Abstract:

Most obstetric complications could be prevented or managed if women had access to a skilled birth attendant SBAs; doctor, nurse, midwife during childbirth. Globally, almost 80% of live births occurred with the assistance of skilled health personnel in the period 2012-2017 up from 62% in the period 2000-2005. Improvements in the coverage of the proportion of births attended by SBAs and their provision of care may have contributed to declines in maternal mortality between 1990 and 2015.The study adopted a survey research design using semi-structured questionnaire and interview guide to collect data. That was collected from June to September, 2017. Interviews were conducted with 370 eligible expectant women residing in Mombasa County. Data was entered in the Epi Data database. Univariate statistics was explored to determine the frequency and percentage. Analysis was conducted in R (version 3.4.3). All the 370 respondents had at one time visited the health facility to seek the services for pregnancy check-up. Factors like mother’s checking their status and of the unborn (42.2%), check-up/examination and treatment (17.6%) were some of reasons cited by expectant mothers for visiting health facility, while factors such as nearness (76.5%) and availability of essential services were some of reasons why expectant mothers visited a particular health facility. There is need to improve the quality of existing facility-based delivery services and strengthening linkages between the expectant mothers and the health facilities as to increase the deliveries.

Keywords: Delivery, Skilled Attendants, Traditional Attendants, Free Maternal Health, Health facilities, Mombasa County.

References:

[1].     Bettina Utz, Ghazna Siddiqui, Adetoro Adegoke & Nynke Van Den Broek (2013). Definitions and roles of a skilled birth attendant: a mapping exercise from four South-Asian countries. Acta Obstetricia et Gynecologica Scandinavica. 92: 1063–1069.

[2].     Fisher AA, Laing EJ, Stoeckel EJ, Townsend WJ (1998). Handbook for family planning operations research design. New York, NY, USA: Population Council; p.36.

[3].     Government of Kenya (GoK, 2012). Accelerating attainment of Health Goals: The First Kenya Health Sector Strategic and Investment Plan – KHSSP July 2012 – June 2018. Afya House, Nairobi.

[4].     Indira, N., Shaver, T., Clark, P.A, Cordero, D., & Faillace, S. (2004). Entry into this World: Who Should Assist? Birth Attendants and Newborn Health.

[5].     John Njuguna, Njoroge Kamau and Charles Muruka (2017). Impact of free delivery policy on utilization of maternal health services in county referral hospitals in Kenya. BMC Health Services Research.17:429

[6].     KDHS. (2014). Kenya demographic and health survey: Key indicators, 1–76.

[7].     Lincetto O, Mothebesoane-anoh S, Gomez P, Munjanja S (2010). Antenatal Care: Opportunities for Africa’s Newborns. New York: World Health Organization.

[8].     Lunan, B., Clements, Z, Mahony, S., & Hope-Jones, D., (2010). Maternal health in Malawi: challenges and Success. Scotland Malawi Partnership.

[9].     Martin LT, McNamara MJ, Milot AS, Halle T, Hair EC (2007). The effects of father involvement during pregnancy on receipt of prenatal care and maternal smoking. Matern Child Health J;11(6):595–602.

[10]. MoHSW (2015). Tanzania Health Sector Strategic Plan 2015–2020 (HSSP IV). Vol. 2020.

[11]. Moore, M., Copeland, R., Chege, S., Pido, D. & Griffiths, M. (2002). A behavior Change Approach to investigating factors influencing Women’s use of Skilled Care in Homabay District, Kenya.

[12]. Mwewa D, Michelo C (2010). Factors associated with home deliveries in a low-income rural setting-observations from Nchelenge District Zambia. Med J Zambia. 37(4):234–9.

[13]. Navaneetham K, Dharmalingam A (2006). Utilization of maternal health care services in Southern India. Soc Sci Med. 55:1849–69.

[14]. Shiferaw, S., Spigt, M., Godefrooij, M., Melkamu, Y., & Tekie, M. (2013). Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth, 13:2393-13-5.

[15]. Sibley, L., & Snipe (2006). Transition to Skilled Birth Attendance, Is there a future role for trained TBAs. Journal Health Pop and Nutrition. 24(4): 472-478.

[16]. Tawiah E (2007). Maternal health in five Sub-Saharan African countries. Poster Presentation at the Fifth African Population Conference. In: (2007); 10-14 December, Arusha Interntional conference center, Arusha.

[17]. Thaddeus S, Maine D (1994). “Too far to walk: maternal mortality in context”. Social Science and Medicine. 38(8):1110.

[18]. Titaley CR, Hunter CL, Dibley MJ, Heywood P (2010). Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy Childbirth. 10:43.

[19]. Utz Bettina, Ghazna Siddiqui, Adetoro Adegoke & Nynke Van Den Broek (2013). Definitions and roles of a skilled birth attendant: a mapping exercise from four South-Asian countries. Acta Obstetricia et Gynecologica Scandinavica. 92: 1063–1069.

[20]. Vieira, C., Portela, A., Miller, T., Coast, E., Leone, T., & Marston, C. (2012). Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: A systematic review. PLoS ONE. 7(10), e47946.

[21]. Wanjira, C., Mwangi, M., Mathenge, E., Mbugua, G. & Ng ang a, Z. (2011). Delivery Practices and Associated factors among Mothers Seeking Child welfare Services in selected Health Facilities in Nyandarua South District, Kenya. BMC, Public Health.

[22]. World Health Organization (2018). Skilled attendants at birth. Global Health Observatory (GHO) data; Maternal and reproductive health.

[23]. World Health Organization (2012). Neonatal and Child Health Profile.

[24]. World Health Organisation (2010). Classifying Health Workers. Geneva.

[25]. WHO (2004). Road Map for Accelerating the Attainment of the MDGs Related to Maternal and Newborn Health in Africa. African Regional Reproductive Health Task Force Meeting. In. Harare.

[26]. World Health Organization (1992). Traditional Birth Attendants: a joint WHO/UNFPA/UNICEF statement. Geneva.

Abstract:

Background: Voluntary medical male circumcision (VMMC) reduces female-to-male transmission of HIV by about 60% leading to the global WHO and UNAIDS recommendation of VMMC to men. A traditionally non-circumcising Luo ethnic community predominantly occupies Homa-Bay County in western Kenya where the uptake of VMMC as an intervention for prevention of HIV acquisition has been low. Community dialogue is a participatory communication process of sharing information aimed at reaching a common understanding and workable solution. The current study documented the baseline status on the acceptability of uptake of VMMC and access to voluntary counselling and testing (VCT) among residents of Homa-Bay County, Kenya prior to intervention (community dialogue).

Methods: Males of Luo ethnic group, uncircumcised and aged 18-49 years drawn from 419 households were recruited. Baseline information (before intervention) were collected to capture the acceptance of VMMC, circumcision status and testing for HIV in the population. Structured and semi-structured questionnaires were used for data collection.

Results: Analysis showed that in Ndhiwa, Rachuonyo North and Suba South Sub-counties, 54.9%, 84.1% and 69.8%, respectively, had accessed VCT, while 3.5%, 0.7% and 10.8%, respectively had undergone VMMC. The proportions of those who accessed VCT services were significantly higher (P<0.0001) while the proportions of those who had undergone VMMC were significantly lower (P<0.0001) across the three sub-counties.

Conclusion: These results demonstrate that even though majority access VCT services to know their HIV status, significantly few men decide to undergo VMMC. This revealed a decreased acceptability of this service in Homa-Bay County prior to the intervention.

Keywords: VMMC, VCT, community acceptability, HIV and AIDS.

References:

[1].Bailey, R.C., Moses, S., Parker, C.B., Agot, K., Maclean, I., Krieger, J.N., Williams, C.F., Campbell, R.T., and Ndinya-Achola, J.O. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369, 643-656.

[2].Brito, M.O., Caso, L.M., Balbuena, H., and Bailey, R.C. (2009). Acceptability of male circumcision for the prevention of HIV/AIDS in the Dominican Republic. PLoS One 4, e7687.

[3].CDC (2013). Adult Blood Lead Epidemiology and Surveillance (ABLES). Cincinnati, OH: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health; 2013. Available at http://www.cdc.gov/niosh/topics/ables/description.html.

[4].Clinics, A.o.O.a.E. (2007). Medical management guidelines for lead-exposed adults. Washington, DC: Association of Occupational and Environmental Clinics; 2007. Available at http://www.aoec.org/documents/positions/MMG_FINAL.pdf.

[5].Feng, N., Lu, F., Zeng, G., Nan, L., Wang, X.Y., Xu, P., Zhang, J.X., and Zhang, S.E. (2010). [Acceptability and related factors on male circumcision among young men with Yi ethnicity in one county of Sichuan province.]. Zhonghua Liu Xing Bing Xue Za Zhi 31, 281-285.

[6].Figueroa, M.E., Poppe, P., Carrasco, M., Pinho, M.D., Massingue, F., Tanque, M., and Kwizera, A. (2016). Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique. Journal of health communication 21, 554-563.

[7].Galbraith, J.S., Ochieng, A., Mwalili, S., Emusu, D., Mwandi, Z., Kim, A.A., Rutherford, G., Maina, W.K., Kimanga, D.O., Chesang, K., et al. (2014). Status of voluntary medical male circumcision in Kenya: findings from 2 nationally representative surveys in Kenya, 2007 and 2012. Journal of acquired immune deficiency syndromes 66 Suppl 1, S37-45.

[8].KAIS (2012). National AIDS and STI Control Programme. Kenya AIDS Indicator Survey 2012: Final Report. Nairobi, Kenya: NASCOP, 2014.

[9].Godden, B. (2004). Sample size formulas. Available at: http://williamgodden.com. Accessed 30th December, 2017.

[10]. KAIS (2014). Kenya AIDS Response Progress Report: Progress Towards Zero, National AIDS Control Council.

[11]. Kosnett, M.J., Wedeen, R.P., Rothenberg, S.J., Hipkins, K.L., Materna, B.L., Schwartz, B.S., Hu, H., and Woolf, A. (2007). Recommendations for medical management of adult lead exposure. Environmental health perspectives 115, 463-471.

[12]. Kwena, Z.A., Bukusi, E., Omondi, E., Ng'ayo, M., and Holmes, K.K. (2012). Transactional sex in the fishing communities along Lake Victoria, Kenya: a catalyst for the spread of HIV. African journal of AIDS research: AJAR 11, 9-15.

[13]. MRC U. (2008). Developing and evaluating complex interventions: new guidance. London: Medical Research Council.

[14]. Luo, H., Liang, X., Chen, J., Yang, X.B., Jiang, J.J., Deng, W., Zou, Y.F., Wei, B., Zhang, Z.Y., Liu, Z.H., and Liang, H. (2011). [Acceptability of male circumcision among male miners in Baise of Guangxi]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 33, 313-317.

[15]. Program, N.T. (2013). Health effects of low-level lead evaluation. Research Triangle Park, NC: US Department of Health and Human Services, National Toxicology Program; 2013. Available at http://ntp. niehs.nih.gov/go/36443.

[16]. Sahlu, T., Agonafir, A.T., and Tsegaye, T.A. (1998). Factors associated with attendance at HIV post-test counselling in Ethiopia. XII World AIDS Conference; Geneva. June–July 1998; abstract 33280.

[17]. UNAIDS (2007). Male circumcision: global trends and determinants of prevalence, safety and acceptability Geneva: World Health Organisation; 2007. Avaiable: http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf. UNAIDS.

Abstract:

Introduction: Aids is a pandemic. In 2016, according to UNAIDS, the number of people living with HIV is 36.7 million. New infected children represent 160 000, mostly via their HIV positive mothers during pregnancy, delivery or breastfeeding. Since 2010, different political decisions were adopted and later the option B+ to reduce the transmission rate. Little is known about their implementation at the operational level in the Center Region of Cameroon.

Method: We aimed to draw the evolution of PMTCT services in the Biyem-Assi District Hospital. From 01 to 26 April 2016, through a descriptive retrospective cross sectional study, we used registers of the consultation (pregnant women, children) and HIV test from 2010 to 2015, Excel software to compile data, describe tables and figures.

Results: We found a good response rate of the HIV screening test in the ANC unit. 99.88% in 2015 compare to 95.93% in 2010. The number of pregnant women newly screened in the delivery room was increasing, 99 in 2013, 279 in 2014 and 786 in 2015. Among these pregnant women newly screened, an increasing number of positive cases; from 2 in 2010 to 10 in 2015. There was a high rate of lost to follow up of HIV-exposed infants (HEI).

Conclusion: Training of health care workers is a priority for the early infant diagnosis of HIV. Further studies are needed to reduce the lost to follow up, to screen and treat the HEI registered in the delivery rooms.

Keywords: PMTCT, HEI, option B+, Biyem-Assi District Hospital, HIV, AIDS.

References:

[1].     Abtew, S., Awoke, W., & Asrat, A. (2015, November 9). Acceptability of provider - initiated HIV testing as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women attending at Public Health Facilities in Assosa town, Northwest Ethiopia. BioMed Central, p. 661.

[2].     Ahmed, C. V., Jolly, P., Padilla, L., Malinga, M., Harris, C., Mthethwa, N., … Preko, P. (2017). A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland. African Journal of AIDS Research: AJAR, 16(4), 321–328. https://doi.org/10.2989/16085906.2017.1380677

[3].     Burton, J., Darbes, L. A., & Operario, D. (2010). Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS and Behavior, 14(1), 1–10. https://doi.org/10.1007/s10461-008-9471-4

[4].     Etoori, D., Kerschberger, B., Staderini, N., Ndlangamandla, M., Nhlabatsi, B., Jobanputra, K., … Teck, R. (2018). Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland. BMC Public Health, 18(1), 374. https://doi.org/10.1186/s12889-018-5258-3

[5].     Ghoma-Linguissi, L. S., Ebourombi, D. F., Sidibe, A., Kivouele, T. S., Vouvoungui, J. C., Poulain, P., & Ntoumi, F. (2015). Factors influencing acceptability of voluntary HIV testing among pregnant women in Gamboma, Republic of Congo. BMC Research Notes, 8, 652. https://doi.org/10.1186/s13104-015-1651-5

[6].     Hampanda, K. M., Nimz, A. M., & Abuogi, L. L. (2017). Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples. AIDS Research and Therapy, 14(1), 17. https://doi.org/10.1186/s12981-017-0142-2

[7].     Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: a decade later. Health Education Quarterly, 11(1), 1–47.

[8].     Jasseron, C. (2013). Prise en charge des femmes enceintes infecées par le VIH en France à l’ère des multithérapies: des recommandations aux pratiques. France.

[9].     Kashitala, J., Nyambe, N., Mwalo, S., Musamba, J., Chishinga, N., Kasonde, P., … Welsh, M. (2015). Is Male Involvement in ANC and PMTCT Associated with Increased Facility-Based Obstetric Delivery in Pregnant Women? African Journal of Reproductive Health, 19(2), 117–124.

[10].  Kieffer, M. P., Mattingly, M., Giphart, A., van de Ven, R., Chouraya, C., Walakira, M., … EGPAF Technical Directors Forum. (2014). Lessons learned from early implementation of option B+: the Elizabeth Glaser Pediatric AIDS Foundation experience in 11 African countries. Journal of Acquired Immune Deficiency Syndromes (1999), 67 Suppl 4, S188-194. https://doi.org/10.1097/QAI.0000000000000372

[11]. Kim, M. H., Ahmed, S., Hosseinipour, M. C., Yu, X., Nguyen, C., Chimbwandira, F., … Abrams, E. J. (2015). Brief Report: Impact of Option B+ on the Infant PMTCT Cascade in Lilongwe, Malawi. Journal of Acquired Immune Deficiency Syndromes (1999), 70(1), 99–103. https://doi.org/10.1097/QAI.0000000000000692

[12]. Ministry of Public Health Cameroon. (2012). National Operational Plan for scaling up of Early Infant Diagnosis (EID), continuum of care 2013-2014, DRAFT one December 2012. Cameroon.

[13].  Moodley, T., Moodley, D., Sebitloane, M., Maharaj, N., & Sartorius, B. (2016). Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa. BMC Pregnancy and Childbirth, 16(1), 35. https://doi.org/10.1186/s12884-016-0821-3

[14].  Olana, T., Bacha, T., Worku, W., & Tadesse, B. T. (2016). Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8 years retrospective analysis. AIDS Research and Therapy, 13(1), 29. https://doi.org/10.1186/s12981-016-0112-0

[15].  Tariq, S., Elford, J., Cortina-Borja, M., Tookey, P. A., & National Study of HIV in Pregnancy and Childhood. (2012). The association between ethnicity and late presentation to antenatal care among pregnant women living with HIV in the UK and Ireland. AIDS Care, 24(8), 978–985. https://doi.org/10.1080/09540121.2012.668284

[16]. UNAIDS. (2017). UNAIDS DATA 2017.

[17]. W H O. (2013). Consolidated Guidelines on the use of Antiretroviral drugs for treating and preventing HIV infection.

[18]. WHO. (2010). PMTCT strategic vision 2010-2015 Preventing mother-to-child transmission of HIV to rach the UNGASS and Millenium Development Goals.

[19]. WHO. (2016). Consolidated Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection; Recommendations for a public health approach-second edition (p. 480).

