Septic arthritis of the hip with intraperitoneal dislocation of the femoral head

Septic arthritis is a potentially crippling infection of the joint cavity. Malnutrition in the setting of poor socioeconomic background is a known predisposing and propagating factor of septic arthritis. Prolonged untreated septic arthritis of the hip joint can be a rare cause of acute abdomen, this is due to the proximity of the hip joint to the pelvis causing the spread of the causative organisms into the peritoneal cavity. We present a case of septic arthritis of the hip joint presenting as acute abdomen with intra-peritoneal dislocation of the head of the femur, and reviewed relevant literature. Keywords: acute abdomen; septic arthritis; peritonitis; fracture dislocation

A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. METHODS/DESIGN: A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01350752

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra state, Nigeria

<p>Abstract</p> <p>Background</p> <p>In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups.</p> <p>Methods</p> <p>A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles.</p> <p>Results</p> <p>It was found that 80.5 % of the households had an LLIN and 64.4 % of the households stated that they actually used the nets the previous night. The findings showed that 42.3 % of pregnant women who had fever within the past month received ACTs, while 37.5 % of children ≪5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1–5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women.</p> <p>Conclusions</p> <p>The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.</p

Influence of annealing on properties of spray deposited nickel oxide films for solar cells.

Research article.Nickel oxide thin films were deposited on soda lime glass substrates by spray pyrolysis technique (SPT). Post-deposition annealing was carried out at 450 oC. Effects of annealing on the structural, elemental and surface morphological properties of the thin NiO films were investigated. XRD confirms polycrystalline with cubic crystalline structures of deposited and annealed NiO films. Preferred orientation was along (1 1 1) peak with intensity along (2 0 0) peak improved by annealing. The annealing process improved on formation of crystalline phases. XRD patterns have peak diffraction at (2θ = 37 o, and 43 o) for (1 1 1) for deposited and annealed. Peak diffraction at (2θ = 64 o, and 79 o) for (2 0 0) planes for 0.1 M and annealed respectively. Annealing improved on the film thickness by over 10 %. Surface morphology of deposited and annealed NiO films reveals nanocrystalline grains with uniform coverage of the substrate surface with randomly oriented morphology. Larger flakes are formed as a result of the annealing process. EDX elemental NiO films composition revealed presence of Ni and O elements in NiO films. A decrease in oxygen concentration was also observed confirming positive effect of annealing as an optimization process. Optimization of nickel oxide deposition process parameters offers opportunities for efficient and affordable solar cells

Systematic review of health data quality management and best practices at community and district levels in low and middle income countries

Research findings have reported lack of reliable health data and poor management for district health information systems in low and middle-income countries (LMIC). This paper aims to review the literature on problems with health data quality management and health information evidences and evidences of best practices and use at community and district levels in LMIC, with a view to making recommendations for future research. Research citations, conference proceedings and diseases surveillance reports from 2000–2011 were accessed in PubMed, Medline, LISTA (EBSCO), CINAHL, Cochrane, and Google. Relevant studies were selected, the methodologies critiqued and synthesized. The researchers accessed 1383, and 38 were reviewed by three reviewers. Poor quality health data, low level of health information use, and poor management of health information systems were found. These findings hinder evidence-based decisions based and planning at community and district levels in LMIC. Though poor practices were found, improved health care services delivery with improved health data efficiency was found to be possible.Web of Scienc