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Texila International Journal of Public Health

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1 Effectiveness of Prevention of Mother-to-Child Transmission of HIV Program in Benue, Nigeria , Plang Jwanle, Franklin Emerenini, Ademola Amosu
Introduction: Over 90% of HIV infections in children are acquired through the mother-to-child transmission route. Mother to child transmission can be prevented through use of efficacious antiretroviral drug regimens and complete avoidance of breastfeeding. This study evaluated the effectiveness of PMTCT program in Benue State, Nigeria. Methods: This was a retrospective study of infants and children perinatally exposed to HIV aged 6 weeks -18 months from Benue State, Nigeria. 5734 consecutive sample of infants and children identified from the EID laboratory register from January 2017-December 2017 were enrolled for this study. The details of ARV therapy commencement for mother and baby, infant feeding choices, and HIV PCR DNA test results were analyzed using SPSS version 20. Result: 225 out of 5734 exposed babies tested positive to HIV giving an overall prevalence of 3.9% (95% CI: 3.4 -4.4). When neither mother nor baby received ARVs the prevalence was 33%; when only baby received ARVs the prevalence was 10.8%; when only mother received ARVs the prevalence was 9.1% and when both mother and baby received ARV for PMTCT the prevalence reduced to 1.5%. Conclusions: This study has shown the usefulness of ARVs as the single most important intervention in PMTCT. There was a high prevalence of HIV among exposed children in our setting, especially if the mother and child pairs did not receive any form of antiretroviral prophylaxis. Therefore, there is need to expand antiretroviral coverage, ensure access of the PMTCT program, and provide effective services to support infected children.
2 Educational Intervention on Breast Self-Examination among Senior Secondary School Girls in Ibadan North East Area of Oyo State, Nigeria , Article by Ogun Millicent Ifechukwude  
Breast cancer is the top most cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increase life expectancy, increase urbanization and adoption of western lifestyles (WHO 2018). It starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body (American cancer society 2017). It is the most common cause of death and the most frequently diagnosed cancer among women in 140 of 184 countries worldwide (Mesfin, Dagne, Roza and Hailu, 2016). Globally, over 1.15million cases of breast cancer are diagnosed every year and about 502,000 women have died from the disease each year, making it the second only to lung cancer as the cause of cancer related deaths among women (WHO 2013). The American Cancer Society in 2015 reported an estimated number of new cases of breast cancer in women in the United States to be 231,840 with an estimated death of 40,290.
3 Assessing the Epidemiology of Road Traffic Accident Cases in the Ashanti Region of Ghana , Article by S. Ogbordjor, A.M.H Gabla, N. Mensah, G. Adjei, G. Ohene-boadi bossman
Abstract Introduction: Road Traffic Accident (RTA) cases are major public health threat worldwide, and without preventative measures are projected to increase over the next 20 years. This study assessed the burden of RTA on the Asante Akyem segment of the Accra-Kumasi trunk road in Ghana. Methods: Structured questionnaire was used to extract data on RTA cases, which occurred in 2011-2015, from Juaso and Konongo Municipal Motor Traffic Units (MTU) registry. The data collected were analysed descriptively using univariate analysis via Epi info version 7. Results: There were 774 RTA cases which recorded 1408 injuries with 293 deaths over five-year (2011-2015) period. The RTA cases mostly occurred on Saturdays between 12 noon and 6pm within the months of March and August. Cargo trucks accounted for m  ost of the RTA cases and the commonest mechanism of the RTA cases was head-on collision. Konongo high street and Odumasi 3 lane areas were the most accident-prone locations with the latter accounting for the highest number of casualties. The Yawkwei and Asankare areas, however, have gained notoriety for fatalities. Conclusions: This study provides an insight into RTA cases as a major public health threat in the Asante Akyem Districts. Most of the causes of RTA seemed to be known, but a multi-sectoral approach will be required to curb the menace. There is the need for all stakeholders including government, the Ghana Private Road Transport Union, road construction engineers, civil society organizations and non-governmental organizations to intensify road traffic and safety education, and enforce road traffic regulations to curtail RTA. Keywords: Road traffic accident, public health, epidemiology, preventative measures.
4 Evaluation of the Implementation and utilisation of a Case Based Diseases Surveillance (electronic Integrated Disease Surveillance and Reporting (eIDSR-CBS)) in the West Nile region: August 2018 to February 2019 , Article by Prosper Behumbiize, John Lule, Bridget Magoba, Carol Kyozira, Joshua Kayiya, Brian Ntale, Shivan Asimire, Monica Amuha, Ann Okoth, David Onyango, Charles Olupot, Eric Munyambabazi, Patrick Omiel, Fulgentius Baryarama
  Introduction: West Nile is vulnerable to repeated disease outbreaks due to instability and refugees from South Sudan and Congo. Uganda is implementing integrated disease surveillance (IDSR) and piloting electronic IDSR (eIDSR-CBS) with Global Health Security Agenda, Infectious disease institute (IDI) and HISP-Uganda between January 2018 to February 2019 in West Nile. This study determined utilization and challenges of implementing eIDSR-CBS, whose aim was improving real-time disease reporting and building capacity of surveillance staff in eIDSR-CBS real-time disease reporting. Methodology: DSFP were trained to train others in eIDSR-CBS, trained other staff, distributed eIDSR-CBS materials and conducted support supervision. In a cross-section evaluation, project documents review and in-depth interviews provided data for utilisation, project relevancy, effectiveness of implementation, collaborations, sustainability, challenges and lessons learned. Findings: eIDSR-CBS used SMS, Web and Android platforms, DSFP supported 1,071 staff in 256 e-IDSR trainings, supported 82% of 363 facilities, distributed 362 IDSR and 1072 eIDSR-CBS materials and 1953 SMS messages. Of 39 facilities, 79% conduct IDSR, 54% e-IDSR, 92% had IDSR and 98% eIDSR-CBS materials. The project built eIDSR-CBS capacity of staff, enhanced collaboration and communication among s stakeholders, was sustainable with improved skills, utilised existing MoH structures and engaging stakeholders. Conclusion: Implementing eIDSR-CBS is feasible in existing MoH structures, with cascade-trainings multiplier effect exponentially disseminating eIDSR-CBS knowledge, trainers and staff and effectively creating ownership, responsibility and sustainability. eIDSR-CBS cascading needs scale-up for early disease outbreak detection. Keywords: SMS (6767) alerting, case-based disease surveillance, integrated disease surveillance, eIDSR-CBS, IDSR, West Nile Region Uganda
5 Integration of Human and Animal Diseases Surveillance Systems in Uganda: The West Nile Experience , Article by Prosper Behumbiize, John Lule, Bridget Magoba, Brian Ntare, Joshua Kawiya, Nguma Willy, Shivan Asimire, David Onyango, Monica Amuha, Charles Olupot, Eric Munyambabazi, Ann Okoth, Patrick Omiel, Mohammed Lamorde, Fulgentius Baryarama, Daniel Ganu
Background: Independent human and animal disease surveillance creates challenges linking zoonotic diseases outbreaks in either populations, while integration improves simultaneous zoonotic disease reporting and response in both populations. This paper evaluates integration within human and animal surveillance systems and challenges of integrating the two, in West Nile, aiming to improve simultaneous zoonotic disease detection in humans and animals. Methods: Cross-sectional data from in-depth interviews on integration of core and support surveillance function of human and animal surveillance systems, collected with an integration assessment tool was analysed on integration levels and gaps within and across the two systems. Findings: Integration was high in human surveillance (0.92); in planning, reporting and outbreak response (1), data processes (0.86), laboratory processes (0.93) and coordination (0.87); but low in animal surveillance (0.56), especially data collection and analysis (0.20). Integration of human varied from animal surveillance systems (0.97 vs. 0.56), especially in data processes (variation of 0.70). Conclusions: Differential integration of core and support surveillance functions between human and animal surveillance systems challenges zoonotic disease surveillance, in data collection, reporting frequency and lack electronic real-time disease notification for anmals diseases. Human IDSR guidelines provide platform to coordinate animal disease reporting and improving zoonotic diseases surveillance. Investments focusing on Point-of-Care animal diseases diagnosis, real-time reporting and eIDSR-CBS, reduce delayed animal disease diagnosis. The integration assessment tool is available for adoption to effectively identified integration gaps. Keywords: Integrated Disease surveillance systems, human and animal disease surveillance systems, zoonotic disease surveillance, West Nile Region Uganda.
6 Prevalence and Determinants of Overweight, Obesity, Prehypertension, and Hypertension in the Banking Industry in Nigeria: An Analysis of a Nationwide Dataset , Article by Idris Muhammad Yakubu, Philip Bigelow
Banking occupations are typically white-collar jobs with long hours of sitting, high workload, little time for breaks, and indulgence in highly processed foods. This lifestyle predisposes bank employees to overweight, obesity, and hypertension, the leading risk factors for cardiovascular disease, the number cause of death globally. This study was a cross-sectional survey of bank employees across Nigeria conducted in 2018. A census sample consisting of 3013 bankers, who participated in a healthy lifestyle program was processed and analyzed using SPSS. The study explored the prevalence and determinants of overweight, obesity, prehypertension, and hypertension in the banking industry. A questionnaire, interview schedule, and anthropometric and blood pressure tools were used in collecting the primary data. The age of the participants ranged from 19 to 59 years, 62% were youth (19-39), 38% middle-aged (40-59), 81% men, and 19% women. Senior staff constituted 52.2%, junior 45.4%, and executive 2.4%. The mean age was 38.8 ± 9.0 years, weight 78.75 ± 14.74kg, height 1.71 ± 0.08m, BMI 26.99 ± 4.89kg/m2, waist circumference 79.13 ± 26.72m, hip circumference 87.24 ± 28.57cm, waist-hip-ratio 0.91 ± 0.07, systolic blood pressure 129 ± 18mmHg, and diastolic blood pressure 80 ± 12mmHg. The prevalence of healthy weight was 35.6%, underweight 1.5%, overweight 39.3%, obesity 23.6%, abnormal waist to hip ratio (WHR) 61%, normotension 32.5%, prehypertension 33.9%, and hypertension 27.6%. Overweight was associated with age and location; obesity with age, sex, office status, and location; prehypertension with age and location; and hypertension with age, sex, location, and obesity. Keyword: Prevalence, Overweight, Obesity, Prehypertension, Hypertension, Banking Industry, Nigeria.
7 Population-based Childhood Immunization Education Intervention Program: Did Parental Hesitancy Risk Perception Translate to Risk Avoidance? , Article by Gbadebo O Ogungbade1, 2, James Oloyede3, Oluwole Odutolu4, Larry Holmes5
Introduction: Vaccines are the most effective prevention tools to eliminate or significantly decrease the incidence of many prevalent vaccine-preventable diseases (VPDs). Risk factors associated with parents’ child immunization hesitancy constituted a major difficulty to routine immunization program to prevent and control infant VPDs. Earlier, we reported that parents’ risk perception of infancy vaccination doubtfulness was remarkable after proper evidence-based information, parental infant immunization indecision risks perception translation to strong-willed early-days immunization behaviors remains unsubstantiated. Methods: We used cross-sectional research method with pilot tested behavioral theories-informed tool to judge whether the observed parental infancy immunization risk acuity actually transformed into risk avoidance to vaccinate their children. Results: The results of this study (N = 359) showed that all respondents had significant awareness of childhood immunization. Among the respondents, 95% reported high school and above education levels and 54% gainfully employed. After correction for confounding with multivariable logistic regression analysis, study participants that had good risk perception were 4 times as likely to vaccinate their children compared with participants with poor perception, adjusted POR (APOR) = 4.05, CI = 1.12 – 14.73. Conclusions: The activities of public health professionals empowered parents to progressively perceive and avoid childhood vaccination risks relevant to healthier children. The findings from this study have far-reaching implications for broad beneficial and effective infant morbidity and mortality reduction. Addressing parents’ specific questions and concerns adequately helped make more informed choices to improve complete wellbeing. Keywords: Parental childhood vaccination hesitancy; effective risk-benefit communication; information seeking/processing; risk perception, Protection motivation; risk avoidance.
8 Obesity and Hypertension: A Product of BMI and WHR is a Better Predictor of Hypertension , Article by Idris Muhammad Yakubu, Philip Bigelow
  Obesity is a modifiable risk factor for hypertension. Waist-hip-ratio is favored over body mass index for assessing truncal obesity and cardiometabolic risk. Is a product of body mass index and waist-hip-ratio a better predictor of hypertension than waist-hip-ratio? The objective of this study was to determine the measure of obesity that best predicted hypertension. The study was a cross-sectional survey of 3013 participants across the 36 states of Nigeria and Abuja. The census sampling technique was used to collect the data. The data collecting instruments included measuring tape, stadiometer, weighing scale, and Amron blood pressure monitor. The data was analyzed using X2 test and correlation. The mean body mass index of the participants was 26.99 ± 4.89kg/m2, waist circumference 79.13 ± 26.72m, hip circumference 87.24 ± 28.57cm, waist-hip-ratio 0.91 ± 0.07, systolic blood pressure 129 ± 18mmHg, and diastolic blood pressure 80 ± 12mmHg. Measures of obesity had statistically significant positive correlation with systolic and diastolic blood pressures. The best predictor of hypertension was a product of body mass index and waist-hip-ratio (r .228 and .200), followed by body mass index (r .191 and .180), then waist-hip-ratio (r .187 and .135), waist circumference (r .082 and .089), and lastly hip circumference (r .040 and .060). A product of body mass index and waist-hip-ratio should be used to assess obesity since it predicts hypertension better than either of the two alone. This study should also be extended to other risk factors of cardiovascular disease like diabetes and dyslipidemia. Keyword: Body Mass Index, Waist Hip Ratio, Waist Circumference, Hip Circumference, Hypertension.
9 The Extent of Poor Adherence to HIV Treatment, Poor Client Appointment Keeping, an Unsuppressed Viral Load at Bugembe, Mpumudde, Walukuba and Budondo Health Centres in Jinja District – Uganda. Part of a PhD Study Results , Article by Balidawa John
Uganda adopted the WHO 2014 test and treat guidelines in 2016, increasing the number of HIV clients diagnosed, started on treatment, and monitored for viral load suppression, against the inadequate health care resources. This has resulted into a low viral load suppression prevalence of 59.6%, and missed appointment of 7.9%. The study determined the occurrence of; poor adherence to HIV treatment, client appointment keeping, and viral load suppression at the study health facilities. The cross-sectional quantitative study was conducted in 4 purposively selected health centres. All files of adult HIV clients who had been in care for at least 6 month and active during October to December 2018 were studied for; missed appointments of more than two weeks, poor adherence to treatment of less than 85%, and unsuppressed viral load above 1000 viral copies per milliliter. 457(14.3%) of 3197 files had at least one of the study HIV care outcomes. Occurrence of the poor HIV care outcomes was the same irrespective of the client’s duration in care. 51 (11.2%) of the client files had poor adherence to treatment, 301(65.9%) had missed appointments for more than two weeks, and 211(46.2%) had unsuppressed viral load. In conclusion, there is no difference in occurrence of the study poor HIV care outcomes based on duration in care. There is limited access to timely viral load tests, hence affecting timely and appropriate decision making. Keywords: HIV care outcomes of adherence to treatment, appointment keeping and suppressed viral load.
10 Epidemiological Assessment of Knowledge and Risk Perception Towards Typhoid Fever among Gyadi-Gyadi Communities in Kano, Nigeria , Article by Ahmad Salisu Aliyu, Maimuna Yahaya Yakasai, Nuru Yakubu Umar, Habu Chadi
Introduction: Typhoid fever is a major public health problem in developing countries. Typhoid fever is transmitted by the feco-oral root through ingestion of contaminated food or water that contains Salmonella typhi. Poor knowledge and risk perception towards typhoid fever contributed to the prolonged transmission of diseases in the community. The aim of this study was to assess knowledge and risk perception towards typhoid fever among Gyadi-Gyadi communities in Kano, Nigeria. Methodology: A community based cross-sectional study was conducted in Gyadi-Gyadi from April, 2019 to May, 2019. Data was collected using a pretested structured questionnaire. Descriptive analysis was performed to obtain the frequency distribution of the variables. Results: Results: The result shows that 300 participants responded to the questionnaire. 165 respondents (55%) were male and the remaining 135 (45%) were female. Regarding sign and symptom most of 287 (95.7%) of the respondents have answered headache. Concerning risk perception, majority 160 (53.7%) agree that lack of hand washing practice contribute to typhoid fever infection Conclusion: The study revealed that the respondents have good knowledge towards typhoid fever. However, the risk perception status of the respondents towards typhoid fever is poor. Recommendation: Supportive supervision for health extension workers in order to strengthen effective health education to the community on the causes of the diseases and possible preventives measure. Keywords: Knowledge; Risk Perception; Typhoid Fever, Gyadi-Gyadi, Kano, Nigeria.
11 Risk Factors Associated with Infant Mortality in Punjab, Pakistan , Article by Mohammad Nasir Alvi
Pakistan was among the pioneers in the developing world to introduce national programs in maternal and child health (MCH) and family planning. However, the pace of development in the social sector could not be maintained over decades of political instability within the country and the perpetually volatile geopolitical situation outside the country. Despite advances in medical science, infant mortality continues to Pakistan. Given the paucity of reliable information this study was undertaken to examine risk factors associated with infant mortality in Punjab, Pakistan. A total of 240 respondents (health workers) were recruited for the study using simple random sampling from selected public hospitals in Punjab, Pakistan. These hospitals were selected applying a purposive sampling approach and were used as a study site. A formal request was made to the authorities of the hospital's understudy for the recruitment/inclusion of respondents (health workers) in the study in order to obtain data. A pre-tested structured questionnaire was administered to the respondents for primary data collection. The questionnaire was formed under three subheadings: pre-pregnancy factors, antenatal factors and post-natal factors. Presentation and analysis of data is done using descriptive statistics and chi-square test. Results obtained showed the existence of a highly significant difference between the parameters that were considered in this study. Therefore, it is surmised that the parameters studied under pre-pregnancy, antenatal and post-natal risk factors contribute to infant mortality in Punjab, Pakistan. Keywords: Infant Mortality, Risk Factors, Pregnancy, IMR.
12 Stress Problems in Elderly people , Article by Krishna Bahadur Bohara
Introduction: Ageing is considered a problem in our society. Old age is the time associated with physical, a psychological and social change which leads to vulnerable conditions to acquire physical, psychological and social health problems. This study aims to find out the health problems among elderly and to determine the factors associated with health problems. So, they need proper physical as well as social care during this period. Methods: A descriptive study was carried out among 40 elderly who were the members of senior societies of ward number 2 Dhangadhi sub-metropolitans. Elderly of aged 65 years & above were selected purposively for the study. Result: The mean age of the elderly were 70 years among them 62% were females. Self-reported chronic illnesses among elderly were hypertension 22%, chronic obstructive pulmonary diseases 19%, diabetes 15%, cardiac problems and joint problems 11 %. Further, 21% had hearing impairment and 11% had vision impairment. Concerning the functional impairment, 51% were partially dependent in performing some of the activities of daily living. Conclusions: Physical health problems that hypertension, chronic pulmonary diseases, diabetes, joint problems are the common. Functional impairment is higher among increased age elderly. Psychological health problems such as cognitive impairment and depression are identified. Experiences of being abused by the family members are also discerned. Hence, it is recommended to plan health promotional strategies for addressing these old age-related health problems. Elderly people should be encouraged to do activities around house or garden that provides glee and light exercise. Keywords: Seniors citizens, Stress, Depression, Health.
13 Assessment of Reasons for Oral Polio Vaccine Refusals in Bebeji Local Government Area, Kano State, Northern Nigeria, 2013 , Article by Musa K. Bawa, Endie Waziri, Aisha Mamman, Suleiman Haladu, Kabir Getso, Chima Ohuabunwo
Background: By 2013, Kano State was the hub of polio transmission in Nigeria. Polio campaign monitoring data indicated a high proportion of Oral Polio Vaccine (OPV) refusals were emerging as a major impediment to polio eradication in Nigeria particularly in Kano state. We conducted a qualitative study to identify reasons for OPV refusals and effective methods to improve OPV acceptance. Methods: We conducted In-depth interview (IDI) using a structured guide. We identified non-compliant households using vaccination tally sheets and interviewed male or female caregivers who had refused OPV for their children at least once in the previous supplemental immunization activities (SIA). Results: Seventeen interviews were conducted across the LGA. Of the 17 respondents, 13 (76.5%) were males. On the question” Is polio a significant health problem in the community” 14 (82.4%) answered no and explained that it should not be a priority but other more serious and prevalent diseases, 3(17.6%) answered yes and explained that it is a significant health problem since they have seen few cases. On why they refused OPV, about half felt there were other more important community needs, three felt they had no need for OPV and lacked trust in Government, five were worried the vaccine may be harmful. On what would they suggest toward making polio campaign more successful, more than half responded more/proper community awareness. Conclusion: Misconceptions about OPV is a major cause of OPV refusals. Public enlightenment and aggressive awareness campaigns on OPV should be scaled-up. Government should provide other essential community needs. Keywords: Assessment, Reasons, OPV refusals, Kano State.
14 Dengue Fever in Nepalese Context , Article by Krishna Bahadur
Dengue fever is one of the leading public health problems of tropical and subtropical countries across the world. Transmission dynamics of dengue fever is largely affected by meteorological and environmental factors, and its temporal pattern generally peaks in hot-wet periods of the year. The aim of this study was to fill this research gap by utilizing epidemiological and earth observation data in Kailalai district, one of the frequent dengue outbreak areas of Nepal. This article evaluates the dengue case notification, surveillance, laboratory facilities, collaboration, and how federal government, province government and local government responded to the outbreak. Methods: Qualitative data collections tools are in-depth interview were used to analyze the dengue outbreak response. Participants were sampled purposively, with deliberate selection regarding their experience, to help ensure involvement of the key stakeholders in the dengue surveillance and outbreak response in Kailali district including federal government policy-makers, officials Results: There was a variation in the proportion of cases confirmed by the laboratory, with participants noting that between (10-50) % of dengue cases were confirmed. The study findings demonstrate the extensive limitations existing in a fragile state that need to be addressed before and during a dengue outbreak. Conclusions: Surveillance system of disease is difficult due to geographical access and lack awareness on community people. But dengue is recently emerged in this province and along the country. The political context can affect the financial and trained human resources available to combat dengue. Three level government systems must be engaged to prevent and control of outbreak. Keywords: Seasonal mosquito induced viral Fever, Dengue fever, Dengue Hemorrhagic Fever, Shock syndrome, preventable.
15   Sewing Tape: A Potential Public Health Tool for Determining BMI in Disadvantaged Populations , Article by Idris Muhammad Yakubu, Philip L. Bigelow
The prevalence of obesity, a risk factor for non-communicable diseases, is on the increase globally. Body mass index is the most widely used measure of obesity worldwide. Measuring body mass index involves the use of stadiometer, weighing scale, and calculator, or expensive BMI machine. Such instruments may not be available to health professionals in certain areas of the world and so this research asks the question: “Can an ordinary sewing tape measure be used to measure body mass index?” The aim of this study was to develop a regression equation for calculating body mass index from waist circumference and hip circumference. It used a secondary dataset consisting of 3013 participants of a survey of bank workers across the 36 states of Nigeria and Abuja. The sampling technique was census sampling. The data was collected using a stadiometer, weighing scale, calculator, and BMI machine, and analyzed with SPSS using multiple linear regression. The participants’ mean body mass index was 26.99±4.89kg/m2, waist circumference 79.13±26.72m, and hip circumference 87.24±28.57cm. Multiple linear regression showed that both waist circumference and hip circumference were significant predictors of body mass index and correlated in 43.5% of cases. The formula for calculating body mass index from waist and hip circumferences was given as: BMI = (WC x 0.209) - (HC x 0.132) + 22.009. This formula is a potential handy public health tool for measuring body mass in disadvantaged communities using an ordinary tailoring tape. Further studies should be conducted to improve on the formula. Keywords: Body Mass Index, Waist Circumference, Hip Circumference, Regression Formula, Tape Measure.
16 Assessment for Enrollment Rate of Multidrug-Resistant Tuberculosis (MDR-TB) Cases in 2017 in Kano State, North West Nigeria , Article by Musa K. Bawa, Mustapha Mukhtar, Ado Umar
Background: Multi-drug resistant tuberculosis (MDR-TB) is one of the greatest challenges to controlling tuberculosis worldwide, Nigeria inclusive. We conducted a descriptive, cross-sectional study to identify and access the enrollment rate of MDR-TB cases in 2017 in Kano state, north west Nigeria Methods: We reviewed the MDR-TB patients line list of Kano state tuberculosis and leprosy control program (TBLCP) using the National TBLCP line listing template. The data was analyzed using Epi Info version 3.5.4 and Microsoft Excel 2007. Results: A total of 121 MDR TB cases were managed in the year 2017 in Kano state, of which 115 (95.0%) were identified within the year, 5 (4,1%) were referred in from other states, 1 (0.9%) carried over to the year. Of the 121 cases managed, 82 (67.8%) were males. Of the 121 cases managed in the year 2017, 77 (63.6%) were enrolled, 3 (2.5%) died before enrolment, 5 (4.1%) refused treatment and 14 (11.6%) loss to follow up. The highest number of MDR cases managed, 38 (31.4%) was in Q3 while Q1 had the lowest number of cases managed as 20 (16.5%). Q3 had the highest enrollment rate of 89.5% (34/38) while Q4 had the lowest enrollment rate of 17.9% (5/28). Conclusions: The MDR TB enrollment rate in Kano state in 2017 is low. Majority of the cases were enrolled in Q3 of the year. There is high rate of loss to follow up. There is need for Kano TBLCP to institute prompt identification of cases for immediate enrollment. Keywords: Assessment, enrollment rate, Multidrug-resistant tuberculosis, Kano state, north west Nigeria.
17 Barriers to Retention in HIV Infected Children on ART: Improvement Strategies at Kaduna State Comprehensive Health Care Facilities in Nigeria , Article by S. Batanda, T. Mduluza, G Yikii , J Morona
Objectives: Identified factors that contributed to poor retention in care of HIV infected children initiated on Anti-Retroviral Treatment and recommended appropriate improvement strategies. Study design: A total of 134 individuals were selected using purposive sampling and participated in the Focused Groups Discussions (FGDs), drawn from Caregivers support groups, HIV positive adolescents and health care workers at the ART clinics. Methods: Exploratory qualitative method using FGD questionnaire guide and retrospective review of secondary cohort clinical data records covering a period of 12 months was conducted using standardized data abstraction forms. Results: There were few studies that had been conducted in Nigeria to explore enablers of retention in care of HIV positive children. However, similar studies from other settings exited. Barriers to retention in care were the most commonly reported across the FGDs, though enablers were also reported. There was also a significant correlation between participant’s responses and data analyzed from the hospital records. Conclusion: It was mostly barriers to retention in care that were reported. Some barriers, however, were reported as enablers to retention in care. Caregiver’s role is critical and additional integrated strategies are urgently required to achieve optimum retention in care of children. Keywords: Retention in care; HIV positive children, Barriers to retention, Enablers to retention, Loss to follow up, Caregivers.
18 Knowledge, Attitude and Preventive Practice of Senior Secondary School Students on Ebola Virus Disease in Ilaro, Ogun State, Nigeria , Article by Oni, Olawale Bashir-Ud-Deen
The recent closing down of schools in some African countries as a result of EBOLA crisis, brought about devastating consequences such as early pregnancies, child labour, forced marriages, physical and sexual abuse to name a few. Designing appropriate interventions for these problems, this study assessed the knowledge, attitudes and preventive practice of Senior Secondary School Students on Ebola Virus Disease (EVD) in Ilaro, Ogun State, Nigeria. The study used a multi-stage and proportionate sampling methods. A total of 460 semi-structured self-administered questionnaires were administered to consenting Senior Secondary School students. The findings of the study revealed that 100 per cent of the respondents had previously heard of EVD. Overall knowledge of EVD was poor 114 (24.8%) and fair for 290 (63%) and good for 56 (12.2%). The relationship between knowledge, practice and attitude score of respondents at their various departments (Science, Art and Commercial) were not statistically significant, setting (p = 0.005). However, the relationship between class of respondents and their attitude towards EVD were statistically significant setting (p = 0.005). Regular hand washing and use of sanitizers were stated as the most useful protective measures against EVD. Based on these findings, it is therefore essential that health education for the students on presentation and prevention of the disease be stressed and routinely taught at schools and the need for government to provide adequate water supply in each school. Keywords: Attitude, Ebola Virus, Knowledge, Prevention Practice, Students.
19 Strategies to Improve on adherence to Treatment, Appointment Keeping and Viral Suppression in HIV Care at Mpumudde, Bugembe, Budondo, and Walukuba Health Centre in Jinja District- Uganda , Article by Balidawa John
The Uganda National HIV viral load suppression prevalence of 59.6% is below the 95% target. The study conducted in in four health facilities of Jinja district, on 437 files of adult HIV clients with; missed appointments of more than two weeks, poor adherence to treatment of < 85%, and unsuppressed viral load of > 1000 viral copies per milliliter, between January and July 2019, was aimed at determining change packages to improve HIV care in the study health facilities. Data was analyzed using Microsoft excel and the following tested changes using the Deming PDSA cycles were used; Intensified health education, and adherence counseling to all patients with poor adherence, pill counting to harmonize the pills supplied with the appointment date, follow up phone calls to patients who miss appointment, creation of a one stop centre for HIV care, and increased staffing of HIV clinic. Study results showed a 13.6% prevalence of the study HIV care poor outcomes at baseline assessment. 11.8%, 65.2%, and 46.5% of the study client files were due to poor adherence to treatment, two weeks missed appointments, and unsuppressed viral load respectively at baseline assessment and 4.7%, 25.1%, and 31.5% respectively at end line assessment. 80% of the studied clients were retention in care between baseline and end line assessments. In conclusion, there was a positive effect on the patient HIV care out comes. Keywords: Adherence to treatment, appointment keeping, and viral suppression in HIV care.
20 Efficacy Studies of Fenugreek Seeds Against Polycystic Ovarian Syndrome , Article by Sehrish Aftab , Kashif Sarfraz Abbasi
Polycystic Ovarian Syndrome also called Stein-Leventhal Syndrome or chronic oligoanoSvulation is a condition related to hormonal imbalance that can cause menstrual disorders like oligomenorrhea or amenorrhea, infertility, hirsutism, obesity, suffering from prompt increase in weight or having trouble in losing weight and other symptoms in type two diabetes, oily skin, and acne. Most of the cases of PCOS are reported in 20s and 30s with complain of difficulty in becoming pregnant. According to the study, frequency of PCOS in the infertility clinics in Pakistan was 17.6%. In this study Fenugreek (Trigonellafoenum-graecum) was investigated to treat PCOD. The plant was also subjected to different physico-chemical and nutraceutical estimations. The present study is single blind randomized controlled trial in 90 premenopausal women diagnosed with PCOS using fenugreek seed powder, over a period of 90 consecutive days. During the course of study, the subjects were counseled about diet and exercise and were regularly monitored for any associated side effects related to the administration of fenugreek seed powder. Vital clinical estimations in the human subjects were carried out at the start of study and by the end of trail i.e. at day 90. Clinical estimations involved evaluation of BMI, FSH, LH, ovarian size, menstrual regularity and FBG. Overall results revealed that the prolong administration of raw fenugreek seeds in women having PCOS was particularly found effective. Intake of fenugreek seeds for three months had positive effect on regularity of menstrual cycle, maturation of eggs, reducing ovarian volume and infertility. Keywords: Polycystic Ovaries, Fenugreek, Infertility, Ovarian Size, Menstrual irregularities.
21 The Prevalence of Diabetes Mellitus among People Living with HIV/AIDS Receiving Anti-Retroviral Therapy in Chiradzulu District, Malawi: A Cross – Sectional Study , Article by Beatrice Chitsa
The study was conducted to determine the prevalence of diabetes and its associated factors in people living with HIV/AIDS receiving Anti-Retroviral Therapy (ART) in Chiradzulu district, Malawi. A hospital-based cross-sectional study was conducted between April and October 2016. Using systematic random sampling, secondary data from patients’ records registered at ART and diabetes clinics were extracted. Categorical variables were compared using Chi-square test, independent samples test was used to compare means and multiple logistic regressions were used to calculate adjusted odds ratios for the effect of potential risk factors on diabetes. Out of 440 participants (10%) were diabetic. After adjusting for other variables, age, BMI, DM family history, hypertension and WHO stage 2 remained significant predictors of diabetes p<0.05. In addition, use of TDF/3TC/ATV/r was also a strong predictor of diabetes mellitus and the adjusted odds ratio (AOR) for TDF/3TC/ATV/r users was 6.08, CI [31.82], P=0.032). The study concluded that diabetes mellitus is a big concern for people on treatment living with HIV/AIDS. Therefore, the study recommends that HIV/ART exposed patients should be checked for DM regardless of the absence or presence of the common diabetes’ risk factors. For the sake of planning and implementing targeted routine monitoring, diabetes risk factors need proper identification. Keywords: HIV/AIDS, diabetes mellitus, Antiretroviral therapy, combined antiretroviral therapy, Body mass index, Atazanavir/ ritonavir.
22 Epidemiological Study on Knowledge, Attitude and Practices Regarding Pulmonary Tuberculosis among Rural Communities of Gulu Kano, Nigeria , Article by Ahmad Salisu Aliyu, Habu Chadi, Nuru Yakubu Umar, Bello Aminu Bello
Background: Tuberculosis (TB) is a chronic infectious disease that has long been one of the major health problems. It affects individuals of all ages and both sexes. Poverty, malnutrition and over-crowded living conditions have been known for decades to increase the risk of developing the disease. According to the Federal Ministry of Health (FMOH) hospital statistics data, TB is the leading cause of morbidity, the third cause of hospital admission (after deliveries and malaria) and the second cause of death in Nigeria after malaria. TB is an obstacle to socio economic development. So, this study is aimed at assessing the knowledge, attitude and practices regarding pulmonary tuberculosis among rural communities of Gulu, Kano, Nigeria. Methods: A community based cross-sectional study was conducted in Gulu from January, 2019 to March, 2019. Data was collected using a pretested structured questionnaire. Descriptive analysis was performed to obtain the frequency distribution of the variables. Results: Among 335 participants, the study showed that the overall level of knowledge was low and the overall attitude and practices related to PTB was highly inadequate. Conclusion: Study respondents had basic awareness about pulmonary TB but knowledge on cause and prevention was inadequate. Their attitude and practices towards TB also need to be improved. Health education activities need to be intensified for the rural population to bring about significant change in their level of awareness on TB. Keywords: KAP, PTB, Awareness, Gulu, Kano.
23 Determinants of Poor Waste Management in Ghana; Challenges and Health Implications , Article by Johnson Kosi Kottoh
The purpose of the study was to analyze the underlying factors affecting effective solid waste management in the Ghana using the Tamale metropolis as a case. Solid waste management has become a major development challenge in Tamale Metropolitan Assembly (TAMA) in recent times. This deserves not only the attention of the Metropolitan Assembly and the waste management institutions but also concerns of corporate organizations and individuals to find a lasting solution to the problem. Therefore, with the aid of concurrent mixed method design, three main techniques employed in gathering the primary data were: preliminary field investigation, questionnaire survey and face-to-face interview. Findings of the study established that factors affecting effective solid waste management in the Metropolis included inadequate skip supply for storing waste, lack of routine collection of waste and poor methods of waste management. The study also concluded that there were inadequate resources for waste management institutions to effectively collect the waste generated. In the light of these problems enumerated above, the research recommended the adequate supply of skips, regular collection of waste, use of Integrated Solid Waste Management Model (ISWM), proper management of the landfill and adequate resourcing of the waste management institutions. Keywords: Ghana, Environment, Waste management, Solid waste.
24 Prevalence and Outcome of Severe Acute Malnutrition among Children 6-59 Months, in Magumeri Local Government Area, Borno State, Attending General Hospital Magumeri, Borno State, Nigeria , Article by Kenneth Onyedikachi Obani
This is a retrospective observational hospital-based study aimed to determine the prevalence and outcome of severe acute malnutrition (SAM) in children 6 – 59 months in Magumeri local Government area admitted to Magumeri General Hospital – INTERSOS Nigeria Stabilization centre during the period December 2018 to June 2019. A total of 171 children with severe acute malnutrition were identified; 104 of cases were male (60.8%) while 67 (39.2%) were females. The mean age of the admitted children was 15.8 months. Children 36–59 months were least affected. The overall prevalence of severe malnutrition was 4.0%, and the general mortality rate was 3.8% while mortality rate among children with severe malnutrition was 2.9%. Amongst children admitted with SAM, 126 (73.7%) had marasmus, 30 (17.5%) had kwashiorkor and only 16 (9.4%) were marasmic-kwashiorkor. The highest prevalence rates occurred in February and April. The common clinical presentations were acute diarrhea disease, upper respiratory tract infection, malaria, urinary tract infections, dermatitis, measles, sepsis and pneumonia. Only 14.6% were fully vaccinated, while 49.7% were not vaccinated. Overall 81.9% improved and were discharged, 8.2% were transferred to the University of Maiduguri Teaching Hospital for management of other severe medical complications, 7 % discharged against medical advice and 2.9 % died. In conclusion, the prevalence and mortality among children with SAM at Magumeri Local Government area were high, and the current management strategies were inadequate to cater for the high cases as a result of the crisis in the region. Keywords: Severe acute malnutrition, Prevalence, Mortality, and Outcome.
25 Socio-Cultural Factors Associated with Gender Based Violence in Chipata City, Zambia , Article by Beatrice May Banda
Social and cultural beliefs in different communities of Zambia have continued to perpetrate Gender Based Violence and this has affected victims in many ways. The impact of GBV has led to an increase in morbidity and mortality rates globally after its physical, mental, emotional and social inflictions on the victims. This has placed a cost on the quality of life as lifestyle changes occur. Therefore, the aim of this study was to establish the socio-cultural factors that are associated with Gender Based Violence in Chipata City. This study adopted an explorative mixed method design. The study sequentially collected quantitative and qualitative data. Responses were gotten from 381 whose sample was deduced from 1,922 female victims, registered from 2014 to 2016 at the GBV One Stop Centre and Chipata City. The study discussions revealed weak community support, poor relationships, alcohol and poverty as being among the major contributing factors to GBV. Major health effects could either be physical implications like a loss of an organ after assault, unwanted pregnancies and STI infections, whose findings were attributed to spouses/partners. Sensitization, in this case, could help curb the incidences of GBV. On conclusion, the study explored the experiences female survivors in Chipata city have had following Gender Based Violence. Socio-cultural and economic factors fueled GBV and victims mention poverty, substance abuse and inactive law enforcement directly enhancing these acts of violence. The key recommendation is massive sensitization about GBV and reinforcing laws to strengthen the curbing of violence. Keywords: Gender Based Violence, Intimate Partner Violence, Socio-Cultural Beliefs.
26 Acceptance and Satisfaction of National Health Insurance Scheme Services among Civil Servants in Sokoto Metropolis, Sokoto State-Nigeria , Article by Abdulrahman Adamu Ahmed, Aisha Aliyu
Difficulty in accessing health care due to inequitable distribution has been a continuous challenge in developing countries. Insurance is a veritable tool for curbing these challenges, as proved in developed countries with assuring results. Nigeria in her efforts to tackle this problem introduced the national health insurance scheme. However, acceptance and satisfaction with the NHIS are obstacles to the achievement of its objectives. The aim of the study is to assess the level of acceptance and satisfaction with the national health insurance scheme among civil servants in Sokoto metropolis. The study was a cross sectional descriptive study conducted in Sokoto metropolis among civil servants who are currently accessing NHIS service. A multi-stage sampling technique was used to select 425 participants. Data was collected using semi-structured self- administered questionnaires and was analyzed using MS Excel Spread sheet 2016. A total 425 respondents were interviewed and their mean age was 41.75 ± 9.3 years and majority were males (282) 66.4%, Most of the respondents (311)73.2% where Hausa/fulani and Muslims (349) 82.1%, the overall Acceptance of NHIS was Good, (272) 64% however only 190 (44.7%) are satisfied with the scheme. The study showed that there is good acceptance of the scheme by civil servants in the metropolis, by the scheme is yet to meet their expectation, thus the poor satisfaction. Keywords: Acceptance, Satisfaction, NHIS Service, Civil Servants, Sokoto Metropolis, Nigeria.
27 Assessing Knowledge, Attitudes and Practice of Hand Washing with Soap among Mothers and Caregivers of Children under Five years in Ntungamo District, Uganda , Article by Topher Byamukama
Background: The study of hand washing practices in Ntungamo district is part of a larger strategy being implemented in different countries to decrease the prevalence of childhood diarrhea, in the frame work of the global public – private partnership for hand washing with soap. Purpose: This study of hand washing practices using soap in Ntungamo district aimed at reducing childhood diarrhea prevalence in the district. It represents a preliminary study designed to collect the information necessary to design appropriate strategies to reduce diarrhea prevalence in under five years of age. Methods: The study used quantitative and qualitative methods to collect data from a representative sample of several supervision areas of Ntungamo district.  Results: The practice of hand washing after latrine use among the respondents was very low (52%) compared to washing hands before and after meals (77%). The study also revealed a low use of soap during hand washing where (52%) who washed their hands after contact with feces, only 14.6% used soap. Whereas whose who washed their hands while handling food were77%, but out of 77% only 28% used soap There was no diarrhea reported among respondents that had A-level education and only 20% of those that had post-secondary education reported having diarrhea episodes among the under-five compared to 64% that reported diarrhea among the under-fives for those that had incomplete primary level of education, 57% among the households of functional adult learning graduates and 49% for those that completed primary level of education. Keywords: Handing washing, Soap, Caregivers, Supervision areas.
28 Prevalence of Type 2 Diabetes Mellitus and Associated Risk Factors among Local Government Workers at Bariadi Town Council, Tanzania, A Cross Section Study 2017 , Article by Chacha Magige Nyabisaga, Mageda Kihulya, James E. , Athuman M. Lupimdu
Background: Although the government-initiated interventions to address the risk of diet-related non-communicable diseases, the prevalence of T2DM is still high, we conducted this study to determine the magnitude of T2DM and associated risk factors among health workers in Bariadi Town Council Tanzania. Methodology: A cross-sectional study approach was applied for 229 participants. Qualitative variable was measured using proportion and quantitative variable were measured using mean and median. Strength of association was assessed by Odds Ratios with their corresponding 95% confidence interval. Both bivariable and multivariable logistic regression was used. Results: The overall prevalence was found to be 7.9% (95%CI=4.7-12.1). Risk factors for T2DM were found to be sex (OR=4.545, 95%CI: 1.069-19.325), age between 30-41 and 41-50 years (OR=8.08, 95%CI: 1.215-53.741; OR=15.08, 95%CI: 2.315-98.342) and history of raised blood sugar (OR=0.032, 95%CI: 0.006-0.167). Conclusion: Prevalence of T2DM was found to be high, female having higher than male. Sex, age, history of diabetes had significant association with T2DM. Control efforts should be directed on screening and public nutrition programmes. Keywords: Diabetes Mellitus; Non-Insulin; Risk factors; prevention.
29 An Assessment of Socioeconomic Determinants of Contraceptive use among Women of Reproductive Age in Tarauni Local Government Area of Kano State, Nigeria , Article by Muhammad Murtala Ibrahim
This study investigated the socioeconomic determinants of contraceptive use among women of reproductive age in Tarauni local government area of Kano state, Nigeria. The research used descriptive survey design to collect and analyse cross sectional data from the study population with the aid of structured questionnaire that was validated. The population of this study comprised of Women of Reproductive Age- 15-49 living in urban and rural parts of the study area. A total of one hundred and twenty (120) participants, selected through simple and systematic random sampling technique participated in the study. The study data was analysed with SPSS version 20 and presented as frequency tables and simple percentage, while chi-square statistics was used to answer the formulated research hypotheses at a 0.05 level of significance. The findings of this study indicate that religion, cultural norms and occupational status of the woman are strongly associated with the use of family planning by women of reproductive age. However, level of education was not significantly associated with the use of contraceptive in this study. The study recommends that interventions targeting Muslims should recognise the diversity among sects and be more targeted; Family planning messages should target and address cultural beliefs and norms including gender roles that hinder use of contraceptive method among women of reproductive age. Government should provide income generating opportunity for women and expand service delivery points with adequate and affordable products and services to encourage use. Keywords: Contraception, Contraceptives, Contraceptive use, Family planning, Women of Reproductive age.
30 Factors Associated to Utilization of Post-Natal Care At 48 Hours: A Case Study of Kanyama 1st Level Hospital in Lusaka, Zambia , Article by Angela C. Mwaba
The post-natal period is the critical stage in the prevention of maternal and neonatal deaths. Zambia has recorded a decline in maternal mortality from 597(2007) to 398/100 000 (ZDHS 2014). WHO recommends that all post-natal women must be reviewed within 48 hours after delivery to avert maternal and neonatal mortality rate. This study was therefore conducted to assess the factors affecting the utilization of post-natal services at 48 hours at Kanyama first level hospital with over 1,000 deliveries every month. A mixed survey (employing both quantitative and qualitative methods) was completed by 197 women using a structured questionnaire. Quantitative was cross sectional while qualitative a case study. Informants included health workers and mothers who had delivered within 6 days at this hospital. The data was analyzed using STRATA 13 for quantitative, descriptive and inferential statistics. Key findings: utilization of post-natal services at the hospital was poor at 6%. No information was given to women to report back within 48 hours, inadequate space and staff to implement this guideline and no association between PNC utilization and social economic, demographic and geographic factors. Conclusion: The survey showed that utilization of PNC at 48hrs was low. Social economic, demographic and geographic factors were not associated with PNC utilization. To improve utilization, increase on staffing, improve on space, provide information to mothers and implementation of guidelines. Keywords: Postnatal Care, Utilization, maternal mortality.
31 Clinical Characteristics of Acne Vulgaris and its Effect on Patient’s Quality of Life , Article by Stephen Aiyedun, Olaniyi Onayemi, Olayinka Olasode, Olumayoma Oninla, Michael Israel, Judith Chuhwak, Olanrewaju Olayemi , Omotoyosi Ilesanmi , Mufutau Oripelaye, Fatai Olatunde, Hamidah Bello
Acne vulgaris is a common skin disease affecting a large segment of adolescents globally. In Nigeria, as at 2015, the population of young people aged 10-24 years accounts for more than 30% of the population and this proportion is projected to rise further by 2050 with a profound effect. Yet, there is paucity of data on how acne affects the quality of life (QOL) of adolescents in our locality. This study, was conducted to determine the clinical characteristics of acne vulgaris and its effects on the QOL of patients attending the dermatology clinic of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. This study used a cross-sectional research design and collected data from two hundred and sixty consenting individuals, in the Dermatology out- patient clinic. Patients were selected randomly using a numerical balloting style. Findings from the study showed consumption of food such as peanut/groundnut, stress and sugary foods/drinks were the top three risk factors for acne vulgaries among the patients. Quality of life (QOL) assessment showed the effect of acne was more pronounced on social life (social interference) of the patients and avoidance of public facility. QOL in acne patients using CADI score was positively correlated with severity of acne vulgaris using GAGS. The impact effect of severity of acne vulgaris on QOL was strongly correlated in females compared to males. Keywords: Acne vulgaries, risk factors, QOL.
32 Determinants of Treatment Adherence and Retention in Care among HIV Positive Pregnant and Breastfeeding Women in a Rural District in Zimbabwe , Article by Addmore Chadambuka, Nicholas Midzi
Background: A preliminary review of St Albert’s Mission Hospital data showed 15% of HIV positive pregnant and breastfeeding women (PPBW) missed drug pick-up appointments and 10% were lost to follow up. This affects Zimbabwe reaching 90% viral suppression target among those on antiretroviral therapy and increases HIV transmission risk to unborn fetus or breastfeeding infant. We determined factors associated with treatment adherence and retention in care among PPBW. Methods: We conducted a cross-sectional analytic study among PPBW receiving care at the hospital. Women were sampled consecutively on presenting for antenatal or postnatal care. We used interviewer administered questionnaire to elicit information from consenting PPBW. We obtained ethical approval and written informed consent from PPBW. Results: We interviewed 120 PPBW. The majority were breastfeeding women (60.0%). Over 95% PPBW disclosed their HIV status. The majority used this hospital because the health workers treated them with respect (66.7%), maintained client confidentiality (75.0%) and had good relations with their clients (70.8%). Skipping medication because of travel (adjusted odds ratio (AOR) 95% confidence interval (CI) 0.06 (0.005-0.79 and having an unpleasant experience while seeking care AOR (95% CI) 0.05 (0.002-0.93) were independently associated with lower medication adherence. Disclosure to avoid hiding taking medication AOR (95% CI) 22.07 (1.64-297.66 and attending this hospital because the health workers maintain confidentiality AOR (95% CI) 22.07 (1.64-297.66) were independently associated with higher retention in care. Conclusion: Health system factors play an important role in adherence and retention of pregnant and breastfeeding women attending care at this facility. Key words: adherence, retention, pregnant, breastfeeding, medication, disclosure.
33 Retention in care among HIV positive pregnant and breastfeeding women in a rural district in Zimbabwe: A dataset analysis , Article by Addmore Chadambuka, Wellington Murenjekwa, Nicholas Midzi
Background: Studies have been done on retention in care for the general population but little is known of this phenomenon for HIV positive pregnant and breastfeeding women (PPBW). St Albert’s Mission Hospital data showed that 10% PPBW were lost to follow up. We determined retention in care in this population. Methods: We conducted a cross sectional descriptive study using records of PPBW receiving care at the hospital from January 2016 to December 2018. We manually abstracted data from registers and from electronic records for analysis onto an Excel based abstraction sheet. We generated survival curves for the PPBW. We obtained waiver of informed consent for analysis of PPBW records. Results: All pregnant women initiated in ART before ANC were retained up to between 25 and 30 months, where about 75% remained in care. Among those initiated during pregnancy, about 70% were no longer in care by 10 months of follow up. Retention rates were better for pregnant women initiated before ANC (p-value = 0.0272. log rank chi square test). Most breastfeeding women were still in care up to between 30 and 40 months for both who were initiated in pregnancy and before ANC for their current pregnancy. Thereafter a small drop in retention rates for those initiated on ART during pregnancy is noted (log rank chi square test p-value= 0.2183). Women initiated before ANC and those initiated during had generally the same retention rates. Conclusion: Retention in care is high among PPBW but lower if ART initiation was due to the current pregnancy. Keywords: retention in care, pregnant, breastfeeding, survival rate.
34 Assessment of Risk Factors Associated with Hypertension in Adult Population in Letlhakane, Botswana , Article by Katlego Pearl Mantimane
Hypertension is an important public health challenge because of its associated morbidity, mortality, and the cost globally. Hypertension is the leading cause for cardiovascular disease in both developed and developing countries including Botswana. Only 3 population-based studies of hypertension have been conducted in Botswana and the latest 2010 STEPS survey reported a prevalence rate of 28.6%. This study was the first of its type to examine the prevalence of Hypertension and its associated risk factors among adults in Central Botswana. The objectives of this study were to estimate the prevalence of hypertension and assess the associated risk factors among adults in Letlhakane, Boteti Sub District-Botswana. A community based descriptive cross-sectional study was carried out on 377 participants (149 males and 228 females) aged 18 years and above, using simple random sampling method. The overall prevalence of hypertension among the study population was 38.5%. Females had a higher prevalence of hypertension (55.2%) as compared to males (44.8%). Age, body mass index, waist circumference, alcohol consumption and tobacco use were found significantly associated with hypertension (p<0.05). Regular screening for hypertension among adults should be done throughout the community for knowledge regarding their individual blood pressure status. Among those who already have hypertension and are on anti -hypertensive drugs; timely blood pressure check-up, screening for cardio vascular diseases and proper self-care management need to be promoted. Intervention measures should be undertaken at the community level; particular emphasis should be placed on primary prevention through adherence to healthy life style. Keywords: hypertension, risk factors, prevalence, cross sectional, community-based, blood pressure
35 Assessment of Patient Satisfaction in an Out Patient Department of Rumbek East County, South Sudan , Article by Nebiyu Lera Alaro
Patient satisfaction surveys are essential in obtaining a comprehensive understanding of the patient’s need and their opinion of the service received. It is a vital tool in evaluating the quality of healthcare delivery service in Primary Health Care. The current study is a cross-sectional descriptive research about assessment of patient satisfaction in Medicine Outpatient Department of Rumbek East, South Sudan. Systemic sampling technique was employed and 76 respondents were statistically calculated. Only respondents whose ages were from 18 years old were included in this study. The research tool was a pre-structured questionnaire and data collection was conducted from December 19th, 2018 to January 5th, 2019. The components of satisfaction study were the socio-demographic characteristics, the patients’ experience with medicine outpatient services, accessibility to Primary Health Care services, and patient satisfaction. This study aimed to find the levels of patients’ satisfaction and the significant relationship between independent and dependent variables. A total of 76 outpatient clients were enrolled in the assessment, all of them were showed interest to participate on the interview. Out of the 76 clients (60.5%) of them were female predominance and (84.2.5%) of the clients were age above 18 years. Considerable number of clients (76.3%) was new first visit within past 3 month. Based on the result of the study, training of code of conduct and courtesy should be given to both clinical and office staffs. Keywords: Patient Satisfaction; Outpatient Department (OPD); Rumbek East, South Sudan, Outpatient Station.
36 Qualitative Study on Barriers and Supportive Factors of Maternal, Neonatal and Child Health (MNCH) Services in Homa Bay County, Kenya , Article by Godfrey Yikii, Isaac Mwanzo, George O. Ochieng, John Paul Oyore, Lucy K., Ogollah, Peter Okoth, Bridget job-Johnson
Introduction: Despite overall global progress and concerted efforts, MDGs 4 (reduce child mortality) and 5 (improve maternal and new born health) have been and are seriously off target for many countries. In Africa, south of the Sahara a woman has a 1 in 39 chance of dying in pregnancy or childbirth, compared to a 1 in 3,800 similar risk in developed countries. The leading causes of maternal deaths are related to obstetric complications around the time of childbirth, with three-quarters of those deaths and significant morbidity being preventable through access to a full continuum of quality reproductive health services. Evidence shows that Africa still has the highest proportion of under-five deaths, with 1 in 91 children dying before their fifth birthday (UNICEF, 2016). Aim: To explore experiences, knowledge, beliefs, practices and attitudes of caregivers and community members associated with the causes of common childhood illnesses, prevention and treatment options. Materials and Methods: The study adopted qualitative approaches grounded in social and health promotion theories (Berkowitz, 2004; Rosenstock, 1966; Bradley et al., 2009). Maximum variability, in combination with sampling designs employed to capture a diversity of perspectives. Results: The study findings identified the most common childhood illnesses as; malaria, diarrhoea, measles, coughs, and colds related to increased cases of child and infant mortality. Pneumonia was rarely cited, the fear of HIV and cancer tests mentioned as key barriers of early initiation and continued use of ANC services. Side effects of vaccines prevent mothers from having their children vaccinated. Conclusion: This study provides a contextual and evidence-based approach for the design of MNCH interventions that are effective, user-friendly and more likely to elicit optimum participation from the targeted community members in Homa Bay County. Keywords: MNCH services, MDG 4 and 5, uptake, barriers, children/pregnant women, Homa Bay.
37 Influence of Family Structure on Recent Trends of Ageing Process , Article by Ann Kavitha Mathew
The demographic background of the elderly plays a pivotal role in the health and health related aspects of the old age population. In India, where the family has an obligation to care for the elderly, the consequences of rapid declines in fertility and mortality on elderly makes living arrangements an important issue in the field of population and development. The study was conducted in the context of Kerala with the purpose of finding out the influence of family structure on the health of the aged. The data was collected through field work and it was a descriptive type of study. The analysis was carried out with definite dependent and independent variables. The study shows that the family size plays an important role in the deterioration health of the aged, the perception about their health condition, the care during their illness. It was also clear from the study that feeling of loneliness and ability of adjustment with the family members varies significantly with the family size. The analysis shows that the disease structure particularly the prevalence of both communicable, non-communicable diseases and occurrence of multiple diseases are more prone to those who belong to large families. Keywords: Family structure, Ageing process, Geriatric health, Elderly, Old age, Living arrangements.
38 Influence of Subject Characteristics on Adoption of Multiple Preventive Health Behaviours against Noncommunicable Diseases: A survey of Female Students at Makerere University , Article by Stanley Tom Asaku, Juliet Kiguli, Judith Agaba Kiiza
Many researchers worldwide report that health behaviours tend to be highly clustered, and can be addressed simultaneously. Yet, more remains unknown than known about how to optimize multiple preventive health behaviour change to mitigate health risks associated with noncommunicable diseases, which currently presents major public health concerns, and represents the greatest global health security threats in the future. There are emerging shifts in epidemiology of these chronic diseases, not only by gender, socio-economic status, disability, ethnicity, but most recently by age- albeit subject characteristics, as they are increasingly causing premature deaths. Nevertheless, the problem remains a neglected public health issue in Uganda, and at Makerere University in particular. A cross-sectional sample of 381 undergraduate female students completed the self-administered questionnaire, whose results were subjected to binary logistic regression modeling to determine extents to which subject characteristics influenced adoption of preventive health behaviours. Multivariate regression models suggest that course of study significantly (p=.013) influenced physician visits, with adjusted odds ratio of 0.32. Pentecostal (p=.018) and Anglican (p=.002) affiliations significantly influenced screening behaviour, with corresponding odd ratios of 0.37 and 0.34. Pentecostal (p= .021), like Science course (p=.030) significantly influenced physical activity, with corresponding odds ratios of 0.34 and 0.44. With respect to multiple preventive health behaviours, only course of study showed significant (p=.036) influence on adoption of all three desired behaviours, with adjusted odds ratio of 3.15. The study contributes to body of knowledge on multiple health behavioral change and the healthy Universities concept. Future health promotions should consider issues around equitable access to essential information, and take advantage of religious places of worship and leaders to channel messaging. Keywords: Noncommunicable diseases, subject characteristics, multiple preventive health behavior.
39 Evaluating Clients’ Satisfaction with National Health Insurance Scheme in Jigawa State, Nigeria , Article by Adamu, Umar Husaini
Background: Health insurance scheme have been introduced with the aim of providing health insurance and making health services accessible and affordable to the average citizen in the country. Our objective is to evaluate clients’ satisfaction with National Health Insurance Scheme in Jigawa State, Nigeria. Method: This study used a mixed method (both qualitative and quantitative designs) approach and was conducted between May 2016 and September 2017. Three hundred and twenty-one (321) enrollees filled questionnaires while 8 participated in face to face interview. The questionnaires were analysed using Statistical Package for Social Science (SPSS) and descriptive statistics was used to summarize the quantitative data using means, proportions and frequencies. Qualitative data were analyzed using themes. Results: The overall satisfaction score of the respondents was 80.6%). Specifically expressed satisfaction with the associated services (e.g. lab, radiology, pharmacy) (92.2%), agreed to have easy access to the medical specialist (77.9%), agreed to get prescribed drugs in the hospital (74.1%), agreed that the amount they pay during each visit before they got drug is reasonable (85.7%), satisfied with surgical procedure under NHIS (69.8%), satisfied with the referral arrangement (77%), satisfied with the overall NHIS services in this hospital (87.3%). Conclusion: More than three quarter (80.6%) of the clients are satisfied with healthcare services provided under NHIS in the hospital. Recommendations: NHIS scheme can be improved by 24 hours availability of designated doctors for NHIS clients, regular supply of drugs and by reducing waiting time. Keywords: Universal Coverage, Health Insurance, National health insurance scheme, Patient satisfaction, Client satisfaction.
40 Strengthening Data Availability for Community Health Programming - A Review of Current Practices , Article by Achille Kabore
There is always a fair amount of data collected, analyzed, stored and disseminated in various formats in the national health systems. In most cases, district and national health management teams are tasked by law to generate quality data for planning, budgeting, programmatic decision making and to respond to requests and needs from stakeholders such as donors. Valuable community health data should be ready-to-use at the point of service delivery and ideally at the household and community levels for real time decision making to improve performance and outcomes. Donors need evidence to measure progress towards the achievement of their objectives, and also to advocate for additional resources. The need for community data fluctuates temporally due to environmental, behavioral, economic, social and political factors. Data collection, management and analysis should be timely, constantly updated and tailored to reflect these fluctuations. Findings from multiple demographic and health surveys (DHS) that collated and analyzed large datasets from households, have shown the importance of collecting quality data, improving their availability and dissemination to build awareness of communities about emerging health issues, and to stimulate and increase data utilization for health programming especially in areas or contexts where there is no or little relevant information. We reviewed current community data collection and management practices, analyzed various sources of data, data usage, formats and performance indicators. We noted that community data ownership is key. Communities who generate health information, should be able to use their own data their data for self monitoring, program planning and implementation in collaboration with local health facilities. Keywords: community data – community health -home visits – data capture - data dissemination -community health worker.
41 The Factors Associated with Attrition and Their Extent in Affecting the Antiretroviral Therapy Clinic in Primary Healthcare Facilities in Anambra State Between May 2016 and May 2018 , Article by Okebugwu Andrew Nwachimere-eze
The success of the third ninety in UNAIDS 90-90-90 by 2020 depends on the sustainability of antiretroviral therapy by clients on therapy. The therapy is inefficient if there is poor adherence. Due to certain factors, a fraction of the clients is lost from the clinic and they contribute to transmission of new infections. The aim is to inquire into these factors and their contribution to attrition in Anambra facilities. A quantitative experimental study using a comprehensive purposeful sampling method. From the electronic medical record data of clients who have not been seen in the clinic for 90 completed days from May 2016 to May 2018 was accessed. These clients were disaggregated according to presence of descriptive addresses and phone contacts. Traceable clients were tracked on phone at seven different times over three weeks. Data was collected in an excel sheet and analysed using SPSS version 22. For a total ever enrolled of 852 clients, there were 12 deaths. 265 clients (31% of total enrolment) that defaulted. 141 (53.5%) were untraceable while 124 (46.5%) were traceable. 29 clients (23.8% of traceable) were on self-transfer. 39 clients (31.7%) promised to return, while 56 clients (44.5%) were uninterested in the therapy. The defaulter rate in these facilities is high and the fact that majority of these clients cannot be tracked due to poor contact information of clients is a source of concern. The negative effects of faith and economy were as well observed. Quality counselling and dialogues with faith leaders are recommended. Keywords: attrition, factors, extent, anti-retroviral therapy, Anambra.
42 The Rate and Determinants of Regular Utilization of Long-lasting Insecticide-treated Nets for Malaria Prevention among Pregnant Women in Keffi, Nigeria , Article by Idris Muhammad Yakubu
Malaria is endemic in the tropics with pregnant women at increased risk. Malaria in pregnancy causes feto-maternal morbidity and mortality. The regular use of long-lasting insecticide-treated nets is a cost-effective vector-control strategy with synergistic insecticidal and barrier-protective dual actions. This study explored the rate and socio-demographic determinants of long-lasting insecticide-treated nets utilization in 100 randomly-selected pregnant women attending a private ultrasound center in Keffi, Nigeria. It was a quantitative cross-sectional survey using a structured interviewer-administered questionnaire. The data was analyzed using statistical package for social sciences. The results revealed a rate of 70% of regular utilization of long-lasting insecticide-treated nets and a statistically significant association between religion and regular long-lasting insecticide-treated nets use (OR 1.51, 95% CI 0.98- 2.34, p .02). The relationship between the free distribution of long-lasting insecticide-treated nets and regular use was not significant (p .363). Regular use of long-lasting insecticide-treated nets would prevent malaria in pregnancy, reduce feto-maternal morbidity and mortality, and improve feto-maternal survival in Nigeria and other malaria-endemic parts of the world. Keyword: Rate, Determinants, Utilization, Insecticide-treated-Nets, Pregnancy, Malaria.
43 Contributors to Childhood Obesity in Bhutan: The Views of PHC Workers and School Staff , Article by Chimi Wangmo, Phudit Tejativaddhana, Mary Cruickshank, David Briggs
Objective: To explore the factors influences on childhood obesity in Mongar, Bhutan to notify and alert future improvement of a childhood obesity interventions for children in Bhutan. Study design: Qualitative study. Methods: Interviews of a purposeful sample with primary health workers and school health coordinator in one district in Bhutan were arranged to explore their perceptions related to the factors contributing to childhood obesity. 11 Primary healthcare workers and two school health coordinators were included. All the discussions were transcribed verbatim in English and iterative thematic approach was used for data analysis. Results: In general, the causes of childhood obesity were perceived to relate to macro-level policy influences, the school environment, sociocultural factors, and family and individual behavioral factors, acting in combination. Conclusion: The findings suggest that primary healthcare workers and school health coordinators have their own views on the causes of childhood obesity which involved behavioral, structural and social causes. A prominent emerging theme was the need for interventions like health workers and public awareness and support for a healthy environment. Any local initiatives in Mongar Bhutan are unlikely to be successful without such support. Keywords: Bhutan, primary health workers, school health coordinator, childhood obesity, exploratory.
44 Sociodemographic Determinants of Outcome of Newborn Admission in Federal medical Center Owerri, Nigeria , Article by Emerenini Franklin C, Ezeofor Tochi C
Introduction: There has been a global decline in infant mortality without an equivalent decline in newborn mortality. Several studies have investigated the influence of each disease entity on childhood mortality concluding that severity of the disease is a major contributor to outcome. However, only few studies have evaluated the influence of social factors in the outcome of newborn hospitalization. This study aimed to investigate the influence of social and some demographic factors on early neonatal hospital admission. Methods: The study was a descriptive retrospective cross-sectional review of clinical records of 170 newborn admitted in to the Special Care Baby Unit of Federal Medical Centre Owerri form May 2014 – May 2015. Case files of all newborn admitted during this period were reviewed and data collated and analyzed using SPSS version 20. Chi-Squared and Odds Ratio were calculated. Results: a total of 170 newborn were admitted, 10 (6.0%) died while 157 (94.0%) were discharged, the outcome of three admissions were missing. Fathers’ education and occupation play significant role in neonatal survival OR 3.23 (1.08- 10.06) p-value 0.04 and OR 6.36 (1.83 – 22.17) p-value 0.004 respectively. Newborn of fathers’ and mothers with paid employment had better outcome. Conclusion: This study demonstrated that paid employment is associated with better outcome of newborn admission. Keywords: Newborn Admission, Federal Medical Center Owerri.
45 Predictors of Treatment Outcomes among Tuberculosis Patients Treated in Specialist hospital, Sokoto State, Nigeria , Article by Nuruddeen Aliyu, Bello Arkilla Magaji
Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide, and the leading cause from a single infectious agent (above HIV/AIDS). Globally, 10.0 million people developed TB disease in 2017 with an estimated 1.6 million deaths. We conducted this study to determine predictors of treatment outcomes among tuberculosis patients treated at specialist hospital, Sokoto State, Nigeria. Methods: A retrospective cohort study was conducted using medical record of 1501 patients treated of tuberculosis between January, 2014 and January, 2017. Treatment outcomes and TB cases were classified according to National TB control program guidelines. Bivariate and multivariate analysis was conducted to identify predictors of unsuccessful treatment outcomes. Odds ratio (OR) and 95% confidence interval (CI) was calculated. P- value of 0.05 was considered as statistically significant. Result: Of the 1,501 patients treated; 72.2% were males with mean age of 36.5 ±14.9 years. Pulmonary TB accounts for 1,143 (76.2%) cases. A total of 174 (11.6%) were co-infected with HIV. successful outcomes accounts for 1,229 (81.9%) cases. Previously treated cases 89 (5.9%). Of the cases, 44 (2.9%) died. Being previously treated (P < 0.001) and co-infection with HIV(p<0.001) are independent predictors of poor treatment outcomes. Conclusion: The treatment success rate was low as compared to the national target. Therefore, targeted interventions of high-risk patients are recommended. Keywords: Tuberculosis, Treatment outcomes, DOT, Sokoto.
46 A Critical Assessment on the Need for Integrating Alternative Birth Attendant into Prevention of Mother to Child Transmission of HIV (PMTCT) Programme in Ekiti State, Nigeria , Article by Charles Olusegun Doherty, Remi Ajayi, Yemi Ajumobi
Background: The 2014 National ANC Sero-prevalence Survey result for Ekiti State, Nigeria recorded HIV prevalence rate of 2.9% for the state, yet the uptake of PMTCT services was found to be low despite the availability of services even in the remotest local government area in the State. This survey investigated factors influencing the low patronage of government facilities and the possibility of integrating TBA/MBA into the PMTCT programme in the state. Methods: Study conducted in the sixteen local Government area of Ekiti State. The sample size was 160 women of reproductive age (18-48) years of age, 35 ABH, and their clients (122), research period of 12 months. The instruments used were questionnaire, unstructured personal interviews and documentary reports. Data were collected and analysed by the use of Statistical Package for Social Sciences (SPSS 20) Software. Results: Of the 16 LGAs in Ekiti State, 14 participated in the survey. Reasons for patronizing TBA/MBA are spiritual assistance 40%, Low bills 10%, Church influence 5.5%, availability 3.4%, personal relationship 7.6%, and other minor reasons. Less than 45%”, 32% of the respondents have very low knowledge of HIV; its mode of transmission and prevention, and 32% also score above 79% (Very good knowledge). 76% of the respondents have linkage system with the Government health facilities, while 24% respondents (24%) said NO. Conclusions: This study showed that integrating TBA/MBA in health care service can be very effective in promoting PMTCT in Nigeria. Keywords: Alternative birth Attendants, HIV, PMTCT, TBA, MBA, Government facilities.
