Missed opportunities for Intermittent Preventive Treatment of Malaria among pregnant women with the recommended number of antenatal care visits in Nigeria: Secondary Analysis of Malaria Indicator Survey 2021.

BACKGROUND AND OBJECTIVES: Missed opportunity (MO) for IPTp SP remains high in Nigeria even among pregnant women with four or more ANC visits. We assessed the current MO rate and its predictors, using data from the 2021 MIS. METHODS: We carried out a secondary analysis of data of women who had at least one live birth and at least 4 ANC visits. Bivariate analyses assessed the relationship between socio-demographic characteristics, type of ANC facility, type of ANC provider, knowledge of malaria prevention, awareness about IPT, and missed opportunity using the Chi-square test. Multivariate analyses were presented as odd ratios at 95% CI, (P value <0.05). RESULTS: Nearly half (47%) had only primary education or none at all. About 30% were poor. Most had their 1st visit ANC in the 2nd trimester (58%). The missed opportunity rate was 55%. Predictors included age 20 to 34 years [aOR 1.3(1.1-1.67)], being very poor [aOR 1.6(1.1-2.4)], late ANC (in 2nd or 3rd trimester) [aOR 0.57(0.4-0.89)], ignorance about malaria prevention [aOR 1.8(1.4-2.4)], ignorance about IPT [aOR 1.3(1.3-2.5)] and residence in the South South and North East [aOR 0.46(0.31-0.68)] regions. CONCLUSIONS: The missed opportunity was high. Place of residence, poor knowledge of malaria prevention and IPT use, late commencement of ANC, poverty, and young age (20 to 34 years) contributed to the burden. Recommendations include stressing the importance of IPT during health talks. Provision of cups and drinking water for the IPT DOT policy by the Government and partners. There is a need for further research to unravel the reasons for the higher MO rates in some regions.

CONTEXTE: Les opportunités manquées (OM) pour le TPIp SP restent élevées au Nigéria, même parmi les femmes enceintes ayant effectué quatre visites ou plus aux soins prénatals. Nous avons évalué le taux actuel d'OM et ses prédicteurs en utilisant les données de l'Enquête sur les Indicateurs du Paludisme de 2021. MÉTHODE: Nous avons réalisé une analyse secondaire des données des femmes ayant eu au moins une naissance en vie et au moins quatre visites de soins prénatals. Les analyses bivariées ont évalué la relation entre les caractéristiques sociodémographiques, le type d'installation de soins prénatals, le type de prestataire de soins prénatals, la connaissance de la prévention du paludisme, la sensibilisation à propos du TPIp, et les opportunités manquées en utilisant le test du chi-carré. Les analyses multivariées ont été présentées sous forme de cotes ajustées avec un intervalle de confiance de 95 % (valeur de p<0,05). RÉSULTATS: Près de la moitié (47 %) avaient seulement une éducation primaire ou n'en avaient pas du tout. Environ 30 % étaient pauvres. La plupart ont effectué leur 1ère visite prénatale au cours du 2ème trimestre (58 %). Le taux d'opportunités manquées était de 55 %. Les prédicteurs comprenaient l'âge de 20 à 34 ans [aOR 1,3 (1,1-1,67)], être très pauvre [aOR 1,6 (1,1-2,4)], début tardif des soins prénatals (au 2ème ou 3ème trimestre) [aOR 0,57 (0,4-0,89)], ignorance de la prévention du paludisme [aOR 1,8 (1,4-2,4)], ignorance du TPIp [aOR 1,3 (1,3-2,5)] et résider dans les régions du Sud-Sud et du Nord-Est [aOR 0,46 (0,31-0,68)]. CONCLUSION: Les opportunités manquées étaient élevées. Le lieu de résidence, la méconnaissance de la prévention du paludisme et de l'utilisation du TPIp, le début tardif des soins prénatals, la pauvreté et l'âge jeune (20 à 34 ans) ont contribué à cette charge. Les recommandations incluent de souligner l'importance du TPIp lors des entretiens de santé. La fourniture de gobelets et d'eau potable pour la politique de l'administration directe du TPI par le gouvernement et les partenaires. Il est nécessaire de poursuivre la recherche pour découvrir les raisons des taux plus élevés d'OM dans certaines régions. Mots-clés: Paludisme pendant la grossesse, traitement préventif intermittent, sulfadoxine-pyriméthamine, opportunité manquée, soins prénatals.

