AMBA CUP: Ensuring Accuracy in Measurement of Volume of Water for Salt Sugar Solution or Oral Rehydration Solution Preparation in Diarrhea Management.

Diarrhea remains a major cause of under-five mortality globally. In 2016, it accounted for 8% of under-five mortality worldwide. Most of these deaths occur in developing countries. Fluid replacement using Oral Rehydration Solution (ORS) or Salt Sugar Solution (SSS), has been the mainstay of diarrhea management. Gaps in knowledge and practice regarding the preparation of these solutions have been identified by various researchers. One challenge encountered by healthcare providers and caregivers of under-five children has been lack of a standard, easy to clean cup for measurement of accurate volume of water for ORS or SSS preparation. Soft drink bottles, which are currently being used, are difficult to clean because of their narrow necks. More so, the size and volume of these bottles change so often that non-numerate caregivers get easily confused. The aim of this paper is to introduce the AMBA CUP, an easy-to-clean cup that can be used to accurately measure one litre of water for SSS or ORS preparation.

Predictors of utilization of facility-based ante-natal care and delivery services in a Nigerian Rural Community.

Background: With maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth. The objective of this study was to assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria. Method: This was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25. Results: Binary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219-1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305-1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616-13.962). Conclusion: The predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.

Factors influencing adherence to antiretroviral therapy among HIV-infected adults in Cross River State, Nigeria: a cross-sectional study.

Introduction: improved access to antiretroviral therapy (ART) has significantly increased the survival and quality of life of HIV-infected persons. Strict adherence to antiretroviral therapy (ART) is crucial if viral suppression must remain optimal. We assessed predictors of adherence to ART among adult patients in Cross River State (CRS), Nigeria. Methods: a cross-sectional survey was conducted among 999 adult patients on ART in selected secondary and tertiary health facilities in CRS from January to June 2017. Respondents were recruited using multistage technique. Data were collected using a pre-tested interviewer-administered questionnaire. Adherence was defined as clients taking at least 95% of their pills in the last seven days. Multivariate analysis was performed to determine predictors of adherence at 5% level of significance. Results: majority (70.5%) of the respondents were females with a mean age of 43.7 ± 11.1 years. The self-reported adherence rate was 60.1%. The commonest reasons for non-adherence was client travelling out of home, being busy, forgetting and lack of food. The significant predictor identified in this study was being on first-line drugs (OR=3.677, 95% C.I=2.523-5.358), were 3 times more likely to have good adherence. Predictors of poor-adherence were alcohol intake (OR=0.382, 95% C.I=0.262-0.559), dosing medications (OR=0.502, 95% C.I=0.381-0.661), CD4 cell count ≥ 500 (OR=0.723, 95% C.I=0.543-0.964), poor attitude to HIV status and medication (OR=0.713, 95% C.I=0.512-0.994) and family support (OR=0.736, 95% C.I=0.544-0.995). Conclusion: adherence to ART among clients in this study was fair. Majority of the reasons for poor-adherence were client-related. There is need for targeted counselling to improve adherence.

Potential barriers to and facilitators of civil society organization engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria: an implementation research.

BACKGROUND: Civil society organizations (CSOs) are important in health care delivery. They have the potential to play significant roles in immunization-related services, such as advocacy, health education, demand creation and resource mobilization. Their roles are often indispensable, diverse and beneficial in reducing infant morbidity and mortality due to vaccine-preventable diseases. This study explored the potential barriers to and facilitators of CSO engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria. METHODS: The study adopted qualitative data collection methods. Twenty-two focus group discussion (FGD) sessions, three in-depth interviews (IDIs) and 26 key informant interviews (KIIs) were conducted. Appropriate guides (FGD guide, IDI guide and KII guide) were used to conduct face-to-face interviews and the discussions. The FGDs, KIIs and IDIs were audio-recorded and transcribed. A framework analysis approach involving five key stages of analysis (familiarization with data, identification of thematic framework, indexing, charting, mapping/interpretation) was used for data analyses and presentation. RESULTS: CSOs encounter barriers in the course of their immunization advocacy, communication and social mobilization due to male child preference, leading to shielding of male children and not allowing them to be given immunization, as well as patriarchy, safety concerns, religious concerns, anti-vaccine misinformation and rumours, low perception of effectiveness and efficacy of vaccines, inaccessibility of localities, low health literacy and superstitious beliefs. Various community structures, such as the institution of the village head, elders' council and town crier (announcer), and the existence of change agents, act as facilitators of immunization advocacy and uptake. Factors such as traditional control mechanisms including masquerades and religion act as either barriers or facilitators depending on the community and the mode of deployment. CSO members are willing to overcome these barriers and leverage the facilitators. CONCLUSIONS: For successful engagement in immunization-related services, there are barriers in the study area that CSOs should overcome, such as male child preference and geographic inaccessibility, as well as facilitators that they should leverage such as traditional information dissemination systems and enforcement of compliance by the chiefs and elders' council.

