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A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study pA cost-effectiveness analysis of provider and commun

By Virginia Wiseman1*, Ogochukwu Ezeoke2, Emmanuel Nwala2, Lindsay J Mangham1, Bonnie Cundill3, Jane Enemuo2, Eloka Uchegbu2, Benjamin Uzochukwu2 And Obinna Onwujekwe2

There is mounting evidence of poor adherence by health service personnel to clinical guidelines for
malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends
that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy
or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over
the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions
designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting
interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines.
Methods/design: A three-arm stratified cluster randomized trial is used to compare the effectiveness and costeffectiveness
of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis
and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard
practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will
be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that
report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by
surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers.
Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes,
including changes in provider and community knowledge. Costs will be estimated from both a societal and
provider perspective using standard economic evaluation mThere is mounting evidence of poor adherence by health service personnel to clinical guidelines for
malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends
that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy
or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over
the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions
designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting
interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines.
Methods/design: A three-arm stratified cluster randomized trial is used to compare the effectiveness and costeffectiveness
of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis
and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard
practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will
be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that
report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by
surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers.
Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes,
including changes in provider and community knowledge. Costs will be estimated from both a societal and
provider perspective using standard economic evaluation methodologies methodologies.

Published: 09/03/2018

Tags: Cost-effectiveness, Malaria, Rapid Diagnostic Tests, Interventions, Guidelines, Economics

Size: 1.49MB

Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

By Obinna Onwujekwe1,2*, Kara Hanson3 And Benjamin Uzochukwu1,2,4

The paper presents evidence about the distribution of the benefits of public expenditures on a
subset of priority public health services that are supposed to be provided free of charge in the public sector,
using the framework of benefit incidence analysis.
Methods: The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states,
southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all
individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES),
rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence
was calculated by subtracting payments made for services from the value of benefits.
Results: The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater
consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for
insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation
services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are
supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and
the poor compared to the urban residents, females and better-off quintiles.
Conclusion: It is concluded that coverage of all of these priority public health services fell well below target levels,
but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for
females. Payments for services that are supposed to be delivered free of charge suggests that there may have
been illegal The paper presents evidence about the distribution of the benefits of public expenditures on a
subset of priority public health services that are supposed to be provided free of charge in the public sector,
using the framework of benefit incidence analysis.
Methods: The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states,
southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all
individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES),
rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence
was calculated by subtracting payments made for services from the value of benefits.
Results: The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater
consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for
insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation
services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are
supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and
the poor compared to the urban residents, females and better-off quintiles.
Conclusion: It is concluded that coverage of all of these priority public health services fell well below target levels,
but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for
females. Payments for services that are supposed to be delivered free of charge suggests that there may have
been illegal payments which probably hindered access to the public health services.payments which probably hindered access to the public health services.

Published: 09/03/2018

Tags: Benefit-incidence- analysis, Public health services, BIA, Equity, Nigeria

Size: 317.52KB

Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: aExploring health providers’ and community perceptions and experiences with mal

By Ogochukwu P Ezeoke1*, Nkoli N Ezumah2, Clare Ci Chandler3, Lindsay J Mangham-jefferies3, Obinna E Onwujekwe1,4, Virginia Wiseman3 And Benjamin S Uzochukwu1,5

The adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated
attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level
for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into
treatment-seeking and practices of health providers. This study explored community members and health providers’
perceptions and experiences with malaria tests in south east Nigeria.
Methods: The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of
18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men
and adult women aged 15 years and above. Twenty- six (26) In-depth interviews were held with public and private
health providers involved in prescribing medicines at public and private health facilities in the study area.
Results: Both providers and community members were familiar with malaria tests and identified malaria tests as
an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering
appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of
testing facilities but above all concerns over the reliability of negative test results, with community members and
providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results
to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining
the use of antimalarial drugs rather than the result of a malaria test.
Conclusion: The results highlight important areas of intervention to promote appropriate malaria treatment. If tests
are to play a role in patient management, demand and supply side interventions are needed to change pThe adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated
attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level
for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into
treatment-seeking and practices of health providers. This study explored community members and health providers’
perceptions and experiences with malaria tests in south east Nigeria.
Methods: The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of
18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men
and adult women aged 15 years and above. Twenty- six (26) In-depth interviews were held with public and private
health providers involved in prescribing medicines at public and private health facilities in the study area.
Results: Both providers and community members were familiar with malaria tests and identified malaria tests as
an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering
appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of
testing facilities but above all concerns over the reliability of negative test results, with community members and
providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results
to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining
the use of antimalarial drugs rather than the result of a malaria test.
Conclusion: The results highlight important areas of intervention to promote appropriate malaria treatment. If tests
are to play a role in patient management, demand and supply side interventions are needed to change people’s
attitude towards malaria test results. people’s
attitude towards malaria test results.

