How Do People Living With HIV (PLHIV) and AIDS Feel About the Quality of Care They Received Amid the COVID-19 Pandemic in Lagos, Nigeria?

Background: This study aimed to assess the perception of quality of care among people living with HIV (PLHIV) in Lagos, Nigeria, and identify factors influencing their perceptions. Methodology: The study was a descriptive cross-sectional survey conducted between December 2020 and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services were provided. Data were collected through pretested questionnaires and analyzed using Stata SE 12. Results: About 83% of the respondents had a good attitude toward their HIV medication, and 95.5% had a good perception of the quality of care they received. PLHIVs with higher education, skilled or professional occupations and higher monthly income had a significantly higher perception of quality of care compared to others (P < .05). Conclusion: The PLHIV in Lagos had a positive attitude toward their medication and a good perception of the quality of care they received during the COVID-19 pandemic. All stakeholders' efforts should be sustained for continuous quality improvement in HIV care in Lagos.

Investigating catastrophic health expenditure among people living with HIV and AIDS in South Western Nigeria.

Background: This study aimed to determine the catastrophic healthcare expenditure (CHE) among people living with HIV (PLHIV) in Lagos and to identify factors associated with CHE among them. Methods: The study was a descriptive cross-sectional survey conducted between January and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services should be provided free of charge. Data were collected through pretested questionnaires and analyzed using Stata SE 12. Results: The mean monthly expenditure on food was N29,282 ($53.2), while expenditure on healthcare averaged N8364 ($15.2). Nearly 60% of respondents experienced CHE, while around 30% had to borrow money to pay for some aspect of their medical treatment. Almost all (96%) had no health insurance plan. Respondents' group, personal income, perception of current health status, and the number of people in their households were significantly associated with catastrophic health expenditure p < 0.05. PLHIV in the racial/ethnic minority/migrants' group and those who earned less than ₦30,000 ($55) were statistically significantly associated with CHE at p < 0.001 with OR of 28.7 and 3.15, respectively. Conclusions: The study, therefore, highlights the widespread financial hardship faced by PLHIV in accessing healthcare, and the need for policies to increase financial risk protection.

Building capacity of primary health care workers and clients on COVID-19: Results from a web-based training.

BACKGROUND: Health care workers (HCWs) in the first line of care play critical roles in providing the correct information about the coronavirus disease to the community. The objective of the study was to determine the effect of virtual training on the knowledge, attitude, and preventive practices among PHC workers and their clients in the prevention and control of coronavirus disease. METHODS: A quasi-experimental intervention virtual training, using a before and after design amongst HCWs and clients was conducted at primary health care facilities in two Local Government Areas of Lagos State. The study instruments were pre-tested questionnaires for both HCWs and their clients. which investigated knowledge of symptoms, modes of disease transmission, methods of prevention, and preventive practices. Changes in knowledge, attitudes, and practices were compared pre-and post-intervention. The level of significance was set at p < 0.05. RESULTS: Sixty-three HCWs (out of 100 recruited at baseline) and 133 clients (out of the initial 226) completed the study. The mean ages of the HCWs and clients were 39.2±9.9 and 30.9±5.0 years respectively. At the baseline, the HCW's knowledge was good in the domains of symptoms, modes of transmission, and preventive measures. The training led to a higher but not significant (p> 0.05) increase in the level of knowledge. Contact with trained HCWs was found to lead to significantly (P < 0.001) higher levels of knowledge, attitudes, and preventive practices. amongst clients. CONCLUSION: The training was effective in improving the knowledge of both the trained HCWs and their clients.

Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria.

BACKGROUND:  The availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services. AIM:  This study assessed maternal and child health (MCH) services' specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria. SETTING:  The study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020. METHODS:  A descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p  0.05. RESULTS:  Overall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p  0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p  0.001). CONCLUSION:  The overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended.

We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria.

Background: Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center. Objective: To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria. Method: A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months. Result: Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers. Conclusion: Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.

Patients' Perception of the Quality of Gynecological Services in a Tertiary Public Health Facility in Lagos, Nigeria.

To facilitate improvements in health service delivery, patients' satisfaction with gynecological services was assessed at a tertiary hospital. Five hundred gynecological care-seekers who presented for outpatient consultation, inpatient care, or theatre procedures had face-to-face interviews using close-ended questionnaires. The assessment encompassed hospital ambience, healthcare providers' attitude, waiting time, duration of consultation among others. Univariate and bivariate analyses were performed with SPSS 22.0 software. Mean age was 37.8 ± 10.9 years; 319(63.8%) had tertiary education; 81(16.2%) and 82(16.4%) had inpatient and theatre care, respectively; 233(46.6%) were managed for infertility. One in five respondents reported delayed retrieval of medical records (20.8%), dissatisfaction with hospital meals (22.2%) and 31.6% were displeased with waiting time. Overall, 92.7%, 74.2%, and 66.7% of participants reported high levels of satisfaction with theatre, outpatient, and inpatient care, respectively. Age and education were significantly associated with outpatient satisfaction level (P = .015; P < .001 respectively). Though the majority expressed satisfaction with the quality of care, outpatients' waiting time was considered lengthy. We recommend a detailed appraisal of outpatient routines and periodic evaluation of gynecological services.

