A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method.

BACKGROUND: Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS: A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS: Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION: Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care.

Gender and Drug-Resistant Tuberculosis in Nigeria.

We conducted a retrospective study of 2555 DR-TB patients admitted to treatment between 2010 and 2016 in six geopolitical zones in Nigeria. We characterized the gender distribution of DR-TB cases and the association between demographics and clinical data, such as age, treatment category, number of previous TB treatment cycles, and geopolitical zone, with gender. The independent effects of being a male or female DR-TB patient were determined using bivariate and multivariate analyzes with statistical significance of p < 0.05 and a 95% confidence interval. Records from a total of 2555 DR-TB patients were examined for the study. A majority were male (66.9%), largest age-group was 30-39 years old (35.8%), most had MDR-TB (61.4%), were HIV-negative (76.6%), and previously treated for TB (77.1%). The southwest treatment zone had the highest proportion of DR-TB patients (36.9%), and most DR-TB diagnoses occurred in 2016 (36.9%). On bivariate analysis, age, HIV status, treatment zone, and clinical patient group in DR-TB were significantly associated with male gender. On multivariate analysis, males aged 20-29 years (AOR: 0.19, 95% CI: 0.33-0.59, p = 0.001) and HIV-positive males (AOR: 0.44, 95% CI: 0.33-0.59, p = 0.001) had lower likelihood of MDR-TB as males in the south-south treatment zone (AOR: 1.88, 95% CI: 1.23-2.85, p = 0.03), and being male and aged ≥60 years (AOR: 2.19, 95% CI: 1.05-4.54, p = 0.036) increased the probability of DR-TB. The older male population from south-southern Nigeria and women of childbearing age had lower incidence of DR-TB than men of the same age. Tailored interventions to reduce HIV and DR-TB prevalence in the general population, particularly among women of childbearing potential, and treatment support for young and older men are relevant strategies to reduce DR-TB in Nigeria.

Building capacity of primary health care workers and clients on COVID-19: Results from a web-based training.

BACKGROUND: Health care workers (HCWs) in the first line of care play critical roles in providing the correct information about the coronavirus disease to the community. The objective of the study was to determine the effect of virtual training on the knowledge, attitude, and preventive practices among PHC workers and their clients in the prevention and control of coronavirus disease. METHODS: A quasi-experimental intervention virtual training, using a before and after design amongst HCWs and clients was conducted at primary health care facilities in two Local Government Areas of Lagos State. The study instruments were pre-tested questionnaires for both HCWs and their clients. which investigated knowledge of symptoms, modes of disease transmission, methods of prevention, and preventive practices. Changes in knowledge, attitudes, and practices were compared pre-and post-intervention. The level of significance was set at p < 0.05. RESULTS: Sixty-three HCWs (out of 100 recruited at baseline) and 133 clients (out of the initial 226) completed the study. The mean ages of the HCWs and clients were 39.2±9.9 and 30.9±5.0 years respectively. At the baseline, the HCW's knowledge was good in the domains of symptoms, modes of transmission, and preventive measures. The training led to a higher but not significant (p> 0.05) increase in the level of knowledge. Contact with trained HCWs was found to lead to significantly (P < 0.001) higher levels of knowledge, attitudes, and preventive practices. amongst clients. CONCLUSION: The training was effective in improving the knowledge of both the trained HCWs and their clients.

Chest X-ray Features in Drug-Resistant Tuberculosis Patients in Nigeria; a Retrospective Record Review.

Chest X-ray (CXR) characteristics of patients with drug-resistant tuberculosis (DR-TB) depend on a variety of factors, and therefore, identifying the influence of these factors on the appearance of DR-TB in chest X-rays can help physicians improve diagnosis and clinical suspicion. Our aim was to describe the CXR presentation of patients with DR-TB and its association with clinical and demographic factors. A retrospective analysis of the CXRs of DR-TB patients in Nigeria between 2010 and 2016 was performed, reviewing features of chest radiographs, such as cavitation, opacity and effusion, infiltration and lung destruction. The association of these abnormal CXR findings with clinical and demographic characteristics was evaluated using bivariate and multivariate models, and a p-value < 0.05 was considered statistically significant with a 95% confidence interval. A total of 2555 DR-TB patients were studied, the majority (66.9%) were male, aged 29−38 years (36.8%), previously treated (77%), from the South West treatment zone (43.5%), HIV negative (76.7%) and bacteriologically diagnosed (89%). X-ray findings were abnormal in 97% of the participants, with cavitation being the most common (41.5%). Cavitation, effusion, fibrosis, and infiltration were higher in patients presenting in the South West zone and in those previously treated for DR-TB, while lung destruction was significantly higher in patients who are from the South South zone, and in those previously treated for DR-TB. Patients from the South East zone (AOR: 6.667, 95% CI: 1.383−32.138, p = 0.018), the North East zone (AOR: 6.667, 95% CI: 1.179−37.682, p = 0.032) and the North West zone (AOR: 6.30, 95% CI: 1.332−29.787, p = 0.020) had a significantly increased likelihood of abnormal chest X-ray findings, and prior TB treatment predisposed the patient to an increased likelihood of abnormal chest X-ray findings compared to new patients (AOR: 8.256, 95% CI: 3.718−18.330, p = 0.001). The finding of a significantly higher incidence of cavities, effusions and fibrosis in DR-TB patients previously treated could indicate late detection or presentation with advanced DR-TB disease, which may require a more individualized regimen or surgical intervention.

Willingness and motivations towards volunteering during the COVID-19 pandemic: A cross-sectional survey among final year medical students in Lagos, Nigeria.

Introduction: Increasing manpower capacity to meet the demands in the healthcare system is important during health emergencies. Medical students have roles to play during a pandemic but their involvement in these duties should be voluntary. The objective of this study was to assess the willingness and motivations of final year medical students in Lagos, Nigeria towards volunteering during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted among medical students in their sixth (final) year of study at the two public Universities in Lagos, Nigeria using total population sampling technique. A web-based questionnaire was used for data collection and data were analysed using SPSS. Logistic regression analysis was used to predict the willingness to volunteer. Results: The mean age of the respondents was 23.4 years ±â€¯2.6SD and 62.6% were female. About 65.9% of the medical students were willing to volunteer. Motivational factors which include self-rated good health status [OR: 2.1(95%CI: 1.16-3.6)], self-rated competence to work as a COVID-19 volunteer [OR: 6.5(95%CI: 3.61-11.54)] and availability of adequate protection and personal protective equipment [OR: 3.3(95%CI: 1.74-6.33)] significantly increased the odds of willingness to volunteer after controlling for other variables. Respondents' opinions on settings where medical students can serve as volunteers during the COVID-19 pandemic include case management (21.7%) and telemedicine (85.8%). Conclusion: Medical students are willing to volunteer during the COVID-19 pandemic. There is a need to prepare and motivate the final year medical students by developing their skills to improve their competence and by providing adequate protection for the willing students to function as volunteers.

Tuberculosis stigma: Assessing tuberculosis knowledge, attitude and preventive practices in surulere, Lagos, Nigeria.

Context: Tuberculosis (TB), though preventable and curable, remains a global health problem, ranked one of the top causes of death worldwide, despite the World Health Organization's strategies. This may be due to the stigma surrounding the disease. Aim: This study assesses TB stigma in light of knowledge, attitudes, and preventive practices among individuals in an urban community. Settings and Design: This was a descriptive, cross-sectional study among 317 residents of Surulere, Lagos, Nigeria, selected by multi-stage sampling. Subjects and Methods: Data were collected using a pretested, semi-structured, interviewer-administered questionnaire and analyzed using Epi InfoTM version 7.2.2.6 2018 (Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA). Statistical Analysis Used: Descriptive variables were summarized as frequencies, and the Chi-square test was used to test the associations. The level of significance was predetermined at P ≤0.05. Results: Most participants were between the age group of 21 and 40 years. Approximately 9 out of every 10 respondents (91.8%) were aware of TB. Overall, only 2.4% of respondents had good knowledge of TB, more than half (59.1%) had positive attitudes toward TB, about one-third (37.1%) had good preventive practices and 22.7% of respondents expressed TB stigma, 63.6% would show no compassion or desire to help people with TB while 64.3% would rather people with TB were never employed. However, good knowledge translated into less stigma (P <0.001). Conclusions: Most participants were aware of TB, although knowledge, attitude, and practice levels were poor. Knowledge was found to reduce TB stigma, reinforcing the need for improved community literacy regrading TB. This has the potential to influence health-seeking behavior and promote better TB prevention, detection, and treatment outcomes.