Published: 09/03/2018

Size: 290.82KB

Examining equity in access to long-lasting insecticide nets and artemisinin-based combinationExamining equity in access to long-lasting insecticide nets and artemisinin-based combination ther

By Chinyere O Mbachu1,2*, Obinna E Onwujekwe1,3, Benjamin Sc Uzochukwu1,2,3, Eloka Uchegbu1, Joseph Oranuba4 And Amobi L Ilika4

In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria
has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free
Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the
levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES)
population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs
amongst different SES groups.
Methods: A questionnaire was used to collect data from randomly selected households in 19 local government
areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality
assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and
utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of
access of LLINS and ACTs to different SES quintiles.
Results: It was found that 80.5 % of the households had an LLIN and 64.4 % of the households stated that they
actually used the nets the previous night. The findings showed that 42.3 % of pregnant women who had fever within
the past month received ACTs, while 37.5 % of children

Published: 09/03/2018

Tags: Malaria, Equity, Long-lasting insecticide nets, LLIN, ACT, Artemisinin-based combination therapy

Size: 206.18KB

Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: influence of provider factors

By Chima A Onoka, Obinna E Onwujekwe, Kara Hanson, Benjamin S Uzochukwu

The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp) in
Nigeria is still low despite relatively high antenatal care coverage in the study area. This
paper presents information on provider factors that affect the delivery of IPTp in Nigeria.
Methods
Data were collected from heads of maternal health units of 28 public and six private health
facilities offering antenatal care (ANC) services in two districts in Enugu State, south-east
Nigeria. Provider knowledge of guidelines for IPTp was assessed with regard to four
components: the drug used for IPTp, time of first dose administration, of second dose
administration, and the strategy for sulphadoxine-pyrimethamine (SP) administration
(directly observed treatment, DOT). Provider practices regarding IPTp and facility-related
factors that may explain observations such as availability of SP and water were also
examined.The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp) in
Nigeria is still low despite relatively high antenatal care coverage in the study area. This
paper presents information on provider factors that affect the delivery of IPTp in Nigeria.
Methods
Data were collected from heads of maternal health units of 28 public and six private health
facilities offering antenatal care (ANC) services in two districts in Enugu State, south-east
Nigeria. Provider knowledge of guidelines for IPTp was assessed with regard to four
components: the drug used for IPTp, time of first dose administration, of second dose
administration, and the strategy for sulphadoxine-pyrimethamine (SP) administration
(directly observed treatment, DOT). Provider practices regarding IPTp and facility-related
factors that may explain observations such as availability of SP and water were also
examined.

Published: 09/03/2018

Tags: Malaria, Intermittent preventive treatment, Pregnancy, Provider factors, Nigeria, Supply

Size: 1.08MB

Inhibition of pro-inflammatory cytokines and inducible nitric oxide byInhibition of pro-inflammatory cytokines and inducible nitric oxide by extract of Emilia sonchifolia L. aerial parts extr

By Chukwuemeka S. Nworu1, Peter A. Akah1, Festus B. C. Okoye3,4, And Charles O. Esimone2

