COVID-19: an opportunity for African governments to rethink social welfare benefits and protection

The emergence of COVID-19 in December 2019 has highlighted several lessons about Public health emergencies. One important lesson is on the role of social welfare benefits and protection in the overall management of public health emergencies. The absence of a functional and digitalized social welfare system in Africa may render ineffective public health measures to mitigate the spread of COVID-19. The social determinant of disease illustrates the nexus between poverty and health outcomes. Therefore, COVID-19 is an opportunity for African governments to rethink their stance on social welfare benefits and protection; and adopt mechanisms that protect the most vulnerable

Factors affecting utilization of antenatal care services and institutional delivery at Koghum in Jos South, Plateau State, Nigeria

Access to antenatal care services promotes safe motherhood and delivery. This study identified factors influencing the utilization of antenatal care services and health facility-based delivery. A cross sectional survey was conducted. Households were enumerated, and a systematic sampling method was deployed. A sample size of 200 was used. Of the 200 HHs, 198 women were interviewed using pretested semi-structured questionnaires. Data was collected on socio-demographics, attendance at the antenatal clinic (ANC), institutional delivery, and reasons for non-utilisation of ANC services. Data analysis was conducted using Epi Info version 3.5.3. The median age of respondents was 29 years (range: 17 - 55). Overall, 192 (97%) women had at least one ANC visit, 116 (58.6%) had ≥ 4 ANC visits and 93 (47.9%) commenced ANC in the second trimester in the last delivery. One hundred and twenty-five (63.1%) had their last delivery at home by a traditional birth attendant (TBA). The independent risk factors for utilization of ANC were partners' consent (aOR 11.5; 95% CI 1.6-82.3) and knowledge on the importance of ANC (aOR 7.4; 95% CI 1.4-38.6). Pregnant women in a polygamous union were less likely to use to ANC (aOR 0.1; 95% CI 0.0 - 0.4). Being a woman with a lower educational status was associated withassisted home delivery (aOR0.3; 95% CI 0.1-0.7). Most women utilized ANC services at least once. Community sensitization on the benefits of ANC and institutional delivery should be targeted at women in polygamous unions, with low educational level and without partner's consent for ANC

Snakebites in a Nigerian children population: A 5-year review

Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes.Objectives: This study was carried out to review the demographics, risk factors, interventions,outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database.Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5­year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi­square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952).Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health­seeking behavior and emergency interventions for snakebite victims

Prostate cancer detected by screening in a semi urban community in Southeast Nigeria: Correlations and associations between anthropometric measurements and prostate-specific antigen

Context: Prostate cancer (PCa) is frequently diagnosed at advanced stages in Nigeria. Aims: To determine the screen detected PCa prevalence in a suburban community and explore any relationships between prostate-specific antigen (PSA) and anthropometric measurements. Settings and Design: Nsukka is a town and local government area (LGA) in Southeast Nigeria in Enugu State. Towns that share a common border with Nsukka are Edem Ani, Alor-uno, Opi, Orba, and Ede-Oballa. Nsukka LGA has an area of 1810 km2 and a population of 309,633 at the 2006 census. All consecutive responders who met the inclusion criteria were recruited. Subjects and Methods: A screening outreach was conducted in one location in Nsukka. PSA testing and digital rectal examinations were performed. Height and weight were measured and body mass index (BMI) was calculated. Statistical Analysis Used: Results were subjected to statistical analysis using SPSS 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Categorical data were analyzed using the Chi-square test, with significance level set at P< 0.05. Pearson's correlation was conducted for interval data (P < 0.05). Results: One-hundred and sixty men met the inclusion criteria and were screened. Age range was 40­81 years; PSA range was 1.20­33.9 ng/ml. Digital rectal examinations (DREs) was abnormal in 17 men. Median BMI was 27.49. A Pearson's correlation coefficient showed a significant correlation between age and PSA, r = 0.127; P ≤ 0.05, and DRE findings and PSA, r = 0.178; P ≤ 0.05. There was no significant correlation between height and PSA, r = −0.99; P = 0.211; weight and PSA, r = −0. 81 P = 0.308; and BMI and PSA, r = −0.066; P = 0.407. 8/21 men consented to prostate biopsy with three positive, giving a screen detected PCa prevalence of 1.875%. Conclusions: Screen detected PCa prevalence in high this population and efforts to improve early detection may be of value in improving treatment outcomes

What factors influence the average length of stay among stroke patients in a Nigerian tertiary hospital?

