Qualitative Analysis of One Primary Health Care per Ward in Ekiti State, Nigeria

The "One Primary Health Care (PHC) per Ward" policy is an important health care component for achieving health for all. This study assesses the functionality, successes and challenges in the implementation of 'one PHC per ward' policy in Ekiti State, Nigeria. In-depth and key informant interview guides serve as qualitative research instruments for data collection. Relevant information was sourced from different stakeholders, including the Executives of the State Primary Health Care Development Agency (SPHCDA), the Local Government Chairmen, the Heads of Departments in PHCs, Staff of PHCs and patients who visited PHC facilities, amounting to twenty-five in-depth and seven key informant interviews. Although all the wards assessed had at least one PHC facility, none of the PHC facilities visited met the minimum standards recommended by the National Primary Health Care Development Agency (NPHCDA). PHC facilities located in the rural areas had fewer infrastructural and human resources than those in the urban areas. Routine immunization exercises were improved across the PHC facilities as the Universal Drug Revolving Scheme adopted by the PHCs was successful, largely because of the re-investment of both principal and profit into the purchase of drugs. Results suggest that while routine immunization as an aspect of PHC services had received remarkable successes, the PHC facilities suffered from inadequate equipment and personnel. There is need for a political will and concerted actions that are designed to improve PHC facilities if PHCs are to realize the objectives for setting them up.

Prostate vascular flow: The effect of the ejaculation on the power doppler ultrasonographic examination.

Power Doppler sonography (PD) can accurately depict tissue perfusion, recognize slow flows, and is relatively angle independent. The monitoring of local blood flow by Doppler ultrasonography is helpful in differentiating prostatic physio-pathological conditions, but the recognizing of physiological variables that could affect it is crucial to apply this technique in clinical practice. This study aimed to evaluate if ejaculation affects blood flow to the prostate and to state how long this effect lasts. Serial PD examinations of prostate were performed in 18 dogs (1-5 years, 6-40 kg) immediately before (T0) and after (T1) the ejaculation, and repeated 6 (T2), 18 (T3) and 24 (T4) hours later. For each examination, two representative PD images were chosen and ranked by two independent observers according to the following scoring system: 0 = mild subcapsular (S) vascularization without clear evidence of parenchymal (P) vascularization; 1 = moderate P and S vascularization; 2 = severe S and moderate P vascularization; 3 = severe P and moderate S vascularization; 4 = severe P and S vascularization. Interobserver agreement was assessed using Kappa of Cohen. Ranked data, grouped according to time, were compared by ANOVA and Tukey HSD test (p < .05). Variations in the vascular flow pattern at different times were observed for all dogs. The statistical analysis evidenced a significant difference for T0 vs T1 and vs T2 and vs T3 (p < .01), with no significant difference for T0 vs T4 (p > .05). Interobserver agreement was very good (Kappa of Cohen = 0.86). This study demonstrated a definite increase in vascular flow to the prostate after ejaculation. The present results suggest a minimum of 24 hr sexual rest before the PD examination of the gland. This result should be taken into account whenever Doppler sonography is used to evaluate potential hyperaemia in dogs suspected of having prostate abnormalities.

Canine prostate specific esterase (CPSE) as an useful biomarker in preventive screening programme of canine prostate: CPSE threshold value assessment and its correlation with ultrasonographic prostatic abnormalities in asymptomatic dogs.

