Quality of life of people living with HIV and AIDS attending Irrua Specialist Teaching Hospital, Edo State, Nigeria

Background: With the use of highly active antiretroviral therapy (HAART), life expectancy of HIV-infected persons had increased and the disease is now managed as a chronic one, but the quality of life (QOL) of the patients is now a concern. Social support enhances QOL of patients with chronic illnesses. However, no study has been done to determine the QOL of people living with HIV and AIDS (PLWHA) in our environment. This study therefore assessed the QOL of PLWHA attending antiretroviral therapy (ART) clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State of Nigeria Methodology: A descriptive cross-sectional study design was used. Two hundred and thirty PLWHA attending the ART clinic of ISTH, Irrua, Edo State, Nigeria, were systematically selected for the study. A structured questionnaire was interviewer-administered to collect data on sociodemographic and clinical profiles of selected participants, and the WHOQOL-HIV BREF questionnaire was used to collect data the QOL of each participant. Data were analyzed with IBM SPSS version 20.0. Results: The overall mean QOL score for the participants was 89.13±1.18 (95% CI=87.95-90.31). The scores in three of the six life domains in the WHOQOL-HIV BREF instrument were similar and high; spirituality/ religion/personal beliefs (16.33±0.36), physical health (15.83±0.28) and psychological health (15.07±0.24). Lower mean QOL scores were observed in the social relationships (13.49±0.28) and environment (13.45±0.20) domains. Clinical HIV stage, marital status, educational status and gender were significantly associated with mean QOL scores in bivariate analysis while only HIV stage 1 and 2 were significantly associated with good QOL in multivariate logistic regression analysis. Conclusion: It is pertinent that PLWHA are kept in early stages of HIV disease through combination of efforts such as prompt enrolment, commencement and monitoring compliance of HAART, and treatment of opportunistic infections, as well as public health measures including education, de-stigmatization, early diagnosis by extensive accessible screening/testing of at-risk population, social supports and economic empowerment, psychotherapy and social integration of affected individuals especially in a functional home.

Compliance of patients to DOTS tuberculosis treatment strategy in a South-East Nigeria Teaching Hospital

Introduction: Tuberculosis ranks the second highest cause of adult mortality after HIV in the world. The Directly Observed Treatment Short course (DOTS) strategy is aimed at following up on patients' adherence to treatment regimen. Objectives: To assess the level of compliance of patients to the DOTS strategy. Materials and Methods: A retrospective study of patients seen at the University of Nigeria Teaching Hospital from January 2013 to April 2015. Relevant information was collected from patients' folders. Data analysis was with the SPSS and results represented in tables. Results: 111 (50%) patients were compliant with their DOTS treatment plan while 107 (41.3%) were non-compliant. Ninety-two patients (41.4%) were successfully treated and discharged home, 7 patients (3.2%) referred to other centers. The proportion of patients regarding their marital status, occupation, educational level and address that was compliant to the DOTS TB reflected varied patterns. Conclusion/ Recommendations: The study reflected poor to average compliance to DOTS. There is a need for creation of more DOTS centers; regular surveys and updates on DOTS TB strategy should be the norm rather than the exception

COVID 19: determinants and barriers to infection prevention and control practice among residents in Bonny Island, Rivers State

Background: Coronavirus disease 2019 (COVID-19) which was declared a pandemic and described as a disease of public health emergency caused worldwide disruption of business activities, education, tourism and health challenges including death. Prevention is a viable strategy to contain the pandemic, including the use of vaccines. However, evidence abound which reveals that majority of people do not comply with proposed health and safety measures recommended by World Health Organization (WHO) and their respective country health authorities. This study identified socio-demographic and other variables which may influence compliance to practice of infection prevention and control (IPC) measures. Method: This is a descriptive cross-sectional study conducted at zonal hospital Bonny. All eligible respondents who visited the hospital for Medicare were included into the study until sample size was achieved. Pretested interviewer administered questionnaire was used to elicit information from respondents. Multinomial regression analysis was used to analyze data with statistical significance set at 0.05. Ethical clearance, permission for the study and informed consent were derived from relevant authorities and respondents respectively. Result: Compliance to good IPC measures was 73.9%. There was statistically significant compliance to good practice among public servants, respondents aged 31-40 years and females. Conclusion: Good IPC measures was high among respondents, COVID 19 vaccine acceptance was poor, while factors such as inability to procure personal protective equipment and non-availability of water were responsible for poor compliance

