Health Literacy Amongst Tuberculosis Patient in a General Hospital in North Central Nigeria

Background: Healthy literacy has been shown to improve health care access and adherence to Tuberculosis (TB) treatment. Still it remains largely unstudied in many high risks, underserved and low literacy African populations. This study aims to bridge the existing knowledge gap by assessing health literacy among patients with TB in a rural town in Northern Nigeria.Methodology: A cross sectional study was conducted among patients who attended the TB clinic of a secondary health care facility in Babura, Jigawa State, Nigeria between Oct 2008 and March 2009. All patients who visited the TB clinic during this period were interviewed.Result: Many (71.6%) reported having been educated about TB by a health worker, mostly on predisposing factors 43.2%, general facts (31.1%) and disease process (21.6%) but less on patient's role in disease management (1.4%). Functional health literacy was high; mean score was 7.9±0.3 out of 10. Knowledge about the disease process, diagnostic requirements and treatment regimen were the highest. However 97.3% felt drugs were no longer necessary once symptoms abated. Patient involvement in treatment decisions was also suboptimal as only 52.7% reported making a joint decision about drug “pick up” options with their physicians.Conclusion: Very high functional literacy score seemed to have been achieved among these rural low literacy TB patients even without a structured health literacy program. However patient participation in treatment seems to be underemphasized and was thus suboptimal. An important gap in patient education regarding continued TB treatment was identified and should be targeted for intervention.Keywords: Health Literacy, Tuberculosis, General Hospital, Nigeri

Antimicrobial activity of camwood (Baphia nitida) dyes on common human pathogens

Antimicrobial activity of four aqueous extracts of camwood dyes obtained from different locations in Nigeria were investigated by agar diffusion, disc diffusion and agar dilution method against five clinical isolates obtained from inpatient attending the University of Port Harcourt Teaching Hospital. The isolates were Staphylococcus aureus, Escherichia coli, Bacillus cereus, Proteus vulgaris and Pseudomonas aeruginosa. Broad spectrum activity revealed B. cereus and S. aureus as more susceptible with zones of inhibition ranging from 5.4 to 19.2 mm, while, E. coli, P. vulgaris and P. aeruginosa were the least susceptible at an inhibition zone ranging from 0.8 to 15.6 mm. Results show that the extracts exhibited inhibitory activity against the test organisms at a minimum inhibitory concentration (MIC) of 37.5 mg/ml. Phytochemical screening revealed the presence of flavonoid and a trace of alkaloids. These results show that camwood dye possessed significant antimicrobial activity and hence can be used as a remedy for pathogenic infections.Key words: Antimicrobial activity, camwood extract, Nigeria, pathogenic microorganisms, zone of inhibition

The managed hypertensive: the costs of blood pressure control in a Nigerian town

Background: The health systems designed to cater for patients with chronic illnesses like hypertension have not fully evaluated the burden oflong term therapy and its effect on patient outcome. This study assessed the financial implication and cost effectiveness of hypertension treatmentin a rural Nigerian town. Methods: A chart review of 250 rural patients with primary hypertension at a regional hospital in Southwest Nigeria wasconducted. Results: The mean age of patients was 61±11.2 years, 59.2% were females, 67% had an income < .20,000 ($133.3) monthly.Diuretics and alpha-Methyl Dopa were the most prescribed drugs. The median number of prescribed drugs was two (range1-4). Mean cost oftreatment was .1440±560 ($9.6±3.7) with 52.8% spending = 10% of their income on treatment. The most cost effective therapies were MethylDopa and Diuretics with Cost-effectiveness ratios of 8 and 12.8 respectively. Patients with co-morbidities, stage 2 hypertension and those on three or four drug regimen had significantly higher treatment costs. Conclusion: The financial burden of long term antihypertensive therapy appears substantial, cost reduction strategies are needed to optimize hypertension treatment in societies with limited resources. Hypertensive management therefore requires a response adapted to the local context.Key words: Hypertensive, management, financial, cost, time, burden, Nigeria, therapy, patients, drugs, resource

Predictors of Indoor Insecticides spray utilization in the Prevention of Malaria related mosquito bites in Ogun State, Nigeria: A Community based study

