In Nigeria, Stillbirths And Newborn Deaths Increased During The COVID-19 Pandemic.

The COVID-19 pandemic has put severe pressure on health care systems worldwide. Although attention has been focused on COVID-19 hospitalizations and deaths, some experts have warned about potentially devastating secondary health effects. These effects may be most severe in low- and middle-income countries with already weak health care systems. This study examines the effect of the COVID-19 pandemic on early infant deaths, a question that is currently unsettled. We present new evidence from Nigeria showing that early infant deaths have significantly increased during the pandemic. Using data on the birth outcomes of a large and diverse cohort of pregnant women enrolled in a prospective study and a quasi-experimental difference-in-differences design, we found a 1.1-percentage-point (22 percent) increase and a 0.72-percentage-point (23 percent) increase, respectively, in stillbirths and newborn deaths. Our findings show that the health effects of the pandemic extend beyond counted COVID-19 deaths. If these findings generalize to other low- and middle-income countries, they may indicate that the hard-won gains in child survival made during the past two decades are at risk of being reversed amid the ongoing pandemic. Policies addressing disruptions to health services delivery and providing support to vulnerable groups-specifically to households with pregnant women-will be critical as the pandemic continues.

Correlates of Infant Feeding Practices Among HIV-positive Mothers and Controls in Northeast Nigeria.

BACKGROUND: Despite the global decline in pediatric HIV infections, infants in sub-Saharan Africa still acquire HIV infection through inappropriate feeding. OBJECTIVE: The objective of the study was to compare knowledge and predictors of infant feeding behavior between mothers living with HIV and controls of unknown HIV status in Gombe, northeast Nigeria. METHODS: A cross-section of clinic-based samples of 84 HIV-positive mothers and 170 controls of unknown status were interviewed using validated questionnaires. Knowledge scores and self-reported infant feeding practices were analyzed. Multivariate logistic regression models were employed to determine predictors for infant feeding practices. RESULTS: Transmission risk perception (95.2% vs. 65.3%) (p<0.05) and adequate knowledge of infant feeding (77.4% vs. 51.2%) (p<0.05) were higher among HIV-positive mothers than controls. Compared with mothers of unknown status (56.5%), a higher proportion of HIV-positive mothers (84.5%) reported breastfeeding the index infant exclusively for 6 months (p<0.05). In contrast, mixed feeding was more prevalent among controls (19.4% vs. 4.8%) (p<0.05). Further, over a third (39.3%) of HIV-positive mothers and 27.6% of controls weaned their infants at ≥12 months (p>0.05). Antenatal attendance, hospital delivery, knowledge, and positive attitude predicted infant feeding practices in both groups. The predictive roles of education and parity were limited to HIVpositive mothers, while the effects of maternal age and infant death were restricted to controls. CONCLUSION: Risk perception, knowledge, and exclusive breastfeeding rates were higher among mothers living with HIV. Antenatal care, hospital delivery, knowledge, and attitude predicted infant feeding practices in both groups. Girl child education, antenatal care, hospital delivery, and sustained promotion of exclusive breastfeeding with antiretroviral therapy are key to HIV-free infant survival.

Healthcare at the Beginning of Life and Child Survival: Evidence from a Cash Transfer Experiment in Nigeria.

Households in poor countries are encouraged (and sometimes coerced) to increase investments in formal health care services during pregnancy and childbirth. Is this good policy? The answer to a large extent depends on its effects on child welfare. We study the effects of a cash transfer program in Nigeria in which households were offered a payment of $14 conditioned on uptake of health services. We show that the transfer led to a large increase in uptake and a substantial increase in child survival driven by a decrease in in-utero child deaths. We present evidence suggesting that the key driver is prenatal health investments.

Maternal Cash Transfers Led To Increases In Facility Deliveries And Improved Quality Of Delivery Care In Nigeria.

Ninety-nine percent of global maternal deaths occur in low- and middle-income countries. The high mortality rates are often attributed to a large portion of births occurring outside of formal health care facilities. This has prompted the creation of programs to promote the use of formal delivery care. However, poor-quality care in health facilities in low- and middle-income countries is well documented. It is not clear that shifting births into health facilities in these settings necessarily leads to better-quality care. We present results from a randomized controlled trial in Nigeria that evaluated a conditional cash transfer intervention that paid pregnant women to deliver in a health facility. We found that the intervention led to a 41 percent increase in facility deliveries. We also found improvements in the quality of delivery care (as a result of more births taking place in formal health care settings) and in overall satisfaction with care. We found no evidence of a reduction in preventable complications that led to maternal deaths, though we found some improvements in self-reported health. Our results indicate that promoting facility deliveries can improve the quality of care received, even in settings where formal care quality is poor. However, modest quality improvements might not be sufficient to substantially improve health outcomes.

Nasopharyngeal Pneumococcal Carriage in Nigeria: a two-site, population-based survey.

Changes in nasopharyngeal (NP) carriage of vaccine-type (VT) Streptococcus pneumoniae can be used to assess the effectiveness of a pneumococcal conjugate vaccine (PCV10). We conducted a baseline carriage survey in rural (Kumbotso, Kano) and urban (Pakoto, Ogun) Nigeria. In this cross-sectional study, we obtained data on demography, clinical history, risk factors, and took NP swabs for pneumococcal culture. We calculated crude and age-standardised carriage prevalence and used log-binomial regression to assess risk factors for carriage. Among children aged <5 years, 92% (95% CI: 88-95%) and 78% (73-82%), respectively, carried any pneumococcus and 48% and 50%, respectively, carried PCV10 serotypes. In Kumbotso, carriage prevalence was >40% across all ages. The age-standardized prevalence of pneumococcal carriage was 66% in Kumbotso and 40% in Pakoto. The most commonly identified serotypes were 19 F, 6 A and 23 F. Risk factors for carriage were young age, recent rhinorrhoea, cohabitation with ≥2 children aged <5 years, and sharing a bed with ≥2 persons. Pneumococcal carriage prevalence is high in this Nigerian population. Persisting prevalence of VT-carriage in older children and adults suggests that PCV10 introduction in children will not eliminate transmission of vaccine serotypes rapidly. High vaccine coverage will therefore be required to ensure full protection of children.

High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study.

BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria. METHODS: We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality. RESULTS: Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1st week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04-1 · 85)), residence outside the city (aHR 3 · 18(2.28-4.45)), previous TB treatment (aHR 3.48(2.54-4.77)), no microbiological confirmation (aHR 4.96(2.69-9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03-2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01-4.53)). CONCLUSIONS: We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.

Predictors of public attitude toward living organ donation in Kano, northern Nigeria.

Organ shortage is a major public health challenge for transplant programs globally. The sustenance of such programs as an effective therapy for end-stage organ failure (ESOF) requires an exploration of public awareness and willingness to donate organs. This is imperative, especially in developing countries where ESOF is highly prevalent. We studied the awareness and predictors of public attitude toward organ donation in Kano city in northern Nigeria. Using interviewer-administered questionnaires, we assessed the awareness and willingness to donate solid organs among 400 adults in the Kano metropolis. Three hundred and five of the 383 respondents (79.6%) reported that they had heard about organ donation. There was a significant variation of awareness by education and ethnicity (P <0.05). Most respondents, 303 (79.1%), were willing to donate an organ. Gender [adjusted odds ratio (AOR) = 2.13; 95% confidence interval (CI): 1.40-4.95], educational attainment (AOR = 2.55; 95% CI: 1.35-5.88), marital status (AOR = 4.5; 95% CI: 2.97-9.1), religion (AOR = 3.40; 95% CI: 1.43-8.10) and ethnicity (AOR = 2.36; 95% CI 1.04-5.35) were significant predictors of willingness to donate an organ. Preferred organ recipients were parents (48.9%), children (21.3%), spouses (14.6%) and other relatives (13.4%). Reasons for willingness to donate organs included religion (51.2%), moral obligation (21.4%) and compassion (11.9%), among others. However, there was widespread ignorance of religious precepts concerning organ donation. The high level of awareness and willingness to donate organs in this society could be further enhanced by intensive information, education and communication strategies providing clear messages on societal benefits, religious aspects and bioethical guidance regarding organ donation.

Pattern, awareness and perceptions of health hazards associated with self medication among adult residents of kano metropolis, northwestern Nigeria.

BACKGROUND: Kano State is the most populous state, and one of those states pronounced with the highest prevalence of drug abuse in Nigeria. However, there is lack of documented data to back the assertion. OBJECTIVE: We determined the pattern, awareness and perceptions of the adult residents of Kano metropolis about self medication. MATERIALS AND METHODS: We used a descriptive cross-sectional design to study a random sample of 380 adult in Kano metropolis. Data was collected using semi-structured questionnaires that were pretested outside the study area. Data analysis was with Epi Info® 3.5.1. RESULTS: The mean age of the subjects was 35.43 ± 15.10 years, majority were males (66.32%), singles (47.11%) and had at least secondary education (67.63%). About three-quarter (78.95%) admitted using drug (s) in the past without prescription. Drugs commonly consumed were antimalarials (42.10%), analgesics (40.56%), antibiotics (29.41%), and cough mixtures (13.31%). Common sources of drugs were patent medicine stores (62.54%) and the market (19.81%). Common reasons for self medication were long queues in the hospitals (38.39%), and in-accessibility to doctors (25.08%). About two-thirds (65.00%) correctly perceived that self medication could be hazardous; and half (51.58%) were aware of at least one hazard of self medication. CONCLUSION/RECOMMENDATIONS: Irrational drug use is a growing challenge to public health in Kano, Nigeria. Thus, drug regulatory agencies in Nigeria should work together to ensure that all drug retail outlets and drug sellers are registered, controlled drugs are dispensed only on prescription of the physicians; and the laws safeguarding drug use are duly enforced. Health authorities should also strengthen efforts towards health educating the public.

Clinical burden and correlates of HIV and malaria co-infection, in northwest Nigeria.

The clinical burden of malaria and HIV/AIDS in sub-Saharan Africa is well-described, but the dynamics of the interaction between the two diseases remain poorly understood. Using a cross-sectional study design, we assessed the prevalence and predictors of malaria infection among HIV-positive patients attending a referral center in urban Kano, northwest Nigeria. Structured questionnaires covering socio-demographic characteristics, HIV diagnosis and treatment, malaria preventive practices, clinical events and treatment were administered to HIV-infected adults (n=363). Information from questionnaires was supplemented with data from case notes. In the preceding year, nearly a third of respondents (32.2%; 95% CI=27.4-37.3) had at least one episode of fever, diagnosed as malaria on blood film examination. Half of all respondents (53.5%) admitted to using insecticide treated nets (ITN). One-third (35.8%) of participants were on malaria chemoprophylaxis at the time of the study. Female sex (adjusted Odds Ratio [aOR]=1.54, 95% confidence interval (CI): 1.32-2.73), immunosuppression (CD4+ cell count <350/µL vs. 600/µL, aOR=2.41, 95% CI 1.23-3.74) and non-use of ITN (aOR=1.97, 95% CI 1.17-2.85) predicted the occurrence of clinical malaria in patients. We report a high burden of malaria in HIV-infected patients attending a tertiary facility in urban Kano, Nigeria. Health communication, standardized protocols and ITN distribution should be integrated into comprehensive HIV programs in this setting.

Prevalence and risk factors for domestic violence among pregnant women in northern Nigeria.

Many women experience domestic violence during pregnancy. The magnitude and risk factors for domestic violence during pregnancy are not well documented in many countries, including Nigeria. Using interviewer- administered questionnaires the authors investigated predictors of domestic violence during current pregnancy among women presenting for antenatal care at a tertiary care facility in northern Nigeria (n = 400). A total of 29 of 392 respondents (7.4%) experienced domestic violence during the current pregnancy. Of those who experienced violence, the majority (58.6%) reported being physically assaulted. Sexual violence was reported by only 4 respondents (13.8%). Financial and domestic issues were the major triggers of domestic violence. After adjusting for potential confounders, it was found that victims' educational attainment and occupation remained significant predictors of domestic violence. Higher educational attainment of women and their engagement in economic activity outside the home were associated with a decreased risk for domestic violence. There is a need for preventive, protective, and redress mechanisms to guard against domestic violence in Nigeria.

Male circumcision and HIV risk behavior among university students in northern Nigeria.

Recent trials demonstrate the effectiveness of male circumcision (MC) in reducing HIV acquisition in men. However, little is known about the prevalence and acceptability of the practice in northern Nigeria. A cross-sectional study design was employed to explore knowledge and attitudes to MC among university students in Kano, Nigeria (n = 375). Almost all respondents (98.1%) reported being circumcised (n = 368; 95% confidence interval = 96.2% to 99.2%). There was no variation in circumcision status by age, ethnicity, religion, or marital status. Majority of the respondents were circumcised by a health worker (51.2%). Most circumcisions were performed between the ages of 5 and 10 years (57.9%) and for religious reasons (79.2%). Only 38% of the respondents (n = 104) were aware of the role of MC in reducing HIV acquisition in heterosexual males. Three quarters of the respondents agreed that circumcised men still need to use condoms. The practice of MC is nearly universal in northern Nigeria, despite low awareness of its protective role in HIV transmission. Public health programs should seize the opportunity offered by high MC acceptance rates to integrate safe medical MC services into existing HIV/AIDS prevention initiatives.

Menstrual patterns and gynecologic morbidity among university students in Kano, Nigeria.

OBJECTIVE: To examine menstrual patterns and effects of menstrual disorders on social and academic lives of undergraduate students in Kano, Nigeria. PARTICIPANTS: Students attending Bayero University Kano, Nigeria (n = 383). INTERVENTION: Self-administered questionnaires. MAIN OUTCOME MEASURES: Sociodemographic characteristics, menstrual patterns, and associated symptoms were elicited. Treatment-seeking behavior and effects of symptoms on academic and social activities were ascertained. RESULTS: The mean age at menarche was 13.7 ± 1.68 years. Menstrual bleeding lasted an average of 5.2 ± 1.6 days. Cycle length was 21-35 days in 92% of cases (n = 353). Approximately 72% of respondents reported dysmenorrhea. After adjusting for confounding, age at menarche, menstrual cycle length, duration of menstrual bleeding and use of contraceptive pills remained significant predictors of dysmenorrhea. Menstrual disorders interfered with social and academic life of 91% and 84% of respondents respectively. CONCLUSIONS: Gynecologic morbidity related to menstruation is common among adolescent Nigerians and is associated with detrimental effects on academic and social activities. Student health services should prioritize measures to mitigate the social and physical impact of menstrual disorders in young women.

Prenatal care and basic emergency obstetric care services provided at primary healthcare facilities in rural Nigeria.

OBJECTIVE: To assess the availability of prenatal care and basic emergency obstetric care services at primary healthcare (PHC) facilities in rural Nigeria. METHODS: In total, 652 PHC facilities enrolled in the Midwives Service Scheme, a government-funded program designed to reduce the national shortage of skilled birth attendants, were surveyed. RESULTS: In all, 44.0% of the PHC facilities evaluated did not provide all components of prenatal care, and only 39.0% of all pregnant women nationwide attended prenatal care clinics 4 or more times. In addition, 52.2% of the facilities were not distributing insecticide-treated nets to pregnant women, while only 36.8% of the PHC facilities provided services to prevent mother-to-child transmission of HIV. By contrast, 70.0% of the PHC facilities had access to antibiotics for the treatment of uncomplicated sepsis. Only 11.0% of clinics reported the use of vacuum extraction during labor and 36.8% provided post-abortion care services. Treatment for pre-eclampsia and eclampsia was initiated at 40.0% and 28.0% of PHC facilities, respectively, prior to referral. CONCLUSION: The present study provides useful information on the state of prenatal and basic emergency obstetric care in rural Nigeria. The data obtained indicate that changes are needed to achieve related Millennium Development Goals.

Sexual and reproductive health communication between mothers and their adolescent daughters in northern Nigeria.

We employed structured interviews and focus groups to investigate reproductive health (RH) communication practices among 184 mother-daughter pairs in Ungogo, northern Nigeria. Transcripts were analyzed using the grounded theory approach. A total of 136 mothers reported discussing RH issues with their daughters. The majority of daughters acquired RH education from their mothers. Parents were more likely to discuss marriage, menstruation, courtship, premarital sex, and sexually transmitted infections (STIs) than other sex education topics. Mothers in northern Nigeria need to be empowered with knowledge and skills to improve the scope and quality of home-based RH education.

Post diagnosis reaction, perceived stigma and sexual behaviour of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Northern Nigeria.

BACKGROUND: The process of becoming aware of one's serostatus, immediate and delayed responses of the individual, family and community have profound implications on health seeking behaviour of PLWHAs especially in developing countries. We investigated post-diagnosis reactions, disclosure, perceived stigmatization and sexual behaviour of PLWHAs in northern Nigeria. METHODS: A triangulation of methods consisting of structured interviewer questionnaire administered on 205 respondents and two Focus Group Discussions with PLWHAs receiving care at Aminu Kano Teaching Hospital was used. HIV serodiagnosis, immediate and delayed reaction to serostatus and responses of family, friends and community members were elicited in addition to perceived stigma and sexual behaviour. RESULTS: Overall, 111 (54.1%) of the 205 patients were counseled before being tested for HIV infection. Majority of women 59 (51.8%) were tested and informed during antenatal care or 46 (40.4%) following diagnostic workup for symptoms related to AIDS. Most men 69 (75.8%) came to know during diagnostic workup or as part of screening for blood transfusion 5 (5.5%). Up to 37.2% of the respondents had kept their serostatus secret. Disclosures were more likely to mothers (51.9%), sisters (31.0%), brothers (11.0%) and spouses (6.1%). Of all respondents, 149 (72.6%) said they were shocked, afraid, angry and sad while 29 (14.1%) reported being indifferent. A higher proportion of females 68 (59.7%) were shocked, sad and angry than males 36 (39.6%) (P<0.05). Significant reductions occurred over time in the proportion of patients that were sad, afraid and shocked (P<0.05). A higher proportion of mothers (67.0%), sisters (44.2%), friends of the same sex (37.1%), father (27.5%) and spouse (23.7%) were perceived to be sympathetic compared to others (P<0.05). Forty-five (21 .9%) of the respondents were discriminated against. Of this, 22 (48.9%) happened at home, 18 (40.0%) in the workplace and the remaining 17 (37.8%) among friends. Of 85 (41.5%) that were sexually active, 78 (91.8%) reported protecting their partners through use of condoms. CONCLUSION: The sub-optimal counseling resulted in strong emotional reactions that threatened the strong social support system of PLWHAs. Supportive counseling could improve VCT uptake and well being of PLWHAs in northern Nigeria.

Domestic violence among women living with HIV/AIDS in Kano, Northern Nigeria.

Despite the increased risk of domestic violence among women living with HIV/AIDS, its burden has not been adequately explored in many developing countries including Nigeria. Using interviewer administered questionnaires we assessed the prevalence and risk factors for domestic violence among 300 HIV seropositive women attending a teaching hospital in northern Nigeria. Participants have been diagnosed HIV positive for an average of 6.7 years; 66.3% were seroconcordant with their intimate partners while 16.3% were serodiscordant, the rest 17.4% did not know the partner's status; 67.1% had disclosed their status to their partners; and 64(22.1%) [95% CI (17.5% to 27.4%)] had experienced domestic violence following HIV diagnosis. Specifically, 30.0% (n = 19) experienced physical violence (slapping, kicking and punching), 59.3% (n = 38) reported verbal violence (insults, threats) and 10.7% (n = 7) endured emotional violence. None was sexually assaulted. Predictors of domestic violence were the woman's age, marital status, disclosure and partner's educational status. This calls for urgent steps and strategies for prevention, protection and post-test counseling on disclosure to avert this human right infringement.

Prevalence and correlates of gender-based violence among female university students in Northern Nigeria.

Gender-based violence (GBV) is a major public health and human rights problem worldwide. The extent of this problem in educational institutions has not been explored in Northern Nigeria. Using self administered questionnaires, we determined the prevalence and risk factors for gender-based violence among 300 female university students in Kano, Northern Nigeria. The overall prevalence of gender-based violence was 58.8% [95% Confidence Interval (CI) = 52.9% to 64.5%]. Specifically, 22.8%, 22.2% and 50.8% of students experienced physical, sexual or emotional violence respectively. Religious affiliation ethnicity, indigeneship, marital status, campus residence and faculty affiliation were significant predictors of GBV. GBV awareness creation programs, legal protection and implementation of an effective redress mechanism are recommended to curb this menace.

Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community.

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] = 1.5, 95% confidence interval [CI] = 1.2-2.6), formal education (AOR = 1.9, 95% CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95% CI = 1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms.

Randomised controlled double-blind non-inferiority trial of two antivenoms for saw-scaled or carpet viper (Echis ocellatus) envenoming in Nigeria.

BACKGROUND: In West Africa, envenoming by saw-scaled or carpet vipers (Echis ocellatus) causes great morbidity and mortality, but there is a crisis in supply of effective and affordable antivenom (ISRCTN01257358). METHODS: In a randomised, double-blind, controlled, non-inferiority trial, "EchiTAb Plus-ICP" (ET-Plus) equine antivenom made by Instituto Clodomiro Picado was compared to "EchiTAb G" (ET-G) ovine antivenom made by MicroPharm, which is the standard of care in Nigeria and was developed from the original EchiTAb-Fab introduced in 1998. Both are caprylic acid purified whole IgG antivenoms. ET-G is monospecific for Echis ocellatus antivenom (initial dose 1 vial) and ET-Plus is polyspecific for E. ocellatus, Naja nigricollis and Bitis arietans (initial dose 3 vials). Both had been screened by pre-clinical and preliminary clinical dose-finding and safety studies. Patients who presented with incoagulable blood, indicative of systemic envenoming by E. ocellatus, were recruited in Kaltungo, north-eastern Nigeria. Those eligible and consenting were randomly allocated with equal probability to receive ET-Plus or ET-G. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by a simple whole blood clotting test repeated 6, 12, 18, 24 and 48 hr after treatment. Secondary (safety) outcomes were the incidences of anaphylactic, pyrogenic and late serum sickness-type antivenom reactions. FINDINGS: Initial doses permanently restored blood coagulability at 6 hours in 161/194 (83.0%) of ET-Plus and 156/206 (75.7%) of ET-G treated patients (Relative Risk [RR] 1.10 one-sided 95% CI lower limit 1.01; P = 0.05). ET-Plus caused early reactions on more occasions than did ET-G [50/194 (25.8%) and 39/206 (18.9%) respectively RR (1.36 one-sided 95% CI 1.86 upper limit; P = 0.06). These reactions were classified as severe in 21 (10.8%) and 11 (5.3%) of patients, respectively. CONCLUSION: At these doses, ET-Plus was slightly more effective but ET-G was slightly safer. Both are recommended for treating E. ocellatus envenoming in Nigeria. TRIAL REGISTRATION: Current Controlled Trials ISRCTN01257358.

Correlates of fertility intentions among HIV/AIDS patients in northern Nigeria.

Little research has been conducted regarding the reproductive intentions of people living with HIV/AIDS (PLWHA) in northern Nigeria. We studied reproductive desires and their predictors among 340 PLWHA receiving care at Aminu Kano Teaching Hospital. Of all respondents, 60 (70.6%) of males and 177 (69.4%) of females were sexually active. Only 65 (19.4%) of them used condoms. One hundred and sixty seven females (65.5%) and 52 (61.2%) males expressed a desire to have more children. Out of these, 16 (7.3%), 106 (48.4%) and 88 (40.2%) wanted to have one, two and three or more children respectively. Significant predictors of higher fertility desires were; religion (OR=1.8), duration of diagnosis (OR=0.42), low parity (OR=6.03) and awareness of partner's scrostatus (OR=2.3). A large proportion of the HIV-positive individuals in the study were sexually active, desired to have children, and wanted to use family planning, indicating unmet need for reproductive health counseling in general and family planning in particular.