Utilization of Alternative Medical Services In An Urban Centre Of North Central Nigeria

Background: The use of alternative therapy is becoming more popular in the recent times especially due to the increasing cost, distrust and limitations of modern western medical care. There is a universal trend toward naturalness and herbal medicine is now being modernized and being accepted by people who would not have used them. This community based study seeks to assess the prevalence, pattern, behaviour and determinants of Alternative Therapy (AT) use.Methods: It was a cross-sectional descriptive survey among adults in the Ilorin city of Nigeria. Participants were selected by multistage sampling and information obtained by the use of semi-structured questionnaire.Results: Total prevalence of AT use was 67.7% while the prevalence of the use of both indigenous and foreign AT use was 44.8% and 30.4%  respectively. Among indigenous AT users, 87.5% will use both conventional and modernized type, while 12.5% will use only the modernized type. More than 10% were new users of AT. Respondents use AT for promotive, preventive and curative purposes. Only 3.5% were considered as safe users according to 12-point items. The male respondents and the never married ones practice a safer use of alternative therapy (p<0.05).  Similarly, the respondents with higher educational status also have a safer practice of AT use (p<0.05).Conclusion: There is high prevalence of unsafe AT use in Ilorin. The regulation of advertisement and sales of harmful herbal medicines should be intensified by NAFDAC and other related agencies. Further research into the safe and effective integration of AT into modern healthcare practice in Nigeria is also recommended.Key Words: Alternative therapy; Utilization; Medical services; Nigeria

Determinants of Referral Practices of Clients by Traditional Birth Attendants in Ilorin, Nigeria

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010; 14[2]:77-84)

Treatment Outcomes among Human Immunodeficiency Virus and Tuberculosis Co-Infected Pregnant Women in Resource Poor Settings of South-western Nigeria

The complex interactions between Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) infections may be magnified, in the presence of another potentially stressful condition like pregnancy. Though co-infection among pregnant women is rare, treatment outcomes may depend on accessibility to comprehensive treatment modalities. The objective of this study is to determine treatment outcomes among pregnant HIV and TB co-infected pregnant women in Lagos, South-western Nigeria. This retrospective, analytical study was carried out among ninety four (94) eligible pregnant women co-infected with HIV and TB at selected health-care facilities in Lagos state between January, 2008 and December, 2009. A standard checklist for data collection was used and analysis was carried out using the EPI info software. Mean age of respondents was 30.8 (±3.9) years. Sixteen (17.1%) TB cases were clinically diagnosed for tuberculosis. Among tuberculosis cases identified through sputum microscopy, 60(63.8%) were acid fast bacilli (AFB) positive and 21(22.3%) were identified in the first trimester. The mean percentage adherence to anti-retroviral drugs was 95.9% (±5.3). None of the participant smoked cigarette. Seventy three {73 (77.7%)} had contact with TB infected or suspected person in the last three months. Treatment outcome in mother showed that 74(78.7%) were cured, 8(8.5%) relapsed while 12 (12.8%) had treatment failures. Among the babies, 83(88.3%) were born alive. Women with both poor adherence (<90%) and with positive TB contact, but neither factor alone, were half-fold less likely to be cured compared with women with both good adherence (>95%) and no TB contact (OR=0.59, CI=0.45-0.95 and p=0.014). Cure rate was substantially lower in this study. This calls for extra strategies such as routine TB screening in antenatal clinics, strict adherence to national guidelines in the treatment of HIV/TB co-infections, focused antenatal care and comprehensive Prevention of Mother to Child Transmission (PMTCT) care and treatment

Awareness and perception toward referral in health care: A study of adult residents in Ilorin, Nigeria

Background and Objective: The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care.Methods: A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scoredand analyzed with Epi-Info 2005 computer software.Results: Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was signifi cantly associated with the knowledge and perception of referral in the health care.Conclusion: There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC

Relationship between Cost of Care and Medication Adherence among Hypertensive Patients Attending a Tertiary Health Facility in Ekiti State, Nigeria

Background: The economic burden of care is a barrier to effective treatment of hypertension as affordability of drugs may affect medication adherence. This study assessed the cost of care and level of medication adherence among patients with hypertension attending a tertiary hospital in Ekiti State, Nigeria.Methods: This was a descriptive cross-sectional study that used a systematic sampling technique to select eligible patients. Data was collected with an interviewer-administered questionnaire. Medication adherence was assessed with eight-item Morisky Medication Adherence Scale (MMAS-8). Data entry and analysis were done using IBM SPSS version 22.0. p-value < 0.05 was considered statistically significant.Results: The median age (Interquartile Range) of respondents was 55.0 (20.3) years with male to female ratio of 1:1.2. The mean monthly cost of care of hypertension was ₦15,964.76 (US$44.35). Only 47 (34.1%) respondents were adherent (MMAS score of ≥8) to their medications. Medication adherence was inversely associated with total cost of admissions (p=0.024) and cost of admission drugs/consumables (p=0.028). Male gender (AOR=12.561;95%CI=2.248–70.189), middle-age (45-64years) (AOR=11.577;95%CI=1.015- 131.998), being unmarried (AOR=0.006;95%CI=0.000–0.300), exercising <3days per week (AOR=0.055;95%CI=0.006–0.489), employment in informal and formal occupations (AOR=0.024,0.022; 95%CI=0.001–0.590,0.001–0.591) and living with someone (AOR=0.000;95%CI=0.000–0.086) were significant predictors of medication adherence.Conclusion: Medication adherence was suboptimal and negatively associated with total cost of admissions and cost of admission drugs/consumables. Attention should therefore be given to developing and implementing measures such as subsidy on drugs and increasing coverage of health insurance that would limit the impact of these costs on the patients. Keywords: Cost of care; Medication adherence; Hypertension; Ekit

