Skip to Content

Instrukcja korzystania z Biblioteki

Serwisy:

Ukryty Internet | Wyszukiwarki specjalistyczne tekstów i źródeł naukowych | Translatory online | Encyklopedie i słowniki online

Translator:

Kosmos
Astronomia Astrofizyka
Inne

Kultura
Sztuka dawna i współczesna, muzea i kolekcje

Metoda
Metodologia nauk, Matematyka, Filozofia, Miary i wagi, Pomiary

Materia
Substancje, reakcje, energia
Fizyka, chemia i inżynieria materiałowa

Człowiek
Antropologia kulturowa Socjologia Psychologia Zdrowie i medycyna

Wizje
Przewidywania Kosmologia Religie Ideologia Polityka

Ziemia
Geologia, geofizyka, geochemia, środowisko przyrodnicze

Życie
Biologia, biologia molekularna i genetyka

Cyberprzestrzeń
Technologia cyberprzestrzeni, cyberkultura, media i komunikacja

Działalność
Wiadomości | Gospodarka, biznes, zarządzanie, ekonomia

Technologie
Budownictwo, energetyka, transport, wytwarzanie, technologie informacyjne

Journal of Public Health in Africa

Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii, which has a wide geographical distribution. The congenital form results in a gestational form that can present a temporary parasiteamia that will infect the fetus. For this reason early diagnosis in pregnancy is highly desirable, allowing prompt intervention in cases of infection. The aim of this study was to determine the seroprevalence of Toxoplasma gondii antibodies among pregnant women attending the Douala General Hospital. The study was carried out between March and July 2009, whereby 110 pregnant women were tested for IgG and IgM antibodies and information about eating habits and hygienic conditions was collected using a questionnaire. These women’s ages ranged from 20-44 years old with an average of 29.9 years; the overall IgG and IgM seroprevalence was 70% and 2.73 % respectively. Seroprevalence was significantly high amongst women who ate raw vegetables (76.39%, P<0.05) and there was a significant trend towards a higher seroprevalence in women who did not have a good source of water (75.58%, P<0.05). This research showed that consumption raw vegetables and poor quality drinking water are two risk factors associated with Toxoplasma gondii infection amongst pregnant women attending the Douala General Hospital in Cameroon.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e24 2011/09/05 - 11:39

Excessive alcohol use is a serious public health concern worldwide, but less attention has been given to the prevalence, risk and protective factors, and consequences of early alcohol use in low-income, developing countries. The purpose of this study was to determine the associations between early alcohol use, before age 13, and problem drinking among adolescents in Uganda and Zambia. Data from students in Zambia (n=2257; 2004) and Uganda (n=3215; 2003) were obtained from the cross-sectional Global School-Based Student Health Survey (GSHS). The self-administered questionnaires were completed by students primarily 13 to 16 years of age. Multiple statistical models were computed using logistic regression analyses to test the associations between early alcohol initiation and problem drinking, while controlling for possible confounding factors (e.g., current alcohol use, bullying victimization, sadness, lack of friends, missing school, lack of parental monitoring, and drug use). Results show that early alcohol initiation was associated with problem drinking in both Zambia (AOR=1.28; 95% CI:1.02-1.61) and Uganda (AOR=1.48; 95% CI: 1.11- 1.98) among youth after controlling for demographic characteristics, risky behaviors, and other possible confounders.The study shows that there is a significant association between alcohol initiation before 13 years of age and problem drinking among youth in these two countries. These findings underscore the need for interventions and strict alcohol controls as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e20 2011/09/05 - 11:39

The study was aimed at assessing the economic cost shouldered by government, as providers, in the provision of free tuberculosis (TB) diagnosis and treatment services in Bauchi State, northern Nigeria. A cost analysis study was designed and questionnaires administered by the principal investigators to officers in charge of 27 randomly sampled government TB services providers across the State of Bauchi. Seventeen of these centers were primary care centers, 9 secondary care providers and one was a tertiary care provider. Data was also collected from personnel and projects records in the State Ministry of Health, of Works as well as the Ministry of Budget and Planning. The cost of buildings, staff and equipment replacement, laboratory, radiology and drugs in facilities were assessed and costs attributable tuberculosis inpatient, outpatient and directly observed therapy (DOT) services were estimated from the total cost based on the proportion of TB cases in the total patient pool accessing those services. The average proportion of TB patients in facilities was 3.4% in overall, 3.3% among inpatients and 3.1% in the outpatient population. The average cost spent to treat a patient with TB was estimated at US $227.14. The cost of inpatient care averaged $16.95/patient; DOT and outpatient services was $133.34/patient, while the overhead cost per patient was $30.89. The overall cost and all computed cost elements, except for DOT services, were highest in the tertiary center and least expensive in the infectious diseases hospital partly due to the higher administrative and other overhead recurrent spending in the tertiary health facility while the lower overhead cost observed in the infectious diseases hospital could be due to the economy of scale as a result of the relative higher number of TB cases seen in the facility operating with relatively same level of resources as other facilities in the state.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e19 2011/09/05 - 11:39

