Akinola Ayoola Fatiregun

Maternal determinants of complete child immunization among children aged 12-23 months in a southern district of Nigeria.

This study was conducted to identify determinants of complete immunization status among children aged 12-23 months in a southern district of Nigeria. The World Health Organization cluster survey was used to evaluate immunization coverage of infants. Mothers of 525 children selected by the two-stage sampling method and interviewed using an adapted questionnaire responded. Completion of the immunization schedule was verified by an immunization card or by reported history indicating that the child had received full doses of four of the antigens included in the Nigeria routine immunization schedule. Multivariate logistic regression was used to identify factors associated with completion of immunization. Only 32.4% of children had completed the immunization schedule. Determinants of complete immunization status included a maternal age less than 30 years (AOR=2.26, 95% CI:1.27-4.03), availability of an immunization card at first contact (AOR=7.72, 95% CI:4.43-13.44), fewer than three children (AOR=2.22, 95% CI:11.1-4.42), completion of post secondary education (AOR=2.34, 95% CI:1.12-4.47) and maternal unemployment (AOR=1.71, 95% CI:1.01-2.89). Identifying mothers whose children are at risk of not completing the immunization schedule and educating them is an important strategy to improve antigen coverage and prevent early childhood deaths from diseases like tuberculosis, poliomyelitis, tetanus, diphtheria, pertussis and measles.

Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria.

OBJECTIVE To assess treatment outcomes and determinants of outcome among tuberculosis patients. DESIGN A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. SETTING Tuberculosis treatment centers in Ibadan, Nigeria. RESULTS A total of 1,254 patients were followed up with a mean age of 35.0+/-3.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P<0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively.The mean age of cured patients was 31.2+/3.1 years which was significantly lower than the mean age of those with poor treatment outcomes (36.7+/3.5 years; P<0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with knowledge. CONCLUSION Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment.

National Health Insurance Scheme: How Protected are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?

BACKGROUND The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. METHODS The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. RESULTS The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000-680,000 naira (46.7-4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1-118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3-16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

Knowledge and attitudes regarding HIV/AIDS and antiretroviral therapy among patients at a Nigerian treatment clinic

INTRODUCTION We assessed the knowledge of and attitudes toward HIV/AIDS and antiretroviral therapy (ART) in people living with HIV/AIDS (PLWHA). METHODOLOGY A descriptive, cross-sectional study design was employed. A structured interviewer-administered questionnaire was administered to consecutive, consenting PLWHA who had been receiving treatment for a minimum of three months. The level of ART adherence was calculated manually for each respondent. RESULTS In total 318 PLWHA completed the questionnaire. The mean and median time on ART was 17.8 months and 19 months respectively. The mean age of the respondents was 39.1±9.6 years. The majority of these respondents (76.9%) had completed secondary education. Over 80% of the respondents reported knowing that HIV can be transmitted through blood transfusions and unprotected sexual intercourse. Seventy-six per cent of the respondents reported knowing that ART suppresses HIV activity. However, 33% of the respondents denied being HIV positive, while 22.6% reported that they felt that taking ART was shameful. Over 32% of the respondents reported that good adherence to ART would raise suspicions about their HIV status, and 66.7% had not yet disclosed their HIV status to anyone. Most (77.7%) respondents had good knowledge of HIV/AIDS while 75.2% had good knowledge of ART. Also 78.9% had positive attitude to HIV/AIDS while 73.9%) had positive attitude to ART. Respondents with good knowledge about HIV/AIDS and a positive attitude about the disease tended to be more adherent to ART (p < 0.01). CONCLUSIONS The majority of respondents had good knowledge of and a positive attitude toward HIV/AIDS and ART adherence.

