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Vancomycin-Resistant Staphylococcus aureus Isolates from HIV Positive Patients in Imo State, Nigeria
Emeka-Nwabunnia,
Ijeoma,
Chiegboka,
Nneamaka Alice,
Udensi,
Ugochi Justina,
Nwaokorie,
Francisca Obigaeri
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
1-7
Received:
21 May 2015
Accepted:
26 June 2015
Published:
2 September 2015
Abstract: Vancomycin continues to be an important antimicrobial agent for treating infections caused by Staphylococcus aureus strains that are resistant to oxacillin (MRSA) and other antimicrobial agents. Vancomycin-resistant Staphylococcus aureus (VRSA) isolates were obtained from HIV-positive patients already on HAART treatment but were not admitted in the hospital. Species identification was confirmed by standard biochemical tests and PCR amplification of the 16S rRNA gene. Vancomycin resistance was determined using the Kirby-Bauer diffusion method and confirmed by Brain Heart Infusion (BHI) vancomycin screen agar plate containing 6µg/ml vancomycin. A total of 8 VRSA were identified from the 59 isolates obtained from the patients. Five out of the eight VRSA isolates were resistant to all the antibiotics tested. However, one unusual strain which was resistant to all the antimicrobial agents tested contained no plasmid, Mec A gene and PVL toxin gene. One VRSA isolate contained a large plasmid (~21.2 kb) and four small plasmids of ~5, 2.5, 1.2 and 0.8 kb respectively. The minimum inhibitory concentration (MIC) for vancomycin susceptibility was >15 µg/ml at disk potency of 30µg. The reduced susceptibility of S. aureus strains to vancomycin leaves clinicians with relatively few therapeutic options for treating these infections and therefore emphasizes the importance of prudent use of antibiotics and the use of infection-control precautions to prevent their transmissions.
Abstract: Vancomycin continues to be an important antimicrobial agent for treating infections caused by Staphylococcus aureus strains that are resistant to oxacillin (MRSA) and other antimicrobial agents. Vancomycin-resistant Staphylococcus aureus (VRSA) isolates were obtained from HIV-positive patients already on HAART treatment but were not admitted in the...
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Antimicrobial Activity and Phytochemical Analysis of Aqueous and Ethanolic Extracts of the Bark of Tabernaemontena pachysiphon Stapf
Duru C. M.,
Anyadoh-Nwadike S. O.,
Okechukwu R. I.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
8-13
Received:
7 June 2015
Accepted:
14 June 2015
Published:
2 September 2015
Abstract: Phytochemical analysis and antimicrobial activities of hot water, hot and cold ethanol ethanolic extracts of the bark of Tabernaemontana pachysiphon Stapf. were assayed, using standard techniques. Escherichia coli ( E. coli ), Serratia marcescens ( S. marcescens ), Staphylococcus aureus ( S. aureus ), Alternaria solani ( A. solani ), Aspergillius niger ( A. niger )and Penicilium notatum ( P. notatum ) were used as the challenge / test organism. Agar well and paper disc diffusion techniques were adopted. Results showed that the bacteria; E. coli, S. marcescens, S. aureus , were susceptible to both hot water and hot ethanol extracts respectively with zones of inhibition as follows: E. coli (9, 12 mm) and (10, 15 mm), S. marcescen (9, 9 mm) and (9, 12 mm), S. aureus (8, 9mm) and (9, 10mm), respectively. The fungus; P notatum was susceptible to hot water, hot and cold ethanol extracts (7.5, 8, 8mm) and (7, 7.5, 7 mm). A. solani and A. niger were resistant to the bioactivity of the extracts. The presence of active principles; alkaloids, anthraquinone, cardiac glycosides, poly phenol, saponins and tannins detected via the phytochemical screening may be responsible for the antimicrobial activities of the extracts.
Abstract: Phytochemical analysis and antimicrobial activities of hot water, hot and cold ethanol ethanolic extracts of the bark of Tabernaemontana pachysiphon Stapf. were assayed, using standard techniques. Escherichia coli ( E. coli ), Serratia marcescens ( S. marcescens ), Staphylococcus aureus ( S. aureus ), Alternaria solani ( A. solani ), Asp...
