Training manual on the use of magnesium sulphate in the management of severe pre-eclampsia and eclampsia [trainee version]

This training manual provides detailed, descriptive, and practical instructions and tips necessary to respond to obstetric emergencies (severe pre-eclampsia and eclampsia). The manual is an integral part of the collaborative efforts between the Federal Ministry of Health and the MacArthur Foundation to scale up the use of magnesium sulphate in the management of severe pre-eclampsia and eclampsia in Nigerian health facilities. Magnesium sulphate has been established as the gold standard in the management of severe pre-eclampsia and eclampsia, but lack of knowledge and necessary skill have been identified as some of the factors responsible for its limited use in Nigeria. This training manual will help fill the critical knowledge gap both in training and practice with respect to the management of severe pre-eclampsia and eclampsia. It is hoped that magnesium sulfate and the standard of care presented in this manual will be made available in all appropriate health facilities, training institutions, and other stakeholders throughout Nigeria to reduce the morbidity and mortality associated with preeclampsia/eclampsia

HIV integrated biological and behavioural surveillance survey (IBBSS) 2010

This report by the Nigerian Federal Ministry of Health highlights the findings of an integrated biological and behavioral surveillance survey (IBBSS) in Nigeria among groups whose behaviors or occupations often place them at higher risk of contracting sexually transmitted infections, including HIV. The main objectives of the study were to assess the knowledge and beliefs of high-risk groups about STI and HIV, determine the prevalence of HIV infection among these groups, and obtain data that will permit identification of trends over time. Since the 2007 IBBSS survey report, a considerable number of interventions have commenced among the study groups

Analysis of the Prevention of Mother-to-Child Transmission (PMTCT) Service utilization in Ethiopia: 2006-2010

<p>Abstract</p> <p>Introduction</p> <p>Although progressive improvements have been made in the coverage and quality of prevention of HIV/AIDS mother-to-child transmission (PMTCT) services in Ethiopia, the national coverage remained persistently low. Analysis of the cascaded PMTCT services can reveal the advancements made and the biggest hurdles faced during implementation.</p> <p>Objective</p> <p>To examine the progresses and unaddressed needs in access and utilization of PMTCT services in Ethiopia from 2006 to 2010 thereby developing best-fit regression models to predict the values of key PMTCT indicators at critical future points.</p> <p>Methods</p> <p>Five-year national level PMTCT data were analyzed in a cascaded manner. Five levels of analysis were used for ten major PMTCT indicators. These included description of progress made, assessment of unaddressed needs, developing best-fit models, prediction for future points and estimation using constant prevalence. Findings were presented using numerical and graphic summaries.</p> <p>Results</p> <p>Based on the current trend, Ethiopia could achieve universal ANC coverage by 2015. The prevalence of HIV at PMTCT sites has shown a four-fold decrease during the five-year period. This study has found that only 53% of known HIV-positive mothers and 48% of known HIV-exposed infants have received ARV prophylaxis. Based on assumption of constant HIV prevalence, the estimated ARV coverage was found to be 11.6% for HIV positive mothers and 8.4% for their babies.</p> <p>Conclusion</p> <p>There has been a remarkable improvement in the potential coverage of PMTCT services due to rapid increase in the number of PMTCT service outlets. However, the actual coverage remained low. Integration of PMTCT services with grassroots level health systems could unravel the problem.</p

Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia

<p>Abstract</p> <p>Background</p> <p>To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia.</p> <p>Methods</p> <p>We interviewed all adult tuberculosis patients who were treated at Arba Minch Hospital in Ethiopia between January and August 2005. After recording socio-demographic information and tuberculosis treatment history, we referred those patients who showed initial willingness to a counsellor for HIV counselling and testing. Rapid test methods were used following a pretest counselling session. The results were disclosed during a post-test counselling session. We used the logistic regression method to assess factors associated with willingness and acceptability.</p> <p>Results</p> <p>190 adult tuberculosis patients were treated at the hospital and all of them consented to take part in the study. Their median age was 30 years (range, 15–68) and 52% of them were males. 49 patients (26%) were previously tested including 29 (59%) HIV positive. Of 161 patients (excluding the 29 already positive), 118 (73%) were willing to be tested and 58% (68/118) of those willing accepted the test. The overall acceptability rate was 35% (56/161). Fourteen (20.6%) were HIV positive and women were more likely to be HIV infected (p = 0.029). Unemployment and self-perceived high risk of HIV infection were associated with initial willingness (OR [95%CI]:2.6 [1.3–5.5] vs. 5.0 [1.1–22.4], respectively). However, only being unemployed was associated with accepting the test (OR = 4.2; 95%CI = 1.9–9.3).</p> <p>Conclusion</p> <p>The low acceptability of HIV counselling and testing among tuberculosis patients poses a challenge to the scale-up of TB/HIV collaborative efforts. There is a need for alternative counselling and testing strategies.</p

Lay beliefs of TB and TB/HIV co-infection in Addis Ababa, Ethiopia: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Knowledge about lay beliefs of etiology, transmission and treatment of TB, and lay perceptions of the relationship between TB and HIV is important for understanding patients' health seeking behavior and adherence to treatment. We conducted a study to explore lay beliefs about TB and TB/HIV co-infection in Addis Ababa, Ethiopia.</p> <p>Findings</p> <p>We conducted a qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients in Addis-Ababa, Ethiopia. We found that a predominant lay belief was that TB was caused by exposure to cold. Excessive sun exposure, exposure to mud, smoking, alcohol, khat and inadequate food intake were also reported as causes for TB. Such beliefs initially led to self-treatment. The majority of patients were aware of an association between TB and HIV. Some reported that TB could transform into HIV, while others said that the body could be weakened by HIV and become more susceptible to illnesses such as TB. Some patients classified TB as either HIV-related or non-HIV-related, and weight loss was a hallmark for HIV-related TB. The majority of patients believed that people in the community knew that there was an association between TB and HIV, and some feared that this would predispose them to HIV-related stigma.</p> <p>Conclusion</p> <p>There is a need for culturally sensitive information and educational efforts to address misperceptions about TB and HIV. Health professionals should provide information about causes and treatment of TB and HIV to co-infected patients.</p

Facilitators for maternity waiting home utilisation at Attat Hospital:a mixed-methods study based on 45 years of experience

Objective To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff.Methods Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation.Results The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby.Conclusions Facilitators for MWH utilisation according to users and staff were perceived high-quality EmONC, integrated health services, awareness of pregnancy-related complications and the husband's support in overcoming barriers. If providing high-quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.</p