RésuméContexte: La tuberculose (TB), bien qu'évitable et curable, reste un problème de santé mondial, classé parmi les causes de décès dans le monde, malgré les stratégies de l'Organisation mondiale de la santé. Cela peut être dû à la stigmatisation entourant la maladie. Objectif: Cette étude évalue la stigmatisation de la tuberculose à la lumière des connaissances, des attitudes et des pratiques préventives chez les individus d'une communauté urbaine. Paramètres et conception: il s'agissait d'une étude transversale descriptive menée auprès de 317 résidents de Surulere, Lagos, Nigéria, sélectionnés par échantillonnage. Sujets et méthodes: Les données ont été collectées à l'aide d'un questionnaire pré-testé, semi-structuré et administré par un intervieweur et analysées en utilisant Epi Info 7.1. Analyse statistique utilisée: les variables descriptives ont été résumées sous forme de fréquences, et le test du chi carré a été utilisé pour tester le les associations. Le niveau de signification était prédéterminé à P ≤ 0,05. Résultats: La plupart des participants étaient âgés de 21 à 40 ans. Environ 9 répondants sur 10 (91,8%) étaient au courant de la tuberculose. Dans l'ensemble, seulement 2,4% des répondants avaient une bonne connaissance de la tuberculose, plus de la moitié (59,1%) avaient des attitudes positives à l'égard de la tuberculose, environ un tiers (37,1%) avaient de bonnes pratiques préventives et 22,7% des répondants ont exprimé la tuberculose stigmatisation, 63,6% ne montreraient ni compassion ni désir d'aider les personnes atteintes de tuberculose, tandis que 64,3% préféreraient que les personnes atteintes de tuberculose ne soient jamais employées. Cependant, une bonne connaissance se traduit par moins de stigmatisation (P <0,001). Conclusions: la plupart des participants étaient au courant de la tuberculose, bien que l'attitude et les niveaux de pratique étaient médiocres. On a constaté que les connaissances réduisaient la stigmatisation de la tuberculose, renforçant la nécessité d'améliorer l'alphabétisation communautaire reclassement de la tuberculose. Cela a le potentiel d'influencer les comportements de recherche de santé et de promouvoir une meilleure prévention, détection et traitement de la tuberculose.

Volunteering during the COVID-19 pandemic: Attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria.

BACKGROUND: Volunteering within the health-care sector is crucial during pandemics. This study aimed to assess the attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria, about volunteering during the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted amongst medical and dental students undergoing clinical postings at the two public universities in Lagos, Nigeria, using total population sampling. Data were collected using a web-based questionnaire and analysed using Statistical Package for the Social Sciences. Chi-square test and logistic regression analysis were used to test for association at the level of significance of 5%. RESULTS: The mean age of the respondents was 23.3 years ± 2.6 standard deviation and 62.5% were females. The majority (82.9%) of the respondents agreed to volunteer if provided with adequate personal protective equipment (PPE) and if adequately trained to do so (79.3%). Although perceived as dangerous, the majority (91.2%) of the respondents considered volunteering during the COVID-19 pandemic as a form of educational experience. Compared to the final-year students, penultimate year students were more likely to volunteer in the event of a health manpower shortage. The final-year students were more likely to volunteer if government made the request. Female students were more likely than male students to volunteer even if they were not compensated but would require parental approval. CONCLUSION: Medical and dental students perceived their involvement during the COVID-19 pandemic as a form of educational experience but would require adequate training and PPE. There is a need to train and provide adequate PPE for them to function as volunteers.

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria.

BACKGROUND: The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010-2016 in Lagos, Nigeria. METHODS: Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. RESULTS: A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014-2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. CONCLUSION: Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.

COVID-19: A review of the effectiveness of non-pharmacological interventions.

COVID-19, a highly infectious disease, caused by a novel virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought about an unprecedented threat to global health. First reported in Wuhan, China, in December 2019, it has now spread to all continents of the world becoming a pandemic. There is no known treatment or vaccine for it although many candidate drugs and vaccines are in various clinical trial phases. For now, non-pharmacological interventions (NPIs) have become the mainstay of response for COVID-19 and are being used across the world to flatten the epidemiologic curve with some success. This review focussed on identifying which NPIs have been effective. NPIs that are effective include isolation and quarantine, physical distancing, use of face masks and hand hygiene. These measures are best used in combination and simultaneously. The evidence is that they should be instituted early in the pandemic and for sustained periods. They should also be implemented in the context of the cultural and socioeconomic conditions of the populace. Ineffective NPIs include ultraviolet irradiation and spraying of outdoor spaces and individuals. We recommend that decision makers weigh the evidence carefully, as it applies to the local setting to inform public health decisions.

Hand hygiene practices in the context of Ebola virus disease: A cross-sectional survey of Lagos residents.

