Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria.

BACKGROUND: Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. METHODS: We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. RESULTS: From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). CONCLUSIONS: Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria

Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria

Introduction: Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of  Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. Methods: It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level.Results: The study showed that  traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas.Conclusion: It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.Key words: Maternal, child, newborn, knowledge management, mapping

Noise exposure, awareness, attitudes and use of hearing protection in a steel rolling mill in Nigeria

Objectives To study exposure to noise, the attitudes and knowledge towards noise-induced hearing loss and the actual use of hearing protection in a steel rolling mill in Nigeria. Methods A structured questionnaire was administered to 116 randomly selected workers to collect information relating to their knowledge and attitudes towards hazardous occupational noise and preventative measures. Noise mapping of the factory was also carried out. Results Time weighted average noise levels were: administrative area 49 dBA, mechanic/maintenance workshop 72 dBA, mill floor 86 dBA and finishing stage 93 dBA. There was high awareness of the hazard of noise to hearing (93%) and of methods of prevention (92%) but only 27% possessed hearing protectors and only 28% of these stated that they used them all the time. Conclusion While noise is recognized as a hazard, initiatives are required to increase use of effective preventative measures

Occupational noise exposure and sensorineural hearing loss among workers of a steel rolling mill

Hearing loss is one of the most common chronic health conditions and has important implications for the patient’s quality of life. However, hearing loss is substantially underestimated and under treated. The purpose of this study was to determine the prevalence of sensorineural hearing loss among the workers in a steel rolling mill in Nigeria. Each of the 150 randomly selected subjects had a structured questionnaire administered to them, followed by a full otological examination. Of these, 116 had tympanometry and pure-tone audiometry. Also a noise mapping of their respective work units was done. The workers were exposed to noise levels varying from 49 to 93 dBA. About 28.2% of the 103 who had their audiogram analysed had mild to moderate sensorineural hearing loss in their better ear and 56.8% of them had mild to moderate sensorineural hearing loss in their worse ear. The pure-tone average and the average hearing thresholds at 4 kHz for the groups significantly increased with an increasing noise exposure level. The prevalence of sensorineural hearing loss among the study population is high; and noise exposure is at least contributory. Pre-employment and regular audiometry while on the job is highly recommended

Medicine use among HIV/Aids patients in public hospitals, Kwara State

Background: The prognosis of HIV/AIDS and HIV-related comorbidities has been revolutionized by the use of medicines. However, World Health Organization reported that 50% of patients do not use their medicines as prescribed.Objective: To assess HIV/AIDS patients’ knowledge of the use of medicines dispensed to them.Method: This study was conducted in seven public hospitals in six local government areas, Kwara State. Exit interviews of 780 eligible HIV/AIDS patients were conducted through use of structured questionnaire. Additionally, there were exit observational checks of medicines dispensed to these patients. Descriptive statistics and Fisher Exact test were used for data analyses.Results: Of the 780 study participants, 36.1% had no formal education, 99.9% knew the ‘quantity’ of medicines to be administered, while 99.2% knew the frequency of administration. All the patients knew the route of administration, 96.7% and 94.3% knew the general precautions to avoid concomitant use of dispensed medicines with alcohol or herbal products respectively, while 93.7% of those who received co-trimoxazole knew of the precaution to use “plenty of water” as the vehicle for its administration. There were no significant associations between the patients’ knowledge of these precautions and duration of antiretroviral therapy (P&gt;0.05). However, the patients lacked knowledge of specific precautions of some dispensed medicines.Conclusion: Most of the patients knew of the administration and the general precautions of dispensed medicines. However, lack of knowledge of specific precautions of some dispensed medicines calls for intervention.Keywords: HIV/AIDS patients, Medicine use, Duration of antiretroviral therapy, Public hospitals, Kwara Stat

Impact of hypertension home-based care on health related quality of life of Nigerian patients: research concept, framework and methodology

Background: Public health importance of hypertension have been documented all over the world. In recent years, there has been increase cases of hypertension reported in African countries including Nigeria. The current management strategy of hypertensive cases within hospital setting are characterized by high default rate, non-adherence, poor medical outcomes and poor quality of life. While past studies emphasized use of medical outcomes to assess treatment or intervention outcomes, only scanty studies take into cognizance the quality of life that patients live. Because of the chronicity of hypertension, it is important to begin to assess the Health Related Quality of Life (HRQoL) of patients and begin to use such as an impact assessment of treatment or intervention strategies. This study proposed to develop and implement a home based follow-up care (HBFC) intervention and evaluate the impact of the intervention on the HRQoL of hypertensive patients in Nigeria. Materials and methods: This study will be a randomized control trial (un-blinded) to be conducted in 3 stages. Stage 1 will develop HBFC program while in stage 2, patients will be recruited, assessed (baseline data), randomized into 2 arms of study and follow-up for 6 months. The third stage will evaluate the impact of the intervention on HRQoL and disseminate the findings. Data will be collected with the use of structured questionnaire which will contain validated tools like SF-36v2 for HRQoL and Morisky scale for medication adherence. Main outcome measurement will be treatment effect using HRQoL while data would be analyzed using SPSS, version 22. Intention to treat (ITT) analysis concept will be employed and main hypothesis will be tested using paired t-test analysis. Level of significance will be set at p-value of < 0.05 and 95% confidence intervals (CI). Expected outcome: The study will contribute to the existing knowledge on home based care program for hypertensive patients in developing countries where literature is scanty. It will generally give insight into the importance of HRQoL measurement in interventional studies on hypertension and other related chronic diseases in this setting

