Clients' satisfaction with HIV treatment and care services in Nigeria.

OBJECTIVE: Many Sub-Saharan Africa countries have witnessed rapid scale-up of HIV treatment and care services in recent years. However, there is increasing evidence suggestive of poor quality of services. In this study, we examined clients' satisfaction with quality of HIV treatment and care services in Nigeria. STUDY DESIGN: This was a cross-sectional survey of people living with HIV (PLHIV) receiving HIV treatment and care services. METHODS: The study included 1212 PLHIV receiving HIV treatment and care in 96 health facilities across 12 states. We collected data on clients' satisfaction with four quality domains (confidentiality, staff attitude, physical structure, and perceived improved health) and the overall quality of care, sociodemographic characteristics, type of facility, distance to facility, and time spent at facility. A logistic regression analysis was conducted with clients' satisfaction with the overall quality of care as the dependent variable. RESULTS: About 90% of the respondents were satisfied with the overall quality of care. Women, rural dwellers, and Muslims, public (government-owned) healthcare facility users, those unsatisfied with confidentiality, and those unsatisfied with staff attitude had statistically significant lower odds of being satisfied with the overall quality of care. After adjusting for sociodemographic characteristics and the type of facility, confidentiality (adjusted odds ratio [AOR] = 0.1, 95% confidence interval [CI] = 0.01-0.81, P = 0.031) and staff attitude (AOR = 0.24, 95% CI = 0.09-0.67, P = 0.006) remained statistically significant. CONCLUSIONS: Clients' satisfaction with the quality of HIV treatment and care services at health facilities in Nigeria appears high. HIV service provision should be in line with standard ethical principles and more patient centered and responsive to sociodemographic characteristics of PLHIV.

The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial.

BACKGROUND: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. METHODS: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect. DISCUSSION: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018.

Psychosocial aspects of murder in Nigeria.

This study is a review of cases of murder reported to Police in Kaduna State from 1983 to 1987 and a survey of the psychosocial profile of the murderers. Most of the murderers, 91.7%, were between the ages of 20 and 40 while 93.6% were male. Of them 56.5% were single while Moslems (51.2%) formed the highest group. Unemployed and ex-service men predominated in the cohort interviewed. Sharp tools such as matchets, knives and axes were used by 66.7%, 83.3% of the murderers are acquitances (friends and family members) of their victims. Socially acceptable reasons were given for 79.1% of the murder while 5.3% were referred for psychiatric assessment. Implications of this study in formulating policy on murder are briefly mentioned.

Gonorrhoea neurosis.

In two years of clinical practice, the authors saw 47 cases of gonorrhoea of strictly psychological origin--25 patients with anxiety neurosis, 10 with hypochondriasis, 7 with depression, and 5 with paranoid reaction, 25 with impotence initially presented for surgical opinion rather than psychiatric assessment. Socio-demographic factors and 4 clinical details are given, including possible related factors, course, treatment and outcome. Liaison between the veneorologists, surgeons and psychiatrists is strongly advocated.

Erythropoietic and bone marrow stimulating activity of terminalia catappa extract: Possible role of nitric oxide signaling.

Aims: We assessed the capacity and mechanism of Terminalia catappa (TC) to induce erythropoiesis in vivo in phenylhydrazine- induced anemic mice. Place and Duration of Study: Sample: This study was carried out at Department of Biochemistry and Center for Biotechnology Research and Training Ahmadu Bello University Zaria, and National Research Institute for Chemical Technology, Zaria. The duration spanned between Jan 2011 and Feb 2012. Methodology: Solvent fractions of Terminalia catappa aqueous extract was used to treat phynylhydrazine-induced anemic mice. Treatment was done for four days, erythropoietic activity of each fraction was assayed by determining the effect of these fractions on intracellular hemoglobin and reticulocyte level from the blood, arginase was also assayed. Bone marrow carbonic anhydrase was assayed to monitor bone marrow erythropoietic stimulation. Results: Terminalia catappa was able to up-regulate the synthesis of intracellular hemoglobin (0.135 ±0.004 μmol/0.1ml) significantly comparable to hydroxyurea (HU) (0.158±0.006 μmol/0.1ml), and normalize the peripheral blood reticulocyte index significantly at P<.05 0.94±0.25% close to the non anemic mice 0.97±0.25% and bone marrow carbonic anhydrase activity. TC inhibited arginase activity significantly (P<.05) comparable to hydroxyurea. Conclusion: The results demonstrate Terminalia catappa extract as an erythropoietic agent that supports normal erythroid differentiation in vivo in phenylhydrazine- induced anemic mice in a synergistic fashion.