2015

Determinants of use of insecticide-treated nets among pregnant women in Nigeria. Ezire O, Adebayo SB, Idogho O, Bamgboye EA, Nwokolo E. Determinants of use of insecticide-treated nets among pregnant women in Nigeria. Int J Womens Health. 2015;7:655?661. Published 2015 Jun 26.

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ABSTRACT : Malaria in pregnancy is still a major health issue in Nigeria, accounting for about 33% of cause of maternal death. Despite massive efforts to make insecticide-treated net (ITN) available to pregnant women in Nigeria, the use is still low. This study was conducted to identify facilitators and inhibitors for the use of ITN/long-lasting insecticidal net (LLIN) among pregnant women in Nigeria.

Methods: Data were obtained from the 2011 State-Specific HIV & AIDS, Reproductive and Child Health Survey conducted in 18 states of Nigeria. The survey was a population-based study among men and women of reproductive age living in households in rural and urban areas of Nigeria. Multistage cluster sampling technique was used to select eligible respondents. The sample size per state was 960 respondents. Data were collected between October and November 2011. The analysis was done using Statistical Package for Social Sciences (SPSS) version 20.

Results: A total of 11.5% of the respondents were pregnant at the time of the survey of which 73.2% lived in rural location and approximately 70% were either not educated or attained at most a primary school education. A total of 93.2% of respondents have heard of net, 82.6% were confident that they can hang or use a net, and 64.6% owned an ITN/LLIN in their household while the actual use was just 19.2%. We found education, location (urban-rural), confidence to use a net, and knowledge that the use of a net can protect a pregnant woman from malaria to be significant at 5% level. The number of nets owned per household, the length of time the net is owned, age, and marital status were not significant. Multiple logistics regression shows that pregnant women who are confident to hang or use a net were almost ten times more likely to use a net than those who do not know, while those who know that the use of an ITN/LLIN can protect a pregnant woman from malaria were almost two times more likely to use a net than those who do not know.

Conclusion: In general, while owning a net facilitates its use, ownership does not necessarily translate to usage. Owning more than one ITN/LLIN per household was not significant in the use of an ITN/LLIN by pregnant women in this study, neither was the length of time the net was owned. This study shows that increasing the number of nets owned per household might not be a critical decider on whether the net will be used or not. We recommend massive education on the use of ITN. Skill building on use and increasing knowledge on the benefits of using nets may contribute to improving ITN use among pregnant women in Nigeria.


Evaluating the Impact of Health System Strengthening on HIV and Sexual Risk Behaviors in Nigeria. Eluwa GI, Adebajo S, Idogho O, Fajemisin O, Anyanti J, Ahonsi B. Evaluating the Impact of Health System Strengthening on HIV and Sexual Risk Behaviors in Nigeria. J Acquir Immune Defic Syndr. 2015;70(1):67?74.

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ABSTRACT :  We evaluated the impact of health system strengthening (HSS) on HIV prevalence and sexual risk behaviors in Nigeria.

Design: Impact of HSS was evaluated in a cross-sectional analysis using 2 rounds of HIV bio behavioral surveys. Logistic regression was used to assess the impact of the HSS program on HIV and risk behaviors.

Setting: Study was conducted between 2007 and 2012 in 16 states in Nigeria.

Subjects: Using a multistage selection criterion for households, a total of 4856 and 11,712 respondents were surveyed in 2007 and 2012, respectively.

Intervention: HSS for state agencies for the control of AIDS was conducted in 7 states.

Results: Overall change in HIV prevalence between 2007 and 2012 was 6·3% vs. 5·3% (P = 0·113) and 3·0% vs. 5·1% (P < 0·001) in the HSS and non-HSS states, respectively. When controlled for age, gender, HSS intervention, location (rural vs. urban), and year (2007 vs. 2012), respondents in the HSS states were less likely to have acquired HIV (adjusted odds ratio [AOR]: 0.78; 95% confidence interval (CI): 0.63 to 0.96), more likely to have comprehensive HIV knowledge (AOR: 1.28; 95% CI: 1.06 to 1.54), and to use a condom consistently in the past 3 months with boy/girlfriends (AOR: 1.35; 95% CI: 1.03 to 1.79).

Conclusions: HIV prevalence decreased in HSS states between 2007 and 2012. Respondents in HSS states were more likely to have lower HIV prevalence and reduced sexual risk behaviors. There seems to be progress in mitigating the burden of HIV by the reduction of HIV-related risk behaviors through HSS. Thus, HSS intervention needs to be sustained and replicated to achieve a wider impact and coverage.


Care-seeking at patent and proprietary medicine vendors in Nigeria. Prach LM, Treleaven E, Isiguzo C, Liu J. Care-seeking at patent and proprietary medicine vendors in Nigeria. BMC Health Serv Res. 2015;15:231. Published 2015 Jun 12.

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ABSTRACT : To achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms.

Methods: In Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop.

Results: Most customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs.

Conclusions: Because care-seeking behaviors vary by symptoms and the sick person’s age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving primary care need to target the places where most people access care, and equip PPMV workers with knowledge and tools to provide basic services.


Differences in malaria care seeking and dispensing outcomes for adults and children attending drug vendors in Nasarawa. Nigeria. Liu J, Isiguzo C, Sieverding M. Differences in malaria care seeking and dispensing outcomes for adults and children attending drug vendors in Nasarawa, Nigeria. Trop Med Int Health. 2015;20(8):1081?1092.