Human immunodeficiency virus, tuberculosis and malaria service readiness at the primary healthcare centers in Ekiti State, Nigeria.

Introduction: access to services encompasses three components: availability, affordability, and acceptability. The physical presence of service delivery, which includes health infrastructure, core health staff, and aspects of service use, is referred to as service availability. This study was conducted to inform the health service availability and preparedness to deliver HIV, TB, and malaria prevention and control services in Ekiti State. Methods: this is a descriptive cross-sectional study conducted among all the Primary Health Centres (177) in Ekiti State Nigeria between August and October 2020. Data were collected with the use of the World Health Organization Service Availability and Readiness Assessment tool and were analyzed using STATA SE 12. Results: close to half (49%) of them had a condom in supply. More than 90% of them provided diagnosis and treatment of malaria. The HIV-specific service readiness index was approximately 40/0%. Only 26.6% of health facilities were ready to offer TB prevention and control services. Malaria specific service readiness index was 61.9%. There was a statistically significant difference in the HIV and TB-specific service readiness of facilities in the urban compared to rural locations. Health facilities located in the urban areas had higher mean readiness scores compared to those in the other residential areas (P=0.014). Conclusion: it is evident that HIV and TB-specific service readiness is very poor among PHCs in Ekiti State. Malaria Service Readiness was fair. Ekiti State government needs to expand investments in PHCs by strengthening the diagnostic services, commodities and medicine supply, adequate equipment and staff training.

Nuances of reproductive decisions by women in a rural community of Lagos, Nigeria.

INTRODUCTION: inadequate utilization of maternal health services due to limited reproductive decision-making capacity could be contributory to high maternal mortality in developing countries. This study sought to assess nuances of reproductive decisions by women in a rural community of Lagos, Nigeria. METHODS: this descriptive, cross-sectional house to house survey was part of a study conducted in April 2015 on females selected from 298 households chosen based on geographical clusters by simple random sampling. The study instrument was adapted from a USAID-funded project and was interviewer-administered. Data entry and analysis were performed with the aid of Epi-info™ 7.0.8.3 statistical software and ethical approval was obtained for the study. RESULTS: spousal age difference was less than 10 years for about half (51.3%) of the respondents. The majority (91.6%) of the respondents had received antenatal care during pregnancy and jointly decided with their spouses on place of care. The most commonly used contraceptives were the pills (23.5%), injectables (16.8%) and condoms (13.8%). Spousal disapproval regarding the use of family planning was almost nil at 1%. Employment status as a socio-economic factor did not significantly affect respondents´ involvement in decision-making. However, there were statistically significant associations between spousal age differences and some indicators of autonomy such as respondents´ involvement in health care decisions and the determinant on choice of antenatal care provider. CONCLUSION: women´s reproductive independence and involvement in health decisions could result in reduction of maternal ill-health and mortality whilst promoting higher male involvement and better maternal health.

How does the public perceive healthcare workers in Lagos? A comparison of health workers in public and private health facilities.

BACKGROUND: The perception of healthcare workers (HCWs) by community members is dependent on the quality of services rendered by HCWs and contributes to utilisation. The objective of the study was to assess the perception of health workers in both public and private facilities by residents of Lagos State. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted using mixed-methods approach. Respondents (n = 2000) were selected using a multistaged sampling technique from four local government areas. An interviewer-administered, pre-tested questionnaire developed for the study was used for data collection and focus group discussions were held. Domains assessed included competence, work attitudes, interpersonal skills and unethical behaviour. A perception index was generated. Data were analysed using the Statistical Package for the Social Sciences version 22, with level of significance set at 0.05 for quantitative data and ATLAS.ti software (Scientific Software, Berlin; version 7) for qualitative data. RESULTS: At least seven out of ten participants (>71%) perceived the HCWs highly in the areas of professional competence, attitude to work, responsiveness and interpersonal skills. Out of a maximum of 12, doctors had the highest mean perception index (10.6 ± 1.9), laboratory scientists had 10.1 ± 2.1, pharmacists had 10.0 ± 2.3 and nurses had 9.6 ± 2.7. A larger proportion of respondents had a significantly better perception of workers in private facilities more than those in government facilities. CONCLUSION: Perception of health workers was high and was better in privately owned facilities. Periodic retraining of health workers and regular assessments of health facilities are recommended.

Unprepared and Misinformed Parents of Children with Sickle Cell Disease: Time to Rethink Awareness Campaigns.

