Secondary Health Facilities Research Articles

Medication Adherence and Health Status in HIV Positive Patients in Akwa Ibom State, Nigeria

Purpose: To assess medication adherence and health status in ambulatory HIV positive patients in Akwa Ibom State, Nigeria.Methods: The 7-item Adherence to Refills and Medication Scale (ARMS-7) was used to assess medication adherence among 500 HIV positive patients in three secondary health facilities in Akwa Ibom State, Nigeria. A single-item question (measuring self-rated health) and depression (CESD-R) questionnaire were also used to evaluate the patients. Recent CD4 count and viral load were obtained from the patients’ folders. The association between independent and dependent variables was evaluated using logistic regression analysis.Results: Only 56 (11.7%) respondents reported 100% adherence to their medications; 190 (39.7%) rated their health as being ‘very good’ and 51 (10.7%) reported being depressed. Respondents who were single were more likely to be nonadherent (aOR = 2.665, 95% CI = 1.336 - 5.318; p = 0.005), and the nonadherent patients were more likely to have lower CD4 cell counts (aOR = 0.998, CI = 0.996 – 0.999; p = 0.007). Those who rated their health as ‘fair’ or ‘poor’ were more likely to be nonadherent (aOR= 11.380, CI = 1.527 – 84.785; p=0.018) and depressed (aOR = 2.748, CI = 1.469 – 5.141; p = 0.002). Patients who were unemployed were more likely to rate their health as fair/poor (aOR = 1.890, CI = 1.197 – 2.985; p=0.006).Conclusion: This work has shown that even though most of the HIV positive patients perceive their health as being very good, their adherence to medications was poor which is directly related to their unemployment status. Intervention to improve adherence directed at socio-economic status of the individual patient is recommended.
 Keywords: Medication adherence; Depression; Self-rated health; Nigeria

Epidemiology and Public Health 2020: Reasons Leading to Influenza Vaccine Acceptance and Decline among Tunisian Healthcare Workers

Despite of recommendations, influenza vaccine (IV) coverage among healthcare workers remains low in many countries. We aimed in this study to assess the main reasons leading to flu vaccine acceptance and decline among Tunisian healthcare workers through a study of knowledge, attitudes and practices towards influenza immunization. It was a cross sectional study conducted in Tunisian primary and secondary healthcare facilities from March to May 2019. Health professionals were enrolled according to a self-weighted multistage sampling. A face to face questionnaire was administered to participants. Reasons leading to IV acceptance and decline were assessed through open-ended questions. A total of 1230 HCWs were included in the study with a mean age of 44.5±9.3 years and a sex-ratio (M: F) of 0.25. Among participants, 43.1% (95%CI: [40.3-46.0]) were willing to receive the flu vaccine if recommended to caregivers and provided for free. According to participating healthcare workers, the main three reasons leading to vaccine acceptance were: self-protection (73.8 % [71.3-76.3]) and family and patients’ protection (49.2% [46.4-52.0] and 28.2% [25.8-30.7] respectively). Regarding reasons leading to IV decline, fear of the vaccine side effects (48.0% [40.3-46.0]), feeling not concerned by the flu vaccine (31.8% [29.3-34.4]) and doubt about vaccine efficacy (31.6% [28.8-34.3]) were the most frequent cited reasons. Less than half of participants were willing to receive the IV. Fear of flu vaccine side effects was the most frequently reported reason leading to vaccine decline. Health authorities should thus organize regular training sessions in healthcare facilities aiming to educate caregivers about IV composition and safety.

Screening for depression among dental patients in Benin city sub population of Nigeria

Introduction: Oral health has been significantly associated with the wellness of an individual which includes physical and psychological wellbeing. In the recent past due to various reasons, depression has been noted to be evident in population. The patients visiting dental clinics are of no exclusion to have experienced depression. Aim: to determine the prevalence of depression among dental outpatients in an secondary health facility in Benin City using the Patient Health Questionnaire-9 (PHQ-9). Materials and Methods: This cross-sectional study mixed observational and clinical study using questionnaire and clinical oral examination was conducted among patients attending the dental outpatient clinic of Stella Obasanjo Hospital between December 2018 and January 2019. Results and Discussion: About one-quarter (28.6%) had depression of the mild severity. Depression was highest among the 31–40 years, females, those with primary education and those that earn less the 30,000 naira monthly and nonindigenous participants. Participants with mild depression presented more with acute apical periodontitis, dental caries, and periodontal disease than those without depression. Conclusion: Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. Further studies on patients with symptomatic chronic dental condition are recommended.

Women’s Knowledge and Perception of Teratogens and Their Effect in First Trimester of Pregnancy in Antenatal Care Units of Secondary Health Facilities in Kebbi State, Nigeria

The study was conducted to evaluate the knowledge and perception of teratogens among pregnant women attending antenatal care units in secondary health facility in kebbi state. A descriptive survey design using a probability sampling technique was employed and 120 patients were selected using a questionnaire as an instrument for data collection. The data collected was analyzed using descriptive statistics, the results was presented in frequency distribution tables and percentages. On knowledge and perception of the respondents on teratogens effect, Findings shows that about 48.3 % of the respondents were aware of the teratogens; while about 51.7 % were not aware of the teratogens and their effect. On the substances that are teratogens in nature 35 % said are the most common teratogens,34.2 % of the respondents said dust is the common teratogens they know.meanwhile;30.8% of the respondents said alcohol is the dangerous teratogens. It can be noted that majority of the respondents (49.2 %) takes drugs on prescription only. While 24.1% takes their drugs on non-prescription bases. 13.3 % of the respondent do smokes and also 13.3% of the respondents keep appointment with A.N.C visits. Also those respondents that visits hospital for any new complains were 17%, while those respondents that use herbal medicine to treat any ailment were 83%.. In conclusion there is no doubt that menace of teratogens effect among pregnant women is increasingly becoming a major public health problem in our society.it was recommended that all pregnant women especially primis should be cautioned extensively about teratogens substances and their consequent effect. This project has shown that the level of knowledge of teratogenic substances and their effect in first trimester of pregnancy is low in secondary health facility in kebbi state. KEY WORDS KNOWLEDGE: information or learning gain through experience or education. PERCEPTION: a way of regarding, understanding or interpreting something. TERATOGEN: any substance, agent, or process that induces the formation of developmental abnormalities in a fetus. TRIMESTER: any one of three successive three-month periods into which a pregnancy is divided. EFFECT: a change which is a result or consequence of an action or other cause. PREGNANCY: the condition or period of being pregnant. WOMAN: an adult human female. DOI: 10.7176/JHMN/82-06 Publication date: November 30 th 2020

Comparison of the Level of Adherence to Laboratory Quality Management System between Public and Private Secondary Health Facilities in Southern Nigeria

BACKGROUND: To achieve improved health outcomes of HIV positive patients receiving ART services, quality laboratory services must form an essential part of the services provided. The aim of this study was to compare service quality by assessing the level of adherence to quality system essentials (QSEs) in laboratory services delivered by public and private health institutions in Southern Nigeria. 
 
 METHODS: This was an analytical cross-sectional study conducted among 50 health facilities’ laboratories in 5 Southern States (Akwa Ibom, Anambra, Cross River, Edo and Rivers) of Nigeria. Randomly selected sample of secondary health facilities’ laboratories (ten per state, and a total of 25 public and 25 private health facilities) receiving equal level of support from the same USAID/PEPFAR implementing partner and had been providing ART services to clients for a minimum of one year, were included in the study. Quarterly Internal quality audit was conducted in the ART Laboratory section of the selected health facilities spanning July 2015 to September 2016. 200 audit reports were checked, cleaned, and analyzed using SPSS version 23. We analyzed changes in mean performance scores over time across 6 quality management essentials using Repeated Measures ANOVA. Results were considered significant at P<0.05.
 
 RESULTS: The result of the study showed that the private health facilities laboratory achieved a significantly higher improvement in Facility and Safety score over time (p=0.019) compared to public health facilities. Overall, temporal improvements were recorded in all facilities in three out of the six QSEs (document and record, p=0.045; organization and personnel, p=0.020; equipment, p<0.001) and total laboratory quality score (p=0.004). But there was no significant quarterly difference in performances on QSEs between public and private health facilities laboratories. 
 
 CONCLUSION: Our findings indicate that despite receiving the same level of external support, private hospital laboratories adhere better to the quality standards on Facility and safety than public hospital laboratories in Southern Nigeria.

Maternity Clients Satisfaction with Client-Health Provider Interaction in State-owned Secondary Health Facilities in Cross River State

INTRODUCTION: Satisfaction with care is a facilitator and major determinant of facility-based maternal healthcare utilization. It is therefore worrisome when maternity clients express dissatisfaction with any aspect of maternity care as this tend to discourage them from patronizing facility-based maternal services. This study examined Maternity Clients Satisfaction with Client-Health Provider interaction in State-owned Secondary Health Facilities in Cross River State.
 
 METHODS: The study adopted a cross-sectional survey design while a multistage sampling technique was used to select a sample population of 754 women of reproductive age found accessing maternal healthcare services in the studied facilities. A structured questionnaire was used to collect data and data obtained was analyse using descriptive techniques. 
 
 RESULT: Maternity clients were dissatisfied with the dimension of healthcare provider respect for clients as 321(42.6%) were dissatisfied and 133(17.6%) were “very dissatisfied”. Areas of dissatisfaction were health provider tone of voice, politeness and show of sympathy and support. However, clients were satisfied with healthcare provider provision of information as 234(31.0%) were “very satisfied” and 225(29.8%) were “satisfied”. 
 
 CONCLUSION: Based on the findings, it was concluded that respect for clients dimension of client-health provider interaction is a cause of dissatisfaction among maternity clients accessing care in State-Owned secondary health facilities. It was therefore recommended that stakeholders should make recruitment and retention of healthcare providers a priority as work overload affects interpersonal interactions. Also, update workshops on respectful maternity care should be organized at regular intervals for healthcare providers involved in maternity services.

Awareness, Risk Factors and Prevalence of Viral Hepatitis B and C among Antenatal Attendees in South-southern Nigeria: A Cross-sectional and Hospital-based Study

Background: Viral hepatitis was responsible for 1.34 million deaths globally in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Although hepatitis B and C viral infections are major causes of liver cirrhosis or/and hepatocellular carcinoma, knowledge is limited and prevalence underestimated because of poor surveillance programs in most developing countries. Objectives: The aim of this study was to evaluate the level of awareness/knowledge, risk factors and prevalence of viral hepatitis B and C amongst antenatal attendees in a secondary health-care facility. Study design: The study was cross-sectional, descriptive and hospital-based. Methods: A total of 218 pregnant women were recruited from the antenatal clinic of Central Hospital Warri using simple random technique after approval from the institutional review board and consent from the participants. They were screened for Hepatitis B and C viral infections using a rapid immune-chromatographic test strip. Samples positive for HBsAg were screened for other HBV biomarkers using a 5 in one test cassette. Result: Of the 218 women screened, 3 (1.4%) were positive for HBsAg while 4 (1.8%) reacted for HCV antibodies. All positive cases for HBsAg were negative for HBeAg and HBsAb, but positive for HBeAb and HBcAb. Age-grade 31-40 gave the highest age-based prevalence 1.92% for HBsAg while participants younger than 20 years had the highest age-based prevalence of 20% (2/10) for HCV. Multiparous women had 2.8% for HBsAg while nulliparous/primiparous participants have the highest HCV antibody prevalence of 3.1%. For other variables measured, self-employed, Secondary school education, lack of HBV vaccination, women who share sharps and participants that engaged the services of quacks for invasive procedures gave the highest prevalence in their respective categories. Conclusion: The prevalence of 1.4% and 1.8% reported by this study for HBV and HCV respectively is relatively low when compared to a previous report for the study region and other Nigerian studies. However, the poor level of awareness/knowledge and high level of exposure to predisposing risk factors among the study population calls for urgent intervention if vision 2030 will be a reality for the study region.

Causes and determinants of neonatal deaths: Evidence from a secondary care hospital in Bangladesh

Background: Neonatal death is a major barrier to improve child survival in Bangladesh. This study assessed the patterns of neonatal admissions, causes of deaths and associated risk factors to prioritize and design interventions to improve quality of services.
 Materials & Methods: This study was conducted at the Satkhira District Hospital, a secondary health care facility in Bangladesh. From January to December 2014 hospital records of neonatal admissions and outcomes were reviewed and analyzed. Risk factors were determined by logistic regression analysis.
 Results: A total of 2,632 neonates were admitted during the period. More than one-third had admission bodyweight below 2500 grams. The leading causes of admissions were perinatal asphyxia (39.6%), prematurity/low-birth weight (LBW) (16.3%), pneumonia (11.9%) and sepsis (10.0%). The overall neonatal case fatality rate (CFR) was 11.7%. The main causes of neonatal deaths were perinatal asphyxia (41.6%) and prematurity/ LBW (35.8%). Most of the deaths (74.3%) occurred on first day of life. Significant risk factors for death were body weight on admission <1500 grams (OR: 17.08; 95% CI: 7.22 - 40.44; p<0.001), first day of life (OR: 7.99; 95% CI: 2.86 -22.27; p<0.001).
 Conclusions: The main causes of neonatal deaths were perinatal asphyxia and prematurity/LBW and most of the deaths occurred on first day of life.
 Bangladesh J Child Health 2019; VOL 43 (3) :138-144

Pattern and treatment of adverse event following immunization (AEFI) in infants attending well-baby clinics in secondary health facilities in Benin City, Nigeria

Pattern and treatment of adverse event following immunization (AEFI) in infants attending well-baby clinics in secondary health facilities in Benin City, Nigeria

Assessment of Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting Among Healthcare Professionals working in Primary, Secondary and Tertiary Healthcare Facilities in Ekiti State, South-West Nigeria.

Adverse drug reactions (ADRs) constitute a significant global healthcare challenge associated with increased morbidity, mortality and healthcare costs; however, there are concerns that ADRs are grossly under-reported by different categories of healthcare professionals (HCPs) in many countries. The main objective of this study was to assess the knowledge, attitude and practice of ADR reporting of HCPs working at the primary, secondary and tertiary levels of care in Ekiti State, Nigeria. This was a self-administered questionnaire-based study conducted among HCPs working in Ekiti State, South-west Nigeria. The questionnaire which was adapted from ones used in similar studies was reviewed for content validity by experts in the field. Healthcare professionals (medical doctors, pharmacists, nurses, community health extension workers, and other allied HCPs) working in the 3 tiers of healthcare participated in the study. The questionnaire consisted of sections on the demographics of respondents, their knowledge, attitude and practice of ADR reporting. Data analysis was done using SPSS (version 25) employing t test, ANOVA and chi-square as appropriate with P-value < .05 accepted as being statistically significant. Three hundred HCPs comprising of nurses (112; 37.3%), physicians (75; 25.0%), pharmacists (53; 17.7%), community health extension workers (40; 13.3%) and others (20; 6.7%) completed the questionnaire with 166 (55.3%) of them working in tertiary healthcare facilities. Male respondents (6.3 ± 1.7; P = .003), pharmacists (7.0 ± 1.6; P < .0001), HCPs and those from tertiary centers (6.2 ± 1.7; P = .028) had higher knowledge scores. While 228 (76%) respondents had observed incidents of ADR during their professional practice, only 75 (25%) have ever reported it. Only 113 (37.7%) of respondents had seen the adverse drug reaction reporting form with only 53 (17.7%) ever using it. The reporting methods preferred by respondents were through email/internet (102; 34.0%), phone/SMS (78; 26.0%) and using the hard copy of the forms (95; 31.7%). The attitude of respondents towards ADR reporting was mainly positive. There was significant variation in the knowledge of different categories of HCPs and facility levels about ADR reporting. Encouragingly, the overall attitude of respondents towards ADR reporting was positive. Based on the above, strategies are needed to build capacity of HCPs in the area of on adverse drug reaction and its' reporting.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

Medical waste management practices in a selected secondary healthcare facility

Introduction: Living things and human activities produce huge waste every day. Globally medical waste is the second most hazardous waste after radiation waste. In this context, this study was a modest endeavor to examine the current situation of ‘Jamalpur 250 Bed General Hospital’s’ medical waste management practice.&#x0D; Methods : This cross sectional study was conducted among doctors, nurses, laboratory technicians and sanitary staffs at ‘Jamalpur 250 Bed General Hospital’. 185 healthcare personnel were purposively interviewed (face to face) to assess previous and existing knowledge and practices of medical waste management. Informed written consent was taken from the study subjects before taking interview. Data was collected by a pretested semi-structured questionnaire.&#x0D; Results : In our current study, out of 185 respondents, 10.0% were doctors and 43.0% were nurses. Five among six color coding segregation system, below 50.0% of the respondent answered correctly. Only 23.8% respondents revealed that the waste handler use PPE properly. 90.8% respondents were mentioned about the lack of storage place for medical waste at hospital premise. 55.7% respondents didn’t know about the in house disinfection process, 56.8% respondents didn’t know about the municipal vehicle support and 52.4% didn’t know about the availability of waste management equipment. Poor knowledge with favorable attitude and risky medical waste management practice of this hospital’s healthcare personnel were detected.&#x0D; Conclusion : This study were indicated that the majority of healthcare personnel did not apply the recommended medical waste management practice set by WHO. Moreover, the current medical waste management practice in selected district hospital was not managed properly and could pose a risk for human health and the environment.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(4): 160-165

Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season

Abstract Background Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination. Methods A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions. Results A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV. Conclusions Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community. Key messages Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.

Determinants of influenza vaccination intention among Tunisian elderly

Abstract Background Influenza vaccination coverage among elderly remains unsatisfactory even in developed countries. Since attitudes are predictors of behavior, understanding factors influencing the intention to receive influenza vaccine (IV) among elderly may orientate interventions to increase vaccination rate. The aim of the current study was to identify factors associated to willingness to receive IV next season among Tunisian elderly. Methods During 2018 -2019 flu season a cross-sectional study was conducted among older persons aged 60 years and over with chronic disease attending primary and secondary health care facilities. The intention to get vaccinated against influenza was measured by means of a face to face questionnaire. Factors that affect willingness to receive IV were identified using a multiple logistic regression analysis. Results Of the 1191 older persons included, 19.4% [17.1-21.9] participants received IV in 2018-2019 flu season, 64.7% [61.9-67.3] expressed willingness to be vaccinated next season. Willingness to receive IV was more likely among persons with chronic pulmonary disease (ORa=2.6), those suffering from diabetes (ORa=1.6), those who received IV in 2018-2019 flu season (ORa=16.5), those who feel that they get enough information about vaccines and their safety (ORa=2.9) and persons who trust the advice of their health care providers (ORa=4.5). Conclusions Vaccination status was the most determinant factor associated to willingness to receive the vaccine. Therefore, sustainable efforts to promote IV may lead to cumulative increase of influenza vaccination coverage year by year. Doctors should be involved more in advocating IV and providing elderly with the necessary information about IV, but that could not be effective without a climate of trust between patients and health care providers. Key messages Positive self-experience of older persons with IV may change their perception about it and encourage them to adhere to the vaccine in the future. Elderly should be provided with the necessary information about IV in terms of effectiveness and safety.

Prevalence of seasonal Influenza vaccination among Tunisian elderly

Abstract Background Surveys to determine the uptake of influenza vaccine (IV) among the at-risk groups are required to evaluate the advancement of national vaccination strategies and the level of awareness in the surveyed population. In this context, the present study aimed to estimate influenza vaccination uptake in elderly in Tunisia during 2018-2019 influenza season and to assess their perceptions toward influenza and IV. Methods It was a national cross-sectional study conducted in 2019 in primary and secondary health care facilities, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire including questions about IV uptake, general knowledge and attitudes about influenza and IV. Perceptions of participants toward general statements about influenza and IV were compared by vaccination status using chi square test. Results In total, 1191 older persons were included. Nearly one third of participants (34.8% [32.2-37.6]) were vaccinated at least once at the past and 19.4% [17.1-21.9] received the vaccine during 2018-2019 influenza season. Compared to unvaccinated elderly, vaccinated persons were significantly more convinced that influenza is more dangerous for elderly people (90.0% vs. 82.2%, p = 0.008), that IV is recommended for older persons (88.7% vs. 70.1%, p &amp;lt; 0.001) and for those with chronic disease (86.1% vs. 64.1%, p &amp;lt; 0.001) and that IV can protect elderly persons (87.9% vs. 71.9%, p &amp;lt; 0.001) and those with chronic disease (88.3% vs. 66.3%, p &amp;lt; 0.001). Regarding attitude about the safety of the vaccine, while 14.4% of unvaccinated persons agreed that IV is not safe for older persons, only 9.5% of vaccinated elderly approved that statement (p = 0.060). Conclusions Our study showed a low influenza vaccination rate among Tunisian elderly. In order to promote IV, campaigns should focus on educating elderly regarding the seriousness of influenza and the efficiency and the safety of IV. Key messages Efforts must be invested to improve influenza vaccination coverage among Tunisian elderly especially those with chronic diseases. Educating elderly regarding influenza and IV is necessary since knowledge is a basis for adopting relevant attitudes and practices.

Willingness of healthcare workers to recommend seasonal influenza vaccine to patients- Tunisia, 2019

Abstract Background Most countries of the Eastern Mediterranean Region have low influenza vaccination coverage mainly among high risk groups. Advice to receive the influenza vaccine by healthcare workers (hcws) seems to be an important motivator for vaccine acceptance among patients. In this study, we aimed to describe the willingness of Tunisian hcws to recommend the seasonal influenza vaccine to patients and to assess its determinants. Methods A cross-sectional questionnaire-based study was conducted in Tunisian primary and secondary healthcare facilities during the 2018-2019 influenza season. A multivariate logistic regression was used to assess the factors associated with the willingness of hcws to recommend the influenza vaccine to patients. Results In the present study, 1231 hcws were included with a mean age of 44.5±9.3 and a sex ratio (Male/Female) equal to 0.25. Among respondents, more than three quarter (79.1%, 95% CI: [76.7-81.3]) declared their willingness to recommend the influenza vaccine to patients if available. In multivariate analysis, belief that influenza vaccine is a severe illness that may lead to death (adj.OR = 2.9, 95% CI: [1.9-4.1]) and previous influenza vaccine uptake among health professionals (adj.OR = 2.4, 95% CI: [1.5-3.9]) were independently associated with the willingness of hcws to recommend the flu vaccine to patients. Conclusions This study showed that hcws with a history of influenza immunization and those who were aware of influenza severity were more likely to be willing to recommend the influenza vaccine to patients. These findings should be considered in future educational programs to enhance hcws' recommendation of influenza vaccine. Key messages Majority of Tunisian healthcare workers declared their willingness to recommend the influenza vaccine to patients. Healthcare workers’ awareness of influenza severity and history of influenza vaccine uptake were associated with a higher willingness to recommend the flu vaccine.

Medication use among pregnant women at a secondary health institution: utilisation patterns and predictors of quantity.

Despite the lack of adequate studies on the safety of drugs in pregnancy, surprisingly, available evidence shows that pregnant women still take large number of drugs. The study aim was to determine drug utilization pattern and predictors of number of medications used by pregnant women. This was a cross-sectional survey of 369 pregnant women attending a secondary health facility. Data were collected using interviewer-administered questionnaire. Descriptive and inferential statistics using the Chi-Square test were carried out with level of significance set at p<0.05. Three hundred and sixty-nine women were interviewed. Their mean age was 27.7 years (SD± 4.78) and the mean number of pregnancies was 2.46 (SD± 1.34). On average, 2.62 medications were taken, with the lowest being 1 and the highest being 12 different medications during the course of pregnancy. Those who were on more than 2 medications were more likely to be older than 30 years, had lower education and with history of associated medical conditions. All participants were on one form of supplements or the other, nearly half had used antimalarials, 12.8%, 5.8% 2.4% were on antibiotics, anti-hypertensive and anti-retroviral medications respectively. All the medications prescribed were from category A, B, C, N, and none from category D and X. Varieties of medications were used during the course of pregnancy among this population, however, most of these drugs were still within safety profile.

Adjuvant chemotherapy-associated febrile neutropenia in a patient with breast malignancy: A case report

Adjuvant chemotherapy has been widely applied in patients with breast malignancy after surgery to prevent its recurrence and to improve survival comprehensively. Febrile neutropenia is one of the most life-threatening chemotherapy-associated toxicities. A 66 years old woman came to an emergency department of a secondary healthcare facility one week after her final chemotherapy with dose regimen of docetaxel and epirubicin, followed by having nausea, vomitus, and general fatigue with a fever of 38.2°C. Based on her medical record, she had experienced breast malignancy for almost two years and had already conducted mastectomy three months after her diagnosis. Her leukocyte number was only 300 cells per mm3, with 23% neutrophil, hypoalbuminemia, and hypokalaemia. She was then treated in an internal ward and was given intravenous ceftazidime, fluid, granulocyte colony-stimulating factor, albumin transfusion, intravenous potassium replacement, and symptomatic medication. After two days of inpatient care, she was referred to an oncology team in a tertiary healthcare facility. Febrile neutropenia is considered as a fever with a low neutrophil number as a result of bone marrow suppression. The neutrophil plays an essential role as the body’s first line of defence. This condition could make the patient more vulnerable to infections. The Patient was given broad-spectrum antibiotics and typically hospitalized to allow close monitoring until the neutropenia was resolved. Febrile neutropenia possesses a serious threat to patients with breast malignancy who are on cytotoxic chemotherapy. Urgent full blood count and immediate broad-spectrum antibiotic administration are significant to reduce morbidity and mortality.

The effect of an educational intervention to improve tuberculosis infection control among nurses in Ibadan, south-west Nigeria: a quasi-experimental study

BackgroundNurses are particularly vulnerable to acquiring tuberculosis (TB) because they are in the frontline of patient care. There is inadequate implementation of cost-effective TB infection control (TBIC) measures in most health facilities. Training has been shown to be effective in improving the knowledge and work practices of nurses. This study sought to utilize a multi-method educational intervention to improve the TBIC-related knowledge and practices of nurses in two secondary health facilities in Ibadan, South-West Nigeria.MethodsThis quasi-experimental study involved 200 nurses (100 each in the intervention and comparison groups). Baseline data were collected in May 2014. This was followed by training of the nurses in the intervention group. After 6 months, the second wave of data was collected and the nurses in the comparison group also received the training thereafter. The final wave of data collection took place 12 months after the commencement of the study. The mean scores of the nurses were determined and comparison was made between both groups at different time points using independent t-test.ResultsThe nurses in both groups were statistically comparable in their socio-demographic characteristics, and baseline mean knowledge (68.6 and 67.7%) and practice scores (79.1 and 80.6%) respectively. After the intervention group received the intervention, there were appreciable improvements in the scores at 6 months (knowledge – 85.9%, practice – 98.5%), which were significantly different from those of the comparison group (knowledge – 69.5%, practice – 78.8%). A large effect size was demonstrated in the improvement in knowledge score in the intervention group at 6 months compared with the other group (Cohen’s d = 1.7). Similarly, there were improvements in the scores of the nurses in the comparison group at 12 months after the group had also received the intervention (knowledge – 88.2%, practice – 93.5%). At this point, the mean scores between both groups were no longer significantly different.ConclusionsThe improvement in post-intervention scores implies that the educational intervention adopted for this study was effective in improving TBIC among the nurses. It also underscores the importance of continuous training/retraining of nurses and other healthcare workers in improving and sustaining TBIC at health facilities.

Association of Intrapartum Risk Factors and Infant Clinical Indicators with Culture Confirmed Early Onset Neonatal Sepsis in a Secondary Care Rural Hospital in India.

The aim of this study is to determine the association of intrapartum risk factors and infant clinical indicators using the National Institute for Health and Care Excellence (NICE) criteria with culture-positive early-onset neonatal sepsis (EONS) from a rural secondary healthcare facility where intrapartum prophylactic antibiotics are routinely administered to high-risk mothers. A single-center prospective observational study was conducted between July 2017 and September 2018. All intramural neonates with at least one NICE criteria at less than 72 h of life, were included. Univariate logistic regression and multivariable logistic backward elimination analyses were conducted to investigate individual risk factors and predictive models for culture proven EONS. Of 236 newborns who were at risk for EONS by NICE criteria, 32 (13.8%) had positive blood cultures. Klebsiella species (n = 13, 39.4%) and Acinetobacter species (n = 11, 33.3%) were the most common isolated bacteria. In univariate analysis, the number of infant clinical indicators were associated with culture positive EONS (OR 1.36; 95% CI 1.01-1.81), but not the number of intrapartum risk factors (OR 0.76; 95% CI 0.4-1.29). The multivariate logistic regression with backward elimination procedure suggested that a model including absolute neutrophil count [adjusted OR (aOR) 0.81; 95% CI 0.72-0.92], C-reactive protein (aOR 1.24; 95% CI 1.08-1.43) and the number of clinical indicators (aOR 1.29; 95% CI 0.93-1.80) could be useful to predict culture positive EONS in our setting. In this maternal and neonatal cohort, infant clinical indicators rather than intrapartum risk factors were associated with culture confirmed EONS.