COMMON UTI ISOLATED FROM PREGNANT WOMEN ATTENDING ANTENATAL

ABSTRACT

This study aimed to define the Common UTI and incidence of urinary tract infections (UTIs) among 55 pregnant women attending the antenatal care clinics in primary health center in Ogoja city, Cross River State.  Clean  voided  mid-stream  urine  samples  were  collected  and  cultured.  Isolated  bacteria  were characterized by standard laboratory tests, and antibiotic sensitivity was performed by disk diffusion method. Clinically significant bacterial growth was detected in 30 (54.5%) of the samples examined. Escherichia coli was  the  most  frequent  etiological  agent  of  UTI  (50  %)  followed  by  Staphylococcus  aureus  (13.3%), and Pseudomonas aeruginosa (3.4%). The antimicrobial sensitivity analysis for E. coli, as the most commonly UTI isolated agents, to antibiotics are as follows: chloramphenicol (93.3%), gentamicin (73.3%), ampicillin (73.%), nalidixic acid (26.%), and tetracycline (2%). Our results reveal a high incidence of UTIs with highly variable pattern of antibiotic resistance. More surveillance is needed to enhance in the administration of antibiotics therapies and management of UTIs. Also, increased public educations about personal hygiene are strongly recommended to decrease the incidence of UTIs in pregnant women.

COMMON UTI ISOLATED FROM PREGNANT WOMEN ATTENDING ANTENATAL

NANOPOROUS MATERIALS: FROM CATALYSIS AND HYDROGEN STORAGE TO WASTEWATER TREATMENT

Abstract

Porous inorganic solids have found great utility as catalysts and sorption media because of their large internal surface area, i.e. the presence of voids of controllable dimensions at the atomic, molecular, and nanometer scales. With increasing environmental concerns worldwide, nanoporous materials have become more important and useful for the separation of polluting species and the recovery of useful ones. Their prospective applications include the use as templates for the production of electrically conducting nanowires and also for highly selective biosensors and biomembrane materials. Inorganic-organic or hybrid nanoporous crystalline materials have recently attracted much attention and increasing interest due to their promising use in gas processing and hydrogen storage. This review covers our recent developments in the synthesis, characterisation and property evaluation of new nanoporous inorganic and some hybrid solids with the emphasis on the silica and phosphate-based frameworks by using hydrothermal and microvawe procedures with X-ray diffraction, spectroscopic (XAS, NMR) and electron microscopy characterization techniques. The functionalization of nanoporous materials by physical and/or chemical treatments, studies of their fundamental properties, such as catalytic effects or adsorption and their applications, emphasising (1) catalysis, (2) hydrogen and energy storage, and (3) environmental pollution control are also reviewed.

Keywords: nanoporous materials, microporous materials, mesoporous materials, zeolites, inorganic-organic hybrids, catalysts, hydrogen storage, wastewater treatment

1. Introduction

1.1. Nanoporous materials on micro- and meso-scale.

International Union of Pure and Applied Chemistry (IUPAC) classifies porous materials into three categories1 – microporous with pores of less than 2 nm in diameter, mesoporous having pores between 2 and 50 nm, and macroporous with pores greater than 50 nm. The term nanoporous materials has been used for those porous materials with pore diameters of less than 100 nm. Many kinds of crystalline and amorphous nanoporous materials such as framework silicates and metal oxides, pillared clays, nanoporous silicon, carbon nanotubes and related porous carbons have been described lately in the literature.2 This review will focus on the microporous and mesoporous silica- and phosphate-based materials with ordered pore structures.

Microporous materials are exemplified by crystalline framework solids such as zeolites, whose crystal structure defines channels and cages, i.e. micropores, of strictly regular dimensions (Figure 1). They can impart shape selectivity for both the reactants and products when involved in the chemical reactions and processes. The large internal surface area and void volumes with extremely narrow pore size distribution as well as functional centres homogeneously dispersed over the surface make microporous solids highly active materials. Over the last decade, there has been a dramatic increase in synthesis, characterization and application of novel microporous materials.3 The 119 Acta Chim. Slov. 2006, 53, 117–135 Zabukovec Logar and Kaučič Nanoporous Materials: From Catalysis composition of crystalline microporous materials ranges from aluminosilicates to aluminophosphates and gallophosphates or recently discovered inorganic-organic hybrids.4 Zeolites, which represent the largest group of microporous materials, are crystalline inorganic polymers based on a three-dimensional arrangement of SiO4 and AlO4 tetrahedra connected through their oxygen atoms to form large negatively-charged lattices with Brønsted and Lewis acid sites. These negative charges are balanced by extra-framework alkali and/or alkali earth cations. The most known zeolites are silicalite-1, ZSM-5, zeolite Beta and zeolites X, Y, and A. The incorporation of small amounts of transition metals into zeolitic frameworks influences their properties and generates their redox activity. Zeolites with their well–organised and regular system of pores and cavities also represent almost ideal matrices for hosting nanosized particles e.g. transition metal oxides that can also be involved in catalytic applications.

