The development of a treatment guideline for childhood malaria in rural Southwest Nigeria using participatory approach.

OBJECTIVE: To describe the development of a treatment guideline for the effective case management of malaria in children at the home level. METHODS: Thirty-three mothers selected from 11 communities in a rural health district, community members and the research team developed a guideline for treatment of malaria at home by caregivers using a participatory approach. This was done in phases using modified focus group discussion sessions. Suggested ideas were depicted in illustrations by a graphic artist. RESULTS: A guideline which illustrated the presentation of clinical types of malaria, the appropriate steps to take for each type and the correct dosage schedule of chloroquine (based on the age of the child) for treatment of uncomplicated malaria was developed. The guideline was in cartoon format and the script in the local language. CONCLUSION: Use of a participatory approach was found acceptable and effective in the development of the guideline. This approach is therefore recommended irrespective of the target population or the intervention to be developed. Practice implications Preparation of educational materials with contributions from end users does not only build capacity at the local level but also increases the acceptability and ownership of such materials.

Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria.

BACKGROUND: Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. METHODS: Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers ("mother trainers") in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. "Mother trainers" disseminated the educational messages about malaria and the use of the guideline to their communities. RESULTS: Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4%) of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p < 0.005). Mothers considered the guideline to be explicit and useful. Mother trainers were also considered to be effective and acceptable. CONCLUSION: The use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

Using "mother trainers" for malaria control: the Nigerian experience.

Studies of care seeking in Nigeria show that a tremendous amount of treatment for malaria takes place at home and, in most instances, such treatments are incorrect. This deficiency is attributed to caregivers' poor knowledge of treatment. This study was designed to empower households to treat malaria correctly in partnership with community members. Selected mothers from study communities were trained as "mother trainers" and were expected to train other members of their communities using a treatment protocol. "Mother trainers" were acceptable to most communities and judged to be effective. They were enthusiastic and their participation in the study boosted their ego and status in the community. Drop-out-rate of "mother trainers" was 24.2%. A few limitations to the use of mothers as trainers that were identified are discussed. It is concluded that mothers have good potential to effectively carry out health education activities in the community if appropriately selected, trained, and supervised.

Sexually transmitted diseases seen in a Nigerian tertiary institution.

BACKGROUND: Surveillance of Sexually Transmitted Diseases (STDs) and Human Imunodeficiency Virus (HIV) infections among high risk groups is an important strategy for the control of the diseases which occurrence have been on the increase worldwide. The objective of this study is to provide a descriptive epidemiology of the pattern of STDs among clinic attendees at a Special Treatment Clinic (STC) of the University College Hospital (UCH), Ibadan. STUDY DESIGN: A retrospective review of records of all new patients presenting at the STC between 1st January 2000 and 31= December 2000 was carried out. RESULTS: Clinic records were available for 336 new patients who visited the clinic in the year under review. The result showed that non-gonococcal urethritis (45.2 %) and gonococcal urethritis (15.9%) were the most common STDs in men, while candidiasis (37.2%) and gardrellena vaginitis (31.8%) were the most common in women. Three 3(1.1%) of the patients had HIV infection, which had not been previously reported in the clinic. CONCLUSION: The findings indicate a change morbidity pattern in the STD clinic that suggests the need to include HIV/AIDS management and care in the services provided.