Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria

Introduction: Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of  Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. Methods: It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level.Results: The study showed that  traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas.Conclusion: It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.Key words: Maternal, child, newborn, knowledge management, mapping

Impact of hypertension home-based care on health related quality of life of Nigerian patients: research concept, framework and methodology

Background: Public health importance of hypertension have been documented all over the world. In recent years, there has been increase cases of hypertension reported in African countries including Nigeria. The current management strategy of hypertensive cases within hospital setting are characterized by high default rate, non-adherence, poor medical outcomes and poor quality of life. While past studies emphasized use of medical outcomes to assess treatment or intervention outcomes, only scanty studies take into cognizance the quality of life that patients live. Because of the chronicity of hypertension, it is important to begin to assess the Health Related Quality of Life (HRQoL) of patients and begin to use such as an impact assessment of treatment or intervention strategies. This study proposed to develop and implement a home based follow-up care (HBFC) intervention and evaluate the impact of the intervention on the HRQoL of hypertensive patients in Nigeria. Materials and methods: This study will be a randomized control trial (un-blinded) to be conducted in 3 stages. Stage 1 will develop HBFC program while in stage 2, patients will be recruited, assessed (baseline data), randomized into 2 arms of study and follow-up for 6 months. The third stage will evaluate the impact of the intervention on HRQoL and disseminate the findings. Data will be collected with the use of structured questionnaire which will contain validated tools like SF-36v2 for HRQoL and Morisky scale for medication adherence. Main outcome measurement will be treatment effect using HRQoL while data would be analyzed using SPSS, version 22. Intention to treat (ITT) analysis concept will be employed and main hypothesis will be tested using paired t-test analysis. Level of significance will be set at p-value of < 0.05 and 95% confidence intervals (CI). Expected outcome: The study will contribute to the existing knowledge on home based care program for hypertensive patients in developing countries where literature is scanty. It will generally give insight into the importance of HRQoL measurement in interventional studies on hypertension and other related chronic diseases in this setting

Applications of health related quality of life (HRQoL) as an intervention impact assessment in the management of hypertension: a systematic review

Introduction: Persons living with hypertension wrestle with the physical, psychological, and social demands of their illness without adequate help or support from medical care. This has buttressed the need to research into the perceptions of patients in the context of their subjective feelings towards their wellbeing. This is termed “health related quality oflife (HRQoL)”. One of the most important goals of all health interventions is to improve the quality of life of persons affected by disease and many researchers had advocated for the need to see health outcome beyond clinical and laboratory parameter alone. Therefore need to study and assess HRQoL as well. This study however set out to review available intervention studies in the scientific literature from 1980 till date (that met the set eligible criteria) and those which employed quality of life as a primary outcome measurement. Methods: The PRISMA and Standard Cochrane Collaboration systematic review techniques were used as guidelines for the review while varieties of online journals, database and library were searched. These yielded over a thousand articles which were screened systematically using stringent eligibility criteria to scale down to 37 articles out of which 6 articles employed intervention as study approach and quality of life as primary outcome measurement. Results: The age range of the participants in the review is between 18 to 80 years. Results revealed that only 4 out of the 6 articles were randomized control trial (RCT) out of which only one was blinded. Four of the studies used SF-36 tool for assessment of HRQoL. Another Four studies reported statistically significant increase in overall HRQoL of intervention group over a control group. Two studies did not analyse significance level. The individual dimensions of HRQoL revealed discrepancies in there viewed articles. Mental health improvement was observed to be the only common improved outcome across the studies. Conclusion: It was concluded that there is still dearth of literature on HRQoL outcome assessment of hypertensive studies. It is suggested that future research on interventional studies should endeavor to use quality of life as a primary or as part of outcome measurements

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

Introduction: Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. Methods: This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value &lt;0.05 was considered statistically significant. Results: 27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Conclusion: Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.Pan African Medical Journal 2016; 2

Mid-term impact of home-based follow-up care on health-related quality of life of hypertensive patients at a teaching hospital in Ilorin, Nigeria

