Udonwa Ne

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.

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.

Intra-family transmission of Vibrio cholerae during a cholera epidemic in rural south-southern Nigeria

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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.

Correlates and Predictors of Low Back Pain Disability and its Impact on Health- Related Quality of Life in a Family Practice Clinic in Calabar, South- South Nigeria

Background: Non-specific low back pain is a common health problem incurring immense health and social costs with concomitant disability, which has assumed significant public health importance in our setting. The impact from this condition is multi-factorial, and includes pain, activity limitations and impairment of quality of life. This study therefore aimed to examine the level of low back pain disability, its correlates and predictors, and the impact on selfperceived quality of life. It also sought to determine the predictors of health-related quality of life among low back pain patients in a Family Practice setting in Calabar, Nigeria. Method: This was a cross-sectional analytical study involving 350 consecutively selected patients with nonspecific low back pain. Standardized questionnaires were used including: the Oswestry Disability Index (ODI) questionnaire, the 12-item General Health Questionnaire (GHQ-12), the Short-form 36 (SF-36) questionnaire and the Visual Analogue Pain Scale. These were used to assess low back pain disability, psychological distress, healthrelated quality of life and pain intensity respectively. Result: The mean age of the respondents was 36.16 ± 9.93 years. Majority (70.6%) were females and had chronic pain lasting more than three months. Most of the respondents (88.9%) characterized their pain as severe. The mean health-related quality of life score was 45.82 ± 4.3. Factors associated with severe disability were: psychological distress and pain intensity. Significant correlations were observed between disability, pain intensity and psychological distress using Pearson’s correlation analysis. Independent risk factors for disability were psychological distress and those with chronic pain lasting more than 3 months. Overweight and obese subjects were more likely to have poor health-related quality of life when compared with those with normal body mass index (X2=8.81, P<0.05). The significant predictors of poor health-related quality of life using logistic regression were overweight/obesity and those with severe disability. Conclusion: This study identified significant correlations between low back pain disability, pain intensity and psychological distress. These correlations could be informative and should guide family physicians in the management of the index problem in our environment. The perception of quality of life in individuals with low back pain should also raise awareness of issues connected to the problem and encourage more research into this area.