African Journal of Laboratory Medicine最新文献

Background: Infection prevention and control (IPC) practices are crucial for protecting patients and healthcare workers (HCWs), especially during the coronavirus disease 2019 (COVID-19) pandemic. This crisis has underscored the importance of IPC strategies in understanding health system readiness and strengthening preparedness for future pandemics.

Objective: This study investigated healthcare personnel's IPC knowledge, adherence to safety policies, and implementation of IPC procedures in COVID-19 treatment centres across Nigeria.

Methods: A cross-sectional, multicentre study was conducted among 113 respondents, that is, 57 HCWs and 56 volunteers, from 23 June 2020 to 15 March 2021. An electronic questionnaire adapted from validated instruments was used.

Results: Out of 113 respondents, 69 (61%) demonstrated good IPC practices, with high adherence (n = 105, 92.9%) to face mask usage and hand hygiene. Only 50 (44.2%) reported receiving basic training on IPC. Although personal protective equipment (PPE) was available, 25% did not consistently wear full PPE when attending to COVID-19 patients. Most HCWs (105; 93%) opposed testing patients without consent, and 100 (88.5%) affirmed the availability of standardised IPC protocols. No significant association was observed between age, gender, years of experience, and IPC compliance (p-values: 0.097, 0.287, and 0.699). Interestingly, 33 (29.2%) HCWs with less than 10 years of experience exhibited better IPC practices. Facility policies such as confidentiality and non-discrimination were mostly upheld, with 90 (79.6%) participants agreeing that discriminatory practices should have consequences.

Conclusion: While face mask use and hand hygiene compliance were high, gaps remained in IPC training and consistent use of full PPE. Strengthening training, IPC knowledge, policy standardisation, and resource equity is important for stronger IPC compliance during health emergencies.

What this study adds: The study identified key factors supporting future pandemic preparedness by examining the control and preventive strategies implemented at various CTCs in Nigeria. It also emphasised the need for standardised policies, which are essential for building resilient healthcare systems during public health crises.

Background: Whole-genome sequencing (WGS) is transforming communicable disease surveillance globally. The National Institute for Communicable Diseases, South Africa, participates in national laboratory-based surveillance for human isolates of Salmonella.

Objective: This study was to investigate human Salmonella isolates from South Africa, 2020-2023, using WGS analysis.

Methods: WGS was performed using Illumina NextSeq Technology. Data were analysed using multiple bioinformatics tools, including those available at the Center for Genomic Epidemiology, Pathogenwatch and EnteroBase. Data analysis allowed for identification and characterisation of isolates. Core-genome multilocus sequence typing was used to investigate the phylogeny of isolates.

Results: Of the 8006 isolates of Salmonella that were analysed using WGS, 130 distinctive serovars and subspecies were identified. Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) (4271/8006; 53.3%) and Salmonella Typhimurium (1430/8006; 17.9%) were the most prevalent serovars, accounting for 71.2% of all isolates. This was followed by Salmonella Typhi (482/8006; 6.0%). Sixteen per cent (1288/8006) of isolates showed the presence of antimicrobial resistance (AMR) determinants associated with ≥ 2 classes of antimicrobials. Salmonella Isangi (167/8006; 2.1%) showed the highest prevalence of AMR, with most isolates (159/167; 95.2%) showing AMR determinants associated with ≥ 7 classes of antimicrobials. Core-genome multilocus sequence typing was used to confirm several suspected clusters and outbreaks and identified additional cryptic or unreported clusters and outbreaks. Investigation of clusters and outbreaks mostly involved Salmonella Enteritidis and Salmonella Typhi.

Conclusion: The implementation of WGS has enabled genomic surveillance of Salmonella, which allows for enhanced characterisation and AMR determination of isolates and identification of clusters and outbreaks, which informs targeted public health investigation and response.

What this study adds: This study describes the population structure of Salmonella isolated from humans in South Africa and hugely contributes to the available Salmonella WGS data from Africa.

Background: Urinary tract infections are among the most common infections affecting the general population. Their high incidence, as well as frequent antimicrobial use, contribute significantly to the development of antimicrobial resistance (AMR).

Objective: To determine the profile and prevalence of uropathogens isolated from urine specimens at a regional hospital and assess susceptibility patterns to commonly used antimicrobials recommended by the National Essential Medicines List (NEML).

Methods: This was a retrospective evaluation of laboratory reports for all urine specimens submitted between 01 January 2020 and 31 December 2023.

Results: The most frequently cultured organisms were Escherichia coli (n = 1481; 42%); Klebsiella pneumoniae (n = 568; 16%); Enterococcus faecalis (n = 249; 7%); Proteus mirabilis (n = 229; 7%), Enterobacter cloacae (n = 137; 4%), and Candida albicans (n = 119; 3%). Escherichia coli maintained high sensitivity to antimicrobials such as nitrofurantoin (92.2%) and gentamicin (90.6%), whilst K. pneumoniae had decreased sensitivities of 40% and 77%, respectively. Cumulative sensitivities of commonly used first-line antimicrobials showed low rates of susceptibility to ciprofloxacin (77%), nitrofurantoin (67%), and amoxicillin/clavulanate (68.7%).

Conclusion: Escherichia coli was the most commonly identified isolate and remains sensitive to nitrofurantoin. It was, however, resistant to ciprofloxacin, amoxicillin/clavulanate, and trimethoprim sulfamethoxazole, as were all the other Gram-negative organisms. These sensitivity patterns do not align with the antimicrobials recommended in the current NEML guidelines, and highlight the need for targeted therapy and interventions.

