Human Immunodeficiency Virus needlestick injury: knowledge and management in a population of Nigerian anaesthetists

Objective: To determine the knowledge of HIV transmission and of post exposure management, following an HIVinfected needlestick injury, in a population of Nigerian anaesthetists. Subjects and Method: A cross-sectional, prospective assessment was conducted voluntarily in anaesthetists at an annual healthcare provider's forum, and at a major general hospital, using a structured questionnaire. Results: 63 Anaesthetists participated in the study. One anaesthetist knew the percentage of infected HIV needlestick injury that would result in HIV infection. ALL the high risk body fluids were correctly identified by 7 (11.1%) respondents. Twelve (19.0%) knew the correct immediate management when injured by a HIV-infected needlestick. Fifty eight (92.1%) were aware of post exposure prophylaxis (PEP), 25 (39.7%) had a PEP policy in their institutions and 57 (90%) knew when to commence PEP.Conclusion: Nigerian anaesthetists, though acutely aware of post exposure prophylaxis, are not aware of the fluids at risk and have not demonstrated adequate knowledge in the management, when injured by a HIV-infected needlestick. Keywords: HIV, needle-stick injury, anaesthetist, knowledge, management South African Psychiatry Review Vol. 11(4) 2005: 131-13

The antibacterial potentials of Nauclea latifolia

Herbal medicine is readily available in diverse African vegetation with the potentials of introducing new templates into medicine worldwide. Evaluating plants from the traditional African system of medicineprovides us with clues on how these plants can be used in the treatment of diseases. In vitro effect of Nauclea latifolia extract in hot water, cold water, petroleum ether and chloroform at concentrations of200, 150, 100, 50% were tested on some pathogenic bacteria such as Staphylococcus aureus, Escherichia coli, Salmonella typhi and Pseudomonas aeruginosa. Using agar diffusion punch holemethod, both the aqueous and alcoholic extracts of the leaves and roots showed appreciable inhibitory effect when compared to the positive control on S. aureus and P. aeruginosa while S. typhi and E. coliwere resistant to the extracts. Using serial doubling dilution, the minimum inhibitory concentration (MIC) was determined. The minimum bacteria concentration was determined by plating variousdilutions of the extracts without turbidity. Aqueous and alcoholic extracts of N. latifolia showed inhibitory and bactericidal activity on the test organisms. The alcoholic extracts showed larger zone ofinhibition on the test organisms. The alcohol leaf extracts showed a higher percentage of growth inhibition when compared to the positive control. The MIC ranges from 6.25 – 150 mg/ml on S. aureusand 12.5 – 150 mg/ml for P. aeruginosa. The MBC ranges from 100 – 150 mg/ml. The phytochemical analysis revealed the presence of saponin, resins, alkaloids, and carbohydrate

A survey of healthcare providers’ knowledge and attitudes regarding pain relief in labor for women in Ethiopia

BACKGROUND: To explore healthcare providers' knowledge and attitudes to the need for pain relief for women in labor. METHODS: A structured questionnaire (n = 200) distributed to healthcare providers working in the obstetric departments, including theatres, of three public hospitals in different settings (rural, peri-urban and urban) in Ethiopia. Descriptive analysis was performed using Excel 2013 and SPSS version 22 for associations. RESULTS: The response rate was 81.5% with 164 questionnaires completed. The majority, 79% of respondents, understood that women can feel moderate to severe pain in labor and 77% were of the opinion that labor pain should be relieved. However, common practices included only supportive measures such as breathing and relaxation exercises, back massage and support from family. The general attitude of healthcare providers is that labor is a natural process, women should be able to cope and that pain relief is not a priority for women in labor. More than half, 52% of healthcare providers had safety concerns with using pharmacological methods to relieve pain in labor. CONCLUSION: The majority of healthcare providers understand that women suffer significant pain during labor. However, providing effective pain relief is currently not provided as part of routine intra-partum care in Ethiopia

Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda

<p>Abstract</p> <p>Background</p> <p>Early and accurate diagnosis of malaria followed by prompt treatment reduces the risk of severe disease in malaria endemic regions. Presumptive treatment of malaria is widely practised where microscopy or rapid diagnostic tests (RDTs) are not readily available. With the introduction of artemisinin-based combination therapy (ACT) for treatment of malaria in many low-resource settings, there is need to target treatment to patients with parasitologically confirmed malaria in order to improve quality of care, reduce over consumption of anti-malarials, reduce drug pressure and in turn delay development and spread of drug resistance. This study evaluated the effect of malaria RDTs on health workers' anti-malarial drug (AMD) prescriptions among outpatients at low level health care facilities (LLHCF) within different malaria epidemiological settings in Uganda.</p> <p>Methods</p> <p>All health workers (HWs) in 21 selected intervention (where RDTs were deployed) LLHF were invited for training on the use RDTs. All HWs were trained to use RDTs for parasitological diagnosis of all suspected malaria cases irrespective of age. Five LLHCFs with clinical diagnosis (CD only) were included for comparison. Subsequently AMD prescriptions were compared using both a 'pre - post' and 'intervention - control' analysis designs. In-depth interviews of the HWs were conducted to explore any factors that influence AMD prescription practices.</p> <p>Results</p> <p>A total of 166,131 out-patient attendances (OPD) were evaluated at 21 intervention LLHCFs. Overall use of RDTs resulted in a 38% point reduction in AMD prescriptions. There was a two-fold reduction (RR 0.62, 95% CI 0.55-0.70) in AMD prescription with the greatest reduction in the hypo-endemic setting (RR 0.46 95% CI 0.51-0.53) but no significant change in the urban setting (RR1.01, p-value = 0.820). Over 90% of all eligible OPD patients were offered a test. An average of 30% (range 25%-35%) of the RDT-negative fever patients received AMD prescriptions. When the test result was negative, children under five years of age were two to three times more likely (OR 2.6 p-value <0.001) to receive anti-malarial prescriptions relative to older age group. Of the 63 HWs interviewed 92% believed that a positive RDT result confirmed malaria, while only 49% believed that a negative RDT result excluded malaria infection.</p> <p>Conclusion</p> <p>Use of RDTs resulted in a 2-fold reduction in anti-malarial drug prescription at LLHCFs. The study demonstrated that RDT use is feasible at LLHCFs, and can lead to better targetting of malaria treatment. Nationwide deployment of RDTs in a systematic manner should be prioritised in order to improve fever case management. The process should include plans to educate HWs about the utility of RDTs in order to maximize acceptance and uptake of the diagnostic tools and thereby leading to the benefits of parasitological diagnosis of malaria.</p

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND: Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services. METHODS: This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings. RESULTS: A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers. CONCLUSION: This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

The effects of different casting techniques on the hardness, energy absorbance and impact strength of sand-cast Pb-Sb-Cu alloys

The effect of casting technique on the impact strength, energy absorbance and hardness of sand cast Pb-Sb-Cu alloys was studied following casting of the alloys using three techniques. Cooling of the alloys after casting was carried out in water, air and furnace in order to vary the micro-structure of the alloys produced. Copper addition to the base alloy was by dispersion of the Cu powder within the Pb-Sb matrix using the three casting techniques. The results showed that Technique A, which involved simultaneous addition of Cu powder and pouring of the molten Pb-Sb into the mould conferred higher impact strength and better energy absorbance on the Pb-Sb-Cu alloys produced, compared to alloys from Techniques B (involving addition of Cu powder intermittently as pouring of Pb-Sb into the mould was going on) and C (involving pouring a stirred mixture of heated Pb-Sb alloy and powdered Cu into the mould). Hardness of the Pb-Sb-Cu alloys was independent of the casting techniques used, but highly dependent on the cooling rate imposed by the cooling medium. Irrespective of the casting technique used, cooling the Pb-Sb-Cu alloys in water conferred higher hardness on the alloys, while higher impact strength and energy absorbance were conferred on the alloys following furnace cooling. Increased Cu addition (up to a maximum of 8.26%) to the Pb-Sb alloy increased correspondingly the impact strength, energy absorbance and hardness of Pb-Sb-Cu alloys so produced.Keywords: Casting technique, sand casting, Pb-Sb-Cu alloy, copper powderInternational Journal of Natural and Applied Sciences, 5(3): 195-202, 200

