A framework for stakeholder engagement in the adoption of new anti-malarial treatments in Africa: a case study of Nigeria.

BACKGROUND: Recent reports of artemisinin partial resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new anti-malarials. This is a case study on the evolution, adoption, and implementation of new anti-malarial treatment policies in Nigeria. The main objective is to provide perspectives to enhance the future uptake of new anti-malarials, with an emphasis on stakeholder engagement strategies. METHODS: This case study is based on an analysis of policy documents and stakeholders' perspectives drawn from an empirical study conducted in Nigeria, 2019-2020. A mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and 33 qualitative in-depth interviews and 6 focus group discussions. RESULTS: Based on policy documents reviewed, the adoption of artemisinin-based combination therapy (ACT) in Nigeria was swift due to political will, funding and support from global developmental partners. However, the implementation of ACT was met with resistance from suppliers, distributors, prescribers, and end-users, attributed to market dynamics, costs and inadequate stakeholder engagement. Deployment of ACT in Nigeria witnessed increased developmental partner support, robust data generation, ACT case-management strengthening and evidence on anti-malarial use in severe malaria and antenatal care management. A framework for effective stakeholder engagement for the future adoption of new anti-malarial treatment strategies was proposed. The framework covers the pathway from generating evidence on drug efficacy, safety and uptake; to making treatment accessible and affordable to end-users. It addresses which stakeholders to engage with and the content of engagement strategies with key stakeholders at different levels of the transition process. CONCLUSION: Early and staged engagement of stakeholders from global bodies to community level end-users is critical to the successful adoption and uptake of new anti-malarial treatment policies. A framework for these engagements was proposed as a contribution to enhancing the uptake of future anti-malarial strategies.

Source identification and health risk assessments of heavy metals in indoor dusts of Ilorin, North central Nigeria.

Background and Purpose: Exposure to heavy metals (HMs) in indoor dusts is a serious public concern that is linked to a myriad of deleterious health outcomes. The objectives of this study are to estimate the contamination levels of HMs in indoor dusts of different residential areas in Ilorin, Nigeria; identify HMs sources in different residential areas; and evaluate human health risks of HMs in selected residential areas. Methods: Indoor dust sampling was conducted in ten randomly selected from low, medium and high population density residential areas of Ilorin, Nigeria. Ten HMs concentration levels, their health risk implication and the associated potential ecological risks were evaluated. Results: The mean concentration levels measured for Fe, Pb, Zn, As, Co, Cr, Cu, Cd, Mn and Ni were 38.99, 5.74, 3.99, 0.08, 2.82, 2.13, 0.47, 0.60, 6.45 and 1.09 mg/kg, respectively. Positive Matrix Factorization (PMF) model was applied to ascertain sources of HMs in sampled indoor dust. Percentage contribution from oil-based cooking (29.82%) and transportation (29.77%) represented the highest source to HM concentrations among the six factors identified. The results of the various pollution indices employed showed that Pb, Zn, As, Co, Cr, Cu, Mn and Ni contributed moderately to HMs concentration levels in the sampled dusts. Cd had highest potential ecological risk factor E r i of between 160 and 320. The average values of Enrichment Factors (EFs) obtained aside from Fe used as the reference metal, ranged between 8.46 (As) and 2521.61(Cd). Health risk assessment results revealed that children are the most susceptible to the risks associated with HMs bound indoor dust than the adults. The percentage risk contributions of Hazard Quotient via ingestion route (HQing) in Hazard Index (HI) for non-cancer risk of indoor HMs were 93.17% and 69.87% in children and adults, respectively. Likewise, the percentage cancer risks contribution through ingestion pathway (CRing) were higher than cancer risks through inhalation and dermal pathways (CRinh and CRdermal), accounting for 99.84% and 97.04% of lifetime cancer risk in children and adults, respectively. The contamination level of Cd recorded is of great concern and signifies very strong contribution from anthropogenic sources. Conclusion: This study has further revealed the levels of HMs in typical African residential settings that could be used by relevant stakeholders and policy makers in developing lasting control measures. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-021-00778-8.

Source identification and health risk assessments of polycyclic aromatic hydrocarbons in settled dusts from different population density areas of Ilorin, Nigeria.