NANOPOROUS MATERIALS: FROM CATALYSIS AND HYDROGEN STORAGE TO WASTEWATER TREATMENT

FACTORS THAT INFLUENCE THE UTILIZATION OF ANTENATAL CARE SERVICES IN SELECTED PUBLIC HOSPITAL IN ILORIN WEST LOCAL GOVERNMENT AREA, KWARA STATE, NIGERIA

CHAPTER ONE

Introduction

  1. Background to the study

Improving maternal health is one of the World Health Organization (WHO) Millennium Development Goals (MDGs) and professional health care during child birth is one of the process indicators in assessing progress towards these goals[1]. WHO has recommended four strategic interventions or four pillars for safe motherhood. These include; Family planning, Antenatal care (ANC), Clean/ safe delivery and Emergency obstetric care. Some of the interventions that have been shown to be effective in detecting, treating or preventing conditions in pregnant women that might otherwise give rise to serious morbidity and mortality are: detection and investigation of anaemia, pregnancy induced hypertension, treatment of severe pre-eclampsia, screening and prevention of infection and diagnosis of obstructed labour. For all the benefits that have been attributable to ANC, the effectiveness of antenatal care in actually reducing maternal and fatal morbidity and mortality, has never been scientifically proven and because of ethical considerations may never be proven[1]. Utilization of ANC services has been identified in a number of studies as an important factor determining maternal and infant mortality. However, the use of health services is a complex behavioral phenomenon. It is affected by socio-demographic factors (such as age, occupation, education, and marital status, religion and income level.), accessibility of the health facility, knowledge about antenatal care services and the quality of care services provided at the health facility. In a study on the determinants of maternal health services in the rural India, it was found that, there is a correlation between household income and utilization of maternal health services [1]. It was evident that as a result of lack of productive resources for women, income earned by women had negative impact on utilization of ANC and Post Natal Care (PNC)[2].

Lack of knowledge about the ANC services could be a major barrier to women’s utilization of ANC services. Due to lack of knowledge pregnant women are likely to have limited knowledge and experiences in seeking health care. Matua[2] cited lack of adequate knowledge and information about pregnancy, laboratory tests results and dangers of late bookings or not attending ANC at all, as contributors to the poor utilization of ANC services. Lack of knowledge about the dangers of not seeking health care in pregnancy and delivery were major barriers to seeking health care among pregnant women in Uganda[2]. It is evident from previous researches that, the knowledge about the antenatal care services, availability and accessibility of the services, the distance to the facility, the efficiency and skills of the staff/ workers hence quality of the services, costs incurred, that is the screening charges, transport costs, and the treatment costs, continuity and comprehensiveness of services, all play a part in influencing the utilization of antenatal care services. This however did not tell us to what extents these factors influence the utilization of ANC services. Furthermore, it is also affected by cultural beliefs, as well as personal characteristics of the user of these services. Sometimes the government policy too may affect ANC utilization.

Nigerian Health Review[3], reports that one of the major causes of maternal deaths is inadequate motherhood services such as antennal care. Approximately two-thirds of all Nigerian women and three-quarters of rural Nigerian women deliver outside of health facilities and without medically-skilled attendants present. Data from the Nigerian Demographic and Health Surveys indicated that among pregnant Nigerian women, only about 64% receive antenatal care from a qualified health care provider. There are wide regional variations, with only about 28% of women in the Northwest Zone and 54% in the Northeast Zone receiving antenatal care from trained health providers (NHR[4]. The rest either do not receive antenatal care at all or receive care from untrained traditional birth attendants, herbalists, or religious diviners.

There are studies in Nigeria that have related maternal health to care utilization and other risk factors. For example, Ibeh[5]studied maternal mortality index in Nigeria in relation to care utilization using Anambra state as case study and attributes high maternal mortality to poor socioeconomic development, weak health care system, low socioeconomic status of women, and socio-cultural barriers to care utilization. He found that about 99.7 percent of women in the locality studied attended antenatal clinics with 92.3 percent of them making 4 or more visits before delivery.

Ajayiet al., [6] studied the attitude of pregnant women to a new antenatal care model with four antenatal visits (focused antenatal care) using a cross-sectional survey data and multiple logistic regression analysis in Enugu, Nigeria. Only 20.3% of the parturient desired a change to the new model. The most common reasons for desiring the change were convenience (65.1%) and cost considerations (24.1%).

FACTORS THAT INFLUENCE THE UTILIZATION OF ANTENATAL CARE SERVICES IN SELECTED PUBLIC HOSPITAL IN ILORIN WEST LOCAL GOVERNMENT AREA, KWARA STATE, NIGERIA

ASSESSMENT OF KNOWLEDGE AND STRATEGIES FOR PREVENTION AND MANAGEMENT OF DIARRHEA DISEASE AMONG UNDER FIVE CHILDREN IN: OKO-ERIN COMMUNITY

CHAPTER ONE

1.1       BACKGROUND OF THE STUDY

Diarrheal disease is highly preventable, yet accounts for nine percent of all deaths among children under age five worldwide [Liu, 2013]. In 2013, this translated into about 580,000 child deaths, or, on average, 1,600 children dying each day due to preventable diarrhea [WHO, 2014].

Diarrhoea is the disturbance of the gastrointestinal tract comprising of changes in intestinal motility and absorption, leading to increase in the volume of stools and in their consistency [Ballabriga, et al 2000]. In diarrhoea, stool contains more water than normal stool and is often called loose or watery stool. In certain cases, they may contain blood in which case the diarrhoea is called dysentery [Obionu, 2007]. Any passage of three or more watery stools within a day [24 hours] is referred to as diarrhoea [Cairncross et al, 2010].

Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. Each year,third world countries of Asia, Africa and Latin America, record approximately five million deaths of children under five years of age from acute diarrhoea. About 80 per cent of these deaths are in the first two years of life [Lucas & Gilles, 2009]. In the developing world as a whole, about one-third of infant and child deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal deaths are caused by dehydration – the loss of large quantity of water and salts from the body, which needs water to maintain blood volume and other fluids to function properly [Gupta & Mahajan, 2005]. UNICEF [2002] summated that in Nigeria, infant mortality rates are twice as high in rural settings as they are in urban ones due to poor hygiene and poor sanitation. About three million infant births in Nigeria, approximately 170,000 result in deaths that are mainly due to poor knowledge and management practices of childhood diarrhoea. Several factors are likely to contribute to the high rate of diarrhoea morbidity and mortality in children under-five years these include poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services [Park, 2009]. Malnutrition is another established risk factor for mortality among children with diarrhoea disease. This may be due to inadequate case management. In 2004, WHO and UNICEF issued a joint statement on clinical treatment of acute diarrhea, recommending the use of low-osmolarity oral rehydration salts [ORS], zinc supplementation, increased amounts of appropriate fluids, and continued feeding [WHO; 2014]. Treatment of diarrhea with ORS is a simple, proven, high-impact intervention that can be provided in home settings by caretakers or by health care providers at community and facility levels to prevent dehydration due to diarrhea and decrease related deaths. The first line of management of diarrhoea is therefore, the prevention of dehydration. This can also be achieved at home using Oral Rehydration Therapy [ORT].

The consistency and the volume of stool constitute how to classify diarrhoea. World Health Organization – WHO [2014] classified diarrhoea as acute or persistent based on its duration. An episode of diarrhoea that lasts less than two weeks is acute diarrhoea, while diarrhoea that lasts more than two weeks is persistent. Calogero et al[2000] further classified diarrhoea according to its typology: Secretary Diarrhoea, osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from active process in the intestinal epithelium stimulated by the presence of toxin, chemical or nutritional product in the intestinal linning. Osmotic diarrhoea is caused by the presence in the intestinal linning of osmotically active solutes that are poorly absorbed by the injection of laxatives such as magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated with damage to the mucosa lining leading to outpouring of mucus, blood and plasma protein among other substances. However, it is important to note that the classification of diarrhoea does not influence the cause.

Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Diarrhoea in most cases is caused by three major groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites [Lucas & Gilles, 2009]. The main agents of diarrhoea are enteroviruses [e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera, salmonella [non typhoid], entamoeba histolytica, giardia lamblia, cryptosporidium]. These are further grouped in the following ways: Viruses

; Bacteria [e.g. shigella, escherichia coli, vibrio cholerae, salmonella non typhoid, campylobacter spp]. Parasites [e.g. entamoeba histolytica, crytosporidium and giardia lamblia]. All over the world, viruses especially rotavirus has been identified as the major cause of acute diarrhoea in children. Studies in Nigeria also found viruses as the major causes of diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20 per cent. Most of these pathogens are transmitted by faeco-oral route. Childhood diarrhoea within the context of this study refers to any type of loose, watery stool that occurs more frequently than usual in a child. The various causative agents vary according to the signs and symptoms manifesting from the disease.

The main consequence of diarrhoea are frequent loose or watery stools, the risk of dehydration, damage to intestine [especially when there is bloody diarrhoea] and loss of appetite with or without vomiting. However, Victoria, Bryce, Fountaine and Monasch [2000] asserted that signs of dehydration are not evident until there is acute fluid loss of approximately 4-5 per cent of body weight. The signs and symptoms of dehydration include sunken fontanels, dry mouth and throat, fast and weak pulse, loss of skin elasticity and reduced amount of urine. This loss leads to shock and untimely death of under-five. Werner [2001] noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan [2004] are passage of frequent loose watery stools, abdominal cramps or pain, fever particularly if there is an infectious cause and bleeding. Bacteria and parasites often can produce bloody diarrhoea [dysentary]. In addition, inflammatory bowel disease, polyps and colorectal cancer can cause blood and mucus in the stools, nausea and vomiting may also be present in the case of infection.

ASSESSMENT OF KNOWLEDGE AND STRATEGIES FOR PREVENTION AND MANAGEMENT OF DIARRHEA DISEASE AMONG UNDER FIVE CHILDREN IN: OKO-ERIN COMMUNITY