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Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ('agbo'; 72%), ground herbs ('agunmu'; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever. [ABSTRACT FROM AUTHOR]

Background: Globally pregnancy and childbirth complications are the leading cause of death among adolescents, with evidence showing that antenatal care (ANC) is a very effective preventive intervention. In Burundi, there is limited information on the extent to which pregnant adolescents utilise such services., Objective: To assess the ANC utilisation and factors associated with its use among adolescent mothers in Ngozi Province, Burundi., Materials and Methods: A cross-sectional, health facility-based study among 216 adolescent mothers who had given birth within two years preceding this study, using structured questionnaires and records from previous ANC booklets. A multistage random sampling technique was used to select respondents while the utilisation of ANC was determined by the frequency of ANC visits and the time when the women enrolled for the first ANC visit., Results: The majority (98.1%) of adolescent mothers in Ngozi Province used ANC services. Most respondents (64.8%) initiated ANC services within the first trimester while 57.8% attained the minimum of four recommended ANC visits. Marital status ( P = 0.001), geographical location ( P = 0.009), occupation of the partner ( P = 0.002) and type of the last pregnancy ( P = 0.012) were associated with ANC initiation within the first trimester while marital status ( P < 0.001), respondent's employment ( P = 0.003) and type of last pregnancy ( P < 0.001) were associated with appropriate ANC frequency., Conclusion: This study revealed a high use of ANC services among adolescent mothers, although more than one-third attended ANC late. There is therefore the need to put more effort into improving early booking for ANC., Competing Interests: There is no conflict of interest., (Copyright: © 2024 Journal of the west African college of surgeons.)

Background: This study aimed to develop a risk-scoring model for hypertension among Africans., Methods: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives., Results: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m 2 , lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset., Conclusions: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention., Competing Interests: Disclosures None.

Background: The fields of stroke genomics, biobanking, and precision medicine are rapidly expanding in sub-Saharan Africa. However, the ethical, legal, and social implications (ELSI) of emerging neurobiobanking and genomic data resources are unclear in an emerging African scientific landscape with unique cultural, linguistic, and belief systems. Objective: This article documents capacity-building experiences of researchers during the development, pretesting, and validation of data collection instruments of the African Neurobiobank for Precision Stroke Medicine-(ELSI) Project. Methods: The African Neurobiobank for Precision Stroke Medicine-ELSI project is a transnational, multicenter project implemented across seven sites in Ghana and Nigeria. Guided by the Community-Based Participatory Research framework, we conducted three workshops with key stakeholders to review the study protocol, ensure uniformity in implementation; pretest, harmonize, and integrate context-specific feedback to ensure validity and adaptability of data collection instruments. Workshop impact was assessed using an open-ended questionnaire, which included questions on experience with participation in any of the workshops, building capacity in Genetic and Genomic Research (GGR), level of preparedness toward GGR, the genomic mini-dictionary developed by the team, and its impact in enhancing understanding in GGR. Data were analyzed qualitatively using a thematic framework approach. Results: Findings revealed the usefulness of the workshop in improving participants' knowledge and capacity toward GGR implementation. It further identified local, context-specific concerns regarding quality data collection, the need to develop culturally acceptable, genomic/biobanking data collection tools, and a mini-dictionary. Participants-reported perceptions were that the mini-dictionary enhanced understanding, participation, and data collection in GGR. Overall, participants reported increased preparedness and interest in participating in GGR. Conclusion: Capacity-building is a necessary step toward ELSI-related genomic research implementation in African countries where scholarship of ELSI of genomics research is emerging. Our findings may be useful to the design and implementation of ELSI-GGR projects in other African countries.