Dengue fever - an update review and implications for Nigeria, and similar countries.

BACKGROUND: In the last five decades, dengue has emerged as one of the most important infectious diseases, following a 30-fold increase in global incidence throughout tropical and sub-tropical regions of the world. The actual numbers of dengue cases are under-reported and many cases are misclassified. OBJECTIVES: This article describes the epidemiology, pathophysiology, clinical features and management of dengue. It also explores the implications of infection with this flavivirus for Nigeria, and similar countries. METHODS: The literature search for publications on dengue in West Africa was performed using PubMed, African Journals Online (AJOL), Google Scholar, Web of Science, databases and grey literature to identify all published papers regarding the topic. A snowballing strategy was adopted to identify additional publications. RESULTS: Recent reports suggest that dengue is a growing public health problem in Nigeria, the magnitude of which needs to be more clearly defined. Nigeria, the most populous country in Africa has an abundance of the Aedes aegypti mosquito which is known to transmit dengue, Zika, as well as chikungunya (CHIKV) and West Nile viruses. CONCLUSION: This article provides practical suggestions for strengthening the dengue virus control programme in Nigeria. The Nigerian health system shares similarities with health systems in many other sub-Saharan countries. Therefore, the practical suggestions provided at the end of this review are likely to be applicable to many other African countries.

Occupational Hazards and Health Problems among Butchers in Uyo, Nigeria.

INTRODUCTION: Butchers are exposed to various types of hazards in the course of their work, which could lead to health problems of varying severity. The aim of this study was to identify the occupational hazards and health problems of butchers in Uyo and also assess the physical conditions of their slaughter facilities. MATERIALS AND METHODS: A descriptive cross-sectional study was carried out among 157 butchers in Uyo using a semi-structured questionnaire for data collection. Facility assessment was made using a checklist. Analysis was carried out using Statistical Package for Social Sciences version 20. Level of significance was set at 0.05. RESULTS: The mean age of respondents was 33 ± 9.94 years. Most respondents were males (83.4%). The most commonly reported workplace hazards were knife (93.6%), bones (57.3%), and slippery floor (24.8%). The most common health problems were knife cuts (87.3%), cuts from bones (50.3%), and neck pain (36.9%). Having injuries from live animals and back pain were significantly associated with working with cows (P < 0.05). The most common de-furring method was burning with firewood (61.1%). The slaughter facilities lacked many expected amenities of a standard abattoir. CONCLUSION: Identified hazards and health problems of butchers were numerous. The slaughter facilities lacked appropriate equipment that promotes workers' health and safety. It is recommended that slaughter facilities be upgraded to meet the standard abattoir practice. Regular training of butchers should be organized by their association to encourage safer practice, including the use of appropriate protective wears. Use of the chemical method of de-furring should also be encouraged to limit exposure to harmful gases.

Occupational hazards and health problems among butchers in Uyo, Nigeria

Introduction: Butchers are exposed to various types of hazards in the course of their work, which could lead to health problems of varying severity. The aim of this study was to identify the occupational hazards and health problems of butchers in Uyo and also assess the physical conditions of their slaughter facilities. Materials and Methods: A descriptive cross-sectional study was carried out among 157 butchers in Uyo using a semi-structured questionnaire for data collection. Facility assessment was made using a checklist. Analysis was carried out using Statistical Package for Social Sciences version 20. Level of significance was set at 0.05. Results: The mean age of respondents was 33 ± 9.94 years. Most respondents were males (83.4%). The most commonly reported workplace hazards were knife (93.6%), bones (57.3%), and slippery floor (24.8%). The most common health problems were knife cuts (87.3%), cuts from bones (50.3%), and neck pain (36.9%). Having injuries from live animals and back pain were significantly associated with working with cows (P < 0.05). The most common de-furring method was burning with firewood (61.1%). The slaughter facilities lacked many expected amenities of a standard abattoir. Conclusion: Identified hazards and health problems of butchers were numerous. The slaughter facilities lacked appropriate equipment that promotes workers' health and safety. It is recommended that slaughter facilities be upgraded to meet the standard abattoir practice. Regular training of butchers should be organized by their association to encourage safer practice, including the use of appropriate protective wears. Use of the chemical method of de-furring should also be encouraged to limit exposure to harmful gases

Ebola virus disease: assessment of knowledge, attitude and practice of nursing students of a Nigerian University.

