Are rural pregnant women disadvantaged in accessing intermittent preventive treatment in pregnancy in Ebonyi State, Nigeria?

INTRODUCTION: Adequate intermittent preventive treatment (IPTp) uptake (≥3 doses) routinely delivered at antenatal clinics is effective in preventing malaria during pregnancy. Whereas, low IPTp uptake (24.0%) had been reported among pregnant women in Ebonyi State, there is paucity of studies comparing the uptake and its predictors in the urban and rural areas of Ebonyi State. We determined IPTp uptake and its predictors in the urban and rural areas of Ebonyi State. METHODS: We conducted a cross-sectional comparative study among 864 reproductive age women selected using multistage sampling. Using a structured interviewer-administered questionnaire, we collected data on respondent's socio-demographic characteristics and IPTp uptake. Uptake was adjudged adequate if ≥3 doses were taken, otherwise inadequate. We estimated the proportion of women with adequate IPTp uptake and determined the factors associated with adequate uptake in rural and urban areas using chi square and multiple logistic regression at 5% level of significance. RESULTS: The mean ages of respondents in the urban and rural areas were 28.5±4.6 and 27.4±5.0 years respectively. Adequate IPTp uptake was 82.5% and 60.8% in the urban and rural respectively (p<0.001). In the urban area, women whose husbands had attained ≥ secondary education (aOR:2.9; 95%CI:1.2-7.4; p = 0.02) and those who paid for sulfadoxine/pyrimethamime (aOR:0.2; 95%CI: 0.1-0.6; p = 0.01) were 2.9 times more likely and 5 times less likely to take adequate IPTp respectively compared to respondents whose husbands had attained ≤ primary education and those who had sulfadoxine/pyrimethamine free. In the rural area, women who had attended ANC <4 times (aOR:0.4; 95%CI: 0.3-0.7; p<0.001) were 2.5 times less likely to take adequate IPTp compared to women that had attended ANC ≥4 times. CONCLUSION: Uptake of IPTp was more in the urban than rural areas of Ebonyi State. Interventions that reinforce the importance of health professionals carrying out actions aimed at pregnant women and their partners (spousal) in order to guide them on preventive actions against malaria and other diseases are recommended in Ebonyi State.

Addressing constraints to informal providers' involvement in tuberculosis control: a qualitative study of patent medicine dealers and tuberculosis programme managers.

BACKGROUND: A major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control. METHODS: This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach. RESULTS: There are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints. CONCLUSIONS: Knowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Appraisal of Healthcare-seeking Behavior and Prevalence of Workplace Injury among Artisans in Automobile Site in Abakaliki, Southeast Nigeria.

BACKGROUND: Healthcare-seeking behavior is a decision-making process governed by an individual's conduct, community norms, and expectations, as well as provider-related characteristics and manners. This study determined factors associated with healthcare seeking behavior of automobile artisans in Abakaliki. MATERIALS AND METHODS: A descriptive cross-sectional survey of 380 artisans was carried out. Respondents were selected using multi-stage sampling method and semi-structured interviewer administered pretested questionnaire was used to gather information. Data were analyzed using SPSS software, and the Chi-squared test was used to test for association at 5% level of significance. RESULTS: The mean age of the artisans was 31.3 ± 10.3 years, and the mean monthly income was N15277. Less than half of the respondents (47.7%) sought medical care in pharmacy/patent medicine stores. A significant association was found between distance to the facility for medical care and period of delay before seeking care (P = 0.01). Bruises (45.3%) and cuts (32.3%) were the most prevalent injuries sustained in the preceding 12 months. A significantly high proportion of those who had bruises and cuts traveled >6 km to seek care and less than half of the respondents (47.6%) who reside within 5 km radius to place of medical care patronized pharmacy/patent medicine shops. However, higher proportion of those with cuts (52.0%) and burns (62.5%) compared to other types of injury went to the hospitals no matter the distance. CONCLUSIONS: The artisans have poor health-seeking behavior and majority sought medical care in pharmacy/patent medicine shops rather than hospitals. However, a significant proportion of those with injuries used hospitals regardless of the distance. It is, therefore, imperative to establish healthcare facilities within 5 km radius from where they live and work.