Utilization of Alternative Medical Services by People of a North central City of Nigeria

Introduction: The use of alternative therapies is becoming more popular in the recent times especially due to the increasing cost, distrust and limitations of modern western medical care. There is a universal trend toward naturalness and herbal medicine is now being modernized and being accepted by people who would not have used them. This community based study seeks to assess the prevalence, pattern, behaviour and determinants of AT use.Materials and Methods: It was a cross-sectional descriptive survey among adults in the Ilorin city of Nigeria. Participants were selected by multistage sampling and information obtained by the use of semi-structured questionnaire.Results: Total prevalence AT use was 67.7% while total prevalence of indigenous and foreign AT use was 44.8 and 30.4% respectively. Among indigenous AT users, 87.5% will use both conventional and modernized type while 12.5% will use only the modernized type. More than 10% were new users of AT. Respondents use AT for promotive, preventive and curative purposes. Only 3.5% were considered as safe users according to 9-point items. The male respondents and the never married ones practice a safer use of alternative therapy (p<0.05). Similarly, the respondents with higher educational status also have a safer practice of AT use (p<0.05).Conclusion: There is high prevalence but unsafe AT use in Ilorin. There should be intensification of regulation of advertisement and sales of  unwholesome herbal medicines. Further research to integrate the practice into modern healthcare is recommended.Key Words: Alternative therapy, utilization, medical services, safety

Sexual Risk Behaviour Among In-School Adolescents in Public Secondary Schools in a Southwestern City in Nigeria

Purpose: Several studies have documented the high sexual activities and risky sexual behaviours among adolescents in most parts of the world thus putting them at high risk of contacting the HIV infection and other complications. This study aimed to determine sexual risk factors among adolescents in secondary schools in urban areas of Osogbo in South western Nigeria. Methods: A descriptive cross sectional study was done among 521 public secondary school students in Osogbo, Southwestern Nigeria, using multistage sampling technique and semi-structured administered questionnaire. Data were analyzed using the SPSS software package version 15. Results: Appreciable number (31.5%) of the respondents have had sexual intercourse (the mean age of sexual debut being 15.2+1 yr). Some of them (14.6%) had had more than one sexual partners, 17 (3.3%) had visited commercial sex workers before, 33 (6.3%) had been raped previously while 25 (4.8%) had been treated for STIs symptoms in the past. Most respondents were aware of common modes of transmission of the HIV virus. Less than half (32.8%) of the respondents were prepared to be screened for HIV infection. Conclusion: Many adolescents studied were sexually active, and taking a lot of risky sexual behaviours that could facilitate transmission of HIV. Advocacy programme that will make adequate information about sexual health available to the adolescents needs to be intensified. Keywords: Adolescents, Sexually transmitted infections, Risky sexual behaviours, HIV/AID

Preferred Choice of Health Facilities for Healthcare among Adult Residents in Ilorin Metropolis, Kwara State, Nigeria

Purpose: The choice of health facilities for healthcare by an individual is largely determined by several factors. This study aims to determine predictors of preferred choice of health facility for care. Methods: In a descriptive cross-sectional study, pre-tested semi-structure questionnaire was administered to 366 adults selected through a multi-stage sampling technique in Ilorin metropolis. Data collected were analysed using Epi Info software version 3.4.1 and level of significance set at p < 0.05. Results: The preferred health facility for medical care was private hospitals (35.2%) followed by pharmaceutical store (27.9%) and 17.0% for general/teaching hospitals and only 12.3% for primary health care (PHC). Quick service and availability of drugs were the major reasons for their preference which were said to be better in private hospitals. Sex, marital status, educational status, occupation and city area where the respondents dwell are all associated with the preferred choice of health facility for care. Conclusion: This study has shown that the private sector is preferred to the public ones with regards to receiving healthcare and that within the public sector, the higher levels of health facilities are preferred to the primary health care centres. Improving the image and performance of the public health facilities especially the PHC is very important for appropriate utilization of health servicesKeywords: Preference, Health Facilities, Public hospital, Private hospita