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ABSTRACT : To characterize the differences in care seeking behaviour and dispensing outcomes between adults and children purchasing drugs for malaria at retail shops in Nigeria.

Methods: In Nasarawa State, retail drug shops were enumerated and a subset of those stocking antimalarials were selected as study sites and surveyed. Customers exiting shops after purchasing antimalarial drugs were surveyed and tested with a malaria rapid diagnostic test. Sick adults and caregivers accompanying sick children were eligible, but individuals purchasing drugs for a sick person that was not present were excluded. Multivariate regression analysis was used to identify the correlates of care seeking and the quality of interaction at the shop.

Results: Of 737 participants, 80% were adults and 20% were children (under age 18). Caregivers of sick children were more likely to obtain a prescription prior to attending a drug retailer than adults seeking care for themselves and waited a shorter time before seeking care. Caregivers of sick children were also more likely than sick adults to have been asked about symptoms by the retailer, to have been given an examination, and to have purchased an ACT. Fewer than half of respondents had purchased an ACT. Only 14% of adults, but 27% of children were RDT-positive; RDT-positive children were more likely to have had an ACT purchased for them than RDT-positive adults.

Conclusions: Children with suspected malaria tend to receive better care at drug retailers than adults. The degree of overtreatment and prevalence of dispensing non-recommended antimalarials emphasize the need for routine diagnosis before treatment to properly treat both malaria and non-malaria illnesses.


Management of paediatric illnesses by patent and proprietary medicine vendors in Nigeria. Treleaven E, Liu J, Prach LM, Isiguzo C. Management of paediatric illnesses by patent and proprietary medicine vendors in Nigeria. Malar J. 2015;14:232. Published 2015 Jun 4.

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ABSTRACT :  In Nigeria and elsewhere, informal drug sellers, or patent and proprietary medicine vendors (PPMVs), are a common source of care for children with malaria, diarrhoea, and pneumonia. However, their knowledge and stocking of recommended treatments for these common childhood illnesses are not well understood.

Methods: A census of PPMV shops was conducted in Kogi and Kwara states. A shop survey was conducted on a subset of 250 shops. Multivariate regression analysis was used to assess associations between shop worker characteristics and (1) knowledge of optimal treatments for malaria, diarrhoea, and pneumonia, and (2) stocking of essential medicines to treat these illnesses.

Results: From the census, 89.9% of shops stocked oral rehydration solution (ORS), while 61.1% of shops stocked artemisinin-based combination therapies and 72.2% of shops stocked amoxicillin. Stocking patterns varied by state, urban/rural location, and according to whether or not the shop was headed by someone with formal health training (e.g. having a professional health education degree). In multivariate analyses, selling drugs wholesale and participating in any training in the past year was associated with a higher likelihood of naming the correct treatment for malaria, and having formal health training was associated with stocking ORS. However, few other PPMV characteristics were predictive of correct knowledge of optimal treatments and stocking behaviour.

Conclusion: Many PPMVs lack the knowledge and tools to properly treat common childhood illnesses. PPMV knowledge and selling of essential medicines for these illnesses should be strengthened to improve child health in Nigeria.


Analysis of Health Facility Based Barriers and Facilitators To Use Of Sexual And Reproductive Health Care Services Among Most At Risk Populations (MARPS): Evidence From A Mystery Client Survey In Nigeria. Ezire, Onoriode et al. “Analysis of Health Facility Based Barriers and Facilitators to Use Of Sexual And Reproductive Health Care Services Among Most At Risk Populations (MARPS): Evidence From A Mystery Client Survey In Nigeria.” Journal of Tropical Diseases & Public Health3 (2015): 1-5

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ABSTRACT : Access to sexual and reproductive health care services for most at risk population (MARPs) is a very important step in stemming the spread of HIV; as HCT and early diagnosis and treatment of STIs can contribute to reduction of the spread of HIV. Within Nigeria and most Sub Saharan African countries, MARPs are highly stigmatized both in the general society and in health care centres. It is important health care facility based facilitators and barriers to MARPs’ access to use of sexual and reproductive health care services by MARPs are identified to guide project design and implementation as well as policy formulation. Methods: Mystery client survey was conducted in thirty-three (33) healthcare facilities in Nigeria. For the purpose of the survey, the mystery clients (MARPs) sought only STI consultation and HIV counselling and testing services. Twelve (12) mystery clients visited each facility seeking either STI or HCT service in the facility. Ethical approval was obtained from the Nigeria Institute of Medical Research (NIMR). SPSS version 20 was used for the Bi-variate and multivariate logistic regression analysis. Results: While positive attitude of health care workers was found to be a facilitator of access to health care services, this study shows that perceived quality of services is a very significant variable in MARPs’ use of a health care facility. We also found that MARPs were more willing to refer their community members to facilities that have educational materials promoting non-stigmatizing attitude towards PLWHAs and MARPs. Amazingly, privacy of services provided was not significant. Conclusion: It is recommended that standard of health care practices should be enforced. Training and re training of health care workers on provision of MARP friendly services should be formalized and scaled up. Investment in educational materials (posters) in health facility settings should be promoted.


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