Preventive practices by households against Lassa fever transmission in Ondo State, Southwest, Nigeria.

Introduction: continued transmission of Lassa fever has been recorded in 6 Local Government Areas (LGAs) of Ondo State in Southwest, Nigeria annually with high case fatality rates. Genomic analysis of the Lassa virus has indicated ongoing transmission from local rodents´ population to humans despite several public health interventions during the outbreak including risk communication on preventive practices against the disease. We assessed adherence to preventive practices by household against the spread of Lassa fever in these affected LGAs. Methods: a descriptive cross-sectional study was conducted among community members in the six affected Local Government Area (LGAs). A semi structured questionnaire was administered to 2992 consenting respondents to assess their reported preventive practice against Lassa fever while their observed practices was assessed using observation checklist. Data analysis was done using frequency, proportions, Chi-Square test and logistic regression of predictors of outcome variable with statistical significance set at p<0.05. Results: a higher proportion of the respondents were females (51.2%) compared to males (48.8%) with mean age of 43.04±13.97 years. Majority of the respondents (88.2%) were married with at least secondary education (76.7%). Majority of the respondents (80.2%) reported washing their hands with soap and water regularly, 84.6% washed their utensils before and after use likewise. However, 10.6% of the respondents reported not storing their food items in lid-covered containers while 61.9% practiced open air drying of food items by the roadside. Also, 34.3% of the respondents were observed to spread food items outside their home in the open air. Overall, 32.6% of the respondent were observed to have poor preventive practices against Lassa fever with their level of education as a significant determinant. Conclusion: the poor preventive practices observed among the respondents in this study could sustain the transmission of the virus hence there is also the need to further intensify enforcement of public health control measures for Lassa fever through existing community structures and institutions to stop the current and prevent future Lassa fever and other related outbreaks in the State.

Missed opportunities for vaccination among children aged 0-23 months visiting health facilities in a southwest State of Nigeria, December 2019.

BACKGROUND: Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. METHODS: This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0-23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. RESULTS: 984 caregivers with children aged 0-23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. CONCLUSIONS: One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers' engagement and screening of vaccination documentation by health workers during every health service encounter.

Lessons Learnt from Epidemiological Investigation of Lassa Fever Outbreak in a Southwest State of Nigeria December 2015 to April 2016.

INTRODUCTION: An outbreak of Lassa Fever (LF) reported and confirmed in Ondo state, Southwest Nigeria in January 2016 was investigated. This paper provides the epidemiology of the LF and lessons learnt from the investigation of the outbreak. METHODS: The incidence management system (IMS) model was used for the outbreak coordination. Cases and deaths were identified through the routine surveillance system using standard definitions for suspected and confirmed cases and deaths respectively. Blood specimens collected from suspect cases were sent for confirmation at a WHO accredited laboratory. Active case search was intensified, and identified contacts of confirmed cases were followed up for the maximum incubation period of the disease. Other public health responses included infection prevention and control, communication and advocacy as well as case management. Data collected were analysed using SPSS 20, by time, place and persons and important lessons drawn were discussed.   Results: We identified 90 suspected LF cases of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed  the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years.   Discussion: One key lesson learnt from the investigation was that the confirmed cases were mainly primary cases; hence the needs to focus on measures of breaking the chain of transmission in the animal-man interphase during Lassa fever epidemic preparedness and response. In addition, the high case fatality rate despite early reporting and investigation suggested the need for a review of the case management policy and structure in the State. Key Words: Lassa fever, Outbreak Response, Incident Management System, Nigeria.

Epidemic preparedness and management: A guide on Lassa fever outbreak preparedness plan.

Epidemic prone diseases threaten public health security. These include diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever for which Nigeria reports considerable morbidity and mortality annually. Interestingly, where emergency epidemic preparedness plans are in place, timely detection of outbreaks is followed by a prompt and appropriate response. Furthermore, due to the nature of spread of Lassa fever in an outbreak setting, there is the need for health-care workers to be familiar with the emerging epidemic management framework that has worked in other settings for effective preparedness and response. This paper, therefore, discussed the principles of epidemic management using an emergency operating center model, review the epidemiology of Lassa fever in Nigeria, and provide guidance on what is expected to be done in preparing for epidemic of the disease at the health facilities, local and state government levels in line with the Integrated Disease Surveillance and Response strategy.

Pattern of the meningococcal meningitis outbreak in Northern Nigeria, 2009.