47 Competence of Community Health Workers in conducting Malaria Diagnostic Test for Children Under-Five for Malaria Management in former Northern Bar El Ghazal-South Sudan , Article by Mubiru Denis
By 2012, the majority of malaria cases were diagnosed and treated clinically and only 25% of the health facilities had malaria diagnostic equipment (microscopy or RDTs) in South Sudan (HMIS, 2012). In 2017, the Government of South Sudan and malaria implementing partners started implementation of mRDT at community level. This study sets out to determine the competence of community health workers under ICCM while conducting malaria diagnostic test for children under-five for malaria management in former Northern Bar El Ghazal. Methods: A cross sectional study was conducted among 480 randomly selected CHWs. Data was collected using a questionnaire consisting of demographics, case management observation checklist, mRDT assessment checklist and competence factors and a focus group discussion guide. Analysis was done using stata V14 and thematic content analysis. Results showed that competence of CHWs in malaria case management was skewed to right; more than 80 percent of CHWs could rightly assess the danger signs of child, classify patient’s illness correctly, gives correct treatment, counsel and records correct relation between classification, diagnosis and treatment. CHWs scored between 75 and 86 percent on the nine important mRDT procedures and a few CHWs (less than 10%) scored below 40 percent on mRDT procedure competence assessment. In conclusion, the majority of CHWs were found to be competent in assessing and treating malaria sick children and conducting mRDTs. Therefore, use of mRDTs can be scaled at community level in South Sudan while strengthening competency determinants such as provision of equipment and supplies. Keywords: Competence, Community Health Workers, Integrated Community Case Management, Malaria Diagnostic Test for Children Under-Five, Malaria Management, mRDT Procedure, Malaria Case Management, mRDT Competence Assessment.
48 Factors Associated with Adherence to mRDT Test Procedure by Community Health Workers during Management of Malaria for Under-Five in former Northern Bar El Ghazal-South Sudan , Article by Mubiru Denis, Edhina Chiwawa
South Sudan Government and health partners started implementation of malaria Rapid Diagnostic Test (mRDT) testing at community level through Community Health Workers in 2017 in order to reduce malaria morbidity and mortality through improvement of malaria case management among children under five. Malaria diagnostic equipment were available at only 25% of the health facilities (HMIS Report 2012). This study was conducted to determine the factors associated with adherence to mRDT test procedure among Community Health Workers (CHW) while managing malaria for under-fives in former Northern Bar El Ghazal. Methods and materials: A cross sectional study design was conducted among 480 randomly selected CHWs. Mixed method data collection methods were conducted by using questionnaire for quantitative data which was divided into three sections; demographic, mRDT assessment checklist and adherence factors and focus group discussion guide for qualitative data. Quantitative data was analysed using stata Version 14. Pearson correlation product moment, chi-square, odds ratio and logistic regression were used to ascertain the association. Qualitative data was analysed using thematic analysis and triangulation was done. Results showed that 30% of the CHWs adhered to mRDT test procedure 100%. Workplace environment (p=0.02), education (p=0.00) age (0.04), equipment and supplies(p=0.01) and documentation and reporting (p=0.02) tools availability were found to be significantly associated with adherence of CHWs to mRDT test procedures. Conclusion: Education, age, workplace environment, equipment and supplies and documentation and reporting tool were significantly associated with adherence of CHWs to mRDT test procedure. Therefore, selection criteria should emphasise education and age. Also programme implementers should provide tools to facility conducting of mRDTs. Keywords: Individual, community, program, Factors, Adherence, mRDT Test Procedure, Community Health Workers during, Management of Malaria for Under-Five, mRDT Procedures, Individual, community, program, Northern Bar El Ghazal.
49 Factors Associated with Adherence to mRDT Test Procedure by Community Health Workers during Management of Malaria for Under-Five in former Northern Bar El Ghazal-South Sudan , Article by Mubiru Denis, Edhina Chiwawa
South Sudan Government and health partners started implementation of malaria Rapid Diagnostic Test (mRDT) testing at community level through Community Health Workers in 2017 in order to reduce malaria morbidity and mortality through improvement of malaria case management among children under five. Malaria diagnostic equipment were available at only 25% of the health facilities (HMIS Report 2012). This study was conducted to determine the factors associated with adherence to mRDT test procedure among Community Health Workers (CHW) while managing malaria for under-fives in former Northern Bar El Ghazal. Methods and materials: A cross sectional study design was conducted among 480 randomly selected CHWs. Mixed method data collection methods were conducted by using questionnaire for quantitative data which was divided into three sections; demographic, mRDT assessment checklist and adherence factors and focus group discussion guide for qualitative data. Quantitative data was analysed using stata Version 14. Pearson correlation product moment, chi-square, odds ratio and logistic regression were used to ascertain the association. Qualitative data was analysed using thematic analysis and triangulation was done. Results showed that 30% of the CHWs adhered to mRDT test procedure 100%. Workplace environment (p=0.02), education (p=0.00) age (0.04), equipment and supplies(p=0.01) and documentation and reporting (p=0.02) tools availability were found to be significantly associated with adherence of CHWs to mRDT test procedures. Conclusion: Education, age, workplace environment, equipment and supplies and documentation and reporting tool were significantly associated with adherence of CHWs to mRDT test procedure. Therefore, selection criteria should emphasise education and age. Also programme implementers should provide tools to facility conducting of mRDTs. Keywords: Individual, community, program, Factors, Adherence, mRDT Test Procedure, Community Health Workers during, Management of Malaria for Under-Five, mRDT Procedures, Individual, community, program, Northern Bar El Ghazal.
50 The Prevalence and Determinants of Overweight, Obesity, and Hypertension in a Bank in Birnin Kebbi, Kebbi State, North-West Nigeria , Article by Idris Muhammad Yakubu
Cardiovascular disease is the leading cause of death globally. Overweight, obesity, and hypertension are the top modifiable risk factors for cardiovascular diseases. Sedentary lifestyle, unhealthy eating, and stress in the banking industry predispose employees to overweight, obesity, and hypertension. The study was a cross-sectional survey of 52 employees of a bank in Birnin Kebbi, North-East Nigeria that participated in a healthy lifestyle program. The aim of the study was to determine the prevalence and determinants of overweight, obesity, and hypertension in bank employees. The data was collected using an interview schedule, anthropometric and blood pressure measurements and analyzed with statistical package for social sciences. The participants aged 26 to 59 years, 65.4% were youth, 34.6% middle-aged, 94.2% men, and 5.8% women. Senior staffs constituted 53.8%, junior 38.5%, and executive 7.7%. The mean weight was 77.99 ± 12.4kg, height 1.72 ± 0.07m, Body Mass Index 26.38 ± 3.93Kg/m2, systolic blood pressure 122 ± 21mmHg, and diastolic blood pressure 76 ± 14mmHg. The prevalence of overweight was 50%, obesity 15.4%, and hypertension 28.8%. Gender was significantly associated with overweight (p .037). The relationship between obesity and hypertension was not statistically significant (p 0.056). Lifestyle modification in form of regular exercise and healthy eating would reduce overweight, obesity, and hypertension as well as cardiovascular morbidity and mortality in the banking industry. There is the need to establish workplace gymnasium and to increase public health awareness on healthy eating and regular exercise. Keyword: Prevalence, Determinants, Overweight, Obesity, Hypertension, Bank.
51 Factors associated with Congenital Abnormalities in North-East Nigeria: A Case Study of Al-Manzoor Diagnostic and Clinical Services, Bauchi, North-East, Nigeria , Article by Idris Muhammad Yakubu
Congenital malformations are rare disorders, but the prevalence is on the increase globally due to access to imaging modalities, particularly ultrasound. Severe congenital abnormalities are not compatible with life leading to miscarriages while others cause fetal, neonatal, infant, and under-five morbidity and mortality. Ultrasonography provides a safe tool for the early diagnosis of congenital abnormalities in pregnancy. This study used a quantitative cross-sectional approach to determine the factors associated with fetal congenital abnormalities in 11 pregnant women diagnosed by ultrasound between January and June 2019 in a private diagnostic center in Bauchi, North-East Nigeria. The primary data was collected using interview schedule and analyzed with statistical package for social sciences. The most common anomaly (33%) was central nervous system abnormality (hydrocephalus - 75% and anencephaly - 25%). The congenital abnormalities were associated with fever in first trimester (100%), poverty (82%), being a housewife (82%), multigravida (73%), illiteracy (73%), 18-27 age group (55%), and ingestion of herbs in the first trimester (54%).  Hydrocephalus was associated with ingestion of drugs and herbs in first trimester and maternal occupation; anencephaly with maternal occupation, spouse occupation, and poverty; fetal ascites with advanced maternal age >38 years and grand-multiparity; and multicystic dysplastic kidney disease with spouse occupation (p .05). Health education, avoidance of drugs and herbs in first trimester, access to healthcare, family planning, and poverty alleviation will prevent congenital abnormalities, reduce feto-maternal morbidity and mortality, and improve maternal and child health in Nigeria and other developing countries. Keyword: Congenital Abnormalities, Factors, Pregnancy, Ultrasound, Nigeria.
52 The Proportion and Nature of Disrespect and Abuse during facility-based care in a rural and an urban setting in Kano, northwest Nigeria; A mixed-method study , Article by Emmnuel Ajuluchukwu Ugwa, Joshua Nweke, Oluchukwu Emmanuel , Iwasam Elemi Agbor
Objectives: Disrespect and abuse is noted to be high but poorly reported, especially in northern Nigeria. This study was undertaken to determine the proportion and nature of disrespect and abuse of women during childbirths in health facilities at selected locations in Kano, a north-west Nigerian State Method: Ethical approval and informed consent were obtained. The study adopted quantitative and qualitative data collection methods. A sample size of 292 women who delivered in the past 1year preceding the study. Quantitative data was analyzed using descriptive statistics (frequencies, percentages, means and standard deviation) and inferential statistics (chi-square). Qualitative data was analyzed along themes using Atlas.ti. P value is ≤ 0.05 was considered statistically significant. Results: The average age of the respondents was 28.3±6.9 years. Most of the respondents were aged 25-29 years, mostly married (96%), housewives (68.8%), of Hausa tribe (85.1%) and had primary education (52.2%). About 50.7% were urban and 49.3% were rural residents. Averagely, 46.5% said that they experienced D&A during care but it was more in urbn (76.3%), compared to rural (18.30%). More than one type of D&A occurred in most individual (76%) mainly at multiple service points, but physical abuse is the most recurrent in various mix. Among types of D&A occurring singly, non-consented care and non-confidential care were mostly reported. Downward pressure placed on the abdomen before baby was born, being blamed for something that happened to them or their babies, health workers did not provide explanations for procedures and sexual abuse were also reported. Conclusion: D&A is common in health facilities in both rural and urban settings of Kano. However, D&A was higher in urban compare to the rural areas. The proportion among urban women was higher than that reported in a previous study in Kano. Although D&A types commonly occurred as a mix. Further studies to explore the determinants and recommendations for D&A are necessary. Keywords: Proportion, Nature, Disrespect, Abuse, Health Facility, Nigeria.
53 Practice and Correlates of Widowhood Rites in A City in North Central Nigeria , Article by Aderibigbe Sunday Adedeji, Lawal Mariam Onyiohu, Olubiyi Simeon Kayode, Akande Oluwatosin Wuraola
Objectives: This study determined the practice and correlates of widowhood rites in a city in North-central Nigeria. Methodology: A descriptive cross-sectional design was used for the study. Multistage sampling technique was used to recruit 450 respondents into the study. Interviewer administered questionnaire and two focus group discussions were used for data collection. Data analysis was done using Epi-info version 3.5.3. A p-value of 0.05 or less was regarded as statistically significant. The study included all males and females over 18years of age residing in Ilorin South Local Government Area. Results: The age range of respondents was between 20 – 79 yrs. A quarter of all respondents (25.9%) were in the fifth decade of life. Widowhood rites commonly practiced in Ilorin South LGA as identified by more than 70% of the respondents include; preventing the widow from going to the farm and market during the mourning period and preventing her from doing household chores. About 16.2% of respondents had ever practiced one or more forms of widowhood rites. There was a statistically significant relationship between age, gender, religion, marital status, educational level, ethnicity and occupation of respondents and the practice of widowhood rites (p< 0.05). Conclusion: Widowhood rites are observed across different categories of people. Age, gender, religion, marital status, educational level, ethnicity and occupation were significantly associated with practice of widowhood rites. There is a need for legislation against harmful widowhood rites by relevant stakeholders. Keywords: Widowhood Rites, Ilorin, Nigeria.
54 Factors affecting Disrespect and Abuse during facility-based care in rural and urban setting in Kano, northwest Nigeria; A mixed-method study , Article by Emmanuel Ajuluchukwu , Oluchukwu Emmanuel , Iwasam Elemi , Joshua Nweke
Objectives: This study was undertaken to explore various factors affecting disrespect and abuse (D&A) of women during childbirths in health facilities in selected locations in Kano, a north-west Nigerian State. Method: Ethical approval and informed consent were obtained. The study adopted quantitative and qualitative data collection methods. A sample size of 292 women who delivered in the past 1year preceding the study. Quantitative data was analyzed using descriptive statistics (frequencies, percentages, means and standard deviation) and inferential statistics (chi-square). Qualitative data was analyzed along themes using Atlas. ti. P value is ≤ 0.05 was considered statistically significant. Results: The age group 25-29years had the highest proportion of D&A (61.84%). Those who were single had more proportion of D&A (55.6%) compared to those who were married (45.7%). The women that leaved in urban setting (75.3%) had more proportion of D&A compared to those who lived in a rural setting (18.3%). The proportion of D&A was highest among parity group 7-8 (100%). D&A greater if the respondent spends 2days (95.7%) and above in the hospital compared to when they spent <2 (45.8%). 94.2% of those who will not recommend the facility for delivery had D&A compared to 22.4% of those who will recommend the facility. Health system inadequacies including lack of supervision, poor remuneration, inadequate staffing and supplies were common barriers mentioned. Conclusion: Socio-demographic, obstetrics, level of health facility, health system inadequacy and social class affect occurrence of D&A. improved socio-demographic status and health systems can reduce the occurrence of D&A. Keywords: Factors; Disrespect; Abuse; Health Facility; Nigeria
55 Public Health Implications of Heavy Metal Contamination of Leaves and Stems of Amarantus Hybridus (African spinach) Consumed in Nigeria , Article by Oche Joseph , Abiodun Olaiya Paul, Stephen Emmanuel
The objective of this study was to measure the concentration and pattern of distribution of Cd, Cr, Co, Cu, Mn, Ni, Pb, and Zn on the leaves and stem of Amaranthus hybridus (African Spinach) one of the most consumed leafy vegetables in Nigeria with an estimated population of over 200 million people, findings from this study showed that with the exception of Cd and Co two heavy metals of public health importance, the results of the analysis for heavy metals using atomic absorption spectrophotometer were within the maximum permissible limits set by FAO/WHO Committee of the Codex Alimentarius Commission and Agency for toxic substance disease registry (ATSDR). The results showed that while the values for Cd were within acceptable limits in the leaves, the concentration in the stem ranged of 0.007 to 0.3358 ppm above the maximum limit of 0.1ppm. The result also showed the presence of Co at a concentration of range of 0.1289 to 0.3487ppm in the leaves and 0.1470 to 0.3719 ppm in the stems above the maximum permissible limit set by the Agency for Toxic Substance Disease Registry (ATSDR) of between 0.05 to 0.1 ppm. The potential consequences of exposure to harmful substances, on either a population or an individual basis, is a fundamental concern in epidemiology and public health, these findings have major public health implication for food safety and quality as the likely accumulation of Co and Cd in the body through diets over a long period of time can further complicate the current public health crisis in Nigeria.
56 Factors Associated with Choice of Place of Delivery and What Motivates Mothers to OPT for TBA Care in West Pokot County- Kenya , Article by Ezekiel Sirya, Edwin , Joseph Rotich
Background: Skilled birth attendance in Kenya declined from 50% in 1988 to 42% in 2003, remained the same by 2008/9 increased to 62% by 2014. By 2008/09, only 43% of births took place at HFs by SBAs while 58% occurred at home. Socio-demographic factors could be attributed to this. Objective: To determine factors influencing mothers’ choice of place of delivery and motivating them to opt for TBA care. Methods: Descriptive cross-sectional study of 375 women. Both quantitative and qualitative data obtained from semi-structured questionnaires and FGDs/KIIs respectively. Statistical techniques; analysis using (SPSS V.20). p<0.05 significant. Results: Majority 340 (90.7%) delivered at home. Education (p<0.001) and religion (p<0.003) were significant predictors. Secondary level education 1.6 times more likely to choose HF delivery. Catholics 4 times and protestants 6 times more likely to deliver at HF compared to non-believers (OR; 95% CI: 3.618(0.715-18.305) and 6.162(1.401-27.102). Socio-cultural beliefs and practices were main impediment to HF delivery. Conclusion: HF delivery found to be low (9.3%) compared 61% national. Level of education and religion impact positively HF delivery whereas socio-cultural beliefs and practices, lack of transport and availability of TBAs main bottlenecks. Recommendation: A comprehensive program on safe motherhood by RH actors to be designed focusing on TBAs and socio-cultural beliefs and practices. Keywords: Place of delivery, skilled birth attendance, socio-cultural beliefs.
57 Diabetic Retinopathy Related Health Educational Intervention - A Contextual and Evaluation Based Design , Article by Gopi Suresh Vankudre, Galal Ismail
Introduction: In the 8th edition of the diabetic report (2018), the age-adjusted Diabetes mellitus prevalence among the Omani adult population was 12.6%. In Oman, the prevalence of DR among diabetics ranges from 14.5% to 42.2%. 10% of this population has an irreversible visual blindness. A pilot study within the population highlighted diabetic retinopathy related awareness and knowledge rift. Cost-effective DR related health promotional activities can reduce the barrier of lacking knowledge leading to the disease burden. Aim: To design an assessment based, validated contextual model of a Diabetic Retinopathy (DR) related to health promotion. Material and Methods: The study followed an evidence-based approach while designing the DR health promotion resource. Our initial surveys tested the DR related knowledge and perception towards current diabetic retinopathy related health promotional tools among Omani population. We used Elsevier (2015) guidelines while structuring these evidences. Results: The duration of the designed health intervention is six minutes fifty-one seconds. The presentation included information on managerial and rehabilitative options. It provides the health education material with no cost or discrimination to the community. The video format is compatible with most of the web browsers. Users can download and view it on personal computers, mobiles or tablets. Conclusion: This study provides a contextual and evidence-based approach for the design of a DR health promotion tool. It can be circulated with no cost or discrimination within the Omani community. Keywords: Diabetic retinopathy eye-health education, eye-health promotion.
58 Prevalence of Schistosoma Haematobium Infection in Nigeria: A Retrospective Case Study in Kuje Village, Federal Capital Territory, Nigeria , Article by A. A Ogundeji, A Salami, O.E Ogundeji, J Ajobiewe, O.M Akinsola
Background: In Nigeria, urinary schistosomiasis was considered a public health problem associated only with the rural communities. Objectives: In this study, the prevalence of Schistosoma haematobium infection presenting at Kuje General Hospital and Zionness Medical Centre (newly developed modern estate) were carried out in retrospect to determine whether the distribution S. haematobium infection rate had a particular trend. Methods: The available records of patients referred for urinalysis between 2011 and 2014 were retrospectively reviewed and analysed. Results: Prevalence of S. haematobium infection at Kuje General Hospital (an urban poor community) was analysed to be 13.4% whilst Zionness Medical Centre (a peri-urban settlement) recorded 7.9%. The infection was higher among males (69.7%) than the females (30.3 %) as observed and recorded at both hospitals. Conclusions: It was concluded that the urban poor communities around Kuje General Hospital are seriously affected by S. haematobium infection as compared to Zionness Medical Centre. Agricultural, economics and recreational activities of these communities’ members living around the river bank in addition to problem associated with lack of good household water supply might possibly account for the high risk of the infection in the urban poor communities that surround the Kuje General Hospital. Keywords: S. haematobium, Prevalence, Urinalysis, Peri-urban settlement.
59 Assessment of Level of Community Pharmacists’ Knowledge and Involvement in Tuberculosis Case Detection and Management in Lagos State, Nigeria , Article by Ukamaka G. Okafor, Ibrahim Oreagba
Introduction: Nigeria is the third highest Tuberculosis (TB)-burden country in the world and number one in Africa. Level of TB case detection and control is low. Community pharmacists can be trained to provide TB case detection of new patients and management of patients who had been earlier assessed and treatment initiated in the hospitals. Aim: To assess the level of Community Pharmacists’ knowledge and involvement in Tuberculosis case detection and management. Methodology: This is the first phase of the interventional study that was aimed at scaling up community pharmacists’ involvement in tuberculosis case detection and management. A cross sectional descriptive study was carried out on 285 randomly selected Community Pharmacists in Lagos State using a multi-staged cluster sampling method and structured questionnaire, followed by Focus Group Discussions and Key Informant Interviews. Results: Knowledge on TB cause, transmission, signs and symptoms was high, 98%, 95.5% and 88.1% respectively while 73.15% of the pharmacists said they have identified clients suspected of having pulmonary TB. Of the Pharmacists that have identified clients suspected of having pulmonary TB, majority (65.7%) had referred them to the health centres. Only 15.4% of the pharmacists were involved in DOTs with TB patients. Correct knowledge of duration of treatment was found among 83.6% of respondents. Conclusion: Community Pharmacists are highly knowledgeable in TB cause, transmission, signs, symptoms, regimen and duration of treatment and are informally involved in TB case detection and management. Keywords: Community Pharmacists; Tuberculosis; Knowledge; involvement; Case Detection, Scaling-up.
60 Correction of Refractive Error: Adolescents’ Choice , Article by Janitha Plackal Ayyappan, Galal Ismail , Kalyani Mohanraj
Objectives: To identify methods of refractive error correction preferred by adolescents in the rural region of India. Materials and Methods: A quantitative cross-sectional, questionnaire-based study was conducted to investigate the choices of refractive correction among teenagers in the junior college, rural district of India. A purposive sampling was done to complete the required sample size. Inclusion criteria for the study was considered as, students who enrolled in the four majors of programme i.e., BiPC (biology, physics and chemistry), MPC(maths, physics and chemistry), HEC (history, economics and civics), CEC(commerce, economics and civics) and Vocational; including CS&E (computer science and Engineering) and A&T(accountancy and taxation). Age ranged from 16-18 yrs. Exclusion criteria; students who were over 18 yrs. were excluded from the study. A self-designed questionnaire was used to obtain the data. Content validation and test-retest were conducted prior to administration of the questionnaire. Results: Total N= 631 participants from four majors were included in the research. The results reveal a 57% of the samples preferred spectacle lens to correct refractive error closely followed by 41.5% of adolescents choosing contact lenses. Contraindication (46.1%) was suggested as a hindrance to the use of contact lens while only 15.5% chose affordability and (38.4%) listed as an occupation is the key factor to not to use contact lenses for correcting refractive error. Most salient features in the research are that more than half of the population considered eye hospital as the healthcare facility to seek in case of inadequate vision. Conclusion: The study concludes that there is a lack of awareness related to primary eye care among the said population, emphasizing the role of eye care professionals in the public health sector. Keyword: Preferences, Refractive Error, Adolescents, Refractive Correction, and Methods.
61 Prevalence of Sexual Violence and Health Related Effects Among Students in Co-Education Public Day Secondary Schools in Kinondoni Municipality, Dar Es Salaam ,  Article by Simeo Japhet
Objective: Sexual violence is a completed or attempted sex act against the victim’s will or involving a victim who is un­able to consent such as abusive sexual contact, forced abortion, forced prostitution, trafficking, non-contact sexual abuse and female genital mutilation. The Purpose of the study was to assess prevalence of sexual violence and health related effects among students in co-education public day secondary schools in kinondoni municipality, Dar es Salaam. Methods: A descriptive cross-sectional study in Kinondoni municipality, Dar es Salaam region. Form four students were systematically selected from 5 randomly selected co-education public day secondary schools which were Makoka, Kigogo, Makurumla, Turiani and Manzese. Self-administered questionnaire with closed ended questions were administered. Results: A total of 430 form 4 students from 5 out of 48 coeducation public day secondary schools with mean age 17.5±1.0 years, range of 15-22 years participated in this study. About 216 (50.2%) experienced at least one form of sexual violence. Chi square test showed higher proportion of students (61.5) who were victims of sexual violence were aged ≥ 18 years than those (41.9%) aged <18 years (P value < 0.05). About 39(33.3%) of 117 female victims were impregnated. Higher proportion (45.6%) of 215 students experienced Low self-esteem by higher proportion (59.3%) of female than male students (28.9%) (p value <0.001). Study limitations: Concealment of information due to sensitivity of questions asked during interviews. Conclusion: This study has shown that sexual violence and health related effects were reported more by female than male students.
62 Effective Training of Schoolteacher for Vision Screening: Strategic Control of Visual Impairment in Schoolchildren , Article by Mohammad Junaid Siddiqui, Imran Mehboob Baig , Arjumand
Introduction: Vision helps to perceive details of surroundings and regarded as the most important tool for learning for schoolchildren. World Health Organization (WHO) has prioritized vision screening in schools to decrease the burden of visual impairment (VI) in children. Any change in vision can be identified by schoolteachers when a child has difficulty in seeing the black board and reading books. Aim: This study is aimed to see if visual screening training to schoolteachers can effectively be used to detect VI in children. Material & Methods: Visual screening of 1134 eyes of 567 students was done by both the investigator and school teachers and results were formulated and compared. There was no difference in result in 66.31 % eyes. Investigator recorded better visual acuity (VA)+ with a 1-line difference in 14.55% eyes and two lines difference 3.35% eyes. Whereas, teachers recorded one-line better VA in 12.79% eyes and two lines better VA in 3% eyes. Result: Out of 578 students from the three different schools of Allahabad district, from class 3 to 6, majority (267) belonged to school 3, whereas school 1 had the least (142) number of students. Conclusion: The present study has identified the role of teachers as visual screeners in schools. The procedure is cost effective and require only visual screening training to the schoolteachers, so they can be used effectively for early detection of reduced vision in schoolchildren. Keywords: Visual screening, health screening, visual impairment, schoolteachers, schoolchildren.
63 Measles Immunization Research Western Lake State, South Sudan , Article by Nebiyu Lera Alaro
Most global estimates indicate that more than 1 million children a year die from acute measles. The actual number of deaths may, however, be considerably higher than this. In addition, the impact of delayed mortality as a result of measles infection is only now being realized. Many months after they contract measles, children continue to experience higher levels of mortality and morbidity than those who do not. Immunization of children against measles therefore prevents mortality and morbidity not only during the acute phase but also during subsequent months. The impact of measles immunization programmes may therefore have generally been underestimated. The effects of measles infection on children during the early months of life are more damaging than those experienced by older children. Children should therefore be immunized against measles as early in life as possible, given the limitations of existing vaccines. As per DHIS, measles coverage amongst children below one year achieved in the first 10 months of 2018 is 56%. This is slightly lower of what was reported in previous years (going back to 2015, when CUAMM started working in Rumbek East) In a context as South Sudan, where several households live far from the nearest Health Facilities and are used to nomadic habits, it is common for children to access EPI services later than the regular immunization schedule, which stipulates getting vaccinated against measles after the first birthday. However, even merging U1 and U2 vaccinated children, the coverage of U5 population remains extremely low, not surpassing 30%. Keywords: Expanded programme on Immunization, Vaccinated, Children Under five, measles coverage, Rumbek East, Western Lake state.
64 Epidemiological Study on Hand Hygiene Practices Among Health Care Workers at Infectious Diseases Hospital Kano, Nigeria , Article by Ahmad Salisu Aliyu, Bello Aminu Bello, Maimuna Yahaya Yakasai, Nuru Yakubu Umar
Background: Effective hand hygiene is essential for reducing healthcare associated infections. However, compliance of healthcare workers to hand hygiene guidelines are reportedly poor. It is important therefore to instill adequate knowledge and good attitudes and practices at the time of primary training of the healthcare workers. The aim of the study was to assess hand hygiene practices among healthcare workers in Infectious Diseases Hospital Kano, Nigeria. It was hoped that the study would benefit all health care workers through making recommendations aimed at improving hand hygiene compliance. Methods: Quantitative, Cross-sectional study, using a self-administered Questionnaire to collect data on 260 participants. The results were analyzed using SPSS version 24.0. Results: The result shows that 260 participants responded to the questionnaire. The majority of participants had good knowledge of hand hygiene and younger participants practiced hand hygiene more than older ones (p<.05). Conclusion: The study highlighted the practices of hand hygiene among health care workers and the status of hand hygiene resources in the hospital which have a negative impact on hand hygiene practices demonstrated that compliance with hand hygiene compliance among health care workers remains unacceptably low, despite the irrefutable scientific evidence that hands are the most common vehicle for transmission of pathogens. A hospital-wide awareness program aiming at healthcare workers and adoption of alcohol-based hand rubs at the point of care can help improve compliance to hand hygiene. Keywords: Hand hygiene, Health care workers, Hand hygiene practices, Health care associated infection, Resource.
65   Outcomes and Determinants of Treatment Adherence among HIV Patients on Art: Evidence from a Retrospective Cohort Study in Selected Clinics in Windhoek, Namibia , Article by A. Ntumba, J. Nakaluudhe, L. Kazembe
Background: Treatment adherence is critical in the management of patients receiving antiretroviral therapy (ART). Objective: To investigate determinant of treatment adherence and health-related outcomes after ART initiation in Windhoek, Namibia. Methods: We used data from retrospective cohort from January 2010 to December 2015. We defined ART adherence at 95%, while non-adherence at <95% . We examined two outcomes: viral suppression and body weight at 6 and 12 months.. We then investigated the relationship between patient individual outcomes and treatment adherence. We applied multivariate binary and multinomial logistic regression models to examine the determinants of ART adherence and outcomes. Results: Of 943 patients on ART, 58.9% were female, 82.1% aged between 25 to 49 years old and 86.6% ever married. Viral suppression at 6 months (p<0.000), and 12 months (p<0.000), and patients’ body weight at 6 months (p = 0.009) were significant more pronounced with ART adherence.. Regarding determinants of ART adherence, the results showed age between 25 and 29 years, and married was associated with higher adherence (OR=1.94, CI: 1.12-3.14). Patients at WHO clinical stage-I were more likely to adhere to treatment (OR=1.28, 95% CI: 1.01-1.73), while those at clinical stage-II were less likely (OR=0.41, 95% CI: 0.18-0.91, p-value = 0.028). Conclusion: ART adherence leads to better outcomes.. Both demographic and clinical factors were associated with ART adherence. Future research should consider evaluating the effect of adherence to an extended coverage of clinics, and allow collecting more detailed factors that are associated with treatment adherence.
66 Evaluation of the Adherence and Viral Load Completion Accomplishments After Antiretroviral Therapy Initiation-Namibia , Article by A. Ntumba, L. Kazembe
Background: Namibia enrolled 93% of HIV patients into ART programme. Objectives: To evaluate adherence and viral load completion accomplishments after ART initiation. Methods: Retrospective cohort study using quantitative method. SPSS was used to analyze the data. Three sets of analyses reported. First compare the age, sex, CD4 and adherence to ART. Then patients with ≥95% adherence to those <95% and viral suppression at 6 and 12 months. Results: About 69% adhered to treatment at least 95%. Of the 614 patients with viral load records, 73.3% (n=450) had viral suppression at 6 months. At 12 months, a total of 518 with viral load records,85.9% had viral suppression. Among the patients with adherence of at least 95% at six months, 75.2% had viral suppression. At 12 months, 89.4% of patients who adhered at least 95% of ART had viral suppression. In multivariate binary regression, the study revealed that those who adhered more than 95%, were 1.65 times more likely to suppress the virus compared to those who did not (p=0.029). The results further showed that having CD4 > 200 at ART initiation was likely to be associated with viral suppression (OR=1.55, 95% CI 1.03-2.33). Conclusions: The adherence to ART, viral load accomplishments, viral suppression did not reach the expected outcomes, targets set by UNAIDS. Although, close to 90% of patients at 12 months showed viral suppression, the number of patients checked for viral load were far from 90% of patients (about 54.5%) ever started on ART. Keywords: HIV; Antiretroviral Therapy; ART adherence; viral load completion accomplishments, viral suppression, UNAIDS targets.
67 Determinants of HIV Positive Infants Treatment Gaps in the Centre Region , Article by Jemia Gordon
Studies from sub-Saharan Africa have highlighted significant challenges in providing antiretroviral therapy (ART) to HIV positive Infants. In these studies, just 24% of HIV positive children are on treatment and in Cameroon Just 18% (UNAIDS, 2017), there are still gaps involved in treatment of these infants. This study aimed at evaluating the treatment gaps and identifying the health care system factors influencing the treatment gaps among HIV-positive infants in the Centre Region of Cameroon. The study was an observational study in which interviews were done in health facilities. Results obtained showed that the main factors that are influencing treatment gaps are occasional stock outs of ARVs and Patients who still find it difficult to accept their status. The factors influencing treatment gabs among HIV-infected infants did not show any difference between rural and urban areas (p=0.204). The main recommendation from this study is that health workers should be trained on Supply chain management.
68  Impact of Eye-Health Motivational and Counselling Intervention Programme on Eye-Health Seeking Behavioral Intentions among Commercial Drivers at Ikeja, Lagos State, Nigeria , Article by Priscilia Uhuanmwen Imade, Nnodimele Onuigbo Atulomah
Eye-health seeking behavioural intentions of commercial drivers is of immense concern considering that driving requires accurate vision because poor vision could result in fatal road accidents. This study was guided by the Information-Motivation-Behavioural-skills-model as a theoretical underpinning to evaluate the impact of eye-health motivational-counselling intervention programme on eye-health seeking behavioural intentions and driving outcomes among commercial drivers in Ikeja local Government Area of Lagos State, Nigeria. Method: This study was a quasi-experimental design involving three major motor parks in Lagos State. Two interventions and a control group with 35 commercial drivers who consented to participate in the study were selected for each group. The designed intervention was based on a previous educational diagnosis of observed deficiencies of Eye-Health Seeking Behavioural-Intentions of commercial vehicle drivers and implemented for twelve-weeks with a control. Validated structured questionnaire, was employed for data collection. Mean scores of major variables were compared for baseline and follow-up of primary and secondary outcome measures using independent-samples t-Test and ANOVA at 5% level of significance. Results: Age-range of drivers was 18-60 years. There was no significant difference for major-variables in the study for all groups at baseline (p>0.05). At follow up, there was significant difference between intervention group two and group one for information (17.18±3.00 and 9.70±5.38; p<0.001), Motivation (33.81±6.55 and 31.33±3.79; p<0.001), Behavioural Skills (10.82±3.22 and 5.61±3.02; p<0.001), and Eye-Health Seeking Intentions and Driving Outcomes (22.94±6.88 and 19.52±6.06; p>0.05). Conclusion: The eye-health educational interventions with motivational-counselling showed more prospects of influencing positive behavioural change on eye-health seeking behaviour among commercial drivers. It is recommended that motivational-counselling be incorporated into driver’s education and strategies for effective management of eye-health and safe-driving in Nigeria. Keywords: Eye-Health-seeking, Health-Education, Motivational-Counselling, Information-Motivation-Behavioural -skills, Commercial-Drivers.
69 Prevalence and awareness of Diabetes Mellitus in Rural Communities of Abuja Nigeria , Article by Orji Ikechukwu Anthony, Ojji Dike Bevis, Ikechukwu-Orji Mercy Uchechi
Introduction: Globally, Diabetes mellitus is reckoned a disease of major public health concern. It is a key risk factor for heart failure, stroke and coronary artery disease. Diabetes contributes significantly to global morbidity and mortality, with more impact in developing countries such as Nigeria. In Nigeria, various studies have reported the prevalence of diabetes to vary across different zones of the country with some reporting an increasing prevalence in rural communities. Objectives: 1. To determine the prevalence of diabetes in rural communities of Abuja, FCT Nigeria. 2. To determine the awareness of diabetes in rural communities of Abuja. Methodology: A community-based cross-sectional study conducted in 2017 in selected communities of Abuja using a multi-stage sampling technique to sample 408 adult participants. Interviewer administered questionnaire was used to collect data and Glucometer used for blood sugar measurements following recommended guidelines while SPSS 20.0 version was used for data analysis. Univariate analysis was performed for Blood Sugar level while multivariate analyses were done to ascertain relationship of the various socio-demographic characteristics to diabetes. Results were considered significant at p-value < 0.05. Results: The prevalence of 4.4% was recorded for diabetes. Female sex and age 45 years and above, were independent predictors of diabetes in these group with appreciable awareness of the condition. Conclusion: The study recorded an increased prevalence of diabetes in rural communities of Abuja. This calls for intensive program directed at controlling diabetes among the rural populace. Keywords: Diabetes, prevalence, awareness, rural communities, Abuja.
70 Assessment of Efforts Made to Improve Patient Safety Related to Medication Safety, Infection Prevention and Quality Care among Addis Ababa Regional Hospitals, 2018 , Article by Tigist Tedla Mulugeta
Background: Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. Hospitalized patients face safety issues from different dimensions among those medication safety, infection prevention and quality of nursing care are most important once. Objective: The main objective of this study was to assess patient safety related to medication safety, infection prevention and quality of care and to explore efforts made towards controlling patient safety efforts among Addis Ababa regional hospitals, 2018 Methods: A qualitative study was conducted to assess patient safety among Addis Ababa regional Hospitals in terms of medication safety, infection prevention and quality of nursing care. Twelve interviews were conducted by principal investigator three interviews in each hospital on purposefully selected health care staffs representing the hospitals pharmacies, infection prevention team members and Head Nurses of inpatient wards on October, 2018 over a one-month period. Interviews were recorded, transcribed and results were summarized based on topics. Results and conclusions: Studies in Ethiopia showed that Patient safety related to Medication safety, infection prevention and Nursing care quality is not encouraging but still effective monitoring efforts aren't in practice among Addis Ababa regional hospitals even though recommended by the EHRIG (Ethiopian hospital reform implementation guideline, 2010). Keywords: patient safety, medication safety, infection prevention, quality care.
71 Educational Diagnosis of Eye-Health Seeking Behavioural-Intentions Among Commercial Vehicle Drivers in Ikeja, Local Government Area, Lagos, Nigeria , Article by Priscilia Uhuanmwen Imade, Nnodimele Onuigbo Atulomah
Eye-health is an important indicator of quality of life. Impairment of visual acuity is considered a great loss of function for those whose vocation depends greatly on excellent visual function such as professional drivers among others. This study was designed to conduct an educational diagnosis of Eye-Health Seeking Behavioural-Intentions of commercial vehicle drivers in Ikeja, Nigeria. Findings from this study would inform a follow-up intervention to strengthen any inadequacies. Method. A cross-sectional study aimed to determine adequacy of factors involved in Eye-Health Seeking Behavioural-Intentions of commercial vehicle drivers in Ikeja, Nigeria was implemented on 103 drivers who were purposively selected following consent to participate after ethical approvals. Instrument developed measured Information-Adequacy about eye-health on 20-point, Reinforcing-Enabling Factors on 60-point scale and Eye-Health Seeking Behaviour of participants on 48-point scale. Data collected were analysed using the statistical package for social sciences (SPSS) version 20 and transformed to interval scales as means and standard deviations. Results. Mean age of participants was 50.10±7.70 years and 89.3% claimed to have received formal education. Majority (89.3%) reported driving with officially issued commercial driver’s licence while 72.8% reported haven driven for over 10 years. Results for information-adequacy was 8.77±3.80, while scores for reinforcing and enabling factors involved in eye-health seeking was 20.12±5.27 and 5.18±3.05 respectively. Participants eye-health seeking and driving outcomes reported a score of 30.96±9.34. Conclusion. There was observed inadequate eye-health seeking and driving outcomes, low information-Adequacy, poor reinforcing and enabling factors among these commercial drivers. Therefore, this study recommends the need for eye-health motivational and counselling intervention programme to improve eye-health seeking behaviour among commercial drivers. Keywords: Eye-Health Seeking, Information-Adequacy, Reinforcing Factors, Enabling Factors, Safe-Driving.
72 An Assessment of the Role of the Civil Sector in the Control of Lassa Fever in Onuenyim Agbaja, Izzi Ebonyi State , Article by Johnson Diara Chijindu
Background: From 1st January to 11th November 2018, a total of 3016 suspected cases of Lasa fever was reported from 22 states but 4 states including Ebonyi state remained in the active phase. Onuenyim Agbaja in Izzi LGA has been in the eye of the storm with all confirmed cases ending in mortality. Objective: To assess the role of civil sectors in the control of Lassa fever in Onuenyim Village. Methodology: This was a descriptive cross-sectional study with data collected using a Likert scale questionnaire rated 1-5 from most negative (low) to most positive (high) responses with a mean value above 3.5 regarded as positive (high) Results: A total of 250 respondents participated in the study which showed that the civil sectors played active role in the control of Lassa fever through advocacy with a mean rating (MNR) of 4.7, resource mobilization with MNR of 4.4 and information sharing and dissemination with MNR of 4.4 These activities had positive effect on the people as shown by an MNR of 3.6. However, the respondents were not sure they knew all they were supposed to know about Lassa fever as shown by an MNR of 1.5. Conclusion/Recommendations: There is great potential for improving public health through systematic collaboration between governments and civil society. This study tried to lay foundation on the role of the civil sectors in the control of Lassa fever but there is need to collect more systematic evidence on the role of civil sectors in the control of Lassa fever, to improve our knowledge. Major players in the health industry including government at all levels need to work with civil society for the social dimensions of health actions for infectious disease control especially the emerging and re-emerging infections like Lassa fever. Keywords: Assessment, Roles, Civil sectors, Control, Lassa fever.
73 Patient Safety Culture among Health Workers in Addis Ababa regional Hospitals, Ethiopia , Article by Tigist Tedla Mulugeta
Background: Improving patient safety highly depends on achieving a culture that supports health workers to report their errors without the fear of punishment. Despite policy emphasis on patient safety in Ethiopia only little studies examine the perception of health workers on patient safety. Objective: The main objective of this study was to assess the magnitude of patient safety culture and associated factors among health workers in Addis Ababa regional hospitals. Methods: Facility based cross sectional study was conducted to assess the magnitude of patient safety culture and associated factors. Results: Magnitude of patient safety culture among health workers in Addis Ababa regional hospitals was 44% CI [42.75,45.36]. Among the 12 dimensions of patient safety " Team work with in Units " (74.78%) was the highest. The least score was for the dimension of " Nonpunitive Response to Errors " (28.70). Five of the 12 dimensions scored above 50%. Only 35 % of respondents gave very good and excellent grades and only 44% of respondents reported at least one event in the past 12 months. Conclusion: Magnitude of patient safety culture for regional hospitals in Addis Ababa was 44 % which is below the acceptable average value (50%), which requires responsible parties’ attention. Keywords: Patient safety, Advert events, patient safety culture.
74 Plasmodium Falciparum Screening among Individuals Purchasing Antimalarial Drugs for Self-Medication , Article by Oche Joseph Otorkpa
The objective of this study was to ascertain the pattern and reliability of self-diagnosis and self-medication with antimalarial drugs. The sample size was 470 comprising 264 men and 206 women. There is a significant difference between the screening results for men and for women (P=0.01186). 71.49% of participants purchasing antimalarial drugs for self-medication in the study area had no parasite antigen in their blood stream. Self-medication practices with antimalarial drugs was found to be more prevalent in the age group 31-40, which accounted for 171 (36.36 %) of participants. Individuals >60 years of age were the least involved in the practice of self-medication practice with antimalarial drugs. Age was found to be significantly associated with self-medication practices with antimalarial drugs (P=0.028156). More single individuals were engaged in the practice of self-medication with anti-malarial drugs 235(50%) as compared to married participants 206(43.83%). The results show that individuals with formal education were the most engaged in self -medication practices with anti-malarial drug as tertiary educated participants accounted for 257(54.68%) as compared with individuals with no formal education (53 or 11.28%). The level of accuracy of self–diagnosis for malaria was higher in women 30.58% as compared to men (21.97%). The precision of self-diagnosis was also highest among participants aged > 60(41.82%) while the lowest was level of accuracy was recorded among participants aged 18-30(15.14%). Based on the level of education, the accuracy of malaria diagnosis was higher in tertiary educated participants (29.18%) and lowest among participants with no formal education (15.09%). Keywords: Antimalaria, Self-Medication, Malaria, Prevalence, Self-Diagnosis.
75 Risk Factors Associated with Tuberculosis and the Impact of the Introduction of Genexpert on the Diagnosis of Tuberculosis in Presumptive cases of a Hospital in Nigeria , Article by Famuyiwa, Maclawrence Kolapo
Objective: To investigate the risk factors and impact of the introduction of XPERT MTB/RIF test on the diagnosis of pulmonary tuberculosis (TB) in presumptive cases in a General Hospital in Nigeria. Design and setting: A retrospective study that examines the record of the hospital, from January, 2015 to December, 2017. A logistic regression analysis was utilized to identify the associated factors. Results: There were total of 753 TB cases out of a total of 3639 people investigated. The rate of TB was 0.207. The multivariable regression analysis revealed that TB was significantly associated with all age groups: 15 -24 years [odds ratio (OR) = 5.316, 95% CI: 3.299 – 8.566], 25-34 years (OR = 4.584 95% CI: 2.899 – 7.248), 35 -44 years (OR = 4.388, 95% CI: 2.765 - 6.964), 45-54 years (OR = 3.044 95% CI: 1.875 - 4.940), 55 -64 years (OR = 2.165, 95% CI: 1.273 - 3.681) and >64 years (OR = 2.135, 95% CI: 1.201 - 3.793). HIV positivity (OR = 0.519, 95% CI: 0.411 – 0.655) and unknown HIV status (OR = 0.277, 95% CI: 0.197 – 0.390) and females, (OR = 0.437, 95% CI: 0.368-0.517), were less likely to have TB. Conclusion: Age group 25-54 is an independent predictor of positive tuberculosis results in presumptive cases. Keywords: Xpert MTB/RIF, tuberculosis, risk factors, Nigeria.
76 A Colonial Identity of Caring Phenomenon in Philippine Public Health , Article by Davis Don Mcleroy G. Gaviola
The study illuminated the caring phenomenon within the provision of health services and the seek of care in Philippine public health. Using a qualitative approach, employing a hermeneutic-phenomenological design, specifically the Husserlian method for phenomenology a Gadamerian hermeneutics, this study was participated by 8 care providers and 8 recipients of care. It utilized generated themes from in-depth interviews which represented the current phenomena of Philippine public health being correlated with historical literatures and events to generate interpretation of what was found to be a colonial identity of care. Furthermore, the tangible manifestation of caring phenomenon in Philippine public health is built within the scaffold of a colonialism, lived and shared by the people through culture influencing and shaping today’s society in its identity as a Filipino and in public health as caring phenomenon occurs. Keywords: Colonial Identity, Public Health, Caring.
77  Knowledge and Practice of Food Hygiene Among Food Vendors in Ihiagwa, Owerri West Local Government Area, Imo State , Article by Okoroafor Ikenna , Ibe Sally N.O, Nwanya Emmanuel, Oyamienlen Christopher Sule
Food hygiene includes all conditions and measures necessary to ensure the safety, suitability and wholesomeness of food at all stages of the food chain. The objective of this study was to ascertain the knowledge and practice of food hygiene among food vendors in Ihiagwa, Owerri-West L.G.A. A descriptive cross-sectional design was used in this study as a quantitative research approach. 221 food vendors were selected using the stratified sampling technique. Data was collected with the use of a questionnaire and also with observations of general hygiene and cleanliness. Data was captured in Excel sheet and imported into SPSS version 20.0 for analysis. The results of this study showed that most of the food vendors 99(44.5%) were between 30-39 years of age. Females recorded 166(75%) while males had 55(25%); 183(82.8%) reported that they have not attended any food hygiene training; only 28(12.7%) of the food vendors reported that they always cover their hair while serving food; 188(85.1%) reported that their food premises have not been visited by environmental health officers, only 51(23.1%) of the food vendors said that they go for routine medical examinations and 5(2.3%) said that well water was their main source of water supply. The age of the respondents showed a significant relationship with their knowledge of food hygiene (X2=15.53 at P=0.008). The Age, gender and educational status of the respondents all showed a significant relationship with their practice of food hygiene. Keywords: hygiene, knowledge, practice, food, vendors, ihiagwa,
78 Reasons for Missed Children during Lot Quality Assurance Sampling Survey in Birnin Kudu LGA of Jigawa State, Nigeria – Polio Immunization Campaigns 2014 , Article by Umar Husaini Adamu
Background: Lot Quality Assurance Survey Sampling (LQAS) is a survey use for estimation of Supplemental Immunization Activity (SIA) coverage (OPV percentage coverage). The survey is mostly conducted in high risk LGAs immediately after SIAs. This paper explored reasons why children were missed during LQAS after Polio Campaigns in Birnin Kudu LGA, Jigawa State of Nigeria in 2014. Method: This descriptive cross-sectional study was conducted between January – April, 2015. Twenty-eight (28) parents whose children were found to be missed during LQAS in Birnin Kudu LGA after 2014 Polio campaign were purposively sampled to participate in the survey but only 24 parents were reached. Survey data were collected by a questionnaire which was applied face to face to parents of 24 children. Data analysis was carried out using descriptive statistics, mean, median, proportions. Findings: the result of the study revealed that children were missed due to the following reasons: 75% due to “child was not at home”, “child was too young for immunization” and “others” constitutes 8% each. “Child was sick” and “too many round” constitute (4%) each. Lowest were “religious belief”, “child was scarred”, “unhappy with the attitude of the vaccination team”, “team didn’t visit the house”, “Political differences”, “no pluses during the visit” and “unmet needs” having 0% each. The study concluded that the major reason why children were to be missed during 2014 LQAS in Birnin-Kudu LGA was as a result of “child not at home” which constitute 75%. Recommendation: Health Education: the government should put more effort in educating the populace about Polio vaccination; emphasize its importance, why it is frequently repeated, how polio hinders lifelong opportunities for their children. Immunization days should be uniform all over the nation so as to be able to capture those who travelled to another part of the country. Keywords: Poliomyelitis, missed child, reasons for missed children, Lot Quality Assurance Sampling Survey.
79 Gender Differentials in Sexual-Reproductive Risk Exposures among High School Students in Ejisu-Juaben Municipality, Ghana , Article by Eric Gyamfi
The issue of adolescent sexual and reproductive health concern is a growing global public health issue that has recently received both national and international attention. The study adopted a non-interventional cross-sectional study design, aimed at assessing gender differentials in sexual-reproductive risk exposures among high school students in the Ejisu-Juaben Municipality of Ghana. The study enrolled 820 participants using structured questionnaire as primary data collection tool and focus group discussion. The study key findings are; no statistically significant difference was observed for ever had boy/girlfriends for male (51.2%) and females (49%). Males (54%) and females (46%) ever had sexual intercourse, with no significant difference (p>0.005). Mean age in years of sexual debut was 15.02 for males and s 15.85 for females. Protection during sexual intercourse was 49% for males and versus 51% for females. Occurrence of pregnancy was 19.5% with 90.2% ending in abortion. Contraceptive use and family planning adoption were not statistically significant for males (58.0%) and females (42.0%) (p>0.005). Multiple sexual partner status was higher for males (54.2%) than females (30.5%). Anal or oral sex among males (60.5%) was more than females (39.5%). Males (68.0%) significantly reported higher involvement in masturbation than females (32.0%) (p<0.005). Same-sex relationship (homosexuality) was higher for males (57%) than females (43%) and was not significant (p>0.005). The study findings suggest inadequate reproductive health knowledge among students. Inclusion of sexual and reproductive health education in the curriculum of schools is essential. Keywords: Gender, Students, Reproductive Risk, Ejisu-Juaben, Ghana.
80 Knowledge, Attitude and Risk Perception on Sexual-Reproductive Behaviours among Adolescents in Ejisu-Juaben Municipality, Ghana , Article by Eric Gyamfi
Knowledge on reproductive health issues is essential in the promotion of positive reproductive behaviours among adolescent. The Study utilised a non-interventional cross-sectional study design to assess knowledge, attitude and risk perception on sexual-reproductive behaviours among adolescents, particularly high school students in the Ejisu-Juaben Municipality of Ghana. The study enrolled 820 participants using structured questionnaire as primary data collection tool and focus group discussion. Level of knowledge on reproductive health and risk related issues were rated more than 50%. Correct responses to knowledge and risk perception questions areas are the folliwng; STI including HIV/AIDS cannot be avoided (42.0%), STI including HIV/AIDS go away without any medication (64.0%), only people who look sick can spread HIV/AIDS virus (73.0%), Teenage girl cannot get HIV from teenage boys who have had sex only a few times (62.2%), girls cannot get pregnant on sexual debut (61.0%), pregnancy can occur in mid-cycle (53.3%), no need of birth control method if a girl has sex once in a while (52.5%), urinating after sexual intercourse can prevent pregnancy (55.3%), a highly reliable method of avoiding pregnancy and STI/HIV is to use a condom (60.3%). Reproductive health knowledge and sexual-reproductive behaviours were not statistically significant (p>0.005), though sexual intercourse and non-protection on sexual debuts were significantly associated with reproductive health knowledge (p<0.005). Sexual -reproductive health education be incorporated into the curriculum of school, establishing health education department in all schools to promote positive health behaviours. Keywords: Ghana, Ejisu-Juaben, Reproductive, Risk, Knowledge, Students.
81 Sero-Prevalence and Risk Factors for HDV Infection Among HIV/HBV Co-Infected Patients in Sokoto North Western Nigeria , Article by Abdulmumini Yakubu, Bello Hali
Background: Hepatitis D virus infection may worsen HBV infection and about 5 % of HBV infected individuals may be infected with HDV infection as these viruses have similar routes of transmission. Severity of HBV infection is worsen by HIV co-infection. Therefore, this study aimed at the determination of prevalence and risk factors of HDV infection among HIV/HBV Co-infected individuals. Methods: This was cross sectional study in which treatment-naïve HIV infected study participants were screened for HBs Ag. Study participants that were positive for HBs Ag were further screened for anti HDV and HBe Ag and also, they were assessed for CD4+ T lymphocytes count, ALT and AST levels. SPSS version 20 was used for the statistical analysis and level of significance was considered at p ≤ 0.05. Results: About 4(10.8 %) of 37 HIV/HBV co-infected study were positive for anti HDV. There was no statistical association of HDV infection with different tested variables, though numerically higher among females (P≤ 0.587), 41-50 years age group (P≤ 0.671), subjects with history of multiple sexual partners (P≤ 0.557), blood transfusion (p ≤ 0.298) and needle sharing (P ≤ 0.456). Mean ALT and AST levels, mean CD4+ T cell counts and HBe Ag prevalence were comparable between anti HDV positive and negative study participants with HIV/HBV co-infection. Conclusion: Substantial number of HIV/HBV co-infected study participants were observed to be infected with HDV infection. We recommend the screening of HDV infection among HIV/HBV co-infected individuals to ensure their proper management. Keywords: HIV infection, HBV co-infection, HDV infection.
82 “Knowledge about Risk Factors of Carcinoma Cervix among the Women Attending for VIA Test in a Selected Hospital” , Article by Syeda Sadia Farzana, Shampa Saha, Abu Sayem Md Shahin, Ismat Ara, Turani Talukder, Irin Hossain
A cross-sectional descriptive study was conducted with the aim to find out the level of knowledge about the risk factors of the cervical cancer among the women attending VIA room of Gynae Out Patient Department, BSMMU on 106 patients selected by purposive sampling technique. Data were collected using pretested, semi-structured questionnaire by face to face interview in May, 2008. Mean age of the respondents was 42.9+6.5 years, 83.0% were Muslim. Majority (17.0%) of the respondents had Primary education. More than one third of the respondents’ monthly income was taka 5001-10,000. Mean age at first marriage was 13.96+2.4 years and 26.4% of them were married for 20-24 years ,40.6% of the patients had history of first birth during their adolescence period. High parity (more than 2 children) was present in 65.0%. Child birth at lower age (94.44%), Multiparity (96.29%) and smoking (66.66%) were the major risk factors mentioned by the respondents. Thirteen percent gave history of Sexually transmitted diseases which is another remarkable risk factor & among them (42.8%) took treatment from MBBS doctor and by Doah-Tabiz (28.6%). The respondents mentioned as main symptoms were lower abdominal pain (98.0%), irregular per vaginal bleeding (57.69%), postcoital bleeding (32.69%) followed by post-menopausal vaginal discharge (26.92%). The findings suggest that programmatic approaches to increase the age at first marriage and first child birth, health education about cervical cancer, its risk factors, symptoms and its treatment will be more effective to reduce cervical cancer in Bangladesh. Keywords: Knowledge, risk factors, carcinoma cervix, VIA test.
83 Effect of Disability Awareness Program on a Regular School in Ujjain India: An Action Research , Article by Pushp Lata Rajpoot, Pushpa Vaishnav, Yogita Sharma and Govind Chaparwal
Background: Regardless of devastating trend of inclusive education, students with disabilities are not being accepted by the typical developing students as well as teachers. Somehow the rejection by their peers and teachers hinder in their social inclusion, achieving academic success, and becoming more independent. Objective: The aim of the study was to see the effect of disability awareness education program on a regular school. Methods: This study develops and implements a disability awareness program in 8th to 12th grade students and their teachers, through action research, determines whether the program was influential in shaping attitudes towards students with disabilities. The students were exposed to 21 disabilities and more focused on physical disabilities, and blindness, and accessibility. The program was designed and implemented in three steps beginning, middle and end, began with questionnaires on disability knowledge. Result: As regard to attitude, the school environment became more inclusive, more welcoming environment for disabled students, and nurtured better friendships among all students. After getting knowledge about different disabilities, students without disabilities became more accepting and understanding of individual differences. The individual activities and discussions enabled students to think critically about how to deal with disabled individuals and the significance of inclusion to enhance their overall development. Conclusion: Disability awareness programs are powerful to overall environment of a school. These programs foster acceptance, understanding and promote knowledge about different disabilities. Therefore, disability awareness programs must be incorporated into the regular school curriculum and received by the all individuals to create a more accepting and positive environment for disabled students which in turn will help them to achieve emotional wellbeing, social inclusion and academic success. Keywords: Disability awareness program, Regular school, Inclusion, Typical developing students, Students with disabilities.
84 Burden of Hypertension and Associated Risk Factors in Rural Communities of Abuja , Article by Orji Ikechukwu Anthony, Ojji Dike Bevis, Ikechukwu-Orji Mercy Uchechi
Introduction: Hypertension have become of medical and public health concern globally. It is a known major risk factor for stroke, coronary artery disease and heart failure. Important risk factors contributing to hypertension are lifestyle and genetic factors. With rapid urbanization and increasing sedentary lifestyle of our rural populace, an explosion in the prevalence of hypertension becomes inevitable. Therefore, the importance of this study to assess the burden and risk factors of hypertension in these rural communities cannot be over emphasized. Objectives: 1. To determine the prevalence of diabetes in rural communities in Abuja FCT Nigeria. 2. To determine the prevalence of and associated risk factors of hypertension in rural communities in Abuja. Methodology: A descriptive cross-sectional design was employed in this study which was conducted between July and December 2017. A multi-stage sampling technique was used to recruit 420 willing adult participants from rural communities, in four political wards, selected from three area councils of FCT Abuja. Data were collected using an interviewer administered questionnaire while measurements were done with standardized instruments for blood pressure and blood sugar as well as weight and height measurements following recommended techniques and guidelines. Data were analyzed using SPSS 20.0 version. Univariate analyses were performed to evaluate the distribution for each variable. Binomial test was used to test the hypothesis. Multivariate analyses were done to identify the risk factors of hypertension. Results were considered significant at p-value < 0.05. Results: The prevalence of 38.3% and 25.2% were reported for hypertension and obesity in rural communities in Abuja respectively. Risk factors such as female sex, age 45 years and above, overweight/Obesity, physical inactivity, family history of hypertension and family history of diabetes were independent predictors of hypertension. Conclusion: This study has highlighted the fact that hypertension in addition to obesity is on the increase in the rural communities of Abuja, Nigeria. Therefore, concerted and coordinated effort from all stakeholders is urgently required to tame and reverse this ugly trend in view of the debilitating morbidity and mortality associated with hypertension. Keywords: Hypertension, prevalence, risk factors, obesity, rural communities, Abuja.
85 Life skill Development of Autistic Children Following Education Therapy in Specialized Schools , Article by Tahmina Sultana, Rowshon Ara, Ummul Khair Alam, Irin Hossain
Life skill development is a comprehensive approach to measuring skills outcome that evaluates an individual’s level of skills that develops. A cross sectional study was done among purposively selected 158 respondents and age range of autistic child was 5 to 20 years old who attended PROYASH specialized school-based treatment in Dhaka city from January to December 2016. All the respondents were school teachers, class teacher assistant and parents of 5 to 20 years old previously diagnosed autistic children with male predominance which was almost 68%. Among 158 cases more than 90% child were diagnosed as autistic within 2 to 3 years of e and 99.4% autistic children get formal education. After getting special intervention in specialized school 61.39% could utter words but couldn’t make sentences, 37.97% could communicate with sentences and 0.63% had no verbal communication. In this study 99.4% children get the treatment for autism. Medicines also help in the regeneration of nerves. In this study 61.4% autistic child only utter words, 38% child make sentences and only 0.6% with autism do not talk at all after therapy. The study identified the apparent situation of skills and relationship among variables and daily living skills could be improved by intervention therapies like SCERTS (Social communication, Emotional regulation, Transactional support) model, Applied Behavior Analysis (ABA), Auditory Integration Training (AIT), Daily Life Therapy, THE HANDLE Institute (Holistic Approach To Neurological Development and Learning Efficiency), Integrated Play Therapy, Picture Exchange Communication Systems (PECS) and so on. Keywords: Life skill Development, Autistic Children, Education Therapy.
86 How Communication for Behavioural Change Can Be Used in the Context of Performance-Based Financing to Improve Institutional Deliveries in Nasarawa , Article by Kum Ghabowen Iwi, Joseph Shu, Sam Franzen, Eubert Vushoma, Jatau Stephen, Adamu Ohaganyi, Mohammed Othman Adis
Introduction : High maternal mortality is an increasing challenge for the achievement of the 5th millennium development goal in sub Saharan African countries particularly in Nigeria where maternal mortality has decreased from 580/100000 live births in 1999 through 570/100000 live births in 2005 and back to 580/100000 live births in 2015. Institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality. In the pilot phase of Performance Based Financing in Ondo, Nasarawa and Adamawa, the trend of deliveries moved from 20% coverage in June 2012 to 64% coverage in June 2016. In Nasarawa state delivery coverage moved from 24% in June 2012 to 45% as of June 2016 but below national rate. We aim to assess socio-behavioural factors associated with low utilization of delivery services in Nasarawa State Nigeria. Methods : A sequential explanatory mixed-methods design. Barrier analysis was carried out to analyse the differences in determinants between doers and non-doers (ratio 1:1) for possible interventions when combined in a matrix table and used to identify community priorities Result: We identified key messages that will be used to design interventions using the BEHAVE Framework to improve on utilization of skilled deliveries. Messages stemmed from identified barriers: Financial barriers, Refusal to allow women to “squat” during delivery, Poor attitudes of staff, Poor conditions of the delivery bed and disapprovals. Conclusion : Barrier analysis and the application of BEHAVE framework can eliminate socio-behavioural factors associated with low utilization of delivery services within the context of Performance-Based Financing. Keywords: Institutional Delivery, Skilled Delivery Normal Assisted Delivery, Maternal and child Health indicators, Performance-Based Financing, BEHAVE and communication for behaviour change.
87   Impact of Violent Extremism on Utilization of Medical Laboratory Services in Nigeria , Article by Paul Rambe Yunana
Adamawa, Borno and Yobe States of North-East Nigeria faced violent conflicts since 2010. Violent conflicts of this nature have profound effect on health. Previous studies have documented impact of violent conflicts on some components of healthcare services. The impact of violent conflict on medical laboratory services is yet to be fully understood in Nigeria. This study was carried out to evaluate the impact of violent extremism on access and utilization of medical laboratory services in Yobe State, Nigeria. The study employed qualitative and quantitative data collection methods. In-depth interview was conducted with medical laboratory staff to elucidate their opinions on how violent conflicts affected medical laboratory services during the period of study. Quantitative method employed the review of medical laboratory records covering the period 2010 -2016. Thematic content analysis was employed on qualitative data for themes that emerged. Quantitative data was analyzed using both descriptive and analytic methods. The findings from in-depth interview revealed that violent extremism impacted negatively on leadership and governance, workforce, finance, medical technology, records/research and service delivery of medical laboratory in State Specialist Hospital Damaturu (SSHD) and General Hospital Potiskum (GHPTKM). The results of quantitative data revealed that the changes in service uptake contributed by magnitude of documented violent attacks can be explained by 7% in SSHD; and by 4% in GHPTKM. The changes contributed by emergency services on routine tests can be explained by 34% in SSHD and 60% in GHPTKM. The supply gaps for safe blood in SSHD and GHPTKM associated with documented violent attacks was 56% and 61% (R2), respectively. The results showed that magnitude of documented attacks was a major factor influencing supply gaps for safe blood in SSHD. These findings imply that the direct violent attacks over the years exacerbated conditions on livelihoods that affected uptake and utilization of medical laboratory services during violent conflicts. The study recommends the use of the proposed best practice guideline to guide and sustain the provision of medical laboratory services in violent conflicts settings. Keywords: Medical Laboratory, Service uptake and utilization Violent extremism, Impact.
88 Exploring Barriers to Uptake of Micronutrient Powders in Rural District, Zimbabwe: Findings from a Qualitative Study , Article by Priscilla Kusena, Gerald Munyoro
Zimbabwe is implementing a micronutrient powder program, which was designed to improve micronutrient supplementation to children aged 6-23 months. One year after program inception, there are indications that uptake of micronutrient powders is very low. Thus, the study sought to identify barriers to uptake of micronutrient powders in Makoni rural district. This was achieved through phenomenology philosophy and case study design. Three villages from rural Makoni district, 11 focus groups and 20 in-depth interviews were done. Key informants included caregivers, community leaders, community health workers, health professionals and key stakeholders implementing the micronutrient powder program. Interviews were digitally recorded, transcribed and thematically analysed using Coding Analysis Toolkit. Findings from the study show that barriers to uptake of micronutrient powders are poor accessibility; lack of adequate information on potential micronutrient powder side effects and poor post distribution monitoring; poor social mobilization and food unavailability. The study recommends that nutrition related programs in Zimbabwe should consider improving accessibility of micronutrient powders by considering community distribution points for micronutrient powders. In addition, nutrition related programs should consider providing adequate information on potential side effects of micronutrient powders and provide micronutrient powders as ready to eat supplements to bridge food unavailability gap. Keywords: Barrier, micronutrient powders, infant and young child feeding, social and behaviour change communication, Zimbabwe.
89 Community Based Mobile Screening Programme for Oral, Breast and Cervical Cancers: A Programmatic Insight from rural Assam, India , Article by Subrata Chanda, Vishal Dogra, Srabana Misra Bhagabaty, Devesh Varma, Amal Chandra Kataki, Shailendra Hegde
The Kamrup district in Indian state of Assam has highest cancer incidence. The population, particularly in rural area has no access and resources for early cancer screening and care services. To fill this service gap, a not-for profit organization (Piramal Swasthya Management and Research Institute-PSMRI) in collaboration with semi-government institute (Dr. Bhubaneshwar Borooah Cancer Institute, Guwahati-BBCI) launched an innovative programme known as DESH (Detect Early, Save Her & Him) in rural Kamrup. The programme aims to reduce the proportion of late-stage diagnosis and mortality from oral, breast and cervical cancers through community-based awareness, screening and referral program. During first year of program operations (November 2017 to June 2018), DESH screened 3937 beneficiaries across 96 villages in three blocks of rural Kamrup district. Out of the total screened population, 157 (4.0%) are initial screen positive (Oral 142; breast 7; cervix 8.) Out of all screen positives, only 62 visited the BBCI for further diagnosis and confirmation. Among screen positives, 4 beneficiaries are confirmed oral cancer cases (all male, 3 in stage 1; 1 in stage 3). Ensuring continuous availability of doctors, greater public engagement and building community awareness of common cancers are some of the identified areas for improvement. In the long run, we see our program as an opportunity to build an evidence-based, cost-effective and replicable model for early detection of Oral, Breast and Cervical Cancers in resource-scarce settings. Keywords: Community, DESH, Oral, Breast and Cervical Cancer, Mammography, Mobile Cancer Screening.
