Factors associated with willingness to use mHealth interventions for medication adherence among people living with HIV attending a tertiary hospital in sub-Saharan Africa.

INTRODUCTION: There is increasing evidence in favor of enhancing adherence to antiretroviral therapy (ART) in people living with HIV (PLHIV) through mobile health (mHealth) assessment and intervention. The study aims to establish the willingness to adopt mobile phone technology to enhance adherence to ART among PLHIV. METHODS: The Researchers adopted a cross-sectional survey. Systematic sampling was employed in selecting 237 PLHIV in the HIV clinic for adults at Ido-Ekiti's Federal Teaching Hospital, Nigeria. Data collection was via a 33-item semi-structured questionnaire administered by the interviewer. Information collected via the questionnaire included details on ownership of mobile phone technology, its usage, and willingness to use it to improve adherence to HIV medication. Descriptive statistics coupled with multivariate regression was employed in analyzing data, with the level of significance at 5%. RESULTS: The respondent's had a mean ±SD age of 46.6 ±10 years. Most of the participants were female (77.6%), and have been on ART for over 2years (88.2%). The vast majority of study participants 233 (98.3%) owned a mobile phone. 168 (70.9%) of them were willing to embrace mHealth interventions on medication adherence. Some of the factors influencing the respondent's willingness to receive the intervention were older age (OR = 0.05, 95%Cl:[0.01-0.24]), having formal education (OR = 7.12, 95%Cl:[3.01-16.53]), being diagnosed over 10years ago (OR = 15.63, 95%Cl:[3.02-80.83]) and previous use of phone to send text messages, record video, access the internet, send email and search the internet for health-related information (OR = 2.2, 95%Cl:[1.2-3.9]; OR = 1.8, 95%Cl:[1.0-3.2]; OR = 2.5, 95%Cl:[1.4-4.7]; OR = 2.7, 95%Cl:[1.2-5.5] and OR = 2.0, 95%Cl:[1.0-3.8]) respectively. CONCLUSION: Many of the PLHIV had a cellphone and expressed willingness on their part to use it in receiving reminders to take their medication. Older age, formal education and internet users were significantly more willing to get reminders to take their medication.

Attitude and predictors of exclusive breastfeeding practice among mothers attending under-five welfare clinics in a rural community in Southwestern Nigeria.

BACKGROUND: Much previous research on exclusive breastfeeding has focused on urban and semi-urban communities, while there is still a paucity of data from rural areas. We assessed the attitude and practice of exclusive breastfeeding and its predictors among mothers attending the under-five welfare clinics in a rural community. METHODS: A cross-sectional study was conducted among consecutively recruited 217 mothers attending the three health facilities under-five welfare clinics in Ido-Ekiti, Southwest, Nigeria. Information was collected with a semi-structured interviewer-administered questionnaire adapted from previously published research works. Descriptive and inferential statistics were carried out using IBM SPSS Statistics for Windows, Version 26.0. RESULTS: More than half of the mothers, 117(53.9%) were ≥30 years old, and 191(88.0%) were married. Almost all, 216 (99.5%) attended an ante-natal clinic; however, 174(80.2%) delivered in the health facility. The respondent's mean ± SD exclusive breastfeeding attitudinal score was 29.94 ± 2.14 (maximum obtainable score was 36), and the proportion of mothers that practiced exclusive breastfeeding was 40.6%. Married mothers were more likely to practice exclusive breastfeeding than their unmarried counterparts (AOR:6.324, 95%CI:1.809-22.114). The common reasons for not practicing exclusive breastfeeding were work schedule 57(26.3%), cultural beliefs and the need to introduce herbal medicine 32(14.7%), and insufficient breast milk 30(13.8%). CONCLUSION: This study revealed a good disposition with a suboptimal practice towards exclusive breastfeeding. Also, being married was a positive predictor of exclusive breastfeeding. Therefore, we recommend policies that will improve exclusive breastfeeding among mothers in rural areas, especially those targeting the unmarried, to achieve the World Health Organization's target.

Short-term COVID-19 vaccine adverse effects among adults in Ekiti State, Nigeria.

