Abdominal obesity, serum estradiol and cardiovascular risk among Nigerian postmenopausal women: a cross-sectional study

Background

Rates of cardiovascular (CV) disease mortality is usually higher in men but this equalizes with that of women following menopause.

Objectives

This was to determine the contribution of abdominal obesity and estradiol to cardiovascular risk in postmenopausal women (PMW) as well as estimate their CV risk profile.

Methods

271 consenting PMW were recruited consecutively into this cross-sectional hospital-based study. Data relating to their socio-demography, blood pressure and anthropometry was obtained and laboratory analysis of lipid profile and serum estradiol was done. Cardiovascular risk of participants was estimated using standardized calculators.

Results

Mean age of participants was 57.8±5.5 years. Significant correlation existed between each of triglyceride (Positive), High Density Lipoprotein (negative) and Waist-Hip-Ratio (WHR) (p=0.001 and 0.000 respectively). Hypertension and dyslipidaemia were significantly associated with WHR (p=0.01 and 0.031 respectively). Significant negative correlation existed between CV risk profile and serum estradiol (rs = -0.140, p = 0.028). Ten-unit increase in WHR was associated with two-fold risk of hypertension (OR> 1.73, C.I.= 1.13-2.66). A unit change in age was associated with 0.61 increase in TC.

Conclusion

Abdominal obesity and serum estradiol significantly influence cardio-metabolic risk. Newer risk calculator which incorporates factors peculiar to women such as serum E2 is hereby recommended.

Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study

Background

Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c.

Methodology

A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16.

Results

The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes.

Conclusion

Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.

Comparative evaluation of three histidine-rich Protein-2 based rapid diagnostic tests, microscopy and PCR for guiding malaria treatment in Ibadan, Southwest Nigeria

Background

Malaria rapid diagnostic tests (mRDTs) are the preferred option for programmatic deployment.

Aims

There are numerous mRDTs on the Nigerian market and there is a need to guide practitioners on the relative performance of the commonly used brands of mRDT in Nigeria.

Subjects and Methods

The performance of three commonly used Histidine-Rich-Protein-2-based mRDTs (SD-Bioline™, Carestart™ and Paracheck-Pf™) against microscopy of Giemsa stained blood and polymerase chain reaction (PCR) was evaluated among 190 febrile under-5 children in Ibadan, Nigeria. We calculated the sensitivity, specificity, predictive values, accuracy, and agreements.

Results

There were 53.2% males. The prevalence of malaria parasite by microscopy was 46.8% and 57.9% by PCR. Malaria parasite detection by SD-Bioline™ was 60.5%, Carestart™: 60.0% and Paracheck-Pf™ 60.0%. Using microscopy as the gold standard, the sensitivities of SD-Bioline™, Carestart™ and Paracheck-Pf™ mRDT were 97.8%, 96.7% and 97.8% respectively while the specificities were 73.0%, 72.0% and 74.0% respectively. Using PCR as the gold standard, the sensitivity for both SD-Bioline™ and Paracheck-Pf™ was 85.5% and for CareStart was 84.6% while the specificity of SD-Bioline™, Carestart™, and Paracheck-Pf™ was 73.8%, 72.4%, and 75.0% respectively. The test accuracy was 81.0% for both SD-Bioline™ and Paracheck-Pf™ and 80.0% for Caresatrt™. The kappa coefficient of agreement between PCR and each of SD-Bioline™, Carestart, ParaCheck™ and microscopy was 0.597, 0.578, 0.609 and 0.739 respectively.

Conclusion

The performance of the three mRDTs is a proof that any of the three is suitable for use in the diagnosis of malaria in the southwest of Nigeria.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background:

The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria.

Methods:

A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively.

Results:

Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens’. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded.

Conclusion:

Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens’. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study

INTRODUCTION

Injury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).

METHODS

A common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.

RESULTS

A total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.

CONCLUSION

At baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.

Common oral conditions and correlates: an oral health survey in Kwara State Nigeria

BACKGROUND

Oral diseases are one of the most prevalent health problems today with distribution and severity varying in different parts of the world and within the same country. Oral health surveys are needed to determine prevalence of oral conditions and the nature and urgency of oral health interventions. A modified version of World Health Organisation pathfinder survey methods was used to determine prevalence of oral conditions amongst 150 respondents in two local government areas in Kwara State, Nigeria. This involved a stratified cluster sampling technique which identified the subgroups; location and certain age groups 5-6, 12 and 35-44 years age groups respectively. Clinical oral examination was carried out to determine the presence and types of common oral conditions among the respondents. Data analysis was done using descriptive statistics and Chi square analysis at 5% level of significance.

RESULTS

Among all the selected subjects 91.3% had an oral condition, while for the rural and urban population it was 93.3 and 89.3% respectively (p > 0.05). The most prevalent oral conditions were plaque and surface calculus found in 66.0% of the respondents respectively. Others are gingivitis (30.0%), enamel wear (15.0%) and dental caries (13.0%). The mean decayed missing filled teeth index was 0.26. The decayed missing filled teeth index did not show any significant difference between the rural and urban areas or male and female gender. The presence of calculus (p = 0.005) and gingivitis (0.015) was more in males than females. The presence of plaque (0.001) and calculus (0.006) was significantly more among the skilled workforce. The 12 year age group had significantly more cases of plaque, calculus and gingivitis while there were more cases of enamel wear among the 35-44 year olds compared with other age groups. There were more cases of trauma (87.5%) seen in urban than rural location (p = 0.029).

CONCLUSION

Oral health in selected communities of Kwara State is suboptimal requiring intervention. The presence of oral conditions is influenced by age, occupation, location and gender.

The Influence of Cultural Perception of Causation, Complications, and Severity of Childhood Malaria on Determinants of Treatment and Preventive Pathways

A cluster sample of 2,052 mothers and other caregivers of children from southwest Nigeria was studied. Qualitative and quantitative methods of data collection were employed, including semi-structured questionnaires, focus groups, in-depth interviews, and parasitological investigation forms/blood smears. “Too much work” (17.7%) and “too much sun” (12.6%) were the two most-often mentioned causes of malaria. Malaria was not perceived as a serious disease. Convulsions and anemia are not perceived as complications of malaria and are preferentially treated by traditional healers. Fifty-eight and one-half percent of children with malaria were treated at home. Choice of drugs used was based on previous experience and advice from various members of the community. Fathers (53.5%) and mother (32.5%) decided on where ill children received treatment. Mothers (51.5%) paid for the drugs more often than fathers (44.6%). Symptoms described as “iba lasan,” which means “ordinary fever,” conform to the clinical case definition of malaria. Cultural practices that are likely to influence appropriate treatment-seeking include cultural perception of malaria as ordinary fever, wrong perceptions of severe malaria, and father's role as decision maker.

