Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria

Introduction: Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. Methods: A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p<0.05. Results: Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. Conclusion: The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.Pan African Medical Journal 2016; 2

Pregnancy outcome of HIV-infected women on anti-retroviral therapy in a treatment centre in Port Harcourt, Nigeria: a retrospective analysis

Introduction: There are conflicting reports of adverse pregnancy outcomes following the administration of antiretroviral treatment (ARVs) to HIV-positive pregnant women. The aim of this study was to assess the magnitude of adverse effects of antiretroviral drugs and to underscore their importance in limiting adverse pregnancy outcomes in newborns.Methods: The study was a retrospective analysis of medical records of HIV-infected pregnant women who received anti-retroviral treatment at the University of Port Harcourt Teaching Hospital between January 2010 and December 2013. Data was analyzed using Epi Info Version 7 Statistical Package. Proportions, measures of centrality/dispersion as well as measures of association between maternal predictors and birth outcomes were computed. The level of significance was set at p≤ 0.05.Results: A total of 290 medical records of women who received anti-retroviral treatment were examined: 68.3% women commenced antiretroviral treatment before pregnancy, 3.8% started in 2nd trimester of pregnancy and 14.1% during labour. Pregnancy outcomes were as follows: 90.7% were live births; 92.4% neonates had Apgar scores ≥7 and 90.7% had birth weights of ≥ 2,500 grams. More than half, 55.9% had haemoglobin levels ≥ 10g/dl, while 84.8% of them were born full term. There were only 9.3% stillbirths and 9.3% low birth weights respectively, and also 15.2% preterm births.Conclusion: The prevalence of adverse pregnancy outcomes in the study was minimal and stresses the value of antiretroviral treatment in the prevention of adverse pregnancy outcomes in newborns. We therefore recommend its intensified utilization for maximum impact in reducing adverse pregnancy outcomes.Keywords: HAART, HIV, PMTCT, pregnancy, Port Harcourt, Nigeri

Treatment Outcomes and Associated Factors of Tuberculosis Patients on Directly Observed Treatment (Short Course) in a Tertiary Hospital in Port Harcourt, Nigeria

Introduction: Although concerted efforts have been implemented to achieve tuberculosis (TB) prevention and control, varying  outcomes have been reported in several quarters, despite the implementation of the directly observed treatment short-course (DOTS) strategy in virtually all parts of the world. It was considered necessary to assess the treatment outcomes of TB patients on DOTS strategy and the associated factors against the World Health Organization (WHO) target at the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, to stimulate improvements in efforts toward patients care in the hospital and elsewhere. Methods: Ahealth facility‑based review of patients’ records(January 1, 2014–December 31, 2018) at the TB Clinic of UPTH was carried out using a validated data record sheet. Patients undergoing treatment were excluded. Data were analyzed with the SPSS software version 20. Outcome frequencies were summarized, and the Pearson’s Chi‑square test was used to determine the association between the outcome and independent variables at P ≤ 0.05 statistical significance level. Results: Overall, 174 (25.7%) had completed treatment, 181 (26.7%) were cured, 95 (14.0%) died, 70 (10.3%) transferred out, 45 (6.6%) defaulted, 49 (7.2%) were not evaluated, 44 (6.5%) were lost to follow‑up, and 8 (1.2%) failed treatment. There was a 17.6% decline in the proportion of patients that completed treatment from 35.9% in 2014 to 18.3% in 2018. On the contrary, there was an increase in the proportion of patients that were cured, from 14.1% in 2014% to 26.1% in 2018. Conclusions: The treatment success rate for TB in the hospital was below the WHO benchmark of 85% cure rate throughout the period under review. Basic reforms in the service delivery processes that specifically targets groups at risk (male patients, sputum  smear‑negative TB patients, and patients with human immunodeficiency virus/TB co-infection) with drug adherence counselling, defaulter tracing arrangements, and emphasis on drug‑susceptibility testing are recommended to improve treatment outcomes. Keywords: Directly observed treatment short-course, Nigeria, Rivers State, tuberculosis treatment, tuberculosis outcome

Benefit-Cost Analysis of FEMA Hazard Mitigation Grants

Mitigation ameliorates the impact of natural hazards on communities by reducing loss of life and injury, property and environmental damage, and social and economic disruption. The potential to reduce these losses brings many benefits, but every mitigation activity has a cost that must be considered in our world of limited resources. In principle benefit-cost analysis (BCA) can be used to assess a mitigation activity’s expected net benefits (discounted future benefits less discounted costs), but in practice this often proves difficult. This paper reports on a study that refined BCA methodologies and applied them to a national statistical sample of FEMA mitigation activities over a ten-year period for earthquake, flood, and wind hazards. The results indicate that the overall benefit-cost ratio for FEMA mitigation grants is about 4 to 1, though the ratio varies according to hazard and mitigation type.

Challenges of residency training and early career doctors in Nigeria study (charting study): a protocol paper

Introduction: Early career doctors (ECDs) make up a significant proportion of the workforce of medical/dental practitioners in Nigeria. ECDs play pivotal roles in the Nigerian healthcare system. However, several factors affect ECDs in their career endeavours, ranging from poor remuneration to psychosocial problems (such as burn out, job dissatisfaction, etc.). While other countries have tried to investigate these factors and their impact, no national inquiry has been done yet in Nigeria. This demonstrates the critical need to conduct a nationally representativestudy exploring these factors, such as demographic, workplace and psychosocial factors, among ECDs in Nigeria. This article is a protocol paper for the challenges of residency training and early career doctors in Nigeria study; charting study to be conducted under the auspices of the Nigerian Association of Resident Doctors of Nigeria(NARD).Methods: The Charting Study would be a mixed study design, utilizing both qualitative and quantitative study designs and access data from structured questionnaire, focus group interview and secondary data available to the association.Conclusion: The outcome of this study will provide great insight into various issues affecting ECDs in Nigeria and make necessary recommendations.Keywords: Nigeria, early career doctors, junior doctors, physicians, dentists, workplace, psychosocial issue

Right-to-left shunt with hypoxemia in pulmonary hypertension

<p>Abstract</p> <p>Background</p> <p>Hypoxemia is common in pulmonary hypertension (PH) and may be partly related to ventilation/perfusion mismatch, low diffusion capacity, low cardiac output, and/or right-to-left (RL) shunting.</p> <p>Methods</p> <p>To determine whether true RL shunting causing hypoxemia is caused by intracardiac shunting, as classically considered, a retrospective single center study was conducted in consecutive patients with precapillary PH, with hypoxemia at rest (PaO₂< 10 kPa), shunt fraction (Qs/Qt) greater than 5%, elevated alveolar-arterial difference of PO₂(AaPO₂), and with transthoracic contrast echocardiography performed within 3 months.</p> <p>Results</p> <p>Among 263 patients with precapillary PH, 34 patients were included: pulmonary arterial hypertension, 21%; PH associated with lung disease, 47% (chronic obstructive pulmonary disease, 23%; interstitial lung disease, 9%; other, 15%); chronic thromboembolic PH, 26%; miscellaneous causes, 6%. Mean pulmonary artery pressure, cardiac index, and pulmonary vascular resistance were 45.8 ± 10.8 mmHg, 2.2 ± 0.6 L/min/m², and 469 ± 275 dyn.s.cm^-5, respectively. PaO₂in room air was 6.8 ± 1.3 kPa. Qs/Qt was 10.2 ± 4.2%. AaPO₂under 100% oxygen was 32.5 ± 12.4 kPa. Positive contrast was present at transthoracic contrast echocardiography in 6/34 (18%) of patients, including only 4/34 (12%) with intracardiac RL shunting. Qs/Qt did not correlate with hemodynamic parameters. Patients' characteristics did not differ according to the result of contrast echocardiography.</p> <p>Conclusion</p> <p>When present in patients with precapillary PH, RL shunting is usually not related to reopening of patent <it>foramen ovale</it>, whatever the etiology of PH.</p

Utilization of intermittent preventive treatment of malaria by pregnant women in rivers state, Nigeria

Background: This study was conducted to assess the level of intermittent preventive treatment of malaria in pregnancy (IPTp) in Rivers State, Nigeria, to identify obstacles prohibiting utilization in order to make recommendations for improved uptake and malaria control in general. Methods: A cross-sectional study was carried out in November 2008 among 339 pregnant women and those who had delivered children in the last 1 year, using a multistage sampling method. Data were analyzed using the Epi-Info version 6.04d statistical software package and hypothesis tests were conducted to compare summary statistics at 95% significance level. Results: Most of the respondents (76.4%) had knowledge that malaria was caused by mosquitoes and was harmful in pregnancy. Although majority of the pregnant women (80.8%) attended antenatal care clinics, knowledge of the correct use of SP was low (32.6%) and only 62.8% took malaria preventive treatment. Of these, 58.4% took SP, while nearly a third, 31.8%, took chloroquine. Only 16.4% took their SP at the health facility directly observed by health workers according to the national guidelines. The commonest reason for not preventing malaria was that they were not sick during the period of pregnancy. Conclusions: Misconceptions about IPTp persist among women known to have attended antenatal care clinics, resulting in only a minority of pregnant women receiving IPTp as recommended by national guidelines. Efforts directed at awareness creation on the new malaria prevention and treatment policy are therefore necessary to enhance the uptake of IPT in pregnancy in Rivers State. Further studies are however, needed to evaluate the knowledge and practices of health care workers on the new malaria treatment policy

Status of Emergency Obstetric Care in a Local Government Area in South-South Nigeria

This study assessed the status of the availability and performance of Emergency Obstetric Care (EmOC) in 12 functional public health facilities out of the existing 19 in Gokana Local Government Area of Rivers State in South- South Nigeria, prior to the Midwives Service Scheme (MSS) launch in 2009. No facility qualified as Basic EmOC, while one had Comprehensive EmOC status. Signal functions that required supply of medical consumables were performed by more facilities than services that required special training, equipment and maintenance. Only two facilities (16.67%) had the minimum requirement of ≥4 midwives for 24-hour EmOC service; while only 2.2% of expected births occurred at the facilities. The poor state of maternal health resources in the study area requires urgent interventions by Local and State Governments for infrastructure upgrade and deployment and training of staff towards attainment of MDG-5. A follow-up evaluation would be required since the commencement of the MSS (Afr J Reprod Health 2012; 16[3]:170-179).Cette étude a évalué l&apos;état de la disponibilité et la performance des soins obstétricaux d&apos;urgence (SOU) dans 12 établissements de santé publics fonctionnels sur les 19 qui se trouvaient dans la région de l&apos;administration local de Gokana, dans l&apos;Etat de Rivers dans le sud-sud du Nigeria, avant le régime de service sages-femmes (MSS ) qui a été lancé en 2009. Aucun établissement n&apos;est qualifié d&apos;assurer le SOU, tandis que l&apos;un avait étendu le statut de rendre le service compréhensif de SOU. Les fonctions de signalisation qui avaient besoin de consommables médicaux ont été effectuées par plus des établissements que les services qui avaient besoin d&apos;une formation spéciale, de l&apos;équipement et de l&apos;entretien. Seuls deux établissements (16,67%) ont eu l&apos;exigence minimale de ≥ 4 sages-femmes pour 24 heures de service SOU, tandis que seulement 2,2% des naissances attendues s&apos;est produite dans les établissements. Le mauvais état des ressources de santé maternelle dans la zone d&apos;étude nécessite des interventions urgentes par les administrations locales et des états pour la mise à niveau des infrastructures, le déploiement et la formation du personnel en vue de la réalisation des OMD-5. Une évaluation de suivi serait nécessaire depuis le commencement du MSS (Afr J Reprod Health 2012; 16[3]:170-179)