BACKGROUND: The safety of the COVID-19 vaccines has been a topic of concern globally. This issue of safety is associated with vaccine hesitancy due to concerns about the adverse effects of the vaccines. Consequently, this study determined the short-term safety profile of the Oxford/AstraZeneca COVID-19 vaccine in Ekiti State, Nigeria. METHODS: Descriptive cross-sectional study conducted between May and July 2021 among individuals who had received the first dose of the first batch of the Oxford/AstraZeneca COVID-19 vaccine at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria. A Google form was used to collect data on the adverse effects of the vaccine. RESULTS: Out of over 1,000 individuals who were approached, 758 respondents completed the study. A large percentage (57.4%) of those who received the vaccines were healthcare workers. Adverse effects were reported in 70.8% of the participants with most manifesting on the first day of the vaccination. The predominant adverse effects were injection site soreness (28.5%), followed by fatigue (18.7%) and muscle pain (8.6%). There was no report of severe adverse effects such as anaphylactic reactions, thrombosis, myocarditis, transient myelitis, or Guillen-Barre syndrome. CONCLUSION: This study found that self-reported adverse effects of the Oxford/AstraZeneca COVID-19 vaccine were mild and short in duration. This outcome has promising implications for improving COVID-19 vaccine uptake in the immediate environment and Nigeria.

Knowledge, attitude and practice of antenatal mothers toward urinary tract infection in selected health facilities in Ekiti state, Nigeria.

Background: Urinary Tract Infections (UTIs) during gravidity are among the most preponderant contagion globally and can culminate in fetal and maternal mortality. Lack of awareness and poor preventive practices can exacerbate this outcome. This study assessed the knowledge and preventive practices of antenatal mothers' towards UTIs in pregnancy. Design: This was a cross-sectional descriptive survey involving antenatal mothers in selected health care facilities in Ekiti State. Methods: A pre-tested adapted questionnaire was used for data collection. Data was analyzed using descriptive statistics and Chi-square at p < 0.05. Results: The mean respondents' age was 24.6 ± 2.1 years and barely less than half (43.8%) were multigravida. The findings of the study revealed that 64.0% of the respondents had good knowledge of UTIs. Overall, majority (78.9%) of the respondents exhibit good preventive practices toward UTIs in pregnancy, although the prevalence of UTIs among the studied subjects was found to be high (54.1%), with nearly half (48.7%) of the respondents reported been tested once for UTIs in the current pregnancy. Furthermore, there was a statistically significant relationship between educational level and respondents' knowledge on the prevention of UTIs in pregnancy (p = 0.00; p < 0.05). Conclusions: Respondents had good knowledge and good preventive practices toward UTIs. However, the high prevalence of UTIs reported among respondents justifies the need for implementation of knowledge enhancement program, routine testing and prompt treatment of UTIs among antenatal mothers.

Traditional birth attendants' knowledge, preventive and management practices for postpartum haemorrhage in Osun State, Southwestern Nigeria.

Traditional birth attendants (TBAs) have become an integral part of the workforce providing delivery services in Nigeria due to the limited number of skilled birth attendants and cultural preferences. This study assessed the knowledge, management and preventive practices regarding postpartum haemorrhage (PPH) among TBAs in selected communities in Osun State, Southwest Nigeria. The study employed a descriptive cross-sectional study design and recruited 260 TBAs in four communities in Osun State. Data were collected by means of an adapted semi-structured questionnaire. Data were analysed using SPSS version 23 and summarized using descriptive and inferential statistics (chi-square and logistic regression) with the level of significance set at p < 0.05. The findings indicated that most (71.4%) of the TBAs were cleric, while others were herbalist (28.6%). Although the majority (76.4%) of the TBAs had good knowledge of the causes and warning signs of PPH, a high percentage (69.3%) of TBAs had poor management practices, while 114 (64.1%) TBAs had inadequate preventive practices. Notably, almost none of the participants practised active management of the third stage of labour; the majority of TBAs did not administer any uterotonic drugs to the mother, nor did they deliver the placenta by controlled cord traction. Gender (P = 0.029), educational level (P = 0.035) and average number of births per month (P = 0.001) significantly influenced TBAs' management practices. Similarly, the TBA type (P < 0.001), average number of births per month (P = 0.003) and experience with formal training (P = 0.005) showed significant associations with TBAs' preventive practices. Furthermore, TBAs' preventive practices towards PPH were influenced by the TBA type (OR: 4.23; 95% CI 1.64-10.90). TBA management practices were also influenced by the TBA type (OR: 4.42; 95% CI 2.03-9.61). Traditional birth attendants in this study had poor management and poor preventive practices for postpartum haemorrhage.