Background: Health-related quality of life (HRQoL) is an important clinical outcome assessment in hypertension management, given the lifelong (chronicity) nature and the need for daily self-management for hypertensive patents. Of some of the studies that implemented home-based interventions on hypertension globally, the HRQoL is rarely used as a primary outcome measure. This study developed, implemented, and assessed the impact of home-based follow-up care (HBFC) on HRQoL of hypertensive patients attending outpatients' clinics in Ilorin, Nigeria. Materials and methods: A total of 149 and 150 patients were randomized to intervention and usual care (control) groups, respectively. A 12-month task-shifting (nurse-driven) HBFC intervention was administered to intervention group. The mid-term impact of intervention on HRQoL was assessed after 6 months intervention. Data were analyzed with intention-to-treat principle. Treatment effects were measured with the t-tests, analysis of covariance, and multivariate analysis of covariance analysis. Significant levels were set at P < 0.05 and 95% confidence interval. Results: The between-group treatment effect was not statistically significant (P > 0.05), whereas the within-group treatment effects were statistically significant for both the intervention and control arms (P < 0.05) at 6 months. After controlling for age and baseline HRQoL, the intervention group had an improved physical component of HRQoL than the control group. The intervention group also had statistically significant improvement in blood pressure control, medication adherence, and symptom counts (P < 0.05). Conclusion: The HBFC intervention for hypertensive patients impacted positively on physical component of HRQoL after controlling for baseline HRQoL and age of the patients at 6 months post-intervention

Determination of Normal and Variant Hemoglobin using Capillary Electrophoresis among Voluntary Blood Donors in North Central Nigeria: Implications on Blood Transfusion Services

Background: Voluntary non-remunerated blood donation is a strategy adopted by World Health Organization aimed at ensuring safety and adequacy of blood supply. Sub-Saharan Africa has a high prevalence of hemoglobin disorders and therefore needs to adopt stringent measures in donor selection to ensure safety for the recipient of blood transfusion. This study aimed to analyze normal and variant hemoglobin among voluntary blood donors. Methods: In this descriptive cross-sectional study, 100 prospective blood donors including 55 (55%) males and 45 (45%) females, aged 18–34 years were recruited. Capillary electrophoresis using the Minicap system was used for determining the hemoglobin variants in alkaline buffer (PH 9.4). Data analysis was done using SPSS version 20 and p-value &lt; 0.05 was considered as the level of significance Results: The mean age of the participants was 22.23&nbsp;±&nbsp;3.3&nbsp;SD years. The proportion of participants with genotype AA was 67 (67%), those with AS were 17 (22&nbsp;%), while those with AC were 11 (11&nbsp;%). While Hb A ≥ 90% was noted in 67 (67%) blood donors, Hb S was seen in 22 (22%) and Hb A2 &gt; 3.5% in 57 (57%). Hb F &gt; 2% was observed in 3% of the studied participants Conclusion: Variant hemoglobin is common among blood donors and this should be taken into consideration whenever blood is being crossmatched for recipients of blood transfusion. Data from this study will be useful in raising awareness and genetic counseling. Keywords: prevalence, hemoglobin variants, capillary electrophoresi

Pattern of utilization of ante-natal and delivery services in a semi-urban community of North-Central Nigeria.

Background: Nigeria accounts for only 2% of the world\u2019s population, but contributes up to 10 % of the global estimates of maternal deaths. The study assesses the utilization of antenatal and delivery services by women of reproductive age in Afon community. Methodology: It was a descriptive cross-sectional study that collected both quantitative and qualitative data using semi-structured interviewer administered questionnaire and focus group discussions (FGD). Interviews were house-hold based. FGD had two homogenous groups. Data was analysed using Epi-info version 3.5.1 software package. Level of statistical significance was set at p &lt;0.05. Results: There was a high level of utilization of antenatal/delivery services in the community. Barriers to utilization of ANC/ delivery services include lack of money, distance from health facility, long waiting time, poor attitude of health workers and no permission from husbands. Level of education and employment status were significantly associated with utilization of ANC/ delivery services. Conclusion: Girl- child education and women empowerment are required to improve utilization of services. Ante-natal care providers need to be trained to improve quality of care in the discharge of their duties

