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

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

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

HIV/TB Co-infection Among HIV Positive Children Attending Clinics In Imo State University Teaching Hospital Orlu, Imo State, Nigeria

Background: Human Immunodeficiency Syndrome and tuberculosis are among the leading causes of death from infectious diseases worldwide. The resurgence of tuberculosis in children is partly attributed to the coexisting burden of human immunodeficiency virus infection, which is most pronounced in sub Saharan Africa.Aim: To determine the prevalence and pattern of HIV/TB co-infection among HIV positive children attending clinics at Imo State University Teaching Hospital.Method: This is a retrospective review of HIV/AIDS children attending HIV clinics at Imo State University Teaching Hospital, Orlu, Imo State, Nigeria from January, 2011- December, 2012.Results: Of the total of 128 HIV infected children reviewed during the 24 months period, 16(12.5%) were coinfected with tuberculosis, (95% CI, 10.7% - 14.3%). Among these 16 patients, TB co-infection was diagnosed before commencement of ART in 93.7% of them. Majority of the TB cases (87.5%) presented with pulmonary TB amongst whom only 25.0% were sputum positive. The factors found to affect TB development significantly were stage of HIV disease (p=0.000) and CD4 count level (P=0.021) of patients. The factor with the highest influence on TB development was the clinical stage of HIV disease (Odds ratio =6.013) and that of least influence was sex of patient (Odds ratio= 0.8319).Conclusion: The study revealed a moderately high TB/HIV co-infection rate. Low CD4 count level below 200cell/ml and late clinical stages of HIV disease contribute significantly to the development of TB disease.Key Words: HIV/AIDS, tuberculosis, co-infection, children

Informed Consent In Research

Background: Ethical problems most often arise in research. One of the most important ethical rules governing research on humans is that participants must give their informed consent before taking part in a study. Informed consent is therefore a vital part of the research process, and as such entails more than obtaining a signature on a form. Most researchers however, do not have the requisite knowledge of the importance of informed consent in research. This paper attempts a synopsis of the place of informed consent in research study. Method: A review of literature on informed consent in research. Literature search was done using Google search engine as well as international and local journals. Result: Informed consent as an aspect of medical ethics, balances autonomy and beneficence, and provides adequate assurance of voluntary and autonomous participation without negative repercussions on access to study benefits. The search showed that this if adhered to in research, will surely maintain the dignity of man and the integrity of research as a field of human endeavour. Conclusion: Researchers must therefore ensure that potential research participants be given sufficient information about a study, in a format they understand, to enable them to exercise their right to make an informed decision whether or not to participate in a given research. Keywords: Informed consent, Research. Afrimedic Journal 2010; 1(1):5-1

Urbanization and health - An overview

Background: The rapid increase in the number of people living in urban areas is among the most important global health issues of the 21st  century. Also, most developing countries are facing the task of planning and ensuring a sustainable, sane and healthy development of cities.Objective: To review the relationship between urbanization and health with emphasis on approach and options for the promotion of healthy  behaviours and safety.Methodology: The main sources of information were online journals, Pub Med/Medline and Google. Additionally, publications from the World Health Organisation and public libraries were consulted for articles on urbanization and its impacts on health.Results: The health of urban populations has changed as cities have  evolved as a result of such factors as features of the social environment, the physical environment, and provision of and access to health and social services. The urban context of particular cities may also affect health as  well as modify the effect that unexpected stressors have on a city. Reliable urban health statistics are largely unavailable globally. However, available data indicate a range of urban health hazards and associated health risks that cut across different sectors, including health, environment, energy, transportation and urban planning.Conclusions: Governments are grappling with the challenges posed by the speed at which urbanization has outpaced their ability to provide essential infrastructure. There is need for planned urbanization to help avert the  negative effects of urban living on health

Awareness, accessibility and use of insecticide treated nets: a cross-sectional survey of ante-natal clinic attendees in a tertiary hospital in South-East Nigeria

