Production of herbal toothpaste: Physical, organoleptic, phyto-compound, and antimicrobial properties.

Objective: To investigate the possibility of producing dental antimicrobial toothpaste from Allium cepa L skin chaff, Azadirachta indica A. seed, and Tetrapleura tetraptera pod extracts. Methods: Ethanolic extracts of the three plant materials were obtained. These were subjected to phytochemical and GC-MS analyses. The different extract combinations were used for the production of various toothpaste. The toothpaste's physical, organoleptic, and antimicrobial properties were determined. Results: From the phytochemical analysis, Allium cepa has the highest phenolic (1.20 mgGAE/g), saponin (14.80%), tannin (0.11 mg/g) and DPPH (82.80%), Tetrapleura tetraptera has the highest flavonoid (0.33 mg RE/g), and alkaloid (20.50 mg/g) while, Azadirachta indica has the highest oxalate (77.50 mg/g). The GC-MS revealed significant chemical components of Allium cepa as 1-heptatriacotanol, germacra-1(10),4,11(13)-trien-12-oic acid, 6-alpha-hydroxy-,gamma-lactone, (E,E)-, 11H-Indeno [1,2b] quinoxaline, 2-methyl- while Azadirachta indica have butyl benzoate, benzoic acid, hexyl ester, hexadecanoic acid, methyl ester and Tetrapleura tetraptera have the following 15-hydroxypentadecanoic acid, cis-9-hexadecenal, and 11,13-dimethyl-12-tetradecen-1-ol acetate. All the produced toothpaste has a brown colour and a pleasant smell, with pH from 7.30 to 8.10 and foamability from 19.23% of stand-alone toothpaste to 44.44% of Allium cepa-based. Amongst the produced toothpaste Allium cepa-based toothpaste has the best antimicrobial activities against the tested bacteria (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca) and fungi (Candida albicans and Candida parapsilosis). The stand-alone toothpaste has the lowest minimum inhibitory concentration of 1.25 mg/mL against bacteria and fungi. Clinical significance: The study provides information on the production of human health-friendly dental antimicrobial toothpaste from plant materials.

Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009-December 2019.

BACKGROUND: Human Immuno-Deficiency Virus (HIV) remains one of the world's significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. METHODS: This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients' care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. RESULTS: Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20-40) vs 19,989 (3311-110,340) cp/ml in virally suppressed, and unsuppressed  respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. CONCLUSIONS: Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.

Serological markers and risk factors associated with Hepatitis B virus infection among Federal Capital Territory prison inmates, Nigeria: Should we be concerned?

INTRODUCTION: Hepatitis B virus (HBV) infection is hyper-endemic in Nigeria. Prisons are high-risk environments for the spread of infectious diseases. Worldwide, seroprevalence of HBV infection is substantially higher among individuals in correctional facilities when compared to general population. We determined the seroprevalence and risk factors associated with HBV infection among Kuje prison inmates, Nigeria. MATERIAL AND METHODS: We conducted a prison facility based cross-sectional study. Interviewer administered questionnaires were used to obtain information on participants socio-demographic characteristics, HBV risk factors, previous HBV test and vaccination history. Blood samples collected from participants were analysed for HBsAg, HBsAb, HBcAb, HBeAg and HBeAb markers using rapid lateral chromatographic immunoassay kit. Univariate, bivariate, and multivariate analysis were performed. RESULTS: A total of 271 inmates (63 convicts and 208 awaiting trial inmates) were recruited into the study as participants. The mean age of the participants was 32.7 SD±9 years. HBV seroprevalence (HBsAg) of 13.7% (95% CI: 9.8-18.3) was found. 55.4% (95% CI: 49.2-61.4) of inmates were susceptible to HBV infection, 20.7% (95%CI; 16.0-26.0) had past HBV infection while 10.3% (95% CI: 7.0-14.6) had acquired natural or artificial HBV immunity. Factors found to be associated with current HBV infection (HBsAg) include age-group ≤25years (aOR = 8.0,95% CI: 2.9-22.3), being ever married (aOR = 4.2, 95% CI: 1.7-10.4) and history of alcohol consumption (aOR = 3.4, 95% CI: 1.3-8.4). CONCLUSION: This study reveals a high seroprevalence of HBV infection among Kuje Prison inmates, hence the need to introduce prison-focused health intervention initiatives such as HBV screening, vaccination and care to reduce the transmission of HBV infection among inmates and ultimately the general population.

