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The COVID-19 pandemic has put severe pressure on health care systems worldwide. Although attention has been focused on COVID-19 hospitalizations and deaths, some experts have warned about potentially devastating secondary health effects. These effects may be most severe in low- and middle-income countries with already weak health care systems. This study examines the effect of the COVID-19 pandemic on early infant deaths, a question that is currently unsettled. We present new evidence from Nigeria showing that early infant deaths have significantly increased during the pandemic. Using data on the birth outcomes of a large and diverse cohort of pregnant women enrolled in a prospective study and a quasi-experimental difference-in-differences design, we found a 1.1-percentage-point (22 percent) increase and a 0.72-percentage-point (23 percent) increase, respectively, in stillbirths and newborn deaths. Our findings show that the health effects of the pandemic extend beyond counted COVID-19 deaths. If these findings generalize to other low- and middle-income countries, they may indicate that the hard-won gains in child survival made during the past two decades are at risk of being reversed amid the ongoing pandemic. Policies addressing disruptions to health services delivery and providing support to vulnerable groups-specifically to households with pregnant women-will be critical as the pandemic continues.

Background: Despite the global decline in pediatric HIV infections, infants in sub-Saharan Africa still acquire HIV infection through inappropriate feeding. Objective: The objective of the study was to compare knowledge and predictors of infant feeding behavior between mothers living with HIV and controls of unknown HIV status in Gombe, northeast Nigeria. Methods: A cross-section of clinic-based samples of 84 HIV-positive mothers and 170 controls of unknown status were interviewed using validated questionnaires. Knowledge scores and self-reported infant feeding practices were analyzed. Multivariate logistic regression models were employed to determine predictors for infant feeding practices. Results: Transmission risk perception (95.2% vs. 65.3%) (p0.05). Antenatal attendance, hospital delivery, knowledge, and positive attitude predicted infant feeding practices in both groups. The predictive roles of education and parity were limited to HIVpositive mothers, while the effects of maternal age and infant death were restricted to controls. Conclusion: Risk perception, knowledge, and exclusive breastfeeding rates were higher among mothers living with HIV. Antenatal care, hospital delivery, knowledge, and attitude predicted infant feeding practices in both groups. Girl child education, antenatal care, hospital delivery, and sustained promotion of exclusive breastfeeding with antiretroviral therapy are key to HIV-free infant survival.

BackgroundThe 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Nigeria without any baseline data on serotype distribution in invasive pneumococcal disease (IPD). To estimate the proportion of IPD attributable to different serotypes, in children aged MethodsWe used the carriage data from one urban and one rural setting in Nigeria, collected within five months of PCV10 introduction (2016). For Model A, we used serotype-specific adult case-fatality ratios from Denmark as proxy for IC. In the second model, we used the ratio of IPD proportions to carriage prevalence (case-carrier ratios) from Kenya (Model B) and the ratio of IPD incidence to carriage acquisition (attack rates) from the UK (Model C) as measures of serotype IC.ResultsThe models predict that serotypes with high carriage prevalence (6A, 6B, 19F and 23F) will dominate IPD. Additionally, Models B and C predictions emphasize serotypes 1, 4, 5, and 14, which were not prevalent in carriage but had high IC estimates. Non-PCV10 serotypes,6A and 19A, also dominated IPD predictions across models and settings. The predicted proportion of IPD attributed to PCV10 serotypes varied between 56% and 74% by model and setting.ConclusionCarriage data can provide preliminary insights into IPD serotypes in settings that lack robust IPD data. The predicted PCV10-serotype coverage for IPD was moderately high. However, predictions for non-PCV10 serotypes indicate that higher-valency PCVs that cover serotypes 6A and 19A may have a larger impact on IPD reductions.

Ninety-nine percent of global maternal deaths occur in low- and middle-income countries. The high mortality rates are often attributed to a large portion of births occurring outside of formal healt...

Ninety-nine percent of global maternal deaths occur in low- and middle-income countries. The high mortality rates are often attributed to a large portion of births occurring outside of formal health care facilities. This has prompted the creation of programs to promote the use of formal delivery care. However, poor-quality care in health facilities in low- and middle-income countries is well documented. It is not clear that shifting births into health facilities in these settings necessarily leads to better-quality care. We present results from a randomized controlled trial in Nigeria that evaluated a conditional cash transfer intervention that paid pregnant women to deliver in a health facility. We found that the intervention led to a 41 percent increase in facility deliveries. We also found improvements in the quality of delivery care (as a result of more births taking place in formal health care settings) and in overall satisfaction with care. We found no evidence of a reduction in preventable complications that led to maternal deaths, though we found some improvements in self-reported health. Our results indicate that promoting facility deliveries can improve the quality of care received, even in settings where formal care quality is poor. However, modest quality improvements might not be sufficient to substantially improve health outcomes.

A contingent cash transfer program in Nigeria—in which expectant mothers were given $14 if they used prenatal, delivery, and postnatal services—led to a large increase in the use of such care and a substantial reduction in child deaths.

Households in poor countries are encouraged (and sometimes coerced) to increase investments in formal health care services during pregnancy and childbirth. Is this good policy? The answer to a large extent depends on its effects on child welfare. We study the effects of a cash transfer program in Nigeria in which households were offered a payment of $14 conditioned on uptake of health services. We show that the transfer led to a large increase in uptake and a substantial increase in child survival driven by a decrease in in-utero child deaths. We present evidence suggesting that the key driver is prenatal health investments.

Changes in nasopharyngeal (NP) carriage of vaccine-type (VT) Streptococcus pneumoniae can be used to assess the effectiveness of a pneumococcal conjugate vaccine (PCV10). We conducted a baseline carriage survey in rural (Kumbotso, Kano) and urban (Pakoto, Ogun) Nigeria. In this cross-sectional study, we obtained data on demography, clinical history, risk factors, and took NP swabs for pneumococcal culture. We calculated crude and age-standardised carriage prevalence and used log-binomial regression to assess risk factors for carriage. Among children aged 40% across all ages. The age-standardized prevalence of pneumococcal carriage was 66% in Kumbotso and 40% in Pakoto. The most commonly identified serotypes were 19 F, 6 A and 23 F. Risk factors for carriage were young age, recent rhinorrhoea, cohabitation with ≥2 children aged

Background The lack of availability of skilled providers in low- and middle- income countries is considered to be an important barrier to achieving reductions in maternal and child mortality. However, there is limited research on programs increasing the availability of skilled birth attendants in developing countries. We study the implementation of the Nigeria Midwives Service Scheme, a government program that recruited and deployed nearly 2,500 midwives to rural primary health care facilities across Nigeria in 2010. An outcome evaluation carried out by this team found only a modest impact on the use of antenatal care and no measurable impact on skilled birth attendance. This paper draws on perspectives of policymakers, program midwives, and community residents to understand why the program failed to have the desired impact. Methods We conducted semi-structured interviews with federal, state and local government policy makers and with MSS midwives. We also conducted focus groups with community stakeholders including community leaders and male and female residents. Results Our data reveal a range of design, implementation and operational challenges ranging from insufficient buy-in by key stakeholders at state and local levels, to irregular and in some cases total non-provision of agreed midwife benefits that likely contributed to the program’s lack of impact. These challenges not only created a deep sense of dissatisfaction with the program but also had practical impacts on service delivery likely affecting households’ uptake of services. Conclusion This paper highlights the challenge of effectively scaling up maternal and child health interventions. Our findings emphasize the critical importance of program design, particularly when programs are implemented at scale; the need to identify and involve key stakeholders during planning and implementation; the importance of clearly defining lines of authority and responsibility that align with existing structures; and the necessity for multi-faceted interventions that address multiple barriers at the same time. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2284-2) contains supplementary material, which is available to authorized users.

Background:\ud Limited availability of skilled health providers in developing countries is thought to be an important barrier to achieving maternal and child health-related MDG goals. Little is known, however, about the extent to which scaling-up supply of health providers will lead to improved pregnancy and birth outcomes. We study the effects of the Midwives Service Scheme (MSS), a public sector program in Nigeria that increased the supply of skilled midwives in rural communities on pregnancy and birth outcomes.\ud \ud Methods:\ud We surveyed 7,104 women with a birth within the preceding five years across 12 states in Nigeria and compared changes in birth outcomes in MSS communities to changes in non-MSS communities over the same period.\ud \ud Results:\ud The main measured effect of the scheme was a 7.3-percentage point increase in antenatal care use in program clinics and a 5-percentage point increase in overall use of antenatal care, both within the first year of the program. We found no statistically significant effect of the scheme on skilled birth attendance or on maternal delivery complications.\ud \ud Conclusion:\ud This study highlights the complexity of improving maternal and child health outcomes in developing countries, and shows that scaling up supply of midwives may not be sufficient on its own.

Many women experience domestic violence during pregnancy. The magnitude and risk factors for domestic violence during pregnancy are not well documented in many countries, including Nigeria. Using interviewer- administered questionnaires the authors investigated predictors of domestic violence during current pregnancy among women presenting for antenatal care at a tertiary care facility in northern Nigeria ( n = 400). A total of 29 of 392 respondents (7.4%) experienced domestic violence during the current pregnancy. Of those who experienced violence, the majority (58.6%) reported being physically assaulted. Sexual violence was reported by only 4 respondents (13.8%). Financial and domestic issues were the major triggers of domestic violence. After adjusting for potential confounders, it was found that victims’ educational attainment and occupation remained significant predictors of domestic violence. Higher educational attainment of women and their engagement in economic activity outside the home were associated with a decreased risk for domestic violence. There is a need for preventive, protective, and redress mechanisms to guard against domestic violence in Nigeria.

Objective To assess the availability of prenatal care and basic emergency obstetric care services at primary healthcare (PHC) facilities in rural Nigeria. Methods In total, 652 PHC facilities enrolled in the Midwives Service Scheme, a government-funded program designed to reduce the national shortage of skilled birth attendants, were surveyed. Results In all, 44.0% of the PHC facilities evaluated did not provide all components of prenatal care, and only 39.0% of all pregnant women nationwide attended prenatal care clinics 4 or more times. In addition, 52.2% of the facilities were not distributing insecticide-treated nets to pregnant women, while only 36.8% of the PHC facilities provided services to prevent mother-to-child transmission of HIV. By contrast, 70.0% of the PHC facilities had access to antibiotics for the treatment of uncomplicated sepsis. Only 11.0% of clinics reported the use of vacuum extraction during labor and 36.8% provided post-abortion care services. Treatment for pre-eclampsia and eclampsia was initiated at 40.0% and 28.0% of PHC facilities, respectively, prior to referral. Conclusion The present study provides useful information on the state of prenatal and basic emergency obstetric care in rural Nigeria. The data obtained indicate that changes are needed to achieve related Millennium Development Goals.

Background The Nigerian Midwives Service Scheme (MSS) is an ambitious human resources project created in 2009 to address supply side barriers to accessing care. Key features include the recruitment and deployment of newly qualified, unemployed and retired midwives to rural primary healthcare centres (PHCs) to ensure improved access to skilled care. This study aimed to understand, from multiple perspectives, the views and experiences of childbearing women living in areas where it has been implemented. Methods A qualitative study was undertaken as part of an impact evaluation of the MSS in three states from three geo-political regions of Nigeria. Semi-structured interviews were conducted around nine MSS PHCs with women who had given birth in the past six months, midwives working in the PHCs and policy makers. Focus group discussions were held with wider community members. Coding and analysis of the data was performed in NVivo10 based on the constant comparative approach. Results The majority of participants reported that there had been positive improvements in maternity care as a result of an increasing number of midwives. However, despite improvements in the perceived quality of care and an apparent willingness to give birth in a PHC, more women gave birth at home than intended. There were some notable differences between states, with a majority of women in one northern state favouring home birth, which midwives and community members commented stemmed from low levels of awareness. The principle reason cited by women for home birth was the sudden onset of labour. Financial barriers, the lack of essential drugs and equipment, lack of transportation and the absence of staff, particularly at night, were also identified as barriers to accessing care. Conclusions Our research highlights a number of barriers to accessing care exist, which are likely to have limited the potential for the MSS to have an impact. It suggests that in addition to scaling up the workforce through the MSS, efforts are also needed to address the determinants of care seeking. For the MSS this means that the while the supply side, through the provision of skilled attendance, still needs to be strengthened, this should not be in isolation of addressing demand-side factors. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1026-5) contains supplementary material, which is available to authorized users.

Organ shortage is a major public health challenge for transplant programs globally. The sustenance of such programs as an effective therapy for end-stage organ failure (ESOF) requires an exploration of public awareness and willingness to donate organs. This is imperative, especially in developing countries where ESOF is highly prevalent. We studied the awareness and predictors of public attitude toward organ donation in Kano city in northern Nigeria. Using interviewer-administered questionnaires, we assessed the awareness and willingness to donate solid organs among 400 adults in the Kano metropolis. Three hundred and five of the 383 respondents (79.6%) reported that they had heard about organ donation. There was a significant variation of awareness by education and ethnicity (P

Recent trials demonstrate the effectiveness of male circumcision (MC) in reducing HIV acquisition in men. However, little is known about the prevalence and acceptability of the practice in northern Nigeria. A cross-sectional study design was employed to explore knowledge and attitudes to MC among university students in Kano, Nigeria ( n = 375). Almost all respondents (98.1%) reported being circumcised ( n = 368; 95% confidence interval = 96.2% to 99.2%). There was no variation in circumcision status by age, ethnicity, religion, or marital status. Majority of the respondents were circumcised by a health worker (51.2%). Most circumcisions were performed between the ages of 5 and 10 years (57.9%) and for religious reasons (79.2%). Only 38% of the respondents ( n = 104) were aware of the role of MC in reducing HIV acquisition in heterosexual males. Three quarters of the respondents agreed that circumcised men still need to use condoms. The practice of MC is nearly universal in northern Nigeria, despite low awareness of its protective role in HIV transmission. Public health programs should seize the opportunity offered by high MC acceptance rates to integrate safe medical MC services into existing HIV/AIDS prevention initiatives.

Malaria in pregnancy is associated with substantial risk of maternal and fetal morbidity and mortality. The uptake of preventive antimalarials is low in malaria endemic countries, including Nigeria. Using a cross-sectional study design, we assessed factors associated with uptake and adherence to intermittent preventive treatment for malaria in pregnancy (IPTp) among antenatal attendees in primary health centers in Kano, northern Nigeria (n = 239). A total of 137 respondents (57.3%) reported receiving preventive antimalarials, but only 88 respondents (36.8%) [95% confidence interval (CI): 30.7–43.3%] reported ingesting pills in the clinic under supervision. Factors associated with adherence to IPTp after adjustment for potential confounding included: advanced maternal age [adjusted odds ratio (AOR) (95%CI) = 2.1 (1.3–6.37)], higher educational attainment [AOR (95%CI) = 3.2 (1.32–6.72)], higher parity [AOR (95%CI) = 1.6 (1.07–3.94)], lower gestational age at booking [AOR (95% CI) = 1.72 (1.24–3.91)], and use of insecticide-treated nets [AOR (95%CI) = 2.03 (1.13–3.26)]. There is a need for strengthening health systems and addressing cultural factors that impede efforts at expanding coverage of malaria prevention strategies in Nigeria.

Despite the increased risk of domestic violence among women living with HIV/AIDS, its burden has not been adequately explored in many developing countries including Nigeria. Using interviewer administered questionnaires we assessed the prevalence and risk factors for domestic violence among 300 HIV seropositive women attending a teaching hospital in northern Nigeria. Participants have been diagnosed HIV positive for an average of 6.7 years; 66.3% were seroconcordant with their intimate partners while 16.3% were serodiscordant, the rest 17.4% did not know the partner's status; 67.1% had disclosed their status to their partners; and 64(22.1%) [95% CI (17.5% to 27.4%)] had experienced domestic violence following HIV diagnosis. Specifically, 30.0% (n = 19) experienced physical violence (slapping, kicking and punching), 59.3% (n = 38) reported verbal violence (insults, threats) and 10.7% (n = 7) endured emotional violence. None was sexually assaulted. Predictors of domestic violence were the woman's age, marital status, disclosure and partner's educational status. This calls for urgent steps and strategies for prevention, protection and post-test counseling on disclosure to avert this human right infringement.

The process of becoming aware of one's serostatus, immediate and delayed responses of the individual, family and community have profound implications on health seeking behaviour of PLWHAs especially in developing countries. We investigated post-diagnosis reactions, disclosure, perceived stigmatization and sexual behaviour of PLWHAs in northern Nigeria.A triangulation of methods consisting of structured interviewer questionnaire administered on 205 respondents and two Focus Group Discussions with PLWHAs receiving care at Aminu Kano Teaching Hospital was used. HIV serodiagnosis, immediate and delayed reaction to serostatus and responses of family, friends and community members were elicited in addition to perceived stigma and sexual behaviour.Overall, 111 (54.1%) of the 205 patients were counseled before being tested for HIV infection. Majority of women 59 (51.8%) were tested and informed during antenatal care or 46 (40.4%) following diagnostic workup for symptoms related to AIDS. Most men 69 (75.8%) came to know during diagnostic workup or as part of screening for blood transfusion 5 (5.5%). Up to 37.2% of the respondents had kept their serostatus secret. Disclosures were more likely to mothers (51.9%), sisters (31.0%), brothers (11.0%) and spouses (6.1%). Of all respondents, 149 (72.6%) said they were shocked, afraid, angry and sad while 29 (14.1%) reported being indifferent. A higher proportion of females 68 (59.7%) were shocked, sad and angry than males 36 (39.6%) (P0.05). Significant reductions occurred over time in the proportion of patients that were sad, afraid and shocked (P0.05). A higher proportion of mothers (67.0%), sisters (44.2%), friends of the same sex (37.1%), father (27.5%) and spouse (23.7%) were perceived to be sympathetic compared to others (P0.05). Forty-five (21 .9%) of the respondents were discriminated against. Of this, 22 (48.9%) happened at home, 18 (40.0%) in the workplace and the remaining 17 (37.8%) among friends. Of 85 (41.5%) that were sexually active, 78 (91.8%) reported protecting their partners through use of condoms.The sub-optimal counseling resulted in strong emotional reactions that threatened the strong social support system of PLWHAs. Supportive counseling could improve VCT uptake and well being of PLWHAs in northern Nigeria.

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] = 1.5, 95% confidence interval [CI] = 1.2-2.6), formal education (AOR = 1.9, 95% CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95% CI = 1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms.

Little research has been conducted regarding the reproductive intentions of people living with HIV/AIDS (PLWHA) in northern Nigeria. We studied reproductive desires and their predictors among 340 PLWHA receiving care at Aminu Kano Teaching Hospital. Of all respondents, 60 (70.6%) of males and 177 (69.4%) of females were sexually active. Only 65 (19.4%) of them used condoms. One hundred and sixty seven females (65.5%) and 52 (61.2%) males expressed a desire to have more children. Out of these, 16 (7.3%), 106 (48.4%) and 88 (40.2%) wanted to have one, two and three or more children respectively. Significant predictors of higher fertility desires were; religion (OR=1.8), duration of diagnosis (OR=0.42), low parity (OR=6.03) and awareness of partner's scrostatus (OR=2.3). A large proportion of the HIV-positive individuals in the study were sexually active, desired to have children, and wanted to use family planning, indicating unmet need for reproductive health counseling in general and family planning in particular.

Background In West Africa, envenoming by saw-scaled or carpet vipers (Echis ocellatus) causes great morbidity and mortality, but there is a crisis in supply of effective and affordable antivenom (ISRCTN01257358). Methods In a randomised, double-blind, controlled, non-inferiority trial, “EchiTAb Plus-ICP” (ET-Plus) equine antivenom made by Instituto Clodomiro Picado was compared to “EchiTAb G” (ET-G) ovine antivenom made by MicroPharm, which is the standard of care in Nigeria and was developed from the original EchiTAb-Fab introduced in 1998. Both are caprylic acid purified whole IgG antivenoms. ET-G is monospecific for Echis ocellatus antivenom (initial dose 1 vial) and ET-Plus is polyspecific for E. ocellatus, Naja nigricollis and Bitis arietans (initial dose 3 vials). Both had been screened by pre-clinical and preliminary clinical dose-finding and safety studies. Patients who presented with incoagulable blood, indicative of systemic envenoming by E. ocellatus, were recruited in Kaltungo, north-eastern Nigeria. Those eligible and consenting were randomly allocated with equal probability to receive ET-Plus or ET-G. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by a simple whole blood clotting test repeated 6, 12, 18, 24 and 48 hr after treatment. Secondary (safety) outcomes were the incidences of anaphylactic, pyrogenic and late serum sickness-type antivenom reactions. Findings Initial doses permanently restored blood coagulability at 6 hours in 161/194 (83.0%) of ET-Plus and 156/206 (75.7%) of ET-G treated patients (Relative Risk [RR] 1.10 one-sided 95% CI lower limit 1.01; P = 0.05). ET-Plus caused early reactions on more occasions than did ET-G [50/194 (25.8%) and 39/206 (18.9%) respectively RR (1.36 one-sided 95% CI 1.86 upper limit; P = 0.06). These reactions were classified as severe in 21 (10.8%) and 11 (5.3%) of patients, respectively. Conclusion At these doses, ET-Plus was slightly more effective but ET-G was slightly safer. Both are recommended for treating E. ocellatus envenoming in Nigeria. Trial Registration Current Controlled Trials ISRCTN01257358, Author Summary Snake bite threatens millions of poor rural folk throughout Africa. In Nigeria, as in many countries of sub-Saharan Africa, it takes a terrible toll on human life and limb. Over the years, the news for those exposed to snake bite has been generally bad: withdrawal of antivenom manufacturers, increasing cost and, most recently, the marketing of ineffective or fake antivenoms in the region. Our paper reports encouraging results achieved by two antivenoms created as a direct consequence of the present crisis in antivenom supply for Africa. They have been assessed in the most powerful trial ever attempted in this field. The trial showed that in people with non-clotting blood following carpet viper bite, the commonest cause of snake bite morbidity and mortality in the West African savannah, administration of the antivenoms- EchiTAb G and EchiTAb Plus-ICP led to permanent restoration of blood clotting in 76% and 83% of the patients within 6 hours, respectively. Generally mild early adverse reactions were recorded in 19% and 26%, respectively. Both antivenoms proved effective and acceptably safe and can be recommended for treating carpet viper envenoming in Nigeria.

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.

The aim of this study was to identify candidate antivenoms with specific activity against the venom of the saw-scaled or carpet viper (Echis ocellatus) in northern Nigeria, where bites by this species cause great morbidity and mortality but where effective antivenoms have become scarce and unaffordable. Selected antivenoms were destined to be compared by randomised controlled clinical trials (RCTs). Standard pre-clinical neutralisation assays were carried out in rodents. We included two licensed antivenoms of established clinical efficacy and 6 candidate antivenoms. Although 6 of the tested antivenoms showed promising efficacy, all but 3 were excluded from further study because of inadequate pre-clinical efficacy or because they were unavailable or unaffordable for the anticipated RCTs. Median effective doses (ED 50) of the remaining three candidate antivenoms suggested that the following doses might neutralise the maximum observed venom yield of 24.8mg (dry weight) of venom milked from captive E. ocellatus: 10ml of MicroPharm " EchiTAb G" (ET-G) antivenom; 30ml of Instituto Clodomiro Picado " EchiTAb-Plus-ICP" (ET-Plus) antivenom; 50ml of VacSera, Cairo " EgyVac" antivenom. A preliminary clinical dose-finding and safety study of these three antivenoms was carried out in 24 patients with incoagulable blood after E. ocellatus bites who were not severely envenomed. A 3+3 dose escalation design was employed. Initial doses of 10ml ET-G and 30ml ET-Plus restored blood coagulability in groups of 6 patients with early mild reactions (pruritus only) in not more than one third of them. EgyVac antivenom did not fulfil efficacy or safety criteria in 12 patients. On the basis of these results, ET-G and ET-Plus were selected for comparison in a RCT. © 2009 Elsevier Ltd.

The report describes successful management of 10 women in 2nd and 3rd pregnancy trimesters with EchiTab IgG antivenom after carpet viper (Echis ocellatus) envenoming. All women survived but foetal loss in a victim with delayed presentation and a case of mild hypersensitivity reaction were recorded. Excellent outcomes can be achieved in rural and semi-nomadic populations without specialized care and immediate access and provision of effective antivenoms is paramount in curtailing snakebite maternal morbidity, mortality and foetal loss.

Background This study was designed to examine the knowledge, attitude and beliefs about causes, manifestations and treatment of mental illness among adults in a rural community in northern Nigeria. Methods A cross sectional study design was used. A pre-tested, semi-structured questionnaire was administered to 250 adults residing in Karfi village, northern Nigeria. Results The most common symptoms proffered by respondents as manifestations of mental illness included aggression/destructiveness (22.0%), loquaciousness (21.2%), eccentric behavior (16.1%) and wandering (13.3%). Drug misuse including alcohol, cannabis, and other street drugs was identified in 34.3% of the responses as a major cause of mental illness, followed by divine wrath/ God's will (19%), and magic/spirit possession (18.0%). About 46% of respondents preferred orthodox medical care for the mentally sick while 34% were more inclined to spiritual healing. Almost half of the respondents harbored negative feelings towards the mentally ill. Literate respondents were seven times more likely to exhibit positive feelings towards the mentally ill as compared to non-literate subjects (OR = 7.6, 95% confidence interval = 3.8–15.1). Conclusions Our study demonstrates the need for community educational programs in Nigeria aimed at demystifying mental illness. A better understanding of mental disorders among the public would allay fear and mistrust about mentally ill persons in the community as well as lessen stigmatization towards such persons.

