Gyuse An

Malaria: knowledge and prevention practices among school adolescents in a coastal community in Calabar, Nigeria.

ABSTRACT Background Malaria prevention and treatment constitute an unbearable economic burden to most African countries, especially south of the Sahara, where about 500 million cases occur annually. The problem of malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children. Attention to malaria among adolescents has also been diverted by the huge burden of HIV/AIDS among adolescents. Some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on school children, who could be used as change agents and as role models for their siblings and peers in the malaria control strategy. Objectives To determine the malaria prevention practices of school adolescents in the coastal community of Calabar, Nigeria. Method This was a cross-sectional survey involving secondary schools in southern Calabar. Four hundred adolescents were randomly selected from the 4565 learners in 5 out of 17 secondary schools in southern Calabar, Cross River State, Nigeria. A self-administered, semi-structured questionnaire was administered to the respondents. Results Most respondents (77.5%) were aware that the vector transmits the malaria parasite through biting. Fewer respondents would prevent malaria attacks by clearing the vegetation in the peri-domestic environment (13.5%), filling up potholes (16.9%), opening up drainage (11%), using insecticide-treated nets (25.7%) or using antimalarial drugs (11.2%). Less than one-tenth (8%) would use various other methods such as not accepting unscreened blood, while only 11% obtained the information from their teachers. Conclusion The study identified knowledge gaps among school children. There is a need to empower teachers with information about the cause of malaria and prevention strategies.

Socio-cultural Factors Influencing Insecticide Treated Bed Net Utilization in a Malaria Endemic City in north-central Nigeria

Objective: To ascertain the socio-cultural factors influencing the rate of utilization of insecticide treated bed nets (ITNs) in a malaria endemic city of Makurdi, north central Nigeria. Methods: The study was cross-sectional in nature using systematic sampling method to identify households. Both quantitative and qualitative data was generated from adult women using structured and semi structured questionnaires, and focused group discussions (FGDs) to obtain information on rate and patterns of utilization of ITNs. Information such as age, educational level, marital status, awareness or otherwise of the existence of malaria, and factors influencing rate of ownership and utilization of ITNs were obtained. FGDs were used to obtain qualitative information on rate of utilization of ITNs not raptured in the questionnaires. Data obtained was analysed using Epi Info 6 statistical software. Results: Among the respondents interviewed, 97.0% (2013/2075) were aware of existence of malaria and 87.0% of these (1751/2013) would associate it with mosquitoes. The rate of ownership of any bed net, ITNs and untreated bed nets (UTNs) was 25.1%. 17.0% and 8.3%, respectively. Utilization of ITNs among children was 30.0% (112/373) and UTNs 12.9% (48/373). Positive contributors to ITNs utilization were literacy, enhanced economy, experience of marriage, and being gainfully employed (P＜0.05); while negative contributors were ignorance, poverty and some cultural beliefs and values. Conclusions: A mole synchronized advocacy should be carried out on the potential benefits of ITNs utilization and sustained. Also ITNs should be made available to the people of the community at minimal or no cost.

Expectations of hypertensive patients attending the GOPC of the University of Calabar Teaching Hospital, Calabar

Background: Hypertensive patients’ expectations are a major determinant of treatment outcomes. This study was undertaken to determine the pattern of expectations of hypertensive patients as a basis for modification of the care given to them. Methodology: This was a descriptive hospital study involving 260 hypertensive patients aged above 20 years, randomly selected. Study participants were engaged in patient-centred consultation during each visit. Their socio-demographic characteristics were collected using a semi-structured questionnaire, while the expectations of the hypertensive patients were also assessed. Their blood pressure was measured on three (3) occasions at two-monthly intervals. Data were analysed using SPSS version 20.0 and data were presented in tables. Results: The majority of the respondents (161, 61.9%) were females while the males numbered 99 (38.1%). Most (219) of the respondents were older than 40 years and had some form of education. The majority of the respondents needed information on hypertension (85.3%), expected that the hypertensive medication they would be given wouldlower their blood pressure (88.5%), and expected a cure of their hypertension (70.4%). There were some respondents who did not have any expectations. Conclusion: Hypertensive patients have varying illness expectations that can be explored using the patient-centred consultation strategy to improve treatment outcomes.