Cost of illness of non-communicable diseases in private and public health facilities in Nigeria: a qualitative and quantitative approach.

Introduction: the cost of illness (COI) of non-communicable diseases (NCDs) has detrimental effects on healthcare outcomes in addition to the serious economic impact on patients and their families. This study estimated and compared the COI of NCDs and its predictors in private and public health facilities (HF) in Ado-Ekiti, Nigeria. Methods: the study was carried out in selected HF (39 private; 11 public) using a comparative cross-sectional design with a mixed method of data collection. Quantitative data were collected from 348 hypertensive and/or diabetic patients (173 private; 175 public) using a semi-structured, interviewer-administered questionnaire while qualitative data were from 5 key informant interviews (KII) conducted with HF heads or their representatives. Results: the average monthly COI of NCDs was higher among patients in private (₦15,750.38±14,286.47 [US$43.75±39.68]) than in public HF (₦13,283.37±16,432.68 [US$ 36.90±45.65]) (P<0.001), however, the indirect cost was higher in public HF (private, ₦1,561.07 [US$4.34]; public, ₦3,739.26 [US$10.39]) (p<0.001). Predictors of COI of NCDs identified were income and admission in both groups. Additionally, age, payment method, type of NCDs, having two or more complications, and exercise were identified in private while socioeconomic status, length of diagnosis, and alcohol were identified in public HF. The KII revealed a long waiting time for the public HF patients which accounted for the huge indirect cost. Conclusion: the study found a huge indirect cost in the public HF that could be minimized by developing policies that would reduce the waiting time of patients. Government and private interventions targeting identified predictors should be applied to reduce the financial burden of NCD.

The Nigeria national health insurance authority act and its implications towards achieving universal health coverage.

The National Health Insurance Scheme (NHIS) faced several inherent and systemic drawbacks towards achieving universal health coverage for all Nigerians, and this has led to the signing of the new National Health Insurance Authority Act (NHIA), 2022. This article highlights the benefits of NHIA, discusses the possible challenges and the way forward in its implementation. A narrative review of past literature searched in PubMed, MEDLINE, African Journal Online, and Goggle was conducted. A total of 76 publications were initially retrieved and following data triangulation, 55 were finally used. The authors also included their experiences. The NHIA addressed some of the shortcomings of the previous NHIS, however, it would still face several challenges in its implementation such as low government funding priority to health, shortage of healthcare workers and poor healthcare coverage, as well as problems with enforcement as it mandates all Nigerians to enroll. These and other impending constraints must be surmounted and all stakeholders must be involved to ensure the Act accomplishes its aim.

Prevalence and pattern of migration intention of doctors undergoing training programmes in public tertiary hospitals in Ekiti State, Nigeria.

BACKGROUND: Emigration of Nigerian doctors, including those undergoing training, to the developed countries in Europe and Americas has reached an alarming rate. OBJECTIVE: This study aimed at assessing the prevalence, pattern, and determinants of migration intention among doctors undergoing residency and internship training programmes in the public tertiary hospitals in Ekiti state, Nigeria. METHODS: This was a cross-sectional study using a quantitative data collected from 182 doctors undergoing residency and internship training at the two tertiary hospitals. An adapted semi-structured questionnaire was used to collect information on migration intention among the eligible respondents. Univariate, bivariate and multivariate data analyses were done. The level of significance was determined at p-value < 0.05. RESULTS: Majority (53.9%) of doctors undergoing training were between 30-39 years, and the mean age was 33.2 ± 5.7 years, male respondents were 68.1%, and 53.8% of the respondents were married. The proportion of doctors undergoing training who had the intention to migrate abroad to practice was 74.2%. A higher proportion of the internship trainees, 79.5%, intended to migrate abroad to practice while the proportion among the resident doctors, was 70.6%. Among the respondents who intended to migrate abroad to practice, 85(63%) intend to migrate abroad within the next 2 years, while the preferred countries of destination were the United Kingdom 65(48.2%), Canada 29 (21.5%), Australia 20 (14.8%) and the United States 18(13.3%). Seventy percent of respondents who intend to migrate abroad had started working on implementation of their intention to migrate abroad. The majority of the junior resident doctors, 56(72.7%), intend to migrate abroad compared with the senior resident doctors, 21(27.3%), (χ2 = 14.039; p < 0.001). The determinants of migration intention are the stage of residency training and level of job satisfaction. CONCLUSION: There is a high prevalence of migration intention among the doctors undergoing training in the public tertiary hospitals in Ekiti State, Nigeria, with the majority already working on their plans to migrate abroad. Doctors undergoing training who are satisfied with their job and those who are in the senior stage of residency training programme are less inclined to migrate abroad. RECOMMENDATIONS: The hospital management in the tertiary hospitals should develop retention strategies for human resources for health, especially doctors undergoing training in their establishment, to avert the possible problems of dearth of specialists in the tertiary health facilities. Also, necessary support should be provided for the residency training programme in the tertiary health institutions to make transition from junior to senior residency stage less strenuous.

