The rationale and relevance of existing cadres of frontline health workers and potential for new mid-level cadres

Front-line health workers (FLHWs) are expected to perform necessary maternal, newborn, and child (MNCH) services appropriately and effectively; however, few studies have investigated the extent to which FLHWs perform requisite primary health care (PHC) services. This study seeks to better understand not only FLHWs’ knowledge and performance of MNCH services, but the factors promoting and inhibiting their services in selected rural local government areas of Nigeria’s Bauchi and Cross River states. It also investigates the potential for a new PHC worker cadre, soliciting stakeholders’ perceptions about its feasibility for addressing maternal and newborn disease burdens in rural communities. The study’s findings show a shortage of all FLHW cadres—and for nurses and midwives, this shortage is critical—as well as insufficient equipment and materials required for FLHWs’ quality MNCH services, inadequate knowledge of critical MNCH issues, and poor staff welfare. The report details the urgent actions needed to strengthen human resources for health in rural communities in Nigeria

Analysis of tobacco control policies in Nigeria : historical development and application of multi-sectoral action

The African Population Health Research Center (APHRC), Kenya and International Development Research Center (IDRC), Canada funded the conduct of study - Analysis of Non-Communicable Disease Policies in Africa (grant # 107209–001) and the publication of this manuscript.Tobacco use is a major risk factor for non-communicable diseases and policy formulation on tobacco is expected to engrain international guidelines. This paper describes the historical development of tobacco control policies in Nigeria, the use of multi-sectoral action in their formulation and extent to which they align with the World Health Organisation “best buy” interventions. This article presents findings from a broader study titled “Analysis for Non-Communicable Disease Prevention Policies in Africa (ANPPA)”

A cross-sectional study of the knowledge and screening practices of diabetes among adults in a south western Nigerian city

Introduction The control of diabetes depends largely on preventive actions and self-management often influenced by knowledge and awareness of the condition, its risk factors, complication, and management. This study assessed the awareness, knowledge, and practices regarding diabetes among adults in two communities in Ibadan, Nigeria. Methods A community-based cross-sectional study was conducted among five hundred randomly selected non-diabetic respondents, aged 18 to 65 years. Data was collected using the pretested, modified version of the WHO STEPS instrument translated into Yoruba language. Data collected were analysed using descriptive and inferential analysis and the level of significance was set at p<0.05. Results Majority of the respondents (89.6%) had previously heard about diabetes. Of these (n=448), 31.8% (13.7±7.3) were knowledgeable about diabetes and only 28% have ever had their blood glucose level measured by a doctor or other health professionals Sex and monthly income were statistically associated with respondents’ diabetes knowledge while age, religion, monthly income, employment status, marital status, ethnicity and level of education were statistically associated with screening practices (p<0.05). Monthly income was found to be a significant predictor of the level of knowledge adjusted by sex. Earning N20,000 ($52.60) or less had higher odds of knowledge compared to earning no income (OR 0.54, CI 0.35, 0.83). Conclusion Though Diabetes awareness is high, knowledge gaps and poor screening practices is of concern. This calls for tailored multi-component, community-based, health education interventions

Improving access to diagnostics for schistosomiasis case management in oyo state, Nigeria:Barriers and opportunities

Schistosomiasis is one of the Neglected Tropical Diseases that affects over 200 million people worldwide, of which 29million people in Nigeria. The principal strategy for schistosomiasis in Nigeria is a control and elimination program which comprises a school-based Mass Drug Administration (MDA)with limitations of high re-infection rates and the exclusion of high-risk populations. TheWorld Health Organization (WHO) recommends guided case management of schistosomiasis (diagnostic tests or symptom-based detection plus treatment) at the Primary Health Care (PHC) level to ensure more comprehensive morbidity control. However, these require experienced personnel with sufficient knowledge of symptoms and functioning laboratory equipment. Little is known aboutwhere, bywhom and how diagnosis is performed at health facilities within the case management of schistosomiasis in Nigeria. Furthermore, there is a paucity of information on patients' health-seeking behaviour from the onset of disease symptoms until a cure is obtained. In this study, we describe both perspectives in Oyo state, Nigeria and address the barriers using adapted health-seeking stages and access framework. The opportunities for improving case management were identified, such as a prevalence study of high-risk groups, community education and screening, enhancing diagnostic capacity at the PHC through point-of-care diagnostics and strengthening the capability of health workers.</p

Knowledge of breast cancer and its early detection measures among rural women in Akinyele Local Government Area, Ibadan, Nigeria

BACKGROUND: Breast cancer is the commonest cancer among women in Nigeria and globally. In Nigeria, late presentations of breast cancer cases have also been consistent for three decades. In an environment where there is no established national screening program for breast cancer, it is pertinent to assess the knowledge of breast cancer and its early detection measures. The objective of this study therefore, was to assess rural women's level of knowledge of breast cancer and its early detection measures. METHODS: The knowledge of various aspects of breast cancer; etiology, early warning signs, treatment modes and early detection measures; was assessed among women in two randomly selected health districts in Akinyele Local Government in Ibadan. The assessment was performed with the use of a self-structured validated questionnaire administered by trained interviewers to 420 women randomly selected from the two health districts. The various aspects of facts about breast cancer were scored and added together to determine respondents' level of knowledge RESULTS: The mean score of knowledge of breast cancer was 55.4 SD 5.4 (range of scores obtainable was 26–78), while the mean score for knowledge of early detection of breast cancer was 24.8 SD 2.3 (range of scores obtainable was 12–36). The leading source of information about breast cancer was "elders, neighbors and friends" and 63(15.4%) acknowledged this source, while only 18 (4.4%) respondents acknowledged health workers as source. Only 54 (13.3%) claimed to have heard about breast self- examination (BSE) however, and the leading source of information about BSE were health workers. Nine (2.2%) of respondents claimed this source. CONCLUSION: This study revealed that respondents lacked knowledge of vital issues about breast cancer and early detection measures. It also revealed that health workers were not forthcoming with information to the public thereby constituting a challenge to community health nurses and other health workers, to provide vital information to the public

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.</p> <p>Methods</p> <p>This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.</p> <p>Results</p> <p>Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.</p> <p>Conclusion</p> <p>Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.</p

Exploring evidence-policy linkages in health research plans: A case study from six countries

The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. The cross-country research consortium provides a unique opportunity to explore the research-policy interface. Three key activities were undertaken during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon. These three activities yielded interesting findings. First, developmental consideration with four dimensions – poverty, vulnerabilities, capabilities, and health shocks – provides an entry point in examining research-policy interfaces in the six settings. Second, research plans focused upon on the ground realities in specific countries strengthens the interface. Third, focusing on research prioritized by decision-makers, within a politicized health arena, enhances chances of research influencing action. Lastly, early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface. The approach described has four main utilities: first, systematic analyses of research proposals using key considerations ensure such issues are incorporated into research proposals; second, the exact meaning, significance, and inter-relatedness of these considerations can be explored within the research itself; third, cross-country learning can be enhanced; and finally, translation of evidence into action may be facilitated. Health systems research proposals in low and middle income countries should include reflection on transferring research findings into policy. Such deliberations may be informed by employing the four key considerations suggested in this paper in analyzing research proposals

Effect of Peer Education on Deaf Secondary School Students' HIV/AIDS Knowledge, Attitudes and Sexual Behaviour

This study evaluated the effect of an AIDS education program on deaf secondary school students' knowledge, attitude and perceived susceptibility to AIDS using peer education. Two secondary schools matched for ownership (government), composition (mixture of hearing and deaf) and teaching arrangement (separate teaching of deaf students using sign language) were used, and each school was randomly allocated the intervention or control status. All students completed a questionnaire on AIDS at baseline and post-intervention. Following baseline, volunteers from the intervention group received four weeks training as peer educators, after which they provided HIV/AIDS information to their peers on one-to-one basis and in group, using a variety of approaches for a period of eight months, while the control subjects did not. Pre-post group differential scores for knowledge of the causes, modes of transmission and methods of prevention of AIDS among intervention group compared with the control group were significant (p < 0.0000001) but not to perceived personal susceptibility (p = 0.64217). This study suggests the influence of peer education on health knowledge of youth but a limitation in changing perception of susceptibility. (Afr J Reprod Health 2000; 4[2]: 93–103) Résumé L'effet de l'éducation de pairs sur la connaissance, les attitudes et le comportement sexuels des étudiants secondaires sourds par rapport au VIH/SIDA. L'étude a évalué l'effet qu'un programme d'éducation sur du SIDA a sur la connaissance, les attitudes et la susceptibilité apercue des étudiants secondaires sourds vis-à-vis le SIDA. L'étude a été faite à l'aide de l'éducation de pairs. On s'est servi de deux écoles considérées comme pareilles du point de vue de la propriété (elles appartiennent au gouvernment), de la composition (mélange des étudiants sourds et les étudiants normaux) et la modalité de l'enseignement (les étudiants sourds sont enseignés à part à l'aide du langage par signe). Chaque école a été assignée au hasard le statut d'intervention ou de témoins. Tous les étudiants ont rempli un questionnaire sur le SIDA à la ligne de base et à la poste-intervention. Suivant la ligne de base, des volontaires du groupe d'intervention ont bénéficié d' une formation de quatre semaines comme formateurs de pairs après quoi ils ont fourni des renseignements sur le VIH/SIDA à leurs pairs de manière univoque et en groupe, à l'aide des approches diverses pendant huit mois, tandis que les sujets témoins n'en ont pas bénéficié. Les cotations différentielles du groupe pre-post pour la connaissance des causes, la manière de transmission et les méthodes de prévention du SIDA au sein du groupe d'intervention étaient significatives par rapport au groupe témoin (P < 0, 0000001) mais pas à la susceptibilité personnelle aperçue (P = 0,64217). Cette étude laisse croire à une influence de l'éducation de pairs sur la connaissance sanitaire des jeunes sourds mais à une limitation quant à la perception de la prédispostion à la maladie. (Rev Afr Santé Reprod 2000; 4[2]: 93–103) Key Words: HIV/AIDS, deaf, peer education, secondary school students, knowledge, attitude, behaviou