Comparison of cold water sponging and acetaminophen in control of fever among children attending a tertiary hospital in South Nigeria

Background: A wide range of childhood illnesses are accompanied by fever, leading to varied attempts at treatment by caregivers at home before coming to a hospital. Common modalities of treatment include use of antipyretics and physical methods such as cold water sponging, fanning and removal of clothing. These treatment modalities have been received with varied attitudes among physicians and the scientific community. This study was to assess the efficacy of both modalities in first-line management of fever in our area. Objectives: The main aim of the study is to compare the effectiveness of cold water sponging with that of oral paracetamol in the treatment of fever in children attending the University of Calabar Teaching Hospital, Calabar. Subjects and Methods: This is a randomized clinical trial. Eighty-eight children aged 12-120 months who presented to the Children Outpatient Clinic (CHOP) and the Children Emergency Room (CHER) of University of Calabar Teaching Hospital, Calabar, with acute febrile illness and axillary temperatures spanning ≥ 38.0-40.0°C. All children within the age limit whose caregivers gave consent were recruited into the study and were randomized to receive either cold water sponging or oral paracetamol. Axillary temperature, pulse rate, respiratory rate and assessment of discomforts (crying, shivering, goose pimples and convulsions) were recorded every 30 min for 2 h. The results were analyzed using the SPSS statistical software and have been presented in the tables. Results: Cold water sponging was very effective in temperature reduction within the first 30 min, with 29 (70.73%) having their temperature reduced to within normal limits. This declined to 12 (29.26%) at 60 min and 4 (10.53%) at 120 min, with the mean temperature differences from the baseline value following the same trends (1.63°C by 30 min, 0.91°C by 60 min and 0.39°C by 120 min). When compared with paracetamol, cold water sponging was more effective in temperature reduction within the first 30 min (P = 0.000), with the difference in effect at 60 min less significant between these two groups (P = 0.229). Paracetamol demonstrated a gradual and sustained reduction in temperature with the proportions of afebrile children in this group increasing from 7 (16.27%) at 30 min to 33 (78.57%) at 120 min. The mean temperature differences from the baseline value also showed the same trend. Children who received cold water sponging had more discomforts compared with those who received only oral paracetamol. Conclusions: It is concluded that cold water sponging, although producing rapid reduction in temperature compared with paracetamol, has effects that last only for a short time. Paracetamol on the other hand produces a gradual but sustained effect. The discomforts experienced should not be a limiting factor to the use of cold water sponging in reducing the body temperature of febrile children. Cold water sponging is safe and its use by mothers and primary caregivers should be encouraged while preparing to take the child to the nearest health facility for definitive treatment of the underlying cause of the fever.

Antimicrobial susceptibility profile of community acquired and nosocomial isolates of Escherichia coli from clinical blood culture specimens at a Nigerian university teaching hospital

Objective: To ascertain the antibiotic susceptibility patterns of Escherichia coli recovered from blood culture specimens in Calabar, Nigeria. Methods: The study was retrospective in nature and was carried out at University of Calabar Teaching Hospital (UCTH) Calabar. Data generated from blood culture specimens over a five year period (Feb. 2004-Feb. 2009) was compiled, relevant information such as age, sex, organism recovered and antibiotic susceptibility patterns were obtained from patients records. Samples were collected, transported, stored and processed using standard laboratory procedures. Data obtained was analysed using Epi Info 6 statistical software. Results: Escherichia coli was responsible for 15.3% (31/203) of the blood infections being the third most common microorganism encountered. The community acquired (CA) isolates of the organism were significantly less resistant (P＜0.05), compared to the nosocomial (NC) isolates against ampicillin, cloxacillin, amoxicillin, tetracycline, co-trimoxazole, chloramphenicol and erythromycin. The sensitivity of both the NC and CA isolates of Escherichia coli to amikacin, augmentin, ofloxacin, ciprofloxacin, ceftazidime, cefuroxime, ceftriaxune and rifampicin was generally high (80-100%) with no significant difference (P＞0.05). Majority (＞95.0%) of the NC isolates of Escherichia coli were resistant to six of the antibiotics tested. Conclusions: Control mechanisms for hospital acquired infections should be stepped up so as to limit the spread of the highly resistant bacterial strains. Also the sale and consumption of antibiotics by the public need to be regulated.

Reflections on family medicine and primary healthcare in sub-Saharan Africa

Primary healthcare (PHC) can be seen as a set of values and principles that guide the health system in its policy, leadership and governance, commitment to universal health coverage and primary care.1 Governance, economics and the primary care workforce are the key structural determinants of effective primary care systems.2 The African continent has 25% of the global disease burden, but only 3% of the world’s health workers and less than 1% of the world’s health expenditure.3 The burden of disease in Africa has historically been dominated by acute and infectious diseases such as malaria, diarrhoeal diseases, lower respiratory tract infections, tuberculosis and measles. Over the last 25 years, however, chronic communicable and non-communicable diseases, such as HIV/AIDS, ischaemic heart disease, stroke and diabetes have become major contributors to the burden of disease.4 Additional contributors include newer threats such as Ebola and global warming, conflicts and displacement of persons, issues of gender and poverty with high rates of interpersonal violence, disadvantage for women in education and earnings and continued high risks during pregnancy and childbirth. Government in Africa is often characterised by flawed democracies and authoritarian regimes, which may not prioritise healthcare.5 Few countries meet the target of 15% of general government expenditure on healthcare that was agreed in the Abuja Declaration of 2001.6 In low-income countries, there are fewer resources to go around, and those resources available are often concentrated in prestigious central referral hospitals. Most countries meet the WHO criteria for having a critical shortage of health workers, defined as fewer than 2.28 doctors, nurses and midwives per 1000 population.7 Health systems in many countries, such as Malawi, rely on mission hospitals, non-government organisations and external donors to fund and provide services.8 These agencies often drive vertical disease-orientated programmes, skew central planning …

Facilitators and barriers to effective primary health care in Nigeria

No abstract available.

