Blood pressure percentiles in a group of Nigerian school age children

Background: Determination of abnormal blood pressure (BP) in children is dependent on comparison with normal percentile values. The commonly used National Institute of Health (NIH) standard is generated from childrenoutside of Africa.Objective: To develop BP percentile values for Nigerian childrenbased on BP cuff width 40% to 50% of arm circumference.Methods: Subjects were pupils from nine primary schools in Midwestern Nigeria recruited using a multi-stage sampling technique. Their BP was measured using a cuff width of 40 to 50% of arm circumference and cuff length of at least 80% of arm circumference respectively. The mean of two BP readings were taken. Hypertension was defined as systolic and or diastolic BP >95th percentile of the study population.Results: There were 1549 subjects, aged 5 to 15 years, of which 757 (48.9%) were males. Prevalence of hypertension was 2.6%. Only age and weight were independent predictors of both elevated systolic and diastolic BP. The 5th, 10th, 50th, 90th and 95th percentiles of Systolic and diastolic BP were generated for both males and females pupils.Conclusion: BP Percentiles have been generated using BP cuff width 40 to 50% of the arm circumference for Nigerian children.Keyword: Blood pressure; hypertension; childhood; percentil

Intestinal Helminths in caregivers working in Orphanages in Benin City, Nigeria

Health knowledge and health care practices of caregivers are important determinants of quality of care of any child. These caregivers in closed institutions such as the orphanages could be a sourceof environmental contamination and transmission of diseases including intestinal helminthic infections.This study was carried out in caregivers working in orphanages in Benin City and was to determine theirknowledge of helminths, preventive practices against intestinal helminths, prevalence and intensity of intestinal helminthiasis among these caregivers.Fresh stool samples from 27 caregivers in 10 orphanages were analyzed using the Kato-Katz technique for the detection of ova of helminths between January and April, 2011. Of the 27 caregivers, 12(44.4%) had knowledge about helminths and translated helminths (worms)intheir local dialect. One-third of the subject knew at least one way of acquiring intestinal helminths; and 13/27(48.1%)agreed that helminths can be prevented. Prevalence of intestinal helminthiasis was 7.4%. The infected caregivers were females; ages 20 and 25 years and were residing within the orphanage. Ascarislumbricoides was the only specie of intestinal helminths isolated and intensity of infection was light. Eggs per gram range was 72 – 144; median egg per gram was108. Though the prevalence of intestinal helminths was low in this study, less than half of these caregivers (irrespective of their educational status) have appropriate knowledge of intestinal helminths, its means of transmission and prevention. There is therefore the need to intensify health education on intestinal helminths among caregivers working in orphanages in Benin City. Keywords: Benin,caregiver, helminthiasis, intensity, orphanag

Financial barriers to utilization of screening and treatment services for breast cancer: An equity analysis in Nigeria

Aim: To determine financial barriers that impede the utilization of screening and treatment services for breast cancer among Nigerian women from different socioeconomic groups.Materials and Methods: A descriptive study was carried out in 2013 among women attending the oncology clinic of a tertiary institution in Enugu, Southeast Nigeria. Data were collected from 270 women using an interviewer‑administered questionnaire. The links between the influence of socioeconomic factors on barriers to the utilization of breast cancer screening and treatment services were examined.Results: A total of 270 women were studied. The mean age was 34.69 (Standard deviation = 5.07) years. Half of the study participants were single 141 (51.3%), while 105 (38.2%) were married. Cost of medical treatment and not having insurance coverage was major financial barriers to utilization of screening and treatment services. The least poor and poor socioeconomic status (SES) groups utilized screening services and treatment more frequently than the very poor and poorest SES groups (P = 0.034). There was no significant difference in the utilization of the different treatment options among the different socioeconomic groups with the exception of surgery (χ2 = 11.397; P = 0.000).Conclusion: Financial barriers limit the ability of women, especially the poorest SES group, to utilize screening and treatment services for early diagnosis and treatment of breast cancer. Interventions that will improve financial risk protection for women with breast cancer or at risk of breast cancer are needed to ensure equitable access to screening and treatment services.Key words: Breast cancer, financial barriers, inequities, screening and treatment services, socioeconomic status, utilizatio

Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria

Aim: Given the enormous economic burden of diabetes in Nigeria and in sub.Saharan Africa, the study  was designed to determine how different population groups cope with payment for type 2 diabetes  mellitus (DM).Materials and Methods: A total of 292 exit interviews were conducted with patients who attended the outpatient diabetic clinic in a specialist public health facility in southeast Nigeria. The monthly  expenditures and strategies that were used to cope with payments for diabetic treatment were  determined. A socioeconomic status (SES) index was used to divide the respondents into SES quartiles (Q1 (poorest), Q2, Q3, Q4 (least poor)). The coping mechanisms were disaggregated by SES.Results: The mean monthly expenditure for the treatment of diabetes was .56,245.11 ($356).  Expenditures were mostly incurred through out.of.pocket payments. The most common coping strategy utilized was household savings (99.0%) followed by support from family members (85.3%). All SES groups used more than one payment coping method. Borrowing, skipping of appointments, and stopping children education were significantly significant (P < 0.05).Conclusion: The mean monthly direct cost in the treatment of type 2 diabetes among the study group was high. There were SES inequities in the use of coping mechanisms, with the poorest SES group (Q1) being worse off than other groups. The financial risk protection mechanisms such as health insurance that will reduce the economic burden of type 2 diabetes on households and provide universal health coverage to people suffering from DM more especially to the disadvantaged group should be developed and implemented.Key words: Inequities, payment coping, socioeconomic status, type 2 diabete

Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries

BACKGROUND: Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. METHODS: Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers’ knowledge of symptoms related to pneumonia – namely fast or difficulty breathing – and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). RESULTS: Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. CONCLUSIONS: These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking