Application of the UNAIDS Incidence Patterns Model to Determine the Distribution of New HIV Infection in Lagos State, Nigeria.

BACKGROUND: Identifying patterns in the distribution of new HIV infections in the population is critical for HIV programmatic interventions. This study aimed to determine the distribution of New HIV infection by applying the incidence patterns mathematical model to data from Lagos state. METHODS: The incidence patterns model (IPM) software is a mathematical model developed by UNAIDS to estimate the demographic and epidemic patterns of HIV infections. This model was adapted in Lagos state to predict the distribution of new HIV infections among specified risk groups in the next 12 months. RESULTS: The IPM predicted a total HIV incidence of 37 cases per 100 000 individuals (3979 new infections) will occur among the 15 to 49 subpopulations. The results also showed that sero-concordant HIV-negative couples with external partners (29%), female sex workers (26%), men-having-sex-with-men (18%), and previously married females (6%) accounted for the majority of the estimated new HIV infections. Overall, key populations constitute almost half (48%) of the estimated number of new HIV infections. CONCLUSION: The study helped to identify the population groups contributing significantly to new HIV infections. Therefore, priority interventions should be focused on these groups.

Health literacy: Prevalence and determinants in Lagos State, Nigeria.

BACKGROUND: Poor health literacy has been associated with poorer physical and mental health function, and higher emergency department and hospital utilizations. The study was conducted to measure the prevalence of health literacy and its determinants among Lagos State residents. METHODS: A descriptive cross-sectional study was conducted in three local government areas in Lagos State. Health literacy was assessed using the Brief Health Literacy Screening tool (BHLS), a three-item tool with possible scores ranging between 3 and 15. Health literacy was classified as inadequate (≤ 9) or adequate (>9). RESULTS: A total of 1831 respondents participated in the study, among whom, 952 (52%) were women. The mean age of respondents was 31.7 (±10.5) years. Three-quarters (74.8%) of respondents had adequate health literacy. Adequate levels of health literacy were associated with being female (OR, 1.35; 95% CI, 1.07-1.71), frequent use of the broad cast media as source of information (OR, 1.33; 95% CI, 1.03-1.70), frequent use of the internet as source of information (OR, 1.49; 95% CI, 1.13-1.96). Adequate health literacy was also associated with having knowledge of a frequently prescribed antibiotic (OR, 1.67; 95% CI, 1.32-2.12) and being more comfortable with the use of the English language (OR, 1.71; 95% CI, 1.32-2.22). CONCLUSION: Gender, the use of broadcast media and the internet are predictive of adequate health literacy and should be taken into consideration in planning health interventions.

Challenges of Tuberculosis Control in Lagos State, Nigeria: A Qualitative Study of Health-Care Providers' Perspectives.

BACKGROUND: Tuberculosis (TB) burden in Nigeria is a reflection of the challenges of TB control strategy in the country. This study explored the challenges encountered by the health workers in public and private TB treatment centers in Lagos, Nigeria. METHODS: In-depth interviews were held with 34 health workers providing TB services in private and public health facilities and the Lagos state Program Officer between October 1, 2016 and January 31, 2017. The transcripts were read severally and coded for qualitative data analysis. Themes were developed from coding. RESULTS: Insufficient or lack of funds to track patients lost to follow-up, conduct home visits, collect drugs from the central stores, and shortage of laboratory reagents were some of the logistical challenges encountered by the health workers. There was shortage of health workers and some were yet to be trained resulting in work overload. This was situation aggravated by the frequent redeployment and health worker attrition in the public and private sector respectively. CONCLUSION: The government need be proactive and show leadership by finding lasting solutions to the logistical and human resource challenges facing the LAgos State TB and Leprosy Program.

Clients and service providers' assessment of Public and Non-Governmental Youth-Friendly Health Services in Lagos Nigeria: a mixed method approach

Background: The World Health Organization prescribed that Youth-Friendly health services must be accessible, acceptable, equitable, efficient, effective, comprehensive and appropriate to meet the health needs of young people. Objective: To compare the clients' and service providers' assessment of services offered at the public and Non-Governmental Organization (NGO) Youth Friendly facilities (YFF) in Lagos Nigeria. Methods: A mixed method approach was used. Structured questionnaires were administered on youths (294 from public and 273 from NGO YFF) from ten (5 public and 5 NGO) YFF. Ten key informant interviews with service providers were also conducted between March 1st and December 31st 2014. SPSS version 22 was used to analyze quantitative data while thematic analysis of interviews with service providers was done. Results: Youths who utilized the public YFF had 60% chance (AOR 1.6, 95%CI 1.3 ­ 2.5, p= 0.005) of experiencing longer waiting times, 80% chance (AOR 1.8, 95%CI 1.2 ­ 2.8, p=0.004) of being counseled in a separate room and over two-fold chance (AOR 2.3, 95%CI 1.7 ­ 3.3, p <0.001) of having free services. Sexual and reproductive health was the major complaint area of the youths while funding was the major challenge of service providers at both the public and NGO YFF. Conclusion: To address the needs of the youths, there is a need to provide more funds and provide necessary logistics required by YFF

Trend of tuberculosis case notification and treatment outcome in Lagos State, Nigeria: a 5-year retrospective study.

