Cataplexy response with extended-release once-nightly sodium oxybate: Post hoc responder analyses from the phase 3 REST-ON clinical trial.

Background: Once-nightly sodium oxybate (ON-SXB), an extended-release oxybate formulation, yielded significant (P < 0.001 at 6 g, 7.5 g, and 9 g) reductions in cataplexy episodes in participants in the phase 3 REST-ON clinical trial (NCT02720744). This post hoc analysis from REST-ON further characterized changes in cataplexy episodes in participants with narcolepsy type 1 (NT1). Methods: Participants with narcolepsy aged ≥16 years received ON-SXB (1 wk, 4.5 g; 2 wk, 6 g; 5 wk, 7.5 g; 5 wk, 9 g) or placebo. Percentages of participants with NT1 who had ≥25%, ≥50%, ≥75%, and 100% reductions from baseline in mean number of weekly cataplexy episodes were determined. Two-sided P values comparing ON-SXB vs placebo were calculated with Fisher exact test. Results: Participants with NT1 (ON-SXB, n = 73; placebo, n = 72; modified intent-to-treat population) had a baseline mean number of weekly cataplexy episodes of 18.9 (ON-SXB) and 19.8 (placebo). Of participants receiving the highest doses of ON-SXB (7.5 and 9 g), approximately half had a 50% reduction, one-third had a 75% reduction, and one-tenth had a 100% reduction in their cataplexy episodes vs placebo. Significantly greater proportions of participants receiving ON-SXB vs placebo had respective reductions in weekly cataplexy episodes of ≥25% at weeks 1 (4.5 g; P < 0.05), 3 (6 g; P < 0.001), 8 (7.5 g; P < 0.001), and 13 (9 g; P = 0.001). Conclusions: A significantly greater proportion of participants receiving ON-SXB vs placebo experienced reductions in weekly cataplexy episodes at all tested doses. Approximately 10% of participants taking the 2 highest ON-SXB doses had complete elimination of their cataplexy.

Socioeconomic Parameters and Well Being of Sickle Cell Anaemic Patients in Southwestern Nigeria.

BACKGROUND: The financial and educational status of individuals living with sickle-cell anaemia contributes to their general well-being. It is widely known that education is closely linked with positive health-seeking behaviors i.e., the more educated a person is, the better the person is likely to seek medical attention when needed, and take care of themselves before the crisis. It is considered that a relatively well-educated person with a means of livelihood would purchase the required drugs for prophylactic use. In most African countries where poverty is acute, it becomes a problem when the resource for education and finance needed for the treatment is not available. This study assessed the socioeconomic parameters (financial and educational status) of individuals living with the disorder within the Ibadan metropolis, southwest Nigeria. METHODS: This study is a descriptive cross-sectional study using quantitative methods that assessed individuals' financial and educational status with sickle cell anaemia. Respondents were recruited from federal and state hospitals, non-governmental foundations, worship centers, and schools. The individuals' educational and financial statuses were accessed using standardized data collection and assessment tools, while the data were analyzed using SPSS (v22). Presentation of inferential statistics was done at a 5% level of significance. RESULTS: The study recruited 253 participants, of which more than half (58.1%) were females. Those between 12-28 years were 64.4%, and the mean age was approximately 27.7±10.3 years. Also, 67.2% had tertiary education, 74.7% were neither engaged nor married at the time of this study, 88.5% were Yoruba, 73.5% of the participants were from a monogamous family, and 73.1% were Christians. A significant directly proportional association was found between financial status, educational status, and general well-being. CONCLUSION: Sociodemographic, as well as educational factors, contributed to the general well-being of the individual participants. Thus, finance, level of exposure, and the environment were found to contribute significantly to well-being. More than half of the participants had tertiary education or are currently in school compared to those without tertiary education. There is an association between those with tertiary education and the number of hospital visits in the selected participants. While no association exists between those with buoyant financial status compared to those without a stable source of income.

CONTEXTE: La situation financière et le niveau d'instruction des personnes vivant avec la drépanocytose contribue à leur bien-être général. Il est largement connu que l'éducation est étroitement liée à des comportements positifs de recherche de santé, c'est-à-dire que plus une personne est éduquée, plus elle est susceptible de rechercher des soins médicaux en cas de besoin et de prendre soin d'elle-même avant la crise. On considère qu'une personne relativementinstruite et disposant de moyens de subsistance achèterait les médicaments nécessaires à des fins prophylactiques. Dans la plupart des pays africains où la pauvreté est aiguë, cela devient un problème lorsque les ressources pour l'éducation et les moyens financiers nécessaires au traitement ne sont pas disponibles. Cette étude a évalué les paramètres socio-économiques (situation financière et d'éducation) des personnes vivant avec la maladie dans la métropole d'Ibadan, au sud-ouest du Nigeria. MÉTHODES: Il s'agit d'une étude transversale descriptive utilisant des méthodes quantitatives qui ont permis d'évaluer la situation financière et éducative des personnes atteintes de drépanocytose. Les personnes interrogées ont été recrutés dans des hôpitaux fédéraux et d'État, des fondations non gouvernementales, des centres de culte et des écoles. La situation éducative et financière des individus a été vérifiée à l'aide d'une collecte de données qui est standardisée et des outils d'evaluation tandis que les données ont été analysées à l'aide de SPSS (v22). Les statistiques inférentielles ont été présentées à un niveau de signification de 5%. RÉSULTATS: L'étude a recruté 253 participants, dont plus de la moitié (58,1 %) étaient des femmes. Les participants âgés de 12 à 28 ans représentaient 64,4 % et l'âge moyen était d'environ 27,7±10,3 ans. En outre, 67,2 % des participants avaient fait des études supérieures, 74,7 % n'étaient ni fiancés ni mariés au moment de l'étude, 88,5 % étaient Yoruba, 73,5 % des participants étaient issus d'une famille monogame et 73,1 % étaient chrétiens. Une association significative directement proportionnelle a été trouvée entre la situation financière, le niveau d'éducation et le bien-être général. CONCLUSION: Les facteurs sociodémographiques et éducatifs, ont contribué au bien-être général des participants. Ainsi, les finances, le niveau d'exposition et l'environnement ont contribué de manière significative au bien-être. Plus de la moitié des participants ont fait des études supérieures ou sont actuellement scolarisés par rapport à ceux qui ne sont pas scolarisés. Il existe un lien entre les participants de l'enseignement supérieur et le nombre de visites à l'hôpital chez les participants sélectionnés. Bien qu'il n'y ait pas d'association entre les personnes ayant une financière par rapport à ceux qui n'ont pas de source de revenus stable. Mots-clés: Anémie drépanocytaire, Éducation, Situation financière, Visites à l'Hôpital, Bilans de santé, Bien-Être.

Maternal and Child Healthcare Delivery in Secondary Healthcare Facilities in Oyo State, Nigeria: Working Towards Sustainable Development Goal 3.

BACKGROUND: The Millennium Development Goals (MDGs) were not achieved by most Sub-Saharan countries including Nigeria. This further led to the proposition of Sustainable Development Goals (SDGs) to run from 2015-2030, to make up for the deficiencies. There is a need to assess the Maternal and Child Healthcare (MCH) delivery, to work towards achieving SDG 3. OBJECTIVES: To evaluate the MCH delivery practices and to identify the related challenges at the secondary care level in Oyo State, southwest Nigeria. METHODS: The study was cross-sectional in design. Twenty-two healthcare facilities were selected by simple random sampling and were assessed using an adapted semi-structured checklist of the WHO manual on Integrated Management of Pregnancy and Childbirth Series. The analysis was done, using Statistical Package for Social Sciences (SPSS) version 21. RESULTS: All the facilities offered normal delivery services and 81.8% offered the three basic child health services (sick childcare, vaccination, and growth monitoring). All the facilities had essential supplies for antenatal and newborn care, and essential drugs for antenatal and childcare. However, only 36.4% had essential delivery medications. Also, 18.2% had available guidelines for MCH delivery, and 42.0% of the staff were present at the time of the survey. The major challenges identified were small staff size (50.0%), lack of equipment (31.8%), and (18.2%) for lack of equipment, medicine, hands-on training, and supervision. CONCLUSION: There is a need for continuous monitoring and evaluation of the MCH services and to improve on the identified challenges. This would help in working towards achieving SDG 3 by the year 2030. Mots clés: Soins prénataux, Soins de santé infantile, Évaluation, Établissement de santé, soins de santé maternelle, soins de santé secondaire, ODD.

