Clients' Perception of and Satisfaction with Quality of Directly Observed Treatment Short Course: A Comparative Study of Private and Public Health Facilities in Southwestern Nigeria.

BACKGROUND AND OBJECTIVES: One third of the world population are at risk of developing active tuberculosis (TB), resulting in significant mortality and morbidity. The reported low patronage in many TB clinics may not be unrelated to the quality of services received by clients. The objective of this study was to determine clients' perception of and satisfaction with quality of DOTs treatments in private and public health facilities in Oyo State. MATERIALS AND METHODS: A descriptive cross sectional study among 410 eligible clients selected using the multistage sampling method was conducted in Oyo State. Research instrument used were a structured pre-tested interviewer-administered questionnaire. Data was analyzed using the SPSS software version 17.0. RESULTS: Mean age of respondents was 39.0 + 0.68 years, 211(51.5%) were male while 199 (48.5%) were females. 321(78.3%) worked in public health facilities. Majority of the respondents, 385 (94.0%), had good perception of quality of DOTs treatment received. These include good perception of communication (96.0%); of quality of care (90.4%), and good perception of staff attitude among 93.9% of respondents About 97% of the respondents had good satisfaction with the quality of DOTs treatment received. Good satisfaction was found among 98.3% in terms of adherence counseling received, 98.7% on TB treatment received and 98.7%, on waiting time spent, and these were far higher among private than public health facilities. Statistically significant association was found between the type of facility attended by respondents and having adherence counseling service and waiting period experienced (P-values < 0.05). Having received services in a private health facility is the major predictor of favourable perception and good satisfaction with quality of DOTS treatment among respondents studied. CONCLUSION: Though perception of and satisfaction with service delivery were good, this was better in private than in public; thus stressing the need for better monitoring and evaluation of services rendered by health care workers in order to encourage patronage by clients.

A pilot study of cancer patients' use of traditional healers in the Radiotherapy Department, University College Hospital, Ibadan, Nigeria.

OBJECTIVE: This descriptive cross-sectional study assessed cancer patients' use of traditional healers, the association between delay in coming to this clinic and patients' use of traditional healers, reasons cancer patients use western medicine after trying traditional treatment and the cost of obtaining traditional treatment. METHODS: Participants were made of 400 consecutive and consenting new patients in the Department of Radiotherapy, University College Hospital (UCH), Ibadan. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data was analyzed using descriptive and inferential statistics. Focus group discussions were held with some of the clients as well as the traditional healers. RESULTS: It showed that 34.5% of the patients patronized traditional healers, while 65.5% used only hospitals. The most common reason given among patients who patronized traditional healers for doing so was their desire to be healed and to be rid of pains (45.9%), while the most common reason they opt for western medicine afterwards was lack of improvement in their health condition (70.1%). The cost of traditional treatment for cancer ranged between no cost to N5,000 (that is approximately $31.25 @ $1 = N160) to be treated. The cost of orthodox care would range from a minimum of N40,000 to several millions of naira. CONCLUSIONS: Patients patronize traditional healers to be rid of pains; hence physicians should endeavor to control cancer-related symptoms, especially pains as the patients await diagnosis. Also, the low cost of obtaining traditional treatment, regular assurance of cure and other assistances given to them, could be an enticing factor in its use. Copyright © 2015 John Wiley & Sons, Ltd.

