Comparative evaluation of three histidine-rich Protein-2 based rapid diagnostic tests, microscopy and PCR for guiding malaria treatment in Ibadan, Southwest Nigeria

Background

Malaria rapid diagnostic tests (mRDTs) are the preferred option for programmatic deployment.

Aims

There are numerous mRDTs on the Nigerian market and there is a need to guide practitioners on the relative performance of the commonly used brands of mRDT in Nigeria.

Subjects and Methods

The performance of three commonly used Histidine-Rich-Protein-2-based mRDTs (SD-Bioline™, Carestart™ and Paracheck-Pf™) against microscopy of Giemsa stained blood and polymerase chain reaction (PCR) was evaluated among 190 febrile under-5 children in Ibadan, Nigeria. We calculated the sensitivity, specificity, predictive values, accuracy, and agreements.

Results

There were 53.2% males. The prevalence of malaria parasite by microscopy was 46.8% and 57.9% by PCR. Malaria parasite detection by SD-Bioline™ was 60.5%, Carestart™: 60.0% and Paracheck-Pf™ 60.0%. Using microscopy as the gold standard, the sensitivities of SD-Bioline™, Carestart™ and Paracheck-Pf™ mRDT were 97.8%, 96.7% and 97.8% respectively while the specificities were 73.0%, 72.0% and 74.0% respectively. Using PCR as the gold standard, the sensitivity for both SD-Bioline™ and Paracheck-Pf™ was 85.5% and for CareStart was 84.6% while the specificity of SD-Bioline™, Carestart™, and Paracheck-Pf™ was 73.8%, 72.4%, and 75.0% respectively. The test accuracy was 81.0% for both SD-Bioline™ and Paracheck-Pf™ and 80.0% for Caresatrt™. The kappa coefficient of agreement between PCR and each of SD-Bioline™, Carestart, ParaCheck™ and microscopy was 0.597, 0.578, 0.609 and 0.739 respectively.

Conclusion

The performance of the three mRDTs is a proof that any of the three is suitable for use in the diagnosis of malaria in the southwest of Nigeria.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background:

The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria.

Methods:

A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively.

Results:

Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens’. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded.

Conclusion:

Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens’. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

The Role of Patent Medicine Sellers in Home Management of Childhood Malaria: A Situational Analysis of Experience in Rural Nigeria

Patent medicine sellers (PMS) play an important role in supplying the medication needs of the community particularly antimalaria. A situational analysis of the role of PMS in home management of malaria was carried out in four rural local government areas in Southwestern Nigeria using both cross sectional and observational study methods. The results showed that patent medicine stores constituted 76.2% of the medicine shops in the areas. The PMS provided not only drugs but also consultation services. Malaria constituted the commonest fever for which drugs were purchased. The most commonly mentioned drug best for malaria was the 4 aminoquinolone. Many (55.4%) of the PMS have received some form of training on malaria treatment. However, this was carried out in many instances (41.9%) by the shop owners to the apprentice PMS or shopkeepers. Health personnel were mentioned as trainers by only 27% of the PMS. The use of guidelines provided by PMS was infrequent and only 13.8% could produce the guideline at the time of survey. PMS would like to have more training on causes and recognition of malaria and antimalaria dosages. These topics were least taught. The rural PMS is important to the management of malaria. If quality training and supervision is provided to them, home management of malaria should improve.

Evaluation of Paracheck-Pf(TM) rapid malaria diagnostic test for the diagnosis of malaria among HIV-positive patients in Ibadan, south-western Nigeria

Febrile illnesses occur frequently among HIV positive patients and these are often treated presumptively as malaria in endemic areas. Parasite-based diagnosis of malaria will eliminate unnecessary treatment, reduce drug-drug interactions and the chances for the emergence of drug resistant Plasmodium. We evaluated finger prick blood samples from 387 people living with HIV (PLWHIV) and suspected of having malaria by expert microscopy and Paracheck-Pf(TM) - a histidine-rich protein-II based malaria rapid diagnostic test. The study was conducted at the PEPFAR supported AIDS Prevention Initiative in Nigeria (APIN) Clinic of the University College Hospital Ibadan, southwest Nigeria. Outcome parameters were prevalence of malaria parasitemia, sensitivity and specificity of Paracheck-Pf as well as the positive and negative predictive values for Paracheck-Pf using microscopy of Giemsa-stained blood film as gold standard. Malaria parasites were detected in 19·1% (74/387) of enrollees by microscopy and 19·3% (74/383) by Paracheck-Pf. Geometric mean parasite density was 501/μl (range 39-749 202/μl). Sensitivity and specificity of Paracheck-Pf at all parasite densities were 55·4% and 89·3% while corresponding figures at parasite densities ≥200/μl were 90·9% and 90·3%. Sensitivity and specificity at parasite densities ≥500/μl was 97·6% and 90·3%. Positive and negative predictive values for parasite density ≥200/μl were 55·4% and 98·7%, respectively. Paracheck-Pf was found to be a useful malaria diagnostic tool at parasite densities ≥200/μl facilitating appropriate clinical management.

