Clustering of cardiovascular disease risk-factors in semi-urban population in Northern Nigeria.

INTRODUCTION: Non-communicable diseases (NCDs) are major causes of morbidity and mortality particularly for developing countries. Large proportion of all NCDs deaths are occurring in low- and -middle-income countries are estimated to occur in people under 70-years-old. These low- and middle-income are undergoing epidemiological transition which allows the concomitant occurrence of both communicable and NCDs due to adoption of western life-style that predisposes them to development of these diseases. It is also known that there are risk-factors that tend to cluster in individuals and make them more susceptible to NCDs especially cardiovascular diseases (CVDs). Among NCDs, CVDs constitute the largest share responsible for 48% of all deaths due to NCDs. To determine extend of clustering of these risk-factors in a semi-urban community in northern Nigeria, a population-based study was carried out. MATERIALS AND METHODS: This study was conducted in Dakace, a semi-urban settlement near Zaria. A simple random sampling of 199 eligible respondents out of 424 was adopted to select study participants. An interviewer-administered questionnaire was used to collect socio-demographic information, smoking habits, alcohol consumption as well as level of physical activity. The following measurements were carried out on these respondents: Blood pressure (BP), fasting blood glucose, serum lipids, weight, and height to calculate body mass index (BMI). RESULTS: There were of 199 participants: 94 males (47.2%) and 105 females (52.8%) with an overall mean age of 39.9 ± 15.6 years. About 20% had no risk factor; more females than males had risk-factors. Proportion of subjects with risk-factors increase with increasing BMI, particularly high BP; physical activity does not protect subjects from developing risk-factors. CONCLUSION: This study clearly shows that CVD risk-factors are prevalent even in segment of the population that hitherto may be considered free and the prevalence of these risk-factors are high compared to some obtained from other part of Nigeria.

Tuberculosis case management and treatment outcome: assessment of the effectiveness of Public-Private Mix of tuberculosis programme in Kaduna State, Nigeria.

BACKGROUND: In an effort to increase tuberculosis (TB) case detection, the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. METHODS: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. RESULTS: Except for the lower use of sputum microscopy for diagnosis, adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients, an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities, 13.1% and 12.2% respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7%) compared to 78.6% in the public health facilities. CONCLUSION: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated.

Impact of health education on home treatment and prevention of malaria in Jengre, North Central Nigeria.

BACKGROUND: Malaria accounts for 1 million deaths among children under five annually. It has been shown that improving home treatment and preventing delays in seeking treatment, by teaching women to respond promptly when their children have fever, can decrease malaria related complications and mortality. This study looks at the impact of health education on knowledge of malaria: its recognition, treatment and prevention among caregivers of children under five in Jengre, North Central Nigeria. METHODS: The study was a community based intervention study conducted in three stages: A preintervention stage, where 150 caregivers, were selected through a multistage sampling te chnique from the households containing children under five. Information for the baseline was collected through an interviewer administered semi-structured questionnaire. The intervention consisted of a series of health education sessions designed based on findings from the pre-intervention stage. The postintervention impact assessment was conducted using a modified version of the questionnaire used in the pre intervention stage. RESULTS: Malaria was recognized as one of the diseases that cause fever in community by all the respondents. Sixty-one (40.6%) had adequate knowledge concerning malaria causation, transmission, prevention and treatment. Twenty eight (56%) of respondents reported self-treatment. There was a statistically significant relationship between years of formal education and first line treatment option (P=.012). Thirty-four (68%) mothers acted within eight hours of onset of fever. The intervention had an effect on perception (P<.001), knowledge (P<.001), malaria prevention practice (P=.001), first line treatment option (P=.031) and the type of treatment given to the children with fever (P=.048). CONCLUSION: Health education impacted positively caregivers' knowledge of malaria and their willingness to access antimalarial treatment when their children have fever. Malaria information should be made available to caregivers visiting child welfare clinics. Caregivers should also be integrated into malaria control activities at community level.

Maternal health in Northern Nigeria: a far cry from ideal.

OBJECTIVE: To determine the level of maternal care in Northern Nigeria. DESIGN: A cross-sectional descriptive study design was used. SETTING: The Study was Community based and carried out in the ten states that constitute UNICEF D zone in northeast Nigeria. POPULATION: Women who delivered in the 11 months preceding the survey and resident in the study area. METHODS: The WHO cluster sampling methodology was used to draw a sample of 210 eligible women in each of the 10 local government areas (LGAs). MAIN OUTCOME MEASURES: Utilization of antenatal care (ANC) services, tetanous toxoid immunization, skilled attendant at delivery and postnatal care. RESULTS: Majority of the respondents, 73.2%, were between the ages 20 and 34 years. Overall, 50% of the women attended antenatal clinics during their last pregnancy, with a range of ANC coverage by LGA of 14.0-81.0%. The proportion of women who booked in the first, second and third trimesters was 22.8, 63.0 and 14.2%, respectively. The antenatal services offered ranged from 95.7% for abdominal examination to 41.2% for urine examination. Sixty percent of the women received no tetanus toxoid in their last pregnancy, 11% had one dose and 29% had at least two doses. Home delivery was still the norm throughout the zone with 1791 (85.3%) delivering at home. Up to 80.5% of the deliveries were supervised by personnel with no verifiable training in sanitary birthing techniques. Only 11.4% (233) of those who received ANC had postnatal check-up. CONCLUSIONS: Maternal health care as evidenced above is far from the ideal. Likewise, the commitment of the 5th Millennium Development Goal is extremely far-reaching: to reduce the maternal mortality ratio by 75% by the year 2015 with this level of maternal care.

Drug treatment costs: projected impact of using the integrated management of childhood illnesses.

The strategy of integrated management of childhood illness (IMCI) aims at improving the skills of first level health workers and consequently, improving the survival chances of children. The guidelines have been shown to be cost-effective. We aimed to determine the potential impact of using IMCI guidelines on drug treatment cost. The cost of drugs prescribed for 129 sick children, by first level health workers, who were managed at three primary health facilities in Sabon Gari Local Government Area of Kaduna State, was calculated. The corresponding cost using the IMCI guidelines was also calculated. There were 74 males and 55 females (M:F=1.3:1). An average of 4.5 drugs per patient were prescribed by the health workers compared to 2.3 drugs per patient when using the IMCI guidelines. The total cost of drugs prescribed by the health workers was N15,279.39 with an average of N118.44 per child. The corresponding costs had the IMCI guidelines been used were N3,062.53 and N23.73, respectively. Treatment cost using the traditional method was 4.98 times more expensive than using methods advocated by the IMCI guidelines. The projected cost savings related to drugs when using IMCI guidelines were based on the assumption that inappropriate drugs would not be prescribed by health workers once they are introduced to and started using the IMCI guidelines.