Applications of health related quality of life (HRQoL) as an intervention impact assessment in the management of hypertension: a systematic review

Introduction: Persons living with hypertension wrestle with the physical, psychological, and social demands of their illness without adequate help or support from medical care. This has buttressed the need to research into the perceptions of patients in the context of their subjective feelings towards their wellbeing. This is termed “health related quality oflife (HRQoL)”. One of the most important goals of all health interventions is to improve the quality of life of persons affected by disease and many researchers had advocated for the need to see health outcome beyond clinical and laboratory parameter alone. Therefore need to study and assess HRQoL as well. This study however set out to review available intervention studies in the scientific literature from 1980 till date (that met the set eligible criteria) and those which employed quality of life as a primary outcome measurement. Methods: The PRISMA and Standard Cochrane Collaboration systematic review techniques were used as guidelines for the review while varieties of online journals, database and library were searched. These yielded over a thousand articles which were screened systematically using stringent eligibility criteria to scale down to 37 articles out of which 6 articles employed intervention as study approach and quality of life as primary outcome measurement. Results: The age range of the participants in the review is between 18 to 80 years. Results revealed that only 4 out of the 6 articles were randomized control trial (RCT) out of which only one was blinded. Four of the studies used SF-36 tool for assessment of HRQoL. Another Four studies reported statistically significant increase in overall HRQoL of intervention group over a control group. Two studies did not analyse significance level. The individual dimensions of HRQoL revealed discrepancies in there viewed articles. Mental health improvement was observed to be the only common improved outcome across the studies. Conclusion: It was concluded that there is still dearth of literature on HRQoL outcome assessment of hypertensive studies. It is suggested that future research on interventional studies should endeavor to use quality of life as a primary or as part of outcome measurements

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

Introduction: Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. Methods: This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value &lt;0.05 was considered statistically significant. Results: 27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Conclusion: Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.Pan African Medical Journal 2016; 2

Health Consumer Expectations and Perception of Quality Care Services at Primary Health Care Level in Nigeria

OBJECTIVE: The study examined the expectations of health consumers and perception used in judging the Quality of health care services at the primary health care level. METHODOLOGY: A cross-sectional study was carried out among randomly selected health consumers that had received health care services in the hospitals designated as primary health care facilities in Kwara State Nigeria. RESULTS: Overall health consumers’ means score expectations was 6.57 while perception was 5.80. Though was high in favour of females with no statistics significant difference. However, correlation test revealed significant association in socio-demographic variables such as age, occupation and educational status. Conversely, relationship was inverse in term of increase in education attainment with lower perception value (pv = <0.001). CONCLUSION: Expectation- perception gap was a major determinant of quality of health care services at primary health care levels. Significant relationship occurred between heath consumer’s age, occupation, educational status and overall expectation -perception of quality health care received. It is recommended that hospital management need to monitor the link between the expectations including perception of services received by patients for quality improvement at primary health care level

Determination of Normal and Variant Hemoglobin using Capillary Electrophoresis among Voluntary Blood Donors in North Central Nigeria: Implications on Blood Transfusion Services

Background: Voluntary non-remunerated blood donation is a strategy adopted by World Health Organization aimed at ensuring safety and adequacy of blood supply. Sub-Saharan Africa has a high prevalence of hemoglobin disorders and therefore needs to adopt stringent measures in donor selection to ensure safety for the recipient of blood transfusion. This study aimed to analyze normal and variant hemoglobin among voluntary blood donors. Methods: In this descriptive cross-sectional study, 100 prospective blood donors including 55 (55%) males and 45 (45%) females, aged 18–34 years were recruited. Capillary electrophoresis using the Minicap system was used for determining the hemoglobin variants in alkaline buffer (PH 9.4). Data analysis was done using SPSS version 20 and p-value &lt; 0.05 was considered as the level of significance Results: The mean age of the participants was 22.23&nbsp;±&nbsp;3.3&nbsp;SD years. The proportion of participants with genotype AA was 67 (67%), those with AS were 17 (22&nbsp;%), while those with AC were 11 (11&nbsp;%). While Hb A ≥ 90% was noted in 67 (67%) blood donors, Hb S was seen in 22 (22%) and Hb A2 &gt; 3.5% in 57 (57%). Hb F &gt; 2% was observed in 3% of the studied participants Conclusion: Variant hemoglobin is common among blood donors and this should be taken into consideration whenever blood is being crossmatched for recipients of blood transfusion. Data from this study will be useful in raising awareness and genetic counseling. Keywords: prevalence, hemoglobin variants, capillary electrophoresi