Cholera outbreak in a southwest community of Nigeria: investigation of risk factors and evaluation of a district surveillance system

BACKGROUND

Following confirmation of cholera outbreak in a southwest community of Nigeria, we set to identify possible risk factors for contracting the disease and to evaluate the completeness as well as the representativeness of the cases reported to a district health authority.

METHODS

Cholera cases were identified through an active case search that involved the review of records in health facilities and a house-to-house search using the standard case definition in the Nigeria integrated disease surveillance and response technical guidelines. Two neighborhood controls appropriately matched on age and sex for each case, were also identified. An interviewer-administered questionnaire was used to collect information on the demographic characteristics and potential risk factors. Completeness of reporting of cases notified to the district health authority was evaluated using a two source capture-recapture method. In addition, the representativeness of the reported cases was determined by comparing the age and sex distributions of notified cases to those identified through the active case search.

RESULTS

Thirty-nine cases were identified, of which 22 consented to participate. Contact with a diarrhoea case at home or in the neighborhood within the last 7 days prior to illness onset in cases was significantly associated with having cholera (Matched triplets Odds Ratio 8.5, 95% CI: 1.36-52.9). The completeness of the district surveillance report was estimated to be 54%. In the district notification data compared with the active case search data, males <5 years (31% vs 18%) and females 15 years (3% vs 21%) were significantly over- and under-represented, respectively.

CONCLUSION

The odds of having cholera were increased in those who had contact with a case of diarrhea. Reporting of cases to the district health authority was not complete and the surveillance data on gender and age grouping were not representative of the cases that occurred in the population. There is a need for efficient reporting of cases to the health authority during outbreaks in order to improve decision-making and public health interventions.

Socio demographic and clinical correlates of knee pain in adult women attending a primary care clinic

AIMS AND OBJECTIVES

The objectives of the study were to determine the socio demographic and clinical correlates of knee pain in women in a primary care clinic.

PATIENTS AND METHODS

The study was a cross-sectional survey of 400 women attending the General Outpatients' clinic of the University College Hospital (U.C.H.), Ibadan, Nigeria using the systematic random sampling technique.

RESULTS

The prevalence of knee pain was 42.0% (95% CI 40.0- 41.0). The radiographic findings in the knees showed mostly osteophytes in 24 out of the 28(85.7%) respondents who had radiographs done. The highest prevalence of knee pain was found in caterers and traders, 62.5% and 51.6%, respectively (p= 0.001). Multivariate analysis done using logistic regression with a backward selection showed that the odds of developing knee pain increases with age (Odds Ratio=1.585, 95% CI 1.321-1.903, p=0.000), and body mass index (Odds Ratio 1.587, 95% CI 1.295-1.946, p=0.000).

CONCLUSION

The prevalence of knee pain in women seen at the primary care clinic is high. Preventive measures for knee pain need to be instituted.

Experimental malaria: the in vitro and in vivo blood pressure paradox

Objective

Malaria causes more deaths worldwide than any other parasitic disease. Many aspects of the biology that governs the pathogenesis of this parasite are still unclear. Therefore insight into the complexity of the pathogenesis of malaria is vital to understand the disease, particularly as it relates to blood pressure.

Methods

In vivo and in vitro experimental models were used for this study. In the in vivo study, mean arterial pressure, pulse rates and heart rates were recorded by cannulation of the carotid artery of rats. In the in vitro study, ring preparations of blood vessels from the rat aorta were studied using standard organ bath techniques. Dose–response curves for phenylepherine (PE)- and acetylcholine (Ach)-induced relaxation were constructed for rings pre-contracted with PE.

Results

Our results showed a significant (p < 0.05) reduction in the mean arterial pressure and pulse rates, while the heart rates remained unaltered in rats with malaria parasites, compared with the controls. Incubation of rat aortic rings with parasitised blood resulted in a significant (p < 0.05) increase in maximum contractile response to phenylephrine in the rat aortic rings but there was no effect on the baseline. The dose–response curve showed a significant (p < 0.05) leftward shift following the addition of parasitised blood and the EC₇₀ (M) values increased from 7 × 10^-7 to 5 × 10^-6 M. Following exposure to parasitised blood, the magnitude of Ach-induced relaxation responses reduced significantly (p < 0.05) from 73 ± 3.6 to 24.75 ± 7.25% in the rat aortic rings.