HIV/AIDS is a major public health pandemic affecting the development, survival and life of young people both in Cameroon and the USA. Youths are more adaptive to change and less hindered by prejudice than adults. Student-to-student peer mentoring is a non-formal way for students to learn new life skills and different cross-cultural values. We report on a two-day consultative meeting on developing international collaboration for the fight against HIV/AIDS between Cameroonian and USA nursing students. We used adult learning approaches consisting of presentations, discussions, questions and answer sessions, role plays and demonstrations. Deliberations and resolutions from the consultative meeting enabled the Vice-Chancellor of the University of Buea to sign a memorandum of understanding with the Goldfarb School of Nursing in the USA on HIV/AIDS international collaboration paving the way forward for more developmental health projects in this domain.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e22 2011/09/05 - 11:39

Tungiasis is caused by infestation with the sand flea (Tunga penetrans). This ectoparasitosis is endemic in economically depressed communities in South American and African countries. However, data on the epidemiology of tungiasis in Tanzania are very limited and the disease does not receive much attention from health care professionals. During a community cross sectional survey in northwest Tanzania, we identified five individuals extremely infested with high number of parasites. A total of 435 lesions were recorded with patients presenting with >75 lesions and showed signs of intense acute and chronic inflammation. Superinfection of the lesions characterized by pustule formation, suppuration and ulceration were common. Loss of nails and walking difficulty was also observed. In Tanzanian communities living under extreme poverty characterized by poor housing condition and inadequate health services, tungiasis may cause severe morbidities. Further studies on risk factors and disease-related behavior of affected populations are needed to design adequate control measures.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e21 2011/09/05 - 11:39

Each year more than half a million women around the world die from complications of pregnancy and childbirth; this number has not declined substantially in over two decades. Ninety-nine percent of these deaths occur in the developing world; Africa and Asia together accounting for 95% of the maternal deaths. The life time risk of maternal death in sub-Saharan Africa is one in 16, while the risk in developed countries is one in 2800. In Nigeria, since the launching of the Safe Motherhood Initiative (SMI) in September 1990, overwhelming evidence suggests a trend towards an increasing rate of maternal mortality. Available data indicate that Nigeria now has the second highest rate of maternal mortality in the developing world. Officially, the maternal mortality rate (MMR) is estimated at 800 maternal deaths per 100,000 live births. However, institutional figures on MMRs are staggering and frightening – 2101 per 100,000 and 3380 per 100,000 from two centres in Nigeria. Whereas Nigeria makes up 2% of the world’s population, it contributes about 10% of the global burden of maternal deaths. These deaths are unacceptably high even by African standard.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e33 2011/09/05 - 11:39

Van Howe and Storm’s paper is commended for asking valid questions regarding the scientific evidence upon which circumcision as an HIV prevention strategy is based. The paper however gives no real practical suggestions as to what the way forward should be regarding the already rolled out circumcision programs in Africa. This contribution seeks to highlight the importance of rigorous program evaluation as a critical practical implication of the paper and a way forward for such programs.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e32 2011/09/05 - 11:39

The need for health care reforms and alternative financing mechanism in many low and middle-income countries has been advocated. This led to the introduction of the national health insurance scheme (NHIS) in Nigeria, at first with the enrollment of formal sector employees. A qualitative study was conducted to assess enrollee’s perception on the quality of health care before and after enrollment. Initial results revealed that respondents (heads of households) have generally viewed the NHIS favorably, but consistently expressed dissatisfaction over the terms of coverage. Specifically, because the NHIS enrollment covers only the primary insured person, their spouse and only up to four biological children (child defined as <18 years of age), in a setting where extended family is common. Dissatisfaction of enrollees could affect their willingness to participate in the insurance scheme, which may potentially affect the success and future extension of the scheme.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e31 2011/09/05 - 11:39