Food superstition, feeding practices and nutritional anthropometry of pregnant women

The survey assessed the food superstition, feeding practices and  nutritional anthropometry of pregnant women attending ante-natal clinic in university of Nigeria teaching hospital Ituku/Ozalla, Enugu state, Nigeria. This survey was embarked upon to identify the superstitions held on food during pregnancy among pregnant women attending ante-natal clinic in university of Nigeria teaching hospital Ituku/Ozalla, Enugu state, to  determine their acceptance of these superstitions and to assess their  feeding practices and nutritional anthropometry. Structured and validated questionnaires were used to obtain information on the socio-economic characteristics, food superstitions and feeding practices of the subjects. Anthropometric indices of the subjects were also assessed using weighing scale, height measuring rod and tape. The data was analyzed using the  SPSS version17 to determine the means with their standard deviations,  frequencies, and percentages as well as drew charts. The result of the  survey shows that the mean weight and height of the subjects were 77.47 ± 12.23kg and 1.66 ± 0.06m respectively. Their mean wrist circumference was 16.17 ± 0.99cm. Also, the mean frame size and mean expected  weight were 10.30 ± 0.60 and 66.97 ± 7.91 respectively. Food superstitions were held on foods like fufu, beans, snail, cocoa drink, okro, dika nut, etc. Conclusively, this research has revealed that 29% acknowledged that there is still an existence of food superstition among pregnant women that  attend ante-natal in UNTH Ituku/Ozalla and about 19% of them still  practice it. The feeding pattern of this 19% was being affected by these superstitions. Their nutritional status is certainly determined by what they eat because "we are what we eat". However, about 42% had normal  expected body weight while 58% of pregnant women were malnourished. Hence, I recommend that nutrition education be intensified in ante-natal clinics and different villages in Nigeria to help teach pregnant women on healthy food selection and importance of nutrition before, during and after pregnancy.Keywords: Food superstition, nutritional anthropometry, pregnant wome

Hepatprotective Activity of Stem Bark Extracts of Garcinia kola in Acetaminophen-Induced Hepatic Injury in rats

This study evaluated the hepatoprotective effect of the aqueous and methanolic extracts of stem bark of Garcinia kola on acetaminophen-induced liver injury in rats. Twenty four (24) male Wister rats weighting between 116-247g were used for the study and the experimental animals were treated with graded doses of the aqueous (AE) and methanolic (ME) extracts of stem bark Garcinia kola for 7 days before induction of liver damage with 750mg/kg body weight of acetaminophen on the 8th day. At the end of the experimental period, serum samples were collected for biochemical studies and results showed markedly lowered mean values of liver maker enzymes (P&lt;0.001) with mean values of 52.90 + 4.21 IU/I, 12.8+ 3.93 IU/I and 14.00 + 2.21 IU/L for APL, ALT and AST respectively in group A (treated with 25mg/kg AE) when compared to respective mean values of 128.32 + 5.04 IU/L recorded in group E.This trend was also observed in groups B, C and D treated with 50mg/kg AE, 25mg.kg (ME) and 50mg/kg ME respectively. Also other biochemical parameters including total protein (TP) and albumin (ALB) showed mean values that demonstrated evidence of hepatroprotection in groups A-D when compared to group E. In conclusion, the aqueous and methanolic extracts of G. kola have been shown to have hepatoprotective activity and it is recommended that the phytochemical principles responsible for this effect be further elucidated through high resolution techniques.Key Words: Acetaminophen, ethnomedicine, hepatoprotective, Garcinia kol