Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study.

BACKGROUND: Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE: To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS: Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS: Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION: Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.

Moving forward: Scaling-up the integration of an HIV and hypertension program in Akwa Ibom State, Nigeria.

Background: As people living with HIV experience increased life expectancy, there is a growing concern about the burden of comorbid non-communicable diseases, particularly hypertension. This policy brief describes the current policy landscape in Akwa Ibom State, Nigeria, the research activities, and five policy recommendations rooted in an ongoing research study designed to integrate hypertension management into HIV care across primary health centers in the state. Analysis: The policy brief was developed in four steps: review of existing policies, using the reviewed policies to inform research activities, solicitation of stakeholder recommendations via focus group discussions, and formulation of the resulting five policy recommendations for integrating hypertension management into HIV care programs in Akwa Ibom. The key analysis for this brief emerged from the thematic analyses of stakeholder responses. Policy Implications: The five policy recommendations for integrating hypertension management in HIV care in Akwa Ibom State, Nigeria are: 1) build capacity by leveraging retired community nurses as mentors; 2) emphasize community engagement; 3) develop consistent training programs on hypertension management for health workers; 4) expand health insurance accessibility; and 5) formally integrate hypertension management into primary healthcare centers in Akwa Ibom State.

Building Capacity of Community Nurses to Strengthen the Management of Uncomplicated Hypertension in Persons Living with HIV in Low- and Middle-Income Countries.

Objectives: Poor training of non-physician healthcare workers (especially community nurses) could hinder the successful integration of cardiovascular disease (CVD) management into HIV chronic care in primary healthcare facilities in low- and middle-income countries. To address this limitation, we included a holistic training programme with a robust module for both practice facilitators and community nurses as part of the formative stages of the managing hypertension among people living with HIV: an integrated model (MAP-IT), which is a study that is evaluating the effectiveness of practice facilitation on the integration of a task-strengthening strategy for hypertension control (TASSH) into primary healthcare centres in Akwa Ibom State of Nigeria. Methods: Between June and November 2021, 3 didactic training workshops were conducted using a training module which is based on the simplified Nigerian Hypertension Protocol for primary care and the World Health Organization (WHO) heart package. Knowledge acquired by the participants was assessed using anonymized pre- and post-training assessments in the first two workshops. Participants' view of the training was assessed using a comprehensive course evaluation questionnaire. Results: A total of 92 community nurses and six practice facilitators were trained in the workshops on managing hypertension in persons living with HIV. Mean pre- and post-test scores improved from 11.9(3.4) to 15.9(2.9); p < 0.001 in the first workshop, and from 15.4(0.9) to 16.4 (1.4); p < 0.001 in the second workshop. The methodology used in the training, understanding of the MAP-IT study programme, and the level of engagement was highly rated by the participants with LIKERT scores of 3.2/4.0, 3.2/4.0, and 3.1/4.0 respectively. Conclusion: Our training methodology, which involved the train-the-trainer model to deliver simplified HIV and HTN care guidelines, showed improvement in the knowledge of managing hypertension in persons living with HIV and was highly rated by participants.

Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration - the MAP-IT trial.

BACKGROUND: As people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a stepped wedge cluster randomized trial (SW-CRT) design to evaluate the effectiveness of practice facilitation on the adoption of a hypertension treatment program for PLWH receiving care at primary healthcare centers (PHCs) in Akwa Ibom State, Nigeria. DESIGN: In partnership with the Nigerian Federal Ministry of Health (FMOH) and community organizations, the MAP-IT trial takes place in 30 PHCs. The i-PARiHS framework guided pre-implementation needs assessment. The RE-AIM framework will guide post-implementation activities to evaluate the effect of practice facilitation on the adoption, implementation fidelity, and sustainability of a hypertension program, as well as blood pressure (BP) control. Using a SW-CRT design, PHCs sequentially crossover from the hypertension program only (usual care) to hypertension plus practice facilitation (experimental condition). PHCs will recruit and enroll an average of 28-32 patients to reach a maximum of 960 PLWH participants with uncontrolled hypertension who will be followed longitudinally for BP outcomes. DISCUSSION: Given the need for integrated NCD-HIV care platforms in low-resource settings, MAP-IT will underscore the challenges and opportunities for integrating hypertension treatment into HIV care, particularly concerning adoption and sustainability. The evaluation of our integration approach will also highlight the potential impact of a health systems strengthening approach on BP control among PLWH. TRIAL REGISTRATION: Clinicaltrials.gov ( NCT05031819 ). Registered on 2nd September 2021.

