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Garcinia kola (Colanut) is a well-known indigenous plant with several pharmacological activities that is widely consumed in most Northern parts of Nigeria. It is traditionally believed to serve as a remedy in the management of diarrhoeagenic bacterial infections. This study investigated the prevalence of pathogenic bacteria on the surface of colanuts sold within Kaduna North Local Government Area, Kaduna State. A total of sixty-four (64) bacteria were isolated from the samples, and were identified based on their cultural, Gram reaction, and biochemical characterizations. The pathogens were tested against selected antibiotics using Agar well diffusion method. The isolates were confirmed to be Salmonella specie (46%), Escherichia coli (32%) and Staphylococcus aureus (22%). People who consume colanut without proper washing are at high risk of contracting infections caused by the aforementioned pathogens. [ABSTRACT FROM AUTHOR]

Personal experience of side effects with antidepressant medicines has a major impact on treatment continuation as it directly influences medication adherence. The aim of this study was to assess self-reported antidepressant side effects and associated factors in patients with major depressive disorders at a tertiary health facility in North east Nigeria. A cross sectional study involving 101 participants was conducted at the Federal Neuro-Psychiatric Hospital Maiduguri from September 2019 to November 2019. Data were gathered using a data collecting form and interviews with respondents. Most of the patients (51.50%) were prescribed the tricyclic class of antidepressants, especially amitriptyline. About 59.4% of the study participants reported some side effects they attributed to their medications. The most commonly reported side effects were headache (19.90%), sleeplessness (19.90%), palpitation (19.90%) and sedation (13.40%). Factors such as; being male (p=0.044, OR= 3.36), having no formal education (p=0.005, OR=4.3) and being unemployed (p=0.029, OR=3) were found to be associated with self report of antidepressant medication side effects among the study participants. In conclusion, self-reported medication side effects are highly prevalent in patients with major depressive disorder in this study site. The most commonly reported side effects were headache, sleeplessness, sedation and palpitation. Socio-demographic factors such as being male, having just primary or no formal level of education and being unemployed were found to be significantly associated to self report of antidepressant side effects in these patients. [ABSTRACT FROM AUTHOR]

Background: The novel SARS-CoV-2 virus that causes Coronavirus disease (COVID-19) has redefined global health and response to Acute Respiratory Infection (ARI). The outbreak of a cluster of influenza-like illnesses in Wuhan, China, has morphed into a pandemic in the last quarter of 2019, stretching from South East Asia to Europe, The Americas, Africa, and the Australian subcontinent. We evaluated the prevalence of depression among outpatients diagnosed with ARI., Materials and Methods: We utilized a cross-sectional, observational design and investigated the prevalence of symptoms of depression among outpatients with ARI and described the characteristics of outpatients with ARI in Kaduna State., Results: The prevalence of symptoms of depression was 19.6% for respondents with symptoms of ARI and 14.4% for those without symptoms of ARI. On no risk of depression, we had a higher proportion of the respondents without symptoms of ARI (86%) than those with symptoms of depression (80%) (M = 318.4, SD = 29.62 case, and M = 344.0, SD = 14.2 control, r = 0.88, CI = 13.5 to 6.5, P = 0.000952). Likewise, in the category with mild risk of depression, respondents without symptoms of ARI were fewer (10%) than those with symptoms of depression (15%) (M = 58.4, SD = 26.0 case, and M = 42.1, SD = 12.7 control, r = 0.86, CI = 11.8 to 5.8, P = 0.0136. There was no significant difference between respondents with symptoms of ARI and without symptoms of ARI in the categories of moderate (M = 13.6, SD = 5.1 case, and M = 11.6, SD = 4.6 control, r = 0.87, CI = 2.3 to 2.1, P = 0.178) and high (M = 5.6, SD = 2.5 case, and M = 4.4, SD = 3.2 control, r = 0.61, CI = 1.2 to 1.5, P = 0.174) risk of depression., Conclusion: Symptoms of depression were commoner among respondents who presented with symptoms of Acute Respiratory Infection (ARI) at the Outpatient Department (OPD). However, further explanatory research is needed to establish causality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Umeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cryptosporidium is one of the most important protozoan parasitic pathogens, and it is a common cause of diarrhoea in humans, domestic animals, and wild vertebrates and has serious public health threats. A cross-sectional study was designed to determine the prevalence of Cryptosporidium oocysts in raw-eaten vegetables in Maiduguri Metropolitan Council (MMC) and Jere Local Government Areas (LGAs). A total of 400 samples were collected from four (4) different locations, namely Tashan Bama, Gomboru, and Monday Markets (n = 100), while fifty (n = 50) each from 202-Vegetable-Vendors and Unimaid Commercials. A total of 16 visits were conducted in all the sampling areas (twenty-five samples per visit). The Cryptosporidium oocysts were detected using the Modified Ziehl-Neelsen Staining Technique. The locations, sources, and types of raw-eaten vegetables were also assessed. The oocysts were confirmed (100×) as bright pink spherules. Data generated were analyzed using IBM-SPSS V23.0, and p ≤ 0.05 was considered significant. Out of the total samples (n = 400) analyzed, cabbage appeared to have the highest number of 10 (12.5%) of Cryptosporidium oocysts detected, while Tomato and garden egg had 9 (11.3%) and 1 (1.2%), respectively. There was a statistically significant association (χ 2  = 12.5, P = 0.014) between the presence of Cryptosporidium oocysts in raw-eaten vegetables and vegetable types. Among the sources of the vegetables sampled, Alau had the highest number of Cryptosporidium oocysts, 15 (12.5%), followed by Kilari-Abdullahi and Zabarmari sources with 4 (10.0%) and 4 (5.0%), respectively. However, Jetete appeared to have the least number 2 (2.5%) of oocysts, and there was a statistically significant association (χ 2 = 10.4, P = 0.034) between the presence of Cryptosporidium oocysts and the sources of vegetables and fruits. The study concludes that the raw-eaten vegetables sampled from Maiduguri Metropolis were contaminated with Cryptosporidium oocysts. The study recommends that all raw-eaten vegetables should be from cleaned sources and washed before consumption. Consumers should be enlightened on the hygienic measures in the food chain in line with the Hazard Analysis and Critical Control Points (HACCP) principles., (© 2023. The Author(s).)

