Chemoprophylaxis for malaria - in pregnancy by public and private health providers in Lagos

Objectives: Malaria in pregnancy is a major public health problems contributing significantly to high morbidity and mortality. Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control, Sulphadoxine-Pyrimethamine, the current drug of choice, is recommended to be administered in the second and third trimesters of pregnancy during antenatal care (ANC) visits. Aim was therefore, to determine and compare the provision of chemoprevention using intermittent preventive treatment (IPTp) in public and private secondary hospitals in Lagos State.Method: This is a comparative, cross sectional study that assessed the factors influencing health care providers - provision of chemoprohylaxis - in public and private secondary health facilities in Lagos State. Data was collected using a pretested questionnaires administered to 302 healthcare providers selected through multistage sampling. Data generated was analysed with Epi-Info 2012 version.Results: The private providers had a better practice and provision of chemotherapy. Only 69.0% of public providers and 74.8% of private providers prescribed IPT using sulphadoxine-pyrimethamine. The private providers were more aware of the timing (recommended time to give IPTp) of IPTp.Conclusion: Both public and private health care providers have not fully embraced the evidence based World Health Organization recommendation of administration of least two doses of sulphadoxinepyrimethamine for malaria in pregnancy.Keywords: Chemoprophylaxis, Malaria, Pregnanc

The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution

Objective: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health‑related behavior among preschool children aged 6–71 months in Lagos.Materials and Methods: This was a descriptive cross‑sectional study in which 302 children aged 6–71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria.Results: The prevalence of ECC among 302 children aged 6–71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle‑fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3–6 months showed significantly lesser caries prevalence. Caries significantly increased with age.Conclusion: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.Keywords: Early childhood caries, Lagos, prevalence, risk factor

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria

Introduction Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. Methods A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. Results Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. Conclusion Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare

Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as, women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care; and these contribute to the increased incidences of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria

Pattern of management for malaria in pregnancy by public and private health providers in Lagos

Background: Malaria in pregnancy is a major public health problem contributing significantly to high morbidity and mortality. Malaria infection during pregnancy predisposes to adverse pregnancy outcomes which include; miscarriage, premature delivery, small for date babies, maternal anaemia and even intrauterine death. Utilization of current national antimalarial treatment guideline showed low level of use of antimalaria guideline by healthcare providers.Objective: The aim of this study was to determine and compare the knowledge, attitude and practice of healthcare providers about malaria in pregnancy in public and private secondary hospitals in Lagos State.Method: This is a comparative, cross sectional study that assessed the factors influencing health care providers knowledge, attitude and practice in public and private secondary health facilities in Lagos State. Data was collected using a pretested questionnaire administered to 302 healthcare providers selected through multistage sampling. Date generated was analysed with Epi-Info 2012 version.Results: The public providers were more (85.4% and 66.75) knowledgeable about the use of microscopic test and rapid diagnostic tool respectively compared to private providers (75.6% and 42.0%). Majority of the providers (87.7% and 84.9%) in both public and private facilities respectively had knowledge of IPTp. Majority of the public providers (93.6%) believed that malaria in pregnancy is very serious while a lesser proportion (82.4%) of the private providers believed the same. Majority of the public health providers (64.9%) used Artemisinin based combination therapy (ACT) in treatment of malaria in pregnancy in 2nd trimester while a lower proportion (55.5%) of the private providers used ACT in treatment of malaria in pregnancy in 2nd trimester.Conclusion: In conclusion, the pattern of antimalarial prescription among secondary health care providers in Lagos State varied widely among the practitioners and the fact that less than half of both public and private health care providers strongly agreed to direct observation of therapy showed that their practice does not fully embraced the evidence based recommendations of the World Health Organization and the National Antimalarial treatment  guideline. However, the public providers had a better practice regarding the management of malaria in pregnancy.Keywords: Case management, malaria, pregnanc

Erection hardness score and family functioning of men with erectile dysfunction in Eku Baptist Hospital, Delta State

