Chemoprophylaxis for malaria - in pregnancy by public and private health providers in Lagos

Objectives: Malaria in pregnancy is a major public health problems contributing significantly to high morbidity and mortality. Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control, Sulphadoxine-Pyrimethamine, the current drug of choice, is recommended to be administered in the second and third trimesters of pregnancy during antenatal care (ANC) visits. Aim was therefore, to determine and compare the provision of chemoprevention using intermittent preventive treatment (IPTp) in public and private secondary hospitals in Lagos State.Method: This is a comparative, cross sectional study that assessed the factors influencing health care providers - provision of chemoprohylaxis - in public and private secondary health facilities in Lagos State. Data was collected using a pretested questionnaires administered to 302 healthcare providers selected through multistage sampling. Data generated was analysed with Epi-Info 2012 version.Results: The private providers had a better practice and provision of chemotherapy. Only 69.0% of public providers and 74.8% of private providers prescribed IPT using sulphadoxine-pyrimethamine. The private providers were more aware of the timing (recommended time to give IPTp) of IPTp.Conclusion: Both public and private health care providers have not fully embraced the evidence based World Health Organization recommendation of administration of least two doses of sulphadoxinepyrimethamine for malaria in pregnancy.Keywords: Chemoprophylaxis, Malaria, Pregnanc

Oral Health Related Quality of Life among Elderly People in a General Practice Setting in Lagos

Background: Oral health-related quality of life is a multidimensional construct. Oral health has an impact on an individual\u27s daily functioning, well-being and the overall quality of life. The elderly are prone to several dental problems such as dental caries and periodontal disease which constitute the major oral health burden all over the world. These two diseases have a high prevalence rate, wide geographical spread, graded severity and are important public health challenges. It is therefore important to examine the role of oral diseases with age and its impact on the quality of life of the elderly.Aim: To assess the pattern of oral health and quality of life amongst elderly patients.Materials and Methods: It is a descriptive cross sectional study, conducted among 294 elderly patients attending Orile Agege General Hospital, Lagos. Data was collected using a semi-structured, interviewer administered questionnaire for individual\u27s oral health using the WHO Oral Health Questionnaires for the adult and oral health related quality of life using OralHealth Impact Profile. Data obtained was subjected to descriptive, bivariate and multivariate analysis using IBM SPSS 20.Results: The mean age of the elderly was 68.65 ± 6.58 years. Nine point five percent of the respondents had less than 20 natural teeth, 46.6% were experiencing discomfort in mouth, 30.6% were using partial removable dentures and 4.8% were utilizing full lower or full upper removable dentures. Only 6.1% reported poor tooth condition and 8.2% stated poor gum condition. However, 42.9% of the respondents cleaned their teeth two times or more daily, 15.0% and 85.7% of subjects used tooth-brush/dental floss and fluoridated toothpaste respectively. On the oral health quality of life (OHQoL), 35.4% had some impact of oral health on QoL with the dominant domains being physical pain (50.3%), psychological discomfort (44.6%) and functional limitation (43.2%). OHQoL was influenced by the number of natural teeth (OR = 5.417, p<0.001), discomfort in mouth (OR = 2.128, p = 0.002), removable dentures (OR = 2.732, p = 0.001) and frequent tooth-brushing (OR = 1.770, p = 0.021).Conclusion: The number of natural teeth, discomfort in the mouth, presence of removable dentures and frequent mouth-washing influenced the quality of life of the elderly. &nbsp

Clients Expectations And Perception Of Quality Of Antenatal Care Services In Public And Private Health Care Facilities In Surulere Local Government Lagos

Background: Antenatal care is an important health service which detects and reduces the risk of complications among pregnant  women. The quality of care is likely to influence effective utilization and compliance with interventions. Lack of adequate quality of antenatal care is a major public health problems contributing significantly to high morbidity and mortality of pregnant women.  Identification of the gaps between expectation and perception of quality of antenatal services will improve antenatal care.Objective: The aim of this study was to determine and compare factors that influence clients expectations and perception of quality of antenatal care services in public and private primary care facilities.Method: This is a comparative, cross-sectional study that assessed the factors that influence client's perception of quality of antenatal care services on public and private primary health care facilities on Surulere Local Government. Data was collected using an adapted Servqual instrument questionnaires administered by interviewers to 418 women receiving antenatal care services selected through systematic sampling. Data was analysed with Epi-Info version 7.0.9.7 .Result: The mean aggregate expectation and perception scores were higher in the private health facilities (82.21 and 82.18) than public  health facilities (80.43 and 79.65). Proportions with positive expectation and perception were higher in the private health facilities (49.8% and 55.5%) than public health facilities (28.2% and 20.6%). The proportion with positive perception was significantly lower than the proportion with positive expectation in public health facilities.Conclusion: The women receiving antenatal care in private health facilities had higher positive expectation and perception of quality of care than women receiving antenatal care in public health facilities. Keywords: Perception, Expectation, Quality, Antenatal car

Pattern of management for malaria in pregnancy by public and private health providers in Lagos

Background: Malaria in pregnancy is a major public health problem contributing significantly to high morbidity and mortality. Malaria infection during pregnancy predisposes to adverse pregnancy outcomes which include; miscarriage, premature delivery, small for date babies, maternal anaemia and even intrauterine death. Utilization of current national antimalarial treatment guideline showed low level of use of antimalaria guideline by healthcare providers.Objective: The aim of this study was to determine and compare the knowledge, attitude and practice of healthcare providers about malaria in pregnancy in public and private secondary hospitals in Lagos State.Method: This is a comparative, cross sectional study that assessed the factors influencing health care providers knowledge, attitude and practice in public and private secondary health facilities in Lagos State. Data was collected using a pretested questionnaire administered to 302 healthcare providers selected through multistage sampling. Date generated was analysed with Epi-Info 2012 version.Results: The public providers were more (85.4% and 66.75) knowledgeable about the use of microscopic test and rapid diagnostic tool respectively compared to private providers (75.6% and 42.0%). Majority of the providers (87.7% and 84.9%) in both public and private facilities respectively had knowledge of IPTp. Majority of the public providers (93.6%) believed that malaria in pregnancy is very serious while a lesser proportion (82.4%) of the private providers believed the same. Majority of the public health providers (64.9%) used Artemisinin based combination therapy (ACT) in treatment of malaria in pregnancy in 2nd trimester while a lower proportion (55.5%) of the private providers used ACT in treatment of malaria in pregnancy in 2nd trimester.Conclusion: In conclusion, the pattern of antimalarial prescription among secondary health care providers in Lagos State varied widely among the practitioners and the fact that less than half of both public and private health care providers strongly agreed to direct observation of therapy showed that their practice does not fully embraced the evidence based recommendations of the World Health Organization and the National Antimalarial treatment  guideline. However, the public providers had a better practice regarding the management of malaria in pregnancy.Keywords: Case management, malaria, pregnanc

Clients satisfaction of antenatal care services in public and private health care facilities in Lagos

Background: Antenatal care involves screening for health and socioeconomic conditions likely to increase the possibility of specific adverse pregnancy outcomes, providing therapeutic interventions known to be effective and educating pregnant women about planning for safe birth. Quality and customer service have been identified as critical strategic issues for both public and private sector organizations. In private sector, customer satisfaction and loyalty are secured through high quality services. Public sector organizations are under constant pressure to improve customer service on a continuous basis. Patient satisfaction has traditionally been linked to the quality of services given and the extent to which specific needs are met.Objective: Aim of the study was to determine and compare factors influencing clients' satisfaction with antenatal care services in public and private primary care facilities.Methods: A descriptive cross-sectional comparative study design was used to recruit 209 respondents each in public and private health facilities in Surulere local government, Lagos state. A questionnaire was used for data collection of socio-demographics and overall satisfaction with care. The data obtained was presented as figures and tables .Chi-square (X2) test was used to test for association between the independent and dependent variables at probability value <0.05 (P-value <0.05). Ethical approval was obtained from Lagos University Teaching Hospital, Health Research and Ethics Committee [LUTH HREC]. Approval for the study was also sought from the authorities of all the selected facilities.Results: The percentage of respondents who were very satisfied with ANC services was higher in private (65.1%) than public (37.3 %). More women (98.6%) would come back in subsequent pregnancy while a lesser proportion (94.7%) in public facilities would come back. More women (98.6%) in private would recommend clinic to others while a lesser proportion (96.7%) in public would do the same.Conclusion: Women receiving antenatal care in private facilities are more satisfied than women attending public health facilities.Keywords: Antenatal care, clients' satisfactio

Male involvement in family planning services in Oshodi-Isolo local government area of Lagos state, Nigeria

Background: Family planning is a major tool in reducing population size, maternal and infant mortality. Even though it is naturally supposed to be a family matter, traditionally, it has always focused on women to the disregard of men. This neglect of men has not gone without attendant implications. The aim of the study was to assess the level of male involvement among married men in an urban setting in Nigeria.Methods: A community based descriptive cross-sectional study was done among married men within the ages of 18-55 years. Multistage sampling method was employed to select 383 participants. An interviewer administered; semi-structured questionnaire was used for data collection. Analysis was done using Epi info software 7, level of significance was set at 0.05.Results: The mean age of respondents was 38.8 years. The level of awareness of family planning was 89%. Only 23.8% of respondents had high involvement in family planning, the rest had low/no involvement. On bivariate analysis, older age, monogamy, religion, higher education were associated with high involvement. The commonest reason for non-use of family planning was desire to have more children.Conclusion: The level of male involvement was very low. To improve this trend, all-inclusive family planning programmes, which are male-friendly, with engagement of community and religious leaders should be designed. Priority should be given to younger men and polygamous families