Background: This study assessed trends of tuberculosis (TB) case notification rate (CNR) and treatment outcomes between 2011 and 2015 in Lagos State, Nigeria. Methods: A retrospective review of TB notification data to the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP) between 1 January 2011 and 31 December 2015 was conducted. Results: A total of 44 516 TB cases were notified during the study period, representing 9.4% of the national figure. The male:female ratio was 1.3:1. About 53%, 44.1% and 2.7% of patients were smear positive, smear negative and extrapulmonary TB cases, respectively. TB notification increased by 12.2% between 2011 and 2013 and subsequently declined by 7.2% in 2015 relative to 2013. The TB CNR declined from 82.9 per 100 000 in 2013 to 72.1 per 100 000 in 2015. However, directly observed treatment short course (DOTS) and microscopy site expansion increased from 0.3 to 0.64 per 25 000 population and from 0.16 to 0.4 per 50 000 population, respectively, from 2011 to 2015. Similarly, there was a slight increase in treatment success rate, from 80.1% in 2011 to 82% in 2015. Conclusion: The CNR declined in Lagos State despite an increasing trend in DOTS and microscopy site expansions between 2013 and 2015. The LSTBLCPs need to re-engineer current strategies of active TB case findings in order to improve case notification in the state.

Factors affecting utilization of youth friendly health services in Lagos State, Nigeria.

Background Youth friendly health services (YFHS) are services that attract, respond to the needs of and retain young people for continuing care. This study was conducted to determine the factors affecting utilization of government (GYFF) and non-governmental youth friendly facilities (NGYFF) in Lagos state, Nigeria. Methods A descriptive cross-sectional study was conducted. A total of 543 adolescents aged 15-24 years, between August 1, 2014 and October 31, 2014 were consecutively recruited from 10 (five government and five non-governmental) youth friendly health facilities that had been in operation for at least 6 months prior to the study. Logistic regression was used to determine predictors of utilization of youth friendly health facilities. Results Overall, the mean age of respondents was 17.9 ± 2.8. However, the mean age of respondents at GYFF (18.5 ± 3.0) was significantly higher than those at NGYFF (17.1 ± 2.5) (p < 0.001). Of the 567 youths enrolled, 196 (34.6%) had good utilization of youth friendly facilities (YFF) (34% from the GYFF and 35.2% from the NGYFF). Marital status, school attendance, having a baby, satisfaction with visit, perception that information shared was kept confidential and accessibility of the youth friendly services were associated with utilization of YFF (p < 0.05). Confidentiality and access to facilities were predictors of utilization of YFF. Conclusion There is poor utilization of both government and non-governmental youth friendly services in Lagos, Nigeria. There is a need for both the government and private sector to harmonize resources aimed at encouraging utilization of YFF in Lagos, Nigeria.

Causative factors for sexual and reproductive health status of pregnant adolescent girls in urban communities of Lagos, Nigeria.

Background The overall goal of this study was to determine the causative factors for pregnancy status in adolescent girls in two communities in the Lagos Island local government area. Methods A mixed methods (quantitative and qualitative) study reviewing routine health facility antenatal care (ANC) records and conducting focus group discussions among 46 pregnant adolescents, exploring their views about sex, contraception, pregnancy and sexual and reproductive health (SRH) services, was carried out. Key informant interviews were also carried out among healthcare workers and community members to assess their perceptions of adolescents' SRH problems. Results Five percent of those accessing ANC services were adolescents. Pregnant adolescents were found to access health services at later stages of their pregnancies due to the shame and stigma associated with their condition. The presence of morbidity in the form of anaemia (33%) and HIV (2.4%) was also found in this population. Social factors such as peer pressure and the desire to develop or maintain a relationship were found to be the major reasons for initiation of sexual activity by the adolescents. There was generally poor knowledge and utilisation of contraceptives, leading to unprotected sex and, thus, unintended pregnancies. Conclusion SRH information and services should be made readily available to adolescents at all levels of care.

Neonatal Jaundice: Knowledge, Attitude and practices of mothers in Mosan-Okunola community, Lagos, Nigeria.

BACKGROUND: A community-based survey was conducted amongst mothers aged 15-49 years living in Mosan-Okunola, Lagos, Nigeria to determine the knowledge of, attitudes to, preventive and treatment practices towards neonatal jaundice (NNJ). MATERIALS AND METHODS: The mothers were selected using a multi-stage sampling technique. A pre-tested interviewer-administered structured questionnaire was used to obtain data. The knowledge of the mothers was scored and scores lower than 50% were graded as poor, 50-74% as fair and ≥75% as good. The practice was also categorised as appropriate if one correct option was identified and was categorised as inappropriate where an incorrect option(s) was identified singly or in combination with a correct option. RESULTS: Three hundred and fifty-eight mothers were recruited. The mean age was 34.8 ± 9.05 years. Two hundred and seventy (75.4%) mothers had ever heard about the condition. Two hundred and forty-seven (91.4%) mothers correctly identified the condition and infection was the only most common known cause (47%). Only 34% of the mothers knew that NNJ could cause brain damage, and 40% identified refusal of feeds as a danger sign. Up to 64% of the mothers believed attending antenatal care could prevent the condition, and 58% were of the opinion that exposing babies to sunlight could prevent the condition. Sixty-eight percent (68.9%) of the mothers had a poor level of knowledge. Age and educational qualification did not show any statistically significant relationship with knowledge about NNJ (P < 0.05) but increasing maternal age had a significant association with an appropriate treatment practice (P < 0.05), the association was negative (r = -0.32). CONCLUSION: Knowledge about NNJ was low in this community and ineffective preventive practices were utilised. Efforts should be made to increase it, and health workers should play a leading role.