An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control

While outbreaks of infectious diseases have long presented a public health challenge, especially in developing countries like Nigeria; within recent years, the frequency of such outbreaks has risen tremendously. Furthermore, with the recent outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic prone diseases in Nigeria demanding immediate public health action, there is a need to strengthen the existing notifiable disease surveillance and notification system with increased clinicians’ involvement in timely reporting of notifiable diseases to designated public health authorities for prompt public health action. Hence, this paper provides the opportunity to increase awareness among clinicians on the importance of immediate reporting of notifiable diseases and intensify engagement of clinicians in disease notification activities by describing various notifiable diseases in Nigeria using their surveillance case definition, outlines the reporting channel for notifying these diseases and highlights the roles of clinicians in the current disease surveillance and notification network for early disease outbreak detection and public health response in Nigeria.

Awareness and Utilization of Affordable Medicine Facility-Malaria among Caregivers of Under-Five Children in Ibadan North-West Local Government Area, Oyo State

Introduction. Distribution of Affordable Medicine Facility-malaria Artemisinin Combination Therapies (AMFm-ACTs) started in Nigeria in 2011, but its use at community level has not been documented. Methods. Four hundred seventy-eight caregivers whose under-five children had fever within two weeks prior to the survey were selected using cluster sampling technique. Information on sociodemographic characteristics, treatment seeking for malaria, and awareness and use of AMFm-ACTs was collected using an interviewer administered questionnaire. Result. More than half of the respondents (51.2%) bought AMFm-ACTs without prescription. Awareness of AMFm was low as only 9.1% has heard about the programme. Overall, 29.2% used AMFm-ACTs as their first line choice of antimalarial drug. On bivariate analysis age, group (25-34 years), public servants, respondents with tertiary education, respondents with high socioeconomic status, respondents with poor knowledge of symptoms of malaria, awareness of AMFm-ACTs, availability of AMFm-ACTs, and sources of drug were significantly associated with utilization of AMFm-ACTs (P < 0.05). Logistic regression demonstrated that only people who were aware of AMFM-ACTs predicted its use (AOR: 0.073; CI: 0.032-0.166; P < 0.001). Conclusion. Interventions which targeted at raising awareness of AMFm-ACTs among people at risk of malaria are advocated for implementation.

Evaluation of Paracheck-Pf(TM) rapid malaria diagnostic test for the diagnosis of malaria among HIV-positive patients in Ibadan, south-western Nigeria

Febrile illnesses occur frequently among HIV positive patients and these are often treated presumptively as malaria in endemic areas. Parasite-based diagnosis of malaria will eliminate unnecessary treatment, reduce drug-drug interactions and the chances for the emergence of drug resistant Plasmodium. We evaluated finger prick blood samples from 387 people living with HIV (PLWHIV) and suspected of having malaria by expert microscopy and Paracheck-Pf(TM) - a histidine-rich protein-II based malaria rapid diagnostic test. The study was conducted at the PEPFAR supported AIDS Prevention Initiative in Nigeria (APIN) Clinic of the University College Hospital Ibadan, southwest Nigeria. Outcome parameters were prevalence of malaria parasitemia, sensitivity and specificity of Paracheck-Pf as well as the positive and negative predictive values for Paracheck-Pf using microscopy of Giemsa-stained blood film as gold standard. Malaria parasites were detected in 19·1% (74/387) of enrollees by microscopy and 19·3% (74/383) by Paracheck-Pf. Geometric mean parasite density was 501/μl (range 39-749 202/μl). Sensitivity and specificity of Paracheck-Pf at all parasite densities were 55·4% and 89·3% while corresponding figures at parasite densities ≥200/μl were 90·9% and 90·3%. Sensitivity and specificity at parasite densities ≥500/μl was 97·6% and 90·3%. Positive and negative predictive values for parasite density ≥200/μl were 55·4% and 98·7%, respectively. Paracheck-Pf was found to be a useful malaria diagnostic tool at parasite densities ≥200/μl facilitating appropriate clinical management.

Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study

Background

Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria.

Methods

A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data.

Results

Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities.

Conclusion

This study’s findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.

Cholera outbreak in a southwest community of Nigeria: investigation of risk factors and evaluation of a district surveillance system

BACKGROUND

Following confirmation of cholera outbreak in a southwest community of Nigeria, we set to identify possible risk factors for contracting the disease and to evaluate the completeness as well as the representativeness of the cases reported to a district health authority.

METHODS

Cholera cases were identified through an active case search that involved the review of records in health facilities and a house-to-house search using the standard case definition in the Nigeria integrated disease surveillance and response technical guidelines. Two neighborhood controls appropriately matched on age and sex for each case, were also identified. An interviewer-administered questionnaire was used to collect information on the demographic characteristics and potential risk factors. Completeness of reporting of cases notified to the district health authority was evaluated using a two source capture-recapture method. In addition, the representativeness of the reported cases was determined by comparing the age and sex distributions of notified cases to those identified through the active case search.

RESULTS

Thirty-nine cases were identified, of which 22 consented to participate. Contact with a diarrhoea case at home or in the neighborhood within the last 7 days prior to illness onset in cases was significantly associated with having cholera (Matched triplets Odds Ratio 8.5, 95% CI: 1.36-52.9). The completeness of the district surveillance report was estimated to be 54%. In the district notification data compared with the active case search data, males <5 years (31% vs 18%) and females 15 years (3% vs 21%) were significantly over- and under-represented, respectively.

CONCLUSION

The odds of having cholera were increased in those who had contact with a case of diarrhea. Reporting of cases to the district health authority was not complete and the surveillance data on gender and age grouping were not representative of the cases that occurred in the population. There is a need for efficient reporting of cases to the health authority during outbreaks in order to improve decision-making and public health interventions.

Socio demographic and clinical correlates of knee pain in adult women attending a primary care clinic

AIMS AND OBJECTIVES

The objectives of the study were to determine the socio demographic and clinical correlates of knee pain in women in a primary care clinic.

PATIENTS AND METHODS

The study was a cross-sectional survey of 400 women attending the General Outpatients' clinic of the University College Hospital (U.C.H.), Ibadan, Nigeria using the systematic random sampling technique.

RESULTS

The prevalence of knee pain was 42.0% (95% CI 40.0- 41.0). The radiographic findings in the knees showed mostly osteophytes in 24 out of the 28(85.7%) respondents who had radiographs done. The highest prevalence of knee pain was found in caterers and traders, 62.5% and 51.6%, respectively (p= 0.001). Multivariate analysis done using logistic regression with a backward selection showed that the odds of developing knee pain increases with age (Odds Ratio=1.585, 95% CI 1.321-1.903, p=0.000), and body mass index (Odds Ratio 1.587, 95% CI 1.295-1.946, p=0.000).

CONCLUSION

The prevalence of knee pain in women seen at the primary care clinic is high. Preventive measures for knee pain need to be instituted.