Determinants of diarrhoeal disease in children living in low-income households in a periurban community in Cape Town, South Africa

Background. Water, sanitation and hygiene are critically important in reducing morbidity and mortality from childhood diarrhoeal disease and malnutrition in low-income settings.Objectives. To assess the association of diarrhoeal disease with factors relating to domestic hygiene, the environment, sociodemographic status and anthropometry in children <2 years of age.Methods. This was a case-control study conducted in a periurban community 35 km from the centre of Cape Town, South Africa. The study included 100 children with diarrhoeal disease and 100 age-matched controls without diarrhoea, who were recruited at primary healthcare clinics. Sociodemographic status, environmental factors and domestic hygiene were assessed using a structured questionnaire; anthropometry was assessed using the World Health Organization's child growth standards. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with diarrhoea. Results. The results of the univariate logistic regression showed significant susceptibility to diarrhoea in study cases compared with controls when the caregiver was ≥25 years old (odds ratio (OR) 1.82; 95% confidence interval (CI) 1.02 - 3.23; p=0.042); when children were in day care or cared for by a family member or a relative than when cared for by their mother (OR 1.97; 95% CI 1.06 - 3.65; p=0.032); and when the mothers were employed rather than at home (OR 2.23; 95% CI 1.21 - 4.12; p=0.01). Multivariate logistic regression analysis was used to identify predictors of diarrhoea, which entailed relaxing the inclusion criteria for the univariate analysis variables (p<0.25). The predictors significantly associated with diarrhoea were household problems relating to rat infestation (OR 2.44; 95% CI 1.13 - 5.28; p=0.027); maternal employment (OR 2.47; 95% CI 1.28 - 4.76; p=0.007); and children in day care or cared for by a relative (OR 2.34; 95% CI 1.21 - 4.54; p=0.01). Significantly more of the mothers who were employed than those who were unemployed had children in day care or cared for by a relative. Conclusion. Practices relating to employment, childcare and the domestic environment were significant predictors of diarrhoea. Effective policy implementation on water, sanitation and domestic hygiene could prevent diarrhoeal disease and reduce its impact on children's growth, especially during the annual diarrhoeal surge season in this and similar periurban communities.

Predictors of pediatric HIV disclosure among caregivers of HIV positive children attending special treatment clinic in dalhatu araf specialist hospital, Lafia, Nigeria.

BACKGROUND: HIV-infected children now live longer due to the availability of HIV counseling, testing, and treatment with highly active antiretroviral treatment (HAART). Efforts to help these children to know about the HIV infection and their status are important steps toward long-term disease management. This study was conducted to determine the factors associated with pediatric HIV disclosure among caregivers of children attending Special Treatment Clinic at Dalhatu Araf Specialist Hospital, Lafia. METHODS: This was a descriptive cross-sectional study conducted among 160 caregivers of children attending the Special Treatment Clinic (STC) at DASH, Lafia, selected by systematic random sampling technique. Interviewer administered structured questionnaire was used to collect data, while bivariate and multivariate analyses were done with the Epi Info version 7. RESULTS: Pediatric HIV disclosure rate in this study was 33.8%. The mean age at pediatric HIV disclosure was 9.85 ± 1.86 years. The independent predictors for pediatric HIV disclosure following logistic regression were child's age, 10-14 years (AOR = 4.46; 95%CI 1.47-13.61), child knowledge of caregivers' HIV status (AOR = 51.18; 95%CI 13.40-195.66), and caregivers' age ≥40 years (AOR = 3.58; 95%CI 1.25-11.74). CONCLUSIONS: The pediatric HIV disclosure was low in this study due to the caregivers' and their wards' factors. Health care workers need to intensify health education on the benefit of pediatric HIV disclosure at the STC clinic.

Effect of Training on Knowledge and Attitude of Health Care Workers towards Health Management Information System in Primary Health Centres in Northwest Nigeria.

