Curriculum Development: Postgraduate Diploma in Health Systems Management.

BACKGROUND: Postgraduate diploma in health systems management (PDHSM) curriculum was designed and developed to equip medical doctors with the knowledge, skills, and attitudes required to manage health systems and resources for quality patient care and safety. OBJECTIVES: Describe processes and steps to design and develop a new curriculum using the development of PDHSM as a guide by identifying learning needs; using the six-step approach to curriculum development; incorporating quality assurance and quality enhancement frameworks; and identifying evaluation methods. METHODOLOGY: Four (4) subject content experts in health policy, planning, and management and experienced public health physicians at the National Postgraduate Medical College of Nigeria deliberated, determined, and compiled learning needs that were incorporated into the design and development of the new curriculum for PDHSM. The learning needs, informal data on key learning issues in health system management and specific challenges in the context and operational environment were analyzed. Triangulation of information from these different perspectives and opinions was aligned with medical doctors' educational needs to acquire competency in managing health systems. The derived instructional needs, assessment methods, and resources were incorporated into the design, development, and evaluation of the PDHSM curriculum. The outline of the curriculum was developed using the curriculum matrix table. RESULTS: The contents of the developed curriculum in PDHSM include the purpose, organization of the programme, educational experience, and evaluation of the curriculum. The curriculum was structured into modules. Each module has intended learning outcomes (ILOs) of major subject areas of HSM and teaching and learning activities that outline methods of instruction and assessments. The Indicative contents of each module are topics of each subject area of the PDHSM. The assessment formats in the curriculum included both formative and summative assessment methods and types. The resources required for instructional and assessment activities were identified. The evaluation methods of the curriculum will be through reviews of assessment results and performance evaluation of students, tutors, and the PDHSM programme. CONCLUSION: The educational needs of medical doctors to function as managers in the health systems determine the development of intended learning outcomes, teaching and learning activities, indicative contents, resources required, and evaluation of the PDHSM curriculum. Quality assurance and quality enhancement should be part of curriculum design and development.

CONTEXTE: Le programme du diplôme de troisième cycle en gestion des systèmes de santé (PDHSM) est conçu et développé pour doter les médecins des connaissances, des compétences et des attitudes nécessaires pour gérer les systèmes et les ressources de santé en vue d'assurer la qualité des soins et la sécurité des patients. OBJECTIFS: Décrire les processus et les étapes de la conception et du développement d'un nouveau programme en s'inspirant du développement du PDHSM, en identifiant les besoins d'apprentissage, en utilisant l'approche en six étapes du développement du programme, en incorporant les cadres d'assurance et d'amélioration de la qualité, et en identifiant les méthodes d'évaluation. MÉTHODOLOGIE: Quatre (4) experts en politique, planification et gestion de la santé et des médecins expérimentés en santé publique du National Postgraduate Medical College of Nigeria ont délibéré, déterminé et compilé les besoins d'apprentissage qui ont été incorporés dans la conception et le développement du nouveau programme d'études pour le PDHSM. Les besoins d'apprentissage, les données informelles sur les questions clés de l'apprentissage dans la gestion des systèmes de santé et les défis spécifiques dans le contexte et l'environnement opérationnel ont été analysés. La triangulation des informations provenant de ces différentes perspectives et opinions a été alignée sur les besoins éducatifs des médecins pour acquérir des compétences en matière de gestion des systèmes de santé. Les besoins pédagogiques, les méthodes d'évaluation et les ressources qui en découlent ont été intégrés dans la conception, le développement et l'évaluation du programme d'études du PDHSM. Les grandes lignes du programme ont été élaborées à l'aide du tableau matriciel du programme. RÉSULTATS: Le contenu du programme d'études élaboré pour le PDHSM comprend l'objectif, l'organisation du programme, l'expérience éducative et l'évaluation du programme d'études. Le programme a été structuré en modules. Chaque module comporte des objectifs d'apprentissage (OIT) dans les principaux domaines de la gestion des systèmes de santé, ainsi que des activités d'enseignement et d'apprentissage qui décrivent les méthodes d'instruction et d'évaluation. Le contenu indicatif de chaque module correspond aux thèmes de chaque domaine du PDHSM. Les formats d'évaluation du programme comprennent des méthodes et des types d'évaluation formative et sommative. Les ressources nécessaires aux activités d'enseignement et d'évaluation ont été identifiées. Les méthodes d'évaluation du programme d'études seront basées sur l'examen des résultats des évaluations et sur l'évaluation des performances des étudiants, des tuteurs et du programme de PDHSM. CONCLUSION: Les besoins éducatifs des médecins en tant que gestionnaires des systèmes de santé déterminent le développement des résultats d'apprentissage prévus, des activités d'enseignement et d'apprentissage, des contenus indicatifs, des ressources nécessaires et de l'évaluation du programme d'études du PDHSM. L'assurance et l'amélioration de la qualité devraient faire partie de la conception et du développement du programme. Mots-clés: Curriculum, Conception, Développement, Évaluation, Assurance qualité.