[20]. Zeng, H., Chow, E. P. F., Zhao, Y., Wang, Y., Tang, M., Li, L., … Zhang, L. (2016). Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis. Sexually Transmitted Infections, 92(2), 116–123. https://doi.org/10.1136/sextrans-2014-051877

Abstract:

Background: Kenya continues to experience a growing gap of health workers at all levels of service provision within its health infrastructure. As a consequence, this gap is a big impediment in her quest to achieve the health objectives and the global Sustainable development goals. This study examines factors influencing retention of health workers in primary health care facilities.

Methods: A cross sectional study design using semi - structured questionnaire tools involving 85 healthcare workers of different cadres at government rural health facilities was used in the County. Descriptive data analysis was used to profile the characteristics of the respondents; while Chi square tests were used to determine the differences between respondents who had stayed at their working station for at least two years. Multinomial Logistic Regression was used to analyse each factor that was considered significant in determining whether healthcare personnel stayed or left.

Results: Age, duration of working, and ability to balance work and personal life, fair evaluation, supervisor’s competence, manageable work load and availability of equipment and logistics were statistically associated with whether healthcare workers would leave or continued staying at their current work stations.

Conclusion: The results show that financial incentives are not the only factors in retention of health workers. The above factors need to be addressed in retention strategies for the retention of health workers at primary health facilities.

Keywords: Retention, Motivation, Primary Health care, Benefits, Leavers, Stayers, Incentives.

References:

[1].Adano Ummuro. 2008. The health worker recruitment and deployment process in Kenya: an emergency hiring program. Human Resources for Health Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557010/?tool=pubmed. Accessed on 20^th May 2009.

[2].Bancroft Emily. 2006. Uganda Health Workforce Retention study manual. Created for the Health Workforce Advisory Board of the Uganda Ministry of Health and The Capacity Project

[3].Bailey. P, Farmer D. Jessop, (2008). Business principles and management, 3^rd edition, Pitman, London, UK

[4].Britten N. 1995. Qualitative Research: Qualitative interviews in medical research. British Medical Journal; 311:251-253.

[5].Buchan J. 2005. Scaling up Health and Education Workers: Increasing the performance and Productivity of an Existing Stock of Health Workers. DFID Health Systems Resource Centre

[6].Centres for Disease Control. 2010. Kenya’s Health Workforce Training Capacity: A situation Analysis. Available at:

www.google.com/search?client=safari&rls=en&q=Kenya+health+workforce+project+2010&ie=UTF-8&oe=UTF-8 Accessed on 23^rd February 2012.

[7].Centres for Disease Control – Malaria.

Available at: http://www.cdc.gov/malaria/cdcactivities/kenya.htm - Accessed on 20^th May 2009.

[8].CREHA Newsletter, December 2008. Improving Health workforce performance

[9].Cameroon, K. and P.M. Pierce, (2007). Building profit through people: Making your workforce the strongest link in the value-profit chain. Alexandria. Virginia: Society for Human Resource Management.

[10]. Chandran, E. (2009). Research Methods, Nairobi: Star bright services limited, Kenya

[11]. Cooper, D.R and Schindler, P.S (2010). Business Research Methods, Tata McGraw-Hill, 8^th Edition, New Delhi, India.

[12]. Dambisya M. Yoswa, May 2007. A Review of Non-Financial incentive for Health worker retention in East and Southern Africa. ECONET discussion paper No. 4.

[13]. Dieleman M, Cuong P, Anh L, Martineau T. 2003. Identifying factors for job motivation of rural health workers in North Viet Nam. Human Resources for Health; 1:10.

[14]. Dieleman M, Harnmeijer JW. 2006. Improving health worker performance: in search of promising practices. Geneva: World Health Organization.

[15]. Dieleman M, Toonen J, Toure H, Martineau T. 2006. The match between motivation and performance management of health sector workers in Mali. Human Resources for Health; 4:2.

[16]. Dussault G, Franceschini MC. 2006. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health, 4:12.

[17]. Gakunju E.M. 2003. Determinants of Health status in Kenya. Available at: http://www.google.com/search?client=safari&rls=en&q=Gakunu+E.M+Determinants+of+Health+status+in+Kenya&ie=UTF-8&oe=UTF-8 - Accessed on 23^rd January 2009.

[18]. Glaser, Barney G & Strauss, Anselm L., 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research, Chicago, Aldine Publishing Company.

[19]. GOK., 2005. Millennium Development goals in Kenya needs & costs, prepared by the Ministry of Planning and National Development, Courtesy of the UNDP, Kenya, and the Government of Finland, Government of Kenya.

[20]. GOK.,1994. National Food Policy. The ministry of Agriculture and Central Bureau of Statistics (Citation - J, Keino. Susan in; Nutrition and the Millennium Development goals- A Kenyan Perspective on the eradication of Extreme Poverty and Hunger).

[21]. Hsieh H-F, Shannon SE. 2005. Three Approaches to Qualitative Content Analysis. Qualitative Health Research; 15:1277-1288.

[22]. Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.

[23]. Lehmann Uta, Marjollein Dieleman, Tim Martineau. 2008. Staffing remote rural areas in middle - and low - income countries: A literature review of attraction and retention. Available at: http://www.biomedcentral.com/1472-6963/8/19Accessed on 23^rd January 2009.

[24]. Lemiere Christophe. 2009. Evaluating and Designing Policy Options for Rural Retention: Some insights from Niger. February 3.

[25]. Lyn N Henderson and Jim Tulloch. 2008.Incentives for retaining and motivating health workers in Pacific and Asian countries. Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569066/ Accessed on 23^rd January 2009.

[26]. Ministry of Health. 2006. Norms and Standards for Health Service Delivery. Nairobi: Health Sector Reform Secretariat

[27]. Manongi R, Marchant T, Bygbjerg IC. 2006. Improving motivation among primary health care workers in Tanzania: a health worker perspective. Human Resources for Health 4:6.

[28]. Mathauer I, Imhoff I: 2006. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Human Resources for Health; 4:24.

[29]. Ministry of Health. 2005. The Second National Health Sector Strategic Plan of Kenya

a.     Reversing the Trends (NHSSP II 2005-10). Nairobi: Ministry of Health.

[30]. Mullei Kethi, Sandra Mudhune, Jackline Wafula, Eunice Masamo, Michael English Catherine Goodman, Mylene Lagarde, Duane Blaauw. 2010. Attracting and retaining health workers in rural areas: investigating nurses’ views on rural posts and policy interventions (BMC Health Services Research: 10(Suppl.1):S1. Available at: http://www.biomedcentral.com/1472-6963/10/S1/S1 Accessed on 31^st March 2011.

[31]. Mwaniki DL, Dulo Charles O. 2008. Migration of Health workers in Kenya: The impact on health service delivery. Discussion paper 55. March, Mustang Management Consultants.

[32]. Nair N.K (2009). Simplified Business management, 2^nd print: Vikas publishing Cox, T. Jr., (2008). The Importance of research in determining organizational Effectiveness, International Journal of Management Reviews, Vol. 2 No.4.

[33]. Ndetei DM; Khasakhala, L; Omolo, JO. 2008. Incentives for health worker retention in Kenya: An assessment of current practice Discussion Paper 62: Available at: www.equinetafrica.org/bibl/docs/DIS62HRndetei.pdf - Accessed on 23^rd January 2009.

[34]. Orute, R. O., Mutua, S. M., Musiega, D. & Masinde, S. W. (2015). Leadership style and employee job satisfaction in Kakamega County, Kenya, International Journal of Management Research & Review, 5 (10), pp. 876

[35]. Olusegun, S.O. (2013). Influence of Job Satisfaction on Turnover Intentions of Library Personnel in Selected Universities in South West Nigeria. Library Philosophy and Practice (e-journal).

[36]. Oyugi, B. O. (2015). Potential impact of devolution on motivation and job satisfaction of health care workers in Kenya: Lessons from early implementation in Kenya and experiences of other sub-Saharan African countries, The Journal of Global Health Care Systems, 5 (1), pp. 1-30

[37]. Okthari, C.R. (2009). Research Methods: Methods and techniques, 3^rd Edition. New age international publishers

[38]. Shattuck –Willis Mischa, Posy Bidwell., Steve Thomas, Laura Wyness, Daune Blaauw and Prudence Ditlopo. 2008. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research 8:247:

Available at: http://www.biomedcentral.com/1472-6963/8/247Accessed on 23^rd January 2009.

[39]. Thaxton Mellisa, 2007. Integrating Population Health and Environment in Kenya. Available at: http://www.prb.org/pdf07/phe-kenya.pdf. Accessed on 20^th May 2009.

[40]. The Private health care consortium, 2007. Private Health Sector Policy

[41]. Development - Presentation Thursday, 6^th December -presented by Dr. Aida Samirand John A. M. Maliti. Available at:

www.hdwgkenya.com/new/index.php?option=com_docman&task=doc_download&Itemid=&gid=121. Accessed on 23^rd January 2009.

[42]. The Yeshiva University fatherhood Project, Introducing Qualitative Hypotheses–Generating Research. Available at: http://www.nyupress.org/webchapters/0814706940chapt1.pdf. Accessed on 30^th May 2010.

[43]. Wheeler Erica,2009. Health Workforce retention and the Kampala declaration; Global workforce Alliance

[44]. World Bank. 2008. Kenya Poverty and Inequality Assessment. Volume1: Synthesis report. Available at: http://siteresources.worldbank.org/INTAFRREGTOPGENDER/Resources/PAKENY A.pdf Accessed on Feb 23rd 2012.

[45]. World Health Organization. 2009. Increasing access to health workers in remote and Rural areas through improved retention WHO global recommendations 1^st expert meeting 2-4 February Geneva.

[46]. World Health Organization. 2006. Health Report - working together, WHO World Health Organization. 2006.Fact sheet N° 302 April. Available at:

http://www.who.int/mediacentre/factsheets/fs302/en/print.html Accessed on 15^th October 2008.

[47]. Zurn Pascal, 2008. Retention of Health workers with a focus on rural areas, 20-21 October. G

[48]. Zurn Pascal, Dolea Carmen, Stilwell Barbara. 2005. Recruitment: developing a motivated workforce. WHO.

Abstract:

Background: Voluntary medical male circumcision (VMMC) reduces transmission of HIV by about 60%. The WHO and UNAIDS recommended it as a new HIV prevention intervention. Counties in western Kenya region which are predominantly occupied by a traditionally non-circumcising Luo ethnic community have low uptake of VMMC. Homa-Bay County leads in HIV and AIDS scourge, thus requires an intervention.

Methodology: Community dialogue, an interactive participatory communication has not been applied to support VMMC in Homa-Bay County. In a longitudinal study, the effect of community dialogue on self-initiated VMMC and uptake of HIV voluntary counseling and testing (VCT) was determined in male residents (aged 18-49 years) resident in Homa-Bay County, Kenya. Baseline (before intervention) and endline (after intervention) information were collected to capture the VMMC and VCT status. Total number counts accessing VCT and VMMC services were used to assess the effect of dialogue on the uptake of VMMC and VCT services.

Results: Following community dialogue, males accessing VMMC services was generally increased: from 829 (January, 2018), 1695 (February, 2018), 815 (March, 2018) and finally 3600 (April, 2018) while for VCT services: from 360 (January, 2018), 1281 (February, 2018), 615 (March, 2018) and finally 1729 (April, 2018). For both VMMC and VCT, there was a positive increment on the numbers of males accessing the services following intervention.

Conclusion: Since community dialogue is an effective intervention and increases the number of males in accessing VMMC and VCT services, it can be used as an intervention in the prevention of HIV infection.

Keywords: VMMC, VCT, community acceptability, HIV and AIDS.

References:

[1].     Ashengo, T.A., Hatzold, K., Mahler, H., Rock, A., Kanagat, N., and Magalona, S. (2012). Voluntary medical male circumcision (VMMC) in Tanzania and Zimbabwe: service delivery intensity and modality and their influence on the age of clients. PLoS One 9, e83642.

[2].     Coates, T.J., Richter, L., and Caceres, C. (2008). Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet 372, 669-684.

[3].     Exner, T.M., Hoffman, S., Parikh, K., Leu, C.S., and Ehrhardt, A. (2002). HIV counseling and testing: women's experiences and the perceived role of testing as a prevention strategy. Perspectives on sexual and reproductive health 34, 76-83.

[4].     FHI (2005). Family Health International (FHI). (2005). Service Delivery Models for HIV Counseling and Testing, FHI, Washington, DC, USA, 2005.

[5].     Gilbert, L., and Walker, L. (2010). 'My biggest fear was that people would reject me once they knew my status...': stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa. Health & social care in the community 18, 139-146.

[6].     Govindasamy, D., Ford, N., and Kranzer, K. (2012). Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. Aids 26, 2059-2067.

[7].     KAIS (2007). National AIDS and STI Control Program (NASCOP) Ministry of Health, Kenya) Kenya AIDS Indicator Survey; 2007.

[8].     KAIS (2012). National AIDS and STI Control Programme. Kenya AIDS Indicator Survey 2012: Final Report. Nairobi, Kenya: NASCOP, 2014.

[9].     KDHS (2008-2009). Kenya National Bureau of Statistics. Kenya Demographic and Health Survey. 2008-2009.

[10]. Kincaid, D.L. (1987). The convergence theory of communication, self-organization, and cultural evolution. In D. L. Kincaid (Ed.), Communication theory: Eastern and western perspectives New York, NY: Academic Press., 209-221.

[11]. Kincaid, D.L. (2004). From innovation to social norm: bounded normative influence. Journal of health communication 9 Suppl 1, 37-57.

[12]. Kundi, G.J., Mphuru, L., McMahan, J., Mwakipesile, P., Mwanasalli, S., and Simbeye, D. (2013). Increased uptake of voluntary medical male circumcision (VMMC) services among older men following mobile technology demand creation in Shinyanga and Simiyu, Tanzania. -ISDS 2013; 2013.

[13]. Martin, S.L., Muhomah, T., Thuita, F., Bingham, A., and Mukuria, A.G. (2015). What motivates maternal and child nutrition peer educators? Experiences of fathers and grandmothers in western Kenya. Social science & medicine 143, 45-53.

[14]. Murdock, G.P. (1956). How culture changes. In H. L. Shapiro (Ed.), Man, culture, and society (pp. 247–260). New York, NY: Oxford University Press.

[15]. Ngetich, A., Abon'go, B., Okomo, G., and Ouma, C. (2018). Community acceptability of voluntary medical male circumcision (VMMC) as a strategy in the fight against the spread of HIV and AIDS among residents of Homa-Bay County Kenya. Texila International Journal.

[16]. Njeuhmeli, E., Forsythe, S., Reed, J., Opuni, M., Bollinger, L., Heard, N., Castor, D., Stover, J., Farley, T., Menon, V., and Hankins, C. (2011). Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Med 8, e1001132.

[17]. Noelle-Neumann, E. (1974). The spiral of silence: A theory of public opinion. Journal of Communication 24, 43–51.

[18]. Noelle-Neumann, E. (2014). Public opinion and social control. In W. Donsbach, C. Salmon, & Y. Tsfati (Eds.), The spiral of silence: New perspectives on communication and public opinion. New York, NY: Routledge., 19-32.

[19]. Ochieng, B., Akunja, E., Edwards, N., Mombo, D., Marende, L., and Kaseje, D.C. (2014). Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian). BMC health services research 14 Suppl 1, S4.

[20]. Sanjobo, N., Frich, J.C., and Fretheim, A. (2008). Barriers and facilitators to patients' adherence to antiretroviral treatment in Zambia: a qualitative study. SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance 5, 136-143.

[21]. Scheufele, D.A., and Moy, P. (2000). Twenty-five years of the spiral of silence: A conceptual review and empirical outlook. International Journal of Public Opinion Research 12, 3-28.

[22]. TACAIDS (. 2013). TACAIDS, ZAC, NBS, OCGS, International I. (2013). Tanzania HIV/AIDS and malaria indicator survey 2011-12: key findings. Dar es Salaam, Tanzania: National Bureau of Statistics, Ministry of Finance; 2013.

[23]. UNAIDS, W.a. (2016). A framework for voluntary medical male circumcision: VMMC 2021 [Internet]. 2016. [cited 2017 December 30th]. Available from: http://www.who.int/hiv/pub/malecircumcision.

[24]. Underwood, C., Brown, J., Sherard, D., and Abdur-Rahman, A. (2011). Reconstructing gender norms through ritual communication: A study of African Transformation. Journal of Communication 61, 197-218.

[25]. Wachira, J., Kimaiyo, S., Ndege, S., Mamlin, J., and Braitstein, P. (2012). What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in Western Kenya? Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 54, 275-281.

[26]. Wegs, C., Creanga, A.A., Galavotti, C., and Wamalwa, E. (2016). Community Dialogue to Shift Social Norms and Enable Family Planning: An Evaluation of the Family Planning Results Initiative in Kenya. PloS one 11, e0153907.

[27]. WHO (2007). WHO, UNAIDS. (2007). New data on male circumcision and HIV prevention (2007): policy and program implications. WHO/UNAIDS technical consultation on male circumcision and HIV prevention: research implications for policy and programming. WHO meeting Montreux, Switzerland. .

[28]. WHO (2015). WHO (2015). WHO progress brief voluntary medical male circumcision for HIV prevention in 14 priority countries in East and Southern Africa. Geneva, Switzerland: WHO; 2015.

Abstract:

Assessing viral load suppression among adolescents leaving with HIV in Uganda. The term "viral load" refers to the number of copies of HIV per mL of blood. In other words, it's the amount of virus in the blood. Provision of Antiretroviral drugs (ARV’) to people leaving with HIV aims mainly at achieving viral suppression. ART are medications that treat HIV. The drugs do not kill or cure the virus. However, when taken in combination they can prevent the growth of the virus. When the virus is slowed down, it is called viral suppression and this also slows down HIV disease.

According to United Nation’s Programme on HIV/AIDS in 2013, 90-90-90 is a set of goals. The idea is that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretroviral will be virally suppressed.

References:

[1].https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/15/virologic-failure

[2].   The United Nations Joint Programme on HIV/AIDS (UNAIDS)

[3].https://za.usembassy.gov/wp-content/uploads/sites/19/2016/06/Innovations-in-Identifying-and-Managing-Unsppressed-Viral-Load-Strategies-and-Processes_-Chazanga-Tembo.pdf

http://www.aidsmap.com/

https://www.verywell.com/

https://tekauganda.org/rise-in-viral-load-among-adolescents-in-soroti-worries-medics/

[4].   JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 October 2007 - Volume 46 - Issue 2 - pp 187-193 doi: 10.1097/QAI.0b013e31814278c0

http://journals.lww.com/jaids/pages/default.aspx

[5].   https://tekauganda.org/rise-in-viral-load-among-adolescents-in-soroti-worries-medics/

Abstract:

This article identifies local barriers and potential promoters of healthcare evidence-based management decision-making in Uganda’s local government context. It puts to local context feasible measures for increasing research evidence utilization by healthcare decision-makers, as part of the efforts to make research more beneficial to intended users, and ultimate recipients of the services. The findings were a result of a cross- sectional semi-structured questionnaire survey of 225 clustered healthcare authorities[1] in Arua District Local Government, West Nile Sub-region of Uganda. The survey data were triangulated with nine key informant interviews (KIIs). Analysis reveals existence of multiple barriers at individual, organizational and system’s levels of the local government healthcare management. Standing out prominently were barriers related to attitude, perceptions and beliefs of healthcare managers, dissemination, accessibility, communication, participation, engagement, capacity, knowledge, skills, cost, time, staffing, workload, leadership, policy enforcement, and culture. Other barriers related to researchers were their competence, authority and level of mutual trust. Fortunately, most of these barriers are consistent with those reported previously by other studies in developing countries. Through a critical logical analysis, recommended strategies for increasing utilization of research evidence were combined into five broad categories; stakeholders’ engagement and participation, contextualized dissemination, capacity building, local leadership and democracy, and knowledge marketing, awareness and visibility. Again, these are not naïve, but important is the manner and details in which they have been contextualized. Hence, this article adds to existing knowledge about multifactorial contextual nature of barriers and promoters of research evidence utilization, and the importance of action research in providing evidence for improving quality of healthcare service delivery.

Keywords: barriers, promoters, research evidence, healthcare authorities.

References:

[1].     Albert, M. A., Fretheim, A., & Maïga, D. (2007). Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Research Policy and Systems, 5 (1), 2.

[2].     Amanda, J. F., Dennis, F., Tara, J. S., Joseph, G.D., LeAnn, E.B., Shawn, C. O.& Bibhuti, K.S. (2009). The Challenges of Implementing Evidence Based Practice: Ethical Considerations in Practice, Education, Policy, and Research. Social Work and Society International Online Journal, 7 (2).

[3].     Amin, M. F. (2005). Social Science Research: Conceptions, methodology and Analysis. Makerere University, Kampala.

[4].     Bamberger, M (2012). Introduction to mixed methods in impact evaluation. InterAction. Retrieved from http://www.interaction.org/sites/default/files/Mixed%20Methods%20in%20Impact%20Evaluation%20%28English%29.pdf.

[5].     Barends, E., Rousseau, D. M., & Briner, R. B. (2014). Evidence Based Management: The Basic principles. Center for Evidence-Based Management.

[6].     Caracelli, V., Greene,J., & Jennifer, C. (1997). "Crafting mixed-option evaluation design." In J. C. Greene and V. J. Caracelli (eds.), Advances in mixed-option evaluation: The challenges and benefits of integrating diverse paradigms. New Directions for Program Evaluation, No. 74. San Francisco, CA: Jossey-Bass, pp. 19-32.460

[7].     Dobbins,M., Paula, R., Donna, C., Steve, H., Roy, C., Linda O'Mara., Kara, D., & Shawna, M. (2009). "A description of a knowledge broker role implemented as part of a randomized controlled trial evaluating three knowledge translation strategies". Implementation science, 4, 23.

[8].     Fraser, I. & Clancy, C. M. (2007). Forward: Importance of adopting evidence-based management in healthcare. https://www.ache.org/pubs/pdf_preface/Kovner_Foreword.pdf.

[9].     Gwenyth R. Wallen, G. R., Sandra A. Mitchell, S.A., Melnyk, B., Fineout-Overholt, E., Miller-Davis, C., Yates, J. & Clare Hastings, C. (2010). Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. J Adv Nurs, 66(12): 2761–2771. doi: 10.1111/j.1365-2648.2010.05442.x

[10]. Hsu, D.H., & Lim, K. (2014). Knowledge Brokering and Organizational Innovation: Founder Imprinting Effects. OrganizationScience , 25 (4), 1134-1153.

[11].      JEBMH (2014). Journal of evidence based medicine (JEBMH). Retrieved from: http://www.jebmh.com/bibliographic.php.

[12].      Kelle, U. (2008). Combining qualitative and quantitative methods in research practice: purposes and advantages. Qualitative Research in Psychology, 3 (4), 293-311.

[13].      Kline, P. (2000). Handbook of Psychological Testing (2nd Ed). London: Routledge.

[14].      Kothari, C. R. (2004). Research Methodology: Methods and Techniques (2nd ed.). New Age International Publishers.

[15].      Kyohairwe, S. (2014). Local democracy and public accountability in Uganda: The need for organizational learning. Commonwealth Journal of Local Governance, Issue 15, Retrieved from: http://epress.lib.uts.edu.au/ojs/index.php/cjlg.

[16].      Lansang, M. A., & Rodolfo, D. (2004). Building capacity in health research in the developing world. WHO, 82 (10).

[17].      Lavis, J. N (2006). "Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges". The Journal of continuing education in the health professions, 26 (1), 37-45.

[18].      Lavis, J., Davies, H., Oxman, A., Denis, J. L., Golden-Biddle, K., & Ferlie, E. (2005). Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy 10 (1), 35-48.

[19].      Lomas, J. (2007). "The in-between world of knowledge brokering". BMJ (Clinical research ed.) 334 (7585), 129-132.

[20].      Lyons, R., Warner, G., Langille, L., & Phillips, S.J. (2006). "Piloting knowledge brokers to promote integrated stroke vare in Atlantic Canada.". Canadian Institutes of Health Research (CIHR) Institute for Population and Public Health, editor. Moving population and public health knowledge into action: A casebook of knowledge translation stories. Ottawa, ON: Canadian Institutes of Health Research (CIHR) Institute for Population and Public Health.

[21].      Meyer, M. (2010). The Rise of the Knowledge Broker Science Communication, 32 (1), 118-127

[22].      Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410–417.

[23].      Mulrow, C. D (1995). Rationale for systematic reviews. Systematic Reviews. Edited by: Chalmers I, Altman DG. 1995, London: BMJ Publishing Group, 1-8.

[24].      Nabyonga, J., Bataringaya-Wavamunno, J., Bakeera, S. K., & Criel, B. (2012). Do guidelines influence the implementation of health programs? - Uganda’s experience. BioMed Central, 7(98), 1-16.

[25].      ODI (2009). Overseas development Institute (ODI) planning tools: Stakeholder Analysis: Toolkits. Retrieved from: http://www.odi.org/publications/5257-stakeholder-analysis

[26].      Oliver, K., Innvar, S., Lorenc, T., Woodman, J & Thomas, J. (2014). A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Services Research, 14, 2, 1-12.

[27].      Paula, R., Dobbins, M., & Decorby, K. (2008). "Life as a knowledge broker in public health". Journal of the Canadian Health Libraries Association (JCHLA/JABSC), 29, 78-82.

[28].      Pfeffer, J., & Sulton. I, R. (2006a). Decision-making: Evidenced-based Management. Harvard Business Review, 84 (1), 63-74. Retrieved from https://hbr.org/2006/01/evidence-based-management

[29].      Pfeffer, J. & Sutton, R. (2006b). Hard Facts, Dangerous Half-Truths and Total Nonsense: Profiting from Evidence-Based Management. Boston, MA: Harvard Business School Press.

[30].      Sauerborn, R., Nitayarumphong, S., & Gerhardus, A. (1999). Strategies to enhance the use of health systems research for health sector reform. Tropical Medicine and International Health. 4(12), 827-835.

[31].      Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B. & Richardson, W. S. (1996). Evidence Based Medicine: What It Is and What It Isn’t, in: British Medical Journal, 312, 71-72.

[32].      Squires, J. E., Hayduk, L., Hutchinson, A. M, et al. (2013). A protocol for advanced psycho-metric assessment surveys. Nurs Res Pract.

[33].      Squires, J. E., Estabrooks, C. A., Gustavsson, P., & Wallin, L. (2011a). Individual determinants of research utilization by nurses: a systematic review update. Implementation Science, 6 (1),1.

[34].      Straus, S. E., Richardson,W. S., & Glasziou, P et al. (2005). Evidence-based medicine, how to practice and teach EBM. Third edition. Edinburgh: Churchill Livingstone.

[35].      Tumushabe, G., Muyomba-Tamale, L., Ssemakula, E. & Lukwago, D. (2010). Uganda Local Government Councils Score-Card Report 2008/09: A Comparative Summary of Findings, Conclusions and Recommendations. ACODE Policy Briefing Paper Series, Kampala.

[36].      Verona, G., Prandelli, E., & Sawhney, M. (2006). "Innovation and virtual environments: Towards virtual knowledge brokers". Organization Studies, 27 (6), 765-788.

[37].      Zohrabi, M. (2013). Mixed Method Research: Instruments, Validity, Reliability and Reporting Findings. Theory and Practice in Language Studies, 3(2), 254-262.

Abstract:

This review is an intellectual plot line of an article by Dr. Shiv Kumar Yadav et al., (2015) titled “Assessment of Knowledge and Treatment Seeking Behavior among Tuberculosis (TB) and Multi-Drug Resistant Tuberculosis (MDR-TB) Patients”. The researchers used unmatched case control study to explore the knowledge on causes, mode of spread, duration of treatment among drug susceptible TB (controls) and MDR-TB (cases) participants. A pre-tested, standardized semi-structured questionnaire was used to collect data which was presented in tables and graphs. In this review, attempt will be made to provide a constructive, supportive and fair assessment of the article based on how it is written. This study revealed that there is wide gap in knowledge and treatment initiation among drug susceptible TB and drug resistant TB patients. Furthermore, this review will analyze the structure, content and relevance of the article in addressing knowledge and health seeking behavior among MDR-TB and TB patients. Numerous articles (Finnie et al., 2011, Skordis-Worrall, Hanson & Mills, 2010; Mavhu et al, 2010; Yimer, Bjune & Alene, 2005) have focused on diagnosis and treatment initiation delays among TB patients. Therefore, this review will identify both the strengths and weaknesses of this article with respect to this subject area and will proffer some supportive suggestions for improvement.

keywords: Drug Sensitive Testing, Health Seeking Behavior, Unmatched Case Control Study, Knowledge, Multi-Drug Resistant Tuberculosis, Drug Susceptible Tuberculosis, Treatment.

References:

[1].     Bjune G. (2005). Tuberculosis in the 21^st century: an emerging pandemic. Nor Epidemiol; 15 (2):133-139.

[2].     Cowan J., Cowan J., Barnhart S., Demamu S., Fiseha D., Graham W. & et al. (2013). A qualitative assessment of challenges to tuberculosis management and prevention in Northern Ethiopia. Int J Tuberc Lung Dis; 17:1071-5.

[3].     Field S.K., Fisher D., Jarand J.M., Cowie R.L. (2012). New treatment options for multidrug- resistant tuberculosis. The Adv Respir Dis;6: 255-268.

[4].     Finnie R.K.C., Khoza L.B., Van Den Borne B., Mabunda T., Abotchie P., Mullen P.D. (2011).

[5].     Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Health. 2011; 16:394-411.

[6].     Marks S.M., Hirsch-Moverman Y., Salcedo K. and the TB Epidemiologic Studies Consortium (2016). Characteristics and costs of multidrug-resistant tuberculosis in-patient care in the United States, 2005-2007. Int J Tuberc Lung Dis; 20:435-41.

[7].     Mavhu W., Dauya E., Banason T., Munyati S., Cowan F.M., Hart G., et al. (2010). Chronic cough and its association with TB-HIV co-infection: factors affecting help-seeking behavior in Harare, Zimbabwe. Trop Med Int Health. 15:574-9.

[8].     Nkosi D., Janssen S., Padanilam X., Louw R., Menezes C.N., Grobusch M.P. (2013). Factors influencing specialist care referral of multidrug and extensively drug-resistant tuberculosis patients in Gauteng/South Africa: a descriptive questionnaire based study. BMC Health Serv Res. Accessed on 1 September 2017; 13:268. doi:10.1186/1472-6963-13-268 PMID: 23837531.

[9].     O’Donnell M.R., Jarand J., Loveday M., et al. (2010). High incidence of hospital admissions with multi-drug resistant and extensively drug-resistant tuberculosis among South African health care workers. Ann Intern Med; 153: 516-22.

[10]. Palomino J.C., Martin A., Von Groll A., Portaels F. (2008). Rapid culture-based methods for drug resistance detection in Mycobacterium tuberculosis. J Microbiol Methods;75: 161-166.

[11]. Parsons L.M., Somoskovi A., Gutierrez C., Lee E., Paramasivan C.N., et al. (2011). Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities ClinMicrobiol Rev;24: 314-350.

[12]. Skordis-Worrall J., Hanson K., Mills A. (2010). Confusion, caring and tuberculosis diagnostic delay in Cape Town, South Africa; 14:171-80.

[13]. Schnippel, K et al., (2018). Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study. Lancet Respir Med 2018 http://dx.doi.org/10.1016/S2213-2600(18)30235-2.

[14]. W.H.O. (2011). Global Tuberculosis control: WHO Report. Geneva: World Health Organization.

[15]. W.H.O. (2013). Global Tuberculosis Report. Geneva: World Health Organization.

[16]. W.H.O. (2015). Global Tuberculosis Report. Geneva: World Health Organization.

[17]. Yimer S., Bjune G., Alene G. (2005). Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethopia: a cross sectional study. BMC Infect Dis. 5:112. Doi: 10.1186/1471-2334-5-112. Available from: http://www.biomedcentral.com/1471-2334/5/112. Download 02 October 2017.

Abstract:

Even though a university is a privileged institution where high level of sanitation is expected to be observed, university students continue to experience sanitation related diseases. The University of Cape Coast was plagued with outbreaks of cholera in 2015 and 2016. This study therefore aimed at assessing the sanitation facilities as well as investigating students’ attitudes towards the sanitary facilities on the campus of the University of Cape Coast, Ghana.

This was a cross sectional descriptive study conducted among 422 students who resided in the university’s halls of residence from January 2018 to February 2018. Both quantitative and qualitative study methods were used to collect data. A structured self-administered questionnaire was used to gather data on students’ assessment of sanitary facilities on campus.

The study found the state of sanitary facilities in the halls and lecture theatres to be generally good. However, most halls were found to be overcrowded with insufficient toilets and wash rooms for students. Most of the toilets (70%) and bath rooms (62.5%) inspected were clean. All (100%) of toilets had hand washing basins. Most (92.5%) of the toilets did not have any anal cleaning materials at the time of inspection. Accommodation and sanitation facilities in the halls were found to be inadequate despite some expansions in toilets and wash rooms. Availability of soaps and anal cleaning materials was found to be inadequate. Students’ bad behavior as well as inadequate number of cleaning personnel must be addressed so as to improve sanitary conditions on campus. Regular sanitation awareness campaigns and educational sessions should be organized by the environmental health section of the University Health Services to address health issues associated with poor sanitation.

Keywords: sanitation, University of Cape Coast, student, overcrowding, Ghana.

References:

[1].     Asamoah, A., Ameme, D.K., Sackey, S.O., Nyarko, K.M., & Afari, E.A. (2016). Diarrhoea morbidity patterns in Central Region of Ghana. Pan Afr Med J. 25(Suppl 1): 17.

[2].     Cao, H., Fujii, H., & Managi, S. (2015). A productivity analysis considering environmental pollution and diseases in China. Journal of Economic Structures, 4(1):1-9.

[3].     De Buck, E., Van Remoortel, H., Hannes, K., Govender, T., Naidoo, S., Avau, B., Vande Veegaete, A., et al. (2017). “Approaches to Promote Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed Method Systematic Review.” Campbell Systematic Reviews 7: 1-447.

[4].     Egbinola, C.N., & Amanambu, A. C. (2015): Water supply, sanitation and hygiene education in secondary schools in Ibadan,Nigeria. In: Szymańska, D. and Środa-Murawska, S. editors, Bulletin of Geography. Socio-economic Series, No. 29, Toruń: Nicolaus Copernicus University, pp. 31–46. DOI: http://dx.doi.org/10.1515/bog-2015-0023.

[5].     Fadairo, G. & Adedeyi Y.M.D. (2012). The menace of public toilets in institutional housing: case studies of selected universities in south-west Nigeria. WIT Transactions on Ecology and The Environment, 160: 126-135.

[6].     Gray, A. "Definitions of crowding and the effect of crowding on health" (2001). Ministry of Social Policy, New Zealand. Retrieved 3 February 2018.

[7].     Gyabaah, D., Awauh, E., & Ackerson, N.O.B. (2009). Sanitation in Basic Schools – A Case study in Tano South District. Accessed at https://www.ircwash.org/.../sanitation-basic-schools-case-study-tano-south- district-paper-prepared-west-africa on 24/2/18.

[8].     Ghana education service- school health education programme unit wash in schools (WinS). Annual report 2012.

[9].     Jasper, C., Le T., & Bartram, J. (2012). Water and sanitation in schools: a systemic review of the health and educational outcomes. Int. J. Environ. Res. Public Health.

[10]. Koopman, J.S. (1978). Diarrhoea and school toilet hygiene in Cali, Colombia. Am. J. Epidemiol. 107:412-420.

[11]. Mahama, E.E. (2009). Assessment of environmental sanitation and disease among students in University of Ghana, Legon. Accessed at ugspace.ug.edu.gh/handle/123456789/8760 on 23/2/18.

[12]. Mensah-Kuffour, A.G., & Gablah, G.P. (2017). Sanitation in Accra Technical University Hostel and Its Environs: A Case Study of Accra Technical University Old Hostel. Hospitality & Management, 2(1):1-12.

[13]. Musa, R.M., & Haque, M. (2016). Assessment of factors contributing to poor environmental sanitation in university’s male hostel. International journal of pharmaceutical research 8(3):59-63

[14]. Nansereko, F. (2010). Adequacy and utilization of sanitation facilities in Mpigi District. Accessed at https://news.mak.ac.ug/documents/.../NANSEREKO_Fatumah.pdf.

[15]. Ofovwe, G., & Ofili, A. (2007). Knowledge, attitude and practice of school health programs among head teachers of primary schools in Ego Local Government Area of Edo State, Nigeria. Annals of African medicine 6(3):99-103.

[16]. Prüss, A., Kay, D., Fewtrell, L., & Bartram, J. (2002) Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environmental Health Perspectives, 110:537–542.

[17]. Rajaratnam, G., Patel, M., Parry J.V., Perry, K.R., Palmer, S.R. (1992). An outbreak of hepatitis A; School toilets as a source of transmission. J. Public Health Med. 14:72-77.

[18]. UNICEF (United Nations Children’s Emergency Fund), Bangladesh, (2012). Water, Environment and Sanitation. Available at: http://www.unicef.org/bangladesh/wes.html accessed at 31/05/18.

[19]. UNICEF. (2012). Pneumonia and Diarrhoea - Tackling the deadliest diseases for the world's poorest children. Retrieved from https://www.unicef.org/publications/index_65491.html.

[20]. UNICEF Ghana. (2016). Accessed at https://www.unicef.org/ghana/wes.html.

[21]. WHO -Situation Report on Cholera Outbreak in Ghana. 24 May 2015. Accessed at https://reliefweb.int/report/ghana/ghana-cholera-mdrgh010-dref-review-report.

[22]. WHO (2016). Sanitation fact sheet. Accessed at http://www.who.int/en/.

[23]. WHO/AFRO (2006). The Health of the People the African Regional Health Report. WHO, 20 Avenue Appia, 1211 Geneva 27, Switzerland.

Abstract:

Introduction: WHO clinical staging and or CD4 were used as eligibility criteria for initiation and monitoring of patients on ART in Sub-Saharan African. With health facility-based ART services, most patients in Sub-Saharan African were initiated on ART at late WHO clinical staging. Data are lacking on the clinical staging at the initiation of community-based ART services in Nigeria. This study describes WHO clinical staging among key populations initiated on community-based ART services using WHO test and treat guideline in Nigeria.

Methodology: This is a baseline data analysis of a longitudinal study of all KPs who initiated community-based ART services in 7 states in Nigeria. Time 1 data abstracted from facility records includes age and sex, marital, educational, and employment status and WHO clinical staging at initiation.

Results: Eighty-two percent of participants were initiated at early WHO clinical staging (1& 2). Among KPs, 85% of FSW were initiated at the early stage, followed by MSM (75%) and then PWID (66%). More PWID (34%) were initiated at the late stage (3&4) followed by MSM (25%) and FSW (15%). Factors positively associated with early initiation include: being a female, sex partners living together, unemployment and low educational status.

Conclusion: Community based ART services using test and treat guideline will improve early initiation of KPs on ART services. However, further study to identify reasons for late ART initiation among KPs is required to support programme effort to achieve the UNAIDS 90-90-90 goals.

Keywords: HIV/AIDS, key populations, community-based antiretroviral therapy, WHO clinical staging, test and treat.

References:

[1].AIDS Info (2017); Guidelines for the use of antiretroviral therapy in adults and adolescents living with HIV. Available at https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/10/initiation-of-antiretroviral-therapy

[2].Alison L. Drake, a,* Suzanne K. Wilson, b John Kinuthia, c Alison C. Roxby, d Daniel Matemo, e (2015); Healthcare-seeking behavior of HIV-infected mothers and male partners in Nairobi, Kenya. Glob Public Health. 2015 Dec; 10(10): 1215–1226. doi: 10.1080/17441692.2014.1003573

[3].Andrea L Wirtz,1,2 Dunker Kamba,3 Vincent Jumbe,4,5 Gift Trapence,3 Rehana Gubin,6 (2014); A qualitative assessment of health-seeking practices among and provision practices for men who have sex with men in Malawi. BMC Int Health Hum Rights. 2014; 14: 20, doi: 10.1186/1472-698X-14-20

[4].Anita Morrison, Lawrence Elliot, Laurence Gruer (2006); Injecting related harm and treatment seeking behavior among injecting drug users. https://doi.org/10.1111/j.1360-0443.1997.tb02853.

[5].Avert (2016); HIV/AIDS in Nigeria; Available at https://www.AVERT.org/Professionals/HIV-around-world/Sub-Saharan-Africa/Nigeria

[6].Avert (2017); People Who Inject Drugs, HIV, and AIDS. Available at https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs

[7].Averts (2018); HIV and AIDS in Nigeria. Available at https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/nigeria

[8].Baveewo S, Ssali F, Karamagi C, Kalyango JN, Hahn JA, Ekoru K, et al. (2011) Validation of World Health Organisation HIV/AIDS Clinical Staging in Predicting Initiation of Antiretroviral Therapy and Clinical Predictors of Low CD4 Cell Count in Uganda. PLoS ONE 6(5): e19089. https://doi.org/10.1371/journal.pone.0019089

[9].Bhekisisa (2017); Africa: Why Does HIV Kill More Men than Women? Available at http://allafrica.com/stories/201708150097.html

[10]. Chigomezgo Munthali, Miriam Taegtmeyer, Paul G Garner, David G Lalloo (2014) Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis. Journal of International AIDS Society 2014, 17:18932 Http://dx.doi.org/10.7448/IAS.17.1.18932

[11]. Delayed HIV diagnosis and initiation of antiretroviral therapy: inequalities by educational level, COHERE in EuroCoord. AIDS 2014, 28:2297–2306. DOI:10.1097/QAD.0000000000000410

[12]. Denis Nash, Olga Tymejczyk, Tsigereda Gadisa, Sarah Gorrell Kulkarni, Susie Hoffman, et al (2016) Factors associated with initiation of antiretroviral therapy in the advanced stages of HIV infection in six Ethiopian HIV clinics, 2012 to 2013; Journal of International AIDS Society. https://doi.org/10.7448/IAS.19.1.20637

[13]. Elias K, Tobias F, Rinke de Wit, Ermias H. Mulu G. Tsehaynesh M. et al (1999) Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers. DOI: 10.1097/00002030-199902250-00011

[14]. Federal ministry of health, Nigeria (2014); Integrated biological and behavioral surveillance survey (IBBSS) 2014. Available at https://www.google.com.ng/search?q=11.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+Integrated+biological+and+behavioural+surveillance+survey&oq=11.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+Integrated+biological+and+behavioural+surveillance+survey&aqs=chrome..69i57.1253j0j7&sourceid=chrome&ie=UTF-8

[15]. Federal Ministry of Health, Nigeria (2014); Integrated national guidelines for HIV prevention, treatment and care 2014. Available at https://childrenandaids.org/sites/default/files/2017-05/Nigeria-Integrated-National-Guildlines-For-HIV-Prevention-treatment-and-care-2014.pdf

[16]. Federal ministry of health, Nigeria (2014); National HIV seroprevalence sentinel survey among pregnant women attending an antenatal clinic in Nigeria. Available at

https://www.google.com.ng/search?q=12.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+National+HIV+seroprevalence+sentinel+survey+among+pregnant+women+attending+antenatal+clinic+in+Nigeria&oq=12.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+National+HIV+seroprevalence+sentinel+survey+among+pregnant+women+attending+antenatal+clinic+in+Nigeria&aqs=chrome..69i57.1456j0j7&sourceid=chrome&ie=UTF-8

[17]. Federal Ministry of Health, Nigeria (2016); National guidelines for HIV prevention, treatment and care 2016. Available at http://apps.who.int/medicinedocs/documents/s23252en/s23252en.pdf

[18]. Federal ministry of health, Nigeria (2016); National guidelines for HIV prevention treatment and care 2016. Available at http://apps.who.int/medicinedocs/documents/s23252en/s23252en.pdf

[19]. Ford, Nathan, b; Migone, Chantal; Calmy, Alexandra; Kerschberger, Bernhard; Kanters, Steve (2018); Benefits and risks of rapid initiation of antiretroviral therapy. JAIDS: Volume 32 - Issue 1 - p 17–23. doi: 10.1097/QAD.0000000000001671

[20]. HIV.gov (2016); the Global HIV/AIDS Epidemic. Available at https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

[21]. Hoots BE1, Finlayson TJ, Broz D, Paz-Bailey G; NHBS Study Group (2017); Antiretroviral Therapy Use Among HIV-Infected People Who Inject Drugs-20 Cities, United States, 2009-2015. J Acquir Immune Defic Syndr. 2017 Jul 1;75 Suppl 3: S392-S396. doi: 10.1097/QAI.0000000000001416

[22]. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23834&Itemid=270

[23]. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/december/20171201_blind spot

[24]. Ian R Grubb,1 Sarah W Beckham,§,2 Michel Kazatchkine,3 Ruth M Thomas,4 Eliot R Albers,5 (2017); Maximizing the benefits of antiretroviral therapy for key affected populations. J Int AIDS Soc. 2014; 17(1): 19320. doi: 10.7448/IAS.17.1.19320

[25]. ILO (2013); The impact of employment on HIV treatment adherence. Available at http://www.workingpositive.net/pdf/treatment-adherence.pdf

[26]. Jean B Nachega, an Olalekan A Uthman,b Karl Peltzer, c Lindsey A Richardson, d Edward J Mills, e (2015); Association between antiretroviral therapy adherence an employment status; systemic review and meta-analysis. Bull World Health Organ. 2015 Jan 1; 93(1): 29–41.doi: 10.2471/BLT.14.138149

[27]. Jennifer L. Weinberg and Carrie L. Kovarik, MD (2010); The WHO Clinical Staging System for HIV/AIDS, American Medical Association Journal Ethics, Volume 12, Number 3: 202-206.

[28]. Laurie Barclay (2015); Women More Likely Than Men to Receive HIV Treatment

[29]. Maria L, Frances U, Susie H, Batya E, Srah GK, et al (2013); The Problem of Late ART initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon? J Health Care Poor Underserved; 24(1): 359–383. doi: 10.1353/hpu.2013.0014

[30]. Medscape public health. Available at https://www.medscape.com/viewarticle/855079

[31]. Mills EJ, Beyrer C, Birungi J, Dybul MR (2012) Engaging Men in Prevention and Care for HIV/AIDS in Africa. PLoS Med 9(2): e1001167. https://doi.org/10.1371/journal.pmed.1001167

[32]. PAHO; Towards a Caribbean Consensus. Improving Access to Key Populations to Comprehensive HIV Health Services available at http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23834&Itemid=270&lang=en

[33]. Pan American Health Organization (2011); Improving Access of Key Populations to Comprehensive HIV Health Services: Towards a Caribbean Consensus, Washington, D.C.: PAHO, © 2011

[34]. Paz Sobrino-Vegas, Johana Rodriguez, Juan Berenguer, Ann Maria Caro-Murillo (2012). An educational gradient in HIV diagnosis delay, mortality, antiretroviral treatment initiation and response in a country with universal health access. Antiretroviral Therapy 2012; 17:1-8. (doi: 10.3851/IMP1939)

[35]. Rose Wilcher (2017); Call for paper: Optimizing the impact of key population programming across HIV cascade. Available at https://researchforevidence.fhi360.org/call-for-papers-optimizing-the-impact-of-key-population-programming-across-the-hiv-cascade

[36]. Schneider G1, Juday T, Wentworth C 3rd, Lanes S, Hebden T, Seekins D.(2013); Impact of healthcare payer type on HIV stage of illness at the time of initiation of antiretroviral therapy in the USA AIDS Care. 2013;25(11):1470-6. doi: 10.1080/09540121.2013.774316.

[37]. Shroufi A, Gunguwo H, Dixon M, Nyathi M, Ndebele W, Saint-Sauveur JF, (2013); HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study. AIDS. 2013 Jul 31;27(12):1971-8. DOI: 10.1097/QAD.0b013e32836149ea

[38]. Siegfried N1, Uthman OA, Rutherford GW. (2017); Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults. Cochrane Database Syst Rev. 2010 Mar 17;(3): CD008272. doi: 10.1002/14651858.CD008272.pub2, https://www.ncbi.nlm.nih.gov/pubmed/20238364

[39]. UNAIDS (2014); 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Available at http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

[40]. UNAIDS Ottawa/Geneva (2017); On World AIDS Day, UNAIDS warns that men are less likely to access HIV treatment and more likely to die of AIDS-related illnesses. Available at

[41]. Vogt, Florian MD, MSc; Rehman, Andrea M. PhD; Kranzer, Katharina PhD; Nyathi, Mary MD; Van Griensven (2017); Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe. JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2017 - Volume 74 - Issue 4 - p 390–398. doi: 10.1097/QAI.0000000000001274

[42]. WHO (2008); HIV/AIDS Care and Treatment for People Who Inject Drugs in Asia and the Pacific: An Essential Practice Guide. Available at http://apps.who.int/medicinedocs/en/d/Js19812en/

[43]. WHO (2014); Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Available at http://apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1&ua=1

[44]. WHO (2015); Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Available at http://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf?sequence=1

[45]. WHO (2016); Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection; recommendation for a public health approach 2nd edition. Available at http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1

[46]. WHO 2005: Treat 3 million by 2005, interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definition for surveillance African region. http://www.who.int/hiv/pub/guidelines/clinicalstaging.pdf?ua=1

Abstract:

Environments continuously receive mixtures of drugs on a global scale. The most popular uses of drugs include human medicine as tools for the treatment or prevention of various diseases, veterinary drugs or husbandry growth promoters with applications on many different aspects of agriculture. Objectives of this study are to identify the major methods used in PWM in the health facilities in Lagos state, Nigeria and to identify the presence of pharmaceutical in the environment. This study comprised 376 respondents of which 68.4% were females. Most frequent age range was 31 – 40 years, (42.3%). 43.4% have been in service between 1-5 years. 34% work in general hospitals while 8.0% work in comprehensive health centers. Majority (37.5%) dispose pharmaceutical wastes in medical waste bin. Unused drugs are mostly returned directly to the supplier (40.4%) while expired drugs are mostly returned to manufacturers (41.2%). Most facilities dispose wastes in biohazard bags (red, 19.95%, yellow and black, 19.68%). 0.634ug/L of amoxillin trihydrate was detected in waste water and 6.791ug/g in sludge. 0.203ug/L of Clavlnic acid was present in tap water, 0.264ug/L of Ciprofloxacin Hydrochloride was found in waste water and 6.353ug/g in sludge. Diclofenac was 0.409ug/L in waste-water. Paracetamol concentration was 0.00379ug/L in tap water, 0.01196g/L in waste water and 0.55768ug/L in sludge. It is concluded that the presence of pharmaceutical wastes in tap water, waste water and sludge in hospital environments is connected with waste management methods. Awareness and training are necessary to avoid environmental pollution of pharmaceutical wastes.

Keywords: Wastes, drugs, Pharmaceutical Waste management, Healthcare workers, Environments, hazards.

References:

[1].     Abahussain, E. A., Ball, D. E., & Matowe, W. C. (2006). Practice and opinion towards disposal of unused medication in Kuwait. Medical Principles and Practice, 15(5), 352-357.

[2].     Awodele, O., Adewoye, A. A., & Oparah, A. C. (2016). Assessment of medical waste management in seven hospitals in Lagos, Nigeria. BMC public health, 16(1), 269.

[3].     Bound, J. P., & Voulvoulis, N. (2005). Household disposal of pharmaceuticals as a pathway for aquatic contamination in the United Kingdom. Environmental health perspectives, 113(12), 1705.

[4].     Caban M., Lis E., Kumirska J., Stepnowski P., (2015). Determi­nation of pharmaceutical residues in drinking water in Poland using a new SPE-GC-MS(SIM) method based on Speedisk extraction disks and DIMETRIS derivatization, Sci. Total. Environ. 538: 402–411.

[5].     Fick J., Söderström H., Lindberg R.H., Phan C., Tysklind M. & Larsson D.G. (2009), Contamination of surface, ground, and drinking water from pharmaceutical production, En­viron. Toxicol. Chem. 28(12): 2522–2527.

[6].     Jovanović, V., Manojlović, J., Jovanović, D., Matic, B., & Đonović, N. (2016). Management of pharmaceutical waste in hospitals in Serbia–challenges and the potential for improvement. INDIAN JOURNAL OF PHARMACEUTICAL EDUCATION AND RESEARCH, 50(4), 695-702.

[7].     Kalyva, M. (2017). Fate of pharmaceuticals in the environment-A review. (accessed: 07/05/2018).

[8].     Kreuzinger, N., Clara, M., Strenn, B. and Kroiss, H., (2004). Relevance of the sludge retention time (SRT) as design criteria for wastewater treatment plants for the removal of endocrine disruptors and pharmaceuticals from wastewater. Water Science and Technology, 50(5), pp.149-156.

[9].     Ngwuluka, N. C., Ochekpe, N. A., & Odumosu, P. O. (2011). An assessment of pharmaceutical waste management in some Nigerian pharmaceutical industries. African Journal of Biotechnology, 10(54), 11259-11264.

[10]. Oaks, J.L., Gilbert, M., Virani, M.Z., Watson, R.T., Meteyer, C.U., Rideout, B.A., Shivaprasad, H.L., Ahmed, S., Chaudhry, M.J.I., Arshad, M. and Mahmood, S., (2002). Diclofenac residues as the cause of vulture population decline in Pakistan. J. Zoological Systematics and Evolutionary Research, 40, pp.65-81.

[11]. Patneedi, C. B., Prasadu, D., Sharma, R. S. K., Sekhar, D. C., & Rao, D. V. (2015). MICROWAVE MEDIATED SYNTHESIS IN PHARMACEUTICAL CHEMISTRY.

[12]. Priya, P., (2017). Management of Pharmaceutical Wastes. Journal of drug discovery and therapeutics, 5(3)

[13]. Radhakrishna, L., Nagarajan, P., Vijayanandhan, S. S., & Ponniah, T. (2014). Knowledge, Attitude and practice (KAP) towards disposal of medicines: A qualitative study among health care professionals in South India. Wld J Pharm Res, 3, 1955-63.

[14]. Scheytt, T., Mersmann, P., Lindstädt, R. and Heberer, T., (2005). Determination of sorption coefficients of pharmaceutically active substances carbamazepine, diclofenac, and ibuprofen, in sandy sediments. Chemosphere, 60(2), pp.245-253.

[15]. Seehusen, D. A., & Edwards, J. (2006). Patient practices and beliefs concerning disposal of medications. The Journal of the American Board of Family Medicine, 19(6), 542-547.

[16]. ter Laak, T.L. and Gebbink, W.A., (2006). Estimation of soil sorption coefficients of veterinary pharmaceuticals from soil properties. Environmental toxicology and chemistry, 25(4), pp.933-941.

[17]. Thiele‐Bruhn, S., (2003). Pharmaceutical antibiotic compounds in soils–a review. Journal of Plant Nutrition and Soil Science, 166(2), pp.145-167.

[18]. World Health Organization. (2017). Safe management of wastes from health-care activities: a summary.

Abstract:

Introduction: Within the Results-Based Financing (RBF)Project in Nigeria, Demand Side Financing (DSF) pilot is implemented to increase the delivery and use of high impact maternal and child health indicators. The DSF strategy implores a conditional cash transfer (CCT) and Transport voucher schemes.

Objective: To investigate how Demand Side Financing reduces financial barriers for the poorest of the poor in accessing health care services in Wamba LGA, Nasarawa State.

Methods: This explanatory case study aimed at analyzing the experiences of Nasarawa State in implementing DSF using the World Bank DSF framework for Health Projects.

Design: We performed a document review and interviews with various stakeholders (n D 30) and then conducted thematic analysis of interview recordings. We carried out 10 Focused group discussions each in the 10 wards of the Wamba LGA piloting DSF. Informants were selected according to variables such as sub-group (Women of Child Bearing age, Health Facility Staff, LGA PHC directors, Ward development Committee (WDC) and Community Based members), Transporters, knowledge of their community, experience with the HC, past or current experience on DSF implementation etc., to allow for maximum variation in the sample.

Results: Study results indicated that, DSF has contributed in reducing financial and geographical barriers for the poor and high risk groups to access health services in PBF health facilities, increased the coverage of maternal child and child health indicators, promoted social inclusion to complement the supply-side components of the NSHIP, and enhance the achievements of the RBF intervention.

Conclusion: This study concisely demonstrates that when supply-side subsidies and demand side subsidies are combined greater gains for the poor and vulnerable populations are achieved.

Keywords: Demand-side financing; Vouchers; Conditional Cash Transfers; Maternal health; Maternal and child health; Implementation; cash transfers; financial barriers, Geographical barriers, High risk groups.

References:

[1].Ahmed, S., & Khan, M. M. (2011). Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Social Science and Medicine, 72(10), 1704–1710. https://doi.org/10.1016/j.socscimed.2011.03.031.

[2].Amakom, U., & Ezenekwe, U. (2012). Implications of households catastrophic out of pocket (OOP) healthcare spending in Nigeria, 1(November), 136–140.

[3].Anselmi, L., Binyaruka, P., & Borghi, J. (2017). Understanding causal pathways within health systems policy evaluation through mediation analysis: an application to payment for performance (P4P) in Tanzania. Implementation Science, 12(1), 10. https://doi.org/10.1186/s13012-016-0540-1.

[4].Antony, M., Bertone, M. P., & Barthes, O. (2017). Exploring implementation practices in results-based financing: the case of the verification in Benin. BMC Health Services Research, 17(1), 204. https://doi.org/10.1186/s12913-017-2148-9.

[5].Bank, A. W. (2009). CONDITIONAL.

[6].Bellows, B., Warren, C., Vonthanak, S., Chhorvann, C., Sokhom, H., Men, C., … Rathavy, T. (2011). Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in th.

[7].Bhatia, M. R., Yesudian, C. A. K., Gorter, A., & Thankappan, K. R. (2006). Demand Side Financing for Reproductive and Child Health Services in India Economic and Political Weekly Demand Side Financing for Reproductive and Child Health Services in India. Source: Economic and Political Weekly, 41(3), 279–284. Retrieved from http://www.jstor.org/stable/4417708%5Cnhttp://about.jstor.org/terms.

[8].Dalinjong, P. A., & Laar, A. S. (2012). The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana. Health Economics Review, 2(1), 13. https://doi.org/10.1186/2191-1991-2-13.

[9].Das, A., Gopalan, S. S., & Chandramohan, D. (2016). Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review. BMC Public Health, 16(1), 321. https://doi.org/10.1186/s12889-016-2982-4.

[10]. Declaration, A. (2013). Health financing in Nigeria Health spending per person in Nigeria Health financing in Nigeria, 2012–2013.

[11]. Domelen, J. Van. (2007). Reaching the Poor and Vulnerable: Targeting Strategies for Social Funds and other Community-Driven Programs, (0711).

[12]. Elmusharaf, K., Byrne, E., & O’Donovan, D. (2015). Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed. BMC Public Health, 15(1), 870. https://doi.org/10.1186/s12889-015-2222-3.

[13]. Engineer, C. Y., Dale, E., Agarwal, A., Agarwal, A., Alonge, O., Edward, A., … Peters, D. H. (2016). Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: A cluster-randomized trial. International Journal of Epidemiology, 45(2), 451–459. https://doi.org/10.1093/ije/dyv362.

[14]. Ensor, T. (2004). Consumer-led demand side financing in health and education and its relevance for low- and middle-income countries. Int. J. Health Plann. Mgmt, 19, 267–285.

[15]. Federal Ministry of Health. (2012). Nigeria State Health Investment Project (NSHIP): Performance-Based Financing User Manual (Draft), (December).

[16]. Fritsche, G. B., Soeters, R., & Meessen, B. (2014). Performance-Based Financing Toolkit. World Bank Group - Open Knowledge Repository. https://doi.org/10.1596/978-1-4648-0128-0.

[17]. Gopalan, S. S., Das, A., & Mutasa, R. (2014). What makes health demand-side financing schemes work in low- and middle-income countries? A realist review. Journal of Public Health Research, 3(3). https://doi.org/10.4081/jphr.2014.304.

[18]. Grittner, A. M. (2013). Results-based Financing Evidence from performance-based financing in the health sector.

[19]. Gupta, I., William, J., & Rudra, S. (2010). Demand side financing in health. How far can it address the issue of low utilization in developing countries? World Health Report, 1–34. Retrieved from http://www.who.int/entity/healthsystems/topics/financing/healthreport/27DSF.pdf.

[20]. Honda, A. (2013). 10 best resources on... Pay for performance in low- and middle-income countries. Health Policy and Planning, 28(5), 454–457. https://doi.org/10.1093/heapol/czs078.

[21]. Hunter, B. M., & Murray, S. F. (2017). Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes ? https://doi.org/10.1186/s12884-017-1445-y.

[22]. Janssen, W., de Dieu Ngirabega, J., Matungwa, M., & Van Bastelaere, S. (2015). Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: A 5-year experience. Tropical Doctor, 45(1), 27–35. https://doi.org/10.1177/0049475514554481.

[23]. Jim Yong Kim. (2013). Government of Japan-World Bank Conference on Universal Health Coverage Tokyo, Japan.

[24]. Manley, B. J., Gitter, S., Slavchevska, V., & Manley, J. (2011). Department of Economics Working Paper Series How Effective are Cash Transfer Programs at Improving Nutritional Status? by.

[25]. Matsuoka, S., Obara, H., Nagai, M., Murakami, H., & Lon, R. C. (2017). Performance-based financing with GAVI health system strengthening funding in rural Cambodia: a brief assessment of the impact, (June 2013), 456–465. https://doi.org/10.1093/heapol/czt030.

[26]. Menya, D., Platt, A., Manji, I., Sang, E., Wafula, R., Ren, J., … O’Meara, W. P. (2015). Using pay for performance incentives (P4P) to improve management of suspected malaria fevers in rural Kenya: a cluster randomized controlled trial. BMC Medicine, 13(1), 268. https://doi.org/10.1186/s12916-015-0497-y.

[27]. Murray, S. F., Hunter, B. M., Bisht, R., Ensor, T., & Bick, D. (2014). Effects of demand-side financing on utilisation, experiences and outcomes of maternity care in low- and middle-income countries: a systematic review. BMC Pregnancy and Childbirth (Vol. 14). https://doi.org/10.1186/1471-2393-14-30.

[28]. Priedeman Skiles, M., Curtis, S. L., Basinga, P., & Angeles, G. (2013). An equity analysis of performance-based financing in Rwanda: Are services reaching the poorest women? Health Policy and Planning, 28(8), 825–837. https://doi.org/10.1093/heapol/czs122.

[29]. Primary, N., Care, H., Agency, D., State, O., Health, P., Development, C., … Agencies, D. (2015). Nigeria State Health Investment Project (NSHIP) Performance-Based Financing User Manual, (December).

[30]. Rusa, L., Schneidman, M., Fritsche, G., & Musango, L. (n.d.). Rwanda: Performance-Based Financing in the Public Sector.

[31]. Sayinzoga, F., & Bijlmakers, L. (2016). Drivers of improved health sector performance in Rwanda: a qualitative view from within. BMC Health Services Research, 16(1), 123. https://doi.org/10.1186/s12913-016-1351-4.

[32]. Service, G. T. (2015). Hartley, Alexandra Gayle (2015) Learning to foster: articulating the dimensions. Ed.D thesis.

[33]. Sieleunou, I., Turcotte-Tremblay, A.-M., Yumo, H. A., Kouokam, E., Fotso, J.-C. T., Tamga, D. M., & Ridde, V. (2017). Transferring the Purchasing Role from International to National Organizations During the Scale-Up Phase of Performance-Based Financing in Cameroon. Health Systems & Reform, 3(2), 91–104. https://doi.org/10.1080/23288604.2017.1291218.

[34]. Version, F. (2009). Republic of Rwanda Ministry of Health Community Performance-Based Financing User Guide. Community Health, (January).

[35]. Witter, S., Fretheim, a, Fl, K., & Ak, L. (2012). Paying for performance to improve the delivery of health interventions in low- and middle-income countries (Review) SUMMARY OF FINDINGS FOR THE MAIN COMPARISON. Cochrance Database of Systemic Reviews, 2(2).

[36]. WORLD BANK NIGERIA. (2015). PIM 4 DSF FOR NSHIP_Collated_29062015 (2).

Abstract:

Introduction: Visual acuity (VA) helps to appreciate the three-dimensional details of surrounding and can be used to measure the visual functions in ocular practice, especially as a screening tool in schoolchildren. Visual impairment (VI) is the major cause of morbidity in children worldwide, which can affect the learning of children globally.

Aim: Present study was aimed to use Snellen’s VA chart as a screening tool to find out habitual VA and VI in schoolchildren of Allahabad.

Material & Methods: Snellen’s chart was used in 567 students belonged to 3 schools from rural and urban areas of Allahabad. The result was tabulated showing number of eyes from 6/60 to 6/6 in schoolchildren between 7 to 11 years of age.

Result: Majority of the schoolchildren (80.42% eyes) had normal VA (6/6), while only 1 student had VA of 6/60 in both of his eyes (0.18%). Both, the urban and rural schools showed a higher number for VA 6/9 in 167 eyes (14.73%) altogether, where 91 eyes belonged to rural school and 76 eyes to urban schools. Schoolchildren from rural and urban schools showed6/12 VA in 19 and 9 eyes, respectively. No such significant difference was seen in VA of 6/18 and 6/24 for rural schoolchildren, while urban school students showed a marked distinction.

Conclusion: The investigator concluded that the identification of reduced habitual VA at an early stage will help to reduce the childhood blindness and might help to assess visual development for the children.

Keywords: Visual acuity, visual impairment, habitual visual acuity, schoolchildren, childhood blindness.

References:

[1]  Anstice N and Thompson B. The measurement of visual acuity in children: an evidence-based update. Clinical and Experimental Optometry. 2013; 97(1): 3-11.

[2]  Azizoglu S, Crewther S, Serefhan F, Barutchu A, Göker S and Junghans B. Evidence for the need for vision screening of school children in Turkey. BMC Ophthalmology. 2017; 17(1): 1-14.

[3]  Brien Holden Vision Institute (2016). Visual Acuity Web Site. Updated November 11, 2016. Retrieved 08:36, April6, 2018, from:https://brienholdenvisioninstitute.app.box.com/s/li51450sx9q0yjuh563uffewjg2mawvn

[4]  Dandona L, Williams JD, Williams BC, Rao GN. Population based assessment of childhood blindness in southern India. Arch Ophthalmol 1998; 116: 545-546.

[5]  Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ. 2001; 79:237–243.

[6]  District Census Handbook, Allahabad (2011). Census of India 2011. Directorate of Census Operations, Uttar Pradesh. https://www.census2011.co.in/census/district/546-allahabad.html

[7]  Education Status Report – Uttar Pradesh (2013). Elementary education. Centre for Education Innovation. WorkingPaper,November2013.Availableat:https://www.educationinnovations.org/sites/default/files/Status%20of%20Elementary%20Education%20in%20Uttar%20Pradesh.pdf

[8]  Gene-Sampedro A, Gene-Morales A, Gené-Morales J, Bueno-Gimeno I and Oliver-Huerta D. Visual Health In The Classroom. Conference Paper. Proceedings of ICERI2016 Conference 14th-16th November 2016, Seville, Spain. Publication at: https://www.researchgate.net/publication/311363145 DOI: 10.21125/iceri.2016.1411

[9]  Gilbert C, Foster A. Childhood blindness in the context of VISION 2020 – ‘The right to sight.’ Bull World Health Org 2001; 79(3): 227-232.

[10]   Harvey E, Dobson V and Miller J. Prevalence of High Astigmatism, Eyeglass Wear, and Poor Visual Acuity among Native American Grade School Children. Optometry and Vision Science. 2006; 83(4): 206-212.

[11]   He M, Huang W, Zheng Y, et al. Refractive error and visual impairment in school children in rural southern China. Ophthalmology 2007; 114: 374–382.

[12]   Marsden J, Stevens S and Ebri A. How to measure distance visual acuity. Community Eye Health. 2014; 27(85): 16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069781/

[13]   Maul E, Barroso S, Munoz SR, Spertudo RD, Ellwein LB. The refractive error study in children: Result from La Florida, Chile. Am J Ophthalmol 2000; 129: 445-454.

[14]   Ministry of Statistics & Program Implementation, Press Information Bureau (June 30, 2015). Government of India. Key Indicators of Social Consumption in India on Education Show Continued Gender Gap and Rural Urban Differences. Retrieved June 11, 2018, from http://pib.nic.in/newsite/PrintRelease.aspx?relid=122881

[15]   Ministry of Statistics & Program Implementation, Press Information Bureau (June 30, 2015). Government of India. Key Indicators of Social Consumption in India on Education Show Continued Gender Gap and Rural Urban Differences. Retrieved June 11, 2018, from http://pib.nic.in/newsite/PrintRelease.aspx?relid=122881

[16]   Mugisha F. School Enrolment among Urban Non-Slum, Slum and Rural Children in Kenya: Is the Urban Advantage Eroding? International Journal of Educational Development. 2006; 26(5): 471-482.

[17]   Pastorino N, Penerini Y. Programa de detección de déficit de la agudeza visual en escolares sin patología ocular aparente." Archivos Argentinos de Pediatría (Buenos Aires) 96.4 (1998): 236.

[18]   Smith JS. Childhood blindness in India [Editorial]. Eye 1995; 9: 543-544.

[19]   Vishnuprasad R, Bazroy J, Madhanraj K, Prashanth H, Singh Z, Samuel A and Muthukumar T. Visual impairment among 10–14-year school children in Puducherry: A cross-sectional study. Journal of Family Medicine and Primary Care, 2017: 6(1): 58-62.

[20]   World Health Organization; 2012. Visual impairment and blindness. Fact sheet no. 282 [Internet]. Geneva: Available from: http://www.who.int/mediacentre/factsheets/fs282/en [cited 2016 Jan 17].

[21]   Zhao J, Pan X, Sui R, Munoz SR, Sperduto RD, and Ellwein L. Refractive error study in children, results from Shunyi District China. Am J Ophthalmol. 2000; 129: 427-435.

Abstract:

Risk assessment before pregnancy is one of the interventions during Preconception care (PCC) that would improve the outcome of pregnancy. A quantitative descriptive non-experimental approach was used to examine the use of preconception interventions in health centres in Blantyre urban. The study assessed the PCC men and women of child bearing age have to ensure a healthy mother and baby after pregnancy. The objectives were to: explore and describe the knowledge men and women of childbearing age have on HTSP and PCC, identify variables that influence men and women to acquire appropriate knowledge on PCC. The study included 300 men and women of child bearing age that attended outpatient clinics for various minor ailments like underfive, family planning and gyneacological clinic who were between 18 to 35 years. Structured questionnaire was used to gather data and descriptive statistics were used to analyse data using SPSS version 20. Kruskal Wallis test and Chi square was used to determine the relationship of specific variables to use of PCC. Most of the respondents were not assessed for chronic problems that would interfere pregnancy like diabetes, hypertension, aneamia and malnutrition. Only 30% were checked for VDRL,43% were vaccinated from tetanus but 74% were assessed for HIV test. Chronic diseases would be controlled before pregnancy to minimize adverse effects of pregnancy like preterm labour, preeclampsia, intra uterine growth retardation (IUGR) and neonatal infections. Universal education should be provided to men and women of child bearing age to improve the understanding to have risk assessments done before pregnancy.

Keywords: Risk assessment; medical assessment; Maternal health; Newborn health; Unintended BMI; Preconception care;

References:

[1].Andale. 2012. Slovin’s Formula: What is it and when do I use it? [Online]. Available at: http://www.statisticshowto.com/how-to-use-slovins-formula/ (accessed 20 July 2015).

[2].Anderson, J, Ebrahim, S, Floyd, L & Atrash, H. 2006. Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period — United States, 2002–2004. Maternal and Child Health Journal 10(6):575-575.

[3].Anon. 2017. What you need to know counselling patients on PCC: Folate and beyond. [Online]. Available at: https://www.pcc.edu/resources/counseling/:// (accessed 19 March 2017).

[4].Ayalew, Y, Mulat, A, Dile, M & Simegn, A. 2017. Women’s knowledge and associated factors in PCC in adet, west gojjam, northwest Ethiopia: A community based cross sectional study. Reproductive Health 14(1):1-10.

[5].Bryman, A. 2012. Social research methods. New York. Oxford University Press.

[6].Bombard, J, Robbins, C, Dietz, P & Valderrama, A. 2013. PCC: The perfect opportunity for health care providers to advise lifestyle changes for hypertensive women. American Journal of Health Promotion 27(sp3): S43-S49.

[7].Curtis, M, Abelman, S, Schulkin, J, Williams, J & Fasset, E. 2006. Do we practice what we preach? A review of actual clinical practice with regards to PCC guidelines. Maternal and Child Health Journal 10(S1):53-58.

[8].Dean, S, Rudan, I, Althabe, F, Webb Girard, A, Howson, C, Langer, A, Lawn, J, Reeve, M, Teela, K, Toledano, M, Venkatraman, C, Belizan, J, Car, J, Chan, K, Chatterjee, S, Chitekwe, S, Doherty, T, Donnay, F, Ezzati, M, Humayun, K, Jack, B, Lassi, Z, Martorell, R, Poortman, Y & Bhutta, Z. 2013. Setting research priorities for PCC in low- and middle-income countries: Aiming to reduce maternal and child mortality and morbidity. PLoS Med 10(9): e1001508 (accessed 10 October 2017).

[9].Dunlop, A, Logue, K, Thorne, C & Badal, H. 2013. Change in women's knowledge of general and personal preconception health risks following targeted brief counselling in publicly funded primary care settings. American Journal of Health Promotion 27(sp3): S50-S57.

[10]. Elsinga, J, Van der Pal-de Bruin, K, Le Cessie, S, De Jong-Potjer, L, Verloove-Vanhorick, S & Assendelft, W. 2006. Preconception counselling initiated by general practitioners in the Netherlands: Reaching couples contemplating pregnancy [ISRCTN53942912]. BMC Family Practice 7(1):1-8.

[11]. Gardiner, P, Hempstead, M, Ring, L, Bickmore, T, Yinusa-Nyahkoon, L, Tran, H, Paasche-Orlow, M, Damus, K & Jack, B. 2013. Reaching Women through Health Information Technology: The Gabby Preconception Care System. American Journal of Health Promotion 27(sp3): eS11-eS20.

[12]. Godfrey, K, Cutfield, W, Chan, S, Baker, P & Chong, Y. 2017. Nutritional intervention preconception and during pregnancy to maintain healthy glucose metabolism and offspring health (“NiPPeR”): Study protocol for a randomised controlled trial. Trials 18(1):1-12.

[13]. Lassi, Z, Imam, A, Dean, S & Bhutta, Z. 2014. Preconception care: screening and management of chronic disease and promoting psychological health. Reproductive Health 11(Suppl 3): S5, 1-20.

[14]. Lu, M, Kotelchuck, M, Culhane, J, Hobel, C, Klerman, L & Thorp, J. 2006. PCC between Pregnancies: The Content of Internatal Care. Maternal Child Health Journal 10(S1):107-122.

[15]. Kothari, C. 2004. Research methodology. New Delhi: New Age.

[16]. Mason, E, Chandra-Mouli, V, Baltag, V, Christiansen, C, Lassi, Z & Bhutta, Z. 2014. PCC: Advancing from ‘important to do and can be done’ to ‘is being done and is making a difference’. Reproductive Health 11(Suppl 3): 1-9.

[17]. Mahmud, M & Mazza, D. 2010. PCC of women with diabetes: a review of current guideline recommendations. BMC Women's Health 10(1):1-7.

[18]. Polit, D, Beck, C & Polit, D. 2012. Resource manual for nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

[19]. Poels, M, Koster, M, Franx, A & Van Stel, H. 2017. Healthcare providers’ views on the delivery of preconception care in a local community setting in the Netherlands. BMC Health Services Research 17(1):1-10.

[20]. Posner, S, Johnson, K, Parker, C, Atrash, H & Biermann, J. 2006. The national summit on preconception care: A summary of concepts and recommendations. Maternal and Child Health Journal 10(S1):199-207.

[21]. Sagel, U., Krämer, A. & Mikolajczyk, R. (2011). Incidence of maternal Toxoplasma infections in pregnancy in Upper Austria, 2000-2007. BMC Infectious Diseases, 11(1):1-7.

[22]. Salihu, H, Salinas, A & Mogos, M. 2012. The Missing Link in Preconceptional Care: The Role of Comparative Effectiveness Research. Maternal and Child Health Journal 17(5):776-782.

[23]. Swaleh, R, Zeng, L, Mbuagbaw, L & Morrison, K. 2015. Outcomes in the offspring of mothers with pre-diabetes during pregnancy: a protocol for a systematic review. Systematic Reviews 4(1):1-5.

[24]. Steel, A, Lucke, J & Adams, J. 2015. The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review. BMC Women's Health 15(1):1-12.

[25]. Tuomainen, H, Cross-Bardell, L, Bhoday, M, Qureshi, N and Kai, J. 2013. Opportunities and challenges for enhancing preconception health in primary care: qualitative study with women from ethnically diverse communities. BMJ Open 3(7):1-9.

[26]. Vinturache, A, Moledina, N, McDonald, S, Slater, D & Tough, S. 2014. Pre-pregnancy Body Mass Index (BMI) and delivery outcomes in a Canadian population. BMC Pregnancy and Childbirth 14(1):1-10.

[27]. Waggoner, M. 2012. Motherhood preconceived the emergence of the preconception health and health care initiative. Journal of Health Politics, Policy and Law 382:345-371.

[28]. World Health Organization. 2015a. WHO/Maternal mortality. [Online]. Available at: http://www.who.int/gho/maternal_health/mortality/maternal_mortality_text/en/ (accessed 14 February 2015).

Abstract:

Quality of life of persons living with diabetes measures their health status with a look at multiple aspects of their life, including: emotional reactions to life occurrences, disposition, sense of life fulfilment and satisfaction in life. This study compares Health related quality of life of persons living with diabetes and those without Diabetes in University of Calabar Teaching Hospital, Calabar. This is a facility based cross sectional descriptive study. Participants were given the World Health Organization quality of life (WHOQOL-BREF) to assess their quality of life. Data were analyzed using Statistical Packages for the Social Sciences (SPSS), version 24. The results were presented in Means, standard deviations, and statistical analyses were performed to compare between QOL between diabetic and non-diabetics. A total 400 respondents (200 people living with Diabetes and 200 people without diabetes) participated in this study. Clinical data of diabetic respondents showed that 70.5 percent (n=141) were living with other disease while 29.5 percent n= 59) of diabetic responds were not living with other diseases. Diseases mostly exhibited by diabetic patients were hypertension 40 percent (n=80) and arthritis 15 percent (n=30). Patients with diabetes had a significant lower mean score than the non-diabetics in their overall quality of life (P = 0.000). Findings from this study also indicate that diabetics had a mean score of 23.17, 20.06, 10.20, 28.0 in their physical, psychological, social and environmental domain respectively compare with those without diabetes that reported a mean score of 24.17, 21.53, 11.43, 28.68 in their physical, psychological, social and environmental domain respectively. There is need for comprehensive management plan to minimize the daunting outcomes of DM and improve the QOL of the diabetics.

References:

[1].Clement S. Diabetes self-management education. Diabetes Care. 1995;18:1204–1214. [PubMed].

[2].Chen T.H, Li L & Kochen MM. 2005. A systematic review: How to choose appropriate health-related quality of life (HRQOL) measures in routine general practice? J Zhejiang Univ Sci B. 2005 Sep;6(9):936-940.

[3].Hossain MA, et al 2010. Diabetes and Ramadan

[4].IDF Diabetes Atlas. Global estimates of the prevalence of diabetes for 2011 and 2030. 8^th Edition 2017.

[5].Odidi V., Ugboka L.U., Oparah A. C. 2010. Quality of life of people with diabetes in Benin city as measured with WHOQOL-BREF. The Internet Journal of Law, Healthcare and Ethics. 2008 Volume 6 Number 2.

[6].Padgett D, Mumford E, Hynes M, Carter R. Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus. Journal of Clinical Epidemiology. 1988; 41:1007–1030. [PubMed]

[7].Suzanne C. et al., 2010. Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Two Volume Set). Twelfth edition.

[8].WHO. Development of the WHOQOL-BREF quality of life assessment. Psychological Medicine. 1998 May; 28(3):551-8.

Abstract:

The role of Traditional Birth Attendants (TBAs) in improving maternal health has been heavily debated, especially in the focus on Millennium Development Goal (MDG) 5. The use of TBAs is still high in Kenya; TBAs attend to 28% of all births, relatives attend to 21% of births, and 7% give birth without any assistance. Up to 90% of these maternal and infant deaths are caused by obstetric complications that are preventable. Understanding the factors that contributes to high utilization of TBAs among Kenyan in spite of the free maternity being offered is very important. Hence, this study aimed at determining and ascertaining the critical predisposing factors to utilization of TBAs by expectant mothers in Mombasa County, Kenya. The study adopted a survey research design and was conducted among expectant mothers using semi-structured questionnaire and interview guide. Data was collected from June to September, 2017. Multinomial logistic regression analyses were used to identify factors associated with utilization of TBAs by expectant mothers. Data was analysed using R (version 3.4.3). The study recruited 370 (96.4%) out of the expected 384 respondents. Various factors such as TBAs live among the community, poverty, culture, facilities being far, fear of harassment by nurses, number of children delivered. To improve the utilization of Skilled Birth Attendants (SBA) services, our finding suggests implementation of strategies like need to improve infrastructure and adequate maternal health services, also improving the staffing and motivation levels for health personnel

Keywords: Predisposing factors, Traditional Attendants, Skilled Attendants, Maternal Health, Mombasa County.

References:

[1].     AMREF (2015). AMREF’s Position on the Role and Services of Traditional Birth Attendants, 1–2.

[2].     Bergström S, Goodburn E. (2001). The role of traditional birth attendants in the reduction of maternal mortality. Studies in HSO&P. 17:85–89.

[3].     Bourbonnais N. (2013). Implementing Free Maternal Health Care in Kenya. Challenges, Strategies, and Recommendations. Kenya National Commission of Human Rights.

[4].     Dietsch E. (2010). The experience of being a traditional midwife: relationships with skilled birth attendants. Rural Remote Health. 10(3):1481.

[5].     Fisher AA, Laing EJ, Stoeckel EJ, Townsend WJ (1998). Handbook for family planning operations research design. 2nd. New York, NY, USA: Population Council; p.36.

[6].     Fotso, J.-C., Ezeh, A. C., & Essendi, H. (2009). Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services? Reproductive Health, 6, 9.

[7].     Ikamari, L., Izugbara, C., & Ochako, R. (2013). Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya. BMC Pregnancy and Childbirth, 13(1), 69.

[8].     KDHS. (2014). Kenya demographic and health survey: Key indicators, 1–76.

[9].     Keri, L., Kaye, D., & Sibylle, K. (2010). Referral practices and perceived barriers to timely obstetric care among Ugandan traditional birth attendants (TBA). African Health Sciences, 10(1), 75–81.

[10]. KNBS, Mombasa. (2009). 2009 Census. Kenya National Bureau of Statistics.

[11]. Mannah, M. T., Warren, C., Kuria, S., & Adegoke, A. A. (2014). Opportunities and challenges in implementing community based skilled birth attendance strategy in Kenya. BMC Pregnancy and Childbirth, 14(1), 279.

[12]. Mwewa D, Michelo C (2010). Factors associated with home deliveries in a low-income rural setting-observations from Nchelenge District Zambia. Med J Zambia.37(4):234–9.

[13]. Navaneetham K, Dharmalingam A (2006). Utilization of maternal health care services in Southern India. Soc Sci Med. 55:1849–69.

[14]. Nyamtema AS, Urassa DP, Roosmalen JV (2011). Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth. 11:30.

[15]. Omollo J. Vistoria, Oboka W. Aluoch, Janet N. Kassilly (2016). Factors influencing mothers’ choice of birth attendants in Bunyala sub- county, Kenya. International Review of Humanities and Scientific Research. 2519-5336

[16]. Shiferaw, S., Spigt, M., Godefrooij, M., Melkamu, Y., & Tekie, M. (2013). Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth, 13:2393-13-5.

[17]. Sialubanje C, Massar K, Hamer DH, Ruiter RAC (2014). Psychosocial and environmental predictors of the intention to Use maternal healthcare services in Kalomo, Zambia. Health Educ Res. 29(6):1028–40.

[18]. Stekelenburg J, Kyanamina S, Mukelabai M, Wolffers I, van Roosmalen J (2004). Waiting too long: low use of maternal health services in Kalabo, Zambia. Trop Med Int Health. 390–398.

[19]. Thaddeus S, Maine D (1994). “Too far to walk: maternal mortality in context,”. Social Science and Medicine. 38(8):1110.

[20]. Titaley CR, Hunter CL, Dibley MJ, Heywood P (2010). Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy Childbirth. 10:43.

[21]. Vieira, C., Portela, A., Miller, T., Coast, E., Leone, T., & Marston, C. (2012). Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: A systematic review. PLoS ONE, 7(10), e47946.

[22]. World Health Organisation (2010). Classifying Health Workers. Geneva.

[23]. World Health Organisation (1992). Traditional Birth Attendants: a joint WHO/UNFPA/UNICEF statement. Geneva.