BACKGROUND: An effective health information system (his) generates information to enable decision makers make evidence-based decisions on health policy and allocate scarce resources. Health care workers at all levels within the health system need the knowledge and the right attitude towards hmis recognizing that they are the keys to recording accurate and reliable data. STUDY DESIGN: A quasi-experimental study design was used, which consisted of baseline, intervention and end line components. RESULTS: The study was carried out among a study and a control group, each consisting of 76 phc workers. The mean age was 34.6 + 8.3 years for the study group and 33.7 + 8.4 years for the control group. The baseline level of good knowledge in the study group increased from 13.2% to 48.7% at end line. The increase was statistically significant (p-value <0.001). In the control group the level of good knowledge increased from 6.6% to 9.7%. The increase was not statistically significant (p-value 0.714). Prior to the intervention, 52.6% of the study group had positive attitude towards hmis which increased to 59.2% after the intervention (p-value 0.414). In the control group, it decreased from 59.2% at baseline to 58.3% at end line (p-value 0.117). The changes in attitude in both groups were, however, not statistically significant. CONCLUSION: This study showed that HMIS training intervention achieved a significant improvement in knowledge and a marginal improvement in the attitude of phc workers. Thus, the training intervention was effective in improving the knowledge and attitude towards hmis in the study group.

Proof of concept of mass dog vaccination for thecontrol and elimination of canine rabies.

For more than 100 years, canine rabies vaccination has been available as a tool for rabies control and elimination. However, domestic dogs still remain a major reservoir for rabies, and although canine rabies has been eliminated through mass dog vaccination in some parts of the world, the disease continues to kill tens of thousands of people every year in Africa and Asia. This review focuses on the situation on those two continents, presenting evidence to show that canine rabies elimination is both epidemiologically and operationally feasible, and could be achieved across a wide range of settings in Africa and Asia. The challenges of achieving the large-scale, comprehensive dog vaccination coverage that is required are discussed, and opportunities for developing new strategies that generate multiple benefits for human and animal health and welfare are highlighted. Finally, the substantial progress that has been made in developing the tools, partnerships and frameworks needed to move towards global canine rabies elimination is outlined.

La vaccination antirabique des chiens est pratiquée depuis plus d'un siècle en tant qu'outil de contrôle et d'élimination de la rage. Néanmoins, les chiens domestiques constituent encore aujourd'hui un réservoir majeur du virus de la rage et si la rage canine a pu être éliminée dans certaines régions du monde grâce à la vaccination massive des chiens, la maladie continue de faire des dizaines de milliers de victimes humaines chaque année en Afrique et en Asie. Les auteurs font le point sur la situation dans ces deux continents en montrant que l'élimination de la rage canine est un objectif réaliste, tant au plan épidémiologique qu'opérationnel, et atteignable dans de très diverses configurations d'Afrique et d'Asie. Ils décrivent les difficultés d'obtenir le niveau requis de couverture vaccinale des populations canines en termes d'effectifs vaccinés et de territoires couverts, et soulignent les perspectives de développement de nouvelles stratégies pouvant générer de multiples bénéfices pour la santé et le bien-être des hommes et des animaux. Enfin, ils évoquent les progrès considérables accomplis dans la mise en place des outils, des partenariats et des cadres nécessaires pour avancer vers l'objectif de l'élimination mondiale de la rage canine.

La vacunación contra la rabia canina es una herramienta utilizada desde hace más de 100 años con fines de control y eliminación de la enfermedad. No obstante, los perros domésticos aún constituyen un importante reservorio de rabia, y pese que en algunas partes del mundo se ha logrado eliminar la rabia canina gracias a la vacunación masiva de perros, esta afección sigue matando a decenas de miles de personas al año en África y Asia. Los autores, centrándose en la situación reinante en estos dos continentes, presentan datos demostrativos de que la eliminación de la rabia canina es un objetivo factible tanto epidemiológica como operativamente, hacedero en muy diversos lugares de África y Asia. También exponen los problemas existentes para lograr la amplia cobertura de vacunación canina a gran escala que se requiere para cumplir tal objetivo y destacan las oportunidades existentes para elaborar nuevas estrategias que deparen múltiples beneficios para la salud y el bienestar de personas y animales. Por último, repasan a grandes líneas los sustanciales progresos registrados en la creación de las herramientas, las alianzas y los marcos de referencia que se necesitan para avanzar hacia la eliminación de la rabia canina en todo el mundo.

