Strengthening Routine Data Reporting in Private Hospitals in Lagos, Nigeria

The availability of routine health information is critical for effective health planning, especially in resource-limited countries. Nigeria adopted the web-based District Health Information System [DHIS], to harmonize the collection, analysis, and storage of data for informed decision-making. However, only 44% of all private hospitals in Lagos state reported to the DHIS, despite constituting 90% of all health facilities in the state. To bridge this gap, this study implemented targeted interventions. This paper describes [i] the implemented interventions, [ii] the effects of the interventions on data reporting on DHIS during the intervention period, and [iii] the evaluation of data reporting on DHIS after the intervention period in select private hospitals in Lagos state. A five-pronged intervention was implemented in 55 private hospitals [intervention hospitals], which entailed stakeholder engagement, on-the-job training, in-facility mentoring, and the provision of data tools and job aids, to improve data reporting on DHIS from 2014 to 2017. A controlled before and after study design was employed to assess the effectiveness of implemented interventions. A comparable cohort of 55 non-intervention private hospitals was selected and data were extracted from both groups. Data analysis was conducted using paired and independent T-tests to assess the effect and measure the difference between both groups of hospitals respectively. An average increase of 65.28% [p < 0.01] in reporting rate and 50.31% [p < 0.01] in the timeliness of reporting on DHIS was seen among intervention hospitals. Similarly, the difference between intervention and non-intervention hospitals post-intervention was significantly different for both data reporting [mean difference= -22.38, p < 0.01] and timeliness [mean difference= -18.81, p < 0.01]. respectively. Furthermore, a sustained improvement in data reporting and timeliness of reporting on DHIS was observed among intervention hospitals 24 months after interventions. Thus, implementing targeted interventions can strengthen routine data reporting for better performance and informed decision-making.

Group B Streptococcus vaginal colonization in pregnant women living with HIV infection: prevalence and antibiotic susceptibility at HIV referral centers in Lagos, Nigeria

OBJECTIVES

Group B Streptococcus (GBS) colonization of the genital tract is often asymptomatic yet associated with increased risks of maternal and neonatal morbidity especially amongst women living with HIV infection. The objectives of this study were to determine the prevalence of GBS colonization of the genital tract in women living with HIV infection and antibiotic susceptibility of GBS in the genital tract.

METHOD

This cross-sectional study recruited 244 pregnant women (122 women living with HIV infection and 122 HIV-uninfected women) between 35 and 37 weeks of gestation. GBS colonization was determined by collecting lower vaginal and anal swabs at recruitment. Swabs were cultured in Todd Hewitt's broth and confirmed by Christie, Atkins, and Munch-Peterson (CAMP) test. Most recent CD4 count and viral load estimates were retrieved from the women's records. Maternal and neonatal outcomes and antibiotic susceptibility were assessed. Statistical analysis was performed at 95% confidence interval at a statistical significance of p < .005.

RESULTS

The prevalence of GBS colonization of the genital tract in all participants was 3.3%; GBS was isolated in 4 (3.3%) of 122 pregnant women living with HIV. No woman with a GBS-colonized genital tract developed puerperal sepsis and no neonatal infection occurred in neonates born to GBS-positive women, irrespective of HIV infection status. In women living with HIV, GBS isolate was resistant to Ampicillin (100%), Ceftriaxone (100%), Vancomycin (100%), yet partially sensitive to Ciprofloxacin (50%).

CONCLUSION

Pregnant women living with HIV do not have an increased risk of genital GBS colonization. Vaginal GBS colonization was not associated with an adverse perinatal outcome. Antibiotic use for GBS colonization should be based on sensitivity pattern and not empiric.

Haemogram and Serum Biochemical Values of Four Indigenous Species of Monkeys in South West Nigeria

Haematological and serum biochemical values are useful guides and biomarkers in health and diseases for reaching a diagnosis, estimating disease prognosis and monitoring treatment progress, in mammals. Reference ranges for some parameters differ among species of mammals and between sexes within a species. There is dearth of information on standard reference value for blood parameters for Nigerian indigenous monkeys. Whole blood and serum samples obtained from 50 apparently healthy adult monkeys in both captivity and from the wild in southwest Nigeria were subjected to haematology and serum biochemistry to obtain preliminary reference values for haematological and serum biochemical analytes for Cercocebus sebaeus (Green monkey), Cercopithecus mona (Mona monkey), Erythrocebus patas (Patas monkey) and Papio anubis (Anubis baboon). Numerical data were summarized as mean and standard deviation and subjected to statistical analysis; Student t test and analysis of variance, to compare values of blood parameters obtained between species and gender. A p-value less than 0.05 was considered significant. The hematocrit of male animals were significantly higher than that of females (P=0.01) in all the 4 species studied but there was no significant difference in other blood parameters such as total white blood cell and the differential counts, platelet count, serum aspartate transferase, alanine transferase, alkaline phosphatase, total plasma protein, albumin, and globulin concentrations between the sexes. Generally, there was no significant difference between total white blood cell and the differential counts, hematocrit, red cell count, haemoglobin concentration, platelet count, serum aspartate transferase, alanine transferase, alkaline phosphatase, total plasma protein, albumin, and globulin concentrations among the monkey species.

Evaluating the quality of antihypertensive drugs in Lagos State, Nigeria

BACKGROUND

As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables.

METHODS

We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria. We assessed drug quality based on (1) the level of active pharmaceutical ingredients (APIs), which identified falsely labeled drug samples; and (2) the amount of impurities, which revealed substandard drug samples in accordance with the international pharmacopoeia guidelines. Good-quality drugs met specifications for both API and impurity.

RESULTS

Of the 102 drug samples collected, 30 (29.3%) were falsely labeled, 76 (74.5%) were substandard,78 (76.5%) were of poor quality and 24 (23.5%) were of good quality.Among the falsely labeled drugs, 2 samples met standards set for purity while 28 did not. Among the 76 substandard drug samples, 28 were also falsely labeled. Of the falsely labeled drugs, 17 (56.7%) came from LGAs with low socioeconomic status, and 40 (52.6%) of the substandard drug samples came from LGAs with high socioeconomic status. Most of the good-quality drug samples, 14 (58.3%), were from LGAs with low socioeconomic status. Eighteen (60%) of the falsely labeled samples, 37 (48.7%) of the substandard samples, and 15 (62.5%) of the good-quality drug samples were from manufacturers based in Asia. The average price was 375.67 Nigerian naira (NGN) for falsely labeled drugs, 383.33 NGN for substandard drugs, and 375.67 NGN for good-quality drugs. The prevalence of falsely labeled and substandard drug samples did not differ by LGA-level socioeconomic status (P = .39) or region of manufacturer (P = .24); however, there was a trend for a difference by price (P = .06).

CONCLUSION

The prevalence of falsely labeled and substandard drug samples was high in Lagos. Treatment of noncommunicable diseases in this setting will require efforts to monitor and assure drug quality.