Experiência do Comité Nacional de Bioética para a Saúdede Moçambique após Covid-19 / Experience of the National Bioethics Committee for Health of Mozambique after Covid-19

O Comité Nacional de Bioética para a Saúde em Moçambique (CNBS) tem como missão principal fazer a revisão, para aprovação ética, de todas as propostas de pesquisa em saúde, que envolvam seres humanos, realizadas em todo o território nacional, submetidas pelos investigadores, sejam estes nacionais ou estrangeiros. É apresentado, de forma sucinta, os objectivos do Comité Nacional de Bioética para a Saúde de Moçambique e da sua redede Comités Institucionais de Bioética paraa Saúde (CIBS ́s) e o modo do seu funcionamento para garantir o cumprimento dos procedimentos éticos na investigação para protecção do agente de pesquisa e do próprio investigador, bem como desenvolver a formação em bioética para a pesquisa, melhorando e agilizando a comunicação entre os investigadores, promotores ou financiadores destas pesquisas. Com o aparecimento da pandemia deCovid-19,e havendo necessidade destes comités, mais do que nunca, manterem-se em funcionamento, introduziram-se algumas alterações à sua actividade, nomeadamente a passagem para um regime de teletrabalho, a obrigatoriedade dos protocolos de estudo conterem um capítulo (se pertinente) sobre comoenfrentaria no terreno, a situação da Covid-19 e a avaliação expedita, entre outras. Conclui-se com o relato dos resultados desta experiência vivida num período de um ano (Janeiro a Dezembro de 2020).

The main mission of the National Bioethics Committee for Health in Mozambique (CNBS) is to review for ethical approval all health research proposals involving human subjects conducted throughout the national territory submitted by national or foreign researchers. The objectives of the National Bioethics Committee for Health in Mozambique and its network of Institutional Bioethics Committees for Health (CIBS's) are briefly presented, as well as how they function to ensure compliance with ethicalprocedures in research for the protection of the research agent and the researcher himself, as well as to develop training in bioethics for research, improving and streamlining communication between researchers, promoters or funders of such research. Withthe appearance of the Covid-19 pandemic and the need for these Committees, more than ever, to remain functional, some changes were introduced to their activity, namely the change to a teleworking regime, the obligation for study protocols to contain a chapter (if relevant) on how they would deal with the Covid-19 situation in the field and the expedite evaluation, among others. We conclude with the report of the results of this experience lived in a period of one year (January to December 2020)

Spatial variation and level of compliance on COVID-19 prevention strategies in Amhara region, Ethiopia: observational survey

Background: The novel Coronavirus was first detected in Wuhan, China in December 2019. In Ethiopia, The COVID-19 pandemic was expanding geopgraphically overtime. Understanding the spatial variation of the pandemic and the level of compliances towards COVID-19 prevention strategies is important to guide focused prevention and control efforts. Aim: This study aimed to explore the level of compliance and spatial variation in COVID-19 prevention strategies in major cities and towns in the Amhara region, Ethiopia. Methods: A community based observational survey was conducted from June 25 to August 10, 2020, in 16 selected cities and towns of the Amhara region. The level of compliance with hand hygiene, physical distancing and mask utilization as per the WHO recommendations were observed from 6,002 individuals and 346 transport services. Getis-Ord Gi* statistics were used to identify hot spot areas with a low level of compliance with COVID19 preventive strategies. Spatial interpolation was performed to predict the level of compliance for un-sampled areas in the region. Results: The practice of hand hygiene, physical distancing and mask utilization were 12.0%, 13% and 26%, respectively. COVID-19 prevention strategies were found to be spacially non-random in Amhara region (Global Moran's I = 0.23, z-score = 9.5, P-value < 0.001). Poor (Hot Spot Areas) COVID-19 Prevention practices were spatially clustered at Northern Amhara (Metema, Gondar, and Woghemira town) and Western Amhara (Moarkos, Enjibara, And Bahir Dar town).Southern (Shewa Robit, and Kemissie Twon) and Eastern (Dessie, Kombolcha, Wolidiya, and Kobo) parts of the Amhara region were spatially clustered as cold spots (better practice) for COVID19 prevention strategies. With regards to the practice of COVID19 prevention strategies, practices were low in northern and northwestern parts of the region ( 5%), whereas this was found to be much higher in the southern part of the region (41%). Conclusion: The level of compliance with regards to hand hygiene, physical distancing and mask utilization exhibit spatial variation across the region. Continuous community-based education using different modalities are necessary to increase the practice of hand hygiene, physical distancing and mask utilization

