Determinants of enrolment in health insurance scheme among HIV patients attending a clinic in a tertiary hospital in South-eastern Nigeria.

Objective: The study aimed to assess the determinants of enrolment in health insurance schemes among people living with HIV. Design: The study was a cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect information from 371 HIV clients attending the clinic. Chi-square statistic was used for bi-variate analysis, and analytical decisions were considered significant at a p-value less than 0.05. Logistic regression was done to determine predictors of enrolment in health insurance. Setting: The study was carried out in the HIV clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Participants: HIV clients attending a clinic. Result: Mean age of respondents was 45.4±10.3, and 51.8% were males. Almost all the respondents were Christians. Only 47.7% were married, and most lived in the urban area. Over 70% had at least secondary education, and only 34.5% were civil servants. About 60% of the respondents were enrolled in a health insurance scheme. Being single (AOR: 0.374, CI:0.204-0.688), being self-employed (AOR: 4.088, CI: 2.315-7.217), having a smaller family size (AOR: 0.124, CI: 0.067-0.228), and having the higher income (AOR: 4.142, CI: 2.07-8.286) were predictors of enrolment in a health insurance scheme. Conclusion: The study has shown that enrolment in a health insurance scheme is high among PLHIV, and being single, self-employed, having a smaller family size, and having a higher monthly income are predictors of enrolment in the health insurance scheme. Increasing the number of dependants that can be enrolled so that larger families can be motivated to enrol in health insurance is recommended. Funding: None declared.

The experience of a regional network of health policy and systems actors in translating evidence into policy and action in West Africa.

Objectives: To identify strategies and interventions to strengthen the generation and use of research evidence in health policy and practice decision-making and implementation in the West African sub-region (knowledge translation). Design: The study design was cross-sectional. Data sources were from a desk review, West African Network of Emerging Leaders (WANEL) member brainstorming, and group discussion outputs from WANEL members and session participants' discussions and reflections during an organised session at the 2019 African Health Economics and Policy Association meeting in Accra. Results: Strategies and interventions identified included developing a Community of Practice, a repository of health policy and systems research (HPSR) evidence, stakeholder mapping, and engagement for action, advocacy, and partnership. Approaches for improving evidence uptake beyond traditional knowledge translation activities included the use of cultural considerations in presenting research results and mentoring younger people, the presentation of results in the form of solutions to political problems for decision-makers, and the use of research results as advocacy tools by civil society organisations. Development of skills in stakeholder mapping, advocacy, effective presentation of research results, leadership skills, networking, and network analysis for researchers was also identified as important. Conclusions: To strengthen the generation and use of research evidence in health policy and practice decision-making in West Africa requires capacity building and multiple interventions targeted synergistically at researchers, decision-makers, and practitioners. Funding: Funding for the study was provided by the COMPCAHSS project (#108237) supported by IDRC.

Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria.

Objective: To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design: A community-based cross-sectional study. Setting: Twelve communities (six urban and six rural) in Abia State, Nigeria. Participants: Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure: Male involvement in family planning services. Results: The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion: Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men. Funding: No funding was obtained for this study.

Predictors of knowledge and practice of newborn care among post-natal mothers attending immunisation clinics in Southeast Nigeria.

Objectives: Evidence-based newborn care practice recommended by WHO reduces neonatal mortality and improves neonatal outcomes. This study assessed the knowledge, practice-associated factors and predictors of essential newborn care among post-natal mothers in two primary health care centres in Southeast Nigeria. Design: A cross-sectional total population study. Setting: Two primary health care centres in two local government areas in Southeast Nigeria. Participants: Post-natal mothers who attended immunisation clinics. Data collection: Quantitative data was collected over four weeks from 400 post-natal mothers. Chi-square test and logistic regression were carried out for associations and predictors, respectively. Analytical decisions were taken at p<0.05 and 95% confidence interval. Outcome measures: Knowledge, attitude, the practice of essential newborn care; predictors of practice. Findings: Mean age of participants was 28.68±5.4. The majority (78.9%) had been counselled on newborn care and 85.2% delivered in a formal health facility. The majority (77%) had good knowledge of essential newborn care and practices (61%). More than half (62.3%) reported support from health workers. Predictors of good practice were older age (AOR: 0.435; 95%CI: 0.212-0.893), being married (AOR: 8.095; 95%CI: 3.732-17.558), living in the urban area (AOR: 0.478; 0.291-0.784), and having good knowledge of newborn care (AOR: 0.239; CI: 0.139-0.411). Conclusions: Good practice was identified in the majority. Being married, older, living in urban areas and having good knowledge were predictors of good practice. Health facility delivery, continuous support by health workers and post-natal education to mothers in rural areas are recommended policy priorities. Funding: None declared.

Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria

Objective: To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design: A community-based cross-sectional study. Setting: Twelve communities (six urban and six rural) in Abia State, Nigeria Participants: Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure: Male involvement in family planning services Results: The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion: Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men

An assessment of perceived prioritisation and resource allocation for health policy and systems research in West Africa.

OBJECTIVES: Globally, adequate funding is a strong underpinning to advance health policy and systems research (HPSR) and ensure its impact on strengthening health systems. This study examined the perceived prioritisation, and resource allocation for HPSR in West Africa. METHODS: A desk review was conducted of literature related to HPSR funding published between January 2010 and December 2019, sourced from various databases and government websites. This was followed by in-depth interviews with senior decision makers and HPSR and non-HPSR research leaders (n = 33) across nine West African countries: Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Liberia, Nigeria, Senegal and Sierra Leone. RESULTS: The majority of the study participants were from ministries of health in their countries (66.7%). All countries except Sierra Leone had a program dedicated to health policy research and/or health planning/program research. There was no specific funding for health research nor HPSR in most countries and a mixed model (demand and supply led) was employed in most instances. HPSR was only considered a priority in two of the nine countries and specific funding for it was non-existent in all nine countries. In all countries, donor agencies played predominant roles in setting health research priorities and resource allocation decisions. Infectious disease and maternal/child health research were the research categories with the highest level of funding. There was limited capacity for HPSR, with a pronounced gap between researchers and policy makers. Stakeholder advocacy, basket funding for health research, multi-stakeholder institutional and individual HPSR capacity building were the major recommendations for improving the status and funding of HPSR. CONCLUSIONS: This study showed that both health research and HPSR were considered low priorities, with no designated funding (budget line) and inadequacy of funding disbursement in the surveyed countries in West Africa. Health research was largely conducted as prioritised and funded by the donor agencies. Given donor fatigue and the transitioning of donor funding, and the pivotal role of HPSR in strengthening health systems, there is an urgent need for West African states to commit to prioritising and funding HPSR and HPSR capacity development.

Effect of multiple intervention models on uptake of HIV testing services and sexual behaviour among residents of military cantonments in south-east Nigeria.

Background: HIV testing and counselling (HTC) has been a viable tool in controlling the spread of HIV/AIDS, and serves as the entry point in the HIV care and treatment cascade. In Africa, HIV-related morbidity and mortality are high with thousands still unaware of their HIV status. This study assessed the effect of on-site multiple HIV control interventions on the uptake of HTC services, knowledge and sexual behaviour among residents of two military cantonments [barracks] in south-east Nigeria. Methods: A quasi-experimental study was conducted among residents of cantonments in two states in Nigeria. A multistage sampling technique was used to select 350 respondents each at intervention and control sites. A pre-tested interviewer-administered questionnaire was used to collect information. On-site HTC services were established, with the training of HTC counsellors and peer educators. HIV awareness carnivals, with information, education and communication activities were conducted. Data were analysed with SPSS software and statistical tests carried out at 5% level of significance. Results: There was a statistically significant increase in the uptake of HTC services from 41.1% pre-intervention to 81.1% post-intervention (χ2 = 113.8, p < 0.001). Also, knowledge about HIV improved significantly from 35.4% to 98.8% (p < 0.001) in the intervention group, together with avoidance of risky sexual behaviour. Conclusion: The study demonstrated the effectiveness of multiple on-site intervention models in improving HIV knowledge, uptake of HTC services, and sexual behaviour among diverse cantonment residents. Establishing on-site HTC services and a constellation of awareness events will contribute significantly towards HIV prevention and control among high-risk populations.

Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship.

OBJECTIVES: Antimicrobial prescribing practices and use contribute to the growing threat of antimicrobial resistance (AMR) to global health. Information on antimicrobial prescribing and use are lacking in most developing countries, including Nigeria. This information is crucial for antimicrobial stewardship programmes, an effective tool in minimising AMR. This study was performed to gather baseline information on antimicrobial prescribing practices in Nigeria. METHODS: A cross-sectional survey was conducted on all inpatients of a tertiary hospital in South East Nigeria. All patients on admission on the day of the survey formed the study population. A standardised questionnaire, web-based data entry and validation process designed by the University of Antwerp, Belgium, were adopted. Information on basic patient demographics, antimicrobial agents used, indication for treatment, laboratory data prior to treatment and stop/review date was collected. RESULTS: Of 220 inpatients surveyed, 78.2% were receiving at least one antimicrobial agent. The highest prevalence of antimicrobial use was in the ICU (100%), adult surgical ward (82.9%) and paediatric medical ward (82.9%). Agents used were mainly third-generation cephalosporins (ceftriaxone 25.1%) and nitroimidazole (metronidazole 24.6%). Antimicrobial prescription was empirical (91.1% in medical wards, 96.8% in surgical wards and 100% in ICU). There was limited use of guidelines but clear documentation of stop/review dates and reasons for antimicrobial use. CONCLUSION: Although a majority of antimicrobial prescriptions were made with indications, they were mostly prescribed empirically and the majority of prescriptions were parenteral formulations. There is a need to develop antibiotic guidelines, to educate prescribers on antimicrobial stewardship and to encourage targeted prescription.

Medical students' perceptions regarding antibiotics use and antimicrobial resistance in ebonyi state, Nigeria'

BACKGROUND AND OBJECTIVES: Medical students as future doctors have important roles to play in the control of antimicrobial resistance. The aim of this study was to assess the perceptions of medical students regarding antibiotics use and antimicrobial resistance in Ebonyi State, Nigeria. METHODS: A cross-sectional survey was conducted among all the 184 fifth and sixth year medical students in Ebonyi State University, Nigeria using semi-structured, self-administered questionnaires. Proportions, chi square and logistic regression were estimated with Epi Info version 7.2 at 5% level of significance. RESULTS: Respondents were mostly males (62.5%), aged 20-29 years (68.9%) with 60.9% of them in final year. Majority (85.9%) had used antibiotics in the last one year. Most (78.3%) rated themselves to have adequate knowledge on antibiotic use and resistance but only 40.2% respondents had positive perception towards antibiotic use and resistance. Similarly, only 46.7% agreed that hand washing was important in controlling antimicrobial resistance. Majority (53.3%) believed that antibiotics were safe drugs and should be used commonly while only 50.5% disagreed with use of antibiotics as first line treatment for sore throat. Desire for more education on antimicrobial resistance and use was a significant predictor of positive perception (OR 0.36, 95% CI; 0.15-0.87; P=0.024) CONCLUSION: There was poor perception towards antibiotic use and resistance in spite of the high rates of antibiotic consumption and self-rated knowledge onantimicrobialuse. Thereisneedforreorientationofmedicalstudents' perceptions towards antibiotic usage and the role of infection control in curbing antimicrobial resistance