BACKGROUND: Ebola virus disease has a high case fatality rate. Health care providers have a key role to play in its management and prevention. OBJECTIVES: The aim of this study was to determine the knowledge, attitude and practice regarding Ebola virus disease (EVD) among students of Nursing in the University of Calabar, Calabar, Nigeria. METHODS: This was a descriptive cross-sectional study. A semi-structured,self-administered questionnaire was administered to 178 nursing students. The respondents were selected using systematic random sampling. RESULTS: Lecturers were the commonest source of information regarding EVD as reported by 84.5% of the respondents followed by television (76.3%). Nearly 27% of respondents indicated that the fear of EVD had dampened their interest and enthusiasm in the nursing profession. Nearly 12 % indicated that they would not take part as theatre nurses in the surgical operation of a patient who had been certified cured of EVD. A similar proportion indicated their unwillingness to attend to a woman in labour even if she had been certified cured of EVD. CONCLUSION: Majority of the students were knowledgeable about EVD. Although majority of them had favorable attitude towards EVD patients, there was evidence of stigmatizing and discriminatory attitude that needs to be addressed.

Factors Responsible for Disclosure of HIV Seropositivity among Residents of Cross River State, Nigeria.

CONTEXT: Disclosure of HIV-positive status to sex partners is viewed as a preventive measure and as a social and legal responsibility for HIV-infected individuals. AIMS: The aim of this study is to determine the proportions and factors responsible for disclosure of HIV seropositivity among residents of Cross River State, Nigeria. SETTINGS AND DESIGN: This was a cross-sectional comparative study. SUBJECTS AND METHODS: It involved 320 HIV-positive individuals equally selected from the urban and rural settings of Cross River State and use questionnaires. STATISTICAL ANALYSIS USED: Data analysis used SPSS version 20.0. Chi-square test and logistic regression were used to identify determinants of HIV status disclosure. RESULTS: Among urban respondents, 93.8% had disclosed compared with 79.4% among rural respondents, the difference was statistically significant (P < 0.001). There was a statistically significant association between HIV status disclosure and age (P = 0.008), marital status (P = 0.027), number of nonspousal sexual partner (P = 0.006), and area of residence (P < 0.001). There was no statistically significant association between HIV status disclosure and gender (P = 0.622), between occupation (P = 0.495) or income (P = 0.351 and head of household (P = 0.241). There was statistically significant association between HIV status disclosure and level of education (P = 0.015), house ownership (P = 0.008), time from diagnosis (P = 0.003), and duration of treatment (P = 0.002). CONCLUSIONS: This study has shown that HIV seropositive status disclosure was higher when compared with other local studies, and age, marital status, and area of residence were factors associated with HIV seropositive status disclosure.

Evaluation of pulmonary tuberculosis case detection improvement with the deployment of XpertMTB/Rif in the tuberculosis control program of cross River State, Nigeria.

OBJECTIVE/BACKGROUND: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl-Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program. MATERIALS AND METHODS: Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif. RESULTS: A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4-89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively). CONCLUSION: The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients.

Child Survival Strategies: Assessment of Knowledge and Practice of Rural Women of Reproductive Age in Cross River State, Nigeria.

Introduction. Nigeria is one of the five countries that account for about 50% of under-five mortality in the world. The objective of this study was to assess the knowledge and practice of child survival strategies among rural community caregivers in Cross River State of Nigeria. Materials and Methods. This descriptive cross-sectional survey used a pretested questionnaire to obtain information from 150 women of reproductive age. Data analysis was done using SPSS version 20. Results. The child survival strategy known to most of the respondents was oral rehydration therapy as indicated by 98% followed by female education by 73.3% and immunization by 67.3%. Only 20% of the respondents had adequate knowledge of frequency of weighing a child while only 32.7% knew that breastfeeding should be continued even if the child had diarrhea. More respondents with nonformal education (83.3%) practiced exclusive breastfeeding of their last children compared to respondents with primary education (77.3%), secondary education (74.2%), and tertiary education (72.2%). Conclusion. Although respondents demonstrated adequate knowledge and practice of most of the strategies, there was evidence of gaps, including myths and misconceptions that could mar efforts towards reducing child morbidity and mortality in the state.

Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study.

BACKGROUND: Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women's compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria. METHODS: A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population. RESULTS: Use of SP-IPTp was self-reported by 41% of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83%). Other barriers were stock-outs of free SP (33%) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33%). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95% CI: 1.70-3.73) and SP (OR = 22.13, 95% CI: 8.10-43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95% CI: 1.24-12.31). CONCLUSIONS: Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP.

