AWARENESS AND GEOSPATIAL EXAMINATION OF HEALTHCARE FACILITIES IN OGUN STATE NIGERIA: NEED FOR HEALTH CARE DEVELOPMENT

Spatial distribution inequity in health care facilities, including primary health care, has been recognized as a wedge towards effective delivery of such services in many countries, including Nigeria. Healthcare facilities are vehicles to attain an acceptable level of health that will enable everyone to lead a socially and economically productive life. One of the core challenges facing the Nigerian health care system is poor access to health facilities, worsened by poverty, poor road networks and transportation. The resultant consequences are high morbidity and mortality in most parts of the country, leading to low economic performance. Access serves as the bridge between availability and utilization. For Sustainable Development Goal 3, people should have access to health facilities closer to their residence. The study employed secondary data and geographic information system mapping in the investigation. The paper aimed to explore the locational distribution of existing health facilities in Ogun State and make informed recommendations for policy intervention in the study area. The study reveals that the distribution pattern of public healthcare facilities in the State is not uniform either at tertiary, secondary, or primary levels. And this scenario negates the essence of providing health care facilities within 5 kilometers distance envisaged by WHO and general health status. Densely populated health facilities were seen in local governments with high populations, industries and Local Government capitals. In contrast, others have fewer health care facilities, perhaps due to their rural and remote nature. Thus, the government needs to ensure even distribution of health facilities and motivated personnel, drugs, and deliverables in the study area to ensure optimal spatial efficiency

LIPIDNA PEROKSIDACIJA KOD DIMLJENOG AFRIČKOG SOMA TRETIRANOG MARINADOM Moringa oleifera, SOLJU I BUTIL HIDROKSI ANISOLOM

Smoke-dried fish is vulnerable to lipid peroxidation, which can reduce product quality and pose health risks to consumers. The study examined the antioxidant potency of Moringa oleifera marinade on oxidative stabilityof smoke-dried catfish in comparison with salt and Butylated hydroxyl anisole (BHA), a synthetic antioxidant. Seventy-two catfish (208±6 g) were processed, randomly assigned to six antioxidant treatment groups and hotsmoked. The treatments are the control (0%), 1%, 2% and 3% (w/v) Moringa oleifera marinade (MOM), 5% Brine (w/v) and 0.2% BHA (w/v). Thesmoke-dried fish were stored at room temperature (35±10C) for 8 weeks. Lipid peroxidation was monitored weekly using Thiobarbituric acid (TBA)assay. The results showed that Moringa oleifera marinade and BHA decreased lipid peroxidation more than (p0.05) difference was observedamong all Moringa treated samples and BHA. Moringa oleifera marinade could be used as an alternative to BHA in suppressing lipid peroxidation in smoke-dried African catfish stored for 8 weeks.Sušena dimljena riba izložena je lipidnoj peroksidaciji, što može smanjiti kvalitetu krajnjeg proizvoda, ali i ugroziti zdravlje potrošača. Ovim istraživanjem ispitanoje potencijalno antioksidantsko djelovanje marinade Moringa oleifera na stabilnost oksidacije kod dimljenog soma te je ono uspoređeno s djelovanjem soli i butil hidroksi anisola (BHA), sintetičkog antioksidanta.Obrađeno je 72 primjeraka soma (208 ± 6 g),a ravnomjerno su raspoređeni u 6 skupina tretiranih antioksidansima te izloženih vrućem dimu. Skupine s obzirom na vrstu tretmana i postotak izloženosti bile su sljedeće: kontrolna skupina (0%), 3 skupine somovatretiranih marinadom Moringa oleifera (MOM)(1%, 2% i 3%), somovi u rasolu (w/v) (5%) i somovi u butil hidroksi anisolu (w/v) (0,2%). Dimljena riba bila je pohranjena na sobnoj temperaturi (35 ± 10C)8 tjedana. Peroksidacija lipida tjedno je praćena pomoću ispitivanja tiobarbiturnom kiselinom (TBA). Rezultati su pokazali smanjenje lipidne peroksidacijekod skupina somova u marinadi Moringa oleifera i u butil hidroksi anisolu (p<0,05), za razliku od rezultata povećane lipidne peroksidacije kod somova iz kontrolne skupine (0,94 mg/MDA/kg) i onih tretiranih solju (0,92 mg/MDA/kg). Dakle, reaktivne promjene prilikom ispitivanja tiobarbiturnom kiselinom (TBARS)su kod pojedinih skupina somova bile manje: uzorci tretirani 1% marinadom Moringa oleifera (0,44 mg/MDA/kg), uzorci tretirani 2% i 3% istom marinadom (0,88 mg/MDA/kg; 0,85 mg/MDA/kg) i uzorci tretirani BHA-om (0,80 mg/MDA/kg). Tijekom izloženosti riba prije navedenim uvjetima, praćen je proces kvarenjariba uzrokovan oksidacijom. Prirast je bio intenzivniji u kontrolnoj i skupini riba tretiranih solju (p<0,05). Nema značajne razlike kod skupina riba tretiranih marinadomMoringa oleifera i onih tretiranih butil hidroksi anisolom. Marinada Moringa oleifera mogla bi se u osmotjednom periodu izloženosti dimljenog afričkog soma koristiti kao alternativa za BHA u suzbijanju lipidneperoksidacije

