A practical approach for geographic prioritization and targeting of insecticide-treated net distribution campaigns during public health emergencies and in resource-limited settings.

BACKGROUND: The use of data in targeting malaria control efforts is essential for optimal use of resources. This work provides a practical mechanism for prioritizing geographic areas for insecticide-treated net (ITN) distribution campaigns in settings with limited resources. METHODS: A GIS-based weighted approach was adopted to categorize and rank administrative units based on data that can be applied in various country contexts where Plasmodium falciparum transmission is reported. Malaria intervention and risk factors were used to rank local government areas (LGAs) in Nigeria for prioritization during mass ITN distribution campaigns. Each factor was assigned a unique weight that was obtained through application of the analytic hierarchy process (AHP). The weight was then multiplied by a value based on natural groupings inherent in the data, or the presence or absence of a given intervention. Risk scores for each factor were then summated to generate a composite unique risk score for each LGA. This risk score was translated into a prioritization map which ranks each LGA from low to high priority in terms of timing of ITN distributions. RESULTS: A case study using data from Nigeria showed that a major component that influenced the prioritization scheme was ITN access. Sensitivity analysis results indicate that changes to the methodology used to quantify ITN access did not modify outputs substantially. Some 120 LGAs were categorized as 'extremely high' or 'high' priority when a spatially interpolated ITN access layer was used. When prioritization scores were calculated using DHS-reported state level ITN access, 108 (90.0%) of the 120 LGAs were also categorized as being extremely high or high priority. The geospatial heterogeneity found among input risk factors suggests that a range of variables and covariates should be considered when using data to inform ITN distributions. CONCLUSION: The authors provide a tool for prioritizing regions in terms of timing of ITN distributions. It serves as a base upon which a wider range of vector control interventions could be targeted. Its value added can be found in its potential for application in multiple country contexts, expediated timeframe for producing outputs, and its use of systematically collected malaria indicators in informing prioritization.

Private sector malaria RDT initiative in Nigeria: lessons from an end-of-project stakeholder engagement meeting.

The malaria rapid diagnosis testing (RDT) landscape is rapidly evolving in health care delivery in Nigeria with many stakeholders playing or having potential for critical roles. A recent UNITAID grant supported a pilot project on the deployment of quality-assured RDTs among formal and informal private service outlets in three states in Nigeria. This paper describes findings from a series of stakeholder engagement meetings held at the conclusion of the project. The agreed meeting structure was a combination of plenary presentations, structured facilitated discussions, and nominal group techniques to achieve consensus. Rapporteurs recorded the meeting proceeding and summaries of the major areas of discussion and consensus points through a retrospective thematic analysis of the submitted meeting reports. Key findings indicate that private providers were confident in the use of RDTs for malaria diagnosis and believed it has improved the quality of their services. However, concerns were raised about continued access to quality-assured RDT kits. Going forward, stakeholders recommended increasing client-driven demand, and continuous training and supervision of providers through integration with existing monitoring and supervision mechanisms.

Factors Responsible for Under-Utilization of Postnatal Care Services in Maiduguri; North-Eastern Nigeria

Background: In Maiduguri; the utilization of available postnatal care services is still very low. This may be influenced by demographic; socioeconomic; cultural; and obstetric factors among others. Objective: The aim of this study is to understand the current status of utilization of maternal postnatal health care services and identify factors responsible for under.utilization of available postnatal care services in Maiduguri. Materials and Methods: A. cross.sectional; questionnaire.based study was conducted involving 350 women in their reproductive age group. (15.49. years); who had delivered previously; residing in Maiduguri and who came to access any of the available maternal health care services at the State Specialist Hospital; Maiduguri over a 3.month period. The Chi.squared statistics and multivariate logistic regression analysis were used. Results: Out of the grand total of 350 questionnaires that were distributed during the study period; 18 questionnaires were excluded from analysis due to incomplete responses; 332 with complete responses were therefore analyzed; giving a response rate of 94.9. The results showed that only 16.9 of the respondents attended postnatal care services within 42. days after delivery. Most of the mothers. (60.9) were not knowledgeable about postnatal care services. A. very high proportion of participants. (69.4) did not attend antenatal clinics; and over. 70of the study population had delivered at home. The study has identified some factors that have an important influence on utilization of postnatal care services in Maiduguri. These included awareness of postnatal care services. (odds ratio. [OR] 12.04; 95 confidence interval. [CI]: 10.26; P =. 0.000); higher educational status of the woman. (OR 7.15; 95 CI: 5.19; P =0.000); lower parity. (OR 5.22; 95 CI: 3.21; P = 0.001) and marital status. (married woman.OR 3.44; 95 CI: 2.17; P =0.002). Educational attainment of the husband also significantly affected the respondents' seeking behavior of postnatal care. (OR 2.01; 95 CI: 1.13; P =0.042). Conclusion: Utilization of postnatal care services is quite low in Maiduguri. Socioeconomic and sociodemographic factors influenced the use of postnatal care services. Government should provide culturally acceptable health educational programs and expands maternal health care services into the communities for the better; effective and efficient health care delivery

Sexual assault against female Nigerian students.

Sexual assault is a common social disorder among students in our tertiary institutions. This study ascertains the extent and effect of sexual assault among Nigerian students. Two hundred and Sixty Eight structured questionnaires were distributed to randomly selected students in 4 tertiary institutions, information on socio demography, sexual history and consequences of their exposure were obtained for analysis and interpretation. Thirty seven (13.8%) of the respondents were sexually assaulted as a student and 19 (7.1%) were assaulted by their lecturers and fellow students, Younger age at coitarche, history of forced coitarche, marriage, coitarche with relations and unknown persons, significantly influenced subsequent risks of sexual assault. Improve security, moral behaviours enforcing dress code and stiffer penalties were suggested ways to prevent sexual assault among the students. Sexual assault is still a common finding in our institutions; effort should be made by all stake holders to prevent this social embarrassment.

Sexual assault against female nigerian students

Sexual assault is a common social disorder among students in our tertiary institutions. This study ascertains the extent and effect of sexual assault among Nigerian students. Two hundred and Sixty Eight structured questionnaires were distributed to randomly selected students in 4 tertiary institutions, information on socio demography, sexual history and consequences of their exposure were obtained for analysis and interpretation. Thirty seven (13.8%) of the respondents were sexually assaulted as a student and 19 (7.1%) were assaulted by their lecturers and fellow students, Younger age at coitarche, history of forced coitarche, marriage, coitarche with relations and unknown persons, significantly influenced subsequent risks of sexual assault. Improve security, moral behaviours enforcing dress code and stiffer penalties were suggested ways to prevent sexual assault among the students. Sexual assault is still a common finding in our institutions; effort should be made by all stake holders to prevent this social embarrassment (Afr. J. Reprod. Health 2010; 14[3]: 189-193)

A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria.

OBJECTIVE: To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. METHODOLOGY: Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. RESULTS: Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had a higher case fatality of 24.0% compared to 15% among book cases, while those with formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11 (21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. CONCLUSION: Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

Trends in maternal mortality in a tertiary institution in Northern Nigeria.

OBJECTIVE: To look at the trends in maternal mortality in our institution over 5 years. METHODS: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. RESULTS: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (chi2=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with chi2=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (chi2=64.69, P =0.00000; and chi2=18.52, P =0.0000168, respectively). CONCLUSION: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.