Community In South-south Nigeria Research Articles

Perceptions and Factors affecting Utilization of Primary Health Care Services in a predominantly Urban Community in South-South Nigeria

Background: Primary Health Care is the cornerstone of a sustainable national health system for the attainment of universal health coverage. There is poor demand for health services at the primary level of care. This study assessed the perceptions and factors affecting the utilization of primary health care services in a predominantly urban community in South-South Nigeria.
 Methods: This descriptive cross-sectional study was done in Egor, Benin City, Southern Nigeria. A structured, and interviewer administered questionnaire was distributed to 371 heads of household who were selected using multistage sampling method. The data were analyzed using IBM SPSS version 25.
 Results: Majority of the respondents were males 191 (51.6%). More than half, 195 (52.5%) were in the age group of 35-49 years. Less than half, 171 (46.1%)of the respondents had utilized primary health care services. Only, 42 (24.6%) perceived the services utilized were satisfactory. Immunization, 45 (26.3%), child, 39 (22.8%) and maternal, 32 (18.7%) health care services were the most utilized. Sex (OR = 0.599; CI = 0.38-0.94, p = 0.027), religion (OR = 2.246; CI = 1.066-4.735, p = 0.033), and occupation (OR = 2.437; CI = 1.106-5.367, p = 0.027) were factors associated with the utilization of health services in the study locale.
 Conclusions: The utilization of the primary health care services was low, and the perception of services utilized was not satisfactory. The Local Government Health Authority needs to strengthen the primary health care system. Also, improved community engagement and participation could enhance health services access and uptake.

Knowledge of common cardiovascular diseases and its risk factors among members of a community in South-South Nigeria

Knowledge of common cardiovascular diseases and its risk factors among members of a community in South-South Nigeria

Barriers to utilization of an eye care facility in a rural community in South-South Nigeria

Objectives: The purpose of the study was to describe the barriers to the utilization of eye care services in a rural community in South-South Nigeria. Material and Methods: A descriptive cross-sectional study using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of the eye clinic at the community’s Comprehensive Health Centre (CHC) for eye care. Results: The study sample included 200 participants. Only 40 (24.1%) respondents had previously consulted at the eye clinic at the CHC in search of eye care. The principal barriers to eye care services utilization were “Ignorance of the existence 53 (47.3%) and schedule” 37 (33.0%) of the eye clinic at the CHC, and “No felt need” 26 (23.2%). Conclusion: Despite the high prevalence of ocular disorders among the study participants, the utilization of available eye care services was markedly low. The common barriers cited were “Ignorance of the existence and schedule of the eye facility in the community. Improved strategies to improve uptake of services is required.”

Prediabetes and its correlates in a suburban community in South-South Nigeria

Prediabetes and its correlates in a suburban community in South-South Nigeria

Age-Dependent Prevalence of Malaria in Akeddei Community in South-South Nigeria

Background: Malaria is highly endemic in Nigeria, making malaria morbidity and mortality a leading public health challenge. The most at risk population of malaria attack is under-five years’ children. However, malaria is presumptively treated in older age groups. This study aimed to determine the age-dependent prevalence of malaria amongst three age groups in a rural community in south-south Nigeria. Methods: A community-based cross-sectional survey comprising febrile and afebrile participants (n = 300) were randomly selected and included for the study. The study participants were grouped into three groups: under-five years old children (n = 100), older children of aged 6-15 years (n = 100) and 16 years and above (n = 100). Malaria Rapid Diagnostic Tests (RDTs) and Giemsa-stained microscopy were used for malaria diagnosis and parasite detection. Clinical and demographic parameters as well as malaria prevalence were analyzed. The level of statistical significance was considered at ρ = 0.05 Results: Malaria prevalence in the under-five age group was 73% by RDTs and 49% by microscopy. For the 6–15 years, the prevalence of malaria was 60% and 43% by RDTs and microscopy respectively while RDTs accounted for 38% and microscopy 17% for the 16 years and above group. Conclusion: Artemisinin-based combination therapies (ACTs) administration to older children and adults should be based on parasitological confirmation of suspected cases with at least malaria RDTs to reduce drug pressure.

Bacterial characterization and quantification of rainwater harvested in a rural community in Nigeria

This study investigated the bacteriological quality of rainwater (RW) harvested from storage facilities located in Ekpoma, a rural community in South-South Nigeria, and the possible health implications resulting from its intermittent or incessant consumption. In this study, 162 samples were collected from different storage devices located in Idumegbo, Ihumudumu, Ujoelen, Emaudo, and Ukpenu Extension areas. In total, ten (10) bacteria species namely: Escherichia coli (E. coli), Salmonella typhimurium, Bacillus subtilis, Micrococcus luteum, Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium perfringens, Enterococcus faecalis, Proteus vulgaris, Yersinia pestis were predominant in the samples. Specifically, 30.2 % of the samples contained E. coli, 16.6 % contained Micrococcus luteum, 14.8 % contained Bacillus subtilis, 12.96 % contained Klebsiella pneumoniae, 11.1 % contained Salmonella typhimurium, 7.41 % contained Clostridium perfringens, 3.7 % contained Proteus vulgaris and Yersinia pestis, and 1.85 % contained Pseudomonas aeruginosa and Enterococcus faecalis. The bacterial load (Heterotrophic Plate Count) measured in the water samples varies widely between 292 x 104 CFU/mL to 2455 x 104 CFU/mL, while E.coli count were in the range of 40 x 104CFU/mL to 884 x 104CFU/mL for all districts in both open and closed tanks. The ANOVA and Welch two sample t-test conducted for open and closed tanks also showed no statistical difference in E. coli counts across all locations (p < 0.05). These results suggest that both the open and closed tanks are affected by multiple sources of pollution, and that airborne pollutants are not a major contributor to E. coli contamination. This further indicates that legacy bacterial contamination plays a significant role in the contamination process. The findings of this study demonstrate that the water is unfit for drinking and constitutes a serious threat to public health. Therefore, chlorination, boiling before use, following best management practices (BMPs) and non-structural management measures (nSMMs) developed at a rural, location-specific scale are progressive and proactive measures can be introduced to prevent or reduce contamination.

Prevalence of Diabetes Mellitus in a Rural, Agrarian Community in South-South Nigeria

Background: Diabetes mellitus (DM) is a global public health threat, often associated with other co-morbidities with significant morbidities and mortality. The aim of this study was to determine the prevalence of DM in a rural agrarian community in Nigeria.Methodology: This cross-sectional study, using quantitative methods, was carried out in Ayua community in Etsako West local government area of Edo state, South-South Nigeria. Structured questionnaire was intervieweradministered while socio-demographics, anthropometric data, blood pressure and weight measurements as well as random blood glucose were obtained from participants.Findings: Two hundred and sixteen participants (58 males, 158 females) completed the study with a mean age of 54.2+16.4 years. Diabetes was found in 30 (13.9%) participants and undiagnosed in 40.0% while hypertension and obesity were found in 61(28.2%) and 57(26.4%) respectively. Diabetes was independently predicted by age &gt; 50 years (OR = 5.7) and the presence of a family history of DM (OR = 43.0) with p &lt; 0.001 each) but not by obesity (p=0.860), hypertension (p = 0.477) or family history of hypertension (p = 0.09).Conclusion: Considering the high prevalence of DM and co-morbidities in this rural agrarian community, we recommend regular screening of adults for these conditions.&#x0D; Keywords: Diabetes mellitus, Hypertension, Nigeria, Rural

Work-Related Respiratory Symptoms among Cement Sellers in a Semi-Rural Community in South-South Nigeria

Work-Related Respiratory Symptoms among Cement Sellers in a Semi-Rural Community in South-South Nigeria

Risk Factors, Management and Other Correlates of Peptic Ulcer Disease in a University Community in South-South Nigeria