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Comparative study of proguanil and sulphadoxine–pyrimethamine in the prevention of malaria in pregnancy

Background: Intermittent preventive treatment of malaria in pregnancy with sulphadoxine–pyrimethamine (SP) is recommended for prevention of malaria in pregnancy. However, chemoprophylaxis with proguanil (PG) is being used in pregnancy for preventing malaria in selected cases. Objective: To compare the efficacy of daily PG and intermittent monthly SP in preventing malaria and its complications during pregnancy. Patients and Methods: This was a prospective comparative study conducted among 270 consenting pregnant women with parity ≤2 at gestational age of 18–24 weeks. Participants were enrolled and randomized to PG or SP group following a baseline hemoglobin estimation and blood film negative for malaria parasite. At 36 weeks of gestation, maternal blood sample was checked for hemoglobin concentration and malaria parasitaemia, and the infant birth weight was assessed at delivery. Statistical Analysis: Appropriate univariate, and bivariate analysis employed and level of significance set at P < 0.05. Results: One hundred and thirty-five participants in each group (246) completed the study. Ten (8.5%) had malaria parasitaemia in the PG group at 36 weeks compared to 15 (11.7%) in the SP group (P = 0.40); 5 (4.3%) in the PG compared with 6 in SP group (4.7%) had anemia (Hb <10 g/dl) at 36 weeks (P = 0.86). In addition, 6 (5.1%) participants in the PG group developed clinical malaria compared to 3 (2.3%) in the SP group (P = 0.25). The mean infant birth weight in the PG and SP groups were 3.05 kg and 3.00 kg, respectively (P = 0.24). Conclusion: PG and SP were comparable in efficacy and outcome for malaria prevention during pregnancy. IPT-SP is recommended for prevention of malaria in pregnancy. However, PG is beneficial in selected patients with known adverse reactions to sulphonamide

Sero-prevalence and determinants of Hepatitis B among a cohort of HIV-infected women of reproductive age in Nigeria.

IntroductionSub-Saharan Africa houses over two-thirds of the 37 million people living with human immunodeficiency virus (HIV) globally and of this, 5-20% are co-infected with Hepatitis B virus (HBV). This is double jeopardy, especially for women of reproductive age in these settings, who can transmit both viruses vertically as well as horizontally to their children. The objectives of this study were to investigate the prevalence and determinants of HBV among women of reproductive age living with HIV.MethodsThis was a cross-sectional study of HIV-infected women of reproductive age in Benue State, Nigeria. Participants were eligible for the study if they were HIV-infected women (ages 18-45 years) receiving care from any of the selected study sites. A global rapid hepatitis B surface antigen (HBsAg) antibody test strip was used to test for HBsAg in plasma. A pretested questionnaire was used to collect data on sociodemographic, clinical and lifestyle characteristics of participants. We estimated prevalence of HBV infection and used multivariable logistic regression to determine factors associated with the infection at a significance level of ResultsA total of 6577 women were screened for HBsAg. The prevalence of HBV was 10.3% (95% CI: 9.5-10.9%). Age, parity and male partner's HIV status were found to be associated with having HBV infection. Compared to women older than 40 years, the odds of HBV infection increased significantly with increasing age until age 35 years and decreased significantly with increasing parity (versus no parity). Women with HIV-infected partners and those without a partner had higher odds of HBV infection compared to women with HIV-negative partners.ConclusionHBV is hyperendemic among HIV-infected women of reproductive age in North Central Nigeria. Specific programs targeting HBV testing, vaccination and treatment of all women of reproductive age need to be developed in this resource-limited, high-need setting