Search

Introduction:palliative care offers a care and support system to people living with Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS). In Nigeria, the palliative care (PC) practice generally is new and still developing. While most studies on HIV/AIDS assess drug treatment and adherence for people living with HIV/AIDS (PLWHA), there is paucity of data on PC services available for them. We therefore assessed the PC services offered and referral services available to PLWHA in health facilities. Methods:we conducted a cross-sectional study across all public secondary and tertiary health facilities offering HIV care services in Abuja, Nigeria between February and May 2017. We used an interviewer-administered semi-structure questionnaire to collect information from the heads of health facilities. The questionnaire assessed palliative care and referral services for PLWHA. Frequencies and proportions were calculated using Microsoft-Excel. Results:of the 17 health facilities assessed, only 6 (35.3%) have constituted a palliative care team but only 3 (17.6%) had some sources of fund for PC. Twelve (70.6%) provided nutritional support for PLWHA, 6 (35.3%) provided spiritual and 8 (47.1%) offered bereavement support for families of PLWHA. Sixteen (94.1%) had well-established referral services for PLWHA. Conclusion:palliative care services for PLWHA were generally poor in all the health facilities. There exists a well-established referral services for PLWHA in most of the health facilities. We recommend that the PC structure for PLWHA should be improved by increasing and ensuring compliance to guidelines and the established referral network should continue to be strengthened.

BackgroundThe standard practice in treating uncomplicated malaria is to prescribe artemisinin-based combination therapy (ACT) for only patients with positive test results. However, health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. Available evidence on HWs perception of mRDT and their level of compliance with test results in Nigeria lacks adequate stratification by state and context. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria.MethodsA cross-sectional survey was conducted among 303 HWs who treat suspected malaria patients in 40 randomly selected public and private health facilities in Ebonyi state. Health workers' perception of mRDT was assessed with 18 equally weighted five-point likert scale questions with maximum obtainable total score of 90. Scores ≥72 were graded as good and less, as poor perception. Data were analysed using descriptive statistics and logistic regression model at 5% significance level.ResultsMean age of respondents was 34.6±9.4 years, 229 (75.6%) were females, 180 (59.4%) community health workers and 67 (22.1%) medical doctors. Overall, 114 (37.6%) respondents across healthcare facility strata had poor perception of mRDT. Respondents who prescribed ACTs to patients with negative mRDT results within six months preceding the survey were 154 (50.8%) [PHCs: 50 (42.4%), General hospitals: 18 (47.4%), tertiary facility: 51 (79.7%) and missionary hospitals: 35 (42.2%)]. Poor HWs' perception of mRDT promoted prescription of ACT to patients with negative mRDT results (AOR = 5.6, 95% C.I = 3.2-9.9). The likelihood of prescribing ACTs to patients with negative mRDT results was higher among HWs in public health facilities (AOR = 2.8, 95% C.I = 1.4-5.5) than those in the private.ConclusionsThe poor perception of mRDT and especially common prescribing of ACTs to patients with negative mRDT results among HWs in Ebonyi state calls for context specific interventions to improve their perception and compliance with mRDT test results.

Smoking is one of the most common forms of recreational drug use. In recent times, tobacco smoking appears to be the most popular form of smoking ahead of pipes, cigars and chewing tobacco and is practiced by over one billion people worldwide [1]. During the 20th century, cigarettes became the predominant form of tobacco used across the world and ushered in the global lung cancer epidemic [2, 3]. Different patterns of diffusion of cigarette smoking across world cultures have been described, noting the early adoption by Western high-income countries and the slower adoption in many lower-income and middle-income countries [2]. According to the "Global youth tobacco survey" approximately 15% of adolescents smoked cigarettes in 4 of 29 sites in African region, 13 of 38 sites in American region, one of 23 sites in Eastern Mediterranean region, 15 of 29 sites in European region, one of 10 sites in South East Asian region, and 13 of 22 sites in West Pacific region. A marginal yearly increase of 3% in cigarette smoking prevalence has been reported for developing countries [4]. Young persons are being introduced to cigarette smoking at an earlier age and because of its addictive nature become hooked on it. Variable rates of increasing smoking prevalence have been reported in Nigeria which was found to be dependent on the settings-either rural or urban [5-8]. Some studies in Nigeria have reported tobacco smoking prevalence of between 3.4% and 17.1% [9-12]. The prevalence among secondary school students is approximately 9% [13] with a mean lifetime smoking prevalence of 7.2% to 42.9% [14]. The increasing rate of cigarette smoking is been consolidated by the various apparently successful marketing strategies of tobacco companies and the poor awareness about the dangers associated with smoking [15]. Cigarette smoking has been associated with an extensive list of health disorders as well as reduction of life expectancy [16]. On the average cigarette smokers lose about 15 years of their life [16] and an estimated 4 million cigarette smokers die worldwide annually [17]. Many researchers have also reported that cigarette may be the first drug to be used by adolescents in a sequel that may include alcohol, marijuana and hard drugs, individuals who are not smoking cigarette by the age of 20 are unlikely to become smokers [16, 18-20]. Multiple levels of influence i.e individual, interpersonal, community have been found to affect behaviour change especially amongst adolescents [21]. One common factor that operates at all these levels of influence is the psycho-social construct of the behavior in question, whether in the forms of personal beliefs, opinions, subjective norms, or social norms. This suggests that perceptions about smokers (at the personal, interpersonal and community levels) constitute one of the factors that may influence adolescents to adopt or reject smoking behavior [21]. Research has shown that perception of the risks and benefits of smoking are associated with cigarette smoking in adolescents [22]. Specifically, adolescents who smoke report lower perceptions of risk, including lower estimates of lung cancer, mortality risk, and getting into trouble, [22-25] as well as higher perceptions of benefits of smoking than adolescents who have never smoked [23, 26-29]. Perceptions of risks and benefits have been shown to increase the chance of adolescent smoking initiation by between two to four times [23]. A systematic review revealed that youths beliefs about the likelihood of addiction, health risks, and consequences of smoking are associated with future smoking behavior [30]. Adolescents' perceptions are expected to change over time as a result of making new friends and social interactions that influences their decision-making abilities. They tend to have poor decision making and risk-judging skills, leading them to believe they are invulnerable to harm [23]. This is made worse by adolescents who smoke and tend to influence their non-smoker friends to adopt the practice. There is however a dearth of research among out of school adolescents as most researches including the "Global Youth Tobacco Survey" [17] were conducted among secondary school adolescents. Out of school adolescents are usually understudied and underrepresented [31] and therefore evidence from researches about them are not usually considered when policy makers make decisions that concerns them. This study was conducted among out of school adolescents in Birnin kebbi metropolis of Northwestern Nigeria where these adolescents form a significant proportion of the total adolescent population with the intent that its findings would add to the body of knowledge about cigarette smoking among out of school adolescents and it will inform better decision making in matters of cigarette smoking that relates to them.

Background Physicians and nurses play vital roles in addressing palliative care (PC) needs of people living with HIV/AIDS (PLWHA). The healthcare workers' (HCWs) experiences determine the success of palliative care delivery. There is paucity of data on PC for PLWHA. For this reason, we assessed the knowledge, attitude and practice of PC for PLWHA and associated factors among health care professionals. Methods We conducted a cross-sectional descriptive study among HCWs in public health facilities in the Federal Capital Territory, Nigeria between February and May, 2017. Multistage sampling technique with proportionate-to-size allocation was used to determine facility sample size and HCWs per professional discipline. Data were collected with questionnaires adapted from Palliative Care Quiz for Nursing, Frommelt Attitude toward Care of the Dying and practical questions adapted from PC standard guidelines. Participants' knowledge, attitude and practice were assessed by awarding one (1) point for each correct answer; incorrect or "not sure" answers took a zero (0) score. Correct responses were summed up to get a total score for each participant. Descriptive statistics was done to describe frequencies and proportions displayed on tables. Linear regression was done to determine factors associated with HCW's knowledge, attitude and practice of PC for PLWHA. Result With a 100% response rate, the mean age of the 348 participants was 37.5 years (SD: ±8.9), 201 (57.8%) were female, 222 (63.8) were nurses and 230 (66.0%) had a work experience of 10 years or less. Majority of the participants, 310 (89.1%) agreed that palliative care focuses on the relief and prevention of suffering and 319 (91.7%) believe that PLWHA required palliative care. Misconceptions about palliative care include "palliative care is disease-oriented and not person oriented", 252 (72.6%) believed; "palliative care is concerned with prolongation of life", 279 (80.6%); and "use of placebos is appropriate in the treatment of some types of pain", 252 (72.6%). Among the participants, 52% disagreed that "palliative care should be given only for dying PLWHA" while only 18 (5.2%) were right on "family should be involved in the physical care of the dying PLWHA". Majority of the participants, 292 (84.1%) initiated palliative care discussion during patients' diagnosis while 290 (83.6%) informed terminally ill patients about their diagnosis. Regarding psychological issues, 22 (6.3%) participants hid the truth from the patients while 196 (56.3%) provided emotional support to the patients. Morphine 240 (69.0%) and Pentazocine 194 (55.7%) were the most commonly used drugs for treatment of severe pain by participants across all centres. Conclusion In-service training and undergraduate training on palliative care were associated with knowledge and practice of palliative care for people living with HIV/AIDS. We recommended continuous quality in-service training and education on palliative care for HCWs. While we ensure voluntariness of participation and other ethical principles, the high response rate could be as a result of more motivated health worker than the norm. The results are unlikely to be representative of doctors and nurses in primary health care centres.

Aim This study aims to evaluate the effectiveness of a peer-led human immunodeficiency virus-sexually transmitted infections (HIV-STI) intervention program based on the Information-Motivation-Behavioral Skills model among undergraduate students at Ahmadu Bello University in northern Nigeria. Subjects and methods We utilized a randomized controlled field trial design to investigate the impact of an HIV-STI intervention program on participants’ HIV-related and STI knowledge, sexual risk behaviors, attitudes towards HIV and STI prevention, and disentanglement of stigmas. Participants were randomized to either the intervention group or the control group. An 8-h peer-led integrated HIV-STI prevention program comprised of four structured modules was developed and delivered to the intervention group, while the control group received another 8-h program on career development. Two-way repeated measure analysis of variance was applied to assess the effectiveness of the intervention. The outcome measures were assessed at baseline, immediately post-intervention, and at 3 months and at 6 months post-intervention. Results Respondents in the intervention arm showed significant improvements in knowledge about HIV and STIs, and in sexual risk behaviors and attitudes towards HIV-STI prevention. Conversely, there was no difference in tolerance toward people living with HIV assessed using the stigma scale. There were significant main effects for group (F = 155.94, p ≤ 0.001, η2 = 0.401); time (F = 248.35, p ≤ 0.001, η2 = 0.516), and group × time interaction (F = 162.96, p ≤ 0.001, η2 = 0.412) for HIV-related knowledge. Similarly, the main effects for group, time, and group × time interaction for STI knowledge, sexual risk behaviors, and attitudes were also significant. Conclusions The peer-led HIV-STI intervention program developed was effective in improving knowledge and attitudes about HIV prevention and reducing sexual risk behaviors among the university students. Scopus

Introduction : In July 2014, Nigeria experienced an outbreak of Ebola virus disease following the introduction of the disease by an ill Liberian Traveler. The Government of Nigeria with the support of Technical and Development Partners responded quickly and effectively to contain the outbreak. The epidemiological profile of the outbreak that majorly affected two States in the country in terms of person, place and time characteristics of the cases identified is hereby described. Methods : Using field investigation technique, all confirmed and probable cases were identified, line-listed and analysed using Microsoft Excel 2007 by persons, time and place. Results : A total of 20 confirmed and probable cases; 16 in Lagos (including the index case from Liberia) and 4 in Port Harcourt were identified. The mean age was 39.5 ± 12.4 years with over 40% within the age group 30-39 years. The most frequent exposure type was direct physical contact in 70% of all cases and 73% among health care workers. The total case-fatality was 40%; higher among healthcare workers (46%) compared with non-healthcare workers (22%). The epidemic curve initially shows a typical common source outbreak, followed by a propagated pattern. Conclusion : Investigation revealed the size and spread of the outbreak and provided information on the characteristics of persons, time and place. Enhanced surveillance measures, including contact tracing and follow-up proved very useful in early case detection and containment of the outbreak.