Emilia sonchifolia L. (Asteraceae) is used in ethnomedicine for the treatment of a wide array of inflammatory disorders.
This practice has also been supported by scientific reports which showed that extracts of E. sonchifolia possess antiinflammatory
effects in rodents. However, the mechanism(s) through which the extracts produce these effects is not
known. In this study, the effect of a methanol/methylene chloride extract of E. sonchifolia (ES) on the levels of IL-1β
and TNF-α after an intraperitoneal lipopolysaccharide (LPS; 1 mg/kg) challenge was investigated in mice. The effect
of ES on TNF-α and inducible nitric oxide (iNO) production by LPS-stimulated bone marrow-derived macrophages
(BMMDM) was also investigated in vitro. BMMDM were pre-incubated for 2 h with ES (20, and 100 μg/mL) or with
Pyrrolidine dithiocarbamate, PDTC (100 μM) and then activated with LPS, and then the IL-1β, TNF-α and NO production
measured in the cell-free conditioned culture supernatant after 24 h of incubation. In groups of mice pre-treated with
ES, the systemic levels of IL-1β and TNF-α induced by LPS were found to be significantly (p < 0.05) lower. In vitro, ES
treatment caused a concentration-dependent decrease in LPS-inducible IL-1β, TNF-α, and NO production by BMDM
compared to the effects of treatment of the cells with LPS alone without affecting the viability of the cells. The results
of these studies suggest that treatment with ES alleviated inflammatory responses possibly through a suppression of
pro-inflammatory mediators and cytokines such as IL-Emilia sonchifolia L. (Asteraceae) is used in ethnomedicine for the treatment of a wide array of inflammatory disorders.
This practice has also been supported by scientific reports which showed that extracts of E. sonchifolia possess antiinflammatory
effects in rodents. However, the mechanism(s) through which the extracts produce these effects is not
known. In this study, the effect of a methanol/methylene chloride extract of E. sonchifolia (ES) on the levels of IL-1β
and TNF-α after an intraperitoneal lipopolysaccharide (LPS; 1 mg/kg) challenge was investigated in mice. The effect
of ES on TNF-α and inducible nitric oxide (iNO) production by LPS-stimulated bone marrow-derived macrophages
(BMMDM) was also investigated in vitro. BMMDM were pre-incubated for 2 h with ES (20, and 100 μg/mL) or with
Pyrrolidine dithiocarbamate, PDTC (100 μM) and then activated with LPS, and then the IL-1β, TNF-α and NO production
measured in the cell-free conditioned culture supernatant after 24 h of incubation. In groups of mice pre-treated with
ES, the systemic levels of IL-1β and TNF-α induced by LPS were found to be significantly (p < 0.05) lower. In vitro, ES
treatment caused a concentration-dependent decrease in LPS-inducible IL-1β, TNF-α, and NO production by BMDM
compared to the effects of treatment of the cells with LPS alone without affecting the viability of the cells. The results
of these studies suggest that treatment with ES alleviated inflammatory responses possibly through a suppression of
pro-inflammatory mediators and cytokines such as IL-1β, TNF-α, and iNO.1β, TNF-α, and iNO.

Published: 09/03/2018

Tags: Cytokines, Emilia sonchifolia, inducible nitric oxide, interleukin (IL-1β), pro-inflammatory mediators, tumour necrosis factor (TNF)-α

Size: 702.01KB

Extracts of Ficus exasperata leaf inhibit topical and systemic inflammation in rodents and suppress LPS-induced expression Extracts of Ficus exasperata leaf inhibit topical and systemic infla

By Chukwuemeka S. Nworu1, Henry C. Nwuke1, Peter A. Akah1, Festus B.c. Okoye2,3, And Charles O. Esimone