Physicians' compliance with malaria treatment guidelines of under-five children in a secondary maternal and child care centre in Lagos State

Background: The global malaria agenda has the ultimate goal of eliminating malaria in all countries of the world by 2030 through universal access to malaria prevention, diagnosis and treatment. Presumptive treatment of malaria with Artemisinin Combination Therapy (ACT) has been associated with the development of resistance, therefore parasitological confirmation of all fevers is crucial in the context of eliminating malaria. This study assessed physicians' compliance with the national guidelines in the treatment of malaria among under-five (U-5) children and their prescription pattern in a Maternal and Child Care (MCC) centre in Lagos State. Methods: This was a descriptive cross-sectional study conducted as an exit interview among 427 mothers/caregivers of febrile U-5 children who were consecutively sampled.The data was collected using a pre-tested interviewer-administered questionnaire and a proforma. Epi-info version 7.2.1 was used to analyze the data and the level of significance was set as p<0.05. Results: Malaria Rapid Diagnostic Test (mRDT) was done for 75 17.6%) of the children and 37 (49.3%) was positive. Anti-malarial drugs were prescribed at consultation to 400 (93.7%) of the febrile children. Artemisinin Combination Therapy (ACT) was prescribed for 364 (91.0%) of the children. The most prescribed ACT was Artemether-Lumefantrine (AL) in 222 (60. 9%).Conclusion: The physician's compliance with malaria treatment guidelines for febrile illnesses in U-5 children was poor with regards to parasitological confirmation before treatment. However, the use of ACTs was adhered to in almost all cases. Regular training workshops are recommended for health workers to improve adherence to parasitological confirmation before treatment

Physicians' compliance with malaria treatment guidelines of under-five children in a secondary maternal and child care centre in Lagos State

Background: The global malaria agenda has the ultimate goal of eliminating malaria in all countries of the world by 2030 through universal access to malaria prevention, diagnosis and treatment. Presumptive treatment of malaria with Artemisinin Combination Therapy (ACT) has been associated with the development of resistance, therefore parasitological confirmation of all fevers is crucial in the context of eliminating malaria. This study assessed physicians' compliance with the national guidelines in the treatment of malaria among under-five (U-5) children and their prescription pattern in a Maternal and Child Care (MCC) centre in Lagos State. Methods: This was a descriptive cross-sectional study conducted as an exit interview among 427 mothers/caregivers of febrile U-5 children who were consecutively sampled.The data was collected using a pre-tested interviewer-administered questionnaire and a proforma. Epi-info version 7.2.1 was used to analyze the data and the level of significance was set as p<0.05. Results: Malaria Rapid Diagnostic Test (mRDT) was done for 75 17.6%) of the children and 37 (49.3%) was positive. Anti-malarial drugs were prescribed at consultation to 400 (93.7%) of the febrile children. Artemisinin Combination Therapy (ACT) was prescribed for 364 (91.0%) of the children. The most prescribed ACT was Artemether-Lumefantrine (AL) in 222 (60.9%). Conclusion: The physician's compliance with malaria treatment guidelines for febrile illnesses in U-5 children was poor with regards to parasitological confirmation before treatment. However, the use of ACTs was adhered to in almost all cases. Regular training workshops are recommended for health workers to improve adherence to parasitological confirmation before treatment

Compliance of Healthcare Providers with National Treatment Guidelines for HIV/AIDS