90 Domestic Violence against Men: Myth or Reality in the Nigerian Setting? , Article by Esther O. Asekun-Olarinmoye, Asekun-Olarinmoye OS, Adebimpe WO, Omisore AG
In many developed countries and some developing countries, incidences of domestic violence perpetrated by their partners have been reported by men. However, the position of authority and superiority accorded the male gender in the African culture tend to give credence to the believe by many people that domestic violence perpetrated by women on men is non-existent in this environment. Even though there is paucity of available empirical data on violence against men in Nigeria, is this to say that it does not exist? In a descriptive cross-sectional study, questionnaires were administered to 483 respondents selected through multi-stage sampling technique. Furthermore, selected Nigerian newspapers were analyzed for the reportage of violence against men and Focus Group Discussions were conducted. Quantitative data was analyzed by Statistical Product for Service Solutions (SPSS) version 20 while qualitative data was analyzed by detailed content analysis. Mean age of respondents was 29.7 + 9.2 years, 55.1% were males and 47.8% were ever-married. Higher awareness of domestic violence against women (DVAW) than against men (DVAM) was found among respondents (89.9% vs 86.1%) while 42.0% considered DVAM a new development in Nigeria. Wives (48.0%) and in-laws (17.2%) were the most commonly cited perpetrators. A quarter (25.7%) of respondents has ever been victims of DVAM, of these three-quarters sought for help. Perceived barriers to seeking for help include pride and embarrassment. Male gender and secondary education or higher were found to be the predictors of good perception of DVAM types. The study showed that DVAM is a reality in Nigeria in spite of cultural underpinning. Both the newspaper audit and the Focus Group Discussion affirmed the growing menace. Keywords: Domestic, Violence, Men, Nigeria.
91 High uptake of Medically Assisted Therapy among People Who Inject Drugs Associated with Modifiable Factors in Mathare Low Income Settlements, Nairobi, Kenya , Article by George Macharia Wambugu, John Gachohi, Joseph Mutai
Background: The dramatic rise in intravenous drug use particularly heroin has been associated with elevated HIV transmission risk in sub-Saharan Africa. Medically assisted therapy (MAT) is crucial for HIV prevention in people who inject opioids including heroin. The objective of the present study was to determine the uptake of MAT among people who inject heroin (PWIH) and associated factors to assist in informing policy. Methods: A cross-sectional study was conducted in Mathare low income settlement in the city of Nairobi, Kenya. Injecting heroin users were recruited in the study during the routine follow-up at a drop-in Centre. Information about factors associated with uptake of MAT among Injecting heroin users was obtained using an interviewer-administered questionnaire. Results: Of the 110 people PWIH enrolled in study, 73 respondents had ever enrolled for MAT (uptake: 66% (95% confidence interval (CI) 57%, 75%)). Socio-demographic factors associated with uptake of MAT included age, gender, marital status, education level and employment status (p<0.05). Association between uptake of MAT and characteristics/practices related to the use of heroin returned four significant variables (p<0.05): length of time the participant had injected heroin, daily frequency of heroin injection, prior attempt to quit heroin injection and polydrug use. Key health systems factors associated with uptake of MAT included personal views about eligibility criteria for PWID and hours of operation of the MAT clinic. Conclusion: Our study identified modifiable factors associated with MAT in low income urban settlers which if prioritized can accelerate the already high uptake found in this study. Keywords: Heroin, Therapy, Opioid, Human Immunodeficiency Virus, Medically Assisted Therapy, People Who inject Drugs
92 The Sustainable Development Goals: Perceptions of a cross section of members of the fourth estate of the realm in Osun State, South-Western Nigeria , Article by Omisore AG, Yusuff OAO, Adeyera OD, Bello TB, Asekun-Olarinmoye O.S, Adesina KA,  Adepoju EG
The role of journalism is central to raising awareness and providing better understanding of the Sustainable Development Goals (SDGs), the 2030 agenda. Considering the fact that media organizations and/or personnel are an important source of information in this part of the world, it is imperative that journalists disseminate useful information on this agenda if its objectives are to be met. This study, therefore, undertakes an assessment of knowledge and attitude of journalists in Osun state towards the SDGs. A cross-sectional study was carried out among 120 Journalists drawn from across Osun State. A semi-structured self-administered questionnaire was used to elicit vital information on the socio-demographic characteristics, knowledge of and attitude towards the SDGs. Data were analysed using IBM SPSS and presented using descriptive statistics. The mean age of the Journalists was 36.4 ± 6.21 years. Almost two-third (64.2%) had ever heard of SDG and only 1.3% had good knowledge. Less than half (43.3%) of respondents had a negative attitude towards learning about the SDGs. The knowledge of journalists in Osun State on the SDGs was very poor and may have adverse consequences for the entire population. Intervention is therefore required to improve their knowledge via education. Key words: Journalists, Perception, Sustainable Development Goals.
93 Incidence and Correlates of Commercial Motorcycle Accidents in Embu Town, Kenya , Article by Paul Muriithi Ngari, John Gachohi, Kenneth Ngure
Introduction: The recent growth of the commercial motorcycle sector in Kenya has seen a concomitant rise in road traffic accidents (RTAs). However, the correlates of RTAs involving commercial passenger motorcycles are largely unknown in Kenya and other developing countries. We sought to determine the incidence of commercial motorcycle accidents (MCAs) in Embu town, Kenya and its correlates. Methods: In January 2018, we recruited 202 commercial motorcycle riders and collected baseline data by means of a questionnaire in Embu town. We then followed them on weekly basis for 3 months till April 2018 to quantify the number of MCA events. Multivariable cox proportional hazards regression models were built to relate the incidence of MCAs and their correlates. Survival analysis was carried out using the Kaplan-Meier approach. Results: We quantified 48 MCA episodes translating into an incidence of 3 crashes per 1000 person-days. On multivariable analyses, riders in singlehood marital status were almost twice as likely to experience a MCA compared to those married [Adjusted HR (AHR) =1.8 (CI: 1.1, 3.4), p=0.046]. Khat (Catha edulis) users were 2-fold likely to experience a MCA relative to non-Khat (Catha edulis) users [AHR=2.1 (CI: 1.1, 4.2; p=0.021]. Conclusion: Efforts to prevent MCAs need to include a program for screening and educating young riders on the dangers of khat Catha edulis use. Keywords: Incidence, correlates, commercial motorcycle accident, Embu, Kenya.
94 Predictors of Utilization of Family Planning Services among HIV Positive Women in Two South Eastern States of Nigeria , Article by Oniyire Adetiloye, Orji Bright, Emmanuel UGWA, Oluwatobi Adebayo, Olowu Banjo, Salami Kabiru
The study objective was to determine the predictors for the use of family planning methods among women living with HIV in two South Eastern States in Nigeria in order to make quality improvement recommendations. This was a descriptive cross sectional study among HIV positive clients attending the HIV clinic in Ebonyi and Enugu State Nigeria. The sample size was 442 clients comprising 142 from Ebonyi and 300 from Enugu. Informed consent was obtained. Data collection was done using interviewer-administered and pretested questionnaires. Quantitative variables were summarized using frequencies, percentages, means and standard deviation. The Chi‑square test was used to evaluate association between categorical variables as appropriate and P-value ≤0.05 was considered statistically significant. Logistic regression analysis was used to assess the relative effect of determinants, adjusting for other predictor variables. Majority (42.3%) of the respondents were aged 30-39years. There were significantly more female (78.4%) respondents compared to males (21.6%). Respondents lived in the urban (47.2%) and sub-urban (48.2%) settings. Most (72.1%) of the respondents, had a tertiary level education and were mostly traders, single and of Christian faith. Less than half (40%) of the respondents had 3-4 babies and had their last babies 5 or more years prior to the study. Occupation and education are strong predictors of contraceptive use among HIV positive clients. Further study will be necessary to determine the behavioral interventions and communication strategy that will further enhance uptake of family planning methods especially among this group in Nigeria. Keywords: Predictors, Family Planning Use, HIV Positive, South-East Nigeria
95 Reducing Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV): Findings from an early Infant Diagnosis Program in Benue State, North Central Nigeria , Article by Plang Jwanle, Franklin Emerenini, and Ademola Amosu
Introduction: A critical opportunity to strengthen follow-up of HIV-exposed children and assure early access to ARV treatment for infected children is provided by early infant diagnosis of HIV. This study describes findings from an EID program and the effectiveness of PMTCT intervention in Benue State, Nigeria. Methods: This was a retrospective study. The study population comprised all perinatally HIV exposed children aged six weeks to 18 months who had Dried Blood Spot (DBS) samples taken for a DNA PCR test between January - December 2017 were enrolled for this study. Details of the ARV regimen received to prevent mother-to-child transmission (MTCT), infant feeding, HIV DNA PCR test results and turnaround time (TAT) for results were analyzed using SPSS version 20. Results 85.9% of mother-baby pairs received ARVs and 98.4% babies had ever been breastfed. Transmission rates for mother-baby pairs who received ARVs for PMTCT was 1.5% compared to 33% when neither baby nor mother received an intervention. Overall the prevalence of transmission in this study is 3.9% irrespective of intervention. The mean and median turnaround time for test results were 69 days (95% CI: 67.89-70.12) and 56 days respectively Conclusions. Reduction of MTCT of HIV is possible with effective PMTCT intervention, including improved access to ARVs and appropriate infant feeding practices. The PMTCT programme in Benue State was found to be effective and achieved outcomes comparable to similar setting. Triple combination ARV drugs is feasible and resulted in low MTCT rates under routine clinic conditions in resource-limited setting. Keywords: mother-to-child transmission of HIV, early infant diagnosis, breastfeeding, vertical transmission.
96 Glycaemic Control among Type 2 Diabetes Mellitus Patient Attending the Out Patient’s Clinic at Parirenyatwa Hospital in Zimbabwe , Article by Pasipanodya Ian Machingura, Memory Mushava, Heather Phillipo, Robson Dembah, Witmore Bayayi Mujaji
Type 2 diabetes mellitus is the most common type of diabetes mellitus accounting for approximately 90% of all cases. Many diabetes mellitus patients experience difficulties following their treatment regimen causing low number of patients achieving glycaemic control target. Failure to achieve glycaemic control is associated with the development of complications. This study sought to determine the prevalence of poor glycaemic control and identify factors associated with glycaemic control among type 2 diabetes mellitus patient attending an out patient’s clinic. All type 2 diabetic patients aged 18 years and above attending the Parirenyatwa out patient’s diabetic clinic during the study period who consented to participate in the study were consecutively enrolled. A questionnaire was administered, the patients’ weight and height were measured. A blood sample was collected for glycosylated haemoglobin analysis using the enzymatic method. A total of 180 type 2 diabetic patients were enrolled into the study of whom 69.4% were female. The median age was 60.0 years, median duration of disease was 6.0 years, median body mass index was 26.0 kg/m2 and median glycosylated haemoglobin was 7.4. Poor glycaemic control was diagnosed in 60.9% of the patients. Gender (p value 0.016), duration (p value ˂0.001) and physical activity (p value 0.007) were significantly associated with glycaemic control. The majority of the type 2 diabetic patients had poor glycaemic control. There is need of coming up with strategies to improve glycaemic control in type 2 diabetic patients attending the out patient’s clinic. Gender, duration and physical activity were associated with glycaemic control. Keywords: Diabetes mellitus, type 2 diabetes mellitus, glycaemic control.
97 Public Health Implications of ABA River Pollution on Communities in ABA North Abia State Nigeria , Article by Udo Stella Ngozi, Elendu Humphery
Aba river continuously undergoes pollution from effluents from activities around the river and this constitutes a public health hazard. The aim of study is to determine the microbial and chemical pollutants, public health risks and recommend appropriate measures for prevention and control by government. Structured questionnaire was administered to 100 residents, direct plate count, culture and Atomic Absorption Spectrophotometry of the water collected were carried out. (upstream-2B and downstream-1B, all in plain and sterile containers). Results indicated that residents were mainly semi-literate (52%); business and petty traders (80%) with low income. The water from Aba River is used for drinking, washing, cooking and other domestic activities; 54% residents were females and 46% men and the age bracket of 21years to 50years were predominate in the area, hospital visits and bills in last 12 months were high due to typhoid, malaria, diarrhoea, worm infestation and food poisoning, no free medical care by government or surrounding industries; microbial analysis and count from the upstream water prior to discharges showed E.coli count of 7.0 cfu/mLand downstream count showed E.Coli count of 197 cfu/mL indicating heavy microbial pollution; chemical analysis showed an increase in organic analytes of Aluminium 355 mg/L, Arsenic 11 mg/L, Iron 301 mg/L, Lead 8 mg/L, Manganese 13 mg/L, Nickel 11 mg/L, Selenium 280 mg/L, Ammonium 0.35 mg/L, Benzene 1.7 mg/L, Pesticides 0.08 mg/L, Polycyclic Aromatic Hydrocarbon 1 mg/L with a conductivity of 2800 ms/cm which are higher than the standard. Conclusion: Aba River is highly polluted and unfit for drinking or domestic use. Keywords: Aba River, pollution, Public Health implication.
98 Malaria Parasitaemia among Different Haemoglobin Genotypes in Federal Capital Territory, Abuja , Article by Udo Stella Ngozi, Elendu Humphery
Malaria is a common and life-threatening disease in many tropical and subtropical areas and transmitted by the female Anopheles mosquitoes with major impact on global public health. It is endemic in Nigeria with up to 97% of the population at risk. Malaria results to 60% outpatient visits to healthcare facilities,25% childhood death, and11% maternal death. Haemoglobin genotype variants have been implicated in reducing malaria parasite replication within the red blood cells and enhance splenic clearance in malaria parasitized erythrocytes. The study of the Malaria parasitaemia among different haemoglobin genotypes in Federal Capital Territory, Abuja, is aimed at determining the effect of haemoglobin genotypes on malaria parasitaemia among residents in FCT. (2mls) of venous blood was collected from 384 randomly selected residents. Determination of malaria parasitaemia was by Microscopy and the cellulose acetate membrane electrophoresis was used for heamoglobin genotype. A structured questionnaire created with Epi-Info version 7 for data collection and analysis. Results of 187 volunteers with malaria parasitaemia indicated that: malaria parasitaemia was more in female (58.8%) and male (41.4%); age groups of 0-10 (42.0%), 11-20 (35.2%) and 21-30(14.5%) and 91.7% within age range of 0-30 years of the studied group; in Gwagwalada (24.6%), followed by Bwari (21.4%), Kuje (18.7%), Kwali (17.7%), Abaji (15.5%) and was least in AMAC (2.1%) and severe ((+++) (> 10,000/ µL)) in blood genotype AA(47.4%) than in AS(0.0%), AC(0.0%) and least in SS(0.0%). It was concluded that malaria and the haemoglobin S gene were endemic in FCT and variant Haemoglobin C and S could confer protection to malaria parasitaemia. Keywords: Malaria, Parasitaemia, Haemoglobin Genotypes.
99 Assessment of the Relationship between Religiosity and Sexual behaviour among Unmarried Adolescents in Selected Secondary Schools in Lusaka, Zambia , Article by Allan Zulu
Objective: The objective of the study was to determine the association between religiosity and sexual behaviour among secondary school adolescents. Research design: The study population included in-school adolescents aged between 15-19 years and used multistage and random sampling to pick elements at every stage. Participants: The total sample size (N= 400) comprised adolescents from selected secondary schools in Matero and Woodlands townships in Lusaka. Main outcome measures: The outcome measures included: levels of religiosity, sexual behaviour and association between religiosity and sexual behaviour. Results: The analysis included all 400 adolescents. The majority of respondents were female (n= 59.3%) and Pentecostal Christians at (29%). The mean age was 16.2 with a standard deviation of 1.33. Age range of respondents was from 15-19 years with the majority aged 15 (34.25%).  87% respondents were religious and 88.25% of respondents were not involved in sexual activities. The Chi-square test results showed significant predictors of religiosity with a p-value less than 0.05. The test results showed that greater levels of religiosity were associated with lower levels of sexual activities and vice versa with a Chi-square value of 0.9954 and p-value=0.318. The relationship was however not significant at p-value 0.05. Conclusion: The study concluded that greater levels of religiosity were associated with lower levels of sexual activities and vice versa with a Chi-square value of 0.9954 and p-value=0.318. The relationship was however not significant at p-value 0.05. Keywords: Adolescent, Association, Behaviour modification, Religiosity, Religion, Sexual behaviour.
100 Effects of Environmental Pollution on Life and Its Preventions in Ghana , Article by Awo Esaah Bempong
This research work will discuss and highlight the problem of environmental pollution and waste mismanagement in Ghana. Everything that surrounds us is directly or indirectly linked with the environment in which we live, and these things affect the environment either negatively or positively. Not only the man, but also other living things as well as nature have effects on our environment. Almost every person living in this World is worried about environmental pollution because we experience their consequences through the food we eat, the air we breathe, the water we use for our daily activities and through the radiations we are exposed to in our environment. Also, the effects of environmental problems are manifested through the lack of natural resources, extinction of plants and animals’ species, bad smell in our environment, flooding as well as the rise of epidemic. The rapid urbanization and industrialization in the last few years have resulted in the significant emission of pollutants that cause negative effects on the urban population, the built environment as well as the terrestrial and aquatic habitat. This research work seeks to address the challenges of environmental pollution, the effects of pollution on the environment and how to manage waste in our environment by gathering data from the field through observation and interviewing of laymen (ordinary citizens), environmental experts, journalists and teachers to organize their ideas on how environmental pollution can be curbed in Ghana. Keywords: Air pollution, Water Pollution, Land Pollution, Noise Pollution, Urbanization and Migration, Environment and Waste Management.
101 An Epidemiological Study to Assess Water, Sanitation and Hygiene Practices among Rural Communities of Gulu, Kano, Nigeria , Article by Ahmad Salisu Aliyu, Bello Aminu Bello, Nuru Yakubu Umar, Maimuna Yahaya Yakasai 
Background: Worldwide, 663 million people do not have access to improved drinking water supplies and 2.5 billion people lack access to improved sanitation including one billion who practice open defecation. Eighty-eight percent (88%) of deaths from diarrheal diseases are attributable to unsafe water, inadequate sanitation, and insufficient hygiene practices. So this study is aimed at assessing water, sanitation and hygiene practice among rural communities of Gulu Kano, Nigeria. Methods: A community based cross-sectional study was conducted in Gulu from January, 2019 to February, 2019. Data was collected using a pretested structured questionnaire. Descriptive analysis was performed to obtain the frequency distribution of the variables. Results: The result shows that 300 participants responded to the questionnaire. The majority of respondents used unprotected spring 70 (23.3%) followed by protected hand dug well 65 (21.7%) for all domestic use. Most of the respondents 205 (68.3%) had covered their stored water and practiced pouring method to withdraw water from the stored container. Majority 204 (68%) of households had access to water within a time of 30 minutes or less. House hold water treatment was not common in the study area, only 25 (8.3%) households practiced. About one hundred and ninety-nine (66.3%) households had latrine facility, of which 208 (69.3%) was open Pit latrine without slab. Of those households having latrine only 111 (37%) households had hand washing facility. Conclusion: This study revealed that most of the respondents had poor water, sanitation and hygiene practice. Thus, it underscores that there should be great attention and further research and interventions are required to search for other sources of water and mobilize and educate the community towards protecting the water sources. Keywords: Water, Sanitation, hygiene, Gulu, Rural Community, Kano, Nigeria.
102 Clients’ experience of the National Health Insurance Scheme (NHIS) at the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja , Article by Christie Omolola Adams, Ekele Peter Ekele, Glory Ogunfowokan, Aishatu Ibrahim Gombe, Elizabeth Ifeyinwa Rasong, Ngozi Lydia Chukwu
Introduction: NHIS is designed to provide easy access to healthcare for all Nigerians. It was rolled out in 2006. The quality of care expected, achievement of the goals and sustainability need to be evaluated. This survey served as a measure to ascertain the expected satisfaction. Materials and Methods: A cross-sectional study of 300 respondents randomly selected from NHIS clients from 14th February – 30th March 2018 with a self-administered modified questionnaire, which assessed satisfaction domains of the client. Associations between dependent and independent variables were subjected to Chi square test and Pearson’s Product-Moment Correlation Coefficient (PPMC). Results: Most respondents were females 64.7 % (194), age range of 38 – 47 years had the highest percentage frequency distribution (33.7%). Most respondent marital status was married 244 (81.3%). They were predominantly civil servants (42.0%). The educational status shows 188 (62.7%) tertiary education. Most respondents felt waiting time was too long 39.7% (119) with health information; and 38.0% (114) with code generation unit. 169 (56.3%) respondents said that they do not get an explanation for the non-availability of the prescribed services. 33.3% respondents pay for drugs out of pockets and 37.0% (111), pay for laboratory services. Findings: NHIS is on-going with many enrollees and the aforementioned units need improvement. Conclusion: Since Ӽ_cal^2 (138.03) is greater than Ӽ_tab^2 (7.81) at the 0.05 significant level, it can be concluded that both the observed and expected distributions differ significantly. That is, there is a significant difference in the level of satisfaction of individuals under the NHIS. Keywords: Health insurance, clients experience, clinic.
103 Knowledge of Chemical Hazards and Safety Practices among Furniture Makers Exposed to Organic Solvents in Ile-Ife Nigeria , Article by Patrick Ayodeji Akinyemi, Caleb Aderemi Adegbenro, Temitope Olumuyiwa Ojo, Olanrewaju Elugbaju
Background: Furniture making industries commonly operate on small scale in Nigeria and their practices are poorly regulated. There has been less focus on the work practice and level of knowledge of related chemical hazards among people working in this sector. Objectives: This study aimed to assess the furniture makers’ level of knowledge on health effect of related chemical hazards and assess the factors affecting their use of personal protective equipment (PPE). Methods: A descriptive cross-sectional study design was employed. 108 participants were enrolled using a multi-stage sampling technique. A semi-structured interviewer-administered questionnaire was used to obtain data from participants while checklist was used to assess their workshop. A p-value of <0.05 was considered to be statistically significant. Result: Good level of knowledge of chemical hazard was observed among 65% of the respondents. The levels of knowledge of PPE use and health effect of exposure to these chemicals were, 64.4% and 54% respectively. Common factors affecting the use of PPE among furniture makers were lack of felt need, awareness and discomfort. None of the workshops inspected met the specifications stipulated for spray painting. Conclusion: Furniture makers are at risk of the health effects of chemical hazards. Majority of the respondents had poor knowledge of the effect of this hazard and did not use PPE, thus putting them at risk. There is a need for health education intervention to improve their level of knowledge which may also serve as motivating factor to improve on the use of appropriate PPE among these artisans. Ethics Approval: Ethical approval was granted by the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University. Keywords: Knowledge, Safety practices, Chemical hazards, Awareness, PPE use, Wood furniture makers.
104 Knowledge, Attitudes, and Practice (KAP) from Baseline Data of Acute Watery Diarrhoea (Awd)/Cholera among Adults (15-49) in the Somali Region of Ethiopia , Article by Godfrey Yikii, Asli Hassan, Richard Odindo, Charles N Kakaire, Andinet B Challa
Despite the many positive health benefits of hand washing, latrine use and household practices, cholera, Acute Watery Diarrhoea (AWD), remains a big challenge globally (WHO 2018). The Somali region of Ethiopia faces multiple disease outbreaks despite government interventions by Somali Regional Health Bureau (SRHB) and development Partners (UNICEF 2017). Deaths due to diarrheal diseases reached 16,573 in 2017 which represented 6.41% of the total deaths (WHO 2017). The purpose of this research study was to establish the role played by family hygiene practices in reducing AWD cases amongst vulnerable children under the age of five and pregnant women in the Somali region. Further, the study sought to target interventions that strengthen individuals (care givers, and community leaders) and institutions’ capacities that shape prevention and treatment seeking in the first 90 days of intervention. Data was obtained from May 1, 2017 to August 1, 2017, and data were analysed using a triangulation of qualitative analysis. Data sources included articles, desk interviews, focus group discussions, and quantitative approaches (facility registers) of the consultation (pregnant women and children). AWD tests from 2015 to 2017 were also analysed, and excel software was applied to compile the data as described in tables and figures. The study identified 45% of the population lacked basic education and knowledge on various ways of preventing diarrhoea such as good hygiene, food preparation, and latrine use practices. The findings revealed disparity in rural and urban communities regarding access to safe water, latrine use, electricity, media, and health facilities. Findings noted percentages of water source consumption as 18.1% use river water, 12.7% rely on open well., 41% use tap water, and only 5.5% use hand pump and ponds. All these factors contributed to the increase of AWD cases. From the literature, public health preventive interventions are a catalyst to avert disease outbreaks such as AWD or cholera with primary focus among children under five, pregnant women, and adults, although this remains challenging. Training of health care workers is a priority for early diagnosis of AWD. Knowledge gaps exist in clinical trials for AWD treatment protocol, prevention, and nutritional services. Further studies are needed to reduce the knowledge gaps, lack of follow-up, diagnosis, treatment, and prevention of AWD and other disease outbreaks. Understanding of the relationship between good hygiene practices and diseases and how this relationship affects the day-to lives of children, women, and the entire community is worth noting. Similarly, there appears to be lack of knowledge about basic prevention options. Keywords: cholera/acute watery diarrhoea, outbreak, diagnosis, prevention, practices, adults, children, pregnant women, and Somali region of Ethiopia.
105 Public Perception on Solid Waste Management and Related Government Policy , Article by Akbar Salihu  
Solid waste is the unwanted or useless materials generated from combined residual, industrial and commercial activities in a given area. Rapid population growth in urban communities and change in consumption pattern are responsible for increase in solid waste production. With the significant increase in urbanization and population, solid waste accumulation is in the for-front, and the improper disposal of such waste materials will lead to an unsanitary conditions, leading to environmental pollution and outbreak of diseases. The above research will be carried out to help the government establish a policy for proper solid waste management for better environment.  
106 Overweight and Obesity: Prevalence and Level of Awareness among Adolescents in Selected Urban and Peri-Urban Secondary Schools in Monze, Zambia , Article by Sophonie Ndahayo  
The purpose of this cross-sectional study was to determine the prevalence, level of awareness and associated risk-factors among adolescents in selected secondary schools in Monze, Zambia. The main objective was to establish the magnitude and level of awareness about the disease burden associated with the consumption of energy-dense foods compacted by physical inactivity among the studied population. A sample of 358 respondents was selected from a population of 2319 pupils. A 57-items structured questionnaire was used to collect data, which was analysed using SPSS 16.0. Of the 358 respondents, the prevalence of underweight was one percent, normal weight 75%, overweight or obesity 24%, and that of that of obesity alone was 5%. These rates are among the highest in sub-Saharan Africa. The results showed a significant difference between residing in peri-urban area and the urban one (ρ= .05%). Applying the Delphi experts’ scores, respondents’ awareness level of overweight and obesity and associated risk-factors was between moderate and low. A school-based policy to prevent overweight and obesity among adolescents in Zambia was recommended among other measures to be taken by all stakeholders. Keywords: overweight, obesity, awareness, urban, peri-urban, adolescents.  
107 Socio-cultural and Economic Determinants of Maternal Health in Ado-Ekiti, Nigeria , Article by Okpoko, Pius Izundu  
A major challenge to global health systems is maternal mortality. The vast majority of these deaths are preventable. This research is aimed at investigating sociocultural and economic determinants of maternal health in Ado-Ekiti, south-west geopolitical zone of Nigeria. It was a cross sectional epidemiological study which determined the association between the independent variables (maternal educational status, maternal religion, maternal occupation, decision maker for the commencement of ANC, and health care availability/accessibility) and the dependent variable (maternal health as represented by choice of ANC provider). The respondents were 418 females of reproductive age group. The modal age group was '51 years and above' (24.4%). The majority of the participants (45.5%) were married. A total number of 50(12.0%) respondents had primary education only, 110(26.3%) secondary education, 130(31.1%) tertiary, while those without any formal education were 16(3.8%). There were 112(26.8%) who did not indicate their educational status and did not give reasons for it. On religion, 216(51.7%) were self-identified as Christians and 188(45.0%) as Muslims. Traditional faith constituted 14(3.3%). Those employed were 178(42.6%), while 102(24.4%) were unemployed. Students constituted 82(19.6%) and Apprentice 56(13.4%) of the respondents. All the variables tested gave a statistically significant value of p<0.05. The selected variables for multivariate logistic regression also gave a statistically significant value of p<0.05. Strategies targeted at improving maternal educational status, making employment available, and encouraging accessibility to health care facilities, may make a significant impact in reducing Maternal Mortality Rates in the studied population. Keywords: Maternal, health, mortality, economic, sociocultural, determinants.  
108 Psychosocial Problems among Parents Caring for Children with Cerebral Palsy Attending a Tertiary Care Hospital in Ile-Ife, South-West, Nigeria , Article by Ganiyu Abiodun Adedeji
Background: It has been established that the challenges faced by children with cerebral palsy bring about a higher level of stress which has negative effect on their physical health as well as their social well-being. The aim of this study was to explore the psychosocial problems encountered by the parents caring for children with cerebral palsy (CP) in an urban setting. Methods: Qualitative research design using focus group discussion (FGD) was used for the study. The setting was a focus group discussion (FGD) at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, South-West, Nigeria. A total of ten parents participated in the focus group discussion. The parents caring for the children with cerebral palsy coming for treatment in the physiotherapy outpatient clinic of the department were contacted and the nature of the study was explained to them. The main outcome measured were the psychosocial problems encountered by the parents caring for children with cerebral palsy. Results: The outcome of the study revealed that problems like finance, health-related problems, impaired social relationships, worries concerning child’s future and requirement for more support were encountered by the parents of these children. Most of the parents had visited different traditional, spiritual homes as well as health care facilities for solution to their children’s problems. Conclusions. Parents caring for children with cerebral palsy encountered varieties of psychosocial problems. Family centered care program can be designed for cerebral palsy children and their parents based on information that may be obtained from research studies of this nature. Keywords: Psychosocial problems, cerebral Palsy, Parents, Care, Children.  
109 Improving Community Sanitation and Hygiene Performance in Kerwa Sub County through the Application of Statistical Thinking , Article by Omona Kizito  
Introduction: Sanitation refers to the provision of facilities and services for the safe disposal of human urine and faeces whereas Hygiene is a set of personal practices that contribute to good health. It includes things like hand-washing, bathing and so forth. Objectives: The purpose and rationale of this project was to improve sanitation and hygiene in Kerwa Sub county. Methods: The project (2years) employed both qualitative and quantitative mixed designs in Kerwa Sub county, located, in Yumbe district, Uganda. Implementation period was from April, 2015 to November, 2016. Results: The total number of households with latrines increased from 775 (43.3%) in the baseline to 1215 (67.8%) in the first year of project implementation then to 1579 (88.2%) in the second year. Similarly, open defecation dropped from 56.7% in the baseline to 32.2% in the first year of project implementation and further to 11.8% in the second year. Hygiene status, measured using hand washing, almost remained the same between baseline and first year of project implementation at about 0.9%. It significantly improved to 20.8% in the second year. Through application of statistical thinking, final reporting time reduced by 60 days, from 210 days before statistical thinking approach to 150 days after the application. Conclusion: Statistical thinking remains a key process of continuous quality improvement in any industry. Keywords: Sanitation and hygiene, statistical thinking.  
110 Awareness and Practice of Cervical Cancer Screening and Human Papilloma Virus Vaccination (HPV) Uptake among Female Staff in Private Tertiary Hospital in Lagos Nigeria , Article by Aisagbonhi Henry Osaro, Mgbeafuluba Ifeyinwa Constance
Cancer burden in Nigeria has become a sudden nightmare which is fast having a disastrous impact on the health and financial economy. The estimated number of new cancer cases in West Africa is 854,790. In Nigeria, about 8.5% of the 51million annual death due to cancer account for cervical cancer. In this cross sectional descriptive study amongst female Private health workers, a significant level of awareness of cervical cancer amongst the female health workers in the private health sector was observed. The level of awareness is strongly associated with enhanced education but there was no link with age or marital status. A significant link between the level of awareness and health occupation especially the core health workers were also observed. However, there was a marginal link with the non-medical health workers. Furthermore, there was a significant link illustrating that a possible increased participation in cancer awareness programs would lead to; Increase in knowledge of CC status, increase in utilization of Pap smear test and improved uptake of HPV vaccine. This outcome serves as an original article data base to resolve any doubt and perception on the level of knowledge and awareness of Cervical Cancer amongst private sector health workers in Lagos state and extendable to Nigeria. Keywords: Cervical Cancer – CC, Human Papilloma Virus- HPV, Vaccination uptake –VU, Papanicolaou (pap) smear test, Sexual transmitted diseases (STD).  
111 Impact of Mental and Health Promotion on Parents Caring for Children with Cerebral Palsy in Ile-Ife, South-West, Nigeria , Article by Ganiyu Abiodun Adedeji, Caleb Aderemi Adegbenro
Background: Studies have shown the correlation between children’s physical disabilities and parental stress. The importance of the length of systemic therapy including stress management has also been emphasized in the literature. This study aims to explore the results of a holistic mental and health promotion intervention on parents caring for children with cerebral palsy. Methods: Self-administered scales (Questionnaires) were employed to measure lifestyle variables, perceived stress, depression and anxiety, locus of control, and spirituality. Prior to commencement of the study, the informed consent of the participants were sought and obtained and ethical clearance was also obtained. A sample size of 80 participants was also calculated for the study. Stress management techniques were taught to the participants in the intervention group who also attended lectures on health behaviors. The control group were placed on normal existing protocol. Odd and even numbers of the participants’ birthdate was employed in allocating them to either the intervention or the control groups. The intervention group participated in the health promotion programs for a period of 8 weeks after the pretest measurements. The control group were only placed on the normal existing protocols after the pretest measurements. Both group participants underwent posttest measurements after the 8 week period. Chi-square test was used to determine any significance difference in terms of sociodemographic variables between the two groups. Independent t-test was employed to determine significantt difference between the two groups in relation to mean scores of psychosocial problems after intervention. Paired t-test was also used to determine any significant difference between mean scores of psychosocial problems before and after intervention in the intervention group. Statistical level of significance was set at P<0.05. Results: The results of the independent t-test revealed that the null hypotheses in respect of the anxiety and depression subscales of Depression Anxiety Stress scale (DASS-21) and Perceived Stress Scale (PSS-14) were rejected. Significant difference was found after intervention between groups regarding the anxiety and depression subscales of DASS-21 (t = 4.75, p < 0.05) and Perceived Stress Scale PSS-14 (t = -2.76, P < 0.05). The results of the Chi-Square test showed no significant difference between the groups regarding the sociodemographic variables of the respondents in respect of the participants’ sex (X2 = 1.127, P > 0.05), participants’ number of children (X2 = 1.747, P > 0.05), participants’ level of education (X2 = 3.936, P > 0.05), participants’ religion (X2 = 0.464, P > 0.05) and participants’ ethnic groups (X2 = 3.387, P > 0.05). However the study found significant difference with respect to the participants’ marital status (X2 = 7.014, P < 0.05). The paired samples t-test showed significant difference between the pre-test and post-test mean scores of the participants’ psychosocial problems with regards to the DASS-21 (t39 = 12.758, P < 0.05) and PSS-14 (t39 = 79.514, P < 0.05) in the intervention group. Conclusion: The objectives of this study to reduce the levels of depression, stress and anxiety in parents caring for children with cerebral palsy in Ile-Ife, south-west, Nigeria was achieved. As a result of these achievements, the objective of improving the Quality Of Life (QOL) of the participants was also realized. Keywords: Mental Promotion, Health Promotion, Cerebral Palsy, Parents, Children.  
112 Effect of Nursing Intervention on Knowledge of Malaria Prevention among Mothers of Under-Five Children in Selected Primary Health Care, Mushin Local Government, Lagos , Article by Olubiyi, S.K. , Folami F., Adebanjo A.T
Introduction: Malaria is a major public health problem in Africa. The disease is a significant contributor to the poor health situation in Africa, in which Africa alone is estimated to lose at least US$ 12 billion per year in direct losses e.g. illness, treatment, premature death. Almost 1 out of 5 deaths of children under 5 in Africa is due to malaria. Due to the high figure, there is still the need for continued awareness and renewed commitment for the prevention of malaria especially among the risk group (under-five and pregnant women). Objective: The study assessed the effect of the nursing intervention on knowledge of malaria prevention among mothers of under five in a selected PHC and also described the level of knowledge of mothers on malaria in a selected PHC in Mushin LGA pre and post-intervention. Methods: This is a quasi-experimental design. Data collection was done using a structured, self-administered questionnaire to obtain information from the participants. This study was carried out in three phase which involved three phase (pre-intervention, intervention and post-intervention) activities in process of data collection. Results: The findings of the study showed significant difference between posttest knowledge of malaria prevention and pretest knowledge of malaria prevention among mothers of under-five children. Conclusion: This study revealed that knowledge of mothers of under-five on malaria and various malaria prevention strategies improved. This study recommended that Mothers of under-five should be regularly exposed to training programs on malaria and malaria prevention. Keywords: Nursing intervention, Malaria prevention, Under-five children, Prevalence.  
113 Demographic and Behavioural Factors Associated with Uptake of at least Three Doses of Intermitted Preventive Treatment of Malaria in Pregnancy (IPTp-SP3) among Nigerian Women , Article by Okoh, O.M, Babalola, S, McCartney-Melstad, A, Tweedie, I, Amosu, A. M
Malaria is a vector borne protozoa disease that is endemic in Nigeria and continues to present significant public health challenge to the Nigerian government. Pregnant women are especially vulnerable to malaria infection due to their compromised immunity. Malaria contributes significantly to poor pregnancy outcomes like low birth weight, premature delivery, still birth, spontaneous abortion and neonatal death. The use of IPTp-SP has been proven to be a safe, cheap and effective means to prevent malaria and its consequences among pregnant women. Consequently, pregnant women are expected to receive a minimum of three doses of IPTp-SP beginning from the 13th week of pregnancy. In spite of this, uptake of IPTp-SP by pregnant women still remains low in Nigeria. This research investigated the demographic and behavioural factors that were associated with uptake of at least three doses of IPTp-SP among women who had a live birth in the two years preceding the survey. The study was quantitative in design and used cross sectional data that included 3205 women from Akwa Ibom, Kebbi and Nasarawa states. Findings from this study suggest that ANC attendance is the most important factor associated with uptake of a minimum of three doses of IPTp-SP (IPTp-SP3). This might not be unconnected to the IPTp-SP strategy being largely a facility based intervention. Household wealth index exhibited a marginally significant relation with uptake of IPTp-SP3. After adjusting for cluster level effects and other potential confounders, a woman’s decision making autonomy and state where she was resident were found to be significantly associated with uptake of IPTp-SP3. An unexpected but logical finding was the inverse relationship between regular use of bed net and uptake of IPTp-SP3. This finding has implication for how bed net use is presented to pregnant women. Results from this study suggests that, improved access to ANC services, improved women’s autonomy , and educating pregnant women that regular bed net use does not preclude the need for IPTp-SP utilization could go a long way in improving uptake of IPTp-SP among pregnant women in Nigeria. Keywords: Malaria, Pregnancy, Ante natal care, IPTP-SP, Behaviour, Nigeria.  
114 Determinants of Intermittent Preventive Treatment of Malaria (IPTp-SP) Ideation among Women with at least one Child not older than 2 years in three Nigerian States , Article by Okoh, O.M\, Babalola, S. , McCartney-Melstad, A., Tweedie, I, Amosu, A. M
Ideation is a set of ideas or ways of thinking that influence how people behave and how these ways of thinking are propagated within a community. Ideation has been successfully used to influence adoption of protective/preventive behavior in HIV and family planning interventions. Its use in the field of malaria is gradually gaining prominence but has been limited to bed net use. This research investigated the demographic and behavioral factors that were associated with higher IPTp-SP ideation among women with a live birth in the two years preceding the survey. The study was quantitative in design and used cross sectional data that included 3205 women from three Nigerian states. Multilevel analysis was used to account for contextual factors. Less than two-fifth of the women included in the analysis had higher IPTp-SP ideation. Factors that were found to be significantly associated with IPTp-SP ideation included uptake of IPTp-SP, use of ANC services, exposure to malaria messages, as well as the geographic location and prevalence of low educational status in the community where a woman lives. Results from this study suggests that, (i) improved access to ANC services, could potentially increase IPTp-SP uptake through its effect on IPTp-SP ideation, (ii) dissemination of malaria messages especially those specific to IPTp-SP use remains a relevant option for improved utilization of IPTp-SP, (iii) there is need for interventions that specifically target communities with high prevalence of less than secondary education, in order to address those factors that negatively impact IPTp-SP ideation in such communities. Keywords: Ideation, Malaria, Pregnancy, Nigeria, Prevention, Sulfadoxine-Pyrimethamine.  
115 Effect of Health Educational Intervention on Knowledge and Perceptions of Asthma among Secondary School Students in Ile- Ife, South-West, Nigeria , Article by Ilesanmi, Oluwafemi Temitayo, Adegbenro, Caleb A, Erhabor, Gregory E, Olatona, Foluke A, Adewole, Olanisun O,  Awopeju, Olayemi F, Adeniyi, Bamidele O
Asthma is a major public health problem among adolescents with significant functional disability. Inadequate knowledge and poor perceptions of the disease are highly contributory to its impact. Patients’ education is vital in addressing this challenge. The study assessed the level of knowledge and perceptions of asthma and the impact of asthma health education programme among a group of the secondary school students in Ile- Ife, Nigeria. It is a quasi- experimental design study which used a pre-tested 71- item, purpose designed, self- administered questionnaires to collect information on knowledge and perceptions of the respondents on asthma before and after intervention. Data were collated and analyzed based on descriptive and inferential study design. The results of this study showed that perceptions and knowledge of asthma were poor among the group. There was a significant difference in the pre- test and post- test knowledge and perceptions scores of asthma of the secondary school students in the intervention group following health education programme intervention. In addition, the results showed that there was a significant change in knowledge and perceptions of asthma overtime for the participants in the intervention group, over a period of 1 week, 3 weeks and over a period of 6 weeks. We concluded that health educational intervention has significant positive effect on knowledge and perceptions of asthma among secondary school students in Ile- Ife, Osun State, South West, Nigeria. Keywords: Asthma; Knowledge; Perceptions; Health Educational Intervention.  
116 Seroprevalence of Human Immunodeficiency Virus, Hepatitis B, Hepatitis C, Syphilis and Co-Infections among Antenatal Women: A Retrospective Case Study at National Hospital Abuja, Federal Capital Territory (FCT), Nigeria , Article by Adedamola Amos Ogundeji  
Objective: The aim of the present study is to determine the seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and co-infections among antenatal women in National Hospital Abuja, Federal Capital Territory (FCT), Nigeria. Background: Sexually transmitted infections and human immunodeficiency virus (HIV)/AIDS are a major public health concern owing to both their prevalence and propensity to affect offspring through vertical transmission. Aim: This study aimed at determining the seroprevalence of HIV, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), syphilis, and co-infections among antenatal women in National Hospital Abuja, Federal Capital Territory (FCT) Nigeria. Materials and Methods: A two (2) years retrospective study of antenatal women that attended National Hospital Abuja, Federal Capital Territory (FCT), Nigeria from 1st March, 2013 to 28th February, 2015. A pretested data extraction form was used to obtain data on socio-demographic variables and screening test results from the antenatal records. The analysis was conducted using SPSS version 17 (Chicago, IL, USA). Results: A total of 3748 antenatal records was used for the study. The seroprevalence of HIV, HCV, HBsAg and syphilis among the pregnant women were 7.9 %( 296/3748), 4.7 %( 176/3748), 10.6 %( 397/3748) and 1.1 %( 41/3748), respectively. The HIV/HBV, HIV/HCV and HIV/Syphilis co-infection prevalence rates were 0.24 %( 9/3748), 0.13 %( 5/3748) and 0.05 %( 2/3748) respectively. There was no HBC and HCV co-infection among both HIV positive and negative antenatal women. There was statistically significant difference in HBV and HCV infection between the HIV positive and negative antenatal women. Conclusion: The prevalence of HIV, HBV, HCV, and syphilis is still a challenge in Abuja. Community health education is urgently require to reduce the prevalence of these infections among the most productive and economically viable age bracket. Our study showed that it is very necessary/important for all pregnant women to be requested to test for HBV, HCV alongside the conventional syphilis and HIV infections, in order to prevent vertical transmission to their unborn babies. Preceptor/location of project: National Hospital Abuja, Federal Capital Territory (FCT), Nigeria.  
117 Malaria Treatment at Community; Can Rapid Diagnostic Test Eliminate Stock-out of Artemisinin-Based Combination Therapy in South Sudan , Article by Dricile Ratib  
Malaria remains endemic in South Sudan, accounting for 20% of deaths and 30 % of hospital admissions (Global Fund, 2015). The 2014 to 2021 South Sudan national malaria strategic plan aims to bring down the morbidity and mortality related to malaria by 80%, but stock-out of drugs is a major challenge (National malaria control program [NMCP], 2017) South Sudan received over fifty five million (55,585,832 USD) United states dollars from Global fund in 2015 for fighting malaria in addition to similar amounts from Department of International development (DFID) but this has not changed the ant-malaria  stock out status(DFID, 2015). In the last quarter of 2014, 854 Community based distributors (CBDs) from two sub-recipients had stock out of Artemisinin based combination therapy (ACTs)  (Global Fund, 2015)  This retrospective study re-analyzed the data used for training 240 community based drug distributors (CBDs) in April 2015 on the use of malaria rapid diagnostic test (RDT). Of those who passed the post test, 131 were given kits of RDT to practice the skills they had acquired and give ACTs only to the children 2-59 months who test positive for malaria. The number of children assessed with fever were 1047, (534 males and 513 females); 1012 were done RDT and only 364(36%) tested positive for plasmodium falciparum malaria.  The iCCM programme in South Sudan treats all fever cases with ACTs. This one month RDT use therefore saved 64% of the ACTs that would have been irrationally used.      
118 Family Planning Practices of Female Garment Workers , Article by Shazly Bari, Irin Hossain
A cross sectional descriptive study was carried out among the garments workers with the objective to assess the family planning practices of female garment workers with structured questionnaire by face to face interview. The proportion of women seeking abortion was 75%. The proportion of female workers were using family planning method was 85% and rest of workers were not using any type of method is 15%. Among those 15% who were using family planning method and apart from them 76.5% were taking OCP and 70% providing by Govt. source. There were also some garment workers who were concern about family planning method but due to long term use of oral contraceptive pills as contraceptive method leading to many chronic diseases. This study reflected family planning practices of female garment workers, for better standard. Further large scale studies needed to explore. Keywords: Family planning practice, female garment workers.  
119 Awareness and Knowledge of Diabetic Retinopathy (DR) among Al-Batinah Population, Oman-A Pilot Study, 2018 , Article by Gopi Suresh Vankudre, Galal Ismail, Shaikha Salim Al-Shumosi
Introduction: As per Oman government’s health report (2013), Diabetes Mellitus (DM) prevalence in Omani population aged 18 and above was 12.3%. Omani young adult and older population, are at a higher risk of being diabetic and developing diabetic retinopathy (DR). There are limited studies conducted in Al-Batinah region, to evaluate the community’s, DR related awareness and knowledge. Evidences on community’s condition related knowledge can further help in enhancing the eye health care system. Aim: To evaluate DR related awareness and knowledge, among Al Batinah population in Oman. Material and Methods: This cross-sectional questionnaire-based study involved 100, randomly selected Omani participants. A self-designed validated questionnaire was used to assess awareness and knowledge of DR, amongst Al-Batinah population. The survey-based responses were analysed using Statistical Package for Social Sciences (SPSS) version 21. Results: All participants have heard of DR. Relative or friend was the most common knowledge (51%) source. 81 % of the study participants were aware that DM leads to ocular complications. 94% participants believed that the eye care visit can be avoided, if DM is under control. Controlled diet was the highly agreed DR prevention strategy among the participants (88%). Agreement on the use of medication, laser and surgery as a part of the treatment, was observed to be 29%, 62%, and 70% respectively. Conclusion: Awareness about DR, among the participants was high. However, the condition related knowledge variations were observed. Keywords: Awareness and Knowledge-Diabetic Retinopathy, Diabetic Eye Disease.  
120 Association between Socio-demographic Characteristics of Community Health Workers with Compliance to Quality Delivery of Integrated Community Case Management of Febrile Illness services in Nigeria , Article by Bright Orji, William Brieger, Lindiwe Innocentia
The objective of the study was to investigate the association between community health workers (CHWs) socio-demographic characteristics with compliance to quality delivery of integrated community case management (iCCM) of malaria, diarrhea and simple respiratory infection. This was an implementation research study conducted in two local government areas of Akwa Ibom State, Nigeria with a total of 152 CHWs. The study used an observational data collected by the ministry of health and implementing agency in 2010. The observational data was re-analyzed using SPSS version 17 to examine the association between the dependent variable, quality improvement performance score and independent variable - socio-demographic characteristics of CHWs. 21% of the CHWs were male while 79% were female CHWs. The CHWs overall mean age was 36.8(±8.7) years. The CHWs were assigned to the following age groups: <36 years (53%), and >36 years (47%).  12.0% of the CHWs had primary education; 74.0% attained secondary school while 14.0% of the CHWs attained post-secondary school. 63.0% of the CHWs were unskilled while 37.0% of the CHWs were skilled. Chi-square test result revealed that 81.5% (n=124) of the 152 CHWs studied were compliant to quality improvement performance. Logistic regression analysis showed that socio-demographic characteristic associated with quality improvement performance was sex (OR 2.717, 95% CI: 1.064-6.937, p=0.037). To introduce and sustain the impact on quality performance among CHWs requires training, supportive supervision and strong coordination. Keyword: So-demographic characteristics, Community health workers, integrated community case management of malaria, pneumonia and diarrhea; quality improvement performance standards.  
121 A Critical Review of the Articles “Rubella Outbreak Investigation, Gokwe North District, Midlands Province, Zimbabwe 2014 , Article by D. Chirundu, P.N. Magande, A.N. Musiya
This was an appraisal of a Rubella outbreak investigation carried out in Gokwe North District (Zimbabwe). The outbreak occurred from 24th June to 12 August 2014 at a primary school. The manuscript has an abstract that provided the stance and thesis. The introductory part covered the epidemiology of the disease. Methods section detailed the study design. Findings of the descriptive and analytical epidemiology investigations are presented in the results sections. The article was published in the Pan African Medical Journal, a peer reviewed journal. This confers credence to the journal. It is tracked by HINARI, and Scopus, among others. The corresponding author is Donewell Bangure, a Zimbabwean epidemiologist. The manuscript was backed up by credible references from World Health Organization and other peer reviewed journals. However, wrong construction of the epidemic curve, may have led to erroneous conclusions. Most of the information in the manuscript was objectively developed. However, some references were unpublished, and, some outdated. The manuscript was published in a peer reviewed journal and this makes it stable. There are three tables and one graph in the article. There are three well labelled tables and a graph in the manuscript. Information in the tables and graph is presented in a way that is comprehensible. Keywords: Rubella, Gokwe North, Outbreak.  
122 Knowledge Intervention on Nutrition among the Primary School Students , Article by M.M Aktaruzzaman, Shazly Bari, Irin Hossain
This quasi experimental study was done among the students of class V of 68 No. Islampur Primary School, Dhamrai, Dhaka to assess & intervene knowledge on nutrition. Purposively 104 students of class V were selected and interviewed with a structured, self-administered questionnaire. Then the respondents were taught with basic nutrition knowledge for 5 days and after completion of teaching, post intervention evaluation was done with same questionnaire. Then the answer scripts were evaluated to understand whether there were any changes in their knowledge on nutrition. As on the analysis it is clearly understood that there is huge difference and increase in percentage before and after the intervention. There was a satisfactory improve of knowledge after giving of intervention on nutrition. The primary objective was to assess the knowledge on nutrition to improve the health of the respondents. On the basis of the findings it may be concluded that the knowledge on nutrition is one of the major health concern, so creating awareness through intervention program on nutrition can reduce the malnutrition problem. Keywords: Knowledge, nutrition.  
123 Barriers to HIV Testing among Adolescents and Young Adults in Harare City, Zimbabwe , Article by Notion Gombe, Nicholas Midzi
The HIV prevalence in the Zimbabwean population aged 15-49 years remains high (15.2%). Most adolescents do not know their HIV status despite knowing a place to get tested. We determined barriers to HIV testing and counseling (HCT) among sexually active adolescents and young adults in Harare City We conducted a cross-sectional study among sexually active adolescents and young adults. Data were collected using a pretested self-administered questionnaire. Information was collected on individual characteristics, HIV testing acceptance, risk behaviors and reasons for having never been tested. Epi-Info 7 was used to analyze data. Chi-square tests and logistic regression models were used to assess independent determinants for not testing for HIV. Statistical significance was set at p< 0.01. A total of 427 adolescents and young adults were recruited. The majority (56.9%) were female. Of these, 186(43.6%) had never tested for HIV. Participants listed not knowing where to get tested (60.8%), low risk perception (29%), never having been offered a test(21.5%), fear of a positive result(16.1%), being embarrassed (10.2%), parents who will not allow (7.5%), failure to afford consultation fees(5.9%), and being worried about health worker confidentiality(5.9%) as reasons for not having been tested. In multivariate analysis being afraid of a positive result [aOR=0.07; 95%CI (0.01-0.30)] and being male [aOR=0.43; 95%CI (0.23-0.80)] were independently associated with never having had an HIV test. Barriers to HIV testing identified in this study can be easily resolved by applying innovative approaches tailored to increase access to and acceptance of HIV-testing services among the adolescent and young adult populations. Keywords: Adolescents, HIV Testing, Correlates, Barriers, Harare City.  
124 Erectile Dysfunction among Diabetic Patients at Parirenyatwa Group of Hospitals in Zimbabwe , Article by Pasipanodya Ian Machingura, Vasco Chikwasha
Erectile dysfunction is a major problem amongst diabetes mellitus patients. However sexual problems are not usually discussed with doctors due to embarrassment and lack of understanding of the condition thus the patients suffer silently. The study sought to determinate the prevalence of erectile dysfunction and associated factors amongst male diabetes mellitus patients attending the outpatient clinic at Parirenyatwa group of hospitals. Adult male diabetic patients who consented to participate in the study had a questionnaire administered on them to collect demographic data and an International Index of Erectile Function (IIEF-5) Questionnaire administered on them by a male medical doctor. Anthropometric measurements were conducted and samples were collected for laboratory investigations. The prevalence of erectile dysfunction was 73.9%. Erectile dysfunction was associated with higher age (p = 0.009), higher systolic blood pressure (p = 0.009) and being on hypertensive drugs (p = 0.007). The proportion of diabetic patients with higher glycosylated haemoglobin was higher among patients with erectile dysfunction (p = 0.020). This study shows high prevalence of erectile dysfunction in diabetes mellitus patients attending Parirenyatwa outpatient clinic. Erectile dysfunction was associated with higher age, higher systolic blood pressure and being on antihypertensive drugs. This study shows the need of consistent screening of erectile dysfunction among diabetic patients for early detection, treatment and prevention. There is also need for a large national study to confirm this prevalence and the associated factors. Keywords: erectile dysfunction, diabetes mellitus.  
125 Strengthening Malaria Service Delivery through Measurement of Quality Improvement of Performance Standards in Nigeria: evaluation of Community Health Workers Performance , Article by Bright Orji, William Brieger, Lindiwe Innocentia
This study monitored quality improvement performance standards of Community Health Workers (CHWs) who were providing integrated community case management of malaria, pneumonia and diarrhea (iCCM) in two selected LGAs. One hundred and fifty-two trained CHWs providing iCCM services in Akwa Ibom State, Nigeria were monitored and assessed using one page tool on quality improvement performance standards. The tool has 37 performance criteria (PC) to measure CHWs’ knowledge, skills and competence in 3 sections: History taking and Examination; Conducting RDTs for Malaria; and Illness Management. Trained assessors observed CHWs providing services. Each correctly performed criterion was scored 1 point. Four rounds of assessments were conducted at an interval of two months from June 2011 - March, 2012 as part of the efforts to strengthen services provided by CHWs. The result shows that during Round 1 CHWs achieved an average of 19 (52.2%) performance standards. This rose to 25 (67.5%) in Round 2; 28 (75. 6%) in 3 and 30 (81.1%) in round 4 and (p = 0.00). Therefore, the number of CHWs that scored >=80 increased from 79 in round-1 to 124 in round-4. PC that needed to be strengthened the most included reinforcement on checking RDT expiry date, recording results, and safe disposing of sharps. Providing feedback in-between rounds of assessments contributed to CHWs improved performance during the subsequent round. The feedback mechanism provides the platform for addressing the barriers that limits the CHWs extent of achieving performance standards for malaria improved service delivery Keywords: Measurement, Quality improvement performance standards, community health workers, integrated community case management of malaria, pneumonia and diarrhea.  
126 Assessment of Effect of Labour Strikes on Access to Service Delivery in Secondary Health Institutions in Cross River State, Nigeria , Article by Samson Olusegun Aturaka, Amosu AM, Robert J. Chiegil, Felix Sanni, Musa Orenyi, Margaret Dakwat, Abiodun Olaiya Paul, Opeyemi Joseph
Frequent labour crisis leading to strikes is common in a developing country like Nigeria. This cross-sectional descriptive study was carried out to assess the effect of labour strikes on access to service delivery in secondary Health Institutions in Cross River State, Nigeria. The 508 respondents were drawn from the outpatient, laboratory and pharmacy departments, Ante-Natal and Post-Natal and ART clinics of the 7 secondary health institutions spread across 3 senatorial districts in the state between January and February 2018. Data were collected with a semi structured, closed- and open-ended questionnaire. Raw data were entered EpiData™ and exported for analysis using the SPSS software version 20. The data were cleaned and validated for use. Frequency tables were produced and associations between categorical variables were determined using chi square test at a significance level of P<0.05. The age range of most repondents was 25 - 45 with the peak value of 198 (39%) recorded for age group 25 – 34 years. The results showed that though many people did not know the reasons why health workers embark on incessant strikes, they did not support strikes. Seven factors were highlighted as the major causes of regular strikes in Nigerian health institutions and the knowledge of respondents about all these factors were tested. Overall, the accessibility of patients to healthcare during labour strikes was approximately 8% which was not a pleasant experience for the patients. Conclusively, labour strike has serious effects on access to service delivery in secondary health institutions in Cross River State, Nigeria. Keywords: Labour Strikes, Access to Service Delivery, Secondary Health Institutions, Healthcare Workers and patients’ educational level  
127 Consistent Condom Use in HIV/AIDS Patients Receiving Antiretroviral Therapy in Northwestern Ethiopia: Implication to Reduce Transmission and Multiple Infections - A Critical Review of Article , Article by D. Chirundu, A.N. Musiya, S. Moyo, C. Muringazuva, Z. Jakopo, P.N. Magande
Introduction: This is a critical review of an article by Zewdneh Shewamene published in the July 2015. The central theme is that consistent condom use among HIV patients is important in preventing transmission of HIV. Article summary: The premise of the authors is that consistent condom use among HIV infected is critical for interrupting transmission of HIV and acquisition of resistant strains of HIV. Among the 317 respondents, condoms awareness was 96.2%. Independent factors for consistent use were, male sex (AOR=6.87; p=0.001), urban residency, (AOR=4.65; p=0.001), a higher education attainment (AOR=8.98; p=0.001), and prolonged duration on ART (AOR=3.91; p=0.001). The conclusion was that some HIV infected people were not using condoms. Article critique: The article maybe considered as objective, and unbiased due to the peer review process. The journal that published it is indexed on PubMed, and, Embase, among others. That the article was published in a journal for those with an interest in HIV and palliative care makes it relevant for HIV programming particularly in Africa where HIV burden is high. The objectives are well spelt, and the methodology is easy to follow. Only verbal consent was obtained from the respondents contrary to the dictates of the Belmont report that requires written informed consent. Conclusion: The articles contributed to literature and can provide a basis of improving future studies of a similar nature. However, it is suggested that measurement of condom use should be serial and be recoded to a dichotomous variable in analysis. Keyword: Condoms, Ethiopia, HIV.  
128 Perception of Refractive Error among Adolescents - A Pilot Study , Article by Janitha Plackal Ayyappan, Galal Ismail, Kalyani Mohanraj
Background: Several studies reported about the prevalence of refractive error among children as well as various age group. Hardly any study reported about the perception of refractive error among adolescents. The purpose of the study was to examine the level perception regard to refractive error in adolescents, rural region of India. Objectives: The aim of the study to find the level of perception of refractive error among adolescents, Andhra Pradesh, India. Materials and Methods: A purposive sampling method was applied to choose 50 subjects aged between 16 years to 18 years from the rural population of Andhra Pradesh were considered for analysis. A self-designed questionnaire with open-ended and closed-ended questions was designed to gather the participants' demographic data such as gender, age, majors, socioeconomic status of the parent, as well as their perception toward refractive error was analysed using a Statistical Package for Social Science (SPSS 10.0.5) (SPSS Inc. Chicago, USA). Results: A total of 50 participants' (n=50) responded to a five-point Likert's scale comprising of 11test items. Out of the 11 test item, 5 item mean score found between 4.06 – 4.42 with SD ± 0.9 -1.3 showed consistently high responses as “strongly agree”. Whereas, four-item mean score ranges from 3.18- 3.86 with SD ± 1.3-1.53 reflected as "agree". Furthermore, 2 test items mean score 4.18-4.36 with SD ± 1.5-1.6 found the responses as "Neutral". However, there is no test item mean score as "disagree" and "strongly disagree" reported by the participant. Conclusion: perception of refractive error among adolescents found to be poor in this study. Keyword: Perception, Refractive Error, Adolescents, Refractive Correction and Methods.  
129 Awareness and Preventions of Malaria in Pregnant Women: A Study of Mile Four Hospital, Nigeria , Article by Mgbe Chinenye G, Mgbe Emeka Kevin, Rita Uzoamaka Nwali
This cross sectional study was conducted at the maternity unit of Mile Four Hospital in Abakaliki Ebonyi State. The aim was to determine the degree of awareness and practice of malaria prevention strategies among antenatal attendees in Mile Four Hospital in Abakaliki Ebonyi State. Semi-structured questionnaires were administered to one thousand five hundred and sixteen pregnant women in the antenatal clinic. The findings revealed among other things that pregnant women attending antenatal clinic in Mile Four Hospital Abakaliki in Ebonyi State are aware of malaria preventive measures and are utilizing malaria preventive measures to prevent themselves. The study recommended among other things that, awareness campaign should be drawn to rural areas so that Pregnant women should be educate on high risk involve in malaria infestation for total eradication of miscarriage, low birth weight, still birth and maternal death. Keywords: Awareness, Malaria, Prevention, pregnant women.  
130 Menstrual Hygiene Practices of Female Garment Workers , Article by M.M Aktaruzzaman,  Irin Hossain
Readymade garment sector has been playing an important role in enhancing Bangladesh economy. Women represent 85 percent of the total 30 million employees in readymade garment industry. A cross sectional descriptive study was carried out among the garments workers with the objective to assess the menstrual hygiene practices of female garment with structured questionnaire by workers. Majority of the respondents were within the age group of 18-23 years. This study showed that only 30.5% respondents were maintaining personal hygiene properly during menstruation and 12% satisfied about their washing facilities in their working place. This study reflected different dimension in their reproductive life which were not upto the level. It should be improved for better standard. Further large scale studies needed to explore the real situation in this regard. Keywords: Menstrual Hygiene practice, garment workers.  
131 Pertussis Vaccine; the Past, the Present and the Future (A Mini Review) , Article by Frank Adusei-Mensah  
The inception of the whole cell pertussis vaccine wP saw global reduction in reported cases, mortality and morbidity burden to the disease. But, in the late 90s, wP was replaced with acellular pertussis vaccine (aP) in most countries due to safety reasons. In recent years however, the annual reported cases of pertussis globally have increase greatly even among highly vaccinated groups, 1; 2. This nurtures concerns about the level of protection aP bestows on the vaccinated individuals, 2. The aim of this current mini review is therefore to assess some recent reports and developments on the matter, evaluate how alarming the situation is by comparing the present to the past and the recommendations for roadmap into the future. Methodology: Boolean search was carried out on popular sites like PubMed and Google on publications and reviews on the topic. Results: Some researchers have attributed the recent surge in reported pertussis cases and deaths to reasons like waning of vaccine induced immunity, inefficacy, resistant strain development and mutated forms in the pathogenic bacteria. Conclusion: For a successful control and eradication of the pertussis disease, new strategies needed to be implemented to factor in the estimated waning effect; 27% / year of 4 years in total reduction in efficacy. Multicomponent aP vaccine (n˃3) has also been reported to be as effective as the wP vaccine hence modification of the current aP vaccine or re-visiting of wP is can also be considered.  
132 Distribution of Socio-Economic Factors with Malaria Occurrence at Federal Capital Territory Abuja, Nigeria: A Retrospective Hospital Based Study , Article by Ibrahim S. A, Ukaga C.N
Malaria remains one of the number one killer diseases in sub-Saharan Africa especially in Nigeria. In the Federal Capital Territory (FCT), Abuja, malaria is the leading cause of morbidity. A retrospective hospital based study on the distribution of socio economic factors with malaria occurrence at FCT Abuja Nigeria was carried out using a five years (2012-2016) hospital records from Wuse District Hospital Abuja. Sampling Technique includes all the patients’ records that were diagnosed of acute malaria confirmed by Giemsa stained thick and thin peripheral blood films prior to treatment at the General Out Patient and those on admission at Wuse District Hospital Abuja. Data was entered and analyzed using IBM, SPSS Chicago version 25. Appropriate tables, graphs and percentages were displayed. A chi square test was performed to determine the level of significance using 95% confidence interval and p- value. The findings revealed that a total of 22,934 patients were diagnosed with acute malaria based on hospital records between 2012 and 2016 in Wuse District Hospital Abuja. From the analysis, the Non Formal Educational accounted for 57.4% of the total number of patients diagnosed.Those who are unemployed accounted for 77.3% and those living in the rural area accounted for 55.7% of the cases. The study concluded that, The level of educational status, occupational status and residence of patients plays significant roles in the occurrence of malaria infection. Keywords: Socio Economic, Malaria, Distribution, Factors, occurrence.  
133 Prevalence of Stress, Psychological Distress and Social Support among Clinical Medical Rehabilitation Students in a Nigeria University , Article by Arilewola Abosede Omotola  
Background: University students are faced with challenges on a regular basis and these could be in form of academics, mental, emotional, social, physical, financial and environmental challenges that predisposes them to stress. The objectives of this study are to assess the prevalence of stress, psychological distress and social support received among clinical medical rehabilitation students of Obafemi Awolowo University, Ile-Ife, Nigeria and also assess for any association with demographic variable. Methods: This study is a cross – sectional study to investigate the prevalence of stress, psychological distress and social support among clinical medical rehabilitation students in a Nigerian University. Self-administered questionnaires consisting of demographic data, perceived stress scale, psychological distress scale, and perceived social support scale questionnaires were used as survey instruments. Data were collated and analyzed using descriptive and inferential statistics. The level of significance was set at p < 0.05. Results: The outcome of the study revealed moderate perceived stress as (69.1%) having the highest percentage, low (27.3%) and high (3.6%). Prevalence for mental distress was (47.3%). Mild distress was (19.1%), moderate (18.2%) severe (10.0 %,) and well/normal was (52.7%). For social support, low support was (9.1%), moderate (40.9%) high (50.0%). Perceived stress had significant correlation with parent marital status and student level in school; p value was 0.039 and 0.038 respectively. Kessler score had significant correlation with students’ living arrangement, p value was 0.050, while social support correlated significantly with family economic status of the students, and p was 0.013. No other factors have been found to be significantly correlated. Conclusions: There is a high prevalence of perceived stress and below average mental distress, symptoms among the university students. Majority had high social support. This is of a great concern in public health. Therefore, there is need for more concerted efforts, preventive measures against mental distress and more sufficient supportive services need be put in place for this group. Keywords: Prevalence, Perceived stress, psychological distress, social supports.
134 Assessment of Antiretroviral Therapy Outcomes among Key Populations after 6 Months of Initiation in Nigeria , Article by Ugbena, Eneojo Richard, Iwuagwu, , Okekearu, Ifeanyi, Wole, Fajemisin, Ioytim Isa
Introduction: Key Populations are disproportionately affected by HIV/AIDS in all settings. Unfortunately, reaching KPs with HIV intervention is a huge challenge because of stigma, discrimination, violence, and criminalization of KPs lifestyles. Because of lack of KP specific interventions, data on KPs ART outcomes is lacking. This study determined ART outcomes among KPs 6-months after initiation. Methodology: The study was a longitudinal study of all HIV positive KPs initiated on ART in 7 One-Stop-Shops from October 2016-March 2017. Both Time-1 and Time-2 data were abstracted from facility record after initiation and 6-month after for each patient. Data abstracted include: age, sex, marital status, educational level, employment status and ART outcome 6 months after initiation. Results: Sixty-seven percent of patients were retained on ART, 1.8% died, 20.6% were lost to follow up, 4.5% transferred to other facilities and 6.2% stopped ART by the end of the 6th month. PWID had highest retention rate (74.6%) more than MSM (70.2%), while FSW had the least retention rate (65.4%) but highest transfer out rate (4.9%) more than MSM (4.7%). Factors positively associated with retention at 6th months include: Being a male P=0.007; higher education P=0.000; employed patient P=0.000; living with sex partner P=0.000. Conclusion: This study has laid a baseline data for ART outcomes among KPs in Nigeria. Further study is however required to identify factors that could improve retention on ART among KPs. This is important if we must achieve the second and third 90s of UNAIDs 90.90.90 goals. Keywords: HIV/AIDS, Antiretroviral therapy; Key Population in Nigeria; One-Stop-Shop; Antiretroviral therapy outcomes.  