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Bacteriological and Physiochemical Analysis of Oguta Lake Water, Imo State, Nigeria
Okorondu S. I.,
Anyadoh-Nwadike S. O.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
14-19
Received:
1 July 2015
Accepted:
22 July 2015
Published:
2 September 2015
Abstract: Bacteriological and Physiochemical analysis were carried out on Oguta lake water from three guage stations; upstream, midstream and downstream used for drinking and recreational purposes in Imo State, South-Eastern, Nigeria. The results obtained were compared with World health organisation (WHO) and Environmental protection agency (EPA) standards for drinking and recreational water respectively. The following parameters; conductivity (30.8 us\cm), colour (90.67 pt\co), iron (0.47 mg\l), lead (0.18 mg\l), cadmium (0.08 mg/l), nitrate (0.9 ml) and odour (unpleasant) did not meet WHO standards while temperature (30.8oC), pH (5.71cpu), total dissolved solids (TDS) (73.87 mg/l), total solids (TSS) (7 mg/l), turbidity (17 ntu), phosphate (0.19 mg/l), sulphate (0.19 mg/l), manganese (0.1 mg/l) and appearance (clear) met the standards. None of the samples conformed to WHO and EPA bacteriological standards for total heterotrophic count of 1.0x10-2 in 100 ml of water, total coliform count and feacal coliform count of 1:100 ml of water for drinking and recreational water. Samonella, Shigella and Vibro cholera were not detected. The presence of coliforms in water for drinking and recreational purposes is of public health significance considering the possibilities of the presence of other bacteria, protozoa and enteric viruses that are implicated in gastro-intestinal water borne diseases and the low infectious dose of these water borne pathogens. Presence of chemicals in water is also of great concern, health effect from chemicals have been difficult to assess because the impact is not acute like that of pathogens, but often cumulatively resulting to cancer and sometimes death. The general public should be educated on dangers of contaminated water as well as prevention of indiscriminate dumping of domestic and industrial wastes into the lake.
Abstract: Bacteriological and Physiochemical analysis were carried out on Oguta lake water from three guage stations; upstream, midstream and downstream used for drinking and recreational purposes in Imo State, South-Eastern, Nigeria. The results obtained were compared with World health organisation (WHO) and Environmental protection agency (EPA) standards f...
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Mechanisms of Microbial Resistance to Known Antibiotics
Ahamefule Augustus Kelechi,
Ezeji Ethelbert Uchechukwu
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
20-24
Received:
24 May 2015
Accepted:
26 June 2015
Published:
8 September 2015
Abstract: Most infectious diseases are known to be caused by microorganisms. The discovery of antimicrobial agents has saved the human race from a lot of sufferings due to the burden of these infectious diseases. Over the years, microorganisms have developed resistance to known antibiotics. Antimicrobial resistance among bacteria, viruses, parasites, and other disease-causing organisms is a serious threat to infectious disease management globally. Factors responsible for antimicrobial resistance include changing microbial characteristics, selective pressures of antimicrobial use, as well as societal and technological changes that enhance the development and transmission of drug-resistant organisms. Microbial resistance to antibiotics can either be intrinsic or acquired. Different mechanisms of microbial resistance to known antibiotics have been proposed. These include antibiotic inactivation, ribosome protection, biofilm formation, target modification, reduced permeability to antimicrobial agents and increasing efflux of antibiotics from microbial cells. It is believed that the understanding of these mechanisms is important in the discovery of better ways to keep existing agents useful and also in the design of better antimicrobial agents that are not affected by the currently known, predicted, or unknown mechanisms of resistance.
Abstract: Most infectious diseases are known to be caused by microorganisms. The discovery of antimicrobial agents has saved the human race from a lot of sufferings due to the burden of these infectious diseases. Over the years, microorganisms have developed resistance to known antibiotics. Antimicrobial resistance among bacteria, viruses, parasites, and oth...