Mean quality of life of hypertensive and diabetic patients: A comparative study of patients in secondary and tertiary health facilities in Kaduna State, Nigeria.

Introduction: Hypertension and diabetes have become major non-communicable diseases of public health importance globally, considering the magnitude of the diseases, the propensity to worsen the patients' quality of life and the associated mortality. This study compared the health-related quality of life (HRQOL) of hypertensive and diabetic patients in both tertiary and secondary health facilities in Kaduna State, north-western Nigeria. Materials and Methods: This was a descriptive comparative cross-sectional study amongst 325 patients, of which 93 (28.6%) were from the tertiary and 232 (71.4%) were from the secondary facilities. All eligible respondents participated in this study. Data were analysed with SPSS version 25 and STATA SE 12, t-test for comparison of two means, Chi-square and multivariate analyses were performed with P < 0.05. Results: The mean age was 55.72 ± 13 years. Two-thirds, 197 (60.6%), were hypertensive only, 60 (18.5%) were diabetic only (18.5%) and 68 (20.9%) were hypertensive diabetic. For the hypertensive only at the tertiary facility, the mean scores for vitality (VT) (68.0 ± 5.97, P = 0.01), emotional well-being (EW) (77.33 ± 4.52, P = 0.0007) and bodily pain (BP), (74.17 ± 5.94, P = 0.05) were significantly higher for tertiary compared with those at secondary facilities. The mean HRQOL for the people with diabetes only at the tertiary facilities also showed statistically significant higher scores for VT (72.2 ± 61, P = 0.01), social functioning (72.2 ± 8.4, P = 0.02), EW (75.44 ± 4.9, P = 0.001) and BP (85.56 ± 7.7, P = 0.01) when compared with the secondary facilities. Conclusion: Patients managed by specialists at the tertiary health facility had better HRQOL than those managed at the secondary health facilities. Continued medical education and the use of standard operating procedures are recommended for improved HRQOL.

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

Periodontal status and its association with self-reported hypertension in non-medical staff in a university teaching hospital in Nigeria.

BACKGROUND: A growing body of evidence suggests a relationship between periodontal disease and non-communicable systemic diseases with rising prevalence in developing countries, Nigeria inclusive. OBJECTIVES: To determine the periodontal status and its association with self-reported hypertension among non-medical staff in a university teaching hospital in Nigeria. METHODS: A cross-sectional study was conducted among non-medical staff using self-administered questionnaires and periodontal clinical examination between July and August 2013. Multivariate analysis was explored to determine the independent variables associated with self-reported hypertension. P values < 0.05 were considered statistically significant. RESULTS: A total of 276 subjects were enrolled into the study. Shallow pockets (CPI code 3) constituted the predominant periodontal disease (46.7%), calculus (CPI code 2) 46%, bleeding gingiva (CPI code 1) in 3.3% and deep pockets ≥ 6mm (CPI code 4) in 2.2%. Self-reported hypertension was the most prevalent self-reported medical condition (18.1%) and found to be associated with periodontitis, increasing age, lower education, and a positive family history of hypertension. CONCLUSION: Periodontal disease was highly prevalent in this study. Self-reported hypertension was associated with periodontitis, older age, lower education and a positive family history. Periodic periodontal examination and regular blood pressure assessment for non-medical staff is recommended.

Quality of life of family caregivers of children with orofacial clefts in Nigeria: a mixed-method study.