Background: A birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions., Methods: This two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang'a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country., Discussion: Ample evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings., Trial Registration: Trial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The need for evidence-based data, to inform policy decisions on malaria vector control interventions in Nigeria, necessitated the establishment of mosquito surveillance sites in a few States in Nigeria. In order to make evidence-based-decisions, predictive studies using available data becomes imperative. We therefore predict the distribution of the major members of the Anopheles gambiae s.l. in Nigeria. Immature stages of Anopheles were collected from 72 study locations which span throughout the year 2020 resulted in the identification of over 60,000 Anopheline mosquitoes. Of these, 716 breeding sites were identified with the presence of one or more vector species from the An. gambiae complex and were subsequently used for modelling the potential geographical distribution of these important malaria vectors. Maximum Entropy (MaxEnt) distribution modeling was used to predict their potentially suitable vector habitats across Nigeria. A total of 23 environmental variables (19 bioclimatic and four topographic) were used in the model resulting in maps of the potential geographical distribution of three dominant vector species under current climatic conditions. Members of the An. gambiae complex dominated the collections (98%) with Anopheles stephensi, Anopheles coustani, Anopheles funestus, Anopheles moucheti, Anopheles nilli also present. An almost equal distribution of the two efficient vectors of malaria, An. gambiae and Anopheles coluzzii, were observed across the 12 states included in the survey. Anopheles gambiae and Anopheles coluzzii had almost equal, well distributed habitat suitability patterns with the latter having a slight range expansion. However, the central part of Nigeria (Abuja) and some highly elevated areas (Jos) in the savannah appear not suitable for the proliferation of these species. The most suitable habitat for Anopheles arabiensis was mainly in the South-west and North-east. The results of this study provide a baseline allowing decision makers to monitor the distribution of these species and establish a management plan for future national mosquito surveillance and control programs in Nigeria., (© 2023. Springer Nature Limited.)

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling., (© 2023. The Author(s).)