Conclusions

The results suggest that malaria parasitaemia caused in vivo reduction in blood pressure, and enhanced the responses to contractile agents and reduced relaxation responses to acetylcholine in vitro. This appears to be a paradox but is explainable by the complex cardiovascular control mechanisms in vivo. This may be independent of direct action on vascular smooth muscle.

Nutritional status of older persons presenting in a primary care clinic in Nigeria

The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional Assessment (MNA) tool and body mass index were used to assess undernutrition and overweight, respectively. The prevalence of nutritional problems was 61.9% (undernutrition = 7.8% and overweight = 54.1%). Being unmarried (P < 0.001), engagement in a job after the age of 60 years (P < 0.001), constipation (P = 0.009), rectal bleeding (P = 0.008), and oral problems (mouth, teeth, and tongue) were significantly (P < 0.001) associated with undernutrition. Younger age (P = 0.050) and female gender (P = 0.011) were significantly associated with being overweight. Logistic regression analysis showed being unmarried OR = 1.355 (95%CI 1.075-1.708) to be the most important factor for the development of undernutrition. The high prevalence of nutritional problems in this study underscores the need for intervention in this population. Correlation analysis (Pearson's) showed a positive association between BMI and MNA scores (r = 0.152, P = 0.001).

Population-based prevalence of abnormal cervical cytology findings and local risk factors in Ibadan, Nigeria: implications for cervical cancer control programs and human papilloma virus immunization

OBJECTIVE

To investigate the prevalence of abnormal cervical cytological findings and local risk factors in Ibadan, Nigeria.

STUDY DESIGN

All women aged ≥15 years in each household in Idikan, Ibadan, were invited to participate in a population-based study. Structured questionnaires were administered to all consenting women. Conventional cervical Papanicolaou smears obtained from sexually active women were classified using the 2001 Bethesda system. The diagnoses were correlated with sociodemographic data and risk factors.

RESULTS

Of 2,870 women aged ≥15 years estimated to live in Idikan, 1,204 sexually active women consented to pelvic examination and cervical smears. Results were available for 1,104 women (mean age: 39.8 years). Mean ages at menarche, first sexual intercourse and first pregnancy were 16.1, 20.3 and 20.7 years, respectively. Cytological results were categorized into atypical squamous cells of undetermined significance and atypical glandular cells 22 (1.99%); low-grade 43 (3.89%) and high-grade squamous intraepithelial lesions (HSIL) 17 (1.54%); invasive cancer 2 (0.18%) and normal 593 (53.8%) and reactive changes 427 (38.7%). The prevalence of epithelial abnormalities is 7.6%. Significant host-related factors in those with HSIL and invasive cancer included older age (mean 56.2 years), high parity and gravidity, lack of formal education and being divorced (p < 0.05).

CONCLUSIONS

This study provides prevalence data and local risk factors for abnormal cervical cytology in a Nigerian population, which will be useful for planning future cervical cancer control programs.

Specificity of vascular reactivity and altered response in experimental malaria

OBJECTIVE

Adherence of erythrocytes infected with Plasmodium falciparum (P falciparum) to microvascular endothelial cells (sequestration) is considered to play an important role in parasite virulence and pathogenesis. In this study, we have examined the possibility that there is altered vascular reactivity due to the direct interaction between the parasitized erythrocytes and vascular endothelial cells and that it could be tissue specific.

METHOD

Ring preparations of blood vessels from the rabbit carotid and rat aorta were studied using standard organ bath techniques. Dose response curves for phenylephrine (PE) and acetylcholine (Ach)-induced relaxation were constructed in rings pre-contracted with PE.

RESULTS

Incubation of rat aortic rings with parasitized blood resulted in a significant (p < 0.05) increase in maximum contractile response to phenylephrine in the rat aortic rings but there was no effect on the rabbit carotid artery. The dose-response curve showed a significant (p < 0.05) left-ward shift following the addition of parasitized blood. Parasitised blood had no effect on baseline in both tissues. Following exposure to parasitized blood, the magnitude of Ach-induced relaxation responses reduced significantly (p < 0.05) in rat aortic rings and (p < 0.05) in rabbit carotid rings; relaxations to acetylcholine was more pronounced in the aortic compared to the carotid rings.

CONCLUSIONS

Malaria altered vascular reactivity through an endothelium-dependent mechanism. The regulation of vascular tone by various vasoactive agents following exposure to malaria parasites might be altered in a vessel-specific manner. This may contribute to or exacerbate the abnormal haemodynamics observed in the microcirculation of numerous vascular beds in malaria.