CONTEXTE: Les Objectifs du Millénaire pour le développement (OMD) n'ont pas été atteints par la plupart des pays subsahariens, y compris le Nigeria. Cela a conduit à la proposition d'objectifs de développement durable (ODD) qui s'appliqueront à partir de 2010. (SDGs) qui s'étendent de 2015 à 2030, afin de combler les lacunes. Il est nécessaire d'évaluer la prestation des soins de santé maternelle et infantile (SMI) afin d'atteindre l'objectif de développement durable 3. OBJECTIFS: Évaluer les pratiques de prestation de soins de santé maternelle et infantile et identifier les défis connexes au niveau des soins secondaires dans l'État d'Oyo, au sud-ouest du Nigeria. MÉTHODES: L'étude était de type transversal. Vingt-deux établissements de santé ont été sélectionnés par échantillonnage aléatoire simple et ont été évalués à l'aide d'une liste de contrôle semi-structurée adaptée sur la prise en charge intégrée de la grossesse et de l'accouchement. L'analyse a été réalisée à l'aide du progiciel de statistiques pour les sciences sociales (SPSS) version 21. RÉSULTATS: Tous les établissements offraient des services d'accouchement normal et 81,8% offraient les trois services de santé infantile de base (soins aux enfants malades, vaccination et suivi de la croissance),Toutes les structures disposaient des fournitures essentiels pour les soins prénatals et néonatals, et de médicaments essentiels pour les soins prénatals et infantiles. Cependant, seuls 36,4% disposaient de médicaments essentiels pour l'accouchement. De plus, 18,2% avaient des directives disponibles pour l'accouchement en SMI, et 42,0% du personnel était présent au moment de l'enquête. Le site principaux défis identifiés étaient la petite taille du personnel (50,0%), le manque ded'équipement (31,8%), et (18,2%) pour lemanque d'équipement, de médicaments, de formation pratique et de supervision. CONCLUSION: Il est nécessaire d'assurer un suivi et une évaluation pour continuer des services de SMI et d'améliorer les défis identifiés. Cela contribuerait à la réalisation de l'ODD 3 par l'année 2030. Mots clés: Soins prénataux, Soins de santé infantile, Évaluation, Établissement de santé, soins de santé maternelle, soins de santé secondaire, ODD.

Postoperative atrial fibrillation following non-cardiac surgery: Predictors and risk of mortality.

BACKGROUND: Postoperative atrial fibrillation (POAF) is a major complication that follows both cardiac and non-cardiac procedures. Many studies have explored POAF after cardiac procedures, however POAF following non-cardiac procedures has been understudied. METHODS: National Inpatient Sample database was utilized to conduct a retrospective study of hospitalizations with diagnosis of POAF following non-cardiac procedures between 2010 and 2015. RESULTS: 294,112 patients met the inclusion criteria. Advanced age, male gender, colonic resections, coagulopathy, fluid and electrolyte disorders and history of congestive heart failure are major predictors of POAF and in-hospital mortality. Race, type of insurance, income quartile and weekend admissions are independent determinants of mortality following POAF. CONCLUSIONS: Development of POAF and mortality is dependent upon a wide range of factors not limited to age and medical comorbidities. Although a patient may be at an increased risk for POAF this does not mean they are at an increased risk for mortality.

An assessment of improved outcomes using low-cost bubble CPAP in very low birthweight neonates in a Nigerian tertiary hospital.

Respiratory distress contributes to the high burden of preterm mortality globally. The aim of our study was to evaluate the use of low-cost Bubble Continuous Positive Airway Pressure devices for treating respiratory distress and their outcomes in preterm infants weighing <1500g. Data was extracted from admission records of 211 infants over two distinct 4-year periods before and after introduction of bCPAP. With survival rates of 26.7% and 61.8% in the pre and post bCPAP eras respectively, significantly improved outcomes were found.

Use of Complementary and Alternative Medicine Among Patients on Long Term Treatment in a Tertiary Health Institution in Jos Nigeria.

