Quality of life among patients with epilepsy in Nigeria: predictors and barriers to routine clinical use of QOLIE-31

Quality of Life Research - To determine the factors predicting poorer quality of life (QOL) among patients with epilepsy attending an out-patient clinic in a Nigerian tertiary hospital, and reflect...     

Syndromic Diagnosis of Malaria in Rural Sierra Leone and Proposed Additions to the National Integrated Management of Childhood Illness Guidelines for Fever

Many countries in Africa, including Sierra Leone, have adopted artemisinin-based combination therapy as first-line therapy for treatment of patients with malaria. Because laboratory testing is often unavailable in rural areas, the cost-benefit and viability of this approach may depend on accurately diagnosing malaria by using clinical criteria. We assessed the accuracy of syndromic diagnosis for malaria in three peripheral health units in rural Sierra Leone and determined factors that were associated with an accurate malaria diagnosis. Of 175 children diagnosed with malaria on syndromic grounds, 143 (82%) were confirmed by the Paracheck-Pf test. In a multivariate analysis, splenomegaly (P = 0.04) was the only clinical sign significantly associated with laboratory-confirmed malaria, and sleeping under a bed net was protective (P = 0.05). Our findings show that clinical malaria is diagnosed relatively accurately in rural Sierra Leone. Incorporating bed net use and splenomegaly into the national Integrated Management of Childhood Illness guidelines for evaluation of fever may further enhance diagnostic accuracy for malaria.     

Environmental Pollution Levels of Lead and Zinc in Ishiagu and Uburu Communities of Ebonyi State, Nigeria

Water and soil samples from the area were therefore analyzed for their lead and zinc content. Computation of pollution statuses of lead and zinc revealed topsoil lead geoaccumulation indices of −0.143 and −0.069 and zinc geoaccumulation indices of 1.168 and 0.713 for Ishiagu and Uburu respectively. The pollution indices were determined to be 0.499 and 0.3564 for soil in Ishiagu and Uburu respectively and also 5.11 and 2.42 for water in Ishiagu and Uburu communities respectively. Water/soil concentration ratio were found to be 0.0018 and 0.0014 for lead in Ishiagu and Uburu respectively. On the other hand, the water/soil concentration ratio for zinc was computed to be 0.001 and 0.0008 for Ishiagu and Uburu respectively. These results seem to suggest that the pollution of the environment by these heavy metals in the areas were as a result of the water being contaminated by lead and zinc not necessarily their concentrations in the soil.     

Investigating payment coping mechanisms used for the treatment of uncomplicated malaria to different socio-economic groups in Nigeria

BackgroundGiven the enormous economic burden of malaria in Nigeria and in sub-Saharan Africa, it is important to determine how different population groups cope with payment for malaria treatment. This paper provides new information about the differences in household coping mechanisms for expenditures on malaria treatment.MethodsThe study was undertaken in two communities in Southeast Nigeria. A total of 200 exit interviews were conducted with patients and their care givers after consultation and treatment for malaria. The methods that were used to cope with payments for malaria treatment expenditures were determined. The coping mechanisms were disaggregated by socio-economic status (SES).ResultsThe average expenditure to treat malaria was $22.9, which was all incurred through out-of- pocket payments. Some households used more than one coping method but none reported using health insurance. It was found that use of household savings (79.5%) followed by reduction in other household expenses (22.5%) were the most common coping methods. The reduction of other household expenses was significantly more prevalent with the average (Q4) SES group (p<0.05). .ConclusionPeople used different coping strategies to take care of their malaria expenditures, which are mostly paid out-of-pocket. The average socio-economic household had to forego other basic household expenditures in order to cope with malaria illness; otherwise there were no other significant differences in the coping mechanisms across the different SES groups. This could be indicative of the catastrophic nature of malaria treatment expenditures. Interventions that will reduce the burden of malaria expenditures on all households, within the context of Universal Health Coverage are needed so as to decrease the economic burden of malaria on households.     

Comparison of isometric and anatomic reconstruction of the medial patellofemoral ligament: a cadaveric study

Recent surgical procedures designed to correct recurrent posttraumatic lateral patellar instability focus on reconstructing the medial patellofemoral ligament. This study evaluated and compared patellofemoral kinematics of isometric and anatomic medial patellofemoral ligament reconstructions. Using an infrared motion capture analysis system, patellar tracking was evaluated in the coronal plane in 6 cadaveric specimens. Reconstruction of the medial patellofemoral ligament using an isometric technique did not restore normal patellar tracking at any flexion angle; however, reconstruction using an anatomic technique restored statistically normal patellar tracking from maximal knee extension to 28 degrees of flexion. Neither technique was able to restore normal kinematics in deeper angles of knee flexion.     

Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes

RATIONALE: Community health workers (CHWs) could be used to bring appropriate and timely treatment of malaria closer to home and there is the need to increase the body of knowledge about the feasibility of implementing the strategy. OBJECTIVE: To determine the processes, costs and outcomes of design and implementation of a strategy based on use of CHWs for near and appropriate treatment of malaria. METHODS: The CHW strategy was implemented in two villages (Adu and Ahani) in Enugu state, southeast Nigeria. Adu and Ahani have a population of approximately 3500 and 5000 residents, respectively. The study was conducted in four phases: (1) baseline survey; (2) design; (3) implementation, supervision and monitoring; and (4) evaluation. Interactive meeting with all the stakeholders were used to fine-tune the design of the CHW strategy. Community members that were selected by the project team with the help of community leaders were trained to become CHWs and their remuneration was through commissions on their drug sales. Community and provider's financial and non-financial costs of the startegy were computed. RESULTS: Non-financial costs were the highest contributor to consumer costs, while financial costs constituted more than 90% of provider costs. The total consumer cost in Ahani was US$2548, while the consumer cost in Adu was US$1585. The total provider cost in Ahani was US$4515, while in Adu it was US$4302. The unit cost cost per villager was US$1.40 in Ahani and US$1.70 in Adu, while the unit financial consumer cost per treated patient was $0.05 in both villages, respectively. The CHWs were acceptable to the people and had an increased market share out of existing malaria treatment provision strategies. CONCLUSION: The cost of starting up the CHW strategy is low and should be affordable to malaria control programs and communities. The CHW strategy is also economically viable and a potential cost-effective source for providing timely, and appropriate treatment of malaria in rural areas. It should be fine-tuned and added to malaria control armamenterium in Nigeria and other parts of sub-Saharan Africa.