The availability of mortality data for any society plays an essential role in health monitoring and evaluation, as well as in the design of health interventions. However, most resource-poor countries such as Ghana have no reliable vital registration system. In these instances, verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana, the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third, blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians, this was assigned as the cause of death for the individual child. During the study period, we recorded 118 deaths from 92 households. Twenty-nine (24.6%) were neonatal deaths with the leading causes of death being neonatal sepsis, birth asphyxia and pneumonia. The remaining 89 (75.4%) were post-neonatal deaths with the most common causes of death being pneumonia, malaria and malnutrition. While 63/118 (53.4%) deaths occurred in the home, there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e18 2011/05/17 - 14:45

Lack of practical knowledge among home-based caregivers on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), anti-retroviral therapy (ART) and poor individual adherence to treatment are among the root causes of ineffective ART ser­vice delivery in Namibia. The purpose of our study was to investigate the knowledge among home-based caregivers in Namibia regarding HIV/AIDS. The study was a descriptive, cross-sectional one in which 89 participants completed a self-administered questionnaire to assess their knowledge of HIV/AIDS. Almost all (93%) of the respondents gave a correct definition of HIV. Over a tenth (11.3%) did not know that HIV decreases the body’s ability to fight disease and 33.7% could not define AIDS. Almost all (98%) the home-based caregivers knew that HIV can be diagnosed only through a blood test and 91% mentioned that consistent and correct use of condoms during sexual intercourse protects one from HIV infection. Fewer than half (44%) of the respondents could indicate on-and-off fever as a symptom of AIDS and 16% mentioned that increased body weight is a sign of AIDS, which is incorrect. Although the knowledge of the caregivers on HIV/AIDS was above average in some aspects, there was still lack of knowledge on isolated issues such as AIDS definitions and signs and how HIV works. Training organisations in home-based care settings should emphasise the knowledge of AIDS definition and signs as well as of post-test counselling, consequence of poor adherence and facilities that issue anti-retroviral treatment.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e6 2011/04/06 - 08:08

Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO, but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions, in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers, their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem, tribal stigma and complete rejection by society. From the 480 structured questionnaires administered, there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1% [95% confidence interval (CI): 74.4-81.8%] from a total of 480. Three hundred and ninety nine (83.1%) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95% CI: 79.7-86.5%). Four hundred and three (83.9%) participants indicated that they could have a handshake and embrace a deformed leper (95% CI: 80.7-87.3%). A total of 85.2% (95.0% CI: 81.9-88.4%) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5% (95.0% CI: 67.5%-75.5%) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e10 2011/03/04 - 13:07

The study of cause of death certification remains a largely neglected field in many developing countries, including Ghana. Yet, mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana, in deaths occurring in homes and those occurring within 48 hours after admission into health facilities, autopsies remain the appropriate option for determining the cause of death. Although these organ-based autopsies may generate convincing results and are considered the ‘gold standard’ tools for ascertainments of causes of death, procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel, it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e7 2011/03/04 - 13:07

Vital registration systems (VRS) are important in the collection of routine data on indicators of development. These are particularly useful if they are properly built to address weaknesses in the system leading to poor data quality. For instance, routine data on health events (e.g. morbidity, mortality etc.) are crucial for rapid assessment of disease burden and mortality trends in the population. They are also useful in the identification of vulnerable groups in populations. Despite their usefulness, VRS in many developing countries including Ghana are poorly structured raising questions about the quality of the output data from these systems. The present study aimed at assessing and documenting the structure and function of the VRS in Ghana, as well as at identifying the structural features that potentially compromise the reliability and validity of the output data the system. To perform this study, collection and review of policy and legal documents establishing the VRS, documentation and evaluation of component structures of the system, assessment of procedural protocols guiding data collection processes and in-depth interviews with staff at the Ghana Births and Deaths Registry were performed. The assessment of the structure of the Ghana VRS, policy documents setting it up and the operational procedures reveals important lapses (e.g. presence of outmoded practices, imperfections in Births and Deaths Registry Act, 1965, Act 301 and imperfect system design) in the system that could compromise validity and reliability of the data generated from the registration in Ghana.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e5 2011/03/04 - 13:07

Genital mycoplasmas are implicated in pelvic inflammatory diseases, puerperal infection, septic abortions, low birth weight, nongonococcal urethritis and prostatitis as well as spontaneous abortion and infertility in women. There is paucity of data on colonisation of genital mycoplasma in women and their drug sensitivity patterns. The aim of our study was to determine the prevalence of genital mycoplasmas (Ureaplasma urealiticum and Mycoplasma hominis) infection and their drug sensitivity patterns in women. A mycofast kit was used for biochemical determination of mycoplasma infection in 100 randomly selected female patients aged 19–57 years, attending the University of Yaoundé Teaching Hospital (UYTH) from March to June 2010. Informed consent was sought and gained before samples were collected. Genital mycoplasmas were found in 65 patients (65%) [95% CI=55.7%–74.3%] and distributed as 41 (41%) [95% CI=31.4%–50.6%] for U. urealiticum and 4 (4%) [95% CI=0.20%–7.8%] for M. hominis while there was co-infection in 20 women (20%) [95% CI=12.16%–27.84%]. In our study, 57 (57%) [95% CI=47.3%– 67%] had other organisms, which included C. albicans (19 [19%]), G. vaginalis (35 [35%]) and T. vaginalis (3 [3%]). Among the 65 women with genital mycoplasma, the highest co-infection was with G. vaginalis (33.8%). Pristinamycine was the most effective antibiotic (92%) and sulfamethoxazole the most resistant (8%) antibiotic to genital mycoplasmas. We concluded that genital mycoplasma is a problem in Cameroon and infected women should be treated together with their partners.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e16 2011/03/03 - 16:28

My association with the Journal of Public Health in Africa (JPHiA) has been as brief as the journal is young. I have had the privilege of seeing this journal grow from being just a twinkle in the eye of one of its founding editors. I am glad that a young researcher from Africa has had the courage to start the journal. Africa generally has a very young demographic profile, and the future of the continent lies in the hands of its youth. Understanding this aspect of the large-scale context of public health is of course one way that countries, institutions, individual researchers, and publishers can see where their priorities lie, for public health in the near-to-long term future....

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e17 2011/03/02 - 18:50

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. This data was collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children <18 years old were recorded. The mean age was 11 years (95% CI 10.9–11.6); 68% (95% CI 65–72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility-based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e15 2011/03/02 - 18:50

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested, interviewer administered, structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently, participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9% and 12.0% of participants in the intervention and control groups, respectively, had heard of Pap smears. Furthermore, less than 10% had correct information on the use of the Pap test. Post-intervention, there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (p<0.05). However, uptake of the test was quite low in the intervention and control groups both pre- and post-intervention and there was no significant change in uptake. We concluded that essential schemes are required to enhance access to screening, as knowledge alone is insufficient to promote acceptance and use of cervical cytological screening tests.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e14 2011/03/02 - 18:50

The prevalence of obesity has continued to rise at an alarming rate world-wide to such an extent that it has been described as a global epidemic. This study aims to determine the pattern and determinants of obesity among adolescent females in private and public schools in Olorunda Local Government Area of Osun state, Nigeria. This is a cross sectional descriptive study. Using the multi-stage sampling technique, 520 pre-tested semi-structured questionnaires were administered to 257 girls from the private schools and 263 girls from the public schools. Most of the respondents from private schools (65.2%) had good knowledge about obesity and related matters, while most from the public schools (65.9%) had poor knowledge. The dietary practice of majority of the girls from private schools (60.2%) was unhealthy, while most of the girls from public schools (68.7%) had healthy dietary practices. Most of the respondents from private schools (64.2%) lived sedentary lifestyles while most from the public schools (64.0%) lived active lifestyles. Using the BMI, majority of the girls from private schools were underweight (52%), 10 (4.0%) were overweight and 3 (1.2%) were obese. For the public schools, using the BMI, majority (55.4%) fell within the normal group, 6(2.3%) were overweight and none was obese. The prevalence of overweight and obesity was higher among the girls in private schools than among girls attending public schools. Awareness should be created to promote a healthy balance of food, drink and physical activity within and outside the school.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e11 2011/03/02 - 18:50

