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

Effectiveness of Provider and Community Interventions to Improve Treatment of Uncomplicated Malaria in Nigeria: A Cluster Randomized Controlled Trial

The World Health Organization recommends that malaria be confirmed by parasitological diagnosis before treatment using Artemisinin-based Combination Therapy (ACT). Despite this, many health workers in malaria endemic countries continue to diagnose malaria based on symptoms alone. This study evaluates interventions to help bridge this gap between guidelines and provider practice. A stratified cluster-randomized trial in 42 communities in Enugu state compared 3 scenarios: Rapid Diagnostic Tests (RDTs) with basic instruction (control); RDTs with provider training (provider arm); and RDTs with provider training plus a school-based community intervention (provider-school arm). The primary outcome was the proportion of patients treated according to guidelines, a composite indicator requiring patients to be tested for malaria and given treatment consistent with the test result. The primary outcome was evaluated among 4946 (93%) of the 5311 patients invited to participate. A total of 40 communities (12 in control, 14 per intervention arm) were included in the analysis. There was no evidence of differences between the three arms in terms of our composite indicator (p = 0.36): stratified risk difference was 14% (95% CI -8.3%, 35.8%; p = 0.26) in the provider arm and 1% (95% CI -21.1%, 22.9%; p = 0.19) in the provider-school arm, compared with control. The level of testing was low across all arms (34% in control; 48% provider arm; 37% provider-school arm; p = 0.47). Presumptive treatment of uncomplicated malaria remains an ingrained behaviour that is difficult to change. With or without extensive supporting interventions, levels of testing in this study remained critically low. Governments and researchers must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines

Production and Quality Evaluation of Yoghurt Enriched with Two Accessions of Passion Fruits (Passiflora edulis f. flavicarpa)

Aims: The broad objective of the research produce acceptable yoghurt flavoured with two accessions of passion fruit (pulp and skin) and evaluate its quality (physicochemical, phytochemical, microbiological, selected mineral and vitamin content). Study Design: The experimental design that was used is Completely Randomized Design. Place and Duration of Study: The study took place at the Department of Food Science and Technology, University of Nigeria, Nsukka between August 2016 and September 2017. Methodology: Yoghurt is a diary product obtained from lactic acid fermentation of milk. Yoghurt and two accessions of passion fruit juices (Passiflora edulis f. flavicarpa O. Deg) were processed to formulate enriched yoghurt in the following ratios 90:10, 80:20, 70:30, 60:40 and 50:50. Yoghurt without the passion fruit juice (100:0) served as the control. Based on sensory evaluation, the best samples were subjected to physicochemical, phytochemical, microbiological, selected mineral and vitamin content evaluation using standard methods. The best enriched yoghurt samples were those in the ratio 90:10 and 80:20. Proximate composition of the enriched yoghurt samples significantly (p<0.05) differed with the controls. Results: Enriched yoghurt showed an increase in the protein content (3.70, 3.52, 3.86, 3.93, 3.94, 3.52%) than control (2.81%). The control had higher fat content (3.43%) than enriched yoghurt (2.93, 3.12, 3.14, 2.78, 3.03 and 2.90%). The ash content ranges from 0.59 - 0.82% while addition of passion fruit juice caused pH to drop from 4.24 in the plain yoghurt to 4.18, 4.20 and 4.23 in the enriched yoghurt. The titratable acidity of yoghurt samples increased from 0.18 in the control to 0.72, 0.54, 0.52, 0.50 and 0.45 in enriched yoghurt. No direct relationship was observed between the pH and the titratable acidity. The total solid content ranges from 4.57-30.03. The phytochemicals were in trace amount. There was no significant (p>0.05) difference in the tannin content. The titratable acidity of yoghurt samples increased from 0.013 µg in the control to 0.015, 0.027, 0.028, 0.016, 0.020 and 0.024 in enriched yoghurt. Significant (p<0.05) difference in the phenolic content value was observed among all the samples. The phenolic content in the yoghurt samples ranges from 0.06 to 0.10 mg/g. The mineral content and vitamin content of the flavoured yoghurt samples significantly (p<0.05) differed with that of the control. An increase in the sodium content was observed in the samples from the control (168.24 mg/100 g) to the enriched sample (209.31, 202.66, 169.48 and 192.82 mg/100 g). Similar increases were  observed for potassium, calcium, magnesium and phosphorus content of the samples. Enriched yoghurt showed an increase in the vitamin C content (6.40, 7.53, 7.29, 7.15 and 7.13 mg/g) than in the control (5.10 mg/g). Vitamin A content ranged from 14.96 µg/100g - 20.67 µg/100 g. The total viable count was higher in the control (5.67 × 105 cfu/ml) than in enriched yoghurt. The mould count of the yoghurt samples varied from 0.33 × 101 cfu/ml - 1.58 × 103 cfu/ml. All the sensory attributes tested in the flavoured yoghurt samples significantly (p<0.05) differed. Conclusion: Yoghurt enriched with local specie passion fruit juice from pulp, was the most accepted

Government Spending Pattern and Macroeconomic Stability in Nigeria: A Vector Autoregressive (VAR) Model

Macroeconomic stability has not kept pace with the pattern of Public sector spending in majority of the developing countries. Unfortunately, past studies have mainly focused on the consequences of aggregate government spending on macroeconomic variables, or at most disaggregated government spending into capital and recurrent. In order to use government spending to effectively bring macroeconomic stability in developing countries, government spending must be decomposed according to sectors. Only very few studies have done this. We made effort to find out the components of government spending that cause macroeconomic instability in Nigeria, using Vector Autoregressive (VAR) Model. Result reveals government capital expenditure on economic services is the major cause of inflation in Nigeria. Impulse response function shows inflation will respond very sharp and positively to any shock in government capital spending in economic sector and social and community services. Therefore, if government must pursue economic stability through inflation control, she must re-examine her investment in those sectors. Keywords: Government, Spending, Pattern, Macroeconomic, Stability JEL Classifications: H5, E

Plasma cholesterol of sicle cell anemia patients in Enugu, Nigeria

No Abstract. Bio-Research Vol. 5 (2) 2007: pp. 241-24