Due to the increased attention that pet-owners devote to their animals and to the improved veterinary care, investigations regarding methods to early detect prostatic disorders that might affect canine life quality have been performed. Canine prostate specific esterase (CPSE) concentration was reported to be higher in dogs suffering from prostatic diseases. This study aimed to estimate the CPSE threshold as a biomarker to early identify prostatic diseases in asymptomatic dogs. The ultrasonographic examination of the prostate was performed in 19 dogs (6-40 kg; 1-5 years) with no symptoms of prostatic diseases. Dogs were grouped according to the presence (Group A) or absence (Group B) of prostatic disorders at the ultrasound (altered appearance, the presence of cysts or irregular borders). For each dog, a venous blood sample was collected to measure serum CPSE and the ratio between calculated and normal expected prostatic volume was assessed for each dog. The CPSE data were statistically analysed (t test, p < .05), and the CPSE threshold in blood serum between groups was calculated by ROC. In 11 dogs, ultrasonography showed signs of prostatic abnormalities (Group A, 2-5 years), while no signs were detected in eight dogs (Group B, 1-3 years). The calculated/estimated volume ratio resulted greater than 1.5 in Group A dogs. The CPSE was statistically different between groups (p < .0001): higher in Group A (mean = 184.9, SD = 126 ng/ml) than in Group B (38.9 ± 22.1 ng/ml). The cut-off CPSE threshold was 52.3 ng/ml (ROC, AUC = 0.974, SE 95.6%, SP 89.2%). This study suggests that CPSE serum concentration higher than 50 ng/ml in asymptomatic dogs is associated with ultrasonographic alterations and increased the prostatic size (volume by 1.5 times greater than the normal size). As the onset of prostatic disorders often remains asymptomatic, the rapid assessment of CPSE could be suitable for selecting preventively those animals that would require further accurate evaluation.

Assessment of the age for a preventive ultrasonographic examination of the prostate in the dog.

The prostate commonly develops benign prostatic hyperplasia (BPH) in dogs over 5 years, while in aged dogs other pathological findings might be revealed by ultrasonographic exam. The aim of the present study was to estimate the most suitable age for a preventive ultrasonographic examination of the prostate in the dog. The prostate of 1003 intact male dogs of 64 different breeds, of different ages (1-18 years) and bodyweights (2-55 kg) was evaluated with ultrasound, irrespective of the reason for clinical examination. The age of each dog was expressed as the ratio between the actual age and the maximum longevity expected for the breed. Dogs were divided in two groups based on breeds' life expectancy as short life (SL) and long life (LL). The size of the prostate (normal, enlarged or small) and the presence of abnormal sonographic findings were recorded for each dog. The results of the present study indicate that the most suitable age for a preventive ultrasonographic exam of the prostate in the dog is approximately at 40% of its expected longevity, both in short and long life breeds, because at this age there is a strong possibility to be able to detect abnormal prostatic findings. In 47.5% of the dogs at least one abnormal finding of the prostate was revealed by ultrasonographic exam, while dogs with long life expectancy showed a significantly higher prevalence of abnormalities, than dogs with short life expectancy. The most frequent findings were the increase of prostatic size (33.5%) and the presence of at least one cyst (33.6%), with no difference between SL and LL dogs. In conclusion, a preventive examination of the prostate starting at 40% of expected longevity in dogs of short and long life breeds is strongly recommended for early detection of abnormalities, for scheduling specific follow up and for suggesting effective therapeutic protocols.

Determination of gestational time and prediction of parturition in dogs and cats: an update.