Purpose : During adolescence, a female child makes several decisions, and the choice to breastfeed in the near future is conceivably shaped. But in sub-Saharan Africa where teenage pregnancy and teenage motherhood is on the rise, there is a dearth of information on the intention of adolescents to exclusively breastfeed (EBF) in community settings. Therefore, this study assessed exclusive breastfeeding intentions, knowledge and attitude of adolescents in urban communities in Ibadan, Nigeria. Methods : A descriptive community-based cross-sectional study was carried out, selecting 271 respondents. Data were analysed with the aid of IBM SPSS version 21 at P ≤ .05. Results : Mean age of adolescents was 17.5 ± 1.3 years, and 96.3% would breastfeed their children later in future. However, only 37.6%, 22.5% and 50.2% had the intention to exclusively breastfeed, good knowledge score and positive attitude, respectively. There were significant relationships between respondents' age, educational attainment, parents' educational attainment, level of knowledge, attitude and intention. The coefficient of knowledge and attitude were significant predictors of good intention to practise EBF. Major predictors of good intention were good knowledge [OR = 36.5; 95% CI (9.2, 145.2)] and positive attitude toward EBF [OR = 9.7; 95% CI (3.6, 25.9)]. Conclusions : The EBF intention was influenced by multiple factors and should be considered in determining the effectiveness of interventions targeting this practice. Therefore, coherent EBF education interventions that commence from adolescence to promote the practice by adulthood are urgently needed to improve knowledge, attitude and intention about EBF rate and confer the cancer-risk reducing benefits.

Introduction: disparity between the demand for and the supply of organs for transplantation remains a major public health issue of global concern. This study evaluated the knowledge and determinants of willingness to donate organs among outpatient clinic attendees in a Nigerian teaching hospital., Methods: a 43-item semi-structured interviewer-administered questionnaire was designed to assess awareness and willingness of individuals attending Neurology, Psychiatry and Geriatrics Outpatient clinics to donate bodily organs for transplantation. Association between participants' characteristics and willingness towards organ donation was investigated using logistic regression models., Results: a total of 412 participants were interviewed and mean age was 46.3 (16.1) years. There were 229 (55.6%) females and 92.5% had at least 6 years of formal education. Overall, 330 (80.1%) were aware of donation of at least one organ for transplantation purposes but only 139 (33.7%) were willing to donate organ. In analyses, adjusting for sex, marital status, family setting and educational status, male gender AOR [2.066(1.331-3.2016)] secondary education [AOR 5.57 (1.205-25.729) p= 0.028] and post-secondary education [AOR-6.98 (1.537-31.702) p= 0.012 were independently associated with willingness towards organ donation., Conclusion: the survey revealed high level of awareness but poor willingness towards organ donation among older Nigerians attending outpatient clinics of a premier tertiary hospital. Male gender and educational attainment were significantly associated with willingness to donate. Educational programs that particularly target women and less educated older Nigerians are needed to promote organ donation in Nigeria., Competing Interests: The authors declare no competing interests., (Copyright: Rufus Olusola Akinyemi et al.)

Background: Deceit into sexual activities without the victim being aware of the intended action is common in tertiary institutions as the environment promote activities that make students vulnerable, especially females, young and new students. The resulting physical, psychological and social consequences, including harassment, sexual assault, non-consensual sex, injury, psychological trauma and suicide attempts, have affected many young people. This study was aimed at exploring the knowledge, perception, experience of sexual entrapment among undergraduate students of the University of Ibadan, Ibadan, Nigeria. Methods: This multi-stage cross-sectional survey involved 422 participants using semi-structured questionnaire and an in-depth interview guide. Quantitative data were analyzed statistically, while Qualitative data was analyzed thematically. Results: Mean age of respondents was 20.5±3.0 years, 52.6% were males, 58.8% and 81% had a good knowledge and perception of sexual entrapment, respectively. Prevalence of sexual entrapment was 18%, affecting more males (55.3%) and first year students (39.5%), 59.2% of the perpetrators are friends of the victim. Students were entrapped on campus through; emotional support (42.1%), money (34.2%), accommodation assistance (7.9%), material things/gifts (21.1%), assignment assistance (10.5%), help with registration (4.0%), religious activities (6.6%), debt repayment (11.8%) and counseling (9.2%). It resulted to; unwanted sex (34%), rape (4%), pregnancy (1.3%), STDs (4%), Injury (13%), psychological trauma (27.6%), loss of trust (52.6%) and attempted suicide (23.7%) among victims. Effective coping mechanisms were adopted by 55.3% of respondents. There was a significant association between knowledge and perception; knowledge and experience; perception and experience (p<0.05). Findings from the in-depth interview revealed care, tutoring, political positions, and pretense to need help as other tactics. Conclusions: Sexual entrapment is common on campus, affecting males and females, knowledge and perception influence experience of sexual entrapment, requiring the need for a holistic approach to reduce its prevalence., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Sule AI et al.)