Knowledge and perception of microbicides among healthcare providers in Calabar, Nigeria.

BACKGROUND: With the worldwide spread of HIV/AIDS, the absence of a known cure and the challenges associated with existing prevention methodologies, there is need for new prevention technologies. The successful uptake of healthcare products and services depend, to a large extent, on healthcare providers' knowledge, perception and attitude regarding them. OBJECTIVES: To determine the knowledge and perception of healthcare providers regarding microbicides. METHODS: A semi-structured questionnaire was administered on 400 randomly selected health care providers in Calabar, Cross River State of Nigeria. Data obtained from the 350 returned questionnaire were analyzed using EPI -Info software version 3.5.1. RESULTS: One hundred and sixty-four (46.9%) respondents were medical doctors while 157 (44.9%) were nurses, 7 (2%) were Pharmacists and 22 (6.2%) belonged to "other" categories. Thirty- two percent knew the advantages of microbicides over condoms. Sixty-eight percent indicated that microbicides would benefit only women while to 27%, it would benefit both men and women. Seventy-five percent of respondents would be willing to act as community advocates for microbicides while 21% would not be willing and 4% were not decided. There was a statistically significant association between professional group and willingness to act as community advocates for microbicides. Medical doctors were more likely to act as advocates than other professional groups (p<0.05). Female respondents were more likely to have correct knowledge regarding microbicides than males (p<0.05). CONCLUSION: There are gaps in knowledge regarding microbicides among the health care providers. Capacity building would be successful since the majority are willing to act as community advocates.

Knowledge and Perception of Microbicides among Healthcare Providers in Calabar; Nigeria

"Background: With the worldwide spread of HIV/AIDS; the absence of a known cure and the challenges associated with existing prevention methodologies; there is need for new prevention technologies. The successful uptake of healthcare products and services depend; to a large extent; on healthcare providers' knowledge; perception and attitude regarding them. Objectives: To determine the knowledge and perception of healthcare providers regarding microbicides. Methods: A semi-structured questionnaire was administered on 400 randomly selected health care providers in Calabar; Cross River State of Nigeria. Data obtained from the 350 returned questionnaire were analyzed using EPI -Info software version 3.5.1 Results: One hundred and sixty-four (46.9) respondents were medical doctors while 157 (44.9) were nurses; 7 (2) were Pharmacists and 22 (6.2) belonged to ""other"" categories. Thirty- two percent knew the advantages of microbicides over condoms. Sixty-eight percent indicated that microbicides would benefit only women while to 27; it would benefit both men and women. Seventy-five percent of respondents would be willing to act as community advocates for microbicides while 21 would not be willing and 4 were not decided. There was a statistically significant association between professional group and willingness to act as community advocates for microbicides. Medical doctors were more likely to act as advocates than other professional groups (p0.05). Female respondents were more likely to have correct knowledge regarding microbicides than males (p0.05) Conclusion: There are gaps in knowledge regarding microbicides among the health care providers. Capacity building would be successful since the majority are willing to act as community advocates."

Awareness of birth preparedness and complication readiness in southeastern Nigeria.

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ(2) = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ(2) = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted.

Malaria: knowledge and prevention practices among school adolescents in a coastal community in Calabar, Nigeria

Background: Malaria prevention and treatment constitute an unbearable economic burden to most African countries, especially south of the Sahara, where about 500 million cases occur annually. The problem of malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children. Attention to malaria among adolescents has also been diverted by the huge burden of HIV/AIDS among adolescents. Some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on school children, who could be used as change agents and as role models for their siblings and peers in the malaria control strategy. Objectives: To determine the malaria prevention practices of school adolescents in the coastal community of Calabar, Nigeria. Method: This was a cross-sectional survey involving secondary schools in southern Calabar. Four hundred adolescents were randomly selected from the 4565 learners in 5 out of 17 secondary schools in southern Calabar, Cross River State, Nigeria. A self-administered, semi-structured questionnaire was administered to the respondents. Results: Most respondents (77.5%) were aware that the vector transmits the malaria parasite through biting. Fewer respondents would prevent malaria attacks by clearing the vegetation in the peri-domestic environment (13.5%), filling up potholes (16.9%), opening up drainage (11%), using insecticide-treated nets (25.7%) or using antimalarial drugs (11.2%). Less than one-tenth (8%) would use various other methods such as not accepting unscreened blood, while only 11% obtained the information from their teachers. Conclusion: The study identified knowledge gaps among school children. There is a need to empower teachers with information about the cause of malaria and prevention strategies