Recognition has been given to patient safety and healthcare quality as central components of a functional health system which has resulted in increased advocacy for elaborate patient safety content in education and training programmes for health professionals. The World Health Organisation's patient safety curriculum is an evidence-based framework that provides a valuable resource for the training of healthcare professionals in enhancing patient safety. Other international organisations have also advocated for the need to restructure healthcare professionals' education to include the concept of patient safety. The ideal time to initiate patient safety education is suggested to be during schooling through curricula that inculcate learning from adverse events. This will prepare pharmacy students as future healthcare professionals who will become better prepared for clinical practice leading to improved healthcare quality and safety., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Emergency preparedness and disaster management are global phenomena that have a significant impact on the economy and healthcare system. Pharmacists have assumed additional responsibilities in the wake of emergencies and disasters that are beyond their training curricula. Some research highlighted the need for pharmacists to assume these responsibilities in the cause of emergency and disaster. The objective of this study is to evaluate pharmacists' knowledge in relation to emergency preparedness and disaster management., Method: A descriptive cross-sectional survey was carried out from April to August 2020, on selected pharmacists from different areas of practice in Kaduna/Nigeria. Participants were evaluated using a self-reported questionnaire which consisted of 15 knowledge questions that were distributed online using pharmacists' social-media platforms. The questionnaire was adapted from previous studies and was validated by the team of expect using face validation and pre-tested., Main Outcome: The majority of pharmacists have good knowledge of emergency preparedness and disaster management., Results: The online poll received 102 respondents, and their knowledge was evaluated by rating respondents out of 15 questions. 55%, 40%, and 5% scored good, fair, and poor knowledge respectively. At p<0.05, there was a relationship between knowledge score and years of practice experience, level of education, and area of practice. 44% reported being taught emergency, with the majority at the undergraduate level. 78% of respondents have never participated in drills or workshops., Conclusion: Pharmacists demonstrated good knowledge of basic emergency and disaster terms, they do, however, need to be more conversant with other emergency areas, which necessitates more training and drills., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Medication counselling is an important activity that improves patient therapeutic outcomes. After this activity has been carried out, patients should be satisfied with counselling, and possess adequate knowledge about their medications., Objectives: To describe outpatient/caregiver medication knowledge and satisfaction with medication counselling at the main outpatient pharmacies of eight public secondary and tertiary hospitals located in two states in Northwestern Nigeria., Methods: Exit interviews were conducted from December 2019 to March 2020 with randomly sampled patients/caregivers who had just been dispensed one or more prescription medications from the main pharmacies of the hospitals. The questionnaire used contained 31 questions in three sections. The first section collected demographic information. The second section assessed respondents' experiences and overall satisfaction with the counselling they had received. The last section evaluated respondents' knowledge of one randomly selected prescription medication that had been dispensed to them. Data collected were coded and analyzed to generate descriptive statistics. To explore associations between respondent characteristics and overall satisfaction, non-parametric tests were used, and statistical significance set at p<0.05., Results: A total of 684 patients/caregivers were interviewed. Majority of respondents agreed that the time spent (97.1%) and quantity of information (99.1%) provided during counselling was adequate. However, over 60% of them also agreed that dispensers did not assess their understanding of information provided or invite them to ask questions. Despite this, their average overall satisfaction with counselling on a 10-point scale was 8.6 ± 1.6. Over 90% of them also correctly identified the routes and frequency of administration of the prescribed medication selected for the knowledge assessment. Although, more than 60% of respondents did not know the duration of therapy or names of these medications., Conclusion: Respondents' satisfaction with medication counselling was fairly high even though they did not seem to know much about their medication., Competing Interests: The authors have declared that no competing interests exist.

Objective: To describe outpatient medication dispensing and counselling processes in pharmacies located in eight hospitals in North-Western Nigeria., Methods: An observational study was conducted from January to March 2020 in 19 hospital pharmacies located in the eight hospitals. Two types of observations were carried out, structured observations to describe the content of patient medication counselling encounters and general observations of other activities. Quantitative data were generated from the structured observations, whereas qualitative data were collected from field notes and informal discussions with dispensers. Data collected during the structured observations were descriptively analysed, whereas other data collected during the general observation periods were grouped and organized into categories., Key Findings: A total of 782 patient counselling encounters were observed during the structured observations. The most frequent types of information provided by the dispensers during these encounters included dose (98%) and route of administration (85%). Information about the name(s), indication(s), side effect(s) of medication as well as the importance of adherence were provided in less than 5% of these cases. Dispensers also made attempts to verify ownership of prescriptions to be dispensed in only 35% of these cases. Other issues observed included lack of interventions by dispensing staff during these processes. A total of 100 dispensing errors were observed, and provision of incomplete information (usually about duration of medicines use) was the most common type of dispensing error seen., Conclusions: Several problems were observed with the medication dispensing and counselling processes for outpatients in the hospital pharmacies observed. Interventions aimed at improving these processes are required if patients are to use their medicines correctly and safely., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Rift Valley fever (RVF) is an emerging mosquito-borne zoonosis that threatens public health and animal agriculture in the endemic areas causing devastating epizootics characterized by abortion storms and high mortalities, especially in newborn animals. A cross-sectional study was conducted to determine the seroprevalence and investigate risk factors associated with exposure to the virus in camels slaughtered in Maiduguri abattoir, Borno State of Nigeria. Camels presented for slaughtered were sampled and data on age, sex, source or origin, utility, presence of post-mortem lesions, body weights and body condition score were collected. Blood samples were collected and sera were harvested and stored at - 20 °C until tested. The sera were tested using a commercial ELISA kit based on the manufacturer's instructions. The overall seroprevalence in the study was 20.7% (95% CI, 13.6-30.0). The analysis showed no significant differences between the presence of antibodies and variables that included the sex of camels (χ 2  = 0.015, df = 1, p = 0.904) and the presence of post-mortem lesion on the carcass (χ 2  = 0.009, df = 1, p = 0.925). There were significant differences between presence of antibodies and three variables that included the age (χ 2  = 4.89, df = 1, p = 0.027), the source (χ 2  = 7.077, df = 2, p = 0.029) and the main utility (χ 2  = 8.057, df = 3, p = 0.045) of the camels. It was concluded that camels presented for slaughter at the Maiduguri abattoir have evidence of exposure to the RVF virus and maybe means of transmission of the virus. Regular monitoring and control of transboundary animal movements were recommended in the study area., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Mammography involves the use of low energy X-rays to image the breast tissue. Although low dose radiation is used, the use of ionising radiation implies the risk of inducing breast cancer. Thus, the study established local DRLs for digital mammography for in-house dose optimisation., Methods: This was a retrospective study that had a total of 240 women that presented for mammography at the two tertiary institutions located in the Northwest region of Nigeria. Patient demographic information including compressed breast thickness (CBT), which is the breast tissue thickness across the imaging plate, and mean glandular dose (MGD) were recorded. Data were analysed based on descriptive and inferential statistics using SPSS statistical software. The DRLs based on MGD and CBT were established and compared with the relevant data in the literature., Results: Local DRLs based on MGD and CBT were established at the 75th percentile (craniocaudal (CC): 1.50 mGy; 57 mm; mediolateral (MLO): 1.60 mGy; 63 mm) and 95th percentile (CC: 3.74 mGy; 69 mm; MLO: 3.61 mGy; 76 mm). The MGD based on manual exposure was significantly (p < 0.005) higher compared to the automatic optimisation parameter (AOP) mode which suggests the need to continuously adhere to the use of AOP mode for in-house dose optimisation., Conclusion: The study established local DRLs for the digital mammography systems at the 75th and 95th percentiles which compared well with the values established in the literature. Manual selection of parameters should only be employed where there are legitimate indications as it is associated with high exposure. Also, manual selection of parameters should be based on preset tables as a function of compressed breast thickness., (Copyright © 2021. Published by Elsevier Inc.)

Background: There is a dearth of qualitative studies exploring in-depth barriers that adolescents face in accessing and utilising reproductive health services (RHS) in Nigerian primary healthcare centres., Aim: This study explored the barriers hindering adolescents' access to and utilisation of RHS in primary healthcare centres., Setting: This study was conducted in three primary healthcare centres in Kaduna North Local government area, Nigeria., Methods: This study used an exploratory descriptive qualitative design. Fourteen adolescents and three RHS providers were selected and interviewed. The data collection methods included individual in-depth interviews with adolescents and key informant interviews with service providers. Interviews were conducted between January 2017 and April 2017. Thematic content analysis was used to analyse the data., Results: This study identified three thematic barriers to adolescent's utilisation of RHS. These included individual, social and health system barriers. Individual factors included the following: inadequate knowledge about RHS and poor attitudes of adolescents towards RHS; social factors such as parental influence, community and religious norms, financial constraints and stigma; and health system factors such as poor attitudes of service providers and inconvenient health facility opening hours hindered adolescents from utilising RHS. Most prominent was the strong influence of the social factors that affected adolescents to the extent that they felt constrained to freely utilise RHS out of a sense of commitment to religious values., Conclusion: The findings highlight the need for the development of programmes that would foster collective responsibility for supportive environments within communities and health facilities for positive adolescent RHS experiences.

Differences in Bacille Calmette-Guérin (BCG) immunogenicity and efficacy have been reported, but various strains of BCG are administered worldwide. Since BCG immunization may also provide protection against off-target antigens, we sought to identify the impact of different BCG strains on the ontogeny of vaccine-specific and heterologous vaccine immunogenicity in the first 9 months of life, utilizing two African birth cohorts. A total of 270 infants were studied: 84 from Jos, Nigeria (vaccinated with BCG-Bulgaria) and 187 from Cape Town, South Africa (154 vaccinated with BCG-Denmark and 33 with BCG-Russia). Infant whole blood was taken at birth, 7, 15, and 36 weeks and short-term stimulated (12 h) in vitro with BCG, Tetanus and Pertussis antigens. Using multiparameter flow cytometry, CD4+ T cell memory subset polyfunctionality was measured by analyzing permutations of TNF-α, IL-2, and IFN-γ expression at each time point. Data was analyzed using FlowJo, SPICE, R, and COMPASS. We found that infants vaccinated with BCG-Denmark mounted significantly higher frequencies of BCG-stimulated CD4+ T cell responses, peaking at week 7 after immunization, and possessed durable polyfunctional CD4+ T cells that were in a more early differentiated memory stage when compared with either BCG-Bulgaria and BCG-Russia strains. The latter responses had lower polyfunctional scores and tended to accumulate in a CD4+ T cell naïve-like state (CD45RA+CD27+). Notably, BCG-Denmark immunization resulted in higher magnitudes and polyfunctional cytokine responses to heterologous vaccine antigens (Tetanus and Pertussis). Collectively, our data show that BCG strain was the strongest determinant of both BCG-stimulated and heterologous vaccine stimulated T cell magnitude and polyfunctionality. These findings have implications for vaccine policy makers, manufacturers and programs worldwide and also suggest that BCG-Denmark, the first vaccine received in many African infants, has both specific and off-target effects in the first few months of life, which may provide an immune priming benefit to other EPI vaccines., (Copyright © 2019 Kiravu, Osawe, Happel, Nundalall, Wendoh, Beer, Dontsa, Alinde, Mohammed, Datong, Cameron, Rosenthal, Abimiku, Jaspan and Gray.)

Background: HIV-exposed but uninfected (HEU) children may be at an increased risk of impaired growth when compared with their HIV-unexposed and uninfected (HUU) counterparts. We compared the growth patterns of HEU to HUU children in Nigeria., Methods: Pregnant women with and without HIV infection were enrolled at the Plateau State Specialist Hospital, Jos, Nigeria. Infants born to these mothers were recruited at birth and the mother-infant pairs followed up for 18 months. Weight, length and head circumference of the infants were measured at each visit. Age- and sex-standardized Z scores were generated for each anthropometric measure using the World Health Organization Child Growth Standards. Children with length-for-age, weight-for-age and weight-for-length Z scores <-2 were classified as stunted, underweight and wasted, respectively., Results: Of 415 children (307 HEU and 108 HUU) recruited for this study, 117 (28.4%), 9 (2.2%) and 32 (7.8%) infants were stunted, underweight and wasted, respectively, at birth. In a multivariable longitudinal analysis, the odds of stunting were higher among HEU as compared with HUU children [adjusted odds ratio: 2.4 (95% confidence interval: 1.4-4.1)]. Similarly, odds of being underweight were higher among the HEU children [adjusted odds ratio: 1.6 (95% confidence interval: 1.1-2.2)]., Conclusions: Linear and ponderal growth were more impaired among HEU as compared with HUU children in Nigeria during the first 18 months of life. Further studies are needed to explore the causal basis for these differences.

Some developing countries have incorporated managed care elements into their national health insurance schemes. In practice, hybrid health management organizations (Hmos) are insurers who, bearing some resemblance to managed care in the USA, are vertically integrated in the scheme's revenue collection and pool and purchase healthcare services within a competitive framework. To date, few studies have focused on these organizations and their level of satisfaction with the scheme's optimal-resource-use (ORU) implementation. In Nigeria, the study site, Hmos were categorized on the basis of their satisfaction with ORU activities. One hundred forty-seven Hmo staff were randomly interviewed. The types of ORU domain categories were provider payment mechanism, administrative efficiency, benefit package inclusions and active monitoring mechanism. Bivariate analysis was used to determine differences among the Hmos' satisfaction with the various ORU domains. The Hmos' satisfaction with the health insurance scheme's ORU activities was 59.2% generally, and the associated factors were identified. According to the Hmos' perspectives related to the type of ORU, the fee-for-service payment method and regular inspection performed weakly. Hmos' limited satisfaction with the scheme's ORU raises concerns regarding ineffectiveness that may hinder implementation. To offset high risks in the scheme, it appears necessary for the regulatory agency to adapt and reform strategies of provider payment and active monitoring mechanisms according to stakeholder needs. Our findings further reveal that having Hmos evaluate ORU is useful for providing evidence-based information for policy making and regulatory utilization related to implementation of the health insurance scheme., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers' perspectives., Methods: A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain., Results: In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains., Conclusions: Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers' (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers' characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation.

Background: Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness., Methods: This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects., Results: Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains., Conclusions: Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users' expectations and their experiences with health services.

The purpose of this study was to assess the prevalence of uterine synechiae among infertile females in our setting. This was a retrospective review of 250 patients who underwent hysterosalpingography using 76% Urografin as part of infertility work-ups at the University of Teaching Hospital between January 1996 and December 2000. Those with uterine synechiae were closely evaluated. The incidence of uterine synechiae was 34 (13.6%). The peak incidence was in the age group 30 - 34 years. Uterine synechiae were less common at the extremes of reproductive years. The prevalence of uterine synechiae is high in our environment and will tend to increase due to promiscuity and criminal abortions by unqualified personnel.

Background: Written informed consent is a pre requisite for surgical intervention as it provides the forum for the patient to appreciate implications of the procedure and the doctor to explain details and effects of the surgery., Objectives: To evaluate the practice of obtaining informed consent pre-operatively by surgeons in Benin City and proffer solutions that would enhance its practice., Design: Cross-sectional study involving surgical patients or their relations or gurdian (in cases involving minors and unconscious patients) who were interviewed with structured ended questionnaires., Setting: Study was carried out at the University of Benin Teaching Hospital, Benin City, between 5th July and 6th September 2002., Results: One hundred and thirty-three respondents; 53(39.2%) males and 80(60.2%) females were interviewed. Documentations regarding consent were noted in 118(88.7%) cases. Of these, 74.6% felt they had enough time to reflect on the consent obtained while 48(36.1%) respondents were meeting the individual who obtained their consent for the first time. The content of information offered patients prior to obtaining consent was found to be significantly related to the levels of education (X2= 31.44; P<0.001). Over a hundred respondents were not informed of risk of procedure. Nonetheless over 50% of respondents felt satisfied with information supplied., Conclusion: The quality of consent obtained from the average patient fell below expected standard. There is need for greater awareness amongst administrators of consent on the essence of improving quality of information given and mode of obtaining consent from patients.

In rural Africa, wild foods provide diversity, vitamins and minerals in the diet. They are also important at times of food shortage. This paper discusses issues concerning wild food use in semiarid West Africa, and presents the results of a study of the use of wild plant foods in northeast Nigeria. Interviews with farmers and herders identified a total of 67 wild foods, coming from 53 species of plant. Knowledge of wild foods varied according to ethnic group and gender. Some wild foods caused side effects if eaten in excess. Land-use change due to agricultural expansion seems to be increasing the areas where wild foods are most commonly found. Wild foods are important as a supplement to daily diet, and at times of food scarcity. In addition, they provide an opportunity to generate income when they are collected and traded. The paper concludes that wild foods are an important coping strategy for rural communities. Further research is needed to determine whether local institutions and community-based natural resource management regimes are sufficient to conserve this resource.