Maternal depression is gradually becoming a prevailing condition among women of reproductive age in Nigeria but there are little efforts towards addressing this problem. Need assessment for health education service provision on maternal depression therefore becomes necessary. Hence, this study assessed the needs of Primary Health Care (PHC) workers regarding the provision of routine health talk on maternal depression. This study was descriptive in design and it adopted a mixed method. Four Key Informant Interviews (KII) and a survey which involved 100 Health Workers (HWs) were carried out. KII participants were purposively selected from the 4 LGAs where volunteers were found and the 100 HWs were conveniently selected from all the Comprehensive Clinics (CCs) in the 5 LGAs. A KII guide and structured questionnaire were used to collect data and data were analyzed thematically, with descriptive statistics and chi-square. The mean age of the key informant's interviewees was 54±6.1years and the mean age of the survey respondents was 42±5.2 years. The interviewees identified HWs' inability to communicate maternal depression to the service users in appropriate local terms and non-availability of Information, Education and Communication (IEC) materials as barriers to giving health talk on maternal depression. Survey respondents identified certain needs with a statistical significance across cadres. Eighty-three (88.3%) identified training need, education aid materials 61.7%; p<0.05, maternal depression health education guide 27.7%; p<0.05 and need for more staff 22.3%. Training need, non-availability of maternal depression targeted educational materials and the need for more staff were the primary identified needs.

This article described the perception of young mothers and selected informal maternity caregivers with no known antecedents of depression residing in two communities in Ibadan, Nigeria about maternal depression. This study is qualitative in design. We purposively selected fifty-one pregnant women and nursing mothers (young mothers) within the communities and the clinics. Thirty-three informal caregivers (Community Birth attendants (CBAs), elderly mothers and men of reproductive age) were also selected. We utilized Focus Group Discussions (FGD), Key Informant Interviews (KIIs), open-ended interviews and document consultation to obtain information about maternal depression. Discussions and interviews were digitally recorded, transcribed verbatim and analyzed using thematic analysis with Nvivo version 15. Common phrases used to describe maternal depression were "severe worrying" and "chronic unhappiness". Young mothers opined that maternal depression was caused by lack of partner support while more of the men and elderly mothers felt spiritual causes were responsible. Symptoms of maternal depression described by the participants included prolonged loss of interest in pleasurable activities and being moody. Common consequences of maternal depression mentioned were premature onset of labour and low birth weight babies. The perceived help-seeking behaviour included special rituals and deliverance. CBAs mentioned referral to a psychiatrist as a last resort. Participants were aware of maternal depression and its symptoms, however, there were misconceptions about the causes which influenced the perceived help-seeking of elderly mothers and men. Health education interventions to dispel these misconceptions should therefore target the mothers and informal caregivers in the study area.

Stroke is becoming a leading cause of disability and death, and a major public health concern in Sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non-communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer high burdens of disease in SSA. This paper describes the process of SIREN project's community engagement activities in Ghana and Nigeria. The aims of community engagement (CE) within SIREN are to: i) elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA; ii) educate the community about stroke and ways to decrease disabilities and deaths from stroke; and iii) recruit 3000 control research subjects to participate in a case-control stroke study. CE focused on three-pronged activities-constitution and interaction with Community Advisory Board (CABs), Focus Group Discussions (n=27) and community education and outreach programs (n=88). FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Almost all indicated that genetic testing could help health provider's better treat stroke and help scientists better understand the causes of stroke. Over 7000 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. The CE core within SIREN is a first of its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high stroke risk populations.