Background: Evidence had shown that low compliance with treatment guidelines by healthcare providers may result in incomplete care of patients thereby defeating the aim of HIV disease management and control. Objectives: This study was conducted to compare the compliance of a site ART treatment team with the National Guidelines' recommendation on criteria for treatment initiation and regimen change among HIV/AIDS experienced patients. Methods: In a retrospective observational double cohort study; the medical records of all adults HIV/AIDS positive and treatment experienced patients (N=267) whose ART regimen were either substituted or switched between January 2008 and June 2009 were evaluated for the fulfilment of criteria required before treatment initiation and change of therapy. Results: The level of compliance with guidelines' recomendations for therapy initiation ranged from 0% - 84.3% (mean= 31.4%; median = 23.2%; SD =21.5%) while compliance with guidelines' recommendations for regimen change ranged from 0% - 61.4% (mean= 31.4%; median = 3.8%; SD =21.5%). There was 100% and 89.2% compliance with 'what to start' and 'when to start' respectively. Conclusions: Majority of the patients were given appropriate ART regimen at the right time based on the guideline recommendations but compliance with guideline's recommendations for therapy change was poor. The extent of compliance with guideline's recommendations is critical to success of HIV/AIDS control programme

Compliance with diabetic retinopathy screening in a Nigerian tertiary hospital

There is little information on default rates and reasons for retinal screening in diabetes. We prospectively studied 179 type 2 diabetic patients referred for screening at a tertiary Nigerian medical centre. Defaulting occurred in 100 patients, i.e. over half (56%). Defaulting was associated with not having had a previous eye examination (p=0.027) and either a short (<1 year) or medium (6­10 year) duration of diabetes (p=0.001). Location of residence, level of education, diabetes treatment, age and gender did not correlate with screening compliance. We recommend that screening be carried out as soon as possible after diagnosis, which may improve future compliance

Compliance to HIV Treatment Monitoring Guidelines can Reduce Laboratory Costs

Background: Panel tests are a predetermined group of tests commonly requested together to provide a comprehensive and conclusive diagnosis; for example; liver function test (LFT). South African HIV antiretroviral treatment (ART) guidelines recommend individual tests for toxicity monitoring over panel tests. In 2008; the National Health Laboratory Services (NHLS) request form was redesigned to list individual tests instead of panel tests and removed the 'other tests' box option to facilitate efficient ART laboratory monitoring.Objectives: This study aimed to demonstrate changes in laboratory expenditure; for individual and panel tests; for ART toxicity monitoring.Method: NHLS Corporate Data Warehouse (CDW) data were extracted for HIV conditional grant accounts to assess ART toxicity monitoring laboratory expenditure between 2010/2011 and 2014/2015. Data were classified based on the tests requested; as either panel (LFT or urea and electrolytes) or individual (alanine transaminase or creatinine) tests.Results: Expenditure on panel tests reduced from R340 million in 2010/2011 to R140m by 2014/2015 (reduction of R204m) and individual test expenditure increased from R34m to R76m (twofold increase). A significant reduction in LFT panel expenditure was noted; reducing from R322m in 2010/2011 to R130m in 2014/2015 (60% reduction).Conclusion: Changes in toxicity monitoring guidelines and the re-engineering of the NHLS request form successfully reduced expenditure on panel tests relative to individual tests. The introduction of order entry systems could further reduce unnecessary laboratory expenditure

Medication Adherence and Risk Factors for Non-adherence among Patients taking Highly Active Antiretroviral Therapy

Background: ART is a life long treatment and its effectiveness depends critically both on the efficacy of the antiretroviral drugs against the virus, and achieving a very high level of adherence (> 95 %) to the medications. Adherence poses a special challenge and requires commitment from the patient and the health care provider.Objectives: The study evaluated medication adherence, and identified risk factors for non-adherence in HIV-infected ART patients.Methods: In a cross-sectional survey, medication adherence of 118 HIV-infected ART patients who received pretreatment and ongoing adherence counseling and education for 6 months was evaluated using a self-administered studyspecific 16-item questionnaire. Self-reported adherence was calculated as the mean of patients' adherence to the medication schedule and the number of prescribed doses of medications missed. Chi-square statistics was used to test the association of adherence with occupation and education at 95 % CI.Results: The mean age of participants was 33.9 (95 % CI, 29.6-38.2) years; and 82.2 % of participants were aged 26-45years; 60.2 % females, 80.5 % attained secondary education at the least; and 77.1 % were employed. All participants reported been counseled on the benefits of ART and medication adherence at ART initiation. On assessment of participants' knowledge of the benefits of ART and medication adherence, 92.2 % were very knowledgeable, 2.9 %reported wrongly that ART is a cure for HIV. The self-reported adherence to medication schedule was 68.9 %(range: 0 % - 100 %), of which 83 (70.3 %) reported > 75 % adherence; while adherence to prescribed doses of medications was 89.2 % (range: 20 % - 100 %), of which 100 (84.7 %) participants reported > 80 % adherence. Mean self-reported adherence (±SD) was 79.1 % ± 14.4 %. Employment status was associated with poor adherence (P < 0.05), unlike the educational status. The major reasons reported for non-adherence were busy at work or school (33.1 %), forgetfulness (15.5 %), fasting (12.0 %), and travelled away from home (10.6%). Conclusion: The self-reported adherence was relatively poor compared to the desired value of > 95%. Employment status was associated with poor adherence and this may be corroborated by the major reason reported for non-adherence (busy at work or school). Routine adherence monitoring and multiple adherence interventions in clinical practice are recommended