OBJECTIVES: Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. METHODS: A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. RESULTS: Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. CONCLUSIONS: The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities.

Epidemiology of road traffic crashes among long distance drivers in Ibadan, Nigeria.

BACKGROUND: Road Traffic Crashes (RTCs) are major causes of morbidity and mortality in Nigeria. Few studies in Ibadan have focused on the distribution and determinants of RTC among long distance drivers. OBJECTIVE: To describe the distribution of crashes by place, times of occurrence, characteristics of persons involved and identify associated factors. METHODS: A cross-sectional study was carried out among consenting long distance drivers within selected parks in Ibadan. RESULTS: Respondents (592) were males, with median age of 42.0 years (range 22.0-73.0 years). Secondary education was the highest level of education attained by 38.0%. About 34.0% reported current use of alcohol. The life-time prevalence of crashes was 35.3% (95% CI= 31.5-39.2%) and 15.9% (95% CI=13.1-19.0%) reported having had at least one episode of crash in the last one year preceding the study. The crash occurred mainly on narrow roads [32/94 (34.0%,)] and bad portions of tarred roads [35/94 (37.2%,)] with peak of occurrence on Saturdays 18/94 (19.1%,). Significantly higher proportions of drivers aged ≤39years (23.4%) versus >39years (11.7%), those with no education (29.9%) versus the educated (13.8%) and those who reported alcohol use (21.9%) versus non users (12.8%) were involved in crashes in the year preceding the study. Significant predictor of the last episode of crashes in the last one year were age (OR=2.2, 95% CI=1.4-3.5), education (OR=2.7, 95% CI=1.5-4.6) and alcohol use (OR=1.8, 95% CI=1.2-3.0). CONCLUSION: Road traffic crashes occurred commonly on bad roads, in the afternoon and during weekends, among young and uneducated long-distance drivers studied. Reconstruction of bad roads and implementation of road safety education programmes aimed at discouraging the use of alcohol and targeting the identified groups at risk are recommended.

Knowledge of birth defects among nursing mothers in a developing country.

BACKGROUND: In the absence of established guidelines, where formal screening is unavailable for birth defects, a lot of responsibility is placed on parents in the recognition of these defects. OBJECTIVES: The aim of the study was to determine the awareness of mothers about birth effects in a developing country and assess what they know about the prevention, detection and treatment of children with birth defects. METHODS: This was a descriptive cross-sectional study of 714 mothers consecutively selected at two major hospitals in Nigeria between May and December, 2012. Data were collected with interviewer administered questionnaires. Descriptive and inferential statistics were performed using SPSS and statistical significance set at p <0.05. RESULTS: The participants were aged 17 to 42 years. Only 183 (25.6%) were aware of birth defects. Factors associated with awareness of birth defects were older age, religious belief, better education, higher socioeconomic class, early age at booking and registering at a tertiary care facility. Education, socioeconomic class as well as month and location of booking were found to be independent predictors of awareness of birth defects. CONCLUSION: Mothers in Ibadan, Nigeria, a country without a formal newborn screening programme, have a poor level of awareness about birth defects.

Clients' Willingness to Pay for Immunization Services in the Urban and Rural Primary Health Centers of Enugu State, Nigeria.

Our study aims at determining the pattern of willingness of clients to pay for childhood immunization services in urban and rural primary health centers of Enugu state, Nigeria. Using a cross-sectional design, 800 clients who presented with their children/wards to receive childhood immunization services were selected at the primary health center in rural and urban local government areas of the state. The mean age was 28.9±4.5 and 26.7±5.1 years in the urban and rural areas respectively. About 54.5% of clients in the urban and 55.3% in the rural area were willing to pay for immunization services. The clients willingness to pay was influenced by: non satisfaction with immunization services, (OR=0.3, 95%CI: 0.2-0.5), younger age, (OR=1.4, 95%CI: 1.0-2.0) marital status (OR=2.8, 95%CI: 1.2-6.5), proximity to health centers (OR=0.6, 95%CI: 0.4-0.8), and delivering in a private health facility (OR=0.4, 95%CI: 0.1-0.9). The study suggests that the economic value that clients give to immunization services was similar in the rural and urban areas, and this could be increased by improving the level of clients' satisfaction for the services among others.

The direct cost of care among surgical inpatients at a tertiary hospital in south west Nigeria.

