Christian Ibeh

Availability and Continuity of Care for Maternal Health Services in the Primary Health Centres in Nnewi, Nigeria (January - March 2010)

Background: In some primary health care settings, even where the health services are not available, provisions are not made to ensure continuity of care. This study aimed to determine the availability and level of continuity of care for maternal health services in the primary health centers (PHCs) in Nnewi, Nigeria. Methods: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from four randomly selected public PHCs in Nnewi, Nigeria were chosen for the study. Data collection employed a mix of quantitative and qualitative methods. Results: The mean ± standard deviation for age of the respondents was 29.2 ± 5.9 years. The facilities studied provided out-patient services, but the only in-patient services provided was for women who delivered or those in labor. None of the facilities is equipped to provide even basic essential obstetric care services. None had standardized a protocol for referring clients, referral forms, a transport system, or a community loan scheme in place. Forty-four (15.7%) women were referred for care outside of the PHCs for the following reasons: Lack of drugs and supplies (9.1%); lack of equipment (90.9%), lack of skilled personnel (45.5%) among others. Conclusions: This study showed that despite the unavailability of some services, appropriate strategies were not in place to ensure the coherent pattern of services within and between the PHCs and other levels of care. Delivery to the clients of comprehensive and integrated maternal health services, and efficient referral systems are thus recommended.

Cervical cancer: Knowledge of Risk Factors and Practice of Preventive Measures among Female Primary School Teachers in Urban Anambra State, Nigeria -

Aim / Background: Cervical cancer is one of the most common forms of cancer among women worldwide. This study was aimed at establishing baseline knowledge of cervical cancer risk factors and practice of its preventive measures among female primary school teachers in urban Anambra State, Nigeria. Methods: A descriptive cross-sectional study in which data on knowledge and practice variables were collected from 250 female school teachers aged 18 to 65 years, using self-administered questionnaires. Same was analysed and data presented in frequency tables. Result: Only 15(6.4%) of the respondents felt they were at risk of cervical cancer even as 149(59.6%) had no idea of any symptom of cervical cancer; and none knew early stages of the disease could present with no symptoms. Moreover, 137(58.3%) knew no risk factor for cervical cancer while a smaller proportion knew HPV infection 20(8.5%) and cigarette smoking 23(9.8%) as risk factors. Only 1(0.4%) respondent had ever had a cervical screening as over 75% of respondents reported not knowing about the screening test as their main reason for not doing the test. About 23% of respondents would recommend cervical screening to another woman. Conclusion: This study has shown very poor knowledge of cervical cancer and its risk factors; and even a poorer practice of cervical cancer screening among the respondents. Female teachers must be well informed about this disease in order for them to give the right information to their students. Therefore, in both formal and informal settings, regular and sustained health education on cervical cancer should be directed at this group.

Comparative Analysis of the Nutritional Status of Under - five Children and their Mothers in Rural and Urban Areas of Anambra State, Nigeria

Aim: Ma lnutrition in the form of under - nutrition is still a major public health problem in developing countries of sub - Saharan Africa including Nigeria. This study compares the nutritional status of under - five children and their mothers in rural and urban areas o f Anambra State Nigeria. Methodology: This was a comparative cross - sectional study carried out in one urban and two rural local government areas of Anambra State, Nigeria namely Awka South, Dunukofia and Anaocha respectively. A total of 657 mother - child p airs were selected from eligible households using the multistage sampling technique. Data on household food security was obtained from the mothers using semi - structured, interviewer - administered questionnaires while anthropometric measurements were carried out on the children and their mothers using weighing scales and height boards. Results: The overall prevalence of stunting, wasting and underweight among the under - five children in this study were 15.1%, 18.1% and 10.4% respectively, and the proportions were higher in the rural area than in the urban. The prevalence of stunting (height < 152 cm) in the mothers was 7.9% in the rural area compared to 9.1% in the urban area. Majority of the women were overweight (BMI ≥ 25.0), more in the urban (69.3%) than i n the rural (59.2%).

Adherence to antiretroviral therapy among people living with human immunodeficiency virus/acquired immunodeficiency syndrome in a tertiary health facility in South Eastern Nigeria