Altered vascular reactivity induced by malaria parasites

OBJECTIVE

In this study, we have examined the possibility that there is altered vascular reactivity due to the direct interaction between parasitized erythrocytes and vascular endothelial cells.

METHOD

Ring preparations of rat aorta were studied using standard in vitro techniques, the rings were mounted in 20 ml organ baths containing PSS under an initial load of 1 g, maintained at 37 degrees C at pH 7.4 and isometric contractions were recorded electronically. Rings were allowed 90 minutes to equilibrate before the commencement of the various protocols: Dose responses to phenylephrine (PE) and other vasoactive agents (high-K+). Acetylcholine (Ach)--induced relaxation in phenylephrine-contracted rings (pre-contraction was induced by EC70 concentration of phenylephrine). Ach-induced relaxation in PE-precontracted, endothelium-denuded rings. Also, relaxation responses to acetylcholine was investigated through application of a single. (EC70) concentration of acetylcholine in rings exposed to blood with varying concentrations and dilutions of parasitized blood and varying durations of exposure.

RESULTS

Incubation with parasitized blood resulted in a significant increase in maximum contractile response to phenylephrine in the rat aortic rings (p < 0.05) but no effect to the base line. Analysis of the whole dose-response curve (using paired t-test) showed a significant left-ward shift following the addition of parasitized blood (p < 0.05), EC70 (M) values increasing from 7 x 10(-7) to 5 x 10(-6)M. Following exposure to parasitized blood, the magnitude of Ach-induced relaxation responses reduced significantly from 73 +/- 3.6 to 24.75 +/- 7.25% in rat aortic rings (p < 0.05). Ach relaxations were significantly enhanced (p < 0.05) at 5-minute exposure; however at longer durations, Ach-relaxations were variable and inconsistent. The lesser the dilution, due to increased volume of parasitized blood, the lesser the relaxation response. Following endothelium removal, there was a marked impairment in endothelium-dependent relaxation responses to ACh in both the control and incubated vessels. Exposure to parasitized blood did not significantly alter contractile responses induced by potassium depolarization.

CONCLUSIONS

This gives evidence in support of an endothelium-dependent action of malaria parasites as vascular effects of malaria parasites are mediated, at least in part, via endothelium-dependent mechanism(s).

Case finding for hypertension in young adult patients attending a missionary hospital in Nigeria

OBJECTIVES

This study was carried out to search for cases of undetected hypertension in young adult male and non-pregnant female patients (18 - 44years) attending a catholic mission hospital in Ibadan, Nigeria so as to provide evidence for routine blood pressure checks in this age group. It also sought to determine risk factors present in those found to be hypertensive and to detect complications of hypertension, if present.

METHODS

Semi-structured questionnaire was administered and physical examination was carried out on the eligibles. Laboratory analysis of blood and urine was done for the consenting subjects with confirmed hypertension. A descriptive, hospital-based cross-sectional study, which took place at the Out-Patients Department of St. Mary's Catholic General Hospital, Eleta, Ibadan. Consecutive young adult male and non-pregnant female patients aged 18 - 44 years attending the hospital for the first time between February 2007 and August 2007, that met the inclusion criteria and consented to participation.

DATA ANALYSIS

Frequency distribution was done to describe the data, while cross-tabulation, t-test, chi-square test and one-way ANOVA were done to explore association between variables as appropriate.

RESULTS

Out of the 405 subjects that participated in the study, 124(30.6%) were hypertensive. The mean age of the subjects was 31.6 +/-6.9 years. A total of 154 (38%) were male and 251(62%) female. Mean BMI was 23.7+/-4.3 kg/m(2). The study revealed that age, occupation, body mass index, waist circumference and hip circumference were significantly associated with high blood pressure. Clinical evidence of target end-organ damage seen include left ventricular hypertrophy in 22(17.7%) congestive cardiac failure in 3(2.4%), retinopathy in 5(4.0%), nephropathy in 12(26.1%) and transient ischaemic attack in 1(0.8%).

CONCLUSION

Undetected cases of hypertension, with complications and target end-organ damage, exist in young adults in Ibadan and family physicians and other primary care physicians, especially in Nigeria, should pay attention to case finding for hypertension in this age group.

Determinants of utilisation of cervical cancer screening facility in a low socio-economic setting in Nigeria

A prospective randomised structured questionnaire survey of 254 women in the low socio-economic class attending the general outpatient clinic at the University College Hospital (UCH), Ibadan revealed a high level of ignorance concerning cervical cancer prevention programmes. Only 3.5% of subjects have heard of a Papanicolaou smear and only 1.2% have had the test prior to this study. Peers (36%) were the most common source of information on cervical smears. The majority (84.6%) of the women were willing to be screened, however only 5.1% of those willing (4.3% of the women studied) actually reported for the test. Twenty-two percent (219) had high knowledge about cervical smears while moderate and poor knowledge were demonstrated in 33% respectively. Eleven per cent had no knowledge whatever. No significant association was found between the knowledge score on Papanicolaou smear and other variables. The cost of the test appeared to have prevented many of the women from having the test. It is recommended that more efforts need to be put into health education of women stressing the importance of the test and its availability.

Community Effectiveness of Artemisinin-Based Combination Therapy for Malaria in Rural Southwestern Nigeria

A descriptive cross sectional survey using an interviewer-administered questionnaire was carried out among 700 caregivers whose children had fever during the previous two weeks. The aim was to determine the community effectiveness of malaria treatment using arthemeter-lumefantrine (AL) among under-5-year-olds in a rural community in southwestern Nigeria. A total of 353 (50.9%) children received AL. About half of these children (49%) were said to have been treated within 24 hours of onset of symptoms; 44% took the drug for the stipulated period of time; 42% received the correct dosage; and only 4% received all the treatment steps. With a drug efficacy of 100%, AL achieved a community effectiveness of 4%. The greatest effort in the home management of malaria strategy should be in reducing delay in treatment and improving dosage and duration of treatment.

Malaria prevention practices among mothers delivering in an urban hospital in southwest Nigeria

BACKGROUND & OBJECTIVES

The pregnant woman is more prone to malaria than her non-pregnant counterpart with grave consequences for both mother and baby. This study aims at determining the malaria prevention practices among pregnant women in an area hyper-endemic for malaria.

METHODS

For the study 983 parturient mothers were enrolled in Ibadan, southwest Nigeria. Information was collected on sociodemographic characteristics, use of malaria chemoprophylaxis, use of anti-vector measures, and malaria parasitaemia.

RESULTS

Most mothers [956/972 (98.4%)] reported the use of anti-vector measures for malaria prevention. These include, window screens (78.9%), insecticides spray (69.9%), mosquito coils (25.3%), untreated bednets (2.5%), and insecticide-treated nets (1.1%). Most mothers used anti-vector measures either singly or in combination. About 86% (840/972) of the mothers used drugs for chemoprophylaxis. Thirteen (1.3%) mothers used chemoprophylaxis alone (CP), 135 (13.9%) used anti-vector measures alone (AV) while 820 (84.4%) used chemoprophylaxis plus anti-vector (CPAV). Weekly dose of pyrimethamine [214 (25%)] and intermittent preventive treatment with sulphadoxine-pyrimethamine [598 (71.2%)] were the widely used chemoprophylactic drugs. The prevalence of patent parasitaemia at delivery was 7.7% (1/13), 12.1% (99/820) and 16.3% (22/135) among CP, CPAV and AV groups respectively. Geometric mean parasite densities among the respective groups were 7840/microl, 1228/microl and 8936/microl.

CONCLUSION

Window screens and insecticide sprays were widely used for malaria prevention while the use of ITN was very low among enrolled mothers. There is a need to pay concerted efforts to improve ITN usage rate in Nigeria.

Haemorheological variables in Nigeria pulmonary tuberculosis patients undergoing therapy

Haemorheological changes in response to therapy have not been fully determined in pulmonary tuberculosis patients living in developing countries. This study was aimed at monitoring haemorheological parameters in newly diagnosed pulmonary tuberculosis patients undergoing therapy. Haemorheological parameters were studied in 40 tuberculosis patients (17 males and 23 females, mean age 33.4+/-1.4 years, range 23-45 years) undergoing treatment and 10 newly diagnosed patients (5 males and 5 females mean age 33.0+/-2.1 years) along with 50 apparently healthy controls age and sex matched. There were significantly lower packed cell volume (PCV), platelet count (PC), and total white blood cell count (p<0.0001). Whole blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and plasma fibrinogen (PF) were significantly higher in pulmonary tuberculosis patients than controls (p<0.0001). The packed cell volume was significantly increased by the 8th week of therapy (p<0.01), there was a significant reduction in the erythrocyte sedimentation rate from the 4th week of therapy (p<0.0001). There was no significant change in blood viscosity by the 4th week of therapy (p>0.05), while the plasma fibrinogen showed significant reduction from the 4th week of therapy till 8th week of therapy (p<0.01 and p<0.0001 respectively). We conclude that thrombocytopaenia, stasis and hyperfibrinogenemia may predispose African PTB patients to bleeding and thrombotic disorders. Haemorheological parameters may be useful indices in assessing response to therapy and drug compliance in pulmonary tuberculosis patients living in developing countries.