Introduction: The proportion of young people exposed to pornographic materials through the internet in Nigeria is increasing. However, the influence of the exposure on their sexual behaviour has not been fully explored. This study therefore explored the effects of internet exposure on the sexual behaviour of young persons in Ibadan North Local Government Area of southwest Nigeria., Methods: A survey of 413 young persons was done using a pretested self-administered questionnaire which included questions on internet exposure and its influence on behaviour. Data were analysed using descriptive statistics, Chi-square test and logistic regression., Results: Mean age of males was 21.7 ± 3.4 years while that of females was 20.9 ± 3.2 years. Forty-nine percent of the respondents used the internet for the first time between the ages of 15-19 years. Main source of information about the internet was friends (63.3%) and 99.3% accessed the internet from cybercafé. Seventy-two percent had ever stumbled on pornographic sites. Reactions included glancing through before closing (45.2%), closure of the sites (38.5%), and minimizing page to view later (12.5%). Post-exposure influence on behaviour included engagement in oral sex (48.3%), body tattoo (18.3%), having multiple sexual partners (11.6%) and homosexuality (5.0%). More males (95% CI OR =1.245-6.465) and frequent users (95% CI OR =1.168-3.497) were likely to report a change in sexual behaviour., Conclusion: Internet use was common among the young persons. Interventions aimed at reducing exposure to sexual content on internet targeting young persons especially the males and cybercafé operators are advocated., Competing Interests: The authors declare no competing interests.

The burden of stroke is on the rise in Nigeria. A multi-faceted strategy is essential for reducing this growing burden and includes promoting medication adherence, optimizing traditional biomarker risk targets (blood pressure, cholesterol) and encouraging beneficial lifestyle practices. Successful implementation of this strategy is challenged by inadequate patient health literacy, limited patient/medical system resources, and lack of a coordinated interdisciplinary treatment approach. Moreover, the few interventions developed to improve medical care in Nigeria have generally been aimed at physicians (primarily) and nurses (secondarily) with minimal input from other key health care providers, and limited contributions from patients, caregivers, and the community itself. The Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES) study is assessing the efficacy of a culturally sensitive multidimensional intervention for controlling blood pressure in recent stroke survivors. A key component of the intervention development process was the constitution of a project task force comprising various healthcare providers and administrators. This paper describes the unique experience in Sub-Saharan Africa of utilizing of an interdisciplinary Task Force to facilitate the development of the multipronged behavioral intervention aimed at enhancing stroke outcomes in a low-middle income country.

Stroke is the leading cause of neurological hospital admissions in sub-Saharan Africa (SSA) and the second leading cause of death globally. The Stroke Investigative Research and Education Network seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other noncommunicable diseases in SSA. One of the first steps to address this goal is to effectively engage the communities that suffer the high burden of disease. The purpose of this article is to describe plans to elucidate information about knowledge, attitudes, beliefs, and practices about stroke and genomics from patients, caregivers, and local leaders, to recruit participation in research activities and dissemination of ongoing results, as well as to facilitate research uptake and impact within the broader communities of scientists, health professionals, policy makers, and others. We describe the (a) study sites and their communities; (b) plans for community advisory boards, focus groups, and surveys; (c) methods for data management in REDCap database; (d) analyses of qualitative data; (e) evaluation of community and public engagement across multiple sites and research teams in SSA and the United States; (f) use of RE-AIM for presentation of evaluation data; and (g) community indicators of success. This is the first of its kind public outreach engagement initiative to evaluate stroke and genomics in SSA, and has implications as a model for assessment in other high-stroke risk populations., (© 2016 Society for Public Health Education.)

Qualitative methods are becoming widely used and increasingly accepted in biomedical research involving teams formed by experts from developing and developed practice environments. Resources are rare in offering guidance on how to surmount challenges of team integration and resolution of complicated logistical issues in a global setting. In this article we present a critical reflection of lessons learned and necessary steps taken to achieve methodological coherence and international team synergy. A series of 10 pretest interviews were conducted to assess instrumentation rigor and formulate measures to address any limitations or threats to bias and management procedures before carrying out the formal phase of qualitative research, contributing to an evidence-based stroke-preventive care clinical trial study. The experience of pretesting notably helped to identify obstacles and thus increase the methodological and social reliability central to conducting credible qualitative research, while also ensuring both personal and professional fulfillment of our team members.

