Scaling training facilities for patent and proprietary medicine vendors in Nigeria: insights and lessons learned for policy implication and future partnerships.

Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.

Is too much sugar bitter? The impacts of sugars on health.

This paper reviews the associations between sugars consumption and non-communicable diseases. Systematic reviews demonstrate associations between sugars intake and dental caries, weight gain, type 2 diabetes and cardiovascular diseases. Children consuming more sugar-sweetened beverages (SSBs) are 1.55 times more likely to be overweight. In adults, higher consumption of SSBs is associated with a 27% higher relative risk of developing type 2 diabetes. In adults, greater free sugar consumption was positively associated with total CVD (HR 1.07; 95% CI: 1.03-1.10), ischaemic heart disease (HR 1.06; 95%CI: 1.02,1.10), and stroke (HR 1.10, 95% CI: 1.04, 1.17). Those consuming sugars higher than the recommended level of 10% of total energy are more likely to develop dental caries; 42 out of 50 studies involving children and 5 out of 5 in adults reported at least one positive association between sugars and caries. Reduction in sugars consumption requires a myriad of interventions to reduce supply and demand at national and global levels, fiscal policies, alongside high-quality research and promoting environments to reduce the burden of NCDs.

Knowledge and preventive practices related to Monkey pox among medical doctors in Sokoto metropolis of Sokoto State, Nigeria

Background: For effective control of Monkey pox (Mpox), clinicians need to have adequate knowledge of the disease and adopt appropriate practices to contain it. This study sought to assess the knowledge and practices of medical doctors regarding Monkey pox. Methodology: A descriptive cross-sectional design was utilized for the study and using a two stage sampling method, 210 medical doctors working in Sokoto metropolis were recruited into the study. A set of structured, pretested and self-administered questionnaire was used to obtain relevant information from the study participants. Data obtained was analyzed using SPSS computer software version 23 with level of statistical significance set at p<0.05 Results: All the respondents were aware of Mpox with more than half (52.3%) having the internet as their commonest source of information. The majority, ((72%) of the clinicians had good knowledge and only years of working experience was significantly associated with knowledge of the disease. Preventive practices were well exhibited by all the respondents with the majority (73%) having appropriate preventive practices. Conclusion and recommendation: This study has demonstrated good knowledge towards Mpox by clinicians in Sokoto metropolis, with a greater majority exhibiting appropriate preventive practices. Sustained awareness and retraining of health care workers in general is necessary to maintain the tempo of high index of suspicion for outbreaks of Mpox and other potential epidemics and also regular use of personal protective equipment

Knowledge and preventive practices related to Monkey pox among medical doctors in Sokoto metropolis of Sokoto State, Nigeria

Background: For effective control of Monkey pox (Mpox), clinicians need to have adequate knowledge of the disease and adopt appropriate practices to contain it. This study sought to assess the knowledge and practices of medical doctors regarding Monkey pox. Methodology: A descriptive cross-sectional design was utilized for the study and using a two stage sampling method, 210 medical doctors working in Sokoto metropolis were recruited into the study. Aset of structured, pretested and self-administered questionnaire was used to obtain relevant information from the study participants. Data obtained was analyzed using SPSS computer software version 23 with level of statistical significance set at p<0.05 Results: All the respondents were aware of Mpox with more than half (52.3%) having the internet as their commonest source of information. The majority, ((72%) of the clinicians had good knowledge and only years of working experience was significantly associated with knowledge of the disease. Preventive practices were well exhibited by all the respondents with the majority (73%) having appropriate preventive practices. Conclusion and recommendation: This study has demonstrated good knowledge towards Mpox by clinicians in Sokoto metropolis, with a greater majority exhibiting appropriate preventive practices. Sustained awareness and retraining of health care workers in general is necessary to maintain the tempo of high index of suspicion for outbreaks of Mpox and other potential epidemics and also regular use of personal protective equipment

Operationalizing strategies for expanding UHC for the vulnerable population in Nigeria.

People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.

A qualitative analysis of health information-sharing networks in the Indonesian poultry sector.

Animal production systems are developing into increasingly complex value chains involving a large diversity of actors with multiple and dynamic linkages, concurrently creating many opportunities for disease spread. Access to timely and good-quality animal health information is vital for designing effective disease management strategies. However, several factors may hamper information flows along those chains. Understanding the structure and dynamics of information networks is essential to develop effective and acceptable health information systems. We applied a qualitative network approach to understand how information about poultry health is generated, disseminated and used for decision-making along the poultry value chain in Indonesia. Maps of the value chain and information networks were generated based on data from key informant interviews to illustrate the linkages and information-sharing patterns between stakeholders. Four types of farm business models were identified: company-owned, contract, partnership and independent. Although companies and most independent farmers collected health and production data routinely, their systems were strongly siloed and still relied on a mix of digital and paper-based methods, which impaired their analytical capacity. Technical service providers from the upstream sector and industry associations were identified as key intermediaries in the information-sharing network with the ability to create informal bridges between separate business networks and public actors. These actors can play a strategic role in the development of integrated information systems to improve stakeholders' capacity to monitor, anticipate and manage disease threats at all levels of the value chain. This study contributes to fill an important knowledge gap regarding the layer sector and may help decision-makers to design effective policies and interventions tailored to the type of business model.

Implementation and Effectiveness Outcomes of a Quality Improvement Intervention to Strengthen the Application of the World Health Organization Surgical Safety Checklist Tool in a Limited-Resource Setting.

BACKGROUND: There is a disparity in the provision of quality and safe surgical care in Nigeria. The capacity to track surgical safety through the use of the surgical safety checklist tool is variable in this setting. This study aimed to assess the outcomes of training on this checklist and the results of its pilot implementation. SUBJECTS, MATERIALS AND METHODS: A mixed-methods research comprising of quantitative and qualitative study designs was conducted to evaluate these 23 weeks intervention in our centre. Implementation was conducted in two phases: training of the surgical team and pilot testing of the intervention. Using the RE-AIM framework, implementation outcomes evaluated included reach of training, adoption of checklist and implementation challenges, while effectiveness outcomes evaluated included change in the knowledge score after the training and self-reported impact of the training and pilot test. Quantitative and qualitative data were collected and analyzed. RESULTS: There was a 2.4-point significant increase in the knowledge score after the training. During the pilot testing phase, 843 patients had surgery. The weekly checklist utilization rate for elective surgery rose to 64% at project completion. Despite logistic and manpower-related implementation challenges, the training intervention facilitated the translation of participant knowledge into practice (81.5%) and the pilot phase had a high impact on the practice of checklist use (3.8 ± 0.9). CONCLUSION: The quality improvement programme enhanced knowledge of checklist use and led to improved behaviour and positive organizational change. However, barriers need to be addressed to strengthen the sustainable use of the checklist tool.

CONTEXTE: Il existe une disparité dans la fourniture de soins chirurgicaux sûrs et de qualité au Nigéria. La capacité de suivre la sécurité chirurgicale par l'utilisation de la liste de contrôle de sécurité chirurgicale est variable dans ce contexte. Cette étude visait à évaluer les résultats de la formation à cette liste de contrôle et les résultats de sa mise en œuvre pilote. SUJETS, MATÉRIEL ET MÉTHODES: Une recherche à méthodes mixtes comprenant des études quantitatives et qualitatives a été menée pour évaluer cette intervention de 23 semaines dans notre centre. La mise en œuvre s'est déroulée en deux phases : formation de l'équipe chirurgicale et essai pilote de l'intervention. En utilisant le cadre REAIM, les résultats de la mise en œuvre évalués comprenaient la portée de la formation, l'adoption de la liste de contrôle et les défis de la mise en œuvre, tandis que les résultats de l'efficacité évalués comprenaient le changement dans le score des connaissances après la formation et l'impact auto-déclaré de la formation et de l'essai pilote. Des données quantitatives et qualitatives ont été recueillies et analysées. RÉSULTATS: Une augmentation significative de 2,4 points du score de connaissances a été observée après la formation. Au cours de la phase de test pilote, 843 patients ont été opérés. Le taux d'utilisation de la liste de contrôle hebdomadaire pour les opérations non urgentes est passé à 64 % à la fin du projet. Malgré les difficultés de mise en œuvre liées à la logistique et à la main-d'œuvre, l'intervention de formation a facilité l'application des connaissances des participants dans la pratique (81,5 %) et la phase pilote a eu un impact élevé sur la pratique de l'utilisation de la liste de contrôle (3,8 ± 0,9). CONCLUSION: Le programme d'amélioration de la qualité a renforcé les connaissances sur l'utilisation des listes de contrôle et a conduit à une amélioration des comportements et à un changement organisationnel positif. Toutefois, des obstacles doivent être surmontés pour renforcer l'utilisation durable de l'outil de la liste de contrôle. Mots-clés: Liste de contrôle, Sécurité des patients, Amélioration de la qualité, Chirurgie, Organisation mondiale de la santé.

A multi-level analysis of prevalence and factors associated with caesarean section in Nigeria.

The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.

Editorial: The WHO Global Oral Health Action Plan 2023-2030.

Oral health is finally on the global agenda. The World Health Organisation Global Oral Health Action Plan (OHAP) 2023-2030 (WHO, 2022a) has been completed following a public consultation which took place during August and September 2022. As oral diseases are the most prevalent non-communicable diseases; it is good to see that the OHAP will co-exist alongside the Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030. This editorial summarises the OHAP and highlights the opportunities and challenges discussed during the September 2022 EADPH congress, held co-jointly with the Council of the European Chief Dental Officers (CECDO).

Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology.

BACKGROUND: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey. OBJECTIVE: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. METHODS: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). RESULTS: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. CONCLUSIONS: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

The WHO Action Plan for Oral Health - How Can the EADPH Contribute - Opportunities and Challenges.

This paper summarises the proceedings of a workshop organised by the European Association of Dental Public Health, held in Montpellier in September 2022. The full proceedings were transcribed and are available on the Community Dental Health website (https://www.cdhjournal.org/article/973). The WHO Action Plan for Oral Health provides a golden opportunity to help raise the profile of oral health, to put oral health on the global public health agenda and ultimately improve oral health. It is to be applauded. However, delivery will present a challenge. Those challenges and opportunities are detailed in this paper.

Stakeholders' perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria.

BACKGROUND: The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS: A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS: Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION: To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.

The Colours of Octopus: Using Spectral Data to Measure Octopus Camouflage.

No animal can so effectively camouflage in such a wide range of environments as the octopus. Thanks to their highly malleable skin, they are capable of adapting their body patterns to the brightness and texture of their immediate environment, and they often seemingly match the colour of background objects. However, octopuses are colour-blind as their eyes have only one type of visual pigment. Therefore, chromatophores in their skin are likely to respond to changes in brightness, not chromaticity. To determine whether octopuses actually match background colours, we used a SpectraScan® PR-655 spectroradiometer to measure the reflectance spectra of Octopus tetricus skin in captivity. The spectra were compared with those of green algae, brown algae, and sponges-all of these being colourful objects commonly found in the octopus's natural environment. Even though we show that octopuses change both lightness and chromaticity, allowing them to potentially camouflage in a wide range of backgrounds in an effective manner, the overall octopus colours did not reach the same level of saturation compared to some background objects. Spectra were then modelled under the visual systems of four potential octopus predators: one dichromatic fish (Heller's barracuda), two trichromatic fish (blue-spotted stingray and two-spotted red snapper), and one tetrachromatic bird (wedge-tailed shearwater). We show that octopuses are able to match certain background colours for some visual systems. How a colour-blind animal is capable of colour-matching is still unknown.

The Impact of Oral Health Training on the Early Year's Workforce Knowledge, Skills and Behaviours in Delivering Oral Health Advice: A Systematic Review.

OBJECTIVES: To determine the effectiveness of training the early year's workforce on their knowledge, skills and/or behaviours in delivering oral health advice. METHODS: Four databases: PubMed, Web of Science, Embase and Scopus were searched to evaluate the effectiveness of oral health training on knowledge, skills and behaviour of the early year's workforce with a minimum of one-month follow-up. Randomised or quasi-randomised trials and before and after studies were included. RESULTS: All six included studies showed improved knowledge and one of the five studies showed significant changes in behaviours of participants post oral health training. None of the included studies addressed changes in skills as an outcome. CONCLUSION: This systematic review found evidence that oral health training of the early year's workforce is effective in improving their knowledge but not necessarily their behaviours delivering oral health advice. Although training of the wider workforce on oral health is recommended, high quality research is required with longitudinal follow-up to assess changes in behaviours and ultimately impacts on oral health.

The impact of HPV vaccination on the prevention of oropharyngeal cancer: A scoping review.

INTRODUCTION: HPV-associated oropharyngeal cancer (OPC) has one of the most rapidly rising incidences of any cancer in high-income countries. HPV vaccination is being tested to prevent HPV-associated OPC. OBJECTIVE: To determine the effect of Human Papilloma Virus (HPV) vaccination on the prevention of OPC in adults worldwide. BASIC RESEARCH DESIGN: Scoping review conducted using PRISMA-ScR Checklist. METHOD: An electronic literature search identified relevant records. Titles and abstracts were screened to assess eligibility by two researchers, and data from relevant full-text articles were extracted and synthesised. RESULTS: Three-hundred-and-forty-three studies were identified, with eleven articles meeting the inclusion criteria. The most common study design was cross-sectional (n = 7), the most common location was the US (n = 6) and data collection periods spanned 2004 to 2020. One article found unvaccinated participants had a 19 times increased risk of developing OPC compared with those who had been vaccinated against HPV. The remaining papers showed that prevalence of HPV-vaccine-type oral infection was significantly lower in vaccinated participants than unvaccinated participants, with a reduction of oral HPV detection ranging from 72% to 93%. This reduction varied by sex. CONCLUSIONS: There is evidence to suggest that HPV vaccination reduces oral HPV infection and decreases the incidence of HPV-associated OPC. There is substantial need for further research which directly examines the relationship between HPV vaccination status and subsequent OPC development.

Assessment of occupational violence towards pharmacists at practice settings in Nigeria

BACKGROUND: Occupational Violence is prevalent among healthcare workers, including pharmacists, and poses a big threat to their job satisfaction, safety, and social wellbeing. OBJECTIVE: This study seeks to assess the incidents and factors associated with occupational violence towards pharmacists in Nigeria. METHODS: A cross-sectional study was conducted among pharmacists practicing in Nigeria, using an online survey (Google FormTM). Occupational violence was assessed using a validated questionnaire. The survey was conducted and reported based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Participants were recruited by sharing the survey link via social media platforms including WhatsApp, Facebook, LinkedIn, and Twitter. RESULTS: A total of 263 respondents returned the online questionnaire, with a completion rate of 99.2%. The prevalence of occupational violence was 92.7% (95% CI, 90 to 96). Violent events occurred among 48.7% of pharmacists with at least six years of experience, and 68.4% of hospital pharmacists. The commonly reported factors associated with the violence include long waiting times in the pharmacy (36.5%), refusal to fulfil aggressor's demands (22.1%), and counseling/poor communication (21.7%). Events related to verbal abuse were reported among 95% of the participants. The prevalence of violence was significantly higher among hospital pharmacists, compared with those practicing in administration/regulatory, and in community pharmacies (chi-square=10.213 (2); p = 0.006). Similarly, physical aggression was higher among hospital pharmacists (chi-square=10.646 (2), p = 0.005). CONCLUSIONS: The prevalence of occupational violence towards pharmacists practicing in Nigeria appeared to be high. Major factors associated with the violence were refusal to fulfil aggressors' demands and frustrations due to long waiting times at pharmacy. Recommended strategies to slowdown the incidences of violence were improved pharmacists' workforce, interprofessional harmony, and penalties against perpetrators

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