Nosocomial Infections in Sub-Saharan Africa

The history of nosocomial infections can be traced to the origin of hospitals themselves and have been defined by the WHO as infections that develop in a patient during his/her stay in a hospital or other types of clinical facilities which were not present at the time of admission. Nosocomial infections are a major public health problem globally and are on the increase despite efforts in hospital infection control measures and contribute significantly to morbidity and mortality. Naturally, any micro-organism has the potential to cause infection in hospitalized patients however, only a few including Staphylococci, Escherichia coli, Pseudomonas aeruginosa, Enterococci, fungi and to a lesser extent, viruses and parasites are responsible for the majority of nosocomial infections. In sub-Saharan Africa, data available show that the incidence of nosocomial infections ranges from 2-49% with patients in intensive care units having the   highest rate ranging from 21.2-35.6%. The prevalence of nosocomial infections have  been reported  to vary  between 1.6%-28.7% in Burkina Faso, United Republic of Tanzania, Ghana, Mali, Cameroon, Gabon, Uganda, Burundi, Democratic republic of Congo and Senegal. In Nigeria and Ethiopia, the total accruing occurrence in surgical wards has been reported to vary from 5.7%-45.8% with the later having an incidence as high as 45.8% and an incidence density equal 26.7 infections per 1000 patient days in paediatric surgical patients. In addition, 3.4 -10.9% of hospital-associated infections often  result to mortality in most developed countries though these figures are suspected to be higher in developing countries of sub-Saharan Africa including Nigeria. However, simple and effective control programmes together with effective training of healthcare workers will go a long way in reducing the endemic nature of nosocomial infections in sub Saharan Africa. This paper highlights the natural history, distribution, risk factors of nosocomial infections especially in sub Saharan Africa as well as its contributory factors. Nosocomial infections are endemic in sub Saharan Africa and are further enhanced by emerging and re- emerging resistant agents. Simple and effective control programme together with computer-based epidemiological surveillance carried out as a global project with considerable inputs from developing countries for monitoring will enable the development of nosocomial infections to be halted if not eliminated. In addition, it is necessary to review the current infection control practices in all hospitals particularly in developing countries including Nigeria so as to incorporate molecular techniques which have been proven to be effective in keeping the spread of nosocomial infections under check. The training and re-training of health care givers on principles of infection control is strongly recommended. Also, the principles of infection control should be incorporated into student nurses, medical students, and other paramedical curriculum as well as employment of adequately competent health workers to avoid over labour which sometimes cause workers to be inefficient resulting in disease outbreaks. Finally, hand washing and other standard infection control practices should be adhered to so that nosocomial infections can be controlled effectively.

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