Socioeconomic Factors Associated with Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya: Descriptive Study Results

Background: Annual Mass Drug Administration (MDA) to at least 65 - 80of the population at risk is necessary for Lymphatic Filariasis (LF) elimination. In Kenya; MDA based on diethylcarbamazine and albendazole; using the community-directed treatment (ComDT) approach has been implemented thrice in the Kwale and Malindi districts. To identify the socioeconomic factors influencing compliance with MDA; a retrospective cross-sectional study was conducted in the two districts after the 2008 MDA. Materials and Methods: In Kwale; the Tsimba location was selected for high and Gadini for low coverage; while in Malindi; the Goshi location represented high and Gongoni; low coverage. Using systematic sampling; nine villages were selected from the four locations. Quantitative data was collected from 965 systematically selected household heads and analyzed using SPSS v. 15. For qualitative data; which was analyzed manually according to core themes of the study; 80 opinion leaders and 80 LF patients with clinical signs were purposively selected and interviewed; and 16 focus group discussions (FGDs) conducted with adult and youth male and female groups. Results: Christians were slightly more (49.1) in the high compliance areas compared to Muslims (34.3); while Muslims prevailed (40.6) in the low compliance areas compared to Christians (29). On the income level; 27from the low compared to 12.2from the high compliance areas had a main occupation; indicative of a higher income; and 95from the low compared to 78from high compliance areas owned land; also an indicator of higher economic status. Accurate knowledge of the cause of swollen limbs was higher (37) in the high compared to 25.8in the low compliance areas; and so was accurate knowledge about the cause of swollen genitals (26.8in high compared to 14in low). Risk perception was higher in the high compliance areas (52compared to 45) and access to MDA information seemed to have been better in the high compared to low compliance areas. Patients from the high compliance areas had a higher mean number of years with chronic disease (15.2 compared to 9.7). Conclusions: There is a need for more investment in reaching out to groups that are often missed during MDAs. Different strategies have to be devised to reach those in specific religious groupings and those in casual employment. This could include prolonging the duration of MDA to capture those who are out during the week seeking for casual and other forms of employment

Compliance with Infant Formula Feeding By HIV-Positive Women One Week after Delivery in Khayelitsha; South Africa

When mixed feeding occurs a few days following delivery; the risk of HIV transmission is likely high. The study aim was to assess infant feeding practices; one week following delivery of HIV-positive mothers who intended to formula feed their infants. A consecutive sample of 95 HIV-positive mother-infant pairs was recruited soon after delivery from a midwife obstetric unit in Khayelitsha. Face-to-face interviews were conducted one week after delivery at the clinic to determine the actual infant feeding practices. Sixty-four HIV-positive mother-infant pairs completed the study. The response rate was 67. The median interview day was day 8. Sixty-two mothers (97) (95 CI: 95 to 99) exclusively formula fed their infants. Fifty (78) (95 CI: 73 to 83) mothers gave their infants formula milk only. Two mothers breast-fed their babies. Twelve (19) gave their babies other fluids or food. Eleven gave water; glucose water or gripe water and one gave cereal or porridge. Breast engorgement occurred in 51 (80) mothers. Only five (8) mothers had received advice about breast engorgement from the facility health providers. Compliance with formula feeding of HIV-positive mothers one week following delivery is at an acceptable level. Levels of breast engorgement and lack of counselling on breast engorgement were high. Advice about non-pharmacological methods of managing breast engorgement must be given to women choosing to formula feed their babies. Mothers must be informed about the dangers of mixed feeding during the first week after delivery