Predictors of vaccine management practices among primary healthcare workers (PHCWs) in Ilorin, North Central Nigeria

Objective: Worldwide, vaccines are becoming more expensive as new ones are being introduced to the immunization schedule. Inspite of this, researches have revealed poor vaccine management practices among health workers. This study aimed to determine the predictors of vaccine management practices among PHCWs providing routine immunization services in static health facilities in Ilorin, north central Nigeria.Methods: This quasi-experimental study was conducted among 216 intervention and 241 control groups of PHCWs using multi stage sampling technique; pretested questionnaire and an observational checklist. Data were analyzed using EPI-INFO software package. Level of significance was predetermined at a p-value of less than 0.05.Results: The mean age of study respondents was 38.5 ± 9.5 years. Factors having positive influence on vaccine management practices include prior training exposure (p = 0.001), years of experience in immunization (p = 0.012) and baseline knowledge of vaccine management (p = 0.015). In addition, regularity of supervisory visit (0.008), adequacy/regularity of vaccine supply (p = 0.001), vaccine 'bundling' (p = 0.013) and type of health facility (p = 0.005) positively influenced respondents' vaccine management practices. However, basic qualification of health workers (p = 0.096) and availability of data tools (p = 0.628) had no significant influence on respondents' vaccine management practices.Conclusion: Training exposure and years of experience in routine immunization have positive influence on vaccine management practices of PHCWs. On-the-job supervision of health workers should be conducted at least bi-annually.Keywords: Predictors, Vaccine management practices, PHCW

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria.Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05.Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents’ occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001)Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority.Keywords: Knowledge, Blood, Donation, North-Central, Nigeri

Assessment of quality of life among patients attending HIV clinics in Ilorin metropolis

Objectives: The Sub-Saharan Africa (SSA), is being hit hard by the epidemic of AcquiredImmunodeficiency Syndrome (AIDS) and carries the globe's heaviest burden of HIV/AIDS. HIV/AIDS has been transformed into a chronic condition, albeit one with no cure, making it important to assess determinants of quality of life (QoL) and, if required, improve the QoL of People Living with HIV (PLHIV). The study assessed the determinants of quality of life of patients attending HIV clinics in Ilorin metropolis.Methods: The study was a descriptive cross sectional study. A sample size of 384 HIV positive patients who were systematically recruited at the 5 public service delivery sites in Ilorin. Data was analyzed using SPSS software version 20.0. Level of significance was pre-determined at p-value < 0.05 at a confidence level of 95%.Results: Majority 213 (55.5%) of the respondents had good QoL, while 171 (44.5%) had low QoL with overall Mean score of 68±14. This study showed that being employed, high income, and low cost of care were associated with good health related (HRQoL). Regression analysis revealed that age > 30yrs (odds = 1.5), longer duration on Highly Active Anti-retroviral Therapy (HAART) >3yrs (Odds = 1.5), CD4 count >500cells/mm3 (Odds = 1.2), high monthly income (Odds=1.6) and low cost of care (Odds= 1.27) were found to determine good QoL.Conclusion: Government should therefore expand access to HIV care by considering more Primary Health Care facilities as Anti-Retroviral Therapy ( ART) treatment centers.Key words: Quality of life, Human Immunodeficiency Virus, Patients, Anti-Retroviral Therap

Effect of training on knowledge, attitude and practice of safety measures among battery chargers in Ilorin metropolis

Objective: Good knowledge of safety measures against hazards of lead-acid battery work is important in the control of the work-related health problems. The study assessed the effects of training on knowledge, attitude and practice of safety measures among battery chargers in Ilorin, Nigeria.Methods: The study was a quasi-experimental (non-randomized) study with pretest and post-test design. A total of 107 battery chargers were recruited each for intervention and control group. The study group was offered training on occupational safety measures while the control group did not have training at this stage. Post intervention data was collected 12 weeks after the pre-intervention. Multistage sampling technique was used to select 214 registered battery chargers working in Ilorin in to the study. Data obtained through interviewer-administered questionnaires were analysed using SPSS version 16 software.Results: Less than one-fifth (15.9%) of the study group had good knowledge of hazards relating to battery which increased significantly to more than three-quarters (76.2%) post-intervention. The majority (85.0%) of the study group and (86.0%) of the control group had positive attitude towards safety measures pre-intervention. There was no significant improvement in attitude post intervention. The safety practice of less than one-tenth (6.5%) of the study group was rated good pre-intervention which increased significantly to almost one-fifth (17.8%) post-intervention. There was no significant improvement in the Kwowledge, attidude or practice of safety measures among the control group post intervention.Conclusion: Association of the battery chargers should organize in conjunction with the health institutions training of their members on hazards prevention and safety practices.Keywords: Training, battery, safety measures, workers, Ilori

Nosocomial infections and the challenges of control in developing countries.

