Clients’ satisfaction with immunisation services in the urban and rural primary health centres of a South-Eastern State in Nigeria

Objectives: To determine clients’ satisfaction with immunisation services in the urban and rural primary health centres of a South-eastern state inNigeriaMethods: A three-stage sampling method was used to select 800 clients who presented with their children/wards to 18 of the 440 primary health centres. Exit interviews were conducted using an adapted, semi-structured questionnaire. A composite index of satisfaction with immunisationservices, denoted as true satisfaction, was assessed as the proportionof clients who reported being satisfied with the immunisation services received on the day of data collection, who were ready to use the health centre again for immunisation services, and who were willing to recommend the health centre to others for the same services.Findings: The mean age of the clients was 28.9±4.5 and 26.7±5.1 years old in the urban and rural areas, respectively. The main reasons why the clients chose the primary health centres for immunisation services were because of their proximity to the health centres in the urban area (34.3%)and the availability of vaccines in the rural area (35.3%). The majority of clients in the urban (84.5%) and rural areas (94.3%) were truly satisfied with the immunisation services. A long waiting time and uncomfortable waiting areas were the major sources of dissatisfaction among the clients. Factors that were associated with the clients’ true satisfaction with  immunisation services included being a client in an urban area (adjusted odds ratio (AOR)=0.2, 95% confidence interval (CI): 0.1-0.4), being married, (AOR=33.5, 95% CI: 12.7- 88.1), being of the Igbo ethnic nationality (AOR=14.9, 95% CI: 3.9-57.4), being a Christian (AOR=21.1, 95% CI: 2.9-154.6), and being in close proximity to the health centres (AOR=2.6, 95% CI: 1.5-4.4).Conclusion: The waiting time needs to be reduced and the physical conditions of the waiting area need to be improved to reduce the clients’ dissatisfaction with the services, particularly in urban areas.Keywords: Clients’ satisfaction, immunisation, primary health centres, urban and rural, Enugu State

Breastfeeding and postimmunisation fever amongst infants receiving Diphtheria- Pertussis-Tetanus vaccine at a tertiary health institution in Ibadan, Nigeria

Objective: To determine the incidence of fever after vaccination with the first dose of diphtheria-pertussis-tetanus (DPT) among exclusively breastfed and non-exclusively breastfed infants in Ibadan, Nigeria.Methods: A prospective study was conducted on a cohort of 710 infants who received first dose of DPT vaccine at the Immunisation Clinic of a tertiary health institution in Ibadan, between July and October 2011. Based on the feeding pattern in a 24-hour feeding recall by mothers, infants were classified into exclusive and nonexclusive breastfeeding groups. Each of the infant's mothers was provided with a digital thermometer and instructed on how to measure the temperature of her infant. The information about the incidence of fever was obtained by telephone on the third day after vaccination.Results: Only 682 completed the study. The overall rates of exclusive and non-exclusive breastfeeding were 48% and 52%, respectively. Compared with the infants who were non-exclusively breastfed, those who were breastfed exclusively had a risk for fever of 0.675 (95% CI, 0.558-0.817). The place of delivery and the highest level of education were confounders and effect modifiers of the association between breastfeeding and fever.Conclusions: These findings suggest that exclusive breastfeeding is associated with a decreased incidence of fever after immunisation.Keywords: Exclusive breastfeeding; Post-immunisation fever; Diphtheria-pertussis-tetanus vaccination; Nigeri

Measles Case-based Surveillance and Outbreak response in Nigeria; An Update for Clinicians and Public Health Professionals

The Federal Ministry of Health recommendations for response during measles epidemics in Nigeria previously focused on case management using antibiotics and Vitamin. A supplements and did not include outbreak responseimmunization (ORI) campaigns. However, with the revision of the existing national technical guideline on measles casebased surveillance and outbreak response in Nigeria in 2012 in line with the World Health Organization  recommendation on response to measles outbreak in measles mortality reduction settings, there is a need to  update members of the Nigerian public health community on these revisions to ensure appropriate implementation and compliance. This article therefore seeks to provide clinicians and other public health professionals in Nigeria with updates on recent developments in measles case-based surveillance and outbreak response in Nigeria.Keywords: Measles surveillance, Outbreak response, Clinicians, Nigeria

Outcome of training on yellow fever surveillance in a South-Western State, Nigeria: Implications for improved field implementation

Nigeria is in the process of strengthening yellow fever case-based surveillance with the collection of serum samples among suspected case patients. Atraining conducted for surveillance officers in the local government areas (LGAs) of Osun State on yellow fever case-based surveillance was assessed to determine its immediate impact on the knowledge of participants. The training focused mainly on how to detect and report a suspected case of yellow fever to the national authorities and the reference laboratory. Training materials included theWorld Health Organization district guidelines for yellow fever surveillance.Apre and post test was used to evaluate the immediate impact of the training on knowledge among participants. Atotal of 31 officers participated. The mean scores for pre and post tests were 7.1 (SD 3.6) and 20.7 (SD 3.4) out of a total of 30 points respectively. More than 80% of participants rated the training as excellent in overall organization.All participants indicated that they were very confident to fully implement yellow fever surveillance in their LGAs

Diagnostic performance of screening methods for urinary schistosomiasis in a school-based control programme, in Ibadan, Nigeria

Background: Indirect diagnostic methods in urinary schistosomiasis are widely used for screening high-risk populations in endemic areas. Their diagnostic performances, however, vary. The objective of this study was to assess their usefulness in the context of a school-based control programme technique (unqualified haematuria, terminal haematuria and dysuria), visual examination of urine and chemical reagent technique were each compared with microscopic examination of urine for schistosome ova. Results: Chemical reagent strip technique was the most sensitive of all indirect methods assessed with sensitivity of 68.3%, followed by unqualified haematuria (41.7%), terminal haematuria (38.2%), dysuria (25.0%) and visual urine examination (16.7%). In terms of specificity, terminal haematuria and visual examination were the most specific with values of 96.1 and 96.0% respectively. Conclusion: The validity of screening methods agreed with previous observations. Their use, however, depends on the endemicity of schistosomiasis in a given area. There is therefore a need to evaluate screening methods on a sample of the target population before being used to estimate prevalence of disease. Keywords: urinary schistosomiasis, diagnostic performance, screening methodsJournal of Community Medicine and Primary Health Care 2005, 17(1): 24-2

Knowledge of birth defects among nursing mothers in a developing country

Background: In the absence of established guidelines, where formal screening is unavailable for birth defects, a lot of responsibility is placed on parents in the recognition of these defects.Objectives: The aim of the study was to determine the awareness of mothers about birth effects in a developing country and assess what they know about the prevention, detection and treatment of children with birth defects.Methods: This was a descriptive cross-sectional study of 714 mothers consecutively selected at two major hospitals in Nigeria between May and December, 2012. Data were collected with interviewer administered questionnaires. Descriptive and inferential statistics were performed using SPSS and statistical significance set at p <0.05Results: The participants were aged 17 to 42 years. Only 183 (25.6%) were aware of birth defects. Factors associated with awareness of birth defects were older age, religious belief, better education, higher socioeconomic class, early age at booking and registering at a tertiary care facility. Education, socioeconomic class as well as month and location of booking were found to be independent predictors of awareness of birth defects.Conclusion: Mothers in Ibadan, Nigeria, a country without a formal newborn screening programme, have a poor level of awareness about birth defects.Keywords: Awareness; Mothers; Birth defects; Developing countr

Health Risks of Obesity

Obesity is becoming of interest as a non-communicable disease. There is however a dearth of information on obesity in this environment, as literature in developing countries is limited. Review of health risks of obesity is useful in order to increase the pool of available information in Nigeria and to draw attention to obesity and its attendant health risks.Keywords: Health, risks, obesity

Quality Of Life Of People Living With Hiv/Aids In Kogi State, Nigeria

Introduction: With the appreciable rise in longevity of people living with HIV/AIDS (PLWHA), the need for supporting their quality of life (QoL) has become increasingly important. However, limited studies have been conducted using the World Health Organization quality of life HIV (WHOQOL-HIV) bref in our environment. Objective: This study assessed the QoL of PLWHA attending antiretroviral (ARV) clinics in Kogi State in north central Nigeria. Methods: A descriptive crosssectional study design was used. Two hundred fifty-two PLWHA from five health care centres located across the three zones of Kogi State in Nigeria were consecutively selected. A questionnaire, administered at interview and containing data on sociodemographic, medical, and the WHOQOL-HIV bref was used to assess each study participant. Results: The overall QoL mean scores in the three domains were similar: psychological health, 15.0±2.8; physical health, 15.2±2.5; and spirituality/religion/personal beliefs, 15.7± 3.4. Lower QoL mean scores were observed in social relationships (13.2±2.5) and environment (13.1±1.9) domains. A significant difference in mean QoL scores in the level of independence domain was observed among women (14.4±1.9) compared to men (13.9±1.7; p=0.028). Conclusions: Lower QoL in the environment and social relationships domains may be suggestive of stigma and discrimination, as well as poor living conditions, in the PLWHA physical environment. Key words: Quality of life, PLWHA, HIV, AIDS, WHOQOL-HIV bref

Comparison of clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients in a specialist neuropsychiatric hospital in Nigeria

Objective: Vagrant mentally ill patients are a highly marginalized group that receive limited care and attention from society. There is a dearth of information on the clinical status of this group in low-income countries. The aim of this study was to compare the clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients admitted to Aro Psychiatric Hospital, Abeokuta, Nigeria. Method: We conducted a retrospective review of clinical records charting vagrant and non-vagrant mentally ill patients treated over a five year period from January 2004 to December 2008. Results: The medical records of 61 vagrant and 122 non-vagrant mentally ill patients were reviewed and compared. The vagrant patients were more likely to be older, unmarried and alone, poorly educated, unemployed or performing unskilled labour, and diagnosed with schizophrenia. This cohort was also more likely to have physical co-morbidities compared with the non-vagrant mentally ill patients. The median time to improvement among the vagrants (211.0 days) was significantly longer than for the non-vagrant patients (34.0 days) suggesting more intractable illnesses. Other factors found to prolong the time to improvement among all patients were old age, education, being single, unemployment, the diagnoses of schizophrenia, and substance abuse. Conclusion: The clinical profiles and treatment outcomes were poorer among the vagrant mentally ill patients, underscoring a need for more comprehensive healthcare resources directed to this patient group in Nigeria.Key words: Vagrant; mental illness; clinical profile; outcome; Nigeri

Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

Background: In this pilot study, we evaluated the postoperative analgesic effect of the new lamina thoracic paravertebral block using a single-shot technique for major breast cancer surgery.Methods: A retrospective observational design was used to compare data involving 16 consecutive ASA 1 and 2 female patients who had unilateral modified radical mastectomy with axillary clearance under general anaesthesia with paravertebral block and 15 others without block between 13/03/2014 to 12/05/2015. We compared the time to the first request for analgesic, total analgesic (opioid and non-opioid) consumption (in mg) and postoperative pain scores over 72 h between the two groups.Results: One patient was excluded from the cohort due to block failure. The median time to first request for analgesic was 43 h (25.2-73.0 h) in the block group versus 2 h (1.0-2.5 h), p=0001. The pain scores was significantly lower at all measurement points among the block patients compared with the no-block group until 24 h postoperatively. No patient in the block group required analgesic within 24 h after surgery. The total consumption of pentazocine was nil (block group) vs. 154.0±74.2 (range 90-300) mg, p=0.0000001.Conclusions: Single-shot lamina paravertebral block provided prolonged postoperative analgesia and reduced opioid and non-opioid consumption