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Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper

By Laura D Howe, Bruna Galobardes, et al

Much has been written about the measurement of socio-economic
position (SEP) in high-income countries (HIC). Less has been written
for an epidemiology, health systems and public health audience
about the measurement of SEP in low- and middle-income countries
(LMIC). The social stratification processes in many LMIC—and
therefore the appropriate measurement tools—differ considerably
from those in HIC. Many measures of SEP have been utilized in
epidemiological studies; the aspects of SEP captured by these measures
and the pathways through which they may affect health are
likely to be slightly different but overlapping. No single measure of
SEP will be ideal for all studies and contexts; the strengths and
limitations of a given indicator are likely to vary according to the
specific research question. Understanding the general properties of
different indicators, however, is essential for all those involved in
the design or interpretation of epidemiological studies. In this article,
we describe the measures of SEP used in LMIC. We concentrate
on measures of individual or household-level SEP rather than
area-based or ecological measures such as gross domestic product.
We describe each indicator in terms of its theoretical basis, interpretation,
measurement, strengths and limitations. We also provide
brief comparisons between LMIC and HIC for each measure.

Published: 09/03/2018

Tags: Socio-economic factors, social class, poverty, measurement, methods, developing countries

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Effect of Trypanosoma Brucei Infections and Diminazene Aceturate Treatment on the Serum Activities of Certain Enzymes

By Aka, L .o, Obidike, I .r, et al

Effect of Trypanosoma Brucei Infections and Diminazene Aceturate Treatment on the Serum Activities of Certain Enzymes

Published: 09/03/2005

Tags: Diminazene Aceturate, Trypanosoma Brucei, Liver Toxicity, Liver Enzymes, Serum Enzymes .

Size: 251.23KB

Association of HIV-Induced Immunosuppression and Clinical Malaria in Nigerian Adults

By Michael O. Iroezindu, Emmanuel I. Agaba, et al

Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a
dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected
adult Nigerians and further investigated the association between their immunological status and the rates of clinical
malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to
December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4
cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours)
and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical
malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical
malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at

Published: 09/03/2018

Tags: HIV, Immunosuppression, Clinical malaria, Adults

Size: 241.92KB

The anti—inflammatory activity of garden egg (The anti—inflammatory activity of garden egg (Solanum aethiopicum) on egg albumin— induced oedema and granuloma tissue formation in rats Solanum

By Chioma A Anosike, Onyechi Obidoa, et al

(S. aethiopicum)] using experimentally induced inflammatory models in rats. Methods: Oedema
wagaesn itn) dinutcoe dth oen s tuhbep rlaatn htainr ds uprafawc eb yo ft hthe ei nrjaetc ptiaown .o Tf i0s.s1u me Lgr uannduilloumtead w fraess ihn edgugc eadlb iunm tihne (rpahtsil obgyi stthice aimnapelasnthtaettiiosend o rf attwso. Gauatrodcelna veegdg ceoxtttroanc tp edlolesetss (w30e rme ga)d umnidneisr ttehree dfl aton kth oef rpartesv fiooru ssleyv eshna cvoends becauckti voef ddiasysse.c Otend douaty a8n,d t hder ieadn.i mRaelssu wltesr:e E kxitlrlaecdt sa onfd g athrdee pne ellgegt ss isgunrirfoicuanndtelyd (Pby< 0g.r0a5n)u rleodmuac etids sthuee fwreesrhe
egg albumin-induced rat paw oedema and also significantly (P