Nosocomial infection is a recognized public health problem world-wide with a prevalence rate of 3.0-20.7% and an incidence rate of 5-10%. It has become increasingly obvious that infections acquired in the hospital lead to increased morbidity and mortality which has added noticeably to economic burden. However, after about three decades of nosocomial infection surveillance and control world-wide, it still remains an important problem for hospitals today. Studies have shown that most hospitals in developing countries especially Africa, have no effective infection control programme due to lack of awareness of the problem, lack of personnel, poor water supply, erratic electricity supply, ineffective antibiotic policies with emergence of multiply antibiotic resistant microbes, poor laboratory backup, poor funding and non-adherence to safe practices by health workers. It is recommended that the cost of hospital infection control programme should be included in the health budget of the country and fund allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks. There is need for adequate staffing and continuous education of staff on the principles of infection control, especially hand washing which is the single most important effective measure to reduce the risks of cross infection.

Determinants of voluntary blood donation among adults in communities of north central region of Nigeria

Objective: The collection of blood from voluntary, non-remunerated blood donors is an important measure for ensuring the safety, quality, availability and accessibility of blood. The study assessed factors affecting voluntary blood donation in North-central zone, Nigeria.Methods: The study design was descriptive cross-sectional, data was collected using a pre-tested interviewer administered questionnaire from 3104 respondents using multistage sampling technique. Data was analyzed using EPI INFO computer software package (version 3.5.3). Level of significance was pre-determined at p-value < 0.05 at a confidence level of 95%.Results: Respondents with good knowledge of voluntary blood donation had better practice of voluntary blood donation. Younger age groups were 8 times more likely to donate blood voluntarily than older respondents. Yoruba ethnic groups are 1.5 times more likely to donate blood than other ethnic groups.Conclusion: For Nigeria and other developing countries at large to achieve 100% voluntary blood donation drive by year 2020, it is critical to change the blood donation culture from replacement to that of volunteerism through more effective communication and mobilization of donors. These efforts must be rendered more methodical and accomplished through a wider range of strategies.Keywords: Determinants, voluntary, blood, donation, Nigeri

Traditional eye medication: A rural-urban comparison of use and association with glaucoma among adults in Ilorin-west Local Government Area, North-Central Nigeria

Background: Globally, the last two decades witnessed increase in the use of  Traditional Eye Medication (TEM); and its use worsens the prognosis of visual outcome. This study assessed and compared the use of TEM and its association with glaucoma among adults in selected rural and urban communities of Ilorin-west Local Government Area, North-Central Nigeria.Methodology: This was a comparative cross-sectional study. Respondents were selected using multi-stage sampling technique. Interviewer-administered structured questionnaire, and clinical report form were used to collect data. Data were analyzed using SPSS version 15. Level of statistical significance was set at p<0.05.Results: A higher proportion of the rural, 174 (38.7%) than the urban, 111 (24.7%) respondents knew about TEM (p<0.001). More of the rural, 83 (18.4%) than the urban, 78 (17.3%) respondents had ever used TEM (p=0.664). TEM known to the respondents in rural versus urban areas included camphor (47.1% vs 28.8%), personal urine (3.5% vs 2.7%) and salt-sugar solution (1.7% vs 14.4%) among others. There exists an association between the use of traditional eye medication and presence of glaucoma within rural (p=0.011) and urban (p<0.001) areas.Conclusion: The use of TEM among the respondents was associated with glaucoma. While the association between glaucoma and uptake of TEM may not be causal, it provides a window of thought for further researches. There is need to strengthen awareness on the dangers of using TEM in the communities. Regular  community-based eye screening involving measurement of intraocular pressure will be useful in early detection of glaucoma.Keywords: Traditional eye medication; Glaucoma; Rural-Urban; Nigeri

