Attitude and Practice of Males towards Antenatal Care in Saki West Local Government Area of Oyo State, Nigeria

This study examined attitude and practice of males towards antenatal care in Saki West Local Government Area of Oyo State, Nigeria. Descriptive survey research design was used for this study and the instrument for data collection is self developed questionnaire in four-point Likert scale format with reliability coefficient of 0.76. Men of reproductive age in Saki metropolis formed the population for this study while the total sample for the study is one hundred and twenty (120) men of reproductive age. Three hypotheses were raised and tested at 0.05 alpha level using inferential statistics of Chi-Square. The result showed, among other findings, that there is significant relationship between men’s level of education and their participation in antenatal care. Consequent upon this, it was recommended that improved strategies hinged on enlightenment and orientation of men should be developed. Key words: antenatal care, male involvement, maternal health, Saki

Biochemical and Toxicological Evaluations of Aqueous Extract of Parquetina nigrescens (Afzel.) leaves on Mifepristone-induced Polycystic Ovarian Syndrome in Rats

The biochemical and toxicological effects of aqueous extract of Parquetina nigrescens leaves (AEPNL) at the doses of 50, 100, and 200 mg/kg body weight on mifepristone-induced in Polycystic Ovarian Syndrome (PCOS) was investigated in female Wistar rats. Sixty female Wistar rats (190.00 ± 13.00 g) were assigned into 6 groups (A - F) of ten each: animals in group A received 0.5 ml of distilled water orally on daily basis for 30 days while the mifepristonized rats in groups B, C, D and E also received orally 0.5 ml of distilled water, 7.14mg/kg of metformin (reference drug) and same volume of the extract corresponding to 50, 100, and 200 mg/kg body weight of AEPNL respectively after which levels of some biochemical and toxicological indices were determined. AEPNL aggravated mifepristone-treatment related increases in albumin, total protein and liver aspartate aminotransferase activity and mitigated the increases in globulin, total bilirubin, urea, creatinine, liver and serum alkaline phosphatase and alanine aminotransferase activities, and no treatment-related histoarchitectural changes occurred in the liver, kidney and uterus of the female rats. Therefore, the aqueous extract of Parquetina nigrescens leaves attenuated and also aggravated some biochemical parameters in the serum, liver and kidney but with no histological changes in the liver, kidney and uterus of the mifepristonized female Wistar rats. Keywords: Mifepristone, toxicology, Parquetina nigrescens, Polycystic Ovarian Syndrome, histolog

Phenytoin–levetiracetam adjunctive treatment-induced neurotoxicity and deregulation of cholinergic neurotransmission with evidence of neurocognitive impairment in male Wistar rats

Introduction: The effects of chronic administration of phenytoin (PHT), levetiracetam (LEV), and PHT + LEV adjunctive treatments were examined on the cognitive functions of male rats.Methods: Twenty-eight male Wistar rats (150–180 g) were randomized into 4 groups (N = 7). Groups I–IV received daily intraperitoneal administration of normal saline (0.2 ml), therapeutic doses of PHT (50 mg/kg), LEV (50 mg/kg) or sub-therapeutic dose of PHT (25 mg/kg) and LEV (25 mg/kg) combination, respectively, for 28 days. Thereafter, the animals were subjected to behavioral assessment and evaluation of the activities of acetylcholinesterase, lipid peroxidation, and lastly the morphological evaluation of the brain. Data were analyzed using descriptive and inferential statistics. The results were presented as mean ± SEM in graphs or tables, while the level of significance was taken at p < 0.05.Results: Working & spatial memory, exploratory activities, and motor-coordination indices were significantly (p = 0.0099) impaired with a reduction in the frontal lobe and hippocampal weight following PHT and PHT + LEV adjunctive treatments. The frontal lobe and hippocampal activities of acetylcholinesterase increased significantly (p = 0.0437) following PHT and PHT + LEV adjunctive treatment. The concentrations of malondialdehyde increased significantly (p = 0.0473) in PHT, LEV, and PHT + LEV compared with the control. There was disorganization in the histoarchitectural profile with chromatolysis, hyalinization, and neural vacuolation in the pre-frontal cortex, hippocampus, and cerebellar tissue, especially in the PHT + LEV treated rats.Conclusion: Impairment of cognitive functions following PHT and PHT + LEV adjunctive treatments may be attributable to the deregulation of cholinergic transmission and neurotoxicity

Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF

Background: Each year an estimated 2.3 million newborns die in the frst 28 days of life. Most of these deaths are pre‑ ventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpa‑ tient small and sick newborn care (SSNC). Methods: Health systems ingredients for SSNC were identifed from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identifed and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations deter‑ mined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by\u3e150 global experts, and refned and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. Results: Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identifed and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n=866, range 2.2–34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n=866) of ingredi‑ ents and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedi‑ cal technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. Conclusion: This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Background: Service readiness tools are important for assessing hospital capacity to provide quality small and sick newborn care (SSNC). Lack of summary scoring approaches for SSNC service readiness means we are unable to track national targets such as the Every Newborn Action Plan targets. Methods: A health facility assessment (HFA) tool was co-designed by Newborn Essential Solutions and Technologies (NEST360) and UNICEF with four African governments. Data were collected in 68 NEST360-implementing neonatal units in Kenya, Malawi, Nigeria, and Tanzania (September 2019-March 2021). Two summary scoring approaches were developed: a) standards-based, including items for SSNC service readiness by health system building block (HSBB), and scored on availability and functionality, and b) level-2+, scoring items on readiness to provide WHO level-2+clin‑ ical interventions. For each scoring approach, scores were aggregated and summarised as a percentage and equally weighted to obtain an overall score by hospital, HSBB, and clinical intervention. Results: Of 1508 HFA items, 1043 (69%) were included in standards-based and 309 (20%) in level-2+scoring. Sixtyeight neonatal units across four countries had median standards-based scores of 51% [IQR 48–57%] at baseline, with variation by country: 62% [IQR 59–66%] in Kenya, 49% [IQR 46–51%] in Malawi, 50% [IQR 42–58%] in Nigeria, and 55% [IQR 53–62%] in Tanzania. The lowest scoring was family-centred care [27%, IQR 18–40%] with governance highest scoring [76%, IQR 71–82%]. For level-2+scores, the overall median score was 41% [IQR 35–51%] with vari‑ ation by country: 50% [IQR 44–53%] in Kenya, 41% [IQR 35–50%] in Malawi, 33% [IQR 27–37%] in Nigeria, and 41% [IQR 32–52%] in Tanzania. Readiness to provide antibiotics by culture report was the highest-scoring interven‑ tion [58%, IQR 50–75%] and neonatal encephalopathy management was the lowest-scoring [21%, IQR 8–42%]. In both methods, overall scores were low (\u3c50%) for 27 neonatal units in standards-based scoring and 48 neonatal units in level-2+scoring. No neonatal unit achieved high scores of\u3e75%. Discussion: Two scoring approaches reveal gaps in SSNC readiness with no neonatal units achieving high scores (\u3e75%). Government-led quality improvement teams can use these summary scores to identify areas for health sys‑ tems change. Future analyses could determine which items are most directly linked with quality SSNC and newborn outcomes

Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF

Background: Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC). Methods: Health systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. Results: Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2–34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. Conclusion: This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action

Neonatal inpatient dataset for small and sick newborn care in low- and middle-income countries: systematic development and multi-country operationalisation with NEST360.

BACKGROUND: Every Newborn Action Plan (ENAP) coverage target 4 necessitates national scale-up of Level-2 Small and Sick Newborn Care (SSNC) (with Continuous Positive Airway Pressure (CPAP)) in 80% of districts by 2025. Routine neonatal inpatient data is important for improving quality of care, targeting equity gaps, and enabling data-driven decision-making at individual, district, and national-levels. Existing neonatal inpatient datasets vary in purpose, size, definitions, and collection processes. We describe the co-design and operationalisation of a core inpatient dataset for use to track outcomes and improve quality of care for small and sick newborns in high-mortality settings. METHODS: A three-step systematic framework was used to review, co-design, and operationalise this novel neonatal inpatient dataset in four countries (Malawi, Kenya, Tanzania, and Nigeria) implementing with the Newborn Essential Solutions and Technologies (NEST360) Alliance. Existing global and national datasets were identified, and variables were mapped according to categories. A priori considerations for variable inclusion were determined by clinicians and policymakers from the four African governments by facilitated group discussions. These included prioritising clinical care and newborn outcomes data, a parsimonious variable list, and electronic data entry. The tool was designed and refined by > 40 implementers and policymakers during a multi-stakeholder workshop and online interactions. RESULTS: Identified national and international datasets (n = 6) contained a median of 89 (IQR:61-154) variables, with many relating to research-specific initiatives. Maternal antenatal/intrapartum history was the largest variable category (21, 23.3%). The Neonatal Inpatient Dataset (NID) includes 60 core variables organised in six categories: (1) birth details/maternal history; (2) admission details/identifiers; (3) clinical complications/observations; (4) interventions/investigations; (5) discharge outcomes; and (6) diagnosis/cause-of-death. Categories were informed through the mapping process. The NID has been implemented at 69 neonatal units in four African countries and links to a facility-level quality improvement (QI) dashboard used in real-time by facility staff. CONCLUSION: The NEST360 NID is a novel, parsimonious tool for use in routine information systems to inform inpatient SSNC quality. Available on the NEST360/United Nations Children's Fund (UNICEF) Implementation Toolkit for SSNC, this adaptable tool enables facility and country-level comparisons to accelerate progress toward ENAP targets. Additional linked modules could include neonatal at-risk follow-up, retinopathy of prematurity, and Level-3 intensive care

Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF.

BACKGROUND: Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC). METHODS: Health systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. RESULTS: Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. CONCLUSION: This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action

The Role of Vitamin D and Oxidative Stress in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major non-communicable disease associated with high rates of premature morbidity and mortality. The prevalence of hypovitaminosis D (deficiency of 25(OH)D or 25D) is greater in racial/ethnic minorities and in patients with CKD than the general population. Low 25D is associated with bone and mineral disorders as well as immune, cardiometabolic and cardiovascular (CV) diseases. Thus, it has been suggested that low 25D contributes to the poor outcomes in patients with CKD. The prevalence of hypovitaminosis D rises progressively with advancing severity of kidney disease with over 30% of patients with CKD stage 3 and 70% patients with CKD stage 5 estimated to have low levels of 25D. This report describes several of the abnormal physiologic and counter-regulatory actions related to low 25D in CKD such as those in oxidative stress and inflammatory systems, and some of the preclinical and clinical evidence, or lack thereof, of normalizing serum 25D levels to improve outcomes in patients with CKD, and especially for the high risk subset of racial/ethnic minorities who suffer from higher rates of advanced CKD and hypovitaminosis D