What medicines do households keep in their cabinets? Understanding the possession and use of medicines at home and the role of health insurance in Nigeria

Background Globally, the possession of medicines stored at home is increasing. However, little is known about the determinants of possessing medicines, their usage according to clinical purpose, which we term 'correct drug match', and the role of health insurance. Methods This study uses data from a 2013 survey evaluating a health insurance program in Kwara State, Nigeria, which upgraded health facilities and subsidized insurance premiums. The final dataset includes 1,090 households and 4,641 individuals. Multilevel mixed-effects logistic regressions were conducted at both the individual level and at the level of the medicines kept in respondents' homes to understand the determinants of medicine possession and correct drug match, respectively, and to investigate the effect of health insurance on both. Results A total of 9,266 medicines were classified with 61.2% correct match according to self-reported use, 11.9% incorrect match and 26.9% indeterminate. Most medicines (73.0%) were obtained from patent proprietary medicine vendors (PPMVs). At 36.6%, analgesics were the most common medicine held at home, while anti-malarial use had the highest correct match at 96.1%. Antihistamines, vitamins and minerals, expectorants, and antibiotics were most likely to have an incorrect match at respectively 35.8%, 33.6%, 31.9%, and 26.6%. Medicines were less likely to have a correct match when found with the uneducated and obtained from public facilities. Enrolment in the insurance program increased correct matches for specific medicines, notably antihypertensives and antibiotics (odds ratio: 25.15 and 3.60, respectively). Conclusion Since PPMVs serve as both the most popular and better channel compared to the public sector to obtain medicines, we recommend that policymakers strengthen their focus on these vendors to educate communities on medicine types and their correct use. Health insurance programs that provide affordable access to improved-quality health facilities represent another important avenue for reducing the burden of incorrect drug use. This appears increasingly important in view of the global rise in antimicrobial resistance

Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria

Introduction: a subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization. Methods: a mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former Kwara community health insurance clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Both quantitative and qualitative data were analyzed and triangulated. Results: most of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (odd ratio=1.61), living in a rural community (odd ratio =1.77), exclusive usage of Kwara Community Health Insurance Programme (KCHIP) prior to suspension (odd ratio=1.94) and suffering an acute illness (odd ratio=3.38) increased the odds of being financially constrained in accessing healthcare. Conclusion: after the suspension of the scheme, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures

Prevalence and Pattern of Blood Pressure and Anthropometric Measurements: A comparative cross-sectional study in Kwara Central, North-Central Nigeria

Background: The elderly are usually prone to different age-related chronic non-communicable diseases like cardiovascular diseases (CVDs). CVDs cause mortality, particularly in the elderly, and hypertension and obesity are important risk factors in their development. This study assessed the prevalence and pattern of blood pressure and anthropometric measurements among the elderly in rural and urban areas of Kwara Central, North-Central NigeriaMaterials and Methods: This study was a cross-sectional analytical (comparative) study among 300 elderly people in the rural and urban communities in Kwara Central, North-central, Nigeria. Respondents were selected through a multi-stage random sampling technique. Data was collected through the use of pre-tested semi-structured interviewer-administered questionnaires. Analysis was carried out using IBM Statistical Package for Social Sciences (IBM-SPSS) version 20. Data were presented in tables and charts. The level of significance was predetermined at a p-value of less than 0.05 at a 95% confidence level.Results: The mean age of the elderly in the rural community was 76 ± 11.6 years compared to 74 ± 10.4 years for the urban community. The proportion of the female respondents was higher than males in both rural group 96 (64.0%) and urban group 84 (56.0%). The waist circumferences and waist-to-hip ratios were significantly higher among the elderly in the urban communities (20.0%, 20.7%) than in the rural communities (11.3%, 16%) (p= 0.039). Similarly, there were significantly more overweight and obese elderly in the urban communities (18.0%, 16.0%) than those in the rural communities (12.7%, 4.7%) (p= 0.003). The proportion of those with elevated blood pressure in the urban group was significantly higher than those in the rural group (p =0.038).Conclusion: The blood pressure pattern and anthropometric indices that portend an increased cardiovascular risk among the elderly were more prevalent in the urban than in the rural communities