More than 40 million people worldwide have been infected with human immunodeficiency virus (HIV) since it was first reported in 1981. Over 25 million of these have lost their lives to the disease. Most of the studies related to HIV/AIDS have been conducted in stable populations across the globe. Few of these studies have been devoted to displaced populations, particularly those in areas of conflict. Displaced populations that are forced to leave their homes in most cases find themselves in unfamiliar territories, often poor and hungry. Many of them become refugees and internally displaced people (IDPs). The objective of this review was to address a number of different social determinants of HIV/AIDS in displaced populations in areas of conflict. A comprehensive review of peer reviewed literature published in English between 1990 and 2010 obtained through an open search of PUBMED database using key words such as “HIV and war”, “HIV/AIDS and conflict”, “AIDS and security” was conducted. Twelve different studies that looked at the implications of HIV/AIDS in conflict or displaced populations were retrieved. The review revealed that there were various factors influencing conflict and HIV/AIDS such as forced population displacement, breakdown of traditional sexual norms, lack of health infrastructure, and poverty and powerlessness of women and children. Social determinants of increased HIV/AIDS prevalence in displaced populations are scarcity of food, poverty, insecurity of displaced populations and gender power differentials.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e9 2011/03/02 - 18:50

In many countries or regions the capacity of health care resources is below the needs of the population and new approaches for health surveillance are needed. Innovative projects, utilizing wireless communication technology, contribute to reliable methods for field-work data collection and reporting to databases. The objective was to describe a new version of a wireless IT-support system for field-work data collection and administration. The system requirements were drawn from the design objective and translated to system functions. The system architecture was based on field-work experiences and administrative requirements. The Smartphone devices were HTC Touch Diamond2s, while the system was based on a platform with Microsoft .NET components, and a SQL Server 2005 with Microsoft Windows Server 2003 operating system. The user interfaces were based on .NET programming, and Microsoft Windows Mobile operating system. A synchronization module enabled download of field data to the database, via a General Packet Radio Services (GPRS) to a Local Area Network (LAN) interface. The field-workers considered the here-described applications user-friendly and almost self-instructing. The office administrators considered that the back-office interface facilitated retrieval of health reports and invoice distribution. The current IT-support system facilitates short lead times from field-work data registration to analysis, and is suitable for various applications. The advantages of wireless technology, and paper-free data administration need to be increasingly emphasized in development programs, in order to facilitate reliable and transparent use of limited resources.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e3 2011/03/02 - 18:50

Aiming to assess the impact of the intervention in reducing the patients’ waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients’ sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t- test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e2 2011/03/02 - 18:50

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely “always” involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to “always” publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e1 2011/03/02 - 18:50

Clinical waste is ineffectively treated and disposed in Cameroon. Disposal sites have unrestricted access and are located within communities. We hypothesize that vector proliferation and exposure to chronic low-level emissions will increase morbidity in children living around such sites. Self-reported disease frequency questionnaires were used to estimate the frequency of new episodes of intestinal, respiratory and skin infections among exposed children less than 10 years. Data was simultaneously collected for unexposed children of the same age, using the same questionnaire. Data reporting by the parents was done in the first week in each of the 6 months study period. The risk ratios were 3.54 (95% CI, 2.19-5.73), 3.20 (95% CI, 1.34-7.60) and 1.35 (95% CI, 0.75-2.44) for respiratory, intestinal and skin infections respectively. Their respective risk differences were 0.47 (47%), 0.18 (18%) and 0.08 (8%). The study revealed that poor treatment and disposal of clinical waste sites enhance morbidity in children living close to such areas. Simple health promotion and intervention programs such as relocating such sites can significantly reduce morbidity.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e13 2011/03/02 - 18:50

Halving the burden of malaria by 2015 and ensuring that 80% of people with malaria receive treatment is among the health related targets of the Millennium Development Goals (MDGs). Despite political momentum toward achieving this target, progress is slow and many with malaria (particularly in poor and rural communities in Africa) are still without access to effective treatment. Finding ways to improve access to anti-malarial treatment in Africa is essential to achieve the malaria related and other MDG targets. During its work in Chad, Sierra Leone and Mali in the period 2004 to 2008, Médecins Sans Frontières showed that it was possible to significantly improve access to effective malaria treatment through: i) the removal of health centre level user fees for essential healthcare for vulnerable population groups, ii) the introduction of free community based treatment for children using malaria village workers to diagnose and treat simple malaria in communities where geographical and financial barriers limited access to effective malaria care, iii) the improved diagnosis and treatment of malaria using rapid diagnosis tests and artemisinin based combination therapy, at both health facilities and in the community. This paper describes and discusses these strategies and their related impact.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e12 2011/03/02 - 18:50

The World Health Organization and UNAIDS have supported circumcision as a preventive for HIV infections in regions with high rates of heterosexually transmitted HIV; however, the circumcision solution has several fundamental flaws that undermine its potential for success. This article explores, in detail, the data on which this recommendation is based, the difficulty in translating results from high risk adults in a research setting to the general public, the impact of risk compensation, and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4 2011/03/02 - 18:50

My association with the Journal of Public Health in Africa (JPHiA) has been as brief as the journal is young. I have had the privilege of seeing this journal grow from being just a twinkle in the eye of one of its founding editors. I am glad that a young researcher from Africa has had the courage to start the journal. Africa generally has a very young demographic profile, and the future of the continent lies in the hands of its youth. Understanding this aspect of the large-scale context of public health is of course one way that countries, institutions, individual researchers, and publishers can see where their priorities lie, for public health in the near-to-long term future....

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e17 2011/03/01 - 20:57

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. This data was collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children <18 years old were recorded. The mean age was 11 years (95% CI 10.9–11.6); 68% (95% CI 65–72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility-based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e15 2011/03/01 - 20:57

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested, interviewer administered, structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently, participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9% and 12.0% of participants in the intervention and control groups, respectively, had heard of Pap smears. Furthermore, less than 10% had correct information on the use of the Pap test. Post-intervention, there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (p<0.05). However, uptake of the test was quite low in the intervention and control groups both pre- and post-intervention and there was no significant change in uptake. We concluded that essential schemes are required to enhance access to screening, as knowledge alone is insufficient to promote acceptance and use of cervical cytological screening tests.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e14 2011/03/01 - 20:57

The prevalence of obesity has continued to rise at an alarming rate world-wide to such an extent that it has been described as a global epidemic. This study aims to determine the pattern and determinants of obesity among adolescent females in private and public schools in Olorunda Local Government Area of Osun state, Nigeria. This is a cross sectional descriptive study. Using the multi-stage sampling technique, 520 pre-tested semi-structured questionnaires were administered to 257 girls from the private schools and 263 girls from the public schools. Most of the respondents from private schools (65.2%) had good knowledge about obesity and related matters, while most from the public schools (65.9%) had poor knowledge. The dietary practice of majority of the girls from private schools (60.2%) was unhealthy, while most of the girls from public schools (68.7%) had healthy dietary practices. Most of the respondents from private schools (64.2%) lived sedentary lifestyles while most from the public schools (64.0%) lived active lifestyles. Using the BMI, majority of the girls from private schools were underweight (52%), 10 (4.0%) were overweight and 3 (1.2%) were obese. For the public schools, using the BMI, majority (55.4%) fell within the normal group, 6(2.3%) were overweight and none was obese. The prevalence of overweight and obesity was higher among the girls in private schools than among girls attending public schools. Awareness should be created to promote a healthy balance of food, drink and physical activity within and outside the school.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e11 2011/03/01 - 20:57

More than 40 million people worldwide have been infected with human immunodeficiency virus (HIV) since it was first reported in 1981. Over 25 million of these have lost their lives to the disease. Most of the studies related to HIV/AIDS have been conducted in stable populations across the globe. Few of these studies have been devoted to displaced populations, particularly those in areas of conflict. Displaced populations that are forced to leave their homes in most cases find themselves in unfamiliar territories, often poor and hungry. Many of them become refugees and internally displaced people (IDPs). The objective of this review was to address a number of different social determinants of HIV/AIDS in displaced populations in areas of conflict. A comprehensive review of peer reviewed literature published in English between 1990 and 2010 obtained through an open search of PUBMED database using key words such as “HIV and war”, “HIV/AIDS and conflict”, “AIDS and security” was conducted. Twelve different studies that looked at the implications of HIV/AIDS in conflict or displaced populations were retrieved. The review revealed that there were various factors influencing conflict and HIV/AIDS such as forced population displacement, breakdown of traditional sexual norms, lack of health infrastructure, and poverty and powerlessness of women and children. Social determinants of increased HIV/AIDS prevalence in displaced populations are scarcity of food, poverty, insecurity of displaced populations and gender power differentials.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e9 2011/03/01 - 20:57

