Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria.

BACKGROUND: Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. METHODS: Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers ("mother trainers") in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. "Mother trainers" disseminated the educational messages about malaria and the use of the guideline to their communities. RESULTS: Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4%) of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p < 0.005). Mothers considered the guideline to be explicit and useful. Mother trainers were also considered to be effective and acceptable. CONCLUSION: The use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

Effect of First Aid Education on First Aid Knowledge and Skills of Commercial Drivers in South West Nigeria.

BACKGROUND: Prompt prehospital care is essential for improving outcomes of road crash victims; however, this service is sub-optimal in developing countries because Emergency Medical Services (EMS) are not readily available. Training of lay responders in first aid has been suggested as a means of filling this gap in settings with inadequate EMS. This study was conducted to determine the effect of first aid training on the first aid knowledge and skills of commercial drivers. METHODS: A before-and-after study was conducted among 128 commercial drivers (62 intervention and 66 controls) selected by multi-stage sampling. Drivers' first aid knowledge and skills were assessed at baseline, immediate, and three months post-intervention. The intervention involved a 2-day training session in first aid. Repeated measures ANOVA was used to test for differences in respondents' pre- and post-intervention scores over the three assessment points. RESULTS: Mean first aid knowledge scores for intervention drivers were 48.9% (SD=12.0), 57.8% (SD=11.2), and 59.2% (SD=9.0) at baseline, immediate, and three months post-intervention. Corresponding scores for the controls were 48.3% (SD=12.8), 39.2% (SD=15.3), and 46.8% (SD=15.3). Mean first aid skill scores for intervention drivers were 17.5% (SD=3.8), 80.7% (SD=8.3), and 72.3% (SD=16.8). Scores for control drivers were 16.5% (SD=4.5), 16.3% (SD=4.7), and 20.4% (SD=9.1), respectively. Repeated measures ANOVA showed significant differences in first aid knowledge and skills scores over the three phases. Independent t-test revealed significant differences in scores between the intervention and control groups post-intervention. CONCLUSION: The training led to significant improvement in first aid knowledge and skills of intervention drivers. This confirms that lay responders can be trained in provision of first aid. The slight drop in skills scores, which occurred three months post-intervention, highlights the need for periodic refresher trainings to be conducted for the drivers in order to maintain the knowledge and skills acquired.

Nigeria's triumph: dracunculiasis eradicated.

This report describes how Nigeria, a country that at one time had the highest number of cases of dracunculiasis (Guinea worm disease) in the world, reduced the number of cases from more than 653,000 in 1988 to zero in 2009, despite numerous challenges. Village-based volunteers formed the foundation of the program, which used health education, cloth filters, vector control, advocacy for safe water, voluntary isolation of patients, and monitored program interventions and cases reported monthly. Other factors in the program's success were strong governmental support, advocacy by a former head of state of Nigeria, technical and financial assistance by The Carter Center, the U.S. Centers for Disease Control and Prevention, the United Nations Children's Fund, the World Health Organization, and many other partners and donors. The estimated cost of the Nigerian program during 1988-2009 is $37.5 million, not including funding for water supply projects or salaries of Nigerian governmental workers.

An assessment of accuracy of mothers' presumptive diagnosis of fever at home in southwest Nigeria: evidence for switch to parasite-based diagnostic test.

OBJECTIVE: Home management of malaria (HMM) strategy was based on presumptive diagnosis of malaria and use of correct dose of chloroquine. However, the development of chloroquine resistant parasites in most endemic areas necessitated the recommendation of artemisinin combination therapy (ACT); and this has been demonstrated to be effective in HMM. However, the recommendation that ACT should be dispensed only to laboratory confirmed cases underscores the need to review the accuracy of mothers' presumptive diagnosis and provide evidence for a switch to parasite based diagnostic test. METHODS: This was a follow-up study nested to a larger controlled intervention study carried out to assess the effect of malaria treatment guideline on mothers' adherence to correct treatment of malaria in children. In a subset, thick blood smears were prepared from finger prick blood samples of febrile children who have been presumptively diagnosed to have malaria by mothers on Days 0, 1, 2, 3, 7 and 14 to detect parasitaemia. The presumed diagnosis was compared with the presence of parasitaemia. RESULTS: A total of 162 children with febrile illness (88 and 74 in intervention and control groups respectively) were studied. Sixty-four (72.7%) and 62 (83.8%) of the febrile cases presumed to have malaria in the intervention and control groups respectively had parasitaemia on Day 0. The sensitivity and specificity of mothers' diagnoses was 78.1% and 29.2%; 82.3% and 8.3%; in the intervention and control groups respectively. CONCLUSION: The low specificity of presumptive diagnosis has implication for the deployment of ACT at the community level in Nigeria. This supports current views on the need for a more sensitive and specific parasite-based diagnosis of malaria before ACT treatment. Further study to compare presumptive diagnosis of malaria with malaria diagnostic test carried out at the community level is needed to inform policy on the adoption of parasite based malaria diagnosis at community level.

Using "mother trainers" for malaria control: the Nigerian experience.

Studies of care seeking in Nigeria show that a tremendous amount of treatment for malaria takes place at home and, in most instances, such treatments are incorrect. This deficiency is attributed to caregivers' poor knowledge of treatment. This study was designed to empower households to treat malaria correctly in partnership with community members. Selected mothers from study communities were trained as "mother trainers" and were expected to train other members of their communities using a treatment protocol. "Mother trainers" were acceptable to most communities and judged to be effective. They were enthusiastic and their participation in the study boosted their ego and status in the community. Drop-out-rate of "mother trainers" was 24.2%. A few limitations to the use of mothers as trainers that were identified are discussed. It is concluded that mothers have good potential to effectively carry out health education activities in the community if appropriately selected, trained, and supervised.