Abstract:

Background: Osteoporosis (OP), a metabolic disorder which affects mainly bones, is characterized by low bone mass and is associated with serious health and economic burden. The main musculoskeletal problems associated with it are hip fractures with a worldwide prevalence of about 1.6 million and high rates of morbidity and mortality. It is a silent disease and usually does not manifest until fractures occur. The Aim of this study were to assess knowledge, attitude and practice toward postmenopausal osteoporosis and its preventive measures among female students aged 17-24years in Khartoum, Sudan.

Methodology: A cross sectional study was conducted in three different faculties of the University of Khartoum. Data was collected from 226 female students aged 17-24 by stratified systematic random sampling using a pre-tested, pre-coded self-administered questionnaire.

Results: The majority (84.8%) of respondents heard about osteoporosis. Faculty curriculum was the main source of information (31.1%), followed by family and friends (15.3%). The overall knowledge of respondents about OP was below average (57.1%), average (42%) and good (0.9%). About three-fifth (58.1%) were aware about their susceptibility to get it in the future and (61%) were concerned about taking preventive measures. The majority of respondents (94.9%) perceived the seriousness of OP. Milk and dairy products were the most commonly identified as sources of calcium (33.8%).

Conclusions: The overall knowledge was below average. Raising knowledge about osteoporosis may be an effective tool in preventing the problem and subsequently osteoporotic fractures later in life.

Keywords: postmenopausal oosteoporosis, hip fractures, knowledge, attitudes, practice.

References:

[1].     Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ. Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann. Intern. Med. 1988;108 (6): 824–8

[2].     Exucutive summary. Middle East and Africa audit. International osteoporosis foundation 2011. A report

[3].     Ghadeer zakai, haytham zakai. Awareness about osteoporosis among students in Jeddah, Saudi Arabia. Journal of Advanced laboratory research in biology 2015; 6.

[4].     Hala M. Elsabagh, Abdelaziz F. Aldeib, Salwa A. Atlam, Shimaa M. Saied. Osteoporosis knowledge and Health Beliefs among Employees of Tanta University. American Journal of Research Communication; 2015: 12.

[5].     Hreybe H, Salamoun M, Badra M, Afeiche N, Baddoura O, Boulos S, Haidar R, Lakkis S, Musharrafieh R, Nsouli A, Taha A, Tayim A, El-Hajj Fuleihan G. Hip fractures in Lebanese patients: determinants and prognosis. J Clin Densitom. 2004; 7(4):368-375.

[6].     I.A. Dontas and C.K. Yiannakopoulos. Risk factors and prevention of osteoporosis-related fractures. J Musculoskelet Neuronal Interact 2007; 7(3):268-272.

[7].     Johnell O and Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. OsteoporosInt 2006; 17:1726.

[8].     Juan Lu, Yongyun Shin, Miao-Shan Yen, and Shumei S. Sun. Peak bone mass and patterns of change in total bone mineraldensity and bone mineral contents from childhood into young adulthood. Assessment & Management of Musculoskeletal Health Journal of Clinical Densitometry: 2014.

[9].     Kh. Eltohami, W.Sami, A. Al eidan, M. Almobarak, F. Alotaibi. Study of knowledge, attitude, and practice of osteoporosis among adult women in Majmaah city, Saudi Arabia. International journal of health and rehabilitation science; 2015:4:3.

[10]. Kumar, Abbas, Aster, Robbins Basic pathology, Ninth ed., Canada, Elsevier 2013;768-770.

[11]. Mansoureh Safizadeh, Elahe Aminizadeh, Hossein Safizadeh. Awareness of osteoporosis among female employees in Kerman, Iran. Russian Open Medical Journal; 2015;4;1

[12]. Morales-Torres J. Strategies for the prevention and control of osteoporosis in developing countries. Clin Rheumatol,2007;26(2):139-143.

[13]. Mukesh Srivastava, Gul Naz Fatima, Richa Srivastava1 and Man Mohan Singh. Assessment of Awareness of Osteoporosis Amongst Unmarried Indian Girl Students Pursuing Undergraduateand Postgraduate Professional Courses..Asian Journal of Oral Health & Allied Sciences 2; 2013; 3.

[14]. Noman-ul-Haq, Maria Tahir, Qaiser Iqbal and Aqeel Naseem. Exploration of Osteoporosis Knowledge and Perception among Young Women in Quetta, Pakistan. J Osteopor Phys; 2015, 3:3.

[15]. Rima Sayed-Hassan, Hyam Bashour &Abir Koudsi. Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus. Arch Osteoporos2013; 8:149.

[16]. Sarah Sayed El-Tawab, Emmanuel Kamal Aziz Saba, Heba Mohmoud Taha Elweshahi, Mona Hamdy Ashry. Knowledge of osteoporosis among women in Alexandria (Egypt): A community based survey. The Egyptian Rheumatologist 2016; 38, 225–231.

[17]. Stacie E. Geller, Richard Derman. Knowledge, beliefs and factors for osteoporosis among African American and Hispanic women. Journal of the national medical association 2001; 93:13-21.

[18]. Toh LS, Lai PSM, Wu DB-C, Wong KT, Low BY, Anderson C. The development and validation of the osteoporosis prevention and awareness tool (OPAAT) in Malaysia. PLoS ONE 2015; 10(5).

[19]. Waleed M Sweileh1, Samah W Al-Jabi, Sa’ed H Zyoud, Ansam F Sawalha1 and Mustafa A Ghanim.Osteoporosis is a neglected health priority in Arab World: a comparative bibliometric analysis; Springer Plus 2014, 3:427

[20]. Y. H Khan, A. Sarriff, A. H Khan, T. H Malhi. KAP survey of osteoporosis among students of tertiary institution in Malaysia. Trop J Pharm Res, 2014;13(1): 155.

[21]. Z Jalili, N Nakhae , R Askar, V Sharifi. Knowledge, attitude and preventive practice of women concerning osteoporosis. Iranian J Publ Health, 2007;36, 2:19-24.

Abstract:

Background: Ghana does not have reliable surveillance programme for ensuring safety of food and herbal products on the market. Data from previous studies have shown the presence of pesticide residues in food products and its associated health risk. In this present study we assessed the residual pesticide content of six most patronized herbal preparations in Kumasi, Ghana and the attendant risk of such contamination to public health.

Methodology: The herbal preparations were cleaned up using Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method for insecticide analysis. Analysis was carried out on GC-MS using 33 external standards.

Results: The total pesticide content in most of the herbal preparations was below the maximum residue limit (MRL). However, the concentration of pirimiphos-methyl in herbal product ‘E’ (HPE) (0.082 mg/kg) was higher than the MRL (0.05 mg/kg). In addition, the hazard indices’ (HI) for five herbal products were less than ‘1’ and safe for consumption without any possible future health risk. However, the HI for HPE was determined to be greater than ‘1’. Aldrin, dieldrin and chlordane which are banned in Ghana were also identified in 50% of the studied herbal preparations.

Conclusion: Data from this study reveals that HPE is contaminated with pirimiphos-methyl pesticide and unsafe for consumption. Also, the presence of banned pesticides in 50% of the studied herbal preparations calls for concern and urgent intervention by relevant regulatory authorities.

Keywords: Herbal medicinal preparation, hazard index, pesticides, contamination, health risk, safety.

References:

[1].     Abdel-Ghany, R., Mohammed, E., Anis, S., Barakat, W., (2016). Impact of Exposure to Fenitrothion on Vital Organs in Rats [WWW Document]. J. Toxicol. https://doi.org/10.1155/2016/5609734.

[2].     Akoto, O., Gavor, S., Appah, M.K., Apau, J., (2015a). Estimation of human health risk associated with the consumption of pesticide-contaminated vegetables from Kumasi, Ghana. Environ. Monit. Assess. 187, 244. https://doi.org/10.1007/s10661-015-4471-0.

[3].     Akoto, O., Oppong-Otoo, J., Osei-Fosu, P., (2015b). Carcinogenic and non-carcinogenic risk of organochlorine pesticide residues in processed cereal-based complementary foods for infants and young children in Ghana. Chemosphere 132, 193–199. https://doi.org/10.1016/j.chemosphere.2015.02.056

[4].     Amoah, P., Drechsel, P., Abaidoo, R.C., Ntow, W.J., (2006). Pesticide and pathogen contamination of vegetables in Ghana’s urban markets. Arch. Environ. Contam. Toxicol. 50, 1–6. https://doi.org/10.1007/s00244-004-0054-8.

[5].     Chouaïbou, M.S., Fodjo, B.K., Fokou, G., Allassane, O.F., Koudou, B.G., David, J.-P., Antonio-Nkondjio, C., Ranson, H., Bonfoh, B., (2016). Influence of the agrochemicals used for rice and vegetable cultivation on insecticide resistance in malaria vectors in southern Côte d’Ivoire. Malar. J. 15, 426. https://doi.org/10.1186/s12936-016-1481-5.

[6].     Darko, G., Acquaah, S.O., (2008). Levels of organochlorine pesticides residues in dairy products in Kumasi, Ghana. Chemosphere 71, 294–298. https://doi.org/10.1016/j.chemosphere.2007.09.005

[7].     Darko, G., Addai Tabi, J., Adjaloo, M.K., Borquaye, L.S., (2017). Pesticide Residues in Honey from the Major Honey Producing Forest Belts in Ghana. J. Environ. Public Health 2017, 7957431. https://doi.org/10.1155/2017/7957431.

[8].     Darko, G., Akoto, O., (2008). Dietary intake of organophosphorus pesticide residues through vegetables from Kumasi, Ghana. Food Chem. Toxicol. Int. J. Publ. Br. Ind. Biol. Res. Assoc. 46, 3703–3706. https://doi.org/10.1016/j.fct.2008.09.049.

[9].     Di Bella, G., Haddaoui, I., Lo Turco, V., Potortì, A.G., Fede, M.R., Dugo, G., (2017). POP levels in beans from Mediterranean and tropical areas. J. Sci. Food Agric. 97, 2610–2616. https://doi.org/10.1002/jsfa.8083

[10]. Ekhator, O.C., Udowelle, N.A., Igbiri, S., Asomugha, R.N., Igweze, Z.N., Orisakwe, O.E., (2017). Safety Evaluation of Potential Toxic Metals Exposure from Street Foods Consumed in Mid-West Nigeria. J. Environ. Public Health 2017. https://doi.org/10.1155/2017/8458057.

[11]. EPA Bans 25 Dangerous Agro-Chemicals, (2008). Mod. Ghana. URL https://www.modernghana.com/news/180428/epa-bans-25-dangerous-agro-chemicals.html (accessed 2.27.18).

[12]. Essumang, D.K., Asare, E.A., Dodoo, D.K., (2013). Pesticides residues in okra (non-target crop) grown close to a watermelon farm in Ghana. Environ. Monit. Assess. 185, 7617–7625. https://doi.org/10.1007/s10661-013-3123-5.

[13]. Fosu, P.O., Donkor, A., Ziwu, C., Dubey, B., Kingsford-Adaboh, R., Asante, I., Nyarko, S., Tawiah, R., Nazzah, N., (2017). Surveillance of pesticide residues in fruits and vegetables from Accra Metropolis markets, Ghana, 2010-2012: a case study in Sub-Saharan Africa. Environ. Sci. Pollut. Res. Int. 24, 17187–17205. https://doi.org/10.1007/s11356-017-9287-8.

[14]. Harrison, R.M., Chirgawi, M.B., (1989). The assessment of air and soil as contributors of some trace metals to vegetable plants. I. Use of a filtered air growth cabinet. Sci. Total Environ. 83, 13–34.

[15]. Johnson, L.A., Welch, B., Whitfield, S.M., (2013). Interactive effects of pesticide mixtures, predators, and environmental regimes on the toxicity of two pesticides to red-eyed tree frog larvae. Environ. Toxicol. Chem. 32, 2379–2386. https://doi.org/10.1002/etc.2319.

[16]. Kimaru, H.P.N.I.W., (2014). GC–MS Analysis of an Herbal Medicinal Remedy to Identify Potential Toxic Compounds

http://www.chromatographyonline.com/gc-ms-analysis-herbal-medicinal-remedy-identify-potential-toxic-compounds-0 (accessed 3.12.18).

[17]. Kuranchie-Mensah, H., Yeboah, P.O., Nyarko, E., Golow, A.A., (2013). Studies on organochlorine pesticide residue in fishes from the Densu river basin, Ghana. Bull. Environ. Contam. Toxicol. 90, 421–426. https://doi.org/10.1007/s00128-012-0931-1.

[18]. Mosaddegh, M.H., Emami, F., Asghari, G., (2014). Evaluation of Residual Diazinon and Chlorpiryfos in Children Herbal Medicines by Headspace-SPME and GC-FID. Iran. J. Pharm. Res. IJPR 13, 541–549.

[19]. Naithani, V., Kakkar, P., (2004). An evaluation of residual organochlorine pesticides in popular Indian herbal teas. Arch. Environ. Health 59, 426–430. https://doi.org/10.3200/AEOH.59.8.426-430.

[20]. Ngoula, F., Watcho, P., Dongmo, M.-C., Kenfack, A., Kamtchouing, P., Tchoumboué, J., (2007). Effects of pirimiphos-methyl (an organophosphate insecticide) on the fertility of adult male rats. Afr. Health Sci. 7, 3–9. https://doi.org/10.5555/afhs.2007.7.1.3.

[21]. Obiri-Danso, K., Adonadaga, M.G., Hogarh, J.N., (2011). Effect of agrochemical use on the drinking water quality of Agogo, a tomato growing community in Ashanti Akim, Ghana. Bull. Environ. Contam. Toxicol. 86, 71–77. https://doi.org/10.1007/s00128-010-0183-x.

[22]. Oh, C.-H., (2009). Monitoring of residual pesticides in herbal drug materials of Korea and China. Bull. Environ. Contam. Toxicol. 82, 639–643. https://doi.org/10.1007/s00128-009-9649-0.

[23]. Osei-Fosu, P., Donkor, A.K., Nyarko, S., Nazzah, N.K., Asante, I.K., Kingsford-Adabo, R., Arkorful, N.A., (2014). Monitoring of pesticide residues of five notable vegetables at Agbogbloshie market in Accra, Ghana. Environ. Monit. Assess. 186, 7157–7163. https://doi.org/10.1007/s10661-014-3917-0.

[24]. Ou, X., Wang, L., Guo, L., Cui, X., Liu, D., Yang, Y., (2016). Soil-Plant Metal Relations in Panax notoginseng: An Ecosystem Health Risk Assessment. Int. J. Environ. Res. Public. Health 13. https://doi.org/10.3390/ijerph13111089.

[25]. Pubchem, n.d. Chlorpyrifos-methyl [WWW Document]. URL https://pubchem.ncbi.nlm.nih.gov/compound/21803 (accessed 7.20.18).

[26]. Pubchem, n.d. Pirimiphos-methyl [WWW Document]. URL https://pubchem.ncbi.nlm.nih.gov/compound/34526 (accessed 7.20.18).

[27]. Pubchem, n.d. Fenitrothion [WWW Document]. URL https://pubchem.ncbi.nlm.nih.gov/compound/31200 (accessed 7.20.18).

[28]. Skovgaard, M., Renjel Encinas, S., Jensen, O.C., Andersen, J.H., Condarco, G., Jørs, E., (2017). Pesticide Residues in Commercial Lettuce, Onion, and Potato Samples From Bolivia—A Threat to Public Health? Environ. Health Insights 11. https://doi.org/10.1177/1178630217704194.

[29]. Wang, X., Sato, T., Xing, B., Tao, S., (2005). Health risks of heavy metals to the general public in Tianjin, China via consumption of vegetables and fish. Sci. Total Environ. 350, 28–37. https://doi.org/10.1016/j.scitotenv.2004.09.044.

[30]. Yang, W.-Z., Kang, C.-Z., Ji, R.-F., Zhou, L.I., Wang, S., Li, Z.-H., Ma, Z.-H., Guo, L.-P., (2017). [Situation analysis and standard formulation of pesticide residues in traditional Chinese medicines]. Zhongguo Zhong Yao Za Zhi Zhongguo Zhongyao Zazhi China J. Chin. Mater. Medica 42, 2284–2290.

Abstract:

Uganda Christian University’s records of 2013-2014 show that approximately 30% of the 3,300 students in the Easter Semester did not register for and therefore could not use the University’s health services.

This study analysed Uganda Christian University students’ health seeking behaviour in order to identify their preferred health care services and rationale for their choice, and the barriers to the University’s health system.

A cross-sectional and mixed design was applied. Data was collected with a questionnaire administered to a sample of 424 Uganda Christian University students in April 2015. Quantitative data was analysed with SPSS 16. Qualitative data was analysed by content analysis.

Most students came from urban (51%) or peri-urban (23.4%) homes and had parents or guardians with post-secondary school education (80%). Most of the students used the university’s Allan Galpin Health Centre (78%) when in need of health care but given choice, they would prefer other health facilities, especially those nearest. The most frequent reason for choice was convenience. The females perceived their state of health differently from the males (p-value 0.03) and they had more unmet health needs. Barriers include unavailability of needed services, long queues, poor customer care, lack of trust in the service, waiting to see if the health problem would resolve and lack of relevant information.

The findings are similar to those from studies done in similar contexts. Key influencers of health seeking behaviour were convenience and gender. Unavailability of needed services and customer care issues were barriers to the University health services.