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR = 20.29, CI = 1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired.

The study explored why actions for early treatment of febrile illnesses in children are delayed by caregivers of children less than five years in five Local Government Areas (LGAs) of southwestern Nigeria using four indicators: caregivers' perception of illness, notion of causation and seriousness, belief in efficacy of selected pathway, and the decision making process. Seven types of febrile illnesses (yellow fever, typhoid fever, ordinary fever/malaria, hot body fever, rain fever, cold fever, and headache fever) were identified and yellow fever was perceived as the most severe type (60.8%). Only 24.2% correctly identified an infected mosquito bite as the cause of ordinary fever/malaria. Use of leftover drugs at home (55.6%) was the main action taken and fathers were the main decisionmakers in all cases. Empowerment of women for improved knowledge on causation, severity, and importance of prompt action for a healthy outcome is recommended.

Background: There is a growing concern that barbering procedures could create opportunities for HIV transmission. However, little is known about Nigerian barbers' practices relating to the prevention of HIV., Objectives: This study assessed the precautionary measures for the prevention of HIV among commercial barbers in Ibadan, Nigeria., Methods: Data were collected using validated checklist to directly observe ninety barbering procedures in forty-five barber shops randomly selected from three communities that have been categorized as inner-core, transitory and peripheral., Results: Respondents were all males with mean age of 36(±10.2) years. Ninety-eight percent had at least primary school education and all of them learnt barbering through apprenticeship. The instruments used were razor blades (11.1%), manual clippers (8.9%) and electric clippers (80%). Clippers were sterilized in 10% and disinfected in 72.5%, while no decontamination was carried out in 17.5% of the sessions. Fifty two percent of the disinfections involved the use of kerosene, a disinfectant not recommended for HIV inactivation; 48.3% of the disinfectants were not in the original containers while 53.4% of the sessions involved the use of same brush for cleaning clipper and brushing hair. Hand-held flame and Ultra-violet light sterilizer were used in 50% of the sterilization process. Barbers in the high-class peripheral communities were more likely to practice appropriate equipment decontamination than those from lower-class inner-core communities. There was blade-to-skin contact in all and accidental cuts occurred in three of the sessions and none was properly managed., Conclusion: The risk of transmitting HIV is high in the barbershops in the study area. Health education strategies such as training, supportive supervision and peer education are needed to facilitate the adoption of effective precautionary measures against HIV infection among barbers.

The study explored home management practices for malaria by caregivers in the Military Cantonment, Ojo Lagos. Data was collected using pre-tested Focus Group Discussion guide and interviewer-administered questionnaire. The 400 survey respondents were selected using the systematic sampling method while the discussion participants were purposively selected. Data analysis was done using EPI Info statistical software and thematic approaches. The mean age of respondents was 29 +/- 15.2 years while 89.8% of respondents were biological parents of the index children. High prevalence of malaria all year round caused by mosquitoes bite was indicated by 281 (70.2%) respondents, while 73 (18.3%) of the respondents reported having lost a child under 5 years old to malaria related illnesses. Preventive practices were uncoordinated while awareness and use of ITNs is low. Home management practices of childhood malaria involved the immediate treatment with medicines available in the home. Sharing of left over drugs and herbs were common practices. Home treatment was preferred because of high costs 250 (62.5%), unfriendly attitude of workers 195 (48.8%) and long waiting time 194 (48.5%) in the health facilities. Based on the findings there is the need to institute an awareness programme aimed at improving prompt home management of malaria in the barracks.