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Prevalence of Intestinal Parasites Among Primary School Children in Three Geopolitical Zones of Imo State, Nigeria
Udensi Justina Ugochi,
Mgbemena Ifenyinwa C.,
Emeka-Nwabunnia Ijeoma,
Ugochukwu Mmasi Godson,
Awurum Ivy Nwaku
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
25-28
Received:
13 June 2015
Accepted:
13 September 2015
Published:
27 October 2015
Abstract: A study of the prevalence of intestinal parasitic infection was conducted among children aged 5-16years in primary schools in rural parts of Imo State, Nigeria. Of the 337 faecal samples examined, 164 (48. 7%) harboured intestinal parasites with 65 (40. 4%) being from Orlu zone, 57 (52. 7%) from Owerri zone, and 42 (61. 8%) from Okigwe zone. The parasites identified were Ascaris lumbricoides (41. 5%), Hookworm (23. 8%), Trichuris trichiura (1. 2%), Teania spp (1. 2%), Entamoeba histolytica (36. 6%), and Giardia lamblia (1. 8%). Among the helminthes, A. lumbricoides (60. 0%) occurred highest among the age bracket of 14-16years, while E. histolytica (44. 4%) was the highest occurring protozoan parasite among children aged 5-7 years. Generally, prevalence of infection decreased with increasing age of children, and more females (53. 9%) than males (48. 1%) were infected. However, there was no statistical significant difference in infection with relation to age and sex of the pupils (p>0. 05). Intestinal parasitic infection is reduced through improved personal hygiene and environmental sanitation as children with high standard of hygiene were found to be less prone to parasitic infection.
Abstract: A study of the prevalence of intestinal parasitic infection was conducted among children aged 5-16years in primary schools in rural parts of Imo State, Nigeria. Of the 337 faecal samples examined, 164 (48. 7%) harboured intestinal parasites with 65 (40. 4%) being from Orlu zone, 57 (52. 7%) from Owerri zone, and 42 (61. 8%) from Okigwe zone. The pa...
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Bacteriological Quality of Water Contaminated with Faecal Wastes from Livestock
Anyadoh-Nwadike S. O.,
Okereke J. N.,
Odah R.,
Obijekwu O.,
Okorondu S. I.,
Obasi K. O.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
29-33
Received:
8 August 2015
Accepted:
10 August 2015
Published:
27 October 2015
Abstract: Water is very important to life but when contaminated, it can be deleterious to life. Livestock from various farms produce large amount of faecal wastes. Most cattle farmers move their animals from place to place around Imo State, Nigeria, in search of pasture, these animals defeacate indiscriminately. Again, many farmers indulge in indiscriminate disposal of animal wastes. These faecal wastes can be carried by runoff water into surrounding water sources causing them to become contaminated. This study was therefore carried out to determine the prevalence of possible pathogenic bacteria in water contaminated with poultry litters, cow and pig dungs. Faecal samples from poultry, cows and pigs were collected from School of Agriculture and Agricultural Technology (SAAT) farm in the Federal University of Technology Owerri (FUTO), Imo State, Nigeria. The contaminated water samples were examined for the prevalence of bacteria. Isolation and characterization of bacteria were done using standard microbiological protocols. Results revealed the presence of Escherichia coli, Enterobacter aerogenes, Serratia marcescens, Erwinia amylovora, Vibrio cholerae, Pseudomonas aeruginosa, Citrobacter freundii, Proteus vulgaris, Staphylococcus aureus, Bacillus subtilis, Streptococcus faecalis and Salmonella typhi. Pseudomonas aeruginosa was the most prevalent isolate followed by Escherichia coli and Vibrio cholera. The presence of these organisms of public health importance in water contaminated by livestock faeces calls for continuous surveillance of various water sources prone to faecal contamination. Appropriate treatment and disposal methods of these faecal samples as well as appropriate treatment of water source prone to such contaminants should be adopted so as to avert the possible health hazards resulting from use of water from such contaminated sources.
Abstract: Water is very important to life but when contaminated, it can be deleterious to life. Livestock from various farms produce large amount of faecal wastes. Most cattle farmers move their animals from place to place around Imo State, Nigeria, in search of pasture, these animals defeacate indiscriminately. Again, many farmers indulge in indiscriminate ...