Keywords: Health Seeking Behaviour, Barriers, Rationale, Uganda Christian University.

References:

[1].Abewe C, Kwesiga B, Zikusooka CM. Who Benefits from Health Care Services in Uganda? Sector-Wide Benefit Incidence Analysis for Uganda (2005/6 and 2009/10) .2012. Available from: http://ssrn.com/abstract=2281752 . [cited 2016 Jan 8^th].

[2].Afolabi M, Daropale V, Irinoye A. and Adegoke A. Health-seeking behaviour and student perception of health care services in a university community in Nigeria. Health, 5, 817-824. 2013. [cited 2015 Jun 19^th] doi: 10.4236/health.2013.55108.

[3].Aldwin C.M, Park C, L, Jeong Y, Nath. R. 2014. Differing pathways between religiousness, spirituality, and health: A self-regulation perspective. Psychology of Religion and Spirituality, 6 (1): 9 DOI: 10.1037/a0034416

[4].Babitsch B, Gohl D. and Lengerke T. Re-revisiting Andersen’s Behavioural Model of Health Services Use: a systematic review of studies from1998- 2011. Special issue: Health care utilization in Germany: The NW In research network. 2012. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488807/pdf/PSM-09-11.pdf [cited 2015 Jun 1^st]

[5].Baruch, Y., 1999. Response Rates in Academic Studies- A Comparative Analysis Survey response rate levels and trends in organizational research. Human Relations 2008; 61; 1139. Available online at

[6]. http://journals.sagepub.com/doi/abs/10.1177/001872679905200401 [cited 2017 May 15^th]

[7].Blum. 2009. Young People: Not as healthy as they seem. The Lancet. Vol. 374 September, 2009.

[8].Bogle V., 2013. A review of the literature: men’s health-seeking behaviourand use of the internet. Available online at https://www.menshealthforum.org.uk/sites/default/files/pdf/mens_health_literature_review_dec2013_final.pdf [cited 2015 Sept 25^th ]

[9].Boltena A.T., Ali Khan F., Benedict O. Asamoah B.O. and Agardh A., 2012. Barriers faced by Ugandan university students in seeking medical care and sexual health counselling: a cross-sectional study. Available at http://www.biomedcentral.com/1471-2458/12/986 [cited 2015 Jan. 29th]

[10]. Isaac, V., Mclachlan, C. S., Baune, B. T., Huang, C.-T., & Wu, C.-Y. (2015). Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan. Medicine, 94(36), e1477. https://doi.org/10.1097/MD.0000000000001477

[11]. Konde-Lule J., Okuonzi S., Matsiko C., Mukanga D., Onama V. and Gitta S.N., 2006. The Potential of The Private Sector to Improve Health Outcomes in Uganda.

[12]. Lawson D., 2004. Determinants of Health Seeking Behaviour in Uganda –Is it Just Income and User Fees That Are Important?. Available online at https://ideas.repec.org/p/ags/idpmde/30553.html [cited 2015 January 20th]

[13]. Lwanga S.K., and Lemeshow S.,1991. Sample Size Determination In Health Studies: A practical Manual. World Health Organisation. Geneva.

[14]. Mackian S., 2003. University of Manchester Health Systems Development Programme. A review of health seeking behaviour: problems and prospects. Available at http://r4d.dfid.gov.uk/pdf/outputs/healthsysdev_kp/05-03_health_seeking_behaviour.pdf [cited 2015 March 13^th]

[15]. Ministry Of Health (Uganda). (2015). Health Sector Strategic and Development Plan (2015-2020) From: http://health.go.ug/content/health-sector-development-plan-201516-201920 [ cited 2015 Dec. 20^th]

[16]. Musoke D, Boynton P, Butler C, Musoke MB. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda. 2014. Available from http://www.bioline.org.br/pdf?hs14155 [cited 2015 Jun 23^rd].

[17]. Naing L., Winn T. and Rusli B.N., 2006. Practical Issues in Calculating Sample Sizes for Prevalence Studies. Archives of Orofacial Sciences 2006; 1:9-14. Available online at http://www.kck.usm.my/ppsg/aos/Vol_1/09_14_Ayub.pdf (cited 2015 Feb. 3^rd]

[18]. National Planning Authority [NPA] (Uganda). Second National Development Plan (NDPII) 2015/16 – 2019/20. 2015. Available from: npa.ug/wp-content/uploads/NDPII-Final.pdf [cited 2015 Oct 10^th].

[19]. Olenja J. Health Seeking Behaviour in Context. East African Medical Journal. 2003. Available from http://www.ajol.info/index.php/eamj/article/viewFile/8689/1927 [cited 2015 Jan 28th].

[20]. Otwombe K., Dietrich J., Laher F., Hornschuh S., Nkala B., Chimoyi L., Kaida A., Gray G.E., and Miller C.L., 2001. Health-seeking behaviour by gender among adolescents in Soweto, South Africa. Available online at http://www.globalhealthaction.net/index.php/gha/article/view/25670/pdf_28 [cited 2016 June 19th]

[21]. Polit, D.F., & Beck, C.T., 2009. Nursing research: generating and assessing evidence for nursing practice. 8th edition. Philadelphia: JB Lippincott.

[22]. Rahman S. 2016. Sex, Gender and Health Seeking Behaviour Determinants. NU Journal of Humanities, Social Sciences & Business Studies Vol. 2, No. 2, January-June 2016. Available at www.nu.edu.bd/.../01.%20Sex,%20Gender%20and%20Health%20Seeking%20Behav...

[23]. [cited 2016 Jan. 3^rd]

[24]. Ssewanyana S., Nabyonga O.J., Kasirye I. & Lawson D., 2004. Demand for health care services in Uganda Implications for poverty eradication. Economic Policy Research Center Research series No. 40, EPRC Makerere University, Kampala Uganda.

[25]. Statistics South Africa., 2004. Perceived health and other health indicators in South Africa Statistics South. Available online at www.statssa.gov.za/.../HealthOHS/HealthOHS1999.... [ cited 2015 Sept. 27^th]

[26]. UBOS., 2012. Uganda Demographic and Health Survey 2011. Uganda Bureau of Statistics Kampala, Uganda

[27]. Uganda Bureau of Statistics (UBOS). The National Population and Housing Census 2014 – Main Report, Kampala, Uganda. 2016.

[28]. Uganda Bureau of Statistics (UBOS). 2013. Statistical Abstract. Uganda Bureau of Statistics, Statistics House. Kampala.

[29]. UNESCO., 2015. What do we mean by “youth”?. Available online at http://www.unesco.org/new/en/social-and-human-sciences/themes/youth/youth-definition/ (accessed on 1^st October 2015).

[30]. WHO., 2010. Workload Indicators of Staffing Need (WISN) User's manual. Available online at http://www.who.int/hrh/resources/wisn_user_manual/en/ (accessed on 7th Oct. 2015)

[31]. Zikusooka C.M., Kwesiga B., Lagony S., and Abewe C., 2014. Universal Health Coverage Assessment Uganda. Global Network for Health Equity (GNHE).

Abstract:

A high average prevalence rate of 11-13.7% % for viral hepatitis B exists in Nigeria. This study examined the barriers to access hepatitis B virus (HBV) testing among senior secondary school students in six public day secondary schools located in Jos South Local Government Area, Plateau state. It also related the beliefs held on HBV in relation to barriers for access to HBV testing following the impact of a peer education intervention.

A quasi-experimental study was carried out on six hundred students selected by a multistage sampling technique. A pre-tested formal self-administered questionnaire (SAQ) was used to collect data pre and twelve weeks post intervention. Chi- square and students t-test was done to compare intervention and control groups on outcome variables. Results showed the age distribution of the respondents was 10-24 years with majority of respondents (86.7%) in the age group 15-19 years. The most frequent reason got as a barrier for accessing HBV test was ‘I did not know a HBV test was available’. This was related to the belief that ‘parents were keen to agree’ for the student to have a hepatitis B test done as shown by the chi-square test performed post intervention between intervention and control group using chi-square test was found. There was no significant difference in the belief by students: I have not done a HBV test. However, the students tested for HBV were only from the intervention group showing access to HBV testing was enhanced by its direct availability in the intervention schools. This is in line with the barrier by students that they did not have availability of HBV test. A prevalence rate of 9.1% was found on HBV testing among the students.

Keywords: Hepatitis B testing, secondary school, student, barrier, access, prevalence.

References:

[1].Aziz Ali, S., Suhail, N., & Ali, A. S. (2016). Cultural and Social Barriers in increased burden of hepatitis B in Pakistan: Literature review. Journal of Infectious Diseases and Diagnosis, 1(2), 105. Retrieved from https://www.omicsonline.org/open-access/role-of-cultural-and-social-barriers-in-increased-burden-of-hepatitis-b-inpakistan-literature-review-jidd-100105.php?aid=75328.

[2].Bequelin, C., Fatou, F., Seydi, M., & Wandele, G. (2018). The current situation and challenges of screening for and treating hepatitis B in sub-Saharan Africa. Expert review of gastroenterology & Hepatology, 12(6). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154452/.

[3].Center for Disease Control and Prevention. (2018). Hepatitis B: Testing and vaccination. Retrieved from http://www.immunize.org/catg.d/p2110.pdf.

[4].Chingle, M. P., Osagie, I.A., Adams, H., Gwomson, D., Emeribe, N., & Zoakah, A.I. (2017). Risk perception of hepatitis B infection and uptake of hepatitis B vaccine among students of tertiary institution in Jos. Annals of African Medicine, 16(2), 59-64. Retrieved from http://www.annalsafrmed.org/article.asp?issn=1596-3519;year=2017;volume=16;issue=2;spage=59;epage=64;aulast=Chingle.

[5].Federal Ministry of Health (2013). National Training Manual on Peer-to-Peer Youth health education. Growing girls and women in Nigeria (G-Win Project). 1-142. Retrieved from http://www.health.gov.ng/doc/TrgManualP2PYHE.pdf.

[6].Giles-Vernick, T., Hejoaka, F., Sanou, A., Shimakawa, Y., Bamba, I., & Traore, A. (2016). Barriers to linkage to care for hepatitis B virus infection: a qualitative analysis in burkina faso, west Africa. American Journal of Tropical Medicine and Hygiene, 95(6). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154452/.

[7].Hu, K. Q., Pan, C. Q., & Goodwin, D. (2011). Barriers to screening for hepatitis B virus infection in Asian Americans. Digestive Diseases and Sciences, 56(11), 3163-71. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21861105.

[8].Ikobah, J., Okpara, H., Elemi, I., Ogarepe, Y., Udoh, E., & Ekanem, E. (2016). The prevalence of hepatitis B virus infection in Nigerian children prior to vaccine introduction into the National Programme on Immunization schedule. Pan African Medical Journal, 23 (128). doi: 10.11604/pamj.2016.23.128.8756. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885699/.

[9].National AIDS/STIs Control Program (2016). Introduction. Guidelines for the Prevention, Treatment and Care of Viral Hepatitis in Nigeria. Federal Ministry of Health. p 1-30.

[10]. Spearman, C.W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohoues-Kouacou, M., Mbaye, S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye,. A.B., Tzeuton, C., Sonderup, M.W. (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The Lancet Gastroenterology & Hepatology, 2(12), 900-909. doi: https://doi.org/10.1016/S2468-1253(17)30295-9.

[11]. Umego, C. F., Mboto, C. I., Mbim, E. N., Edet, U. O., George, U. E., Tarh, J.E. (2018). Epidemiology of hepatitis B virus infection in South South Nigeria: A review. Retrieved from https://www.researchgate.net/publication/323044245_Epidemiology_of_Hepatitis_B_Virus_Infection_in_South-South_Nigeria_A_Review.

[12]. World Health Organization (2018). Global Health Sector Strategy on Viral Hepatitis 2016–2021: Towards Ending Viral Hepatitis 2016. Retrieved from http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ ID: 101666147.

Abstract:

Adequate knowledge and consistent practice of specialized diabetic foot care greatly improves the quality of life of diabetics. However, there has been a near absent practice of specialized diabetic foot care observed in health institutions in Rivers State, Nigeria. The study assessed the knowledge of diabetic foot care among 100 nurses in the University of Port Harcourt Teaching Hospital and the Rivers State Hospitals Management Board Hospitals (which include General Hospitals from all the local government areas) in Rivers state, Nigeria before and after interventional training. A one-day hands-on training workshop on diabetic foot care, adopted from the National Institute for Healthcare Excellence (NICE), was implemented to train one hundred (100) nursing practitioners. A structured questionnaire containing questions on different aspects of diabetic foot care was interviewer-administered to the nurses and scored accordingly before and after the training. Knowledge of footwear assessment and assessment of patient’s capacity for self-care was found to be significantly low prior to training. There was significant improvement in knowledge of the different aspects of diabetic foot care among the nurses after the intervention. This buttresses the need for formal training of nursing practitioners on diabetic foot care for improvement of the quality of diabetes care in Rivers State, Nigeria.

Keywords: Diabetes, Diabetic Foot, Foot Care, Nursing Practitioners, Interventional Training.

References:

[1].     Abdullah, W. H., Al-Senany, S., Al-Otheimin, H. K. (2017) Capacity Building for Nurses’ Knowledge and Practice Regarding Prevention of Diabetic Foot Complications. International Journal of Nursing Science, 7(1): 1-15.

[2].     Ahmed, A. A., Elsharief, E., Alsharief, A. (2011) Diabetic foot in the Arab world. The Journal of Diabetic Foot Complications, 3(3): 55–61

[3].     Akogu, I. (2010) The Prevalence of Diabetes mellitus in Nigeria updates and challenges.

[4].     Ali, S. A., Osama A. M., Al-khaldi, Y. M. (2013) Diabetic Patients' Knowledge and Practice Regarding Prevention of Diabetic Foot. Med. J. Cairo Univ., 81(2): 197-205.

[5].     American Diabetes Association (2013). Economic costs of diabetes in the U.S. in 2012. Diabetes Care: 1033-1046.

[6].     Beiranvand, S. Fayazi, S., Asadizaker. M., (2015) Effect of Educational Programs on the Knowledge, Attitude, and Practice of Foot Care in Patients with Diabetes, IOSR Journal of Nursing and Health Science, (4)4 :14-20.

[7].     Chinenye, S., Oko-Jaja, R. I., Young, E. E. (2013). Diabetes and other non-communicable diseases in Nigeria: the need for primary care in the rural setting. Africa Health. 36: 24–7.

[8].     Drass JA, Muir-Nash J, Boykin PC et al (2009) Perceived and actual level of knowledge of diabetes mellitus among nurses. Diabetes Care 12(5): 351-6.

[9].     Hu, F. B. (2011). Globalization of diabetes: the role of diet, lifestyle and genes. Diabetes Care, 34: 1249–57.

[10]. International Diabetes Federation (African Region)/World Diabetes Foundation. Type 2 Diabetes Clinical Practice Guideline for sub-Saharan Africa. July 2009.

[11]. Lim, S. S., Vos, T., Flaxman, A. D., (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 380: 2224–60.

[12]. Mohammed, A. H. (2013). Bringing Diabetes Under Control." Bringing Diabetes Under Control. 3 Jan. 2013 EzineArticles.com. 5 Jan. 2013.

[13]. National Institute for Healthcare Excellence (2015) Model of Care for Diabetic Foot. United Kingdom.

[14]. Oputa, R. N. Chinenye, S. (2015). Diabetes in Nigeria – A translational medicine approach. African journal of diabetes medicine. 23(1):7 – 9.

[15]. Oyetunde, M. O., Famakinwa, T. T. (2014). Nurses’ knowledge of contents of diabetes patient education in Ondo – state, Nigeria. Journal of Nursing Education and Practice, 4(4): 91-98.

[16]. Rashmi, P. J. (2017) A study to assess the knowledge regarding foot care among diabetic patients attending OPD’S at selected hospitals of Lucknow. International Journal of Nursing and Health Science. 3(2): 7-9.

[17]. Schaper, N. C., Apelqvist, J., Bakker, K., (2012) Reducing lower leg amputations in diabetes: a challenge for patients, healthcare providers and the healthcare system. Diabetologia. 55(7):1869-72.

[18]. Soriguer, F., Goday, A., Bosch-Comas, A. (2012). Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The Diabetes Study. Diabetologia. 2012;55(1):88-93.

[19]. Trepp, R., Wille, T., Wieland, T., Reinhart, W. H. (2012) Diabetes-related knowledge among medical and nursing house staff. Swiss Med Wkly. 140(25-26): 370-375.

[20]. Uba, M., Alih, F., Kever, R., Lola, N. (2015). Knowledge, attitude and practice of nurses toward pressure ulcer prevention in University of Maiduguri Teaching Hospital, Borno State, North-Eastern, Nigeria. International Journal of Nursing and Midwifery. 7: 54–60.

[21]. Umeadi M, Chinenye S. (2014). Dietary Management of Diabetes. Lagos, Nigeria: Diabetes Association of Nigeria (DAN), 28–31.

[22]. Vileikyte L (2011) Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Rev 17: 246-249.

[23]. Zarchi, K., Latif, S., Haugaard, V. B., Hjalager, I. R., Jemec, G. B. (2014). Significant differences in nurses’ knowledge of basic wound management—Implications for treatment. Acta Dermato Venereologica, 94: 403–407.