135 A Peer Review of the Relationship of Socio-Economic Status on Contraction of Tuberculosis among Tb Patients in Windhoek District, Namibia: A Public Health Practice Perspective , Article by Francis Farai Chikuse  
The article by Murimba Winnie titled “The Relationship of Socio-Economic Status on Contraction of Tuberculosis among TB Patients in Windhoek District, Namibia: A Public Health Practice Perspective” is reviewed. It is published in Online Journal of Medicine and Medical Science Research Volume 3, Issue 2 of 2014. The review engage the logical presentation of writing, follow of ideas, content and structure and its efficacy in tackling the risk factors of in-patients infected with tuberculosis. Socio-economic factors which predispose people to TB diseases have been investigated before and therefore the review will focus on the relevancy, objective and accuracy of this article on this topic. Keywords: Socio-Economic Status, Poverty, Katutura Intermediate Hospital, Tuberculosis, Poverty, Namibia.  
136   Prevalence and Correlates of HIV Testing and Counseling among Sexually Active Adolescents and Young Adults in Harare City, Zimbabwe , Article by Notion Gombe, Nicholas Midzi
The HIV prevalence in the Zimbabwean population aged 15-49 years remains high at 15.2%. Most adolescents do not know their HIV status. This is despite knowing a place to get tested. We determined the prevalence and correlates of HIV testing and counseling (HCT) among sexually active adolescents and young adults in Harare City. We conducted a cross-sectional study among sexually active adolescents and young adults. Data were collected using a pretested self-administered questionnaire. Epi-Info 7 was used to capture and analyze data for frequencies, odds ratios and their corresponding 95% confidence intervals. Chi-square tests and logistic regression models were used to assess independent correlates of HIV testing. Statistical significance was set at p< 0.01. A total of 427 adolescents and young adults were recruited. The majority (56.9%) were female. The overall prevalence of HIV testing among participants was 56.4%. On multivariate analysis, knowing a facility that offers HIV testing [aOR=5.05; 95%CI (2.55-10.00)], reporting being involved in a sexual relationship with one’s partner [aOR=3.24; 95%CI (1.67-6.30)], being afraid of a positive result [aOR=0.07;95%CI(0.01-0.30)]and being male [aOR=0.43;95%CI(0.23-0.80)]were independent correlates of HCT among adolescents and young adults in Harare City. Although comparable to other settings in Sub-Saharan Africa, HIV testing among adolescents and young adults in Harare City is still considered very low. Interventions should therefore aim at raising awareness on the importance of HIV testing. In addition city authorities should consider addressing barriers for HCT observed in this study including fear of living with a positive result. Keywords: Adolescents, HIV Testing, Correlates, Prevalence, Harare City.  
137 Family Planning Knowledge, Attitude and Practice among Married Couples in Abakpa Nike, Enugu East Local Government Area, Enugu State, Nigeria , Article by Mgbe Chinenye G, Mgbe Emeka Kevin, Rita Uzoamaka Nwali, Odenigbo Josephine C
This study set out to assess family planning knowledge, attitude and practice among married couples in Abakpa Nike, Enugu East Local Government Area, Enugu State. A survey design approach was adopted for the study. Out of a population of 1130 married couples, 295 of them were randomly selected through taro yamane. Four research questions were formulated and analyzed in the course of this study. The mean value statistical analysis was used to analyze the research questions of the study. The results showed that there is positive knowledge of family planning methods among married couples in Abakpa. Husband’s involvement in family decision, support of national policy of 4 children per family and Contraceptives actually being effective in planning families; control the attitude of married couple towards the use family planning methods in Abakpa Nike, Enugu. There is adequate practice of family planning methods among married couples in Abakpa. Effectiveness and Partner involvement were the major factors influencing the Choice of Family Planning in Abakpa Nike, Enugu. Consequent upon the findings, the following recommendations, among others, were made: It is therefore necessary for religious leaders to be targeted and carried along in the campaign for modern contraceptive methods. The mass media should also be encouraged to do more in public (eg traditional method) have been associated with high enlightenment on the benefits of modern contraceptive methods. So, awareness and pattern of utilizing family planning services among married couples in Abakpa Nike, Enugu should be encouraged. Keywords: Family planning, Contraceptives, married couples, Mortality.  
138 Reproductive Health Practices of Female Garment Workers , Article by Mita Rahman, Shafiur Rahman, Ummul Khair Alam, Irin Hossain
A cross sectional descriptive study was carried out among the garments workers in two garments factory to assess the reproductive health practices of female garment workers with structured questionnaire by face to face interview. A total of two hundred female garment workers were selected purposively in this area who were married within 18-45 years of age. The proportion of women seeking abortion was 75%. Among 28 respondents who were pregnant, highest proportion of them (89.3%) were under regular ANC in pregnancy. More than one third (10.7%) of the respondent were not under regular ANC. Among the 28 respondents half of the respondents (21.43%) did not take Tetanus vaccination and half (78.57%) took tetanus vaccination. This study reflected different dimension in their reproductive life, for improved their better standard. Large scale studies needed. Keywords: Reproductive health practice, garment workers.  
139 Preference for Utilization of Skilled Birth Attendants (SBA) Services by Expectant Mothers in Mombasa County , Article by Johnson S. , Oso W. Yuko, Bob O. Opiyo
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.  
140 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 , Article by Albert Ngetich, Benard O. Abongo, Gordon Okomo, Collins Ouma
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.  
141 Lessons of the Prevention of the Mother to Child Transmission (PMTCT) of HIV in the Biyem-assi District Hospital From 2010 to 2015   , Article Judith Maka, Patrice Takam Soh, Robinson Enow Mbu, Vladimir Pente Yamou  
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.  
142 Factors Influencing Retention of Health Workers in Primary Health Care Facilities (A Case Study of Kakamega County, Kenya) , Article by Songa Jairo Fredrick  
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.  
143 Effect of Community Dialogue on Self-Initiated Voluntary Medical Male Circumcision (VMMC) and Uptake of HIV Voluntary Counseling and Testing (VCT) among Male Residents of Homa-Bay County, Kenya , Article by Albert Ngetich, Benard O. Abongo, Gordon Okomo , Collins Ouma
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.  
144 A Study Protocol to Assess Viral Load Suppression Rate among Adolescents Leaving With HIV , Article by Tibananuka Evelyne  
Introduction 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. Viral suppression is defined as, literally, suppressing or reducing the function and replication of a virus. Even if no virus is present in the blood, HIV infected cells may remain in the body. Therefore, there is the possibility that the virus could begin to replicate (copy itself) again if antiretroviral therapy were to be stopped. Furthermore, having an "undetectable" viral load simply means that there are too few copies of the virus to be detected by current tests As such, "undetectable" is a moving target. Viral suppression is achieved by 12 weeks of initiation on antiretroviral (ARV) therapy in patients who have 95% adherence. Unsuppressed Viral load. Using WHO criteria, virological treatment failure is defined as having detectable VL after 6 months of adherence to ART beyond 1000 copies/ml. This is also called unsuppressed viral load. In 2016, HIV prevalence in Uganda currently stands at 7.3 percent up from the 6.2 percent when Uganda had made strides in HIV prevention. According to the Ministry of health, Uganda registers 120,000 new HIV infections every year, more than1.5 million Ugandans are estimated to be living with HIV and AIDS. Out of those infected so far, 84 percent transmission of HIV is through unprotected sex, 14 percent is mother-to-child-transmission (MTC), while 2 percent is accidental or through other modes of transmission. There remain uncertainties as to whether all adolescent needs on ART have HIV viral suppression after six months of treatment. This project will assess the accessibility, utilization and compliance of adolescents (aged 10-19 years) to ARVs from selected HIV clinics in Uganda, their viral load monitoring and suppression. The study results shall inform advocacy and programming of adolescent friendly services in HIV clinics by humanitarian partners.  
145 Healthcare Evidence-Based Management: Towards Overcoming its Barriers in Uganda’s Local Government Healthcare System , Article by Stanley T. Asaku, Gerald K. Karyeija, Fred Alinda, Kennedy O. Ojwang, Martine D. Andua , Patrick Y. Anguzu
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 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.  
146 A Peer Review of the Assessment of Knowledge and Treatment Seeking Behavior among Tuberculosis and Multi-Drug Resistant Tuberculosis Patients: A Case Control Study , Article by Francis Farai Chikuse, Pathcare Namibia
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.  
147 Assessment of Sanitation Facilities at the University of Cape Coast, Ghana , Article by James Kojo Prah  
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.  
148 WHO Clinical Staging at Initiation of Community-based ART Services among Key Populations in Nigeria , Article by Ugbena, Eneojo , Iwuagwu, Stella, Jennifer Anyanti, Okekearu, Ifeanyi, Emeka Chima
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.  
149 Pharmaceutical Wastes Management and the Presence of Pharmaceuticals in the Environment of Health Facilities in Lagos State, Nigeria , Article by Afusat Adesina, Sanni O. Felix
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.  
150 Reducing Financial Barriers for the Poorest of the Poor in Accessing Health Services: The Case of Demand Side Financing (DSF) in Wamba LGA , Article by Kum Ghabowen Iwimbong  
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.  
151 Habitual Visual Acuity in Schoolchildren from Rural and Urban Regions of Allahabad , Article by Mohammad Junaid Siddiqui, Imran Mehboob Baig, Arjumand
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.  
152 Risks Assessment Before Pregnancy: A Healthy Mother and Baby After Delivery , Article by A. Kadango  
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;  
153 Health-Related Quality of Life of Diabetes Mellitus Patients and Non-Diabetic Persons in Calabar, Cross River State, Nigeria , Article by Iquo Okon  
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.  
154 Major Predisposing Factors to Utilization of Traditional Birth Attendants by Expectant Mothers in Mombasa County, Kenya , Article by Johnson S. Manyiwa, Oso W. Yuko , Bob O. Opiyo
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.  
155 Knowledge, Attitude and Practice of Postmenopausal Osteoporosis among Females Aged 17-24 Years, Khartoum, Sudan , Article by Shahd Khalid Mohammed El Khalil
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.  
156 Pesticide Residue and Health Risk Analysis of Six Commonly Used Herbal Medicinal Products in Kumasi, Ghana , Article by Frank Adusei-Mensah, Isaac Tabiri Henneh, Martins Ekor
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.  
157 Students’ Health Seeking Behaviour and its Rationale at Uganda Christian University , Article by Edward Kibikyo Mukooza, Deirdre Carabine, Ekiria Kikule
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.  
158 Investigation of Barriers to Access Hepatitis B Testing among Secondary School Students after a Peer Education Study in Jos, Nigeria , Article by Mary Mathew, Sonika Raj, Femi Rufus Tinuola
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.  
159 Knowledge of Diabetic Foot Care among Nursing Practitioners after Interventional Training in Rivers State, Nigeria , Article by Lilly-West B. R, Mildred E. John
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.  
160 Individual Predictors of Healthcare Research Utilization: A case of Arua District Local Government, West Nile Uganda , Article by Stanley T. Asaku, Gerald K. Karyeija, Fred Alinda, Kennedy O. Ojwang, Martine D. Andua , Patrick Y. Anguzu
Despite increasing knowledge of potential benefits of research utilization in improving quality of healthcare management decision (HMDs) outcomes and practice, the use of research evidence by healthcare authorities continues to be a global concern. We examined individual predictors of research utilization in management decisions of healthcare authorities in a local government’s context of Arua district in West Nile Uganda. The observational cross-sectional survey design was used, involving 225 questionnaires and nine key informant interviews, and the extent of influence of individual variables on research uptake was determined by estimation of predicted probabilities, and the corresponding odds ratios and coefficients using the binary logistic regression model. The results reveal that research utilization was significantly influenced by individual characteristics, whose overall predicted probability was 0.030 (p<0.05) with attitudinal variables being most significant, whereby belief in research-based HMDs (p= 0.020) or improved quality of HMDs (p= 0.012) recorded high corresponding odds ratios. Hence, the study substantiates the multifactorial nature of research utilization, being influenced to varying extents by individual factors, and emphasizes attitudinal change, information sharing and capacity building to increase uptake. Key words: Research utilization, individual characteristics, research evidence, healthcare authorities, and healthcare management decisions.  
161 Factors Associated with Health-care Service Delay in Diagnosis among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre in Zaria-Nigeria , Article by A. A Ogundeji, I Ahmadu, J Awotoye, J Ogwu, S Laraban, J Ajobiewe, O.M Akinsola  
Background: Any delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. Objectives To assess delays in diagnosing new TB patients and the factors associated with these delays in NTBLTC Zaria, Nigeria. Methods: The study population was TB patients attending the NTBLTC, Zaria. Analysis of contingency tables was done and Chi-square statistics were used to test for association between variables and level of significance. Logistic regression was used to calculate the odd ratio. Results: Age, marital status, economic status, sex, education, and alcohol consumption were significantly (P<0.05) associated with patient delays while smoking and CD4 count were statistically not significant with patient delays. Female (OR=1.046; 1.04-2.17), literacy (OR=1.02; 0.29-1.98) and single (OR=1.00; 0.14-4.67) were the major determinants that influence extended patient delay. Age, economic status, education, smoking and alcohol consumption were significantly (P<0.05) associated with health system delays while sex, marital status and CD4 count were statistically not significant with health system delays. Conclusion: Factors associated with delay in seeking health care for more than 30 days included age, sex, marital status, economic status, education, smoking and alcohol intake while for patient delay includes age, sex, marital status, economic status, education and alcohol intake. This factor should be taken into consideration for policy planning to help the containment of the spread of the disease. Keywords: Health care service delay, cross-sectional, odd ratio, tuberculosis, Logistic regression, patient delay.  
162 Evaluation of Diagnostic Accuracy of TB LAM Rapid Urine Antigen Screening Assay, GeneXpert and Smear Microscopy for TB and HIV Co-infected Population in the Guinea Savannah Zone of Nigeria , Article by A. A Ogundeji, I Ahmadu, J Awotoye, J Ogwu, S Laraban, J Ajobiewe, M Iwakun, O.M Akinsola
Background: Report at the lunch of 1st Nigeria, National Strategic Plan for TB Control report opined that, at the current rate of transmission and development of Tuberculosis, over four million cases are forecasted to occur in Nigeria between 2015 and 2020 (WHO, 2015). Objectives: A study was conducted to examine diagnostic accuracy of GeneXpert, smear microscopy and TB LAM Rapid Urine Antigen Screening Assay for TB and HIV co-infected Population. Methods: 323 specimens from approximately 400 patients were enrolled using probability sampling technique. Selection intensity (CD4 count < 100, critical symptoms of TB and HIV) with stringent conditions was set to reduce eligible population for TB-LAM test. Differences between two groups was tested using t-test in SPSS-24 statistical package. Sensitivity, specificity, NPV and PPV were computed using Diagnostic or Screening Test Evaluation 1.0 using OpenEpi (version 2.3). Results: There were significant differences (P<0.05) among diagnostic accuracy for sensitivity, specificity, PPV, NPV and prevalence rate. The highest sensitivity was in GeneXpert (86.2%, 25/29) while TB-LAM the least sensitivity (57.5%, 46/80). EMS-AFB was significant (P<0.05) and more sensitive than Spot-AFB and TB-LAM. Specificity was significant (P=0.04) and slightly lower in the group tested with GeneXpert (90.8%) as compared to TB-LAM (100%), EMS-AFB (93.1%) and Spot-AFB (92.7%). The proportion of total study population with TB-LAM decreased linearly (23.2% - 7.4%) as the grades increases. Conclusion: This clearly suggest that TB-LAM might not be a robust testing for point of care diagnostics among TB-HIV co-infected Population using Zaria Metropolis of North Western, Nigeria. Keywords: GeneXpert, Lipoarabinomannan, Tuberculosis, Human Immunodeficiency Virus, Sensitivity.  
163    Feeding Practices and Nutritional Status of Chepang Children of Dhading District, Nepa , Article by Ghimire Jeeban  
Background: Proper feeding with supplement is a vital means for compensating health deficits and enhancing the nutritional status of children. However, documentation about child-feeding practices and the nutritional status among ethnic communities like the Chepang is limited. Objective: The present study therefore aims at exploring the feeding practices and nutritional status of Chepang children in two municipalities of the Dhading district of Nepal. Method and material: The study was cross-sectional in nature. It approached mothers of children aged 6-24 months. A quantitative study was conducted between February and March 2018. Height, weight and mid-upper arm circumference (MUAC) of the children were measured and analyzed according to WHO cut-offs. Results: A total of 347 mothers (238 from Benighat Rorang and 109 from Gajuri Rural Municipalilty) participated in the study. It was found that 26.8% children were underweight, 66% were stunted and 6.6% were suffering from wasting. There was no significant association between exclusive breast-feeding and nutritional status, dietary diversity, malnourishment, minimum meal frequency and health-related status. Conclusion: It was observed that parents of Chepang children were aware of the benefits of exclusive breast feeding, dietary diversity and meal frequency, but there was no difference in their exclusive breast feeding practices with nutritional food items for the children. So further study is needed to explore other factors to promote healthy growth and development of the children. Keywords: Chepang, nutrition, stunting, underweight, wasting.  
164 Addressing Drug Abuse on College Students , Article by Allan Zulu  
Substance Abuse is not a new phenomenon worldwide but experts believe that the rate at which college students are abusing drugs is so alarming to an extent that it (Substance Abuse) is now one of the major global public health concerns. The National Survey (2010), reported that more of today’s college students are abusing prescription drugs than was the case in the early 1990s and that the number of students involved in the daily use of marijuana doubled to more than 4 percent. Literature review revealed that not only is there an increase of Substance Abuse among college students but also an increase of adverse effects due to binge drinking. It also revealed that higher levels of education i.e. diploma or higher was associated with greater levels of drug abuse. However, despite these concerns, very few studies have in-depth analyzed, let alone prescribe the measures of addressing the problem. A number of studies conducted in the United States of America (U.S.) have indicated that SA is becoming a serious public health problem nationwide as well as globally. However, not much has been done to address this problem. The main objective of this study was to establish the extent of the problem of Substance Abuse in order to have a basis of prescribing measures to address the issue among college students. The study brought to light the extent and effects of Substance Abuse and as such, will benefit not only college authorities and students but parents and policymakers in order to come up with mitigation strategies. Keywords: Establishment, Substance Abuse, Addressing, College Students.  
165 Prevalence of Hepatitis B among School Adolescents in Jos, Plateau State Nigeria , Article by Mary , Femi Rufus Tinuola, Sonika Raj Goel, Olaniyi Taiwo, Jalo Philip
A high average prevalence rate of 11-13.7% for viral hepatitis B exists in Nigeria among the general population (National AIDS/STIs Control Program (2016). This study was the first of its type however, to examine the prevalence of hepatitis B among a specific target group, the senior secondary school students in Jos, Plateau state in Nigeria. It was conducted in six public day secondary schools located in Jos South Local Government Area, Plateau state, findings of which would help determine interventions for the prevention and control of hepatitis B Virus (HBV) infection among this important age group. The study was primarily carried out to determine the effect of peer education, an intervention, on knowledge and belief levels of hepatitis B in Jos but in the process of achieving this, the prevalence of hepatitis B was also identified. A quasi-experimental study was carried out on six hundred students selected by a multistage sampling technique. Testing for hepatitis B was offered post intervention to only three hundred students, who were in the intervention group of three schools in the study. 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. One hundred and ten (110) students agreed to the test and 10 students were found positive for hepatitis B. Keywords: Peer education, positivity rate, prevalence, hepatitis B, secondary school student.  
166 Identification of Intervention Gaps in Adolescents Sexual and Reproductive Health Programs in Nigeria , Article by Dave-Agboola Itunu Omolade  
This study identified the intervention gaps in Adolescents Sexual and Reproductive Health (ASRH) Programs in Nigeria through a desk review of the ASRH program being implemented currently in Nigeria. Adolescent health is influenced by an intricate set of social and biological factors as adolescents discover their identities and their probability of risky behavior increases. Many young people experience their sexual debut at the adolescent stage and this sexual experience may result in adverse reproductive health outcomes. Quite a number of donor-funded Adolescent Sexual and Reproductive Health Programs are currently being implemented in Nigeria to reduce the risk of unsafe sexual practices. However, some gaps have been identified in the program implementation approach. This paper highlights the major gaps in implementation of adolescent sexual and reproductive health programs in Nigeria identified through exploratory analysis and recommendations are proffered to bridge the gaps. Keywords: adolescents, health care, reproductive health, sexual health, sexual and reproductive health care.  
167 Promoting an Enabling Environment for Adolescent Sexual and Reproductive Health Intervention Programs in Nigeria: Towards Family Planning 2020 , Article by Itunu O. Dave-Agboola  
This article on adolescent sexual and reproductive health is based on the ecological framework and it identifies the core elements for building and maintaining a conducive climate for Adolescent Sexual and Reproductive Health (ASRH). The ecological framework approach is hinged on the key elements that are necessary in the creation of an enabling environment for ASRH. The components of the ecological framework include individuals, relationships, the community and the society as a whole. At the individual level, adolescents are empowered to boost their self-esteem and improve their decision-making capacity. At the level of relationship, parental support and communication with peers and significant others are encouraged to create support networks for the adolescents. At the level of the community, the community stakeholders are engaged to create an enabling environment foe ASRH programs. Finally, at the highest level, which is the society, efforts to influence policies and regulations that protect and promote the adolescents’ rights on ASRH issues should be put into consideration. Keywords: Adolescent, Sexual and Reproductive Health, enabling environment.  
168 The Significance of Social and Behaviour Change Communication in Promoting Uptake of Micronutrient Interventions in Rural District, Zimbabwe , Article by Priscilla Kusena, Gerald Munyoro  
Zimbabwe is implementing a micronutrient powder program, which was designed to improve micronutrient supplementation to children aged 6-23 months. One year after program inception, there are reports of low uptake of micronutrient powders. The study sought to understand the importance of social and behaviour change communication in promoting uptake of micronutrient powders. The study was conducted in Makoni rural district of Zimbabwe. Key informant and focus group discussions were employed to explore the significance of social and behaviour change communication in promoting uptake of micronutrient powders. Qualitative data analysis methods of transcribing, organizing, categorizing, and coding were used to sift themes and emerging issues. Out of 81 community participants in this study, we found that social and behaviour change communication approaches employed increased knowledge, positive attitude and infant feeding practices among caregivers. On the other hand, we found that lack of adequate information on side effects of micronutrient powders may hinder optimal uptake of micronutrient powders. Social mobilization and capacity building approaches were used utilized to disseminate information on micronutrient powders. We found that few community engagement platforms, limited advocacy and mass media to disseminate information on MNPs may hinder optimal uptake of micronutrient powders. We suggest that nutrition programs in Zimbabwe should consider utilizing an integrated social and behaviour change communication approach and provide adequate information to caregivers on side effects to promote uptake of Micronutrient Powders. Keywords: Social and behaviour change communication, Micronutrient powders, Uptake, Nutrition, Infant and young child feeding, Zimbabwe.  
169 Environment Factors and Host Factors Associated with Incident of Leprosy in Jeneponto District , Article by Sapriadi S, Risman Wanci
Leprosy is an infectious disease which feared by the community. This disease can be transmitted from one person to another with an inclusion period of 40 days to 40 years, an average of 3-5 years. This study aims to analyze environmental factors and host factors related to the incidence of leprosy in Jeneponto District. This research used a case control design. A total of 31 leprosy patients and 31 non lepers were sampled in this study. The primary data consists of data on environmental factors variables obtained through observation at the house of lepers (cases) and houses non lepers (control). Host factor variable data were obtained through questionnaires. Statistical analysis of Chi square test was used to determine the relationship between environmental factors and host factors with the incidence of leprosy. The results showed that there was a significant relationship between environmental factors namely environmental hygiene with the incidence of leprosy (p value = 0.002 <0.05) and the room temperature with leprosy (p = 0.004 <0.05). In addition, there was a significant relationship between host factors, namely the contact history with the incidence of leprosy (p = 0.007 <0.05). but different with knowledge variable. the knowledge did not have a significant relationship with the incidence of leprosy, (p = 0.203> 0.05). There needs to be attention to environmental factors to prevent leprosy transmission in the community. Health promotion is needed to educate people to better protect the environment to improve their health. Keywords: environment factors, host factors, leprosy.  
170 Assessing Community Health Workers Compliance to who Best Practices for Safe Injection of Contraceptive in a Rural Community Setting of Tanzania ,  A. Kalolella, D. Danda, I. Nyarusi, J. Baraka, A. Rusibamayila, E. Mlay, C. Festo, C. Baynes, F. Eetaama, M. Hiza, J. Phillips
The objective of this study was to assess Community health workers (CHW) compliance to WHO guideline of safe injection steps in community settings. The cross sectional descriptive study design using structured observation checklist was adopted to collect injection safety steps data. The CHWs trained to provide injectable contraceptive were direct observed by reproductive health nurse while administering intramuscular injection to women in need of injectable contraceptiveas part of family planning program in Kilombero district, Tanzania. About 1704 women received injection from 35 trained CHW. In this study we assessed if intramuscular injection and infection prevention steps taken complied to WHO based best practices for safe injections when CHW interacted with client. Results: Majority of CHW complied to WHO best practice for safe injection: Over 89 % steps for infection prevention measures and over 91% steps for intramuscular injection technical performance complied to WHO safe injection guideline. The result also shows that CHW are likely to comply to WHO safety when they conduct injection at their own homes compared to other locations; infection prevention at CHW’s home -90.7%, health centre -80%, client home - 77% and 59.4% in other settings, while intramuscular injection steps; CHW’s home -89.6%, health centre- 83.1%, patient’s home -84% and other places -81%. Young CHW aged 18-25 years are highly likely to comply to the guideline for infection prevention steps by 79.3% compared to 77.2% CHWs aged 25 years and above, while for safe intramuscular steps -91.7% for CHW aged 17-24, and 82.4% for CHW aged over 25 years. Keywords: WHO Compliance, Safe injection procedures, community health workers, Blood borne infection, intramuscular injection technical performance, infection prevention.  
171 New Ways of Working: How Well are Public Hospital Staff in Nigeria Willing to be Knocked off Their Comfort Zones? , Maclawrence Kolapo Famuyiwa  
Purpose: The study examines how welcoming the staff of public hospitals in Nigeria will find the introduction and implementation of new ways of working to satisfy the yearnings of hospital patients for flexibility in receiving health care services in these public hospitals in Nigeria. Methodology: The study was done in a General Hospital in Nigeria. Staff preference for a way of working was assessed by self-administered and pretested questionnaire. Descriptive statistics to elucidate on the demography of the respondents were done; mean score and standard deviation values were used to examine the variables. Spearman’s rho correlation was used to identify the association in the responses. Findings: The mean score of the traditional ways of working (TWW) and the new ways of working (NWW) were 2.66 ± 1.27 and 3.88± 1.73 respectively and with a negative relationship (r= −0.926, p < 0.001). Research Limitations: More General Hospitals should be involved in new studies for more generalizability. Practical implications: The benefits of NWW have to be more preached to health workers, since probably because of the fear of the unknown they still prefer their traditional way of working. Social implications: ‘New Ways of Working’ will allow patients to access care anywhere, while staff will have the opportunity of combining work and home life better. Value of the Paper: The introduction and successful implementation of ‘New Ways of Working’ will be able to meet the satisfaction of both staff and their patients in terms of flexibility to the work and clinic appointments of both respectively. Keywords: New Ways of Working, Traditional Ways of Working, Public Hospitals, Staff, Patients, Satisfaction.  
172 An Assessment of Depo-Provera Injection Practice in Primary Health Care Facilities of Kilombero District, Tanzania , Article by A. , E. Mlay, D. Danda
The objective of this study was to assess Depo-Provera injection practice among health care workers (HCW) in primary health care facilities in kilombero district, Tanzania. The cross sectional descriptive design using structured observation checklist was used to collect data. About 261 HCWs participated in the study to assess best practise of intramuscular injection technics and infection prevention measures. The SPSS descriptive statistics and chi-square tests were used to analyze data. Results indicate that majority of HCWs had adequately practiced infection prevention and intramuscular technics but did not perform well hand washing steps before and after giving injection. Many of them didn’t check labels or shake vials before giving injection. Three quarter practiced critical steps of using sterile syringes, avoiding recapping the needle and use of safety box to discard contaminated sharps, while three quarter of HCW could not practice steps of hand wash before and after giving injection. Three quarter of participants correctly practiced filling drug into syringes, expel air from it, injected deep muscles, aspirated and pushed all drug into the muscles, Secondary graduates and nurse officer with diploma have significantly performed well in injection practice to ensure that before injecting the drug, aspirated through syringes and needle to ensure that the injecting needle is in the muscle and not in the vein. In conclusion, healthcare workers showed adequate practice of injection technics and infection prevention. However hand washing, drug label check and Depo-Provera preparation needs in house training and supervision. Keywords: injection practice, contaminated waste, Blood borne infection, intramuscular injection technics, infection prevention.  
173 Health Impact of the Indiscriminate use of Herbicides in Nigeria , Oche Joseph Otorkpa
The health impact of the indiscriminate use of herbicides in Nigeria is a public health concern. randomly selected food crops were found to be contaminated with residues of herbicides such as 2, 4-dichlorophenoxyacetic acid (2, 4-D) at 0.59mg/kg beyond maximum residue limits of 0.1mg/kg, while residues appear to persist in the soil at very high concentration of 0.180 and 0.023 mg/kg for atrazine and paraquat respectively, therefore increasing the risk of surface and ground water contamination with potentially lethal consequences on humans, livestock, and the environment. There is high prevalence of disregard for safety measures amongst horticultural farmers, (42%) of them do not use any form of protective wear during application of herbicides. Despite the establishment of links between the most commonly used herbicides in the country and certain forms of cancer, the sales of herbicide is still controlled mainly by semi-literate traders in open markets which appears to be contributing significantly to the level of pollution in the country. Based on the weight of evidence analyzed, the haphazard nature of the agrochemicals market and the indiscriminate use of herbicides in Nigeria cannot be completely extricated from the increasing rate of cancer in the country. Keywords: Herbicides, Indiscriminate, Contamination, Health, Impact  
174 Ultrasonographic Study in Pregnancy and Sex Preference in Bangladesh , Sultana Arju, Afroza Begum, Irin Hossain, Shazly Bari, M.M.Aktaruzzaman
A cross sectional descriptive study was conducted to find out the ultrasonographic evaluation in pregnancy and sex preference among rural pregnant mother. A semi structured questionnaire was used for data collection and face-to-face interviews were conducted to collect data regarding socio-demographic characteristics, ultrasonographic evaluation in pregnancy and sex preference related information. The result showed that the mean age of the respondents was 22.60 (±4.5) years. In this study according to ultrasound scan about 55% pregnant women were come for USG in third trimester and among the respondents about 66% were done USG for the purpose of sex detection. There was significant association between personal income and sex preference of the respondent. This study found that there was significant association between parity and sex preference of the respondents. This study revealed that about 55% of the respondents had preference about sex of the child before child birth, on the other hand about 76% respondent’s husband had preference about sex of the children. The present study detected son preference 41% whereas daughter preference only 14%, son preference was higher than the daughter preference among the respondents and also son preference was more high among the respondents husband than daughter. Keywords: Sex Preference, Ultrasonogram, Respondent  
175 Factors that Influence Practice-Nurses to Promote Physical Activity , Sophonie Ndahayo  
McDowell, McKenna, and Naylor (1997) research article entitled “Factors that influence practice nurses to promote physical activity”, which appeared in the British Journal of Sports Medicine number 31, pages 308-313 had as objective to investigate what factors may influence practice-nurses to promote physical activity. The study is of paramount importance because there is a worldwide concern about increasing rates of obesity and decreasing population levels of physical activity. Yet, it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities (Douglas et al 2006).Though it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities (Douglas et al 2006), Steptoe et al. (1999) stated that in Catalonia in the United Kingdom, there was a lack of evidence regarding the levels of physical activity promotion. There are various constraints that impede the success of physical activity promotion programmes. Nevertheless, this study showed that the two stage measures (activity promotion and personal behaviour) of the health care professional are associated with important differences in patient and practice factors for physical activity promotion.Their view will be presented in the following order: summary of the article; structure; critique that will focus on: the authority of the authors/ researchers, accuracy of style of writing, relevance of the study subject or topic, objectivity of the research and its stability. Finally, the review will analyze the graph and draw a conclusion on the whole article.  
176 Knowledge, Attitude and Perceptions of Pregnant Women towards Caesarean Section among Antenatal Clinic Attendants in Cape Coast, Ghana ,  James Kojo Prah, Andreas Kudom, Obed Uwumbornyi Lasim, Emmanuel Kwasi Abu
Over the years, caesarean section has become increasingly safe and remains one of the most commonly performed surgeries in obstetric practice worldwide. Even though there is an increased rate of Caesarean section in both developed and developing countries, some studies have suggested that African women have an aversion for it. We therefore set out to assess the knowledge, attitude and perceptions of Ghanaian women towards caesarean section. A descriptive cross sectional study was conducted in the University of Cape Coast Hospital. A structured questionnaire was used to assess the knowledge, attitude and perception of 412 pregnant women towards caesarean section. Total knowledge was categorized as inadequate (<50%) and adequate (≥50%). All the 412 respondents were aware of caesarean section. There was, however, a low level of adequate knowledge (39.6%) among the respondents. Majority of the women (94%) preferred vaginal delivery to caesarean section as their primary mode of delivery. Although 40% perceived that most women undergoing CS may die, 95.7% were willing to undergo the operation when indicated. However, 4.3% of the pregnant women would refuse the surgery even if indicated. Formal education (p=0.018), parity (p=0.035) and a previous experience of caesarean section (p<0.0001) were significantly associated with adequacy of knowledge on caesarean section. Even though there was a high awareness among the pregnant women, there was a low level of knowledge on caesarean section in our setting. Educational messages on caesarean section should be prepared to address especially issues on safety of the procedure and how post-operative pain is managed. Doctors should actively get involved in the education on caesarean section at the antenatal clinics, probably this will increase the knowledge of antenatal clinic attendants on CS. Keywords: Caesarean section, awareness, knowledge, perception, University of Cape Coast Hospital, Ghana.  
177 Hypertension and Isolated Office Hypertension in HIV-Infected Patients Determined by Ambulatory Blood Pressure Monitoring: Prevalence and Risk Factors ,  Orji Ikechukwu Anthony, Bernardino Jose Ignacio, Mora Marta, Zamora Francisco Xavier, Arribas Blanca, Montes Maria Luisa, Pascual-Pareja Francisco, Jose Belen San, Peña Jose Maria, Arribas Jose Ramon
This review extensively evaluated literatures related to the subject, and assessed the structure, accuracy currency, authority, relevance, objectivity and stability of the article. Other sections assessed were the analysis of the tables, appraisal of the recent advances on the topic in addition to the credibility and accessibility of the article. The study has its objective as determining the prevalence as well as the risk factors of hypertension and isolated office hypertension (IOH), among people living with HIV/AIDS. The study was a cross-sectional study that used a 24-hour ambulatory blood monitor to measure the blood pressure of the participants. A prevalence of 14.8% for hypertension and 5.5% for isolated office hypertension was recorded in the study amongst others. The study also found hypertension to be strongly associated with family history of hypertension, age, male gender and number of antiretroviral regimens. Largely, the article is an objective, credible and relevant scholarly piece which has contributed significantly to the body of knowledge in this important field of HIV/AIDS. Hypertension with its attendant cardiovascular morbidities/mortalities expected in the rising aging population of HIV infected patients underscores the importance and timely nature of this work. It will be useful to clinicians, researchers, academicians and donor agencies sponsoring HIV/AIDS programs. The article is current, accessible and relevant for clinical services, further research, academic purposes and policy decision making in HIV/AIDS programs. Keywords: Hypertension, Isolated office hypertension, Prevalence, Risk factors, HIV infected patients, Ambulatory Blood Pressure Monitoring.  
178 Implications for Factors Affecting Prevention of Mother-to-Child Transmission of HIV Programs in University Teaching Hospitals in Anambra State ,  Michael Olugbamila , Ogbodo, Uchechukwu Chibuzo
Background: Vertical Mother-to-child transmission of human immunodeficiency virus (HIV) remains a cause for alarm in the course of new HIV infections in newborns in Sub-Saharan Africa. Poor utilization of PMTCT services accounts for the high HIV burden recorded in Anambra State of Nigeria. Aiming pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programs against HIV infection of newborn babies. Objective: This study aimed to investigate obstacles and implications associated with the poor access and utilization of PMTCT services in selected teaching hospitals in Anambra State. Methods: A descriptive cross-sectional study was employed using interviews with 128 adult pregnant HIV-infected women attending antenatal care clinics of two teaching hospitals in Anambra State of Nigeria. Trained data collectors administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about HIV and PMTCT, satisfaction with service care providers and obstacles to utilization of PMTCT services. Results: 99% of the study participants knew that HIV was a deadly virus transmitted through sex and other blood contact routes. 76% of the participants knew that HIV could be transmitted from mother to child and about 53% of them actually knew the major ways of MTCT of HIV. 41% of the participants did not know how HIV could be passed from mother to child. Lack of awareness and knowledge about HCT, late presentation at ANC clinics, low numbers of PMTCT centers within locality of respondents, poor involvement of male partners/spouses and stigma were the main reasons cited for poor utilization of PMTCT programs in the state. Conclusion: In order to overcome the obstacles highlighted in this study, strong political and economic commitments need to be incorporated in PMTCT service provider delivery. HIV counselling and testing among ANC attendees and creating knowledge/awareness about MTCT of HIV ought to be a priority. Further research should be conducted qualitatively to augment the quantitative data. Keywords: Human immunodeficiency virus, Prevention of mother to child transmission HIV counselling and testing, Antenatal Care  
179 Epidemiological Updates of Zika Transmission and Emphasizing the Critical Role of Public Health Interventions ,   Soosanna Kumary, Vijay Kumar Chattu
Since the start of Zika epidemic this year, till date there are more than 45 countries with active Zika virus transmission. Considering its spread at an alarming rate with large clusters of microcephaly and neurological complications, the Emergency Committee of the World Health Organization (WHO) under the International Health Regulations (IHR) announced that Zika constitutes Public Health Emergency of International Concern (PHEIC) on February 1, 2016. Countries in Central America and South America show a decreasing trend of cases where as there is an increasing number of cases in USA and some Caribbean states. Recently after careful review of the existing evidence the scientists at CDC concluded that Zika virus causes Microcephaly a condition in which the size of baby’s brain and head is smaller than the normally expected. For planning more effective disease control and prevention activities for Zika fever there is great need for a functional and intensified Public Health Surveillance system Preparedness for the prevention and control of Zika virus infection. Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures. Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus. Attention should be given to women of childbearing age and particularly pregnant women so that they have the necessary information and materials to reduce risk of exposure Keywords: Zika virus, Public Health Emergency of International Concern, International Health Regulations, Guillain-Barre Syndrome, Microcephaly, Vector control  
180 Use of Technology to Improve Healthcare Outcomes is the Need of the Hour! , D. Chirundu , S. Tapesana , P.N.Magande, Gershem Madzingaidzo, T. Mduluza
Introduction: Forgetfulness is often cited as a cause for non-adherence to antiretroviral therapy. High cell phones usage has provided opportunities for utilization of mhealth to improve health outcomes. Short message reminders can be used as a behavioral intervention to remind clients to take medication. It is against this background that we investigated the willingness of HIV clients on ART at Rimuka Clinic to receive SMS reminders for adherence. Method: We used a cross sectional study design. We randomly selected 522 respondents from HIV clients registered at Rimuka Health Centre. Data were collected by means of a pretested interviewer-administered questionnaire and analyzed using Epi-Info 7 statistical software. Independent factors were identified using a stepwise backward logistic regression model. Results: Five hundred and twenty-two respondents were recruited into the study. Respondents who reported owning a cell phone were 512 (92.75%). Ninety-seven (17.8%) reported a lost or damaged cell phone12 months prior to the study. Four hundred and ninety-nine respondents (97.4%) thought a text message could be useful in adherence to ART. However, 496 (97.06%) among those with cellphones were willing to be reminded by SMS to take their ART medication .Independent factors for willingness to receive SMS reminders were perceiving anti-retroviral therapy to be of benefit (a OR=0.2 p=0.04), having disclosed HIV status to family (a OR=5.37; p=0.04), indicating review schedules at 3 months (a OR=6.59; p=0.04), thinking text messages are helpful in adherence to ART (a OR=185.7; p<0.05), and using a cellphone as a medication reminder (a OR=4.8; p=0.03). Conclusion: Clients attending Rimuka Clinic are willing to receive SMS reminders for adherence. Keywords: Cellphone, SMS, ART, Rimuka Kadoma Adherence  
181 Environmental Indices and Awareness among Residents of Klerksdorp, South Africa (A Cross-Section Study) , O.O Alewi  
While increase in urbanization and industrialization has brought many social benefits, including high living standard, economic prosperity, and education. Regrettably, it has also “invited” many material and social problems, diseases, epidemics from poor environmental awareness and behaviour-which all lead invariably to reduce health status of the population; by way of increased air pollution from vehicular congestion, and industrial revolution with their attendant noise pollution, human activities tampering with the eco system and ozone depletion just among others. The aim of this cross-sectional study is to assess the level of environmental indices awareness and education about the associated diseases that results from poor environmental health practices; among residents of Klerksdorp city in South Africa. A cross sectional study of 100 residents was conducted using a random multistage cluster sampling technique. The target population was drawn from Klerksdorp residents (55% male and 45% female) between the ages of 20 and 65 years. Data collection was performed using a well-structured self-administered, 35-item questionnaire covering environmental awareness on ten indices of environmental factors, and knowledge of adverse health effects associated with them with therapeutic options. Only 13% on the average have basic environmental health awareness of the indices; leading to a very poor correlation between awareness and associated diseases. 21% of the respondents have knowledge of adverse health effects associated with environmental hazards. Therapeutic options were fairly demonstrated however; as over 70% know they have to seek medical attention from hospital if they feel sick. Males score relatively higher than females especially on air pollution and its ill-effects. The study concludes that, there is an urgent need for health promotion in terms of environmental health and indices awareness and health education about healthy environmental practices among the residents survey with a view to enhance health care system.  
182 HIV/AIDS: Group versus Individual Right , Oladimeji Akeem Akinyemi  
HIV/AIDS management keeps on evolving since its discovery, so also are the ethical issues surrounding it. Policies formulated and laws enacted by various nations also keep on changing like the mutant variants of the virus itself. International organisations (WHO, UNHCR) guidelines have been instrumental to streamline the ethical issues about HIV/AIDS worldwide. Disparities in implementation of the guidelines still exist among nations despite the guidelines. To certain extent, this may be due to cultural differences. This article explains the ethical issues on HIV/AIDS in relation to “Individual vs. Group/community rights” Keywords: HIV/AIDS; mutant; WHO; UNHCR; ethical issues; guidelines.  
183 Knowledge and Attitude towards Obesity among Secondary School Students of Royal Crystal College, Ile-Ife, Nigeria , Arilewola Abosede Omotola  
Background: Obesity has reached an epidemic proportion in the developing and developed countries. It contributes or serves as risk factors to many non-communicable diseases. Knowledge and attitude of adolescent needs be assessed as childhood obesity has been found to translate to obesity in adulthood. Methods: This study is a cross-sectional study to investigate knowledge about obesity risk factors and attitudes of students of secondary school, Ile-Ife, Osun State, Nigeria. A pretested 34 item, purpose designed and structured, self-administered questionnaire were used to collect information on knowledge and attitudes of the respondent on knowledge and attitudes towards obesity. Data were collated and analyzed based on descriptive and inferential study design. Results: The result showed that the total percentages of respondents with good level of knowledge is 58.2% (232), and 42.2% (168) respondents having poor knowledge level. About 24.1% of the respondents had favorable attitude to obesity, 531.9% had moderate favorable attitude and 22% had unfavorable attitude toward obesity. In addition, the result showed no significant association between demographic variables and knowledge scores and significant association between attitude scores and class and type of housing composition of secondary school students (p <0.05). The results also showed significant correlation between knowledge score and attitude score of the students (p <0.05). Conclusion: It was, therefore, concluded that the secondary school students of Royal Crystal College, Ile- Ife have good knowledge and favorable attitude towards obesity. Keywords: Obesity, knowledge, attitude.  
184 Willingness to Pay for HIV Treatment - A Case of Clients Seeking Care at Rimuka TB and HIV Site Kadoma Zimbabwe (2016) ,  D. Chirundu, S. Tapesana, P. Magande, T. Mduluza
Introduction: In Zimbabwe, clients are not supposed to pay for HIV services. However, it is common for clients to purchase medical sundries from the private sector. This is in addition to other opportunity costs like transport. Of late, there is decreasing funding for HIV programs and the health system is constrained. We therefore, assessed the willingness to pay for HIV treatment in case there is a policy change. Method: We used a cross sectional study design. The contingency valuation method was used to assess the willingness to pay. We randomly selected 552 respondents from the ART database. We used an interviewer-administered questionnaire to collect data. Analysis was done using Epi-Info 7 software. Independent factors were identified using stepwise backward logistic regression. Results: Among the 552 respondents interviewed, 336 (66.4%) were willing to pay for HIV treatment. The independent factors predicting positive willingness to pay for ART services were being employed, (aOR=3.7; p=0000), satisfaction with health workers, (aOR=6.23; p=0.04) and disclosure of HIV status to a friend (aOR=1.59; p=0.02). Having a household budgetary change due to being on ART (aOR=0.6; p=0.05); practicing no religion (aOR=0.33; p=0.01) were negatively associated with willingness to pay for HIV treatment. Conclusion: The majority of the people interviewed at RITHS are willing to pay for HIV treatment. However, whilst people on HIV treatment may be willing to pay for treatment we recommend sourcing extra funding from charity and donations in order to maintain equity in providing healthcare services to the population. We, therefore, recommend that treatment should continue to be free. Keywords: ART, Rimuka, Kadoma  
185 Diabetes Mellitus Prevalence in HIV Patients on Antiretroviral Therapy at Parirenyatwa Group of Hospitals Opportunistic Infections Clinic, Harare, Zimbabwe ,  Pasipanodya Ian Machingura, Adam Chindore
HIV patients have increased life expectancy due to the access to antiretroviral drugs treatment. However the increasing age comes with increased risk to non communicable diseases which include diabetes mellitus. However the prevalence of diabetes mellitus amongst HIV patients has not been extensively studied in Zimbabwe. Thus we sought to determine the prevalence of diabetes mellitus amongst HIV patients on antiretroviral therapy treatment attending Parirenyatwa Group of Hospitals Opportunistic Infections Clinic, Harare, Zimbabwe. A cross-sectional study was conducted at Parirenyatwa Group of Hospitals Opportunistic Infections Clinic, Harare, Zimbabwe. All HIV patients (18 years and older) on antiretroviral therapy attending Parirenyatwa Group of Hospitals Opportunistic Infections Clinic during the study period were given information on the study. Only those who consented to participate in the study were recruited. Demographic data was obtained from patients by administration of questionnaires. Blood samples were collected for glycosylated haemoglobin analysis on a Mispa-i2 Chemistry Analyser. A total of 60 HIV patients on antiretroviral therapy were recruited into the study, 33 (55%) were females and 27 (45%) were males. The mean age was 43.48 ± 10.3 years. Majority of the patients (33.3%) were on tenofovir, lamivudine and efavirenz. The prevalence of diabetes mellitus was 8.3%. Diabetes mellitus prevalence amongst the HIV patients on antiretroviral therapy treatment was 8.3%. There is need for need to investigate the factors associated with diabetes mellitus in HIV patients on antiretroviral therapy treatment and confirm the prevalence in a study with a large sample size. Keywords: Human Immunodeficiency Syndrome, antiretroviral therapy, diabetes mellitus  
186 Knowledge and Practices of Food Safety among Senior Secondary School Students of International School, Obafemi Awolowo University, Ile- Ife, Nigeria , Ilesanmi Oluwafemi Temitayo  
Background: Food safety is a global public health concern. The problem of food safety not only affects human health but also causes the economic damage of nations. School children have been the foremost victim of food borne illnesses due to their unsafe behavior in food consuming. Knowledge and practices of food safety is very important among students since they are also consumers. Objective: The objectives of this study were to assess the level of knowledge and practices of food safety; to investigate the association of certain demographic characteristics with the level of food safety knowledge and practices and to determine the correlation between the food safety knowledge and practices among senior secondary school students of International School, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Methods: This is a cross- sectional study which used a pre-tested 27- item, purpose designed, self- administered questionnaires to collect information on knowledge and practices of the respondents on food safety. Data were collated and analyzed based on descriptive and inferential study design. Results: The result showed that the total percentages of respondents with good level of food safety knowledge is 86.0% (339) with only 14.0% (55) respondents having poor food safety knowledge level as majority of the respondents 97.7% (385) also have high level of food safety practices with only 2.3% (9) of them having low practices on food safety. In addition, the result showed significant association between religion of the respondents and food safety knowledge scores and significant association between food safety practice scores and class of the students (p <0.05). The results also showed significant correlation between food safety knowledge and practices of the students (p <0.05). Conclusion: It was, therefore, concluded that the senior secondary school students of International School, Obafemi Awolowo University, Ile- Ife, have good food safety knowledge and high food safety practices. Keywords: Food safety, knowledge, practices  
187 Knowledge of Pregnant Mothers on the use of Prevention of Mother to Child Transmission of HIV Services in Kenya: A Cross Sectional Study at Bungoma County Referral Hospital ,  Taratisio Ndwiga  
Background: Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provides a unique opportunity for the implementing prevention of mother-to-child transmission (PMTCT) programs against HIV infection of newborn babies. Objective: To identify factors affecting Knowledge of prevention of mother to child transmission of HIV services among pregnant women attending antenatal clinic in Bungoma County Referral Hospital. Methodology: A cross-sectional study was conducted among pregnant mothers attending antenatal care clinic at Bungoma County Referral Hospital. A systematic random sampling technique was used to select 50 respondents, using Fisher et al, 1999. The data was collected using structured interviewer administered questionnaire prepared to address knowledge, and associated factors on PMTCT services. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Findings: A big number (40%) of the mothers did not know about PMTCT services which were being offered in the hospital. It was noted that the respondents who had little or no knowledge of the services were mostly below 25 years of age and those with low education levels. On the attitude towards PMTCT services it was found that (44%) reported that it is good to take on PMTCT services if reactive and (56%) of respondents reported that PMTCT services are wastage of time because AIDS has no cure. Conclusion: The educational level was the most important factor in understanding PMCTC services Recommendation: To improve and increase sensitization and awareness to the communities on what PMTCT program entails. Keywords: Prevention of mother to child transmission, Human immunodeficiency virus, Acquired immunodeficiency syndrome, Antenatal clinic.
188 The Burden of Hypertension and Diabetes Mellitus in Rural Communities in Southern Nigeria by Alphonsus Rukevwe Isara and Patrick Otamere Okundia ,  Orji Ikechukwu Anthony
This is a review of the article titled "The burden of hypertension and diabetes mellitus in rural communities in southern Nigeria" written by the duo of Alphonsus Rukevwe Isara & Patrick Otamere Okundia as published in the journal Pan African Medical Journal of February, 2015, volume 20: page 103, with DOI number; doi:10.11604/pamj.2015.20.103.5619, and accessed from, http://www.panafrican-med-journal.com/content/article/20/103/full/. The review covered the evaluation of related literature, the structure of the article, authority, currency, accuracy, relevance, objectivity and stability. Furthermore, appraisal of the tables, recent advances, credibility and accessibility of the article were carried out. The objective of the original article was to determine the prevalence of hypertension and diabetes mellitus among adult residents of rural communities in southern Nigeria. Chronic diseases such as hypertension, diabetes & obesity evidently had been on the increase and now are of public health importance in rural communities of developing countries, where it has been shown to complicate the outcome of cardiovascular diseases. The authors employed a cross- sectional survey method to screen adult residents of the selected rural communities in Southern Nigeria. Blood pressure, random blood sugar, weight, and height were measured and Body Mass Index was calculated from height /weight, as well, the respondents were interviewed with the aid of a structured interviewer-administered questionnaire. The result showed one-third of the participants had hypertension, one–third were obese/ overweight, while about 4% had diabetes amongst others. Overall, this is an objectively written article, credible in all ramifications and has contributed to the body of knowledge on the topic especially in this part of the world. The challenge of hypertension, diabetes, and obesity is enormous and requires urgent intervention to forestall the rising trend of these disease conditions and its attendant complications in developing countries. Keywords: Hypertension, Diabetes, Obesity, Overweight, Prevalence, Rural Communities.  
189 Views and Perceptions of Teachers and Adolescents on Adolescent’s Pregnancy in School in Kavango Region, Namibia , Taimi Amakali Nauiseb, Joan M. Kloppers, Honore K. Mitonga
The objective of this study was to determine the views and perceptions of teachers and adolescent’s on adolescent’s pregnancy in school in Kavango Region, Namibia. A cross-sectional analytical study was conducted using mixed methods - quantitative approaches among 350 school learners (grade 6 to grade 12) and 150 school dropout adolescents (aged 12 to 19 years). For the qualitative approaches 15 school learners and 25 teachers went through an in-depth interview. In total a sample of 540 was utilized. The stratified random sampling techniques were used in the selections of the circuit and the schools. Structured questionnaires were used in face-to-face interviews, and in depth interviews were conducted among the key informants (teachers). Themes and subthemes were identified and discussed: Challenges for learners in grasping or understanding the concept on reproductive health towards; Poverty – early marriages, bribe from men. Identified cultural barriers on reduction of the prevalence of adolescent pregnancy, towards; Culture – uncomfortable and shy to talk about sex. The study found that the following aspects/factors: lack of parental supervision; poverty; lack of knowledge and communication skills to talk to their children regarding sex & contraceptives; parental irresponsibility; lack of sex education; were associated with adolescent pregnancy in Kavango region. Keywords: Adolescents, Teachers, Reproductive health, Sexual health.  
190 Promotion of Birth Preparedness Plan in Zambia: Impact of Male Partner Involvement on Childbirth Preparation as Strategy to Improve Maternal Health Care ,  Elvis Chipili
Background: Every pregnant woman faces a risk of life-threatening obstetric complications. It is estimated that 398 women every year die in Zambia from pregnancy related complications out of every 100,000 live births. The primary cause of this high maternal mortality is lack of access to professional delivery care. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women’s access to and utilization of professional maternal health services that can improve maternal health outcomes and prevent maternal mortality. However, in Zambia, the relationship between birth preparedness and decision-making on location of birth and assistance by skilled birth attendants in regard to male involvement is one subject that has not been studied. The purpose of this study was therefore to evaluate the impact of male partner involvement in childbirth preparation and contribute to the prevailing board of evidence on male involvement in addressing the high maternal mortality. Methods: This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. Primary analysis included studies from randomised controlled trials (RCT) whilst secondary analysis involved studies of non-randomised control trials, observational studies descriptive studies and key government reports. Results: The study established that women have higher chances of delivering at the health facility and access skilled delivery care if they consulted and made the decision with their spouses. The proportion of women making savings for birth preparedness plan, including savings for emergencies and transport was very low without male partner involvement whereas involvement of male partners in ANC services increased the number of women attending antenatal care (ANC) services and resulted into a higher likelihood of expectant mother receiving not only skilled delivery services but also postpartum care. Conclusion: This study provides novel evidence about male involvement during childbirth. The findings could have important implications for program planners, who should pursue all avenues and ways to involve husbands (male partners) in maternal health interventions and assess the effectiveness of education strategies targeted at husbands.  Therefore, it should be viewed that examining the role of the spouses, during pregnancy and childbirth is important to understanding women’s access to and utilization of professional maternal health services that can prevent maternal mortality.   
191 Highlighting the Historical, Current, and Future Challenges to Control and Eradicate Malaria in Uganda - A Narrative Review ,  Katwesige Wycliff
Background: For the last century, malaria has caused a serious developmental setback to African countries. Historically, In Uganda, the control of malaria and its eradication challenges can be traced for more than 100 years ago especially the control and elimination activities connected to research and malaria control between1892 to 1949. During the early part of the 21st century, malaria received global health priority recognition until 1998 when the World Health organization (WHO) adopted a Rollback strategy. Currently, In May 2015, The World Health Organization (WHO) adopted a global Strategy for Malaria 2016–2030. This ambitious strategy apparently challenged by the fact that current tools are not adequate to achieve the planned targets. The future challenges to eradicate malaria are also real and need urgent solutions. Methods: We searched Cochrane Libraries, EMBASE, Google Scholar, and unpublished ministry of health Uganda reports. Objectives: To assess the historical, current and future challenges to malaria control and eradication and propose solutions to address them. Results: Uganda has failed to eradicate malaria in the past century, due to challenges like lack of political commitment, limited resources for eradication programs, rampant history of antimalarial drug resistance, chronic and persistent antimalarial stock-outs in public facilities, resistance by parasites to ITNs and fragmentation in the coordination. Findings reveal that the past challenges still exist and are likely to last for more than a decade unless measures are in place to mitigate them. Uganda will face challenges in implementing newer effective interventions in future as well as the history of malaria eradication challenges may keep repeating itself. Conclusion: The historical challenges in the eradication of malaria in Uganda are still affecting the current plans to eradicate malaria. Uganda may not eradicate malaria in next the15 years, basing on its current and future challenges ahead. Keywords: Malaria, control, eradication, Uganda, challenges, Historical, current, Future.  
192 The Effect of Sociocultural Factors on HIV/AIDS Prevalence amongst Adolescents and Youths in Niger State, Nigeria , Otojareri Kohwo Anthony  
Human Immunodeficiency Virus (HIV) which causes the disease, Acquired Immunodeficiency Diseases Syndrome, is one of the public health challenges facing both developing and developed nations. This descriptive study was carried out to examine the effect of socio-cultural factors on the prevalence of HIV/AIDs amongst adolescent and youths attending the antiretroviral clinics of four general hospitals in Niger State, Nigeria. These were the general hospitals in Bida, Minna, Suleja and Kontagora. In order to participate in the study, the participants must be within the age bracket of adolescent and youths and must be retroviral positive. The instrument for data collection was a pretested semi-structured questionnaire. Data analysis was carried out using both descriptive and inferential statistics. Results: A total of 268 respondents were interviewed. More male participated in the study and majority of the participants were concentrated within the age bracket (21 – 25) years. About 71.6 percent of respondents said alcohol intoxication did not lead them to indulge in unprotected sex whilst 79.9 percent respondents did not experience influence of watching pornographic file on their sex life. Conclusion: The study showed, socio-cultural factors were found not to have had influence on HIV/AIDs prevalence. From the finding, more awareness programs about HIV/AIDs should be carried out among adolescent and youths. Government and Nongovernmental organization should partner with the community, faith based organization, schools to implement these findings. Keywords: Human Immunodeficiency Virus, Adolescent, Youth, Socio-Cultural factors.  
193 Evaluation of the Maternal Death Surveillance and Response System, Sanyati, Zimbabwe 2017 ,  S. Tapesana, D. Chirundu, T. Juru, G. Shambira, N. Gombe, M. Tshimanga
Background: Combating maternal mortality requires a functional Maternal Death Surveillance and Response system (MDSR). In Zimbabwe, maternal mortality ratio was 651 deaths per 100 000 live births in 2015. Only five out of 25 deaths were notified on time in Sanyati District 2015-2016. We evaluated the system to determine if it was serving its intended purpose. Methods: We conducted a descriptive cross sectional study using the MDSR technical guidance and the updated CDC guidelines for evaluating public health surveillance systems. Data were collected using interviewer administered questionnaires, key informant interviews, focused group discussions and records review. Medians, proportions and frequencies were calculated using Epi Info 7. Qualitative data was analysed using word cloud. Results: We interviewed 216 health workers out of 230 involved in MDSR. Ninety-nine percent were nurses. Sixty-two percent correctly defined a maternal death. Ninety-eight percent found the system useful. Those confident to notify a maternal death were 139(68%). Easy access to case information was reported by 91(62%). Data was analysed by 138(80%) and used to monitor maternal mortality trends. Information sharing with stakeholders was reported by 59(31%). Ninety-seven percent were willing to continue participating. The cost of notifying a single death was USD$ 246.09. All community deaths were not being captured by the system as reported by 128(59%). Key informants and focused group discussions outcomes highlighted concerns of unreported community deaths. There was no zero reporting of community maternal deaths. Conclusion: The MDSR system was useful, acceptable, simple and not costly. The system was also unstable, unrepresentative and not timely. Minimal stakeholder and community involvement, inadequate human resources and training, hampered the systems performance. We recommend health worker training and conducting an interventional study to assess the effectiveness of community involvement in reporting maternal deaths. Keywords: Maternal Death, Surveillance, Response, Sanyati, Zimbabwe.  
194 A Community-Based Study of Hypertension and Cardio-Metabolic Syndrome in Semi-urban and Rural Communities in Nigeria ,  Dr. Orji Ikechukwu Anthony
This work is a critical review of the article titled “A community-based study of hypertension and cardio-metabolic syndrome in semi-urban and rural communities in Nigeria authored by Ulasi Ifeoma. I., Ijoma Chinwuba. K. & Onodugo Obinna. D and published in BMC Health Services Research journal of 2010, volume 10, page 71 with DOI number; doi: 10.1186/1472-6963-10-71 which was retrieved from http://www.biomedcentral.com/1472-6963/10/71. This review appraised literature related to the subject, evaluated the article structure, authority, relevance, currency, accuracy, stability, and objectivity. Other sections appraised were the tables, recent advances on the subject, accessibility, and credibility of the article. The reviewed original article has its objective as determining the prevalence of Cardio Metabolic Syndrome in rural & semi-urban communities in South-East Nigeria, with attention to the general population and population with hypertension. The authors involved the  use a cross-sectional design in this population based study which involved adult residents of the selected communities between the ages of 25 & 65 years. They were screened for metabolic syndrome using standard equipment and interviewed with structured questionnaires. The results yielded prevalence among general population of 18% and 10% for Cardio Metabolic Syndrome in the semi-urban & rural community respectively. While among the group with hypertension, the authors recorded a prevalence of 34.7% and 24.7% in the semi-urban and rural communities respectively. The study demonstrated a high prevalence of Cardio Metabolic Syndrome especially as it concerns semi-urban communities as well among the population with hypertension  Fundamentally, this is a current and relevant work in the area of non-communicable disease epidemiology in Africa and can be generalized to Blacks in other parts of the world. The work has contributed significantly to the pool of knowledge and can be referenced in future works as it's also an avenue that can be explored for future collaborations in research regarding this topic. The work was written objectively, clearly presented, easy to understand and accessible for researchers, academicians, clinicians and other players in the health sector and can serve the members of the above-listed groups in their various capacities. Keywords: Cardio Metabolic Syndrome, Hypertension, Prevalence, semi-urban community, Rural Community.    
195 The Influence of Positive Behavioural Changes on HIV/AIDS Prevalence amongst Adolescents and Youths in Niger State, Nigeria ,  Otojareri Kohwo Anthony  
Human Immunodeficiency Virus (HIV) which causes the disease, Acquired Immunodeficiency Diseases Syndrome, is a public health challenge that is yet to have a cure and still contributes to the global disease burden. This descriptive study was carried out to examine the effect of positive behavioural factors on the prevalence of HIV/AIDs amongst adolescent and youths attending the antiretroviral clinics of four general hospitals in Niger State, Nigeria. These were the general hospitals in Bida, Minna, Suleja and Kontagora. A total of 268 participants took part in the study in which a multistage (2-stage) random sampling technique was used (Bamise, Bamise and Adedigba, 2011). First stage involved the random selection of the four general hospitals used for the study whilst the second stage involved the random selection of participants at the various general hospitals selected for the study. In order to participate in the study, the participants must be within the age bracket of adolescent and youths and must be retroviral positive. The instrument for data collection was a pretested semi-structured questionnaire. Data analysis was carried out using both descriptive and inferential statistics. Results: A total of 268 respondents were interviewed. More male participated in the study and majority of the participants were concentrated within the age bracket (21 – 25) years. The awareness of the participants about HIV/AIDs is high with 98.2 percent participants believed that condom use prevented HIV/AIDs. About 66 percent of respondents had only one sexual partner, 56.3 percent used condom and other preventive method as a form of positive life style change in behaviour whilst 51.1 percent of respondents practiced abstinence from sexual intercourse. Conclusion: The study showed there was high level of awareness about HIV/AIDs and positive life style behaviour was found to have effect on prevalence of HIV/AIDs among the target group for the study. From the finding, more awareness programs about HIV/AIDs should be carried out among adolescent and youths. Government and Nongovernmental organization should partner with the community, faith based organization, schools to implement these findings. Keywords: Human Immunodeficiency Virus, Adolescent, Youths, lifestyle changes.  
196 Health Care Waste Management Practice amongst Health Care Workers in Health Facilities in Bida Local Government Area, Niger State - Nigeria ,  Otojareri K.A, Omosigho O P, Otojareri U.C.G, Emumwen E.G
Health care wastes (HCW) are all waste generated from health care facilities, research facilities and other associated laboratories. The aim of this study is to determine the knowledge, attitude, practice and factors affecting health care waste management practice amongst health care staff in health facilities in Bida Local Government Area. This descriptive study was carried out among health care personnel in all the health facilities in Bida Local Government. The respondents who had worked in the health facilities for a period of one year and above were studied. The tools for data collection were semi structured questionnaires and observational checklist. A total of 314 respondents were interviewed. The mean age of respondents was 33.8±6.8 years. The level of knowledge of health care staff in the health facilities was fair. Respondents’ attitudes were excellent in 22.3%, good in 46.8% and poor in 30.9%. Respondents’ practice of health care waste management (HCWM) was fair in 56.4%, excellent in 23.6% and poor in 20.1%. Also, noted was that awareness of existing policy on HCW, a standing Supervisory Committee on HCW in the various health facilities affected positively the practice of HCWM. The study showed that the level of knowledge and attitude amongst health staff in health care facilities in Bida Local Government was fair and their current practice of health care waste management was found to be good. From the findings in the study, the knowledge, attitude and practice of health care waste management amongst health care staff can be improved by organizing training and retraining programmes like workshops, seminars etc. Policies on health care waste management should be widely circulated to improve the awareness amongst health care staff. Keywords: Health Care Waste; Health Care Waste Management, Bida Local Government Area.  
197 High Prevalence of Asymptomatic Plasmodium falciparum Infection in Primary School Children in the Volta Region of Ghana ,  Verner N. Orish, Kokou Hefoume Amegan-Aho , Jones Ofori-Amoah, Lennox Mac-Ankrah , Ibrahim Jamfaru, Innocent Afeke , Festus K.Adzaku
Asymptomatic Plasmodium falciparum infections are very common in older children and can pose a great problem for malaria control programs. This study was a cross sectional study-design that looked at the prevalence of Plasmodium falciparum infection among school aged children in five primary schools in 3 districts in the Volta Region of Ghana. Questionnaires were administered and blood samples were collected for malaria detection using RDT and microscopy. Pearson chi square test was used to evaluate the association between P. falciparum infection and other variables in the study. A total of 550 primary school children were enrolled in this study. Three hundred and five children (55.45%) were positive for malaria with RDT and 249(45.27%) were malaria positive with microscopy. Children from Evangelical Presbyterian (EP) primary school in Afegame and Davanu primary schools, both in remote, rural and farming communities had the highest prevalence of P falciparum (RDT, 92, 74.80%, p<0.001; Microscopy, 73, 59.35%, p=0.007) and (RDT, 57, 72.15%, p<0.001; Microscopy, 36, 45.57% , p=0.007), respectively. There was a significant higher prevalence of RDT positive boys than girls seen in this study (152, 61.40%, p=0.023). A significant higher prevalence of P. falciparum infection was seen with RDT, in children whose mothers were farmers (109, 69.87%, p=0.001). There was a high prevalence of asymptomatic P. falciparum infection in the three districts, especially in rural areas. As a matter of urgency, malaria control programs should intensify efforts in these areas to reduce the burden of detrimental asymptomatic infections in school going children.  
198 Determinants of Attitudinal Dispositions of Secondary Health Care Providers and HIV Positive Mothers towards Exclusive Breastfeeding Practice in Selected Healthcare Facilities in Akwa Ibom State, Nigeria , Grace C. Essien, Mary A. Mgbekem
The World Health Organization has recommended that children of HIV positive mothers be exclusively breastfed for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe. The main objective of the study was to identify factors influencing attitudes of secondary health care providers and HIV positive mothers towards exclusive breastfeeding. Focus Group Discussion was used to elicit information from the respondents. Approval to conduct the study at the health facilities was obtained from the Ethical Review Committee of the Akwa Ibom State Ministry of Health, Uyo. A purposive sampling technique was used to select three secondary health facilities (one per senatorial district) out of 34 secondary facilities that conduct focused antenatal care, deliveries and post-natal care services. There were 46 participants comprising of Nurse/Midwives, and Medical Doctors. A total of six FGD sessions were conducted. Five themes emerged from the FGD namely: Awareness of the exclusive breastfeeding concept; health care provider attitude towards EBF by HIV positive mothers; HIV positive mothers’ perception towards HIV and exclusive breastfeeding; factors that can influence HIV positive mothers to breastfeed exclusively; and opinion on who will approve or disapprove HIV positive mother to breastfeed exclusively. The result showed that effective and adequate counselling was identified as a key factor that will influence HIV positive mothers to breastfeed exclusively. Poor knowledge and fear of transmission of the virus to baby were cited by most respondents as factors that will influence health care providers and HIV positive mothers’ attitude towards exclusive breastfeeding. This study recommended the need for more breastfeeding education for health care providers that will take into consideration current policy and guidelines for feeding HIV exposed infants since health care providers are uniquely positioned to educate HIV positive mothers on infant feeding options. Keywords: Exclusive breastfeeding, HIV-Positive mothers and Health Care Provider.  
