Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria.

BACKGROUND: The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. METHODS: A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. RESULTS: A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Coverage of indoor residual spraying for malaria control and factors associated with its acceptability in Nasarawa State, North-Central Nigeria.

INTRODUCTION: Indoor residual spraying (IRS) is among the major vector control strategies recommended for endemic populations by the World Health Organization (WHO). The success of IRS requires high coverage which is dependent on its acceptability. In Nigeria, IRS pilots have been ongoing and rejection has been a major setback to its coverage. We assessed coverage of IRS and determined factors associated with its acceptability in Nasarawa Eggon district, Nasarawa state, Nigeria. METHODS: A cross-sectional survey involving 409 households selected using multi-stage sampling was carried out. Trained data collectors administered pre-tested structured questionnaire to collect data on socio-demographic characteristics of household heads or their representatives, their perceptions on IRS and factors associated with IRS acceptability. Descriptive, bivariate and multivariate analyses were done at 5% level of significance. RESULTS: Majority of respondents were male (79.7%) and married (82.6%), and their mean age was 36.4 ± 13.3 years. Coverage of IRS was 99.3%. However, only 82.6% of those who previously accepted IRS were willing to accept it in again. Factors independently associated with acceptability were perceived effectiveness of IRS (aOR = 21.8; 95%CI = 6.9-68.8) and lower household cost of malaria prevention after IRS (aOR = 5.0; 95%CI = 1.1-21.8). CONCLUSION: IRS coverage in the communities studied met WHO minimum standard of 85%. However, for similar results to be achieved in future, acceptability must be promoted by providing information on its effectiveness and its ability to reduce household cost of malaria prevention.

Trend of malaria cases in Kaduna State using routine surveillance data, 2011-2015.

INTRODUCTION: in 2015, 212 million malaria cases and 429,000 malaria deaths were estimated globally. Kaduna State, located in northern Nigeria had a malaria prevalence rate of 36.7% among children less than 5 years old which was higher than the national average of 27%. We assessed the trend of malaria cases in Kaduna State from 2011 to 2015, to analyse trend of malaria in Kaduna as well as describe malaria in time, place and person. METHODS: we conducted secondary data analysis of Kaduna State malaria data between January 2011 and December 2015. Data were extracted from the Integrated Disease Surveillance and Response (IDSR) 003 form. Data of uncomplicated malaria defined as "any person with fever or history of fever within 24 hours; without signs of severe disease (vital organ dysfunction)" was analysed. In IDSR, a case of malaria is based on presumed diagnosis. Frequencies and proportions were calculated. We also conducted trend analysis of incidence of malaria. RESULTS: in the period under study, 1,031,603 malaria cases were recorded with 238 deaths (CFR = 0.23 per 1,000). There was a downward trend with a slope of -3287.2. The data showed higher seasonal variation for quarters 2 (1430.96) and 3 (Q2 = 6,460.23) compared to Quarters 1 (6,857.19) and 4 (-1,034.01). Overall, the age group 12 -59 months had the highest number of incident cases 225, 537 (20.3%). Malaria death was highest in children 1 to 11 months (26.5%) and least, in children 0 -28 days (2.5%). CFR was also highest in children 1 to 11 months (0.45 per 1,000). The highest incidence of malaria cases was in Jaba Local Government Area (47.7%) and the least, in Lere (2.4%). CONCLUSION: there was a decreased incidence of malaria from 2011 to 2015. Malaria was most common in the second and third quarters of each year. Age group 12-59 months was most affected. Kaduna State Malaria Programme should sustain the programs it is implementing and focus more on the under-five years age group.

Evaluating a surveillance system: live-bird market surveillance for highly pathogenic avian influenza, a case study.

INTRODUCTION: Highly pathogenic avian influenza H5N1 was first reported in poultry in Nigeria in February 2006. The only human case that occurred was linked to contact with poultry in a live bird market (LBM). LBM surveillance was instituted to assess the degree of threat of human exposure to H5N1. The key indicator was detection of H5N1 in LBMs. We evaluated the surveillance system to assess its operations and attributes. METHODS: We used the US Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems. We reviewed and analyzed passive surveillance data for HPAI (January 2006-March 2009) from the Avian Influenza National Reference Laboratory, and live bird market surveillance data from the Food and Agriculture Organization of the United Nations, Nigeria. We interviewed key stakeholders and reviewed reports of live bird market surveillance to obtain additional information on the operations of the system. We assessed the key system attributes. RESULTS: A total of 299 cases occurred in 25 (72%) states and the Federal Capital Territory (FCT). The system detected HPAI H5N1 virus in 7 (9.5%) LBMs; 2 (29%) of which were from 2 (18.2%) states with no previous case. A total of 17,852 (91.5%) of samples arrived at the laboratory within 24 hours but laboratory analysis took over 7 days. The sensitivity and positive predictive value (PPV) were 15.4% and 66.7% respectively. CONCLUSION: The system is useful, flexible, complex and not timely, but appears to be meeting its objectives. The isolation of HPAI H5N1 virus in some of these markets is an indication that the markets are possible reservoirs of the virus in Nigeria. We recommend that the Federal Government of Nigeria should dedicate more funds for surveillance for HPAI as this will aid early warning and reduce the risk of a pandemic.

Palliative care research in Africa: consensus building for a prioritized agenda.

CONTEXT: Palliative care research in Africa is in its relative infancy, with dedicated financial support extremely limited. Therefore, setting research priorities to optimize use of limited resources is imperative. OBJECTIVES: To develop a prioritized research agenda for palliative care in Africa. METHODS: We used a two-stage process involving palliative care professionals and researchers: 1) generation of an initial topic list at a consultative workshop of experts and 2) prioritization of that list using a consensus development process, the nominal group technique. RESULTS: Phase 1: 41 topics were generated across five groups, with several topics nominated in more than one group. Phase 2: 16 topics and three broad thematic areas were identified. The two most prioritized topics within each of the three themes were the following: Theme 1: patient, family, and volunteers-1) care outcomes and the impact of palliative care as perceived by patients and caregivers and 2) palliative care needs of children; Theme 2: health providers-1) impact of palliative care training on care and practice and 2) integration of palliative care and antiretroviral therapy services; and Theme 3: health systems-1) palliative care needs assessments at the micro-, meso-, and macro-levels and 2) integration of palliative care into health systems and educational curricula. CONCLUSION: Consensus-based palliative care topics determined by the study can assist researchers in optimizing limited research capacities by focusing on these prioritized areas. Subsequent to the identification and publication of the research agenda, concrete steps will be undertaken by the African Palliative Care Research Network and other partners to help implement it.

Community engagement and informed consent in the International HapMap project.

The International HapMap Consortium has developed the HapMap, a resource that describes the common patterns of human genetic variation (haplotypes). Processes of community/public consultation and individual informed consent were implemented in each locality where samples were collected to understand and attempt to address both individual and group concerns. Perceptions about the research varied, but we detected no critical opposition to the research. Incorporating community input and responding to concerns raised was challenging. However, the experience suggests that approaching genetic variation research in a spirit of openness can help investigators better appreciate the views of the communities whose samples they seek to study and help communities become more engaged in the science.