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Antibiogram of Bacteria Isolated From Pre-School Children with Asymptomatic Bacteriuria
Jacinta C. Elo-Ilo,
Elochukwu Cajetan Ilo,
Sylvia O. Anyadoh-Nwadike
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
34-39
Received:
29 August 2015
Accepted:
18 September 2015
Published:
27 October 2015
Abstract: Under five mortality which implies the death of a child before his or her fifth birthday is a major problem in developing countries like Nigeria. Aside other factors; microbial infection is grossly implicated in under five mortality. More problems however are caused by antimicrobial resistant microorganisms. Antimicrobial resistance by bacteria has become a global problem leading to much treatment failure. This study was therefore carried out to ascertain the antimicrobial profile of clinical isolates from pre-nursery school children between the ages of 3 and 5 years with a view to proposing the antibiotic of choice against the common isolates. Known isolates from pre-school children in Nnewi were used for the study. These isolates were subjected to standard microbiological and biochemical protocols to confirm their identities. The disc diffusion method was used to ascertain the susceptibility of the test organisms to commonly used broad spectrum antibiotics. Multidiscs containing ten broad spectrum antibiotics were used. The data obtained from this study were analyzed using the statistical package for social science (SPSS) version 9.5. The mean, range and standard deviation of the variables were determined where applicable. Frequency distribution, percentages and cross tabulation to examine relation between variables was done. The difference between frequencies was tested using Yate’s corrected chi square (χ2) test or Fisher’s exact test. Statistical significance was set at p < 0.05. The overall invitro sensitivity of the isolates was 100% to ciprofloxacin, 90.6% to clindamycin, 68.8% to gentamicin and 59.4% to cefuroxime. Fifty percent of the isolate were sensitive to cephalexim. The isolate were 34.4% sensitive to nitrofuraintoin and nalidixic acid, 25% sensitive to cotrimoxaole and 9.4% sensitive to erythromycin. All isolates were resistant to ampicillin.
Abstract: Under five mortality which implies the death of a child before his or her fifth birthday is a major problem in developing countries like Nigeria. Aside other factors; microbial infection is grossly implicated in under five mortality. More problems however are caused by antimicrobial resistant microorganisms. Antimicrobial resistance by bacteria has...
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Knowledge, Attitude and Practice of Laboratory Staff on Computer: Role in Scaling up Xpert MTB/RIF in Nigeria
Nwadike P.,
Gidado M.,
Sani U.,
Nwokoye N.,
Elom E.,
Onazi J.,
Ajiboye P.,
Iwakun M.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
40-44
Received:
30 August 2015
Accepted:
11 October 2015
Published:
27 October 2015
Abstract: Information, Communication Technology (ICT) has become the order of the day. Globally, there is increasing quest for use of ICT in various spheres of life. The Health care sector is not left out: Computer based diagnosis is the hope of fast and accurate diagnostic process. GeneXpert machines for rapid diagnosis of Tuberculosis (TB) and drug resistant tuberculosis (DR-TB), work with GeneXpert (GX) software and computer programs. This study was carried out to assess Knowledge, Attitude and Practice of Laboratory staff on computer with the view to unraveling its role in scaling up Xpert MTB/Rif in Nigeria. The survey was done using a structured, closed-ended questionnaire administered to laboratory staff operating GeneXpert machine, who participated in the study. A total of 76 GeneXpert machine operators (56.7%) out of 134 laboratory staff trained from 31 Xpert sites in Nigeria were interviewed. These included 49 Laboratory Scientists, 15 laboratory technicians and 12 other laboratory staff that operate the machine. Majority, 55 (72.4%) of the respondents had good knowledge of computer; 43 (78.2%), 4 (7.3%) and 8 (14.5%) of these were laboratory scientists, technicians and other laboratory staff respectively. Good computer knowledge was highest among scientists and lowest among technicians. These differences were statistically significant (df = 1 P < 0.01). Age, gender, owning a personal computer and formal computer training significantly influenced computing knowledge. Most Xpert MTB/RIF users 45 (64.5%) had positive attitude towards computing and this was significantly influenced by respondent's age and formal computer training. Only 38 (50%) had good computing practice; this was significantly associated with owning a personal computer (P < 0.01) and formal computer training. The major computer operation challenges observed among the laboratory staff included; Xpert calibration; completion of electronic recording tool and software operations like importing of assay definition file; plunger maintenance; generating system and error log reports as well as archiving/retrieving of tests. Introduction of basic computer training module into the Xpert training curriculum, strict adherence to SOP, continuous supportive supervision and mentorship training are recommended in Nigeria to boost efficiency of laboratory staff.
