Tuberculosis/HIV Prevalence and Treatment Success among Children Receiving Care in Two Tertiary Health Facilities within Ogun State, Nigeria.

Background: About 1 million children become ill with tuberculosis every year, representing 10-12% of all cases of tuberculosis notified globally. HIV infection in children is often due to transmission from mothers to children. HIV infection in children increases their risk of having tuberculosis. Sub-Sahara Africa has one of the highest TB incidences and HIV prevalence thus children in this region bear a huge burden of TB/HIV infection. In addition, the treatment success rate in many countries is rarely disaggregated to evaluate children. Thus, this study aims to determine the prevalence of TB/HIV coinfection and treatment success among children with tuberculosis attending clinics in two tertiary institutions in Ogun State, Nigeria. Methodology: The study was a retrospective cohort study of routine programme data of all children diagnosed and treated for tuberculosis from January 2015 to June 2017 in two tertiary hospitals in OgunState, Nigeria. The hospitals were Olabisi Onabanjo University Teaching Hospital Sagamu and Federal Medical Centre Abeokuta, Ogun State. Data were retrieved from the facility TB register and analyzed using epi info. Results: A total of 759 patients were registered for treatment at the two tertiary facilities between January 2015 and June 2017. Of these, 112(14.8%) were children 0-14 years of age. Most of the children (95.54%) had pulmonary tuberculosis. Treatment success was 81.3%. About half (46.4%) of the patients were HIV positive. Age, site of disease, bacteriological diagnosis, and weight at the commencement of treatment were significantly associated with HIV status while none of the socio-demographic variables were associated with treatment outcome. Conclusion: There is a need to look for ways to further improve the current treatment success rate of children with tuberculosis. There should be increased efforts also to find better ways of diagnosing childhood tuberculosis. The high HIV rate among children with TB is of concern and strategies should be put in place to prevent HIV transmission to children.

Maternal and perinatal outcomes of birth preparedness and complication readiness in recently delivered women of a Southwestern Nigerian Town.

Context: Birth preparedness and complication readiness (BPCR) have been shown to increase knowledge of danger signs and enhance access to skilled obstetric care. Previous studies have focused on intermediate outcomes of BPCR such as utilization of skilled care for pregnancy and delivery. Aims: This study aims to determine the maternal and perinatal outcomes associated with birth preparedness and complication readiness. Settings and Design: A cross-sectional study involving 827 recently delivered women, attending selected health facilities in Ikenne, southwestern Nigeria. Materials and Methods: BPCR was determined from a set of eight indicators that were developed by the John Hopkin's Bloomberg School of Public Health. Statistical Analysis: The data were analyzed using SPSS version 21. Bivariate analysis was done using Chi-square test, and binary logistic regression model was used to assess factors related to BPCR practice among respondents. The level of statistical significance was set to P < 0.05. Results: BPCR was observed in 470/827 (56.8%) of the participants. Only a minority had knowledge of financial - 125/827 (15.1%) and transportation assistance - 56/827 (6.8%). Knowledge of ≥ 5 danger signs of pregnancy was also low, 286/827 (34.6%). Institutional delivery was in only 331/827 (40%), and it depended on being birth prepared and complication ready (adjusted odds ratio [AOR] =0.534, 95% confidence interval [CI] =0.319-0.893). Significantly more perinatal deaths occurred to women who were not birth prepared (AOR = 2.951, 95% CI = 1.436-6.062), although no difference existed for perinatal (AOR = 1.202, 95% CI = 0.653-2.214) and maternal (AOR = 0.744, 95% CI = 0.452-1.226) morbidities. Conclusion: The knowledge and practice of key indicators of BPCR that reflect utilization of community resources in Ikenne Local Government Area is very poor. BPCR was an important determinant of perinatal survival.

RésuméContexte: Il a été démontré que la préparation à L'accouchement et la préparation aux complications (PAPC) permettent d'accroître la connaissance des signes de danger et d'améliorer l'accès à des soins obstétriques spécialisés. Des études antérieures ont mis l'accent sur les résultats intermédiaires du PAPC, comme l'utilisation de soins spécialisés pour la grossesse et l'accouchement. Objectifs: Cette étude vise à déterminer les résultats maternels et périnatals associés à la préparation à la naissance et à la préparation aux complications. Paramètres et Design: Une coupe transversale de l'étude impliquant 827 récemment livré des femmes, fréquentent les établissements de santé sélectionnés dans Ikenne, sud-ouest du Nigéria. Matériel et Méthodes: la PAPC a été déterminée à partir d'un ensemble de huit indicateurs élaborés par la John Hopkins Bloomberg School of Public Health. Analyse statistique: Les données ont été analysées à l'aide de la version 21 du SPSS. Une analyse bivariée a été effectuée à l'aide du test du Chi carré, et un modèle de régression logistique binaire a été utilisé pour évaluer les facteurs liés à la pratique du PAPC chez les répondants. Le niveau de signification statistique a été fixé à P < 0.05. Résultats: le PAPC a été observé chez 470/827 (56,8%) des participants. Seule une minorité avait une connaissance de l'aide financière ­ 125/827 (15,1%) et de l'aide au transport ­ 56/827 (6,8%). La connaissance de ≥ 5 signes de danger de grossesse était également faible, 286/827 (34,6%). Le taux d'accouchement en établissement n'était que de 331/827 (40%), et il dépendait de la préparation de la naissance et de la complication (rapport de cotes ajusté [RAO] =0,534, intervalle de confiance à 95% [IC] =0,319­0,893). Il y a eu beaucoup plus de décès périnataux chez les femmes qui n'étaient pas préparées à la naissance (RAO = 2,951, IC à 95% = 1,436­6,062), bien qu'aucune différence n'ait été observée pour les morbidies périnatales (RAO = 1,202, IC à 95% = 0,653­2,214) et maternelles (RAO = 0,744, IC à 95% = 0,452­1,226). Conclusion: la connaissance et la pratique des indicateurs clés du PAPC qui reflètent l'utilisation des ressources communautaires dans la zone de Gouvernement Local D'Ikenne est très faible. Le PAPC a été un déterminant important de la survie périnatale.

A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria.

BACKGROUND: Despite increased investment in community-level maternal health interventions, process evaluations of such interventions are uncommon, and can be instrumental in understanding mediating factors leading to outcomes. In Nigeria, where an unacceptably number of maternal deaths occur (maternal mortality ratio of 814/100,000 livebirths), the Community Level Interventions for Pre-eclampsia (CLIP) study (NCT01911494) aimed to reduce maternal and neonatal mortality and morbidity with a complex intervention of five interrelated components. Building from previous frameworks, we illustrate a methodology to evaluate implementation processes of the complex CLIP intervention, assess mechanisms of impact and identify emerging unintended causal pathways. METHODS: The study was conducted from 2013-2016 in five Local Government Areas in Ogun State, Nigeria. A six-step approach was developed to evaluate key constructs of context (external factors related to intervention), implementation (fidelity, dose, reach, and adaption) and mechanisms of impact (unintended outcomes and mediating pathways). The steps are: 1) describing the intervention by a logic model, 2) defining acceptable delivery, 3) formulating questions, 4) determining methodology, 5) planning resources in context, lastly, step 6) finalising the plan in consideration with relevant stakeholders. RESULTS: Quantitative data were collected from 32,785 antenatal and postnatal visits at the primary health care level, from 66 community engagement sessions, training assessments of community health workers, and standard health facility questionnaires. Forty-three focus group discussions, 38 in-depth interviews, and 23 structured observations were conducted to capture qualitative data. A total of 103 community engagement reports and 182 suspected pre-eclampsia case reports were purposively collected. Timing of data collection was staggered to understand feedback mechanisms that may have resulted from the delivery of the intervention. Data will be analysed using R and NVivo. Diffusions of innovations and realist evaluation theories will underpin analysis of the interaction between context, mechanisms and outcomes. CONCLUSION: This comprehensive approach can serve as a guide for researchers and policy makers to plan the evaluation of similar complex health interventions in resource-constrained settings, and to aid in measuring 'effectiveness' of interventions and not just 'efficacy'. TRIAL REGISTRATION: This research is a part of the Community Level Interventions for Pre-eclampsia Study, NCT01911494. The trial is registered in Clinicaltrials.gov, the URL is https://clinicaltrials.gov/ct2/show/NCT01911494 The trial was registered on June 28, 2013 and the first participant was enrolled for intervention on March 1, 2014.

Treatment Outcomes of Childhood TB in Lagos, Nigeria.

BACKGROUND: : Treatment outcomes of tuberculosis (TB) in children are rarely evaluated by most national TB programmes in sub-Saharan Africa. This study evaluated the treatment outcomes of children treated for TB in Lagos State, Nigeria. METHODS: A retrospective review of programme data of the Lagos state TB and the Leprosy control programme in Nigeria from 1 January 2012 to 31 December 2012. Treatment outcomes were categorized according to the national TB guidelines. RESULTS: A total of 535 cases of childhood TB were notified in 2012, representing 6.3% of the total TB cases notified in Lagos state in 2012. The prevalence of TB/HIV co-infection was 29%. The treatment success rate was 79.2% in TB/HIV-negative children compared with 73.4% in TB/HIV-positive children (p = 0.1268). Children <1 year had the worst treatment outcomes (p < 0.001). CONCLUSION: There is a need to intensify effort at improving notification and treatment outcomes in children.

Knowledge of HIV/AIDS and predictors of uptake of HIV counseling and testing among undergraduate students of a privately owned university in Nigeria.

INTRODUCTION: The spread of HIV/AIDS among the reproductive age group particularly young adults is a major public health concern in Nigeria. Lifestyles of students on university campuses put them at increased risk of contracting the HIV. The aim of this study was to assess the level of HIV/AIDS knowledge and to investigate the factors that were correlated with the uptake of and willingness to take up HIV counseling and testing. METHODS: A cross-sectional study of 1,250 university students selected by 2-stage random sampling technique using self-administered questionnaire. RESULTS: The participants consisted of 57.7% females and 42.3% males with ages ranging from 15 to 32 years and a mean of 19.13 ± 2.32 years. The awareness of HIV was universal. The knowledge about HIV/AIDS was very high with a mean score of 8.18 ± 1.60 out of 10; and 97.1% of participants having good knowledge of HIV/AIDS. The major source of HIV/AIDS information was the mass media. There was a significant difference in knowledge of HIV/AIDS by gender where male students had better knowledge about HIV/AIDS than females [t (1225) = 3.179, p = 0.002]. While 95% of the participants knew where to get an HIV test done, only 30.4% had tested for HIV within the six months preceding the study. However, 72.2% of them were willing to test for HIV. There was no significant association between demographic characteristics and having tested for HIV in the preceding six months but there was significant association between willingness to have an HIV test and the participants' age groups, sex, marital status and their knowledge of HIV/AIDS. Participants who were aged 21 years and above and had good knowledge about HIV were more willing to take an HIV test. Females were more willing to take an HIV test than males. CONCLUSION: The participants' knowledge about HIV /AIDS was quite good, the willingness to have HIV test done was high and the knowledge of a place where test can be done was nearly universal yet HIV testing was low. Innovative school based programs should be put in place to leverage on the willingness to test and translate it to periodic HIV testing.