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

Adherence to combined Antiretroviral therapy (cART) among people living with HIV/AIDS in a Tertiary Hospital in Ilorin, Nigeria

Introduction:&nbsp;this study aims to assess the treatment adherence rate among People Living With HIV/AIDS (PLWHA) receiving treatment in a Nigerian tertiary Hospital. Methods:&nbsp;this was a cross-sectional study that assessed self-reported treatment adherence among adults aged 18 years and above who were accessing drugs for the treatment of HIV. Systematic random sampling method was used to select 550 participants and data were collected by structured interviewer administered questionnaire. Results:&nbsp;the mean age of respondents was 39.9±10 years. Adherence rate for HIV patients was 92.6%. Factors affecting adherence include lack of money for transportation to the hospital (75%), traveling (68.8%), forgetting (66.7%), avoiding side effects (66.7%), and avoiding being seen (63.6%). Conclusion:&nbsp;the adherence rate was less than optimal despite advancements in treatment programmes. Adherence monitoring plans such as home visit and care should be sustained

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

The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients – a systematic review

Background: Several observational reports from different parts of the world have shown that systemic hypertension (hypertension) was the single commonest comorbid condition in hospitalized COVID-19 patients. Hypertension is also the most prevalent comorbidity reported among patients who developed severe disease, were admitted to Intensive Care Unit, needed mechanical ventilatory support, or who died on admission. The objective of this systematic review is to study the association between hypertension and specific clinical outcomes of COVID-19 disease which are- development of severe COVID-19 disease, need foradmission in the intensive care unit (ICU) or critical care unit (CCU), need for mechanical ventilation or death Methods: We searched the PubMed, SCOPUS, and Google Scholar databases up till June 28, 2020 for original research articles that documented the risk factors of mortality in patients with COVID-19 using the PRISMA guideline. Results: One hundred and eighty-two articles were identified using pre-specified search criteria, of which 33 met the study inclusion criteria. Only three were prospective studies. Most studies documented hypertension as the most prevalent comorbidity. The association of hypertension with development of severe COVID-19 disease was not conclusive, majority of studies however found an associated with mortality. Conclusion: Hypertension affects the clinical course and outcome of COVID-19 disease in many cohorts. Prospective studies are needed to further understand this relationship. Keywords: Hypertension and COVID-19; SARS –Cov-2; severity; mortality; ICU care; mechanical ventilation

Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)

Background: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research project "QUality Improvement Cardiovascular care Kwara - I (QUICK-I)" aims to assess the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme. Methods/Design. Design: prospective observational hospital based cohort study. Setting: a primary health care centre in rural Nigeria. Study population: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan. Measurements: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. Measurements will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated. Outcomes: 1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom

SARS-CoV-2 variants-associated outbreaks of COVID-19 in a tertiary institution, North-Central Nigeria: Implications for epidemic control.

The COVID-19 global pandemic is being driven by evolving SARS-CoV-2 variants with consequential implications on virus transmissibility, host immunity, and disease severity. Continuous molecular and genomic surveillance of the SARS-CoV-2 variants is therefore necessary for public health interventions toward the management of the pandemic. This study is a retrospective analysis of COVID-19 cases reported in a Nigerian tertiary institution from July to December 2021. In total, 705 suspected COVID-19 cases that comprised 547 students and 158 non-students were investigated by real time PCR (RT-PCR); of which 372 (~52.8%) tested positive for COVID-19. Using a set of selection criteria, 74 (~19.9%) COVID-19 positive samples were selected for next generation sequencing. Data showed that there were two outbreaks of COVID-19 within the university community over the study period, during which more females (56.8%) tested positive than males (47.8%) (p<0.05). Clinical data together with phylogenetic analysis suggested community transmission of SARS-CoV-2 through mostly asymptomatic and/or pre-symptomatic individuals. Confirmed COVID-19 cases were mostly mild, however, SARS-CoV-2 delta (77%) and omicron (4.1%) variants were implicated as major drivers of respective waves of infections during the study period. This study highlights the importance of integrated surveillance of communicable disease during outbreaks

Impact of home-based follow-up care intervention on health-related quality of life among hypertensive patients at a teaching hospital in Ilorin, Nigeria

Introduction: The usual care for hypertension within hospital settings in Nigeria is characterized by poor medical outcomes and poor health related quality of life (HRQoL). Of those few studies that have implement home based interventions on hypertension, not many of them used HRQoL as an outcome measure. This study developed, implemented and assessed the impact of home based follow-up care on HRQoL of hypertensive patients attending outpatients’ clinics in Ilorin, Nigeria. Methodology: An individual open (un-blinded) Randomized Controlled Trial (RCT) was conducted among 229 consented hypertensive patients in two outpatients’ clinics of University of Ilorin Teaching Hospital, Ilorin, Nigeria using systematic random sampling. A total of 149 and 150 patients were randomly allocated to intervention and control groups respectively. The intervention was a six month taskshifting (Nurse driven) home based follow-up care. The primary outcome measurement was HRQoL. Data was collected with the use of pretested questionnaire that contained validated SF36v2 and MMAS-8 tools for the assessment of HRQoL and medication adherence respectively. Data was analyzed with intention-to-treat principle. The SPSS version 22 software was used for analysis and both descriptive and inferential statistics were presented. Treatment effects were measured with the t-tests, ANCOVA and MANCOVA analysis. Significant levels were set at p-value of <0.05 and 95% Confidence Interval (CI). Results: A total of 29 and 31 patients dropped out of intervention and control groups respectively, making a combined attrition rate of 20.1% in this study. At baseline only general health (50.44) and vitality (52.68) of the 8 subscales of HRQoL had better score than the reference population average of 50.00 (+10). Both physical and mental components of the HRQoL were below population average. The between group treatment effect was not statistically significant (p>0.05) while within group treatments effects were statistically significant for both intervention and control arms (p<0.05). After controlling for age and baseline HRQoL, intervention group had 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 home based follow-up care intervention by this study was shown to impact positively on physical component of HRQoL after controlling for baseline HRQoL and age of the patients. Symptom count, medication adherence and blood pressure control were positively impacted upon by the home based follow-up intervention

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