Use of malaria rapid diagnostic test and anti-malarial drug prescription practices among primary healthcare workers in Ebonyi state, Nigeria: An analytical cross-sectional study.

BACKGROUND: The recommendation of universal diagnostic testing before malaria treatment aimed to address the problem of over-treatment with artemisinin-based combination therapy and the heightened risk of selection pressure and drug resistance and the use of malaria rapid diagnostic test (MRDT) was a key strategy, particularly among primary healthcare (PHC) workers whose access to and use of other forms of diagnostic testing were virtually absent. However, the use of MRDT can only remedy over-treatment when health workers respond appropriately to negative MRDT results by not prescribing anti-malarial drugs. This study assessed the use of MRDT and anti-malarial drug prescription practices, and the predictors, among PHC workers in Ebonyi state, Nigeria. METHODS: We conducted an analytical cross-sectional questionnaire survey, among consenting PHC workers involved in the diagnosis and treatment of malaria, from January 15, 2020 to February 5, 2020. Data was collected via structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariate generalized estimating equations. RESULTS: Of the 490 participants surveyed: 81.4% usually/routinely used MRDT for malaria diagnosis and 18.6% usually used only clinical symptoms; 78.0% used MRDT for malaria diagnosis for all/most of their patients suspected of having malaria in the preceding month while 22.0% used MRDT for none/few/some; 74.9% had good anti-malarial drug prescription practice; and 68.0% reported appropriate response to negative MRDT results (never/rarely prescribed anti-malarial drugs for the patients) while 32.0% reported inappropriate response (sometimes/often/always prescribed anti-malarial drugs). The identified predictor(s): of the use of MRDT was working in health facilities supported by the United States' President's Malaria Initiative (PMI-supported health facilities); of good anti-malarial drug prescription practice were having good opinion about MRDT, having good knowledge about malaria diagnosis and MRDT, being a health attendant, working in PMI-supported health facilities, and increase in age; and of appropriate response to negative MRDT results was having good opinion about MRDT. CONCLUSIONS: The evidence indicate the need for, and highlight factors to be considered by, further policy actions and interventions for optimal use of MRDT and anti-malarial drug prescription practices among the PHC workers in Ebonyi state, Nigeria, and similar settings.

Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey.

Aim: Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. Subject and Method: The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Result: Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Conclusion: Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.

Predictors of knowledge and practice of newborn care among post-natal mothers attending immunisation clinics in Southeast Nigeria.

Objectives: Evidence-based newborn care practice recommended by WHO reduces neonatal mortality and improves neonatal outcomes. This study assessed the knowledge, practice-associated factors and predictors of essential newborn care among post-natal mothers in two primary health care centres in Southeast Nigeria. Design: A cross-sectional total population study. Setting: Two primary health care centres in two local government areas in Southeast Nigeria. Participants: Post-natal mothers who attended immunisation clinics. Data collection: Quantitative data was collected over four weeks from 400 post-natal mothers. Chi-square test and logistic regression were carried out for associations and predictors, respectively. Analytical decisions were taken at p<0.05 and 95% confidence interval. Outcome measures: Knowledge, attitude, the practice of essential newborn care; predictors of practice. Findings: Mean age of participants was 28.68±5.4. The majority (78.9%) had been counselled on newborn care and 85.2% delivered in a formal health facility. The majority (77%) had good knowledge of essential newborn care and practices (61%). More than half (62.3%) reported support from health workers. Predictors of good practice were older age (AOR: 0.435; 95%CI: 0.212-0.893), being married (AOR: 8.095; 95%CI: 3.732-17.558), living in the urban area (AOR: 0.478; 0.291-0.784), and having good knowledge of newborn care (AOR: 0.239; CI: 0.139-0.411). Conclusions: Good practice was identified in the majority. Being married, older, living in urban areas and having good knowledge were predictors of good practice. Health facility delivery, continuous support by health workers and post-natal education to mothers in rural areas are recommended policy priorities. Funding: None declared.

Effect of multiple intervention models on uptake of HIV testing services and sexual behaviour among residents of military cantonments in south-east Nigeria.

Background: HIV testing and counselling (HTC) has been a viable tool in controlling the spread of HIV/AIDS, and serves as the entry point in the HIV care and treatment cascade. In Africa, HIV-related morbidity and mortality are high with thousands still unaware of their HIV status. This study assessed the effect of on-site multiple HIV control interventions on the uptake of HTC services, knowledge and sexual behaviour among residents of two military cantonments [barracks] in south-east Nigeria. Methods: A quasi-experimental study was conducted among residents of cantonments in two states in Nigeria. A multistage sampling technique was used to select 350 respondents each at intervention and control sites. A pre-tested interviewer-administered questionnaire was used to collect information. On-site HTC services were established, with the training of HTC counsellors and peer educators. HIV awareness carnivals, with information, education and communication activities were conducted. Data were analysed with SPSS software and statistical tests carried out at 5% level of significance. Results: There was a statistically significant increase in the uptake of HTC services from 41.1% pre-intervention to 81.1% post-intervention (χ2 = 113.8, p < 0.001). Also, knowledge about HIV improved significantly from 35.4% to 98.8% (p < 0.001) in the intervention group, together with avoidance of risky sexual behaviour. Conclusion: The study demonstrated the effectiveness of multiple on-site intervention models in improving HIV knowledge, uptake of HTC services, and sexual behaviour among diverse cantonment residents. Establishing on-site HTC services and a constellation of awareness events will contribute significantly towards HIV prevention and control among high-risk populations.