Towards Canine Rabies Elimination in South-Eastern Tanzania: Assessment of Health Economic Data.

An estimated 59 000 people die annually from rabies, keeping this zoonosis on the forefront of neglected diseases, especially in the developing world. Most deaths occur after being bitten by a rabid dog. Those exposed to a suspect rabid animal should receive appropriate post-exposure prophylaxis (PEP) or risk death. However, vaccination of dogs to control and eliminate canine rabies at the source has been implemented in many places around the world. Here, we analysed the vaccination and cost data for one such campaign in the area surrounding and including Dar es Salaam, Tanzania and estimated the cost per dog vaccinated. We also estimated the cost of human PEP. We found that the cost per dog vaccinated ranged from $2.50 to $22.49 across districts and phases, with the phase average ranging from $7.30 to $11.27. These figures were influenced by over purchase of vaccine in the early phases of the programme and the significant costs associated with purchasing equipment for a programme starting from scratch. The cost per human PEP course administered was approximately $24.41, with the average patient receiving 2.5 of the recommended four vaccine doses per suspect bite. This study provides valuable financial insights into programme managers and policymakers working towards rabies elimination.

Financial hardship in settling medical bills among households in a Semi-Urban Community in Northwest Nigeria.

BACKGROUND: An equitable health care system that responds to the needs of its people is important to break the cycle of poverty and ill-health. However, rising health care cost, and the preponderance of user fees to finance health care have often limited access to needed health services. STUDY DESIGN: A cross-sectional descriptive study design was employed, using a pretested, semi-structured, interviewer-administered questionnaire. RESULTS: The study was carried out among 188 respondents. Majority (88.2%) of the respondents were within the age-group 20-49 years, about two-thirds 63.8% were married and about half (42.8%) had family size between 5 and 9. The study revealed that about a quarter (26.1%) experienced hardship in settling their medical bills. While one-third (31.1%) had to sell their assets, about half (45.2%) had to secure loan while 16.6% had to resort to begging because of hardship encountered in settling the medical bills. Furthermore, of those who sold theirs asset; 46.2% sold their farmlands, 38.5% sold a piece of land, while 16.3% sold their vehicles. CONCLUSION: This study has revealed that inhabitants of Samaru community experience hardship in settling their medical bills. Consequently, innovative strategies like deferment of payment and fee exemption, enrolling into community-based health insurance schemes as well as voluntary contributory health insurance schemes etc need to be considered, in order to alleviate the hardship in settling the medical bills.

Understanding the Barriers to the Utilization of Primary Health Care in a Low-Income Setting: Implications for Health Policy and Planning.

The essence of primary health care is the provision of essential health services and commodities to individuals and communities using available, acceptable and sustainable resources. However, there has been a growing lack of confidence by the populace as evidenced by poor utilization of the services. This study sought to identify the predominant barriers affecting the utilization of primary health care services in Batsari Local Government in Katsina State, Nigeria. A cluster of 630 households was surveyed in the catchment of the 21 health primary health facilities. A catchment been defined as a household located within 5 km of a primary health center. Using a three digit randomly generated numbers a household was selected. Once selected the start house and twenty-nine contiguous houses were visited. a total of 630 households were surveyed. In all households, questions were asked on the predominant health problems, as well as the major determinants of access and utilization of primary health care services .The results were computed and analyzed using the Statistical Package for Social Sciences software SPSS. Version 17.0. The findings from all the respondents (n=630) showed that majority of the people preferred to seek care from the patent medicine stores (53.63%) as against only 7.6% who utilized the primary health care services. The commonest reasons why respondents do not utilize these services were lack of essential drugs, high cost of services as well as inadequate infrastructure in primary healthcare facilities. The study has highlighted some of the multiple factors affecting the utilization of primary healthcare services. It is expected that these findings will guide policy makers in improving healthcare delivery particularly where the need is greatest - at the grassroots - in line with the national health policy and national health strategic development plan.

