Prevalence of depression among people living with HIV in rural hospitals in South-Western Nigeria-Association with clinico-demographic factors.

Major depression is the most common neuropsychiatric disorder among people living with HIV (PLWH) and is predictive of high morbidity and mortality among them. This study estimated the prevalence and explored factors associated with depression among PLWH in two rural secondary health facilities providing anti-retroviral therapy (ART) services in Southwestern Nigeria between September and December 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to screen and identify PLWH aged 18 years or older with depression. Descriptive statistics, bivariate and multivariate analyses were performed with SPSS version 23. A total of 172 respondents were screened. The prevalence of depression was 16.3% (95% CI 11.1%, 22.7%). Mild, moderate, and moderately severe depression was identified in 17 (9.9%), 8(4.7%) and 3(1.7%) of the participants, respectively. One (0.6%) respondent had suicidal ideation. Of PLWH with any depression, 20/28(71.4%) were within the 40-59 years of age range. None of the participants was on antidepressants. The factor most associated with depression was hypertension, with adjusted odd ratios of 9.8(95% CI 3.5-27.3, p < 0.0001). The study highlights the importance of screening for the severity of depression among PLWH in rural hospitals providing ART services in Africa. PLWH with comorbid hypertension were more likely to suffer from some form of depression.

Prevalence and correlates of psychological distress amongst healthcare workers during the COVID-19 pandemic: An online survey.

BACKGROUND: Understanding the mental health needs of healthcare workers during coronavirus disease 2019 (COVID-19) pandemic with a view of mitigating its impact on occupational functioning is vital. AIM: To determine the prevalence and correlates of psychological distress amongst healthcare workers. SETTING: The study was carried out in Nigeria during COVID-19 pandemic. METHODS: A cross-sectional quantitative study using a convenience sample was conducted amongst healthcare workers. The survey comprised of two Google formatted self-report questionnaires, a 12-item General Health Questionnaire and a questionnaire containing socio-demographic, work related and knowledge of COVID-19 variables. Questionnaires were distributed via closed professional WhatsApp platforms. Data were analysed using descriptive statistics, chi-square test and logistic regression. RESULTS: There were 313 respondents and prevalence of psychological distress was 47.0%. Females were almost twice as likely to have psychological distress as males (OR = 1.92, 95% CI: 1.21-3.04, p = 0.006). Healthcare workers who had no contact with COVID-19 positive patients had an 87% reduced risk of psychological distress (OR = 0.13, 95%CI: 0.23-0.25, p = 0.018) compared with those who had contact with COVID-19 positive patients. Healthcare workers with poor knowledge of COVID-19 had a 44% reduced risk of psychological distress compared with those with good knowledge (OR = 0.56, 95% CI: 0.34-0.93, p = 0.025). CONCLUSION: Findings revealed that healthcare workers in Nigeria reported psychological distress during COVID-19 pandemic. Greater risk was amongst females and those who had contact with COVID-19 positive patients whilst poor knowledge was protective.

Prevalence and Correlates of Intimate Partner Violence Experience Among Partners of Naval Personnel in Lagos, Nigeria.

BACKGROUND: Military personnel are one of the high risk groups recognized as perpetrators of intimate partner violence (IPV). Little is known about IPV experience of partners of naval personnel. This study determined the prevalence and correlates of IPV experience among partners of naval personnel. METHODS: A cross-sectional survey of 435 male and female partners of naval personnel selected using the multistage sampling technique from the Navy Barracks in Lagos, Nigeria was conducted. Data were collected using a 40 item interviewer-administered questionnaire between August and September 2017. Univariate, bivariate and multivariate analysis was done to identify the predictors of partners' experience of IPV. Analysis was done at p-value ≤0.05. RESULTS: The mean age of the respondents was 32.7 ± 7.86yrs and 72% were females. The lifetime prevalence of any IPV experience was 40.7% (with 74.4% of this experienced by females, CI: 0.81-1.91). The prevalence of controlling behaviour, psychological, sexual, economic and physical IPV were 31.5%, 16.3% 12.4%, 12.0% and 8.5% respectively. There was a positive association between experience of IPV and respondents' occupational status (p < 0.0001), lifetime experience of physical (p < 0.0001), sexual abuse (<0.0001), and history of childhood abuse (p < 0.0001). After adjustment for confounders, age (AOR = 2.11, CI = 1.07-4.16), occupational status (AOR = 4.56, CI = 2.30-9.02), history of childhood abuse (AOR = 2.10, CI = 1.26-3.49,) and partners' alcohol use (AOR = 3.41, CI = 1.38-8.39) remained significant factors influencing experience of IPV. CONCLUSION: The prevalence of IPV experience among partners of naval personnel was high. Being unemployed, experience of abuse in childhood and having a partner who consumed alcohol increased partners' vulnerability to IPV. Naval personnel would benefit from marital counseling and training on non-violence conflict resolution strategies.

Caregivers' knowledge and utilization of long-lasting insecticidal nets among under-five children in Osun State, Southwest, Nigeria.

BACKGROUND: Utilization of long-lasting insecticidal nets (LLIN) has been associated with reduction of malaria incidence, especially among children. The 2013 Nigeria Demographic and Health Survey revealed Osun State had the least proportion (5.7%) of under-five children (U5) who slept under LLIN the night before the survey. A study was conducted to assess caregivers' knowledge about LLIN, utilization of LLIN and factors influencing LLIN use among U5 in Osun State, Nigeria. METHODS: A cross-sectional study was carried out among 1020 mothers/caregivers of U5 selected from six communities in Osun State using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on socio-demographic characteristics, mothers' knowledge about LLIN, ownership and utilization of LLIN and factors influencing use of LLIN in U5. Questions on knowledge about LLIN were scored and categorized into good (scored ≥ 5) and poor (score < 5) knowledge out of a maximum obtainable score of seven. Utilization of LLIN was defined as the proportion of U5 who slept under net the night before the survey. Data were analysed using descriptive statistics, Chi square test and logistic regression at α < 0.05. Transcripts from focus group discussions (FGD) were analysed for emerging themes related to caregivers' perspectives on utilization and factors affecting use of LLIN among U5. RESULTS: Majority of the respondents 588 (58.3%) fall between age 25-34 years, with a mean age of 30.0 ± 6.3 years. All were aware of LLIN but only 76.1% had good knowledge and 59.0% reported use of LLIN among their U5. Reported barriers to utilizing LLIN were; heat (96.4%), reactions to the chemical (75.5%) and unpleasant odour (41.3%). These were corroborated at FGD. Those with formal education [adjusted odds ratio (aOR) = 1.4; 95% CI 1.0-2.1] and those with good knowledge of LLIN (aOR = 1.8; 95% CI 1.4-2.5) were more likely to use LLIN than their counterparts without formal education and those with poor knowledge of LLIN respectively. CONCLUSIONS: The level of knowledge of respondents about LLIN was high and the utilization of LLIN among U5 was above average, however, it is still far below the 80% target. Efforts should be made to further improve utilization of LLIN through intensified promotion and health education.

Malaria Rapid Diagnostic Tests and Malaria Microscopy for Guiding Malaria Treatment of Uncomplicated Fevers in Nigeria and Prereferral Cases in 3 African Countries.