Accurate prediction of delivery date in canine and feline allows a better management of parturition, reducing the loss of neonates. This review evaluates the most common methods adopted to accurately predict the day of delivery: determination of ovulation and hormonal assays, first appearance of embryonic/foetal structures using ultrasound or radiography, echographic measurement of extra-foetal and foetal structures, or evaluation of foetal flux and heart rate. Determination of ovulation and hormonal assays at the time of breeding and close to pregnancy term is widely used to predict parturition in dogs (Concannon et al. American Journal of Veterinary Research 44, 1983, 1819; Hayer et al. Journal of Reproduction and Fertility, Suppl. 47, 1993, 93; Hase et al. Journal of Veterinary Medical Science, 62, 2000, 243; Kutzler et al. Theriogenology, 60, 2003a, 1187). In cats, some studies have been carried out, but no hormonal parameters for accurate prediction of parturition have been described so far (Buff et al. Journal of Reproduction and Fertility, Suppl. 57, 2001, 187; De Haas van Dorsser et al. Biology of Reproduction, 74, 2006, 1090; DiGangi et al. Journal of the American Veterinary Medical Association, 237, 2010, 1267; Dehnhard et al. Theriogenology, 77, 2012, 1088). Many studies suggested that gestational timing can be obtained by observation using ultrasound or radiography of specific structures in relation to the time of appearance during gestation (Concannon and Rendano American Journal of Veterinary Research, 44, 1983, 1506; Rendano et al. Veterinary Radiology, 25, 1984, 132; Shille and Gontarek Journal of the American Veterinary Medical Association, 187, 1985, 1021; Davidson et al. Veterinary Radiology, 27, 1986, 109; England et al. Journal of Small Animal Practice, 31, 1990, 324; Yeager et al. American Journal of Veterinary Research, 53, 1992, 342; Zambelli et al. Theriogenology, 57, 2002a, 1981; Zambelli et al. Journal of Feline Medicine and Surgery, 4, 2002b, 95; Zambelli and Prati 2006; Lopate Theriogenology, 70, 2008, 397; Davidson and Baker Topics in Companion Animal Medicine, 24, 2009, 55). Ultrasonographic measurement of extra-foetal and foetal structures is a common and accurate method for the prediction of parturition day during pregnancy, when specific formulae are used depending on the ultrasonographic parameter, the species and, in canines, the size of the bitch (Shille and Gontarek Journal of the American Veterinary Medical Association, 187, 1985, 1021; England et al. Journal of Small Animal Practice, 31, 1990, 324; Luvoni and Grioni Journal of Small Animal Practice, 41, 2000, 292; Luvoni and Beccaglia Reproduction in Domestic Animals, 41, 2006, 27; Lopate Theriogenology, 70, 2008, 397; Michel et al. Reproduction in Domestic Animals, 46, 2011, 926; Beccaglia and Luvoni Reproduction in Domestic Animals, 47, 194, 2012). Recent studies demonstrated that in dogs, the imminence of parturition could be predicted by evaluating foetal flux and foetal heart rate by ultrasound (Gil et al. Theriogenology, 82, 2014, 933; Giannico et al., Animal Reproduction Science, 154, 2015, 105). For an accurate prediction of parturition date, the combination of different methods is desirable.

Prediction of whelping date in large and giant canine breeds by ultrasonography foetal biometry.

OBJECTIVES: To derive the growth curves of the inner chorionic cavity and the biparietal diameter in large and giant dog breeds by ultrasonographic foetal biometry. To evaluate their accuracy in the prediction of whelping date and the effect of litter size and foetal sex ratio. METHODS: Foetal biometry parameters were obtained using serial ultrasonographic examinations in eight large (26 to 40 kg) and nine giant (>40 kg) pregnant bitches with known breeding dates and concentrations of serum progesterone during oestrus. The relationship between inner chorionic cavity or biparietal diameter growth and days to parturition were analysed by linear regression and the equations derived from the growth curves were applied to predict the whelping day. The accuracy of the prediction (whelping day ±1 day and ±2 days) and the litter size and sex ratio were recorded. RESULTS: The results showed a significant relationship between days before parturition and inner chorionic cavity or biparietal diameter. The overall accuracy at ±2 days was greater, than that at ±1 day. In giant breed bitches, the accuracy of the prediction by biparietal diameter was significantly lower in small, than normal litter size. No effect of foetal sex ratio was observed. CLINICAL SIGNIFICANCE: Foetal biometry parameters obtained by ultrasonography can be used to predict whelping dates in large and giant dog breeds.

Feto-maternal heart rate ratio in pregnant bitches: effect of gestational age and maternal size.

Few information is available on parameters that can be used to objectively assess the foetal health during canine pregnancy. To identify a reliable parameter for the evaluation of foetal well-being, the effect of pre-gestational maternal bodyweight and gestational age on foetal heart rate (FHR) and on feto-maternal heart rate ratio (FHR/MHR) was investigated. Seventeen client-owned pregnant bitches of different pre-gestational maternal bodyweight were examined by serial echo colour Doppler. Only data from 11 uncomplicated pregnancies were included in the statistical analysis. The relationship between FHR, and FHR/MHR, and independent variables was analysed by polynomial regression (p ≤ .05). The FHR and the FHR/MHR significantly fitted a multiple quadratic regression for all independent variables. They both increased from 35 to 20 days before parturition and then a decreasing pattern followed. Higher values of both parameters were observed in bitches of lowest and highest bodyweight. Patterns of FHR and FHR/MHR were similar, but the ratio better describes the effect of the independent variables on the data. Thus, the highest significance of FHR/MHR compared to FHR alone encourages the application of this ratio to evaluate foetal well-being. The equation derived by the regression analysis of FHR/MHR could be applied in clinical practice to obtain its expected values in healthy pregnancies.