INTRODUCTION: This study was conducted to assess the direct cost of care and its determinants among surgical inpatients at university College Hospital, Ibadan. METHODS: A retrospective review of records of 404 inpatients that had surgery from January to December, 2010 was conducted. Information was extracted on socio-demographic variables, investigations, drugs, length of stay (LOS) and cost of care with a semi-structured pro-forma. Mean cost of care were compared using t-test and Analysis of variance (ANOVA). Linear regression analysis was used to identify determinants of cost of care. Level of significance of 5% was used. In year 2010 $1 was equivalent to 150 naira ($1=₦ 150). RESULTS: The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were 257(63. 6%). The mean overall cost of care was ₦66,983±â‚¦31,985. Cost of surgery is about 50% of total cost of care. Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of ß=₦17,207(95% CI: ₦4,003 to ₦30,410). Neuro Surgery (ß=₦36,210), and Orthopaedic Surgery versus General Surgery(ß=₦10,258),and Blood transfusion (ß=₦18,493) all contributed to cost of care significantly. Increase of one day in LOS significantly increased cost of care by ₦2,372. 57. CONCLUSION: The evidence evaluated here shows that costs and LOS are interrelated. Attempt at reducing LOS will reduce the costs of care of surgical inpatient.

Diagnostic proficiency and reporting of Lassa fever by physicians in Osun State of Nigeria.

BACKGROUND: Lassa fever is highly contagious and commonly results in death. It is therefore necessary to diagnose and report any suspected case of Lassa fever to facilitate preventive strategies. This study assessed the preparedness of physicians in the diagnosis and reporting of Lassa fever. METHODS: The study design was descriptive cross-sectional. The consenting medical doctors completed a self-administered questionnaire on the diagnosis and reporting of Lassa fever. Descriptive and inferential statistics were used in data analyses. RESULTS: One hundred seventy-five physicians participated in the study. The mean age was 41.5 ± 10.9 years (range, 24-75 years). Most of the physicians were male (78.9%) and had practiced medicine ≥ 20 years (51.5%). Most of the physicians had a good knowledge regarding the diagnosis and reporting of Lassa fever; however, none of the physicians had ever diagnosed or reported a suspected case. Predictors of good knowledge include male sex, not practicing at a secondary health care level and post graduation year more than 20 years. CONCLUSION: There is disparity in knowledge and practices of physicians regarding the diagnosis and reporting of Lassa fever. Thus, it is necessary to improve the knowledge and practices of physicians regarding the diagnosis and reporting of Lassa fever.

National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

BACKGROUND: The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. METHODS: The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. RESULTS: The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000-680,000 naira (46.7-4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1-118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3-16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

Determinants of uptake of third doses of oral polio and DTP vaccines in the Ibadan North Local Government Area of Nigeria.

BACKGROUND: High dropout rates in the uptake of oral polio vaccine (OPV) and DTP vaccine persist despite efforts to improve immunisation coverage. This study identified determinants of uptake of third doses of OPV3 and DTP3 among infants who received first doses of either or both vaccines at immunisation centres in the Ibadan North Local Government Area of Nigeria. METHODS: Using a cohort study design, 400 mother-child pairs were assessed. A semi-structured, interviewer-administered questionnaire was used to collect data from each participant who were followed up for 90 days. Dates of subsequent doses of the vaccines were recorded. Multivariate analysis was performed using the log-rank test and Cox's regression analysis to identify predictive factors. RESULTS: Only 43.5% (174/400) and 24.8% (89/359) of children completed the OPV3 and DTP3 vaccines, respectively. Factors predictive of uptake of OPV3 were first birth (HR=1.66, 95% CI 1.11-2.48) and attending a tertiary health facility (HR=2.27, 95% CI 1.41-3.65), while attending a secondary health facility was significant for DTP3 uptake (HR=2.43, 95% CI 1.30-4.61). CONCLUSIONS: Uptake of third doses of vaccines was influenced by the type of health facility attended and the child birth order. Efforts to reduce vaccination dropouts should include creation of awareness of the importance of completing immunisation schedules for children of higher birth orders as well as improved service delivery at health facilities.

Assessing full immunisation coverage using lot quality assurance sampling in urban and rural districts of southwest Nigeria.

BACKGROUND: This study was conducted to identify administrative wards (lots) with unacceptable levels of full child immunisation coverage, and to identify factors associated with achievement of a complete child immunisation schedule in Ibadan North East (IBNE) and Ido local government areas (LGAs) of Oyo State, Nigeria. METHODS: A cross-sectional survey involving 1178 mothers, 588 from IBNE LGAs and 590 from Ido LGAs, with children 12-23 months of age was conducted. Children were considered 'fully-immunised' if they received all the vaccines included in the immunisation schedule. Lot quality assurance sampling was used to determine lots with acceptable and non-acceptable coverage. Samples were weighted based on the population by lot to estimate overall coverage in the two LGAs and a logistic regression model was used to identify factors associated with the fully immunised child. RESULTS: Mean age of the mothers was 28.5 ± 5.6 and 28.1± 6.0 years in IBNE and Ido LGAs, respectively. Eleven of 12 wards in IBNE and all the wards in Ido had unacceptable coverage. The proportion of fully immunised children was 40.2% in IBNE and 41.3% in Ido. Maternal age ≥30 years, retention of an immunisation card, completion of tertiary education, or secondary education, hospital birth and first-order birth were significant predictors of complete childhood immunisation. CONCLUSION: The level of full immunisation coverage was unacceptable in almost all the wards. Educational intervention on the importance of completion of immunisation schedule should target young, uneducated mothers, mothers who delivered their babies at home and those with a high birth order.

Willingness to receive pandemic influenza A (H1N1) vaccine among doctors and nurses in public health facilities in Ibadan, Nigeria.

BACKGROUND: As part of global efforts to contain the spread of the 2009 pandemic influenza A (H1N1), the Federal Ministry of Health of Nigeria is embarking on the vaccination of health care workers employed in health facilities nationwide. This study was designed to assess the willingness of doctors and nurses working in public health facilities in Ibadan, Nigeria to receive the influenza A (H1N1) vaccine. METHODS: A descriptive cross-sectional study design was employed. Stratified simple random sampling was used to select a total of 304 doctors and nurses who worked at the public primary (70), secondary (51) and tertiary (183) levels of health care facilities in Ibadan. A self-administered, structured questionnaire that contained items on socio-demographics, sources of information, knowledge about the infection and the vaccine, risk perception, willingness to receive the vaccine and suggestions to improve vaccination acceptance by health-care workers was used to collect the data. MAIN FINDINGS: A total of 255 providers responded for an overall response rate of 84%. The mean age of the respondents was 35.0 ± 9.7 years. A high proportion (88.2%) of the participants, including 94.9% of the doctors and 87.0% of the nurses, reported a willingness to receive the vaccine. Perceptions regarding the risk of contracting influenza, the availability of effective vaccinations for prevention and beliefs that the disease is fatal were reasons given by respondents who reported willingness to receive the vaccination. Those participants who reported ever hearing about the pandemic (AOR 2.0, 95% CI 1.2-3.2) and those who had a high-risk perception of contracting the disease (AOR 2.0, 95% CI 1.2-3.7) were likely to receive the vaccine. CONCLUSION: Doctors and nurses at the three levels of health care facilities in Ibadan were willing to receive the pandemic influenza A (H1N1) vaccine. Efforts should be made to deliver the vaccines via adequate planning.

Reducing waiting time at a Nigerian HIV treatment clinic: opinions from and the satisfaction of people living with HIV/AIDS.

We assessed the waiting time and perceived satisfaction with care among people living with HIV/AIDS (PLHIV) at an antiretroviral clinic in Nigeria. A structured questionnaire was administered during interviews. Four hundred patients completed the questionnaire. The mean age of the respondents was 36.4 years (SD 9.7 years), and 61% of them were females. A majority, 72.9%, reported that the time elapsed between entry into the clinic and access to medical care services (waiting time) was more than an hour. However, a majority (77%) expressed satisfaction with the medical care they received. Although the majority of PLHIV were satisfied with their medical care, more needs to be done to reduce patient waiting time before access to medical services.

Knowledge and attitudes regarding HIV/AIDS and antiretroviral therapy among patients at a Nigerian treatment clinic.

INTRODUCTION: We assessed the knowledge of and attitudes toward HIV/AIDS and antiretroviral therapy (ART) in people living with HIV/AIDS (PLWHA). METHODOLOGY: A descriptive, cross-sectional study design was employed. A structured interviewer-administered questionnaire was administered to consecutive, consenting PLWHA who had been receiving treatment for a minimum of three months. The level of ART adherence was calculated manually for each respondent. RESULTS: In total 318 PLWHA completed the questionnaire. The mean and median time on ART was 17.8 months and 19 months respectively. The mean age of the respondents was 39.1±9.6 years. The majority of these respondents (76.9%) had completed secondary education. Over 80% of the respondents reported knowing that HIV can be transmitted through blood transfusions and unprotected sexual intercourse. Seventy-six per cent of the respondents reported knowing that ART suppresses HIV activity. However, 33% of the respondents denied being HIV positive, while 22.6% reported that they felt that taking ART was shameful. Over 32% of the respondents reported that good adherence to ART would raise suspicions about their HIV status, and 66.7% had not yet disclosed their HIV status to anyone. Most (77.7%) respondents had good knowledge of HIV/AIDS while 75.2% had good knowledge of ART. Also 78.9% had positive attitude to HIV/AIDS while 73.9%) had positive attitude to ART. Respondents with good knowledge about HIV/AIDS and a positive attitude about the disease tended to be more adherent to ART (p < 0.01). CONCLUSIONS: The majority of respondents had good knowledge of and a positive attitude toward HIV/AIDS and ART adherence.

Maternal determinants of complete child immunization among children aged 12-23 months in a southern district of Nigeria.

This study was conducted to identify determinants of complete immunization status among children aged 12-23 months in a southern district of Nigeria. The World Health Organization cluster survey was used to evaluate immunization coverage of infants. Mothers of 525 children selected by the two-stage sampling method and interviewed using an adapted questionnaire responded. Completion of the immunization schedule was verified by an immunization card or by reported history indicating that the child had received full doses of four of the antigens included in the Nigeria routine immunization schedule. Multivariate logistic regression was used to identify factors associated with completion of immunization. Only 32.4% of children had completed the immunization schedule. Determinants of complete immunization status included a maternal age less than 30 years (AOR=2.26, 95% CI:1.27-4.03), availability of an immunization card at first contact (AOR=7.72, 95% CI:4.43-13.44), fewer than three children (AOR=2.22, 95% CI:11.1-4.42), completion of post secondary education (AOR=2.34, 95% CI:1.12-4.47) and maternal unemployment (AOR=1.71, 95% CI:1.01-2.89). Identifying mothers whose children are at risk of not completing the immunization schedule and educating them is an important strategy to improve antigen coverage and prevent early childhood deaths from diseases like tuberculosis, poliomyelitis, tetanus, diphtheria, pertussis and measles.

Human immunodeficiency virus postexposure prophylaxis at IBadan, Nigeria.

HIV infection from occupational and nonoccupational exposures can be prevented through risk assessment and management with antiretroviral drug therapy (ART). This study sought to examine the pattern of presentation and outcome of clients who were given postexposure prophylaxis (PEP) at the University College Hospital, Ibadan, Nigeria. A retrospective review of case notes of clients presenting for HIV PEP from January 2005 to December 2006 was carried out. A total of 48 clients with a mean age of 27.9 +/- 12.3 years underwent PEP during the period under review. Rape constituted 50% of reasons for PEP, while needle pricks and blood splash into mucous membranes constituted 25% each. Among those who received therapy, 10 (23.8%) could not complete drug therapy because of side effects. Although no client was HIV positive after the recommended 6 months of follow-up, 8 (16.7%) clients did not complete attendance to the clinic during the period.

Cost-effectiveness of screening methods for urinary schistosomiasis in a school-based control programme in Ibadan, Nigeria.

OBJECTIVE: To carry out a comparative cost-effectiveness analysis of screening methods for urinary schistosomiasis; terminal haematuria, unqualified haematuria, dysuria, visual urine examination and chemical reagent strip technique, in a school-based control programme. DESIGN: Estimation of costs and determination of cost-effect ratios of the screening methods applied in a school-based screening and treatment programme, from the perspective of a programme manager. SETTING: A junior secondary school in Ibadan, Nigeria. MAIN OUTCOME MEASURES: Cost per number of cases correctly diagnosed. RESULTS: Unqualified haematuria was found to be the most cost-effective method costing N51.06 (US$ 2.16) to diagnose a case correctly, followed by terminal haematuria N58.91 (US$ 2.50) and dysuria N84.24 (US$ 3.57). Despite the relatively high input costs of chemical reagent strip technique over visual urine examination (N22.12 (US$ 0.94) per student vs. N6.44 (US$ 0.27) per student), it was found to be more cost effective costing N304.56 (US$ 12.91) to diagnose a case correctly than visual examination of urine cost of N317.58 (US$ 13.46) per correct case diagnosed. CONCLUSION: From the viewpoint of a programme manager, interview method of screening by asking for blood in the urine remains the most efficient means of screening for urinary schistosomiasis in school-based control programmes in our environment.