Insecticide Treated Nets Possession and Utilization among Pregnant Women in Enugu Nigeria: A Descriptive Cross-sectional Study

Background: Pregnant women, particularly the primigravida are doubly at risk of malaria. The use of insecticide treated nets (ITNs) among pregnant women take into account the community attitudes and beliefs about malaria.  This study examined the socio-demographic, cultural and economic factors that influence the use of ITN among pregnant women in Enugu, Nigeria.Methods: The study design was descriptive cross-sectional and it involved 290 ante natal clinic attendees in three facilities selected by simple random sampling method and data collected using interviewer-administered questionnaires. Results: The mean age of respondents was 30±5.9 years and they exhibited an overall ITN knowledge of 254 (87.9%). The overall ITN utilization rate among the pregnant women was 20.7%. About 88.3% had no fear about ITN use, but 50 (18.5%) and 41 (15.2%) of them gave feeling of “suffocation” and “heat” respectively as reasons for not using ITN while 140(49.5%) of respondents expressed preference for white ITN colour. Conclusion: Government and other stakeholders should make ITNs available and affordable to all pregnant women, while decisions about the nets should consider their shape, size, designs and colour. Key words: Insecticide Treated Net, Utilization, Pregnant women, Enug

Effect of Free ACT and ITN Provision on Caregivers’ Attitude and Practice of Home Management of Malaria in a Local Government Area of Anambra State

In Nigeria, only about 20% of malaria episodes are treated in the health centres, while care provided at home and community ranked first in the actions taken during illness in under fives. These treatments are usually incorrect or sub-optimal, sometimes due to poor accessibility to essential anti malarial drugs. The main purpose of this study is to test the effectiveness of health education with free supply of ITNs and ACTs in enhancing and improving the practice of home management of malaria among mothers in Dunukofia Local Government Area of Anambra State, Nigeria. Two rural communities, Ifitedunu and Ukwulu in Dunukofia LGA were randomized into study (ACT, ITN and Health Education) and control groups (only Healthy Education). A total of 425 Caregivers with children aged 0-5 years were studied. Data was collected at baseline and 3 months after using an interviewer administered questionnaire. SPSS version 11 software package was used for data analysis with the hypotheses tested at 0.05 percent level of significance. Caregivers who used ACTs in the study group increased markedly from 4.3% to 61.4% post-intervention and the same was true for ITN use (17.4% to 57.8%). Also window and door nets use increased from 44.1% to 66.8% at post intervention while patronage of drug stores reduced markedly from 25 (21.6%) to 6 (5.5%). No significant changes occurred in the control group. Provision of free ITNs and ACTs brought significant improvement in their usage. Therefore, the availability of these products remains a sine-qua-non for their sustained appropriate utilization in the home management of malaria among Caregivers. Key words: ACT, ITN, Caregiver, Practice of Home management of Malari

Prediction of low birth weight from other anthropometric parameters in Nnewi, south eastern Nigeria

Background: Low birth weight is a global problem but presents a major burden on the neonatal services in developing countries such as Nigeria, and brings to bear a greater strain on the meagre resources available for health care delivery and family financing. In a resourceconstrained setting as ours, proper weighing of all newborn infants and medical surveillance of low birth weight infants, although highly desirable, are often not achieved due to unavailability of suitable, functional weighing scales. There are serial cut-off points for the various anthropometric indices for the normal birth weight babies below which any baby is termed low birth weight. This study assessed the predictive values of anthropometric measurements in the detection of low birth weight newborn babies and also determined the local specific cut-off points for these measurements in Nnewi, Southeast Nigeria.Methods: This was a crosssectional study in which length, occipitofrontal circumference, mid-arm circumference and maximum thigh circumference of 428 singleton babies were ascertained within 24 hours of delivery. Data were analysed using the Statistical Package for Social Sciences (SPSS) software. Correlation and linear regression analyses were done to examine the linear relationship between the predictors and birth weight. The sensitivity, specificity and predictive values were calculated at serial cut–off points and the points of best discrimination determined.Results: The low birth weight prevalence was 15.2%. Maximum thigh circumference attained the highest correlation with birth weight (r = 0.904), greatest coefficient of determination (r2=0.817), and least measure of dispersion around the actual birth weight. Thus maximum thigh circumference, which has a cut-off point of 16.75cm, was the best predictor of low birth weight, with 98.5% sensitivity, 92.3% specificity and diagnostic accuracy of 93.2% (P<0.001).Conclusion: Routine measurements of maximum thigh circumference in resource-poor countries is an effective proxy for weight at birth in prenatal assessments and epidemiologic surveys.Key words: anthropometric parameters,low birth weight, newborn, Nigeri

Caregivers’ satisfaction and supervision of primary health care services in Nnewi, Nigeria

Although major gains were made in the reduction of childhood health indicators in the previous decade, stagnations or reversals were seen in many countries since the 1990s. Despite presence of primary health centers (PHC) in Nigeria, there are still high levels of morbidity and mortality among children because the quality of child health services falls short of what it could be in the country. Supportive supervision of PHCs should also improve the quality of child health services. This study assessed the level of clients’ satisfaction with care received and the quality of supervision of child health services in selected PHC facilities of Nnewi, Nigeria. The study design was cross sectional. Four health facilities were selected by simple random sampling technique from a list of 12 public PHC facilities that provide at least three of the range of essential child health services. Using interviewer administered questionnaire, data were collected from 305 caregivers and analyzed accordingly. Also key informant interviews were used to elicit information facility supervision frequency and adequacy. The mean age of the mainly female caregivers was 31.9 ± 9.4 years. Majority of the caregivers attended health facilities closest to them but 18.5% of the 65 who do not, said they did not like the health workers. Although more than 80% of clients were satisfied with quality of child health services received, yet 41.3% of them felt that the number of service days were inadequate. None of the health facilities had a work plan, supervision schedule or supervision checklist. Increasing the number of service days and providing supervision schedules and checklists at the health facilities can improve caregiver satisfaction and hopefully enhance quality of child health services at the PHCs.Key words: Caregivers, satisfaction, supervision, PHC, Nnew

Effectiveness of data collection and information transmission process for disease notification in Anambra State, Nigeria

Background: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria, thus, its inability to promptly detect and control epidemics.Objective: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state.Materials and Methods: The study was of cross‑sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review.Results: One hundred (43.9%) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms, 25% and 16.2% reported it was irregular and usually out of stock, respectively. Most facilities (81.5%) returned completed forms monthly. Secondary health facilities were less likely to submit completed forms, while majority of primary health facilities submitted theirs monthly (X2 = 4.42, P = 0.035). With respect to correctness of records, Health Management Information System records (55.6%) were the least correct, while out‑patient register (88.9%) was the most correct. Only 10.0% of health facilities submitted completed forms 5 days after completion, 88.9% of them submitted completed IDSR002 forms within 2 days of completion, while the remainder was submitted 4 days later.Conclusion: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training–retraining of health personnel on DSN, improved funding, provision of logistics, improved supervision, and feedback of information.Keywords: Data collection, disease notification, effectiveness, information transmission processNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Complete Hydatidiform Mole Coexisting with a Live Fetus

Hydatidiform mole co-existing with a normal fetus is very rare. We report a case of a 36 year old woman Para 4+0 who presented with amenorrhoea of twenty four weeks duration, vaginal bleeding , abdominal pain and  pre-eclampsia. Ultrasound examination revealed a hydatidiform mole  coexisting with a normal living fetus. The patient underwent a caesarean section at twenty eight weeks for maternal distress due to unbearable   abdominal pain. The baby died after seven days. Post operatively she had an eclamptic fit and developed oliguria and persistent trophoblastic disease which were all successfully treated.Key words: hydatidiform mole, living fetus, perisitent trophoblastic disease

Comparative Analysis of Patient Satisfaction Levels in HIV/AIDS Care in Secondary and Tertiary Health Care Facilities in Nigeria

Background: Continuous quality improvement is linked to the use of timely and useful feedback from clients in HIV care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction of Antiretroviral Drugs (ARTs) services in Nigeria has significantly impacted positively on the overall well being of people living with HIV/AIDS (PLWHAs). However, there is little understanding of their satisfaction and perception of quality of care provided. Objective: This study comparatively assessed patients' satisfaction with ambulatory HIV/AIDS care in secondary and tertiary health facilities in Anambra State. Methods: This was a descriptive comparative crosssectional study of 300 PLWHAs conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi (150) and at St. Charles Borromeo Catholic Hospital (SCBH), Onitsha (150). Sample selection was by systematic sampling technique whereby every 3rd patient registered to see the doctor each day was recruited. Data was collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. Results: Patients in Nnewi were more likely to spend more 2 money on transport (÷ = 33.36, p=0.0001), while those in Onitsha were more likely to incur more expenses on non-HIV 2 tests (÷ = 5.73, p=0.017). Patients visiting the tertiary health facility were significantly more satisfied with access to care than those visiting the secondary health care facility were, (

Lipoma of the transverse colon: Review of literature and a case report in a young Nigerian female

Colonic lipomas are rare benign tumour of the gastrointestinal tract(GIT); however, they remain the commonest nonepithelial(mesenchymal) benign neoplasm of the GIT tract. The majority remains asymptomatic. They can mimic malignant tumours of the GI tract. We present a review of literature and our experience with the management of a case of this rare tumour. A 35year old woman presented to us with an upper abdominal pain of six  weeks,vomiting and passage of bloody  mucoid stool of four weeks. A huge palpable mass in the epigastric region.  Contrast-enhanced Computed tomography revealed a well-defined, 18cm, fatty tissue mass in the transverse colon. She had a right hemicolectomy. Histology confirmed the diagnosis revealing a submucous lipoma. One year follow up, she remained symptom-free with no evidence of recurrence. This study raises the awareness of this rare tumour as a cause of GIT symptoms and highlights the challenges in differentiating it from the more common malignancy of the colon. Keywords: Colonic lipoma, lipoma of transverse colon, Non-epithelial tumour Nigerian femal

Eff ect of the sub-chronic administration of some commonly used herbal products on the liver enzymes, body weight, and feed intake of albino Wistar rats: Any implication for public health?

The present study was focused to assess the effects of the administration of commonly used herbal products viz.:Yoyo cleansing bitters, T. angelica herbal tonic, and Bio-Strath elixir on the liver enzymes, body weight, and feedintake in adult albino Wistar rats. A total number of seventy Wistar rats were divided into three major groups.Each group received a particular herbal product and each of these groups was further subdivided into subgroupsthat received various dosages of each of the herbal products. The rats were acclimatized for 14 days after whichthey received different doses of each of the herbal products for 6 weeks. The body weight, feed intake, andmodulation in liver enzymes were evaluated. The feed intake and body weights were reduced in animals thatreceived T. angelica herbal tonic and Yoyo cleansing bitters at twice the normal dose once and twice daily, butthe reverse was the case for the rats that received Bio-Strath elixir even at higher doses. The liver enzymes wereincreased at all doses in rats which were given Bio-Strath elixir but it was not significant (P > 0.05), while thoseof Yoyo bitters and T. angelica herbal tonic were significantly increased (P < 0.05), especially at higher doses.From our study results it was suggested that a higher dose than the manufacturer’s recommended dose takenfor a longer duration can elevate liver enzyme, thus causing abnormal liver function

Mechanisms underpinning interventions to reduce sexual violence in armed conflict: A realist-informed systematic review

Sexual violence is recognised as a widespread consequence of armed conflict and other humanitarian crises. The limited evidence in literature on interventions in this field suggests a need for alternatives to traditional review methods, particularly given the challenges of undertaking research in conflict and crisis settings. This study employed a realist review of the literature on interventions with the aim of identifying the mechanisms at work across the range of types of intervention. The realist approach is an exploratory and theory-driven review method. It is well suited to complex interventions as it takes into account contextual factors to identify mechanisms that contribute to outcomes. The limited data available indicate that there are few deterrents to sexual violence in crises. Four main mechanisms appear to contribute to effective interventions: increasing the risk to offenders of being detected; building community engagement; ensuring community members are aware of available help for and responses to sexual violence; and safe and anonymous systems for reporting and seeking help. These mechanisms appeared to contribute to outcomes in multiple-component interventions, as well as those relating to gathering firewood, codes of conduct for personnel and legal interventions. Drawing on pre-existing capacity or culture in communities is an additional mechanism which should be explored. Though increasing the risk to offenders of being detected was assumed to be a central mechanism in deterring sexual violence, the evidence suggests that this mechanism operated only in interventions focused on gathering firewood and providing alternative fuels. The other three mechanisms appeared important to the likelihood of an intervention being successful, particularly when operating simultaneously. In a field where robust outcome research remains likely to be limited, realist methods provide opportunities to understand existing evidence. Our analysis identifies the important potential of building in mechanisms involving community engagement, awareness of responses and safe reporting provisions into the range of types of intervention for sexual violence in crises