The leaves of Ficus exasperata are mashed and prepared as poultices that are placed on swellings, wounds, and arthritic
joints to relieve swelling and pains by the Igede tribal community of Nigeria. The leaf and stalk are also squeezed and
used to mitigate itching or inflammation. These claimed benefits inspired this study in which topical and systemic
(acute, chronic) anti-inflammatory activities of a methanol/methylene chloride leaf extract of F. exasperata (MFE)
were assessed in rodents. Effects of an aqueous leaf extract (AFE) on lipopolysaccharide-induced expression of
interleukin-1β (IL-1β), tumor necrosis factor (TNF)-α, and inducible nitric oxide (iNO) were also investigated in murine
bone marrow-derived macrophage (BMDM) cultures. Treatment of rats with MFE (200 and 400 mg/kg) led to significant
inhibition of acute and chronic inflammation induced by, respectively, agar and formaldehyde in the paws. Topically,
pre-application of mice with MFE (5 μg/ear) also significantly inhibited (by up to 21%) ear edema induced by xylene.
In vitro, pre-treatment of BMDM with 5–100 μg AFE/ml significantly inhibited IL-1β, TNFα, and iNO production in a
dose-related manner. BMDM viability was not significantly affected AFE at concentrations up to 200 μg/ml. Initial
studies showed that flavonoids, alkaloids, and terpenoids were the predominant phytoconstituents in each extract. In
conclusion, the results of the various investigations indicated that F. exasperata leaf extracts possess anti-inflammatory
properties that could underlie the benefits associated with the folklore use of the plant. The results also show that the
extracts may be acting through a suppression of mediators of inflammation, such as IL-1β, TNFα, and The leaves of Ficus exasperata are mashed and prepared as poultices that are placed on swellings, wounds, and arthritic
joints to relieve swelling and pains by the Igede tribal community of Nigeria. The leaf and stalk are also squeezed and
used to mitigate itching or inflammation. These claimed benefits inspired this study in which topical and systemic
(acute, chronic) anti-inflammatory activities of a methanol/methylene chloride leaf extract of F. exasperata (MFE)
were assessed in rodents. Effects of an aqueous leaf extract (AFE) on lipopolysaccharide-induced expression of
interleukin-1β (IL-1β), tumor necrosis factor (TNF)-α, and inducible nitric oxide (iNO) were also investigated in murine
bone marrow-derived macrophage (BMDM) cultures. Treatment of rats with MFE (200 and 400 mg/kg) led to significant
inhibition of acute and chronic inflammation induced by, respectively, agar and formaldehyde in the paws. Topically,
pre-application of mice with MFE (5 μg/ear) also significantly inhibited (by up to 21%) ear edema induced by xylene.
In vitro, pre-treatment of BMDM with 5–100 μg AFE/ml significantly inhibited IL-1β, TNFα, and iNO production in a
dose-related manner. BMDM viability was not significantly affected AFE at concentrations up to 200 μg/ml. Initial
studies showed that flavonoids, alkaloids, and terpenoids were the predominant phytoconstituents in each extract. In
conclusion, the results of the various investigations indicated that F. exasperata leaf extracts possess anti-inflammatory
properties that could underlie the benefits associated with the folklore use of the plant. The results also show that the
extracts may be acting through a suppression of mediators of inflammation, such as IL-1β, TNFα, and iNO. iNO.

Published: 09/03/2018

Tags: Arthritis, chronic inflammation, Ficus exasperata, inflammatory mediators, macrophages, paw edema

Size: 831.10KB

Statistical Assessment of Average Global and Diffuse Solar Radiation on Horizontal Surfaces in Tropical Climate P

By P. .e. Ugwuoke* ,c. .e. Okeke

The hourly and monthly average global and diffuse solar radiation on horizontal surfaces in Nsukka, a tropical
climate on Lat. 60 52' N, Long. 70 24' E and 397 metres above sea level, were critically evaluated for each month of the year,
starting from November 2009 to October 2010. For each month, the hourly average global and diffuse irradiance obtained were
correlated with local time of the day, using second degree polynomials, while the monthly average values were correlated with
the months of the year, using third degree polynomials. These correlations were performed to facilitate easy prediction of
global and diffuse irradiance at any time and month of the year in Nsukka. The maximum hourly average global irradiance of
773 W/m2 was observed at 12.00 noon for the month of January 2010, while the minimum hourly average value of 426 W/m2
was observed at 2.00 pm for the month of August 2010. The monthly average global radiation varied from 243 W/m2 for the
month of August 2010 to 427 W/m2 for the month of January 2010, while the monthly average diffuse irradiance varied from
28.83 W/m2 in June 2010 to 42.84 W/m2 in January 2010.The hourly and monthly average global and diffuse solar radiation on horizontal surfaces in Nsukka, a tropical
climate on Lat. 60 52' N, Long. 70 24' E and 397 metres above sea level, were critically evaluated for each month of the year,
starting from November 2009 to October 2010. For each month, the hourly average global and diffuse irradiance obtained were
correlated with local time of the day, using second degree polynomials, while the monthly average values were correlated with
the months of the year, using third degree polynomials. These correlations were performed to facilitate easy prediction of
global and diffuse irradiance at any time and month of the year in Nsukka. The maximum hourly average global irradiance of
773 W/m2 was observed at 12.00 noon for the month of January 2010, while the minimum hourly average value of 426 W/m2
was observed at 2.00 pm for the month of August 2010. The monthly average global radiation varied from 243 W/m2 for the
month of August 2010 to 427 W/m2 for the month of January 2010, while the monthly average diffuse irradiance varied from
28.83 W/m2 in June 2010 to 42.84 W/m2 in January 2010.

Published: 09/03/2018

Tags: Statistical Assessment, Global and Diffuse Solar radiation, Horizontal Surfaces, Tropical Climate

Size: 455.28KB

Optimal Evaluation of Coag-Flocculation Factors for Alum-Brewery Effluent System by Response Surface Methodology

By M.c. Menkiti1*, M.c. Aneke2, E.b. Ogbuene3, O.d. Onukwuli1, E.o. Ekumankama4

This work investigates coag-flocculation optimization treatment of alum-brewery effluent system
via response surface methodology (RSM). To minimize suspended and dissolved particles (SDP),
experiments were carried out using nephelometric jar test and 23-factorial design with three
star-points, six-center-points and two replications. A central composite design, which is the
standard design of RSM, was used to evaluate the effects and interactions of three major factors
(coagulation pH, coagulant dosage, settling time) on the treatment efficiency. Multivariable
quadratic model developed for the response studied indicates the optimum conditions to be 9,
500mg/l and 20minutes for coagulation pH, coagulant dosage and settling time, respectively. At
optimum, the SDP was reduced from 10831.490mg/l to 801.451mg/l, representing 92.601%
removal efficiency. RSM has demonstrated to be appropriate approach for the optimization of
the coag-flocculation process by statistical evaluaThis work investigates coag-flocculation optimization treatment of alum-brewery effluent system
via response surface methodology (RSM). To minimize suspended and dissolved particles (SDP),
experiments were carried out using nephelometric jar test and 23-factorial design with three
star-points, six-center-points and two replications. A central composite design, which is the
standard design of RSM, was used to evaluate the effects and interactions of three major factors
(coagulation pH, coagulant dosage, settling time) on the treatment efficiency. Multivariable
quadratic model developed for the response studied indicates the optimum conditions to be 9,
500mg/l and 20minutes for coagulation pH, coagulant dosage and settling time, respectively. At
optimum, the SDP was reduced from 10831.490mg/l to 801.451mg/l, representing 92.601%
removal efficiency. RSM has demonstrated to be appropriate approach for the optimization of
the coag-flocculation process by statistical evaluationtion.

Published: 09/03/2018

Tags: Coag-flocculation, Brewery effluent, Alum, Response surfacCoag-flocculation, Brewery effluent, Alum, Response surface methodology, Central composite designe methodology, Central composite design

Size: 375.10KB

Quality Characteristics of Bread Made from Wheat and Nigerian Oyster Mushroom (Pleurotus plumonarius) Powder

By J.n.c. Okafor1, G.i. Okafor2, A.u. Ozumba1 And G.n. Elemo1

Bread containing graded levels of Mushroom Powder (MP) were produced by replacement of
Wheat Flour (WF) with 0, 5, 10, 15, 20 and 25% MP. Effect of MP supplementation on the bread making
properties, proximate composition and sensory qualities were evaluated. Water absorption was significantly
(p0.05) difference between 5% MP fortified bread and 100% WF bread
(control) in all the attributes evaluated. Equally, 10% MP fortified bread did not differ significantly in crust color,
taste, chew ability and overall acceptability, it compared favorably well with control bread in these attributes.
Bread with 15% MP though had significantly (p

Published: 09/03/2018

Tags: Mushroom powder, bread, fortification, quality, acceptability

Size: 80.67KB

Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria

By Herbert A Obu1*, Josephat M Chinawa1, Agozie C Ubesie1, Christopher B Eke1 And Ikenna K Ndu2

