Impact of malaria rapid diagnostic tests on prescription patterns of artemisinin-based combination therapy in Oyo State, Nigeria.

Background: In the era of valuable and costly artemisinin-based combination therapy (ACT) for malaria it has been recommended that the use of ACTs is restricted to only those with confirmed positive malaria diagnosis. The potential benefits of rapid diagnostic tests (RDTs) on anti-malarial drug consumption have been demonstrated in a number of clinical trials. It is unknown if the introduction of RDTs in Nigeria has achieved the desired goal of reducing ACT consumption. This article assesses the impact of a state-wide roll-out of RDTs on ACT prescription in Oyo State, Nigeria. Materials and Methods: ACT prescribing patterns for febrile patients were compared pre- and post-RDT introduction in 106 primary health care facilities. Routine data from the national malaria control programme monthly facility summary forms were extracted for three months before and after the RDT intervention and compared using a 'before and after' design. Results: RDT testing rates for patients with fever revealed no trend; mean testing rate in the post RDT period was 64.5%. The mean malaria positivity rate was 71.3%, which equalled a proportional morbidity rate of 45.9% of all fever cases. ACT treatment to confirmed case ratio was consistently above the expected value of one and the ratio of treatment to tested patient exceeded one (mean ratio of 1.1) for the three months post RDT. The absolute number of ACT doses prescribed increased remarkably after the introduction of RDTs and ACTs revealing an extra utilisation of 14,199 doses, 5,534 (±517) versus 10,267 (±2,452), p<0.001. Relative Risk of ACT prescription in the post RDT period was 1.71 (1.33-2.25). Conclusion: There is notable non-adherence to RDT results, with an increase in ACT prescriptions after the initial introductory period for RDTs. This over reliance on ACTs for the management of non-malaria illness could compromise gains from reducing malaria morbidity and mortality and needs to be addressed urgently.

Prevalence and determinants of adherence to HAART amongst PLHIV in a tertiary health facility in south-south Nigeria.

BACKGROUND: Adherence to Highly active antiretroviral therapy (HAART) is a major predictor of the success of HIV/AIDS treatment. Good adherence to HAART is necessary to achieve the best virologic response, lower the risk of drug resistance and reduce morbidity and mortality. This study therefore aimed to determine the prevalence and determinants of adherence to HAART amongst PLHIV accessing treatment in a tertiary location in Cross River State, Nigeria. METHODS: A cross-sectional study was conducted among patients on HAART attending the Presidential Emergency plan for AIDS relief (PEPFAR) clinic of the University of Calabar Teaching Hospital between October-December 2011. A total of 411 PLHIV visiting the study site during the study period were interviewed. PLHIV who met the inclusion criteria were consecutively recruited into the study till the desired sample size was attained. Information was obtained from participants using a semi-structured, pretested, interviewer administered questionnaire. Adherence was measured via patients self report and were termed adherent if they took at least 95% of prescribed medication in the previous week prior to the study. Data were summarized using proportions, and χ2 test was used to explore associations between categorical variables. Predictors of adherence to HAART were determined by binary logistic regression. Level of significance was set at p < 0.05. RESULTS: The mean age of PLHIV who accessed treatment was 35.7 ± 9.32 years. Females constituted 68.6% of all participants. The self reported adherence rate based on a one week recall prior to the study was 59.9%. The major reasons cited by respondents for skipping doses were operating a busy schedule, simply forgot medications, felt depressed, and travelling out of town. On logistic regression analysis, perceived improved health status [OR 3.11; CI: 1.58-6.11], reduced pill load [OR 1.25; 95% CI: 0.46-2.72] and non-use of herbal remedies [OR 1.83; 95% CI: 1.22-2.72] were the major predictors for adherence to HAART. However, payment for ART services significantly decreased the likelihood of adherence to HAART. [OR 0.46; 95% CI: 0.25-0.87.]. CONCLUSIONS: The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load and ensuring an uninterrupted access to free services regimen is strongly recommended.

Comparative study of mental health and quality of life in long-term refugees and host populations in Oru-Ijebu, Southwest Nigeria.