Published: 09/03/2018

Tags: Solanum aethiopicum IOnefldaemmma arteidonuction GRraatsnuloma tissue

Size: 335.63KB

Social implications of robots – An overview

By V. C. Chijindu1* And H. C. Inyiama2

Machines by their design are aimed at increasing and improving the efficiency of productive activities
where they are applied. The result is that they are given preference against manually operated
productive activity. This paper explored the gradual and yet progressive introduction of machines,
namely, robots into the production processes of industries following the industrial revolution of the
20th century and the attendant ‘threat’ to the percentage of human capacity engaged in the production
processes of industries in most of the industrialized nations. It is observed that the automation of
industrial operations using robots will result in precision production and maximum throughput.
However, the more robots are engaged by industrialized nations, the more human capacity is rendered
redundant and consequently people are thrown out of job. It is therefore proposed that industrialized
nations and other emerging economies embracing modern automation using robots should set in
motion a long-term mechanism of re-engineering of the workforce through reforms in their educational
curricula to prepare the displaced workforce for alternative employment and subsequently redirect the
workforce of the future towards survival in an industrial revolution where robots will take over most of,
if not all, the technical and operational functions of today’s industrieMachines by their design are aimed at increasing and improving the efficiency of productive activities
where they are applied. The result is that they are given preference against manually operated
productive activity. This paper explored the gradual and yet progressive introduction of machines,
namely, robots into the production processes of industries following the industrial revolution of the
20th century and the attendant ‘threat’ to the percentage of human capacity engaged in the production
processes of industries in most of the industrialized nations. It is observed that the automation of
industrial operations using robots will result in precision production and maximum throughput.
However, the more robots are engaged by industrialized nations, the more human capacity is rendered
redundant and consequently people are thrown out of job. It is therefore proposed that industrialized
nations and other emerging economies embracing modern automation using robots should set in
motion a long-term mechanism of re-engineering of the workforce through reforms in their educational
curricula to prepare the displaced workforce for alternative employment and subsequently redirect the
workforce of the future towards survival in an industrial revolution where robots will take over most of,
if not all, the technical and operational functions of today’s industries.

Published: 09/03/2018

Tags: Robots, automation, workforce, replacing people, reducing labour costs

Size: 111.85KB

Antimicrobial activity of Psidium guajava Linn. stem extracts against methicillin-resistant Staphylococcus aureus

By Charles Okechukwu Esimone1, Anthony Amaechi Attama2, Kwaliafon Salamatou Mundi2, Nneka Nwamaka Ibekwe3* And Kennedy F. Chah4

The antimicrobial activities of the water and methanolic extracts of Psidium guajava Linn. stem bark were evaluated against eight methicillin-resistant Staphylococcus aureus (MRSA) isolates. The plant material was extracted and phytochemical analyses were performed by standard procedures. The agar diffusion method was employed for the assessment of the sensitivity of the extracts, while the agar dilution technique was employed for the quantitative determination of the bacteriostatic and bacteriocidal activities of the plant extracts. The phytochemical studies of P. guajava revealed the presence of carbohydrates, glycosides, tannins, and proteins as its major constituents. Results show that the methanolic and water extracts of P. guajava stem bark exhibited antibacterial activity against methicillin resistant S. aureus bacteria. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the stem bark water extracts ranged from 125 to 500 μg/ml while that of the stem bark methanol extract ranged from 6The antimicrobial activities of the water and methanolic extracts of Psidium guajava Linn. stem bark were evaluated against eight methicillin-resistant Staphylococcus aureus (MRSA) isolates. The plant material was extracted and phytochemical analyses were performed by standard procedures. The agar diffusion method was employed for the assessment of the sensitivity of the extracts, while the agar dilution technique was employed for the quantitative determination of the bacteriostatic and bacteriocidal activities of the plant extracts. The phytochemical studies of P. guajava revealed the presence of carbohydrates, glycosides, tannins, and proteins as its major constituents. Results show that the methanolic and water extracts of P. guajava stem bark exhibited antibacterial activity against methicillin resistant S. aureus bacteria. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the stem bark water extracts ranged from 125 to 500 μg/ml while that of the stem bark methanol extract ranged from 62.5 to 250 μg/ml.2.5 to 250 μg/ml.

Published: 09/03/2018

Tags: Psidium guajava, antimicrobial activity, phytochemical screening, methillin-resistant staphylococcus aureus.