Knowledge And Attitude Of Nigerians On Snoring As A Health Problem

Abstract is simply that of adaptation , hence many do not This is a cross sectional study on snoring was consider it worthwhile to seek medical attention. There conducted among adults aged 18 years and above at is need to create public awareness on snoring as a Ilorin, Kwara State, Nigeria. Simple random sampling treatable health problem that require detailed technique using the primary health care (PHC) House evaluation with definitive medical, surgical and numbering was used to select households from which ancillary treatment of the condition. adult subjects were interviewed. 400 subjects were Key words: Low knowledge, attitude, Nigerians, sampled, 383 consented and completed the survey. This Snoring. gave a participatory rate of 96%. Introduction Pre-tested semi-structured questionnaires on Snoring is the production of sound from the knowledge, attitude of Nigerians on snoring as a health upper aero digestive tract during sleep due to turbulent problem were administered to the subjects by trained airflow 1. It is part of sleep disordered breathing (SPB) research assistants. Completed questionnaires were which ranged from obstructive sleep apnoea (OSA) at analyzed using EPI 2000 software package. one end to simple snoring at the other end 2. A total of 383 subjects were interviewed in the One of the most important risk factors associated with age range of 18-60 years (mean of 29.09 ±1.23 years) snoring is obesity. Over two-thirds of individuals with There were 194 females (50.7%) and 189 males Obstructive sleep apnoea syndrome (OSAS) are 20% (49.3%) with a male/female sex ratio of 0.97 to 1.0. On above their ideal body weight 3. Obese individual have consideration of snoring as a health problem, majority enlarged neck size which make them to be prone to of the respondents 202 (52.7%) did not feel so, 147 snoring as their tongues fall back during sleep leading (38.4%) considered it as a health problem while 34 to obstruction 4. (8.9%) were undecided. Only 42 (11%) admitted they According to WHO, in 2005, there are 400 were told they snore, 290 (75.7%) do not snore while 51 million obese individuals in the world with a projection (13.3%) do not know if they snore. of 700 million by 2015 4. Obesity co-exists with the The age distribution showed increase of snorers with problem of under nutrition in developing countries increasing age, from 7.1% among 16-20 and 21-25 year affecting all ages and socio economic groups due age groups to 26.2% in 45years and above. probably to consumption of more energy dense, On the knowledge of predisposing factors of nutrient poor foods with high levels of sugar and snoring, 356 (93.5%) agreed that overweight/obesity is saturated fats 4. strongly associated, alcohol consumption in 206 Obesity rate has risen three folds or more since (53.8%), cigarette smoking among 169 (44.0%), 1980 in North America, United Kingdom, Eastern fatigue and tiredness in 94 (24.6%) and upper airway Europe, Middle East, Pacific Islands, Australia and obstructions amongst 68 (17.8%). On attitudes towards China 3. Other risk factors associated with snoring/ snorers, 71.1% claimed they adapt to it, only 23.3% OSAS include diabetes, hypertension, stroke and were disturbed and 15.4% simply ignore it. There was certain form of cancers 5, 6. no significant difference in gender and age group of the The clinical features associated with OSAS respondents in relation to whether they snore or not. include nocturnal symptoms such as loud snoring, The knowledge of snoring as a health problem fragmented sleep, apneas, restless sleep, among Nigerians is quite low despite their awareness of oesopharyngeal reflux and dry mouth with nightmares the predisposing factors/causes of snoring and attitudeis simply that of adaptation , hence many do not This is a cross sectional study on snoring was consider it worthwhile to seek medical attention. There conducted among adults aged 18 years and above at is need to create public awareness on snoring as a Ilorin, Kwara State, Nigeria. Simple random sampling treatable health problem that require detailed technique using the primary health care (PHC) House evaluation with definitive medical, surgical and numbering was used to select households from which ancillary treatment of the condition. adult subjects were interviewed. 400 subjects were Key words: Low knowledge, attitude, Nigerians, sampled, 383 consented and completed the survey. This Snoring

The practice of hepatocellular cancer surveillance in Nigeria

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCCsurveillance a daily routine among patients at risk by all physicians. Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening

Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation