Medicine Vendors Research Articles

Medicinal Plants Used in the Treatment of urogenital disorders in the Drâa-Tafilalet region of Southeastern Morocco: An Ethnobotanical Survey

This study presents an ethnobotanical survey of medicinal plants used in the treatment of urogenital disorders in the Drâa-Tafilalet region, located in southeastern Morocco. The survey involved 200 herbalists and medicinal plant vendors across three provinces: Errachidia, Tinghir, and Zagora. Ethnobotanical data were analyzed using metrics such as use value (UV), frequency of citation (FC), relative frequency of citation (RFC), and family importance value (FIV). The study identified 80 species belonging to 44 plant families. The most represented families were Asteraceae (8 species), Lamiaceae (7 species), Apiaceae (7 species), and Fabaceae (6 species). The species most frequently cited treating urogenital disorders included Petroselinum sativum Hoff. (RFC = 0.018), Arenaria rubra L. (RFC = 0.016), Ziziphus lotus (L.) Lank. (RFC = 0.016), Zea mays (RFC = 0.013), Artemisia herba-alba (RFC = 0.013), and Ammi visnaga (RFC = 0.011). Leaves were the most commonly used plant part (35%). The primary preparation methods of these remedies were decoction (53.75%) and infusion (30%), with oral administration being the preferred route (95%). The findings of this study provide a valuable resource for researchers and practioners of traditional medicine, highlighting the importance of Morocco's medicinal flora. This ethnobotanical knowledge not only supports the conservation of national pharmacopoeia but also offers a promising foundation for the discovery of new therapeutic agents, particularly for the treatment of urogenital disorders. Future research could further investigate the bioactive compounds present in the identified species, potentially leading to innovative treatments for urogenital health issues.

Characteristics and health insurance profile of brought-in-dead children in a rural tertiary hospital

BackgroundDespite the regular occurrence of brought-in-dead (BID) phenomenon, little is known about their prevalence, pattern and prehospital contributors in rural settings in Nigeria. In addition, the impact of health insurance...

Factors influencing the acceptability of the test, treat and refer practice for malaria among caregivers of under 5 children at community pharmacies and drug shops in Nigeria

BackgroundMalaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates. In sub-Saharan Africa, Patent and Proprietary Medicine Vendors (PPMVs) have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities, but PPMVs are not usually tested before fever cases are treated as malaria or refer clients. The aim of this study was to explore the factors influencing caregivers’ acceptance of the test, treatment and referral practices for malaria management provided by CPs and PPMVs in Kaduna and Lagos states, Nigeria.MethodsA cross-sectional quantitative telephone survey was conducted among 150 caregivers of children under five years old who received malaria services from trained CPs and PPMVs between May and July 2022. Descriptive and bivariate analyses were performed to identify factors significantly associated with the acceptability of malaria management services. All statistically significant factors from the bivariate analysis were explored using logistic regression models, and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. The 95% level was used to define statistically significant associations (p ≤ 0.05).ResultsAll caregivers were asked questions that aided in obtaining a diagnosis of malaria. More than two-thirds of the caregivers (68%) reported that the child was tested by a CP/PPMV. Among those treated (148), 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria. At the bivariate level, acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0–12 months (93% vs. 76%, p = 0.004). Caregivers of children who prescribed ACT had greater acceptance than did those not prescribing ACT (92% vs. 69%, p = 0.010). Multivariate analysis revealed that these relationships held.ConclusionsThe adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the widespread practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes.

Relationship between Prices and Quality of Essential Medicines from Different Manufacturers Collected in Cameroon, the Democratic Republic of the Congo, and Nigeria.

Achieving universal access to affordable medicines and at the same time ensuring the quality of medicines presents a challenge, especially in low- and middle-income countries. Here, the relationship between medicine prices and medicine quality was investigated in three African countries. From different types of health facilities and medicine vendors, 711 samples of 18 different essential medicines were purchased and analyzed for quality (assay and dissolution) according to the United States Pharmacopeia. Without exception, all originator brand medicines and all SRA generics (generic medicines manufactured in countries with stringent regulatory authorities [SRAs]) complied with pharmacopeial specifications. In contrast, 21.1% of the non-SRA generics (manufactured in countries without SRAs) were substandard. The median prices of originator brands and SRA generics were three times and two times higher than those of non-SRA generics, respectively. Within the non-SRA generics, no positive correlation was observed between medicine quality and medicine price. Medicines manufactured in India, China, or African countries showed similar quality and similar prices. Only a single WHO-prequalified medicine sample was found among the 711 samples. Non-SRA generic medicines produced by manufacturers for which WHO had published Public Inspection Reports showed a significantly lower rate of substandard medicines (7.3%) and, at the same time, significantly lower prices (by 33%) than other non-SRA generics. Falsified medicines (total 2.0%) were found among all categories of medicines and had prices similar to those of non-SRA generics. Our findings indicate that adequate quality assurance does not necessarily imply an increase in medicine prices.

Over fifteen years of chloroquine withdrawal in Nigeria: a qualitative investigation into the execution of this policy by healthcare providers and amongst patients in a rural community.

Background Chloroquine (CQ) was once an important drug used in malaria treatment especially due to its affordability, ease of use and high anti-malarial efficacy. However, it was withdrawn from clinical practice in Nigeria in 2005 following a widespread of resistance cases reported in the public health domain. This study aims to ascertain the level of compliance with the policy on CQ withdrawal among patients, Patent and proprietary medicine vendors (PPMVs), Pharmacists and Physicians. Method A cross-sectional survey involving both online and offline data collection was carried out. A total of 582 participants were recruited and consisted of patients (N = 300), PMVs (N = 94), Physicians (N = 94), and Pharmacists (N = 94). Patients spanned across health services at primary health centers and hospitals in the Anaocha community. Result Our findings show that the patients were equally aware of what CQ is used for (χ² = 7.071, p = 0.215). However, significant disparities were observed in the knowledge, attitude, and perception of CQ resistance and its continual use among health professionals and PPMVs (χ² = 160.54 and 158.54, p = 0.000). Additionally, despite the chloroquine withdrawal policy in Nigeria, there was evident non-compliance among majorly PPMVs and other healthcare professionals. A few of patients continued to utilize CQ for malaria treatment and PPMVs were mostly likely to prescribe and stock CQ. Conclusion The study revealed that chloroquine use in Nigeria is still sustained notwithstanding the switch in the antimalarial drug policy from chloroquine to ACTs in 2005. Feasible implementation strategy through awareness program and campaign especially in the primary health centers across Nigeria and through associations such as Nigeria Association of Patent and Proprietary Medicine Dealers (NAPPMED), Pharmaceutical Society of Nigeria (PSN) and Nigeria Medical Association (NMA) is recommended.

A cross-sectional assessment of expanding basic healthcare services to rural and underserved communities through proprietary patent medicine vendors in Northern Nigeria

A cross-sectional assessment of expanding basic healthcare services to rural and underserved communities through proprietary patent medicine vendors in Northern Nigeria

Ungoverned Spaces Among Informal Health Providers in Nigeria and Health Security Implications

Ungoverned spaces refer to systems that are evasive of government regulations. They manifest in health systems when health authorities struggle to regulate certain healthcare providers. The current study underscored Informal Health Providers (IHPs) such as Patent Medicine Vendors (PMVs), Herbalists, Traditional Birth Attendants (TBAs), etc., as typical of ungoverned heath spaces in Nigeria and a threat to citizens’ health security. Interviews and group discussions were used to collect data from 90 participants. The findings showed some groups of IHPs without interface with government health authorities. Although PMVs and TBAs had some interface with the government, the study still found many aspects of their practices that were not governed. Unions of the IHPs could be parallel to health authorities. Indeed, IHPs can provide care in difficult contexts where formal healthcare is lacking, however, their continuous ungoverned operations could undermine citizens’ rights to quality healthcare, which conflicts with the ideals of the social service workforce. Therefore, future research should focus on co-designing policies and programs that can help to pull IHPs into an effectively governed pool.

Occupational Morbidities and Health-Seeking Behavior among Automobile Mechanics in the Western Region of Nigeria

Background: Automobile mechanic work is associated with illnesses and injuries. These occupational diseases can result in sickness absence, economic loss, disability, or death of these workers. This study assessed self-reported health problems and health-seeking behavior of automobile mechanics in Surulere, Lagos State. Methods: A cross-sectional study was used in this study carried out in December 2014. A systematic sampling method was employed to select 120 respondents from various workshops within their Local Government Area and were interviewed using a structured questionnaire. Data entry and analysis were done using epi-info3.5.1 Results: About 27.5% of the respondents reported at least one work-related illness or injury. Five percent of the respondents had musculoskeletal disease. About 11.5% of the respondents reported having cuts and crushing injuries. Most (86.7%) of these workers do not have health workers available around their workplaces. Slightly less than half (48.3%) visit health facilities between 6 to 15 minutes of estimated walking distance. Most (70%) respondents visit health facilities when ill or injured; 33.3% patronize traditional healers/ herbs/ prayer houses (spiritualists); 25% patronize patent medicine vendors and practice self-medication. The level of education of the workers was inversely significantly associated with the occurrence of occupational injury or illness. Conclusion: High work-related morbidities were managed by a few available health workers who were majoring in the patent medicine vendor category. The importance of level of education in the control of workplace injuries and illnesses was demonstrated by this study.

Mothers’ choice of health management services for under-five children with common illnesses: evaluating social workers’ impact in Nigerian health sector

ABSTRACT Introduction Every child deserves the right to life. In Nigeria like other African countries, a high burden of child mortality prevails. Attaining a low-mortality rate of children entails that mothers who are the primary caregivers are in the best position to provide quality healthcare management. Method With the phenomenological approach in qualitative research, the researchers sourced data using Focus Group Discussions (FGDs) and In-Depth Interviews (IDI) from 38 mothers of various categories. The participants were purposively selected from four government and mission health institutions in a semi-urban Nsukka town, Enugu State. Data were analyzed thematically. Findings Results revealed that mothers utilize health institutions including government, mission, private, pharmacies and patent medicine vendors when seeking healthcare for their children. Their inability to recognize potential life-threatening conditions is the leading factor in increasing child mortality. Findings show that because participants were concerned about financial challenges; they were ready to adopt traditional medicine as an alternative to modern medicine. The study showed evidence of unsafe strategies mothers adopt for the health management of their under-five children with common illnesses. Participants indicated little knowledge of social workers’ engagement in health institutions. Conclusion Healthy living is essential in the protection from illnesses. Since under-five children are vulnerable to illnesses, their mothers should provide them with quality healthcare management. The study recommends that social workers’ engagement with health providers and users in semi-urban societies could help propagate healthcare awareness and strategies in mothers’ choice of health management for under-five children in Nigeria. Overall, adequate health policy consideration should be given to all under-five children in Nigeria.

Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey.

To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9-3.9) were used per 1000 adult inhabitants per day. Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.

Assessing knowledge of hypertension and diabetes mellitus among informal healthcare providers in urban slums in southeastern Nigeria

Informal healthcare providers (IHPs) often serve as the first point of contact for healthcare services for non-communicable diseases in urban slums and their ability to identify risk factors and symptoms of the diseases is crucial for early detection and management. This paper assesses level of knowledge of hypertension and diabetes mellitus (DM) among IHPs. A cross-sectional survey was conducted in eight slums in Enugu and Onitsha cities in south-eastern Nigeria. Data was collected from 238 IHPs including patent medicine vendors, traditional birth attendants, traditional bonesetters, and herbalists. Knowledge scores were computed for each respondent. Adequate knowledge was set at ≥ 50% score and inadequate knowledge at < 50%. Binary logistic regression analysis was used to identify factors/independent variables associated with adequate knowledge among IHPs. Independent variables in the regression model were seven items that describe the profile of IHPs and can influence their access to information on non-communicable diseases. Knowledge of risk factors and symptoms of hypertension and DM among IHPs was low since only 21 (8.82%) and 19 (7.98%) of them had adequate knowledge of hypertension and DM, respectively. In regression analysis, IHPs who had received formal training in the past demonstrated significantly higher levels of knowledge, with odds of adequate knowledge in hypertension being 14.62 times greater for trained providers, and the odds of adequate knowledge of both non-communicable diseases being 21.34 times greater for trained providers. Training of IHPs is needed to address the critical knowledge deficit of risk factors and symptoms of hypertension and DM. This would contribute to better health outcomes and reduced disease burden in urban slums.