Influence of Spirituality and Religion on Adherence to Highly Active Antiretroviral Therapy in Adult HIV/AIDS Patients in Calabar, Nigeria

The emergence of a chronic medical illness such as Human Immune Deficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) may be the time when people turn to the Sacred through spirituality and religion. HIV is a chronic illness that requires strict adherence to medication regimens that may be influenced by spirituality/religion. This study was aimed at finding the association between spirituality/religion and adherence to highly active antiretroviral therapy (HAART) in adult HIV/AIDS patients. This is a cross-sectional descriptive study of 370 patients. Adherence was measured using an adapted adult AIDS clinical trial group (AACTG) and visual analogue scale (VAS) tools. Spirituality was assessed using Functional Assessment of Chronic Illness Therapy-Spirituality Expanded (FACIT-Sp-Ex) scale, religiosity with Duke University Religion index (DUREL), and religious coping with Brief Religious Coping (RCOPE) scale. Adherence rates were 86.2 and 43.8% using AACTG and VAS tools, respectively. Statistical significant correlation was found between spirituality and adherence to HAART (r 5 0.265; p 5 0.00). Also, significant correlation was found between positive religious coping and adherence (r 5 0.15, p 5 0.003). Odds ratio indicated that female respondents were 1.6 times more likely to be adherent, compared with males. Similarly, every unit rise in spirituality score yielded a 1.3 times increased likelihood of adherence to HAART on multiple logistic regression of adherence to HAART with relevant predictors. Both spirituality and positive religious coping have positive influence on optimal adherence. Therefore, the training of health care personnel to assess and provide spiritual care and involvement of chaplains/religious leaders is advocated for improved adherence.

Clinical Correlates of Diarrhea and Gut Parasites among Human Immunodeficiency Virus Seropositive Patients

CD4 count estimation which is not readily available in most resource poor settings in Nigeria is an important index determining commencement of antiretroviral therapy (ART). It is imperative for physicians who come in contact with these patients in such settings to recognize other parameters to evaluate these patients. The clinical correlates of diarrhoea and gut parasites amongst HIV- seropositive patients attending our special treatment clinic were studied. Three hundred and forty consenting HIV-positive adult subjects were enrolled. Their stool and blood samples were collected over a period of three months. Stool samples were analyzed for the presence of diarrhoea and gut parasites. The Patients were clinically evaluated by physical examination for the presence of Pallor, dehydration, oral thrush, wasting lymphadenopathy, dermatitis, skin hyperpigmentation and finger clubbing. Participants with diarrhoea represented 14.1% of the population, while 21.5% harboured one or more parasites. In the subjects with diarrhoea, 14.6% harboured gut parasites. The presence of diarrhoea was associated with a low CD4 count. Clinically, oral thrush, wasting and rashes were more reliable predictors of low CD4 count levels while the presence of pallor, dehydration, wasting and rashes correlated with the presence of diarrhoea. HIV-patients presenting with pallor, dehydration, wasting and rashes should be evaluated for the presence of diarrhoea. The clinical variables associated with low CD4 count in this study may guide commencing antiretroviral therapy in resource poor settings.

Assessment of Hypertensive Patients' Illness Experience Using Patient-centred Consultation among Patients Seen in an Urban Family-practice Setting in Nigeria

Objectives: The study aimed at determining the hypertensive patients’ illness experience, using the patient-centred consultation approach in order to form a better partnership with the patients. Design: This was a cross-sectional hospital-based study using a semi-structured questionnaire that assessed the socio-demographic characteristics of the respondents. The respondents’ fears about hypertension, ideas about its cause and expectations from consultation were explored. The response was based on a Likert scale. The data were analysed with the SPSS software version 15. Settings: This study was conducted at the GOPC, UCTH Calabar. The GOPC is the “window” of the Hospital. Subjects/participants: Two hundred and sixty eight hypertensive patients were recruited into the study. Results and Conclusions: The respondents expressed fear regarding most aspect of hypertension. Most (74.7%) agreed that hypertension could be caused by stress. A few participants gave non-biomedical views of the aetiology of hypertension, including attributing it to spiritual forces. Over three quarters of respondents (85.1%), expected their medications to give them corrective measures to hypertension. The study supports the fact that hypertensive patients have varying illness experiences that should be explored using the patient-centred consultation style and recommends that doctors should manage individual patients to suit the patients’ unique experience. There was an established significant relationship between expectation and fears/ideas.