Worldwide, sickle cell disease (SCD) poses a significant public health concern. It causes recurrent morbidity, and premature death is a distinct possibility, especially in Nigeria, which bears half the world's burden of SCD patients. Nigeria has yet to establish a newborn screening program; consequently, most affected children are diagnosed between one and three years of age when a health problem arises. Parents are unprepared to identify SCD and seek comprehensive management early enough for the best outcome. Awareness of carrier status and knowledge of SCD would ensure informed reproductive choices. Questionnaires were employed to conduct a prospective, cross-sectional study of the occurrence of missed carrier status of one biological parent of children enrolled at the pediatric sickle cell disease clinic of a teaching hospital. The institution's ethics committee approved the study. Of 133 respondents, 53% of the parents were unaware of being sickle cell carriers and did not expect to have children with SCD. Among families in which one or both parents proactively sought to know their genotype, 35% of all parents received incorrect genotyping results regarding the SCD risk of their offspring. The majority of incorrectly assigned hemoglobin AA results occurred in private laboratories. More than 60% of the respondents reported gaining awareness regarding SCD through antenatal care (51%) and schools (17%), as opposed to public awareness campaigns (8%). Many parents in our study population were unprepared for their children's SCD diagnosis. Awareness campaigns need to be revisited as a major potential modality to increase outreach about SCD. Standardization and improved quality control of laboratory testing involving screening of the sickle cell trait could reduce the frequency of wrong genotype assignment.

Children who have received no routine polio vaccines in Nigeria: Who are they and where do they live?

Nigeria has made remarkable progress against polio, but 2 wild polio virus cases were reported in August 2016; putting an end to 2 y without reported cases. We examined the extent of geographical disparities in childhren not vaccinated against polio and examined individual- and community-level predictors of non-vaccination in Nigeria. We applied multilevel logistic regression models to the recent Nigeria Demographic and Health Survey. The percentage of children not routinely vaccinated against polio in Nigeria varied greatly and clustered geographically, mainly in north-eastern states, with a great risk of spread of transmission within these states and potential exportation to neighboring states and countries. Only about one-third had received all recommended 4 routine oral polio vaccine doses. Non-vaccinated children tended to have a mother who had no formal education and who was currently not working, live in poorer households and were from neighborhoods with higher maternal illiteracy rates.

Youth friendly health services in a rural community of Lagos, Nigeria: are the youths receptive?

BACKGROUND: Globally, the youths constitute a major segment of most societies particularly in developing countries. This study was undertaken to assess the perception and practices related to youth friendly health services (YFHS) by in-school adolescents in a rural community of Lagos, Nigeria. METHODS: A descriptive cross-sectional survey was conducted on 400 proportionately selected consenting respondents from the senior classes of the three secondary schools in Agbowa community. A pre-tested interviewer-administered questionnaire was used for data collection and analysis was done with the aid of statistical software. RESULTS: Most of the respondents were in the age range of 12-15 years with mean age being 15.33±1.54 years. About half (46.8%) of the respondents correctly described adolescents as persons between the ages of 10 and 19 years. The majority (83.2%) of the respondents first heard about the Youth Friendly Health facilities from parents, guardians and friends. However, only few of the respondents had ever visited a Youth Friendly Center. A good location, convenient hours and comfortable surroundings were the most appealing aspects of YFHS. The provision of a seminar room and educational materials (60.8% and 70.8%, respectively) are important to the respondents. Reproductive health (56.8%) was the most preferred health education topic chosen by the respondents. CONCLUSION: Sensitization of the youths in the Agbowa community about youth friendly health services and provision of such services would be useful in reducing risky practices and improving their health.

Pharmacovigilance amongst patent medicine vendors (PMVs) in Ekiti state, Nigeria.

With the current population of Nigeria and the limited number of trained health care providers, PMVs are inevitable and highly needed especially in the rural areas for the supply of drugs in treating minor illnesses. Thus, pharmacovigilance (PVG) activity in Nigeria cannot exclude the roles of PMVs; therefore, this study was aimed to determine the knowledge of PMVs on PVG and adverse drug reaction reporting system. The study was a descriptive cross-sectional survey of the knowledge of Pharmacovigilance and adverse drug reaction reporting system of 96 PMVs in Ekiti state, Nigeria before the National Pharmacovigilance training in February, 2011 and after the training. The data obtained before the training showed that more than 87% of the respondents had at least secondary level of education. About half of the respondents (58.5%) knew the correct meaning of PVG and 56.6% knew how to report ADRs. But only about one third of them (35.8%) knew where to obtain ADR forms. Very few respondents 3 (5.7%) had received report/complaints of ADR from patients in the last 1 month while just 2 (3.8%) of them reported. The most commonly mentioned factors/reasons for poor reporting of ADRs/compliance with PVG guideline by the respondents were fears of indictment (61.3%), poor public knowledge (88.7%), and poor training on PMVs (92.5%). However, the results after the training showed a statistically significant (p ≤ 0.005) improvement in the proportion of respondents who were aware of PVG (from 55.8% to 89.1%), those who knew the meaning of PVG (from 49.0% to 61.7%), where to obtain ADR form (28.3% to 92.1%) and those who knew how to report ADRs (44.2% to 88.0%). PMVs are ready to practice PVG if they are properly trained. Training has been revealed to play a significant role in the knowledge of the concept of PVG amongst PMVs. It is therefore recommended that National Pharmacovigilance Centre should continue to organize periodic trainings for PMVs especially those with poor knowledge on PVG.