In Nigeria the Zaria Prevention of Maternal Mortality (PMM) team one of 12 multidisciplinary teams in the international PMM Network conducted a series of interventions to reduce maternal mortality. After conducting a 1989 situation analysis to identify barriers faced by women needing emergency obstetric care interventions were designed to improve the quality of care at the health facilities. Then in 1995 efforts were made to address the community-level barriers of cost and transportation difficulties. A revolving emergency loan fund was established in each project community in early 1995. The interest-free loans were financed by community contributions and were restricted to use by women with obstetric complications who had repaid previous loans from the fund. The loans had a 6-month repayment grace period a 24-month repayment period and a 12-month residency requirement. The second community intervention involved mobilizing transport owners to provide an affordable round-the-clock community transport service. Community leaders introduced both plans to the villagers through an intensive campaign. Data on program operation from March to December 1995 show that the amount of money raised at each fund-raising event increased from US$572 to $8116 to $11803. By the third event 81 community members pledged lifetime contributions totaling $18.45/day. In the same period 18 loans were made ranging from $52 to $69; repayment data are unavailable. Participation of vehicle owners also increased from 3 to 15 to 40 with 28 vehicle owners pledging permanent participation. Women with complications began using the services as soon as they were available. The cost of these community interventions was $5681 with 60% covered by the community and 40% by the PMM team. The community interventions failed to reverse the downward trend in health facility utilization but may have slowed it. Involvement of traditional community leaders in the intervention should promote project sustainability.

This study aimed to develop and implement a customized training program related to the delivery of an integrated human immunodeficiency virus - sexually transmitted infections (HIV-STI) risk reduction intervention for peer-facilitators and to evaluate its immediate outcome including changes in trainee knowledge, attitudes, and self-reported competence and confidence. We developed and delivered a structured training program and materials about HIV and STI prevention in a university setting. The training was offered to candidate facilitators who were planned to be involved in a larger project, known as Integrated HIV-STI Risk Reduction Program. Ten candidate facilitators participated in the training program and completed both the pretest and posttest survey questionnaire. The data were analyzed using SPSS version 17.0 software package and Wilcoxon signed rank test was applied to assess the impact of the training program. Overall, the trainees' performance in HIV-related and STI knowledge, attitude and stigma scores had significantly increased compared to the baseline. The median scores for HIV and STI knowledge after the training significantly increased from 22.0 to 30.5 (p=0.007) and 8.0 to 9.5 (p=0.005), respectively, whereas the median score on the positive attitude towards HIV and STI prevention rose from 39.0 to 57.0 (p=0.011). Upon completion of the program, 80-100% of the trainees believed that they were competent and confident in performing most of the designed sexual health intervention activities. This preliminary study suggests that a customized on-site training program on sexual health intervention could significantly improve their knowledge, attitude and practice related to HIV-STI prevention. 2012 Royal Society of Tropical Medicine and Hygiene. Scopus

Background Contraceptive use and fertility rates vary substantially among developing countries. In some sub-Saharan African countries, fewer than 10% of married women use contraception. Despite all efforts by governments to ensure availability of the products, prevalence has remained low. We conducted a community-based study to examine contraceptive knowledge, attitude and practice of family planning among married women in Samaru, Zaria, Nigeria. Multi-stage random sampling technique was used to study 200 women in Samaru community of Zaria, Nigeria. Mean age of the respondents was 30.6 ± 1.5 years. In this study contraceptive prevalence was 12.5% and respondents had a positive attitude towards family planning. Thirty years after Alma Ata of which one of the components is to ensure maternal and child health (MCH) and family planning, contraceptive use in most of the communities in Northern Nigeria is low. There is urgent need to step-up public awareness campaigns on family planning to ensure wide spread acceptability and utilization among women within reproductive age group.

Anemia is one of the most common and most serious health disorders worldwide. The World Health Organization (WHO) estimated that about 40% of the total world's population (more than 2 billion individuals) suffer from anemia. In developing countries, the prevalence rate of anemia is about 20% in school-aged children. More than 10 million African children are thought to be anemic (Hb11 g/dl). Also, in Africa, it is estimated that more than half of all children over 5 years and pregnant women are anemic. Community-based estimates of anemia prevalence in settings where malaria is endemic range between 49% and 76%. In Nigeria, the prevalence rate for anemia among children was 29.4%. It was highest in the South-East (49.7%) and lowest in the North-East (11.1%).The study aimed at evaluating the effectiveness of deworming and participatory hygiene education strategy in controlling anemia among children aged 6-15 years in the Gadagau community, north-western Nigeria.A cross-sectional descriptive study of 306 children aged 6-15 years selected from two rural communities (Gadagau, which was the study group and Karau-Karau, which was the control group) in the Giwa Local Government Area of Kaduna State Nigeria using a multistage sampling technique. The studies involved parasitological examination and anemia evaluation before and at 3 months after the children were dewormed.Only 301 children (150 children in study group and 151 children in control group) were studied. The results showed that those who were dewormed and had participatory hygiene education lectures (study group) had significantly higher mean hemoglobin, from an initial 10.4 g/dl to a post-intervention of 12.4 g/dl (paired t-test = 13.96; P = 0.00). Also, there was a rise in the mean hemoglobin of the control group, but not as much as in the study group, from an initial mean hemoglobin of 10.5 g/dl to a post-intervention of 11.2 g/dl (paired t-test = 2.89; P = 0.004). Comparing the study and the control groups, those who were dewormed and also had participatory hygiene education lectures (study group) had a significantly higher reduction in the level of children who had ova of intestinal helminthes present in their stool than those in the control group (Χ 2 = 31.61; df = 1, P = 0.00).This study therefore concludes that including participatory hygiene education to deworming programmes will greatly improve the hemoglobin level of children in areas where there is a high prevalence of hookworm infections, especially as a short-term preventive measure for anemia in children.

Carcinoma of the breast is an important public health problem in Nigeria and studies have reported low levels of awareness and practice of breast self examination as an important method of prevention. Breast self examination is a cost-effective method of early detection of cancer of the breast especially in resource poor countries. We assessed knowledge and practice of breast-self examination (BSE) among female undergraduate students of Ahmadu Bello University Zaria, Nigeria.In this study, knowledge and practice of BSE were examined among 221 female students aged 16-28 years old studying at Ahmadu Bello University Zaria using self administered questionnaires.It was found that despite nearly three quarter of the respondents (87.7%) had heard of BSE, only 19.0% of them were performing this examination monthly. Regarding the sources of information about BSE among respondents, media was found to be most common followed by health workers accounting for 45.5% and 32.2% respectively. Regular performance of BSE was significantly correlated with duration of stay in the University (X2 = 81.9, df = 3, P 2 = 17.4, df = 2, P CONCLUSION: We observed a disparity between high levels of knowledge of BSE compared to a low level of practice. Public health education using the media could significantly reduce the knowledge-practice gap and early detection of breast lump.

To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria.Checklist consisting of minimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development Agency (NPHCDA) was adopted and used to assess drugs availability, while Focus Group Discussions were conducted to determine the perceptions of clients on drugs situation in the health centres.Results show that, all the 3 primary health centres in Tafa LGA do not implement Bamako initiative (BI) and none was operating Drug Revolving Fund (DRF) system. Out of the minimum recommended score of 54 points for the availability and adequacy of drugs and consumables, New Wuse primary health centre in the LGAheadquarters scored highest points of 19, while New Bwari and Iku primary health centres scored 13 points each. All these are far below the minimum requirement. Similarly, the results of the FGDs confirmed poor availability of drugs and clients dissatisfactions with the drugs situation in the primary health centres.This study has revealed that despite Bamako Initiatives put in place in late 80s essentials drugs are still mirages in many of the primary health care facilities in the study area. It is therefore recommended that, any effort aimed at reforming or repositioning primary health care must take into account resuscitating Bamako Initiative by ensuring functional DRF system in all the primary care facilities.