'Cut medicine for me': addressing suboptimal dosing of antimicrobials as a critical issue to combat AMR in Nigeria.

Antimicrobial resistance (AMR) is a critical health challenge in Nigeria as in many other countries in the sub-Saharan region of Africa. Our article describes how the challenges in the regulation and operations of Patent and Proprietary Medicine Vendors (PPMVs) in Nigeria provide a blind spot for the underuse of antimicrobials. This article also sheds light on how patients' antibiotic use and seeking behaviour facilitate this unwholesome practice. In addition, our article looks at the social determinants of this practice, such as poverty and poor education, and proffers solutions towards solving it. While previous research has investigated the knowledge, perceptions and attitudes of PPMVs towards antimicrobial use and AMR, our article is the first to critically raise concerns about the common practice of antimicrobial underdosing in Nigeria.

Challenges in the distribution of antimicrobial medications in community dispensaries in Accra, Ghana.

The dispensation of medicines in some low- and middle-income countries is often carried out by private vendors operating under constrained conditions. The aim of this study was to understand the challenges reported by employees of dispensaries, specifically, chemical and herbal shops and pharmacies in Accra, Ghana. Our objectives were twofold: (1) to assess challenges faced by medicine vendors related to dispensing antimicrobials (antibiotic and antimalarial medications), and (2) to identify opportunities for improving their stewardship of antimicrobials. Data were collected in 79 dispensaries throughout Accra, in 2021, using a survey questionnaire. We used open-ended questions, grounded on an adapted socioecological model of public health, to analyze these data and determine challenges faced by respondents. We identified multiple, interlocking challenges faced by medicine vendors. Many of these relate to challenges of antimicrobial stewardship (following evidence-based practices when dispensing medicines). Overall, medicine vendors frequently reported challenges at the Customer and Community levels. These included strained interactions with customers and the prohibitive costs of medications. The consequences of these challenges reverberated and manifested through all levels of the socioecological model of public health (Entity, Customer, Community, Global). The safe and effective distribution of medications was truncated by strained interactions, often related to the cost of medicines and gaps in knowledge. While addressing these challenges requires multifaceted approaches, we identified several areas that, if intervened upon, could unlock the great potential of antimicrobal stewardship. The effective and efficient implementation of key interventions could facilitate efforts spearheaded by medicine vendors and leverage the benefits of their role as health educators and service providers. Addressing barriers faced by medicine vendors would provide an opportunity to significantly improve the provision of medications, and ultimately population health. Such efforts will likely expand access to populations who may otherwise be unable to access medications and treatment in formal institutions of care such as hospitals. Our findings also highlight the broad range of care provided by shopkeepers and vendors at dispensaries. These findings suggest that the meaningful engagement of dispensaries as valued conduits of community health is a promising pathway for interventions aiming to improve antimicrobial stewardship.

Fidelity of implementation of national guidelines on malaria diagnosis for children under-five years in Rivers State, Nigeria

BackgroundMalaria is still a disease of global public health importance and children under-five years of age are the most vulnerable to the disease. Nigeria adopted the “test and treat” strategy in the national malaria guidelines as one of the ways to control malaria transmission. The level of adherence to the guidelines is an important indicator for the success or failure of the country’s roadmap to malaria elimination by 2030. This study aimed to assess the fidelity of implementation of the national guidelines on malaria diagnosis for children under-five years and examine its associated moderating factors in health care facilities in Rivers State, Nigeria.MethodsThis was a descriptive, cross-sectional study conducted in Port Harcourt metropolis. Data were collected from 147 public, formal private and informal private health care facilities. The study used a questionnaire developed based on Carroll’s Conceptual Framework for Implementation Fidelity. Frequency, mean and median scores for implementation fidelity and its associated factors were calculated. Associations between fidelity and the measured predictors were examined using Mann Whitney U test, Kruskal Wallis test, and multiple linear regression modelling using robust estimation of errors. Regression results are presented in adjusted coefficient (β) and 95% confidence intervals.ResultsThe median (IQR) score fidelity score for all participants was 65% (43.3, 85). Informal private facilities (proprietary patent medicine vendors) had the lowest fidelity scores (47%) compared to formal private (69%) and public health facilities (79%). Intervention complexity had a statistically significant inverse relationship to implementation fidelity (β = − 1.89 [− 3.42, − 0.34]). Increase in participant responsiveness (β = 8.57 [4.83, 12.32]) and the type of malaria test offered at the facility (e.g., RDT vs. no test, β = 16.90 [6.78, 27.03]; microscopy vs. no test, β = 21.88 [13.60, 30.16]) were positively associated with fidelity score.ConclusionsThis study showed that core elements of the “test and treat” strategy, such as testing all suspected cases with approved diagnostic methods before treatment, are still not fully implemented by health facilities. There is a need for strategies to increase fidelity, especially in the informal private health sector, for malaria elimination programme outcomes to be achieved.

When one door closes: a qualitative exploration of women’s experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BackgroundCOVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.MethodsThe study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.ResultsWomen reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.ConclusionCOVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Ethnobotany and diversity of Citrus spp. (Rutaceae) as a source of “Kem-kem” traditional medicine used among the Karo sub-ethnic in North Sumatra, Indonesia

The Karo sub-ethnic is one of five Batak sub-ethnicities in the Karo Regency, North Sumatra Province, Indonesia. They are famous for their local knowledge about the traditional use of medicinal plants to treat various diseases. The “Kem-kem” traditional medicine is one of the traditional healing practices that involve using plants passed down through generations from their ancestors. One of the plant genus group in the Rutaceae family utilized in the traditional “Kem-kem” healing practice is a citrus known as “Rimo”. This study aims to document the local knowledge about the diversity of Citrus spp. as Kem-kem's herbal medicinal plant. This study was conducted from April to July 2023 in the Kabanjahe and Berastagi districts, Karo Regency, North Sumatra. Data was collected using interviews with traditional healers, herbal medicine vendors, and direct observations at traditional markets, involving a total of 8 Citrus spp. The Karo uses “Rimo” with different local names as sources of traditional medicinal ingredients in practicing “Kem-kem”. There are 15 local names comprising eight species of Citrus. Four are hybrids, i.e., Citrus x aurantiifolia (Christm.) Swingle, Citrus × aurantium L, Citrus × junos Siebold ex Yu.Tanaka, and Citrus × taitensis Risso. Two of the remaining species are recognized in infraspecific rank, one variety (Citrus medica var. sarcodactylis (Hoola van Nooten) Swingle) and one form (Citrus × aurantium f. deliciosa (Ten.) M.Hiroe). They were used as material sources for Kem-kem traditional medicine to treat at least nine health problems. There are two species with six local names included in the Least Concern (LC) category, namely C. medica (Rimo Gawang, Rimo Hantuantu, Rimo Kayu), C. medica var. sarcodactylis (Rimo Kuku Harimau), and C. medica (Rimo Telur Buaya), C. maxima (Burm.) Merr. (Rimo Malem). Nine local names are included in the Not Evaluated (NE) category, namely C. × junos (Rimo Kejaren), C. × taitensis (Rimo Jungga), C. × aurantium f. deliciosa (Rimo Keling), C. × aurantium (Rimo Kersik), Citrus hystrix DC. (Rimo Mukur), C. × taitensis (Rimo Puraga), C. × aurantium (Rimo Kalele), Citrus swinglei Burkill ex Harms (Rimo Pagar), and C. x aurantiifolia (Rimo Bunga). Rimo Kejaren (C. × junos) is a species that has the most benefits.

Health-seeking Behavior among Mothers of Under-five Children in Sokoto Metropolis, Sokoto, Nigeria.

In most developing countries, the health of the children is strongly dependent on maternal health-care-seeking behavior. The ability of caregivers to recognize and seek appropriate care for childhood illnesses is instrumental in reducing childhood deaths and preventing significant number of complications. The study aimed to determine the health-care-seeking behavior and associated factors among the mothers of under-five (U5) children in Sokoto Metropolis. This was a descriptive, cross-sectional study carried out among 386 mothers of U5 children in Sokoto metropolis from August 1 to September 30, 2021. The study participants were selected using the multistage sampling technique. A structured questionnaire was used to collect the information. Data were analyzed using the SPSS version 24. The level of significance for Chi-square was set at a P < 0.05. Majority 312 (80.8%) of the respondents U5 children had fallen sick in the last 6 months, most of which 238 (61.7%) were not taken to a health facility. The major reasons why respondents do not take their U5 children to a health facility when sick are because they bought drugs from patent medicine vendor and perceiving the illness of the U5 as not serious to warrant taking the child to a health facility in 93 (24.1%) and 63 (16.3%), respectively. There was association (P ≤ 0.05) between health-care-seeking behavior and respondents' level of education, occupation, monthly income, as well as distance taken to reach a health facility within 30 min' walk. The health-seeking behavior of the mothers for their U5 was poor. Maternal level of education, occupation, income, and lesser number of children in the family were the factors that were significantly associated with seeking health facility care for a sick U5. This study recommends girl child education, women empowerment, and increase access to family planning by the government.

A Review of the Impact of Patent Medicine Vendors in Driving Community Tuberculosis Case Finding in the COVID-19 Pandemic in Nigeria

This review elucidates the pivotal role of patent medicine vendors (PMVs) in advancing community tuberculosis (TB) case finding in Nigeria, amidst the disruptions caused by the COVID-19 pandemic. By synthesizing insights from in-depth analyses, the article explores PMVs’ adaptability, knowledge, community trust, and contributions to TB case-finding efforts during this unprecedented period. The study reveals that PMVs, despite varying levels of knowledge on TB symptoms and diagnosis, have demonstrated significant resilience and adaptability, incorporating innovative approaches such as virtual consultations to sustain case finding during the pandemic. Their substantial involvement in health-care delivery, especially in underserved areas, and the evident community trust in their services, positions them as crucial health-care resources in regions with limited access to formal health-care services. However, the review also uncovers challenges, including the need for quality assurance and adherence to guidelines, and emphasizes the importance of tailored training programs to bridge knowledge gaps and empower PMVs to contribute more effectively to early TB detection. The study underscores the potential of PMVs to bridge gaps in health-care access and advocates for strengthened collaborations between PMVs and formal health-care systems to optimize their role in identifying and referring suspected TB cases effectively. In conclusion, the article highlights the transformative contribution of PMVs in TB case finding in Nigeria, during the COVID-19 pandemic and proposes recommendations to enhance their impact through capacity strengthening, integration into formal health-care systems, and leveraging innovative technologies. The findings suggest that harnessing the potential of PMVs can significantly contribute to controlling TB and improving public health outcomes, especially in anticipation of further outbreaks, by fostering a more community-centered approach to case finding.

Improving Contraceptive Service Quality and Accessibility for Adolescents and Youth Through Proprietary Patent Medicine Vendors in Four Nigerian States.

In Nigeria, health care services and commodities have increasingly been accessed through private sector entities, including retail pharmacies and drug shops (also called proprietary patent medicine vendors [PPMVs]). However, PPMVs cannot provide long-acting or permanent methods, and concerns have been raised about their quality of services and their need to better comply with government regulations. This article describes how The Challenge Initiative's (TCI) family planning program supported 4 state governments in Nigeria to develop a model to strengthen public-private partnerships between PPMVs and primary health centers (PHCs) to leverage PPMVs to provide adolescents and youth with high-quality contraceptive information, services, and referrals to PHCs. The intervention implemented a hub-spoke model by strengthening the linkages between neighboring PPMVs and large PHCs for delivering contraceptive services to adolescents and youth. The steps in the implementation process included: (1) introducing the intervention to state governments, (2) selecting PPMVs as spokes and high-volume PHCs as hubs, (3) conducting whole-site orientations jointly with PPMV and PHC staff, (4) strengthening referral links between PPMVs and PHCs, (5) implementing supportive supervision and coaching, and (6) strengthening client data management. TCI worked with the state and local ministry of health to improve PPMV operators' knowledge, attitudes, and skills to deliver adolescent- and youth-friendly services. Implementing the PPMV intervention with state governments and PHCs strengthened the public-private partnership. A functional referral system in Plateau State demonstrated significant success, enabling increased contraceptive choice and adherence to regulations for adolescents and youth. We recommend that the government strengthen the working relationship between PPMVs and PHCs, incorporate PPMVs into the routine supportive supervision of the state health system, and incorporate a referral linkage with PHCs into the design and implementation of PPMV programs.

Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa.

The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.