BACKGROUND: Modern medicine tends to interpret health in terms of medical interventions and to overemphasize the importance of medical technology. It is important to promote the concept of health as theresult of the interaction of human beings and their total environment.METHODS: This was a descriptive cross-sectional study. A cluster sampling technique was used to select the participants into the study. The study was carried out between January 2012 and February 2012. One participant per household was selected into the study. A semi- structured questionnaire was used to collect relevant information which was collated and analyzedusing SPSS 15 statistical software.RESULTS: A total of 400 households were recruited into the study. The prevalence of insecticide spray utilization in the last 6months was 18.5%. Source of information on the use of insecticides included the radio/TV 174 (43.5%), Relatives 78 (19.5%), Health workers 54 (13.5%), friends 68 (17.0%) and others 26 (6.5%). Reasons for not using insecticides includedbeing expensive (cost) 94 (23.5%), fear of side effect 16 (4.0%), Inconvenience 38 (9.5%) and un-availability 74 (18.5%). Predictors of utilization of insecticide spray were young age (<30 yrs) of heads of household (O.R=5.10, C.I=1.06-21.7), tertiary education (OR= 9.14C.I=1.13-53.08), Nuclear family structure (OR=2.45 C.I=1.13-3.74) and availability of insecticide spray (OR=2.21 C.I=1.24-4.05).CONCLUSION: The study shows that households with heads that are young and educated are more likely to use insecticide spray. The study indicates that programs that will be geared towards increasing the knowledge and awareness of indoor insecticide spray in the prevention of Malaria should be introduced at the community level

The role of laboratory confirmations and molecular epidemiology in global eradication of measles

This review reports on the role of laboratory confirmation and molecular epidemiology in global eradication of measles. The role of laboratory confirmation and molecular epidemiology in defining the origins of measles outbreaks cannot be overemphasized. New serological tests based on recombinant proteins detect only a fraction of the total measles virus (MV) specific antibodies. Several assays based on recombinant MV-haemagglutinin (ELISA and flow cytometry) or MV-fusion protein (flow cytometry) as well as neutralization and haemagglutination test have been evaluated using a large panel of lowtitre and negative sera. Isolation of measles virus confirmed the diagnosis. Phylogenetic trees are invaluable tools for monitoring the progress of immunization activities. Recent advances in genomic sequencing technology have lent its support to the monitoring and evaluation of vaccination programmes. More so, indigenous prepared measles antigens has been advocated to be produced, refined further and reproduced massively. This will be highly cost effective especially in field for seromonitoring and surveillance of measles. There is therefore, continual need for simpler diagnostic tests in elimination and eventual eradication of measles

Breastfeeding in the community—how can partners/fathers help? A systematic review

Support from partners/fathers and families can play a significant role in a mother’s decision to initiate, continue or cease breastfeeding postnatally. This study systematically reviewed published studies to determine the impact of specific types of partner support on breastfeeding initiation, duration and exclusivity. We used the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for the review. Seven computerized bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) were searched. Of a total of 695 articles retrieved from the databases, seven studies met the inclusion criteria and reported on breastfeeding initiation, duration and exclusivity. Four of the seven studies found that partner support in the form of verbal encouragement to new mothers increased breastfeeding duration and exclusivity. Other types of partner supportive actions that led to improved breastfeeding behavior included sensitivity of the partner to the nursing mother’s needs, assistance in preventing and managing breastfeeding difficulties, and helping with household and child care duties. This review showed that specific supportive actions of partners/fathers in the community positively improved breastfeeding practices. To maximise the impact of breastfeeding policies and interventions among new mothers, breastfeeding programmes should consider the involvement of partners/fathers and their specific roles

Quality Performance of Drugs Analyzed in the Drug Analysis and Research Unit (DARU) during the Period 2006-2010

During the period 2006-2010, the Drug Analysis and Research Unit analyzed 583 samples. The samples comprised 50.6% local and 49.4% imported products. Samples were subjected to compendial or in-house specifications. The failure rate was 12.2% for local products and 14.2% for imports.  Antibacterial products recorded the highest failure rate (21.6%) while  anticancers and drugs acting on the gastrointestinal, respiratory and  reproductive systems all passed in the tests performed. The failure rate for antiprotozoals, antimalarials, antifungals, anthelminthics and analgesics was 14.3%, 12.5%, 11.8%, 8.9% and 11.5%, respectively.Key words: DARU, drug product, assay, dissolution, antimicrobial, antimalaria

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

Reliability and validity of the Thai version of the PHQ-9

<p>Abstract</p> <p>Background</p> <p>Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.</p> <p>Methods</p> <p>The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.</p> <p>Results</p> <p>Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 ≥ 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).</p> <p>Conclusion</p> <p>The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.</p

Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals

Background: There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Methods: Anonymous questionnaires were distributed to nursing students at the Makerere Nursing School and Aga Khan University Nursing School in Kampala, Uganda, during July 2006, using convenience sampling methods, with 139 participants. Two focus groups were also conducted at one university. Results: Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the U.S. (59%) or the U.K. (49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or U.K./U.S. practices were less likely to express a sense of professional obligation and/or loyalty to country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intent to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall. Conclusion: Improving remuneration for nurses is the top priority policy change sought by nursing students in our study. Nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda.University of Washington Department of Global Healt