Spectrum of COVID-19 infection in children in Southern Nigeria

Background: Corona virus disease 2019 (COVID-19) is a global pandemic that affects all age groups. Infected asymptomatic children can transmit the disease to vulnerable adults with co-morbidities resulting in severe disease in the latter. There are few reports of COVID-19 in children in Sub-Saharan Africa in general and in Nigeria in particular. Aim: To determine the prevalence, symptoms and risk factors for COVID-19 in Southern Nigerian children. Methods: This was a one-year retrospective cross-sectional study between April 2020 and March 2021. Data of all children tested for COVID-19 was extracted from the Epidemiology unit of Akwa Ibom state ministry of health. All patient identifiers were omitted and data was analyzed using STATA version 13. Results: Two hundred and fifty five children (2.25%) out of a total of 11,289 people were tested for COVID-19. Fifty -four children (0.47%) of the total number of persons tested for COVID-19 were positive. Twenty one percent of the 255 children tested were positive for COVID-19. Two hundred and fifty- four (99.6%) of children that were tested had a positive history of contact with a confirmed COVID-19 case. Five (9.3%) of COVID-19 positive children were symptomatic. The commonest symptoms seen were Fever (90.9%), Anosmia (63.6%) and Aguesia (36.4%). Increasing age (15 years and above) was significantly associated with COVID-19 positivity (p=0.000). In addition, the presence of symptoms was significantly associated with COVID-19 positivity (p=0.04). Conclusion/Recommendation: The prevalence of COVID-19 in Southern Nigerian children is low. Majority of the children have asymptomatic disease. Increasing age is significantly associated with COVID-19 positivity. We recommend increased COVID-19 testing in the general children population.

Prevalence of Chronic Kidney Disease as a Marker of Hypertension Target Organ Damage in Africa: A Systematic Review and Meta-Analysis.

INTRODUCTION: Hypertension is a major global cause of cardiovascular disease and death with rising worldwide prevalence, particularly in low-income countries. With low awareness, poor treatment, and low control of hypertension in Africans, there is an increased number of patients with target organ damage (TOD), especially chronic kidney disease (CKD), as a consequence of hypertension. The aim of our study is to assess the prevalence of CKD from studies in Africa reporting TOD related to hypertension. METHODS: We performed a search of PubMed/MEDLINE, Web of Science, EBSCOhost, and African Journals Online (AJOL) for studies reporting on CKD as TOD in patients with hypertension. The pooled estimate of CKD was then presented by subregions, age group, eGFR equations, and urban or rural location. RESULTS: We identified 1,334 articles from which 12 studies were included for quantitative analysis. The studies included 5297 participants from 6 countries (Ghana, Nigeria, Uganda, Tanzania, Democratic Republic of Congo, and South Africa). The pooled prevalence of CKD was 17.8% (95% CI 13.0-23.3%), and CKD was significantly more prevalent in West Africa (21.3% (95% CI: 16.1-27.0); p < 0.0001) and in studies conducted in urban settings (p < 0.001). CKD prevalence was not significantly different by type of GFR equation or age. CONCLUSION: This study reports a high prevalence of CKD related to hypertension with a higher prevalence in urban than rural areas. This emphasizes the role of hypertension in causing kidney damage, and the need for strategies to improve awareness, treatment, and control of hypertension in Africans. This study is registered with PROSPERO registration number CRD42018089263.

Knowledge, awareness and perception of health care workers towards COVID-19 in Southern Nigeria

Context: Severe acute respiratory coronavirus disease 2019 (SARS-COVID-19) is a novel worldwide pandemic. Health care workers (HCWs) are at high risk of contacting the infection. Objective: To determine the knowledge, awareness and perceptions of HCWs towards COVID-19 in Southern Nigeria. Methods: A descriptive cross-sectional questionnaire study carried out between May 2020 and July 2020. Healthcare workers responded to questions covering their sociodemographic characteristics, knowledge of transmission, cure and outcome of COVID-19. Other questions asked were their perception about contacting the disease, and their facility preparedness to handle the pandemic. Data was analysed using Stata version 13. Results: A total of 366 healthcare workers completed the questionnaires. The mean age of respondents was 35.2 years. There were 209 (57.1%) males. Majority (44.5%) of the respondents were doctors. The top three symptoms identified by respondents were cough (97%), fever (92.9%) and sore throat (88%). Three hundred and sixty-four (99.5%) respondents had good level of knowledge of COVID -19. Two hundred and ninety (79.2%) of the respondents were worried about contacting COVID-19. Two hundred and thirty-five (64.2%) respondents said their facilities were not prepared to manage COVID-19 cases. Areas of concern were the absence of test kits and sample materials (70.5%), lack of personal protective equipment (PPE) (67.2%) and lack of dedicated intensive care units with ventilators (62%). Conclusion: There was good knowledge of COVID-19 among HCWs. However, there was a high degree of anxiety of contacting COVID-19 among HCWs and concerns about a general lack of preparedness for COVID-19 management. We therefore recommend the adequate provision of PPE and improved testing.

Assessment of Resources for Primary Health Care: Implications for the Revitalization of Primary Health Care in Akwa Ibom, Nigeria.

CONTEXT: Primary health care (PHC) is the cornerstone of the Nigerian National Health Policy. The national policy on PHC under one roof is undergoing implementation nationwide as a means of strengthening the PHC system. Akwa Ibom State (AKS) is set to commence full implementation of the policy. AIMS: The aim of the study was to assess the existing human resource and infrastructure in PHC facilities in AKS. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out in 18 facilities selected from the three senatorial zones of AKS, Nigeria. SUBJECTS AND METHODS: A rapid assessment of selected PHC facilities based on a checklist adapted from the minimum standards for PHC as provided by the National PHC Development Agency. The results were analyzed using Excel and presented in tables. RESULTS: A total of 18 health facilities were included in the study. Human resources available were 276 full time core health workers, of which 48 (17.4%) were volunteer workers. There was inequitable distribution in district and facility type as 122(44.2%) work in Ikot Ekpene Senatorial district and 242 (87.7%) of them work in the Operational Base. Basic lifesaving equipment such as resuscitation sets was unavailable in more than 50% of the health facilities. CONCLUSIONS: There are absolute deficit and inequitable distribution of available human resources in AKS PHCs. Basic-lifesaving equipment is grossly inadequate. There is an urgent need for more health workers to be employed and provision of basic equipment for the PHCs.

Private sector malaria RDT initiative in Nigeria: lessons from an end-of-project stakeholder engagement meeting.

The malaria rapid diagnosis testing (RDT) landscape is rapidly evolving in health care delivery in Nigeria with many stakeholders playing or having potential for critical roles. A recent UNITAID grant supported a pilot project on the deployment of quality-assured RDTs among formal and informal private service outlets in three states in Nigeria. This paper describes findings from a series of stakeholder engagement meetings held at the conclusion of the project. The agreed meeting structure was a combination of plenary presentations, structured facilitated discussions, and nominal group techniques to achieve consensus. Rapporteurs recorded the meeting proceeding and summaries of the major areas of discussion and consensus points through a retrospective thematic analysis of the submitted meeting reports. Key findings indicate that private providers were confident in the use of RDTs for malaria diagnosis and believed it has improved the quality of their services. However, concerns were raised about continued access to quality-assured RDT kits. Going forward, stakeholders recommended increasing client-driven demand, and continuous training and supervision of providers through integration with existing monitoring and supervision mechanisms.