How well equipped are healthcare facilities to manage childhood malaria? The situation in selected local government areas in South Western Nigeria

Using a structured questionnaire, surveys were conducted in 55 of 123 primary and secondary healthcare facilities in 4 selected local government areas in Southwestern Nigeria. Heads of healthcare facilities (HCFs) surveyed include nurses (41.8%), medical officers (21.8%) and community extension workers (21.8%). Twenty five (45.5%) HCFs run special clinics for children. About one fifth (20.3%) of staff had received continuing education on management of malaria. Forty seven (85%) HCFs possessed and used national guidelines for management of malaria. Although 48.9% of HCFs had microscopes, fewer had microscope slides, lancets and Giemsa stain which are also required items for definitive diagnosis of malaria. Healthcare workers were not well informed on some aspects in the management of malaria. Selected healthcare workers from various categories attended a workshop where they were trained to correct inadequate knowledge, attitude and practice in the management of malaria. These workers were to train their colleagues on their return to their respective HCFs.

Pre-hospital treatment of febrile illness in children attending the General Outpatients Clinic, University College Hospital, Ibadan, Nigeria

Many childhood febrile illnesses are treated at home prior to presentation. This study gathered information on treatment practices of caregivers for febrile illnesses in an urban area. A Cross sectional survey of consenting guardians of 535 consecutive febrile children under 10 years presenting at General Outpatients' (GOP) Clinic. University College Hospital. Ibadan was carried out. Thick blood smears were examined for malaria parasite. The mean (SD) age of the febrile children was 3.2 (2.8) years. Nineteen (17.5%) children were brought within 24 hours of noticing fever. Malaria was presumed to be the diagnosis by 217 (40.6%) respondents: 247 (46.2%) did not know the cause of fever. Most. 469 (87.7%) respondents gave drugs bought from chemists/pharmacy shops before presentation at the GOP. Paracetamol 1380 (81.0%)] and chloroquine [171 (36.5%)] were the most commonly used drugs. Twenty-six (15.2%) respondents used chloroquine correctly. One hundred and ninety-nine of 476 children (41.8%) were smear positive and 88 of 191 (46.1%) children whose guardians presumed malaria had parasites. This study reiterates the fact that majority of childhood febrile illnesses are first treated at home. It underscores the need to empower caregivers by appropriate education on knowledge, attitude and practice of the management including home management of malaria.

Patient satisfaction with the services provided at a general outpatients' clinic, Ibadan, Oyo State, Nigeria

Patient-based assessments of medical care are increasingly being used to measure the quality of health care. A variety of methods - qualitative and quantitative - are available. However, patient satisfaction surveys are frequently used. Triangulation of methods increases both the validity and reliability of data. This study assessed patients' perception of care provided at an outpatient clinic using triangulation of methods. No evaluation of care provided at this clinic has been carried out since established. Four hundred and seven adult patients selected by systematic sampling technique were interviewed, 10 focus group discussion sessions (FGD) were held and observations were made at the record clerks' desk, nurses' desk and waiting hall. Also, 35 consultations were observed. Generally, all methods revealed high level of satisfaction with the different aspects of care assessed. However, assessment of satisfaction using survey method concealed a variety of negative experiences reported at FGD and observation. These discrepancies were related to satisfaction with the organization of the clinic, attitude of record clerks' and consultation process. The study provided valuable information to assist in improving the quality of care at the clinic; specifically, the long waiting time, attitude of the record clerks, the dearth of basic amenities, deficient patient-doctor communication skills and health promotion services.

Mobilization for cervical cancer screening: lessons from a poor-urban Yoruba community in Nigeria

Cervical cancer is a major public health problem worldwide and it remains one of the commonest malignancies in Nigeria. Screening remains the most effective tool for the detection of pre-invasive stages of cervical cancer, giving the opportunity for prompt and effective treatment before the emergence of invasive disease. In Nigeria, as in most developing countries, the concept of screening for cancer and its pre-emptive treatment is underdeveloped. The fact that the facilities and logistics for cervical cancer screening are generally located in the hospital setting, a place where one goes when ill, according to local beliefs, makes acceptance more difficult. That Nigeria urgently needs to set up or develop cervical screening programmes that will reach women outside the hospital setting in a culturally acceptable milieu is not in doubt. A community cervical screening survey for the prevalence of cervical intraepithelial neoplasia and HPV infection was initiated in Idikan, a poor-urban inner core area of Ibadan. The challenges and experiences encountered in the execution of the project which could serve as useful knowledge to those undertaking similar exercises, requiring mass mobilization for cancer screening of an uninformed group, are highlighted. Our experience in the course of this study is important as it brought out the probable influences of community dynamics and social organization in illness decisions and prescriptions for health operative in this particular population group. Cervical cancer screening programmes should therefore make provisions to accommodate the occasional outcomes as we had encountered. In addition, screening programmes in developing societies would require sensitive designs that should address the cultural attitudes, personal conflicts, expectations of treatment and overall context of preventive care.

