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Turning the tides against infectious diseases: The microbial pathologist’s nexus – Part 3

By Michael Simidele Odimayo
18 March 2020   |   3:40 am
Reasons for non-usage include non-availability (350) (75.9%), high cost (389) (84.4%), inadequate sizes of available ones (300) (65.9%), lack of interest for unexplained reasons (150) (32.5%) and infectiveness of nets after some months of usage coupled with inability to retreat them (120) (26%).

Continued from yesterday
Reasons for non-usage include non-availability (350) (75.9%), high cost (389) (84.4%), inadequate sizes of available ones (300) (65.9%), lack of interest for unexplained reasons (150) (32.5%) and infectiveness of nets after some months of usage coupled with inability to retreat them (120) (26%).

We recommended health education, participation of private organization in promotion of ITNs and provision of free or highly subsidized ITNs through existing effective health programs such as routine immunization and family planning. These recommendations are still relevant today for effective use of ITNs by Nigerians. ITNs have life-saving capability. Therefore, the advocacy should be stepped up. Maybe Nigerians will change to its use (Odimayo & Araoye 2008). The ranging scourge of HIV was terrific in those days. Only few people could afford the treatment as there was no subsidy at that time. The need to bring people to treatment as a way of prevention of further spread of the disease was major in our minds as Medical Researchers and Practitioners. To bring people to treatment, we must make the diagnosis. But how could we make the diagnosis unless we screen? The question was, how willing were the people? We assessed a group of Medical students for willingness to screen for HIV and found that majority 85.4% had not been screened though they were aware that they were at high risk of HIV infection both professionally and socially. We discovered that 78.2% would be willing to screen without pay. From the study we advocated for free screening especially for high risk groups. Today, free screening for HIV and even free treatment is the rule and these efforts has significantly reduced the HIV scourge (Akandeet al2004).

As time goes on in the HIV/AIDS scourge, free treatment became available and many patients were able to access treatment through support from PEPFAR, NACA, ICAP, SACA among many other supportive organizations. Since we were then able to manage and co-manage many patients, we needed to get more patients into treatment early to reduce mortality due to delay presentation. So we went ahead to access the pattern of presentation of HIV/AIDS patients in Makurdi, Benue State Nigeria. From that study, we found that the commonest clinical features associated with HIV/AIDS was oral thrush. Pulmonary tuberculosis, and peripheral lymphadenopathy were also major pointers to HIV/AIDS. These were relevant findings then because mortality rates among HIV/AIDS patients on treatment was found to be 14.7% and respiratory failure was the commonest cause of death. Therefore, capitalising on those pointers especially oral thrush was important in early diagnosis and commencement of treatment to reduce mortality. (Adediran et al2009).

The prevalence and death rate seen among HIV/AIDS patients who presented in the hospital was disturbing. We needed some extra work, this made us to move into the community to determine the factors responsible for such level of HIV/AIDS prevalence in some of our communities. A rural community called Abwa Mbagen was used as our study site. To our surprise an HIV prevalence of 27.5% was found, far higher than the 9% prevalence determined from National statistics for the state. Prevalence was higher among the divorcee, individuals with low level of education and farmers. We also found that though there was a high awareness on the existence and mode of transmission of HIV/AIDS, cases of AIDS deaths, unprotected casual sex, transfusion with unscreened blood and polygamy was prevalent in the community (Odimayoet al 2009).