Abstract: Information, Communication Technology (ICT) has become the order of the day. Globally, there is increasing quest for use of ICT in various spheres of life. The Health care sector is not left out: Computer based diagnosis is the hope of fast and accurate diagnostic process. GeneXpert machines for rapid diagnosis of Tuberculosis (TB) and drug resista...
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Geo-helminthes Associated with Geophagic Pupils in Selected Primary Schools in Oyi, Anambra State
Okereke J. N.,
Obasi K. O.,
Nwadike P. O.,
Ezeji E. U.,
Udebuani A. C.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
45-50
Received:
7 July 2015
Accepted:
2 September 2015
Published:
10 November 2015
Abstract: Identification of geo-helminthes associated with geophagy as well as risk factors predisposing to such infestations among primary school pupils were carried out. Ethical permissions were obtained from headteachers of schools and pupils to collect stool samples of 200 volunteer pupils, aged 5-13years (106 males and 94 females) from rural and urban primary schools in Oyi Local Government Area of Anambra State, Nigeria. Stool samples were examined microscopically using wet mount (normal saline and iodine) technique. Data collected via questionnaires were analyzed to assess the relationship between geophagia, regular ingestion of soil and soil-transmitted parasites. Three intestinal parasites: Ascaris lumbricoides (A.lumbricoides), Ancylostoma duodenale (A. Duodenale) and Trichuris trichiura (T. Trichiura) were commonly observed. A total of 178 pupils (89%) found to be infected with one or more of these worms. A.lumbricoides had the highest prevalence of 52.8%, while A.duodenale and T.trichiura had 32.58% and14.61% respectively in all five villages in the Local Government Area. Infection rates and geophagic habits were established to be highest in children between the ages of 5 and 7years (p>0.05). Location and sex were observed to be insignificant factors in the distribution of these parasites (p>0.05). Geophagy and any other form of contact with the topsoil and children orally should therefore be noted as an important risk factor for orally acquired parasitic infections among children. Education on geophagy prevention should be an integral component of all soil-transmitted parasite control programs.
Abstract: Identification of geo-helminthes associated with geophagy as well as risk factors predisposing to such infestations among primary school pupils were carried out. Ethical permissions were obtained from headteachers of schools and pupils to collect stool samples of 200 volunteer pupils, aged 5-13years (106 males and 94 females) from rural and urban p...
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Evaluation of Factors Influencing Diabetes Management Among Pregnant Women in Ahiazu Mbaise, Imo State
Nwaokoro J. C.,
Onwuliri V. A.,
Emerole C. O.,
Ibe S. N. O.,
Nwadike P. O.,
Nwufo R. C.,
Ebiriekwe S. C.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
51-57
Received:
8 August 2015
Accepted:
10 August 2015
Published:
10 November 2015
Abstract: Diabetes mellitus is a group of metabolic diseases characterized by elevated blood glucose level (hyperglycaemia) resulting from defects in insulin secretion, insulin action or both. Many pregnant women are at the risk of developing diabetes, however most may be unassuming. This study therefore, sought to determine the level of knowledge of diabetes management among pregnant women in Ahiazu, Mbaise. The study employed a descriptive study design to ascertain the level of knowledge of pregnant women in Ahiazu, Mbaise on the management of diabetes. A total of 220 respondents were assessed with the use of questionnaire between April and October, 2014 at Ahiazu, Mbaise L.G.A. The collected data were analyzed with descriptive statistics using the computer software called Statistical Package for Social Science (SPSS). Results revealed the knowledge level to be higher (54.5%) among pregnant women at the age range of 31-35 years. The educational status was seen to be higher (49.5%) among respondents in secondary level of education. Those with high blood pressure were 59.1% and those who have trace of family history of diabetes were found to be 76.4%. Generally, study subjects had good understanding of the factors that influence the management of diabetes. However, there should be more health education for people in the study area and beyond on the management of diabetes in order to reduce the mortality and morbidity rate of diabetes diseases.