BACKGROUND: The World Health Organization recommends that malaria treatment be based on demonstration of the infecting Plasmodium parasite specie. Malaria rapid diagnostic tests (RDTs) are recommended at community points of care because they are accurate and rapid. We report on parasitological results in a malaria study in selected rural communities in 3 African countries. METHODS: In Nigeria, community health workers (CHWs) performed RDTs (SD-Bioline) and thick blood smears on all children suspected to have malaria. Malaria RDT-positive children able to swallow received artemisinin-based combination therapy (Coartem). In all countries, children unable to take oral drugs received prereferral rectal artesunate irrespective of RDT result and were referred to the nearest health facility. Thick blood smears and RDTs were usually taken at hospital admission. In Nigeria and Burkina Faso, RDT cassettes and blood smears were re-read by an experienced investigator at study end. RESULTS: Trained CHWs enrolled 2148 children in Nigeria. Complete parasitological data of 1860 (86.6%) enrollees were analyzed. The mean age of enrollees was 30.4 ± 15.7 months. The prevalence of malaria parasitemia in the study population was 77.8% (1447/1860), 77.6% (1439/1855), and 54.1% (862/1593) by RDT performed by CHWs vs an expert clinical research assistant vs microscopy (gold standard), respectively. Geometric mean parasite density was 6946/µL (range, 40-436 450/µL). There were 49 cases of RDT false-negative results with a parasite density range of 40-54 059/µL. False-negative RDT results with high parasitemia could be due to non-falciparum infection or result from a prozone effect. Sensitivity and specificity of SD-Bioline RDT results as read by CHWs were 94.3% and 41.6%, respectively, while the negative and positive predictive values were 86.1% and 65.6%, respectively. The level of agreement in RDT reading by the CHWs and experienced research staff was 86.04% and κ statistic of 0.60. The malaria parasite positivity rate by RDT and microscopy among children with danger signs in the 3 countries was 67.9% and 41.8%, respectively. CONCLUSIONS: RDTs are useful in guiding malaria management and were successfully used for diagnosis by trained CHWs. However, false-negative RDT results were identified and can undermine confidence in results and control efforts.

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study.

BACKGROUND: Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication. METHODS: In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)-based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention. RESULTS: A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9-2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2-127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59-.78; P < .0001). CONCLUSIONS: Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management. CLINICAL TRIALS REGISTRATION: ISRCTN13858170.

Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus.

Background: Substance use (SU) contributes to poor health outcomes, yet limited data exist to inform strategies to optimize SU treatment among persons with human immunodeficiency virus (HIV). We describe SU and SU treatment utilization among women with and without HIV in the Women's Interagency HIV Study (WIHS). Methods: We included data from women enrolled in WIHS from 2013 to 2020. Current SU was self-reported, nonmedical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was self-reported use of a drug treatment program in the past year. Multivariable regression models were used to investigate associations between participant characteristics and SU treatment. Results: Among 2559 women (1802 women living with HIV [WWH], 757 women without HIV), 14% reported current SU. Among those with current SU (n = 367), 71% reported crack/cocaine followed by 40% reporting opioids, and 42% reported any treatment in the past year. The most common treatments were methadone (64%), Narcotics Anonymous (29%), inpatient programs (28%), and outpatient programs (16%). Among women using opioids (n = 147), 67% reported methadone use in the past year compared to 5% using buprenorphine/naloxone. Multivariable analysis showed lower odds of treatment utilization among WWH with concurrent alcohol or marijuana use. Visiting a psychiatrist/counselor was associated with higher odds of treatment. Among WWH, SU treatment was not associated with HIV-related clinical outcomes. Conclusions: Treatment utilization was high, especially for methadone use. Our results highlight opportunities for accessing SU treatment for WWH, such as the need to prioritize buprenorphine and comprehensive, wraparound services in HIV care settings.

Poverty and fever vulnerability in Nigeria: a multilevel analysis.

BACKGROUND: Malaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels. METHODS: Determinants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted. RESULTS: About 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6 months), whereas the effect of wealth no longer reached statistical significance. CONCLUSION: While, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation.

Decomposition of changes in malaria prevalence amongst under-five children in Nigeria.

BACKGROUND: Malaria remains a major public health problem in Nigeria. Changes in malaria prevalence can be attributed to three major control interventions: insecticide treated nets (ITNs), indoor residual spraying (IRS) and intermittent preventive treatment in pregnancy (IPTp). Use of ITNs has proven to be a practical, highly effective, and cost-effective intervention against malaria. Although, several studies have assessed the utilisation of ITNs, its impact on the prevalence of malaria over time is yet to be documented in Nigeria. Therefore, this study was conducted to decompose changes in malaria prevalence amongst under-five children between 2003 and 2013. MATERIALS AND METHODS: A retrospective analysis of the 2003 and 2013 Nigeria Demographic Health Survey (NDHS) dataset was conducted. Occurrence of fever was used as a proxy for malaria. Percentage change in both outcome and explanatory variables between 2003 and 2013 was estimated. A multivariate decomposition technique was used to partition changes in malaria prevalence into two components: contribution of changes in determinants and changes in the effect of determinants. RESULTS: A total of 5204 and 28634 records of children under-five were available in 2003 and 2013 respectively. Malaria prevalence declined from 31.8% to 13.1% between 2003 and 2013 (p<0.001). Changes in determinants contributed 4.7% and changes in the effect of determinants contributed 95.3% to the change in malaria prevalence. CONCLUSIONS: There was a decline in the prevalence of malaria amongst children under five in Nigeria in the last ten years. Ownership of ITNs and their utilisation were the most contributing factors to the decline in malaria prevalence. Continued efforts should be made in promoting ITNs and their consistent and appropriate utilisation.

Models for Predicting Time to Sputum Conversion Among Multi-Drug Resistant Tuberculosis Patients in Lagos, South-West Nigeria.

Background: Multi-drug resistant tuberculosis (MDR-TB) develops due to problems such as irregular drug supply, poor drug quality, inappropriate prescription, and poor adherence to treatment. These factors allow the development and subsequent transmission of resistant strains of the pathogen. However, due to the chronic nature of MDR-TB, cure models allow us to investigate the covariates that are associated with the long-term effects of time-to-sputum conversion among multi-drug resistant (MDR-TB) tuberculosis individuals. Therefore, this study was designed to develop suitable cure models that can predict time to sputum conversion among MDR-TB patients. Methods: A retrospective clinic-based cohort study was conducted on 413 records of patients who were diagnosed of MDR-TB and met inclusion criteria from April 2012 to October 2016 at the Infectious Disease Hospital, Lagos. The main outcome measure (time-to-sputum conversion) was the time from the date of MDR-TB treatment to the date of specimen collection for the first of two consecutive negative smear and culture taken 30 days apart. The predictor variables of interest include: demographic (age, gender and marital status) and clinical (registration group, number of drugs resistant to at treatment initiation, HIV status, diabetes status, and adherence with medication) characteristics. Kaplan-Meier estimates of a detailed survivorship pattern among the patients were examined using Cox regression models. Mixture Cox cure models were fitted to the main outcome variable using Log-normal, Log-logistic and Weibull models as alternatives to the violation of Proportional Hazard (PH) assumption. Akaike Information Criterion (AIC) was used for models comparison based on different distributions, while the effect of predictors of time to sputum conversion was reported as Hazard Ratio (HR) at α0.05. Results: Age was 36.8 ± 12.7 years, 60.8% were male and 67.6% were married. Majority of the patients (58.4%) converted to sputum negatives. Patients who were resistant to two drugs at treatment initiation had 39% rate of conversion than those resistant to at least three drugs [HR: 1.39; CI: 0.98, 1.98]. The likelihood of sputum conversion time was shorter among non-diabetic patients compared to diabetics [HR: 0.55; CI: 0.24, 0.85]. The overall median time for sputum conversion was 5.5 (IQR: 1.5-11.5). In the cure model, resistance to more drugs at the time of initiation was significantly associated with a longer time to sputum culture conversion for Log normal Cox mixture [2.06 (1.36-3.47)]; Log-logistic Cox mixture cure [2.56(1.85-4.09)]; and Weibull Cox mixture [2.81(1.94-4.19)]. Diabetic patients had a significantly higher sputum conversion rate compared to non-diabetics; Log-normal Cox mixture [2.03(1.17-3.58)]; Log-logistic Cox mixture cure [2.11(1.25-3.82)]; and Weibull Cox mixture [2.02(1.17-3.34)]. However, Log-normal PH model gave the best fit and provided the fitness statistics [(-2LogL: 519.84); (AIC: 1053.68); (BIC: 1078.04)]. The best fitting Log-normal PH model was Y = 1.00X1+2.06X2+0.98X3+2.03X4+ε where Y is time to sputum conversion and Xs are age, number of drugs, adherence, and diabetes status. Conclusion: The models confirmed the presence of some factors related with sputum conversion time in Nigeria. The quantum of drugs resistant at treatment initiation and diabetes status would aid the clinicians in predicting the rate of sputum conversion of patients.

Trends and drivers of skilled birth attendant use in Nigeria (1990-2013): policy implications for child and maternal health.

INTRODUCTION: While Nigeria accounts for only 2% of the world population, it regrettably shares 14% of global maternal death burden. Whether its reported increase in antenatal care utilization is accompanied by increased use of skilled birth attendants (SBAs) is not known. This study assessed trends in utilization of SBAs in Nigeria between 1990 and 2013 and identified its determinants. METHODS: Data from four consecutive Nigerian Demographic and Health Survey reports between 1990 and 2013 were pooled. We used basic descriptive statistics, test of association, and logistic regression to assess the prevalence, relative change, and determinants of SBA use at 5% significance level. Sample weights were applied, and adjustment was made for survey design and sampling errors. RESULTS: Nearly half (46.7%) of the respondents were aged 25-34 years, while half (50.3%) of the respondents had no formal education. The prevalence of SBA use increased only marginally across the years and characteristics studied, from 32.4% in 1990 to 38.5% in 2013, an insignificant 6% increase. Educated women used SBA more than women with no education (92.4% vs 13.1%), and their odds ratio of using SBA were thrice that of uneducated women (odds ratio =3.09, 95% confidence interval =2.17-4.38). Women involved in decisions regarding their use of health facility were 12% more likely to use SBAs than others who do not. Educational attainment, religion, tribe, rural/urban residence, and zone of residence were significant to the use of SBA. CONCLUSION: The use of SBA was very low throughout the study period, barely at one third usage with insignificant changes over the studied period. Women empowerment, including decision-making power and residence, were the strongest determinants of SBA use. To overturn poor child and maternal health outcomes in Nigeria through SBA use, efforts should be targeted at educating girls, sexual and reproductive health education, and accessible and improved health care facility services.

A pragmatic randomized controlled trial comparing pathway-based versus usual care in community-acquired acute kidney injury.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular or interstitial disease, and pregnant women were excluded. Thirty-eight patients were enrolled from March 2012 to December 2013. The primary outcome was LOS. Secondary outcomes included: 30-day readmission, in-hospital mortality, determinants of LOS, and patient-centered outcomes. Eighteen patients were randomized to PC, and 20 to UC. Baseline characteristics were comparable in both groups. Using an intention-to-treat analysis, the median LOS was 4.96 [interquartile range (IQR) 6.57] and 4.80 days (IQR 6.84) for PC and UC, respectively (P = 0.770). Of the five readmissions, none were for AKI. No in-hospital mortality was reported. The CHAMP-Path AKI pragmatic trial demonstrated that PC was not different than UC in reducing LOS. There was no difference in 30-day re- admission, in-hospital mortality, and patient-centered outcomes.

STEMI vs NSTEACS management trends in non-invasive hospital.

OBJECTIVES: To compare the clinical features, management, and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTEACS), in the Western Region of Saudi Arabia. METHODS: A total of 71 patients were enrolled in a longitudinal study at a tertiary hospital without cardiac catheterization facility. These data were collected from Saudi Project for Assessment of Coronary Events registry. RESULTS: Twenty-three patients with STEMI were compared to 48 patients with NSTEACS. Mean age for STEMI was younger, 57.4±13.7 years compared to 63.2±13.9 years respectively (p=0.19). Forty-four percent arrived at the hospital by ambulance. History of hypertension and hyperlipidemia were more frequent in NSTEACS (p=0.05), while both groups showed no difference in diabetes mellitus, 17% vs 22% and smoking, 30% vs 17%. In-hospital medications were: Aspirin (100%) both groups, Clopidogrel (91% vs 100%) (p=0.03). There was more aggressive use of beta-blockers (74% vs 95%) (p=0.01) and statins (87% vs 100%) (p=0.01) in NSTEACS. In-hospital outcomes showed one recurrent myocardial infarction and one death in NSTEACS group (2%). Other outcome in the two groups showed recurrent ischemia (13% vs 29%) (p=0.14) and cardiogenic shock (9% vs 2%) (p=0.17). No stroke or major bleeding was reported in both groups. CONCLUSION: NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors.

Controlling malaria in pregnancy: how far from the Abuja targets?

Background: The Roll Back Malaria (RBM) initiative recommended that all pregnant women receive Inter mittent Preventive Treatment (IPTp) and that by 2010 at least 80% of people at risk of malaria (including pregnant women) use insecticide-treated bednets (ITN) in areas with stable transmission. We evaluated ITN/IPTp coverage, explored its associated factors, and estimated the number of pregnancies protected from malaria. Materials and methods: This analysis was based on data from the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus). To assess ITN coverage, we used the population of women that was pregnant (n=22,438) at the time of the survey. For IPTp coverage, we used women that had a live birth in the 5 years preceding the survey (n= 118,187) and extracted the population of pregnant women that, during their last pregnancy, received drugs for protection against malaria. We estimated the number of live births using the projected population of females in each state, population of women of child -bearing age and the total fertility rate. The estimated number of pregnancies covered/protected by ITN and IPTp was obtained from a product of the estimated live births and the reported coverage. Multivariate logistic regression was used to determine factors associated with ITN and IPTp use. Results: We estimated that there were 5,798,897 live births in Nigeria in 2012, of which 3,537,327 and 2,302,162 pregnancies were protected by ITN and IPTp, respectively. Four of 36 states achieved the 80% RBM target for ITN coverage. No state achieved the 100% target for IPTp. Education and socio-economic status were associated with IPTp use. Conclusion: ITN cover age was higher than in previous estimates even though it is still below the RBM targets. However, IPTp coverage remained low in 2012 and was not likely to increase to match the 2015 target coverage of 100%.

Mothers' awareness of anorectal malformations: a pointer to delayed diagnosis in a developing country.

INTRODUCTION: Delay in the presentation of babies with anorectal malformations (ARMs) to the pediatric surgeon accounts for a major cause of morbidity and mortality in developing countries. In countries lacking proper guidelines for screening and newborn physical examination, a lot of responsibility is placed on parents and caregivers; with mothers often being the first to note abnormalities in their babies. The aim of the study was to assess the awareness of mothers about ARM and their knowledge about normal or abnormal appearance of the anus. MATERIALS AND METHODS: A descriptive cross-sectional study involving mothers attending immunization clinics at two hospitals in a developing country was conducted using a structured interviewer administered questionnaire. Data were obtained on sociodemographic characteristics, awareness of ARM, and knowledge of appearance of the anus by requesting mothers to identify if three pictures of the perineum were normal or abnormal. RESULTS: A total of 365 mothers participated in the study with age ranging from 17 to 42 years. Only 71 (19.5%) mothers had ever heard about ARM. A picture of a girl with ARM and rectoperineal fistula was correctly identified by 66 (18.1%) and that of a boy with ARM and rectoperineal fistula by 71 (19.5%) mothers. A higher proportion (25.0%) of the mothers who were older than 30 years were aware of ARM than those younger than 30 years (16.0%), (p = 0.035). Participants with tertiary education were more likely to be aware of ARM than those with 12th grade or less education (31.1 vs. 6.9%, p < 0.001). Skilled workers were also more likely to be aware of ARM than unskilled workers and artisans (41.1 vs. 8.1%, p < 0.001). The predominant technique of "checking" the anus by the mothers was "inspection of their baby's perineum." CONCLUSION: Level of awareness of ARMs was low among women interviewed. Educational intervention targeting young mothers from low socioeconomic class is suggested.

Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria.

The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26-30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education.