Experimental malaria: the in vitro and in vivo blood pressure paradox

Objective

Malaria causes more deaths worldwide than any other parasitic disease. Many aspects of the biology that governs the pathogenesis of this parasite are still unclear. Therefore insight into the complexity of the pathogenesis of malaria is vital to understand the disease, particularly as it relates to blood pressure.

Methods

In vivo and in vitro experimental models were used for this study. In the in vivo study, mean arterial pressure, pulse rates and heart rates were recorded by cannulation of the carotid artery of rats. In the in vitro study, ring preparations of blood vessels from the rat aorta were studied using standard organ bath techniques. Dose–response curves for phenylepherine (PE)- and acetylcholine (Ach)-induced relaxation were constructed for rings pre-contracted with PE.

Results

Our results showed a significant (p < 0.05) reduction in the mean arterial pressure and pulse rates, while the heart rates remained unaltered in rats with malaria parasites, compared with the controls. Incubation of rat aortic rings with parasitised blood resulted in a significant (p < 0.05) increase in maximum contractile response to phenylephrine in the rat aortic rings but there was no effect on the baseline. The dose–response curve showed a significant (p < 0.05) leftward shift following the addition of parasitised blood and the EC₇₀ (M) values increased from 7 × 10^-7 to 5 × 10^-6 M. Following exposure to parasitised blood, the magnitude of Ach-induced relaxation responses reduced significantly (p < 0.05) from 73 ± 3.6 to 24.75 ± 7.25% in the rat aortic rings.

Conclusions

The results suggest that malaria parasitaemia caused in vivo reduction in blood pressure, and enhanced the responses to contractile agents and reduced relaxation responses to acetylcholine in vitro. This appears to be a paradox but is explainable by the complex cardiovascular control mechanisms in vivo. This may be independent of direct action on vascular smooth muscle.

Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria

Background

Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness.

Methods

We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis.

Results

The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 – 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 – 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 – 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening.

Conclusion

The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

Global teaching and training initiatives for emerging cohort studies

A striking disparity exists across the globe, with essentially no large-scale longitudinal studies ongoing in regions that will be significantly affected by the oncoming non-communicable disease epidemic. The successful implementation of cohort studies in most low-resource research environments presents unique challenges that may be aided by coordinated training programs. Leaders of emerging cohort studies attending the First World Cohort Integration Workshop were surveyed about training priorities, unmet needs and potential cross-cohort solutions to these barriers through an electronic pre-workshop questionnaire and focus groups. Cohort studies representing India, Mexico, Nigeria, South Africa, Sweden, Tanzania and Uganda described similar training needs, including on-the-job training, data analysis software instruction, and database and bio-bank management. A lack of funding and protected time for training activities were commonly identified constraints. Proposed solutions include a collaborative cross-cohort teaching platform with web-based content and interactive teaching methods for a range of research personnel. An international network for research mentorship and idea exchange, and modifying the graduate thesis structure were also identified as key initiatives. Cross-cohort integrated educational initiatives will efficiently meet shared needs, catalyze the development of emerging cohorts, speed closure of the global disparity in cohort research, and may fortify scientific capacity development in low-resource settings.

Oral morphine effectiveness in Nigerian patients with advanced cancer

Oral morphine elixir in the immediate release form became available in Nigeria in the year 2006 after decades of use in the treatment of cancer pain in many other countries. In order to determine the effectiveness of oral morphine in Nigerian patients, 182 patients presenting with severe cancer pain at the Radiotherapy Clinic, University College Hospital (UCH), Ibadan, Nigeria, were recruited in a prospective descriptive observational study. Information on patient's demography, diagnosis, baseline intensity and character of pain, morphine dosages, and effects were collected using a semistructured questionnaire administered at recruitment and biweekly in the follow-up period. Mean (+ SD) age of the patients was 47 (+ 14.6) years and the most common types of cancer diagnosed in the study participants included cancer of the breast and uterine cervix. The pretreatment pain intensity score mean (+ SD) was 8.09 (+ 1.51). Of the 166 patients whose data were analyzed, 84.3% (95% confidence interval [CI] 77.8-89.5%) achieved a 3-point reduction in pain intensity using the 11-point Numerical Rating Scale at the end of the first week of treatment. Twenty-six patients (15.7%) required adjuvant therapy. The reduction in pain intensity was maintained throughout the 3 months follow-up period, with the mean 24-hour morphine consumption of 55.54 mg in the first month and 61.54 mg in the third month. Oral morphine significantly reduced cancer pain in Nigerian patients (P < .01). Increasing dose as required was found to enhance the effectiveness of oral morphine.

Nutritional status of older persons presenting in a primary care clinic in Nigeria

The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional Assessment (MNA) tool and body mass index were used to assess undernutrition and overweight, respectively. The prevalence of nutritional problems was 61.9% (undernutrition = 7.8% and overweight = 54.1%). Being unmarried (P < 0.001), engagement in a job after the age of 60 years (P < 0.001), constipation (P = 0.009), rectal bleeding (P = 0.008), and oral problems (mouth, teeth, and tongue) were significantly (P < 0.001) associated with undernutrition. Younger age (P = 0.050) and female gender (P = 0.011) were significantly associated with being overweight. Logistic regression analysis showed being unmarried OR = 1.355 (95%CI 1.075-1.708) to be the most important factor for the development of undernutrition. The high prevalence of nutritional problems in this study underscores the need for intervention in this population. Correlation analysis (Pearson's) showed a positive association between BMI and MNA scores (r = 0.152, P = 0.001).

Population-based prevalence of abnormal cervical cytology findings and local risk factors in Ibadan, Nigeria: implications for cervical cancer control programs and human papilloma virus immunization

OBJECTIVE

To investigate the prevalence of abnormal cervical cytological findings and local risk factors in Ibadan, Nigeria.

STUDY DESIGN

All women aged ≥15 years in each household in Idikan, Ibadan, were invited to participate in a population-based study. Structured questionnaires were administered to all consenting women. Conventional cervical Papanicolaou smears obtained from sexually active women were classified using the 2001 Bethesda system. The diagnoses were correlated with sociodemographic data and risk factors.

RESULTS

Of 2,870 women aged ≥15 years estimated to live in Idikan, 1,204 sexually active women consented to pelvic examination and cervical smears. Results were available for 1,104 women (mean age: 39.8 years). Mean ages at menarche, first sexual intercourse and first pregnancy were 16.1, 20.3 and 20.7 years, respectively. Cytological results were categorized into atypical squamous cells of undetermined significance and atypical glandular cells 22 (1.99%); low-grade 43 (3.89%) and high-grade squamous intraepithelial lesions (HSIL) 17 (1.54%); invasive cancer 2 (0.18%) and normal 593 (53.8%) and reactive changes 427 (38.7%). The prevalence of epithelial abnormalities is 7.6%. Significant host-related factors in those with HSIL and invasive cancer included older age (mean 56.2 years), high parity and gravidity, lack of formal education and being divorced (p < 0.05).