Nutritional status and pattern of infant feeding practices among children under five in a rural community of northwestern Nigeria.

The study assessed the factors influencing nutritional status of children less than five years in Biye village in rural Nigeria. The study was a cross sectional descriptive study: 119 caregivers and mothers were interviewed. A structured questionnaire was used to collect data using multi-stage sampling. Anthropometric measurements of children were also taken. Data analysis was done using SPSS version 17.0. Respondents age ranged from 11-50 years, mean age of 26 (± 11.7); 79.8% had Quranic education; and 50.4% were not gainfully employed. Two-thirds (68.9%) were polygamous, and 64.7% had 1-3 children. Less than 1% of children were exclusively breast fed. From anthropometric data obtained, 62.2% were stunted, 12.6% wasted, and 48.7% underweight. A statistically significant relationship exists between family size and children's nutritional status. The prevalence of malnutrition was high with poor child feeding practices. Thus, healthcare providers should carry out community-wide health education on the need to promote appropriate infant feeding practices and nutritional status.

Quality of care in primary health centres of Tafa Local Government Area of Niger state, North central Nigeria; the clients' perspective.

BACKGROUND: Quality of care is one of the major public health concerns in this 21st century. We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area in Niger state North central Nigeria. METHODOLOGY: A cross sectional descriptive study was conducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. RESULTS: Result from the research shows that more than one-third (39%) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7%) of the total clients load. On their experiences during receiving care all the clients (100%) were seen by the health worker, more than half of the clients (57%) obtained all drugs prescribed, three-quarter (76%) were satisfied with questions asked during consultation and less than half (44%) were examined. Furthermore, more than four-fifth (83%) were informed on how to take drugs and 62% were informed of when to come back. More than one-third of the respondents (36.7%) waited for about 1-3 hrs.. When their overall satisfaction was placed on the Likert's 5-point scale, 3% highly satisfied, 8% were satisfied, 39% fairly satisfied, 29% dissatisfied and 9% were highly dissatisfied. CONCLUSION: In conclusion, despite the level of advancement attained in health care in the 21st century which is regarded as the era of Total Quality Management, Quality of care in primary health care centres leaves much to be desired. This therefore calls for an urgent, deliberate, sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system.

Contraceptive knowledge, attitudes and practice among married women in Samaru community, Zaria, Nigeria.

Contraceptive use and fertility rates vary substantially among developing countries. In some sub-Saharan African countries, fewer than 10% of married women use contraception. Despite all efforts by governments to ensure availability of the products, prevalence has remained low. We conducted a community-based study to examine contraceptive knowledge, attitude and practice of family planning among married women in Samaru, Zaria, Nigeria. Multi-stage random sampling technique was used to study 200 women in Samaru community of Zaria, Nigeria. Mean age of the respondents was 30.6 +/- 1.5 years. In this study contraceptive prevalence was 12.5% and respondents had a positive attitude towards family planning. Thirty years after Alma Ata of which one of the components is to ensure maternal and child health (MCH) and family planning, contraceptive use in most of the communities in Northern Nigeria is low. There is urgent need to step-up public awareness campaigns on family planning to ensure wide spread acceptability and utilization among women within reproductive age group.

Quality of Care in Primary Health Centres of Tafa Local Government Area of Niger State; North Central Nigeria; The Clients' Perspective

Background: Quality of care is one of the major public health concerns in this 21 century.We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area in Niger state North central Nigeria. Methodology: A cross sectional descriptive study was conducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. Results:Result from the research shows that more than one-third (39) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7) of the total clients load. On their experiences during receiving care all the clients (100) were seen by the health worker; more than half of the clients (57) obtained all drugs prescribed; three-quarter (76) were satisfied with questions asked during consultation and less than half (44) were examined. Furthermore; more than four-fifth (83) were informed on how to take drugs and 62were informed of when to come back. More than one-third of the respondents (36.7) waited for about 1- 3hrs.. When their overall satisfaction was placed on the Likert's 5-point scale; 3highly satisfied; 8were satisfied; 39fairly satisfied; 29dissatisfied and 9were highly dissatisfied. Conclusion:In conclusion; despite the level of advancement attained in health care in the 21 century which is regarded as the era of Total Quality Management; Quality of care in primary health care centres leavesmuch to be desired. This therefore calls for an urgent; deliberate; sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system

