Essential drugs in primary health centres of north central Nigeria; where is Bamako initiative?

To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. Checklist consisting ofminimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development Agency (NPHCDA) was adopted and used to assess drugs availability, while FocusGroupDiscussionswere conducted to determine the perceptions of clients on drugs situation in the health centres. Results showthat, all the 3 primary health centres in Tafa LGAdo not implement Bamako initiative (BI) and none was operating Drug Revolving Fund (DRF) system. Out of the minimum recommended score of 54 points for the availability and adequacy of drugs and consumables, NewWuse primary health centre in the LGA headquarters scored highest points of 19,while New Bwari and Iku primary health centres scored 13 points each.All these are far below the minimum requirement. Similarly, the results of the FGDs confirmed poor vailability of drugs and clients dissatisfactionswith the drugs situation in the primary health centres. This study has revealed that despite Bamako Initiatives put in place in late 80s essentials drugs are stillmirages inmany of the primary health care facilities in the study area. It is therefore recommended that, any effort aimed at reforming or repositioning primary health care must take into account resuscitating Bamako Initiative by ensuring functional DRF systemin all the primary care facilities.Keywords: Essential drugs;Primary Health Centres; Bamako Initiative Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.9-1

Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria

Background: Household expenditure on health is increasingly becoming a major source of health care financing in Nigeria. Recognizing the limitations of this pattern of financing health care, the government has introduced a social health insurance scheme policy that has provided for government meeting the health care costs of children. However, there is a dearth of information on the pattern and costs of under-five illnesses at community level. This study therefore sought to determine the magnitude and causes of illnesses among under-fives, sources of healthcare and out of pocket expenditure among children under-five in Layin Zomo, a semi-urban area of Northern Nigeria Methodology: A cross-sectional community-based descriptive study design was used to study a population of under-fives in the settlement. A 50% sample of all under-fives in the settlement was drawn using systematic sampling method. Information was sought from the mothers/caregivers on illness episodes in the three months preceding the study, place and cost of treatment among the 324 sampled population. Result: The findings showed that 26. 9% of the children had been ill within three months of the study with fever; cough and diarrhoea being the leading causes of illness. Majority of respondents, 41.7% sought treatment from patent medicine vendors. The median out of pocket expenditure on treatment per illness episode was 171 Naira ($1.2) and the estimated annual per capita out of pocket treatment cost per child was 255 Naira ($1.8). Conclusion: While the study has provided some data for computation of the out of pocket health expenditure for treatment of under-five illnesses, the poverty context within which such expenditures are incurred limits the utilization of such information to determine the premium rate for the proposed children under five programme under the National Health Insurance Scheme. Key Words: Healthcare; Out-of-pocket expenditure; Under-fives; Zaria Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 29-3

Household Barriers to Effective Malaria Prevention and Control in a Rural Community of North-Western Nigeria

Background: Malaria is endemic throughout Nigeria. Majority of Nigerians live in rural areas where subsistence farming is their main occupation. Most of them live below poverty line, earning less than $1.25 a day. In rural communities, many household factors constitute barriers to effective malaria prevention and control.Objective: This study was conducted to assess the factors that constitute barriers to prevention and control of malaria in Gimba village, a rural community in Soba Local Government area of Kaduna State, Nigeria.Methodology: A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of Ahmadu Bello University, Zaria in July 2012. An interviewer- administered questionnaire was used to collect data from the total population of household heads in the community.Results: Of the 686 respondents, most were farmers (69.7%). In terms of malaria prevention, most of the households (81.8%) own a mosquito net, but in 40.8% of the households, no member slept under a mosquito net the night before the survey. A significant proportion of the households (32.9%) use “otapiapia”, a cheap, unpatented, locally made pesticide as mosquito repellent, while 20.7% of the households do not use any method for malaria prevention. Respondents that had formal education, or with less than 5 children were more likely to use malaria preventive methods compared to those with no formal education or with more than 5 children. Regarding malaria treatment, most of the households, 73%, treated their last cases of presumptive malaria at chemist shops.Conclusion: Some socio-demographic characteristics of respondents and household practices militate against effective malaria prevention and control in the study area. Health Education and Socioeconomic Development in rural areas are recommended for successful malaria prevention and control.Keywords: Household, Barriers, Malaria, Prevention, Rural Community, Nigeri

Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria

<p>Abstract</p> <p>Background</p> <p>Equitable improvement of treatment-seeking for malaria will depend partly on how different socio-economic groups perceive the ease of accessing and utilizing malaria treatment services from different healthcare providers. Hence, it was important to investigate the link between socioeconomic status (SES) with differences in perceptions of ease of accessing and receiving treatment as well as with actual health seeking for treatment of malaria from different providers.</p> <p>Methods</p> <p>Structured questionnaires were used to collect data from 1,351 health providers in four malaria-endemic communities in Enugu state, southeast Nigeria. Data was collected on the peoples' perceptions of ease of accessibility and utilization of different providers of malaria treatment using a pre-tested questionnaire. A SES index was used to examine inequities in perceptions and health seeking.</p> <p>Results</p> <p>Patent medicine dealers (vendors) were the most perceived easily accessible providers, followed by private hospitals/clinics in two communities with full complement of healthcare providers: public hospital in the community with such a health provider and traditional healers in a community that is devoid of public healthcare facilities. There were inequities in perception of accessibility and use of different providers. There were also inequity in treatment-seeking for malaria and the poor spend proportionally more to treat the disease.</p> <p>Conclusion</p> <p>Inequities exist in how different SES groups perceive the levels of ease of accessibility and utilization of different providers for malaria treatment. The differentials in perceptions of ease of access and use as well as health seeking for different malaria treatment providers among SES groups could be decreased by reducing barriers such as the cost of treatment by making health services accessible, available and at reduced cost for all groups.</p

Lipoic acid plays a role in scleroderma: insights obtained from scleroderma dermal fibroblasts

Abstract Introduction Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and organs. Increase in oxidative stress and platelet-derived growth factor receptor (PDGFR) activation promote type I collagen (Col I) production, leading to fibrosis in SSc. Lipoic acid (LA) and its active metabolite dihydrolipoic acid (DHLA) are naturally occurring thiols that act as cofactors and antioxidants and are produced by lipoic acid synthetase (LIAS). Our goals in this study were to examine whether LA and LIAS were deficient in SSc patients and to determine the effect of DHLA on the phenotype of SSc dermal fibroblasts. N-acetylcysteine (NAC), a commonly used thiol antioxidant, was included as a comparison. Methods Dermal fibroblasts were isolated from healthy subjects and patients with diffuse cutaneous SSc. Matrix metalloproteinase (MMPs), tissue inhibitors of MMPs (TIMP), plasminogen activator inhibitor 1 (PAI-1) and LIAS were measured by enzyme-linked immunosorbent assay. The expression of Col I was measured by immunofluorescence, hydroxyproline assay and quantitative PCR. PDGFR phosphorylation and α-smooth muscle actin (αSMA) were measured by Western blotting. Student’s t-tests were performed for statistical analysis, and P-values less than 0.05 with two-tailed analysis were considered statistically significant. Results The expression of LA and LIAS in SSc dermal fibroblasts was lower than normal fibroblasts; however, LIAS was significantly higher in SSc plasma and appeared to be released from monocytes. DHLA lowered cellular oxidative stress and decreased PDGFR phosphorylation, Col I, PAI-1 and αSMA expression in SSc dermal fibroblasts. It also restored the activities of phosphatases that inactivated the PDGFR. SSc fibroblasts produced lower levels of MMP-1 and MMP-3, and DHLA increased them. In contrast, TIMP-1 levels were higher in SSc, but DHLA had a minimal effect. Both DHLA and NAC increased MMP-1 activity when SSc cells were stimulated with PDGF. In general, DHLA showed better efficacy than NAC in most cases. Conclusions DHLA acts not only as an antioxidant but also as an antifibrotic because it has the ability to reverse the profibrotic phenotype of SSc dermal fibroblasts. Our study suggests that thiol antioxidants, including NAC, LA, or DHLA, could be beneficial for patients with SSc.http://deepblue.lib.umich.edu/bitstream/2027.42/112060/1/13075_2014_Article_411.pd

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Quality of Care in Primary Health Centres of Tafa Local Government Area of Niger State, North Central Nigeria; The Clients' Perspective

Quality of care is one of the major public health concerns in this 21 century.We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area inNiger state North central Nigeria. A cross sectional descriptive study wasconducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. Result from the research shows that more than one-third (39%) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7 %) of the total clients load. On their experiencesduring receiving care all the clients (100%) were seen by the health worker, more than half of the clients (57%) obtained all drugs prescribed, three-quarter (76%) were satisfied with questions asked during consultation andless than half (44%) were examined. Furthermore, more than four-fifth (83%) were informed on how to take drugs and 62% were informed of when to come back. More than one-third of the respondents (36.7 %) waited for about 1- 3hrs.. When their overall satisfaction was placed on theLikert's 5-point scale, 3% highly satisfied, 8% were satisfied, 39% fairly satisfied, 29% dissatisfied and 9% were highly dissatisfied : In conclusion, despite the level of advancement attained in health care in the 21 centurywhich is regarded as the era of Total Quality Management, Quality of care in primary health care centres leaves much to be desired. This therefore calls for an urgent, deliberate, sustained and purposeful effort toinstitutionalize Quality Assurance mechanism as an integral part of our health system.Keywords: Quality, Care, Primary Health Centres, Clients, Perspective

Assessment of the knowledge, attitude and practices related to the treatment and prevention of lymphatic filariasis among the adult residents of Bokkos local government area of Plateau state, Nigeria

No Abstract