Facility review at the secondary hospital in Makarfi revealed a lack of drugs and skilled personnel and delays in treating and referring women with obstetric complications.In 1994, maternity facilities were renovated, a revolving drug fund was introduced, midwives were trained and an ambulance was restored to service. Attempts to secure a physician with skills in treating obstetric emergencies were unsuccessful. Prior to these activities, obstetric services at the referral hospital were improved. Community interventions focused on improving utilization by women with complications.Between 1990 and 1995, substantial increases occurred in antenatal attendance (2517 to 5565 per year) and deliveries (325 to 1952 per year). The number of women with complications seeking care at this facility, however, dropped from 85 in 1990 to 28 in 1995. Referrals to higher level facilities increased from four in 1990 to 17 in 1995.The cost of the interventions was approximately US $32,000. Ninety-eight percent was paid by the government and 2% by PMM.Improving the quality of maternity services can increase utilization by women with uncomplicated pregnancies. However, utilization of emergency services appears to be influenced by other factors, such as the ability to treat obstetric complications and prevailing economic conditions.

Background : Welders are exposed to a variety of occupational hazards with untoward health effects. However, little is known of welders' awareness of health hazards and their adherence to safety precautions in developing countries. This study assessed the awareness of occupational hazards and adherence to safety measures among welders in Kaduna metropolis in northern Nigeria. Methods : A structured questionnaire was administered on a cross-section of 330 welders in Kaduna metropolis in northern Nigeria. Information was sought on their socio-demographic characteristics, their awareness of occupational hazards and adherence to safety measures. Results : All welders were males with a mean age of 35.7 ± 8.4 years. The illiteracy rate was 7.6%. Overall, 257 (77.9%) of the welders were aware of one or more workplace hazards. This was positively influenced by educational attainment, age, nature of training and work experience. Of the 330 respondents, 282 (85.3%) had experienced one or more work-related accidents in the preceding year. The most common injuries sustained were cut/injuries to the hands and fingers (38.0%), back/waist pain (19%), arc eye injuries/foreign bodies (17.0%), burns (14.0%), hearing impairment (7.0%), fractures (4.0%) and amputation (1.0%). Only 113 (34.2%) welders used one or more types of protective device with eye goggles (60.9%), hand gloves (50.3%) and boots (34.5%) being more frequently used. Regular use of safety device, shorter working hours and increasing experience were protective of occupational accidents. Conclusions : The level of awareness of occupational hazards was high with sub optimal utilization of protective measures against the hazards. There is therefore need for health and safety education of these workers for health and increased productivity.

BACKGROUND Increasing sexual networking among university students exposes them to the risk of sexually transmitted infections (STIs) including HIV/AIDS. Despite this, the level of condom use and sexual abstinence is low. OBJECTIVE The objective of the study was to describe sexual behavior and identify predictors of condom use among students in a Nigerian university. METHODS A cross sectional survey was conducted using self-administered questionnaires among 404 students of the Federal university of Technology, Minna in northern Nigeria. FINDINGS A total of 328 (81.2%) questionnaires were completed and returned. There were 230 male and 98 female respondents giving a sex ratio of 1:2.3. The respondent's ages ranged from 16 to 38 years with an overall mean of 23.53.51 years. A significantly higher proportion of males 184 (80.0%) reported being sexually experienced compared to 64 (65.0%) females (chi2 = 8.05 P < 0.05). The mean age of first sexual experience was also significantly higher among male students [18.92.1 years] compared to female students [16.41.7 years] (t = 11.36, P < 0.01). Similarly, a significantly higher proportion (56.2%) of sexually active males had multiple partners compared to females (38.1%) (chi2 = 11.9, P = 0.001). In addition, the mean number of lifetime sexual partners was significantly higher (5.3) for males compared to females (2.6) [t = 12.0, P < 0.001]. Condom was consistently used by 38.3% (n=95) of sexually active students in both genders. A higher proportion (44.6%) (n=82) of male students reported regular use of condoms compared to (20.3%) (n=13) of (partners of) sexually active female students (chi2 = 11.8 P = 0.001). Significant predictors of regular condom use include (male) gender, (higher) level of study and (single) marital status. CONCLUSION Most students were sexually active and many practiced unsafe sex. This indicates the need for youth friendly reproductive health programmes targeting these students.