We swept into action. Our activities continued for a long time in the community using health education as our main tool. We later established HIV counselling and testing (HCT) centres and ensure the establishment of prevention of Mother to child transmission of HIV (PMCTC) in the community. We advocated for establishment of vocational centres within the community. In the course of the efforts at establishing the PMTCTC in the community, I became very close to the state coordinator of PMCTC, a person of Dr Sunday Ochejele. After the PMCTC establishment, we decided to review the HIV/AIDS in Benue state. We got the data on PMTC documented in the state over a period of 3 years for analysis. It was a heavy but carefully collated data across Benue state. The screening methods was serial algorithm. Over thirteen thousand pregnant women who were screened during the 3 years period were analysed with respect to partner notification and partner screening. Among the HIV seropositive patients, between 53-72% accepted to notify their partners for screening during the period. However, between 15 – 47% of the partners accepted screening. Among these, 46%, 57% and 45.3% serodiscordance were seen in year 2006, 2007 and 2008 respectively. Among a cohort of 20 serodiscordant couples followed up in the course of the study, 80% of them were still serodiscordant four years after the initial discovery. We were highly interested in knowing why the couples were serodiscordant. This is because such findings could be relevant to the development of HIV vaccines. We hope to research further into these discoveries with the hope of HIV vaccines development (Odimayo et al 2015).

Our findings made it abundantly clear that presentation in hospitals at late stages of disease may be responsible for the high rate of mortality seen among the study population.
Mr Vice Chancellor Sir, in the family of infectious diseases, tuberculosis is a disease of recon. However, many of our people are majorly aware of pulmonary tuberculosis. Tuberculosis can affect any organ in the body but the commonest site is the lungs which is regarded as pulmonary tuberculosis.

Tuberculosis of the fallopian tubes and the endometrium is intimately bond to the problem of sterility and can be missed especially in our clinical settings. We diagnosed two cases of endometrial tuberculosis within a space of 14monthsin the early 2000. They were aged 26 and 32 years. We were alerted to report it in order to sensitise our colleagues on the high possibility in our environment. Diagnosis of endometrial tuberculosis is by histology and bacteriologic study of tissue and secretions. Furthermore, 8 years review was done on endometrial samples of all infertility cases in the 8 years period. We discovered that TB endomentritis was not a frequent cause of infertility as this condition was only seen in 0.45% of cases reviewed. However, it is still important to be reminded that some of the infertility cases can be due to uterine tuberculosis and we should watch out for its possibility. Today, serologic screening methods for tuberculosis is available in some Microbial Pathology laboratories and when properly interpreted can be valuable in the initial screenings of infertility patients. I hereby encourage our colleagues to take advantage of the availability of this test whenever the need arises(Ojo et al2007; Ojo et al 2008).

Our health system has made great impact in enhancing the health and productivity of the populace. There is no doubt that appropriate medical practice is a wonder! For example, from the end of World War I to the present, African population growth has been rapid largely due to improvements in medical services and standards of living (Renkou Yanjiu 1984). Max et al (2020), discovered that from the 1950s till 2015, African mortality rates has reduced from 1-in-3 children (32 percent) to below 1-in-12 (8 percent).

From a total African population of 100million in the early 1900. As at year today, about a hundred years later, the population of Nigeria alone So there is no doubt that Medicine saves lives. However, sometimes we inadvertently add to the suffering of our patients through hospital acquired infections. This awareness is important to all health professionals in order to reduce the incidence of nosocomial (Hospital Acquired) infections, also called Healthcare Associated Infections (HAI) in our various health facilities. We did an extensive study in which 15,202 hospital discharges were reviewed over two and a half years in Ilorin. We found a total of 637 (4.2%) HAI cases spread across various wards in the hospital. HAI was highest in the orthopaedics ward and lowest in amenity wards of O & G department, University of Ilorin Teaching hospital. Among the pathogens isolated, Klebsiella spp. was the commonest. Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli were also commonly isolated. Our study showed the reality and pattern of distribution of HAIs. We are hereby reminded of the need to put in our best towards the control of hospital acquired infections through proper surveillance, utilization of proper aseptic procedures, regular screening of members of the health team, proper hand washing, appropriate restriction of visitors, proper antibiotic prescription policy among others, are essential for effective control of HAIs. Every standard hospital should set up Infection Control Committee (ICC) and Infection Control Team (ICT) and ensure their effectiveness (Odimayo et al 2008).

Odimayo is Professor of Microbial Pathology/Infectious Diseases delivered this inaugural lecture series 1 in Ondo, recently.