199 Population-based Childhood Immunization Education Intervention Program: Process and Impact Assessment , Gbadebo O Ogungbade, James Oloyede, Oluwole Odutolu, Larry Holmes, Jr
Background: Vaccine hesitancy remains a public health issue, given the influence of parental belief, thoughts, feelings and perception on childhood vaccination. We assessed the process and impact of education intervention public health professionals conducted to eliminate the risks due to parental childhood vaccine indecisions behaviors. Methods: We used cross-sectional research method with behavioral theories-informed tool to assess the process and impact of efforts on parental childhood vaccination hesitancy in our sample. Chi square statistic and logistic regression model were used to characterize the sample and test the study related hypotheses respectively. Results: The overall response rate for the survey was 80% (359 of 450). Sixty-three percent of the participants were female, 62% were employed full time, and 77% were educated above secondary school level. Ninety-five percent of the 450 participants cast their votes of confidence for the safety and protectiveness of childhood vaccines. In the multivariable logistic regression analysis, study participants with positive response to TV as a good source of information were 4 times as likely to perceive childhood immunization risks judged against those with negative response, adjusted prevalence odds ratio (APOR) = 4.35, 95% Confidence Intervals (CI) = 0.10 – 0.74. Conclusions: The source of information significantly influenced vaccine hesitancy in our sample. These data is suggestive of the need for public health education via mass media in reducing vaccine hesitancy. Keywords: Childhood immunization, parental vaccine hesitancy; risk communications; behavior change; vaccine acceptance  
200 Pattern and Distribution of Malaria Disease in Wulu- A Typical County in South Sudana ,  Gabriel Omoniyi Ayeni , Okwuoma C. Abanobi, Daniel O. Ebenezer, Olagbegi M. Oladapo, Oyewale M. Morakinyo
South Sudan was reported as having one of the highest malaria burdens in sub-Saharan Africa. A better understanding of the pattern and distribution of the infection is considered to have implication on prevention and control. The objective of this study was to investigate the pattern and distribution of reported Malaria infection in Wulu, South Sudan Secondary data on malaria cases managed between January 2014 and December 2016 across all the eleven health districts of the county were obtained from the Health Management Information System and the District Health Information Software. Descriptive statistics were used to analyze the extracted data. The finding showed similar trend in the pattern and distribution of Malaria disease across the health districts between 2014 and 2016. Also the incidence rates for the overall population were 29.5%, 23.7% and 36.7% for 2014, 2015 and 2016 respectively. However a much higher incident rate was recorded among the under-5 year population for the same period (76.5%, 47.1%, and 64.5%). Malaria cases among under-5 years of age in the area account for 52-59% of Outpatient department consultations between 2014 and 2016. Also the finding showed sharp rise in the number of cases reported for 2016 although the same yearly trend was maintained across the year and districts. The finding showed similar trend in pattern and distribution of Malaria infection over the period of 2014 to 2016 and across the health districts; it did not however suggest a reduction in the trend of occurrence. More attention should be given to the under-5 year population. Keywords: Malaria, Pattern and distribution, Outpatient department, Under-5 years, Wulu.  
201 Qualitative Assessment of Factors Affecting Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programs in University Teaching Hospitals in Anambra State, Nigeria ,  Dada Michael Olugbamila, Amosu, Ademola M, Ogbodo, Uchechukwu Chibuzo
Background: Human Immunodeficiency Virus (HIV) infection in newborns is one of the leading causes of infant mortality globally and accounted for about 1.8million childhood deaths in 2010. Despite international interventions aimed at reducing pediatric infections at antenatal clinic entry points, however, there is still limited access and utilization of Prevention of Mother to Child Transmission (PMTCT) services resulting in low target coverage due to obstacles existing at facility, community and state levels. Anambra State still records a low patronage of PMTCT interventions by pregnant mothers. Objective:  This study was carried out to determine the factors affecting prevention of mother-to-child transmission (PMTCT) of HIV programs in university teaching hospitals in Anambra state, Nigeria qualitatively. Methods: This is a descriptive cross-sectional study involving 128 randomly selected HIV positive pregnant women attending antenatal care clinics and service providers of two purposively selected teaching hospitals in Anambra state, Nigeria. Qualitative data were obtained through focus group discussions and key in-depth informant interviews. Data analysis was carried out using NVivo version 9 qualitative data analysis Software. Results: The findings of this work show that ninety-nine percent (99%) of the study participants knew that HIV was a deadly virus transmitted through sex and other blood contact routes. Seventy six percent (76%) of the participants knew that HIV could be transmitted from mother to child, while about 53% of them knew the major ways of MTCT of HIV. The participants that did not know how HIV could be passed from mother to child were 41%. Others factors are lack of awareness and knowledge about HCT, late presentation at ANC clinics, low numbers of PMTCT centers within locality of respondents, poor involvement of male partners/spouses and stigma were the main reasons cited for poor utilization of PMTCT programs in the state. Conclusion: The study highlights a referral linkage of traditional birth attendants to health facilities for PMTCT interventions in the state to have profound impact on the health of the mother, child and nation at large. Keywords: Human immunodeficiency virus (HIV), Prevention of mother to child transmission (PMTCT), HIV counselling and testing, Antenatal Care.  
202 The Pattern of Prevalence of Severe and Moderate Acute Malnutrition among Under-Five Children of Three Counties in a War-Torn Lakes State South Sudan ,  Ebenezer O. Daniel, Ademola M. Amosu, Gabriel O. Ayeni, Oladapo M. Olagbegi
The prevalence of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) of under-five children, in south Sudan is reportedly high and is being aggravated by various negatives factors. The situation has attracted the attention of various international organizations like World Food Programme (WFP), United Nations Children Emergency Fund (UNICEF), and other International Non-governmental Organizations (INGOs), for possible interventions. However, there are scarce study reports on the current prevalence pattern of SAM and MAM among under-five children, as it may assist in the implementation of nutrition therapy programme implemented by these humanitarian organizations. A retrospective cohort study was conducted by collecting thirty six (36) month reported data of SAM and MAM of under-five children, from District Health Information Software (DHIS)-the standard source of health information in south Sudan, across three years; 2014, 2015 and 2016 for three counties, and was analyses using SPSS. Findings revealed statistical significant differences in SAM and MAM within each county and among the three counties across the three years. The results further revealed that there was rising median values of SAM and MAM among the counties across the three years. It was suggested that adequate pre-intervention survey should be conducted, reducing local government’s sentiments and infiltration during screening exercise for malnutrition among under-five children, ensuring peace in south Sudan, and conduct of post-intervention surveys for feed-backs, may serve as a clue towards implementing an effective and efficient nutrition therapy programme in the war-torn Lakes State of south Sudan. Keywords: Prevalence pattern, Malnutrition, SAM, MAM.  
203 Work stress and self-Reported Health problems in Female Ready Made Garment Workers ,  Suraiya Ahmed, Manzurul Haque Khan, Irin Hossain
A cross sectional descriptive study was conducted to assess work stress and self-reported health problems in female ready-made garment workers. This cross sectional study was carried out on a sample of 310 female workers selected purposively from a ready-made garment factory located in Savar, Dhaka. Work stress was estimated by using an ERIs questionnaire; while self-reported health problems, work-related information and socio-demographic information were obtained using a semi-structured questionnaire by face to face interview. The study was conducted for a period of one year extending from January 2014 to December 2014 in a Ready-made Garment factory of Bangladesh located in Hemayetpur bus stand, Savar, Dhaka. The mean age of the respondents was 27.26±5.93 years and they were mostly married (71.3%). Most of them (55.5%) had primary education and another 20.0% never went to school. The mean monthly and per capita family incomes of the respondents were Tk7573.55± 961.06 and Tk3831.50± 1892.94 respectively. Among the respondents, 59.7% worked in the sewing section, followed by 14.8% in the finishing section. Their mean duration of employment and total working hours per week was 36.68±17.92 months and 58.35±3.08 hours respectively. About one fifth (22.9%) of the study participants were found to have high stress. Almost 53.2% respondents were found to have been suffering from headache for last 2 months. Back pain and chronic cough was significantly associated with age and total work time per week (p<0.05). Shoulder pain, stomach problem, pain/burning of eye, fatigue and general weakness was significantly associated with age (p<0.05). Painful/burning micturation was also significantly associated with age and total work time per week (p<0.05). High stress was not uncommon among female ready-made garment workers. Self-reported health problems were found to be associated with socio-demographic and work related factors. Programs should be taken to reduce working environment stressors, to enhance wellbeing conditions. A further analysis report using delegate sample from ready-made garment sector needs to be undertaken to obtain generalizable findings. Keywords: Work stress, self-reported health problem, Ready Made Garment Workers.  
204 Musculoskeletal Problems among Handloom Workers ,  Moshiur Rahman, Manzurul Haque Khan, Irin Hossain, Shazly Bari, M M Aktaruzzaman
A cross sectional descriptive study was conducted in the industry with the objectives of determination of MSDs symptoms prevalence in different anatomical location of body region; identification of major factors and socio-demographic characteristics associated with MSDs symptoms in handloom occupation. First, musculoskeletal problems were surveyed by questionnaire among 450 weavers selected conveniently. The results of this part revealed that symptoms from the musculoskeletal system occurred in high rate among weavers with the prevalence significantly higher. All body region were affected by musculoskeletal problems, among them high prevalence found in neck (69.72%) and shoulder (69.17%) region and lowest in ankle (23.89%) region in last 7 days. Most of the sick leave found for neck, knee, and shoulder and hips pain. Statistical analysis indicated that age of the handloom workers influence musculoskeletal problems was significantly higher in lower back and ankle region (p<0.05). Personal income and family income was a factor to aggravate musculoskeletal problem but it was not statistically significant (p≥0.05). Family size was a strong factor to influence musculoskeletal problems in upper back, lower back and knee region (p<0.05). Job experience was a key factor to aggravate musculoskeletal problems in all body region was statistically significant (p<0.05). Among all body region, highest musculoskeletal problems was found in lower back region (p<0.05). Working hour was significant only in elbow region (p<0.05). Working days per week was significantly severe in ankle region (p<0.05). General working condition score was 2, 3, 4 among 13. General working condition score were significantly higher in some body region, among them knee (p<0.05) region was significantly higher. Ankle pain was statistically significant with working posture of handloom workers (p<0.05). Musculoskeletal problems were positively associated with age, individual and family income, family size, job experience, working hour per day, working days per week, general working condition and working posture. Long hours of static work with awkward posture at traditionally designed looms can lead high prevalence of musculoskeletal problems among handloom weavers. Keywords: Musculoskeletal Problems, Handloom Workers.  
205 Women’s Autonomy and Birth Preparedness of Rural Women ,  Aysha siddiqua, Irin hossain
A cross sectional descriptive study was conducted to find out the extent of relationship between women’s autonomy and birth preparedness among rural women in selected area of Manikganj Sadar Upazila of Manikganj District, during 1st January 2015 to 31st December 2015. The sample size was 400. Purposive sampling was done, semi structured questionnaire was used for data collection and face to face interview had held to collect data regarding socio-demographic characteristics, women’s autonomy and birth preparedness related information. To measure the birth preparedness and complication readiness in pregnant women of rural Bangladesh, ten explanatory variables, such as, identification of a place of delivery , SBA, emergency fund, a health facility for emergency, blood donor, preparation for clean and safe delivery, designate decision maker, saving money, arrange for transportation and danger signs of pregnancy were considered. The result showed that there was significant association between birth preparedness and personal income, educational status, autonomy, knowledge of danger signs of the respondents. Age at marriage, age at first pregnancy significantly effects birth preparedness. Keywords: Women’s autonomy, Birth preparedness, Respondent.  
206 Assessment of Quality of Life from HIV Counselling and Social Support among PLWHA Clinic Attendees in Specialist Hospital Yola, Adamawa State, Nigeria ,  J E Chiegil, K U Suru, S O Adeyemi, O F Martins
The purpose of the study was to assess the quality of life from HIV counselling and social support among PLWHIV clinic attendees in specialist hospital Yola. A descriptive research was conducted. Data was collected using a structured questionnaire, where a total of 370 randomly selected PLWHA adult from the age of 18 years and above attending clinic at Specialist Hospital Yola participated in this study. Data was analysed using SPSS version 21.0. Descriptive statistics was used to analyse the demographic variables while tables and charts were used for the presentation of results. Pearson’s correlation was used between relevant variables while linear regression was used to predict outcomes. Statistical significance of this study was set at P≤ 0.05. The results indicate that most of the respondents were well informed (78.2%) about basic issues in HIV. This was like their levels of counselling and social support received (71.7%), perceived self-efficacy (63.8%), self-reported treatment adherence (80%) and self-reported quality of life (64.3%). This revealed that correct information, knowledge and awareness about basic issues in HIV and social support are very crucial to improving the behavioural skills and increase the level of confidence among PLWHA to perform adherent behaviours thereby significantly improve the quality of life of PLWHA clinic attendees. Keywords: People living with HIV/AIDs, Quality of life, treatment adherence, information and social support.  
207 Assessment of Ghana’s Progress towards Attainment of Millenium Development Goal 6, Target a - A Review of Sentinel Survey Data ,  Owusu Oduro Paul
Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV) [1, 2, 3]. HIV is spread primarily by unprotected sex (including anal and oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding [4]. In 2015, about 37.3 million people were living with HIV and it resulted in 1.2 million deaths [5, 6]. Most of those infected live in sub-Saharan Africa [7]. Between its discovery and 2014 AIDS has caused an estimated 39 million deaths worldwide [8]. HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading [9].HIV is believed to have originated in west-central Africa during the late 19th or early 20th century [10].AIDS was first recognized by the United States Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade [11]. HIV was first confirmed in Ghana at the Noguchi Memorial Institute for Medical Research in 1986 [12, 13]. The infection has since spread to all parts of the country and is established within the whole society. The national prevalence as at 2015 was 1.37% with Greater Accra recording the highest prevalence by region [14]. At the Millennium Summit in September 2000 the largest gathering of world leaders in history adopted the UN Millennium Declaration, committing their nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets, with a deadline of 2015, which have become known as the Millennium Development Goals. The Millennium Development Goals (MDGs) are the world's time-bound and quantified targets for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate shelter, and exclusion-while promoting gender equality, education, and environmental sustainability [15]. Since the first case of HIV was diagnosed, enormous national and international efforts and resources have been expended through the National HIV and AIDS response to contain the epidemic [16, 17, 18]. Following the Declaration of commitment of the United Nations General Assembly Special Session on HIV/AIDS in 2001, the Government of Ghana earmarked 15% of its health budget for HIV/AIDS activities with support from multilateral partners including the World Bank [19]. MDG 6 specifically addresses HIV/AIDS with the following targets; To halt by 2015 and have started to reverse the spread of HIV/AIDS To achieve global access to treatment for HIV/AIDS for those who need it by 2010[20]. The goal of this study is to review Ghana’s progress on MDG 6 using the HIV Sentinel Survey (HSS) report.  
208 Prevalence of Underweight among Children Under-Five Years of Age in Rural Communities in Abuja ,  Orji Ikechukwu Anthony
Background: The pre-MDGs prevalence of underweight among children under five years of age (MDGs goal 1, target 2, and indicator 4) for Nigeria was 35.1% by 1990. How successful was MDGs goal 1, target 2, indicator 4 in rural communities that benefited from MDGs activities in Nigeria? This is the cardinal research question that prompted this work. Objectives: To describe the post-MDGs underweight prevalence among children under-five years of age in the target population. To evaluate the progress made in reducing underweight among children under-five years of age with respect to achieving the MDGs goal 1, in the selected rural communities. Methods: This cross-sectional study used both primary and secondary data. The primary data was collected by direct weight measurement of the children under-five years of age from the selected communities, while secondary data were generated from the growth monitoring and delivery registers of the district PHC. Data were collated and analyzed using SPSS version 20.0. Result: The study recorded an underweight prevalence of 19.3% for children under-five years of age. Prevalence of underweight among the female subjects was 19.2%while their male counterpart was 19.5%. Conclusion: The under-five underweight prevalence for these communities was 19.3% slightly better than the National 2014 prevalence of 19.5%, however, still below the MDGs target of 17.75% at the end of 2015. More effort is therefore needed in the SDGs program to sustain the gain made via the MDGs activities and further improve the nutritional status of children under-five years of age in rural communities. Keywords: Prevalence, underweight, under-five children, rural communities, SDGs, MDGs goal1.  
209 Exploration of Adherence Clubs as a Model of Care for Patients: a Literature Review ,  Ndumiso Tshuma, Keitumetse Lebelo, Sangiwe Moyo, Olufunke A. Alaba, Peter S. Nyasulu
The basis of outcomes assessment in epidemiology provides a framework for analyzing and understanding potential relationships between outcomes and medical interventions. Adherence clubs are a community and facility based intervention that is targeted at decongesting health facility, improving quality of care and retaining patients on ART and chronic medication. The study sought to model the relationship between health outcomes and the implementation of the adherence clubs. A literature review was conducted on the internal and external factors that generally influence health outcomes among adherence club patients. Due to the limited literature on adherence clubs patients, general patient related health outcome literature was used in the construction of the model. Common themes were grouped into broad categories to map out the model. The study shows that there are individual, economic, social, and environmental factors that generally influence health outcomes among patients. Furthermore, these are likely to be the leading elements to improved health outcomes among adherence club members. Keywords: differentiated models of care, adherence clubs, health outcomes, chronic patients, antiretroviral therapy, HIV, health facility, decongestion  
210 Predicting the Length of Stay among Healthcare Workers in Underserved Communities: A Quantitative Retrospective Cohort Study ,  Sangiwe Moyo, Tuan Nguyen Doan, Jessica A. Yun, Ndumiso Tshuma
Background: While prior studies have identified a number of demographic factors related to general health practitioners’ decision to stay in public health practice, recruitment agencies have no validated methods to predict how long these health workers will commit to their placement. We aim to use machine learning methods to predict health professional’s length of practice in the rural public healthcare sector. Methods: Recruitment and retention data from Africa Health Placements (n=13 698 with 1 838 completers) was used to development machine learning models to predict health workers’ length of practice. A cross-validation technique was used to validate the models, to evaluate which model performs better, based on their respective aggregated error rate of prediction. Length of stay was categorised into 4 groups (less than 1 year, less than 2 years, less than 3 years, and more than 3 years). Three machine learning models were trained and used 10-fold cross validation techniques to attain evaluative statistics. Results: The three models attain almost identical results, with negligible difference in accuracy. The ‘best’-performing model (Multinomial logistic classifier) achieved a 47.34% [SD 1.63] while the decision tree model achieved an almost comparable 45.82% [SD 1.69]. The three models achieved the average AUC of approximately 0.66 suggesting sufficient predictive signal at the four categorical variables selected. Conclusions: Machine learning models give us an effective tool to predict the recruited health workers’ length of practice. These models can be adapted beyond the scope of demographic information such as information about placement location and income. This modelling will also, allow strategic planning and optimization of public health care recruitment. Key message Human resource planning in healthcare can employ machine learning to effectively predict length of stay of recruited health workers who are stationed rural areas.  
211  Assessment of Efficacy of Homoeopathic Remedies for the Treatment of Uncomplicated Malaria (‘A Case Study in Effiduase, Sekyere East District of Ashanti Region’ Ghana) ,  Eric , John Awuni Abugire, Takyi Clifford, Abigail Adusei
Globally, Malaria Is Noted To Be Among That Important Diseases Related To The Environment. However, Problem Related To Malarial Still Remains Very Enamours With Little Improvement. Much Is Interventions Are Needed To Be Done Particularly In Most Africa And Its Sub-Regions. Owing To A Widespread Resistance to Previously Known Anti-Malarial Chemotherapies, the Revision of Antimalarial Drug Policies by Most Sub-Saharan African Countries Is Essential It Is Of This Concern That This Controlled Clinical Trial Study Was Conducted To Assess The Efficacy, Safety And Tolerability Of Single And Combination Antimalarial Homoeopathic Remedies For The Treatment Of Uncomplicated Malaria In The Sekeyer East District Of Ashanti Region, Ghana.  The Study Documented The Following At The End Of The Trial. No Statistically Significance Difference Was Observed Between The Two Treatment Groups Of The Trial. A Percentage Efficacy Of 95.8% And 95% Was Observed For Treatment with Single Remedy and Combination Remedy Respectively. Again Participants On Control Group Showed No Improvement On Malaria Status At The End Of The Study. This Proved A Significant Efficacy of Homoeopathic Anti-Malaria Remedies. With Reference To These Finding, The Study Recommend The Following As Well; Homoeopathy Remedies Be Advocated For Nationwide Usage As It Has About 90% To 95% Success Rate For The Treatment Of Uncomplicated Malaria With No Or Minimal Side Effect, The Research Should Be Reproduced In A Different Geographical Location Involving Large Samples Of Participants To Confirm The Validity Of The Present Findings And To Enhance Generalization. Keywords: Un complication malaria, Homoeopathic remedies, Clinical trials, Sekeyere East District.  
212 Environmental and Public Health Impact of Poorsolid Waste Disposal in Kano Metropolis Nigeria ,  Kabiru Mustapha Y
Poor solid waste disposal is one of the major environmental and public health issues in Kano Metropolis, like in other cities in Nigeria and developing world at large. Poor solid wastes disposal pose threat to public health and environmental quality in the metropolis. The objective of this study was to examine the environmental and public health impact of poor solid waste disposal in Kano metropolis. The study was cross sectional descriptive studies, simple random sampling technique was applied to sample the study population, and structured questionnaire were designed, pretested and re-distributed to participants. Secondary data sources were used. The result revealed that overall there were 554 households participated, with a response rate of 539 (98%). Demographic characteristics of respondents indicated 236 (44%) males, 303females (56%), marital status of the respondent indicated 198 (37%), were marriage, and other demographic characteristics. The result shows significant findings that relates to poor solid wastes disposal and the impact on environment and public health, 75% of household engaged in open mass dumping of solid wastes, other factors that contributes to poor solid waste disposal were observed and documents, distance to disposal sites, household storage of wastes, and poor separation of wastes. Over 77% households had perception about disease transmission from poor solid waste disposal. 53% had good knowledge about diseases related to solid waste disposal. Significant awareness as well as perception was good among the households but there is poor behavior in terms of effective management of solid waste, proper health education message dissemination must be enforced for better behavioral change by the relevant authorities. Keywords: Environment, Health Solid waste Disposal, Dumpsite.  
213  The Effect of Malaria Integrated Supportive Supervision (Miss) on Knowledge and Practice of Malaria Prevention and Management: A Comparative Study of Miss Supported and Non Supported Primary Health Facilities in Nasarawa State, Nigeria , Alabi Babatunde  
Background: Malaria is a major cause of morbidity and mortality in Nigeria, directly contributing to poverty, low productivity, and reduced school attendance. The mosquito-borne illness causes over 100 million clinical cases every year. It accounts for about 60% of all outpatient attendances and 30% of all hospital admissions and is responsible for the annual death of 300,000 children under 5 years as well as 11% of maternal mortality cases reported each year. In children, malaria is responsible for 25% of all infant-related mortality and 30% of child-related mortality. (National Malaria Control Strategic Plan FMOH 2009-2013)  Integrated Supportive Supervision (ISS) is a harmonized supervisory system which uses a common tool and reporting format based on a collection of indicators from as many work processes/initiatives/programmes as possible. It is driven by a common supervisory team usually working as several sub-teams, thus ensuring that managers are in the field on a regular basis (monthly or quarterly) to check the performance of subordinates and help them to improve on their competencies and output. What is also key besides getting managers into the field on a regular basis and thus understanding the context and challenges within which health workers function, is the importance of both supervisors and supervisees agreeing on a plan of action to improve health care delivery. This plan of action must include activities/actions by both the supervisor and the supervisee. This is critically important and can be used to measure progress on subsequent visits. This study aimed at evaluating the effect Malaria Integrated Supportive Supervision (MISS) on Malaria Service Delivery in MISS supported Primary Health Facilities and Non-Supported Primary Health Facilities across various LGAs in Nasarawa State. Materials and Methods: This was a facility-based interventional study with MISS intervention and MISS non- intervention groups. The study subjects were Officers in charge of each Primary Health Facility, selected through a multistage sampling technique and data collection was done using semi structured self-administered questionnaire, all data were entered in an Excel sheet and analyzed using SPSS version 17.0. Paired t test was used in testing for significance between intervention and non-intervention group. Results: On the Knowledge and Practice of malaria prevention and vector control, the mean score for the MISS and Non MISS groups are; 92.98 and 53.41respectively. The two-tailed P value equals 0.0395 which by conventional criteria, this difference is considered to be statistically significant. Mean score on Diagnosis and Treatment knowledge and practice between the MISS intervention and Non-MISS intervention groups are; 81.49 and 66.53 respectively. The two-tailed P value equals 0.0642. By conventional criteria, this difference is considered not to be quite statistically significant. This could however be attributed partly to the fact that trainings on diagnosis and treatment was held jointly among the two groups. Malaria in Pregnancy mean score between the MISS intervention and Non-MISS Intervention groups was 86.38 and 66.10 respectively. The two-tailed P value equals 0.0138 which by conventional criteria, this difference is considered to be statistically significant Conclusion: This study has demonstrated that integrated supportive supervision is an effective tool of improving knowledge and practice of malaria prevention and case management in Primary Health Facilities  
214 Factors Contributing to Low Postnatal Coverage in Ga East Municipality ,  Oscar Vetsi
Postnatal period is a very critical stage for both the mothers and their babies. The importance of postnatal care services has been established in various studies globally. Yet postpartum care is the most neglected aspect of women’s health care, not only in developing countries but also in some developed countries. In Ghana 23% of postpartum mothers do not receive postnatal at all. This study seeks to explore contributory factors associated with low postnatal service utilization in Ga East District of Greater Accra Region (GAR). The study design was a cross sectional explorative and qualitative research using focus group discussions. The target population for the study were women in the reproductive age and living in the Municipality. The study used five focus group discussions to determine factors contributing to low postnatal coverage in Ga East Municipality. A purposive sampling was employed to carry out to recruit the participants. The researcher moderated all discussions assisted by one trained assistants. The taped discussions were transcribed and the resulting texts analyzed by using thematic analysis. The findings of the study will be communicated to both the School of Public Health and the Ghana Health Service. Keywords: PNC; Postpartum; Postnatal; Coverage; Factors; Period.  
215 Experiences of Health Care Providers with Integrated Sexual Reproductive Health (SRH) and HIV Services in Oyo State ,  Michael Olabode Tomori  
Background: There has been wide agreement in some part of the world where there is generalized HIV/AIDS and high reproductive disease incidence that integration of sexual reproductive health (SRH) and HIV services is of great importance. Integration is assume to increase accessibility to and uptake of health services; it also ensures better use of resources as it improves efficiency at cheaper cost. But there are few studies on the significance of health care providers’ experiences to the system. This research study was carried out among frontline health personnel to investigate provider experiences on integration to establish their importance to the success of integrated health facilities. Methods: Semi-structured questionnaires were administered with 32 frontline health care providers in some facilities providing integrated SRH and HIV services in Oyo State. The interviews were then transcribed and analyses by the researcher and research assistants. Results: Respondents reported the benefits they are the clients received as a result of integration. Shortage of manpower to carter for increased workload was by far the most obvious challenge facing the health workers. Others included inadequate infrastructure, stock-out of materials, lack of motivation due to untimely payment of salary, gaps in training, language barrier, poverty and misconceptions: Conclusions: The roles of health care providers is very critical to the successful implementation of integrated SRH and HIV services. Their performances can also be affected by some challenges identified in this study. However, this study has shown that integration can assist in ameliorating these identified problems and these valuable opportunities deserves further probing. Keywords: Experiences; Health Care Providers; Integrated; SRH; HIV; Services; Oyo State.  
216 Factors Influencing Full Immunization Coverage among Children Aged 12-23 months in Chadereka Rural Community, Zimbabwe , Priscilla Kusena
Full Immunization (a child having received BCG, 3 doses of oral polio, three doses of pneumococcal conjugate, three doses of pentavalent and measles vaccine) against vaccine preventable diseases reduces deaths of under-fives in developing countries. Zimbabwe records show low full immunization coverage of 69.2% in 2015 and the causalities are poorly understood. We examine factors undermining full immunization coverage among children aged 12-23 months in Chadereka community, Centenary district. We adopted a cross sectional study design using modified cluster sampling method to select study participants. Fifteen systematically selected clusters of 8 children were utilized to determine full immunization coverage. Data collection was done using a pretested structured questionnaire and analysed using excel software. Mothers (n=120) with children (aged 12-23 months) were sampled and history of immunization was extracted from child’s baby card plus mother’s history. We found that 64.2% (95% CI: 53.9-74.5) of study participant had achieved full immunization. Specific vaccine coverage for BCG, three doses of polio, three doses of pneumococcal conjugate, three doses of pentavalent, and measles vaccine were 90.8%, 89.4%, 86.1%, 82.4% and 70% respectively. Source for immunization were health centre (53.5%), outreach services (37%) and hospital (9.5%). Mother’s awareness (p-value 0.0317) and wealth status (p value 0.01592) were the major predictors of full immunization coverage. Reasons given for failure to fully immunize children were obstacles (74.4%), lack of motivation (11.6 %), lack of information (9.3%) and community factors (4.7%). We conclude that improved awareness to mothers and empowering women potentially increase the national full immunization coverage. Keywords: Full immunization, factors, coverage, vaccine preventable diseases.  
217 Study to Determine the Prevalence of High Blood Pressure amongst Bankers Working in Abuja, the Federal Capital Territory, Nigeria ,  Karthy christy Ebhohimen  
Hypertension is one of the most important causes of the total disease burden in the world (Lloyd-Sherlock et al., 2014). Non-communicable diseases, especially Coronary Artery Disease (CAD) including hypertension as a major risk factor accounts for almost 53% and 44% of deaths and disability adjusted life years (DALYs) (Mengistu, 2014). Blood pressure is the single most useful test for identifying individuals with CAD (Barron et al., 2014). CAD are nowadays increasingly seen in working people in age group of 35-64 years, in whom 35% of CAD deaths are observable (Adeloye et al., 2015; Angaw, Dadi and Alene, 2015). Hypertension is an increasingly important medical and public health issue worldwide (Ma et al., 2013; Chen et al., 2014). Currently, the prevalence of hypertension in many developing countries, particularly in urban societies is said to be as high as those observed in developed countries (Addo, Smeeth and Leon, 2007; Guwatudde et al., 2015). The burden of hypertension in Nigeria is high and still growing (Adeloye et al., 2015) and we still cannot say with certainty the exact burden because of lack of usable data(Ujunwa et al., 2013).  
218 Medical Practitioners’ Knowledge about and Attitude towards Transgenders in India ,  Pethuru Devadason, Sreedhar Muthyala, Liaquat Roopesh Johnson, Alber M. Mathiyarasu, Diana Thamby Ebenezer
Transgender is an umbrella term that refers to people with diverse gender identities and expressions that differ from stereotypical gender norms. Medical practitioners’ attitude towards Transgenders affects health care offered to such patients who experience health and health care disparities and have specific health care needs. There is sparse of literature that explores the knowledge and attitudes of health care providers towards Transgenders. Objectives: This study was carried out with the following two objectives: 1) to assess the Indian Medical Practitioners’ knowledge about and attitude towards Transgenders. 2) To find out the current exposure and self-efficiency of Medical practitioners on treating transgender persons in their clinical set up and to identify the significant factors associated with them. Methodology: This is a web based cross sectional study carried out among the Medical Practitioners of Allopathic medical system, all over India to assess their knowledge about and attitude towards Transgenders through an online survey questionnaire. The questionnaire collected the basic socio demographic details and clinical practice details of the participants. It also contained set of questions to assess their knowledge, attitude, current exposure of treating transgender individuals and their comfort level (self- efficiency) on treating them. Results: There were 128 Medical practitioners who completed the online survey questionnaire within one month duration of the study period. Two third of the respondents are residing in urban area (81 -63.3%) and two third of them (68 - 67.2%) are working in tertiary care centre setups. Only 27 (21.1%) respondents know any transgender personally and only 22 (17.2%) respondents have treated any transgender so far. The average number of transgender individuals treated by these 22 respondents in the past year and past 1 month is only 4.18 and 0.91 respectively. While 95 (74.5%) participants correctly responded that the transgenderism due to biological causes, 64 (50.0%) participants correctly responded that the transgenderism is due to psychosocial causes. Years of experience is the only statistically significant factor affecting the participants’ general knowledge on transgenders and having provided treatment to any transgender individual. Conclusion: 1) The study participants have very good positive attitudes towards transgender individuals while there is a gap in their knowledge on Transgenders. 2) Only 21.1% respondents know any transgender individual personally and only 17.2% respondents have treated any transgender individuals. 3) Years of experience is the statistically significant factor associated with having general knowledge on Transgenders and having provided treatment to any transgender individual. 4) The confidence on clinical skills and comfort level of treating the transgender individual are less in the study population and which can be improved by continuing medical educations. Keywords: Transgenders, Knowledge and Attitude, Medical Practitioners, India, KAP on Transgenders.  
219 Microbiological Control of Honeys Bought from Kinshasa’s Markets in Democratic Republic of the Congo ,  Mandjo Aholoma M. J. L, Ntankoy Nkombe C., Komba Etambala J., Soki Kahavo D., Mpona Minga. F
Honey is one of the foods that can be found abundantly in different provinces of Democratic Republic of the Congo (DRC). Harvesting in a traditional way, honey is being marketed in Kinshasa. It can easily be placed in the market without any microbiological control so far. However, honey is often used both as additive food and poison cure. This study concerns the microbiological control of seven samples of honey collected randomly in different markets of Kinshasa. Their physicochemical and microbiological parameters were analyzed and the results indicated that the samples of honey that came from DRC’s different areas had an average pH of 3 (5 ± 2.1), were contaminated by the fungal flora 69% and bacterial 31%. Molds (Aspergillus flavus and Penicillium sp.) account for 38%, yeasts (Candida sp.) for 31%, and bacteria (Staphylococcus aureus and Streptococcus sp.) for 31%. These results reflect a poor hygienic quality of honeys that is being sold in Kinshasa’s various markets. These results prove the possibility of arising an alarm bell on the risks that consuming this foodstuff can affect the population’s health. Keywords: Microbiological control - Honey - Kinshasa market – DRC.  
220 Maternal Mortality, Proteinuria and Pregnancy Induced Hypertension: Case Study of a Regional Hospital in Brong Ahafo Region, Ghana , Jacob Kwadwo Amponsah Abebrese, Samuel Fosu Gyasi, Vincent NimoAfriyie,Isaac Kwofie , Ephraim Kobina
Globally, one of the public health problems confronting the medical community is maternal mortality. This study seeks to investigate the relationship between maternal mortality, proteinuria and pregnancy induced hypertension among some pregnant mothers in Ghana. In this study, protein in the urine and blood pressure of some 450 pregnant women who visited the Hospital between Januarys to December, 2015were monitored. Retrospective data based on maternal death from January 2010 and December 2015 were also retrieved and analysed. This was augmented by interviewing150 respondents (75 each from antenatal and postnatal section of the hospital) based on maternal health history, knowledge on PIH etc. The results of the study with respect to proteinuria and the blood pressure (BP) monitoring showed that, 36% of these mothers had traces of protein in their urine whiles 32 mothers out of 450 had elevated systolic and diastolic BP. The study also revealed, when data on maternal mortality and PIH of pregnant mothers were retrieved that, a total of 75, 439 (N=75,439) mothers attended the antennal section of the Hospital. Out of this, 139 of them (0.18%) died due to PIH. Maternal child bearing behaviour, nulliparity when analysed showed that, greater proportions of antenal (AN) mothers (32.00%) were nulliparous compared to their PN counterpart (0%) (p<0.0001). Results of our study has shown that, maternal mortality due to PIH were high due to elevated systolic and diastolic blood pressure as well as high doses of trace amount of protein in pregnant mothers’ urine. Keywords: Maternal, Mortality, Eclampsia, Clinical, Hypertension, Postnatal.  
221 Seasonal variation in the prevalence of post-abortion complication in northern nigeria , Mathew Okoh
Complications from miscarriages and unsafe abortion often lead to short and long term morbidities. About 40% of maternal deaths in Nigeria are attributable to complications from miscarriage and unsafe abortion. Seasonal variations in the incidence and prevalence of spontaneous miscarriage have been reported in other climes but there is no literature describing this phenomenon in Nigeria. This analysis aimed to determine if there was a seasonal variation in the prevalence of post abortion complications cases managed in Kano State, Nigeria. This analysis was based on a retrospective review of records of all women who presented for treatment of post abortion complications in 30 hospitals over a 36 months period. Stata SE version 14 was used for analysis. Aggregated monthly number of cases over the three year period revealed a cyclical pattern with two dips in December and June and a peak around the months of February and March. This pattern remained consistent when the data was disaggregated into the different years. No statistically significant difference was observed in the number of PAC cases treated during the rainy season compared to those treated in the dry season. However, there was a statistically significant difference in the number of PAC cases treated in the first year compared to the second and third year. Findings from this study indicates that there was no difference in the number of PAC cases treated in Kano state during the rainy season compared to those treated during the dry season. The number of cases treated however, appeared to differ across years. Keywords: Miscarriage, Complication, Post-abortion care, Post-abortion contraception, seasonal, Trimester.  
222 The Effects of Birth Weight on Newborn Apgar Score with Other Potential Medical and Child Risk Factors, Brussels Cohort Study ,  Jerry-Jonas mbasha  
The new born weight is one of the major indicator providing information of the nine months’ intrauterine life and may predict the survival rate of new born. In fact, birthweight is one of the most accessible and most misunderstood variables in epidemiology. A baby’s weight at birth is strongly associated with mortality risk during the first year and, to a lesser degree, with developmental problems in childhood and the risk of various diseases in adulthood(1). Epidemiological analyses often regard birthweight as on the causal pathway to these health outcomes. Under this assumption of causality, birthweight is used to explain variations in infant mortality and later morbidity, and is also used as an intermediate health endpoint in itself.(1). The scope of this study will not be extended to the measurement of news born health outcomes after one minutes of life. A second factor is that birthweight is an extremely powerful predictor of an individual baby’s survival. In general, the lower the weight, the higher a baby’s risk of infant mortality. On a population level, mean birthweight is associated with infant mortality. Groups with lower mean birth weight often have higher infant mortality(1,2)(e.g. the infants of mothers who smoke, or of mothers with lower socioeconomic status). Finally, birthweight is associated with health outcomes later in life. Asthma, low IQ, and hypertension have all been reported to be more common among those who were small at birth(1). However, the birthweight standards that are used to determine gestational age are often applied without consideration of their appropriateness to the population under study(3). Thus, birth weight can’t be considered itself in isolation, it need to be linked to other factors, both intrinsic (e.g. fetal, sex, ethnicity, maternal parity, and plurality of pregnancy) and extrinsic (e.g. mother’s socio-economic characteristics maternal).(3). Standards that are most applicable to the infants under study will use available WHO proposed birth weight classification standards.(4).  
223 Ownership and Use of Insecticide Treated Nets by Pregnant Women at Dworzark Community in Freetown, Sierra Leone ,  Sulaiman Lakoh, Darlinda F. Jiba, Mohamed Bawoh
Background: Malaria remains a major public health problem in Sierra Leone. One contributory factor to the high malaria burden is the unavailability of Insecticide Treated Nets (ITN). This study assessed ownership and use of ITN by pregnant women. Methodology: Cross sectional study design and multi-stage cluster sampling were employed to collect data from 333 eligible and consenting pregnant women. An Interviewer-administered, semi-structured questionnaire was used for data collection. Analyses was done using SPSS version 21. Mean, median and standard deviation were used to summarize quantitative variables and frequencies and proportions for qualitative variables. Association between demographic and pregnancy variables and ITN use was statistically tested. Level of significance for all tests was at 5%. Result: The mean age of the surveyed pregnant women was 28.49 years. While only 30.3% of pregnant women owned ITN, 97.2% slept under bed net the night before the survey and, 79.2% slept under bed nets always in the 3 months preceding the survey. The ITN ownership by household was 35.4%. The sources of ITN include street traders (38%), mass campaign (25%), health facilities (18%) and shops (15%). The reasons for not sleeping under ITNs are unavailability (79.7%), heat (25.8%), odour (19%), use of other malaria preventive measures (12.1%), and cost, inconveniences and itching (13.8%). ITN use by pregnant women is statistically associated with their educational status, age and ownership of at least one ITN Conclusion: Pregnant women should have access to ITN at all times as this may increase ITN use during pregnancy. Keywords: Insecticide Treated Nets, Pregnant, Women, and Malaria.  
224 Overview of Child Malnutrition at Katima Mulilo Hospital (Zambezi Region/Namibia) , Amisi Bitoma  
Malnutrition among children is very common in developing countries. Malnutrition is a physical state in which physical function of an individual is impaired to the point at which he or she can no longer maintain adequate bodily performance processes (growth, pregnancy, lactation, physical work, and resisting or recovering from diseases.) (1). Malnutrition presents a double burden in the world currently. Severe acute wasting Malnutrition also called thinness (2) which is fast or rapid wasting of body weight [weight for height ratio below < -3 standard deviation (SD)] or bilateral nutritional edema. Severe overweight also called Obesity (3) which is defined as excess body fat deposited in the body contributing to comorbidity. Body Mass Index (BMI) is the measurement of obesity [when BMI is > 30 or when waist circumference is > 88cm (Female) and > 102cm (Male), there is obesity]. Severe acute wasting Malnutrition and obesity are all conditions that have an impact on a Public Health Point of view. Indeed, according to the data published by UNICEF, WHO and World Bank Group in 2015 (4): Stunting also called shortness (meaning chronic malnutrition based on height per age ratio) are dropping but 159 million children around the world are still affected. There are 41 million overweight children in the world, about 10 million more than there were 2 decades ago. Wasting still threatens the lives of 50 million children across the globe. The majority of children under 5 suffering from wasting live in Asia. In 2015 , 34,3 million wasted children under 5 were from Asia which represent 68% of the globally number of wasted children under 5(Southern Asia being the house to more than half of all wasted children under 5 globally) (4). Africa is the second worst continent with the second higher number of wasted children under 5 which is around 13, 9 million (28% of the global number) (4). 57% of world stunted children are from Asia while 37% of world stunted are from Africa mostly in Eastern Africa, Middle Africa and Western Africa. (4). Low income and lower middle income countries are the majority of countries that experience more of wasting and stunting among children under 5(4). Namibia is one of the Southern African Countries with a small number of the population (+/- 2 million according to the latest census done in 2011). Namibia is among the countries in the world with a high prevalence of HIV infection. According to Namibia HIV Sentinel Survey 2016 (5), the prevalence of HIV in Namibia is 17.2%. Katima Mulilo, the main town of Zambezi region has the highest prevalence of the HIV in the whole Namibia which is 32.9% (Near to 1 among 3 persons of Katima mulilo has HIV). Namibia is among the countries with lower middle income countries in the Southern Africa (6). HIV is the main health problem with Tuberculosis. Malnutrition has never been pointed among the major health problems in Namibia. As a Medical officer at Katima Mulilo District Hospital , the only one hospital in Katima Mulilo Town and the whole Zambezi Region (one among the 13 regions of Namibia) , I have decided to look at the number of cases of severe Malnutrition among children in Zambezi Region knowing that, being a worker at the unique hospital of Zambezi region , most of the severe cases of Malnutrition will be referred to Katima Mulilo Hospital (unless if the patient recovers fast or dies before arrival to the hospital). This article is an overview of severe malnutrition among children in Katima Mulilo (via Katima Mulilo Hospital) particularly and by extension in the whole Zambezi Region in general.  
225 Assessment of 12 Months Retention in Care among Children living with HIV in a Pediatric Reference Hospital, Yaounde Cameroon ,  Andreas A. B. Frambo, Francis Ateba. Ndongo
Poor retention in HIV care is a known main challenge for antiretroviral treatment programs resulting to poor performance and increased morbi-mortality. Many studies related to retention are focused on adults including pregnant women, leaving out children, especially in sub Saharan Africa. The objective of this study is to assess 12 months retention and determine factors associated with retention among children on ART. A cross-sectional study was carried out in a pediatric reference in Yaounde, Cameroon. Registers of children enrolled on antiretroviral therapy from Oct 2015 to Oct 2016 were reviewed for retention. Factors associated with retention in children were determined for future improvement. A total of 416 children were enrolled and after 12 months follow up, 398 (90.9%) were found to be alive and still on treatment. Young age (age less than 1 year) of start on ART and CD4% were the factors associated with poor retention & attrition at 12 months after initiation. Twelve months retention in care for children living with HIV is near optimal (90.0%) with a high chance of long term survival. Age less than 1 year and CD4% were baseline risk factors for poor retention. Given that children rely on their caregivers for optimal retention, there is need for robust prevention of mother to child transmission programs and pediatric case finding & linkage to care strategies. Quality data will help improve strategies and procedures to boost long term retention required for viral suppression needed end the HIV pandemic. Keywords: HIV, Assessment, Retention, 12 months, Children, Cameroon.  
226  The Effectiveness of Provider Initiated Testing and Counselling within Nutrition Clinics for Malnourished Children less than 5 years in Adamawa State, Nigeria ,  Samson Olufemi Adeyemi , K U Suru, J E Chiegil, O F Martins
Background: Paediatric HIV infection and malnutrition remain two major health issues in Nigeria. Malnutrition is one of the clinical presentation of HIV in children who survive infancy undiagnosed, diagnoses usually occurs on presentation to health care services. We investigated the effectiveness of integrating provider-initiated testing and counselling (PITC) with nutrition services for children less under 5 years attending primary care clinics. Methods: After an evaluation of HTC services for malnourished children aged 6-59 months in 2 primary health care facilities offering community management of acute malnutrition (CMAM) sites in Adamawa State, Nigeria, PITC was integrated into nutrition services. The change in the proportion of eligible children offered and receiving HIV tests and yield of HIV-positive diagnosis were compared for periods of 6 months before the integration of PITC and 6 months after the integration of PITC into CMAM OTP. Results: There were 440 and 278 malnourished children eligible for HIV testing before and after the integration of PITC within nutrition services. The proportion of eligible malnourished children offered testing increased from 59% to 100% and test uptake improved from 50% to 98% in PITC integration period compared with before PITC integration period. The yield of HIV diagnosis increased from 0 to 1.5%, and a malnourished child attending the clinic post intervention had 0.03 increased adjusted risk (95% CI: 0.01 to 0.08) of receiving an HIV test in PITC integration period compared with pre-intervention period. Conclusion: PITC integration into CMAM intensified paediatric HIV case finding.  
227 Isoniazid Preventive Therapy Implementation among People Living with HIV/AIDS Enrolled in Care at Specialist Hospital Yola, Nigeria , Kabiru Usman Suru , J E Chiegil, S O Adeyemi, O F Martins  
Background: Nigeria ranks 5th among the 22 countries that contributed 80% of the global Tuberculosis (TB) burden. The risk of developing TB is between 20 and 37 times greater in people living with HIV (PLWHIV) than among those who do not have HIV infection. The purpose of this study was to assess the level of Isoniazid Preventive Therapy (IPT) implementation among PLWHIV. Methods: Retrospective cohort study conducted to examine the IPT implementation among the PLWHIV in Specialist Hospital Yola, Nigeria. Information’s were extracted from the IPT enrolment register and client’s folders, analyzed with excel and compared with the data in the District Health Information System (DHIS). Chi-square test was used to measure the strength of associations between the various variables and probability of statistical significant level set < 0.05 at 95% Confidence interval Results: Eight hundred and seventy-three (873) clients were enrolled in to HIV care and treatment from January-December 2015 and were all screened for TB. 777 (89%) clients had no presumptive TB, only 273 (35%) clients were initiated on IPT out of those without presumptive TB. 143 (93%) clients on ART completed their IPT as against the 97 (80%) Pre-ART clients that completed IPT. Conclusion: The IPT utilization in the prevention of TB among the PLWHIV in this health facility was very low, however consistent availability of Isoniazid and effective adherence counselling to eligible PLWHIV before commencement of IPT would help in increasing uptake and reducing the rate of defaulters on IPT. Keywords: Tuberculosis, Implementation, Isoniazid Preventive Therapy, PLWHIV, Nigeria.  
228 HIV-Yield and Linkage in 13 Military Health Facilities in Cameroon: a Retrospective Study ,  R. Medang, U. Tamoufe, G. Dion, K. Saylors, N. Ortiz, M. Haile, J.C. Aba, A. Mama, M. Mpoudi-Etame, V. Meguia, D. Iwoi, E. Ambe, G. Bualo, M. Dieffi, I. Tonye, N. Manga
    Since a number of years, many changes and a great evolution have occurred in the process of care and treatment as well as program management of HIV/AIDS control, worldwide. Many terms and paradigms have in fact emerged in the field of HIV/AIDS. New terms and paradigms such as the 90-90-90 target by 2020, the “test and treat”, the linkage or the yield. As a matter of fact and according to the UNAIDS [11], “Ending the AIDS epidemic is more than a historic obligation to the 39 million people who have died of the disease. It also represents a momentous opportunity to lay the foundation for a healthier, more just and equitable world for future generations.” This will undoubtedly be an enormous achievement for mankind as a whole, for what has been one of the greatest fears of the last 30 years. Thus, one of the biggest demands to date to achieve the elimination of the HIV epidemic is certainly the need to make the treatment universal, through the availability of ARVs.it should be admitted that, not only must treatment be made available, but it must also be ensured that all those who have been initiated into antiretroviral treatment remain faithful to it throughout their lives; hence the notions of linkage to treatment and retention to treatment. It should be remembered that a good follow-up of the antiretroviral treatment not only reduces the viral load in the individual undergoing treatment, resulting in a better quality of life and a longer life but also reduces the capacity of the infected person to transmit the HIV infection to others. Therefore, advantages obviously exist for both the infected individual and the entire community. In this respect, a powerful momentum initiated by the UNAIDS [11], is now building towards a new narrative on HIV treatment and a new, final, ambitious, but achievable target: By 2020, 90% of all people living with HIV will know their HIV status; - By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; - By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.”  
229  Trends in Management of HIV/AIDS Clients in a Tertiary Health Facility in South West Nigeria , Article by Amenkhienan Ibidun Florence  
Introduction: The scourge of HIV/AID has negative impact on human existence. Global trends in HIV prevalence are alarming despite the use of potent antiretroviral medications for many decades. The impact on individual in a society and communities at large is a public health concern and all hands should be on deck to curb this social menace. The big question is what more can we do to help get to Zero? The objective of this study was to reflect on the trends in HIV care in a tertiary health facility in South West Nigeria and compare with what is obtainable globally and elucidate what more can be done now, to safeguard the future of the next generation. Methods: In this study, secondary data was used. Monthly records of seropositive patient enrolled in ART care for 10 consecutive years were retrieved. Including routine clinic visits, and wards admissions. A review of monthly records of seropositive clients’ (adult, paediatric and antenatal clinics) enrolled in ART programs of Federal Medical Centre Owo Ondo Nigeria was conducted. Data analysis was done using SPSS version 22.0. Result: Total number of seropositive clients enrolled between the years 2006 to 2015 in the adult ART clinic is 3844 with a monthly average of 344.4 clients. Total number of male that attended ART clinic was 1782 (46.5%) while total number of female was 2058 (53.5%). Prevention of Mother to Child Transmission (PMTCT) the total of pregnant women tested from year 2008 to 2015 is 19,641 but only 3530 (17.97%) were seropositive. Highest enrollment occurred in year 2008 which was 857(22%), with lowest enrollment occurring in 2006 which was 251(6.5%). Therefore, showing decrease in enrolment over the years. A total of 225 clients were transferred out, 19.5% were lost to follow up. However, total pregnant women tested from year 2008 to 2015 is 19,641 out of which 3530 (18%) were seropositive. There is an appreciable decline in the incidence of HIV/AIDS among pregnant women from 2008 till 2015, from 884 (25%) to 173 (4.9%). The prevalence of seropositive pregnant women have reduced from 7.95% in 2008 to 0.9% in 2015. Conclusion: Early enrolment in ART programme will ensure access to drugs and help safeguard the future. Adequate counseling will help form good habits and thereby reduce the spread of HIV. The use of antiretroviral therapy is significant in reducing morbidity and mortality in HIV positive clients especially in developing countries. Keywords: Trends, Client, Seropositive, Antiretroviral.  
230 Perception of Rural Communities in Akoko North West Local Government Area of Ondo State Nigeria towards Ikaram Millennium Village Project , Kareem Adesola Olawumi  
Background: Millennium Village Project (MVP) is designed to harness the progress of the time-bound Millennium Development Goals (MDGs). Objective: This study aimed to assess the perception of the Ikaram Millennium Village Project by the residents of Akoko North–West Local Government Area of Ondo State. Method: A descriptive cross-sectional study of 496 residents of five out of the seven communities that make up the Ikaram MVP was done. The perceptions of the respondents were rated poor or good by scoring response to eight validated questions. Chi square test was used to assess significant association. Result: The mean age of the respondents was 42.20±17.1 years, 250 (50.4%) were females, married were 311 (62.7%). Only 15(3%) were from other tribes aside Yoruba, 430(86.7%) have ever accessed the MVP health services. Poor perception was reported among 353 (82.1%) respondents. Among the Yorubas 79(17.1%) had good perception compared to 7(46.7%) from other tribes, p= 0.003. The location of the health facility contributed to the poor perception about the Ikaram MVP. Conclusion: For community orientated health projects to be successful community participation is important. Keywords: Millennium Village project, rural communities, perception, health facilities, community participation.  
231 Profile of Stunted Children in Cameroon, A Mics 2014 Analyses ,  Eveline Ngwenyi, Eric Gyamfi
Background: Under Nutrition Is One of World’s Most Serious but Least Addressed Health Problems. Malnutrition Is Widespread In Cameroon Especially In The Northern Regions Of Cameroon. There Are Currently Very Little Or No Data On Factors Associated With Stunting In Cameroon. This Paper Presents Some Factors Associated With Stunting In Adamaoua, East, Far North And North Regions Of Cameroon. Method: This Study Analysed Dataset Of The Firth Round Of Cameroon Multiple Indicator Cluster Survey (MICS5) To Establish Risk Factors Associated With Stunting In Four Regions Of Cameroon Results: 3085 Cases were Analysed, with stunting Prevalence Rates Of 31.7% At National Level, 37.8%, 35.8% , 41.9% And 33.8% Respectively In Adamaoua, East, Far North And North Regions. The Highest Risk of Stunting Was Among Children Age 36-45 Months (10.2%, 8.8%, 11.9%, And 10.4% Respectively In the Adamaoua, East, Far North and North Regions). Rural Children across All Four Regions Were More Affected By Stunting (22%, 27%, 31.9%, And 27.4% Respectively In Adamaoua, East, Far North and North Regions than Their Urban Counterparts (13, 9%, 8%, 8%, And 6.5% Respectively). Conclusion: The Study Recorded High Prevalence Of Stunting, Underweight And Wasting Among Children Age 6-59 Months. Malnutrition was noted as a Burden in Children Age 6-59 Months in Cameroon, Particularly the Four Regions of the Study. Age And Place Of Residence Of Child, Were Found To Be Significantly Associated With Stunting And That Child Age Was Significantly Associated With Minimum Acceptable Diet. Keywords: Cameroon, Under-Nutrition, Stunting, Determinants, Association.  
232 The unmatched Public Health Humanitarian Emergencies Context with persistently outdated methods of response -Case of South Sudan 2017 ,  Sebit Musfafa  
Introduction: This study aims to determine the unmatched Public Health Humanitarian Emergencies Context with recurrently outdated methods of response -South Sudan is used as a case study. With specific objective: to increases the support for vital, approach in Public health activities in humanitarian emergencies and ascertain new ways of delivering Public health activities in humanitarian emergencies system. Methodology: The study, was secondary research to track down useful existing published information and a review of the secondary literature on Public health activities in humanitarian emergencies, the principle investigator summaries the articles from South Sudan NGOs forum, BioMed central , Web of Science (2005- 2017) and PubMed (2005- 2017). Results: South Sudan reported the highest Humanitarian access incidence in the region, most frequent report in 2017, (101) in August 2017 laterally, and most implicate violence against humanitarian workers and properties. Evidence indicate South Sudan is not receiving enough support and appropriate global focused, due jeopardy, that lead to losing more humanitarian support. Yet, it’s not the humanitarian agencies that’s going to solve the Public health humanitarian emergencies in South Sudan, than the political will and support. Conclusion: South Sudan situation cannot be put in to one box, because it has many vigorous, therefore need different approaches and interventions. The study recommends that improved data are imperative towards supporting inter-sectorial work in addressing Public health care needs of the persons of concern to Humanitarian agencies. Keywords: Complex emergency, humanitarian, Health Information System (HIS) – Public health -0 persons of concern to Humanitarian agencies.  
233 Factors Affecting the Uptake of Modern Contraception Services among Women of Reproductive Age in Nigeria ,  Oluwasina, Folajinmi Oluyemi  
Contraception has proven to be an effective way of controlling fertility and spacing births. Studies have shown that contraception can avert high risk pregnancies and consequently reduce maternal deaths. Uptake of modern contraception is promoted as a mechanism to address the reproductive health needs of men and women, as well as the crucial challenge of rapid population increase. Therefore, this study was conducted to assess the factors affecting the uptake of modern contraception services among women of reproductive age in Oyo state, Nigeria. A cross sectional descriptive study using a two stage systematic sampling technique was used to select 530 women of reproductive age in five wards using sample size based on proportion to size in 20,000 households. Respondents were interviewed using a semi structured questionnaire which included questions on socio-demographic characteristics, awareness, knowledge, factors affecting the usage of modern contraceptives and perception of contraceptive use. Knowledge was assessed on a 5 point scale in which score of ≤ 2 were rated poor while perception was scored on a 36 point-scale in which scores ≤ 18 rated low. Data were analysed using descriptive statistics, Chi-square test and logistic regression at p=0.05. Age of respondents was 30.3 ±7.8 years and 73.0% were married. Sixty percent were muslims and 34.5% had secondary education. Seventy two percent of the respondents were self-employed. About 90% had good knowledge of contraception while 60.8% had ever used contraceptives. The commonest source of information about contraception was mass media (72.8%). Twenty six percent obtained husbands’ approval before using contraceptives while 20.0% had used modern contraceptives before first birth. Fifty percent of the respondents agreed that contraception helps in improving standard of living and 64.7% had good perception about contraception. Factors that hindered effective uptake of contraceptive services included poor service providers’ attitude (33.3%) and congestion at the service centers (4.5%). Respondents with non-use of contraceptive before first birth were less likely to subsequently use contraceptives (OR= 0.324, 95%CI= 0.1-0.5). Husband’s approval of contraceptives use was the major determinant of women’s contraceptive use (OR = 3.4, 95%CI = 1.3-8.7). About 42.0% of the respondents had family planning centers not more than 5 kilometers walking distance to their residence. Twenty-one percent of those who had to take transportation to the service venues did not use contraception services. Majority of the women in Ibadan North West were knowledgeable and aware of contraception services but husband’s approval on the use of modern contraceptives remains poor. Programmes that enhance husbands’ approval of modern contraception are thus recommended. Keywords: Contraception uptake, Husband’s approval, Service provider’s attitude.  
234 Accidental Exposure to Blood: Case Reporting and Management of Healthcare workers in the Biyem-assi District Hospital in 2016 ,  Judith Maka, Vladimir Pente Yamou, Joseph Essama
Introduction: Accidental Exposure to Blood and body fluids (AEB) is one of the most important risks among Healthcare workers (HCW), and is less reported in some settings. They are exposed to many blood borne pathogens including HIV, Hepatitis C virus, and Hepatitis B virus. The objective of this study was to assess the quality of the case reporting, the post-exposure management and to address some suggestions for the HCW protection in the Biyem-assi District Hospital (BDH). Method: We obtained an administrative authorization, we conducted a cross sectional hospital-based study from 6th September to 20th October 2016. We used the register of all the reported Accidental injuries, a convenience sampling in the different HCW groups in contact with patients, and addressed a questionnaire to assess their knowledge, their immunization status against HBV. We performed a descriptive analysis of data using Epi info version 7.1.1.14. Results: There is a good knowledge of the definition of the AEB. Only injuries with the HIV positive patients were reported, no hepatitis test and Anti-Hbs titer were performed on the victims. Less information is known about the outcome after the post-exposure prophylaxis, 48.84% of the HCW have not received a vaccination against Hepatitis B. 83.72% of the participants do not have any Health insurance. Conclusion: AEB is less reported in the BDH. 48.84% of HCW are not vaccinated against the HBV. There is a need for Sensitization for a complete case -reporting, follow-up after injuries; Strong regulations for a mandatory immunization among HCW. Keywords: Accidental- Exposure, Healthcare -workers, HIV, HBV, HCV.  
235 Preventive Health-Seeking Behaviour relating to Hypertension among Non-Teaching Staff of College of Medicine, University of Ibadan, Oyo State, Nigeria , Mercy Uchechi Ikechukwu-Orji  
Hypertension contributes largely to morbidity and mortality experienced from cardiovascular diseases worldwide. Studies have been conducted on hypertension among various populations in Nigeria, but only a few have provided data on hypertension-related preventive Health-Seeking Behaviour (HSB) among workers in the hospital environment. This study was conducted to determine the preventive HSB relating to hypertension among non-teaching staff of the College of Medicine, University of Ibadan (CoMUI). A total of 315 non-teaching staff University College Hospital was involved in the study. Data were collected using a pre-tested a semi-structured questionnaire. Respondents’ preventive HSB were assessed through preventive practices. Respondents’ attitudes towards preventive behaviour were measured on 20-point scale. Using SPSS, Data were analysed via descriptive statistics, Chi-square and logistic regression. Preventive behaviour by respondents included non-consumption of alcohol (65.1%), regular BP check-up (46.3%), regular exercise (41.9%) and low salt intake 47.3%. Few respondents (39.3%) had positive attitude towards preventive HSB. Non-alcohol consumption was 4 times more likely to be observed (OR: 4.2; 95% CI 2.6-6.9) while exercise was twice less likely (OR: 2.1; 95% CI 0.3-0.7) by the respondents. Respondents’ educational qualifications and administrative rank were significantly associated with preventive HSB (p<0.05). Less than half (43.8%) of the respondents had low knowledge of hypertension prevention (screening/early detection; 14.9%). Although more than half of the respondents do not consume alcohol, other aspects of preventive behaviours practices were relatively low which therefore calls for effective work-place health promotion and education programme for behavioural change towards prevention of hypertension. Keywords: Hypertension, Hypertension prevention, Hypertension risk factors, Preventive Health- seeking behaviour, University Non-teaching staff, Hospital environment.  
236   Risk Factors for Contracting Anthrax in Ntabeni South Ward of Kwekwe District, Zimbabwe, 2016 , Addmore Chadambuka
Background: A report of suspected human anthrax in Kwekwe District was received by Midlands Provincial Medical Director. Anthrax is a notifiable disease. We investigated factors associated with contracting anthrax in Kwekwe. Methods: An unmatched 1:2 case control study was conducted. A case was an Ntabeni resident and satisfied the standard case definition of anthrax. Controls were residents who did not develop anthrax. Unmatched analysis was used to establish risk factors. Results: Twenty-one cases, median age 33 (Q1=16; Q3=49) and 43 controls, median age 33 (Q1=27; Q3=44) were interviewed. Twelve cases were males. All cases had contact with dead cattle or their products. Knowledge on anthrax was low. Risk factors were skinning OR = 8.9 (95% CI 2.32-33.8) and cutting meat OR = 3.2 (95% CI 1.07-9.58). Not handling anthrax infected carcasses was protective OR = 0.06 (95% CI 0.01-0.3), having no cuts OR = 0.04 (95% CI 0.003-0.28) and having no cattle deaths in the household OR = 0.12 (95% CI 0.03-0.45). Epidemic preparedness and response was below the national standards. No communication system was in place. Cost of the outbreak control activities was US$19950. Conclusion: Outbreak resulted from contact with and consumption of anthrax infected carcasses. Skinning and cutting were risk factors for contracting anthrax. Quality of outbreak response was poor. We recommend that the district prioritize Ntabeni clinic for radio provision, hold zoonotic committee meetings and conduct an awareness campaign. Keywords: notifiable, zoonotic committee, epidemic preparedness.
237 Education for Internationalism with Respect to Globalization, Modernization, and Multiculturalism ,  Abdulai Abdul-Malik  
There is no agreed construction of an acceptable inclusive definition of term international education. The term therefore is ambiguous as it appears to refer to contrasting usages in educational studies. The terminology most often discussed in the context of the fields that are related to comparative education, but a different sense of the term has also developed in the context of the theory and practice of education in international schools and other institutions (Cambridge*et al, 2004) . This write up will therefore explore the different perspectives of the terminology. International education will also be discussed with with respect to globalization, modernization, and multiculturalism. A comparative analysis of education in USA and Japan with respect to the constitutional provision, administration, finance and educational structure will also be discussed.  
238 Occupational Health Hazards among Construction Workers in Gaborone, Botswana , Joseph Emuron  
The purpose of this study was to identify and highlight the hazards that are most commonly found at construction sites in Botswana. Respondents from Estate Construction Company located in Gaborone was selected for this study. Questionnaire survey was conducted on the construction site to establish the health and safety hazards prevailing and control measures therein. A physical observation was also conducted on the construction sites in order to relate questionnaire responses to what actually obtains on the construction site. In Botswana, the construction industry is booming as economic development takes its course. However, much as construction has come with its benefits, records of the factories inspectorate of the department of labour reveal that between 2000 and 2003, five fatalities were recorded in Botswana’s construction industry. Even though the number of these accidents is not alarming, the benefits paid to the accidents victims are high. These accidents represent a considerable economic and social burden to employers, employees and to the society as a whole. This therefore calls for urgency in mitigating this problem. This study will help come up with comprehensive measures to rectify this problem such; identifying the hazard, assessing the risk and controlling the risk to ensure a safe and conducive working condition for the workers. Implementation of control measures requires different approaches due to changing working environment at the construction sites. Keywords: Construction, Hazards, Safety, Workers, Booming, Industry.  
239 Understanding Barriers to Utilization of Maternal and Childhood Services through Community Dialogue in the Context of Result Based Financing ,  Priscilla Kusena  
Zimbabwe is implementing a Result Based Financing program since 2011, which was designed to improve utilization of maternal and child health services offered by public health facilities. Four years after the program inception, reports of low vitamin A coverage and, high home deliveries are common. The study sought to understand why there is still low uptake of maternal and child health services. Using cases of Mazowe district health facility catchments, community dialogues were employed to explore underlying causalities to low maternal and childhood health services uptake. Qualitative data analysis methods of transcribing, organizing, categorizing, and coding were used to sift themes and emerging issues. Out of 135 community leaders who participated in this study, we found poor accessibility of health facilities (high transport cost, poor road network, long walking distance and unavailability of outreach services), limited health service promotion, and socio-cultural beliefs (clients linked early attendance for antenatal care with abortion from bewitchment) as major barriers to health service utilization in the study community. We also found dialoguing a good method to inform, educate and stimulate collective responsibility towards improving health services uptake in our study communities. We suggest that health programs in Zimbabwe should consider improving accessibility of health facilities, promotion of health services and increase dialoguing with communities on cultural barriers in order to increase the impact of Results Based Health Financing Programs. Keywords: Barriers, Utilization, Maternal and Childhood Services, Community dialogue, Results Based Financing.  
240 Assessing Knowledge, Attitude and Practice of Health Care Providers on Integration of Sexual Reproductive Health and HIV Services in Oyo State, South West, Nigeria , Michael Olabode Tomori  
Integration of sexual reproductive health (SRH) and Human Immunodeficiency Virus (HIV) services is very poor in Nigeria, but it is very important because of its benefit to both the clients and the health care providers. However, successful implementation of integration of SRH and HIV services depends a great deal on adequate awareness, knowledge, positive attitude and best practices of all personnel involved in the system. Respondents from 65 health facilities were selected from 20 Local Government Areas in the three Senatorial Districts in the state. Their knowledge, attitude and practice towards the integration of SRH and HIV services programme were assessed. Findings showed that health care providers are adequately aware and also have average knowledge of the integration system. But there is capacity gap identified among the respondents in the area of training and documenting program activities. Also they generally exhibit positive attitude towards the programme but perform most of their service delivery with poor motivation under fairly comfortable working environment. It is recommended amongst others for the system to be very effective, there should be training and retraining programs for the personnel in the health facilities. This will hopefully enhance their skills thus enabling them perform all core integrated services successfully to clients. Keywords: Assessing; Knowledge; Attitude; Practice; Integration; SRH; HIV; Health Care Providers; Oyo State; Nigeria.  
