Treatment seeking behaviour and associated factors among adults with high blood pressure from three selected states in Nigeria.

Management of hypertension is challenging in multi-cultural and multi-ethnic sub-Saharan African countries like Nigeria. This diversity calls for multi-dimensional interventional approaches for hypertension control. This study assessed the treatment seeking behaviour and associated factors among adults with high blood pressure from three ethnic groups in Nigeria. A cross-sectional study was conducted among 762 adults with high blood pressure from three purposively selected States representing the three main tribes in Nigeria. Using a multistage stratified sampling technique, five communities were selected from two Local Government Areas (LGAs) stratified into urban and rural LGAs in each State. All consenting respondents in each community were consecutively screened for hypertension and recruited. A pretested interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics, treatment seeking behaviour and factors affecting their choice. Data were summarized using descriptive statistics. Relationship between individual, health-related factors and treatment seeking behaviour, as well as the predictors were assessed using a binary logistic regression. at p<0.05 Participants' mean age was 55.4 ± 16.6 years, 63.0% were females and most were Igbo speaking (39.9%). About half (368, 48.3%) were unaware of their status. Of those aware, most (58.9%) went to hospital upon diagnosis of hypertension while some sought advice from health care professionals (28.5%) mostly Hausas, others either went to chemists (6.2%) or did nothing (5.1%), predominantly Yorubas. Significant predictors of orthodox treatment seeking practices for hypertension were female gender [(AOR = 2.60; 95%CI (1.18-5.71)], availability of medicine and personnel [(AOR = 8.7; 95%CI (4.15-18.3)] and perceived good quality of care [(AOR = 4.88; 95%CI (1.81-13.1)]. Orthodox treatment was the common choice among adults with high blood pressure. To further encourage patronage of orthodox treatment, the health facilities should be adequately equipped with medications and trained personnel to improve the quality of care. Targeted education on continuous practice of orthodox treatment is recommended.

Clustering of cardiovascular disease risk factors among first-year students at the University of Ibadan, Nigeria: a cross-sectional study

ABSTRACT BACKGROUND: Cardiovascular disease (CVD) is the second leading cause of death in sub-Saharan Africa. Globally, there is substantial evidence that modifiable risk factors for CVD are increasing in adolescents. Unfortunately, there is a paucity of information on the prevalence and clustering of these risk factors in adolescents. OBJECTIVES: This study explores the modifiable risk factors for CVD among first-year students at the University of Ibadan, Nigeria. DESIGN AND SETTING: This cross-sectional study was conducted at the University of Ibadan, Nigeria. METHODS: A total of 546 newly admitted students at the University of Ibadan, Nigeria, were recruited using stratified random sampling. An interviewer-administered questionnaire was used to obtain information from study participants between January and February 2016. RESULTS: The mean age of respondents was 19 ± 2.2 years with a male-to-female ratio of 1:1. The reported risk factors for CVD were smoking (1.6%), abdominal obesity (3.3%), alcohol consumption (3.7%), overweight/obesity (20.7%), unhealthy diet (85.3%), and physical inactivity (94.5%). Clustering of ≥ 2 risk factors was reported in 23.4% of students. Female students were twice as probably overweight/obese as male students (adjusted odds ratio [AOR] = 2.2; confidence interval [CI] = 1.41-3.43). Students whose fathers were skilled workers were 3.5 times more likely to be physically inactive (AOR = 1.7; CI = 0.97-2.96). The clustering of ≥ 2 risk factors was significantly higher among women and Muslims in bivariate analysis, whereas no significant association was found in multivariate analysis. CONCLUSIONS: Public health strategies to prevent CVD risk factors should begin in schools and extend to the entire community.

Clustering of cardiovascular disease risk factors among first-year students at the University of Ibadan, Nigeria: a cross-sectional study.