Introduction: As more and more people with human immunodeficiency virus (HIV) live longer and enjoy healthier lives because of antiretroviral therapy, there are an increasing number of sexual transmissions of HIV. It is exceedingly important to assess the proportion of unsafe sexual practices among people living with HIV/AIDS (PLWHAs) and their disclosure status so that behavioral intervention can be designed optimally for them in order to curb secondary HIV transmission and potential reinfection with different or drug resistant strain of HIV. Aim: To assess sexual behavior and serostatus disclosure of PLWHAs attending antiretroviral therapy (ART) center in Vadodara. Settings and Design: The current cross-sectional study was carried out at ART center of a tertiary care hospital - Shree Sayaji General (SSG) Hospital, Vadodara after taking necessary permissions and approval from institutional review board (IRB). Materials and Methods: A semistructured questionnaire was used for interview with PLWHA who are on ART after taking written and informed consent. Data was entered and analyzed using Epi Info software. Results: A total of 175 PLWHAs were enrolled in this study. Forty-three percent of the PLWHAs practiced premarital sex, while 15% of them practiced extramarital sex (EMS). Nearly 90% of these sexual practices were unsafe. Fifty-eight percent of the PLWHAs continued these unsafe sexual practices even after HIV diagnosis. Nearly 20% of the PLWHAs did not receive any counseling regarding sexual behavior. Ninety-five percent of respondents had disclosed their serostatus to their spouse. Conclusions: Still a remarkable proportion of PLWHAs indulge in unsafe sexual practices and the most common reason encountered among them was desire for child. Although majority of the participants had disclosed their serostatus to their spouse, many respondents did not mention their serostatus to other sexual partners. There is a need to stress on the importance of safe sex among PLWHAs not only to prevent transmission to their partners, but also to help them avoid receiving potentially resistant HIV strains in case of seroconcordant couples. A need-based sexual behavior-related motivational counseling needs to be focused on.Introduction: This study was carried out among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receiving antiretroviral therapy (ART) in a tertiary health facility in Nigeria and it is aimed at determining practice of adherence among these patients. Materials and Methods: A total of 282 HIV positive patients receiving ART in Nnamdi Azikiwe University Teaching Hospital, Nnewi were selected by systematic random sampling technique and using a semi-structured, interviewer administered questionnaire, responses were elicited from them on knowledge and perception of ART and adherence. Practice of adherence was determined by self-report. Findings were analyzed using Statistical Package for the Social Sciences version 17 (IBM Corp, Chicago Illinois, USA). Results: Most of the respondents were females (66.3%) and their mean age of the respondents was 36.63 ΁ 8.56 years. Most of the respondents have good knowledge of ART and adherence, even though most of them (64.2%) thought that ART cures HIV/AIDS. Most patients still considered HIV/AIDS as a serious illness (78.0%). Only about half of them (50.7%) were of the opinion that ART reduces the risk of HIV transmission. However, the general perception of adherence was good. The mean level of adherence was 97.8%, however, about 86% of them attained optimal adherence level. Conclusion: The study revealed fairly good knowledge and perception of ART and adherence among the patients. The level of ART adherence was also high; however there is a need to address some gaps in knowledge identified as part of measures aimed at improving adherence in the long run.Context: Disclosing ones human immunodeficiency virus (HIV) status helps in reducing the spread of the disease. Intimate partners are encouraged to reveal their status to each other. Such strategies aid in determining discordance and also target proven interventions to the correct demographic. Objective: The objective was to determine the rates of discordance among HIV positive pregnant women and their partners attending Nnamdi Azikiwe University Teaching Hospital, Nnewi. Materials and Methods: Partners of HIV positive pregnant women who had been notified of their spouses status were invited, counseled, and those who accepted, were tested for HIV using the national testing algorithm. Pre- and post-test counseling was offered to all tested partners. Results: A total of 10,070 new patients booked for antenatal care during the study period. Eight thousand nine hundred and seventy-nine (89.2%) of them were counseled, with 8317 (92.6%) of them accepted to do the HIV test. Seven hundred and ninety-seven women tested positive giving a sero-prevalence of 9.6%. Although 84.4% (673) of the positive mothers stated their intent to notify their partners, only 21% (141) of the partners presented for counseling and testing. On the whole, 98.6% (139) of the partners who presented accepted the test with 45.3% (63) of them testing positive, giving a sero-discordance rate of 54.7%. Conclusion: The discordance rate among tested partners is high in our center and suboptimal counseling, and testing rates were observed in the male partners. Interventions aimed at increasing partner involvement should be devised and adapted for our region. This will yield more data, give a truer picture of discordance rates as well as the aid in better management of scarce resources in program implementation.Opportunistic fungal infections account for a significant amount of morbidity associated with human immunodeficiency virus (HIV) disease. Oral candidiasis is one of the earliest premonitory signs of HIV infection and its diagnosis may have grave prognostic implications for the eventual development of full blown acquired immunodeficiency syndrome (AIDS). It is considered as an important marker of immune suppression and may be the initial manifestation of the disease in about 10% of HIV-infected adults. Careful history taking and detailed examination of the patients oral cavity are important parts of the physical examination, and diagnosis requires appropriate investigative techniques. Early recognition, diagnosis, and treatment of HIV-associated oral lesions may reduce morbidity. This review is intended to provide information on clinical variants of oral candidiasis and management as dental care providers are likely to be among the first to recognize such manifestations.Motor neuron diseases (MND) are extremely rare neurological manifestations of human immunodeficiency virus (HIV). We report a case of a 33-year-old known HIV seropositive male who presented with progressive asymmetrical onset of weakness and wasting of both distal limbs along with dysphagia and difficulty in speech. Examination revealed significant atrophy with visible fasciculations in thenar and hypothenar areas of both hands and dorsum of both feet associated with brisk deep tendon reflexes and jaw jerks, but diminished gag reflexes. Electromyography revealed evidence of denervation pattern. Investigations for underlying causes of MND other than HIV were noncontributory. Administration of riluzole along with continuation of antiretroviral therapy brought significant relief to his limb weakness, but bulbar features continued to progress. The case report highlights the rare, but definite association between HIV and amyotrophic lateral sclerosis (ALS) and partial reversibility of disabling clinical features on highly active antiretroviral therapy, which mandates ruling out HIV in all cases of ALS.through implementation of option B+ would have various other benefits. The total fertility rate in Malawi is high, around five to six births per woman, which is unlikely to be much lower in HIV‑infected women. Soon after the breastfeeding period (median duration 23 months) many women become pregnant again. Thus, a stop‑start approach to ART administration is almost redundant. Many women present for antenatal care late in pregnancy—an estimated 50% are thought to attend after 28 weeks of gestation—and continuing prophylaxis with antiretroviral drugs would mean that the next pregnancy could be protected from conception. The stopping of ART after cessation of breastfeeding might lead to viral rebound, with the risk of transmission to a sexual partner or fetus being notably raised. In women in Zimbabwe even those with CD4 cell counts higher than 350 cells per μL had a risk of death around six times higher than that in noninfected women within 24 months post‑partum [2,3] , and early ART could reduce mortality by 50‑90%. [4] Prevention