CONCLUSIONS

This study provides prevalence data and local risk factors for abnormal cervical cytology in a Nigerian population, which will be useful for planning future cervical cancer control programs.

Knowledge of malaria and preventive measures among pregnant women attending antenatal clinics in a rural local government area in Southwestern Nigeria

OBJECTIVE

This study determined the level of knowledge of malaria and preventive measures among pregnant women and its influence on the uptake of preventive measures.

METHODS

A cross-sectional survey was carried out among 209 participants selected from pregnant women attending antenatal clinics in primary healthcare centres in Irepodun/Ifelodun, a local government area in Ekiti state, Nigeria.

RESULTS

Knowledge of malaria was found to be very good, average and poor among two (1.0%), 165 (78.9%) and 42 (20.1%) respondents, respectively. Of the 109 (52.2%) respondents who had heard about intermittent preventive treatment, eight (7.3%) scored "very good" on knowledge, while 53 (48.6%) and 48 (44.1%) scored "average" and "poor," respectively. Of the 144 (68.9%) respondents who had heard about insecticide-treated nets, 95 (66.0%) scored "good" on knowledge, while 49 (34.0%) scored "poor." Factors that significantly influenced knowledge about malaria were occupation, level of education, months at first appearance at antenatal clinic and transportation cost. Knowledge significantly influenced uptake of insecticide-treated nets and intermittent preventive treatment in pregnancy ( p < .05).

CONCLUSION

There is a need to intensify efforts to provide health education on malaria and preventive measures as well as to encourage preventive practices among pregnant women.

Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26-30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education.

Specificity of vascular reactivity and altered response in experimental malaria

OBJECTIVE

Adherence of erythrocytes infected with Plasmodium falciparum (P falciparum) to microvascular endothelial cells (sequestration) is considered to play an important role in parasite virulence and pathogenesis. In this study, we have examined the possibility that there is altered vascular reactivity due to the direct interaction between the parasitized erythrocytes and vascular endothelial cells and that it could be tissue specific.

METHOD

Ring preparations of blood vessels from the rabbit carotid and rat aorta were studied using standard organ bath techniques. Dose response curves for phenylephrine (PE) and acetylcholine (Ach)-induced relaxation were constructed in rings pre-contracted with PE.

RESULTS

Incubation of rat aortic rings with parasitized blood resulted in a significant (p < 0.05) increase in maximum contractile response to phenylephrine in the rat aortic rings but there was no effect on the rabbit carotid artery. The dose-response curve showed a significant (p < 0.05) left-ward shift following the addition of parasitized blood. Parasitised blood had no effect on baseline in both tissues. Following exposure to parasitized blood, the magnitude of Ach-induced relaxation responses reduced significantly (p < 0.05) in rat aortic rings and (p < 0.05) in rabbit carotid rings; relaxations to acetylcholine was more pronounced in the aortic compared to the carotid rings.

CONCLUSIONS

Malaria altered vascular reactivity through an endothelium-dependent mechanism. The regulation of vascular tone by various vasoactive agents following exposure to malaria parasites might be altered in a vessel-specific manner. This may contribute to or exacerbate the abnormal haemodynamics observed in the microcirculation of numerous vascular beds in malaria.

Altered vascular reactivity induced by malaria parasites

OBJECTIVE

In this study, we have examined the possibility that there is altered vascular reactivity due to the direct interaction between parasitized erythrocytes and vascular endothelial cells.

METHOD

Ring preparations of rat aorta were studied using standard in vitro techniques, the rings were mounted in 20 ml organ baths containing PSS under an initial load of 1 g, maintained at 37 degrees C at pH 7.4 and isometric contractions were recorded electronically. Rings were allowed 90 minutes to equilibrate before the commencement of the various protocols: Dose responses to phenylephrine (PE) and other vasoactive agents (high-K+). Acetylcholine (Ach)--induced relaxation in phenylephrine-contracted rings (pre-contraction was induced by EC70 concentration of phenylephrine). Ach-induced relaxation in PE-precontracted, endothelium-denuded rings. Also, relaxation responses to acetylcholine was investigated through application of a single. (EC70) concentration of acetylcholine in rings exposed to blood with varying concentrations and dilutions of parasitized blood and varying durations of exposure.

RESULTS

Incubation with parasitized blood resulted in a significant increase in maximum contractile response to phenylephrine in the rat aortic rings (p < 0.05) but no effect to the base line. Analysis of the whole dose-response curve (using paired t-test) showed a significant left-ward shift following the addition of parasitized blood (p < 0.05), EC70 (M) values increasing from 7 x 10(-7) to 5 x 10(-6)M. Following exposure to parasitized blood, the magnitude of Ach-induced relaxation responses reduced significantly from 73 +/- 3.6 to 24.75 +/- 7.25% in rat aortic rings (p < 0.05). Ach relaxations were significantly enhanced (p < 0.05) at 5-minute exposure; however at longer durations, Ach-relaxations were variable and inconsistent. The lesser the dilution, due to increased volume of parasitized blood, the lesser the relaxation response. Following endothelium removal, there was a marked impairment in endothelium-dependent relaxation responses to ACh in both the control and incubated vessels. Exposure to parasitized blood did not significantly alter contractile responses induced by potassium depolarization.

CONCLUSIONS

This gives evidence in support of an endothelium-dependent action of malaria parasites as vascular effects of malaria parasites are mediated, at least in part, via endothelium-dependent mechanism(s).

An assessment of accuracy of mothers' presumptive diagnosis of fever at home in southwest Nigeria: evidence for switch to parasite-based diagnostic test

OBJECTIVE

Home management of malaria (HMM) strategy was based on presumptive diagnosis of malaria and use of correct dose of chloroquine. However, the development of chloroquine resistant parasites in most endemic areas necessitated the recommendation of artemisinin combination therapy (ACT); and this has been demonstrated to be effective in HMM. However, the recommendation that ACT should be dispensed only to laboratory confirmed cases underscores the need to review the accuracy of mothers' presumptive diagnosis and provide evidence for a switch to parasite based diagnostic test.

METHODS

This was a follow-up study nested to a larger controlled intervention study carried out to assess the effect of malaria treatment guideline on mothers' adherence to correct treatment of malaria in children. In a subset, thick blood smears were prepared from finger prick blood samples of febrile children who have been presumptively diagnosed to have malaria by mothers on Days 0, 1, 2, 3, 7 and 14 to detect parasitaemia. The presumed diagnosis was compared with the presence of parasitaemia.

