Development and evaluation of a package to improve hypertension control in Nigeria [DEPIHCON]: a cluster-randomized controlled trial.

BACKGROUND: Nigeria's healthcare system capacity to stem the increasing trend in hypertension is limited in coverage, scope and manpower. Use of trained community-based care providers demonstrated to be an effective complement in improving access to, and supporting healthcare delivery has not been adequately examined for hypertension care in Nigeria. This study is proposed to evaluate the effectiveness of using trained community-oriented resource persons (CORPs) to improve hypertension control in Nigeria. METHODS: An intervention study will be conducted in three states using a mixed method design. First is a baseline survey using a semi-structured pre-tested questionnaire to collect information on demographics, clinical data, knowledge, occurrence and risk factors of hypertension among 1704 adults ≥18 years. Focus group discussions (FGD) and key informant interviews (KII) will be conducted to explore a community's experience of hypertension, challenges with hypertension management and support required to improve control in 10 selected communities in each state. The second is a cluster-randomized controlled trial to evaluate effect of a package on reduction of blood pressure (BP) and prevention of cardiovascular (CVD) risk factors among 200 hypertensive patients to be followed up in intervention and control arms over a 6-month period in each state. The package will include trained CORPs conducting community-based screening of BP and referral, diagnosis confirmation and initial treatment in the health facility, followed by monthly home-based follow-up care and provision of health education on hypertension control and healthy lifestyle enhanced by phone voice message reminders. In the control arm, the usual care (diagnosis, treatment and follow-up care in hospital of a patient's choice) will continue. Third, an endline survey will be conducted in both intervention and control communities to evaluate changes in mean BP, control, knowledge and proportion of other CVD risk factors. In addition, FGD and KII will be used to assess participants' perceived quality and acceptability of the interventions as delivered by CORPs. DISCUSSION: This research is expected to create awareness, improve knowledge, perception, behaviours, attitude and practices that will reduce hypertension in Nigeria. Advocacy for buy-in and scale up of using CORPs in hypertension care by the government is key if found to be effective. TRIAL REGISTRATION: PACTR Registry PACTR202107530985857 . Registered on 26 July 2021.

How can we really improve childcare practices in Nigeria?

Suboptimal care is an important risk factor for undernutrition and disease. Such care includes inappropriate breastfeeding (BF) and child-feeding practices and inadequate immunization and supplementation. Over the past several years, Nigeria has increased the availability of health workers and health facilities. The use of health services has also increased. However, this has not led to an improvement in childcare practices, and certain practices that are mediated through behavior change communication, such as BF, have even declined. This article presents the result of a study that identified potential reasons for the decline in these childcare practices. The study was conducted in a primary health-care center (PHC) in South Eastern Nigeria. A key informant interview was held with the Chief Matron of the PHC. The delivery of nutrition and health information to mothers was observed over a 3-month period, and 107 women completed questionnaires to document their knowledge and practice of appropriate childcare practices. The findings from this study show that both health worker and maternal factors may contribute to less than optimal childcare practices. Health workers had received training in nutrition and health education, but their delivery of information was inconsistent and unstructured. Moreover, many mothers who regularly utilized the PHC services, and were aware of adequate childcare practices, were not adopting the practices. These results underscore the need to improve existing behavior change communication channels, as well as identify the barriers to the utilization of the information provided.

Experiences of girls with hearing impairment in accessing reproductive health care services in Ibadan, Nigeria.

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR = 20.29, CI = 1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired.

Breaking the poverty/malnutrition cycle in Africa and the Middle East.

The cost to developing countries, for current and future generations, of not eradicating hunger and poverty - in terms of recurrent conflicts and emergencies, widening inequalities, depleted resources, ill health, and premature death - is enormous. Although strategies are underway to address certain problems in Africa and the Middle East, much remains to be done. Breaking the poverty cycle in these regions demands both local and international attention. Nutrition transition is a key factor, since many countries in the region also suffer the consequences of the excessive and unbalanced diets that are typical of developed countries. This paper reviews the experiences with facing malnutrition in Sub-Saharan and North Africa and the Middle East.