Achieving the 6th MDG: An Evaluation Drug Treatment of Malaria in Selected PHC in Osun State.

Introduction: The burden of malaria in Nigeria and Africa is well documented. The current Nigeria anti-malaria drug policy has recommended artemisinin-based combination therapy (ACT) as the first-line drug treatment for uncomplicated malaria since 2005. It is now 8 years since the adoption of ACT and two years to the set time for the achievement of the MDGs. Objective: To assess the adherence of the PHC to the new policy on drug treatment for uncomplicated malaria. Methods: Using a pro-forma, relevant information about drug prescription of malaria cases between January 2008 and December 2009 was extracted from patients’ folders in the 3 comprehensive health centres being used by LAUTECH Teaching Hospital, Osogbo. Additional data were also collected through the use of in-depth interviews. Data were analyzed with Epi-Info software 3.4.2. Results: A total of 8881 episodes of malaria were analyzed of which male children (0-5years) constituted the highest number. The commonest prescribed anti-malaria was oral Chloroquine (21.6%) for the 3 CHC combined. However, for each CHC, CQ was the commonest drug prescribed for Ilie and Atelewo CHC (41.6% and 25.5% respectively), while for Akogun CHC alone, it was Artesunate + SP. Akogun CHC was found to have the highest prescribed pre-packaged ACT. Factors responsible for inappropriate prescription were non-availability and perceived patients' nonaffordability and unwillingness to buy drugs. Conclusion: Prescription of CQ and SP as mono-therapy continues to prevail in the CHC. There is urgent need for ensuring compliance to the current and acceptable treatment for malaria. Other means of sustaining availability of anti-malaria drugs should be considered.

Practices, Scope and Determinants of School Health Services in Osun State, Nigeria.

Introduction: A healthful school environment is that which embraces the health and safety of learners and other members of the school community. Undergoing pre-school medical examination (PSME) is not only necessary to screen for previously undiagnosed health conditions and subsequent recognition of those with special care but it is also imperative to have base-line health information about the pupils. This study seeks to elucidate the practices and determinants of school health services (SHS) in Osun state. Methodology: In the cross-sectional descriptive study, a total of 229 heads of schools (102 primary and 127 secondary) in Osun state were interviewed using a selfadministered questionnaire. Data were analyzed with SPSS version 16. Level of significance was set at p-value of 0.05. Results: All the respondents were aware of SHS with 114(50.7%) having good knowledge. Although up to 209 (91.3%) are aware of PSME and 188 (83.6) agreed that it was necessary, only 46 (20.1%) have their pupils undergo PSME. Most schools (76.8%) provide toilet facilities mainly of the pit type. Overall knowledge of SHS was good in 114 (50.7%) of the respondents. Medical services are provided through First Aid box. 221(96.5%) and School clinic 43(19.5%) most (92.7%) of which are free. Overall practice of SHS was good in 42 (18.7%) of the respondents. Respondents from secondary and private schools had better knowledge and practice of SHS. Conclusion: The practice of SHS is below expectation. There is a need to improve knowledge of heads of schools concerning SHS emphasizing the importance of SHS.

Treatment outcomes among human immunodeficiency virus and tuberculosis co-infected pregnant women in resource poor settings of South-Western Nigeria

The complex interactions between Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) infections may be magnified, in the presence of another potentially stressful condition like pregnancy. Though co-infection among pregnant women is rare, treatment outcomes may depend on accessibility to comprehensive treatment modalities. The objective of this study is to determine treatment outcomes among pregnant HIV and TB co-infected pregnant women in Lagos, South-western Nigeria. This retrospective, analytical study was carried out among ninety four (94) eligible pregnant women co-infected with HIV and TB at selected health-care facilities in Lagos state between January, 2008 and December, 2009. A standard checklist for data collection was used and analysis was carried out using the EPI info software. Mean age of respondents was 30.8 (±3.9) years. Sixteen (17.1%) TB cases were clinically diagnosed for tuberculosis. Among tuberculosis cases identified through sputum microscopy, 60(63.8%) were acid fast bacilli (AFB) positive and 21(22.3%) were identified in the first trimester. The mean percentage adherence to anti-retroviral drugs was 95.9% (±5.3). None of the participant smoked cigarette. Seventy three {73 (77.7%)} had contact with TB infected or suspected person in the last three months. Treatment outcome in mother showed that 74(78.7%) were cured, 8(8.5%) relapsed while 12 (12.8%) had treatment failures. Among the babies, 83(88.3%) were born alive. Women with both poor adherence (<90%) and with positive TB contact, but neither factor alone, were half-fold less likely to be cured compared with women with both good adherence (>95%) and no TB contact (OR=0.59, CI=0.45-0.95 and p=0.014). Cure rate was substantially lower in this study. This calls for extra strategies such as routine TB screening in antenatal clinics, strict adherence to national guidelines in the treatment of HIV/TB co-infections, focused antenatal care and comprehensive Prevention of Mother to Child Transmission (PMTCT) care and treatment

Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010; 14[2]:77-84)