Quality of Care in Primary Health Centres of Tafa Local Government Area of Niger State; North Central Nigeria; the Clients' Perspective

Quality of care is one of the major public health concerns in this 21 century.We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area in Niger state North central Nigeria. A cross sectional descriptive study was conducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. Result from the research shows that more than one-third (39) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7) of the total clients load. On their experiences during receiving care all the clients (100) were seen by the health worker; more than half of the clients (57) obtained all drugs prescribed; three-quarter (76) were satisfied with questions asked during consultation and less than half (44) were examined. Furthermore; more than four-fifth (83) were informed on how to take drugs and 62were informed of when to come back. More than one-third of the respondents (36.7) waited for about 1- 3hrs.. When their overall satisfaction was placed on the Likert's 5-point scale; 3highly satisfied; 8were satisfied; 39fairly satisfied; 29dissatisfied and 9were highly dissatisfied : In conclusion; despite the level of advancement attained in health care in the 21 century which is regarded as the era of Total Quality Management; Quality of care in primary health care centres leaves much to be desired. This therefore calls for an urgent; deliberate; sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system

Psycho-active substance use among in-school adolescents in Zaria, north western Nigeria: what are the triggers?

BACKGROUND: Psycho-active substances have been used by various societies since the dawn of civilization, and still remain a major public health concern in the 21st century. Evidence has shown that in the last 2 decades in Nigeria, adolescents are a major group involved in the use of psychoactive substances. The study was carried out to determine pattern of use and the push factors for such use among in school adolescents in Zaria, Nigeria. METHOD: The study was cross sectional descriptive in design. A multi-stage sampling technique was used to interview 280 respondents using self administered, structured and pre tested questionnaires. Data was analyzed manually and chi-square test statistic was used to test for significance of association between categorical variables at p value of < 0.05. RESULTS: A total of 280 respondents, 195 (69.6%) males and 85 (30.4%) females senior secondary school adolescent were interviewed. The study shows that 157 (56%) use one or more substance or the other. The commonest ones are kola nut followed by cigarette and marijuana. The commonest push factor for use is to experiment (54%). The study also shows, statistically significant relationship between family background and psychoactive substance use (chi2 = 21.57, df = 2 p < 0.05), there was however no statistical significance between age, class of the students and substance use respectively (chi2 = 1.94, df = 2 p > 0.05) (chi2 = 0.97, df = 2p > 0.05). CONCLUSION: The prevalence of psychoactive substances use is unacceptably high and the main trigger identified was the process of experimentation in order to discover their effects. There is the need to institutionalize preventive strategies against substance abuse in our secondary schools. Further studies in this area are also recommended.

Essential drugs in primary health centres of north central Nigeria; where is Bamako initiative?

OBJECTIVE: To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. METHODS: Checklist consisting of minimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development Agency (NPHCDA) was adopted and used to assess drugs availability, while Focus Group Discussions were conducted to determine the perceptions of clients on drugs situation in the health centres. RESULTS: Results show that, all the 3 primary health centres in Tafa LGA do not implement Bamako initiative (BI) and none was operating Drug Revolving Fund (DRF) system. Out of the minimum recommended score of 54 points for the availability and adequacy of drugs and consumables, New Wuse primary health centre in the LGAheadquarters scored highest points of 19, while New Bwari and Iku primary health centres scored 13 points each. All these are far below the minimum requirement. Similarly, the results of the FGDs confirmed poor availability of drugs and clients dissatisfactions with the drugs situation in the primary health centres. CONCLUSION: This study has revealed that despite Bamako Initiatives put in place in late 80s essentials drugs are still mirages in many of the primary health care facilities in the study area. It is therefore recommended that, any effort aimed at reforming or repositioning primary health care must take into account resuscitating Bamako Initiative by ensuring functional DRF system in all the primary care facilities.