BACKGROUND: The Ebola virus disease outbreak that ravaged parts of West Africa has been described as the most severe acute public health emergency seen in modern times. Hand washing was promoted among other measures for infection prevention. OBJECTIVE: This study assessed the awareness of Ebola virus disease and hand-washing practices among Lagos residents, southwest Nigeria. METHODS: A descriptive cross-sectional study was used. A total of 1982 respondents aged 18 ⩾ years were selected using a multi stage sampling technique. An interviewer-administered, pre-tested questionnaire was used for data collection between August and November 2015. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22, with level of significance set at 0.05. RESULTS: Almost all (97.3%) respondents were aware of Ebola virus disease, with over half of respondents having heard about it from television. A majority of 1890 (95.4%) respondents were aware of the importance of hand washing in disease prevention. Similarly, high proportions of respondents were aware they should wash their hands after an outing, toilet use, touching pets, before and after meals, while 1628 (82.1%) of respondents knew to wash their hands after a hand shake. However, less than half of respondents (38.8%) always washed their hands after handshakes. DISCUSSION: A majority of respondents surveyed were aware of Ebola virus disease and hand washing, but the practice of hand washing, which is key in prevention of infection, lagged behind the knowledge of the respondents.

Pediatric Oncology in Nigeria: A Panoramic View.

PURPOSE: A large number of children still die as a result of cancer in low- to middle-income countries, and factors such has poor infrastructure, inadequate human resources, and poorly developed health insurance are responsible for most of these deaths. Nigeria is a country with a young population and a struggling health system. We aimed to survey pediatric oncologists in Nigeria using an online survey instrument. METHODS: We surveyed the national group of pediatric oncologists using an instrument designed to assess manpower availability, infrastructural support, support services, and presence of radiotherapy and medications. RESULTS: A total of 14 institutions responded, represented by 24 oncologists of the 42 oncologists on the platform, with a response rate of 57.1%. Most of the oncologists had practiced for more than 10 years, but only two institutions had a dedicated pediatric oncology ward. There was no population-based pediatric oncology tumor registry. Molecular diagnostic capability was not available, nor was a structurally efficient radiotherapy support service. The centers also struggled with inadequate blood and blood product provision. CONCLUSION: Pediatric oncology services in Nigeria are still grappling with weak human capital, poorly developed infrastructure, weak regional and national referral systems, and poor support services.

Spectrum of Thyroid Abnormalities among Children Living with HIV in Lagos, Nigeria.

Thyroid disorders have been described in an adult population but are underreported in the pediatric population. The aim of this study was to determine the prevalence and describe the spectrum of thyroid abnormalities among HIV infected children on Highly Active Antiretroviral Therapy (HAART) in Lagos, Nigeria. This was a cross-sectional study carried out at a teaching hospital with an antiretroviral therapy (ART) center. Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) were analyzed in 83 children living with HIV on HAART and 51 controls. The prevalence of thyroid dysfunction and correlation of fT3, fT4, and TSH with duration on HAART, age, CD4 count, and nutritional status were assessed. Thyroid abnormalities were seen in 9.6% of the children living with HIV comprising subclinical hypothyroidism in 6%, euthyroid sick syndrome in 2.4%, and overt hypothyroidism in 1.2% as compared to 2% subclinical thyroid disease among the controls (p= 0.15). Hypothyroidism was correlated with CD4 count and viral load. None of the patients had clinical features of thyroid disease. Thyroid abnormalities were more prevalent among children living with HIV and yearly screening with follow-up is advocated.

How does the public perceive healthcare workers in Lagos? A comparison of health workers in public and private health facilities.

BACKGROUND: The perception of healthcare workers (HCWs) by community members is dependent on the quality of services rendered by HCWs and contributes to utilisation. The objective of the study was to assess the perception of health workers in both public and private facilities by residents of Lagos State. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted using mixed-methods approach. Respondents (n = 2000) were selected using a multistaged sampling technique from four local government areas. An interviewer-administered, pre-tested questionnaire developed for the study was used for data collection and focus group discussions were held. Domains assessed included competence, work attitudes, interpersonal skills and unethical behaviour. A perception index was generated. Data were analysed using the Statistical Package for the Social Sciences version 22, with level of significance set at 0.05 for quantitative data and ATLAS.ti software (Scientific Software, Berlin; version 7) for qualitative data. RESULTS: At least seven out of ten participants (>71%) perceived the HCWs highly in the areas of professional competence, attitude to work, responsiveness and interpersonal skills. Out of a maximum of 12, doctors had the highest mean perception index (10.6 ± 1.9), laboratory scientists had 10.1 ± 2.1, pharmacists had 10.0 ± 2.3 and nurses had 9.6 ± 2.7. A larger proportion of respondents had a significantly better perception of workers in private facilities more than those in government facilities. CONCLUSION: Perception of health workers was high and was better in privately owned facilities. Periodic retraining of health workers and regular assessments of health facilities are recommended.