Objectives: Our goals were to train health professionals in Nigeria using the text, "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers", and then evaluate the knowledge dissemination process using a pre- and post-test assessment. The manual was developed by the ACCP, WHO, IARC, PATH, Engender Health, JHPIEGO, and PAHO with funding from the Gates Foundation. It is an inclusive guide to implementation and maintenance of screen-and-treat cervical cancer prevention clinics and is ideally suited for programs operating in the developing world., Methods: Training took place at a conference in Ibadan, Nigeria. Participants included teams of physicians, nurses, bioengineers, data managers, and administrators who met in joint and parallel sessions to "train the trainers". This meeting was designed to provide both training and equipment to personnel to be involved in the implementation of a cervical cancer control initiative in Nigeria. A 36 item pre-test was administered prior to a group study sessions. A slide presentation summarized salient points before the post-test was given. The results were entered into an MS Excel spreadsheet for descriptive statistics about (1) the participants, (2) the test, (3) an examination of profession, years of work experience, years of education, and gender as predictors of two outcomes (low pre-test score and large difference between pre- and post-tests) and (4) overall performance on the exam., Results: There were 70 participants and trainers, of which 53 took the exam. Most of the examinees were physicians. Some participants did not fill out the post-test, leaving their tests inevaluable. A closer look at the test revealed eight questions that were confusing and nine that were too easy. All participant subgroups performed better on the post-test than the pre-test; the improvements were statistically significant. While profession impacted the results, profession was not statistically significant. Years of work experience, years of education, and gender did not affect test results., Conclusions: While the study suffers from a small sample size, a few ambiguous questions, and the need for pilot testing the instrument prior to the meeting, the report evaluates the manual very favorably. The authors showed a significant gain in knowledge. The manual gives "the big picture" and does so with clarity. The text and supplementary material outline the work that needs to proceed in an organized program, and the material was easily understandable in Nigeria. Future evaluations could benefit from more participants and varied learning structures.

Each year, around half a million children aged under 15 become infected with HIV and more than 90% are the result of mother-to-child transmission. Services to prevent mother-to-child HIV transmission (PMTCT) are therefore important entry points for HIV/AIDS prevention, treatment and care services for women, their children and families. The study aimed at identifying level of awareness and knowledge of PMTCT services that can be utilized in improving access. The methodology consisted of 20 individual in-depth interviews spread over Adabeji, Adeoyo/Agbadagbudu, Jakiru/Onipasan and Eleta communities, in Ibadan among household heads, religious and community based leaders. Key factors identified were low knowledge of mother to child transmission, lack of knowledge of the PMTCT services, inadequate community sensitization, inadequate healthcare facilities. The success of PMTCT programmes demands a shift towards a more community-based approach which calls for strong advocacy, enlightenment and community mobilization for improved awareness and utilization of PMTCT services.

Polio immunisation has faced challenges of refusal from care givers in recent times despite the efforts put in to ensure its success. To identify the role of service providers in this attitudinal shift, a survey describing the perception of health workers about the supplemental immunization activities was carried out among 265 health workers who participated in the 3rd round of the 2003 sub-national immunization days in Gombe local government area (LGA) of Gombe state, Nigeria. Data was collected using pretested qualitative and quantitative instruments. Quantitative data was analysed using EPI Info statistical software and the qualitative using thematic areas. Results showed that 211 (79.6%) knew fecal-oral route as the commonest mode for poliovirus transmission, 231 (87.2%) knew the age for vaccination, 224 (84.5%) knew the correct use of vaccine vial monitor while 143 (53.9%) knew the correct action to take when a case of polio was identified. On perception, 22 (8.3%) perceived that OPV was harmful due to repeated administration, 26 (9.8%) perceived that OPV had sterility property, contained harmful materials 14 (5.3%) and HIV 11 (4.2%). Main reasons for immunisation rejection were sterility 115 (43.3%) and contamination with HIV 94 (35.5%). The study found that irrespective of adequate knowledge on transmission, misconceptions still exist among health workers on the polio vaccine. Based on this, there is the need for continuous training to remove the misconceptions concerning their perceptions and rumors about the vaccine and the programme.

Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ("agbo"; 72%), ground herbs ("agunmu"; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever.