Factors associated with interruption of treatment among Pulmonary Tuberculosis patients in Plateau State, Nigeria. 2011

Introduction: Nigeria has one of the highest tuberculosis (TB) burdens in the world with estimated  incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the  TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect  adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state,  Nigeria.Methods: Between June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio- demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info  software. Results: Of 378 records reviewed, 229 (61%) patients were male; mean age 37.6 ±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living > 5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment. Conclusion: This study revealed knowledge of the patients on the duration of treatment, distance and health workers  attitude as the major determinants of adherent to TB treatment. Training for health care workers on  patient education was conducted during routine supportive supervision.Key words: Interruption, treatment, Tuberculosis, Nigeri

Development of a Master Health Facility List in Nigeria

Introduction: Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.Methods: The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.Results: The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.Discussion: Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS.Conclusion: Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

Development of a Master Health Facility List in Nigeria

Abstract INTRODUCTION: Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome. METHODS: The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state. RESULTS: The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria. DISCUSSION: Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. CONCLUSION: Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort

Duplication of effort across Development Projects in Nigeria: An example using the Master Health Facility List

ObjectiveDuplication of effort across development projects is often the resultant effect of poor donor coordination in low and middle income countries which receive development assistance. This paper examines the persistence of duplication through a case study of health facility listing exercises in Nigeria.MethodsDocument reviews, key informant interviews and a stakeholder’s meeting were undertaken to identify similar health facility listing exercises between 2010 and 2016.ResultsAs an outcome of this process, ten different health facility listing efforts were identified.Discussions Proper coordination and collaboration could have resulted in a single list grown over time, ensuring return on investments. This study provides evidence of the persistence of duplication, years after global commitment to harmonization, better coordination and efficient use of development assistance were agreed to.ConclusionsThe paper concludes by making a proposal for strategic leadership in the health sector and the need to leverage information and communications technology through the development of an electronic Health Facility Registry that can archive the data on health facilities, create opportunity for continuous updates of the list and provide for easy sharing of the data across different country stakeholders thereby eliminating duplication

The role of the laboratory in outbreak investigation of viral haemorrhagic fever in Nigeria, 2014

On 26th March 2014, a newspaper published an article on the death of a 15 year old female student who attended a private university in Nasarawa state from suspected VHF; presumably Ebola. We investigated to know the cause of death, identified the agent and the source and proposed recommendations. We defined a suspected a case of Viral Haemorrhagic Fever (VHF) as any person with onset of fever and no response to usual causes of fever and at least one of the following signs: bloody diarrhoea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine within and around Abuja from 9th February 2014 to 2nd April 2014. We reviewed the hospital records of the index case and re-tested stored blood samples. We searched actively for contacts with the index case in hospitals where she was treated before her demise. Hospital staff were line listed at the various hospitals. We confirmed one death (index case) a 15 year old female who died on 15th March 2014. Serum sample tested positive for Dengue virus serotypes 1,2,3 and 4 using ELISA and PCR. We implemented VHF detection, management and reporting for health professionals in the country. We recommended sero-surveillance and entomological surveys be done to determine the prevalence of Dengue virus and its vector in Abuja and Nasarawa state. Dengue and other VHFs are emerging diseases that can easily be missed or misdiagnosed in early stages. Equipping laboratories and improving surveillance can help in early detection, management and epidemic aversion.The Pan African Medical Journal 2016;2

Prevalence and Determinants of Childhood Lead Poisoning in Zamfara State, Nigeria

Background. Lead poisoning is a great public health concern in the Nigerian state of Zamfara due to widespread gold ore mining by artisan miners using rudimentary and unsafe processing techniques. Children aged ≤6 years are especially vulnerable to lead poisoning, which accounts for 0.6% of the global burden of disease. We undertook this study to find out the prevalence and determinants of childhood lead poisoning in Kawaye, a village located in Zamfara’s Anka local government area (LGA). Methods. We conducted a cross-sectional study in April 2013. Using simple random sampling technique, 307 eligible children aged ≤6 years were recruited. Data were collected using interviewer-administered semi-structured questionnaires. Blood specimens were collected via venous draw for blood lead level (BLL) assessment and soil at individual households was tested for presence of lead contamination using a portable X-ray fluorescence spectrometer. Statistical tests of Chi-square and multivariable logistic regression analyses were performed to evaluate factors potentially associated with elevated childhood BLL (≥5 μg/dL). Results. A total of 307 children ≤6 years old were sampled, with males constituting 51% of the total (171). Mean age of children = 38.5 months ± 18.5 SD. Parents/guardians of the studied children were predominantly farmers (37%) and miners (15%), with 53.7% having some informal education while 4.2% had no education. Processing of ore within the living compound was reported by 4% of the miners; 7.5% returned home wearing working clothes; 7.2% brought tools home. Thirty percent of parents/guardians were living below the poverty line. The prevalence of lead poisoning (BLL ≥5 μg/dL) among the children studied was 92.5%, with 34 children (11.1%) having BLL ≥45 μg/dL. Fourteen percent of the households had soil lead levels >400 mg/kg. Being age 24–35 months, having childhood anemia, using kohl eye cosmetic and the combination of father’s/guardian’s low level of education and low socioeconomic status were found to be significant risk factors associated with childhood lead poisoning in the regression analyses. Conclusions. The prevalence of childhood lead poisoning was high in Kawaye, which may be attributable to widespread unsafe mining and ore processing activities in the community. We recommended beginning treatment in all cases where severe lead poisoning was identified, and that further targeted interventions should be designed to address the identified risk factors in order to control and prevent further lead poisoning in the village and the state at large. Competing Interests. The authors declare no competing financial interests

Human Exposure to Novel Bartonella Species from Contact with Fruit Bats

Twice a year in southwestern Nigeria, during a traditional bat festival, community participants enter designated caves to capture bats, which are then consumed for food or traded. We investigated the presence of Bartonella species in Egyptian fruit bats (Rousettus aegyptiacus) and bat flies (Eucampsipoda africana) from these caves and assessed whether Bartonella infections had occurred in persons from the surrounding communities. Our results indicate that these bats and flies harbor Bartonella strains, which multilocus sequence typing indicated probably represent a novel Bartonella species, proposed as Bartonella rousetti. In serum from 8 of 204 persons, we detected antibodies to B. rousetti without cross-reactivity to other Bartonella species. This work suggests that bat-associated Bartonella strains might be capable of infecting humans

Bat and lyssavirus exposure among humans in area that celebrates bat festival, Nigeria, 2010 and 2013

Using questionnaires and serologic testing, we evaluated bat and lyssavirus exposure among persons in an area of Nigeria that celebrates a bat festival. Bats from festival caves underwent serologic testing for phylogroup II lyssaviruses (Lagos bat virus, Shimoni bat virus, Mokola virus). The enrolled households consisted of 2,112 persons, among whom 213 (10%) were reported to have ever had bat contact (having touched a bat, having been bitten by a bat, or having been scratched by a bat) and 52 (2%) to have ever been bitten by a bat. Of 203 participants with bat contact, 3 (1%) had received rabies vaccination. No participant had neutralizing antibodies to phylogroup II lyssaviruses, but ≥50% of bats had neutralizing antibodies to these lyssaviruses. Even though we found no evidence of phylogroup II lyssavirus exposure among humans, persons interacting with bats in the area could benefit from practicing bat-related health precautions