Duration of secretory IgM and IgA antibodies to respiratory syncytial virus in a community study in Guinea-Bissau.

Respiratory syncytial virus (RSV) is probably the single major cause of lower respiratory infection (LRI) among infants worldwide. Its relative importance may be underestimated, as the diagnosis is based on antigen detection and antigen may only be detectable in the early phase of infection. We have therefore assessed the duration of secretory IgM and IgA antibody responses and whether assays for these antibodies can be used to improve the diagnosing of RSV-associated infections. During two RSV epidemics in Guinea-Bissau, 32 RSV antigen-positive children with LRI were followed with sequential nasopharyngeal suction on days 7, 14, 30, 60 and 120 in the first epidemic and every fortnight for 6 mo after the second epidemic to measure the duration of secretory IgM and IgA responses. Nearly all of the children had an IgM response during the first month after infection. The response ratio was highest on days 7 and 14, being 84% and 71%, respectively. After 30 d the IgM response decreased rapidly. Among 27 age- and sex-matched controls, only 1 child was positive for IgM. During the second epidemic, when the children were followed more intensively, half of the children were IgM-positive after the acute phase of infection. A secondary response may be more likely in children with low IgM responses in the acute phase (RR = 2.08 (95% confidence interval (CI) 0.92-4.70)). The IgA response was highest on days 28 and 42 after antigen detection, 72% having a detectable IgA response within the first 1.5 mo. Among 27 controls, only 2 were IgA-positive (7%). In the second epidemic with more intensive follow-up, 62% (8/13) of the IgA-positive children had a response that lasted 10 wk. Of the children with no persistent IgA response, half (5/10) had a subsequent IgA-positive response after the first 42 d. All of these children had a simultaneous IgM-positive response. When 29 of the children were tested after an epidemic when they were 1-3-y-old, >80% again had high IgM (24/29, 82%) and IgA (28/29, 94%) levels. Among samples collected over a 1-y period from infants with LRI in a community morbidity surveillance conducted at the local health centre and via paediatric outpatient consultation, 17% (110/659) were antigen-positive, 26% (171/659) IgM-positive and 38% (248/659) either antigen- or IgM-positive. IgM responses are short-lived among infants and may therefore be used as an indication of recent RSV infection among children with LRI. Using both antigen and IgM detection may significantly improve our detection of RSV infections.

Secretory IgM and IgA antibodies to respiratory syncytial virus in nasopharyngeal aspirates: a diagnostic supplement to antigen detection.

BACKGROUND: RSV-shedding during an RSV-infection declines dramatically after the first week of infection. It could be of interest to be able to diagnose RSV-infection for a longer period of time by detection of specific RSV-IgM and RSV-IgA in nasopharyngeal aspirates (NPA) in order to minimize unnecessary antibiotics. OBJECTIVES: To evaluate an ELISA to detect specific RSV-IgM and RSV-IgA in NPA as a supplement to RSV-antigen detection. STUDY DESIGN: A total of 104 NPA from 101 children (median age 9 months) with acute respiratory disease (group 1) admitted to hospital and consecutive NPA (collected on day 0, 7, 14, 30 and 60) from 11 children (median age 3 months) with a proven RSV infection (group 2) were collected. All NPA from group 1 were analysed for RSV-antigen, RSV-IgM and RSV-IgA. NPA from group 2 were analysed for RSV-IgM and RSV-IgA. RESULTS: Thirty-five NPA in group 1 were positive for RSV-antigen and 64 were positive for RSV-antigen test alone found 44% and the RSV-IgM test alone found 80%. In group 2 8/11 (73%) has an excellent RSV-IgM response day 7, the rest responded later. Only 5/11 (46%) had a less pronounced RSV-IgA response on day 7, three cases responded later and three did not respond at all. RSV-IgM disappeared in 8/11 (73%) and RSV-IgA in 7/8 (88%) between day 30-60. CONCLUSIONS: Specific RSV-IgM is a valuable supplement to RSV-antigen detection for the diagnosis of acute and recent RSV infection.