241 Mabutsane Sub District Tuberculosis Program Performance from 2013 to 2015 , Kazadi Mantanki Emmanuel  
A retrospective research through review of Tuberculosis (TB) registers was conducted in Mabutsane sub district from July to September 2016. This study was intended to assess the TB program achievements from the period of 2013 to 2015 in order to improve TB case management for better district Tuberculosis performance. To this end, the cure and success rates, the proportion of TB patients with completed treatment, the defaults, as well as the HIV testing rates have been determined. The results were as follows: the cure rates 29.57% (2013), 19% (2014), 11.10% (2015), the treatment completion 80 %( 2013), 79.4 %( 2014), 68.5 %( 2015), and the default rate was below 5% for the whole study period. The success rates were 78.6% (2013), 78% (2014) and 67.1% (2015). The overall cure rate was low, and very low among patients seen in 2015. There have been a marked completion treatment and success rate over the first two years of a study with decline in 2015 due to poor documentation or poor program. HIV testing rate was more than 90% among Tuberculosis patients throughout the all years, with TB/HIV co infection rate between 40% and 60%. Mabutsane sub district Tuberculosis program is a weak program as shown by a low cure rates, and sputum follow up. Keywords: Tuberculosis cure and success rates, HIV testing rate, default rate, treatment completion.  
242 The Pattern of Activities and the use of Sex-Performance Enhancing Drugs among Commercial Drivers in Ile Ife Osun State Nigeria , Akinyemi Patrick Ayodeji  
Objectives: This research work aimed at assessing prevalence and pattern of drug use for enhancement of daily and sexual activities among commercial drivers in Ile-Ife, Osun State. Methodology: a descriptive cross-sectional study designed was utilized. A semi-structured interviewer administered questionnaire was used to obtain data from 240 commercial drivers. Data obtained include socio-demographic variables, drug use for daily activity enhancement, the pattern of perceived sexual challenges, usage of the drug for sexual performance enhancement and willingness accept counselling. Data were analysed using Statistical Program for the Social Sciences (SPSS) version 20 and a p-value of <0.05 was considered to be statistically significant. Result: Though 67.9% believe their activities can be enhanced only 57.1% do take any psychoactive substance. Prevalence of alcohol consumption was 55.8% and it is the most commonly abused substance to enhance their daily activity performance. Most common means of sexual performance enhancement was the use of herbal mixture (20.3%). Worry about sexual performance, daily activity enhancement, smoking, and alcoholism are predictors of sexual performance enhancing drug usage. A number of sexual partners, age and religion were not significant factors in the use of sexual performance enhancement drugs. Conclusion: commercial drivers are one of the groups at risk of substance abuse in our society. There is a need for behavioural change communication for this group and create a more suitable environment for counselling on the sex related matters in the health facilities. The existing law prohibiting sales of a psychoactive substance in the motor parks should be enforced. Keywords: commercial drivers, herbal mixture, psychoactive substance, sexual dysfunction.  
243 Blood Transfusion Safety among Blood Donors and Recipients in Minna - North-Central Nigeria, 2014 ,  Musa K. Bawa, A. Olayinka, K. Getso, G. Umar, A. Mamman
Background: Transfusion usually is a life-saving therapeutic intervention, however many preventable errors may make it hazardous for donors or recipients. Ensuring supply of safe blood is a key intervention in reducing mortality and morbidity attributable to blood transfusion. We conducted a descriptive, coss-sectional study among blood donors to assess blood donor safety in Minna, north-Central Nigeria. Methods: We recruited consecutively, all consenting, HIV, hepatitis B and C and anaemia screened blood donors between September, 2013 and January, 2014. We screened all subjects for haematological indices using a haematological analyzer (Abacus analyzer 2.75, Diatron® U.S.A) respectively. We administered structured questionnaires to obtain socio-demographic and socio-economic characteristics and practices. Data was subjected to descriptive statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p<0.05. Results: A total of 345 subjects were recruited, 336 (97.4%) males. Mean age ± SD was 32.4± 8.5 years. Monthly earnings ranged from $109 to $212 136(40.6%). The majority of the blood donors 195 (55.9%) were anaemic (PCV<36, Hb<12g/dl), 158 (81.0%) of which were for purpose of family replacement. Strata of the blood donors were family replacement 274 (79.4), voluntary 60 (17.4), commercial interest 11 (3.2%). Conclusions: The blood donor safety is low in Minna. Majority of the blood donors were anaemic. The quality of routine donor screening for anaemia should be improved. Keywords: Anaemia, Transfusion, Blood donors, Safety, Nigeria.  
244 Effects of Educational Intervention Programmes on Reproductive Health-Behavioural Intentions among Sickle-Cell Disease Population in South-West Nigeria ,  Oyeneye, Elizabeth. O , Nnodimele O. Atulomah  
Youths with Sickle Cell Disease (SCD) are sexually active and at higher risk of uncertain reproductive health outcomes because of their health status. This study was a theory-grounded quasi-experimental design to evaluate the effects of two Reproductive Health-Information (RHI) Education intervention programmes with counseling among youths with SCD in South-west Nigeria. Seventy five participants were purposively assigned to control (CG) and two intervention groups that were randomly selected. All groups completed pretest of Behavioural-Intentions (BI) measures by questionnaire, however, only intervention group one (IG-1) received Reproductive Health-Information (RHI) Education while intervention group two (IG-2) received both (RHI) Education with counseling. At 13th week follow-up, post-test BI was measured for all groups. Data were analyzed using descriptive statistics and ANOVA to compare pre- and post-test measures for all groups at p=0.05. There was no significant difference in measures among the three groups at baseline in respect of RHI (19.16±6.61; 16.40±9.35; 16.68±6.31), Motivation (15.08±4.13; 11.88 ±5.26; 12.80±3.81), Behavioural Skills/Self-Efficacy (14.88±4.79; 15.20±7.80; 16.40±7.16) and Behavioural Intentions (18.04±7.96; 16.68±9.04; 16.32±8.04) respectively. However, at 13th week follow-up, Intervention group 2 demonstrated significantly higher scores in respect of RHI (17.20±4.38; 16.68±6.33; 32.32±18.87), Motivation (14.80±3.37; 14.96±4.39; 17.40±2.84), Behavioural Skills/Self-Efficacy (19.24±5.83; 16.28±4.74; 21.04±4.95) and BI (18.88±6.68; 23.40 ±5.61; 26.68±7.42) than Intervention group 1 and Control respectively. Intervention 2 combining RHI -Education with counseling had the most significant impact on youth reproductive health behavioural-Intentions. It is therefore recommended that reproductive health information for the SC youths should strategically be accompanied with counseling to achieve behavioural change. Keywords: Reproductive Health, Information, Motivation, Behaviour, Behavioural Intentions, Sickle Cell youths.  
245  Child Bearing Decisions among Women Enrolled In PMTCT Programme: A Comparative Study of the Rural and Semi-Urban Setting of Malawi Chiradzulu District , Olive Jean Makuwira  
Background: HIV and AIDS have caused untold harm and human suffering globally. Over 90% of people infected with this deadly virus live in sub-Saharan Africa including Malawi. In Malawi HIV disproportionally affects women in comparison with men. According to Demographic and Health Survey (2015-2016) key indicators, HIV prevalence among women aged 15-64 was 12.8% compared to men 8.2% public health. As per 2010 Malawi demographic and health survey, HIV prevalence in the southern region was twice as high as prevalence in the other regions (Southern 14.5%, Central 7.6% and northern region (6. 6%).Women and children are more affected than the rest of the general population. HIV infection in children below 15 years is largely due to mother-to-child transmission (MTCT). Worldwide, over two million children have been infected through MTCT. Type of Research Study: The study adopted a qualitative research design using the inductive research technique or grounded theory research in which the steps occur simultaneously, observing, collecting data and forming theory from the data at the same time. Problem Statement: HIV prevalence in Southern Region of Malawi is twice as high as Northern and Central regions, at 14.5% where fertility rate at 5.7% are also high. A combination of high fertility rate and high HIV prevalence have contributed to the undermining of an effective PMTCT continuum of prevention, care and treatment programme towards achieving virtual elimination of mother to child HIV transmission and keeping the mothers alive. Therefore, there is need to examine how and through what pathways learning about one’s HIV positive status could alter one’s childbearing decisions. Objectives: This study explored the decision-making process on pregnancy decisions among PMTCT participants and their family support systems; Examined factors that influence decision making process among PMTCT participants and their immediate family networks; Determined the gaps in the PMTCT service delivery; Explored the knowledge and attitudes of health providers PMTCT mothers; and analysed the gap between the PMTCT policy guidelines and their implementation This study revealed factors that influence fertility decisions among pregnant women with HIV attending ANC and ART clinic at Chiradzulu District Hospital. Some of participants became pregnant because they desired to have another child and others because their partners wanted a child. A proper understanding of factors associated with pregnancies among these women is essential to guide interventions and counselling strategies to better inform and support them. Religious doctrines, beliefs about having a healthy baby, personal desire and familial desires to have a baby, combined with the social stigma that accompanies HIV, puts women who are HIV-positive in a difficult situation. HIV-positive women must be appropriately counselled about the risks of childbearing rather than focusing only on issues related to mother-to-child transmission of HIV.  
246 Hepatoprotective Effect of Methanolic Leaf Extract of Vernonia Amygdalina against Acetaminophen-Induced Hepatotoxicity in Wistar Albino Rats ,  Adegboye A.A, Aadunmo, G.O, Bolaji, M. Jimoh A. A., Dan M. I.
This study investigated the hepatoprotective effect of methanolic leaf extract of Vernonia amygdalina against acetaminophen-induced hepatotoxicity in Wistar albino rats. Albino rats (wistar strain) were randomly divided into groups of five rats each, Group I served as control and was administered normal saline only, Group II were induced 75.35 mg/kg of acetaminophen, Group III were given 200mg/kg of methanolic leaf extract of Vernonia amygdalina, while Group IV and V were administered 75.35mg/kg of acetaminophen along with different doses (the former were administered 200 mg/kg and the latter were administered 400 mg/kg ) of methanolic leaf extract of Vernonia amygdalina five minutes after the administration of acetaminophen. Administration of the methanolic leaf extract of Vernonia amygdalina were given orally while intra-peritoneal administration was adopted for acetaminophen induced liver damage rats. All administration was done once daily. There after the rats were sacrificed by cervical dislocation and sera collected was used for various biochemical analyses. Liver enzymes (Alanine aminotransferase, Aspartate aminotransferase and Gammal glutamyl transferase), total proteins, albumin and lipid profiles activities were determined. This study showed that administration of the methanolic extract of Vernonia amydalina reduced the damages to the liver against acetaminophen- induced hepatotoxicity in wistar albino rats. Keywords: Methanolic, Hepatoprotective, Vernonia amydalina, Liver enzymes.  
247 Gender based Violence in Nigeria: A Review of Attitude and Perceptions, Health Impact and Policy Implementation , Stella Chinyere Okwundu  
Gender based violence (GBV) is a fundamental public health and human rights concern across the world. This article provides a systematic review of attitude and perception of GBV, heath impact and policy implementation in Nigeria. Materials to be reviewed were selected based on search criteria which are relevant to the study at hand. Only 21 articles met the set criteria. Intimate partner violence (wife beating) and rape were the categories of violence being studied. Result showed that wife being is widely justified in Nigeria by the women if they go out without telling him, being disrespectful, neglects the children and burns his food. The men also justified GBV as a means of earning respect as the women are the weaker sex. Rape is considered a crime but the perception of what constitutes rape is poor as marital rape and rape by boyfriends and man friends are not considered as rape. GBV has physical, mental and social health impact among the victims. Policy implementation of GBV is considered to be poor in Nigeria. Recommendations were made based on the findings made from review of the articles. Keywords: Gender based violence, rape, intimate partner violence, attitude, perception, policies and policy implementation, Nigeria.  
248 Investigation Report on Laboratory Confirmed Measles Case in the Hurungwe District Doro Clinic- Garangwe Area; Nziradzepatsva Village, Hurungwe District ,  C.K. Chigodo; A. Chiganga, K. Chivende; E .Chibika
This paper was carried on an Investigation in Hurungwe district, Doro catchment area following confirmation of a measles Igm measles positive case. Doro clinic is 56 km from the district hospital, in the western direction and the laboratory confirmed case is 20 km in the same direction. The community derives its income from tobacco and maize farming. Their religion is Christianity. The area has some hard- to-reach families by district and by religion. Several cases on measles were detected and filed following the laboratory confirmation. Based on the findings from the investigation, the following are recommend: VHW Mberikwenyanga to visit the Phiri family (vaccine objectors) to actively search for clinical measles cases and refer, Continued information giving at gatherings and homesteads by community leaders and Community-based Health Workers, Community-based active search by VHWs, Continued information-giving to the community, Continued Active search for more cases, Continued monitoring of the index case, especially nutrition-wise, Conduct headcount of children below 1 year and 5 years, Indicate populations by village, by hard-to-reach on the REC Map, Continued mobilisation and distribution of resources and logistics, Conduct operational research, since the child received 2 valid measles dose, Urgent replacement of obsolete refrigerators and fridge tags Keywords: Laboratory Investigation, Measles, Hurungwe District, Doro Clinic.  
249  The Role of Leadership in Management of Maternal Health Service in Kagera Region, Tanzania , James Barongo Bashweka  
This paper is about the role of leadership for effective management of maternal health in Kagera Region Tanzania. Maternal health leadership is a very important component in the entire Maternal and child health (MCH) Programme and its smooth running depend on leadership capacities in management of services. In Kagera region it was claimed that leadership gaps contribute to low user rate of maternal health services that lead to high maternal mortality. However, its role in management, success and challenges in the overall programme has not been explored. Therefore, this paper is detailing about findings on what extent to which leadership is responsible for ensuring effective maternal health delivery. Method: Study design was an exploratory qualitative approach that employed in-depth interviews. Interviews involved formal health leaders who are involved in maternal health services including: Regional Health Management (RHMT) members and Council Health Managing Team (CHMT) members who were considered to be information rich cases. Ethical consideration was attained through approval from Texila American University and seeking permission from Tanzania Government authority. Participation was voluntary whereby informed consent from participants was sought and adherence to confidentiality. Result: Coding and analysis of results on self-competencies revealed Professionalism, Ethic, Self-reflection, critical thinking, developing others through teaching, developing others through mentoring, interdisciplinary team building and negotiation. Leadership competences in relation to wider community revealed; working with community, working with systems, policy adherence and policy advocacy. It was found out that respondents have high level of understanding in working with community, policy adherence and working with system. However, it was observed that; respondents lacked awareness and recognition, ethics, self-reflection, critical thinking and less aware on developing others through mentoring, interdisciplinary team building and negotiation. Conclusion: Basing of the above finding it is concluded that leadership play a major role in the management of maternal health services. Recommendations were put forward including to increase understanding about maternal health leadership competence in MCH programme with more emphasis on interdisciplinary team building, negotiation, and capacity, policy advocacy practices which were not recognized by respondents and improve understanding on all identified weakness. Keywords: Role, Leadership, maternal health, management, Kagera region, Tanzania.  
250 Antimalarial Drugs Inventory among Urban and Rural Patent Medicine Vendors , Bright Orji, Enobong Ndekhedehe, Dipo Emmanuel Otolorin
Nigeria changed its malaria treatment drug (AMD) policy in 2005 from use of chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) to more effective Artemisinin-based combination therapy (ACT). SP is exclusively reserved for malaria in pregnancy prevention. Sixty percent of Nigerians patronize Patent Medicine Vendors (PMVs). This study assessed AMDs stocking and dispensing practices of urban and rural based PMVs. This is a cross-sectional survey of 120 PMVs in ten LGAs of Akwa Ibom State, Nigeria. The LGAs were divided into five urban and five rural.12 PMVs were selected from each LGA. A one page questionnaire was used to elicit information on brand-names of AMDs, drug-active-ingredients, cost, and popularity amongst clients. Data was analyzed and results presented in simple frequencies, mean, and confidence intervals (CI). 1,150 AMDs were found under 86 brand-names. Mean in urban shops was 22.6 [SD±20.5] compared to rural 20.1 [SD±16.9]. ACT was more common in urban (71.1% at 95% CI: 0.579-0.822); SP (36.4% at 95% 0.109-0.692); CQ (33.3% at 95% CI: 0.075-0.701); and rural ACT (28.8 % at 95% CI: 0.178-0.421); SP (63.6% at 95% CI: 0.308-0.891); CQ (66.7%. at 95% CI: 0.299-0.925). Drug popularity in both areas, clients preferred ACT (74.0%, CI: 0.639-0.832); CQ (12.7%, CI: 0.066-0.217), SP (8.6%, CI: 0.033-0.161); and MADs (4.8%, 0.013-0.115).The cost of drugs ranged < N100 per dose for SP and CQ to ACTs > N301. Twelve years after the change, non-recommended drugs are still prescribed. Promoting training, cost reduction and availability of appropriate and efficacious AMDs may boost current malaria control efforts. Keywords: Antimalarial drugs, patent medicine vendors, urban and rural, stocking and dispensing.  
251 Factors Responsible for Oral Polio Vaccine Rejection by Some Parents in Northern Nigeria , Adamu, Umar Husaini  
Nigeria is the most populous country in Africa, with a population of over 140 million and it is one of the fastest growing nations in the world. It has a very rich cultural heritage, with over 300 ethnic and linguistic groups. The major ethnic groups are Hausas, Yorubas and the Igbos. The most popular religions are Islam (mainly in the Northern Parts), Christianity (mainly in the southern parts), and traditional African religion, mainly freely practiced alongside other religions (Babalola and Aina, 2004). The population of the Northern Nigeria is more than that of the southern part of the country. The first census of Nigeria was conducted in 1911 about three years before creation (Yakasai, 2006). This means that there are more children in the northern Nigeria than other part of the country. The issue of polygamy which is largely practice in the northern part of Nigeria also contributed to the large number of children in the area.  
252 Does one shoe fit all? Time to Consider Body-Weight Wise Regimens to Treat TB Patients under DOTS – A Study from South India , Prashant Bhat  
Background: India accounts to one fifth of the global TB burden. It is implementing all the components of WHO STOP TB strategy for TB control through the Revised National TB Control program (RNTCP) since 1997. However, RNTCP neither has a policy to monitor TB treatment based on body weight of the patients nor provisions for nutritional support to TB patients with low body weight. Recent evidences also show that relapse and MDR rates are high in India compared to other High TB Burden Countries (HBCs). Karnataka (population 63 million) is a southern State in India implementing RNTCP with overall annual TB case notification of ~ 103 per 100,000 population and success rate of ~ 83% for new smear positive (NSP) cases below the global benchmark of >85%. Our hypothesis is that unfavorable treatment outcomes were more common among patients with lower body weight at initiation of treatment. We studied the relapse and MDR rates in India in 2011 from the published data, in comparison to other HBCs and the outcomes of TB patients treated under RNTCP in 2012, in two districts of Karnataka with the specific objective to examine the effect of initial body weight on treatment outcomes. Methodology: In this record based cohort study, we reviewed two separate data set. In first, we examined the published data on all TB patients treated nationally (covering 1.25 billion population) in 2011 for published relapse and MDR rates. In second, we examined treatment cards of all adult TB patients weighing more than 30 kgs, registered for treatment in the year 2012 from two districts (Gadag and Uttara Kannada) of Karnataka covering ~ 2.6 million populations. Results: Part 1: National level: Of the total 754,829 incident TB cases (NSP plus Reinfection/Reactivation) treated in India, 112,508 (15%) had relapse. MDR TB among retreatment cases was 15%. Part 2: Study districts: Of the 2147 adult patients (with initial body weight more than 30 kgs) enrolled for treatment, the mean body weight was 43 kgs (IQR 38-48 kgs), with p5 at 32 kgs and p95 at 58 kgs. Outcome “died” was highest among patients weighing between 30-39.9 kgs across all the types of TB (Chi square=13.82, df=2, P<0.001); failure was also highest in this weight band among retreatment cases (Chi square=6.72 df = 2, P<0.05). Conclusion: Standardized treatment regimen in India had high relapse and MDR rates. Lower body weight at initiation of treatment is associated with higher risk of death across all types of TB and with failure among retreatment cases. While further study is indicated to explore the reasons for these findings, clearly, National TB Programs should have strategies to monitor treatment based on initial body weight and consider nutritional support to TB patients with low body weight at diagnosis to improve survival. Keywords: Tuberculosis, Body-weight, TB-Treatment, Nutrition, RNTCP.  
253 Emergency Department Capabilities in the Kingdom of Swaziland Africa ,  Erika Phindile Chowa, Patrick Masitsela Mhlanga, Janice A. Espinola, Ashley F. Sullivan, Carlos A. Camargo
Introduction: Emergency care is available in many forms in Swaziland and to our knowledge, there has never been a systematic study of emergency departments (EDs) in the country. The purpose of this study was to describe the characteristics, resources and capacity of emergency departments (EDs) in the Kingdom. Methods: The National Emergency Department Inventory (NEDI)-International survey instrument (www.emnet-nedi.org) was used to survey all Swaziland EDs accessible to the general public 24/7. ED staff were asked about calendar year 2014. Data were entered directly into Lime Survey, a free, web-based, open-source survey application. Responses were analyzed using descriptive statistics, including proportions and medians with interquartile ranges (IQR). Results: Sixteen of 17 EDs participated (94% response rate). Participating EDs were in either in hospitals (69%). EDs had a median of 53,399 visits per year (IQR 15,000 to 97,895). Fourteen (88%) EDs had a contiguous layout and the other 2 (12%) were noncontiguous. Overall, 8 (53%) had access to cardiac monitors and 11 (69%) had a 24/7 clinical laboratory available. Only 1 (6%) ED had a dedicated CT scanner, while 2 (13%) others had limited access through their hospital. The typical ED length-of-stay was between 1 and 6 hours (44%). The most commonly available specialists were general surgeons, with 9 (56%) EDs having them available for in-person consultation. No EDs had a plastic surgeon or psychiatrist available. Overall, 75% of EDs reported running at overcapacity. Conclusions: Swaziland EDs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major challenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.  
254 Assessment of Knowledge Attitude and Perception of People Living with HIV Regarding Tuberculosis Infection and Control in Agege, Lagos State , Dada Julianah Imoleayo, Abiodun Olaiya Paul
Background: About one-third of the world's population are infected with latent TB, which implies that these people have been infected but not yet ill and cannot spread the disease (WHO, 2016). Those infected with TB have 10% lifetime risk of falling ill, while immunosuppressed states such as people living with HIV(PLHIVs) and other immunosuppressive conditions have higher risks of falling ill (WHO, 2016). Therefore, this study aimed to assess the level of knowledge, attitudes and perception of PLHIVs regarding Tuberculosis infection and control in Agege local government area, Lagos. Methodology: A quantitative research using descriptive cross- sectional design and simple random sampling technique was utilized to administer a structured questionnaire which was used for data collection. The data collected was analyzed using SPSS version 20 Results: Many of the respondents (71.9%) were aware of TB but only 35.7% demonstrated good knowledge of TB infection prevention and control in their response. Females had higher overall fair knowledge with 75 (60.9%) females out of 123 and only 48(39%) males out of 123 having over all fair knowledge of TB infection control. Also, there was statistically significant association between gender and knowledge of respondents about TB. Discussion and conclusion: Findings from this study revealed that despite a relatively fair perception and attitude towards TB infection control by people living with HIV, there was poor knowledge about TB infection prevention and control. This showed poor understanding of the information given, therefore there is need to give adequate detailed information about TB to all PLHIV. Keywords: Tuberculosis, HIV/AIDS, co-infection, Knowledge, Attitude, Perception.  
255 Poliomyelitis and its Health Consequences in the Whole Community in Kabul City, Afghanistan ,  Mohammad Aqa Stanikzai  
Poliomyelitis is an acute infection caused by a poliovirus. It’s a nonspecific minor illness called (abortive poliomyelitis) and, less often, flaccid weakness of various muscle groups called (paralytic poliomyelitis). This is a disease of childhood and can not be happened after five years of age, can affect both sex in all country including Afghanistan. According to the world Health Organiztion (WHO) report for 2015 the polio virus has totally been eliminated from the whole world except three countries, (Afghanistnan, Pakistan, and Nigeria).  
256 Prevalence of Opportunistic Infection and Associated Pregnancy Complication among HIV Positive Women Delivering in Tanzania , Admirabilis Kalolella  
Objective: The objective of this study was to assess the prevalence of opportunistic Infections (OIs) and associated pregnancy complication among HIV Positive women giving birth in hospitals of Dar es salaam, Tanzania. Design: The cross sectional study design using OIs checklist was used to collect data among 105 participants. The Epi Data software was used for data entry. The complete data set was later transferred to SAS version 9.4 for data analysis and interpretations. The associations of categorical variables were determined by the Chi- squire test, in which, p-values <0.05 were considered as significant association. Result. Among 105 participants, 63(60%) of them were diagnosed with OIs, while 42(40%) did not show any symptoms of OIs. The most common OIs symptoms reported were; frequently fatigue 46(43.8%), Persistent profuse night sweats 43(40.9%), Persistent muscle aches 41(39%), and unexplained recurring fever 39(37.1%). Participants with recurrent memory loss, depression and neurological disorders had more 5(20.8%) babies born with body weight below 2500g, underweight baby, compared to 5(6.1%) women without these symptoms, P- Value <0.0316. Participants without recurrent severe pneumonia, 24(35.2%), which is among the late HIV stage OIs (WHO clinical stage 3 &4) are slightly protected to developed vaginal tears during birth compared to those 7 (18.9%) with recurrent severe pneumonia. P- Value <0.0693. Conclusion. In conclusion, the majority of HIV infected pregnant women giving birth suffer from OIs. Recurrent memory loss, depression and neurological disorders and recurrent severe pneumonia are risk factors for pregnancy complication Keywords: HIV infected pregnant women, Opportunistic infection, pregnancy complication underweight baby, neurological disorders, vaginal tear, ARV.  
257 The Use of Integrated Supportive Supervision (ISS) Visits to Strengthen Family Planning Service Delivery in Two Selected States of Nigeria , Oniyire Adetiloye  
Efforts to expand access to contraception for healthy timing and spacing of pregnancies (HTSP) includes the engagement and capacity building for service providers. The quality of services being provided by SPs during integrated supportive supervision (ISS) visits has not been assessed. This study assessed the quality improvement of FP service delivery during ISS visits to secondary health facilities in 2 states of Nigeria. Twenty program managers competent on FP service delivery were drawn from each of the two states; and trained for 4 days on the use of ISS checklist to monitor quality of FP services. A 13-page ISS checklist developed by the FMoH, and field tested by Jhpiego in collaboration with other stakeholders was used to elicit data from 20 health facilities. Two Rounds of ISS were conducted between October 2014 and March 2015. Data was entered and analyzed using SPSS 17.0 version. FP new acceptors increased from 48.7% at 95% CI, 0.272-0.728 in Round-1 to 50.3% at 95%CI, and 0.272-0.728 in Round-2. Only 2.5% at 95% CI, 0.001-0.249 of the SDPs reported stock-out of FP commodities in Round-1 while none in Round-2. Stock-out of consumables reduced in-between rounds notably sterile gloves from 40.0% to 26.3% in Round-2; Examination gloves from 50.0% to 23.7%; Gauze swabs from 50.0% to 28.9%; Gaps still exist in number of SHFs reporting poor availability of infection prevention equipment. ISS is a key strategy that can help to reduce programming barriers and achieve desired objectives. Feedback in-between rounds was used by the SPs to plan for performance improvement. Keywords: Family planning, quality improvement, integrated supportive supervision, secondary health facilities  
258 Delay between Breast Cancer Detection and Arrival at Specialist Clinic Preliminary Revelations of Multicentered Survey in Nigeria , Agodirin O, Olatoke S, Rahman G, Kolawole O, Oguntola S, Olasehinde O, Ayandipo O, Olaogun J, Katung A, Etonyeaku C, Habeeb O, Adeyeye A, Agboola J, Akande H, Akanbi O, Abiyere H, Fatudimu O.
Delay between breast cancer detection and arrival at specialist clinic. Preliminary revelations of multicenter survey in Nigeria Background: Level of breast cancer awareness and rate of late presentation usually have inverse relationship. The parallel relationship witnessed in Nigeria is a paradox requiring urgent intervention. Aim: To understand the paradox, we described the patient’s journey from lump detection to arrival at the specialist clinic. Barring awareness, identifying where the major delays still resided will help to re-direct our strategies in the control of breast cancer scourge. Method: Cross-sectional multicenter questionnaire based survey conducted in surgery outpatient clinics of 10 tertiary institutions in North central and Southwestern Nigeria. Face-to-face interview was conducted using pretested questionnaire. Data was analyzed using SPSS, version 18. p-value was set at 0.05. Results: One hundred newly diagnosed women responded in this preliminary analysis. Age ranged 26-80 years (mean 50.5± 13.2). Eighty-one (81%) were aware of breast cancer before detecting their lump(s). Eighty-eight (88%) had lumps ≤5cm at detection. Sixty-nine (69%) (p= 0.0001) visited the first orthodox personnel when their lumps were ≤5cm. Only 39(39%) arrived at specialist clinic when their lumps were ≤5cm. Ninety-five respondents (95%) (p=0.0001) visited orthodox personnel first to seek treatment. The first personnel was general practitioner 72% of the times (p=0.0001) (see figure 2). Fifty-eight (58%) consulted the first orthodox personnel within 8 weeks (p=0.133). Only 26% arrived at a specialist clinic within 8 weeks (p=0.0001). Mean interval from detection to first personnel was shorter (61 days) than mean interval between first personnel and specialist clinic (157 days) (P=0.0001) Conclusion: The longest stretch of journey was between the first orthodox consultation and the specialist clinic. Keywords: breast cancer, detection, Journey to specialist clinic.  
259 The Knowledge of Primary Health Care System among Patients Accessing Health Care in Supreme Faith Hospital, Ado-Ekiti, Nigeria , Pius Izundu Okpoko  
Objective: To determine the knowledge of Primary health care system among patients who access health care in Supreme Faith Hospital, Ado-Ekiti, Nigeria. Study design and Setting - A cross-sectional study design that made use of quantitative survey method involving data collection and analysis. Participants - 120 voluntary adults who access health care services at Supreme Faith Hospital, Ado-Ekiti, Nigeria. Method: A semi-structured questionnaire was administered to participants who also consented to the survey. A cross-sectional study was deemed fit for this research because it enables any desired data to be collected at one point in time. Results: There were 38 (31.7%) males as against 82 (68.3%) females in the study. Majority of the respondents fell within high reproductive age group, 21-30. The respondents who indicated that they were aware/have knowledge of PHC in the study were 98 (81.7%), while those who were ignorant of PHC were 22 (18.3%). Conclusions: The awareness of PHC was high among patients who access health care in Supreme faith hospital. 98 (81.7%) out of 120 respondents studied were aware of PHC. Although there was high level of awareness of the services of PHC, a sizeable number of patients preferred secondary health care facilities to primary health care. PHC facilities should be strengthened through investment in facility, staffing, and training of the already engaged workforce. Keywords: Awareness, Facilities, knowledge, Patients, Primary health care, Public health.  
260 Comparative Study on the Respiratory Outcomes among Underground Gold Miners and Non Miners in Orkney, South Africa ,  Olukayode O. Alewi, Ademola M. Amosu, Ebenezer O.Daniel
There is scarce knowledge about respiratory outcomes among underground gold miners in Orkney, South Africa. Due to the occupational exposure to poor ventilation, dust and others underground gold mine workers are vulnerable to respiratory or pulmonary disorders and diseases. There has not been a documented literature in the past to compare the respiratory outcome of gold miners and non-miners in Orkney area of South Africa. This was a cross sectional study designed to investigate and compare respiratory outcomes among gold miners and non-miners. A comparative cross sectional survey of gold miners and non-miners living in the same geographical location of Orkney, South Africa was carried out using a modified health assessment questionnaire to determine the prevalence of such respiratory disorders among these underground gold miners and comparing the same with the non-miners. A total of 222 gold miners and 222 non gold miners were surveyed using the questionnaire while trying to match the two groups as closely as possible. Data analysis was done using the Statistical Package for Social Science (SPSS) version 20. Paired sample t-test was used to compare the mean differences between the gold miners and the non-gold miners. Statistical level of significance was set at P-value <0.05. Result shows a higher prevalence of respiratory diseases (2.71 times higher) among the underground gold mine workers when compared to the non-miners. With a standard deviation of +-11.46 and +-9.79 respectively. It was concluded that occupational exposures to respirable dust mainly silicon must have contributed significantly to the observed difference in these two groups. More protective and preventive measures become imperative in controlling this outcome. Employers of gold miners should therefore take more appropriate health preventive measures aimed at reducing significantly the exposure rate and amount to respirable dust among the miners. Keywords: Respiratory, disorders, exposure, underground.  
261  Work Stress and Self-Reported Health Problems in Female Ready Made Garment Workers , Suraiya Ahmed, Manzurul Haque Khan, Irin Hossain
A cross sectional descriptive study was conducted to assess work stress and self-reported health problems in female ready-made garment workers. This cross sectional study was carried out on a sample of 310 female workers selected purposively from a ready-made garment factory located in Savar, Dhaka. Work stress was estimated by using an ERIs questionnaire; while self-reported health problems, work-related information and socio-demographic information were obtained using a semi-structured questionnaire by face to face interview. The study was conducted for a period of one year extending from January 2014 to December 2014 in a Ready-made Garment factory of Bangladesh located in Hemayetpur bus stand, Savar, Dhaka. The mean age of the respondents was 27.26±5.93 years and they were mostly married (71.3%). Most of them (55.5%) had primary education and another 20.0% never went to school. The mean monthly and per capita family incomes of the respondents were Tk7573.55± 961.06 and Tk3831.50± 1892.94 respectively. Among the respondents, 59.7% worked in the sewing section, followed by 14.8% in the finishing section. Their mean duration of employment and total working hours per week was 36.68±17.92 months and 58.35±3.08 hours respectively. About one fifth (22.9%) of the study participants were found to have high stress. Almost 53.2% respondents were found to have been suffering from headache for last 2 months. Back pain and chronic cough was significantly associated with age and total work time per week (p<0.05). Shoulder pain, stomach problem, pain/burning of eye, fatigue and general weakness was significantly associated with age (p<0.05). Painful/burning micturation was also significantly associated with age and total work time per week (p<0.05). High stress was not uncommon among female ready-made garment workers. Self-reported health problems were found to be associated with socio-demographic and work related factors. Programs should be taken to reduce working environment stressors, to enhance wellbeing conditions. A further analysis report using delegate sample from ready-made garment sector needs to be undertaken to obtain generalizable findings. Keywords: Work stress, self-reported health problem, Ready Made Garment Workers.  
262 Pattern and Distribution of Malaria Disease in Wulu-A Typical County in South Sudan , Gabriel O. Ayeni, Okwuoma C. Abanobi, Daniel O. Ebenezer, Olagbegi M. Oladapo, Oyewale M. Morakinyo
South Sudan was reported as having one of the highest malaria burdens in sub-Saharan Africa. A better understanding of the pattern and distribution of the infection is considered to have implication on prevention and control. The objective of this study was to investigate the pattern and distribution of reported Malaria infection in Wulu, South Sudan. Secondary data on malaria cases managed between January 2014 and December 2016 across all the eleven health districts of the county were obtained from the Health Management Information System and the District Health Information Software. Descriptive statistics were used to analyze the extracted data. The finding showed similar trend in the pattern and distribution of Malaria disease across the health districts between 2014 and 2016. Also the incidence rates for the overall population were 29.5%, 23.7% and 36.7% for 2014, 2015 and 2016 respectively. However a much higher incident rate was recorded among the under-5 year population for the same period (76.5%, 47.1%, and 64.5%). Malaria cases among under-5 years of age in the area account for 52-59% of Outpatient department consultations between 2014 and 2016. Also the finding showed sharp rise in the number of cases reported for 2016 although the same yearly trend was maintained across the year and districts. The finding showed similar trend in pattern and distribution of Malaria infection over the period of 2014 to 2016 and across the health districts; it did not however suggest a reduction in the trend of occurrence. More attention should be given to the under-5 year population. Keywords: Malaria, Pattern and distribution, Outpatient department, Under-5 years, Wulu.  
263 Knowledge and Perceptions of Asthma in a Nigerian High School , Ilesanmi, Oluwafemi Temitayo, Adegbenro, Caleb A , Awopeju, Olayemi F , Olatona, Foluke A 
Asthma is a serious global health problem that affects people of all backgrounds and ages with morbidity and mortality higher among older school-age children and early adolescents which causes have been attributed to inadequate knowledge and the wrong perceptions about asthma. The study assessed the level of knowledge and perceptions of asthma; investigated the association of certain demographic characteristics with the level of asthma knowledge and perceptions and determined the correlation between the asthma knowledge and perceptions among secondary school students of Ambassadors College, Ile-Ife, Nigeria. It is a cross- sectional study which used a pre-tested 71- item, purpose designed, self- administered questionnaires to collect information on knowledge and perceptions of the respondents on asthma. Data were collated and analyzed based on descriptive and inferential study design. The result showed that the majority of the respondents had intermediate level of asthma knowledge (68.5%, 285). It also showed that majority of the respondents 63.7% (265) have intermediate level of asthma perceptions. In addition, the result showed significant association between asthma knowledge score and age; and class of the respondents (p <0.05). It also showed a significant association between asthma perceptions scores and age; and class of the students (p <0.05). The results also showed significant correlation between asthma knowledge and perceptions scores of the students (p <0.05). It was, therefore, concluded that the secondary school students of Ambassadors College, Ile- Ife, Nigeria have intermediate asthma knowledge and perceptions levels. Keywords: Asthma, knowledge, perceptions.  
264 The Pattern of Prevalence of Severe and Moderate Acute Malnutrition among Under-Five Children of Three Counties in a War-Torn Lakes State South Sudan , Ebenezer O. Daniel, Ademola M. Amosu, Gabriel O. Ayeni, Oladapo M. Olagbegi
The prevalence of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) of under-five children, in south Sudan is reportedly high and is being aggravated by various negatives factors. The situation has attracted the attention of various international organizations like World Food Programme (WFP), United Nations Children Emergency Fund (UNICEF), and other International Non-governmental Organizations (INGOs), for possible interventions. However, there are scarce study reports on the current prevalence pattern of SAM and MAM among under-five children, as it may assist in the implementation of nutrition therapy programme implemented by these humanitarian organizations. A retrospective cohort study was conducted by collecting thirty six (36) month reported data of SAM and MAM of under-five children, from District Health Information Software (DHIS)-the standard source of health information in south Sudan, across three years; 2014, 2015 and 2016 for three counties, and was analysed using SPSS. Findings revealed statistical significant differences in SAM and MAM within each county and among the three counties across the three years. The results further revealed that there was rising median values of SAM and MAM among the counties across the three years. It was suggested that adequate pre-intervention survey should be conducted, reducing local government’s sentiments and infiltration during screening exercise for malnutrition among under-five children, ensuring peace in south Sudan, and conduct of post-intervention surveys for feed-backs, may serve as a clue towards implementing an effective and efficient nutrition therapy programme in the war-torn Lakes State of south Sudan. Keywords: Prevalence pattern, Malnutrition, SAM, MAM.  
265 Child Feeding Practice and Perception of Mothers/Caregivers on Nutrition Therapy Programme in Three Counties of Lakes State South Sudan , Ebenezer O. Daniel, Ademola M. Amosu, Gabriel O. Ayeni, Oladapo M. Olagbegi
The food supplement feeding practice and the overall perception of mothers/caregivers about the nutrition therapy programmes in the associated humanitarian interventions, for the under-five children play important role in achieving the maximum success in such laudable programmes. A cross sectional survey study was carried out on the mothers/caregivers in three counties-Cueibet, Yirol West and Rumbek North. Data was collected through structured questionnaire containing questions on the mothers’/caregivers’ feeding practice of the supplementary foods, and their perception on the nutrition therapy programme. Data were analyzed using descriptive and inferential statistics. Statistical level of significance was set at P-value <0.05. The results showed that more than 90% of mothers/caregivers in Cueibet and Yirol West counties have varying degrees of poor feeding practices and perceptions about the nutrition therapy programme, while in Rumbek North county, over 50% of the mothers/caregivers have good feeding practices but more than 50% of them also have varying degrees of poor perception about the nutrition therapy programme. Chi-square test revealed significant association between the marital status and feeding practice of the mothers/caregivers in the three counties, and a significant association between their level of education and perception on the nutrition therapy programme. Suggestions for improvement among others include; intensive nutritional health education of mothers/caregivers on good feeding practice of the food supplements, increased community awareness programme on nutrition therapy, and periodical conduct of field monitoring visits to the programme sites. Keywords: Feeding practice, perception, nutrition therapy, Mothers/caregivers.  
266 Long Lasting Insecticide Treated Net and Factors Limiting Effective Utilization in a High Malaria Incidence County of Wulu, South Sudan , Gabriel O. Ayeni, Okwuoma C. Abanobi, Daniel O. Ebenezer, Olagbegi M. Oladapo
Incidence of malaria disease is still very high in many areas of South Sudan which perhaps might be as a result of poor /noncompliance to preventive measures. The objective of this study was to investigate the use of LLITN, and factors limiting compliance to its utilization. A case – control study was conducted among population in a typical County of South Sudan. A multistage random sampling technique was used; case-control matching was done. Information relating to access and use of LLITN was gathered and analyzed. Descriptive and inferential data analysis were carried out. A total of 396 samples (cases=198 and control=198) were analyzed. The finding did not show satisfactory utilization of LLITN. Non-use of LLITN was significantly associated to the occurrence of malaria (OR=19.6, CI=11.78-32.54), p=). Poor understanding and not-taught how to use were significantly associated to the malaria occurrence (OR=4.6, 3.0; CI=2.98-7.28, 1.94 -4.60; p=0.000) and year-round utilization of LLITN (OR=5.2, 3.9; CI=3.27-8.19, 2.49-6.18; p=000). The finding showed poor LLITN retention and year-round use. There was significant association between factors promoting non-compliance and occurrence of malaria (p= 0.000). Also, finding showed care-giver level education is significantly associated to the use of LLITN (p=0.000). This study showed that the identified LLITN factors had significant association to its year-round regular use the regular use of LLITN and occurrence of malaria. Improving the use of LLITN remains important component especially in developing countries where resources to achieve simultaneous implementation of integrated malaria control programme could not be guaranteed. Keywords: Malaria, Long Lasting Insecticides Treated Net, Non-compliance, Prevention, South Sudan.  
267 Assessment of Level of Right Beliefs about Stroke and Associated Factors among Private School Teachers in Faith Standard Primary School, Ile Ife, Nigeria , Lamidi Rasheed Emmanuel, Caleb A Adegbenro
Background: There are many misconceptions or wrong belief about stroke. These wrong beliefs are held by non-health care professionals due to their little understanding and awareness about stroke. The aim of this study is to assess the level of right beliefs about stroke and its associated factors among private primary school teachers from Faith Standard Primary School, Ile Ife, Nigeria. Methods: A descriptive cross-sectional study design using 27-item, self-administered questionnaires to collect information on level of right beliefs about stroke among the respondents. Data were analyzed and presented using descriptive statistics. Results: A total of 29 private primary school teachers from Faith Standard School, Ile Ife, Osun State, Nigeria with 13.8% males and 86.2% females took part in this study. The overall stroke belief score obtained was 68.28 ± 18.09. Among all the sociodemographic variables considered in this study, statistical significant relationship was found only between marital status and the mean stroke belief scores (F (2, 26) = 7.655; P= 0.02). Also, 25.58%, 65.52% and 6.90% of the respondents have high, moderate and low level of right beliefs about stroke respectively. Conclusions: There is moderate level of right beliefs about stroke among the private primary school teachers from Faith standard primary school, Ile Ife. Therefore, there is still need for public health education on right beliefs about stroke to correct some misconceptions (wrong notions) held about stroke beliefs among them. Keywords: Stroke, right beliefs, misconceptions, teachers.  
268 Health Effects of Dust Exposure on Respiratory Functions among Underground Mine Workers in the South African Gold Mining Industry , Olukayode O. Alewi, Ademola M. Amosu, Ebenezer O.Daniel
Studies on the health effects of occupational exposure to dust on the respiratory function of the gold miners in Orkney gold minefields in South Africa are reportedly scarce. This study was aimed at revealing the physiological effect(s) of exposure to dust, in the underground mine on respiratory functions such as the forced vital capacity (FVC), the forced expiratory volume in one second (FEV1), and the peak expiratory flow (PEF); and compare this with non-miners. A case-control study was conducted with the participants matched as close as possible. The gold miners were the case while the non-miners were the control. The major instrument that was used to assess the respiratory function was the CONTEC SP10 digital spirometer. For the secondary effects, sphygmomanometer, digital weight scale, digital heart rate monitor were used. Data Analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 20 and the paired sample t-test. There were statistically significant differences in all the 3 respiratory functions assessed between the gold miners and non-miners. The forced expiratory volume for the gold miners and non-gold miner are weakly and positively correlated (r = 0.289, p < 0.000). There was a significant mean difference between the FVC for gold miners and non-gold miners in Orkney (t221 = 8.135, p < 0.000) .Urgent steps at reducing the amount of occupational exposure to dust with possible resultant silicosis are needed to curb these observed variations. Keywords: Dust exposure, respiratory functions, silicosis, underground mine workers.  
269  Cost of Paediatric Diabetes Mellitus Treatment on Carers of Diabetic Children Attending Three Hospital Out-Patient Clinics in Zimbabwe , Pasipanodya Ian Machingura, Ismail Ticklay, Robson Dembah,  Fredrick Richard Heller
There is paucity of information on the economic impact of diabetes mellitus in low and middle income countries, including Zimbabwe. The study sought to determine the patient treatment cost of paediatric diabetes mellitus on families of diabetic children attending Parirenyatwa, Harare and Chitungwiza hospital out-patient clinics in Zimbabwe. A cross sectional study was conducted at Parirenyatwa, Harare and Chitungwiza hospitals between 10 May 2017 and 27 September 2017 in which all paediatric diabetic patients and carers were given the information on the study. A questionnaire was administered on all carers of paediatric diabetic patients’ who consented to participate in the study. Only (36/85) 42% of the carers of paediatric diabetes mellitus children, who had attended the out-patient clinic in the year preceding the study at least once at Parirenyatwa, Harare and Chitungwiza hospital were accessed. Only 53% of the 36 children had a measure of glycaemic control, of whom 74% had HbA1c ≥7.5% indicating poor glycaemic control. Cash was the mode of payment used by the majority of the carers for child treatment, and the monthly expenditure was almost half of the family total income. This study indicates a considerable portion of the family income is spent in child care of diabetic children and loss of productive time due to child care. Only a small proportion of the children was accessed during the study population which can be attributed to financial problems limiting clinic attendance. There was poor diabetic control amongst the paediatric diabetic patients who had HbA1c results. Keywords: diabetes mellitus, diabetes mellitus cost, paediatric diabetes mellitus.
270 Does Pregnancy Potentiate the Occurrence of Adverse Drug Reactions to Antiretroviral Drugs among Nigerian Women? , Samson C Emelike  
HIV transmission can occur from mother to child during pregnancy, delivery and breastfeeding. The use of Anti-Retroviral Drugs (ARD or ARVs) in Prevention of Mother to Child Transmission can significantly reduce this mode of transmission. The use of ARVs has been associated with occurrence of noxious effects known as Adverse Drug Reactions (ADRs). It is well known that women react more to drugs than men and some reasons proffered by some literature include hormonal differences in both sexes; but it is not known whether pregnancy can increase the chances of women reacting adversely to ARVs. Objective: The objective of the research is to investigate whether pregnancy can potentiate the occurrence of ADRs to ARVs. Methodology: The research employed a cross sectional Study Design on 150 HIV positive pregnant women, who were receiving ARVs at the time of study but who started ARVs before the current pregnancy. A simple Random Sampling Technique was employed in selecting the subjects. A well-structured questionnaire was applied on the selected women to collect data. Data Analysis: The result was analyzed in a Mcnemar’s test using Statistical Package for Social Sciences to determine the strength of association between the variables pregnancy and occurrence of ADRs for both the pregnant and the non-pregnant statuses of the same subjects. Result: The result showed that pregnancy does not contribute to the occurrence of Adverse Drug Reactions to Antiretroviral drugs among HIV pregnant women. Keywords: Pregnancy, adverse, drug, reaction, ARVs, potentiate.  
271 Effect of Social Support on Parenting Stress of Korean Mothers of Children with Cerebral Palsy: An Article Review , Ganiyu Abiodun Adedeji, Caleb Aderemi Adegbenro
Background: Parenting stress in mothers of cerebral palsy children had been linked with common themes such as disturbed social relationships, health problems, financial problems, moments of happiness, worries about future of the child and need for more support services. The objective of this paper was to critically review the article titled: ‘Effect of Social Support on parenting Stress of Korean Mothers of Children with Cerebral Palsy' in the Journal: J.Phys.Ther.Sci. Methods: The review gave a short literature review on the subject. Following this, a summary of the article was given. The article summary summarized the contents of the review. This was followed by a brief analysis of how effective the structure of the article is, investigating how the information is set out and whether or not the reader can have access to it. The presentation of the content of the article including the alignment as well as the format of this article was assessed. The third section was the critique of the article, evaluating its authority and currency. The accuracy, objectivity as well as coverage of the article was as well reviewed. Similarly, the relevance of the content of the article with respect to its title was reviewed. The stability of the article as related to its publication was not left out of the review. This review also carried out an analysis of the figures and tables prior to finally judging the article’s accessibility and credibility. Recent advances that are related to the article was briefly explained. Findings: On the whole, the article was found to be relevant, clear and well written. Conclusion: The structure, strength, content as well as the limitations of the article were analyzed and critiqued. This article has contributed to the literature considering its valuable critique of current research study on social support and parenting stress. Keywords: Parenting Stress, Social Support, Cerebral palsy, Mothers, Children.  
272 Knowledge of Stroke Risk Factors and Warning Signs among Private Primary School Teachers from Moro Community in Ife North Local Government, Nigeria , Lamidi Rasheed Emmanuel, Caleb A Adegbenro
Background: Knowledge of stroke, especially the risk factors and warning signs is important in the control of the disease. This knowledge vary between patients and are difficult to interpret, especially for non-health professionals. The aim of the study is to evaluate the knowledge of stroke risk factors and warning signs among teachers in the private primary schools in Moro Community, Ife North Local Government, Osun State, Nigeria. Methods: This study is a cross-sectional study design involving the use of pre-tested 43- item, purpose designed, and self- administered questionnaires to collect information on knowledge of stroke risk factors and warning signs among the respondents. Data were collated and analyzed based on descriptive statistics. Results: The result showed that the respondents generally demonstrated poor knowledge of risk factors (40.6%) and warning signs of stroke (41.5%). The most correctly identified risk factor of stroke was hypertension (73.3%) while the least correctly identified risk factor of stroke were obesity (28.1%) and increasing age (28.1%). Difficulty in speech (70.2%) was the most correctly recognized warning sign of stroke and the least correctly identified warning sign of stroke in this study was difficulty in understanding (31.6%). Conclusion: This study reveals a poor awareness of knowledge of stroke warning signs and risk factors among the private primary school teachers. Therefore, considerable education is needed to increase public awareness and health education on stroke. Keywords: Stroke, warning signs, risk factors, teachers.  
273 Perceptions and Factors of Influenza Vaccination among Nurses , Roy Rillera Marzo, Sayi Bhanu Krishnan, Vikraman Chakravarthy Moganaraja
Introduction: Annual influenza vaccination is recommended for nurses in order to decrease the morbidity related to influenza in healthcare settings. The aim of this study was to determine the perception and factors of influenza vaccine among community nurses (Klinik Kesihatan Maharani, Klinik Kesihatan Parit Jawa and Klinik Kesihatan Bukit Pasir) and hospital nurses in Hospital Pakar Sultanah Fatimah (HPSF) at Muar, Malaysia. Methods: From October 25 and December 10, 2015, we conducted a descriptive, cross-sectional study of perceptions and factors of influenza vaccination among community and hospital nurses. Convenience sampling of all the community and hospital nurses available in the area of Muar district. After brief explanation of the aim, 100 (50 community nurses; 50 hospital nurses) nurses had completed survey questionnaire. Results: Influenza vaccination status was low in hospital nurses but high in community nurses, varying from 52% in hospital and 86% in community. The perception of nurses were considering influenza a severe disease (36% community nurses; 40% hospital nurses), protecting patients overall of 68%, protecting family (76% community nurses; 68% hospital nurses) and self-protection (100% community nurses; 96% hospital nurses), responsibility (94% community nurses; 90% hospital nurses), as a symptomatic treatment (72% community nurses; 58% hospital nurses) and adverse effects overall of 78%. Discussion: The perception of nurses were considering influenza a severe disease, patients, family and self-protection, responsibility, as a symptomatic treatment and adverse effects. The encouraging factors associated with being vaccinated were working in health sector, afraid nurses will be infected by patients and nurses are old or having chronic disease; those that barriers associated for not vaccinated were concern about side effects of vaccine and afraid of influenza. Conclusion: Influenza vaccination status seemed to be low in nurses especially in hospital nurses with differences between workplace settings. Specific continuous educational and vaccination programs for should be organized to reduce morbidity in high risk nurses and mandatory policy if vaccination program failed to achieve its aim. Keywords: Vaccine, Influenza, Healthcare workers, nurses, hospital, community  
274 Assessment of Contraceptive Uptake among Men Aged 20-50 Years in Mwembe Estate, Kisii Town, Kisii County, Kenya , Taratisio Ndwiga, Angela Maiyo, Moraro R Bosire
Background: Comprehensive contraception uptake involving not only women but also their male partners is very vital if the projected decline in fertility rates by 2025 is to be attained. Men’s involvement is of great essence if potential acceptability of contraception programs is to be achieved. Objective: The main objective of the study was to assess the utilization of contraceptives among men aged 20-50 years in Mwembe estate, Kisii Town. Methodology: A cross-sectional study design was employed on 288 sampled men aged 20-50 years. Stratified random sampling technique was used to select the respondents for the study. The data was collected using structured questionnaires and key informant guides. Data Analysis: Analyses of quantitative data was done in SPSS version 20. Chi-square test was used to measure the strength of associations between the various variables where a p-value of = or < 0.05 was considered statistically significant. Findings: Condoms and vasectomy were the modern contraceptive methods available to men. 99% of the study subjects had the knowledge on contraceptives but only 56% admitted consistent use. Among those who used, condoms were most preferred at 58% with traditional methods still being employed. Only 32% of respondents had objections to contraception, among which 16% based on religious, 12% on personal and 4% on cultural reasons. The use of contraceptives was closely associated with religion (χ2 = 6.67, df = 2, PV = 0.036). Discussion: The high awareness levels (99%) can be attributed to technological advancements. Condoms use was leading (56%) because they were easily available and accessible, they required no prescription and they offered dual protection. Vasectomy service utilization was low (1%) as it had not been embraced in most societies. Religion was the major barrier of contraception (16%) since contraception was thought to be against God’s will. Other men (14%) had personal reasons against contraception owing to the perceived side effects of female contraceptives in order to protect their women’s health Conclusion: Condoms were most common (70%) than other methods hence information on proper use of condoms should be given. Knowledge on contraception was high (99%) with low use (56%) hence more is required to bridge the knowledge-practice gap. Utilization of contraceptives still low (56%) compared to that of developing regions (67%+). Religion, societal and personal holds hinder contraception practice. Recommendations: Innovations of other contraceptive options through research by government. Men should be encouraged to take up contraception with communication among partners being emphasized. Health personnel to adopt religious-based and individual-based FP promotion approaches. Keywords: Contraceptive, Utilization, Prevalence, Total Fertility Rate  
275  Health promotion strategies for the prevention and control of non-communicable diseases in Nigeria , Okafor CN, Young EE, Nwobi AE
Non-communicable diseases have shown an increasing impact on health status of populations globally with a rising rates in developing countries especially Nigeria. However, government in Nigeria are not keeping pace with the ever expanding needs for policies, legislative services and infrastructure to prevent NCDs. This paper is aimed at identifying the modifiable risk factors for NCD in Nigeria, the determinants of health involved and the health promotion strategies which can be initiated and implemented at various sectors. Secondary data was obtained from results of search from WHO NCD country profiles 2014, WHO global status report on NCD 2011, WHO global action plan for prevention and control of NCD 2013-2020 and Health Reform Foundation of Nigeria 2011 amongst others. The results showed that the modifiable risk factors included tobacco smoking, alcohol consumption, raised blood pressure and obesity with about 6%, 10%, 35% and 6.5% respectively. The determinants of health spanned from economic, natural and social environments amongst sustainability, transport, lifestyle and community services. Health education, nutritional intervention, lifestyle and behavioral changes in addition to environmental modifications are strategies which can help prevent and control NCD through addressing the risk factors and determinants. Keywords: Non-communicable diseases, Health Promotion  
276 Effect of Socio-demographic Characteristics on Healthcare Seeking Behaviour among Users of Primary Health Care Facility in Ado-Odo Ota Local Government Area, Ogun State, Nigeria , Musah K.Toyin  
Introduction: Healthcare seeking behaviour has been defined as any set of actions undertaken by an individual who perceives a health problem or an illness for the purpose of finding an appropriate remedy1. This is based on an Explanatory model which has a coherent picture of specific cultural features and these features in turn predispose an individual to certain health behaviour. Against the backdrop of the need for understanding the effects of socio-demographiccharacteristics on  healthcare seeking behaviour of individuals from sociological perspectives, this study assessed some of those factors among users of primary health care facility (PHC)in Ado-Odo Ota local government (LGA), Ogun State, Nigeria. Methods: Descriptive cross sectional study among 300 selected users of PHC that are resident of Ado-Odo Ota using multistage sampling method. Data was analyzed using the SPSS software version 21.0.  Three hundred (male-97, female 203) users of PHC were sampled through multistage sampling technique in these wards. Instrument used for data collection was a self-developed, validated questionnaire with reliability of 0.72 using Chrombach alpha coefficient. Multiple regression, Analysis of Variance and Independent T-test were used to test the hypotheses at 0.05 level of significance. Results: Using the framework from the ‘‘four As’ theories and concepts; findings based on the survey revealed that household headship, educational level and income predicted increase in service utilization at PHC in Ado-Odo Ota LGA (R = .252; R2 = .064; Adj. R2 = .054) ;(F calculated (3, 299) = 6.715 > f-table = 3.86; p <.05).  Statistical significance also existed in service utilization between male and female in the study area. Conclusion: Based on the study outcome, it was recommended among others that there is need for continuous community mobilization by healthcare providers especially the Public/Community health Nurses and Community extension workers to enhance active community involvement and continuous increase in service utilization. Keywords: Healthcare seeking, PHC Users, Ogun State, Nigeria.  
277 Knowledge and Practices of Food safety among Senior secondary school students of Ambassadors College, Ile- Ife, Nigeria , Lamidi Rasheed Emmanuel  
Background: Food safety is a public health concern and it remains a critical issue with outbreak of food- borne illness resulting in substantial costs to individuals, the community health systems, the food industry and to the economy in general. College students are one of the most at- risk population groups due to their unsafe behavior in food consumption. Knowledge and practices of food safety is very important among students since they are also consumers. Methods: This study is a cross- sectional study to investigate food safety knowledge and practices of senior secondary school, Ile –Ife, Osun State, Nigeria. A pre-tested 27- item, purpose designed, self- administered questionnaires were used to collect information on knowledge and practices of the respondents on food safety. Data were collated and analyzed based on descriptive and inferential study design. Results: The result showed that the total percentages of respondents with good level of food safety knowledge is 75.8% (310) with only 24.2% (99) respondents having poor food safety knowledge level as majority of the respondents 65.8%(269) also have high level of food safety practices with only 34.2% (140) of them having low practices on food safety. In addition, the result showed significant association between mothers’ educational level and food safety knowledge scores and significant association between food safety practice scores and age, gender, class and household composition of the senior secondary school students (p <0.05). The results also showed no significant correlation between food safety knowledge and practices of the students (p <0.05). Conclusion: Senior secondary school students of Ambassadors College, Ile- Ife have good food safety knowledge and high food safety practices. Keywords: Food safety, knowledge, practices  
278 Factors Affecting Dengue Fever among the Population in Bandar Maharani, Muar, Johor, Malaysia , Roy Rillera Marzo, Lee Chin Ying, Mah Li Hui
Background: Dengue is a mosquito-borne viral disease. The trend of dengue incidence in Malaysia has continued to increase since 2001 until 2014. Despite the close monitoring and continuous efforts from the Ministry of Health and Municipals to conduct the prevention and control activities, the number of dengue cases continued to increase due to multiple uncontrolled factors. Aim: Our objective is to assess the factors affecting dengue fever among the population in Bandar Maharani, Muar, Johor, Malaysia. Methodology: A descriptive, cross-sectional study design based on simple random sampling, resident aged between 18 to 60 years old was randomly chosen. Data was collected using assisted self-administered questionnaire that covered 4 parts i.e. socio-demographic data, knowledge about dengue infection, attitudes towards dengue fever and practices of dengue prevention. Data was analyzed using PASW statistics student version 18. Results: It was found that knowledge among the respondent was only moderate. The respondents’ attitude was neutral and the practice was good. The most common source of information on dengue was from the television (72.1%). There was significant association between knowledge and practice (p = 0.000) and also between attitude and practice (p = 0.000). Attitude was associated with ethnicity (p = 0.002) and education level (p = 0.031). Conclusion: The study has highlighted that despite having satisfactory level of practice on dengue prevention, the knowledge and attitude can be further strengthened. Information, education and communication materials can be provided at areas that are more accessible. This would help to increase knowledge and mold positive attitude among the Muarian to eliminate dengue fever. Keywords: Dengue Fever, Knowledge, Attitude, Practice, Malaysia  
279 An Evaluation of the Effectiveness of Infant and Child Survival Interventions in Yendi District , Sukerazu Ahmad Alhassan  
Introduction: Child survival continues to improve worldwide. The total number of deaths of children under five years old fell from 12.4 million in 1990 to 8.1 million in 2009. The mortality rate in children under five years old has fallen correspondingly from 89 per 1000 live births in 1990 to 60 per 1000 live births in 2009, representing a reduction of about one third. At the same time, the average annual rate of decline has accelerated over the period 2000–2009 compared with the 1990s. The level of mortality, however, remained alarmingly high in certain regions of the world. Method: The study was a community-based cross sectional study. The study employed multi-stage random cluster sampling procedure to select households and villages in Yendi district. Both quantitative and qualitative methods were used to collect data from the study target population which included the caregivers, the community based agent and community health officers. Results: Majority of the respondents practice exclusive breastfeeding up to six months of child’s age whiles other practice up to four months. A good percentage (48%) of the caregivers introduced complementary food at six months and beyond and fed their children more than five times in a day as indicated in the figure below. This showed good feeding practice by caregivers. Greater percentage (68.5%) of children are immunized through the outreach services and 31.5 were immunized through the static clinic sessions Conclusion: The finding concluded that there was general improvement in the infant and child health interventions. These findings predict that improvement in outreach and community level service is potential for improving child survival. There is also low uptake of vitamin A supplementation and de-wormers. A significant number (30.3%) of new born missed OPV at birth. As the ages of the children increased coverage of antigens decreased. This finding is worrisome and needs attention by health providers.  
280 The Awareness on Smoking Health Warning and Its Impact Among Muar Community , Roy Rillera Marzo, Thanamletchumy Subramaniam, Hemavathy Thirumalai Rajan
Introduction: Currently worldwide 3 million deaths annually estimated to be responsible for smoking. On average, everyday Malaysian adult smoker smoked 14 cigarettes per day. Most smokers were aware of the deleterious of smoking and had strong intentions to quit smoking but they were not motivated enough to stop. Aim: To assess awareness on smoking health warning and its impacts among Muar Community. Methodology: It was a quantitative survey done on 383 respondents from Bandar Maharani, Muar. The participants were aged 13-70 years. This was a descriptive, cross-sectional study using two- step sampling methods which are cluster sampling and simple random sampling. Data analysis including descriptive statistics was used to describe participants’ socio-demographic characteristics and texts, tables, graphs, percentages and independent t-test was used to present the results. Result: The highest smoking rate noted between the ages of 25-44. Among the races, Malays were the highest smokers which was 74 %.( p=0.019). Smokers (64.1%) are married and there were significantly difference (p = 0.000) between the marital status and the smokers. Majority of the smokers were employed with 77.1% and it was significantly different (p=0.000). Greater number of smokers and non-smokers (90.9%) were aware about the presence of smoking health warning on cigarette packs. Smokers with 75% were planning to quit and about 58.3% of them perceived that cigarette health warning does not influence to prevent or to stop smoking (p=0.000). Majority of the smokers and non-smokers selected the graphic models based on its threatenig effects compared to other models. Conclusion: Majority of the respondents has good awareness on smoking health warning and have seen or read the smoking health warning on the cigarette packs. The influence of cigarette health warning had no effect on smokers to stop smoking. Among the 6 models shown, graphic image lung cancer (Model A) has the highest number of choice by the smokers (32.3%) and non-smokers (27.2%). Threatening images was the most preferable choice among the respondents. Recommendations: Each workplace recommended to set-up smoking cessation programs. Hospital based intervention program should be given by health practitioners in the hospital setting on pre-admission clinic for smokers. There must be tobacco rehabilitation programs in all levels of healthcare service centers for easy accessibility and promote their services for better outcomes. Existing graphic health warning should be improved in terms of size, appearance and message to be more effective. Current quitline services should be promoted more through the web sites and social media pages. Keywords: Smoking, awareness, health warning, threatening, health  
281 Learning Style Preferences Among Medical Students in Malaysian Medical Universities , Roy Rillera Marzo, Thilagarani M, Maniarasi M.
Introduction: Medicals students are being exposed to different learning environments, at the same time receiving vast extents of information. The information on learning style can also benefit the students by helping them to formulate appropriate learning strategies to enhance their learning. VARK is a questionnaire that determines a person’s sensory modality preferences. Aim: The aim of this study is to identify the learning style preference among medical students in Malaysian medical universities. Methodology: A descriptive cross sectional study was done in 2015. Convenience sampling was used to choose the sample population. Sample size was 239 students. VARK© questionnaire Version 7.8 was used to assess the learning style among preclinical and clinical medical students from three medical universities in Malaysia. Questionnaire was distributed among students in the form of hard copy after taking an informed consent. Results: Majority (53.61%) out of 97 preclinical students preferred unimodal learning style. 46.39% out of 142 clinical students had highest preference towards multimodal learning style. Kinesthetic was the mode of choice from the VARK component for both preclinical and clinical students. In multimodal learning style, trimodal and bimodal mode was preferred by preclinical and clinical students respectively. Conclusion: Kinesthetic modality is the strongest single preference for both preclinical and clinical students. Preclinical students preferred unimodal learning style and clinical students preferred multimodal learning style. Keywords: VARK, learning style, preclinical and clinical, gender, ethnicity  
282 Socio Economic Determinants of Applicability ofthe Child Right Act Among Parents in Ibadan North Local Government Area of State Nigeria , Ogun Millicent Ifechukwude, Ademola J. Ajuwon, Babawarun Tolulope O
Nigeria has been a signatory to the Convention on the rights of the child and the African Charter on the Rights and Welfare of the C1hild since 1991 and 2001 respectively. The Nigerian Child Rights Act (CRA) was drafted in 1993 and signed into law in 2003. Despite these measures, too many children still see their fundamental rights violated every day. The global statistics are dramatic, and may even be underestimations as 72 million children are not in school, of whom 56% are girls; 218 million children are working; 126 million are trapped in the worst forms of child labour; 25 million children are refugees and displaced; 9.2 million children die before their fifth birthday; 1.5 million children die every year from poor sanitation and unsafe water. The study is a descriptive cross-sectional survey among parents in Ibadan North Local Government Area (LGA) of Oyo State to investigate the knowledge and practice of parents on child’s rights.The data were analyzed using descriptive statistics, Chi-square and Independent t-test. Finally, information obtained were summarized and presented in tables and charts. Findings revealed that respondents had inadequate knowledge of the rights of children. Respondents with poor, fair and good knowledge of child’s rights were 81.0%, 11.5% and 7.5% respectively. However, the attitude displayed by respondents is favourable towards the observance of the Child’s Rights Act. Factors limiting the effective implementation of the Child’s Rights from the perspective of respondents include economic situation, man-made disaster, poor enforcement by regulatory agencies and societal values and norms. This lack of awareness has been attributed to the vulnerability of the Nigerian child to social vices and harmful practices such as child labour, child trafficking, early marriage, female genital mutilation and widowhood practices.  
283 Terror and Tears in the Labour suit: The Prevalence and Forms of patient Abuse by Health workers during Childbirth in Uganda , Kasule Aaron, Jerome K. Kabakyenga
Background: Among the factors contributing to the high maternal morbidity and mortality in Uganda is the proportion of pregnant women who do not deliver under skilled supervision. There is paucity of data concerning the magnitude of patient abuse by health workers which is a main factor preventing facility delivery. This study aimed to determine the magnitude of abuse and the forms of abuse the patients in Bushenyi district in Uganda. Methods: In this cross sectional survey, 374 women who had just delivery in the health facilities were interviewed to identify any form of abuse treatment. The independent predictors of patient abuse were analysed at bivariate and multivariate level using binary logistic regression analysis. Results: The prevalence of patient abuse among the respondents was found to be 41.1% (P = 0.013). The commonest form of abuse reported was patient neglect 31.9% (p = 0.000), verbal abuse (29.3 %) and bribery (15.1%). The associated with patient abuse were; patient age 15-25years, prime gravidity and low Health center facility. Conclusions: The prevalence of patient abuses during childbirth very high and detrimental the health system. Close supervision midwives especially in the lower level facilities, as well as keeping the company of the relatives or friends to especially the younger the patients around the labour suite, Community sensitisation and empowerment through health education are suggested. Keywords: Patient abuse, childbirth, South Western Uganda  
284 Prevalence of Smear Positive Tuberculosis among Patient Attending, National Hospital Abuja, Federal Capital Territory, Nigeria , Adedamola Amos Ogundeji  
Objective: This study was planned to determine the prevalence of smear positive pulmonary TB among patients receiving care at a tertiary reference Hospital - National Hospital Abuja, Federal Capital Territory (FCT), Nigeria. Background: With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern1. Eighty percent of all cases worldwide occur in 22 high-burdens, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB co-infections in resource-limited countries2. In low income countries (Nigeria inclusive), Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment3. There is dearth of data on the prevalence of pulmonary tuberculosis (PTB) among patient attendees from individual Institutions and Health Care Facilities performing sputum smear microscopy in Nigeria. This retrospective study will analyze sputum smear microscopy results among pulmonary TB suspected patients presenting to National Hospital Abuja, Federal Capital Territory (FCT), Nigeria. Sputum smear microscopy for Acid Fast Bacilli (AFB) results of new suspected pulmonary TB (Diagnosis) patients and their demographic data comprising age and sex recorded from January 2010 to December 2014 were retrieved from the TB Laboratory Register of the Medical Microbiology department and analyzed. Methods: This hospital based retrospective study analyzed sputum smear microscopy results among pulmonary TB suspected patients presenting to the National Hospital Abuja, Federal Capital Territory, Nigeria. Sputum smear microscopy for Acid Fast Bacilli (AFB) results of new suspected pulmonary TB (Diagnosis) patients and their demographic data comprising age and sex recorded from January 2010 to December 2013 were retrieved from the TB Laboratory Register of the Medical Microbiology department and analyzed. Data processing and statistical analysis were performed using SPSS software (Windows version 16.0). The results were expressed as percentage, with significance at 5%. Results: The overall prevalence of sputum smear positive cases were 17.3% (63 0f 364) and most of the positive patients were within the age range 15 – 44 years. The highest percentage of TB was seen in the age group of 15 - 24 years compared with the lowest percentages in the age group below 14 years and above 45 years. A total of 63 (17.3%) suspects were found to have at least one positive. Of these, 56 (88.9% of those with one or more positive smears and 92% of those who fulfilled the case definition) were detected from the first specimen and 7 (11.1%) were positive on the second specimen but not the first. The third specimen did not have any additional diagnostic value for the detection of AFB. Conclusion: The prevalence of sputum smear positive cases of 18.3% increases with age up to the age 44 years. Our result show that examining two sputa smears was sufficient for the detection of AFB in our laboratory. Further research involving different laboratories from all of the six geo-political groups in Nigeria is needed to reassess these findings.  
285 Knowledge, Attitude and Practice (KAP) Study on Contraceptive Prevalence among Health Care Providers , Robina Kousar, Muhammad Afzal
Objective: To assess the knowledge, attitude and practices of contraceptives among health care providers. Methodology: A cross sectional study was conducted from Feb 2015 to January 2016on health care providers of public Hospitals in Lahore. A total of 216 participants were selected who has 2 or more children and lies at the age of 20 above. Data was collected on a self-developed close ended questionnaire. Responses were analyzed on Statistical Package of social Sciences using descriptive statistics. Results: Mean age 31-40 years (50 %) had secondary school certificate, 86 (39.8%) Nurse Midwife, 190 (88%) were having two children 94(43.5%). Regarding the knowledge and awareness about contraceptives 212 (98.1%) respondents had knowledge about contraceptives and 172 (79.1%) got the knowledge from professional study. 82 (38%), 50 (23.1%) said that Hospital and Family Planning Clinic respectively are the resource places for contraceptives. Overall 84.3% health care providers were using different contraceptive methods. Condom used by partners was 74 (34.3%) but the preferred method of participants was oral contraceptive pills 34 (15.7%). Moreover, 134 (62%) had no constrains in using contraceptives and constrains faced by the partner were 20 (9.3%). Conclusion: Findings of the study shows that the knowledge and awareness of contraceptive is high among health care providers however the practice of contraceptive method was comparatively high by their husbands. There is need to motivate the health care providers for contraceptive use in order to increase the prevalence in general population. Keywords: Health Care Providers, Contraceptives, Knowledge, Practice, Attitude  
286   Ultrasonographic Prediction of Prostatic Enlargement in Urualla Imo State, Nigeria , Mgbe Kevin E., & Mgbe Chinenye Glory
Background: The prostate is a reproductive gland found in males. It is responsible for the production of the fluid that carries sperm during ejaculation. The prostate gland usually enlarges with age and eventually gets to a size when it causes obstruction to urine flow which is the most common symptom. A small amount of prostate enlargement is present in many men over age 40. Two common identifiable causes of prostatic enlargement are benign prostatic enlargement and prostatic cancer. Ultrasonography is a non-invasive non ionizing imaging method that uses sound waves to evaluate internal organs of the body. Aim: The main objectives of this research were to determine the percentage of population with prostatic enlargement, to ascertain relationship of prostatic enlargement with age. Method: Prospective study design was used and data collected was focus on men from the age group of 50 years and above. Results: The average age of those screened was 63.11+/-7.85years. There was a higher age average of 64.28years for those with prostatic enlargement when compared with normal subjects with average age of 62.33 years. Conclusion: Ultrasonographic evaluation of prostatic volume is an important screening tool for both benign prostatic enlargement and prostate cancer. Keywords: Prostatic enlargement, Ultrasonogragph.  
287 Road Traffic Accidents and Injuries Among Form 6 Students in Muar , Roy Rillera Marzo, Geerththanah Vijayakrishnan, Jananny Mumudi Vanthen
Introduction: Road traffic accident refers mainly to any accident involving at least one road vehicle, occurring on a road open to public circulation, and in which at least one person is injured or killed. Road traffic accidents are a recognized dominant cause of injury and death among teenagers worldwide and in Malaysia. Road traffic accidents and injuries is a public health problem worldwide. In 2002, there are 1.2 million people die as a result of road traffic accidents and 50 million are injured and disabled. It is also the 11th cause of death in the world and accounts for 2.1% of all deaths globally. Methods: This is a descriptive cross sectional study that targeted form six students as our population in 6 different higher secondary schools in Muar with 280 respondents. Data was collected through a 12 items of multiple structured questions and 5 items of feedback questions, which of overall 17 items of questions in our questionnaire Results: Among 280 respondents, 84.6% of them had met with an accident. Majority of the respondents are male (90.7 %), Malay (89.9 %), and come from a low income background (97%). Surprisingly, there are 66 (90.4%) have not attended a driving lessons while 82 (94.3%) of them did not have a driving license. Among the entire respondent surveyed, 76 (96.2 %) of them did not wear seatbelts or helmets. The remaining 43 which is 15.4% of them had not met with an accident. There is a significant association between motor vehicles accidents towards driving lessons (P=0.001), driving license (P=0.001), usage of seatbelts or helmets (P=0.001) Conclusion: Our study shows that there was a significant association between road traffic accident and injuries with not having a driving license, not attending driving lessons and usage of seatbelts or helmets. Recommendation: Our government should implement strict rules and tough penalties such as increasing fines and summon as to curb traffic accidents. For the awareness, schools have a role to play by emphasizing the importance on road safety, like usage of seat belts, proper driving practice by organizing awareness campaigns and seminars which is given by road traffic officers. The media also needs to draw the attention of all road users both to dangers and to safe practices on the road. Keywords: Car occupant accidents, Car occupant injuries, late adolescents, Students, Safety belt or helmets  
288 Impact of Safe Water and Improved Sanitation on Incidence/Prevalence of Typhoid Fever Globally , Otojareri Kohwo Anthony  
Typhoid fever is a systemic infection caused by the bacterium salmonella typhi. It occurs worldwide and more in developing countries. This study is a review of existing journals on typhoid fever is aimed to determine whether safe water usage or consumption and improved sanitation had an impact on the incidence/prevalence of typhoid fever globally. A literature search is carried out reviewing current and existing journals on typhoid fever. From the view, it was noted in most of the articles by various authors that safe water usage and improved sanitation impacted on incidence and prevalence of typhoid fever. It is however recommended that with implementation of various public health strategies on safe water, improved sanitation and personal hygiene there will be a reduction in the incidence of typhoid fever in our environment. Vacuration program on Typhoid should be stepped to further curb the high mortality rate from this water borne disease. Keywords: Typhoid fever, safe water, unproved sanitation.  
289 Health Equity: A Challenge and Achievable Goal for Africa , Lamboly Kumboneki  
The conditions in which people are born, live, grow and age are important and impact greatly on their health. However, equity is not about sameness but each and every individual deserving the same opportunity concerning health, education, housing, working and living conditions.-Health inequities are found worldwide at different levels and stem from various factors. Africans are experiencing health inequity related to the social, economic, cultural and political environment in which they live. Immediate actions, coupled with a good political will substantially reduce the existing gaps and ensure that we achieve health equity in a nearer future. Keywords: Health, equity, inequity, social determinants.  
290 Assessment of Healthcare Waste Management Practice in Facilities with Previous Capacity Building on Healthcare Waste Management (HCWM) in Nigeria , Ugbena, Eneojo Richard  
Introduction: Health care wastes constitute a small stream of all waste generated by human yet proper disposal of this waste is a great concern because of its hazardous nature. Most developing countries have poor culture of hospital waste management due to competing medical needs and lack of commitment by hospital management. AIDS Support and Technical Assistant Resources (AIDSTAR1) a development partner supported government of Nigeria to build capacity of health care workers in line with World Health Organization (WHO) and national guideline on HCWM.. It is expected that this support would yield the desired result of improving HCWM in Nigeria. This study is to assess the level of implementation of national guideline on HCWM in Nigeria. Methodology: A cross sectional descriptive study was conducted using key informant interview and direct observation of HCWM practices in 5 facilities selected from 3 out of the 6 priority states supported by AIDSTAR1. The guideline on minimum package for HCWM in Nigeria was used as a tool for assessing level of implementation at each health facility. Results: There was marked improvement in HCWM practices across the facilities compared to only 2.5% of facilities who met minimum standard for HCWM as described in the baseline assessment in 2011. All the facilities had infection prevention committee and all the various types of waste boxes were available and used in the facilities for waste segregation. Wastes were evacuated to points of final disposal even though there were some operational challenges with the process. There was high awareness of the hazardous nature of hospital waste and the need to dispose them in a sanitary manner. Conclusion: Training of all cadres of health care workers including waste handlers, management staffs, and provision of necessary material for HCWM has lead to improved HCWM in Nigeria. It is hereby recommended that government should ensure that guideline for minimum package of healthcare waste management are continuously implemented in health facilities in line with the national policy on HCWM. Key words: Healthcare waste management, Hazardous health waste, National healthcare waste management guideline, Healthcare waste segregation.  
291 Exploring the perception of women attending Nyagatare Health District, in Rwanda on abortion as one of family planning methods , Desire Urindwanayo & Charlotte Engelbrecht  
This paper is focusing on abortion issue in Rwanda particularly the view of population living in Nyagatare District to the abortion. In this study, a quantitative descriptive design with a positivist paradigm guided the whole research process. Two levels of sampling were done. The first was random sampling for the selection of healthcare centres where five healthcare centres were selected out of a total of eighteen. The second level was probability sampling with a systematic strategy, which was used to select the participants at healthcare centres. A total of 137 women volunteered to participate in the study and completed an anonymous questionnaire. The authorisation to carry out the research was obtained from Nyagatare District and five healthcare centres. The research was approved by the University of KwaZulu-Natal Ethics Committee. The gathered data were analysed using SPSS version 19. Among participants 12.4% wish to use abortion as family planning method. The views on abortion remain different among people. Keywords: Family planning, Abortion, spacing of births, abortion and family planning  
292 Comparing the risk of obesity-related morbidity and mortality in different ethnic groups , Ana Cristina Diniz Silva  
Objective: This paper aims to review the current literature in order to compare different ethnic groups with respect to the known racial disparities in the risk of obesity-related morbidity and mortality, thus orienting clinical practitioners for a better practice in light of evidence-based data. Methods: Literature review using key words - obesity, metabolic syndrome, ethnic differences, BMI, cardiovascular risk - through PubMed database from 2000 to now. Results: The prevalence of metabolic syndrome and cardiovascular diseases as complications of overweight and obesity are variable among different ethnicities worldwide. Recent studies contra-indicate the use of global cutoff points for measures like body mass index (BMI) and waist circumference (WC) as it has been demonstrated that, for similar BMI and WC values, different populations present distinct patterns of body shape and fat deposition. For instance, South Asians are at increased risk of cardio-metabolic disorders even with a lesser degree of body adiposity. Conclusions: Instead of a direct cause-effect relationship, biologic/genetic and environmental factors like socioeconomic status, culture, religion, health habits, geographic location, and their intricate interactions form the complex basis of ethnic disparities on predisposing to obesity-related diseases, thus the importance of an individualized analysis of the obesity indexes, in order to optimize patient management and to reduce health risks. Keywords: obesity, BMI, adiposity, ethnicities, metabolic syndrome, diabetes  
293  Calculating the Financial Health Economic Impact of Weight Loss in Obese Populations , Ana Cristina Diniz Silva  
Health promotion programs have been constantly developed by the Health Surveillance Agencies of many countries aiming at tackling obesity. U.S. data revealed impressive obesity-related costs of $117 billion in 2000 - $61 billion for direct medical costs and $56 billion for indirect costs, i.e., those related to the impact of the disease on the country’s economy. In the UK, economic projections revealed that indirect costs might have reached £27 billion by 2015. The majority of the educational and preventive actions target lifestyle changes, childhood obesity and diabetes. More than making the population aware of the benefits of healthier habits and their potential savings, stakeholders and funders are looking forward to better assessing the economic impact of health education programs, which can be quantified by different methods such as the time value of money analyses, shadow pricing, and the cost-benefit and cost-effectiveness indexes. In the specific case of obesity as a risk factor for cardio-metabolic diseases, estimates obtained from different analysis reveal that great amounts of money – as high as 11.2 billion dollars – can be saved by delaying type 2 diabetes onset in 6 years, in a hypothetical population of 2 million obese adults who have effectively lost weight. Furthermore, in agreement with the ancient philosopher Virgil, who quoted “the greatest wealth is health”, by living longer and healthier, people may produce more and improve individual and familiar financial lives, thus contributing economically to their communities and countries. The aim of this paper is to briefly report how to assess and calculate the financial impact of public health programs to tackle obesity. Keywords: obesity, public health, weight loss, economy, cost-benefit, cost-effectiveness  
294 Preferred Health care System of the people residing at Arpookara, Kottayam district in India: A cross-sectional Study , Quereishi M.J, Puthenparambil S
This study was designed to study about the preferred health care system of the people residing at Arpookara, Kottayam district in India. In this study investigator tried to find out the common health problems, preferred place for treatment, preferred system of medicine, main obstacles to access the better treatment and expectations from government for better health care delivery, of the study population. The populations for the study were the people residing at Arpookara, Kottayam district in India which includes 410 households with 2360 members. One hundred households (samples) from the study population were selected so that findings can be generalized for the population. Simple random technique is used for samples selection. Samples include 100 households with 456 members, out of which 243 members are males and rest 213 are females. The tool used for data collection is an interview schedule which consists of 2 Performa, Performa 1 and Performa 2. Performa 1 seeks personal details while Performa 2 seeks information about common health problems, preferred place for treatment, preferred system of medicine, main obstacles to access the better treatment and expectations from government for better health care delivery, of the study population. After the data collection its analysis is done. Members of 73 (73%) households are preferring government hospital for treatment while private hospital, private practitioners and traditional healing centers are preferred by 19 (19%), 6(6%) and 2(2%) house members respectively. In 94 (94%) houses, Allopathic system of medicine is preferred while Ayurvedic and Homeopathy system of medicine are preferred by only 4 (4%) and 2 (2%) houses respectively. The major health problems of members (above age of 6 years) are Chikungunya-39 (9.51%), Jaundice-17 (4.41%), Typhoid-1 (0.24%), Bronchial Asthama-1 (0.24%), Viral fever--1 (0.24%), Coronary heart disease-2 (0.48%), Stroke- 3 (0.73%) and Diabetes-1 (0.24%). About 345 (84.14%) members were not suffered from any disease since last year. According to 56 (56%) households both the Service unavailability and financial problem are the main obstacles to access better treatment while 18 (18%) households suggests that service unavailability only and rest 26(26%) households suggested that main obstacle is financial problem. for the better healthcare delivery, 44 (44%) households expects availability of pure drinking water, regular cleaning of surroundings and primary health centre from government. About 31 (31%) households’ needs pure drinking water and rest 16 (16%) households needs regular cleaning of surroundings. Rest 9 (9%) households expects primary health center at their ward. On the basis of findings of this study, Researcher recommended his suggestions to higher healthcare administrative staff to take preventive measures for prevention and control of diseases and thus too maintain a high standard of health. Keywords: Healthcare System; Treatment Place; Medicine System; Health Problem; Obstacle.  
295 Causes of Low Case Detection and Pulmonary Smear Positive Rates of Tuberculosis in Northern Region of Ghana , Abass Abdul-Karim  
The study had two main broad but related objectives. The first objective was to determine the actual causes of under detection of pulmonary TB cases in the Northern Region of Ghana. Data was collected through administering a structured questionnaire; and collection of sputum samples from the respondents. The second objective was to determine the actual causes of low smear positive rates by assessing the capacity to effectively perform sputum smear microscopy for Acid Fast Bacilli (AFBs) in the district hospitals where the study was conducted. Collection of data here involved the use of a structured checklist for the laboratory and the staff who performed Tb microscopy. In all, 26 laboratory staff who performed Tb microscopy in the study district hospital laboratories were involved. The study lasted for a period of three months. The study revealed that, 41.2% of the study participants did not go to hospital when they fell sick. Out of this figure, 20.4% (21) attributed their inability to do so to poverty, 4.9% (5) to lack of access, 35.9% (37) to stigma, 28.2% (29) to cultural beliefs and 10.6%(11) attributed it to other reasons.  
296 Staff Satisfaction to the Introduction of New Ways of Working in General Hospitals in Nigeria , Maclawrence Kolapo Famuyiwa  
Purpose: The study examines the level of satisfaction that staff of General Hospitals in Nigeria hope to derive from the introduction and implementation of ‘New Ways of Working’ in General Hospitals in Nigeria. Methodology: The study was conducted in a typical General Hospital in Nigeria. Satisfaction level to the introduction and implementation of New Ways of Working was assessed by self-administered and pretested questionnaire. Descriptive statistics to explain the demography of the respondents were done; mean score and standard deviation values were used to examine the variables. Findings: The average mean score of the satisfaction level to the components of new ways of information if introduced was (3.52 ± 1.54). Respondents showed highest level of satisfaction to the component afford them a free hand to make impactful decisions on their work schedule (2.20 ± 1.18), and least level of satisfaction when they are provided with means of deriving more information about their work when they are provided with information technology within the hospital premises (4.95 ± 1.85). Research Limitations: More General Hospitals should be involved in new studies for more generalizability. Practical implications: Staff believe they will derive some satisfaction with the introduction of ‘New Ways of Working’. Social implications: Staff satisfaction to the implementation of ‘New Ways of Working’ will allow patients to access care with flexibility. Value of the Paper: The study is promoting the introduction of ‘New Ways of Working’, to afford staff and patients more flexibility. Keywords: Satisfaction, Staff, New Ways of Working, General Hospitals.  
297 Assessment of Uptake of Free Maternity Services among Women Visiting Kisumu East District Hospital, Kisumu County, Kenya , Chepkemoi Judy, Taratisio Ndwiga
Introduction: Maternity services are an essential part in any and all communities. This includes care from a traditional birth attendants or a trained H W. This is aimed at improving the maternal health and reducing child mortality which in the long run will lead to development. Problem statement: There has been a problem of overcrowding and poor quality of services already in public hospitals before the introduction of free maternity. This new change saw a rise in the number of women delivering in the hospital increase drastically causing a strain in the already tight situation. Many women hence prefer to deliver delivering in the hands of traditional birth attendants and only coming to the hospital if and when complications occur. This has led to the high mortality and maternal morbidity rates Justification: Maternity is a crucial part in any and all societies in ensures continuity from generation to generation. It is important to ensure that all women of child bearing age can easily access the services from a skilled birth attendant. Objectives: Broad: To assess the Uptake of free maternity services among women visiting Kisumu East District Hospital. Kisumu East District Hospital was selected for the research due to its convenience and proximity to the researcher. Descriptive study design was chosen that seeks to describe the pattern of a phenomena by person, place and time. Convenience sampling was used by drawing a representative data. People were selected because of the ease of their volunteering and units because of their availability of easy access. Data collection: Data was collected by administration of questionnaires where key informants were interviewed. Analysis: SPSS version 20.0 used for data analysis. Findings: Ninety four percent 94% of the respondents were aware of the free maternity services 93% of the women visited ANC clinic during their last pregnancy while only 7 % did not. A total of 76% of the respondents delivered at home while the rest 24% delivered in hospital. The most common reason for delivering at home among the women was accessibility to a health facility at 41%. Conclusion: Most mothers were aware of the free maternity services available in Kenya hence attended attend ante-natal and post-natal clinics. Although they are aware of the services available, many of the mothers do not deliver in the hospital due to the low standards of the services caused by overcrowding, low stuffing and insufficient supply of medication. Recommendation: Undertake a comprehensive maternal health education campaign which focuses on key causes of delay of treatment and seeks to promote gender equality in health decision-making to allocate more funds to the free maternity services implementation to improve its implementation and improve the quality of services provided in the health facilities. Keywords: Free maternity services, maternal morbidity and mortality rates, Antenatal care and maternal deaths  
298 Public Awareness of the National Health Insurance Scheme (NHIS) among Patients accessing Healthcare in Supreme Faith Hospital, Ado-Ekiti, Nigeria , Pius Izundu Okpoko  
Objective - To determine the public awareness of the National Health Insurance Scheme (NHIS) among patients accessing health care in Supreme Faith Hospital, Ado-Ekiti, Nigeria. Study design and Setting - A cross-sectional study design that made use of quantitative survey method involving data collection and analysis. Participants - 120 voluntary adults who access health care services at Supreme Faith Hospital, Ado-Ekiti, Nigeria. Method - A semi-structured questionnaire was administered to participants who also consented to the survey. A cross-sectional study was deemed fit for this research because it enables any desired data to be collected at one point in time. Results – The study revealed that a greater number of respondents i.e. 82 (68.3%) were aware of the existence of the National Health Insurance Scheme (NHIS) but only 38(31.7%) were enrolees in a hospital setting which is accredited to providing health care services under NHIS. There were more females (64.2%) than males (35.8%) among the respondents. A greater number of respondents were educated; Secondary (36.7%) and Tertiary education (48.3%), while Primary education (8.0%) and none/others (10.0%) were much lesser. There was weak statistical significant finding between education and awareness of NHIS (p=0.045). Conclusions – The awareness of NHIS was high among patients who were accessing health care services in an accredited facility in Nigeria. However, the number of enrolees among them was much lesser than expected. It is recommended that effort should be geared towards improving the rate of enrolment process, especially in the face of the heavy burden of out-of-payment expenditure in health care. Keywords: Enrolee, Healthcare, Health insurance, Nigeria, Out-of-pocket payment, Services.  
299 A Retrospective Study of Pulmonary Tuberculosis (PTB) Prevalence among Patients in Eastern Nigeria Medical Centre Enugu, Nigeria , Mgbe Chinenye Glory, Mgbe Kevin E
A retrospective study aimed at ascertaining the prevalence of Pulmonary TB amongst patients visiting Eastern Nigeria Medical Centre, Enugu State was conducted between September, 2015 and November, 2015. Sputum samples were obtained from one hundred and twenty patients. Samples were smeared on glass slides, stained using Ziehl Neelsen Stain and observed under light (oil immersion) microscopy. Data obtained were analysed using SPSS Statistic Base 17.0, where descriptive analyses such as sum, percent distribution, and mean, were computed. While Chi- Squared Goodness of Fit, degree of differences, p- value in order to statistically determine if any significance between variables such as age groups, sex of subjects, AFB positivity and prevalence existed. The results showed positive results for tuberculosis with prevalence of 42 (35%) out of 120 subjects. The age group 21-30 years had the highest prevalence of 18 (43%) out of 42 of PTB positive subjects. There was no significant difference between sex of subjects with PTB positivity (X2: 1.33 at P= 0.12). There was significant difference between age groups of subjects with PTB positivity (X2: 33.18 at P= 0.01). It is observed that PTB is still a serious health burden in this part of the world, thus, there is need for improved TB awareness, treatment and control programme. Keywords: Tuberculosis (TB), Pulmonary, Ziehl Neelsen.  
300 Health Seeking Behaviour Towards Sexually Transmitted Infections among Students of a Nigerian Tertiary Institution , Saratu O. Ajike, Elendu Zikar, Ajike Saratu, Ogunsanmi Ololade, Olaoye Titilayo
Sexually Transmitted Infections have a very serious impact on sexual and reproductive health worldwide and they rank among the top five disease categories for which young adults seek healthcare. Therefore this study assessed the health seeking behavior of undergraduate students of Tai Solarin University of Education (TASUED) towards STIs. The study was a descriptive cross-sectional survey that applied both qualitative (focus group discussion) and quantitative methods (questionnaire) of data collection. Four hundred and thirty-one respondents participated in the study. Data was analyzed using SPSS version 21 to generate descriptive (frequency tables and charts) and inferential statistics (correlation). Results showed that majority (74.2%) of the respondents have heard of STIs; HIV (80%) was the most commonly known, and Trichomoniasis (128; 29.7%) as least. The major source of information was television (350;81.2%); most preferred treatment source was private hospitals (205; 47.6%). Self -preference, inconvenience as a result of symptoms and knowledge of a place to get treatment were the best motivators of seeking treatment. Perceived risk of ill-health was high at 19.25 on a 28 point scale. There was a positive significant relationship between treatment options and perceived risk of ill-health (r =.318, p < .01). Respondents had a fair health seeking behavior towards STIs, but misconceptions still exist. More synchronized actions need to be made by schools, the government, NGOs, the media and other stakeholders to enhance young people’s health seeking behavior towards STIs. Keywords: Health seeking behavior, STIs, Youths, Ill-health, Source of care, Students  
301 Prevalence and Correlates of Depression, Anxiety and Academic Stress among Science Students in Oduduwa University, Ile- Ife, Nigeria , Lamidi Rasheed Emmanuel  
Background: There is an increasing concern on the mental health of university students worldwide. The objectives of this study are to assess the prevalence and correlates of depression, anxiety and stress among science students of Oduduwa University, Ile-Ife, Nigeria. Methods: A descriptive cross sectional study design was employed on 367 sampled undergraduate science students of Oduduwa University aged 16-30using sample of convenience. The data was collected usingself-administered questionnaires and data analysis was done using SPSS version 22. The level of significance was set at p < 0.05. Results: The prevalence of depression, anxiety and stress among these science students were 62.6%, 67.8% and 17.8% respectively. Academic performance was found to be significantly associated with depression. Family economic situation was found to be significantly associated with stress. Marginal significant association was found between ethnicity and depression and between parent marital status and stress. No other factors have been found to be significantly associated. Conclusions: There is a high prevalence of depression, anxiety and stress symptoms among the university students. This stands as a great concern in public health. Therefore, there is need for concerted efforts, preventive measures and sufficient supportive services to be put in place for this group. Keywords: DASS 21, depression, anxiety, stress, university students, Nigeria.  
302 Knowledge, Attitude and Acceptability of Premarital Genetic Services for Sickle Cell Disease among Undergraduates of a Nigerian Private Tertiary Institution , Olufisayo. A Bademosi, Titilayo Olaoye, Saratu. O Ajike
In Nigeria annually, 150,000 children are born with sickle cell anemia. One way of preventing sickle cell disease is through premarital genetic counseling and screening. This study therefore assessed the knowledge, attitude and acceptability of premarital genetic services for sickle cell disease among Babcock University Undergraduates. The study was descriptive and cross sectional in design. Three hundred and seventy seven respondents were randomly selected using multistage sampling technique. Data was collected using a validated semi-structured questionnaire that was self-administered with a Cronbach-Alpha test of 0.747. It was analyzed using the statistical package for social science (SPSS) version 21 to generate descriptive and inferential statistics. The results showed that more than half 229 (60.7%) of the respondents were females while 148 (39.3%) of the respondents were males. Three hundred and fifteen of the respondents were between the age range of 16-20 years with the mean age of 18.99 and SD±0.107. 363 (96.3%) of respondents had heard of sickle cell diseasewhile, 229 (60.7%) agreed that intending couples should attend premarital genetic services and thus showed positive attitude. Another 350 (92.8%) of the respondents would undergo premarital genetic services if it is available. There is a significant difference between knowledge and acceptability of respondents towards premarital genetic services (P= 0.047) In conclusion, the respondents had a high level of knowledge and acceptability on premarital genetic services and sickle cell disease. All sectors should increase efforts in creating awareness about premarital genetic services and locations. Keywords: Premarital, genetic services, Knowledge, Acceptability, Attitude, sickle cell anemia  
303 Evaluation of Prevention of Mother to Child Transmission of Human Immunodeficiency Virus Program (Option B+), Kadoma City, Zimbabwe, 2016 , Pamela Nyaradzai Magande, Notion Gombe, Donewell Bangure, Mungati More, Tshimanga Mufuta, Daniel Chirundu
Background: In 2013, Zimbabwe adopted Option B+, lifelong anti-retroviral therapy (ART) for all pregnant and breastfeeding HIV positive women and Nevirapine prophylaxis for their infants as a PMTCT method. Kadoma city started implementing the same in 2014. An evaluation was done to assess progress and determine reasons for loss of follow-up to advice and improve the program. Methods: A process-outcome program evaluation using a logical framework was conducted. Pretested interviewer administered questionnaires, checklists and monthly reports were used for data collection. Epi Info 7 was used to calculate means and frequencies. Microsoft-Excel 2013 was used to consolidate monthly reports. Results: Thirty health workers and 43 Option B+ clients were recruited. Although resources were limited, all the 324 women who tested positive in 2014 and 2015 received ART. CD4+ monitoring increased from 54% in 2014 to 65% in 2015. All the 240 exposed infants identified within 72 hours received Nevirapine prophylaxis in 2014 and 2015. HIV positivity at six weeks in infants decreased from 4% in 2014 to 2% in 2015. Reasons given by health workers for loss to follow-up were: clients’ limited understanding (37%), poor tracking mechanisms (23%), mobility of clients (20%), religious beliefs (17%) and side effects (3%). Clients’ involvement in community support groups was poor (3%). Conclusions: Despite limited resources, there was an improvement in Option B+ services. Reasons for loss to follow-up include poor tracking mechanisms, clients’ mobility, religious beliefs and side effects. Clients have been referred to community support groups and retention has improved. Keywords: PMTCT, anti-retroviral therapy, Option B+, Kadoma, Zimbabwe  
304 Assessing Knowledge and Practice of Prevention of Mother to Child Transmission of HIV Documentation among Health Workers in Oyo State, South West, Nigeria , Michael Olabode Tomori  
Prevention of mother to child transmission of HIV (PMTCT) programme in Nigeria started in July 2002 with the goals of providing effective PMTCT services for women in the reproductive age group in selected health facilities while providing useful information for policy formulation and decision on intervention for comprehensive PMTCT in Nigeria. However, most of the health workers documenting the PMTCT programmes in the health facility lack the required skills and capacity in offering PMTCT services and effecting efficient documentation of programme activities. Information on the knowledge and practice of PMTCT documentation among health workers in Oyo State was obtained through administration of close-ended questionnaires to the respondents in 113 health facilities. The study concluded that most of the health workers have good knowledge of PMTCT documentation with those working in the public facility having better understanding than those in the private facility. In addition, most of the respondents lack proper understanding of PMTCT HIV testing algorithms. However, private facility will benefit tremendously from further training on documentation and serial HIV testing. Keywords: HIV; PMTCT; Nigeria; Knowledge; Practice; Health workers; Public; Private; Facility  
305 Public Health Aspects of Refugee Health: A Review of the Evidence on Health Status for Refugees Globally , Krishan Puri  
Introduction: Asylum seekers and refugees are identified as those who did not make voluntary choice to leave their origin country and cannot return home safely. Internally displaced persons and refuges are extremely vulnerable to human rights abuses, especially the absence and denial of mental and physical health care. For more than 50years, the fundamental framework of refugee protection has been established and accepted globally. The lack of respect to human rights of refugees and failure to provide adequate humanitarian help such as health care. The Geneva Conventions, the Universal Declarations of Human Rights, Statute of the office of the United nations High Commissioner for Refugees, and the Convention Relating to the Status of Stateless Persons, all establish international standards for private and governments organizations that set guidelines for assimilation and repatriation of refugees that create international standards. Methods: The study was conducted through a systematic literature review of articles dating between 2001 and 2015 on Embase, PsychInfo, Medline and Cochrane Controlled Trials, UNHCR, IOM and World Health Organization databases. The study decided on the articles to review by reading abstracts to determine inclusion of data about the health status of either the internally displaced person or the refugees. The abstracts were selected randomly and independently. A limited random search of the reference lists of all included studies was also undertaken. And also few English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Results: The internally displaced people’s and refugees are extremely vulnerable to human rights abuses From the research, it is clear that across the globe, access of primary healthcare amongst the refugees is overwhelmingly shaped by the regulations of the migration process and legal frameworks of individual states and nations. The study discusses that there is a primary need for advanced communication with refugees and coordination of activities between agencies either public or private within and beyond the health care structure. The study seeks to unveil the channels that create the neglect of refugees’ right to a chance of survival. The study recommends that improved data are imperative towards supporting inter-sectorial work in addressing health care needs of refugees. Keywords: Refugee health, public health, migration health, healthcare, global  
306 The Various Misconceptions of Bipolar Disorder in Barbados , Marlo A.R Browne  
Bipolar disorder, also known as manic depressive illness, is a complex, chronic and severe mental health disorder that is characterized by episodes of mania, depression or a combination of both. The study seeks to examine the plethora of current and prevalent misconceptions perceived by members of the general population within the Caribbean country of Barbados. Different research methodologies were employed for the purpose of the study, including the conduction of the survey, which illustrates the general misconceptions, held by the Barbadian public, as well as interviews with local mental health professionals to discredit these misapprehensions. Four hundred people completed the survey. Results indicate that there is a percentage of the population which understood the disease, but which believes that effective knowledge dissemination was the key to the increase of awareness and the reduction of the misconceptions, as well as the fact that females were susceptible to the disorder, especially during the ages of 25-29. Keywords: Bipolar Disorder, Misconceptions, Barbados  
307 Knowledge of Auxiliary Healthcare Workers on Injection Safety and Biological Waste Handling in Taraba State, Nigeria , Danung Monday Langche, Jegede Feyisayo, Usman Abdulrasheed
Background: Individuals working in healthcare settings occasionally are at risk of infections as a result of exposure to certain diseases causing agents. However, in most developing countries attention on prevention is mainly focused on skilled healthcare workers (HCWs) with “neglect” of auxiliary health workers (AHWs) who may not be knowledgeable on job health hazard and carries high risk of exposure to infectious agents. Objective: To assess knowledge of auxiliary healthcare workers on injection safety and biological waste handling as well as attitude towards post exposure prophylaxis in the event of any exposure. Methods: A descriptive cross-sectional study conducted among AHWs on knowledge on injection safety and biological waste handling in June 2016. Participants included ward orderlies (WOs), lab attendants (LAs), compound laborers (CLs), theater attendants (TAs) and laundry personnel (LPs) randomly selected. A semi structured questionnaire administered to consented respondents. Data was presented as descriptive analysis and percentage compared using Chi-square test with significant level 0.05 at 95% Confidence interval. Results: A total of 68 auxiliary healthcare workers consisting of male 44.1% (n=30) and female 55.9% (n=38) were interviewed. Respondent’s mean ± (SD) age was 31± 5.30 years and ranged from 27- 55 years. Knowledge on injection safety and biological waste handling among AHWs showed (WOs) 42/68 (61.7%), (LAs) 5/68 (7.4%), (CLs) 9/68 (13.2%), (TAs) 5/68 (7.4%) and (LWs) 7/68 (10.3%). A significant difference in knowledge on injection safety and biological waste handling among AHWs was observed. (X2= 1.56, df 4, critical value 9.488 at 95% confidence level. Conclusion: There is low level of knowledge on needle stick injury (NSI), biological waste handling and poor attitude towards PEP among auxiliary healthcare workers in GH Wukari and GH Zing. Keywords: Knowledge, Auxiliary, Biological, Injection, Waste, Safety  
308 Effective Communication as a Panacea for Gaining Acceptance of Hospital Services by Clients , Onwubiko Iheanyichukwu Samuel  
Health communication is essential in providing avenue for effective dissemination of health information in order to improve healthcare delivery. Lack of effective communication between healthcare providers and their clients especially in secondary health facilities has impeded the effective and efficient delivery of quality healthcare. The objective of this study is to demonstrate effective communication as a solution for clients to accept quality healthcare services. A descriptive cross-sectional study of three secondary health facilities in Northern Cross River, Nigeria. Population of 2050 in 3 facilities with sample size (n) of 335 allocated 147, 57, 98 and 33 among the 3 facilities and staff categories respectively. Systematic sampling technique was used and semi-structured self-administered questionnaire for data collection. Data analysis was done using statistical package for social science. Non-parametric statistics was used in the analysis as data was categorical and not normally distributed. Out of 335 respondents, 278 completed the questionnaire giving a response rate of 83%. Modal Age group is 25-34 (29.5%) and Modal level of education is tertiary (38.5%). Majority of clients (53.6%) concurred to good communication skills (listening skills and allowing feedback from patient) from healthcare providers improved acceptance to healthcare delivery (P=0.019). Majority (45.3%) who confirmed friendly approach of health workers maintained them as their health providers. Effective communication is key to acceptance of services rendered to clients by healthcare personnel and also, for clients to have a positive perception of services rendered. Keywords: Communication barriers, communication tools, acceptance, healthcare delivery, healthcare provider, cross river,  
309 Risk Factors of Type 2 Diabetes among Mbororo Population of Guiwa-Yangamo Village in the East -Cameroon , Judith Maka, Félix Assah, Clarisse Mapa-Tassou, Clément Kufe, Akenji Siri , Jean-Claude Mbanya  
In the world in 2013, Diabetes affected 382 million of people, and 316 million were at risk of developing it. Diabetes was responsible for the dead of 5 million persons aged 20-79, that was 8,4% of the world’s mortality for this age range (1). Type 2 diabetes is the most common type and is the challenge of the 21st century for health (2). Its risk factors like obesity and complications like limbs amputations and others cost much (3). It therefore presents a severe health problem for the population with low socio-economic level and disfavored groups. Described by the WHO, the minority « Autochthones », « Aborigines » or « Indigenous » people know the abnormal high of prevalence, complications, risk factors, and a high mortality compared to non autochthones of the same age group (4),(5). In 2007, the United Nation Organization launched the declaration of the right of these 5% of the world’s population who experiencing many Burden (6). In the Sub Sahara Africa, the word « Indigenous » is contested (7),(8)and the scarcity of data on diabetes in this « indigenous « community makes the situation of diabetics complex in the « massai » of Kenya, « pygmies » and Mbororo » of Cameroon, and « San » of South Africa; these could compromise the effectiveness of the health services (9)and the stable development(10).  
310 Review of Maternal Mortality and Near-Miss Events in Kintampo Municipality in the Brong Ahafo Region of Ghana , Gabriel Opoku  
Background: Ghana is one of the countries associated with high maternal deaths and near-miss events. This country has adopted the millennium development goals including reducing maternal mortality by three-quarters, and put improvement in maternal health as one of the health sector development programme performance indicators. The purpose of the study was to review maternal mortality and near-miss events in Kintampo Municipality in the Brong Ahafo Region of Ghana in the past 5 years. Objectives: The measurement of the study were antenatal and postnatal services family planning and abortion practices, delivery care, education and information services, delay in reaching health facility and facility delay Methods: Study participants were 196. Secondary data was used to collect information at facility level of which 16 health staff took part. In all, 30 maternal deaths and 45 near-misses from 2007 to 2011 were reviewed. Verbal autopsy was used on 180 participants from 5 communities. Results: 92% of maternal deaths occurred among young adults. 73% were in critical condition upon arriving at the hospital. 97% of the death occurred at the health facility. Attitude of health staff and inadequate maternal health services were significantly associated with maternal deaths. 90% were not practicing family planning. 48% of them have practiced unsafe abortion before. Facility delay is significantly associated with maternal death and near-miss events Conclusion: The results of the study can stimulate a change in clinical practice. The study can be used as a quality improvement tools in facilities.  
311 Factors Associated with Adherence to Sickle Cell Crisis Preventive-Practices among Youths of Sickle Cell Clubs in Abeokuta, Ogun State, Nigeria , Nnodimele O. Atulomah ,Elizabeth O. Oyeneye
Adherence to sickle cell crisis preventive-practices is a major problem in at-risk population. Evidenced-based studies on factors associated with adherence to crisis prevention are few. This study sought to explore how the Information-Motivation-Behavioural Skill (IMB) model can provide understanding of underlying factors associated with adherence to crisis-preventive-practices behaviour among youths with sickle cell disease in Abeokuta, Nigeria. This cross-sectional descriptive study employed a validated 43-item questionnaire to collect information from 84 participants who consented about crisis-risk prevention. Variables in the study were information, motivation, self-efficacy and adherence behaviour and measured on a 10-, 36-, 15- and 21- point scale respectively. Correlation and regression analysis was used to test for association, significance and prediction of best pathway to adherence with a cut-off at p≤0.05 level of significance. The Mean Age of the participants was 20.07(0.69) ± 6.28 with 40.5% males and 59.5 % females. Majority were Yoruba and single with minimum of secondary school education. The sample mean scores reported for knowledge about crisis-prevention in sickle cell disease was 7.93±1.22, motivation was 30.07 ± 4.67 and self-efficacy skills were 11.88 ±2.88. The Adherence behaviour mean score was 11.23 ±3.30 giving a behaviour prevalence rate of 53.5%. Motivation was significantly associated with self-efficacy skills and adherence behaviour, while information was not significantly associated with either. Self-efficacy skills were significantly correlated with adherence behaviour. Path-analysis showed that the combined motivation and self-efficacy adherence behaviour (r2=0.34). Findings showed that an informed and motivated sickle cell youth with good self-efficacy skills will adhere better to the crisis prevention-practices. The study recommends that counselling that provides information should be motivational to build self-efficacy that promotes crisis-prevention behaviour. Keywords: Sickle cell crisis, preventive-practices, Information, Motivation, Adherence behaviour, Self-efficacy skill.  
312 Prevalence of Undiagnosed Diabetes Mellitus amongst Hypertensive Patients Attending an Outpatient Clinic in Harare, Zimbabwe , Pasipanodya Ian Machingura, Rosinah Murambiwah  
Diabetes mellitus is amongst the largest health emergencies of the 21st century. However studies have reported that a substantial proportion of people with diabetes mellitus had not previously been diagnosed. On the other hand hypertension prevalence has been reported to be on the increase. Hypertension has also been associated with the development of diabetes mellitus. The study sought to determine the prevalence of undiagnosed diabetes mellitus in hypertensive patients attending an outpatient clinic in Harare, Zimbabwe. A cross sectional study was conducted at Parirenyatwa Group of Hospitals Outpatient Clinic. All hypertensive patients attending the outpatient during the study period were given the information about the study. All hypertensive patients who were previously not diagnosed of diabetes mellitus who consented to participate in the study were consecutively enrolled. A questionnaire was administered and blood samples were collected for Glycosylated hemoglobin analysis. Glycosylated hemoglobin was analysed using a Mindray BS800 Chemistry Analyser. One hundred and four hypertensive patients were enrolled into the study whose mean age was 60.91(± standard deviation of 14.06) years. Patients with duration of hypertension greater than 10 years constituted 34% (35) of the study population. The prevalence of undiagnosed diabetes mellitus was 22.1% (23). Among the previously undiagnosed diabetic patients 56.5% (13) were females and 43.5% (10) males. The prevalence of undiagnosed diabetes mellitus was found to be 22, 1% among hypertensive patients which is higher than that reported in Kenya but lower than that reported in Uganda. Diabetes mellitus can be highly prevalent in hypertensive patients thus there is need for constant monitoring for the development of diabetes mellitus and further research using a national representative sample. Keywords: Diabetes mellitus, pre-diabetes, glycosylated haemoglobin  
313 Evaluation of Pharmaceutical Waste Disposal Practices in Healthcare Facilities in Lagos State, South West Nigeria , Margaret Okama Obono  
The objective of this study is to find out how unused, expired, damaged and unwanted medicines are handled and disposed of in health facilities in Lagos State, South West Nigeria. An average hospital stocks between 2000 to 4000 drug items for use by patients at any point in time. Hospitals and households have been identified as the largest source of Pharmaceutical waste going into the sewer system. A large quantity of Pharmaceutical Waste generated in hospitals include regulated hazardous and non-regulated hazardous Pharmaceutical waste and a significant amount of these have been found in underground water and drinking water. 195 health facilities made up of 5 tertiary teaching/specialist hospitals, 25 secondary healthcare facilities and 165 primary healthcare centres were evaluated using structured questionnaires to collect data. Data were analyzed using SPSS version 20. Results show that 85% of disposal of pharmaceutical waste was done by open burning, a method that causes air pollution. There was no significant association between category of Health Facility and method of disposal of pharmaceutical waste. Less than 10% of Health Facilities had Pharmaceutical Waste Disposal(PWD) programmes in place.15% of respondents see the need for designated drug take – back centres and will consider establishing one. The need for additional training on PWD was identified. Keywords PHARMACEUTICAL WASTE:- Solid, liquid or gas waste from Pharmaceutical products that can pose a substantial hazard to human/animal health and the environment when not properly managed (40 CFR part 261). HAZARDOUS WASTE:- Wastes with properties that make the product dangerous or potentially harmful to human health or the environment. HAZARDOUS WASTE LANDFILL:- A disposal facility where hazardous waste is placed in a land treatment facility, a surface impoundment, an underground injection well, a salt dome formation, a salt bed formation, an underground mine, a cave or a corrective action management unit (40 CFR 260.10) DRUG TAKE –BACK EVENTS: - Any programme or series of programmes organized by the Drug Enforcement Administration (DEA).Drug takes back initiative on which the public can return unwanted, unused or expired drugs. LISTED HAZARDOUS WASTES:- Materials specifically listed by regulatory authorities as waste from non-specific sources, specific sources or discarded chemical product. OTC MEDICINES:– Over -the- counter drugs that can be sold directly to a client without a prescription from a healthcare professional.  
314 Need, Demand and Supply of Health Care in Regards to Growing Emerging and Reemerging Diseases in Sub-Saharan Africa , Medang Raphael
Need in relation to health care, has generally been defined as the amount of medical care that medical experts believe a person should have to remain or become as healthy as possible, based on a current medical knowledge. This is also true for the individual and for the entire community. Thus, if a problem, a barrier or difficulty continues to exist on the path to accession to a higher level of health, the need exists. In “The definition and identification of need for health care[1],” Acheson stated that there exist four phenomena underlying health needs including: - the risk of pain and illness (in the sense of discomfort, or "malaise") - the risk of sickness - the inadequacy and deficiency - the mortality risk. Finally, although certain health needs are expressed, they do not correspond to real needs. This would provide different areas related to health interventions, including: The ideal zone (a need corresponds to an expressed demand and adequate health action); The area of ​​non-use (a health action not corresponding to any demand); Non-use of family planning services in both high population growth areas but also high poverty The waste area (a health action corresponding to a demand but with no corresponding need); The prescription of laboratory tests and other unnecessary medical procedures in response to public solicitation, especially persons holding health insurance The discontent area (a demand triggered by a real need, but to which no health action is taken); The recurrence of malaria cases in one region, and the desire by local residents, to have currently non-existent measures, to be taken by health and government authorities, on the environmental and sanitation plan.    
315 Sexual Behaviors and Pregnancies of in School and out of School Adolescents in Kavango region, Namibia , Taimi Amakali-Nauiseb, Honore K.Mitonga  
The objective of this study is to determine the sexual patterns among their school and out of school adolescents in Kavango region, Namibia and identify the association between the socio-demographic characteristics of the adolescents and their sexual behaviors. A cross-sectional analytical study was conducted using mixed methods - quantitative and qualitative approaches among 350 school learners (grade 6 to grade 12) and 150 school dropout adolescents (aged 12 to 18 years). The stratified random sampling techniques were used in the selections of the circuit and the schools. Structured questionnaires were used in face-to-face interviews, and in depth interviews were conducted among the key informants (teachers). The following variables include the demographics (age, grade, parent marital status, and school drop-out status), sexual behavior (age at first sexual intercourse, number of sexual partners, abortion, and age at abortion), economic (employment, financial support). Descriptive statistics was used to summarise the above-mentioned variables. Cross-tabulations of demographic, sexual and economic variables were used to describe the relative frequencies. The associations between different categorical variables were assessed using Chi-square test whilst the identification of different determining factors was analyzed with the epidemiological methods using odds ratios and/or estimated relative risks. The means, standard deviation and 95 % confidence interval were computed. The differences between different variables or factors were considered to be statistically significant for p-values less than 0.05. The study found that early sexual debut, first sexual intercourse, number of sexual partners, relationship with sexual partners older than 5 years and dropping out of schoolwere associated with adolescent pregnancy in Kavango region. Keywords: Adolescence, Adolescents, Reproductive health, Sexual behaviors, Sex education.  
316 Potential Risk Characteristics of Adolescent Pregnancy in Schools and out of school in Kavango Region, Namibia , Taimi Amakali-Nauiseb, Honore K.Mitonga
The objective is this study is to determine the potential risk characteristics among the in-school and out of school adolescents in Kavango region, Namibia. A cross-sectional analytical study was conducted using mixed methods - quantitative and qualitative approaches among 350 school learners (grade 6 to grade 12) and 150 school drop-out adolescents (aged 12 to 19 years). The stratified random sampling techniques were used in the selections of the circuit and the schools. Structured questionnaires were used in face-to-face interviews, and in depth interviews were conducted among the key informants (teachers). The following variables include the potential risk characteristics alcohol used, drug used, marijuana used, more than one sexual partner in past 12 months, partner older than 5 years, orphan, abortion, sex regularly, mothers education, contraceptive used, current pregnancy and outcome of birth. Descriptive statistics was used to summarise the above mentioned variables. Cross-tabulations of demographic, sexual and economic variables were used to describe the relative frequencies. The associations between different categorical variables were assessed using Chi-square test whilst the identification of different determining factors was analyzed with the epidemiological methods using odds ratios and/or estimated relative risks. The means, standard deviation and 95 % confidence interval were computed. The differences between different variables or factors were considered to be statistically significant for p-values less than 0.05. Keywords: Adolescence, Adolescents Contraceptives, First intercourse, Sexual health, Sexual partner.  
317 Risk Factors for Contracting Malaria in Nyanga District, Zimbabwe: a Case Control Study , Mashizha S, Gombe N T, Gunda T
Introduction: A review of Nyanga District malaria weekly surveillance data showed that malaria cases had surpassed the thresholds from week 4 confirming that an outbreak was underway. We investigated the outbreak to determine risk factors associated with contracting malaria. Methods: A 1:1 Unmatched Case control study was carried out in Nyanga district. Interviewer administered questionnaires and WHO adapted Integrated Disease Surveillance and Response (IDSR) checklists were used to collect information on risk factors and on outbreak response. Data were analysed using Epi-Info 7 statistical software. Results: Eighty three cases and 83 controls were enrolled into the study. Most (76%) of the under 5 year cases came from villages across the border in Mozambique. Presence of stagnant water bodies near home [OR= 11.06; 95%CI (2.32; 52.68)] was associated with contracting malaria. Consistently sleeping under a net [OR= 0.13; 95% CI (0.03; 0.59)] Use of mosquito repellents [OR= 0.16; 95% CI (0.04; 0.58)] and having received health education on malaria in the past year [OR= 0.19; 95% CI (0.07; 0.52)] were protective against contracting malaria. Conclusion: The district was not prepared for the outbreak and the outbreak mainly affected children under five years from Mozambique. The risk factor for contracting malaria during the outbreak was presence of stagnant water bodies near homes which facilitated breeding of the vector. Consistently sleeping under a mosquito net, use of mosquito repellents and reported history of receiving health education on malaria in the past year were protective. As a result of this study health education was given to the community. Keywords: Thresholds, Malaria, Case Control, Risk Factors  
318 Perception of Health Care Workers on Prevention and Treatment of Uncomplicated Malaria in Pregnancy , Vakkai Dominic Esther  
Introduction: Malaria is the commonest endemic disease, and the most vulnerable group of persons affected by malaria is the pregnant women. This has posed serious public health challenge in Nigeria; it is with these considerations that the Nigerian Government in the past few years has renewed efforts towards controlling malaria. Several interventions have been introduced amongst which were the introductions of Artemisinin-based combination therapies (ACTs) and massive distribution of long lasting insecticidal nets. Statistic has shown that 8 million women are pregnant every year in Nigeria and about 545 women out of every 100,000 die as a result of pregnancy-related complications. Objectives: This study was done to ascertain the Diagnosis and treatment characteristics of malaria in pregnant women and assessed the training, work experience, knowledge, and perception of health workers regarding malaria in pregnancy, in North Western Nigeria. Method: Arandom sampling method was carried out across 10 local governments and 15 health facilities in North Western Nigeria. Two participants from each facility gave a total of 300 health care workers recruited into this study. Results: 91% of the participant believe that RDT /microscopy is the appropriate test for malaria; 38% of them agree that the test miss malaria cases while 14% believe that treatment should be given to a client that test Negative to either of the test. 37% of the participant prescribed Quinine, while 48% of the participant will prefer ACT and the least 2% will still go for Chloroquine. Conclusion: This study exposed the under-diagnosis as well as miss treatment of malaria in pregnancy and the need for training and retraining of health care workers as well as establishing the malaria diagnosis quality assurance program to ensure the accuracy of malaria microscopy and RDT results at all levels.  
319 Barriers to Prompt Malaria Diagnosis and Effective Treatment among Children Under Five Years of Age in Mpika District , David Silweya  
Background: Prompt malaria diagnosis and effective treatment, is a key malaria control strategy which reduces morbidity and mortality in many settings. However, in Zambia studies show that, only 19% caretaker of children under five years of age accessed prompt and effective treatment in 2010 at health facilities. The factors contributing to this problem are not well understood in Zambia. The objective of this study is to determine barriers to prompt diagnosis and effective malaria treatment among children under the age of five years in Mpika district. Methods: An analytical cross section study was conducted in Mpika district of Zambia using both the quantitative and qualitative methods with sample size was 380 caregivers and 8 Focused Group Discussions (FGDs) respectively. Results: The study found that only 13.9% of children diagnosed with malaria received prompt malaria treatment. The following variables were found to significantly predict uptake of prompt malaria treatment; distance of less than five kilometers to the health facility (Adjusted OR 2.45 95%CI: 1.22 – 5.11 P = 0.012, adequate household income (AOR 2.27 95%CI: 1.18 – 4.39 P = 0.014), first action being; taking the child to the health facility (AOR 2.45 95%CI: 1.26 – 4.76 P = 0.008 and having health education (IEC) done in the community (AOR 2.14 95%CI: 1.10 – 4.13 P = 0.024). Non availability of antimalarial drugs at health facilities and self-treatments with antipyretics or herbal medication were reported in FGDs to be associated with delays in seeking appropriate malaria treatment. Conclusion: The findings of this study highlight the barrier that exits in accessing prompt malaria treatment in a rural setting of Zambia. It underscores the need to formulate and implement interventions aimed at fostering appropriate health seeking behaviors in caretakers of under five children through community health education and addressing socio-economic barriers that exits in rural setting.  
320 Healthcare Waste Management Practices in Jalingo: A Reflection of the State of Healthcare System in Taraba State, Nigeria , Paul Rambe Yunana  
A strong healthcare system is known by efficiency in service delivery through its individual components. The poor quality service delivery by any of these components is a reflection of the degree of its weakness. To achieve a strong health system that will provide efficient and effective health services, there must be a deliberate effort towards strengthening the system and continuous improvement of quality of services in each component at all levels. Previous studies in some hospitals in central and southern parts of Nigeria revealed poor knowledge and waste management practices. The study was undertaken to assess healthcare waste handling practices in some selected hospitals in Jalingo Taraba state and appraise how the poor health system is reflected in this area of service delivery. The assessment was conducted by extensive review of literature on Nigerian health system as relates to healthcare waste management practices; and by direct observation of waste handling practices in those hospitals, compared to standard practices of healthcare waste management. The results revealed that the healthcare waste management in those health facilities is far below WHO standards. This is attributable to the weak and poor healthcare system in the state and the country. Having an implementable hospital waste management plan, training healthcare workers of all cadres on proper waste management and regular supervision by health facility management were recommended as measures to improve healthcare waste management in the state, which is also a way of health system strengthening through this aspect of service delivery. Keywords: Healthcare, Inefficiency, Waste Management, Quality Service, System Strengthening.  
321 Knowledge and Practices Regarding Psychosocial Aspects of Palliative Care among Healthcare Workers in Ohangwena Region, Namibia , Hileni Niikondo, Kabwebwe H. Mitonga
In Namibia, palliative care service is necessitated by the situation of progressive life limiting illnesses, which demand access to psychosocially appropriate holistic palliative care. Little is known about the knowledge and practice of healthcare workers on the psychosocial aspects of holistic palliative care. This study was conducted to critically analyze the knowledge and practice of healthcare workers on psychosocial aspects of holistic palliative care and identify their training needs. A cross-sectional analytical study was conducted in the public health facilities in Ohangwena region, amongst the randomly selected sample of 56 healthcare workers. Structured questionnaires were self administered to capture the respondent’s knowledge and skills. Respondents mean age was 36.2 ± 9.81.Male respondents were 20 (35.71%) while female were 36 (64.29%). Of the 56 healthcare workers who participated in the study, 2 (3.6%) were medical practitioners, 44 (78.6%) nurses, 1 (1.8%) physiotherapists, 3 (5.4%) social workers and 6 (10.7%) pharmacists. Mean years of professional experience was 9.43± 9.62. Most healthcare workers 39 (69.6%) indicated not received any training on holistic palliative care. Knowledge of correct classification for morphine was associated with access to internet (p<0.05). There was a significant association between those confronted by palliative care situation and knowledge of morphine (p<0.05). Knowledge of pain intensity among children was significantly associated with access to internet (p=0.01). Healthcare workers lack knowledge in the psychosocial aspects of holistic palliative care which can implicate the quality of care to patients. This study suggested training of healthcare workers as well as internet access. Keywords: Palliative care, healthcare workers, knowledge, psychosocial care, pain, training  
322 Passive Smoking and its Effects among Children of a Rural Population in South Tamilnadu, India , Pethuru , Arya Rajendran, Akhila Vinod, Annu Ann Zachariah, Anoop S., Aarthy T., Annie Rexalin Pradeepa T., Akhila PM
Tobacco kills nearly 6 million people each year. Passive smoking is a major hazard to the health of millions of children worldwide. Globally, an estimated 40% of children are reported to be exposed to passive smoke. Adverse effects of smoking in rural population are well studied in any parts the world. But the impact of passive smoking on the children is not widely studied. Objectives: This study was carried out with the following two objectives: 1) To determine the prevalence of passive smoking among children in a rural population in South India and 2) To find out the effects of passive smoking on children in the study population. Methodology: This is a community based cross sectional study. It was carried out in Marappadi village in Kulasekharam Panchayat, Kanyakumari District, Tamilnadu in October 2014. 150 children under 15 years in the village were approached at their houses, with questionnaire for socio demographic details and passive smoking history. Apart from this the history of Low birth weight, Growth retardation, and number of URTIs, LRTIs, Ear Infections, Allergy and Asthma episodes were elicited. Data collected was entered in Excel spreadsheet and Analysis was done using SPSS version 16. Results: There were 150 under 15 children in the study which were collected from 96 households. They were 82 (54.7%) males and 68 (45.3%) females. Passive smoking was present in 32 (21.3%) children. Overcrowding was present in 61 (40.7%) children’s houses. 64 (42.7%) children didn’t have adequate ventilation. Smoke from kitchen was present in 126 (84.0%) houses. 40 (26.7%) of the households were having anti mosquito usage in their house. The number of URTIs was significantly more with children having history of passive smoking as denoted by significant p- value is 0.002. Asthma was present in 20 (13.3%) of children; ear infection was there in 6 (4.0%) children and Allergy was present in 18 (12.0%) children at the time of study. They were more with children having history of passive smoking by looking at the simple percentages. But they were not statistically significant (p – value > 0.05). Conclusion: 1) The prevalence of Passive Smoking in the study population is 21.3%. 2) Environmental risk factors like Overcrowding, Lack of adequate ventilation, Smoke from kitchen and Anti Mosquito smoke are significantly more associated with children having Passive Smoking. 3) Upper Respiratory Infections are more significantly associated with those who have history of Passive Smoking. Keywords: Passive Smoking, Rural Population, Smoking among Children, Smoking complications, Rural India.  
323 Assess knowledge, attitude and practice regarding Cigarette and Other Tobacco Products Act (COTPA) and tobacco related health problems in rural setting of Bihar, India , Rajendra Kumar Singh  
Tobacco addiction is most widespread addiction and it is the most important cause of death in the world. A cross sectional community based study was conducted in Buxar district of Bihar to assess knowledge, attitude and practice regarding Cigarette and Other Tobacco Products Act (COTPA) and tobacco related health problems in rural setting of Bihar, India. Data regarding awareness about tobacco control law in India, tobacco related health problems, attitude regarding tobacco control law and information on tobacco use were collected by interview method using a questionnaire. The study shows that awareness of COTPA is low, although knowledge and perception about certain components of the COTPA is relatively higher. Attitude and beliefs of participants regarding COTPA showed that at least half of the participants agreeing that provisions were successful in curbing the consumption of tobacco. The mean scores for knowledge, attitude and practice section did not show any statistically significant difference between tobacco users and non-tobacco users after adjusting for sex, age group, occupation. The data shows significant difference in mean score of attitude section between tobacco users and non-users after adjusting for the education status of the individual, no such difference in seen in knowledge and practice totals. The survey has pinpointed clear areas where a huge gap in knowledge exists; which could be fixed by effective public private partnership. The availability of adequate knowledge and information will lead to change in the attitude regarding consumption of tobacco products in rural India. A cross Sectional Study in rural population for knowledge, Attitude and Practice of Cigarettes and Other Tobacco Products Act among population of Simri village of Simri Block in Buxar district of Bihar in India.  
324 A Study Protocol to Assess Accessibility, Utilization, and Compliance on Adolescent Sexual Reproductive Health Services in South Sudan Context , Katwesige wycliff  
Introduction: Provision of Sexual reproductive health (SRH) to people living in complex humanitarian emergencies is quite challenging. According to World Health Organization (WHO), addressing the health needs of adolescents living in crisis and fragile settings is a fundamental step on the pathway to both sustain the gains of the millennium development goals and achieve the new 2030 sustainable development goals. South Sudan’s humanitarian situation remains fragile, precarious, complex and uncertain. The capacity of the nation to respond to the health of its people is crumbled. More than 4.9 million People are in dire need of humanitarian assistance, maternal mortality rate is 789, 33% of the population is youth under 24years. There remain uncertainties as to whether the humanitarian response efforts are taking account of adolescent needs. This project will assess the accessibility, utilization and compliance of adolescents (aged 10-19 years) to health services provision within WHO set standards from selected camps in South Sudan. The study results shall inform advocacy and programming of SRH services by humanitarian partners. Methodology: The search criteria will include; Cochrane libraries, PubMed, and others. Literature will be organized and referenced by research software like Mendeley. A cross-sectional study using qualitative and quantitative approaches will be conducted. Results will be analyzed using WHO recommended expand-net framework. Ethics: Participation in an assessment will be voluntary. Parental consent for minors will be obtained before participating in the study. Approval from South Sudan Ministry of Health ethical committee shall be sought.1951 conventions of rights of refugees will be respected. Foot note: The cross-section, Complex. Humanitarian, Adolescent, sexual Reproductive Health, Refugees, South Sudan  
325 Factors Influencing the Purchase of Counterfeit Drugs among Consumers in Rural Community of Cross River State, Nigeria , Agada Peter Okpe, Okareh Oladapo Okareh, Ugobo Emmanuel Eteng
Background: The purchase of counterfeit drugs by consumers is a serious public health problem and there are no sufficient researches dedicated to understanding the problem of drug counterfeiting from the consumers’ perspective. Aim: The aim of this study to assess factors influencing the purchase of counterfeit drugs among consumers in rural community using the concept of planned behavior (TPB) as a guide. Methodology: This study is a cross-sectional descriptive research, using pretested questionnaire for data collection to ensure validity and reliability of instrument. A sample size of 236 was used for this study. Data was analyzed using SPSS version 20.0. Results: The respondents mean age is 30.51years (SD=11.46). Findings from this study showed that 139(58.9%) of the respondents were males while 97(41.1%) were females. Majority of the respondents 56(23.7%) reported the cost of the drug as frequently used means of identification of counterfeit drugs in the community. Respondents perceived associated risk of counterfeit drugs includes: unexpected side effects 33(14%), allergic reactions 38(16.1%), worsening of their medical condition 48(20.3%), death 46(19.5%) and overdose 19(8.1%). Findings from this study also showed a correlation between behavioural intention and attitude (R= 0.64). Subjective norms were associated with behavioural intention (R=0.65) but was not significant at 0.005. There was also an observed significant relationship between behavioural intentions and motivation (R = 0.52). Conclusion: Drug consumers mainly use cost of drugs as a means of identification of counterfeit drugs. Consumers behavior, intention and attitude towards counterfeit drugs are correlated. Keywords: counterfeit drugs, consumers perspectives, planned behavior.  
326 Patient Safety Culture of Iganga, Kamuli Mission and Kakira Hospitals of South Eastern Uganda , Balidawa John  
Background: Health care is one of the most important services that every one desires to be of high quality and safety, but in real practice, this is not always the case. In the event of seeking health care, many patients are harmed and some get serious disabilities or even death. System failures and blame for errors committed are the ones that mostly promote occurrence of medical errors hence resulting into unsafe healthcare. Blame prevents health care providers from reporting errors for future prevention of re occurrence. Patient safety, which is a component of quality healthcare, is defined as the absence of avoidable harm to patients during the process of health care, (Carmen A. n.d.). To achieve 100% absence of avoidable harm to patients is hard to realise as `to err is human` but efforts to avoid harm are of great importance. In developed countries, thousands of patients are reported to suffer serious harm and death in the event of receiving health care services. In 1999, Institute of Medicine in the USA estimated 44,000 to 98,000 preventable deaths annually due to medical errors in USA hospitals, (IOM 1999). In Uganda`s healthcare system, many patients are harmed and many even die during the event of seeking for healthcare but due to poor reporting systems there is limited information on the magnitude of preventable harmful medical errors. The study to determine patient safety culture of Iganga, Kakira and Kamuli Mission in south eastern Uganda, had five objectives of; assessing the knowledge of health workers on patient safety, the role of the hospital management in promotion of patient safety culture, determine patient safety culture practices, point prevalence of common inpatient safety incidents, and causal pathways. Methodology: The study was an observational, descriptive and cross-sectional survey. A sample of 144 health workers were interviewed using a questionnaire, three focus group discussions with hospital managers were conducted, and 169 inpatient records were reviewed. Data was entered in SPSS 16. 0 software then into Excel for further analysis and later presented in graphs. Results: The study revealed that the knowledge of health workers on patient safety in the study hospitals was just above average at 55.8%. Under and over dosing of patients, dispensing of wrong drugs and poor infection control being the most common medical errors known, where as Uganda clinical guideline was found to be the most known guideline for patient safety. The study also showed that, the majority of health workers would not report errors due to ignorance and fear of blame. The study showed existence of team work and channels for communication of patient safety issues between management and staff. However, management role in promotion of patient safety is still demanding as there was limited availability of policies and guidelines, lack of patient safety incident record books and patient safety committees. There existed fairly good patient safety practices as communication, hand washing, dispensing and team work were all above average. However it was found out that poor reporting, fear of blame, under staffing and inadequate waste disposal practices did exist. Incidents of failure to monitor vital signs and delayed investigations were more prevalent in over 70% of all records studied. The majority of the surgical operations were done without pre-operative investigations and had inadequate post operative notes increasing the chances of harm to surgical patients. Causal pathways for medical incidents were mainly lack of guidelines and policies, poor monitoring of adherence to guidelines, limited skills and training of staff, understaffing, heavy workloads, lack of logistics and faultiness of equipments and lack of reporting procedures for patient safety. Conclusion: In conclusion, the level of knowledge on patient safety culture is just average as awareness is still limited. There is a significant lack and limited availability of policies and guidelines, incident record books and committees that promote patient safety. The bad practices of fear to report incidents, under-staffing and fear of blame for errors committed need improvement. Failure to monitor vital signs, difficulty to access high skilled staff especially the medical officers and inadequate post operative notes also need serious attention as they are part of the causal pathways for patient safety incidents in the study hospitals. Provision of policies and guidelines, training of health worker, management leadership and effective communication and monitoring of patient safety in the study hospitals are highly recommended.  