What this study adds: This retrospective analysis identifies predominant uropathogens' updated antimicrobial susceptibility profiles, some of which misalign with NEML guidelines. Insights will guide targeted antimicrobial stewardship, empiric therapy, and local surveillance to curb AMR.

Background: Glucose-6-phosphate dehydrogenase deficiency (G6PDD), a common inherited enzyme defect, associated with severe neonatal anaemia and hyperbilirubinaemia, can result in permanent neurologic damage or death. Prevalence of G6PDD-induced anaemia in vulnerable groups, like children, is not known in our setting.

Objective: This study was aimed at determining the prevalence of erythrocyte G6PDD-induced anaemia among children aged 0-5 years old seen at Jos University Teaching Hospital, North-Central Nigeria.

Methods: This was a hospital-based cross-sectional study conducted from February to June 2023. Glucose-6-phosphate dehydrogenase and haemoglobin levels were analysed colourimetrically. Data were analysed; p < 0.05 was considered significant.

Results: Out of 100 children aged 0-5 years (54 male, 46 female), 40 (40%) were G6PD deficient. Nineteen (35.2%) of the G6PD-deficient children were male and 21 (45.7%) were female. Fifty-one (51%) children were anaemic, 23 (57.5%) were G6PDD-induced; 85 (85%) of the parents had no knowledge of G6PD and its deficiency.

Conclusion: This study showed a high prevalence of G6PDD-induced anaemia among children in Jos. This suggests that there may be a need for early routine G6PD screening in children for early detection and proper intervention in those with the deficiency.

What this study adds: This study has objectively established high prevalence of anaemia, G6PDD and G6PDD-induced anaemia in children aged 0-5 years in Jos, Nigeria, highlighting the importance of G6PD screening in children.

Background: Despite the widespread acceptability of glucometers as a blood glucose self-monitoring and point-of-care device, their usage is confronted with operational, technical, regulatory, and quality control concerns.

Objective: This study assessed knowledge, estimated competence, and measured experience of healthcare practitioners using glucometers for patient care in two states of Northern Nigeria.

Methods: This cross-sectional, descriptive study used a total population sampling strategy and self-completed questionnaires. A total of 768 questionnaires were distributed to hospitals in Jigawa and Kogi States, Nigeria, from December 2019 to April 2022. The questionnaire had three sections: collecting details about type of healthcare facility, sociodemographic characteristics and educational qualifications of participants, and assessment of knowledge, competence and practice. Data were analysed and results expressed as frequencies and percentages.

Results: Overall, 570 questionnaires were filled and retrieved, giving a response rate of 74.2%. Most of the participants were male (312; 54.7%); female participants totalled 258 (45.3%). Most participants were aged < 50 years (25-40 years, 215 [37.7%]; 41-50 years, 246 [43.2%]). The majority of participants were Medical Laboratory Scientists (124, 21.8%]), Technicians (151, 26.5%), or Nurses (132, 23.2%). Most participants (284, 49.8%) reported having no formal training prior to first use of glucometers in patient care. Many participants (379, 66.5%) knew about glucometer calibrators; 235 (41.2%) did not know what specific purpose calibrators served.

Conclusion: This study found a lack of knowledge, competence and experience among healthcare practitioners, especially for hands-on use of glucometer calibrators and standard operating procedures for blood glucose testing using glucometers.

What this study adds: The study brings to fore the need for training and retraining of healthcare practitioners on the theoretical and practical skills required for operating glucometers. Periodic calibration of glucometers and provision of quality control materials should be incorporated into standard operating procedures at point-of-care testing workstations in health facilities.

Background: Newer equations, which are more accurate than the Friedewald formula (FF), have been published for the calculation of low-density lipoprotein (LDL) cholesterol. The impact of their adoption on decision-making has not been examined in Nigerian laboratories.

Objective: This study examined the clinical implications of differences in estimating LDL cholesterol by the FF, Martin-Hopkins (MH), and Sampson-National Institutes of Health (NIH) equations.

Methods: Between 01 January 2019 and 31 December 2023, lipid profile data, and the associated gender, were retrieved from the laboratory information system of Synlab Nigeria for persons aged 18-75 years. Differences in LDL cholesterol estimates from the three equations, and agreement with category assignments that determine clinical decisions, were examined.

Results: Lipid profile data from 19 126 records were retrieved. This included data from 8234 (43.1%) women. The difference between FF estimates of LDL cholesterol and the other two equations was less than 10% for over 96% of the data. This difference increased with triglyceride levels. There was at least substantial agreement in the clinical category assignment of the equations, (ĸ > 0.715, p < 0.001). However, when triglycerides were > 1.69 mmol/L, the FF classification of < 1.81 mmol/L was classified as > 1.81 mmol/L in 43.3% and 25.1% of cases by MH and Sampson-NIH, respectively. For triglycerides > 4.51 mmol/L, there was constant bias, with MH higher than Sampson-NIH.

Conclusion: Using the FF formula may significantly impact primary prevention of atherosclerotic cardiovascular disease. Switching to the MH or Sampson-NIH equation is advisable.

What this study adds: This study provides a basis for Nigerian laboratories to switch from the Friedewald formula to one of the newer equations for the calculation of LDL cholesterol.