RESULTS

A total of 162 children with febrile illness (88 and 74 in intervention and control groups respectively) were studied. Sixty-four (72.7%) and 62 (83.8%) of the febrile cases presumed to have malaria in the intervention and control groups respectively had parasitaemia on Day 0. The sensitivity and specificity of mothers' diagnoses was 78.1% and 29.2%; 82.3% and 8.3%; in the intervention and control groups respectively.

CONCLUSION

The low specificity of presumptive diagnosis has implication for the deployment of ACT at the community level in Nigeria. This supports current views on the need for a more sensitive and specific parasite-based diagnosis of malaria before ACT treatment. Further study to compare presumptive diagnosis of malaria with malaria diagnostic test carried out at the community level is needed to inform policy on the adoption of parasite based malaria diagnosis at community level.

Case finding for hypertension in young adult patients attending a missionary hospital in Nigeria

OBJECTIVES

This study was carried out to search for cases of undetected hypertension in young adult male and non-pregnant female patients (18 - 44years) attending a catholic mission hospital in Ibadan, Nigeria so as to provide evidence for routine blood pressure checks in this age group. It also sought to determine risk factors present in those found to be hypertensive and to detect complications of hypertension, if present.

METHODS

Semi-structured questionnaire was administered and physical examination was carried out on the eligibles. Laboratory analysis of blood and urine was done for the consenting subjects with confirmed hypertension. A descriptive, hospital-based cross-sectional study, which took place at the Out-Patients Department of St. Mary's Catholic General Hospital, Eleta, Ibadan. Consecutive young adult male and non-pregnant female patients aged 18 - 44 years attending the hospital for the first time between February 2007 and August 2007, that met the inclusion criteria and consented to participation.

DATA ANALYSIS

Frequency distribution was done to describe the data, while cross-tabulation, t-test, chi-square test and one-way ANOVA were done to explore association between variables as appropriate.

RESULTS

Out of the 405 subjects that participated in the study, 124(30.6%) were hypertensive. The mean age of the subjects was 31.6 +/-6.9 years. A total of 154 (38%) were male and 251(62%) female. Mean BMI was 23.7+/-4.3 kg/m(2). The study revealed that age, occupation, body mass index, waist circumference and hip circumference were significantly associated with high blood pressure. Clinical evidence of target end-organ damage seen include left ventricular hypertrophy in 22(17.7%) congestive cardiac failure in 3(2.4%), retinopathy in 5(4.0%), nephropathy in 12(26.1%) and transient ischaemic attack in 1(0.8%).

CONCLUSION

Undetected cases of hypertension, with complications and target end-organ damage, exist in young adults in Ibadan and family physicians and other primary care physicians, especially in Nigeria, should pay attention to case finding for hypertension in this age group.

Knowledge and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in primary health care centers in rural southwest, Nigeria: a cross-sectional study

Background

Intermittent preventive treatment for prevention of malaria in pregnancy (IPTp) is a key component of malaria control strategy in Nigeria and sulfadoxine-pyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in Nigeria is low. This study set out to assess the use of IPTp among pregnant women attending primary health centres in the rural area and determine factors that influence the uptake.

Methods

A cross-sectional study was carried out between July and August 2007 among 209 pregnant women selected by systematic random sampling from antenatal care attendees at primary health care in a rural Local Government Area of Ekiti State, Nigeria. Information on knowledge of IPT, delivery, adherence and acceptability was obtained using an interviewer administered questionnaire. Descriptive statistics such as means, range, proportions were used. Chi-square test was used to examine association between categorical variables. All analyses were performed at 5% level of significance.

Results

One hundred and nine of 209 (52.2%) respondents have heard about IPTp but only 26 (23.9%) were able to define it. Fifty seven (27.3%) reported to have received at least one dose of IPTp during the index pregnancy and all were among those who have heard of IPTp (52.3%). Twenty one of the 57 (36.8%) took the SP in the clinic. Only three of the twenty-one (14.3%) were supervised by a health worker. Twenty two of the 36 women (61.1%) who did not take their drugs in the clinic would have liked to do so if allowed to bring their own drinking cups. Almost half (43.9%) of those who had used IPTp during the index pregnancy expressed concern about possible adverse effect of SP on their pregnancies. Periodic shortages of SP in the clinics were also reported.

Conclusion

In this study, IPTp use among pregnant women was very low and there was poor adherence to the Directly Observed Therapy (DOT) scheme. Concerted effort should be made to increase awareness of IPTp among the public especially women of child bearing age. Health workers should also be trained and monitored to ensure adherence.

Determinants of utilisation of cervical cancer screening facility in a low socio-economic setting in Nigeria

A prospective randomised structured questionnaire survey of 254 women in the low socio-economic class attending the general outpatient clinic at the University College Hospital (UCH), Ibadan revealed a high level of ignorance concerning cervical cancer prevention programmes. Only 3.5% of subjects have heard of a Papanicolaou smear and only 1.2% have had the test prior to this study. Peers (36%) were the most common source of information on cervical smears. The majority (84.6%) of the women were willing to be screened, however only 5.1% of those willing (4.3% of the women studied) actually reported for the test. Twenty-two percent (219) had high knowledge about cervical smears while moderate and poor knowledge were demonstrated in 33% respectively. Eleven per cent had no knowledge whatever. No significant association was found between the knowledge score on Papanicolaou smear and other variables. The cost of the test appeared to have prevented many of the women from having the test. It is recommended that more efforts need to be put into health education of women stressing the importance of the test and its availability.

The development of a treatment guideline for childhood malaria in rural Southwest Nigeria using participatory approach

OBJECTIVE

To describe the development of a treatment guideline for the effective case management of malaria in children at the home level.

METHODS

Thirty-three mothers selected from 11 communities in a rural health district, community members and the research team developed a guideline for treatment of malaria at home by caregivers using a participatory approach. This was done in phases using modified focus group discussion sessions. Suggested ideas were depicted in illustrations by a graphic artist.

RESULTS

A guideline which illustrated the presentation of clinical types of malaria, the appropriate steps to take for each type and the correct dosage schedule of chloroquine (based on the age of the child) for treatment of uncomplicated malaria was developed. The guideline was in cartoon format and the script in the local language.

CONCLUSION

Use of a participatory approach was found acceptable and effective in the development of the guideline. This approach is therefore recommended irrespective of the target population or the intervention to be developed. Practice implications Preparation of educational materials with contributions from end users does not only build capacity at the local level but also increases the acceptability and ownership of such materials.

Using "mother trainers" for malaria control: the Nigerian experience

Studies of care seeking in Nigeria show that a tremendous amount of treatment for malaria takes place at home and, in most instances, such treatments are incorrect. This deficiency is attributed to caregivers' poor knowledge of treatment. This study was designed to empower households to treat malaria correctly in partnership with community members. Selected mothers from study communities were trained as "mother trainers" and were expected to train other members of their communities using a treatment protocol. "Mother trainers" were acceptable to most communities and judged to be effective. They were enthusiastic and their participation in the study boosted their ego and status in the community. Drop-out-rate of "mother trainers" was 24.2%. A few limitations to the use of mothers as trainers that were identified are discussed. It is concluded that mothers have good potential to effectively carry out health education activities in the community if appropriately selected, trained, and supervised.

