Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria

Background: Detection and management of female genital schistosomiasis (FGS) within primary healthcare is crucial for achieving schistosomiasis elimination, however, current technical strategies are not feasible in many settings. In Nigeria, there are currently no established standard operating procedures to support front-line health workers. This article presents an evaluation of piloting an FGS care package in two LGAs of Ogun State, Nigeria. Methods: We used quantitative and qualitative analysis, including 46 interviews with patients, health workers and the quality improvement team; observations of training, learning sessions and supervision across 23 heath facilities; and records of patients detected and managed. Results: Of 79 women and girls who were screened, 66 were treated and followed up. Health workers assimilated knowledge of FGS and effectively diagnosed and managed patients, demonstrating the feasibility of using symptomatic screening and treatment tools to diagnose and care for women or girls with suspected FGS. Challenges included establishing a referral pathway to tertiary care for patients with complications, insecurity, gender norms that limited uptake and sensitization, the limited capacity of the workforce, conflicting priorities and praziquantel acquisition. Conclusions: Simple tools can be used in primary healthcare settings to detect and manage women and girls with FGS. Contextual challenges must be addressed. Sustainability will require political and financial commitments

A comparative assessment of the awareness of danger signs and practice of birth preparedness and complication readiness among pregnant women attending rural and urban general hospitals in Lagos State

Background: Nigeria still experiences a high burden of unsafe motherhood. The knowledge of obstetric danger signs and the effective application of the principles of birth preparedness and complication readiness (BPACR) have the potential to significantly reduce the high maternal and perinatal morbidity and mortality rates. However, rural-urban differences may exist in the knowledge and practice of  BPACR among women, and these may limit its potential benefit. We set out to assess and compare the knowledge of obstetric danger signs and practice of BPACR among pregnant women attending Rural (Agbowa) and Urban (Gbagada) Hospitals in Lagos State. Materials and Methods: In this cross-sectional comparative study, pregnant women attending antenatal clinics in each health facility were recruited into the study using a systematic sampling method. A structured interviewer administered questionnaire adapted from the safe motherhood John Hopkins Program for International Education in Gynecology and Obstetrics prototype questionnaire was used for data collection. Data were analyzed using SPSS version 17.0. Results: Awareness of obstetric danger signs during pregnancy was good among rural and urban study participants accounting for 62.4% and 68.4%, respectively. The most commonly identified danger sign in pregnancy, labor, and after delivery was bleeding from the genital tract. The awareness of danger signs during labor and after delivery identified by the women was low in both settings, though relatively higher in the urban area. The level of BPACR was low in both groups of women but was higher among women attending the urban center (31.6%) compared with the rural center (13.2%) P-value < 0.001. Conclusion and Recommendations: Activities aimed at improving birth preparedness practices particularly among rural women should be considered

Clinical Characteristics of COVID‑19 Patients Admitted at the Federal Medical Center, Abeokuta

Background: As the coronavirus disease 2019 (COVID‑19) continues to ravage the world as a pandemic, there is a paucity of data in resource poor countries like ours on the clinical characteristics of these patients. Aim: The aim of our study was to find the sociodemographic, clinical, and laboratory characteristics of COVID‑19 patients admitted in our facility between May and July 2020. Materials and Methods: A cross-sectional observational study was carried out on COVID‑19 patients admitted during the study period. Their baseline demographic, clinical, and laboratory details were obtained from their clinical notes, recorded electronically, and analyzed. Results: Twenty‑six COVID‑19 patients were admitted during this period, with a mean age of 47.19 (standard deviation 16.56) years, and more males 16 (61.5%). Fever was the most common complaint 17 (65.4%), followed by breathlessness 15 (57.7%), weakness 11 (42.3%), and cough 9 (34.6%). Hypoxemia (SPO2 &lt;93%) was present in 10 (38.5%)of patients at admission, with dyspnea being the most common abnormality on general physical examination 20 (76.9%). Eleven (42.3%) patients had associated comorbidities with hypertension being the most common 7 (43.7%), followed by diabetes mellitus 4 (25.0%). Just 3 (11.5%) patients had mild disease, 13 (50.0%) had moderate disease, and 10 (38.5%) had severe disease. Lower respiratory tract infection or suspected COVID‑19 was the initial diagnosis in 10 (38.5%) of patients at admission, while 16 (61.5%) were admitted with other diagnosis. Leukocytosis was found in 8 (30.8%) patients, 14 (53.8%) patients had anemia, elevated urea in 20 (76.9%), and elevated Creatinine in 11 (42.3%). Seventeen (65.4%) patients were discharged home, 2 (7.7%) referred to another center for hemodialysis, while 7 (26.9%) died. Conclusion: Understanding the clinical and laboratory characteristics of COVID‑19 in our local environment will be integral to earlier identification and treatment outcomes for our patients

Assessment of treatment outcomes for HIV Positives transitioned from Tenofovir/Lamivudine/Efavirenz to Tenofovir/Lamivudine/Dolutegravir in a Nigerian Tertiary Hospital

Objective: Dolutegravir, an integrase inhibitor replaced nevirapine or efavirenz (both NRTIs) in a fixed dose combination with Tenofovir/Lamivudine, as the preferred first-line option for the prevention and treatment of HIV infection. This study aimed to assess the treatment outcomes of the new Tenofovir/Lamivudine/Dolutegravir (TLD) regimen at the Federal Medical Centre Abeokuta. Methods: This retrospective study used data drawn from the treatment register of patients who transitioned from Tenofovir/Lamivudine/Efavirenz (TLE) to TLD. Data were analyzed using SPSS v23. Descriptive statistics were used to describe categorical and continuous variables. Statistically significant independent variables in univariate analyses were included in the multivariate model. The level of significance was set at p<0.05. Results: The 358 cases reviewed showed a mean age of 44.29 ± 11.5 years. The majority (267; 74.6%) were females. Viral load suppression (≤1000 copies/ml) was achieved in 313 (87.4%) while on TLE but increased to 339 (94.7%) when transitioned to TLD. Also, 36.3% had a high CD4 count while on TLE, this increased to 67.3%. The mean CD4 counts (428.59±251.85) while using TLE increased exponentially when transitioned to TLD (634.89±244.72) (t-31.601; p-value- 0.001). Before the transition, 90.5% of respondents were at WHO stage 1 compared to 92.5% after the transition to TDF/3TC/DTG. Conclusion: Treatment outcome was greatly improved in terms of virologic, immunologic and clinical parameters among patients who transitioned from TDF/3TC/EFV to TDF/3TC/DTG. The outcome of this work supports and encourages the use of TDF/3TC/DTG as the preferred first-line regimen in HIV treatment for the patient’s maximum clinical benefit

Morbidity and mortality patterns among patients in a tertiary hospital, South-west, Nigeria: a five-year retrospective study

Objectives: Morbidity and mortality statistics are essential tools for assessing population health status as well as effective elements to adapt to the changing epidemiological trends. This study aimed to assess the morbidity and mortality pattern in the facility while also looking into the patterns of presentation at the facility. Methods: A hospital-based descriptive cross-sectional study was employed, involving the review of patient’s medical records from January 2016 to December 2020. The data were analyzed using SPSS version 24.0. Descriptive statistics such as frequency distribution, percentages and central tendencies were used. The level of significance was set at 0.05. Results: A total of 2,809 patient records were scrutinized from January 2016 to December 2020. The mean age of the respondents was 27±20.5 years, the majority were urban dwellers (91.4%) and males were predominant (55.7%). Infectious and parasitic diseases were found to have the highest prevalence among the respondents (44.1%). Diseases of the respiratory system and the circulatory system had a prevalence of 14.9% and 4.2% respectively. The mortality rate among the respondents was 3.6%. Conclusion: The morbidity pattern in this facility was largely dominated by infectious and parasitic diseases thus showing that communicable diseases such as Malaria, HIV/AIDS, and tuberculosis are still prevalent in Nigeria with a high burden on the health system. There is an urgent need to strengthen disease prevention measures across all levels of Health care to stem this tide