Tuberculosis infection prevention and control measures in DOTS centres in Lagos State, Nigeria.

Nigeria is a high tuberculosis (TB) burden country. However, there is limited evidence on implementation of tuberculous infection prevention and control (TBIC) practices in Nigeria. To assess TBIC practices, and barriers to their implementation, in TB-DOTS centres in Lagos State, Nigeria. A descriptive cross-sectional study was used to assess 112 TB-DOTS centres in primary and secondary health facilities in Lagos State using mixed methods. Quantitative data comprised a survey and measurement of the air exchange rate in a subsample of centres. The qualitative aspect comprised focus-group discussions to highlight health care workers' (HCWs') perceptions of TBIC guidelines and barriers to their implementation. The majority of the DOTS centres had a dedicated TBIC officer, while a fifth (21%) had documented TBIC plans. About 57% of DOTS centres had staff that had been trained on TBIC and 37% provided some form of personal respiratory protection (face masks/tissue papers) for staff or patients. The air exchange rate was adequate in 21% of centres. The HCWs' perception of being at risk of contracting TB was reported to affect the way they relate to TB patients. The key barrier to implementing TBIC was the design of DOTS centres. TBIC measures at study centres were inadequate. Institutional commitment, renovation of existing and appropriate design of new DOTS centres in the future to improve TBIC implementation is recommended. .

Community perception of quality of health care received and client satisfaction in Lagos, Nigeria

Background: Quality of health care and client satisfaction are key elements in improving the performance of health systems. A community-based assessment was conducted to determine the level of client satisfaction and the perception of the quality of services received by citizens of Lagos State.Methods: A descriptive cross-sectional study using both quantitative and qualitative methods, was conducted in four local government areas of Lagos State. Respondents were selected by multi-stage sampling technique. The survey instruments included an interviewer-administered, pre-tested questionnaire and a 10-itemed focus group discussion guide.Results: Two thousand respondents with a mean age of 37.6±10.21 years were recruited. Almost all respondents (98%) rated the health facilities to be clean, 96% felt they received effective treatment from their providers. Six out of ten respondents rated the waiting time to be short and 60% felt that most drugs were available. Eight-five percent opined that the quality of care received was good and 95% were satisfied with the services received. There was a significant correlation between quality of care and client satisfaction (ρ=0.145, p=0.001). Short waiting time was predictive of client satisfaction (OR=13.9, 95%CI, 5.68-33.33, p<0.001) and confidence in health care providers was predictive of both client satisfaction (OR=3.489, 95%CI, 1.554-7.835, p<0.001) and perception of good service quality (OR=2.234, 95%CI, 1.509-3.308, p<0.001)

Community perception of quality of health care received and client satisfaction in Lagos, Nigeria

Background: Quality of health care and client satisfaction are key elements in improving the performance of health systems. A community-based assessment was conducted to determine the level of client satisfaction and the perception of the quality of services received by citizens of Lagos State. Methods: A descriptive cross-sectional study using both quantitative and qualitative methods, was conducted in four local government areas of Lagos State. Respondents were selected by multi-stage sampling technique. The survey instruments included an interviewer-administered, pre-tested questionnaire and a 10-itemed focus group discussion guide. Results: Two thousand respondents with a mean age of 37.6±10.21 years were recruited. Almost all respondents (98%) rated the health facilities to be clean, 96% felt they received effective treatment from their providers. Six out of ten respondents rated the waiting time to be short and 60% felt that most drugs were available. Eight-five percent opined that the quality of care received was good and 95% were satisfied with the services received. There was a significant correlation between quality of care and client satisfaction (ρ=0.145, p=0.001). Short waiting time was predictive of client satisfaction (OR=13.9, 95%CI, 5.68-33.33, p<0.001) and confidence in health care providers was predictive of both client satisfaction (OR=3.489, 95%CI, 1.554-7.835, p<0.001) and perception of good service quality (OR=2.234, 95%CI, 1.509-3.308, p<0.001)

A survey of the perception of the quality of and preference of healthcare services amongst residents of Abeokuta South Local Government, Ogun State, Nigeria.

BACKGROUND: The choice of healthcare facilities by individuals is determined in part by their taste, satisfaction with services, and the perceived quality of care provided. The aim of the study was to explore the healthcare preferences of residents of Abeokuta South Local Government Area (LGA) and their perception of quality of services received, and to determine the factors influencing their choice of healthcare facilities. MATERIALS AND METHODS: A descriptive cross-sectional study design was used to assess perception of clients regarding quality of healthcare received and their choice of healthcare service delivery. Data were collected using a pre-tested interviewer-administered questionnaire, and analysis was done using SPSS version 17. Statistical significance was set at P <0.05. RESULTS: The mean age of respondents was 45.7 ± 11.7 years. Government-owned general hospitals were preferred for common health problems such as body pain and fever. Overall, about 73% of the respondents preferred government-owned facilities. Determinants of the preference of the government facilities were reduced cost (P< 0.001) and effectiveness of care (P= 0.024), whereas private facilities were preferred more significantly because of short waiting time and good attitude of staff (P = < 0.001). Almost 78% of the respondents were satisfied with the quality of care received. CONCLUSIONS: Government-owned general hospitals were the preferred source of health services and the quality of healthcare services received was generally perceived to be high.

Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria.

INTRODUCTION: Hypertension has been reported as the strongest modifiable risk factor for cardiovascular morbidity and mortality. AIMS: The aim of the study was to identify the most prescribed antihypertensive drugs, its patterns, comorbidities, cost of medications, and laboratory investigations. SETTINGS AND DESIGN: This study was a cross-sectional, descriptive study of hypertensive patients conducted at the Lagos State University Teaching Hospital, Ikeja. SUBJECTS AND METHODS: A total of 200 case notes were retrieved from the medical records unit over a period of 8 weeks. Information on antihypertensive prescriptions and comorbidities was retrieved. The average cost of medications and laboratory investigations was calculated. Statistical Analysis Tool Used: SPSS software version 16. RESULTS: The mean age of the patients was 58.44 ± 12.65 years. Of the 200 patients, 5 (2.5%) were on monotherapy and 195 (97.5%) were on combination therapy. One hundred and twenty (60%) patients had comorbidities which included congestive heart failure 55 (27.5%), diabetes mellitus 22 (11%), hyperlipidemia 15 (7.5%), and cardiovascular disease 13 (6.5%). The various classes of antihypertensive drugs prescribed were diuretics 128 (64.0%), beta-blockers 126 (63.0%), calcium channel blockers 106 (53.0%), angiotensin-converting enzymes inhibitors 103 (51.5%), angiotensin receptor blockers 33 (16.5%), alpha blockers 9 (4.5%), and fixed drug combinations 2 (1.0%). The average cost per month of the antihypertensive medications was ₦ 2045 (US$10.2). CONCLUSIONS: Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure. Community-based insurance scheme should be encouraged and effective implementation of integrated noncommunicable diseases screening into the primary health care services would be helpful.

Tuberculosis infection control measures in health care facilities offering tb services in Ikeja local government area, Lagos, South West, Nigeria.

BACKGROUND: Tuberculosis infection among health care workers is capable of worsening the existing health human resource problems of low--and middle-income countries. Tuberculosis infection control is often weakly implemented in these parts of the world therefore, understanding the reasons for poor implementation of tuberculosis infection control guidelines are important. This study was aimed at assessing tuberculosis infection control practices and barriers to its implementation in Ikeja, Nigeria. METHODS: A cross-sectional study in 20 tuberculosis care facilities (16 public and 4 private) in Ikeja, Lagos was conducted. The study included a facility survey to assess the availability of tuberculosis infection control guidelines, the adequacy of facilities to prevent transmission of tuberculosis and observations of practices to assess the implementation of tuberculosis infection control guidelines. Four focus group discussions were carried out to highlight HCWs' perceptions on tuberculosis infection control guidelines and barriers to its implementation. RESULTS: The observational study showed that none of the clinics had a tuberculosis infection control plan. No clinic was consistently screening patients for cough. Twelve facilities (60%) consistently provided masks to patients who were coughing. Ventilation in the waiting areas was assessed to be adequate in 60% of the clinics while four clinics (20%) possessed N-95 respirators. Findings from the focus group discussions showed weak managerial support, poor funding, under-staffing, lack of space and not wanting to be seen as stigmatizing against tuberculosis patients as barriers that hindered the implementation of TB infection control measures. CONCLUSION: Tuberculosis infection control measures were not adequately implemented in health facilities in Ikeja, Nigeria. A multi-pronged approach is required to address the identified barriers to the implementation of tuberculosis infection control guidelines.

Immunogenicity, safety and reactogenicity of the 10-valent pneumococcal non-typeable haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Nigerian Infants: a randomised trial.

AIMS AND OBJECTIVES: The immunogenicity, reactogenicity and safety of the 10- valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) were evaluated in a cohort of Nigerian infants included in a study conducted in Mali and Nigeria (ClinicalTrials.gov identifier: NCT00678301). SUBJECTS AND METHODS: In this open, randomised, controlled study, 119 healthy infants received combined diphtheria-tetanus-whole-cell pertussis-hepatitis B/ Haemophilus influenzae type b vaccine (DTPw-HBV/Hib) and oral poliovirus vaccine (OPV) co-administered with PHiD-CV (PHiD-CV group) or without PHiD-CV (control group) at 6-10-14 weeks of age. Pneumococcal antibody responses and opsonophagocytic activity were measured and adverse events were recorded. RESULTS: One month post-dose 3, for each of the vaccine pneumococcal serotypes, e"90.1% of PHiD-CV recipients had an antibody concentration e"0.2 ug/mL compared to < 9 % (except for serotypes 14 [32.4%] and 19F [27.8%]) in the control group. For each of the vaccine pneumococcal serotypes, e"90.6% of infants in the PHiD-CV group had an OPA titre e"8, compared to % 18% (except for serotype 7F [60.0%]) in the control group. Anti-protein D antibody geometric mean antibody concentrations were 2949.7 EL.U/mL in the PHiD-CV group and 68.9 EL.U/mL in the control group. For each DTPw-HBV/Hib antigen antibody seroprotection/seropositivity rates were e"94.4%. Tolerability was generally comparable between the PHiD-CV and control vaccination groups. CONCLUSIONS: PHiD-CV co-administered with routine vaccines was immunogenic for all vaccine pneumococcal serotypes and protein D in Nigerian infants. Vaccine tolerability was generally comparable between the PHiD-CV and control groups. These results suggest PHiD-CV can be co-administered with other vaccines included in the National Programme on Immunisation.

Nigerian medical students are at risk for hepatitis B infection.

Medical students are exposed to blood and body fluids. This study was conducted to estimate the prevalence of hepatitis B virus (HBV) infection amongst medical students of the Lagos State University College of Medicine, Ikeja, Nigeria. Data were collected through a self-administered questionnaire and through blood analysis for hepatitis B surface antigen (HBsAg), hepatitis B 'e' antigen (HBeAg) as well as antibodies to the core (anti-HBc), surface (anti-HBs) and 'e' (anti-HBe) antigens. Three hundred and thirteen of 325 students (96%) participated. The mean age was 24.3+/-3.98 years; 231 (74%) were pre-clinical students and 82 (26%) were in the clinical years of study. Only 8 (2.6%) had received three doses of vaccination against HBV. Eighty-one (26%) tested positive for anti-HBc, 10 (3.2%) were positive for HBsAg and 56 (17.9%) had anti-HBs antibodies. A significant relationship was found between students who had a positive history of hepatitis B in the family and anti-HBc (P=0.03). Age was also significantly associated with HBsAg (P=0.012). Two hundred and twenty-five (72%) students were susceptible to the infection and required vaccination. Most students at this medical school are susceptible to HBV infection and should be vaccinated.

Splenectomy in a rural surgical practice.

We reviewed the clinical presentation and indications for splenectomy in a rural community in Southern Nigeria from January 1988 - December, 2000, a period of 12 years. A total of 17 cases were seen. Twelve (70.6%) were for big spleens due to sickle-cell anaemia, tropical splenomegaly syndrome, malignancy and 5 (29.4%) were due to trauma from road traffic injuries. Anaemia was a common feature in all the cases. Patients were followed up for 18 months but all those suspected to have malignancies died within eight months of surgery. Diseased spleen is commonly seen in rural community, its management in the face of limited facilities could be tasking, but some modicum of treatment has to be offered those who may not be able to honour a referral. It is the surgical treatment thus offered that is being shared in this review.

Prevalence of hepatitis B surface antigen in vaccinated children and controls in rural Nigeria.

OBJECTIVE: To determine the prevalence of hepatitis B surface antigen (HBsAg) amongst vaccinated children and controls aged 1-4 years in a rural community in mid-western Nigeria. METHODS: The vaccinated children had received at least three doses of hepatitis B vaccine. The vaccines included recombinant hepatitis B vaccine at birth and a combined diphtheria, tetanus, pertussis (whole cell) plus hepatitis B (DTPw-HBV) vaccine. HBsAg was determined by a rapid immunoassay method based on the immunochromatographic sandwich principle. Two hundred and twenty-three children and 219 controls were recruited into the study. RESULTS: The prevalence of HBsAg was significantly lower in the vaccinated group (1.3%) than in the control group (4.6%, p=0.04). The prevalence rates were significantly higher in males (p=0.02) and two-year birth cohort (p=0.01). The controls were estimated to be at a six-fold higher risk of being positive for the surface antigen than the vaccinated children. The vaccine effectiveness was estimated to be approximately 80%. CONCLUSION: These results confirm that hepatitis B vaccine protects against hepatitis B surface antigen carriage and confirm immunogenicity of the combined DTPw-HBV vaccine.

HIV: knowledge and sexual practices amongst students of a school of communnity health in Lagos, Nigeria.

A cross sectional study was conducted amongst students of a school of health technology in Yaba. Lagos. Nigeria to determine their knowledge about HIV/AIDS and their sexual practices. A self-administered questionnaire was used to collect data. Two hundred and thirty-six students out of 250 participated in the study (94% response rate). The mean age was 24.7+5.2 years, 167 (71%) respondents were females while 69 (29%) were males. One hundred and seventy-seven (75%) students were single and 59 (25%) were married. Knowledge on HIV was graded using twenty-nine items on the questionnaire, each scored one mark. A maximum score of 29 was obtainable and respondents with scores greater than 50% were classified as having a satisfactory level of knowledge. Ninety-nine percent had heard about HIV/AIDS through several sources. Knowledge of symptoms, methods of transmission and prevention were generally satisfactory. One hundred and seventy one (72%) students were sexually active, 48% engaged in casual sex and 9% had multiple partners. Of the 171 who were in sexual relationship with a primary partner, 49 (29%) used condoms all the time. One hundred and fourteen (48%) admitted to having casual sex but 60 (53%) used condoms all the time during casual sex. Partner and personal dislike as well as reduction in sexual pleasure were reasons for non-use of condoms. A significantly higher proportion of students in the higher classes (74/94, 79%) possessed a higher level of knowledge than those in the lower class (78/142, 55%, p=0.0003). One hundred and fifty-two (64%) students possessed a satisfactory level of knowledge on the subject, but many engaged in risky behaviour.

The effect of an educational intervention on improving rational drug use.

OBJECTIVE: To evaluate the effect of an educational intervention on rational drug use amongst Primary Health Care workers in two Local Government Areas (LGAs), Mushin and Ikeja, in Lagos State. METHODS: Mushin was randomly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention designed to improve prescribing practices was carried in Mushin LGA for four weeks. Drug use indicators were measured before, at two weeks and three months post intervention. RESULTS: At baseline, most of the drug-use indicators in the intervention LGA were significantly worse (p < 0.05) than the control LGA. However, at the two-week evaluation, the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3+ 2.8 to 6.3 + 2.3 (p=0.000) compared to the control LGA where there was no significant change (from 4.9+ to 4.8+2.2, p=0.647). There was also a significant increase in the percentage of patients rationally managed from 18% to 30% (p=0.0005) in the intervention LGA unlike the control LGA (from 33% to 31%,p=0.693.). The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA (+14% )compared to the control LGA (+2%,p=0.0000). The improvements were not sustained at the three-month evaluation, as most of the indicators were similar to values obtained at the baseline. CONCLUSION: The intervention programme significantly improved rational drug use in the short-term period only. Other cost effective and sustainable intervention models for improving prescribing practices should be developed.

Short term evaluation of a rural immunization program in Nigeria.

BACKGROUND: Immunization remains the primary strategy in both the control and prevention of common childhood diseases, particularly in the developing world. Immunization and preprimary health care services were commenced in a rural community in Nigeria in 1998, when vaccine coverage for all Expanded Program on Immunization (EPI) diseases (tuberculosis, polio, diphtheria, pertussis, tetanus, measles, and hepatitis B) was considerably low with only 43% of children fully immunized. METHODS: Children aged 0-2 years and living in a rural community were recruited into the study. Data on vaccination history was collected by both vaccination card and maternal history. Three hundred and twenty-seven children were recruited into the study. Study participants were vaccinated for EPI diseases. Hepatitis-B vaccine was administered at birth, and a combined diphtheria and tetanus toxoids, and pertussis whole cell vaccine (DTP) plus hepatitis-B vaccine was administered in a single injection after six weeks. RESULTS AND CONCLUSIONS: Two years after the program was started, immunization coverage rates were 94% for BCG, 88% for DTP (third dose), and 82% for measles. All antigens showed significant improvements from baseline values (p < 0.0001). Eighty four percent of children were fully immunized against all six diseases, compared with 43% at the commencement (p < 0.0001). Hepatitis-B coverage (three doses) was 58%. The vaccination program has significantly improved vaccination coverage and could be a model for under served, non-industrialized communities.

Antibiotic susceptibility of microorganisms at a general hospital in Lagos, Nigeria.

OBJECTIVE: To determine susceptibility patterns of microorganisms to antibiotics in a large general hospital in Lagos, Nigeria. METHODS: Clinical samples received in the laboratory were processed according to standard methods. Susceptibility to antibiotics was done using a disk diffusion technique. RESULTS: Five hundred and fifty-one samples from urine, wound, reproductive tract and other body fluids were analysed. The most frequently isolated pathogens (n=586) were Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae. Most of the organisms were sensitive to ciprofloxacin, perfloxacin, cefuroxime, ceftriaxone and azithromycin but were resistant to ampicillin, cotrimoxazole and penicillin. Pseudomonas aeruginosa was multi-resistant. The susceptibility pattern obtained at this hospital is similar to what obtains in teaching hospitals in Nigeria. CONCLUSION: Microorganisms isolated at this hospital are more sensitive to newer antibiotics.

Computing and information technology skills of final year medical and dental students at the College of Medicine University of Lagos.

This study was conducted to determine awareness, level of use of computers and the use of the Internet for medical research amongst final year medical and dental students at the University of Lagos. A self-administered structured questionnaire was used to collect data. A response rate of 88% was achieved (136/155). Eighty per cent had used the computer before. Use of software applications was poor with computer games being the most frequently used (19%) followed by word processing softwares (18%). The Internet and electronic mail had been used by 58% but only 23% had used the Internet for medical research. Twenty-one percent classified themselves as proficient on the computer, 59% had little skills and 20% had no skills. Younger students (age less than 26 years) were found to have significantly better skills than older colleagues (p = 004). Majority of final year students at College of Medicine, University of Lagos have little computing skills.

Breast cancer: knowledge, attitudes, and practices of female schoolteachers in Lagos, Nigeria.

This article examines the knowledge, attitudes, and practices of female schoolteachers concerning breast cancer. A cross-sectional survey was conducted among 200 schoolteachers randomly selected from 12 schools in Lagos, Nigeria. A self-administered questionnaire was used to investigate their knowledge about the symptoms of breast cancer, methods of diagnosis, risk factors, and breast self-examination. A response rate of 94% (188 respondents) was achieved. Eighty-five percent knew breast cancer was a serious disease, but only 53.2% knew that a breast lump was the most commonly recognized sign. Other symptoms were even less well known. Only 13.8% knew the methods of diagnosis, and knowledge of risk factors was also poor. Breast self-examination was practiced by 62% of respondents; 11% practiced it on a monthly basis, but only 25% were deemed to possess sufficient knowledge about the procedure. One-quarter of participants were categorized as possessing a satisfactory knowledge of breast cancer. The level of awareness on breast cancer is very low among this group of female schoolteachers.

Career aspirations of house officers in Lagos, Nigeria.

OBJECTIVE: To identify the career aspirations of interns (house officers) working in two hospitals in Lagos, Nigeria. METHODS: All house officers working in the Lagos University Teaching Hospital and the General Hospital, Ikeja were invited to participate in a cross sectional survey. A self-administered questionnaire was used to collect data. RESULTS: Specialization choice was evident in 97.1% of the interns while they were undergraduates but this declined to 82.9% on qualifying, though chosen specialties did not vary much between both periods. The preferred specialties were surgery (18.1%), obstetrics and gynaecology (18.1%), paediatrics (9.5%) and dental sciences (10.5%). Doctors who were below the age of 26 years were significantly more likely to want to specialize than others (P=0.017). Furthermore, respondents who had no regrets about selecting medicine as a career were significantly more willing to specialize than others (P=0.013). The major reasons for wanting to specialize were interest in specialty (72.4%), job satisfaction (67.6%) and bright prospects in selected field (54.3%). However, 14.4% no longer wanted to practise medicine while 69% would have liked to leave Nigeria, mainly for the United States of America. Financial considerations were a major reason for both groups. CONCLUSION: Surgery, obstetrics and gynaecology continue to attract young doctors to the detriment of other specialties. Financial considerations are also a key determinant of with regard to place of future practice.

Clinical profile of acute otitis media among Nigerian children.

A one-year prospective clinical study to assess principal clinical symptoms, signs and bacteriological isolates in Nigerian children with acute otitis media. This is a multicentre study conducted from January-December, 1998 in three University Teaching Hospitals. A strict recruitment protocol was followed. Patient symptoms had to be less than one week before enrollment. Eighty-one children were recruited into the study. The major findings indicative of acute otitis media were ear pain (92.6%), fever (88.9%), redness of the tympanic membrane (89.9%) and loss of light reflex (84%). Rupture of the tympanic membrane occurred in 15 patients (18.5%) Staphylococcus aureus was the most common pathogen (50%) isolated from the ear swabs. A high index of suspicion is necessary to diagnose acute otitis media early in children especially those who may have fever as the main symptom. This will minimise the frequency of tympanic membrane perforations.

Breast cancer knowledge, attitudes and practice among nurses in Lagos, Nigeria.

A cross-sectional survey was conducted among nurses working in a general hospital in Lagos to determine their knowledge, attitude and practice regarding breast cancer. A self-administered questionnaire was used to investigate knowledge of symptoms, methods of diagnosis and use of cancer screening methods. Two hundred and four nurses out of 280 participated in the study (73% response rate). Knowledge about symptoms, methods of diagnosis and self-breast examination was generally very good. However, only 30% had had a clinical breast examination and 8% a mammogram within the past three years. Use of cancer screening methods was significantly associated with knowledge of the subject (p = 0.03). Twenty-eight percent did not know how to estimate the risk of cancer and 61% believed they were not at risk. Nurses possess adequate knowledge about breast cancer but they need more information on cancer risk estimation.

Socio demographic profile and career aspirations of medical students in a new medical school.

All fifty-two pioneer medical students in a new medical school (The College of Medicine of Lagos State University), participated in a cross sectional survey to identify their socio-demographic profile and career intentions. A self-administered structured questionnaire was used to collect data. The students were observed to be mature. Their mean age was 23.6 years +/- 3.8. A third were graduates with at least a first degree, while 23% had parents with medical background. Factors influencing their choice of medicine as a career were desire to serve mankind (91%), primary interest in the profession (90%) and parental influence (84%). Sixty-seven per cent of them would want to specialize while the most frequently chosen fields were obstetrics and gynaecology (28.6%) and surgery (25.7%). The main reasons influencing specialisation were primary interest in the specialty (91%), service to humanity (91%) and job satisfaction (85.7%). A desire to specialize was evident even in these medical students who were just starting medical school.