Seasonal variation in mortality secondary to acute myocardial infarction in England and Wales: a secondary data analysis.

BACKGROUND: Acute myocardial infarction (AMI) is a leading cause of death globally. Increase in AMI mortality during winter has also been identified in existing literature. This has been associated with low outdoor and indoor temperatures and increasing age. The relationship between AMI and other factors such as gender and socioeconomic factors varies from study to study. Influenza epidemics have also been identified as a contributory factor. OBJECTIVE: This paper aims to illustrate the seasonal trend in mortality due to AMI in England and Wales with emphasis on excess winter mortality (EWM). METHODS: Monthly mortality rates per 10 000 population were calculated from data provided by the UK Office for National Statistics (ONS) for 1997-2005. To quantify the seasonal variation in winter, the EWM estimates (EWM, EWM ratio, Excess Winter Mortality Index) for each year were calculated. Negative binomial regression model was used to estimate the relationship between increasing age and EWM. RESULTS: The decline in mortality rate for AMI was 6.8% yearly between August 1997 and July 2005. Significant trend for reduction in AMI-associated mortality was observed over the period (p<0.001). This decline was not seen with EWM (p<0.001). 17% excess deaths were observed during winter. This amounted to about 20 000 deaths over the 8-year period. Increasing winter mortality was seen with increasing age for AMI. CONCLUSION: EWM secondary to AMI does occur in England and Wales. Excess winter deaths due to AMI have remained high despite decline in overall mortality. More research is needed to identify the relationship of sex, temperature, acclimatisation, vitamin D and excess winter deaths due to AMI.

Characteristics of Mycobacterium Tuberculosis Positive Patients Screened for Drug-Resistant Tuberculosis at a Tertiary Health Facility in Lagos, Nigeria.

BACKGROUND: Nigeria is one of the ten countries with the highest tuberculosis (TB) burden globally and is experiencing an increasing incidence of drug resistance. This study aimed to determine the prevalence of mycobacterium tuberculosis and rifampicin resistance (DR-TB) among patients screened at the TB clinic of a tertiary institution in Lagos, South-West, Nigeria. METHODS: A review of records of 840 patients with suspected drug-resistant TB was carried out from Gene Xpert test clinic register at a tertiary health facility from November 2013 to April 2015. The Data was analyzed with SPSS version 20, Chi square test was used to determine association between DR-TB and the factors examined and the level of significance was set at P < 0.05. RESULTS: MTB detection among all screened suspects was 43.3%. The prevalence of rifampicin resistance was 17.6% among patients that were investigated for DR-TB and this occurred more in the working age group (15-54 years) with male to female ratio of 1.8:1. However, only history of close contact with known DR-TB patient was associated with DR-TB (P < 0.01). CONCLUSION: The burden of DR-TB may be higher than previously thought. Drug resistance testing should be made more available to detect cases and thus control the emerging problem.

Private sector malaria RDT initiative in Nigeria: lessons from an end-of-project stakeholder engagement meeting.

The malaria rapid diagnosis testing (RDT) landscape is rapidly evolving in health care delivery in Nigeria with many stakeholders playing or having potential for critical roles. A recent UNITAID grant supported a pilot project on the deployment of quality-assured RDTs among formal and informal private service outlets in three states in Nigeria. This paper describes findings from a series of stakeholder engagement meetings held at the conclusion of the project. The agreed meeting structure was a combination of plenary presentations, structured facilitated discussions, and nominal group techniques to achieve consensus. Rapporteurs recorded the meeting proceeding and summaries of the major areas of discussion and consensus points through a retrospective thematic analysis of the submitted meeting reports. Key findings indicate that private providers were confident in the use of RDTs for malaria diagnosis and believed it has improved the quality of their services. However, concerns were raised about continued access to quality-assured RDT kits. Going forward, stakeholders recommended increasing client-driven demand, and continuous training and supervision of providers through integration with existing monitoring and supervision mechanisms.

Causative factors for sexual and reproductive health status of pregnant adolescent girls in urban communities of Lagos, Nigeria.

