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Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Yusuff HA, Christian UC, Adekanmbi O, Ojimba AO, Aremu JT, Habila KL, Oiwoh SO, Tobin EA, Johnson SM, Olaitan A, Onyeaghala C, Gomerep SS, Alasia D, Onukak AE, Mmerem J, Unigwe U, Falodun O, Kwaghe V, Awang SK, Sunday M, Maduka CJ, Na'uzo AM, Owhin SO, Mohammed AA, Adeiza MA. Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study. Lancet Infect Dis 2023; 23:1418-1428. [PMID: 37625431 DOI: 10.1016/s1473-3099(23)00427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. METHODS We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. FINDINGS We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). INTERPRETATION During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. FUNDING None.
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Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria.
| | | | | | - Mildred Okowa
- Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria
| | - Nneka Marian Chika-Igwenyi
- Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria
| | | | - Umenzekwe Chukwudi Christian
- Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - John Tunde Aremu
- Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kambai Lalus Habila
- Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria
| | | | - Ekaete Alice Tobin
- Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria
| | - Abimbola Olaitan
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Chizaram Onyeaghala
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Simji Samuel Gomerep
- Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Juliet Mmerem
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Uche Unigwe
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Olanrewaju Falodun
- Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria
| | - Mogaji Sunday
- Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria
| | | | - Aliyu Mamman Na'uzo
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
| | - Sampson Omagbemi Owhin
- Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria
| | - Abdullahi Asara Mohammed
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
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Adeiza MA, Abdullahi U. A Retrospective Study on Changing Trends of Acquired Immunodeficiency Syndrome related Kaposi's Sarcoma in North-Western Nigeria. West Afr J Med 2022; 39:663-669. [PMID: 35921757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of AIDS-related Kaposi's sarcoma (KS) has been reducing following the widespread use of highly-active anti-retroviral therapy (HAART). In Nigeria, recent trends in the prevalence of KS in HIV-infected patients has not been described. We determined the prevalence, clinical pattern and treatment outcome of AIDS-related KS in Zaria, Nigeria. METHODS Over a 5-year period, a retrospective study was conducted at the HIV treatment and care centre of Ahmadu Bello University Teaching Hospital, Zaria and all patients with histologically confirmed AIDS-related KS were included. RESULTS A total of 4721 patients were enrolled during the period under review, out of which 45 were diagnosed with AIDS related KS, which constituted 0.95% of all patient seen. The male to female ratio was 1:1.5 with a mean age of 35.2 ± 6.5 years. Twenty-six (58%) were on HAART, with median duration of 4 months (IQR: 1-31 months) between HAART commencement and KS diagnosis, while KS was reported as presenting illness in 19 (42%) patients. The lower extremity was the most frequently involved site in 24 (53.3%) patients and disseminated disease was present in 14 (31.1%) patients, commoner in the HAART-naïve group. Following KS treatment, 27 (60%) patients recovered fully, 12 (26.7%) died, while 6 (13.3%) were lost to follow up. Disseminated disease, male gender, and low CD4+ T-cell count was associated with higher mortality. CONCLUSION Kaposi's sarcoma remains an important AIDS defining illness though with a decreasing prevalence. Early diagnosis and treatment should be prioritized at the time of HAART initiation in HIV service delivery programs in Nigeria.
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Affiliation(s)
- M A Adeiza
- Infectious Disease Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
- Office of Global Health, Department of Internal Medicine, Yale University School of Medicine
| | - U Abdullahi
- Dermatology Unit, Department of Internal Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Ogoina D, Iliyasu G, Kwaghe V, Otu A, Akase IE, Adekanmbi O, Mahmood D, Iroezindu M, Aliyu S, Oyeyemi AS, Rotifa S, Adeiza MA, Unigwe US, Mmerem JI, Dayyab FM, Habib ZG, Otokpa D, Effa E, Habib AG. Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria. Antimicrob Resist Infect Control 2021; 10:73. [PMID: 33931108 PMCID: PMC8086089 DOI: 10.1186/s13756-021-00940-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR. METHODS In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert's scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model. RESULTS A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr. CONCLUSIONS Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria's NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.
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Affiliation(s)
- Dimie Ogoina
- Dimie Ogoina Infectious Disease Unit, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State, Nigeria.
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | - Vivian Kwaghe
- Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria
| | - Akan Otu
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Iorhen Ephram Akase
- Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, University College Hospital/University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Dalhat Mahmood
- Nigeria Centre for Disease Control (NCDC), African Field Epidemiology Network (AFENET), Abuja, Nigeria
| | - Micheal Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Shamsudin Aliyu
- Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Abisoye Sunday Oyeyemi
- Department of Community Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Stella Rotifa
- Department of Community Medicine, Federal Medical Centre Yenagoa, Yenagoa, Bayelsa State, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Department of Internal Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Uche Sonny Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Juliet Ijeoma Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Farouq Muhammad Dayyab
- Infectious Disease Hospital, Kano, Nigeria
- Department of Medicine, Federal Medical Center, Nguru, Yobe State, Nigeria
| | - Zaiyad Garba Habib
- Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria
| | - Daniel Otokpa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Emmanuel Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria
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Abstract
Background Cytomegalovirus (CMV) retinitis is one of the most important opportunistic infections in HIV-infected patients in developing countries before the introduction of highly active antiretroviral therapy. In Nigerian and African HIV populations, CMV retinitis is under-reported. Patients and Methods In a cross-sectional study, 250 HIV-infected adults ≥18 years were recruited by systematic random sampling from March to August 2013. Using a structured questionnaire, information was obtained on socio-demographic characteristics and symptoms of visual impairment. HIV disease was staged according to the WHO clinical staging, and CD4+ T-lymphocyte count was measured. Participants with symptoms of impaired vision and/or CD4+ T-lymphocyte count <50 cells/μL had indirect ophthalmoscopic examination of the retina to detect CMV related eye lesions. Results Two hundred and fifty adults were HIV-infected, out of which 114 (46%) were males and 136 (54%) were females. The mean age of study participants was 35 years. History of impaired vision was reported by 21 (8.4%) of participants. The right eye was involved in 7 (33%), the left eye in 4 (19%), and both eyes in 10 (48%) of participants. The predominant symptoms were blurred vision 9 (43%), floaters 9 (43%), and blindness 3 (14%). Among participants who had indirect ophthalmoscopy, 3 (1.2%) had characteristic retinal changes suggestive of CMV retinitis. Two (67%) of patients with CMV retinitis were females and 1 (33%) was male. Mean CD4+ count was 25.33 ± 14.19 and all were WHO HIV clinical stage 4 with death occurring within 6 months of diagnosis. Conclusion CMV retinitis though rare is associated with advanced HIV disease and attendant morbidity and mortality. We recommend integration of CMV diagnostic services and ophthalmological services as routine in HIV care and treatment programs in Nigeria targeted toward high-risk patients.
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Affiliation(s)
- M A Adeiza
- Department of Medicine, Infectious Disease Unit, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - A G Habib
- Department of Medicine, Infectious and Tropical Disease Unit, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, UngwaUku, Kano, Nigeria
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