Prevalence of papillomavirus infection in women in Ibadan, Nigeria: a population-based study

To investigate the prevalence of and the risk factors for cervical infection with human papillomavirus (HPV) in an inner-city area of Ibadan, Nigeria, we interviewed and obtained a sample of cervical cells from 932 sexually active women aged 15 years or older. A total of 32 different HPV types were identified with an HPV prevalence of 26.3% overall and 24.8% among women without cervical lesions; or age-standardised to the world standard population of 28.3 and 27.3%, respectively. High-risk HPV types predominated, most notably HPV 16, 31, 35 and 58. In all, 33.5% of infections involved more than one HPV type. Unlike most populations studied so far, HPV prevalence was high not only among young women, but also in middle and old age. Single women (odds ratio, OR=2.1; 95% confidence interval, CI=1.1–3.9) and illiterate women (OR=1.7; 95%CI=1.1–2.5) showed increased HPV positivity. Associations were also found with anti-Herpes simplex-2 antibodies (OR=1.6; 95% CI: 1.1–2.1) and with the husband's extramarital relationships (OR=1.6: 95% CI: 1.0–2.6). High prevalence of HPV in all age groups may be a distinctive feature of populations where HPV transmission continues into middle age and cervical cancer incidence is very high.

Breast and cervical cancer screening activities among family physicians in Nigeria

Breast and cervical cancers are the two commonest malignancies among Nigerian women; where they constitute about 50% of female cancers. A total of 63 out of 82 family physicians from 4 out of the 6 health zones in Nigeria and the Federal Capital Territory, Abuja, Nigeria completed a self-administered questionnaire to determine their knowledge and screening practices for breast and cervical cancers. Forty nine percent (49%) of family physicians perceived cancer as one of the serious health problem facing women in Nigeria. Although 93.7% of responding physicians have heard of breast cancer screening facilities and 96.8% of cervical screening facilities, only 74.6% and 55.6% of these respondents offered screening services for breast and cervical cancers respectively. Breast examination was carried out monthly by 48.9% of the physicians on their regular patients. A comprehensive programme of continuing medical education and training in view of setting up facilities and offering service are recommended for family physicians. These stand to bridge the gap between the knowledge and the practice of breast and cervical cancer screening activities. The umbrella Association for Family Physicians and other regulating bodies should facilitate access to screening facilities and initiate training of willing physicians with a view to setting up services.

Post operative pain therapy: a survey of prescribing patterns and adequacy of analgesia in Ibadan, Nigeria

OBJECTIVE

To establish prescribing patterns for post operative pain therapy, it's adequacy, as well as patients' satisfaction with the prescriptions.

DESIGN

A survey of doctors' prescriptions for post operative pain therapy over a six month period.

SETTING

The University College Hospital Ibadan, Nigeria, the oldest teaching hospital in the country.

SUBJECTS

All consecutive adult elective general surgical patients operated on over a six month period, who were on admission for at least 72 hours after surgery. Patients with prolonged post operative unconsciousness or those unwilling to answer the questionnaire were excluded.

INTERVENTION

The anaesthetic charts, recovery room and treatment sheet were reviewed to complete a structured, pretested and precoded questionnaire. Two other questionnaires were administered to patients at 24 and 48 hours post operatively to review the effect of the analgesic prescribed.

RESULTS

149 patients met the inclusion criteria. Moderate to unbearable pain was reported in 68.7% of the patients at 24 hours and 51.7% of patients by 48 hours. Post operative analgesics were to be given via only the intramuscular route in all cases. There was a limited range of drugs to choose from; pethidine, pentazocine and dipyrone were the only drugs available. Pethidine was prescribed four hourly in 2.7%, six hourly in 46.9% and eight hourly in 25.9%, of the cases. Eighty five percent of the patients who were given dipyrone complained of moderate to unbearable pain post operatively. Inadequate doses of analgesics were generally given. Despite the high incidence of pain, 63.9% of patients still reported that they were very satisfied with their pain relief.