BACKGROUND: Refugees as "People Living in Highly Stressful Situation" are particularly vulnerable to mental ill-health as a result of the trauma experienced pre- and post-migration. The lack of information on the mental health disparities of refugees and non-refugees in West Africa is what this study aimed to bridge. A cross-sectional study design was employed using a cluster sampling technique. Interviewer-administered structured questionnaires consisting of the Mini-International Neuropsychiatric Interview (MINI), WHO quality of life (WHOQOL-BREF) and the Community Quality of Life (CQoL) were used for data collection. Data were analyzed with SPSS version 17. Logistic regression analysis was used to determine the predictors of mental health status and QoL. RESULTS: Respondents consisted of 444(45.7%) refugees and 527(54.3%) non-refugees. Two-thirds 292 (66%) of the refugees were Liberians. Mean age: refugees--34.8 ± 12.8 years versus non-refugees--33.3 ± 8.1 years (p < 0.05). While the majority 376(84.7%) of the refugees were married, most 468(88.8%) of the native population were not (p < 0.001). Significantly higher proportion of refugees had polygamous marriages, lived in poorer type of accommodation and had no formal education compared to the non-refugees (p < 0.05). The overall QoL and CQoL scores were both significantly lower for the refugees (p < 0.001). Refugees were three times more likely than non-refugees to have poor mental health [OR: 3.43; 95% CI: 1.83-6.40]. Overall, being currently ill tripled the odds of mental ill health [OR: 2.73; 95% CI: 1.98-3.77]. Unskilled workers [OR: 2.78; 95% CI: 1.68-4.60], skilled workers [OR: 2.98; 95% CI: 2.03-4.38] and the unemployed [OR: 1.94; 95% CI: 1.29-2.92] had two or more times the odds of poor mental health compared to professionals. CONCLUSIONS: QoL and occupational status were the major threats to the mental health of the refugees. Results of this study point to the need for continued attention to not only the healthcare needs but the welfare, housing, employment and overall QoL to support the long-term mental health of refugees and non-refugee populations alike.

Preventing child sexual abuse: parents' perceptions and practices in urban Nigeria.

This study examined parents' perceptions of child sexual abuse as well as prevention practices in an urban community in southwest Nigeria. Questionnaires were collected from 387 parents and caregivers of children younger than 15 years of age. Results showed that many parents felt CSA was a common problem in the community, and most parents disagreed with common child sexual abuse myths. In addition, almost all parents ( >90%) reported communicating with their child(ren) about stranger danger. However, about 47% felt their children could not be abused, and over a quarter (27.1%) often left their children alone and unsupervised. There were no significant variations in the perceptions of child sexual abuse and communication practices. The implications of findings for child sexual abuse prevention are discussed.

Public health perspectives of preeclampsia in developing countries: implication for health system strengthening.

OBJECTIVES: Review of public health perspectives of preeclampsia in developing countries and implications for health system strengthening. METHODS: Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database were reviewed. RESULTS: The prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7%. Many challenges exist in the prediction, prevention, and management of preeclampsia. Promising prophylactic measures like low-dose aspirin and calcium supplementation need further evidence before recommendation for use in developing countries. Treatment remains prenatal care, timely diagnosis, proper management, and timely delivery. Prevailing household, community, and health system factors limiting effective control of preeclampsia in these countries were identified, and strategies to strengthen health systems were highlighted. CONCLUSION: Overcoming the prevailing challenges in the control of preeclampsia in developing countries hinges on the ability of health care systems to identify and manage women at high risk.

A rural-urban comparison of client-provider interactions in patent medicine shops in South west Nigeria.

The increasing prominence of patent medicine vendors (PMVs) in healthcare provision makes information about how they operate of interest. This study assessed consumers' behavior and PMVs' performance in the treatment of childhood illnesses in rural and urban communities in South West Nigeria. Non-participatory observations were carried out in 163 licensed patent medicine stores in Oyo State, Nigeria. Many PMV shops (70.6% rural and 61.9% urban; p = 0.141); stocked non proprietary drugs. Clients often requested for drugs by name (75.4% urban versus 62.2% rural; p = 0.002) and PMVs mostly sold drugs as requested without questions (65.3% urban 57.8% rural; p = 0.07). Inappropriate treatment practices and invasive procedures were observed more often in urban PMVs shops (p < 0.001). PMVs functioned mostly as sales persons supplying clients' drug requests. Strategies to improve PMV treatment practices should include caregiver education to be effective.