Polycyclic aromatic hydrocarbons (PAHs) have attracted significant attention in recent times on account of their reasonably high environmental burden and extreme toxicity. Samples of indoor dusts were obtained daily over a period of 2 weeks from 10 residences located within low, medium, and high density residential areas of Ilorin City. The concentration levels, potential sources, and cancer health risks of sixteen polycyclic aromatic hydrocarbons (PAHs) were investigated using gas chromatography/mass spectrometry. PAHs total concentrations varied from 3.95 ± 0.19 to 8.70 ± 0.43 µg/g with arithmetic mean of 6.09 ± 0.46 µg/g. Fluoranthene was the most dominant PAHs congener. High molecular weight (HMW) PAHs (4-6 rings) were the most prevalent PAHs and were responsible for 79.29% of total PAHs in sampled residences. Chrysene (Chry) was the most abundant compound among the 7 carcinogenic PAHs (CPAHs). Moreover, diagnostic ratios and positive matrix factorization (PMF) employed to apportion PAHs suggested that indoor dusts originated from indoor activities and infiltrating outdoor air pollutants. Diagnostic ratios revealed that PAHs are from mixed sources which include coal/wood combustion, non-traffic and traffic emissions, petroleum, petrogenic (gasoline), and petroleum combustion. Similarly, positive matrix factorization (PMF) model suggested five sources (factors) were responsible for PAHs in indoor dusts comprised of petroleum combustion and traffic emissions (60.05%), wood and biomass combustion emissions (20.84%), smoke from cooking, incense burning and tobacco (4.17%), gasoline combustion from non-traffic sources (13.89%), and emissions from coal burning and electronic devices (1.05%). The incremental lifetime carcinogenic risks (ILCR) of PAHs in adults and children estimated by applying benzo(a)pyrene (BaP) equivalent were within the satisfactory risk limits in Ilorin. Indoor PAHs emissions in Ilorin residences could be monitored and controlled by using data provided in this study.

Pattern and predictive factors of health-related quality of life of patients with hypertension, diabetes and concomitant hypertension with diabetes in Ilorin, Nigeria.

BACKGROUND: Hypertension and diabetes are the two most important modifiable risk factors for cardiovascular disease (CVD) among Nigerian population. Because of the lifelong nature of the two diseases and the attendant long treatment regimen required, assessing the health-related quality of life (HRQoL) is an important outcome of these diseases. OBJECTIVE: This study assessed the pattern and predictive factors of HRQoL among patients with hypertension, diabetes and concomitant hypertension and diabetes using the 36-item short-form version 2. PATIENTS AND METHODS: A cross-sectional study of 1203 patients attending the outpatient clinics of the University of Ilorin Teaching Hospital, Ilorin; the patients were sampled using systematic random sampling methods. Patients were divided into those with hypertension, diabetes and both diseases. The predictors of physical and mental component summaries of HRQoL were analysed using Norm-based Scoring. The level of significance was set at P < 0.05 and 95% confidence interval. RESULTS: The patients with both diseases have lowest physical HRQoL (45.6), while the diabetic patients have the worst mental HRQoL (39.5). Negative predictors of physical HRQoL across the three groups were: drug regimen (hypertension P < 0.001, diabetes P < 0.001, both P = 0.005), CVD complication (hypertension P < 0.001, diabetes P = 0.025) and accompanying persons (P < 0.001). The positive predictors of physical HRQoL across the three groups were medication adherence (hypertension P < 0.001, diabetes P < 0.001 and both P = 0.002). Similarly, medication adherence was the positive predictor for mental HRQoL across the three groups of patients (hypertension P < 0.001, diabetes P = 0.001 and both P < 0.001). CONCLUSION: This study provided evidence to show that HRQoL across the three categories of patients in Ilorin, Nigeria, is suboptimal. Drug regimen, medication adherence and support from accompanying persons were important predictive factors of HRQoL.

Ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in South West Nigeria.

INTRODUCTION: Malaria has proven to be the most horrendous and intractable amongst the health problems confronting countries in the sub-Saharan Africa. This study aims to determine the ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in a state in South West Nigeria. METHODS: Multi-stage sampling technique was used to recruit 2560 households spread across the 16 LGAs of the state. Interviewer administered standardized questionnaire was used for the survey. Data analysis was done using Stata 10 software. RESULTS: Sixty eight point six percent (68.6%) of the households had at least one under-five child living in the household while 32.6% had at least one pregnant woman living in the household. A total of 2440 (95.3%) households received LLIN during the campaign. Overall, the utilization rate for all respondents was 58.5%. Despite the fact that 2440 households received LLINs during the campaign, only 84.3% of them were seen to have hung theirs during the survey. CONCLUSION: Coverage and ownership of LLINs increased significantly following the free distribution campaign. There was a discrepancy between net possession and net use with rate of use lower than possession. Post distribution educational campaign should be incorporated into future distribution campaigns to help increase net utilisation.

Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria.

INTRODUCTION: Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. METHODS: It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. RESULTS: The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. CONCLUSION: It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.