Background: The use of Complementary and Alternative Medicine (CAM) is on the increase globally and found to be more pronounced among those with chronic illnesses even in the face of insufficient scientific evidence to support its efficacy. Hence, this study was conducted to assess the level of use of CAM and its predictors among patients on long term care in tertiary health institution. Methods: This was a cross-sectional study conducted among 176 patients accessing treatment for chronic medical conditions in Jos University Teaching Hospital using quantitative method of data collection. Epi Info statistical software version 7 was used for data analysis and a value of P < 0.05 was considered statistically significant. Results: The median age of respondents was 50 (IQR 30-84) years with 83 (47.2%) being 51 years and above. Utilization of CAM was reported among 72 (40.9%) with herbal preparation ranking highest among 56 (77.8%) the respondents. Absence of side effects (AOR = 2.23; 95% CI = 1.6918-3.2135) and consistency with culture (AOR = 4.46; 95% CI = 1.4695-6.1851) were identified predictors of CAM use. Conclusions: This study has demonstrated a relatively high level of CAM use with perceived absence of side effects, peer influence, and consistency with culture predicting its use.

Outcome of Hydroxyurea Use in SCD and Evaluation of Patients' Perception and Experience in Nigeria.

Introduction: Hydroxyurea (HU) has been shown to be beneficial in the management of sickle cell disease (SCD) as it improves treatment outcomes. However, despite the benefits of HU, its uptake among SCD patients in Nigeria remains low. Objective: This study aimed to assess the perception and experience of patients with SCD in Nigeria who are using or had used HU, thereby informing and promoting its use. Methodology: A multi-centre, cross-sectional study was conducted among 378 SCD patients aged 1-53 years who have enrolled on Sickle Pan African Research Consortium (SPARCO) registry as HU users. The SPARCO project was funded by the National Institutes of Health (NIH) to establish a sickle cell disease (SCD) registry, strengthen skills and plan research in three African countries. The Nigerian SPARCO registry had 6453 SCD patients at the time of this report with <15% of this population on HU. Data on sociodemographics, perception and experience about HU use were obtained and analysed using descriptive statistics. Findings: Out of the 378 participants, 339 (89.7%) were using HU while 39 (10.3%) had stopped using HU at the time of the study. 281 (74.3%) found HU expensive, while 194 (51.3%) reported none to minimal side effects while using HU. Among patients that stopped HU, cost (59%) and availability (51.3%) were the commonest reasons for discontinuing the drug. Furthermore, 347 (92.5%) had fewer pain crises, 173 (84.8%) had a fewer need for blood transfusion, 145 (86.3%) had improved PCV and 318 (84.6%) had fewer hospital admissions. Finally, the study also showed that 322 (85.2%) respondents would recommend the drug to other patients, whereas 14 respondents (3.7%) would not. Mean corpuscular volume (MCV) and fetal hemoglobin (HbF) levels were not collected in this study and may have improved findings. Conclusion: This study showed that the majority of the SCD patients had good perception and experience with the use of HU while a few had to stop the medication mostly on account of cost and availability. Patients' based advocacy could be leveraged to improve HU uptake while more efforts are needed to ensure that it is readily available and affordable.

Once-nightly sodium oxybate (FT218) demonstrated improvement of symptoms in a phase 3 randomized clinical trial in patients with narcolepsy.

STUDY OBJECTIVES: To assess the efficacy and safety of FT218, a novel once-nightly formulation of sodium oxybate (ON-SXB), in patients with narcolepsy in the phase 3 REST-ON trial. METHODS: Narcolepsy patients aged ≥16 years were randomized 1:1 to uptitration of ON-SXB (4.5, 6, 7.5, and 9 g) or placebo. Three coprimary endpoints were change from baseline in mean sleep latency on the Maintenance of Wakefulness Test, Clinical Global Impression-Improvement rating, and weekly cataplexy attacks at 9, 7.5, and 6 g. Secondary endpoints included change from baseline on the Epworth Sleepiness Scale. Safety included adverse drug reactions and clinical laboratory assessments. RESULTS: In total, 222 patients were randomized; 212 received ≥1 dose of ON-SXB (n = 107) or placebo (n = 105). For the three coprimary endpoints and Epworth Sleepiness Scale, all three doses of ON-SXB demonstrated clinically meaningful, statistically significant improvement versus placebo (all p < 0.001). For ON-SXB 9 g versus placebo, increase in mean sleep latency was 10.8 versus 4.7 min (Least squares mean difference, LSMD [95% CI], 6.13 [3.52 to 8.75]), 72.0% versus 31.6% were rated much/very much improved on Clinical Global Impression-Improvement (OR [95% CI], 5.56 [2.76 to 11.23]), change in mean weekly number of cataplexy attacks was -11.5 versus -4.9 (LSMD [95% CI], -6.65 [-9.32 to -3.98]), and change in Epworth Sleepiness Scale was -6.5 and -2.7 (LSMD [95% CI], -6.52 [-5.47 to -2.26]). Common adverse reactions included nausea, vomiting, headache, dizziness, and enuresis. CONCLUSIONS: ON-SXB significantly improved narcolepsy symptoms; its safety profile was consistent with SXB. ON-SXB conferred efficacy with a clearly beneficial single nighttime dose. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT02720744, https://clinicaltrials.gov/ct2/show/NCT02720744.