Introduction: Increased emphasis is being laid on ensuring that health resources are efficiently utilized, especially in resource-constrained settings such as in Nigeria. One of the main indices of how efficiently a health institution is being run is Length of Stay (LOS), which is likely to be higher in chronic diseases such as stroke and diabetes. Stroke is a chronic disease that is currently on the rise in Low and Middle income countries (LMICs) who are also characterized by constraint of health resources. This study seeks to determine the LOS of stroke patients as well as factors that affect it.Methods: A retrospective analysis of health records of stroke victims admitted into the medical wards of the University College Hospital, Ibadan between January 2012 and December 2014 was conducted. Data on sociodemographic information, comorbidities and risk factors were extracted while LOS was calculated by counting the number of days the patient was admitted. Analysis was carried to using SPSS.Results: A total of 143 records were used in the final analysis with 53.1% of them being males and having a mean age of 61.5 ± 14.2 years. More than half (53.8%) of the cases were ischemic strokes. The average length of stay was 13.7 ± 8.9 days while bivariate analysis showed that a greater proportion of cases who consumed alcohol, had diabetes and hypertension had LOS of over 7 days than those who did not. However, these differences in proportions were not statistically significant (0.310<p<0.883).Conclusion: LOS of stroke patients in Nigeria was shown to be prolonged especially when compared to similar settings in West Africa. The high prevalence of some of the risk factors of stroke such as diabetes mellitus indicates that policy and advocacy to drive changes in lifestyle are necessary to reduce the incidence of stroke and its consequent burden on health systems

The prevalence liver function and immunologic status of children with HIV and Hepatitis B virus coinfection in Enugu, Nigeria

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection; predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication; hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu; determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital; Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6; P = 0.56). After the initiation of HAART; 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children = 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco- infected; (P = 0.67). However; in children = 5 years; it was 25% and 15 % respectively (P =0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment; and co-infection is associated with impaired immunity and probably liver enzyme derangement

Prevalence and risk factors for hepatitis c and human immunodeficiency virus co-infection among children in Enugu, Nigeria

Background: Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), are major public health challenges in the developing world especially sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of Hepatitis C virus infection among children infected with HIV. Methods: This was a cross-sectional study conducted at the Paediatric HIV Clinic, UNTH, Enugu between July and December 2009. Antibodies to HCV were analyzed by newer generation rapid chromatographic immunoassay method using the Chromatest one step HCV test kit. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 15 statistical software. The chi squared test was used to test for significant association of categorical variables. A p-value of <0.05 was accepted as significant. Results: One hundred and eighteen children HIV-infected children, aged between eighteen months to fifteen years were included in the data analysis. Eight of the HIV infected subjects were positive for HCV, giving an HIV-HCV co-infection prevalence of 6.8%. Co-infection was more prevalent among males and in those in age group 11-15 years. Blood transfusion, irrespective of frequency (p<0.015), and injections for immunization (p<0.049) were the significant risk factors noted Conclusion: There is need for strengthening of existing preventive strategies against HCV and HIV infections such as screening of donor blood and safe injection practices in our locality

Prevalence pattern and determinants of disclosure of HIV status in an anti retroviral therapy clinic in the Niger delta region of Nigeria

Background: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. Materials and Methods: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. Results: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7,95% CI 1.2-132.7)and being currently married (OR-8.8,95% CI 2.1-36.8). Conclusion: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners

Assessment of Mild Cognitive Impairment with Mini Mental State Examination among Adults in Southeast Nigeria

Background: Mild cognitive impairment is a recently described neuropsychiatric entity with the possibility of evolving into overt dementia. It has been found to respond to therapeutic intervention; thus halting or significantly retarding the progression to dementia. Resource-poor countries like Nigeria can hardly afford to provide optimal care for dementia patients. Knowledge about mild cognitive impairment in Nigeria is limited. An appreciation of the probable burden may help stimulate and galvanize appropriate public health policies in response. Aim: This cross-sectional; descriptive study sought to determine the frequency of subclinical mental state abnormalities in a cohort of apparently normal adult Nigerians. Subjects and Methods: One hundred and thirty-five apparently normal adult Nigerians of both sexes seen at the University of Nigeria Teaching Hospital; Enugu; were interviewed. The Mini Mental State Examination (MMSE) of Folstein; Folstein; and McHugh was used to assess cognitive function in each subject at a single instance. The results obtained were analyzed using SPSS version 11.3 (Chicago; IL). Consent was obtained from each person and approval obtained from the hospital's ethics review board. Results: A cut-off score of ?17 was obtained for normal cognitive function in this population using the MMSE. Minimum score obtained was 12; while the maximum score was 30. A mean (2SD) of 24.84 (7.94) was obtained on analysis of the overall MMSE scores of the 135 individuals. Cognitive impairment was identified in 5.93(8/135) of the subjects examined. These persons thus represent otherwise normal functional individuals with unrecognized mild cognitive impairment who may be at risk of developing overt dementia in future. Conclusion: The concept of mild cognitive impairment needs further large-scale studies in Nigerians with possible multi-centre participation to fully elucidate the scope of the problem. Strategies for the appropriate management of dementia need to be strengthened