In many countries or regions the capacity of health care resources is below the needs of the population and new approaches for health surveillance are needed. Innovative projects, utilizing wireless communication technology, contribute to reliable methods for field-work data collection and reporting to databases. The objective was to describe a new version of a wireless IT-support system for field-work data collection and administration. The system requirements were drawn from the design objective and translated to system functions. The system architecture was based on field-work experiences and administrative requirements. The Smartphone devices were HTC Touch Diamond2s, while the system was based on a platform with Microsoft .NET components, and a SQL Server 2005 with Microsoft Windows Server 2003 operating system. The user interfaces were based on .NET programming, and Microsoft Windows Mobile operating system. A synchronization module enabled download of field data to the database, via a General Packet Radio Services (GPRS) to a Local Area Network (LAN) interface. The field-workers considered the here-described applications user-friendly and almost self-instructing. The office administrators considered that the back-office interface facilitated retrieval of health reports and invoice distribution. The current IT-support system facilitates short lead times from field-work data registration to analysis, and is suitable for various applications. The advantages of wireless technology, and paper-free data administration need to be increasingly emphasized in development programs, in order to facilitate reliable and transparent use of limited resources.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e3 2011/03/01 - 20:57

Aiming to assess the impact of the intervention in reducing the patients’ waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients’ sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t- test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e2 2011/03/01 - 20:57

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely “always” involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to “always” publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e1 2011/03/01 - 20:57

Clinical waste is ineffectively treated and disposed in Cameroon. Disposal sites have unrestricted access and are located within communities. We hypothesize that vector proliferation and exposure to chronic low-level emissions will increase morbidity in children living around such sites. Self-reported disease frequency questionnaires were used to estimate the frequency of new episodes of intestinal, respiratory and skin infections among exposed children less than 10 years. Data was simultaneously collected for unexposed children of the same age, using the same questionnaire. Data reporting by the parents was done in the first week in each of the 6 months study period. The risk ratios were 3.54 (95% CI, 2.19-5.73), 3.20 (95% CI, 1.34-7.60) and 1.35 (95% CI, 0.75-2.44) for respiratory, intestinal and skin infections respectively. Their respective risk differences were 0.47 (47%), 0.18 (18%) and 0.08 (8%). The study revealed that poor treatment and disposal of clinical waste sites enhance morbidity in children living close to such areas. Simple health promotion and intervention programs such as relocating such sites can significantly reduce morbidity.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e13 2011/03/01 - 20:57

Halving the burden of malaria by 2015 and ensuring that 80% of people with malaria receive treatment is among the health related targets of the Millennium Development Goals (MDGs). Despite political momentum toward achieving this target, progress is slow and many with malaria (particularly in poor and rural communities in Africa) are still without access to effective treatment. Finding ways to improve access to anti-malarial treatment in Africa is essential to achieve the malaria related and other MDG targets. During its work in Chad, Sierra Leone and Mali in the period 2004 to 2008, Médecins Sans Frontières showed that it was possible to significantly improve access to effective malaria treatment through: i) the removal of health centre level user fees for essential healthcare for vulnerable population groups, ii) the introduction of free community based treatment for children using malaria village workers to diagnose and treat simple malaria in communities where geographical and financial barriers limited access to effective malaria care, iii) the improved diagnosis and treatment of malaria using rapid diagnosis tests and artemisinin based combination therapy, at both health facilities and in the community. This paper describes and discusses these strategies and their related impact.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e12 2011/03/01 - 20:57

The World Health Organization and UNAIDS have supported circumcision as a preventive for HIV infections in regions with high rates of heterosexually transmitted HIV; however, the circumcision solution has several fundamental flaws that undermine its potential for success. This article explores, in detail, the data on which this recommendation is based, the difficulty in translating results from high risk adults in a research setting to the general public, the impact of risk compensation, and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections.

http://www.publichealthinafrica.org/index.php/jphia/article/view/Jphia%202011.e4 2011/03/01 - 20:57