Paracetamol (also known as acetaminophen) is the commonest available analgesic and anti-pyretic. It
is readily accessed from pharmacy, patent medicine and provision shops as over the counter drug making it a
potential drug of abuse, especially in children. We sought to find its use and/or misuse in children seen at the
paediatric outpatient clinic of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu.
Objective: To determine the dosage, formulation, and frequency of paracetamol administration to children by
caregivers and factors associated with its use and/or misuse.
Method: An observational prospective study involving 231 children and their caregivers seen at the paediatric
outpatient clinic of the University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu between June and November
2011 was undertaken. Data on paracetamol use before presentation to the clinic, in addition to demographic and
other data were obtained from the caregivers using a structured questionnaire. Ethical consent for the study was
obtained from the Hospital Ethics and Research Committee and informed consent was further obtained from the
caregivers of the children.
Results: A total of 231 children aged six weeks to 16 years and their caregivers participated in this study. The mean
ages of the children and their caregivers were 3.8 and 33.9 years, respectively. One hundred and thirty three of the
children studied were males while 98 were females. Most of the children (75.6%) received paracetamol at home
before presenting. Paracetamol tablet alone or in combination with the syrup was mostly used (60%) and this
observation was made across all age groups. The commonest reason for using paracetamol tablet instead of the
syrup was that it was more effective. Most caregivers relied on past experience (71.2%) rather than on enclosed
information leaflet to decide the appropriate dosage. Half of the children also received other medications, mainly
anti-malarials and antibiotics.
Conclusions: Paracetamol was commonly given to children on “self prescription” basis and the tablet formulation
was most frequently used, with the possibility of misuse and overdose. Caregivers need to be educated on ageappropriate
formulatioParacetamol (also known as acetaminophen) is the commonest available analgesic and anti-pyretic. It
is readily accessed from pharmacy, patent medicine and provision shops as over the counter drug making it a
potential drug of abuse, especially in children. We sought to find its use and/or misuse in children seen at the
paediatric outpatient clinic of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu.
Objective: To determine the dosage, formulation, and frequency of paracetamol administration to children by
caregivers and factors associated with its use and/or misuse.
Method: An observational prospective study involving 231 children and their caregivers seen at the paediatric
outpatient clinic of the University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu between June and November
2011 was undertaken. Data on paracetamol use before presentation to the clinic, in addition to demographic and
other data were obtained from the caregivers using a structured questionnaire. Ethical consent for the study was
obtained from the Hospital Ethics and Research Committee and informed consent was further obtained from the
caregivers of the children.
Results: A total of 231 children aged six weeks to 16 years and their caregivers participated in this study. The mean
ages of the children and their caregivers were 3.8 and 33.9 years, respectively. One hundred and thirty three of the
children studied were males while 98 were females. Most of the children (75.6%) received paracetamol at home
before presenting. Paracetamol tablet alone or in combination with the syrup was mostly used (60%) and this
observation was made across all age groups. The commonest reason for using paracetamol tablet instead of the
syrup was that it was more effective. Most caregivers relied on past experience (71.2%) rather than on enclosed
information leaflet to decide the appropriate dosage. Half of the children also received other medications, mainly
anti-malarials and antibiotics.
Conclusions: Paracetamol was commonly given to children on “self prescription” basis and the tablet formulation
was most frequently used, with the possibility of misuse and overdose. Caregivers need to be educated on ageappropriate
formulations which are less likely to lead to overdose.ns which are less likely to lead to overdose.

Published: 09/03/2018

Tags: Paracetamol, Use, Misuse, Children, Caregivers

Size: 221.73KB

Obstacles to Obtaining Optimal Physiotherapy Services in a Rural Community in Southeastern Nigeria

By Chinonso Igwesi-chidobe

Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and AfricBackground. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and Africa largely comprising of the elderly.a largely comprising of the elderly.

Published: 07/03/2018

Size: 558.19KB

Obstacles to Obtaining Optimal Physiotherapy Services in a Rural Community in Southeastern Nigeria

By Luc Vanhees

Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and Africa largely Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and Africa largely comprising of the elderly.comprising of the elderly.

Published: 07/03/2018

Size: 558.19KB

Obstacles to Obtaining Optimal Physiotherapy Services in a Rural Community in Southeastern Nigeria

By Luc Vanhees

Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and Africa largely Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise
of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining
Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study
of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal
physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and
community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage
of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in NkanuWest Local
Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There
is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities
in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in
rural areas of Nigeria and Africa largely comprising of the elderly.comprising of the elderly.

Published: 07/03/2018

Size: 558.19KB

The Co-existence of the Mosque and the Catholic in our Contemporary Nigeria.

By Agha, U. Agha

This paper emphasizes that both Christians and Muslims must divest themselves of a disposition to censure, but should be possessed with feelings of love and decorum, tolerance and sobriety.

Published: 07/03/1989

Tags: Muslim, Catholic, Mosque, Love.

Size: 437.27KB