Effectiveness of artemisinin-based combination therapy used in the context of home management of malaria: a report from three study sites in sub-Saharan Africa

Background

The use of artemisinin-based combination therapy (ACT) at the community level has been advocated as a means to increase access to effective antimalarial medicines by high risk groups living in underserved areas, mainly in sub-Saharan Africa. This strategy has been shown to be feasible and acceptable to the community. However, the parasitological effectiveness of ACT when dispensed by community medicine distributors (CMDs) within the context of home management of malaria (HMM) and used unsupervised by caregivers at home has not been evaluated.

Methods

In a sub-set of villages participating in a large-scale study on feasibility and acceptability of ACT use in areas of high malaria transmission in Ghana, Nigeria and Uganda, thick blood smears and blood spotted filter paper were prepared from finger prick blood samples collected from febrile children between six and 59 months of age reporting to trained CMDs for microscopy and PCR analysis. Presumptive antimalarial treatment with ACT (artesunate-amodiaquine in Ghana, artemether-lumefantrine in Nigeria and Uganda) was then initiated. Repeat finger prick blood samples were obtained 28 days later for children who were parasitaemic at baseline. For children who were parasitaemic at follow-up, PCR analyses were undertaken to distinguish recrudescence from re-infection. The extent to which ACTs had been correctly administered was assessed through separate household interviews with caregivers having had a child with fever in the previous two weeks.

Results

Over a period of 12 months, a total of 1,740 children presenting with fever were enrolled across the study sites. Patent parasitaemia at baseline was present in 1,189 children (68.3%) and varied from 60.1% in Uganda to 71.1% in Ghana. A total of 606 children (51% of infected children) reported for a repeat test 28 days after treatment. The crude parasitological failure rate varied from 3.7% in Uganda (C.I. 1.2%–6.2%) to 41.8% in Nigeria (C.I. 35%–49%). The PCR adjusted parasitological cure rate was greater than 90% in all sites, varying from 90.9% in Nigeria (C.I. 86%–95%) to 97.2% in Uganda (C.I. 95%–99%). Reported adherence to correct treatment in terms of dose and duration varied from 81% in Uganda (C.I. 67%–95%) to 97% in Ghana (C.I. 95%–99%) with an average of 94% (C.I. 91%–97%).

Conclusion

While follow-up rates were low, this study provides encouraging data on parasitological outcomes of children treated with ACT in the context of HMM and adds to the evidence base for HMM as a public health strategy as well as for scaling-up implementation of HMM with ACTs.

Malaria prevention practices among mothers delivering in an urban hospital in southwest Nigeria

BACKGROUND & OBJECTIVES

The pregnant woman is more prone to malaria than her non-pregnant counterpart with grave consequences for both mother and baby. This study aims at determining the malaria prevention practices among pregnant women in an area hyper-endemic for malaria.

METHODS

For the study 983 parturient mothers were enrolled in Ibadan, southwest Nigeria. Information was collected on sociodemographic characteristics, use of malaria chemoprophylaxis, use of anti-vector measures, and malaria parasitaemia.

RESULTS

Most mothers [956/972 (98.4%)] reported the use of anti-vector measures for malaria prevention. These include, window screens (78.9%), insecticides spray (69.9%), mosquito coils (25.3%), untreated bednets (2.5%), and insecticide-treated nets (1.1%). Most mothers used anti-vector measures either singly or in combination. About 86% (840/972) of the mothers used drugs for chemoprophylaxis. Thirteen (1.3%) mothers used chemoprophylaxis alone (CP), 135 (13.9%) used anti-vector measures alone (AV) while 820 (84.4%) used chemoprophylaxis plus anti-vector (CPAV). Weekly dose of pyrimethamine [214 (25%)] and intermittent preventive treatment with sulphadoxine-pyrimethamine [598 (71.2%)] were the widely used chemoprophylactic drugs. The prevalence of patent parasitaemia at delivery was 7.7% (1/13), 12.1% (99/820) and 16.3% (22/135) among CP, CPAV and AV groups respectively. Geometric mean parasite densities among the respective groups were 7840/microl, 1228/microl and 8936/microl.

CONCLUSION

Window screens and insecticide sprays were widely used for malaria prevention while the use of ITN was very low among enrolled mothers. There is a need to pay concerted efforts to improve ITN usage rate in Nigeria.

Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria

Background

Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine.

Methods

Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers ("mother trainers") in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. "Mother trainers" disseminated the educational messages about malaria and the use of the guideline to their communities.

Results

Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4%) of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p < 0.005). Mothers considered the guideline to be explicit and useful. Mother trainers were also considered to be effective and acceptable.

Conclusion

The use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

Background

The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated.

Methods

A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs.

Results

Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported.

Conclusion

ACTs can be successfully integrated into the HMM strategy.

Haemorheological variables in Nigeria pulmonary tuberculosis patients undergoing therapy

Haemorheological changes in response to therapy have not been fully determined in pulmonary tuberculosis patients living in developing countries. This study was aimed at monitoring haemorheological parameters in newly diagnosed pulmonary tuberculosis patients undergoing therapy. Haemorheological parameters were studied in 40 tuberculosis patients (17 males and 23 females, mean age 33.4+/-1.4 years, range 23-45 years) undergoing treatment and 10 newly diagnosed patients (5 males and 5 females mean age 33.0+/-2.1 years) along with 50 apparently healthy controls age and sex matched. There were significantly lower packed cell volume (PCV), platelet count (PC), and total white blood cell count (p<0.0001). Whole blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and plasma fibrinogen (PF) were significantly higher in pulmonary tuberculosis patients than controls (p<0.0001). The packed cell volume was significantly increased by the 8th week of therapy (p<0.01), there was a significant reduction in the erythrocyte sedimentation rate from the 4th week of therapy (p<0.0001). There was no significant change in blood viscosity by the 4th week of therapy (p>0.05), while the plasma fibrinogen showed significant reduction from the 4th week of therapy till 8th week of therapy (p<0.01 and p<0.0001 respectively). We conclude that thrombocytopaenia, stasis and hyperfibrinogenemia may predispose African PTB patients to bleeding and thrombotic disorders. Haemorheological parameters may be useful indices in assessing response to therapy and drug compliance in pulmonary tuberculosis patients living in developing countries.

How well equipped are healthcare facilities to manage childhood malaria? The situation in selected local government areas in South Western Nigeria

Using a structured questionnaire, surveys were conducted in 55 of 123 primary and secondary healthcare facilities in 4 selected local government areas in Southwestern Nigeria. Heads of healthcare facilities (HCFs) surveyed include nurses (41.8%), medical officers (21.8%) and community extension workers (21.8%). Twenty five (45.5%) HCFs run special clinics for children. About one fifth (20.3%) of staff had received continuing education on management of malaria. Forty seven (85%) HCFs possessed and used national guidelines for management of malaria. Although 48.9% of HCFs had microscopes, fewer had microscope slides, lancets and Giemsa stain which are also required items for definitive diagnosis of malaria. Healthcare workers were not well informed on some aspects in the management of malaria. Selected healthcare workers from various categories attended a workshop where they were trained to correct inadequate knowledge, attitude and practice in the management of malaria. These workers were to train their colleagues on their return to their respective HCFs.

Pre-hospital treatment of febrile illness in children attending the General Outpatients Clinic, University College Hospital, Ibadan, Nigeria

Many childhood febrile illnesses are treated at home prior to presentation. This study gathered information on treatment practices of caregivers for febrile illnesses in an urban area. A Cross sectional survey of consenting guardians of 535 consecutive febrile children under 10 years presenting at General Outpatients' (GOP) Clinic. University College Hospital. Ibadan was carried out. Thick blood smears were examined for malaria parasite. The mean (SD) age of the febrile children was 3.2 (2.8) years. Nineteen (17.5%) children were brought within 24 hours of noticing fever. Malaria was presumed to be the diagnosis by 217 (40.6%) respondents: 247 (46.2%) did not know the cause of fever. Most. 469 (87.7%) respondents gave drugs bought from chemists/pharmacy shops before presentation at the GOP. Paracetamol 1380 (81.0%)] and chloroquine [171 (36.5%)] were the most commonly used drugs. Twenty-six (15.2%) respondents used chloroquine correctly. One hundred and ninety-nine of 476 children (41.8%) were smear positive and 88 of 191 (46.1%) children whose guardians presumed malaria had parasites. This study reiterates the fact that majority of childhood febrile illnesses are first treated at home. It underscores the need to empower caregivers by appropriate education on knowledge, attitude and practice of the management including home management of malaria.

Patient satisfaction with the services provided at a general outpatients' clinic, Ibadan, Oyo State, Nigeria

Patient-based assessments of medical care are increasingly being used to measure the quality of health care. A variety of methods - qualitative and quantitative - are available. However, patient satisfaction surveys are frequently used. Triangulation of methods increases both the validity and reliability of data. This study assessed patients' perception of care provided at an outpatient clinic using triangulation of methods. No evaluation of care provided at this clinic has been carried out since established. Four hundred and seven adult patients selected by systematic sampling technique were interviewed, 10 focus group discussion sessions (FGD) were held and observations were made at the record clerks' desk, nurses' desk and waiting hall. Also, 35 consultations were observed. Generally, all methods revealed high level of satisfaction with the different aspects of care assessed. However, assessment of satisfaction using survey method concealed a variety of negative experiences reported at FGD and observation. These discrepancies were related to satisfaction with the organization of the clinic, attitude of record clerks' and consultation process. The study provided valuable information to assist in improving the quality of care at the clinic; specifically, the long waiting time, attitude of the record clerks, the dearth of basic amenities, deficient patient-doctor communication skills and health promotion services.

Mobilization for cervical cancer screening: lessons from a poor-urban Yoruba community in Nigeria

Cervical cancer is a major public health problem worldwide and it remains one of the commonest malignancies in Nigeria. Screening remains the most effective tool for the detection of pre-invasive stages of cervical cancer, giving the opportunity for prompt and effective treatment before the emergence of invasive disease. In Nigeria, as in most developing countries, the concept of screening for cancer and its pre-emptive treatment is underdeveloped. The fact that the facilities and logistics for cervical cancer screening are generally located in the hospital setting, a place where one goes when ill, according to local beliefs, makes acceptance more difficult. That Nigeria urgently needs to set up or develop cervical screening programmes that will reach women outside the hospital setting in a culturally acceptable milieu is not in doubt. A community cervical screening survey for the prevalence of cervical intraepithelial neoplasia and HPV infection was initiated in Idikan, a poor-urban inner core area of Ibadan. The challenges and experiences encountered in the execution of the project which could serve as useful knowledge to those undertaking similar exercises, requiring mass mobilization for cancer screening of an uninformed group, are highlighted. Our experience in the course of this study is important as it brought out the probable influences of community dynamics and social organization in illness decisions and prescriptions for health operative in this particular population group. Cervical cancer screening programmes should therefore make provisions to accommodate the occasional outcomes as we had encountered. In addition, screening programmes in developing societies would require sensitive designs that should address the cultural attitudes, personal conflicts, expectations of treatment and overall context of preventive care.

Prevalence of papillomavirus infection in women in Ibadan, Nigeria: a population-based study

To investigate the prevalence of and the risk factors for cervical infection with human papillomavirus (HPV) in an inner-city area of Ibadan, Nigeria, we interviewed and obtained a sample of cervical cells from 932 sexually active women aged 15 years or older. A total of 32 different HPV types were identified with an HPV prevalence of 26.3% overall and 24.8% among women without cervical lesions; or age-standardised to the world standard population of 28.3 and 27.3%, respectively. High-risk HPV types predominated, most notably HPV 16, 31, 35 and 58. In all, 33.5% of infections involved more than one HPV type. Unlike most populations studied so far, HPV prevalence was high not only among young women, but also in middle and old age. Single women (odds ratio, OR=2.1; 95% confidence interval, CI=1.1–3.9) and illiterate women (OR=1.7; 95%CI=1.1–2.5) showed increased HPV positivity. Associations were also found with anti-Herpes simplex-2 antibodies (OR=1.6; 95% CI: 1.1–2.1) and with the husband's extramarital relationships (OR=1.6: 95% CI: 1.0–2.6). High prevalence of HPV in all age groups may be a distinctive feature of populations where HPV transmission continues into middle age and cervical cancer incidence is very high.

Breast and cervical cancer screening activities among family physicians in Nigeria

Breast and cervical cancers are the two commonest malignancies among Nigerian women; where they constitute about 50% of female cancers. A total of 63 out of 82 family physicians from 4 out of the 6 health zones in Nigeria and the Federal Capital Territory, Abuja, Nigeria completed a self-administered questionnaire to determine their knowledge and screening practices for breast and cervical cancers. Forty nine percent (49%) of family physicians perceived cancer as one of the serious health problem facing women in Nigeria. Although 93.7% of responding physicians have heard of breast cancer screening facilities and 96.8% of cervical screening facilities, only 74.6% and 55.6% of these respondents offered screening services for breast and cervical cancers respectively. Breast examination was carried out monthly by 48.9% of the physicians on their regular patients. A comprehensive programme of continuing medical education and training in view of setting up facilities and offering service are recommended for family physicians. These stand to bridge the gap between the knowledge and the practice of breast and cervical cancer screening activities. The umbrella Association for Family Physicians and other regulating bodies should facilitate access to screening facilities and initiate training of willing physicians with a view to setting up services.

Post operative pain therapy: a survey of prescribing patterns and adequacy of analgesia in Ibadan, Nigeria

OBJECTIVE

To establish prescribing patterns for post operative pain therapy, it's adequacy, as well as patients' satisfaction with the prescriptions.

DESIGN

A survey of doctors' prescriptions for post operative pain therapy over a six month period.

SETTING

The University College Hospital Ibadan, Nigeria, the oldest teaching hospital in the country.

SUBJECTS

All consecutive adult elective general surgical patients operated on over a six month period, who were on admission for at least 72 hours after surgery. Patients with prolonged post operative unconsciousness or those unwilling to answer the questionnaire were excluded.

INTERVENTION

The anaesthetic charts, recovery room and treatment sheet were reviewed to complete a structured, pretested and precoded questionnaire. Two other questionnaires were administered to patients at 24 and 48 hours post operatively to review the effect of the analgesic prescribed.

RESULTS

149 patients met the inclusion criteria. Moderate to unbearable pain was reported in 68.7% of the patients at 24 hours and 51.7% of patients by 48 hours. Post operative analgesics were to be given via only the intramuscular route in all cases. There was a limited range of drugs to choose from; pethidine, pentazocine and dipyrone were the only drugs available. Pethidine was prescribed four hourly in 2.7%, six hourly in 46.9% and eight hourly in 25.9%, of the cases. Eighty five percent of the patients who were given dipyrone complained of moderate to unbearable pain post operatively. Inadequate doses of analgesics were generally given. Despite the high incidence of pain, 63.9% of patients still reported that they were very satisfied with their pain relief.

CONCLUSION

Prescription patterns for post operative pain relief have not changed to include many of the new methods presently available. Only one route of administration is still used for a limited range of opioid and non-opioid drugs. Patients still experience a high incidence of moderate to unbearable pain in the post operative period. This can be improved by prescribing drugs at shorter intervals to reflect their pharmacokinetics and using newer techniques of drug administration.

Socio-demographic characteristics and sexual behaviour of adolescents attending the STC, UCH, Ibadan: a 5 year review

As a continuation of the on-going efforts to prevent and control the spread of sexually transmitted diseases (STDs) and the Acquired Immunodeficiency Syndrome (AIDS) in adolescents, this retrospective clinic-based study identifies the socio- demographic characteristics, describes the sexual practices, identifies the common STDs, including drug utilization patterns in this risk group at the special treatment clinic of the University College Hospital, Ibadan. Results reveal that adolescents constituted between 3.3% and 4.8% of the total number of patients seen each year. The characteristics of the subjects were as follows: 54 (38.3%) were aged 19 years, 133 (94.3%) were single, 79 (53.2%) were females and 103 (73.0%) were students. As regards sexual behaviour, 22 (15.71%) denied previous history of sexual intercourse. Vaginal intercourse was reported in all the sexually active youth, 2(1.71%) reported oral sex, while 10 (8.41%) admitted that they had multiple sexual partners. Gonorrhoea was diagnosed in 23 (21.51%) of sexually active youths. Among those who had used drugs before presentation ampicillin was the common drug used for treatment by 14 (26.4%). The importance of encouraging adolescents to present at STD clinics is highlighted. Health workers need to have a sympathetic attitude and assure them of confidentiality. The need for more community-based education is shown, including the importance of proper and complete documentation of hospital records.

Evaluation of the nutritional status of first year school children in Ibadan, Southwest Nigeria

Height for age, weight for age, and weight for height as indices of nutritional status were evaluated in 1309 pupils from different socioeconomic classes in Ibadan, Nigeria. The data obtained were compared with United States National Centre for Health Statistics (NCHS) reference population. When all the pupils studies were considered together 46.1%, 44.3% and 12.7 percent of the pupils were underweight, stunted and wasted, respectively. Both stunting and wasting were observed in 7.2% of the overall population. Only 0.6% were overweight. Generally, the proportion of stunting, underweight, wasting and both stunting and wasting increased as socioeconomic status declined, but the prevalence of overweight was higher in the 2 upper socioeconomic status schools. When all pupils were considered based on sex and irrespective of school types, significantly more male (49.5%) than female (37.4%) pupils suffered from stunting (P < 0.0001), wasting (13.8% versus 11.1% P < 0.01) and underweight (54.3% versus 35.5%: P < 0.0001). More females were overweight than males though this did not reach statistical levels (P > 0.05.) The prevalence of malnutrition in this study was higher that of previous studies in this environment, which may be a reflection of the deteriorating economic situation of Nigeria.

Knowledge and attitude of general outpatient attendants in Nigeria to cervical cancer

OBJECTIVES

This study sets out to determine: a. How much women in low socio-economic settings know about cancer and cervical cancer. b. Their source of information. c. Their general attitude to cervical cancer.

DESIGN

A cross sectional study.

SETTING

General outpatient (GOP) department of a tertiary hospital in Ibadan, Nigeria.

SUBJECTS

254 randomly selected women aged 20 to 65 years attending or visiting the GOP department in a University Teaching Hospital were studied.

MAIN OUTCOME MEASURES

Knowledge about cancer and cervical cancer as well as source of information.

RESULTS

The response rate was 100%. Of the respondents, 90% had heard of cancer at one time or the other while only 15% had heard of cervical cancer. The media (38%) and peers (36%) were the major sources of information on cancer. Fifty five percent, 53% and 61% had no knowledge while 40% and 23% had poor to moderate overall knowledge of cervical cancer.

CONCLUSION

Knowledge about cervical cancer is poor in these women, unlike findings in developed countries. There is need to educate our women on the early warning signs of cervical cancer as failure to recognise the early symptoms and signs contribute to the late presentation common in Nigeria.

The use of mail reminders in STD contact tracing in Ibadan, Nigeria

Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide, and different strategies have been introduced into it in recent years to improve its effectiveness. Of all these strategy components, index patient counselling and co-operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first two years of its usage. It demonstrates that, like the other components of the contact tracing strategies, it is not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. The intensification of efforts towards encouraging the index patient in contact tracing must therefore be ever more strongly emphasised as the top priority in STD control in Nigeria and similar developing countries for the success of this strategy.

Contact tracing in the control of STD in Ibadan, Nigeria

Contact tracing carried out at this clinic was analysed as part of measures for control of sexually transmitted disease (STD). Results showed that 50% of 156 contacts could not be traced at all for various reasons, and that 47% of the contacts were brought in through persuasion by index patients who had been counselled at the clinic. Only four contacts were traced, and two of these attended the clinic. Index patient cooperation is thus identified as the most important factor in the success of contact tracing, because of the high level of illiteracy and poor communications facilities in Nigeria, compared with industrialised countries.