CONCLUSION

Prescription patterns for post operative pain relief have not changed to include many of the new methods presently available. Only one route of administration is still used for a limited range of opioid and non-opioid drugs. Patients still experience a high incidence of moderate to unbearable pain in the post operative period. This can be improved by prescribing drugs at shorter intervals to reflect their pharmacokinetics and using newer techniques of drug administration.

Socio-demographic characteristics and sexual behaviour of adolescents attending the STC, UCH, Ibadan: a 5 year review

As a continuation of the on-going efforts to prevent and control the spread of sexually transmitted diseases (STDs) and the Acquired Immunodeficiency Syndrome (AIDS) in adolescents, this retrospective clinic-based study identifies the socio- demographic characteristics, describes the sexual practices, identifies the common STDs, including drug utilization patterns in this risk group at the special treatment clinic of the University College Hospital, Ibadan. Results reveal that adolescents constituted between 3.3% and 4.8% of the total number of patients seen each year. The characteristics of the subjects were as follows: 54 (38.3%) were aged 19 years, 133 (94.3%) were single, 79 (53.2%) were females and 103 (73.0%) were students. As regards sexual behaviour, 22 (15.71%) denied previous history of sexual intercourse. Vaginal intercourse was reported in all the sexually active youth, 2(1.71%) reported oral sex, while 10 (8.41%) admitted that they had multiple sexual partners. Gonorrhoea was diagnosed in 23 (21.51%) of sexually active youths. Among those who had used drugs before presentation ampicillin was the common drug used for treatment by 14 (26.4%). The importance of encouraging adolescents to present at STD clinics is highlighted. Health workers need to have a sympathetic attitude and assure them of confidentiality. The need for more community-based education is shown, including the importance of proper and complete documentation of hospital records.

Evaluation of the nutritional status of first year school children in Ibadan, Southwest Nigeria

Height for age, weight for age, and weight for height as indices of nutritional status were evaluated in 1309 pupils from different socioeconomic classes in Ibadan, Nigeria. The data obtained were compared with United States National Centre for Health Statistics (NCHS) reference population. When all the pupils studies were considered together 46.1%, 44.3% and 12.7 percent of the pupils were underweight, stunted and wasted, respectively. Both stunting and wasting were observed in 7.2% of the overall population. Only 0.6% were overweight. Generally, the proportion of stunting, underweight, wasting and both stunting and wasting increased as socioeconomic status declined, but the prevalence of overweight was higher in the 2 upper socioeconomic status schools. When all pupils were considered based on sex and irrespective of school types, significantly more male (49.5%) than female (37.4%) pupils suffered from stunting (P < 0.0001), wasting (13.8% versus 11.1% P < 0.01) and underweight (54.3% versus 35.5%: P < 0.0001). More females were overweight than males though this did not reach statistical levels (P > 0.05.) The prevalence of malnutrition in this study was higher that of previous studies in this environment, which may be a reflection of the deteriorating economic situation of Nigeria.

Knowledge and attitude of general outpatient attendants in Nigeria to cervical cancer

OBJECTIVES

This study sets out to determine: a. How much women in low socio-economic settings know about cancer and cervical cancer. b. Their source of information. c. Their general attitude to cervical cancer.

DESIGN

A cross sectional study.

SETTING

General outpatient (GOP) department of a tertiary hospital in Ibadan, Nigeria.

SUBJECTS

254 randomly selected women aged 20 to 65 years attending or visiting the GOP department in a University Teaching Hospital were studied.

MAIN OUTCOME MEASURES

Knowledge about cancer and cervical cancer as well as source of information.

RESULTS

The response rate was 100%. Of the respondents, 90% had heard of cancer at one time or the other while only 15% had heard of cervical cancer. The media (38%) and peers (36%) were the major sources of information on cancer. Fifty five percent, 53% and 61% had no knowledge while 40% and 23% had poor to moderate overall knowledge of cervical cancer.

CONCLUSION

Knowledge about cervical cancer is poor in these women, unlike findings in developed countries. There is need to educate our women on the early warning signs of cervical cancer as failure to recognise the early symptoms and signs contribute to the late presentation common in Nigeria.

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.

Contact tracing in the control of STD in Ibadan, Nigeria

Contact tracing carried out at this clinic was analysed as part of measures for control of sexually transmitted disease (STD). Results showed that 50% of 156 contacts could not be traced at all for various reasons, and that 47% of the contacts were brought in through persuasion by index patients who had been counselled at the clinic. Only four contacts were traced, and two of these attended the clinic. Index patient cooperation is thus identified as the most important factor in the success of contact tracing, because of the high level of illiteracy and poor communications facilities in Nigeria, compared with industrialised countries.