11 research outputs found
Evaluating Health Workersâ Knowledge Following the Introduction of Clinical Mentoring in Jigawa State, Northern Nigeria.
Clinical mentoring is work-based training for the capacity building of health care workers. This study determined if there were benefits and increases in knowledge levels for 33 selected health workers across 5 health facilities in Jigawa State following the introduction of clinical mentoring. Questionnaires were used to determine biodata and knowledge scores of mentored health workers and also key departmental activities before and after a 6 months period of introduction of clinical mentoring. Data was analyzed with SPSS version 20. Over 90% of the 33 mentored health workers showed an increase in their knowledge scores. The mean percentage score of the health workers increased significantly from 56.3 ± 2.1 before the start of clinical mentoring to 74.7 ± 1.7 (p<0.001) six months later. Mortality review meetings were also introduced. This study has shown that clinical mentoring is beneficial for improving the clinical knowledge of mentored health workers. (Afr J Reprod Health 2015; 19[3]: 118-125). Keywords: Health workers, clinical mentoring, capacity building, northern Nigeria Le mentorat clinique est la formation en milieu de travail pour le renforcement des capacitĂ©s du personnel de la santĂ©. Cette Ă©tude a dĂ©terminĂ© sâil y avait des avantages et des augmentations dans les niveaux de connaissances pour les 33 membres du personnel de la santĂ© sĂ©lectionnĂ©s Ă travers 5 Centres de santĂ© de l'Etat de Jigawa suite Ă l'introduction de mentorat clinique. Des questionnaires ont Ă©tĂ© utilisĂ©s pour dĂ©terminer un curriculum vitae et des notes de connaissances du personnel de la santĂ© qui sont passĂ©s par le mentorat et aussi des activitĂ©s clĂ©s du ministĂšre avant et aprĂšs une pĂ©riode de six mois de l'introduction du mentorat clinique. Les donnĂ©es ont Ă©tĂ© analysĂ©es avec la version SPSS 20. Plus de 90% des 33 des membres du personnel de la santĂ© qui ont subi le mentorat ont montrĂ© une augmentation dans leurs scores de connaissance. Le score moyen de pourcentage du personnel de la santĂ© a augmentĂ© considĂ©rablement de 56,3 ± 2,1 avant le dĂ©but de mentorat clinique Ă 74,7 ± 1,7 (p <0,001) six mois plus tard. Les rĂ©unions pour lâexamen de la mortalitĂ© ont Ă©tĂ© Ă©galement introduites. Cette Ă©tude a montrĂ© que le mentorat clinique est bĂ©nĂ©fique pour amĂ©liorer la connaissance clinique du personnel de la santĂ© qui a subi le mentorat. (Afr J Reprod Health 2015; 19[3]: 118-125). Mots-clĂ©s: personnel de la santĂ©, mentorat clinique, renforcement des capacitĂ©s, nord du Nigeri
The Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants in Sub-Saharan Africa
BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. METHODS: We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, IPTi delivery costs and country specific provider and household malaria treatment costs. FINDINGS: In sites where IPTi had a significant effect on reducing malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36-4.03 based on trial specific data and USD 0.68-2.27 based on the pooled analysis. For IPTi using alternative antimalarials, the lowest cost per case averted was for AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi was shown to be cost effective in all the sites and highly cost-effective in all but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced health system costs and showed significant savings to households from malaria cases averted. A threshold analysis showed that there is room for the IPTi-efficacy to fall and still remain highly cost effective in all sites where IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS: IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective
Knowledge of safe motherhood among women in rural communities in northern Nigeria: implications for maternal mortality reduction
An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholdersâ perceptions about clinical mentoring
Increasing health equity and access to skilled birth delivery services for the poor through community-based health-care interventions: evidence from northern Nigeria
Using health and demographic surveillance system (HDSS) data to analyze geographical distribution of socio-economic status; an experience from KEMRI/CDC HDSS
Continuous monitoring in health and demographic surveillance sites (HDSS) allows for collection of longitudinal demographic data, health related, and socio-economic indicators of the site population. We sought to use household survey data collected between 2002 and 2006 in the Kenya Medical Research Institute in collaboration with Centers for Disease Control and prevention (KEMRI/CDC) HDSS site in Asembo and Gem Western Kenya to estimate socio-economic status (SES) and assess changes of SES over time and space. Data on household assets and characteristics, mainly source of drinking water, cooking fuel, and occupation of household head was annually collected from 44,313 unique households during the study period. An SES index was calculated as a weighted average of assets using weights generated via Principal Component Analysis (PCA), Polychoric PCA, and Multiple Correspondence Analysis (MCA) methods applied to the pooled data. The index from the best method was used to rank households into SES quintiles and assess their transition over time across SES categories. Kriging was employed to produce SES maps at the start and the end of the study period. First component of PCA, Polychoric PCA, and MCA accounted for 13.7%, 31.8%, and 47.3%, respectively of the total variance of all variables. The gap between the poorest and the least poor increased from 1% at the start to 6% at the end of the study period. Spatial analysis revealed that the increase in least poor households was centered in the lower part of study area (Asembo) over time. No significant changes were observed in Gem. The HDSS sites can provide a platform to assess spatial-temporal changes in the SES status of the population. Evidence on how SES varied over time and space within the same geographical area may provide a useful tool to design interventions in health and other areas that have a close bearing to the SES of the population
Erratum to: Knowledge of safe motherhood among women in rural communities in northern Nigeria: implications for maternal mortality reduction
The costeffectiveness of intermittent preventive treatment for malaria
Background: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30 % in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. Methods: We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP
Effect of myeloid differentiation primary response gene 88 on expression profiles of genes during the development and progression of Helicobacter-induced gastric cancer
Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial
Meeting abstract FRAB0101LB from 21st International AIDS Conference 18â22 July 2016, Durban, South Africa.
Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIVâinfected adults and children with advanced disease in subâSaharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown.
Methods:
The REALITY 2Ă2Ă2 factorial openâlabel trial (ISRCTN43622374) randomized ARTânaĂŻve HIVâinfected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (antiâtuberculosis) and fluconazole (antiâcryptococcal/candida), 5 days azithromycin (antiâbacterial/protozoal) and singleâdose albendazole (antiâhelminth)), versus standardâofâcare cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixedâdose combination. Two other randomizations investigated 12âweek adjunctive raltegravir or supplementary food. The primary endpoint was 24âweek mortality.
Results:
1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% lossâtoâfollowâup). Median baseline CD4 was 36 cells/mm3 (IQR: 16â62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54â0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58â0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2).
Conclusions:
Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIVâinfected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this lowâcost broad infection prevention package which could save 3.3 lives for every 100 individuals treated