We are delighted to present the maiden edition of the Journal of Public Health in Africa (JPHIA). Like most great innovations, the idea behind JPHIA was spontaneously conceived upon observing the precarious state of public health care delivery in the African continent. The JPHIA is set up as non-profit making open source that will compete with other world class journals. The strength of JPHIA is in the people behind the journal’s existence as well as the teeming interested readership. The journal will be published online and quarterly. No effort will be spared in ensuring that we publish high quality refereed materials despite our limited resources at this point.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2010.e1 2011/02/18 - 01:13

This study is premised on the increasing global concerns over the widespread resistance to polio eradication campaign in northern Nigeria. It aims to determine the level of campaign acceptance and compare the influences of mass media and interpersonal communication sources in Zaria local government area, being one of the high-risk (WPV-endemic) areas in northern Nigeria, where campaign resistance is known to be high. By way of quantitative survey, the study utilized 10% sample of the populations of eight out of the thirteen Wards in Zaria local government area, with a response rate of 78.6%. Findings reveal close ranks between campaign acceptance and resistance in the local government area, thus further confirming the difficulties still faced in polio eradication campaign in the region. This study also indicates higher performance of Interpersonal than Mass Media sources in influencing campaign acceptance and resistance in the local communities. Contact with friends and relations was rated the most influential interpersonal sources in the acceptance and resistance decision of individuals, while newspapers and magazines were rated most influential media sources that influenced campaign resistance in the local communities. The study concludes that a polio eradication campaign, backed with competent and sufficient communication expertise that utilizes knowledge-based indigenous interpersonal communication strategies will likely result in greater community acceptance in northern Nigeria.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2010.e2 2011/02/18 - 01:13

Human immunodeficiency virus (HIV) contributes significantly to morbidity and mortality in sub-Saharan Africa, with Nigeria having the third highest burden of HIV infection globally; efforts are made to increases access to HIV/AIDS care and treatment. This has currently reached rural areas with limited manpower and laboratory evaluation capacity. This review is necessitated by the paucity of interim report on treatment profile in Nigerian rural areas. We report on the immunological profile of patients on antiretroviral therapy (ART) in Otukpo General Hospital, a rural Nigerian hospital. This is a retrospective cohort study of patients receiving ART treatment and care, on April 2009, when 2347 patients were under ART therapy. Out of these, 96 patients were selected by simple random sampling from hospital register, with their data abstracted from standardized Ministry of Health registers and facility documents kept at the hospital, and analyzed for descriptive and biometric measures. Ninty-six patients (29% males) with a median age of 35 years, median baseline CD4 lymphocyte count 221 cells/mL, median one year CD4 lymphocyte count of 356 cells/mL and median one year CD4 lymphocyte increment of 124 cells/mL were studied. There is no statistically significant difference in baseline CD4 lymphocyte count when data is disaggregated by type of drug regimen (AZT, D4T and TDF). Fourty-four percent, 23% and 33% of patients were on TDF, D4T & AZT based regimen, respectively (P=0.66). Increment of >100 cells/mL was seen in 64.58% of the reviewed patients. There was a higher CD4 lymphocyte count increment in patients on TDF & D4T compared with those in AZT based regimens (ANOVA; P<0.0003). Multivariate linear regression model showed one year CD4 lymphocyte count, one year increment in CD4 lymphocyte count, WBC count, and absolute neutrophil count to be significant correlates of baseline CD4 lymphocyte count (P<0.0001). Equally, multivariate logistic regression found age, platelet count and CD4 lymphocyte count at 12 months showed to be significant predictors of CD4 lymphocyte increment above 100 cells/µL (P<0.0001). Despite advanced disease presentation and a very large-scale program, high quality HIV/AIDS care was achieved as indicated by good short-term, immunologic outcomes, while TDF & D4T induce higher immunological recovery compared with AZT. This report suggests that quality HIV care and treatment can be effective despite the challenges of a resource-limited setting.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2010.e3 2011/02/18 - 01:13

There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment, social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals, 6 medical doctors and 18 nurses, working at the DH level and at the FLHC level, respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6% (7/66) HIV cases. Up to the time of the survey, 5 TB (6.6%) and 18 HIV+ patients (27.3%) have been hospitalised for care at least once, 64 TB (85.3%) had been declared cured and 38 HIV (54.5%) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11, the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool, to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action.

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2010.e4 2011/02/18 - 01:13