Background: Erectile dysfunction is a common male sexual disorder which is largely under-reported by sufferers and overlooked by healthcare providers. A dysfunctional family relationship is a source of stress that is not salutary to erectile function. The aim of this study is to determine the prevalence of erectile dysfunction and the family functioning of men attending Eku Baptist Hospital.Methods: The study was a descriptive cross-sectional one of three months duration, from September 2013 to December 2013 in the general outpatient clinics of Eku Baptist Hospital. Data was collected using an interviewer-administered questionnaire. The Erection Hardness Score was used to screen for erectile dysfunction. The family APGAR was used to assess family functioning. Data collected from 199 subjects was analyzed using the Statistical Package for Social Sciences version 20. A p-value < 0.05 was considered significant.Results: The prevalence of erectile dysfunction was 46.2%. Majority (61.3%) had functional families. Erectile dysfunction was more prevalent among men from dysfunctional families (34.7%) compared to men from functional families (11.5%). The association between erectile dysfunction and family functioning was significant (X2=95.097, p<0.001).Conclusion: Primary healthcare providers should acquaint themselves with screening and management of erectile dysfunction in the context of the family setting.Keywords: Sexual health, erection hardness score, family functioning, erectile dysfunctio

The Physics of Family Medicine as Basis for Training of Family Physicians in West Africa

The biopsychosocial model is a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the social to the subatomic particle using the General System Theory. The aim of this paper was to bring to the attention of doctors the thinking that underpins the unique training of family physicians as specialist in West Africa. A review of relevant literature was done using internet search engines on the subject. Qualitative analysis methods included collation, theme identification and triangulation. Result revealed a major hindrance in the advancement of Family practice in West Africa as a discipline is the insistence on describing it in the terminology of traditional biomedical medicine. The traditional biomedical medicine, the doctor fits the patient's illness into a precise class linking the symptoms and signs with organic pathology and identifying single external causes. He explains the patient's illness in terms of his own worldview during the consultative process by taking a domineering stance on the assumption that he, the doctor has sufficient knowledge and skills about the positive health outcome of the individual patient. On the other hand, Family Medicine interprets symptoms in terms of its own method and objectives. Interpretation of the patient (patient-centered method) rather than the symptoms (disease-centered method) is the crux of clinical competence in family practice. This method is consistent with Einsteinian physics rather than Newtonian physics which are the basis of traditional biomedical medicine. In conclusion, the value of the biosychosocial model is not the discovery of a new scientific law, but the application of medical knowledge to the needs of each patient for which the family physician is adequately trained. This forms the basic science background for the training of family physician in West Africa as envisaged by the founding fathers in the 1980s.. Keywords: Biopsychosocial model, Dualism, Reductionism, Clinical practice, Training, family medicine. The Nigerian Medical Practitioner Vol. 51 (6) 2007: pp. 119-12

Baseline knowledge, practices and experiences of traditional birthd attendants (TBAs) on HIV/AIDS before commencement of training for prevention of mother to child transmission of HIV (PMTCT) in South West Nigeria

No Abstract.Nigerian Medical Practitioner Vol. 53 (6) 2008: pp. 103-10

Determinants of Utilization of Maternal Health Services Among Traders in Lagos Markets

Background: Utilization of health services is a complex behavioral phenomenon, related to the availability, quality and cost of services, social structure, health beliefs and characteristics of the users. Objective: This study was carried out to examine factors influencing the use of maternal health care services amongst traders in Lagos markets. Methods: A cross sectional descriptive survey of market traders in16 markets within Lagos metropolis was conducted using a 28-item questionnaire to obtain information about the socio-demographic characteristics, knowledge about the locations of Primary Health Care (PHC) services, type of services received, perceived quality, reasons for choice and sources of alternative maternal health care. Results: The majority [73.5%] admitted awareness of a primary health care center in the area, 64% of them used them, for antenatal care [44%], delivery [34%], and family planning services [22%]. Among users, 91.6% expressed satisfaction with the services. Other sources of maternal health care used included private hospitals [66.7%], general/teaching hospitals [8.6%], chemist shops [9%] and traditional birth attendants [7.9%]. Reasons for their preferences related to better service, better attitudes and perceived proficiency of staff and proximity to home or place of trade. Utilization of maternal health services was significantly related to level of maternal education, knowledge of location of PHC, age, marital status, number of children, satisfaction with services received, perceived severity of danger signs of pregnancy and labour [