Mobile phone reminders for enhancing uptake, completeness and timeliness of routine childhood immunization in low and middle income countries: A systematic review and meta-analysis.

Immunization remains one of the most effective public health interventions offering protection for children from vaccine preventable diseases. However, many children living in low- and- middle income countries do not get adequate immunization due to several factors. Mobile phone reminder interventions have shown great potential in enhancing a number of immunization outcomes. However, the evidence supporting its use in these countries is vague. This systematic review was conducted to provide evidence for mobile phone reminder in enhancing immunization uptake, completeness and timeliness. This review was conducted in accordance to the PRISMA recommendations. Three online databases; PubMed, Cochrane Library and African Journals Online, were systematically searched for potentially relevant studies. Screening of records (titles/abstracts from and full-texts) was done using Covidence. Meta-analyses were conducted using the Cochrane Collaboration Review Manager (v5.4). The GRADEpro was used to evaluate the certainty of evidence/summary of findings. Eleven RCTs assessing immunization uptake, completeness and/or timeliness by means of SMS, phone calls or a combination of voice message and SMS were included in both quantitative and qualitative synthesis. Overall, the included studies were of moderate quality. Majority of the included studies indicated that mobile phone reminders were beneficial. Meta-analyses indicated that using mobile phone reminder interventions for the review outcomes was of variable effect with high level of heterogeneity. A combination of voice message and SMS has a greater effect followed by phone calls then SMS reminders for immunization completeness. The use of SMS for immunization uptake and timeliness were largely insignificant (p > 0.05). Furthermore, evidence to support the efficacy of mobile phone reminder from the GRADE synthesis was between low and moderate. Mobile phone reminders, particularly a combination of voice message + SMS and perhaps phone calls appears to be more effective in enhancing immunization outcomes. However, more studies are required in view of methodological inadequacies in existing studies.

Occupational exposure to HIV among healthcare workers in PMTCT sites in Port Harcourt, Nigeria.

BACKGROUND: Rivers State is among the states with high HIV prevalence in Nigeria. Occupational exposure to HIV through blood or body fluids of HIV/AIDS patients is a recognised risk factor of HIV infections among healthcare workers. We identified the determinants of occupational exposures to HIV among healthcare workers in Prevention of Maternal to Child Transmission (PMTCT) sites within Port Harcourt metropolis in Rivers State. METHODS: A descriptive cross-sectional study was conducted and multi-stage sampling technique was used to select 341 healthcare providers from 22 public and 22 private health facilities in PMTCT sites in Port Harcourt metropolis. The data collected were analysed using descriptive statistics, Chi-square and logistic regression models (p-value = 0.05). RESULTS: Respondents' mean age was 35.9 ± SD8.4 years, 270 (80.1%) and 171(50.7%) were females, and from public health facilities respectively. Prevalence of occupational exposure of healthcare workers to HIV in the past 12 months was 153 (45.0%), and 96 (63.3%) experienced such exposure more than once. Contacts with potentially infectious body fluid accounted for the largest proportion 51 (33.3%); followed by needle stick prick 49 (32.6%). About 189 (56.1%) had safety information at their disposal and this serves as a reminder on safety precautions. The likelihood of occupational exposure was significantly higher among doctors (AOR = 2.22, 95% C.I = 1.16-4.25,) but lower among environmental health workers (AOR = 0.10, 95% C.I = 0.02-0.46,) than nurses/midwives when other factors were included in the model. CONCLUSION: Occupational exposure to blood and body fluids remains a frequent occurrence among healthcare workers; highest among doctors in PMTCT sites in the study area. Provision of protective safety materials, training and enforcement of adherence to universal precaution strategies are highly recommended.

Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria.

BACKGROUND: The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. METHODS: A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. RESULTS: A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Health workers' perception of malaria rapid diagnostic test and factors influencing compliance with test results in Ebonyi state, Nigeria.

BACKGROUND: The standard practice in treating uncomplicated malaria is to prescribe artemisinin-based combination therapy (ACT) for only patients with positive test results. However, health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. Available evidence on HWs perception of mRDT and their level of compliance with test results in Nigeria lacks adequate stratification by state and context. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria. METHODS: A cross-sectional survey was conducted among 303 HWs who treat suspected malaria patients in 40 randomly selected public and private health facilities in Ebonyi state. Health workers' perception of mRDT was assessed with 18 equally weighted five-point likert scale questions with maximum obtainable total score of 90. Scores ≥72 were graded as good and less, as poor perception. Data were analysed using descriptive statistics and logistic regression model at 5% significance level. RESULTS: Mean age of respondents was 34.6±9.4 years, 229 (75.6%) were females, 180 (59.4%) community health workers and 67 (22.1%) medical doctors. Overall, 114 (37.6%) respondents across healthcare facility strata had poor perception of mRDT. Respondents who prescribed ACTs to patients with negative mRDT results within six months preceding the survey were 154 (50.8%) [PHCs: 50 (42.4%), General hospitals: 18 (47.4%), tertiary facility: 51 (79.7%) and missionary hospitals: 35 (42.2%)]. Poor HWs' perception of mRDT promoted prescription of ACT to patients with negative mRDT results (AOR = 5.6, 95% C.I = 3.2-9.9). The likelihood of prescribing ACTs to patients with negative mRDT results was higher among HWs in public health facilities (AOR = 2.8, 95% C.I = 1.4-5.5) than those in the private. CONCLUSIONS: The poor perception of mRDT and especially common prescribing of ACTs to patients with negative mRDT results among HWs in Ebonyi state calls for context specific interventions to improve their perception and compliance with mRDT test results.

Women's experience with group prenatal care in a rural community in northern Nigeria.

OBJECTIVE: To assess women's experience of group prenatal care in a rural Nigerian community. METHODS: In an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data. RESULTS: In total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28-19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86-2.16). Commitment to birth preparedness plans was impressive. The mothers enjoyed the group sessions and shared the lessons they learned with others. CONCLUSION: Group prenatal care was feasible and acceptable to women in the present study setting. Comparative trials would be helpful to demonstrate the benefits of the tested model in low-income settings.

A cross-sectional study of traditional practices affecting maternal and newborn health in rural Nigeria.

INTRODUCTION: Certain traditional practices which have negative effects on maternal and child health continue to be practiced in sub-Saharan African countries. A survey was carried out in a rural village in Nigeria to understand the scale and range of these practices. METHODS: This was a cross-sectional study in which trained interviewers administered pre-tested questionnaires on child-bearing women using questionnaires embedded on android devices. RESULTS: The median age of marriage and pregnancy were 15 and 16 years respectively. Home births were high (90.4%) while non-skilled birth attendant was 87.4%. The community had a son preference index ratio of 1:4.1. Up to 81.5% of mothers responded that one form of unhygienic traditional procedure or the other was performed on their children. Time to initiation of breast feeding was in hours in the majority (76.3%) of mothers, with a high rate of use of prelacteal feeds (85.2%). Being an adolescent mother (AOR 0.403, 95%CI 0.203, 0,797) and utilizing a skilled provider at birth (AOR 0.245, 95%CI 0.088, 0.683) were associated with less likelihood of having an unhygienic procedure performed on children. CONCLUSION: The findings of our study suggest that traditional practices which could have negative effects on maternal and child health are still ongoing in the study community. Child protection laws and safeguarding principles could help to reduce these practices and would need to be developed and implemented in these settings where these practices are still prevalent.

Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015.

INTRODUCTION: Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. METHODS: We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. RESULTS: Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2nd-5th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. CONCLUSION: There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the Governments to scale up sensitization of mothers/caregivers to improve their knowledge on routine immunization through radio jingles.

Health care workers' knowledge and attitude towards TB patients under Direct Observation of Treatment in Plateau state Nigeria, 2011.

INTRODUCTION: Tuberculosis (TB) is a public health problem in Nigeria. Adherence to the total duration of treatment is critical to cure the patients. We explored the knowledge of the health care workers on management of TB patients including their perceived reasons for patient non adherence to treatment to develop strategies to improve the quality of the TB control service in the state. METHODS: We conducted a cross sectional study. We used self administered questionnaire to extract information from the health workers on their trainings for TB control, knowledge of the control services, patients' education including prevention of defaulting from treatment. We conducted focus group discussion with the health care workers. We performed descriptive analysis using epiInfo software. RESULTS: Of the 76 respondents 41 (53.9%) were female, 39.9% were community health extension workers, 26.3% were nurses/midwifes 30.3% lacked training on management of TB patient. Only 43.4% knew when to take action on patients who miss their drugs in the intensive phase, 30.3% and 35.5% knew defaults among category 1 and category 2 in the continuation phases of treatment respectively. They identified side effects of drugs (80%), daily clinic attendance (76.3%), health workers attitude (73.4%) and lack of knowledge on duration of treatment (71.1%) including their unfriendly attitudes towards the patients as the major barriers to patients' adherence to treatment. CONCLUSION: Lack of knowledge of the health care workers on management of TB patients and poor interpersonal relation and communication with patients have negative effect on patients' adherence to the long duration of TB treatment.

High concentration of blood lead levels among young children in Bagega community, Zamfara - Nigeria and the potential risk factor.

INTRODUCTION: In May 2010, lead poisoning (LP) was confirmed among children <5years (U5) in two communities in Zamfara state, northwest Nigeria. Following reports of increased childhood deaths in Bagega, another community in Zamfara, we conducted a survey to investigate the outbreak and recommend appropriate control measures. METHODS: We conducted a cross-sectional survey in Bagega community from 23rd August to 6th September, 2010. We administered structured questionnaires to parents of U5 to collect information on household participation in ore processing activities. We collected and analysed venous blood samples from 185 U5 with LeadCare II machine. Soil samples were analysed with X-ray fluorescence spectrometer for lead contamination. We defined blood lead levels (BLL) of >10ug/dL as elevated BLL, and BLL ≥45ug/dL as the criterion for chelation therapy. We defined soil lead levels (SLL) of ≥400 parts per million (ppm) as elevated SLL. RESULTS: The median age of U5 was 36 months (Inter-quartile range: 17-48 months). The median BLL was 71µg/dL (range: 8-332µg/dL). Of the 185 U5, 184 (99.5%) had elevated BLL, 169 (91.4%) met criterion for CT. The median SLL in tested households (n = 37) of U5 was 1,237ppm (range: 53-45,270ppm). Households breaking ore rocks within the compound were associated with convulsion related-children's death (OR: 5.80, 95% CI: 1.08 - 27.85). CONCLUSION: There was an LP outbreak in U5 in Bagega community possibly due to heavy contamination of the environment as a result of increased ore processing activities. Community-driven remediation activities are ongoing. We recommended support for sustained environmental remediation, health education, intensified surveillance, and case management.

Bacteriuria and urinary schistosomiasis in primary school children in rural communities in Enugu State, Nigeria, 2012.

INTRODUCTION: According to a study conducted in1989, Enugu State has an estimated urinary schistosomiasis prevalence of 79%. Recently, studies have implicated bacteriuria co-infection in bladder cancer. These bacteria accelerate the multi-stage process of bladder carcinogenesis. Knowledge about the prevalence of this co-infection is not available in Enugu and the information provided by the 1989 study is too old to be used for current decision making. METHODS: We carried out a cross-sectional survey of primary school children aged 5-15 years, who were randomly selected through a multi stage sampling method using guidelines recommended by WHO for schistosomiasis surveys. An interviewer administered questionnaire was used to collect data on demography, socioeconomic variables and clinical presentations. Urine samples were collected between 10.00am and 2.00pm. Each sample was divided into two: (A) for prevalence and intensity using syringe filtration technique and (B) for culture. Intensity was categorized as heavy (>50ova/10mls urine) and light (<50ova/10mls urine). Significant bacteriuria was bacteria count ≥ 105 colony forming units/ml of urine. RESULTS: Of the 842 pupils, 50.6% were females. The prevalence of urinary schistosomiasis was 34.1%. Infection rate was higher(52.8%) among 13-15 years(Prevalence Ratio = 2.45, 95% Confidence Interval 1.63-3.69). Heavy infections wad 62.7% and egg count/10mls urine ranged from 21-1138. Significant bacteriuria among pupils with urinary schistosomiasis was 53.7% compared to 3.6% in the uninfected(PR = 30.8,95% CI 18.91- 52.09). The commonest implicated organism was Escherchia coli. CONCLUSION: We found high prevalence of bacteriuria co-infection among children with urinary schistosomiasis in Enugu State. This underscores the need for concurrent antibiotics administration and follow-up to avert later complications.

Factors associated with interruption of treatment among Pulmonary Tuberculosis patients in Plateau State, Nigeria. 2011.

INTRODUCTION: Nigeria has one of the highest tuberculosis (TB) burdens in the world with estimated incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state, Nigeria. METHODS: Between June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio-demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info software. RESULTS: Of 378 records reviewed, 229 (61%) patients were male; mean age 37.6±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living >5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment. CONCLUSION: This study revealed knowledge of the patients on the duration of treatment, distance and health workers attitude as the major determinants of adherent to TB treatment. Training for health care workers on patient education was conducted during routine supportive supervision.

Stigmatization of people with mental illness among inhabitants of a rural community in northern Nigeria.

BACKGROUND: Despite the fact that mental illness is a common problem in society, people's perception of the mentally ill and community attitude towards them is still rather poor, making their rehabilitation and reintegration into society an uphill task. AIMS: To examine the stigmatization of people with mental illness within a rural community and identify the socio-demographic variables involved. METHOD: A cross-sectional descriptive study using a multi-stage random sampling technique to obtain data through an interviewer-administered questionnaire to 325 adult inhabitants of a rural community in Nigeria. RESULTS: The results showed widespread ignorance about causation, mode of transmission and remedies available for mental illness, with only 0.9% of respondents attributing mental illness to brain disease. The others attributed it to spiritual attack, punishment for evil doing and illicit psychoactive substance use, among other things. Negative views about the mentally ill were also widely expressed resulting in discriminatory practices. CONCLUSION: Stigmatization of people with mental illness is still rampant in our community. There is a need for adequate public education about the causes and mode of transmission of mental illness and the treatment options available in the community.

Costs and Patterns of Financing Maternal Health Care Services in Rural Communities in Northern Nigeria: Evidence for Designing National Fee Exemption Policy.

BACKGROUND: As population and access to information increases, so does the demand for health services. Unfortunately, many people who genuinely require these services do not usually have access to them. To increase access, various financing options have been used. Despite this, maternal morbidity and mortality rates remain high and spending is still largely out of pocket. This study assesses maternal health problems, preferred sources of care and the pattern of financing in a semi-rural community in North Western part of Nigeria. METHODOLOGY: A cross-sectional descriptive study design was used. The study population consisted of women within the reproductive age group who had experienced childbirth 12 months or less prior to the study. A sample size of 240 was drawn using cluster and random sampling techniques. Interviewer administered questionnaires were used and the results were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The mean age of the respondents was 29 years and 49% had no personal income. Fever was the commonest problem. Although majority received antenatal care, those who lacked antenatal care mostly cited financial difficulties. Nearly half of the women delivered at home as opposed to a health facility. On average, women spent between Nigerian Naira (N) N1, 350-N14, 850 (USD$9-99) for a total package of maternal health services. Out of pocket spending by the husbands or household heads and the women themselves accounted for 73.3% of expenses. CONCLUSION AND PUBLIC HEALTH IMPLICATIONS: In Nigeria, women are still vulnerable to common and preventable causes of maternal morbidity and mortality due to lack of access to antenatal health care. Out of pocket spending is still a popular method of financing. Harmonization of fee exemption policies can improve access to maternal healthcare.

Knowledge, attitude and practice of cervical cancer screening among market women in Zaria, Nigeria.

BACKGROUND: Cervical cancer is the most common genital cancer and one of the leading causes of death among female population. Fortunately, this cancer is preventable by screening for premalignant lesions but this is rarely provided and hardly utilised. We assessed the knowledge, attitude and utilisation of cervical cancer screening among market women in Sabon Gari, Zaria. MATERIALS AND METHODS: This was a cross-sectional study to evaluate the knowledge, attitude and practice of cervical cancer screening among market women. A total of 260 women were administered with questionnaires which were both self and interviewer administered. These were analysed using SPSS version 11. RESULTS: Respondents exhibited a fair knowledge of cervical cancer and cervical cancer screening (43.5%); however, their knowledge of risk factors was poor. There was generally good attitude to cervical cancer screening (80.4%), but their level of practice was low (15.4%). CONCLUSIONS: There was a fair knowledge of cervical cancer and cervical cancer screening among Nigerian market women in this study, their practice of cervical cancer screening was poor.

Sero-prevalence of hepatitis B virus infection and its risk factors among pregnant women attending antenatal clinic at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Neonates who contract the HBV have about 90risk of developing chronic HBsAg carriage (HBsAg: hepatitis B surface antigen) and chronic liver disease. Neonatal immunization interrupts this vertical and perinatal transmission. Objectives: To determine the seroprevalence of HBsAg among pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital (AKTH) and to identify potential risk factors associated with HBV infection. Materials and Methods: A case control study was conducted involving a total of 303 pregnant women attending the antenatal clinic at AKTH and 303 nonpregnant women of childbearing age. Blood sample was collected from each woman and the serum tested for the presence of HBsAg using latex rapid agglutination slide test kit (Cal-Tech Diagnostic Inc.; USA) in the laboratory of the hospital. Reactive samples were stored at -20oC and further confirmed for HBsAg using enzyme-linked immunosorbent assay (ELISA) kits (Bio-Rad; France). HBsAg-positive samples were tested for hepatitis B e antigen (HBeAg) using ELISA kits (Orgenics; Israel). A pretested; structured questionnaire was used for the collection of sociodemographic data and possible risk factors. Results: The prevalence of HBsAg among pregnant women and nonpregnant women were 7.9 and 7.6; respectively. There was no statistically significant difference in the prevalence of HBsAg in pregnant and nonpregnant women. The presence of HBeAg was statistically significant among both pregnant and nonpregnant women who tested positive for HBsAg. The risk factors associated with HBV infection were blood transfusion; ear piercing; history of an affected sibling with HBV infection; tattooing; and abortion among pregnant women. Conclusion: The prevalence of HBsAg in this study was not statistically different in pregnant and nonpregnant women. There was a high level of HBeAg infection among pregnant women who tested positive for HBsAg. History of an affected sibling with HBV infection; tattoo; and abortion were significant risk factors for HBV infection