BACKGROUND: Orofacial clefts (OFCs) are common birth defects that may impose a large burden on the health and psychosocioeconomic well-being of affected individuals and families. This study aims to identify qualitative factors that affect the quality of life (QOL) of family caregivers of children with OFCs. METHODS: A mixed-method study in which family caregivers of OFCs children were consecutively recruited from cleft clinics over a 3-month period. Quantitative data were analyzed using SPSS version 17 and focus group discussion by framework analysis. RESULTS: A total of 107 caregivers participated in the entire study, and 24 caregivers participated in the focus group discussions. About 50% of the children had cleft lip and palate (CLP), 28% with cleft lips only (CL) and 23.4% with cleft palate only (CP). Poor access to specific information and lack of empathy of professionals affected the quality of life and delivery of family-centered care. CONCLUSIONS: To improve the quality of life of family caregivers, individual-focused counseling sessions should be organized for caregivers soon after birth. This will provide an opportunity to discuss the laid out plans for supportive care. It will also be as an avenue to address the arising social issues by health professionals and counselors.

Use of HIV Screening Services and Sexual Behavior of In-School Adolescents in Surulere LGA, Lagos State.

BACKGROUND: The health and development.of populations irrespective of where they live is dependent on their behaviour. Adolescents constitute a huge chunk of the global population. A high proportion of the burden of diseases therefore occur in this age group as well. The maturation process occurs throughout this period and behaviours adopted often last for life and are determinants of healthy adult life. High prevalence of Sexually Transmitted Infections including Human Immunodeficiency Virus has been documented in adolescents. OBJECTIVE: This study was carried out to assess the use of HIV screening services and sexual behaviour of in-school adolescents in Surulere an urban community in Lagos State, Nigeria. METHODS: Cross sectional descriptive study design was used. Simple random sampling was used to select 9 public senior secondary schools in Surulere Local Government Area. All the enrolled and willing students in SSS3 who were available during the period of data collection were included in the study (1,029). Information was collected with a self-adrministered questionnaire. Data analysis was done with Epi info version 3.5.4. Frequency tables were generated and analysis was explored using chi square at. p<0.05. RESULTS: The mean age was 16 years. Majority of the students were in the 15-19 years age bracket, females, Christians and lived in monogamous homes. All the three arms namely commercial class, arts class and science class were included. Less than one tenth of the students 90 (8.9%) had been screened for HIV infection. Among this group., more than half had tested once and 37.8% tested because they had participated in risky behavior. Fifteen percent were sexually active, among this group 20% engaged in transactional sex. Only 36.8% used condom at first sex which increased to 57.2% at last sex, however consistent condom use was practiced by 22.4%. Students who are sexually experienced (p<0.001) were more likely to have been screened while those in science class (p=0.012) were more willing to screen for HIV. Male students were more likely to have had sex (p<0.001).Compared to Science and Commercial students, those in Arts class were more likely to have had sex (p=0.004), use condoms (p=0.017) and use it consistently (p<0.001). CONCLUSION: Even though the adolescents in this study. engage in risky sexual behaviour, use of HCT services and other STI prevention strategies was poor. It is essential that young people have access to and utilize all HIV prevention tools at their disposal.

Awareness, perception and coverage of tetanus immunisation in women of child bearing age in an urban district of Lagos, Nigeria.

AIMS AND OBJECTIVES: This study assessed the level of awareness and perception of women of child bearing age to tetanus immunisation and determines the cover- age rate in Ojodu Local Council Development Area (LCDA) of Lagos State, Nigeria. SUBJECTS AND METHODS: This is a descriptive cross-sectional study of 288 women of child bearing age selected using multistage sampling technique. Information was obtained using structured close-ended questionnaire. Data analysis was done using Epi-InfoTM software, version 3.5.1. RESULTS: There was high level of awareness of tetanus immunisation among respondents (89%) and as a method of prevention of tetanus (76%). There was a positive association between the level of awareness and respondents' educational level and occupation (p < 0.05). However, there is a low level of awareness regarding the number of doses of the vaccine required in pregnancy(14.4%) and for life protection (19.5%). Those who ever received the vaccine,got it post-injury (48.9%) and in pregnancy (45.2%). Age, occupation and parity were positively associated with receiving the vaccine (p < 0.05), while parity and marital status were positively associated with number of dose of vaccine received (p < 0.05). Only about 20% of the respondents had received two or more doses of the vaccine. CONCLUSION: This study concludes that despite the high level of awareness about tetanus and tetanus immunisation, there is a low coverage rate of tetanus immunisation among women of child bearing age in Ojodu LCDA of Lagos State. Women of child bearing age should also be targeted at the community level in tetanus immunisation campaign programme.

