Medicinal Plants Used in Wound Care: A Study of Prosopis africana (Fabaceae) Stem Bark

The effects of the methanol extract of the stem bark of Prosopis africana (Guill., Perrott. and Rich.) Taubert (Fabaceae) on bleeding/clotting and coagulation time, excision and dead space wounds were studied in rats. Also, the extract was subjected to antibacterial, and acute toxicity and lethality (LD₅₀) tests. The extract significantly (P<0.05) reduced bleeding/clotting and coagulation time in rats. It also reduced epithelialization period of excision wounds in rats and inhibited the growth of laboratory strains of Staphylococcus aureus, Bacillus subtilis, Salmonella typhi, Pseudomonas aeruginosa and Klebsiella pneumoniae to varying extents. Acute toxicity and lethality (LD₅₀) test on the extract established an LD₅₀ of 774 mg/kg (i.p) in mice while phytochemical analysis gave positive reactions for alkaloids, saponins, tannins, flavonoids, steroids, terpenoids and carbohydrates. The results of this study demonstrate the beneficial effects of the stem bark of P. africana in wound care.

Assessment of a free maternal and child health program and the prospects for program re-activation and scale-up using a new health fund in Nigeria

Background

A Free Maternal and Child Health program (FMCHP) was implemented in 12 states in Nigeria by the National Health Insurance Scheme (NHIS), between 2009 and 2015, using funds from the debt relief gains. It was called the Millennium Development Goals (MDGs) NHIS-MDG FMCHP. The program ended with the termination of the MDG in 2015. With the creation of the Basic Health Care Provision Fund (BHCPF) in Nigeria, this study sought to examine the past implementation experiences of the NHIS-MCH project with a view to identifying the enabling and constraining factors to program implementation, and the opportunities for adaptation and program scale-up in Nigeria using the BHCPF.

Methods

The study was undertaken in the Federal Capital Territory, Abuja, and involved review of relevant documents and in-depth interviews with 21 key informants. The program was assessed in themes from the conceptual framework. Interviews were transcribed and analyzed using thematic analysis.

Results

The program enrolled about 1.5 million pregnant women and children during the period of implementation in the country. The respondents perceived the program as pro-poor, efficient, and effective, and led to marked improvement in the functionality of the facilities, availability of services and reduced out-of-pocket expenditure, which led to increased demand and utilization of MCH services. There was inadequate stakeholder consultation, alleged corrupt practices, challenges with registration, issues with counterpart funding and public financing management issues identified. Most respondents supported the idea of using the new fund (BHCPF) to revitalize/scale-up the Free MCH program.

Conclusion

This study highlights the key lessons and implementation challenges identified by the respondents. The NHIS-MDG FMCHP had positive impact on the target population though it was not sustained following the conclusion of the MDG program. The findings will inform policy decisions about the appropriateness of sustaining the program and the feasibility of extending healthcare coverage using the proposed BHCPF. The new fund (BHCPF) can be used to reactivate and scale-up the Free MCH program, but the current level of funding will not assure universal health coverage for the target beneficiaries as realized from the costing aspect of this study.

Comparison of urine protein-creatinine ratio and urine dipstick test for significant proteinuria in preeclamptic women

Background

Assessing for significant proteinuria in pregnancy (SPIP) stands as a key indicator for diagnosing preeclampsia. However, the initial method typically employed for this assessment, the urine dipstick test, often yields inaccurate results. While a 24-h urine collection is considered the most reliable test, its implementation can lead to delays in diagnosis, potentially affecting both maternal and fetal well-being. The urine protein-creatinine (P/Cr) ratio can be used as an alternative to 24-h urine protein analysis, but its diagnostic accuracy has remained uncertain. There is a need to compare the diagnostic accuracy of urine P/Cr ratio and dipstick urinalysis for SPIP, especially in resource-poor settings.

Objectives

To determine and compare the diagnostic accuracy of urine P/Cr ratio and dipstick urinalysis in a spot urine specimen for the diagnosis of SPIP among women evaluated for preeclampsia using 24-h urine protein excretions as a gold standard.

Design

This is a comparative cross-sectional study.

Methods

The study involved 82 singleton pregnant women evaluated for preeclampsia from 20 weeks of gestation who underwent dipstick and P/Cr ratio tests in the same urine sample. Women at risk of preeclampsia were given a specimen container for the collection of urine samples on an outpatient basis. Participants were trained and told to collect the urine sample 24 h prior to their next antenatal appointment. However, those on admission and evaluated for preeclampsia had their 24-h urine collected in the hospital. The outcome measures included sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio and accuracy for the two tests. Significant proteinuria was defined as a P/Cr ratio >0.27 or ⩾2+ of proteinuria on the dipstick test. Preeclampsia was confirmed in women with both high blood pressure and SPIP.

Results

The mean age of participants was 28.65 ± 5.76 years. Comparatively, the diagnostic accuracy (91.46% (95% CI = 83.29-96.59) vs 59.76% (95% CI = 48.34-70.44), p = 0.001), sensitivity (94.74% vs 70.00%, p = 0.021), specificity (84.00% vs 43.75%, p = 0.001), negative predictive value (87.50% vs 48.28%, p = 0.003) and positive predictive value (93.10% vs 66.04%, p = 0.001), respectively, were higher for the spot urine P/Cr ratio than dipstick test. In addition, the positive likelihood ratio and the negative likelihood ratio for spot urine P/Cr ratio versus dipstick test were (1.93 vs 1.24) and (0.07 vs 0.69), respectively.

Conclusion

The spot urine P/Cr has superior diagnostic accuracy in the determination of significant proteinuria in pregnant women being evaluated for preeclampsia than the widely used dipstick test. A more robust multicenter study is needed to compare the diagnostic accuracy of spot urine PCR with the standard 24-h urine protein in low-income settings.

Assessing Determinants of Enrollees' Satisfaction with Quality of Health Services within the State Social Health Insurance Scheme: An Application of Modified SERVQUAL Model

BACKGROUND

Patient satisfaction is an important indicator to measure the quality of healthcare and provider performance. Understanding enrollees' satisfaction with the quality of health services provided by Anambra State Health Insurance Scheme is crucial for its effectiveness.

AIM

This study assessed health insurance enrollees' satisfaction with the quality of care and its determinants in Anambra State, Nigeria.

METHODS

This was a cross-sectional study that involved 447 enrollees selected from health facilities using a multistage sampling technique. Data was collected using a 25-item structured close-ended patients' satisfaction questionnaire adapted from the SERVQUAL model. Data analysis was done using SPSS version 25. Logistics regression analysis was done to identify determinants of overall satisfaction. The level of significance was set at a P value <0.05.

RESULTS

The overall level of satisfaction with services rendered was 80.6%. Enrollees were satisfied with tangibility (87.2%), reliability (89.3%), responsiveness (80.3%), assurance (90.2%), empathy (87.5%), and affordability (81.4%). Significant factors associated with the enrollees' satisfaction across the six dimensions of care assessed were facility ownership (AOR = 1.42; CI 0.24-0.74; P < 0.00) and geographical location (AOR = 1.33; CI 0.14-0.78; P < 0.01). Age (AOR = 2.86; CI 1.55-5.29; P < 0.00) was the only demographic characteristic associated with satisfaction with care.

CONCLUSION

The quality of care was satisfactory across dimensions of care assessed. However, enrollees' satisfaction was positively influenced by facility-related factors. Managers and healthcare providers should focus on continuous quality improvement efforts in public and rural facilities to improve the quality of services and enrollees' retention within the health insurance scheme.

What Does it Cost to Provide Free Maternal and Child Health Services in Primary Health Centres? A Case Study of Imo State, Southeast Nigeria

BACKGROUND

This study estimated the cost of providing free maternal and child health (MCH) services at the primary health centre (PHC) level in southeast Nigeria. The costs of providing an essential benefit package of maternal and child health (MCH) services are unknown. Such information is required for optimal resource allocation decisions and for replicating similar programmes in different settings.

METHODS

The full and unit costs of providing a thin benefit package of MCH services in all the 418 PHC centers in Imo State, southeast Nigeria were computed using an ingredient and activity costing approach from a provider perspective. Data on costs were collected both retrospectively and cross-sectionally. Data on service utilisation by mothers and children under five years were collected from the PHC attendance registers.

RESULTS

The total cost was $27,710,009.00, whilst the unit costs for delivering combined MCH services in 418 PHCs were $37.2. However, for just child health services, the unit cost was $13.7 per child, whilst the unit cost of providing just maternal health services was $42.7 per pregnant woman. Personnel costs contributed 84.6% of the total cost.

CONCLUSION

The findings will guide the design and scale-up of a similar programme towards the achievement of universal health coverage of MCH services.

Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria

Background

Adolescents' sexual and reproductive health has an important influence on a country's long-term national growth. There is a high level of burden due to poor adolescent sexual and reproductive health (ASRH) in Nigeria, especially the Ebonyi State. Evidence shows that in the Sub-Saharan African region, most adolescents experience poor access to information and other services relating to their sexual and reproductive health. Many cultures in Africa see matters around sex and sexuality as social taboos.

Aims

This study aimed to access variations in the utilization of health facilities for sexual and reproductive health information and services among adolescents in the Ebonyi State, Nigeria. This will inform the design of interventions to improve ASRH.

Patients and Methods

A total of 1,057 in-school and out-of-school adolescents aged 13-18 years were selected using cluster sampling of households from the six selected local government areas (LGAs) in this cross-sectional survey. Structured questionnaires were used to collect data. Descriptive statistics were performed alongside stratification analysis. Tabulation, bivariate and multivariate logistic regression analyses were undertaken. A household wealth index was calculated using the total household consumption calculated divided by the number of people in the household (per capita household consumption). The per capita household consumption was used to categorize the households into socioeconomic quintiles. The variable was used to differentiate key variables into socioeconomic quintile equity analysis.

Results

A majority of the respondents had never visited any type of health facility to receive either sexual and reproductive health (SRH) information (90.2%) or services (97.1%). The utilization rate of health facilities for SRH information was 9.8% while for other SRH services was 2.8%. The patent medicine vendor (PMV) was the most visited type of facility for SRH information and other services. Schooling was a strong predictor of health facilities' utilization for SRH information (P < 0.01) and other services (P < 0.01).

Conclusion

Utilization of health facilities for information and services among adolescents in the Ebonyi State is very low and favorable toward informal service providers such as PMVs. The establishment and strengthening of the existing youth-friendly centers, school clinics, and occasional outreach programs designed specifically to target adolescents would perhaps improve adolescents' access to adequate information and health facility utilization for sexual, reproductive, and health services.

Diagnostic accuracy of transvaginal ultrasonography and hysterosalpingography in the detection of uterine cavity pathologies among infertile women

Background

Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings.

Purpose

To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard.

Materials and Methods

A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard.

Results

Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; p = .0004) and adhesions (73.9% vs 87.5%; p = .0002), respectively.

Conclusion

HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.