The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs).Treatment choices include standard triple therapy. This study evaluated the patterns of prevalence, life-style risk factors and correlates of management of PUD among Staff and Students of Delta State University, Abraka Campus, Nigeria. A descriptive cross sectional study was initiated among 450 willing staff and student respondents. A total of 126 respondents that had been diagnosed for PUD were further evaluated for prevalence and patterns, confounding life-style factors, drug therapy and other correlates of PUD management by using self-designed, pre-tested questionnaires that addressed the objectives of the study. Data was analyzed using Statistical Package for Social Sciences, version16.0 (SPSS Inc. Chicago Illinois). Duodenal Ulcer (DU) had a higher prevalence than Gastric Ulcer (GU) in a ratio of 1.5:1. The prevalence of GU was higher among Staff, Males and those older than 35 years; DU had a higher prevalence among the Students, Females and 16-35 yrs age group. The greatest life-style risk factors identified were consumption of NSAIDs, Tobacco and Alcohol. Regarding drug treatment, over 90% of drugs prescribed were antibiotics; nearly all respondents claimed to experience side-effects which included Diarrhea, Abdominal Pain and Headache; nearly all respondents often adhered to instructions to avoid Alcohol. In this population, PUD prevalence and pattern was structured along gender and age. There were issues with life-styles which could have contributed to the pathophysiology of PUD. Patients experienced some side-effects that affected adherence to instructions. Management seemed appropriate with the use of triple therapies. However, there is still a dire need for strategic health education on PUD risk factors and self-care practices.

Assessment of Risk Factors For Hypertention in A Rural Community in South-South Nigeria

Background: Hypertension is an important and often symptomless chronic condition yet implicated as an important cause of various cardiovascular complications; stroke, renal failure, blindness thereby reducing the quality of life and productivity of untreated hypertensives’. Risk factors for hypertension as revealed in literatures include the following- Age, Gender, family history of hypertension, race, high intake of alcohol, physical inactivity, smoking, obesity, high intake of saturated fat, diabetes mellitus etc. Objectives of the study: To assess the prevalence, risk factors for hypertension amongst rural dweller in Etsako West LGA of Edo State. Additionally, the study sought to determine the relationship between basal metabolic index (BMI ) and hypertension. Methods: The descriptive cross sectional study was carried out using pre-tested self-administered questionnaires; it was distributed among 350 respondents who were recruited via multistage sampling technique. The blood pressure was measured in the sitting position using the left arm held at the level of the heart. Blood pressure (BP) was measured to the nearest 2 mmHg on two occasions at an interval of 5 minute. The target populations were rural dwellers in South Ibia, Etsako West LGA of Edo State in South –south Nigeria. Variables were entered and analyzed was using SPSS software package. The association between various variables (risk factors, hypertention ) were tested using appropriate test of statistics. Results: Majority of the participants were within the age range of 18-27. Out of the 350 respondents 171 and 179 were male and female respectively. The prevalence of hypertension was 31.4% among the study participants. Majority of the respondents had normal body mass index (58.7%), this was followed by pre-obese (18.7%), obese (12.8%) and underweight (9.9%). Conclusion: Early and prompt diagnosis of hypertension is key to prevention and control of its complications. This study emphasized the need to reduce weight through continuous exercise. Also, increased awareness of risk factors among rural dwellers will go a long way in reducing the burden of hypertension and its associated effects.

Attitude of Residents of a Rural Community in South-South, Nigeria towards Alternative Medical Therapy

Background: Up to 80 percent of Africans are reported to use some form of alternative medical therapy (AMT) to meet their health needs. There are gaps in knowledge relating to attitude towards AMT in southsouth Nigeria. An understanding of beliefs and the prevailing factors that influence the patronage of traditional medicine in this environment may help inform policy interventions. Objectives: This study aimed to assess the awareness of and attitude towards AMT amongst the inhabitants of a rural community in south-south Nigeria. Materials and Methods: This was a cross sectional survey involving 300 respondents selected by a two stage sampling technique, using a self-designed interviewer administered structured questionnaire. Results were presented as proportions with chi-squared test done to determine associations. Level of significance was set at 0.05. Results: Mean age of the 300 respondents was 35.7±11.7 with 237 persons (79.0%) earning less than $250 monthly and 168 (56.0%) having secondary education. Majority 297 (99%) were aware of AMT and 287 (95.7%) cited herbal concoctions as the most prevalent method. Few were aware of side effects of AMT 71 (23.7%). Majority 208 (69.3%) preferred AMT to orthodox treatment, and Original Research Article Maduka and Ejimkaraonye; BJMMR, 8(4): 334-342, 2015; Article no.BJMMR.2015.456 335 were willing to refer others to AMT practitioners. Of these 159 (76.4%) claimed AMT to be more effective and 140 (67.3%) more affordable. Age of respondents, educational status, occupation and average monthly income were all found to be associated with preference of AMT (p<0.5). Conclusion: Alternative medical therapy is favoured by majority of the respondents in spite of the risks. Public enlightenment campaigns, better regulation, and implementation of community health insurance for affordable health care are advocated.

Knowledge, Attitude and Uptake of Premarital Screening for the Sickle Trait Among Married Couples in a Semi-Urban Community in South-South Nigeria

More than 24% of Nigerians are carriers of the sickle cell gene, while about 2% of all the newborns in Nigeria are born with the sickle cell disease. The disease is a lifelong cause of severe morbidity that often require prolonged hospital admission; even as the patients have 92% excess mortality. The prevention of the disease is therefore very important, especially in Nigeria whose contribution to the global total has been projected to increase. Premarital screening for the sickle cell gene is considered one of the best ways of preventing the sickle cell disease. This study assessed the knowledge, attitude and uptake of the premarital screening among married couples in Choba, a semi-urban community in south-south Nigeria. A descriptive cross-sectional study design was used, with the data collected using structured, interviewer-administered questionnaire that was administered on married male members of the study community. A total of 290 questionnaires were administered and retrieved. The respondents had an average age of 30.55 ±4.1 years; majority (65.86%) had a tertiary education and they were all Christians. All the respondents knew about the sickle cell disease, while 84.83% were aware of the premarital screening for the disease. All had positive attitude towards the premarital screening, with 88.97% recommending that the screening be made compulsory for all intending couples. Most (72.76%) of the respondents carried out the premarital screening when they got married. The age, educational attainment and the religious denomination of the respondents significantly influenced the uptake of the screening (p-value > 0.001). A total of 9.00% of the respondents were of the same HbAS genotype as their intended spouses; out of which 21.05% went ahead and got married, citing as reasons the difficulty of jettisoning their spouses (25.00%); and the power of God to prevent a child with sickle cell disease (75.00%). The knowledge, attitude and uptake of premarital screening for sickle cell disease are high in the study, even as the screening programme is not driven by the government. The input of the government is however required in providing health education, genetic counselling and prenatal diagnosis.

High blood pressure in a semi-urban community in south-south Nigeria: a community - based study

Non communicable diseases (NCDs) are taking their toll in most low and middle income countries; incidentally, in the same populations that are struggling to deal with communicable diseases, hence presenting a picture of "double tragedy". Most of the researches conducted on NCDs are facility-based; often in urban locations. To determine the prevalence of high BP in a semi-urban community in Nigeria. It was a cross-sectional study, where all the adult residents of the community were enrolled. Data was collected using a multi-section questionnaire, including anthropometric measurements. Data entry and analysis was done using SPSS 17.0 for windows and STATA 10. The results showed that 47.0% of the study population had a raised BP ≥140/90mmHg. At a univariate level, age, sex, higher income, more people in the household, daily cigarette smoking, daily alcohol intake and BMI, showed increased risk for high BP. However, sleeping for at least 8 hours a day showed protective influence against raised BP among the participants. In the adjusted model, only age, sex and BMI remained statistically significant with Odds Ratio (OR) of 1.04 (95%CI; 1.00, 1.08), 0.45 (95%CI; 0.22, 0.90) and 1.08(95%CI; 1.03, 1.13) respectively. The model had an area under curve of 71.9%. It was concluded that there is a high prevalence of raised BP in this semi-urban community, thus the need for intervention and preventive services to curb the looming epidemic of hypertension in this community in particular, and Nigeria as a whole, cannot be overemphasized.

Prevalence of hypertension and its modifiable risk factors amongst traditional chiefs of an oil-bearing community in south-south Nigeria

Background: The epidemiological transition has firmly berthed in Nigeria's oil-bearing communities, but the pace is often different in subsets of the community, depending on how readily the western lifestyle is being adopted. This study determined the prevalence of hypertension and its modifiable risk factors amongst the traditional chiefs of an oil-bearing community in Rivers State, Nigeria. Materials and Methods: A descriptive cross-sectional study design was used, with the data collected using a modified form of the WHO STEPS instrument that consists of a questionnaire component and measurement of body mass index (BMI) and blood pressure. The questionnaire was used to collect information on the socio-demographic characteristics of the respondents, the use of tobacco, and consumption of alcohol. Results: A total of 106 traditional chiefs were studied. They were all males, mostly married (95.28%), with a mean age of 56.5 ± 4.10 years. The study population had a mean systolic blood pressure of 149 ± 17 mmHg, a mean diastolic blood pressure of 98.7 ± 14.8 mmHg, and prevalence of hypertension was 68.9%. Most (63.01%) of the hypertensive chiefs were aware of their status and were on anti-hypertensive drugs (50.68%). None of the chiefs were underweight, and most were either overweight (51.89%) or obese (26.42%). Nearly all (92.45%) the chiefs regularly took alcoholic beverage, while 24.53% currently smoke cigarettes.Conclusion: The prevalence of hypertension amongst the traditional chiefs was higher than in the general population. This can be attributed to their older age and acculturation.

Ethical scrutiny of HIV testing in the ante-natal clinic of a secondary health care facility in Rivers State, Nigeria.

Background: HIV testing has been shown to be a crucial gateway to treatment, prevention, and support services; hence the urgent need to swiftly scale-up testing in a wide range of clinical encounters, as a means of controlling the pandemic. Fears have however been expressed that such swift scale-ups might result in unethical practices, especially in developing countries without strong civil institutions and legal protection. Aim: To carry out an ethical scrutiny of HIV testing, in a secondary health care facility, in an urban community in south-south Nigeria. Methods: The study was carried out in March 2006, in Omoku General Hospital, a secondary health care facility, with the full complement of staff and facilities. In-depth interviews were held with the relevant staff of the hospital, to ascertain the HIV testing procedure in the ante-natal clinic of the hospital. These were corroborated with exit interviews of women attending the clinic. Results: The HIV testing procedure showed several ethical breaches. The women that attended the ante-natal clinic had mandatory HIV test, were inadequately counselled, and tested without proper linkage with prevention, care and treatment facilities. Conclusion: Most of the ethical breaches stemmed from poor funding, and improper linkage with other services. Funding of HIV testing programmes must go beyond the provision of test kits. Keywords: HIV testing, Ethics, Ante-natal clinic, Secondary health care facility, Rivers State, NigeriaPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 32-36

Mandatory HIV testing and uptake of ante-natal services in a primary health care centre in South-South Nigeria

Background: The Nigeria\'s national policy on HIV/AIDS did not allow for mandatory HIV testing. But several health institutions in Nigeria insist on an HIV test before certain services are given. Fears have been expressed that such mandatory HIV testing might lead to poorer uptake of associated services. Aim: To assess the impact of mandatory HIV testing on the uptake of ante-natal services in a primary health centre located in Obrikom - a semi-urban community in south-south Nigeria. Method: A cross-sectional study was carried out, using the ante-natal records of the primary health centre. The HIV testing procedure of the health centre was clearly established using in-depth interview of staff, and exit interview of women attending the ante-natal clinic. A four-year (October, 2002 to September, 2006) review of the ante-natal records of the health center was then carried out to coincide with the period, two years before, and two years after the introduction of Mandatory HIV testing in the health centre. Results: The health centre had a total of 281 new antenatal registrations during the study period; out of which, only 75 (26.69%) were registered two years after the introduction of the policy. This is a significant reduction (p-value < 0.001), when compared to the number that registered before the introduction of the policy. There is also a significant decrease in the number of antenatal visits (p-value < 0.05); the number of visits decreased from a total of 840 visits, and an average quarterly visits of 105 (s.d 19.94) before the implementation of the policy, to 394 visits and an average quarterly visits of 44.75 (s.d 15.1). Conclusion: Mandatory HIV testing can lead to a significant decrease in the uptake of associated health care services. Efforts should be made to discourage it. Keywords: Mandatory HIV testing, Uptake of services, Ante-natal clinic, Primary health centre, South-south NigeriaPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 257-262

Child Abuse in a semi-urban community in south-south Nigeria: The case of a 12 Year Old Girl Accused of Witchcraft

In spite of the passage of the 2003 Child Right Act in Nigeria, and the signing and ratification of several international legal instruments that dealt with child abuse, the incidence of child abuse in Nigeria is still very high. We report the deprivation, physical and psychological abuse suffered by a 12 year old girl accused of witchcraft by members of her family, in Egbema, a semi-urban, oil bearing community in the Niger Delta region of Nigeria. This case is reported to highlight the increasing number of children accused of witchcraft by charismatic religious groups; and to emphasize the need for doctors to seek out such abuses, and act to protect the abused children.Nigerian Hospital Practice Vol. 2 (1) 2008: pp. 10-13

Perception of bed nets and malaria prevention amongst users of insecticide-treated bed net in a semi-urban community in south-south Nigeria

Assessment of the use and success of insecticide treated nets (ITN) in malaria control requires a good insight into the people's perceptions of malaria and ITN. This study reports on the perception of mothers of malaria, malaria prevention, and ITN, before and one year after the ITNs was bought from a social marketing programme. The study was an intervention study carried out using an interviewer-administered questionnaire. The respondents were mothers who bought ITN sold by a social marketing project in Egbema a semi-urban community in Rivers State. The pre-intervention study was carried out at the time of purchase of the nets, while the post-intervention study was done one year later. There was a significant increase in the proportion of respondents who mentioned mosquito as the sole cause of malaria. (P < 0.001). There was also a significant reduction in the malaria burden of the household (P < 0.001). Most of the respondents (84.8%) stated that they liked the ITN because it ensures a good night sleep, free from the nuisance of mosquitoes. However, 48.31% complained of heat, and 26.40% complained of the task of having to mount the net every night for their children. Sustained health education and use of ITN can promote the use of the nets for malaria control.

Social marketing of insecticide-treated bed net for malaria control: an experience in a semi-urban community in south-south Nigeria

Background: The effectiveness of the insecticide-treated bed net in reducing the morbidity and mortality associated with malaria has been proved at all levels of malaria transmission. Several models on how to achieve massive coverage have been suggested, but social marketing of the nets is highly favoured for its sustainability. Aim: To report the experience of a small-scale social marketing project for insecticide-treated bed net in a semi-urban community in south-south Nigeria. Methods: The social marketing project was established in 2003 in Egbema, a semi-urban community in Rivers State, with a population of 47,000. A descriptive cross-sectional study design was used for the study, with the sales records of the project and a structured, interviewer-administered questionnaire as study tools. The sales records were analysed to assess the performance of the project, while the questionnaire was used to collect data on the socio-economic characteristics of buyers of the net. Results: In six months, the project achieved an uptake rate of 1.10 ITN per month, per 1000 population, and a 6.5% coverage of the target population. Most, 208 (67%), of the paid up sales were achieved at the well-child clinic and the antenatal clinic of the health facilities that serve the community. Buyers in the two lower socio-economic quartiles bought only about one third of the nets. Members of the community were predominantly farmers/fishermen, but only 19 (10%) of the buyers of the nets identified themselves as such. Conclusion: The study shows that the use of social marketing for promoting the use of ITN for malaria control is slow in a poor community. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 145-150

The effect of insecticide-treated bed net on malarial parasitaemia and haemoglobin level of under-five children in a semi-urban community in south-south Nigeria

Background: Imperfect control measures like insecticide-treated bed net that merely reduces transmission, appear unlikely to have any significant effect on malarial morbidity in an area of intense perennial malaria transmission. Also, some field studies have indicated that the efficacy achieved might be due to the high coverage rate achieved during the trial that produced a mass killing of mosquitoes in the communities. Aim: To assess the impact of the use of the insecticide-treated bed net in a programme situation, on malarial parasitaemia, haemoglobin levels and spleen sizes in under-five children, in an area of intense perennial malaria transmission in South-South Nigeria. Methods: The study was carried out over a six-month period in two communities in the Ogba/ Egbema/ Ndoni Local Government Area of Rivers State, South-South Nigeria. A non-randomized control group pre-intervention-post-intervention study design was used. Fifty five children under five years systematically chosen from buyers of the nets sold by a social marketing project were used as the intervention group. Fifty eight children were recruited as controls, from a neighbouring community about ten kilometers away, and matched for age and socio-economic status of their parents with those in the intervention group. Results: The baseline data of the study groups were broadly the same (p > 0.1). However, in the post-intervention study, there was a 0.75g/dl (p