Congenital abnormality of the vagina complicated by haemato-pyocolpos in a 1-year labrador retriever.

A 1-year-old female Labrador retriever was referred with a few days history of haematic-like vulvar discharge. Physical examination, vaginal inspection and palpation did not reveal any remarkable finding. Transabdominal ultrasound showed echogenic fluid accumulation in the vagina suggesting haemato-pyocolpos. An exploratory laparotomy was performed: a well-delimited ectasic vagina was identified. Ovariohysterectomy and partial vaginectomy and vaginoplasty were performed to spay the bitch and to remove the ectasic vagina. Post-operative recovery and 12-month follow-up were uneventful. Clinical, morphological and histological findings were consistent with a congenital abnormality of the muscular layer of the vagina complicated by haemato-pyocolpos. The disorganization of the vaginal tunica muscularis may have acted as locus minoris resistentiae in the vaginal wall. The organ was dilated and atonic due to the gradual accumulation of physiological fluids complicated by an overgrowth of genital bacteria. This congenital disorder has to be taken into account as differential diagnosis of haemato-pyocolpos with vaginal discharge in young bitches.

Plant poisoning in domestic animals: epidemiological data from an Italian survey (2000-2011).

An Italian epidemiological study based on the human Poison Control Centre of Milan (Centro Antiveleni di Milano (CAV)) data related to domestic animal poisoning by exposure to plants, was carried out in collaboration with the Veterinary Toxicology Section of the University of Milan. It encompasses a 12-year period, from the beginning of 2000 to the end of 2011. Calls related to toxic plants accounted for 5.7 per cent of total inquiries (2150) received by CAV. The dog was the most commonly poisoned species (61.8 per cent of calls) followed by the cat (26 per cent). Little information was recorded for other species. Most exposures (73.8 per cent) resulted in mild to moderate clinical signs. The outcome was reported in only 53.7 per cent of cases, and fatal poisoning accounted for 10.6 per cent of these cases. Glycoside, alkaloid, oxalate, toxalbumin, saponin, terpene and terpenoid-containing plants were recorded and found to be responsible for intoxication. Cycas revoluta, Euphorbia pulcherrima, Hydrangea macrophylla, Nerium oleander, Rhododendron species and Prunus species were the plants most frequently involved. Epidemiological data from this Italian survey provide useful information on animal exposure to plants and confirm the importance of plants as causative agents of animal poisoning.

Effect of imazaquin applications on the growth, leaf chlorophyll and yield of soybean in the Guinea savanna of Nigeria.

Field trials were conducted during the wet seasons of 1989, 1991, 1994 and 1995 to evaluate the effects of pre-emergence and post-emergence applications of four rates of imazaquin (0.00; 0.15; 0.30 and 0.45kg a.i/ha) on the growth, leaf chlorophyll types and grain yield of soybean c.v. SAMSOY 2. Imazaquin applications had no significant effect on the growth of soybean roots on most of the sampling dates, but pre-and post-emergence applications of imazaquin at 0.30 and 0.45kg a.i/ha reduced soybean root nodules at 5 and 7 weeks after planting (WAP). Soybean shoot growth was generally reduced at 5WAP by the pre-emergence and at 7WAP by the higher rates (0.30 & 0.45kg a.i/ha) of post-emergence application of imazaquin. Pre-and post-emergence applications of imazaquin showed a strong tendency to reduce the concentration of chlorophyll a and total chlorophyll at 3 and 5WAP respectively. The concentrations of chlorophyll types in soybean leaves at 9WAP was generally comparable among most treatments especially in 1991. Whole plant fresh weight of soybean at 7WAP was reduced by all rates of post-emergence application of imazaquin. However, there was no significant difference in the whole plant dry weight of soybean at 3 to 7 WAP in 1989 and at 3, 5 and 9WAP in 1991. In each trial, pre-and post-emergence applications of soybean significantly increased the grain yield of soybean compared with the control treatment. This study showed that, inhibition of soybean shoot growth and leaf chlorophyll concentration was transient and that soybean plants require about 6 weeks for complete recovery from imazaquin phytotoxicity.