Size: 102.90KB

Acute toxicity assessment of crude lead-extract from electronic waste materials in Nigeria

By O. C. Eneh1* And P. A. Akah2

Lead, with its toxic emission and pollution, is one of the hazardous chemical coLead, with its toxic emission and pollution, is one of the hazardous chemical components of electronic wastes (e-wastes) rapidly generated in developing countries. This study assessed the environmental health effects of crude lead extracted from e-wastes materials, as determined by its acute toxicity (rat, oral). Diluted HNO3 and hot concentrated HCl tests were used to confirm the presence of lead in the extract. LD50 (400 mg/kg) showed higher toxicity than the lowest toxic dose of 790 mg/kg reported in literature. There was a perfect positive correlation between the log dose and dead percentage, which was significant at 0.014, with 0.99° of confidence. The R2 (0.839) and significance F (0.029) showed high reliability. In view of this, we recommend the inclusion of enlightenment and making/enforcing adequate policies for improved management and control of e-waste materials. components of electronic wastes (e-wastes) rapidly generated in developing countries. This study assessed the environmental health effects of crude lead extracted from e-wastes materials, as determined by its acute toxicity (rat, oral). Diluted HNO3 and hot concentrated HCl tests were used to confirm the presence of lead in the extract. LD50 (400 mg/kg) showed higher toxicity than the lowest toxic dose of 790 mg/kg reported in literature. There was a perfect positive correlation between the log dose and dead percentage, which was significant at 0.014, with 0.99° of confidence. The R2 (0.839) and significance F (0.029) showed high reliability. In view of this, we recommend the inclusion of enlightenment and making/enforcing adequate policies for improved management and control of e-waste materials.

Published: 09/03/2018

Tags: Environmental health effect, toxic chemical component, e-waste

Size: 669.09KB

Correlates of resistance to gastrointestinal nematode infection in Nigerian West African dwarf sheep

By Ik Idika1*, Sn Chiejina2, Li Mhomga3, Pa Nnadi4, La Ngongeh2

African dwarf (WAD) sheep. Methods: Thirty three sheep were randomly assigned to two groups, Aco n(nt=ro2l7. ) which were used for experimental infections, and B (n=6) which served as uninfected Each infected animal received weekly escalating infections with infective larvae (60% Haemonchus contortus (H. contortus) and 40% Trichostrongylus colubriformis (T. colubriformis)
fcooru n4 t w(FeEeCk)s,. wTohrem r beusprdoenns e(sW obf) , aplal ctkheed i ncfeellc tveodlu amned (PcoCnVt)r,o bl osdhye ewpe iwghetr e(B awsts),e assnedd b boyd yf aceocnadli teiogng score (BCS). On the basis of their individual faecal egg output, Lambs in group A with epg≤1 0w0i0th o enp agn yb estawmepenli ng day were classified as low faecal egg count (LFEC) phenotype (n = 16), those feacal egg count 1 000 and 10 000 as intermediate (n=5) and lambs with epg > 10 000 as high highly significan(tH FEC) phenotype (n=6). Results: The difference between the FEC classes was control and (P=0.001). The BCS and weight gained at the end of the experiment by the LFEC sheep was significantly higher (P≤0.05) than those of the intermediate and HmFeEasCu rpehse naontdy ptehse. tTrhioe roef was a significant and negative correlation between the parasitological indicated that the BCS, PCV and Bwt of sheep. Conclusions: The result of the study of FEC, weight African dwarf (WAD) sheep. Methods: Thirty three sheep were randomly assigned to two groups, Aco n(nt=ro2l7. ) which were used for experimental infections, and B (n=6) which served as uninfected Each infected animal received weekly escalating infections with infective larvae (60% Haemonchus contortus (H. contortus) and 40% Trichostrongylus colubriformis (T. colubriformis)
fcooru n4 t w(FeEeCk)s,. wTohrem r beusprdoenns e(sW obf) , aplal ctkheed i ncfeellc tveodlu amned (PcoCnVt)r,o bl osdhye ewpe iwghetr e(B awsts),e assnedd b boyd yf aceocnadli teiogng score (BCS). On the basis of their individual faecal egg output, Lambs in group A with epg≤1 0w0i0th o enp agn yb estawmepenli ng day were classified as low faecal egg count (LFEC) phenotype (n = 16), those feacal egg count 1 000 and 10 000 as intermediate (n=5) and lambs with epg > 10 000 as high highly significan(tH FEC) phenotype (n=6). Results: The difference between the FEC classes was control and (P=0.001). The BCS and weight gained at the end of the experiment by the LFEC sheep was significantly higher (P≤0.05) than those of the intermediate and HmFeEasCu rpehse naontdy ptehse. tTrhioe roef was a significant and negative correlation between the parasitological indicated that the BCS, PCV and Bwt of sheep. Conclusions: The result of the study of FEC, weight gain, P, P

Published: 09/03/2018

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Aquifer Transmissivity from Surface Geo-electrical Data: A Case Study of Owerri and Environs, Southeastern Nigeria

By A. C. Ekwe1 And A. I. Opara

The combination of layer resistivity and thickness in the so called Da-zarrouk parameters S (longitudinal
conductance) and R (transverse resistance) have proved useful in the evaluation of the transmissivities of the aquifers
around Owerri and environs. The area is underlain by the unconsolidated to semi-consolidated coastal Benin Formation.
The surface direct current electrical resistivity method was used in the study. Seven Vertical Electrical Soundings (VES)
data by the Schlumberger array was acquired in the area. A maximum current electrode spacing (AB) of 1000 m was
used for data acquisition. Four of the soundings were carried out near existing boreholes. Computer modelled interpretative
methods was utilized in processing the data. Results show that the depth to the water level is shallow around Ife and
Egbu areas with a mean depth of 30 m. Semi- deep aquifers were encountered around Okpalla and AVU areas with a
mean depth of 90 m while very deep aquifers were sensed around Owerri and Obinze areas with a mean depth
of 125 m. Aquifer thicknesses in the study area range from 8 m at Ife and 117 m at Owerri. The diagnostic Kσ = constant
value have proved so useful in calculating transmisivities and hydraulic conductivities of all the sounding locations
including areas where no boreholes exist. Hydraulic conductivity varies between 6.19m/day at Ife and 24.7 m/day at
Obinze. Transmissivity values also very between 51.39 m2/day at Ife and 1379.56 m2/day at Owerri. It is hoped that the
results would help in long term planning of groundwater exploitation schemes within the study area.The combination of layer resistivity and thickness in the so called Da-zarrouk parameters S (longitudinal
conductance) and R (transverse resistance) have proved useful in the evaluation of the transmissivities of the aquifers
around Owerri and environs. The area is underlain by the unconsolidated to semi-consolidated coastal Benin Formation.
The surface direct current electrical resistivity method was used in the study. Seven Vertical Electrical Soundings (VES)
data by the Schlumberger array was acquired in the area. A maximum current electrode spacing (AB) of 1000 m was
used for data acquisition. Four of the soundings were carried out near existing boreholes. Computer modelled interpretative
methods was utilized in processing the data. Results show that the depth to the water level is shallow around Ife and
Egbu areas with a mean depth of 30 m. Semi- deep aquifers were encountered around Okpalla and AVU areas with a
mean depth of 90 m while very deep aquifers were sensed around Owerri and Obinze areas with a mean depth
of 125 m. Aquifer thicknesses in the study area range from 8 m at Ife and 117 m at Owerri. The diagnostic Kσ = constant
value have proved so useful in calculating transmisivities and hydraulic conductivities of all the sounding locations
including areas where no boreholes exist. Hydraulic conductivity varies between 6.19m/day at Ife and 24.7 m/day at
Obinze. Transmissivity values also very between 51.39 m2/day at Ife and 1379.56 m2/day at Owerri. It is hoped that the
results would help in long term planning of groundwater exploitation schemes within the study area.

Published: 09/03/2018

Tags: Transmissivity, Porous media, Da-zarrouk Parameters, Owerri, Southeastern Nigeria

Size: 412.00KB

A STUDY OF THE OPTICAL PROPERTIES OF UN-DOPED AND POTASH DOPED LEAD CHLORIDE CRYSTAL IN SILICA GEL.

By U.v. Okpala, F.i. Ezemaa*, R.u. Osujia

The optical properties of potash doped lead chloride (PbCl2) have been studied by sol gel
technique. The optical properties of the materials were determined using a JENWAY 6405
UV-VIS spectrophotometer operating at a wavelength range of 200nm to 1200nm at an
interval of 5nm. It was observed that the crystals are optically transparent. The average
refractive index (n) is between 0.6 and 2.9. The refractive index greater than 2.0 makes the
crystals good materials for protective coatings. The band gaps are from 3.9 to 5.0 showing
that they are wide band gap materials and are good refractory materials.

Published: 09/03/2018

Tags: Sol gel, Optical Properties, Silica Model and Local Impurities

Size: 794.02KB

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

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