 22 °C. We also observed that the gas yield with poultry manure was higher than that with cow dung.

Background: Measles remains a serious problem of infancy and childhood in the developing world, despite the availability of vaccine. Increasing urbanization is changing patterns of endemicity. Objective: This paper critically examines the epidemiological impact of this nationwide measles immunization campaign and routine immunization, while taking into account any changes in surveillance performance. Methods: Blood samples were obtained from 4159 client at the surveillance focal sites scattered across the 123 district (LGAs) and were tested for measles specific immunoglobulin M (IgM). Five (5) ml of blood was collected from each subject into plain sterile bottle following informed consent. Blood samples were centrifuged and sera were separated and stored at -20oC until used. Samples were analyzed in batches for measles specific IgM using commercial ELISA (MV-ELISA) (Enzygnost; Behring Diagnostics, Marburg, Germany) in accordance with the manufacturer’s instructions. Tests were read on a pre-programmed spectrophotometer Quantum II, wavelength 450/630nm, manufactured by Abbott. Results: In total, 465 (11.2%) tested positive for measles specific IgM antibodies. Of these, 1962 were male and 2197 were female. The highest number of IgM positive cases was found in those less than 5 years (79.8%), while those aged 5-15 years, and 15 years and above recorded 17.2% and 3.0% respectively. The distribution of measles burden between urban and rural setting indicates that urban dwellers 53.8% were more susceptible to measles than rural dwellers (46.2%), this relationship was established as statistically significant with (p< 0.0001) and odds ratio was also high 1.669 (95% CI 1.375-2.025). A high significance of association between development of measles and vaccination status of subjects is also observed in this study (p < 0.0001), while odds ratio was also observed to be high 6.144 (95% CI 4.977-7.511). Conclusions: Improved understanding of measles epidemiology and risk factors are prerequisites for effective control. Possible strategies should include vertical vaccination efforts in addition to routine programmes.

Systemic lupus erythematosus (SLE) is a multisystem disorder affecting almost every organ system. It is a chronic inflammatory disorder occurring almost exclusively in women. The presentation and course are highly variable ranging from indolent to fulminant. Older literature considers SLE to be rare in the African. Recently, however, it has been shown that SLE is seen in a significant number of Africans, but the low incidence stems from underdiagnosis. We present one such woman who presented with quadriparesis having been misdiagnosed initially when she had just the classical triad. Diagnosis was clinical and also confirmed with immunological tests. This patient is a 32-year-old female, with a 9 month history of persistent, progressive joint pains involving the ankles and feet. Six months later she noticed bilateral leg swelling and gradual involvement of the upper limbs. She was referred to the Neurology unit on account of inability to walk and recurrent fever. She had associated generalized hyper-pigmented raised patches on the trunk with tender edematous hand and feet joints and high blood pressure. A diagnosis of SLE was made after the initial review. Investigations revealed the proteinuria, thrombocytopenia, and positive anti-nuclear antibodies and double-stranded DNA autoantibodies. Thereafter, a definitive diagnosis of SLE was made. She was commenced on Prednisolone which controlled the flare. After one month of admission, the Prednisolone was tapered down. She had standing re-education with physiotherapy. She had started walking before discharge. SLE is also seen in African women living in Africa. The protean manifestations make diagnosis difficult; however, the availability of the immunological tests in our practice has made the diagnosis easier. There yet remains a need for a high index of suspicion. The classical triad of fever, joint pain and rash in a woman of childbearing age should prompt investigation and diagnosis of SLE.