BACKGROUND: Cardiovascular disease (CVD) is the second leading cause of death in sub-Saharan Africa. Globally, there is substantial evidence that modifiable risk factors for CVD are increasing in adolescents. Unfortunately, there is a paucity of information on the prevalence and clustering of these risk factors in adolescents. OBJECTIVES: This study explores the modifiable risk factors for CVD among first-year students at the University of Ibadan, Nigeria. DESIGN AND SETTING: This cross-sectional study was conducted at the University of Ibadan, Nigeria. METHODS: A total of 546 newly admitted students at the University of Ibadan, Nigeria, were recruited using stratified random sampling. An interviewer-administered questionnaire was used to obtain information from study participants between January and February 2016. RESULTS: The mean age of respondents was 19 ± 2.2 years with a male-to-female ratio of 1:1. The reported risk factors for CVD were smoking (1.6%), abdominal obesity (3.3%), alcohol consumption (3.7%), overweight/obesity (20.7%), unhealthy diet (85.3%), and physical inactivity (94.5%). Clustering of ≥ 2 risk factors was reported in 23.4% of students. Female students were twice as probably overweight/obese as male students (adjusted odds ratio [AOR] = 2.2; confidence interval [CI] = 1.41-3.43). Students whose fathers were skilled workers were 3.5 times more likely to be physically inactive (AOR = 1.7; CI = 0.97-2.96). The clustering of ≥ 2 risk factors was significantly higher among women and Muslims in bivariate analysis, whereas no significant association was found in multivariate analysis. CONCLUSIONS: Public health strategies to prevent CVD risk factors should begin in schools and extend to the entire community.

Risk factors for COVID-19 infection and disease severity in Nigeria: a case-control study.

Introduction: identifying risk factors for SARS-CoV-2 infection and disease severity is critical to developing measures to protect vulnerable groups. We aimed to identify risk factors for SARS-CoV-2 infection and severe disease. Methods: this was an unmatched case-control study that recruited participants in the country from April to July 2020. Cases tested positive on Reverse-Transcription Polymerase Chain Reaction (RT-PCR), while controls tested negative on RT-PCR. Data were collected by trained research assistants using an interviewer-administered questionnaire. Cases were categorized into severe and non-severe to identify risk factors for severe disease. Results: there were 497 cases and 997 controls recruited. Contact with a symptomatic confirmed case adjusted odds ratio (aOR) 1.91 (95% CI: 1.30-2.80) and attendance of mass gatherings aOR 1.74 (95% CI: 1.10-2.74) were associated with SARS-CoV-2 infection, while the use of private transportation aOR 0.56 (95% CI: 0.37-0.85) and use of a face mask aOR 0.43 (95% CI: 0.19-0.95) were associated with lower odds of infection. We identified 38 (7.7%) severe cases and 459 (92.3%) non-severe cases. Multivariate analysis identified age ≥ 50 years aOR 4.54 (95% CI: 1.86-11.08), male sex aOR 2.95 (95% CI: 1.07-8.11), hypertension aOR 3.52 (95% CI: 1.46-8.50), and diabetes aOR 5.76 (95% CI: 2.01-16.50) as risk factors for severe disease, while Hausa ethnicity aOR 0.15 (95% CI: 0.04-0.62) lowered the odds of severe disease. Conclusion: our findings highlight the importance of exposure history, mass gatherings, private transportation, and the use of face masks. Being over 50 years, male and having comorbidities indicate a worse prognosis.

Malaria and COVID-19: commonalities, intersections and implications for sustaining malaria control.

The devastating impact of infectious disease outbreaks and pandemics on health systems could be overwhelming especially when there is an overlap in clinical presentations with other disease conditions. A case in point is the disruptive effect of the Ebola Virus Disease outbreak on health service delivery and its consequences for malaria management in the affected West and Central African countries between 2014 and 2016. This could be the case with the current infectious disease pandemic (COVID-19) the world is experiencing as malaria illness shares many symptoms with COVID-19 illness. Caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 is reported to have originated from Wuhan city, China in December 2019. COVID-19 was declared a Public Health Emergency of International Concern on 30 January 2020 and declared a pandemic on March 11, 2020 by the World Health Organization (WHO). Practically, all community infrastructure has been activated in affected countries in response to COVID-19. However, the deployment of huge resources in combating COVID-19 pandemic should not be a missed opportunity for the advancement of infectious diseases control including malaria. This calls for conscious and heightened effort to sustain the gains in malaria control. The WHO has emphasized that the response to the COVID-19 pandemic must utilize and strengthen existing infrastructure for addressing malaria and other infectious diseases globally. Leveraging these to maintain malaria control activities in endemic countries could boost and help to sustain the gains in malaria control in accordance with the 2016-2030 Global technical strategy for malaria (GTS) milestones. In addition, it will help to keep the "High burden to high impact" (HBHI) and other initiatives on track. This article highlights the commonalities of the two diseases, discusses implications and recommendations to support decision making strategies to keep malaria control on track in the COVID-19 pandemic era.

Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria.

BACKGROUND: Malaria in pregnancy has adverse effects on maternal and child health. Intermittent preventive treatment (IPTp) with three doses of Sulfadoxine/Pyrimethamine is an effective preventive measure for malaria in pregnancy. However, 24.0% of women use this prophylactic regimen in Ebonyi State. Previous studies have focused on the level of uptake with less attention given to factors influencing uptake. Therefore, we examined the predictors of IPTp uptake in the last pregnancy among women in Ebonyi State, Nigeria. METHODS: This was a community-based cross-sectional study among 340 women of reproductive age selected using multistage sampling technique. A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, IPTp uptake and reasons for not taking IPTp. Adherence was judged adequate if three or more doses of IPTp were taken, otherwise inadequate. Data were analyzed using descriptive statistics, Chi- square test and logistic regression model at 5% level of significance. RESULTS: Mean age of respondents was 28.8 ± 5.2 years, 96.5% were married, 19.4% had tertiary education, and 11.2% were from polygamous family. Uptake of IPTp was 74.2%. The level of IPTp uptake was 12.5 and 41.0% among women with no formal and tertiary education respectively. A similar pattern of IPTp uptake was observed among women from monogamous (38.0%) and polygamous (39.5%) families. Women education, husband education and family type were associated with uptake of IPTp, however only husband education remained a predictor of uptake. Women whose husband had secondary education (aOR = 4.1, 95%CI: 1.66-10.06) and tertiary education (aOR = 4.8, 95%CI: 1.76-12.90) were more likely to have IPTp uptake than those whose husbands had below secondary education. CONCLUSION: Adequate IPTp uptake among women in their last pregnancy was below WHO recommendation. Intervention aimed at improving couple's education could facilitate increase in IPTp uptake in Ebonyi State.

Consequences of restricting antimalarial drugs to rapid diagnostic test-positive febrile children in south-west Nigeria.

OBJECTIVES: To investigate the consequence of restricting antimalarial treatment to febrile children that test positive to a malaria rapid diagnostic test (MRDT) only in an area of intense malaria transmission. METHODS: Febrile children aged 3-59 months were screened with an MRDT at health facilities in south-west Nigeria. MRDT-positive children received artesunate-amodiaquine (ASAQ), while MRDT-negative children were treated based on the clinical diagnosis of non-malaria febrile illness. The primary endpoint was the risk of developing microscopy-positive malaria within 28 days post-treatment. RESULTS: 309 (60.5%) of 511 children were MRDT-positive while 202 (39.5%) were MRDT-negative at enrolment. 18.5% (50/275) of MRDT-positive children and 7.6% (14/184) of MRDT-negative children developed microscopy-positive malaria by day 28 post-treatment (ρ = 0.001). The risk of developing clinical malaria by day 28 post-treatment was higher among the MRDT-positive group than the MRDT-negative group (adjusted OR 2.74; 95% CI, 1.4, 5.4). A higher proportion of children who were MRDT-positive at enrolment were anaemic on day 28 compared with the MRDT-negative group (12.6% vs. 3.1%; ρ = 0.001). Children in the MRDT-negative group made more unscheduled visits because of febrile illness than those in MRDT-positive group (23.2% vs. 12.0%; ρ = 0.001). CONCLUSION: Restricting ACT treatment to MRDT-positive febrile children only did not result in significant adverse outcomes. However, the risk of re-infection within 28 days was significantly higher among MRDT-positive children despite ASAQ treatment. A longer-acting ACT may be needed as the first-line drug of choice for treating uncomplicated malaria in high-transmission settings to prevent frequent re-infections.

CONSÉQUENCES DE LA RESTRICTION DES ANTIPALUDIQUES AUX ENFANTS FÉBRILES POSITIFS AU TEST DE DIAGNOSTIC RAPIDE DANS LE SUD-OUEST DU NIGÉRIA: OBJECTIFS: Investiguer la conséquence de restreindre le traitement antipaludéen uniquement à des enfants fébriles avec un résultat positif à un test de diagnostic rapide (TDR) du paludisme dans une zone de forte transmission du paludisme. MÉTHODES: Les enfants fébriles âgés de 3 à 59 mois ont été dépistés avec un TDR du paludisme dans des établissements de santé du sud-ouest du Nigéria. Les enfants avec un TDR positif ont reçu de l'artésunate-amodiaquine (ASAQ), tandis que ceux avec un TDR négatif ont été traités sur la base du diagnostic clinique de maladie fébrile non liée au paludisme. Le critère d'évaluation principal était le risque de développer un paludisme positif au microscope dans les 28 jours suivant le traitement. RÉSULTATS: 309 (60,5%) des 511 enfants étaient positifs au TDR du paludisme tandis que 202 (39,5%) étaient négatifs au moment de leur inscription. 18,5% (50/275) des enfants TDR-positifs et 7,6% (14/184) des enfants TDR-négatifs ont développé un paludisme positif au microscope endéans le jour 28 après le traitement (ρ = 0,001). Le risque de développer un paludisme clinique endéans le 28è jour après le traitement était plus élevé dans le groupe TDR-positif que dans le groupe TDR-négatif (OR ajusté = 2,74; IC95%: 1,4 - 5,4). Une proportion plus élevée d'enfants TDR-positifs au moment de l'inscription étaient anémiques au 28è jour par rapport au groupe TDR-négatif (12,6% contre 3,1%; ρ = 0,001). Les enfants du groupe TDR-négatif ont effectué plus de visites non planifiées en raison d'une maladie fébrile que ceux du groupe TDR-positif (23,2% contre 12,0%; ρ = 0,001). CONCLUSION: Le fait de limiter le traitement de combinaison à l'artémisinine (TCA) aux seuls enfants fébriles présentant un résultat positif au TDR n'a pas eu d'effet indésirable significatif. Cependant, le risque de réinfection dans les 28 jours était significativement plus élevé chez les enfants TDR-positifs malgré le traitement par ASAQ. Un TCA à action prolongée pourrait être nécessaire en tant que médicament de choix en première ligne pour traiter le paludisme sans complications dans les régions à forte transmission afin de prévenir les réinfections fréquentes.

Practice of antimalarial prescription to patients with negative rapid test results and associated factors among health workers in Oyo State, Nigeria.

INTRODUCTION: Contrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test (mRDT)-negative patients, thus increasing overuse and the risk of parasite resistance to the antimalarials. The reasons for this are not clear. We identified factors associated with antimalarial prescription to mRDT-negative patients. METHODS: We conducted a cross-sectional study among 423 HWs. Data on socio-demographic characteristics, training, supervision experience and fever management practices were collected. We tested associations between independent variables and prescription of antimalarials to mRDT-negative patients using Chi square and logistic regression at p < 0.05. RESULTS: The HWs were mostly community health workers (58.6%), with mean age of 41.0 (±8.8) years and 13.6 (± 9.0) years of professional practice. Females were 322 (76.1%) and 368 (87%) were married. Of the 423 HWs interviewed, 329 (77.8%) received training on mRDT use, 329 (80.6%) received supervision and 129 (30.5%) had good knowledge of causes of fever. Overall, 110 (26.0%) of the HWs prescribed antimalarials to mRDT-negative patients. A higher proportion of non-trained vs trained HWs [Adjusted Odds Ratio (aOR) = 4.9; 95% Confidence Interval (CI) (2.5-8.3)], and HWs having poor knowledge vs HWs having good knowledge of causes of fever [aOR = 1.9; 95% CI (1.0-3.5)], prescribed antimalarials to mRDT-negative patients. CONCLUSION: HWs' lack of training on mRDT use and poor knowledge of causes of fever were associated with prescription of antimalarials to mRDT-negative patients. We recommend training on management of fever and mRDT use to reduce such inappropriate antimalarial prescriptions.

Performance of malaria rapid diagnostic test in febrile under-five children at Oni Memorial Children's Hospital in Ibadan, Nigeria, 2016.

INTRODUCTION: The World Health Organization (WHO) recommends testing of suspected malaria cases before treatment. Malaria rapid diagnostic test (mRDT) has been recommended for this purpose in endemic countries where microscopy is not accessible. However, its diagnostic performance remains a concern in clinical settings. We assessed diagnostic performance of RDT among febrile under-five children (U5) presenting at Oni Memorial Children's Hospital, Ibadan (OMCH). METHODS: A cross-sectional study was conducted among 370 febrile U5 attending OMCH February to May, 2016. We examined their finger prick blood samples for malaria parasitaemia using CareStartTM histidine rich protein II (HRP-2) RDT and microscopy. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), false positive (FP), invalid rates (IR), likelihood ratio of positive and negative tests (LRP and LRN), were calculated. RESULTS: Mean age of the children was 28.17 ± 15.59 months. Malaria prevalence was 21.6% and 15.1% by mRDT and microscopy, respectively. Sensitivity of CareStartTM HRP-2 RDT was 94.6% (95% confidence interval (CI): 84.2-98.6), specificity: 91.4% (CI: 87.6-94.2), PPV: 66.3% (CI: 54.7-76.2), NPV: 98.9% (CI: 96.8-99.7), FPR 6.5%, IR 8.1%, LRP:10.6 and LRN:0.1. CONCLUSION: Diagnostic performance of CareStartTM used in the study met the ≥ 95% sensitivity at 100 parasites/µL recommended by WHO. This finding provides clinical evidence that testing before anti-malarial treatment as recommended by WHO will identify cases of malaria infection and reduce unnecessary use of drugs. Healthcare workers should be educated on diagnostic accuracy of mRDT and adhere to the WHO's test-treat strategy for anti-malaria therapy.

High acceptance of artemisinin-based combination therapy for the home management of malaria in rural communities in southwest Nigeria.

Background: Artemisinin based combination therapy (ACT) is the global gold standard for treatment of malaria. In sub-Saharan Africa the majority of malaria cases is treated at home. In rural southwest Nigeria we set out to evaluate the feasibility and acceptability of using artemether-lumefantrine (AL) at the community level to treat acute uncomplicated malaria. Materials and Methods: Following advocacy and community mobilisation in a rural area in south-west Nigeria, 60 community medicine distributors (CMDs: patent medicine sellers, selected mothers from the community and health-care workers) were trained to recognise the signs and symptoms of childhood malaria and to treat febrile children aged 6-59 months with AL, after ruling out certain danger signs. At the end of one year, the programme was evaluated by conducting a 2-week fever recall survey among caregivers, inspection of CMD records to evaluate caregivers' adherence to the treatment schedule, CMDs' performance and the coverage of febrile children with AL. Data was analysed using descriptive statistics. Results: Based on CMDs' records, 97.6% (1019/1044) of the children treated with AL received the correct dose. Over half (52.3%) of the children (288/551) whose caregivers participated in the 2-week fever recall survey reportedly received AL from a CMD. Reasons for not receiving AL included non-availability of a CMD [35.7%; 94/263] or drug stock out [28.1%; 74/263]. Of the children treated with AL, 80.2% (231/288) received prompt treatment at the correct dose and for the correct length of time. Ninety-eight percent of the caregivers perceived AL to be effective and none reported severe adverse events. Conclusions: The use of AL at the community level is feasible and acceptable in the home management of malaria in rural southwest Nigeria. Challenges that must be addressed include avoiding stock outs, ensuring adequate number of CMDs and providing incentives to ensure their availability.