Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

INTRODUCTION: Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. MATERIALS AND METHODS: This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. RESULTS: A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. CONCLUSION: This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Prevalence and patterns of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria: a facility-based cross-sectional survey.

BACKGROUND: This study aimed to examine the prevalence and pattern of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria. METHODS: This descriptive cross-sectional study was conducted among 422 mothers of children aged 0 to 24 months attending any of the 3 leading immunization clinics in Ile-Ife, Nigeria. The respondents were selected using the multi-stage sampling technique. Data were collected using a pretested structured interviewer-administered questionnaire and analyzed using IBM SPSS ver. 26.0. The chi-square test was used to test associations, while binary logistic regression was used to determine the predictors of mothers' responses to adverse events following immunization (AEFIs). A p-value of <0.05 was considered statistically significant. RESULTS: The mean age of the respondents was 29.99±5.74 years. About 38% of the children had experienced an AEFI. Most mothers believed that the pentavalent vaccine was the most common cause of AEFIs (67.5%). Fever (88.0%) and pain and swelling (76.0%) were the most common AEFIs. More than half of the mothers (53.7%) administered home treatment following an AEFI. Younger mothers (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.20-5.01), mothers who delivered their children at a healthcare facility (OR, 3.24; 95% CI, 1.08-9.69), and mothers who were knowledgeable about reporting AEFIs (OR, 2.53; 95% CI, 1.04-7.70) were most likely to respond appropriately to AEFIs. CONCLUSION: The proportion of mothers who responded poorly to AEFIs experienced by their children was significant. Therefore, strategies should be implemented to improve mothers' knowledge about AEFIs to improve their responses.

Determinants of zinc utilisation in the management of diarrhoea among under-five children in Nigeria: a population-based, cross-sectional study.

BACKGROUND: Diarrhoea remains the foremost cause of sickness and death among children aged <5 y (under-five) in low- and middle-income countries. The WHO and UNICEF recommend that any child with diarrhoea signs be given zinc tablets as part of the treatment within 24 h. Therefore, we aimed to assess the prevalence and determinants of zinc utilisation for diarrhoea among under-five children in Nigeria. METHODS: The Nigeria Demographic and Health Survey 2018 was used for this study. Data were analysed using IBM SPSS version 25.0. A multilevel analysis technique employing the generalised linear mixed model was used for analysing the data of 3956 under-five children with diarrhoea. RESULTS: Only 29.1% of children who experienced diarrhoea received zinc combined with other forms of treatments during the diarrhoea episode. However, mothers with a secondary or higher level of education had a 40% higher likelihood of zinc utilisation during childhood diarrhoea (AOR, 1.40; 95% CI 1.05 to 2.22). Similarly, children whose mothers were exposed to media were more likely to receive zinc during diarrhoea than those whose mothers were not (AOR, 2.50; 95% CI 1.01 to 3.87). CONCLUSIONS: In this study, the prevalence of zinc use among under-five children with diarrhoea in Nigeria was low. Therefore, appropriate strategies to improve zinc utilisation are needed.

Determinants of incomplete vaccination among children 12-23 months in Nigeria: An analysis of a national sample.

Objectives: The study aimed to assess the prevalence and the determinants of incomplete childhood vaccination in Nigeria. Materials and Methods: The data for this study was the 2018 Nigeria Demographic and Health Survey. Multivariable multilevel logistic regression analysis techniques using Stata statistical software (version 13) were used in analyzing the data of 5,384 children aged 12-23 months old. Results: About 69.6% of the children were incompletely vaccinated. Individual-level factors such as maternal education, household wealth were associated with incomplete vaccination. The odds of incomplete vaccination among children of mothers without education was 68% higher than those with secondary education and above (adjusted odds ratio [AOR]: (AOR = 1.68; 95% confidence intervals [CI]: 1.56-2.56). Equally children from high wealth index have reduced odds of incomplete vaccination compared to those from low wealth index (AOR = 0.58; 95% CI: 0.47-0.71). Community-level factors such as place of residence, difficulty in getting to health facility were equally associated with vaccination status. The likelihood of incomplete vaccination was 26% higher among children whose parents had difficulty reaching the health facility (AOR = 1.26; 95% CI: 1.11-1.50) than those that did not. In addition, the likelihood of been incompletely vaccinated reduced for children whose mothers live in urban areas (AOR = 0.47; 95% CI: 0.40-0.59). Conclusions: Incomplete childhood vaccination is prevalent in the country and associated with various individual and community factors. Program and policies aimed at improving childhood vaccination uptake should target the identified factors.

Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria.

OBJECTIVE: The study aimed to examine health workers' perceptions of the coronavirus disease 2019 (COVID-19) vaccine in Nigeria and their willingness to receive the vaccine when it becomes available. METHODS: This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0. RESULTS: The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50-5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25-3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40-6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01-1.68). CONCLUSION: Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers' perceptions and attitudes toward the COVID-19 vaccine are needed.

Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria.

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks. Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as healthcare-associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date.

COVID-19 outbreak: a potential threat to routine vaccination programme activities in Nigeria.

COVID-19 is an infectious disease caused by the most recently discovered coronavirus (SARS-CoV-2). The virus and disease were unknown before the outbreak began in the city of Wuhan, China, in December 2019. Nigeria and other sub-Sahara Africa countries like the rest of the world introduced several lockdown measures as part of their public health response to mitigate the spread of the virus. This, however, was not without the likelihood of consequences considering the weak health systems. The access and supply side of vaccination was more likely to have been affected by the lockdown measures. When vaccination services are disrupted even for brief periods during emergencies, the risk of outbreak-prone vaccine-preventable diseases increases, leading to excess morbidity and mortality. This highlights the importance of maintaining essential services such as vaccination in times of emergency. There is therefore an urgent need to ensure that children are protected against those diseases for which vaccines already exist. The COVID-19 outbreak has posed a new hindrance to vaccination activities in Nigeria and across Sub-Saharan Africa with associated threat to surveillance of vaccine-preventable diseases. Achieving and sustaining high levels of vaccination coverage during this period must, therefore, be a priority for all health systems.

Determinants of prelacteal feeding practices among mothers of children aged less than 24 months in Ile-Ife Southwest Nigeria: a community cross-sectional study.

INTRODUCTION: Prelacteal feeding remains an obstacle in achieving the best breastfeeding practices in the country. The growing poor breastfeeding practices are made worse by the continued engagement of the communities in prelacteal feeding practices. This study aimed at assessing the determinants of prelacteal feeding among mothers of children aged less than 24 months in Ile-Ife Southwest, Nigeria. METHODS: A community-based cross-sectional study that employed quantitative and qualitative methods. Two hundred and fifty-five (255) mother with children aged 0-23 months were recruited into the study using a multistage sampling technique. SPSS version 20 was used for data analysis Descriptive statistics, bivariate and multivariable logistic regression analysis was done. RESULTS: In this study, 26.3% of children were given prelacteal feeds. Glucose water (46.3%), sugar water (25.4%) and infant formula (17.9%) were commonly given prelacteal feeds. On multivariate analysis initiating breastfeeding after one hour (Adjusted Odds Ratio (AOR): 2.74, 95% CI 1.43, 5.23), not attending antenatal clinic (AOR = 2.52, 95% CI 1.05, 5.33), delivery via caesarian section 52% (AOR = 1.52, 95 % CI 1.10, 6.34) were associated with increased odds of giving prelacteal feeds. Delivery attended by health professional 25% (AOR = 0.75. 95% CI 0.42, 0.97), highest wealth quintiles 21% (AOR =0.79, 95 % CI 0.51, 0.94) were associated with lowers odds of giving prelacteal feeds. CONCLUSION: Prelacteal feeding was prevalent in the study community and associated with community, individual and health service-related factors. Intervention that strengthens individual and community access to appropriate health information and maternal health services is vital in reducing prelacteal feeding practices.

Reducing the risk of nosocomial Hepatitis B virus infections among healthcare workers in Nigeria: a need for policy directive on pre-employment screening and vaccination.

Healthcare workers (HCWs) are at increased risk of contracting Hepatitis B virus (HBV) infection and other vaccine-preventable diseases, especially if they are not protected by immunity derived from previous infection or vaccination. Sub-Sahara Africa countries including Nigeria is reported to have the highest rate of HBV. Vaccination of HCWs is essential in protecting them from acute and chronic sequelae of HBV or any other form of vaccine-preventable diseases; however, HCWs vaccination remains a challenge for many developing countries including Nigeria due to lack of policy directive on pre-employment screening and vaccination. Poor political will and inadequate funding of healthcare in the country also impacts negatively on the implementation of effective pre-employment screening and vaccination programmes needed to protect HCWs. The aim of this opinion paper is to promote policy direction on pre-employment screening and vaccination in other to protect HCWs from nosocomial HBV infection. The most appropriate time perhaps for promoting the importance of employee immunisation is during pre-employment screening. The policy options are either for employers to allocate financial resources towards HCWs pre-employment screening and vaccination or alternatively initiate a programme where new HCWs provide evidence of protection against HBV or other vaccine-preventable diseases specified in the policy directive. Protecting HCWs form nosocomial HBV infection requires well-articulated policy directive, proper implementation, supported by adequate funding and good political will on the part of employers and government.

Analysis of the Effect of Health Education Activities on Selected Child Health Determinants in Two Communities of Ile Ife, Nigeria.

BACKGROUND: Child survival in Nigeria is threatened not just by the direct causes of childhood mortality such as the common childhood diseases but also by the associated child health determinants. Health education activities as part of community integrated management of childhood illness have the potential to improve these child health determinants. The objective of this study was to assess the effect of community level health education activities on selected child health determinants in Ile Ife, Nigeria. METHODS: A cross-sectional comparative study was carried out among 722 caregivers in two LGAs of Osun State, Nigeria, using a multistage cluster sampling method. Data were collected from mothers of index children aged 0-59 months using an interviewer-administered questionnaire. RESULTS: Vitamin A supplementation before the study was received by 89.1% and 79.8% of the children aged 9 months old and above in implementing and non-implementing LGAs (p=0.002). Amongst children age 12-23 months in the implementing LGA, 93.4% received DPT3, (91.8%) received measles compared with non-implementing LGA in which 66.7% received DPT and (64%) measles. Children in the CIMCI implementing LGA were three times more likely to receive DPT Vaccine (Adjusted odds ratio (AOR) 3.02, 95% confidence interval (CI) 1.55-7.98), and five and half times more likely to receive measles vaccine (AOR 5.56, 95% CI 2.76-12.54). CONCLUSION: The study concluded that community level health education activities have a positive effect on child health practices and determinants.

Effect of Community Integrated Management of Childhood Illness on Mothers' Healthcare-Seeking Behaviour and Home Management of Childhood Illness in Ile Ife; South-West Nigeria: A Household Survey

Background. Care-seeking interventions; as part of community integrated management of childhood illness (CIMCI); have the potential to substantially reduce child mortality in countries where common childhood illnesses are a major problem. Prompt and appropriate care-seeking practices are important to avoid many deaths attributed to delays in or not seeking care; particularly in developing countries such as Nigeria.Objective. To assess the effect of community-level intervention on mothers' care-seeking behaviour for common childhood illnesses and related influencing factors. Methods. The study had a comparative cross-sectional design and was conducted in two local government areas (LGAs) of Osun State; South-West Nigeria. A total of 722 mothers of index children aged 5 years were selected through a multistage cluster sampling technique. Data were collected and analysed using SPSS version 16.0. Descriptive; bivariate and multivariate analyses were performed. Results. Care-seeking for children who reported illness was higher in the CIMCI-implementing LGA (90.2%) compared with 74.8% in the non-implementing LGA (p

Effect of community level intervention on nutritional status and feeding practices of under five children in Ile Ife, Nigeria.

INTRODUCTION: Childhood malnutrition remains a widespread problem in developing world like Nigeria. The country ranks second among the ten countries contributing to sixty percent of the world's wasted under-five children. Community Integrated Management of Childhood illness (CIMCI) is a programme that employs the use of community based counsellors to address child health and nutritional challenges of the under-five and has the potential to reduce the morbidity and mortality resulting from poor nutritional and feeding practices. The study assessed the effect of community level intervention on nutritional status and feeding practices of children in Ile-Ife, Nigeria. METHODS: A cross-sectional comparative study that employed the use of multi stage cluster sampling techniques in selecting 722 mothers of index under five children. The study was done in two Local Government Areas of Osun State, Nigeria. Quantitative techniques were used in data collection. Data analysis was done using SPSS version 20.0. Descriptive and bivariate analyses was performed. RESULTS: The two Local Government Area (LGA) did not differ significantly in their wealth index (p = 0.344). However, more children in the non-implementing LGA (16.1%) had low weight for age compared with 3.6% in the CIMCI implementing LGA (p = 0.000). A statistically significant difference exist in the MUAC measurement of children 12-23 months between the CIMCI implementing and non-implementing communities (p = 0.007). A higher percentage of caregivers (19.3%) introduced complementary feeding earlier than 6 months in the non-implementing area (p < 0.001). CONCLUSION: Using community level nutritional counseling can greatly improve nutritional status and feeding practices of under five children.