Background The overall goal of this study was to determine the causative factors for pregnancy status in adolescent girls in two communities in the Lagos Island local government area. Methods A mixed methods (quantitative and qualitative) study reviewing routine health facility antenatal care (ANC) records and conducting focus group discussions among 46 pregnant adolescents, exploring their views about sex, contraception, pregnancy and sexual and reproductive health (SRH) services, was carried out. Key informant interviews were also carried out among healthcare workers and community members to assess their perceptions of adolescents' SRH problems. Results Five percent of those accessing ANC services were adolescents. Pregnant adolescents were found to access health services at later stages of their pregnancies due to the shame and stigma associated with their condition. The presence of morbidity in the form of anaemia (33%) and HIV (2.4%) was also found in this population. Social factors such as peer pressure and the desire to develop or maintain a relationship were found to be the major reasons for initiation of sexual activity by the adolescents. There was generally poor knowledge and utilisation of contraceptives, leading to unprotected sex and, thus, unintended pregnancies. Conclusion SRH information and services should be made readily available to adolescents at all levels of care.

A malariometric survey of under-fives residing in indoor residual spraying-implementing and non-implementing communities of Lagos, Nigeria.

BACKGROUND: Indoor residual spraying (IRS) is used as part of the integrated vector management strategy for the control of malaria in Lagos, Nigeria. The purpose of this study was to compare the malariometric indices of children under 5 years old living in IRS-implementing and non-IRS-implementing communities of Lagos, Nigeria. METHODS: The study was a community-based, comparative, cross-sectional study of 480 children under five recruited using a multi-stage sampling method. Data on each child were collected using a household questionnaire administered to the consenting care-giver of each selected child. Each child underwent a comprehensive physical examination. On-the-spot malaria rapid diagnostic testing and haemoglobin estimation to assess parasitaemia and anaemia, respectively, were also carried out. Risk factors for parasitaemia and anaemia were identified using multivariate logistic regression. RESULTS: A total of 238 children were studied in the IRS-implementing group while 242 children were studied in the non-IRS-implementing group. The IRS -implementing community had a lower level of parasitaemia (1.3 %) compared to the non-IRS-implementing community (5.8 %) (p < 0.001). There was no significant difference in anaemia, spleen rate and fever in the IRS-implementing group (10.9, 9.7 and 5 %) and the non-IRS-implementing group (9.9, 8.8 and 8.7 %), respectively. Residing in an IRS-implementing community was associated with lower odds of parasitaemia (OR 0.17, p < 0.01). Sleeping under a bed net was the only factor associated with anaemia (p < 0.01). CONCLUSION: IRS has led to a reduction in the level of parasitaemia in the under-fives in the study areas.

Neonatal Jaundice: Knowledge, Attitude and practices of mothers in Mosan-Okunola community, Lagos, Nigeria.

BACKGROUND: A community-based survey was conducted amongst mothers aged 15-49 years living in Mosan-Okunola, Lagos, Nigeria to determine the knowledge of, attitudes to, preventive and treatment practices towards neonatal jaundice (NNJ). MATERIALS AND METHODS: The mothers were selected using a multi-stage sampling technique. A pre-tested interviewer-administered structured questionnaire was used to obtain data. The knowledge of the mothers was scored and scores lower than 50% were graded as poor, 50-74% as fair and ≥75% as good. The practice was also categorised as appropriate if one correct option was identified and was categorised as inappropriate where an incorrect option(s) was identified singly or in combination with a correct option. RESULTS: Three hundred and fifty-eight mothers were recruited. The mean age was 34.8 ± 9.05 years. Two hundred and seventy (75.4%) mothers had ever heard about the condition. Two hundred and forty-seven (91.4%) mothers correctly identified the condition and infection was the only most common known cause (47%). Only 34% of the mothers knew that NNJ could cause brain damage, and 40% identified refusal of feeds as a danger sign. Up to 64% of the mothers believed attending antenatal care could prevent the condition, and 58% were of the opinion that exposing babies to sunlight could prevent the condition. Sixty-eight percent (68.9%) of the mothers had a poor level of knowledge. Age and educational qualification did not show any statistically significant relationship with knowledge about NNJ (P < 0.05) but increasing maternal age had a significant association with an appropriate treatment practice (P < 0.05), the association was negative (r = -0.32). CONCLUSION: Knowledge about NNJ was low in this community and ineffective preventive practices were utilised. Efforts should be made to increase it, and health workers should play a leading role.