A cross-sectional study for algorithm in diagnosing simple uncomplicated malaria in children in health facilities without laboratory backup in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine an algorithm for malaria diagnosis using presenting signs and symptoms of children (aged 0-13 years) with uncomplicated malaria in Gwagwalada Area Council of Abuja, Nigeria. MATERIALS AND METHODS: A validated questionnaire was used to obtain relevant data from 400 children diagnosed presumptively of simple malaria by clinicians and 400 other children of similar sex and age considered as not having malaria. Giemsa-stained thick blood films were used to determine parasitaemia. Data obtained was analysed using Epi-Info version 3.3.2. RESULTS: Thirty-eight per cent of children with presumptive diagnosis of malaria had parasitaemia. Fever, rigor, vomiting, jaundice, pallor and spleen enlargement had significant statistical relationship with parasitaemia on bivariate analysis, but only fever (p=0.00), rigor (p=0.00), vomiting (p=0.00), and pallor (p=0.00) maintained the relationship when subjected to logistic regression analysis. But these symptoms individually had low sensitivity and/or specificity. Candidate algorithms (combinations of symptoms) were then successively subjected to bivariate, logistic and validity analyses. Fever with vomiting gave the highest sensitivity (56.2%), specificity (76.4%) and PPV (60.0%) and were therefore adopted as the algorithm of choice. CONCLUSION AND RECOMMENDATIONS: Children presenting with fever and vomiting without any other obvious cause in health facilities without laboratory support in the research area should receive antimalarial treatment, to help reduce the malaria scourge. This algorithm should be field-tested and if found reliable should be adopted to ease the problem of malaria diagnosis in peripheral health facilities.

JOB SATISFACTION AND PSYCHOLOGICAL HEALTH OF MEDICAL DOCTORS IN CALABAR, SOUTHERN NIGERIA.

BACKGROUND: Employees should be happy at their work, considering the amount of time they devote to it throughout their working life. There is paucity of data on the job satisfaction and psychological health of medical doctors in Nigeria. OBJECTIVE: To assess the level of job satisfaction and its relationship to psychological health among medical doctors in a southern city of Nigeria. DESIGN: A cross-sectional descriptive survey. SETTING: Three major public hospitals in Calabar, Nigeria. SUBJECTS: Medical doctors who had worked for at least six months in the hospitals. RESULTS: Response rate was 73.0%. More than half (56.7%) of the respondents expressed overall satisfaction with their job. Inadequate pay and work overload were the most commonly mentioned reasons for job dissatisfaction. About a fifth of the respondents were at increased likelihood of psychological disorder. There was a statistically significant negative correlation between job satisfaction scores and GHQ scores. Satisfied respondents were least likely to have psychological disorder. CONCLUSION: Causes of job dissatisfaction among medical doctors should be addressed to improve their psychological health.

Effect of government-community healthcare co-financing on maternal and child healthcare in Nigeria.

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an intervention component, conducted amongst 240 women from Igboukwu (intervention area), and Ekwuluobia (control area), of Anambra State of Nigeria. RESULTS: The biosocial characteristics of the respondents were essentially similar. Better utilization of health services occurred in the intervention area post-intervention. Quality of service from intervention clients' perspective showed significant improvement post-intervention. Distance less than five km, transportation cost less than N40, and maternal education above secondary level impacted positively on utilization of maternal and child health services. Acceptability of the scheme was better for the intervention facility evident from the higher number of respondents showing "willingness to join", and "willingness to pay". CONCLUSION: Health sector funding partnership, positively impacts on maternal and child health services. Government's total commitment, backed with legislation, and community mobilization, will sustain the scheme.

Perception of quality of care in HIV/AIDS programmes among patients in a tertiary health care facility in Anambra State.

BACKGROUND: Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. METHODS: The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. RESULTS: The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent < or = 240 naira (98 versus 52). Similarly, the number of subjects that spent >30 minutes are significantly larger than the number that spent < or = 30 minutes to reach the clinic (142 versus 8). Also significantly greater number of participants spend >750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. CONCLUSION: HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current level of quality of care provided to the patients and if possible improve upon it. However, efforts should be made to further decentralize ART services to make them more accessible to the growing number of PLWHAs needing care and support.

Effect of peer education intervention on secondary school adolescents' reproductive health knowledge in Saki, Nigeria.

BACKGROUND: Adolescents' reproductive health needs and problems have become contemporary concerns globally. Of great concern is the high rate of sexually transmitted infections including HIV/AIDS arguably influenced by lack of reproductive health knowledge. OBJECTIVE: The study aimed at examining the effect of peer education on school adolescents' reproductive health knowledge in Saki, Southwestern, Nigeria, in a nurse-led concurrently controlled community interventional study. MATERIALS AND METHOD: The study employed pre - and post - intervention (quasi - experimental) design. The experimental group was exposed to the peer education programme for six months. Pre and post differential data in the experimental and control groups were compared and analysed using analysis of covariance. RESULTS: The intervention had significant effect on adolescents in the experimental group compared with the control group in the area of knowledge of reproductive health issues (F1,519) = 37.117, (p < .05). CONCLUSION: The intervention significantly improved the adolescents' reproductive health knowledge. It is recommended that community health nurses as well as other community workers should embrace peer education approach as a strategy to empower adolescents with reproductive health knowledge.

Eye health of professional drivers of a Nigerian University.

BACKGROUND: Safe driving and road traffic accident prevention could be attained through ensuring good condition of vehicles, the road as well as the physical and mental state of the driver among others Objectives: To determine the ocular health status of professional drivers of the University of Ibadan, Nigeria METHODS: A cross sectional survey of all drivers in the employment of the University of Ibadan, excluding the College of Medicine, was carried out between March and June 2002 at the University Medical Centre and the eye clinic of the University College Hospital, Ibadan. RESULTS: One hundred and ninety seven all male drivers were screened. Their ages ranged from 31 to 64 years (mean 48.3 +/-5.9yr). Less than satisfactory presenting (functional) binocular visual acuity (< 6/18) was found in 11(5.6%) of the drivers. With refraction no driver had binocular vision of <6/18, but three drivers each had corrected visual acuity in the worse eye of 6/12, 6/18 and 6/36 respectively. The commonest visual problems were presbyopia 100 (50.8%), and refractive errors 38 (19.3%). Other ocular pathologies included pterygium 11 (5.6%), optic atrophy 9 (5.0%), colour vision defects 7 (3.6%) cataract 2 (1.0%), age related macular degeneration 4 (2.0%), glaucoma 3 (1.5%) retinal scar 2 (1.0%), exotropia 1 (0.5%), and pingueculum 1 (0.5%), CONCLUSION: Periodic screening of driver population of any establishment is a worthwhile task that may help to identify potentially blinding or visually impairing conditions such as glaucoma and refractive-error which can be promptly treated.

Knowledge and practice of universal precautions against blood borne pathogens amongst house officers and nurses in tertiary health institutions in Southeast Nigeria.

PURPOSE: To examine the knowledge and practice, as well as factors influencing universal precautions practices amongst Nigerian House officers and Nurses. METHODS: A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed using EPI-info. RESULTS: Most Doctors, 66.6%, were aged 26-30 years while the Nurses, 41.1%, were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the nurses were females. Knowledge of universal precautions measures was high for both categories of respondents--97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. The most important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interfering with technical skills. CONCLUSIONS: Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospital workers are of absolute necessity to prevent infections from blood and body fluid pathogens.

A socio-cultural study of traditional healers role in African health care.

BACKGROUND: There is a widely held view that a major cause of delay in diagnosis of cancer at an early stage in Africa is the fact that many patients consult traditional healers first and are often treated by them until curative treatment cannot be undertaken. PURPOSE: This qualitative study aimed at identifying cancer patients who have used traditional healers and their traditional healers' understanding of cancer, its causes and treatment, patients' motivations for patronizing traditional healers and their opinion about collaboration between physicians of western medicine and traditional healers as part of overall health care system. METHODS: Ethical approval was obtained from the UI/UCH IRB. Twenty people participated in the study, nine cancer patients, six traditional healers and five faith based healers using three focused group discussions employing a semi structured interview. DATA ANALYSIS: The audio taped recorded responses to the semi structured questions were transcribed and thematically analyzed. The themes that emerged from focus group discussions with the patients and healers relate to the meaning of cancer, the causes of cancer (due to satanic attack), the cure for cancer (being possible through prayers to God and use of herbs), reason for using traditional healers (financial consideration, convenience, incorporation of their spiritual beliefs and recommendation by others) and need for collaboration between orthodox medicine and traditional healers. CONCLUSION: Patients and alternative healers have a poor understanding of the causes and treatment of cancer. They desire to seek a closer collaboration between healers and western physicians to enhance better care for cancer patients. This has implication for policy makers who will facilitate the relationship in order to control cancer care and improve the quality of care of cancer patients in Nigeria.

DETERMINANTS OF CHOICE OF HEALTH FACILITY FOR REPRODUCTIVE MORBIDITY BY FEMALE TRADERS IN A NIGERIAN CITY.

BACKGROUND: Reproductive health (RH) services are important to reduce reproductive morbidity and mortality. This is only possible if such services are used. Knowledge of the determinants of choice health facility for reproductive morbidity is useful to design interventions aimed at increasing utilization of RH services. OBJECTIVE: This study therefore explored the determinants of choice of health facility for reproductive morbidity among female traders within Ibadan metropolis. METHODS: This was a cross-sectional study using interviewer-administered questionnaire among 410 female traders aged 15-49 years selected by systematic random sampling in Aleshinloye market in the city of Ibadan, Nigeria. Government and private hospitals were classified as orthodox health facilities. Data was analysed using logistic regression at 5% significance level. RESULTS: Mean age was 34.6 ± 7.8, 78.2% were married and 58.7% had secondary education. Above half (52.9%) used orthodox health facilities. Perceived quality of care influenced the use of orthodox facilities and likelihood of using the same facility in the future. Factors predicting the use of orthodox health services were social economic status (OR 2.77 95%CI 1.06-6.73), delay in attaining conception (OR 2.70 95%CI 1.39-5.22), menstrual problems (OR 2.15 95%CI 1.19-3.90) and complications in previous pregnancy (OR 2.11 95%CI 1.21-3.78). CONCLUSION: The use of orthodox health facilities was affected by respondents' past experience of reproductive morbidity and socioeconomic status. These factors should be borne in mind in planning interventions for improvement in reproductive health service utilisation.

TOBACCO CESSATION SERVICES AND RELATED CHALLENGES AMONG DENTISTS IN SOUTHWEST NIGERIA.

INTRODUCTION: Oral health problems arising from tobacco use have been reported and some of these conditions can be prevented through Tobacco Cessation (TC). Dentists are well positioned to provide tobacco cessation services to patients. In Nigeria, little is documented on the provision of cessation services among dentists and the challenges. This study was conducted to assess the cessation practices of dentists and their related challenges in Southwest Nigeria. METHODS: A cross sectional study was carried out in all the tertiary healthcare facilities within the six states of the Southwest geopolitical zone. A total population survey involving dentists below the cadre of Consultant/Chief Dental Officers undergoing postgraduate training and/or providing services in the tertiary hospitals was conducted using a pretested semi structured self-administered questionnaire. This included questions on challenges experienced in the provision of TC services in their respective facilities. RESULTS: A total of 224 eligible dentists were approached to participate in this study with a response rate of 91.5%. Mean age and completed years of working experience were 33.8±5.2 and 6.1±4.4 respectively. In reporting challenges to implementing tobacco cessation services, 60% of respondents reported 'lack of perceived efficacy and training' as the major barriers. CONCLUSION: From this study, incorporation of tobacco cessation into the dental curriculum will increase the knowledge and competence of dentists. Provision of systems support to dentists willing to help patients quit smoking may be important in ensuring the health system is responsive to the tobacco control needs of patients in Southwest Nigeria.

The prevalence of occupational asthma and rhinitis among woodworkers in south-eastern Nigeria.

Wood dusts are known to cause respiratory disorders like rhinitis and asthma. This study was therefore done to determine the magnitude of the problem among woodworkers in south-eastern Nigeria exposed to high level of wood dust. Five hundred and ninety one woodworkers were selected using a stratified random sampling. The prevalence of woodwork-related rhinitis and asthma were then observed in the study population. Also the peak expiratory flow rate (PEFR) of each woodworker was obtained. The prevalence of occupational rhinitis was 78%, while that of asthma was 6.5%. As period of woodwork increased the prevalence of rhinitis and asthma increased (rhinitis: chi2 trend = 53.015, df = 1, P = 0.000). For asthma, chi2 trend = 19.721, df = 1, P = 0.000). Also the PEFR significantly became low with increasing years of exposure to woodwork (chi2 trend = 75.965, df = 1, P = 0.000). In conclusion the prevalence of rhinitis and asthma in woodworkers was high and significantly increased with years of working as a woodworker.

PREVALENCE AND DETERMINANTS OF STUNTING AMONG PRIMARY SCHOOL CHILDREN IN RURAL AND URBAN COMMUNITIES IN OBAFEMI OWODE LOCAL GOVERNMENT AREA, SOUTHWESTERN NIGERIA.

BACKGROUND: Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the prevalence and predictors of stunting among selected primary school children in rural and urban communities of Obafemi Owode Local Government Area, Ogun State. METHOD: A cross-sectional study of rural and urban primary school children was conducted. An interviewer-administered questionnaire was used to collect information on respondents' and parents' socio-demographic characteristics. Stunting was defined as height-for-age less than two standard deviations from the median height-for-age of the standard World Health Organization reference population. Using EPI-INFO version 6.03, children were classified as stunted if z-scores of height-for-age were less than 2 standard deviations below the National Centre for Health statistics (NCHS)/WHO median. Height and weight were taken using a stadiometer and weighing scale respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 while predictors were determined using logistic regression at 95% level of significance. RESULTS: A total of 1,160 primary school children were studied with 52.2% from rural schools. Males constituted 57.1% and 51.8% in the rural and urban school respectively. Prevalence of stunting among rural school children was 46.2%, and was significantly higher (p≤0.001) than among urban children at 33.8%. Younger children <10 years (OR: 0.088; 95CI: 0.052 - 0.150) and children between 11-12 years (OR: 0.534; 95CI: 0.322 - 0.886) were at a significantly lower risk of stunting both in rural schools compared to children >13 years. CONCLUSION: The prevalence of stunting was high especially among pupils from schools in the rural communities. This underscores the need for urgent feasible and effective nutrition programs for primary school children especially those in rural schools within the study area.

Ocular findings seen among the staff of an institution in Lagos, Nigeria.

BACKGROUND: The degree to which ocular morbidity affects workers productivity in the developing countries has not been studied adequately. A federal government research institute based in Lagos introduced an annual health screen for all its workers, which included eye tests. This provided an opportunity to study the pattern of ocular conditions among workers who were 30 years and above, and to determine the effect of eye diseases on the workers productivity. STUDY DESIGN: Detailed eye examination including refraction, was done on every respondent at the institution's clinic by an ophthalmologist. A questionnaire on ocular health status and occupational history was administered independently by an ophthalmic nurse. Sickness absenteeism, use of the clinic were obtained from clinic records, and the results were analysed. RESULTS: The common ocular conditions were uncorrected or poorly corrected refractive error, uncorrected or poorly corrected presbyopia and allergic. conjunctivitis. Glaucoma, maculopathy and optic atrophy were causes of severe visual impairment or blindness in 1.9 % of the subjects. Absenteeism and clinic use were more common in subjects with ocular morbidity than those with non-ocular morbidity. Subjects with ocular morbidity had more illnesses, absenteeism and used the clinic more. CONCLUSION: Ocular problems which reduce worker's productivity are prevalent among the staff of the institution studied. They are mostly unrecognised.

Relationship between blood pressure and body mass index in lean populations.

Associations between body mass index (BMI) and blood pressure (BP) have been consistently observed, but remain poorly understood. One unresolved question is whether there is a linear relationship across the entire BMI range. We investigated this question among 11,235 adult men and women from seven low-BMI populations in Africa and the Caribbean. We used kernel smoothing and multivariate linear and spline regression modeling to examine gender differences in the relationship and to test for a threshold. Age-adjusted slopes of BP on BMI were uniformly higher in men than women, with pooled slope ratios of 2.00 and 2.20 for systolic and diastolic BPs, respectively. Men displayed no evidence of age modification or nonlinearity in the relationship, and the age-adjusted slope of systolic BP on BMI was 0.90 (95% confidence interval [CI], 0.76 to 1.04). Women demonstrated both age modification and nonlinearity. For both younger (<45 years) and older (45+ years) women, the optimal change point for a single threshold model was found to be 21 kg/m2. Slopes of systolic BP on BMI above this threshold were positive and significant: 0.68 (95% CI, 0.54 to 0.81) and 0.53 (95% CI, 0.29 to 0.76) for younger and older women, respectively. Slopes below the threshold were essentially zero for both groups of women, and the difference between the slopes above and below the threshold was significant for younger women (P=.019). In summary, we observed a threshold at 21 kg/m2 in the relationship between BMI and BP for women but not for men. This contributes to the effort to identify the mechanisms that underlie this relationship and how they differ by gender.

Studies on Plasmodium falciparum parasitemia and development of anemia in Nigerian infants during their first year of life.

Bimonthly surveys were carried out for 12 months to investigate the dynamics of the acquisition of malaria parasitemia in relation to hemoglobin genotype, development of anemia, and body weight in infants during their first year of life. Thick blood smears for malaria, a capillary blood sample for measurement of packed cell volume (PCV) levels, and body weights were obtained at each survey. Generally, parasite rates (P < 0.001) and mean parasite densities (P < 0.025) increased with age. With a few exceptions, parasite rates and densities were similar in infants with hemoglobin AA and AS during the first year of life. Malaria parasitemia significantly lowered the PCV levels of the study infants only at four (P < 0.001), six (P < 0.025), eight (P < 0.001), and 10 (P < 0.01) months of age. No significant difference was observed in the mean body weight of malaria-positive and -negative infants during the first year of life except in infants two months of age (P < 0.05). The fairly rapid increase in parasite rate and density after two months of age is indicative of the decrease in protection after the first 2-3 months of life.

A longitudinal study of seroreactivities to Plasmodium falciparum antigens in Nigerian infants during their first year of life.

The kinetics of passively transferred maternal antibodies to antigens of Plasmodium falciparum and the dynamics of acquisition of these antibodies during the first year of life was investigated in infants born in a malaria endemic area of south-western Nigeria. Blood samples were collected from the infants at bi-monthly follow-up visits for the analysis of total serum immunoglobulin G, IgM, IgA and antibodies to the antigen Pf155/RESA and against synthetic peptides representing antigenic sequences of the blood stage antigen Pf155/RESA and Ag332 or the circumsporozoite protein (CSP). IgG levels fell from birth till 4 months and a steady rise was observed thereafter till ten months of life. On the contrary mean IgM and IgA levels increased throughout the first year of life. Generally the number of infants positive for antibodies to the antigens under investigation fell from birth and between 4-6 months of age was either low or absent. None of the infants were positive for antibodies to the peptide representing Ag332 during the first year of life. The earliest seroconversion was detected at 6 months of age involving the Pf155/RESA and (NANP)6 antigens. The results indicate a high level of exposure in this study area to malaria infection early in life. The finding of an active antibody response to malarial antigens in infancy encourages the hope that a malaria vaccine administered early in life may accelerate the development of naturally acquired immunity and thus protect the population most at risk.

A comparative study of the commonly used nutritional assessment tools for primary health care.

This is a community-based, cross-sectional study of the three commonly recommended nutritional assessment tools, namely, weight for age (as the Road to Health Chart), weight as a percentage of standard weight for height (as the Thinness Chart), and mid-upper arm circumference (as the Shakir strip). The study was done in the Igbo-ora Community of Oyo-State. Done on 204, one to four year old children, the study shows that all the methods show high levels of correlation with each other's classification of the children. Compared with the Thinness Chart and the physicians standardised clinical assessment, the epidemiological usefulness of the Shakir strip as one point screening tool for severely malnourished children can be improved by the use of 13.5cm rather than the 12.5cm previously recommended at the cut-off point for individuals patient intervention. This cut-off is therefore recommended for the use of the Shakir strip in this locality for the situations where its use is found appropriate. Compared with the other assessment methods, the borderline class interval of the Thinness chart as currently recommended appears too wide. Far too many children, apparently normal even by weight for age, were classified in the borderline category by that instrument. It is therefore recommended that the interval should also be narrowed down for a more adequate use of that instrument in this locality.

PIP: A physician visited at least 204 1-4 year old children in their homes in Pako and Igbole villages of Igbo-ora town in Oyo State, Nigeria over a 2-month period to measure their weight, height, and mid-upper arm circumferences and to perform a clinical examination to compare the Thinness Chart (the weight as a percentage of standard weight for height) with the Shakir Strip (mid-upper arm circumference). He also intended to compare the classifications of both these assessments with the 1-point categorizations of the Road-to-Health Chart (weight for age). All 3 methods of assessing malnutrition were very highly associated (p.00001). Further, in a comparison of the Shakir Strip and the clinical assessment performed by the physician, the researcher found that the Shakir Strip using the 12.5 cm cut off only identified 3 of the 7 clinically malnourished children. If the cut off would have been 13.5 cm, it would have identified all 7. In comparison with the Thinness Chart, he found the 13.5 cm cut off increased the sensitivity of the Shakir Strip from 16.7-58.3%. he therefore recommended that 13.5 cm be the cut off for undernutrition in Nigeria. In addition, the researcher learned that the Thinness Chart rated too many children as borderline malnourished when, according to the other methods, they were nutritionally normal. Even though prospective studies of health outcome of these children are needed, he suggested reducing the range of the borderline categorization of the Thinness Chart for use in Nigeria. In conclusion, primary health care programs in Nigeria should adapt these changes to more effectively identify children at risk of malnutrition.

The use of mail reminders in STD contact tracing in Ibadan, Nigeria.

Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide, and different strategies have been introduced into it in recent years to improve its effectiveness. Of all these strategy components, index patient counselling and co-operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first two years of its usage. It demonstrates that, like the other components of the contact tracing strategies, it is not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. The intensification of efforts towards encouraging the index patient in contact tracing must therefore be ever more strongly emphasised as the top priority in STD control in Nigeria and similar developing countries for the success of this strategy.

PIP: Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide and different strategies have been introduced in recent year to improve its effectiveness. Of all these strategy components, index patient counselling and co- operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first 2 years of its usage. It demonstrates that, like other components of the contact tracing strategies, it in not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. Of the 141 letters sent to defaulting index patients, 38% and 19% of them were returned as untraceable addresses by the postal services in 1985 and 1986. The remaining 103 letters were assumed to have reached their correct destination. Only 7 of these 103 index patients attended the clinic on account of mail reminders, while non of the 39 contacts to whom slips were sent came for follow-up. 11 of the non-responding 96 index patients were later traced physically. 7 of these 11 were found, 6 of whom would not return to the clinic because they felt cured. Efforts must be intensified towards involving index patients in contact tracing as a top priority in STD control in Nigeria. (Author's modified).