Improving TB case notification and treatment coverage through data use.

BACKGROUND: This was a study on national TB data. OBJECTIVE: To assess improvement in TB case notification and treatment coverage through improved data use for action in Nigeria. DESIGN: We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. RESULTS: Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (P < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (P < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (P < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020. CONCLUSION: TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.

CONTEXTE: Il s'agit d'une étude sur les données nationales relatives à la TB. OBJECTIF: Évaluer l'amélioration de la notification des cas de TB et de la couverture du traitement grâce à une meilleure utilisation des données pour l'action au Nigéria. MÉTHODE: Nous avons analysé les données du programme secondaire de lutte contre la TB avant et après l'intervention, y compris les données sur l'augmentation des visites de supervision, les mesures incitatives pour les travailleurs de la santé, l'expansion du système DOTS, les activités de proximité et la surveillance des codes géographiques. L'analyse des tendances a été réalisée à l'aide du test du χ2 de Cochran-Armitage pour les tendances linéaires. RÉSULTATS: La recherche de cas est passée de 104 904 cas en 2017 à 138 591 en 2020. On observe une augmentation de 2,0% de 2017 à 2018, de 13,0% de 2018 à 2019 et de 15,0% de 2019 à 2020 (P < 0,001). La couverture DOTS des établissements est passée de 7 389 établissements en 2017 à 17 699 en 2020. On observe une augmentation de 30,0% en 2018, 31,0% en 2019 et 40,0% en 2020 (P < 0,001). Le nombre d'installations déclarantes est passé de 5 854 en 2017 à 12 775 en 2020. Par rapport à 2017, il y a eu une augmentation de 20,0% en 2018, 38,0% en 2019 et 32,0% en 2020 (P < 0,001). Le taux de couverture du traitement est passé de 24% en 2018 à 27% en 2019 et 30% en 2020. CONCLUSION: L'expansion des services de lutte contre la TB, l'amélioration de la surveillance et l'utilisation des données pour la prise de décision sont essentielles pour augmenter la couverture du traitement de la TB.

Substance Use and Treatment Outcome among People Living With HIV [PLWHIV] Accessing Care at CIDC 161 NAF Hospital, Makurdi, Nigeria: Implication for Intervention.

INTRODUCTION: Substance use is an increasing menace in Nigeria. It is common and even higher among PLWHIV compared to the general population. Substance use increases a person's chance of acquiring HIV due to increased risky behaviours. Gap exists on our understanding of why some clients fail on Antiretroviral Therapy (ART) adherence or appointment. Exploring psychoactive substance use among people living with HIV (PLWHIV) and their effect on treatment outcome may help in addressing these problems. METHODS: The study was at Military Hospital in Makurdi, Benue state, Nigeria. It involved 700 HIV positive clients >18 years selected using simple random sampling method. Analytical cross-sectional study using questionnaire (WHO ASSIST V3.1) was done. Chi-square test was used for association of characteristics of clients with substance use and treatment outcome (CD4 count and Viral load) at p < 0.05. Binary logistic regression was used to identify predictors. RESULTS: Prevalence of ever used and current use of any psychoactive substance were 539(77.0%) and 459(65.6%) respectively. Commonest used substances were alcohol 445(63.6%), Bitter cola/Kola nut 260(37.1%) and tobacco products 138(19.7%). Predictors of ever used substance were; Males (AOR 2.21; 95% CI 1.41-3.49), single (AOR 3.63; 95% CI 1.58-18.38), Christians (AOR 8.88; 95% CI 1.19-66.31), keeping to appointments (AOR 2.26; 95% CI 1.37-12.01). Ever used substance was predictor for CD4 count increase (AOR 1.45; 95% CI 1.22-1.83) and viral load suppression (AOR 0.40; 95% CI 0.12-0.75). CONCLUSION: There was a high prevalence of substance use. Ever used psychoactive substance were determinants for treatment outcome. There is need for new strategy and involvement of mental health professional in the care of PLWHIV to address this.

INTRODUCTION: La consommation de substances psychoactives est une menace croissante au Nigeria. Elle est courante et même plus élevée chez les PVVIH que dans la population générale. La consommation de substances psychoactives augmente le risque de contracter le VIH en raison de l'augmentation des comportements à risque. VIH en raison de l'augmentation des comportements à risque. Il existe des lacunes dans notre compréhension des raisons pour lesquelles certains clients n'adhèrent pas à la thérapie antirétrovirale (TAR) ou ne prennent pas de rendez-vous. L'étude de la consommation de substances psychoactives chez les personnes vivant avec le VIH (PVVIH) et de son effet sur le résultat du traitement peut aider à résoudre ces problèmes. MÉTHODES: L'étude a été menée à l'hôpital militaire de Makurdi, dans l'État de Benue, au Nigeria. Elle a porté sur 700 clients séropositifs de plus de 18 ans sélectionnés par une méthode d'échantillonnage aléatoire simple. Une étude transversale analytique a été réalisée à l'aide d'un questionnaire (WHO ASSIST V3.1). Le test du chi carré a été utilisé pour l'association des caractéristiques des clients avec la consommation de substances et les résultats du traitement (numération des CD4 et charge virale) à p < 0,05. Une régression logistique binaire a été utilisée pour identifier les prédicteurs. RÉSULTATS: La prévalence de l'utilisation antérieure et actuelle de toute substance psychoactive était de 539 (77,0%) et 459 (65,6%) respectivement. Les substances les plus fréquemment consommées étaient l'alcool (445, 63,6 %), le cola amer/la noix de kola (260, 37,1 %) et les produits du tabac (138, 19,7 %). Les facteurs prédictifs de la consommation de substances étaient les suivants : hommes (AOR 2,21; IC 95% 1,41-3,49), célibataires (AOR 3,63 ; IC 95% 1,58-18,38), chrétiens (AOR 8,88 ; IC 95% 1,19-66,31), respect des rendez-vous (AOR 2,26 ; IC 95% 1,37-12,01). Le fait d'avoir déjà consommé une substance était un facteur prédictif de l'augmentation du nombre de CD4 (AOR 1,45 ; IC 95 % 1,22-1,83) et de la suppression de la charge virale (AOR 0,40 ; IC 95 % 0,12-0,75). CONCLUSION: La prévalence de la consommation de substances psychoactives était élevée. Les substances psychoactives déjà consommées étaient déterminantes pour les résultats du traitement. Pour y remédier, il est nécessaire d'adopter une nouvelle stratégie et d'impliquer les professionnels de la santé mentale dans la prise en charge des PVVIH. Mots-clés: Substances psychoactives, PVVIH, résultats du traitement, Makurdi, Nigeria.

Health Worker (HW) Factors in Delayed Access to Pediatric Surgery in Low- and Middle-Income Countries (LMICs).

Background: In the developing world, access to pediatric surgery has been associated with sociocultural factors and healthcare funding challenges. Aim: This study aims to evaluate health worker (HW) factors in delayed access to appropriate care for children with surgical problems in South East Nigeria. Subjects and Methods: A cross-sectional analysis of the awareness of children's surgery and ability for appropriate referral among 503 HWs of various cadres in South East Nigeria was carried out using a structured questionnaire. Data was analyzed using IBM SPSS 21. Results: Of 419 (83.3%) respondents, 211 (50.4%) were doctors, 217 (51.8%) were aged 26-35 years, 261 (62.3%) indicated awareness of pediatric surgical conditions, 114 (27.2%) knew of sites to examine on the newborn at birth, and 147 (35.1%) inclined to timely referral to experts. Predictors of early referral include age <35 years, (P = 0.001) and cadre: doctors (P = 0.006). Female HWs (P = 0.013) and doctors (P = 0.008) displayed better knowledge of pediatric surgical cases. Delayed referral was mostly HW-related and included inaccurate diagnosis and wrong assumption of competence. Conditions commonly misdiagnosed were intussusception and posterior urethral valve. Conclusion: Awareness of surgical needs of children is poor among HWs in our setting. To address this and improve access to care, there may be a need to incorporate basic training in common pediatric surgical conditions in the training curriculum for HWs at various levels.

Prevalence and Factors Associated with HIV Sero-Discordance among In-Union HIV Patients Receiving Care in a Private Health Facility in Jos, North Central, Nigeria.

INTRODUCTION: The burden of HIV infection in households of people living with HIV (PLHIV) is usually high. The existence of HIV discordance and reasons for that is largely unknown. Moreover, how people in a discordant relationship can live happily together with negative partner not getting infected and/or safely have children are not well understood. This study is to determine the prevalence and factors associated with HIV sero-discordance among in-union HIV patients receiving care in a private health facility in Jos, north central Nigeria. METHODS: A descriptive cross sectional design was used for the study involving HIV clients. Their records were reviewed and a proforma used to extract needed information. Questionnaire was equally used. A total of 1505 patients were studied out of which 75 were sero-discordant. They were recruited consecutively. Data was analyzed using SPSS version 20 and presented using frequencies, percentages, and tables. RESULTS: Findings revealed that 75 (5.0%) were discordant giving a prevalence of 5%. Majority of the clients were females: [non-discordant 805(56.3%), discordant 45(60.0%)], attained secondary education [non-discordant 590(41.3%), discordant 60(80.0%)], have been in partnership for 1-10 years [non-discordant 525(36.7%). discordant 45(60.0%)], have sex with partner weekly [non-discordant 1385(96.9%), discordant 60(80.0%)], have no other sexual partner [non-discordant 1070(74.8%), discordant 75(100.0%)]. have viral load of <100 [non-discordant 1315(92.0%), discordant 75(100.0%)], have CD4 count of 200-499 [non-discordant 585(40.9%), discordant 30(40.0%)]. Most of participants knew that ART, consistent use of condom, abstinence and post exposure prophylaxis prevent HIV. There were statistical significant associations of characteristics of clients and their knowledge on HIV prevention with HIV status of partner. CONCLUSION: Prevalence of discordance is high. There was no identified predictor of HIV status of partner. For HIV prevalence and sero-discordant status to reduce, women should have a say or be at an equal platform as men in terms of control over their sexuality.

INTRODUCTION: Le fardeau de l'infection par le VIH dans les ménages de personnes vivant avec le VIH (PVVIH) est habituellement élevé. L'existence de la discordance du VIH et les raisons de cette discordance sont largement inconnues. En outré la façon dont les personnes dans une relation discordante peuvent vivre heureuses avec un partenaire négatif qui n'est pas infecté et / ou avoir des enfants en toute sécurité n'est pas bien comprise. Cette étude vise à déterminer la prévalence et les facteurs associés à la sérodiscination du VIH chez les patients syndiqués du VIH recevant des soins dans un établissement de santé privé à Jos, dans le centre-nord du Nigéria. MÉTHODES: Un plan transversal descriptif a été utilisé pour l'étude portant sur des clients séropositifs. Leurs dossiers ont été examinés et un formulaire a été utilisé pour extraire les informations nécessaires. Le questionnaire était également utilisé. Au total, 1505 patients ont été étudiés, dont 75 étaient séro-discordants. Ils ont été recrutés consécutivement. Les données ont été analysées à l'aide de la version 20 du SPSS et présentées à l'aide de fréquences,et tableaux. RÉSULTATS: Les résultats ont révélé que 75 (5.0%) étaient discordants, ce qui donne une prévalence de 5%. La majorité des clients étaient des femmes : [805 (56.3 %), 45 (60.0 %) discordants], ont fait des études secondaires [590 non discordants (41.3 %), discordants 60 (80.0 %)], sont en partenariat depuis 1 à 10 ans [non discordants 525 (36.7 %). discordants 45 (60.0 %)], ont des relations sexuelles avec un partenaire hebdomadaire [non discordant 1385 (96.9 %), discordant 60 (80.0 %)], n'ont pas d'autre partenaire sexuel [non discordant 1070 (74.8 %), discordant 75 (100.0 %)]. ont une charge virale de <100 [non discordant 1315 (92.0%), discordant 75 (100.0%)], ont un compte de CD4 de 200- 499 [non discordant 585 (40.9%), discordant30(40.0%)]. La plupart des participants savaient que le TAR, l'utilisation régulière du condom, l'abstinence et la prophylaxie post-exposition préviennent le VIH. Il y avait des associations statistiquement significatives de caractéristiques deles clients et leurs connaissances sur la prévention du VIH avec le statut VIH de partenaire. CONCLUSION: La prévalence de la discordance est élevée. Il n'y avait pas de prédicteur identifié du statut VIH du partenaire. Pour que la prévalence du VIH et le statut de sérodispondant diminuent, les femmes devraient avoir leur mot à dire ou être sur un pied d'égalité avec les hommes en termes de contrôle sur leur sexualité. Mot-clé: Séro-discordance, Immunodéficience humaine, Cohabitation Couple.

Knowledge and Utilization of PMTCT Services among Women accessing Antenatal Care in Private Health Facilities in Abakaliki, Nigeria.

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.

Le programme de prévention de la transmission mère-enfant (PTME) du VIH fournit un traitement antirétroviral aux femmes enceintes séropositives pour réduire la probabilité de transmission à leurs nourrissons. Malgré les efforts concertés pour étendre les services de PTME au Nigeria, la couverture et l'utilisation des services par les personnes participant aux soins prénatals (ANC) sont inférieures à l'acceptable. Les établissements de santé privés fournissent des services de soins prénatals à un grand nombre de femmes, mais ils sont peu impliqués dans les interventions de renforcement des capacités de PTME. Cette étude a évalué la connaissance et l'utilisation des services de PTME chez les femmes ayant accès aux soins prénatals dans les établissements de santé privés à Abakaliki, dans l'État d'Ebonyi. Il s'agissait d'une étude transversale descriptive dans les cliniques de soins prénatals des établissements de santé. Les données ont été recueillies à l'aide d'un questionnaire administré par l'intervieweur et analysées avec le logiciel Statistical Package for Social Sciences (SPSS) version 22.0 et le test d'association a été effectué par le Chi carré au niveau de signification P<0,05. Les résultats ont montré que l'âge moyen des répondants était de 27 ± 4,6 ans. La majorité des personnes interrogées (83,4%) avaient une bonne connaissance de la PTME, mais seulement 68,4% ont eu accès au HCT lors de la grossesse de référence, la peur de la stigmatisation étant citée comme la principale raison de ne pas pratiquer le HCT. Seulement 54,5% des participantes séropositives ont pris des médicaments antirétroviraux (ARV) pendant la grossesse, bien qu'elles aient toutes utilisé des ARV pendant le travail/l'accouchement. L'utilisation des services de PTME du VIH était significativement associée au niveau d'instruction et à la profession. CONCLUSION: Il y avait une bonne connaissance de la PTME mais l'utilisation des services était sous-optimale. La formation et l'encadrement des agents de santé dans les établissements privés sur les programmes de dépistage du VIH sont importants pour améliorer l'utilisation des services de PTME et dissiper les craintes de stigmatisation parmi les femmes enceintes. Mots clés: Médicaments antirétroviraux, séropositifs, transmission mère-enfant, femmes enceintes, hôpitaux privés.

Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria.

BACKGROUND: Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. METHODS: The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8-10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs. RESULTS: The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073-0.986) and number of children (OR: 1.196, p < 0.01,CI: 1.563-7.000) were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244-2.164) and age (OR: 0.115, p < 0.001, CI: 0.838-0.948) determined better use of delivery and family planning services respectively. CONCLUSIONS: Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality. Behavioral change programs with high local content need to be implemented within rural areas especially among younger, illiterate women .

Behavioral disorder amongst adolescents attending secondary school in southeast Nigeria.

BACKGROUND: Adolescents are prone to various forms of behavioral problems. These behavioral issues in adolescents can have serious consequences for the adolescents. OBJECTIVES: The objectives of the study are to determine the causative factors of adolescent problems and specific manifestations. METHODS: Behavioral problems were investigated using a random sampling of adolescents from secondary schools in southeast Nigeria from February to April, 2014. A self-administered questionnaire was developed from Health Kids Colorado Questionnaire. RESULTS: A total of 763 subjects completed the questionnaire. Adolescents who reported to have used tobacco 3 to 5 and 6 to 9 times during the last 30 days are just 3.14% and 3.4%, respectively. Nineteen (2.49%) adolescents claimed that they have had sex before but not in the last 3 months. Adolescents who attempted suicide are from 15 years and peaked at 18. Eighty-three (11%) adolescents who are 15 years old attempted suicide in a year; this peaks at 17 years where 235 (30.8%) committed suicide. Majority of adolescents with behavioral disorder are from the upper class family. CONCLUSION: This study revealed that adolescents exhibit several forms of behavioral problems.

Rural retention of human resources for heath.

BACKGROUND: Health workers are the heart of the health system in any country and are made up of health service providers and the health support workers. The global health workforce is over 59 million and 67% of them are the service providers. AIM: The goal of this paper is to review the most relevant papers on the retention of health workers in the underserved areas and also on how to attract and retain health workers in the rural areas. METHODOLOGY: A systematic search of literature was conducted. Grey literature (conference papers, technical reports), journal articles, abstracts, relevant books and internet articles were reviewed. RESULTS: Shortage of health workers are among the constraints in achieving the three health related Millenium Development Goals and this is more pronounced in the resource poor countries. These same resource poor countries are faced with international migration of health workers to the developed countries. CONCLUSION: The numbers of health workers across the globe are few relative to need and this is more pronounced in the rural areas of the world who unfortunately bear the greater burden of disease and there is need for policies and actions that will help to attract and retain rural health workers.