Determinants of Care-Seeking Practices for Children with Sickle Cell Disease in Ekiti, Southwest Nigeria.

BACKGROUND: Due to the chronic nature of sickle cell disease (SCD), affected individuals may seek help from diverse places thus raising the need to understand their health-seeking behavior (HSB) in order to design an appropriate management policy for them. AIM: The aim of this study was to evaluate the HSB among pediatric SCD patients relative to their non-SCD counterparts attending a tertiary facility in Southwest Nigeria and identified predictors of poor HSB among SCD patients. METHODS: A total of 110 children with SCD were recruited and studied for their HSPs which were compared with 110 non-SCD patients with other chronic medical conditions. Questionnaires were used to obtain self-reported information on participants' socio-demographic data and HSB. Logistic regression was used to determine the predictors of poor HSB among the SCD cohort. RESULTS: More SCD patients received treatments at private hospitals, patent medicine stores and faith-based centers compared to their non-SCD counterparts (p=0.0052; 0.006; and 0.007), respectively. No difference was observed in the patronage of traditional care centres 10 (9.1%) vs 6 (5.5%). More SCD patients 61 (55.5%) vs 35 (31.8%) exhibited poor HSB (p=0.0004). SCD patients who were not enrolled on health insurance scheme were 18 times more likely to have poor HSB (OR=18.38, 95% CI (4.41-76.57), p value= <0.0001) while absence of VOC within the preceding year reduces the risk of poor HSB by 91.5% (OR=0.085, 95% CI (0.028-0.258), p value= <0.0001). CONCLUSION: SCD patients in the study locality had poor HSB. This raises the need for their education on proper HSB. More enrollment into health insurance scheme and the prevention of VOC will lessen the burden of poor HSB. The high patronage of non-hospital care facilities in this study raises the need for stakeholders to monitor activities and train the operators at these informal care centres.

Self-medication among health workers in a tertiary institution in South-West Nigeria.

INTRODUCTION: Inappropriate self-medication results in wastage of resources, resistance to pathogen and generally entails serious health hazard. This study was undertaken to determine the knowledge, practice and reasons for practice of self-medication among health workers in a Nigerian tertiary institution. METHODS: This was a cross-sectional descriptive study conducted among staff of Federal Medical Center Ido-Ekiti, Nigeria. Simple random sampling technique was used to select 305 respondents that were interviewed via a pretested semi-structured questionnaire. Analysis was done using SPSS version 15 and while chi-square test was used to test significance between variables, significant (p value set<0.05). RESULTS: Among the 305 respondents interviewed, the age range was 18-52yrs with greater proportion being males (51.8%). Majority of respondents were aware of self-medication (94.8%), but only 47.2% had good knowledge of it. Reasons for practicing self-medication were financial problem (10.8%), mild sickness (10.8%), lack of time (13.4%), knowledge of diagnosis (5.6%), convenience (2.3%) and non-availability of doctors (3.0%). The drugs used by respondents without prescription included analgesics (38.2%), antibiotics (19.0%) anti-malaria drugs (13.3%), and others (29.4%). Conditions for which respondents self-medicated were body pains (14.9%), catarrh (14.9%), headache (14.3%), sore throat (11.5%), diarrhea (11.2%), fever (9.0%) and toothache (5.6%). CONCLUSION: The study demonstrates that the prevalence of self-medication is relatively high. There is need for health education on the implication and danger of self-medication. There is also need for government to pass and enforce law to restrict free access to drugs.