Context: Until recently, the role of men in family planning and other reproductive health programmes has been neglected. Reports from other places indicate an increase in the role played by men in these activities. In rural northern Nigeria, the culture and religion are different from what obtains elsewhere and it is important to investigate men's role in reproductive choices. The outcome may be of use in planning reproductive services in similar communities. Objective: To investigate the role men played in contraceptive decision making in a rural northern Nigerian community. Study Design/Setting and Subjects: A cross-sectional community-based study was conducted in Fanshekara village near Kano. Using systematic sampling, 120 married men in a rural area of Northern Nigeria were selected and interviewed using a semi-structured questionnaire. Results: Among the respondents, 65% disapproved of the very concept of contraception. Disapproval was higher among those with low educational attainment. Reasons for the men's disapproval were mainly based on religious and cultural factors. More than two-thirds (68%) of the men felt that family size determination and contraceptive decision-making was entirely their responsibility, while 73% had never discussed these issues with their wives. A positive attitude in the husband was significantly associated with current use of contraception (χ2 = 5.32; df = 1, p Conclusions: The findings have revealed a need to integrate men into various aspects of reproductive health programmes and to bridge the gap between family planning service providers, and the religious and other community leaders in the northern part of Nigeria. Key Words: Contraception, Decision-Making, Empowerment. [Trop J Obstet Gynaecol, 2003, 20: 24-27]

Introduction: Integrated management of childhood illnesses (IMCI) is a holistic approach to reducing under-5 morbidity and mortality, and improving growth and development of children. This study compared key household and community practices in IMCI implementing and non-implementing communities in two local government areas (LGAs) of Kano State, Nigeria. Materials and Methods: A cross-sectional study was employed with multistage cluster sampling selection of caregivers of children 0-59 months of age and their index children (n = 400). The study was conducted from February 2009 through January 2010. Data analysis was performed using EpiInfo TM v6.0 and Minitab TM software. Results: The adoption of IMCI key household and community practices was generally better in IMCI-implementing communities than in non-IMCI communities. Exclusive breastfeeding (EBF) rate among children under 6 months was higher in IMCI communities than in non-IMCI communities (P = 0.05). Non-IMCI communities also had a greater proportion of low weight-for-age children (42.5%) than IMCI communities. Mothers from IMCI communities (30.5%) were more likely to have antenatal care (ANC) during the first trimester than those from non-IMCI communities (P < 0.05). There was no difference between the study communities with regard to use of insecticide-treated nets (ITN) during pregnancy (P = 0.09), and having skilled attendance during last childbirth (P = 0.23). Conclusion: Mothers in communities implementing IMCI are more likely to adopt EBF and to attend ANC services than their counterparts in communities not implementing IMCI. Expanding IMCI activities to other LGAs in northwest Nigeria will have a positive impact on reducing morbidity from common childhood diseases.

Background: Population based mortality data are scarce especially in developing countries including Nigeria. Despite its limitations, hospital mortality analysis assesses the quality of health-care delivery and provides a proximate measure of mortality. We reviewed the magnitude and causes of death among in-patients in a tertiary hospital in northern Nigeria. Methods: Analysis of mortality rate and causes of death for the period 20052008 (inclusive) in Aminu Kano Teaching Hospital. Causes of death were prospectively entered on a database and classified according to the International Classification of Diseases (ICD-10). Results: Out of 51,975 patients admitted to the hospital, 4,029 of them died. This gives a mortality rate of 7.8% (95% Confidence Interval of 7.5% to 8.0%). Specifically, of the 15,484 males admitted, 2,361 died giving a mortality rate of 15.2% while of the 36,491 females admitted, 1,668 died giving a mortality rate of 4.6%. The median age for all patients that died was 32.4 years (range: less than 1 day to 101 years), but 36.1 years (range: less than 1 day to 101 years) for the male and 29.3 (range: less than 1 day to 87 years) for the female subsets. The ten most common causes of mortality were HIV/AIDS (8.3%), Septicaemia (6.8%), cerebrovascular disease (6.3%), chronic renal failure (3.9%) chronic liver disease (3.3%), diabetes mellitus (3.2), neonatal jaundice (2.9%), severe birth asphyxia (2.6%), prematurity (2.5%) and bronchopneumonia (2.4%). Conclusion: The mortality rate and causes of death are comparable to similar centres. Regular mortality audits could identify management errors and prevent recurrence of avoidable deaths. Key words : Mortality, causes, Teaching hospital, Kano, Nigeria