Response of Late Season Maize/Soybean Intercropping to Nitrogen in the Humid Environment of South Southern Nigeria

Intensification of maize/legume production during early rains in the High Rainforest region of South Southern Nigeria is limited by heavy rainfall. Production of late season maize/legume by peasant farmers is gaining prominence though yields are low due to low soil fertility and improper crop arrangement. The objective of this research was to investigate the yield performance of late season maize/soybean intercropping in response to nitrogen fertilization and spatial arrangement of the intercrops. The trial was a split-plot design in randomized complete block with three replications. Treatments consisted of five rates of nitrogen (0, 25, 50, 75 and 100 kg ha-1) and five crop arrangements (sole maize at 53,333 plants ha-1, sole soybean at 266,666 plants ha-1 and maize: soybean additive mixture arrangements of 1:1, 2:2 and 1:2). Nitrogen fertilization increased yield in both maize and soybean at all the treatment levels, when grown sole or in mixtures. Application of 100 kg N ha-1 to maize increased number of ears per plant, 100-grain weight, cob yield and grain yield by 46, 35, 138 and 153 percents, respectively in 2007, and by 15, 48, 88 and 109 percents, respectively in 2008, over no nitrogen application. Similarly, application of 100 kg N ha-1 to soybean increased number of pods per plant, number of barren pods and 1000-seed weight by 53, 120 and 16 percents, respectively in 2007, and by 55, 99 and 14 percents, respectively in 2008, over no nitrogen application. Optimum seed yield in soybean was obtained at 50 kg N ha-1. The yield values of 1,352.8 and 1,158.2 kg ha-1 were higher than those obtained at 0 kg N ha-1 by 31 and 21 percent in 2007 and 2008. Increasing the nitrogen level further to 100 kg ha-1 depressed seed yield by 8 percent in 2007 over 0 kg ha-1. The nitrogen x crop arrangement interaction effects on grain yield and all other parameters were not significant (p< 0.05). Late season maize and soybean populations may be superimposed on each other and fertilized with 50 kg N ha-1 to take advantage of optimum soybean seed yield and 66-76 percent of the maize grain yield. Key words: maize, soybean, intercropping, additive mixtures, nitrogen fertilize

Hepatitis B Virus Knowledge and Vaccination Status among Health‐care Workers in Calabar, Nigeria

Background and Objectives: The World Health Organization estimates that 2 million health‐care workers (HCWs) are at risk of occupational exposure to hepatitis B virus (HBV), with the majority (90%) of such infections arising in sub-Saharan Africa. This study aimed to determine HBV knowledge and vaccination uptake among HCWs. Materials and Method: This was a cross sectional analytical study conducted among 392 HCWs from two major health institutions in Calabar i.e. the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC), Cross river State. Multi-staged sampling method comprising of two stages was used to recruit participants into the study. The study population comprised of doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Study Design: This was a cross-sectional, study of HCWs in Calabar. Sampling Method: Multi-staged sampling method was used to select participants from two major health institutions in Calabar, i.e., the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC). Thereafter, through balloting, simple random sampling technique was used to recruit the participants. Study Population: Three hundred and ninety-two HCWs were recruited from UCTH and GHC under the following categories: doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. Data Management: A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Results: Overall, 67.9% of the respondents were found to have adequate knowledge of HBV vaccination and infection. Less than half (43.4%) of HCWs admitted receiving three doses (i.e., full coverage) of the vaccine. Difficulty in accessing the vaccine (48, 23.4%) was identified as the major reason given for suboptimal vaccination. Conclusion: The knowledge of HBV infection and vaccination is quite modest among HCWs in Calabar. Despite this observation, the vaccination status among HCWs is unsatisfactory. The implication of the findings of our study for health policy and practice is to prevent further occupational exposure of HCWs to HBV infection through mandatory vaccination

Quality of life of patients with kidney failure in sub-Saharan Africa: protocol for a systematic review of quantitative studies

Introduction: The burden of chronic kidney disease (CKD) is rising in sub-Saharan Africa. Access to kidney replacement therapy (KRT) remains limited and modelling suggests a significant hidden burden of kidney failure managed without KRT. Kidney failure is contributing to serious health-related suffering (SHS) at a global level. Despite this, access to palliative care remains extremely disparate. There is an urgent need for greater palliative care provision for patients with kidney failure in sub-Saharan Africa. To inform this, it is important to understand their current quality of life. This article outlines our review protocol, ensuring transparency of our planned methods and reporting. Methods and analysis: A comprehensive search will be conducted of MEDLINE (Ovid), EMBASE, CINAHL, African Index Medicus and Africa Journals Online. ProQuest Dissertations & Theses Global will be searched for grey literature. Eligible sources will be quantitative observational studies, conducted in sub-Saharan Africa, and published in English or French. The primary outcome measure will be quality of life of those with kidney failure, measured using a validated quality of life tool. Abstract screening, data extraction and risk of bias assessments will be conducted independently by two reviewers. Meta-analysis will be performed on study subgroups, if appropriate, based on heterogeneity of included studies; otherwise results will be summarised narratively. This protocol is structured according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance. Ethics and dissemination: Ethical approval is not required because this review will synthesise published data. Findings will be disseminated in a peer-reviewed journal. PROSPERO registration ID: 27543

Nutrient Status and Ameliorating Effects of Poultry Droppings on Soil pH and Sustainable Production of Garden Egg

Sustainable production of crops on tropical soils requires soil amendment to remediate soil acidity status and raise fertility level. Industrial lime and inorganic fertilizers are either not available or too expensive to buy. This study was carried out with the objective of investigating the effects of poultry droppings on soil acidity amelioration and increased fertility for sustained production of garden egg (Solanum aethiopicum L.).The field trials were conducted at the Teaching and Research Farms of the University of Agriculture, Makurdi, and the Faculty of Agriculture, Cross River University of Technology, Obubra in 2009 and 2010. Two varieties of African garden egg (Gilo and Kumba) and three rates of poultry droppings (5, 10 and 15 t ha-1) were in factorial combinations. The experiment was laid out in a Randomized Complete Block Design with three replications.  The results obtained showed that all rates of the manure reduced the soil pH within 30 days after incorporation in both years and locations. At 60 days after application, and up to 140 days after incorporation, all manure rates increased the soil pH in both locations and years. The highest increase occurred with 15 t ha-1 poultry droppings at 140 days after incorporation. With no manure application, there was a steady decrease in pH up to the harvest time. All manure rates significantly (P<0.05) increased the yield of the garden egg varieties over when no manure was used. Poultry droppings at 15 t ha-1 produced the highest fruit yield in both years and locations. The crop yields were significantly (p<0.05) higher in Makurdi than Obubra in both years. Yield for 2010 was significantly higher than 2009 in both locations. Poultry dropping at the rate of 15 t ha-1 may be used to remediate soil pH and improve fertility for sustainable production of garden egg in the Guinea savanna or the Rainforest agro-ecologies

The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria

AIM: This paper examines the activities of mobile services units including ultrasound services in rural and urban communities in the Calabar region of South-South, Nigeria.MATERIALS AND METHODS: Consenting individuals were invited and attended five medical outreach activities in rural and urban areas of the Calabar region between January and June 2016. Abdomino-pelvic scans were done. Subsequently the results were analyzed.RESULTS: Five hundred and seventy-four (574) individuals had Abdomino-pelvic scans done, using a curvilinear probe to assess the abdomino-pelvic organs. The female to male ratio was 1.46:1. The age ranged from 1-78 years with a mean of 40.63 (standard deviation of 17.5). The commonest sonographic finding was uterine fibroids, 21 (8.1%). Fifty-four percent of the scans were normal. The commonest sonographic finding in men was prostatic enlargement.CONCLUSION: Medical outreach activities provided by mobile units provide much needed ultrasound services in poor resource settings in Nigeria. Significant clinical pathologies were identified at fairly high rates

mHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study

From BMJ via Jisc Publications RouterHistory: received 2021-12-19, accepted 2022-07-12, ppub 2022-08, epub 2022-08-26Publication status: PublishedFunder: UK National Institute for Health Research (NIHR) [NIHR Global Health Research programme /NIHR Research Unit on Health in Situations of Fragility].; Grant(s): 16/136/100Objective: To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. Design: Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with trend analysis of blood pressure (BP) control using paired t-test for quantitative data and thematic analysis for qualitative data. Setting: PHC facilities in rural and urban communities in Cross River State, south eastern Nigeria. NCDs were not part of routine training previously. As in most low-and-middle-income settings, funding for scale-up using conventional classroom in-service training for NCDs is not available in Nigeria, and onsite supervision poses challenges. Participants: Twenty-four health workers in 19 PHC facilities. Intervention: A self-paced mHealth training module on an NCD desk guide was adapted to be applicable within the Nigerian context in collaboration with the Federal Ministry of Health. The training which focused on hypertension, diabetes and sickle cell disease was delivered via Android tablet devices, supplemented by quarterly onsite supervision and group support via WhatsApp. The training was evaluated with pre/post-course tests, structured observations and focus group discussions. This was an implementation pilot assessing the feasibility and potential effectiveness of mHealth training on NCD in primary care delivery. Results: Nurses who received mHealth training recorded a statistically significant difference (p<0.001) in average pretest and post-test training scores of 65.2 (±12.2) and 86.5 (±7.9), respectively. Recordings on treatment cards indicated appropriate diagnosis and follow-up of patients with hypertension with significant improvements in systolic BP (t=5.09, p<0.001) and diastolic BP (t=5.07, p<0.001). The mHealth nurse training and WhatsApp support groups were perceived as valuable experiences and obviated the need for face-to-face training. Increased workload, non-availability of medications, facility-level conflicts and poor task shifting were identified challenges. Conclusions: This initiative provides evidence of the feasibility of implementing an NCD care package supported by mHealth training for health workers in PHCs and the strong possibility of successful scale-up nationally

Overuse of medications in low- and middle-income countries: a scoping review

OBJECTIVE: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. METHODS: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. FINDINGS: We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. CONCLUSION: Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications

Implementing health worker training on sepsis in South Eastern Nigeria using innovative digital strategies: an interventional study

Background: Sepsis is a leading cause of morbidity and mortality especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. Objectives: To assess the effectiveness of a digital health educational module on sepsis in improving the knowledge of medical doctors in Cross River State Nigeria on the diagnosis and management of patients presenting with sepsis. Design: Quasi-experimental analytical study. Methods:: We developed and deployed a sepsis module through an innovative application (Sepsis tutorial app) to doctors in Calabar, Nigeria. We assessed quantitative pre- and post-intervention knowledge scores for those completing the tutorial on sepsis between both assessments. A user satisfaction survey evaluated the content of the tutorial and the usability of the app. Results:: One hundred and two doctors completed the course. There were more males than females (58.8% versus 41.2%). Over half (52%) were junior doctors, a minority were general practitioners and house officers (3% and 5%, respectively), and 72.6% had practiced for periods ranging from 1 to 15 years post-qualification. Gender and age appeared to have no significant association with pre- and post-test scores. The oldest age group (61–70) had the lowest mean pre- and post-test scores, while general practitioners had higher mean pre- and post-test scores than other cadres. The majority (95%) of participants recorded higher post-test than pre-test scores with a significant overall increase in mean scores (25.5 ± 14.7%, p < 0.0001). Participants were satisfied with the content and multimodal delivery of the material and found the app usable. Conclusion:: Digital training using context-responsive platforms is feasible and may be used to close the critical knowledge gap required to respond effectively to medical emergencies such as sepsis in low- to middle-income settings

Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia.

BACKGROUND: Malaria is a major public health concern in The Gambia. There is limited data on the clinical manifestation and outcome of severe malaria in adult patients in The Gambia. The study therefore assessed the clinical manifestations and outcome of severe malaria in adult patients admitted at the Edward Francis Small Teaching Hospital. METHODS: The study retrospectively reviewed the records of all malaria patients admitted from 18th October 2020 to 2nd February 2022. Demographic data, clinical features, investigations, treatment, and outcomes were recorded. RESULTS: A total of 131 confirmed malaria patients were recruited into the study. The median age was 21 yrs, range (15-90) and most of them were within the youth age group (15-24yrs) 85 (64.9%). The majority of the patients were also male 88 (67.2%) with a male to female ratio of 2:1. The most common symptom at presentation was fever 119 (90.8%) and the most common sign was pallor 48 (36.6%). Seventy-six patients (58.1%) and 55 (41.9%) patients met the criteria for severe malaria and uncomplicated malaria diagnosis, respectively. The most common clinical feature amongst patients with severe malaria were impaired consciousness 34 (44.7%), severe anaemia 26 (34.2%) and acute kidney injury 20 (26.3%). Patients with severe malaria were younger with mean age of 22.9 vs. 29 yrs (p = 0.004), more likely to be referred from a lower-level health facility 62 (81.6%) vs. 34 (61.8%) (p = 0.012), to have a longer duration of admission (p = 0.024) and to die 13 (17.1%) vs. 0 (0%) (p = 0.001) as compared to patients with uncomplicated malaria. The total mortality was 13 (9.9%) and all the patients who died had severe malaria. Mortality was higher in patients with impaired consciousness 9 (26.5%) and there was a significant relationship between death and impaired consciousness 9 (69.3%) vs. 25 (21.4%) p = 0.001. CONCLUSION: Severe malaria still affects young adults in an endemic area with significant mortality. This suggests the need for targeted malaria prevention, surveillance, case management and control strategies in this population group in The Gambia to help reduce morbidity and mortality of malaria