Reducing Waiting Time at a Nigerian HIV Treatment Clinic Opinions from and the Satisfaction of People Living with HIV/AIDS

We assessed the waiting time and perceived satisfaction with care among people living with HIV/AIDS (PLHIV) at an antiretroviral clinic in Nigeria. A structured questionnaire was administered during interviews. Four hundred patients completed the questionnaire. The mean age of the respondents was 36.4 years (SD 9.7 years), and 61% of them were females. A majority, 72.9%, reported that the time elapsed between entry into the clinic and access to medical care services (waiting time) was more than an hour. However, a majority (77%) expressed satisfaction with the medical care they received. Although the majority of PLHIV were satisfied with their medical care, more needs to be done to reduce patient waiting time before access to medical services.

Epidemiology of measles in Southwest Nigeria: an analysis of measles case-based surveillance data from 2007 to 2012

BACKGROUND In Nigeria, a system of measles case-based surveillance with laboratory confirmation of suspected cases was introduced in 2005 as one of the strategies for the control of measles morbidity and mortality. In this report, we provide an epidemiological distribution of confirmed cases of measles reported from the southwest of the country between 2007 and 2012, and predict the expected number of cases for the ensuing years. METHODS A descriptive analysis of persons and place and time of confirmed measles cases (laboratory and epidemiological link) reported in the case-based surveillance data was carried out. Using an additive time series model, we predicted the expected number of cases to the year 2015, assuming that current interventional efforts were sustained. RESULTS From the 10 187 suspected cases investigated during the time period, 1631 (16.0%) cases of measles were confirmed. The annual incidence rose from <1 case per million in 2007 to 23 cases per million in 2011. Cases were confirmed from all six states within the zone and most (97.4%) were in individuals aged less than 20 years. Seasonal variation existed with peaks of infection in the first and second quarters of the year. There was an increasing trend in the number of expected cases based on projections. CONCLUSIONS Case-based surveillance provided an insight into understanding the epidemiology of measles infection in Southwest Nigeria. There is a need to work out alternate strategies for control of measles and to strengthen the surveillance system.

Pattern of condom use among clients at a Nigerian HIV Counseling and Testing Centre.

BackgroundStudies in Nigeria have shown that the main route of HIV transmission is sexual intercourse and that effective condom use protects people against infection. The objective of this study was to determine the pattern of condom use among clients of a friendly HIV Counseling and Testing (HCT) Centre in Osogbo southwestern Nigeria.MethodsThis was a review of the HCT Centre records from 2006 to 2010 retrieving socio-demographic information, sexual behaviour, condom use and result of HIV testing. Data obtained were analyzed using descriptive and inferential statistics.ResultsOne thousand nine hundred and twenty-one client records were reviewed. The mean age of the study population was 35.4 (SD 10.5) years. The majority (53%) of the respondents were females, 232 (12%) were HIV positive, and 38.2% had multiple sexual partners. Only heterosexual vaginal sex was reported among the clients. Overall 45.2% of the clients did not use a condom in their last sexual act. Factors identified to be significantly associated with non-use of condoms were; younger age, having had higher education and positive HIV status.ConclusionUnprotected heterosexual intercourse was common among the study population, indicating a need to step up HIV preventive programme through behavioural change communication strategy.

Cost-effectiveness of screening methods for urinary schistosomiasis in a school-based control programme in Ibadan, Nigeria.

OBJECTIVE To carry out a comparative cost-effectiveness analysis of screening methods for urinary schistosomiasis; terminal haematuria, unqualified haematuria, dysuria, visual urine examination and chemical reagent strip technique, in a school-based control programme. DESIGN Estimation of costs and determination of cost-effect ratios of the screening methods applied in a school-based screening and treatment programme, from the perspective of a programme manager. SETTING A junior secondary school in Ibadan, Nigeria. MAIN OUTCOME MEASURES Cost per number of cases correctly diagnosed. RESULTS Unqualified haematuria was found to be the most cost-effective method costing N51.06 (US

Willingness to receive pandemic influenza A (H1N1) vaccine among doctors and nurses in public health facilities in Ibadan, Nigeria.

2.16) to diagnose a case correctly, followed by terminal haematuria N58.91 (US

Human Immunodeficiency Virus Postexposure Prophylaxis at Ibadan, Nigeria

2.50) and dysuria N84.24 (US