Disclosure of Sexual Orientation and its Predictors among HIV-Positive Men Who Have Sex with Men in a Contemporary African Setting.

BACKGROUND: Sexual orientation disclosure has been reported to promote good peer support, improve psychological health, as well as access to STIs and HIV prevention services. Hence, this study sought to assess the level of disclosure sexual orientation and its predictors among HIV-positive men who have sex with men (MSM) in Plateau state Nigeria. METHODS: This was a cross-sectional study design conducted between October 2018 and December 2019 among 114 HIV-infected MSM through respondent driven sampling technique. Epi Info version 7 was used for the data analysis with adjusted odds ratio and 95% confidence interval (CI) used as point and interval estimates on the logistic regression model and P < 0.05 considered statistically significant. RESULTS: The mean age of the respondents was 26.0 ± 5.4 years with disclosure of sexual orientation to nonpartner being reported by 45 (39.5%). Positive family history of same sex practice was found to significantly predict self disclosure of sexual orientation (adjusted odds ratio: 3.30; 95% CI: 1.2356-8.8038; P = 0.017). CONCLUSIONS: This study has revealed a low level of disclosure of sexual orientation among HIV-positive MSM in Plateau state with a positive family history of same sex involvement as its predictor.

Retention in HIV care and its predictors among HIV-infected men who have sex with men in Plateau state, North Central Nigeria.

BACKGROUND: Retention in HIV care is the constancy of engagement in HIV treatment, care and support services which is essential to reducing morbidity and mortality associated with the infection as well as halting the development of resistance to antiretroviral therapy (ART). In most African countries, Nigeria inclusive, men who have sex with men (MSM) are major contributors to HIV/AIDS burden. HIV-positive MSM are generally understudied and mostly underserved due to social, political and legislation factors resulting in limited characterization and documentation of the existing health disparities particularly with regards to retention in HIV care. It was against this backdrop that we conducted this study to assess the level of retention in HIV care and its predictors among MSM linked to HIV care. METHODS: A cross-sectional study conducted among 114 HIV-positive MSM in 2019 using interviewer-administered questionnaire. Data analysis was carried out using version 7 of Epi Info statistical software version 7 and a probability value of less than 0.05 used as the cut-off for drawing statistically significant conclusion. RESULTS: The average age in years of the respondents was 26.0 ± 5.4 while 43 (37.7%) of the participants were adequately retained in HIV care. Adequate retention in HIV care was found to be predicted by awareness of regular male partner's HIV status (AOR = 11.2; 95% confidence interval [CI] = 1.924-65.167) and financial difficulty (AOR = 0.1; 95% CI = 0.022-0.840). CONCLUSIONS: A suboptimal level of retention in HIV care was demonstrated in the study with awareness of male partner's HIV status and financial buoyancy as its main predictors.

NATIONAL HEALTH INSURANCE SCHEME: PERCEPTION AND PARTICIPATION OF FEDERAL CIVIL SERVANTS IN IBADAN.

Introduction: The National Health Insurance Scheme is a social health insurance programme designed by the Federal Government of Nigeria to complement sources of financing the health sector and to improve access to health care for the majority of Nigerians. Presently, the enrolment level on the Scheme is majorly among those in the formal sector and user experiences have been different. This study seeks to determine the perception and participation of Civil Servants regarding the National Health Insurance Scheme in Ibadan. Methods: A descriptive cross-sectional study was conducted among 273 civil servants working at the Federal Secretariat, Ikolaba, between October and November 2015. An interviewer-administered questionnaire was used to collect information on socio-demographic characteristics, awareness, and membership of the NHIS, perception of NHIS, and health-seeking behaviour. Participation was defined as the number of civil servants registered or enrolled under the scheme, in other words, members of the scheme. Information on perceptions was sought using a 3-point Likert scale. Descriptive statistics and chi-square tests were used for data analysis at a 5% level of significance. Results: About 60.1% of the respondents were males. The average age was 39.7±9.1 years, with 85.0% of the respondents being married. The majority (65.2%) of the respondents were mid-level cadre workers, 17.62% were working as senior-level workers and the remaining 17.6% were low cadre workers. The majority (88.9%) completed tertiary education, while just 11.1% completed basic education. The mean household size was 2.5±0.6. Awareness of the National Health Insurance Scheme was very high (95.2%) with 83.5% enrolled under the scheme. About (50%) of the respondents joined the scheme because it is cheap and affordable. There was a significant association between awareness, level of education, knowledge of NHIS, and registration into the scheme by respondents. The majority of the respondents (87.3%) claimed that NHIS is a better means of settling healthcare costs than Out-of-pocket-payment. The majority of the respondents thought that health insurance is a viable programme. Conclusion: The perception of health insurance among civil servants was varied while participation was high. Relevant intervention should be introduced to remove bottlenecks to accessing and operating the scheme.

Workplace Bullying and Its Associated Factors Among Medical Doctors in Residency Training in a Tertiary Health Institution in Plateau State Nigeria.

BACKGROUND: Bullying is public health problem globally in workplaces with untold deleterious effects on the health and well-being of individuals at the receiving end. Bullying has been found to disrupt social interaction at workplace thereby creating an unhealthy and seemingly unproductive work environment. Studies have reported varying rates of workplace bullying as high as 83% in Europe, 65% in the Americas and 55% in Asia with very little documented in the contemporary African setting and Nigeria in particular. It therefore became imperative to assess the level of bullying and its associated factors among medical doctors in residency training in a tertiary health institution in Plateau state Nigeria. METHODOLOGY: This was a cross sectional study conducted among resident doctors in Jos University Teaching Hospital between November 2019 and February 2020 using quantitative method of data collection and SPSS version 20 was used for data analysis. Crude and adjusted odds ratios as well as 95% confidence interval were used in this study with a p-value of ≤0.05 considered statistically significant. RESULTS: The mean age of the respondents was 32.3 ± 3.9 years with 78 (62.9%) being 31 years and above. Bullying was currently being experienced by 74 (59.7%) of the respondents with verbal aggression and threats as well as insult and use of derogatory remarks being the forms of bullying experienced by 85.1 and 74.3% of the respondents, respectively. Furthermore, witnessing a colleague being bullied was the sole factor found to be significantly associated with workplace bullying (AOR = 0.18; 95% CI = 0.068-0.449; p < 0.001). CONCLUSION: Workplace bullying has been found to be in existence and relatively high among medical doctors in residency training in this setting with witnessing someone being bullied as its sole associated factor.

Point Prevalence Survey of Antimicrobial Prescribing in a Nigerian Hospital: Findings and Implications on Antimicrobial Resistance.

BACKGROUND: Antimicrobial resistance is a global health challenge. There is inadequate information on antimicrobial prescribing practices in many sub-Saharan African countries including Nigeria. A standardized method for surveillance of antimicrobial use in hospitals was employed to assess the antimicrobial prescribing practices in UCH, Ibadan, Nigeria. METHODS: A point prevalence survey (PPS) was conducted in December 15, 2017 at the UCH Ibadan. The survey included all in-patients receiving an antimicrobial on the day of PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.be). RESULTS: This survey included 451 patients from 38 different wards of which 59.6% received at least one antimicrobial. The neonatal medical wards contributed the highest number of patients who received antibiotics. A total of 172 therapeutic antibiotic prescriptions were issued, mainly for Community Acquired Infections (n=119; 69.2%). Most prescriptions for Healthcare Associated Infections (n=53) were intervention related (47.2%). Frequently used antibiotics include third generation cephalosporins (23.9%; mainly ceftriaxone); followed by combination of penicillin's (17.4%; mainly amoxicillin with enzyme inhibitor) and fluoroquinolones (16.6%). Majority, 312(69.9%)of the patients had parenteral antibiotics and only 95 (21.3%) of all antibiotic prescriptions had a documented stop or review date. Although the reason for antibiotic prescription was indicated for 413 (92.4%) prescriptions, targeted therapy was the basis for only 17 (3.8%)of these prescriptions. For surgical prophylaxis, 98.7% of all prescriptions were given for more than one day. Compliance to guidelines was non-existent. CONCLUSION: Our findings showed high broad spectrum prescribing, high number of intervention related health care infections, high use of prolonged surgical prophylaxis, inexistence of local guidelines; and low utilization of laboratory facilities. Hospital related intervention should include development of antibiotic guideline and increased enlightenment on rational prescribing practices.

Maternal Instruction About Jaundice and the Incidence of Acute Bilirubin Encephalopathy in Nigeria.

OBJECTIVE: To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice. STUDY DESIGN: This was a multicenter, before-after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice. RESULTS: Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction. CONCLUSIONS: Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission.

Knowledge of electronic medical records system among frontline health care workers in Jos University teaching hospital, Plateau State Nigeria.

BACKGROUND: Electronic Medical Records system (EMRs) in any healthcare system has the potential to transform healthcare in terms of saving costs, reducing medical errors, improving service quality, increasing patients' safety, decision-making, saving time, data confidentiality, and sharing medical. Evidence on the current state of EMR system in Nigeria health system particularly its knowledge among health professionals is limited. Hence, this study was conducted to assess the level of knowledge EMRs among frontline health care workers in a tertiary health institution in Jos, Plateau State. METHODS: This was a cross-sectional study conducted between April and August 2019 among 228 frontline health care workers in Jos University Teaching Hospital using quantitative method of data collection. SPSS version 20 was used for data analysis and a p-value of ≤ 0.05 considered statistically significant. RESULTS: The mean age of the respondents in this study was 35±8 years with 93 (40.8%) being 36 years and above. The overall level of knowledge of EMRs was adjudged to be good among 163 (71.5%) of the participants. Category (pharmacists) of the respondents was found to influence good knowledge of EMRs (OR=1.37; 95% CI=1.007-1.865; p=0.045). CONCLUSIONS: This study has demonstrated a relatively high level of good knowledge of EMRs with variation existing along the categories of health care workers bringing to light the existence of a good knowledge base in the light of future EMRs implementation.

PREDICTORS OF WILLINGNESS TO TASK SHIFT AMONG FAMILY PLANNING PROVIDERS IN A SOUTH-WESTERN NIGERIAN STATE.

BACKGROUND: Task shifting, the balanced reallocation of tasks usually from a higher cadre to a lower cadre among the health workforce team, has been proposed as a possible solution to the serious shortage of human resource in the health sector is being experienced in many developing countries. This study aimed to assess the views and experiences of nurses on task shifting in family planning services in Ibadan, Southwest Nigeria. METHODOS: A descriptive cross-sectional study of 400 nurses with at least a year experience in providing family planning services at purposively selected tetiary, secondary and primary facilities in Ibadan was carried out using an intervieweradministered questionnaire. Chi-square test was used to determine association between categorical variables at 5% level of significance. RESULTS: Mean age of the respondents was 41.1±8.7 years and 62% of the respondents were registered nurses/registered midwives. Although majority (91.5%) of the respondents were aware of the concept of task shifting, only 52.2% were willing to task shift family planning services to lower cadre staff and only 38.5% have actually task shifted family planning services to lower cadre staff. Age, educational status and awareness about task shifting were predictors of willingness to task shift family planning services. CONCLUSION: Older registered nurses or registered midwives who were aware of the concept of task shifting were more willing to task shift family planning services. Also, a combination of both awareness and willingness to task shift among married women enhances the practice of task shifting of family planning services.

Effectiveness and Safety of Hydroxyurea in the Treatment of Sickle Cell Anaemia Children in Jos, North Central Nigeria.

BACKGROUND: Hydroxyurea has been shown to positively modify sickle cell disease pathogenesis, but its use is low among Nigerian sickle cell anaemia (SCA) patients because of effectiveness and safety concerns. METHODS: We conducted a quasi-experimental study to evaluate the effectiveness and safety of hydroxyurea in 54 SCA children aged 4-17 years. Clinical and haematological parameters were compared at baseline and 12 months after hydroxyurea therapy. The participants were monitored for adverse events. The parameters were compared using relative risk and Wilcoxon Signed-Rank Test. RESULTS: The number of subjects who had more than two episodes of painful crises reduced from 27 (50%) to 2 (2.7%) (p < 0.001), while those who had acute chest syndrome reduced from 6 (11.1%) to 0 (0.0%; p < 0.001). The risk of being transfused more than once was 0.11 times the risk in the 12 months period preceding therapy (95% CI = 0.02-0.85; p = 0.016). Similarly, the risk of hospital stay >7 days was 0.08 times the risk at the baseline (95% CI = 0.02-0.24; p < 0.0001). The median haematocrit and percentage foetal haemoglobin increased from 26 to 28% and 7.8 to 14%, respectively (p < 0.0001). A dose-dependent but reversible leucopenia was observed among six children (11.1%), otherwise, hydroxyurea was safe in the study population. CONCLUSION: Hydroxyurea is effective and safe in SCA children in Jos, Nigeria. The findings could strengthen educational programme aimed at improving the utilization of hydroxyurea among SCA children.

FACTORS INFLUENCING HEALTH-SEEKING BEHAVIOUR AMONG CIVIL SERVANTS IN IBADAN, NIGERIA.

BACKGROUND: Health-seeking behaviours (HSB) are closely linked with the health status of a nation and thus its economic development. Several studies have described HSB within the context of various diseases. However, knowledge of HSB among population sub-groups is still scanty. This study aims to determine factors most important to civil servants when seeking health care. METHODS: A descriptive cross-sectional study was conducted among 337 civil servants working in the Federal Secretariat, Ibadan, Nigeria. An intervieweradministered semi-structured questionnaire was used to collect information. Chi-square tests were used to test for associations while binary logistic regression test was used for determining predictors. All data analysis were done at 5% level of significance. RESULTS: Members of the poorest quartile were 6 times more likely to have inappropriate HSB than the richest quartile (Q4:Q1= 5.83;O.R: 16.12, 95% C.I: 2.61-11.03). Visits to the hospital or clinic (62.2%) was the most common source of healthcare sought. This was followed by visits to the chemist (33.0%), traditional healers (4.3%). A little more than one-third (34.5%) of respondents considered good service delivery as the most important factor affecting HSB. This was followed by proximity (23.9%), affordability (20.4%), prompt attention (8.8%) and readily-available drugs (7.1%). Completing only basic education [O.R: 0.24 (0.06, 0.96)] and out of pocket payment [O.R: 0.04 (9.16, 82.45)] were associated with a reduction in the likelihood of seeking healthcare from formal sources. CONCLUSION: Appropriate health-seeking behaviour was found to be high among civil servants. However, lower cadre workers and those with lower levels of education need to be targeted during policy formulation to improve health-seeking behaviour. In addition, health insurance schemes should be extended to cover more of the population in order to improve health-seeking behaviour.

Diagnostic Performance Analysis of the Point-of-Care Bilistick System in Identifying Severe Neonatal Hyperbilirubinemia by a Multi-Country Approach.

IMPORTANCE: The real prevalence and clinical burden of severe neonatal jaundice are undefined due to difficulties in measuring total serum bilirubin (TSB) outside secondary and tertiary clinical centers. OBJECTIVE: To assess the diagnostic performance of the point-of care Bilistick System (BS) in identifying neonatal jaundice patients requiring treatment. DESIGN: Between April 2015 and November 2016, 1911 neonates, were recruited to participate in the study. Blood samples were simultaneously collected for the TSB determination by BS and by hospital laboratory (Lab). Data were collected and sent to the Bilimetrix headquarter in Trieste where statistical analysis was performed. Newborns with neonatal jaundice were treated with phototherapy according to each center's guidelines. SETTING: 17 hospitals from Nigeria, Egypt, Indonesia, and Viet Nam. PARTICIPANTS: 1911 newborns were included, of which 1458 (76·3%) fulfilled the inclusion criteria. RESULTS: TSB level measured by BS agreed (p < .0001) with the lab result in all four countries. The diagnostic performance of BS showed a positive predictive value (PPV) of 92·5% and a negative predictive value (NPV) of 92·8%. CONCLUSIONS AND RELEVANCE: BS is a reliable system to detect neonatal jaundice over a wide range of bilirubin levels. Since Bilistick is a point-of-care test, its use may provide appropriate and timely identification of jaundiced newborns requiring treatment.