Background: The use of insecticide treated net (ITN) for protection against malarial vectors has remained a cost effective and highly effective tool in global and national malarial control policies. Despite this effort towards reducing the intolerable burden of malaria, the disease continues to be a major public health problem in Nigeria.Objective: To determine the awareness, accessibility and use of ITN among women attending antenatal clinic (ANC) in a tertiary hospital in South-East Nigeria.Methodology: A cross-sectional study of 400 women attending ANC in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi was done. Data was collected using pre-tested semi-structured interviewer administered questionnaires and analyzed using Epi-info version 3.5.1 software. Tests of statistical significance were carried out using chi square tests for proportions. A p-value of <0.05 was considered significant.Result: The age range of the respondents was between 20 and 39 years. All the respondents were married. Out of the 400 women studied, 384 (96.0%) were aware that malaria is transmitted by the mosquito, 212 (64.6%) reported that their source of awareness of ITN was the hospital campaigns. A total of 312 (79.6%) of the respondents use ITN out of which 176 (56.4%), claimed to be using it on all nights. Educational status did not influence affordability (p 0.421)Conclusion: The accessibility and the use of ITN by pregnant women attending ANC in NAUTH was relatively good. However, there is need for this to be sustained through continued health education on the role of ITN in malaria control.Keywords: Affordability, ante-natal clinic, malaria, mosquito, NAUTHNnewi, pregnant wome

Clients’ knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria

Background: Clientsf knowledge, perception of and satisfaction with the quality of maternal health services (QMHS) enables maternal health programs to assess the impact of their services from the clients'  perspective.Objective: The objective of this study is to assess the knowledge,  perception of and clients' satisfaction with the QMHS at the primary health care (PHC) level in Nnewi, Nigeria.Materials and Methods: This was a cross.sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from randomly selected PHC facilities in Nnewi, Nigeria were selected for the study. Data were collected using a mix of quantitative and qualitative methods. Quantitative data were analyzed using Statistical Package for Social Sciences version 16, while qualitative data were reported verbatim, analyzed thematically and necessary quotes presented.Results: A total of 280 women were studied. The mean age of the  respondents was 29.2±5.9 years. 231 (82.5%) were married. 89 (31.8%) did not report any knowledge about QMHS. Level of satisfaction was not different among women of different socioeconomic groups (P > 0.05). Sociodemographic characteristics of clients were not found to be associated to the perception of waiting time: (P > 0.05). The attitude of health care providers toward the clients was reported as good.Conclusions: Despite the poor quality of services provided, this study  showed that client's knowledge of quality of services was good. Furthermore cost, local language used, staff attitude and interaction with clients was acceptable and may be the reason for high level of satisfaction reported.Key words: Clients' knowledge, clientsf perception, clients' satisfaction, primary health care level, quality of maternal health service

Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria

Background: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications.Objective: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos.Methodology: A cross‑sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self‑administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi‑square tests for proportions. P < 0.05 was considered significant.Results: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10–19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities.Conclusions: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group. Key words: Contraception, knowledge, Lagos, military barracks, practice, student

The Effect of Socio-demographic Status of Mother s on the Management of Febrile Illnesses Among Under-Fives that Presented in a Tertiary Hospital In South-east Nigeria: A Two-Year Review

Background: Infant and child mortality rates due to febrile illnesses are high in resource poor countries especially in sub Saharan Africa. The World Health Organization estimates that seeking prompt and appropriate care could reduce child deaths due to acute respiratory infections, by 20%. There is high disease burden from febrile illnesses with malaria contributing 30-50% of outpatient burden and 35% of hospital admissions. Objective: This is to measure the effect of sociodemographic status of mothers on the management of febrile illnesses in under-fives. Methods: This is a 2-year retrospective survey. A proforma was used to retrieve information from the case notes of underfives who presented with febrile illness in a tertiary health institution in Anambra State from January 2006 to December 2008. Results: Out of a total of 1000 under-fives that presented in the children's outpatient and children's emergency room in the institution during the study period, 400 had febrile illness with malaria accounting for (32.5%) 130 cases of the febrile conditions. Majority of the mothers, 50% (200) were between the ages of 26 and 30 years, and 25%; (100) were illiterate mothers. Fifty percent (200) were traders; 12.5% (50) artisans; 25% (100) were full time housewives, 12.5% (50) were civil servants, while 25.0% (100) did not receive any form of formal education. Conclusion: The fourth Millennium Development Goal (MDG) is to reduce child and infant mortality in the world by two thirds by 2015. As such an understanding of the roles that socio-demographic factors play in improving health and health-seeking behavior is important for public health policy. Findings of this study will equip stakeholders with the necessary input for planning and implementation towards an effective child health care services delivery and attainment of the MDG 4. Keywords: Socio-demographic status, febrile illnesses, Tertiary Hospital. Afrimedic Journal 2010; 1(1): 27-3