Morbidity pattern and factors that influence family dynamics among elderly attending selected Primary Care Centres in Lagos

Background: The most vulnerable and high-risk groups in terms of morbidity and health status is the elderly. With ageing comes deterioration of functional capacity of an individual. The elderly usually has co-morbidities which results in a rapid decline in their health status. Family dynamics constitute the pattern of interactions between the family members. This is influenced by health status of the members. The health of the elderly is affected by social factors which involves children leaving their parents in search for jobs, leaving their parents isolated without support in daily activities and health-care system factors such as lack of effective health insurance system for elderly.Objective: To determine the morbidity pattern and family dynamics among elderly in selected Primary Healthcare Centres in LagosMethods: A cross sectional study was carried out on 207 elderly patients. A  multistage simple random sampling technique was used to select respondents and data was collected by using questionnaires from past studies to collect information on morbidity pattern, family type, family model, healthcare financing and  satisfaction. The obtained data was analyzed with SPSS version 20 software.Results: Of all the respondents, 133 (64.3%) were married, 64 (30.9%) widowed while 4.8% were either divorced or separated. Majority of the respondents,  113(54.6%) practiced monogamy. More than three quarter of the respondents live with family/caregivers. More than half of the respondents (53.1%) were unemployed, 74 (35.8%) self-employed while the remaining 23 (11.1%) were pensioners. About 94% paid out of pocket for their services, only 12 (5.8) were enrolled on NHIS. There were significant associations between Ischemic heart disease, tremor and satisfaction with service quality. Polygamy was found to be associated with Back pain, Parkinson disease, Depression, Arthritis, Hearing impairment. Interacting type of family model was found to be associated with Asthma, Hypertension, and Ischemic Heart Disease.Conclusion: The most prevalent medical condition in the elderly was Hypertension followed by back pain. Out of pocket was the most common (94.2%) means of payment for medical bills. Based on Stevenson's family model, the Interacting type was constituted by 87.9% of the respondents while the remaining proportion was made up of actualizing type

Poor utilization of medical microbiology laboratory by clinicians in a tertiary hospital in Lagos State Nigeria

Background: The clinical diagnosis of infection without laboratory confirmation leads to overprescription of antimicrobials and the resultant antimicrobial resistance. Global point prevalence survey done in Lagos University Teaching Hospital showed low targeted antimicrobial therapy meaning poor utilization of Medical Microbiology laboratory for the diagnosis of infections This study is aimed at finding the reasons for poor utilization of the Medical Microbiology laboratory for the diagnosis of infectionsMethods: A cross sectional survey of clinicians in Lagos University Teaching Hospital was conducted using self-administered structured questionnaire to obtain information on utilization of the medical microbiology laboratory for diagnosis of infections.Result: Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: houseofficers (13.7%), junior registrars (36.3%), senior registrars (34.3%), consultant (11.3%) and medical officers (4.4%). The years of practice were: 1 – 10years (77.3%), 11 – 20 years (14.8%), 21 – 30 years (4.4%), >30 years (3.5%). One hundred and forty four participants (70.6%) reported good use of Microbiology laboratory for the diagnosis of infection. Of 60 participants (29.4%) that reported poor use of Medical Microbiology laboratory, only 41 gave reasons. The main reason for poor utilization was that “Clinical diagnosis is sufficient” (56.1%), followed by” Results are often delayed and end up being irrelevant to patient management” (22.0%). Only 7.3% reported that their reason for poor use of the Microbiology laboratory was that their patient cannot afford the cost. Other reasons were: 'No access to Medical Microbiology Laboratory” (4.9%), 'No confidence in the accuracy of laboratory result” (4.9%) “Already know potent antibiotics, so there's no need for laboratory test”. None of the participants gave the following reasons: “No pathologist to ensure the quality of laboratory services” and “Don't need Medical Microbiology laboratory to manage patients with infection”. Microscopy, culture and sensitivity was the investigation most often requested for (63.7%) participants) while antigen detection was the Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: house least (6.4 %) participants. Of all the variables assessed, only being a senior registrar was associated with good use of medical microbiology laboratory.Conclusion:This result showed poor utilization of the laboratory (29.2%) and the main reason for this poor utilization is the presumption by prescribers that clinical diagnosis is sufficient for the diagnosis of infection (56.1%). Prescribers should be educated on the use of the Medical Microbiology for targeted antimicrobial therapy