The effect of a sexuality education programme among out- of- school adolescents in Lagos, Nigeria.

AIMS AND OBJECTIVES: This study was conducted to assess the effect of a community based sexuality education programme on the sexual health knowledge and practices of out of school female adolescents. SUBJECTS AND METHODS: This Intervention study was conducted in two markets within Lagos, Nigeria. Representative samples of adolescents were interviewed on their sexual health knowledge and practices. An Education- entertainment programme provided sexuality education to adolescents in Mushin market only (intervention group) followed by post intervention surveys in Mushin market and Sangrouse market (control group). The pre and post intervention surveys were compared 6 months post intervention to detect any changes. RESULTS: Sexual health knowledge and behaviour was similar among respondents in both markets pre intervention. Post intervention, the sexual health knowledge of the respondents in the intervention site improved significantly. (p<0.05) Fewer adolescents initiated sex in the intervention site than in the control site and contraceptive use increased. However among the sexually active, there was no significant change in their condom use and number of sexual partners. CONCLUSION: Community based health education programmes can be used to provide effective sexuality education for out of school adolescents. Provision should be made by government and non-governmental organisations during adolescent reproductive health programming for sexuality education targeted at out of school adolescents.

Evaluation of a health resources management course for Nigerian doctors.

AIMS AND OBJECTIVES: This study aimed to evaluate the March 2010 edition of the regular biannual two-week course on health resources management organised by the National Postgraduate Medical College of Nigeria. The main objectives were to assess participants' perception of the course and to measure change in their knowledge brought about by the course. SUBJECTS AND METHODS: This is a primarily cross-sectional study but with a before and after component. The study population comprised all participants who attended the course. Data were collected using pre-tested structured self- administered questionnaires. Data analysis was done with Epi Info 3.5.1. Student's T-test was used to compare mean scores at pre-test and post-test and the p-value of <0.05 was considered statistically significant. RESULTS: Majority (95.8%) of the participants were senior registrars from teaching hospitals and most of them (70.5%) claimed the course met their needs a great deal/to a large extent. The participants were satisfied to a varying degree with different aspects of the course but overall 50.9% claimed they got value for their money. There was a statistically significant difference in the knowledge score at pre- and post-test (t = 3.19, p = 0.002). CONCLUSION: The course met the needs of the participants largely and was able to improve their knowledge of health resources management as intended. A behaviour evaluation is recommended in order to assess the usefulness of the course to participants' practice.

Alcohol consumption and cigarette smoking pattern among brothel-based female sex workers in two local government areas in Lagos state, Nigeria.

BACKGROUND: Alcohol and tobacco use are known risk factors for non communicable diseases especially among women. Brothel based female sex workers may be at increased risk of exposure to these two substances. OBJECTIVE: To assess the pattern of alcohol and tobacco use among female sex workers in two selected local government areas in Lagos state, Nigeria. METHODS: A cross-sectional descriptive study was carried out among 323 brothel-based female sex workers in 39 consenting brothels. Data was collected by trained interviewers using a pretested structured questionnaire. RESULTS: Majority (67.8%) were current drinkers with 89.5% of these having their most recent drink less than a week ago. Most of them (89%) consumed more than the reference limits for alcohol use among women. Up to 20.7% were current smokers with (92.5%) having their most recent cigarette less than a week ago. More than a third (37.4%) were heavy smokers while 19% were dual users. Current drinking was associated with current smoking. Smokers consumed significantly more units of alcohol than non-smokers. CONCLUSION: The prevalence of harmful alcohol use and cigarette smoking are very high among this group of female sex workers. Programs that address the use of these substances should be made available for these women.

Prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos, Nigeria.

AIMS AND OBJECTIVES: A descriptive cross-sectional study was carried out to determine the prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos State. SUBJECTS AND METHODS: Tejuosho market, one of the large popular markets was selected from a list of markets that met the inclusion criteria of being major markets dealing in general goods using a simple random sampling technique by balloting. Four hundred (400) traders were selected using a systematic random sampling. Each trader was interviewed with a well-structured questionnaire and had blood pressure and anthropometric measurements (height, weight and body mass index). RESULTS: Female traders made up (74.3%) 297 of the total population. The mean age was 45.48+11.88 and 42.29+10.96 years for males and females respectively. Majority 239 (59.8%) fell within the age range of 35 - 55 years. The cardiovascular risk factors identified and their prevalence rates were hypertension (34.8%), physical inactivity (92%), previously diagnosed diabetes mellitus (0.8%), risky alcohol consumption (1%), cigarette smoking (0.3%) in females and (17.5%) in males, obesity (12.3%) and overweight (39.9%). CONCLUSION: The study recommended that any health promoting, preventive or intervention programme for this population would have to be worked into their market activities if it is to make an impact.

An observational survey of child car safety practices in private pre-primary and primary schools in two local government areas of Lagos State, Nigeria.

OBJECTIVE: To describe child car safety practices among children aged 0-8 years. Eight schools from two local government areas (LGAs) were selected by simple random sampling. Passenger cars were observed for child seating position and restraint use at each selected school as children were being dropped off in the morning. RESULTS: Observed child restraint use was very low, as was the rate of appropriate restraint for age (10.8% and 4.2%, respectively, in Eti-Osa, and 7.0% and 1.8% in Ikeja). Child restraint use decreased with increasing age group from 25% in those below 1 year, to 12% in those aged 1-3 years, and 7.4% in those aged 4-8 years. A large proportion of restrained passengers were inappropriately restrained in a seatbelt alone. Front seating among observed child passengers was not as high as in studies from similar environments (9.4% and 17.5% in Eti-Osa and Ikeja, respectively). Factors associated with child restraint use were number of child passengers in car, and whether or not the driver wore a seatbelt. Seating position of the child was significantly associated with the relationship of the driver to the child, and driver's gender. CONCLUSION: The level of child restraint use observed in this study is unacceptably low. The relatively low prevalence of front seating while riding in cars should however be further reduced. The study recommends the enactment of specific country legislation on the use of child restraints, accompanied by multifaceted intervention programmes to improve the availability and use of child car safety seats and booster seats.

The National Health Insurance Scheme (NHIS): a survey of knowledge and opinions of Nigerian dentists' in Lagos.

This study was designed to assess the knowledge and perceptions of Nigerian dentists to the National Health Insurance scheme (NHIS). A cross-sectional descriptive survey was conducted amongst 250 dentists employed in private and public dental clinics in Lagos State, Nigeria. The survey instrument was a self-administered questionnaire designed to assess their knowledge and attitudes towards the scheme. Data analysis was done using the Epi-Info statistical software (version 6.04). Statistical tools used included measures of central tendency, frequency distribution and chi-square test. A total of 216 dentists (response rate of 82.4%) participated in this study. Most 132 (61.1%) of the respondents had a fair knowledge of the NHIS, while 22 (10.2%) and 62 (28.7%) had poor and good knowledge respectively. Majority (70.4%) viewed the NHIS as a good idea that will succeed if properly implemented. Most (76.6%) respondents also believed that the scheme will improve access to oral health services, affordability of services (71.4%), availability of the services (68.3%) and recognition of dentistry as a profession (62.4%). Most of the respondents (66.2%) considered oral health care as not properly positioned in the NHIS and 154 respondents (74.4%) found the current position of oral health on the NHIS unacceptable. A good number of the respondents (77.3%) would like dentistry to operate at the primary care level on the NHIS. Majority of the dentists involved in this study had some knowledge of the NHIS and were generally positively disposed towards the scheme and viewed it as a good idea.

Substance use among secondary school students in an urban setting in Nigeria: prevalence and associated factors.