Abstract: Diabetes mellitus is a group of metabolic diseases characterized by elevated blood glucose level (hyperglycaemia) resulting from defects in insulin secretion, insulin action or both. Many pregnant women are at the risk of developing diabetes, however most may be unassuming. This study therefore, sought to determine the level of knowledge of diabete...
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Possible Health Implications Associated with Cosmetics: A Review
Okereke J. N.,
Udebuani A. C.,
Ezeji E. U.,
Obasi K. O.,
Nnoli M. C.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
58-63
Received:
28 August 2015
Accepted:
28 October 2015
Published:
17 December 2015
Abstract: Cosmetics are products applied to the body or face to improve appearance. Theycleanse, beautify, promote attractiveness and alter appearance of the body. The concept of beauty and cosmetics is as old as mankind and civilization. Assorted beauty products such as skincare products, hair products, fragrances, oral hygiene, and nail products, which may contain toxic chemicals that can be harmful to health are used especially by women. Most cosmetic products contain hazardous chemicals like Sodium Laureth Sulphate, Talcum, Parabens, Coal tar dye, Phthalates, Fragrance, Mineral oil, Triethanolamine and some heavy metals eg, Lead, Arsenic, Nickel, Cadmium, and Mercury. The bioaccumulation of theseharmful chemicals andmetals in the body over time has been associatedwith cancer, reproductive and developmental disorders, contact dermatitis, hair loss, lung damage, ageing, skin disease and reaction, allergies, and damage of nails. The deleterious chemicals and metals can enter into the body by inhalation of perfumes, deodorant, nail polish, scented powder, etc; by absorption through penetration of harmful chemicals from body creams, moisturizers, cleanser, eye shadow, etc. It can also be by ingestion of chemicals and metals in lip sticks, lip balm, lip gloss, etc. through the mouth.
Abstract: Cosmetics are products applied to the body or face to improve appearance. Theycleanse, beautify, promote attractiveness and alter appearance of the body. The concept of beauty and cosmetics is as old as mankind and civilization. Assorted beauty products such as skincare products, hair products, fragrances, oral hygiene, and nail products, which may...
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Risk Factors Associated with Infant Mortality in Owerri Metropolis, Imo State, Southeastern Nigeria
Nwaokoro Joakin Chidozie,
Ibe Sally N. O.,
Ihenachor Chinenye A.,
Emerole Chima O.,
Nwufo Regina C.,
Ebiriekwe Sabinus Chidubem,
Onwuliri Viola A.
Issue:
Volume 3, Issue 5-1, September 2015
Pages:
64-71
Received:
30 July 2015
Accepted:
13 September 2015
Published:
17 December 2015
Abstract: Despite, new advances in medicine, infant mortality continues to threaten many families and the country in general. Investigation of the risk factors associated with infant mortality in Owerri metropolis, Imo State, Nigeria was therefore carried out. Selected hospitals in Owerri metropolis were used as study areas. A total of 200 respondents (health workers) were recruited for the study. Pre-tested structured questionnaires were administered to the respondents for data collection. Presentation and analysis of data were done using descriptive statistics and chi square test. Results obtained showed that pre-pregnancy factors (previous number of children, birth spacing, previous birth complications, Human Immunodeficiency Virus (HIV) infection, malnutrition, alcohol intake, level of mother’s education, previous caesarian section), antenatal factors (low birth weight, gestational diabetes, failure to receive tetanus toxoid vaccine, congenital malformation, drinking alcohol, smoking or staying near a smoker, malaria in mother, obesity, feeding habit of a pregnant woman) and post natal factors (over weight of a baby, place of delivery, birth attendant, preterm birth, length of labour, placenta abnormalities, caesarian section, failure to have a wellness baby check, jaundice) were observed to contribute to infant mortality. There existed high significant difference among the parameters that were considered. Therefore, it was surmised that the parameters that were studied under pre-pregnancy, antenatal and post-natal risk factors contributed to infant mortality in Owerri, metropolis.
Abstract: Despite, new advances in medicine, infant mortality continues to threaten many families and the country in general. Investigation of the risk factors associated with infant mortality in Owerri metropolis, Imo State, Nigeria was therefore carried out. Selected hospitals in Owerri metropolis were used as study areas. A total of 200 respondents (healt...
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