OBJECTIVE: Substance use continues to be major risk behaviour among youth, with consequent physical and/or mental health complications. The current study aimed to establish the prevalence and associated factors of substance use among selected secondary school students in Lagos. METHOD: This was a cross-sectional and descriptive study among selected secondary school students in Lagos. Permission was obtained from appropriate school authorities; as well as consent from each participant. The WHO Students' Drug Use Questionnaire which had been previously validated in the country was used to obtain the drug use information from the subjects. Analysis of the data was conducted using Epi-info version 5. RESULTS: A total of 402 students were studied - of whom 43.5% (n=175) were males and 56.5% (n=227) females. The mean age was 15.9 years. 83.1% (n=334) lived with their parents, 7.6% (n=31) with their relatives and 7.2% (n=29) with friends. The commonest substances used by the subjects were caffeine (kolanut and coffee), mild analgesics (paracetamol and aspirin) and the antimalarials, most especially chloroquine with lifetime use prevalence rates of 85.7%, 73.8% and 65.7% respectively. Generally, the prevalence rates for lifetime use of the substances varied from 3.8% (n=14) for Heroin and Cocaine to 85.7% (n=344) for psychostimulants; and for current use varying from 2% (n=8) to 56.5% (n=213). For the so called "gateway drugs": alcohol and tobacco, their lifetime use prevalence rates were 9.2% (n=34) and 5.2% (n=19) while the lifetime use prevalence rate for cannabis was 4.4% (n=16). In terms of gender, the prevalence rates for males were generally higher than for their female counterparts except for antibiotics, analgesics, heroin and cocaine. Reasons for using substances included relief from stress, 43.5% (n=175), self medication to treat illness, 23.8% (n=96), and to stay awake at night to study, 14.9% (n=60). CONCLUSION: Substance use was found to be prevalent among students in this study involving over-the-counter and socially acceptable substances as well as the abuse of illicit substances. It is advocated that there is a need to review existing health educational programmes.

Enhancing data management skills of primary health care workers in enugu state, Nigeria.

OBJECTIVE: The objective of this study was to evaluate the outcome of a training scheme on data collection, recording, reporting and utilisation practices among primary health care workers in Enugu State. METHODS: This is a "before and after" intervention study conducted among 107 Primary Health Care (PHC) workers in Enugu State. A multistage sampling technique was used. A pre-tested, semi-structured questionnaire and an observation checklist were the instruments used in data collection pre and post-intervention. RESULTS: The workers in this study pre-intervention recorded data using health management information system (HMIS) forms, registers and exercise books. Seven (77.8%) and 6(66.2%) of the study and control health centres respectively kept monthly health center copies of HMIS form 000. These forms and registers were neither completely and correctly filled nor were kept up-to-date. Post-intervention, the reported and observed practices improved significantly (p<0.001) in the study unlike in the control health centress. Pre-intervention, none of the health centres entered data into the register 1-2weeks prior to this study and none remitted same monthly to the monitoring and evaluation units of the LGAs. Post-intervention, early data entry, reporting and local uses of data improved significantly (p<0.001) in the study group unlike in the control group. CONCLUSION: The data management skills of PHC workers studied were generally inadequate pre-intervention. Training greatly enhanced their overall data management skills.

The use of artemisinin-based combination therapies (ACTs) in public secondary health facilities in Lagos, Nigeria.

OBJECTIVES: The objectives of the study were to assess the prescription pattern of Artemisinin Combination Therapies (ACTs) in uncomplicated malaria and the knowledge, attitude and practice of physicians as regards use of ACTs in the outpatient clinics of public secondary health facilities in Lagos State. PATIENTS AND METHODS: All the ten General Hospitals under the Lagos State Health Management Board were studied and classified as either rural or urban. 1878 retrospective antimalarial prescriptions of outpatients between March, 2005--March, 2006 were systematically sampled and questionnaires were distributed to prescribers in April--May, 2006. Prescription assessment was based on the recent Nigerian National Antimalarial Treatment Policy and WHO/INRUD drug use indicators. RESULTS: The percentage of prescriptions containing ACTs was found to be rather small (5.9%) inspite of the high proportion (59.2%) of prescribers who were favourably disposed to the National antimalarial policy change from Chloroquine to ACTs as first line. There was no statistically significant difference in frequency of ACTs prescription between the rural and urban health facilities. The prescription of Artemisinin derivatives as monotherapy was 18.2%. The prescription of Chloroquine was found to be more predominant, (48.8%) in all the health facilities. CONCLUSION: Despite the national policy change from Chloroquine to (ACTs) as the first line antimalarial, their use in the public secondary health facilities in Lagos State does not reflect this policy change and it appears that Chloroquine still remains the choice antimalarial drug.

Perceptions and practices of private medical practitioners to adolescent reproductive health in Lagos State, Nigeria.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.