327 Relationship between Climate Change and Health of Adult Residents of Ile-Ife, Nigeria , Ganiyu Abiodun Adedeji  
Background: Climate change has had a profound effect on socioeconomic, cultural, political, technological and even biological nature of man and plants in the world. This study is aimed at investigating the relationship between climate change and health of adult residents of Ile-Ife, Nigeria. Methods: A sample survey method was used with structured questionnaire and oral interview. Random sampling technique was employed to get the sample size of 142. Informed consent of participants was obtained before commencement of the study. 142 questionnaires were duly completed and returned. Data were analyzed using frequencies, mean, standard deviation and percentages. Pearson Product Moment Correlation was employed to find the relationship between the test variables of the hypotheses. Findings: Majority of respondents (48.6%) had tertiary education, 20.4% had secondary education, while 18.3% are illiterate. 42.3% got their information on climate change through radio, while only 4.9% got theirs through research institutes. 54.9% had adequate knowledge about climate change and only 9.2% had very inadequate knowledge. 37.3% experienced malaria and headache together due to climate change, while few (0.7%) experienced skin rashes. Significant relationship existed between the socioeconomic characteristics of the respondents and their present health status (r = 0.348, p = 0.001, α = 0.05). Significant relationship was similarly found between the socioeconomic characteristics of respondents and their perception of the effect of climate change on their health (r = 0.392, p = 0.001, α = 0.05). Conclusion: Climate change had negative impacts on the health of adult residents of Ile-Ife. Governments should ensure preservation of the ozone layer and also increase awareness of the citizens on climate change and the effects on human health. Keywords: Climate, Climate change, Health, Relationship, Adult residents, Knowledge.  
328 The Power of Academic Research for Innovation in Practice and Policy: Systemic Review of Literature , Bala Ibn Shehu Uthman  
The aim of this paper was to explore and present the impact or power of the academic research for innovation in practice and policy, that is, the academic research collaboration in the progress of policy in government and innovation in professional practices with particular emphasis on northern Nigerian region. It is a systemic review type of study design. As a matter of fact, universities and other higher institutions like polytechnics schools, have been serving our societies for virtually a thousand years and we have no doubt in our minds that over that period of time, universities, schools of polytechnic, colleges of higher education and the world have undergone significant transformation mainly due to advancement in research that influence policy formulation and its implementation. It is obviously clear to everyone that, the world is now more complex, more interwoven or inter-connected and changing more rapidly and that we also live in an environment that is coerced by news cycles, passing manners and uncertainty in the futures. Moreover, social structures are changing, as well as values and attitudes. There are also competition that is growing, people are increasingly mobile and the global economic becomes centre of gravity that is changing at a speed not seen before. As such, governments have to address such problems as climate change, potential pandemics of diseases and food insecurity that are global in scope and require a coordinated global response. These are achieved through research (both academic and other form of researches) Natural and man-made disasters are becoming more common and their consequences greater. People everywhere feel under pressure. Change is inevitable and one of the important roles of universities and other higher institutions has been to make some of these changes possible through mostly academic researches that create new understanding, new technologies and the potential for action; and by providing a store of knowledge and capabilities that society as a whole has been able to draw upon. In this paper, therefore, the author reviewed some papers written by other authors on the subject and then expressed the situation obtainable here in Nigeria, the gaps and challenges in the use of academic research in policy development and practice in the area under review. Some recommendations were also made. Keywords: Academic Research, Innovation, Growth and Development, Policy Development.  
329 Role of Counseling in the Disclosure of HIV Status to Sexual Partners among HIV Positive Women Accessing PMTCT Services in South Nigeria , Adetumi Adetunji Subulade  
HIV infection is still associated with a lot of stigmatization and discrimination, which makes it difficult for infected individuals to disclose their status. Many studies have shown different rates of disclosure of HIV status with average of 71% in the developed world and 52% in the developing world (WHO 2004)). Different reasons were attributed to non-disclosure of HIV status which included fear of abandonment, fear of rejection and discrimination, fear of violence and fear of upsetting family members. Counseling is integral to guiding the infected persons to disclosure and a study by Alemayehu et al (2014) in Northern Ethiopia support that counseling is important to HIV disclosure. In ANC in Nigeria, opt out counseling and testing is practiced as recommended by WHO which focused on group counseling, it is however recommended that HIV positive individuals should be privileged to have one on one counseling with counselors to avail them of the opportunity to be properly counseled on the benefits of disclosure and other HIV care (FHI, 2008).  
330 Infant Feeding Challenges Encountered by HIV Positive Mothers in Korogocho Slums, Nairobi, Kenya , Bennadette Mugita Siruri  
Mother to child transmission of HIV is the major route of HIV infection in children and is responsible for nearly 90% of childhood infections. International guidelines on infant feeding for HIV- positive mothers promote exclusive replacement feeding (ERF) or exclusive breastfeeding (Laar and Govender, 2013). In spite of these guidelines, poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Korogocho, with potential detrimental effects on child growth and survival. Rates of exclusive infant feeding, both breast-feeding and formula-feeding, are suboptimal in Korogocho slums with exclusive breastfeeding for the first six months being at about two per cent. (Kimani-Murage et al., 2013). This study was thus carried out with the main objective of assessing the infant feeding challenges of HIV positive mothers in this slum which leads them to practice poor infant feeding. Purposive sampling was used to select the study site and simple random sampling was used to select a sample of 103 calculated using Fischer’s method from a target population of 140. Data was collected using interviewer administered questionnaires and three focus group discussions were conducted. Quantitative data was cleaned, coded, entered and analyzed using SPSS Version 16. Qualitative data was analyzed using a three stage thematic approach through transcription of the tape recordings, summarization, thematical description and direct reporting where necessary. Quantitative data was presented in the form of tables and textual summaries. Results from this study showed poor knowledge of appropriate infant methods as only 46 (44.7%) mothers were satisfied with the infant feeding counseling they had received from the health personnel. Poor clinic attendance by 61(59.2%) of the mothers may have led to short and few sessions and it also affected the time of infant feeding thus the poor quality of counseling. Most of the mothers were aware of mother to child transmission (MTCT) of HIV through breastfeeding and 62(60.2%) knew that it could be prevented through exclusive breastfeeding, 60 (58.3%) through replacement feeding and 54 (52.4%) through early and abrupt cessation of breastfeeding though quite a number lacked this knowledge. The concerns raised by breastfeeding mothers included; 29(56.9%) inability to produce sufficient milk, 23 (45.1%) infections in the baby’s mouth, 19 (37.3%) breast infections and 9(11.8%) inability to control the feeding due to the influence of the extended family. Feelings of guilt 33(94.3%) and cost of replacement feeding 26(74.3%) were the major concerns among replacement feeding mothers. Though 17 (16.5%) had ceased breastfeeding early, up to 15(88.2%) of them lacked advice on the appropriate feeding methods after breastfeeding cessation. Mothers in this study were aware of the WHO recommendations on infant feeding and MTCT through breastfeeding and its prevention. However, they faced several challenges which include poor knowledge on appropriate infant feeding methods, inability to produce sufficient milk, high cost of replacement food and lack of knowledge on appropriate infant feeding practices after cessation of breastfeeding. More emphasis should be put on proper clinic attendance by the mothers as this will provide additional time for the health personnel to provide full information infant feeding. Provision of information on appropriate infant feeding practices after cessation of breastfeeding should be enhanced. Further investigations are required to determine the cause of insufficient milk production by the mothers.  
331 Assessment of Knowledge Attitude Perception and Practice of Health Insurance Scheme among Community Pharmacies in Lagos State , Ukamaka Gladys Okafor  
Introduction: In most developing countries, Nigeria in particular, there is little equity and a clear lack of universal coverage of health care. Majority of the health seeking people first visit the community pharmacies when they are ill, before visiting the hospitals, yet a large percentage of Community Pharmacies are not registered with the National Health Insurance Scheme. The objective of the study was to assess the Knowledge, Attitude, Perception and Practice of the Health Insurance Scheme among Community Pharmacists in Lagos State, with the hope that it would serve as a baseline study towards improving Community Pharmacists’ involvement in the implementation of the Health Insurance Scheme. Method: A cross-sectional descriptive study was carried out on 200 Community Pharmacists in Lagos State using a multi-staged stratified random sampling method and structured questionnaire. Analysis was done with Statistical Package for Social Sciences (SPSS) version 14.0 to obtain the frequencies, percentages and descriptive statistical results. Result: Majority of the respondents were females (60%), in the age range of 41years and above (47%), without additional qualifications (70%), and 73% with more than 16 years post qualification experience. More than 80% had poor knowledge of the major guidelines and activities in Health Insurance Scheme while 86% were neither registered nor participating. Lack of integration among health care providers, lack of prescription from hospitals, need for cumbersome data, inadequate funding and training, lack of capitation for pharmacists were seen as the major hindrances to their participation. Conclusion: The study revealed poor knowledge, attitude, perception and practice of the Health Insurance Scheme, among Community Pharmacists. Adequate training of community pharmacists and funding of the scheme, modifying the payment system to capitation as well as improving coordination, integration and standard of operation of the Health Insurance Scheme will improve their involvement. Keywords: Community Pharmacists, Knowledge, Attitude, Perception, Practice, Health Insurance  
332 Periodical Screening and Health Education at Work: Producing Healthy Workforce , Adegoke Titilayo  
This article investigates the benefit of workplace wellness programs, their prevalence, their impact on employee’s health and medical cost, facilitators of their success in each programs (Workplace Wellness Programs Study Soeren Mattke, et.al.) Workplace-based health and wellness programs (HWPs) may be an obvious yet under-utilized strategy for promoting positive health-related behaviors among older workers and for increasing their ability to continue to work. Given the unprecedented number of older adults who extend their labor force attachment beyond traditional retirement ages, a new vision of older adults’ economic security and overall quality-of-life should take into account the intersections of aging, work, and health.  
333 Knowledge and Practice of Self-medication among Students of School of Nursing in selected schools in Osun State , Abioye Abigail Adebisi  
Self-medication can potentially do well and also harm people. It is a common practice and internationally has been reported as being on the rise. Studies have observed self-medication as a common practice among group of health workers that included dental, midwifery and nursing students. Hence, this study assessed the knowledge and practice of self-medication among students of school of nursing in selected schools in Osun State. It was a descriptive cross-sectional survey. Samples of two hundred nursing students were included in the study using purposive sampling. The result in this study showed that majority (91%) of the nursing students had high level of knowledge and about two third (64.5%) indulge in high practice of self medication respectively. More than half of them signified that presence of minor ailments and having enough knowledge about drugs were the factors that always make them to self-medicate, while more than forty percent indicated that financial constraint, previous experience, time saving, advertisement and unavailability of health care services as factors that sometimes influence self-medication. Significant relationship existed between knowledge and practice of self medication (t = -3.116, df = 198, P < 0.05). Nursing students demonstrated high level of knowledge about medication and its effects. Majority indulge in self-medication practices. Those with high level of knowledge practice of self medication less. It would be safer if those who self-medicate have sufficient knowledge to prevent serious effects. It is recommended that policies be formulated to control the purchase and use drugs. Keywords: Practices of self-medication among nursing students  
334 Prevalence, Knowledge and Perception of Domestic Violence among Women Attending Antenatal Care at Baraudikko Specialist Hospital, Kaduna, Nigeria , Patricial Idoko  
In early Roman Society, a woman was deemed the property of the husband and was therefore subject to his control. The Catholic Church’s endorsement of “the Rules of marriage” in the 15th century exhorted the husband to stand as ‘judge of his wife. He was, to beat her with a stick upon her commission of an offense. According to the rules, beating showed a concern for the wife’s soul. In 18th century France, if it became public that a wife had beaten the husband, he was forced to wear an outlandish costume and ride backwards around the village on a dnkey. It was not until the 1870s that the first states in the US banned a man’s right to beat his family. Violence against women, whether pregnant or not occurs commonly around the world especially the developing world. The act cuts across all ages, cultures, ethnicity religion and educational barriers. Domestic violence refers to any harmful behaviour directed at women or girls because of their sex it is also known as gender based violence. The violence can take various forms, and could be physical, psychological, (emotional) sexual, economic or a combination or even neglect. It can also be in the form of threats of such acts, coercion, or arbitrary deprivation of liberty whether occurring in public or private life. A new dimension has been added now in the form of acid baths used by men especially to discipline women, girls. The prevalence of domestic violence against women ranged between 17-37% with considerable regional variation. Domestic violence can broadly be classified into domestic abuse, spousal abuse, child abuse, intimate partner violence (IPV), elder mistreatment. Domestic violence or spousal Abuse in this content is a form of violence against women and when it involves pregnant women, it calls for a closer attention because of the greater danger it entails. Both the world health organization WHO and international federation of obstetricians and gynecologists (FIGO) recognize the scourge of violence against women and starting train the nineties passed various declarations on the elimination of violence against women. The factors which lead to domestic violence are a legion and range from no offence, minor to major offences.  
335 Ethical Challenges of International Outbreaks-A Case Study of Ebola Virus Disease , Okafor CN, Nwobi AE, Anyaehie BU, Young EE
Public health measures are strictly required to prevent increase in the spread of Ebola virus disease and that includes identifying cases and quarantining persons who are suspected to have come in contact with the disease or its agent. Though quarantine restricts freedom of movement of those affected, the reasons may be justified based on the fact that health of the public needs to be protected. But though the personal rights and liberties of individuals may be expected to be lost in international outbreaks, it should not be totally taken away. There ought to be a balance between preserving individual rights and maintaining public health. Thus a legal and political framework is needed while research for therapy and vaccine are encouraged. Keywords: Ebola virus disease, ethical challenges, international outbreaks.  
336 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) , Geethamma Jolly  
Middle East respiratory syndrome (MERS) is a highly lethal respiratory disease caused by a novel single-stranded, positive-sense RNA beta coronavirus (MERS-CoV). Dromedary camels, hosts for MERS-CoV, are implicated in direct or indirect transmission to human beings, although the exact mode of transmission is unknown. The virus was first isolated from a patient who died from a severe respiratory illness in June, 2012, in Jeddah, Saudi Arabia. As of May 31, 2015, 1180 laboratory-confirmed cases (483 deaths; 40% mortality) have been reported to WHO. MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in health care settings. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). Both community-acquired and hospital-acquired cases have been reported with little human-to-human transmission reported in the community. Although most cases of MERS have occurred in Saudi Arabia and the United Arab Emirates, cases have been reported in Europe, the USA, and Asia in people who travelled from the Middle East or their contacts. Clinical features of MERS range from asymptomatic or mild disease to acute respiratory distress syndrome and multiorgan failure resulting in death, especially in individuals with underlying comorbidities. No specific drug treatment exists for MERS and infection prevention and control measures are crucial to prevent spread in health-care facilities. MERS-CoV continues to be an endemic, low-level public health threat. However, the virus could mutate to have increased interhuman transmissibility, increasing its pandemic potential. Keywords Introduction Ecology and transmission of MERS-CoV Virology Origin Middle East respiratory syndrome 3-D image Tropism Transmission Evolution Natural reservoir Taxonomy Transmission Modes Possible sources and modes of transmission Bats Camels Clinical feature Diagnosis Treatment Prevention Imaging findings at presentation in Saudi patients withMERC-CoV Ways of protection against the MERC-CoV Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV Recommendations Minimize Chance for Exposures Before Arrival Upon Arrival and During the Visit Ensure Adherence to Standard, Contact and Airborne Precautions Hand Hygiene Personal Protective Equipment Gloves Gowns Respiratory Protection Eye Protection Using More than one Kind of Personal Protective Equipment (PPE) Patient Placement Manage Visitor Access and Movement within the Facility Implement Engineering Controls Monitor and Manage Ill and Exposed Healthcare Personnel Train and Educate Healthcare Personnel Implement Environmental Infection Control Establish Reporting within Hospitals and to Public Health Authorities MERS-CoVStatistics Comparisons Summary and Recommendations References  
337 Review of Prevention of Mother-To-Child Transmission (PMTCT) program in a Primary Healthcare Centre in Abuja, Nigeria , Orji Ikechukwu Anthony, Okoli Ugochukwu Thompson  
Background: It has been shown that nearly all pediatric seropositive HIV cases were infected via their seropositive mothers, as well; almost all of these cases can be prevented through a robust PMTCT service that provides extremely effective Anti-retroviral therapy and prophylactic intervention (FMOH, 2010). As we work towards elimination of MTCT of HIV in our country, the importance of this review of PMTCT services cannot be over emphasized. Objectives: The objectives of the study were; to assess the prevalence of HIV among pregnant women who attended ANC at the Health center (January –December, 2015). 2. To evaluate the percentage of HIV positive pregnant women who were placed on ART in the review period. 3. To ascertain the percentage of babies born to HIV positive mothers who were given ART in the review period. Methods: Secondary data review was employed in this descriptive cross-sectional study. It involved data extraction from ANC booking registers, PMTCT HIV screening registers, ART administration registers and case/delivery notes of HIV positive mothers, covering the review period of January-December 2015, in the study center. Results: All the 1,418 ANC clients reviewed were screened for HIV with a sero-prevalence of 2.8%. However, the percentage of seropositive clients who were placed on ART was 75%, while, 25% were lost to follow-up. Furthermore, only 33% of the babies born to seropositive mothers received ART prophylaxis in this center. Conclusion: An ANC sero-prevalence of 2.8% with below average ART initiation for positive pregnant women and babies born to them portends great danger towards elimination of MTCT of HIV. Therefore the study recommends urgent strengthening of PMTCT in this center and other similar centers across the country. Keywords: PMTCT, Ante-Natal Care, HIV, Prevalence, Anti-Retroviral Therapy, Primary Health Centre  
338 Tuberculosis and Gender in Nigeria, Sex Differences in Diagnosis and Treatment Outcome of TB and TB HIV Infected Patients , Ejike Kenneth Nwene  
Background: Worldwide, gender differences are reported in diagnosis and treatment outcome of TB and TB HIV patients. Religious and socio-cultural factors are responsible but largely controversial. This study assessed gender issues in diagnosis and treatment outcome of TB and TB HIV patients. Objective: To assess gender differences in diagnosis and treatment outcome of TB and TB HIV infected patients. Methodology: We did a cross sectional retrospective analysis of 980 TB patients treated in 6 out of 21 randomly selected local government areas of Anambra state Nigeria between 2008 and 2012. Information on age, sex, HIV status, case notification, treatment outcome was evaluated from TB treatment cards and TB registers. Treatment outcome was recorded as cured, completed treatment, failed, defaulted, died. Results: The male female ratio among the 980 TB patients was 57.4% vs 42.6%.. The study HIV prevalence is 27.7%; women contributed 52.6% of this population. Women had better treatment success rate than men (85.7% vs. 80.5%). TB treatment outcome in women compared to men were Cured (50.4% vs 40.7%, p = 0.063), treatment completed (35.3% vs 39.8%, p= 0.330), died (5.5% vs5.5%, p=0.8812), defaulter (6.55 vs10.5%, p = 0.042), failure (1.6% vs 1.5%, p=0.749). Conclusion: We conclude more TB cases in males but females are more prone to TB HIV confection, have better treatment outcome and lower default rate. Gender-specific strategies, including active case finding among women, increased tracking and adherence for male, are warranted to optimize TB management. Keywords: Gender, Nigeria, Tuberculosis, HIV, Co infection, NTBLCP.  
339 The use of Task Shifting in the Implementation of Prevention of Mother to Child Transmission of HIV (PMTCT) Services in Cameroon; the Option B+ Experience , Nguosi Wam Joel  
Interventions to Prevent Mother to Child Transmission in the world have evolved over the years. Cameroon like every other country has been conforming to new recommendations from WHO based on evidence for better quality of service. Option B+ which entails provision of lifelong Antiretroviral Therapy (ART) to each pregnant and breastfeeding woman was recommended as the standard for PMTCT in 2012(1). Cameroon adopted these guidelines and set out for implementation in October 2013. The purpose of this study is to evaluate the effectiveness of task shifting from nurses to doctors in the rapid scale up of option B+ in Cameroon. Results show that within a period of fifteen months, a total of 520 nurses from 266 PMTCT sites in the South West region were trained on the provision of ART at MCH (maternal and child health) units. They were able to adequately provide ART to 1,754 women by December 2015 (Mvogo, 2016). These results set the pace for the scale up of Option B+ to other sites and regions across the country without putting pressure on the limited number of doctors in the country. Keywords: Task shifting, PMTCT, Option B+, ART, MCH, HIV.  
340 Exploration into the Factors Affecting the Coverage of Household Latrines in Kagera, Tanzania , James Barongo Bashweka  
Low coverage of household latrines in the Kagera Region of Tanzania continues to exist despite past and current interventions to improve the situation. A limited understanding of the reasons for the low coverage restricted solving of this problem. The research which aimed to explore the perceptions of community members and latrine promoters was sought to increase understanding of this problem. Methods: Study designed was an exploratory qualitative approach that employed two qualitative research methods: focus group discussions and in-depth interviews. Focus groups discussion involved elderly community members and Ward Development Committee members who are leaders and latrine promoters. In-depth interviews involved key informants whose job descriptions includes the promotion of household latrines. Ethical approval was obtained from University of Western Cape and authorisation to conduct the study from the Kagera Regional Administrative Secretary. Results: Content analysis revealed a thick description of respondent’s perceptions in relation to factors which affect the coverage of household latrines in the Kagera Region. Interlinked factors were revealed including low community involvement and participation, poverty, cultural beliefs and taboos, gender disparity, low technical capacity of latrine promoters and poor packaging. Conclusion: This study revealed myriad factors which affect the coverage of household latrines in Kagera Region of Tanzania. Recommendations were put forward including adoption of an integrated approach, empowerment of members, and provision of capacity building interventions for the key latrine promoters. Insights gained through this study could contribute towards improving the coverage of household latrines in the Kagera Region of Tanzania. Keywords: Low coverage, household, latrine, sanitation, factors, promotion, perception, Muleba District, Kagera Region, Tanzania  
341  Knowledge of Contraceptives and Unmet Needs of Family Planning among Adolescents Aged 15-19 Years , Bernard Temitayo Ayobami  
Background: It is essential to cater to unmet needs of contraception among the adolescent group if meaningful strides are to be achieved in the uptake of contraception and prevention of unwanted pregnancies in the society. Objective: The main objective of the study is to assess the extent of knowledge and unmet needs of family planning among adolescents aged 15-20 years. Methodology: Secondary data from the 2013 NDHS will be used. The sample was selected using a stratified three-stage cluster design consisting of 904 clusters, 372 in urban areas and 532 in rural areas. A representative sample of 40,680 households was selected for the survey, with a minimum target of 943 completed interviews per state. A complete listing of households and a mapping exercise were carried out for each cluster over two months. The resulting lists of households serving as the sampling frame for the selection of regular households. A fixed sample take of 45 households were selected per cluster. Data analysis: Analyses of quantitative data will be done in SPSS version 20. Chi-square test will be used to measure the strength of associations between the various variables where a p value of = or < 0.05 will be considered statistically significant.  
342 Risk Factors for Teenage Pregnancy and Youth Health Needs in Nkalashane, Swaziland , Busisiwe Prudence Tsabedze  
Teenage pregnancy is an enormous challenge in Swaziland. The Nkalashane clinic (Lubombo region) observed a growing number of teenage pregnancies. In 2014 alone, 49% of pregnancies were among women who had their first child before their 19th birthday. The objective of this study was to investigate risk factors of teenage pregnancy among teenage mothers (TM), teenage fathers (TF), and services needed by the at-risk youth (ARY) to prevent teenage pregnancy. Participants were identified from the clinic’s registers, snowball sampling, and the 3 schools in the area. Participants completed questionnaires and focus group discussions (FGDs). Data was summarized using descriptive statistics. 43 TM, 8 TF and 73 ARY participated. TM had a family history of teenage pregnancy (42%), had guardians with only a primary education (63%), and had older partners (mean age difference 5.2 years). Only 44% of TM and 38% of TF reported using contraception at the time of first pregnancy. Reasons for not using contraception included: lack of knowledge on pregnancy (47%) and contraception (38%). TM reported engaging in transactional sex due to peer pressure or lack of money. In FGDs, lack of knowledge, peer pressure, difficult access to contraception, and lack of parental guidance were discussed as risk factors. The main risk factors were: lack of knowledge; peer pressure; intergenerational sex; and difficult access to contraceptives. Recommendations include: offering comprehensive sexual education to both youth and adults; strengthening the relationship between schools, communities, and clinics; training clinic staff on youth-friendly services.  
343 Prevalence of HIV in South Sudan , Etiki John Firstday  
Human immunodeficiency virus (HIV) is the virus that causes AIDS. It attacks the body’s immune system by weakening the human body’s defence against disease and consequently makes one vulnerable to a number of potentially life-threatening infections and cancers. HIV is transmitted through exposure to infected blood and blood products and from infected mother to child during childbirth. This study is a cross sectional study on HIV Prevalence in South Sudan. The study reveals a prevalence rate of 2.7 % for the whole country and about 14 % in some areas with the most vulnerable being between the ages of 15 to 49. It also reveals that social factors like poverty and prevailing gender relations contribute to infection and reinfection among People Living with AIDS and their partners. This study identified that Non-Governmental Organizations (NGO) and the United Nations (UN) are key in the fight against HIV in South Sudan; as the Government of South Sudan (GOSS) is battling with basic life need such as food and shelter for the population of South Sudan. There is therefore a need for a renewed campaign against HIV/AIDS. Keywords: HIV, AIDS, Prevalence, NGO, UN, GoSS  
344 A New Look Care of Mother at Pregnancy & Lactation: Socio-Cultural Practices in Neglected Population in Kapilvastu District of Nepal , Shashi Kumar Lal Karna  
The study made a new look into existing practice of care of mother during pregnancy and lactation in neglected population predominantly among Muslim, indigenous and lower caste in Kapilvastu district of Nepal. Early marriage, early pregnancy and multiple pregnancies are common socio-cultural practices which is still prevalence in the community. Women usually go to check pregnancy only for Tetanus injection. The main reason for not visiting check-up is due to family belief that it is ‘not necessary’. The husband feels shyness if his wife goes to health facility to see the service providers. The additional foods during pregnancy are not compulsion by the family and women herself. Pregnant women are mostly fed with normal food as usual. Supplementary and more nutritious food during pregnancy are provided especially among economically affluent families. Social belief is that better nutrition during pregnancy will increase baby size which may cause difficulty in delivery and requires operation. Family care and support during pregnancy is low in economically backward communities. Women from poor and Dalit households have high workload during pregnancy. Home deliveries are more common in compare to institutional deliveries 33.4%. Delivery at health facility is not necessary’, ‘not customary’ and ‘husband or family did not allow to go health facility’ as mother in law delivered her many child at home. They try all measures in home; if not succeed then only go to hospital. Women still have their babies at home because of the traditional practice of giving birth at home due to lack of money for transportation facility. Women’s low autonomy to decide on maternal health issues could be one of the reasons for low institutional delivery. Unfortunately, women in Kapilvastu district were less aware on danger signs during pregnancy and delivery, and some of the lives threating signs are considered normal. Women who had made sufficient antenatal visit were more likely to deliver at health facility. People preferred to have maternity services from local traditional practitioners called Chamain[i] over professional services. The Chamaini helps them in their own home together with family members; they also do massage, and bathing of women and baby. Family members, especially mother in law and relatives also support the women during delivery. The study also revealed that mal-practices in the community are high during delivery. eg, when women find difficulties in removing placenta after birth, there is practice of putting mother’s hair in the mouth. People believe that this cause vomiting which results force in uterus and hence placenta is removed. Heating the place of birth, massage with heated mustard oil to the women during postnatal period is common. Postnatal women are provided to take local made sweet soup called ‘Veli’ [ii]soup, which people believe will increase breastmilk and also accelerates uterus constriction. In Tharu culture practices providing to take chilly soup to recently delivered mothers for betterment of mother and child. Women during postnatal period receive less care and support from the family if the new-born is female child. The care is even less if the women is repeatedly giving birth to female child. More than50% of the women are not aware about danger signs during pregnancy. The symptoms such as swelling, vaginal bleeding, dizziness, fever and headache were not considered as threats to the health. In home delivery, cord cutting is done by Chamain, until and unless she arrives. The most frequently mentioned cord care by applying naval cream (36.3%), followed by oil (19.0%) and Kerosene (17.3%) and ashes. Around 47% of the new-borns bath within 24 hours of birth among Kurmi and Dalit ethnicities. In Dalit[iii] communities, where there is belief that new-borns are contaminated with dirty blood are bathed immediately after birth. Pre-lactating feeds are given in 45% of the neonates; most common being sweet liquid (60.7%). There is widespread belief that such sweet foods might be more energetic and child will be able to suck breast milk easily. Other pre-lacteal foods include animal milk and plain water. Pre-lacteal feeding are more prevalent among indigenous (54.3%), Muslim (46.7%) and Dalit (44.9%). Women herself hardly make decision to seek maternal care by themselves. Husbands and mothers-in-law were the one who have final saying in such decisions. Very low proportion of women alone had final saying in decisions related to whether to have another child (5.0%), going for ANC visit (9.3%) and place of delivery of the baby (8.7%).    
345 A Study on Factors Contributing to Communities not Accessing Anti Retro Viral Therapy [ARVs] in some Rural Health Facilities in Eastern Province of Zambia , James Mwale  
The competing economical, social and political challenges makes health to remain neglected in developing countries. Patients cannot access the ARVs without CD4 count tests, as it is a marker for immune system. Patients have easy access for HIV (Human Immune Virus) testing than for CD4 count. It is for this reason that Pima CD4 testing machines were introduced to enable those previously unable to offer CD4 testing, to do so. Study data shows that facilities with Pima CD4 machines have higher patients number on ARVs than those who do not have. It is for this reason that government and cooperating partners should support procuring more Pima CD4 machine for point of care.  
346 Knowledge, Attitude and Practice Towards Guinea Worm among the Resident’s of Juba County in Central Equatoria State , Sebit Mustafa Sebit Ebead  
Introduction: Dracunculiasis is one of the oldest diseases known to man. Although it is not a killer disease, it is a disease of high morbidity and complications found mostly in farming populations. Its health, social, educational and economic cost to the individual, the household and the community which is considerable and it’s transmission cycle are well documented. Key intervention strategies to eradicate guinea worm are safe water supply, vector control using abate, health education and case management. General objective: To determine the Knowledge, attitude, Practices, towards Guinea Worm Disease in Juba County. Methodology: The study was a cross-sectional study using both quantitative and qualitative methods of data collection. The quantitative method was face to face interviews while the qualitative method included Key Informants (KIs). It was conducted in Juba county 2015 by the principal investigator (PI) and a group of trained research assistants (RAs) to establish residents’ Knowledge, Attitude and Practices, towards Guinea Worm. Result: More than a quarter of respondents or relative have ever fallen victim of Guinea worm in their life (50/138 (36%)). A large proportion of respondent perceive drinking infected water was a cause of infection (79/138 (55.7%)), Most of respondent obtained drinking water from River/Stream (100/232 (43%)), most respondent said someone with Guinea worm has very much difficulty in farming (63%), Education level was found to be strongly associated with knowledge on the cause of infection of Guinea worm. (X2=26.249, d.f. =6, p>0.000). Conclusion: A large proportion of respondent perceive drinking infected water as a cause of infection Guinea worm, More than a quarter of respondent’s family member fallen victim of Guinea worm, In general the knowledge attitude and practice of respondent’s in Juba County in addition to other confounding factors have had an impact on the Guinea worm eradication Recommendations: both focused and integrated health education by the health workers need to be emphasized stressing to the communities the importance of Guinea worm eradication. This can be done both at the health unit and through specific and integrated outreaches such as immunization or mass awareness to cover three messages: That Guinea worm comes from contaminated water, Villagers should prohibit a person with blisters or ulcer from entering source of drinking water and that drinking water should be filtered or boiled before drinking.           
347 Effect of Regular Baths on the Development of Ring Worm among Primary School Children , Ifezue Uchechi Grace
Effect of regular baths on the development of ringworm of the body among primary school children was carried out using a sample size of 100 pupils from LEA primary school Pyankasa, Abuja, Federal capital Territory. This study was guided by research question and hypothesis. Inferential statistics of Chi square was used in the analysis of data collected. On the basis of the findings, conclusions were drawn and recommendations, made. Keywords: Regular baths, Ringworm, Children.  
348 The Effectiveness of Handwashing Health Education Session on Raising School Children’s Knowledge and Skills of Proper Handwashing Technique. a Pre test- Post Test Design , Marie Louise Umwangange  
Background: Hand washing is one of the core interventions to prevent diarrhea and pneumonia among children and is the single and only cost- effective intervention. Objective: The main objective of this study is to evaluate the effectiveness of handwashing health education session on raising school children’s knowledge and skills of proper handwashing technique. Methods: The study design will be a quasi-experimental pre test- post test single group design. A sample of 108 school children studying in primary grade 4, and 5 at two Public schools (One urban: Gacurabwenge primary school and one rural school: Kibali primary school) in Northern Province participated in the study after a stratified systematic sampling. The study was done in October 2016 and data were analyzed in SPSS version 16.0 using paired t-test for normally distributed data and Wilcoxon rank test for data which were not normally distributed. The mean score was computed and theoretical and skills score were categorized as excellent (80-100%=16-20), very good (70-79%=14-15.9), good (60-69.9%=12-13.9), fair (50-59%=10-11.9) and poor (0-49%=0-9.9) Results: In urban school, the results of pretest theory revealed that 70.4% had excellent knowledge, 11.1% had very good knowledge. The post test theory in the same school was 70.4% for excellent knowledge, 18.5% for very good knowledge. The difference between theory pretest and posttest in urban school was statistically significant (p=0.007) The results of pretest theory in rural school were different from those found in urban school with only 27.8% with excellent knowledge, 37% with very good knowledge. The post test theory for the same school was 48.1%, 40.7% for excellent and very good knowledge respectively. The difference between theory pretest and posttest in rural school was statistically significant (p<0.001) There was a significant increase in handwashing skills from pretest to post test in both urban and rural school. In urban school the pretest revealed 22.22% of school children with excellent handwashing skills, and in post test almost all (94.4%) school children in urban school demonstrated excellent skills of handwashing. The difference between pretest and post test skills was statistically significant (p<0.001). In rural school, the same difference has been found from pretest to post test handwashing skills; in pretest, only 9.26% of school children had excellent handwashing skills and in posttest in the same school, all school children (100%) had excellent handwashing skills and the difference between pretest and post test skills was statistically significant (p<0.001). Conclusion: Handwashing health education was effective to increase the knowledge and skills of school children regarding proper technique of handwashing in urban and rural public primary school and there is a need to teach other school children the detailed technique of handwashing with emphasis on those studying in rural area as their baseline handwashing knowledge and skills are poor compared to urban school children. Keywords: Effectiveness, handwashing, school children, health education, knowledge, skills.  
349 Clinical and Radiographical Evaluation of the Healing of Large Periapical Lesions using Triple Antibiotic Paste, Photo Activated Disinfection and Calcium Hydroxide When used as Root Canal Disinfectant , Dexton Antony Johns  
Elimination of microorganisms from the root canal system is one of the objectives of the root canal treatment and has a substantial effect on the treatment outcome. Accepted treatment procedures to eliminate the infection include a combination of chemo-mechanical debridement, application of an inter appointment dressing containing an antimicrobial agent and finally sealing of the root canal. Unfortunately, micro organisms may remain after conventional canal preparation, either within the dentinal tubules or bound within the apical dentin plug. Therefore for complete eradication of infection, the pulpal remnants as well as smear layer should be removed from the root canals. Some investigators recommend the use of calcium hydroxide as an intracanal dressing in a multiple-visit approach. The environment within the system, however, is such that delivering the medicament and maintaining a high pH homogeneously is a challenge. For these and other reasons, certain microbial species in a limited group of cases do survive and can be responsible for persistent infections (1,2). Thus, the search for a better alternative has led to the discoveries of newer antimicrobial agents.  
350 Prevalence, Knowledge and Perception of Domestic Violence among Women Attending Antenatal Care at Barau Dikko Specialist Hospital, Kaduna , Patricia Elameyi Idoko  
In early Roman Society, a woman was deemed the property of the husband and was therefore subject to his control. The Catholic Church’s endorsement of “the Rules of marriage” in the 15th century exhorted the husband to stand as ‘judge of his wife. He was, to beat her with a stick upon her commission of an offense. According to the rules, beating showed a concern for the wife’s soul. In 18th century France, if it became public that a wife had beaten the husband, he was forced to wear an outlandish costume and ride backwards around the village on a donkey. It was not until the 1870s that the first states in the US banned a man’s right to beat his family. Violence against women, whether pregnant or not occurs commonly around the world especially the developing world. The act cuts across all ages, cultures, ethnicity religion and educational barriers. Domestic violence refers to any harmful behaviour directed at women or girls because of their sex. it is also known as gender based violence. The violence can take various forms, and could be physical, psychological, (emotional) sexual, economic or a combination or even neglect. It can also be in the form of threats of such acts, coercion, or arbitrary deprivation of liberty whether occurring in public or private life. A new dimension has been added now in the form of acid baths used by men especially to discipline women, girls. The prevalence of domestic violence against women ranged between 17-37% with considerable regional variation. Domestic violence can broadly be classified into domestic abuse, spousal abuse, child abuse, intimate partner violence (IPV), elder mistreatment. Domestic violence or spousal Abuse in this content is a form of violence against women and when it involves pregnant women, it calls for a closer attention because of the greater danger it entails. Both the world health organization WHO and international federation of obstetricians and gynecologists (FIGO) recognize the scourge of violence against women and starting from the nineties passed various declarations on the elimination of violence against women. The factors which lead to domestic violence are a legion and range from no offence, minor to major offences.  
351 Pre-Menstrual Training, Menstrual Hygiene Practices, Attitudes and Disorders among Nigerian Adolescents , Afusat Adesina  
Objectives: Menstruation is a normal physiological process that begins during adolescence and may be associated with various symptoms occurring before or during the menstrual flow. Normal menstruation depends on a highly coordinated interaction between the hypothalamus, pituitary glands, ovaries and endometrium, with all events usually occurring in a cycle time frame often between 21 to 35 days. This study is therefore carried out to determine the influence of pre-menarcheal training on menstrual hygiene practices, the various menstrual disorders among the girls, as well as, the influence of educational status on menstrual hygiene practices, with a view to making necessary recommendations that would help improve such practices. Methods: This cross sectional study was carried out in Lagos Nigeria. The target population was adolescent girls in this city. A multi-stage sampling technique was used to select the respondent. All data were statistically analysed, using statistical package for the social sciences (SPSS) and statistical test of significance was performed with Chi-Square test. Results: A total of 526 consenting respondents participated in the study with a mean age ± SD of 14.09 ± 2.21 years. Most of the respondents had their menarche (first menstruation) around 12 to 13 years of age, with the mean age ± SD being 12.51 ± 1.44 years. 184 (35.0%) experienced dysmenorrhoea (painful menstruation) during their last menstrual period and menorrhagia by 34 (6.5%) of the respondent. Also, 142 (27.0%) of the respondents have had a cycle < 21 days or >35 days within their last three menstrual cycles. Conclusion: Pre-menstrual training is common among these adolescent girls as it is evident in their menstrual hygiene practices. However, dysmenorrhoea and menorrhagia are common problems among adolescent girls thus health education & health promotion are the best ways to deal with menstrual hygiene & disorder issues effectively. Keywords: Training, menstrual, hygiene, adolescent, Nigeria.  
352 The Three Delay Model as Framework to Assess the Burden of Maternal Deaths in the Urban District of Kitwe, Zambia , Elvis Chipili  
In Zambia, it is estimated that in excess of 398 women every year die from pregnancy related complications out of every 100,000 live births. The lifetime risk of a woman dying from a pregnancy related complication is 1: 20. The largest contributor to this high number of maternal deaths from the national level perspective has long been considered to be the delay in deciding to seek maternal and obstetrical care at both household and community levels with very little attempts to explore on extent to which the third delay factors have contributed to the high numbers of maternal deaths that have continued to occur un averted in facilities serving s referral centres. This study therefore provided an assessment framework based on the Three Delay Model to explore and assess how the third delay was impacting on the current burden of maternal mortality in an urban setting of Kitwe District of Zambia. Method: The study was prospective cross-sectional descriptive study involving case file review of maternal deaths that occurred in the delivery facilities of Kitwe District (Hospital and Clinics). The Study Population included all women that had died from pregnancy related complications in the delivery centres of an urban district (Kitwe) of Zambia in 2014 and 2015. The study investigated 30 maternal deaths (25 reviewed cases and 5 unreviewed cases). Data was collected using an adapted 2004 WHO tool: Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer and the Country’s Ministry of Health document: ‘Beyond the Numbers; Maternal Death Review Forms. Results: The study revealed majority (56%) came from the low density areas within the age range of 25-29 years (50%). Majority (44%) were referred from health centres within the vicinity hospital, 22% accessed the facilities using their own means of transport. Referral response was poor with 50% of the deceased being evacuated after 3 hours following decision to transfer them from the attending local clinic. Most mothers (55%) came into the facility in a fully conscious state with normal vital signs. Haemorrhage following delivery (PPH) was the leading cause involving 44% of the diseased, followed by hypertensive disorders including eclamptic fits. Sepsis following incomplete abortion led to 22% of deaths with deaths occurring on average of 8hrs following admission to the facility. All attendant staff was skilled birth attendants. Conclusion: The three Delay Model provides such a frame work to explore and identify different barriers women face in accessing quality, timely and effective maternal health care services needed to prevent such deaths. Using this framework, this study has revealed that the burden of maternal deaths occurring in Kitwe District is mainly due to the factors related to the third delay causes of maternal deaths.  
353 Economic Burden of Low Back Pain among Quarry Workers Attending Outpatient Physiotherapy Clinic at a Tertiary Health Institution in Ondo State, Nigeria , Ebenezer Obi Daniel  
Problem: The economic burden of health care in developing countries (like Nigeria) especially among the low social class and those involved in risky environment and occupations is worrisome and increase the out-of-pocket expenses of such individuals and expose them to poverty. A limited amount of data exists on the burden of low back pain (LBP) especially in developing countries. Objective: This study was carried out to determine the economic burden of LBP of quarry workers who attend out-patient physiotherapy clinic of a tertiary health institution in Owo, Ondo State. Methods: This study was carried out at Federal Medical Centre Owo in Ondo State, Nigeria. A descriptive cross sectional survey of forty quarry workers with LBP (28 males, 12 females) receiving physiotherapy at Federal Medical Centre, Owo, was carried out with purposive sampling method (non-probability sampling). Data on the economic burden of LBP and socio-demographic information of participants were collected using a self-developed questionnaire, reviewed by research experts. Data was analyzed using descriptive statistics of proportions, mean and standard deviations. Outcome: It was discovered in this study that, the cost of Physiotherapy represents the highest cost (63%) among the direct costs, followed by the cost expended on Physician visit (23.56%) while the cost of diagnostic tests represents the least (3%). Among the indirect costs, the expenditure on paid help, 34000 naira (45.7%) is the highest, while that of meals outside home, 9738.46 naira (13.0%) is the lowest. On the overall, this study reveals that the direct cost of low back pain among quarry workers (60.6%) forms the bulk of expenses of the management of low back pain by quarry workers. It is recommended that, policy formulation on alleviating the economic burden of ailments associated with risky jobs should be considered in developing countries, the research work should be carried out using larger population, inclusion of other risky occupations in future researches and that other possible factors that can be responsible for the low back pain of such workers should be taken into consideration in future studies.  
354 The Prevalence, Risk Factors and Treatment Methods for Tungiasis among Residents of Musokoto Sub-Location, in Kenya , Ngetich , Kirorei Kiprotich
Tungiasis is a parasitic skin disease caused by sand flea Tunga penetrans. In Kenya, little data has been published regarding tungiasis. In Nambale health centre, tungiasis accounted for 4% of total morbidities. Therefore this study sought to assess the prevalence of, risk factors and treatment methods for tungiasis among residents of Musokoto, in Kenya. Purposive sampling method was used. Logistic regression was used to determine the risks factors associated with tungiasis. A total 1557 participant from 333 randomly selected households took part in the study. Of the 1557 participants, a total of 441(28.3%) at least had jiggers at one point in their life. Out of the 441, 287(65%) were confirmed to have jiggers on examination whereas 9(2%) did not have jigger by the time of the study. Toes on the extreme sites were more infested however the distribution of infestation was moral less the same for the all toes. Above 50% of those infested were aged 10 years and below. Logistical regression analysis revealed that place of sleeping (P<0.001, OR = 1.319, CI = 1.180 - 1.474) significantly influenced jiggers infestation. The type of floor of the house (P = 0.036, OR = 3.608, CI = 1.089 - 11.955) was also found to significantly influence jiggers infestation. Source of water was more likely to influence jigger infestation (P = 0.001, OR = 2.050, CI = 1.334 - 3.150). The results are essential for community, local Public Health Officers, national and international public health agencies for interventions aimed at controlling jigger’s infestation. Keywords: Tunga penetran, Tungiasis, Ectoparasitosis and Fecundation.  
355 Plasmodium Falciparum and Schistosoma Heamatobium Infections in Pregnant Women Attending Antenatal Clinic in Sekondi-Takoradi Metropolis Western Region Ghana , Verner. N. Orish, Danny flint Yeboah, Ekene Nwaefuna, Richmond Afoakwah
Plasmodium falciparum and Schistosoma hematobium infections are very common parasitic infections that affect pregnant women in the tropics. In this study we evaluated the prevalence and contribution to anemia of Plasmodium falciparum and Schistosoma heamatobium among pregnant women attending antenatal clinic in Sekondi Takoradi Metropolis. This is across sectional study involving pregnant women attending antenatal clinic in Effia nkwanta regional hospital, Esikado hospital, Takoradi hospital and Jemima Crentsil hospital. Plasmodium falciparum detection and hemoglobin estimation were done from blood samples collected. Urine microscopy was done using the wet mount technique to detect the presence or absence of Schistosoma heamatobium A total of 872 pregnant women were sampled, 23.4% (204/872)were infected with plasmodium falciparum infection, 3.3% (29/872) were infected with Schistosoma heamatobium infection and 34.2% (298/872) were anemic. Plasmodium falciparum infection had a significant association with anemia 32.2% (96/298)(P<0.001), Schistosoma heamatobium infection had no significant association with anemia, 4.4% (6/298) (p=0.3) Plasmodium falciparum infection was higher and contributes more to anemia in pregnant women than Schistosoma heamatobium infection in this study. However it is very important to screen pregnant women for other parasitic diseases with lower prevalence than malaria to evaluate their burden and contribution to morbidity in pregnancy.  
356 Determining the Relationship between Home Environment and Academic Performance. a case of Clinical Medical Rehabilitation Students of Obafemi Awolowo University , Ilesanmi Oluwafemi Temitayo  
The environment a child finds himself goes a long way in determining his learning ability and ultimately his academic performance in school. Home environment has been recognized as having a relationship with the academic achievement of students. The present research study was designed to assess the various home environment variables which are predictive of academic performance of clinical Medical Rehabilitation students in Obafemi Awolowo University (OAU). The variables under consideration were the academic performance (grade point average) as a dependent variable and the parents’ level of income, level of education, residential area, marital status, family structure, and students’ accommodation type, average number of meals taken per day, study hour, and gender were independent variables. The data were collected from 102 clinical students who were purposively sampled from the department of Medical Rehabilitation using structured questionnaire. Data were collated and analyzed using descriptive and inferential statistics of Pearson Chi-square and multiple regression analyses. The result showed that there was statistical significant association between academic performance and father’s level of income, the number of study hours per day and the average number of meals taken per day. In conclusion, this study reveals that father’s level of income, number of study hours per day and average number of meals taken per day as home environment variables considered is predictive of academic performance of Clinical Medical Rehabilitation Students of OAU. Keywords: Home environment, academic performance, clinical students  
357 Perceived Determinants of Distribution of Counterfeit Drugs in Community Pharmacies, Calabar Municipality Local Government Area, Cross River State, Nigeria , Agada Peter Okpe, Okareh Oladapo Okareh, Ugobo Emmanuel Eteng
Background: The proliferation of counterfeit drugs is of public health concern and worthy of discourse. Aim: The aim of the study is to assess the perceived factors affecting the distribution of counterfeit drugs in community pharmacies in Calabar municipality. Methodology: This study is a cross sectional descriptive study that employed the use of closed ended pretested questionnaire for the collection of data. Data was analyzed using the SPSS 20.0. Results: Findings show that 23(74.2%) of the respondents were males while 8(25.8%) were females. Majority of the respondents 28(90.8%) were community pharmacist, 2(6.5%) nurses and 1(3.2%) pharmacy technician. Findings show that about 58% of purchase of drugs is been determined by the medical/pharmacist representative while 42% of drugs purchased is been determine by the distributor. Majority of the respondents 19(61.3%) buy their drugs from medical /pharmacist representative. Respondents were able to detect counterfeit drugs through: customers report (19%), close scrutiny (32%), regulatory officials (13%) and news/company alerts (36%). Poverty 10(32%), greed 6(19%), heavy taxes/VAT on drugs 5(16%), government policies towards health care delivery 5(16%), and poor implementation of relevant laws by government agencies 5(16%) were factors identified as responsible for proliferation of counterfeit drugs. Conclusion: Poverty is a significant factor responsible for the proliferation of counterfeit drugs. The most common means used by community pharmacists to identify counterfeit drugs are scrutiny and news/alerts.  There is need to create more awareness, and seek collaboration with community stakeholders in the fight against counterfeit drugs. Keywords: Counterfeit drugs, community pharmacists, drug distribution  
358 Knowledge and Practices of Personal Hygiene among Senior Secondary School Students of Ambassadors College, Ile- Ife, Nigeria , Ilesanmi Oluwafemi Temitayo  
Background: Personal hygiene deficiency diseases have been found to be a serious public health problem and people often affected are school children. These have been attributed to inadequate knowledge of personal hygiene and its practices. Methods: This study is a cross- sectional study to investigate personal hygiene knowledge and practices of senior secondary school, Ile –Ife, Osun State, Nigeria. A pre-tested 25- item, purpose designed, self- administered questionnaires were used to collect information on knowledge and practices of the respondents on personal hygiene. Data were collated and analyzed based on descriptive study design. Results: The result showed that the senior secondary school students who participated in the study were almost evenly distributed by gender (50.7% males and 49.3% females). Most of the respondents (50%) were in the 12-14 year age bracket. The result also showed that majority of the respondents (98.2%) had good knowledge of personal hygiene, could accurately identify the components and some of the harmful consequences of not engaging in sufficient personal hygiene practices. The result also showed that majority of the respondents had good hygienic practices including taking bath (99.6%), brushing teeth (98.2%) and washing hands (65.9%). Conclusion: Senior secondary school students of Ambassadors College, Ile- Ife have good personal hygiene knowledge and good personal hygiene practices. Keywords: Personal hygiene, knowledge, practices  
359 Prevalent Leadership Styles and their Compatibility to the New Ways of Working in General Hospitals in Nigeria , Maclawrence Kolapo Famuyiwa  
Context: Hospital patients desire more flexibility in health care delivery, hence developing new ways of working (NWW), and making the leadership styles in these hospitals to be compatible will ensure this. Design: Prevailing leadership style and its compatibility to New Ways of Working were assessed by self-administered and pretested questionnaire. Descriptive statistics to elucidate on the demography of the respondents were done, mean score and standard deviation values were used to examine the variables. Spearman’s rho correlation was used to identify the association in the responses. Setting/Participants: A stratified sampling method was used to select samples for this study, and these samples were surveyed for their views on the prevalent leadership styles and how this prevailing leadership style can accommodate NWW. Outcome measures: Some features of both task-oriented and person-centered leadership styles were identified. Then the respondents’ agreement to the existence of these features of each leadership style and how NWW could be accommodated was examined. Results: 100 questionnaires were distributed, 81 (81%) of the questionnaires were returned. The mean score of the two leadership styles were 2.11 ± 1.11 and 2.16 ± 1.11 respectively with a significant correlation (r = 0.871, p < 0.001). The compatibility of prevalent leadership style to ‘New Ways of Working’ was 4.29 ± 1.74. Conclusion: Both task-oriented and person-centered leadership are present, and little adjustment are necessary for NWW to be accommodated. NWW will allow patients to overcome the encumbrances of busy schedules robbing them off an access to quality health care. Keywords: Compatibility, Leadership styles, New Ways of Working, General Hospitals.  
360 Prevalence of Hepatitis-B infection among Pregnant Women in a Primary Healthcare Centre in Abuja, Nigeria , Orji Ikechukwu Anthony, Okoli Ugochukwu Thompson
Background: Hepatitis B is adjudged to be one of the most infectious diseases in the world and a major public health problem with about 5% of the world population as asymptomatic carriers translating to 350 million people harboring hepatitis B virus (HBV) globally. Chronic infection with HBV occurs in up to 90% of infants infected at birth, 30% for children aged one year to five years, and 6% from six years and above. Thus, prevention of perinatal infection is an important strategy to reducing the prevalence of chronic hepatitis B infection in Nigeria being an endemic country. Emphasis therefore is placed on the screening of all pregnant women for HBsAg during the antenatal visit so as to detect positive women whose new borne will need prophylaxis to reduce the risk of contracting the infection. Objectives: 1. to determine the percentage of pregnant women who were screened for Hepatitis B at PHC Karu, Abuja in 2013.2. To determine the sero-prevalence of Hepatitis B among pregnant women screened at PHC Karu, Abuja, in 2013.3. To determine whether the policy of prophylaxis against peri-natal infection for neonates of sero-positive mothers were strictly followed at this PHC during the review period. Methods: This is a retrospective cross-sectional study which used secondary data extracted from antenatal registers, laboratory registers, HBsAg-positive patients’ antenatal and delivery case notes for the period under review – Jan.-Dec. 2013. Results: All the 856 pregnant women who registered for ANC in this PHC were offered HBsAg screening, 99.3% (850) complied with the screening, and 8.5% (72) sero-prevalence recorded. All the positive cases were referred to secondary health facility for HBIG prophylaxis; however no follow-up was done to ascertain the outcome. Conclusion: The high endemic rate of HBV infection, (8.5% prevalence) requires more effort at preventing the vertical transmission. 100% screening rate for all ANC clients is highly encouraged as well as 100% follow up rate for exposed infants’ HBIG prophylaxis. Keywords: Prevalence, asymptomatic, HBV infection, pregnant women, Primary Healthcare Centre, HBsAg screening.  
361 Retrospective Study of Fatal Dengue Hemorrhagic Fever in Lahore City , Samra Ashraf  
Dengue fever is one of the most common mosquito-borne viral diseases of human beings. It has become a major reason for public health concern internationally over the recent years because of disease morbidity and mortality. Globally around 2.5 billion people are living in areas where dengue viruses can be transmitted. Spread of mosquito vectors & viruses in geographical distribution are two main reasons of rise in incidence and prevalence of dengue fever & appearance of dengue hemorrhagic cases. Urban areas of the tropics have been identified to be highly endemic. According to estimates made by WHO around 50–100 million infections of dengue are prevalent every year globally. (Deen et al. 2006)In Pakistan first dengue outbreak was reported in Karachi in 1994 as environmental conditions are conducive to Aedes mosquito breeding. Economic and security related migration introduced virus to Lahore as well. According to Punjab Health Department 590339 suspected cases were reported in Lahore & 21685 confirmed by serology. It has been observed that 5-10% of these cases develop DHF.(Mahmood et al. 2013) Dengue is mainly transmitted by mosquito vector i.e. Aedesaegypti and can also be transmitted by A. albopictus to a lesser extent. Virus that causes dengue has four different types that are closely related to each other. Infected female mosquitoes transmit this virus to human beings through bite. An infected mosquito can transmit this virus to humans for the rest of its life. Symptoms of dengue range from very mild fever to very high fever including intense headache, retro-orbital pain, muscular and joint pain, and rashes. There is no vaccine or any specific medicine to treat dengue. Patients having dengue fever are advised to take rest and drink ample fluids. They are advised to use paracetamol in order to reduce high grade fever or visit the physician if fever persists. Recovery from infection by one provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. There have been enough proofs showing that subsequent infection increases the risk of severity of disease which can result in DHF (WHO).  
362 An Assessment of the Psychosocial Effects of Almajiri system on Child’s Development in Gwange Ward Maiduguri, Borno State, Nigeria ,
Emmanuel O. Chukwu, Habu Haruna and Terna M. Fiase
363 An Assessment of the Psychosocial Effects of Almajiri system on Child’s Development in Gwange Ward Maiduguri, Borno State, Nigeria , Emmanuel O. Chukwu, Habu Haruna, Terna M. Fiase
Children are known to be the source of joy in every family especially when the parents can afford their basic needs. Children in the northern part of Nigeria are prone to deprivation through almajiri system of education mainly due to respect for misunderstood religious concept and culture among other causes. This study of psycho-social effects of almajiri system on child’s development was conducted in Gwange ward, Maiduguri, is aimed at identifying the psychological effects of almajiri system on child’s development as well as the social effects of almajiri system on child’s development. A descriptive design was used for the study. Data was obtained from respondents (almajiris) using structured questionnaire. The data was presented and analysed using descriptive statistics. Hypotheses were formulated and tested using Chi-square. The findings of this study revealed that the almajiris are affected both psychologically and socially due to lack of adequate care, loneliness, feeling of anger, lack of proper feeding and security, exposure to dangers and negligence by the society. Based on these findings, community health workers, psychologists, sociologists and government should be in the fore front of taking care of the almajiri system. Recommendations were made to families, communities, government and Non Governmental Organisation’s on ways of improving the system and incorporating it with western education. Keywords: psychosocial, effects, almajiri, development  
364 Innovative Policies on Air Pollution Control in China - A Case Study of the Relationship between Environmental Changes and Health Conditions in China , Zubairu Aishat Gimbiya  
China has seen the fastest rate of growth and development in recent times. Despite this reality, there has been a disconnect between the development of the economy and the welfare of the citizenry, and while we saw policies in place aimed at driving economic growth and development, a comprehensive policy aimed at protecting environmental health was either non-existent or poorly implemented. The importance of the environment cannot be overemphasized especially with respect to China and the many changes it has encountered over the past couple of decades. China has seen a great deal of development happen rapidly, numerous policy changes over a short period of time and most importantly, a direct impact on the health and welfare of the citizens. This study aims to look at the policies driving innovation and development, the extent of implementation of said policies as well as the effect on the everyday Chinese and what measures are in place to curtail the negative effect of such changes and the extent of implementation of said measures. We strive to establish an imbalance in the rate of development across all sectors of the economy leading to a negative effect, especially on health and welfare as well as life expectancy, quality of life and death toll. Keywords: Air pollution; Innovative policies; China; Health.  
365 Knowledge and Attitude towards Prevention and Control of Malaria in Nigeria – The Implications , Okumagba Mamodesan, Nigeria
OBJECTIVES To ascertain the level of knowledge about malaria, its prevention, and control; to determine the relationship between knowledge acquisition and malaria disease; and to determine malaria treatment preference with regards to what and where malaria treatment(s) are received in the community. METHODS This cross sectional study used semi-structured questionnaires to gather information from participants in Ukwuani Local Government Area of Nigeria. Trained interviewers used direct one-on-one interviews. Collected data were analysed using Statistical Package for Social Sciences (SPSS) version 21. RESULTS From a total of 262 participants, 100 (38.17%) respondents didn’t actually know what malaria is, 85 (32.44%) didn’t really know the cause of malaria, and only 109 (41.6%) participants practice some form of malaria prevention and control. A logistic regression analysis of malaria incidence in the last four weeks as the dependent variable, and levels of educational qualification as the independent variable gave a significance of <0.05. Out of the total 46 respondents who got infected with malaria disease in the last four weeks, 21 (45.65%) did not attend any health facility, but opted for self medication. CONCLUSION The level of knowledge about malaria, its prevention, and control can be improved on through well planned consistent health promotion. KEYWORDS Knowledge and attitude, malaria, prevention and control, Nigeria.  
366 Barriers to the Utilisation Of Skilled Birth Care Services Provided by Healthcare Professionals in Bongo District, Ghana   , Peter Adatara, Ghana
Maternal mortality rates are still alarmingly high in Sub-Saharan Africa. Skilled delivery care during childbirth is the most critical intervention for improving maternal health. Despite the importance of skilled delivery services, performance of skilled delivery care is still low in the Bongo District. The researcher, being an indigene of this district, and a professional nurse, observed that skilled birth care during pregnancy, labour and childbirth has been low within the Bongo community and its environs. The study aimed at determining the barriers to utilisation of skilled birth care services provided by healthcare professional from the perspective of mothers in the Bongo District of Upper East Region of Ghana. A descriptive study with cross-sectional design of 610 mothers, selected through simple random sampling technique was conducted. Data were collected using a structured interviewer-administered questionnaire, and analysed using SPSS statistics. The study identified women’s age; education; marital status; religion; husband’s education; parity and health insurance status as the socio-demographic characteristics of women that were significantly associated with utilisation or non-utilisation of skilled delivery services. The study also identified lack of money to pay for transportation and cost of treatment; poor quality of services and poor attitudes of health personnel; availability and influence of TBAs; long distance and lack of means of transportation; and cultural reasons as the major barriers to the utilisation of skilled delivery services. The recommendations emerging from the study reinforce the importance of skilled attendants’ awareness regarding attitude, and the need for development of interpersonal communication skills into education and training that women are treated with respect, understanding and dignity. It is also recommended that midwives and other skilled attendants in deprived areas should reorient their caring practices to more culturally appropriate and evidenced- based maternity care. éFurther research on women’s experiences of care received, and health care delivery in rural areas is needed.  
367 Prevalence and Severity of Dental Caries by Gender, Age and Educational Levels in Rural Dominican Republic   , PayalKahar, Christine A. Tisone
OBJECTIVE To determine prevalence and severity of dental caries using WHO methods by age, gender and educational levels and compare actual DMFT scores to self-reported scores. METHOD Cross-sectional study was conducted using face-to-face interviews and oral examinations in La Esquina community, Province Maria Trinidad Sanchez, Dominican Republic (DR) among 104 adult participants. Caries experience was determined using DMFT scores. RESULTS Prevalence of caries was high with 94.2% of participants affected by it. Mean DMFT index (11.95±9.67) for participants having ≤ 8 years of school education was significantly higher than the mean score (6.69±4.39) for people with >8 years of education (F=9.3; p<0.01). Likewise, mean DMFT score for age group ≥55 years was significantly higher than for younger age categories (F=5.87; p<0.01). Caries severity was found to be statistically significant by age groups (χ2 =17.42, p=.002) with more proportion of participants ≥ 55 years having DMFT score≥14. Actual mean DMFT score was 4.51 higher than mean self-reported score (9.51 versus 5.08) (Spearman r=.27; p= .01). CONCLUSIONS This study provides preliminary data on caries prevalence and identifies unmet treatment needs in rural DR. While caries experience among adults increased significantly both by age and educational levels, caries severity increased significantly with age alone. KEYWORDS Caries experience, DMFT score, oral health, Dominican Republic, rural  
368 Mix Communications Strategies and Rate of Utilization During Polio Vaccination Campaign Retrospective Study in Western Bahar E-Lgzal State, Republic Of South Sudan Wau , Mezgebu Chaka
Effective communication activity is an essential type of program action in support of Polio eradication initiatives (PEI), and routine immunization. Communication activity includes: Social mobilization, Advocacy, and behavioral change communication aspired to improve immunization services and use of those services. Other key components of effective immunization services include: Vaccine procurement for service delivery, cold chain, logistics and capacity building for health workers to provide high quality immunization service and to conduct surveillance on vaccine preventable disease to monitor disease circulation in the country to guide immunization Polio eradication initiative (PEI) was launched in May 1989 by world health Assembly (WHA) resolve to eradicate poliomyelitis from the word by the year 200 using the following strategies; Establishing high level national commitment to the program to ensure that adequate personnel and financial resources are made available Administering oral polio vaccine in the manner that will effectively interrupt the transmission of wild polio virus Attain high level of routine immunization coverage with at least three dosed of OPV administration Implement action oriented surveillance for all possible cases of poliomyelitis/Acute Flaccid Paralysis (AFP)  
369 Prevalence of Urinary Tract Infection (UTI) and Antimicrobial Susceptibility Pattern among Patients Attending National Hospital Abuja, FCT - Nigeria , Adedamola Amos Ogundeji
INTRODUCTION Urinary Tract Infection (UTI) is a significant health problem worldwide, affecting all ages and both sexes. Hence, the need for determination of microorganisms causing urinary tract infection (UTI) and their in-vitro susceptibility test is of paramount important to improve service delivery to patients. With this background, a retrospective study was carried out from July 2013 to December 2013 at National Hospital Abuja (NHA). OBJECTIVE This study is planned to determine the prevalence of urinary tract infection (UTI) among different sexes and age groups as well as the predominant bacterial pathogens and their sensitivity to antibiotics so as to guide empirical antibiotic therapy. This is aimed at providing improved patient care and management. MATERIALS AND METHODS A total of 2640 urine samples from patients attending both inpatient and Outpatient departments of NHA were included in this study. Data of all patients who had positive urine culture between July 2013 and December 2013 were systematically and retrospectively collected from the Laboratory register of the Medical Microbiology and Parasitology Department. Demographic data of these selected individuals’ patient, sex, marital status, pathogens isolated and their antimicrobial sensitivity pattern were collated and analyse. These urine samples were earlier subjected to culture and sensitivity test with the use of standard bacteriological techniques as described by American Society for Microbiology (ASM). RESULTS Twenty five percent of the total urine samples (2640) showed significant bacterial growth. Ten different bacterial species were isolated. Among these, Escherichia coli (49.5%) was significantly the most predominant one (P<0.05) followed by Staphylococcus aureus (14.9%), Klebsiella spp (11.8%), Enterococcus faecalis (8.9%), Pseudomonas aeruginosa (4.4%), Proteus spp (3.3%) and others. Majority of Gram-negative bacteria showed susceptibility towards Ciprofloxacin, Gentamicin, and Amikacin. The age group with highest frequency of UTIs was 21–30 years with females predominating in all the age groups except in less than 1 and above 60 years (Fig. 7). The results showed that married women are more likely to be affected than their single or widowed counterparts while the reverse was the case in males (Fig. 8). CONCLUSION This outcome of this study shows that there is need for more work in this area be to consistently determine the changing pattern of microbial uropathogens and their antimicrobial profiles.  
370 The Effectiveness of Acid Fast Bacilli (AFB) Smear Microscopy Training in Performance Improvement Among Nigerian Military Hospital Tb Laboratory Personnel: Analysis of Pre and Post Training Evaluation Scores , Adedamola Amos Ogundeji
OBJECTIVE This study is planned to determine the effectiveness of AFB smears microscopy training and refresher training on the performance of TB laboratory personnel working in the Nigerian Military Hospital. BACKGROUND With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern1. Eighty percent of all cases worldwide occur in 22 high-burdens, mainly resource-poor settings of which Nigeria ranked 13th. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB co-infections in resource-limited countries2. In low income countries (Nigeria inclusive), Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment3. In order to have efficient and reliable AFB microscopy centres, it is very necessary to have continuous refresher training for laboratory professionals and strong External Quality Assessment (EQA) system. However, very little data exists as to the effect of in-service training on performance of laboratory personnel in Nigeria.   METHODS A cross-sectional retrospective study was conducted to appraise theoretical and practical performance of TB Laboratory personnel drawn from various Nigerian Military hospitals supported by the joint partnership of Nigerian Ministry of Defence (NMOD)/United States Department of Defense Walter Reed Program-Nigeria (USDOD WRPN), before and after AFB microscopy training. Theoretical assessment was based on standard questions while practical assessment was based on smear reading of 10 standard slides. Data generated from four (4) rounds of a five days AFB Smear Microscopy training at NTBLTC, Zaria, Kaduna State, Nigeria between 2011 and 2013 was retrospectively collated and analyzed using SPSS 16.0 statistical software. RESULT The pre-training mean score of the theoretical knowledge and practical skills were 64.3% and 64.5%, respectively. The post training mean scores were 83.6% and 85.3% for theoretical knowledge and practical skills, respectively. The increase in mean score of both theoretical and practical assessment was statistically significant (p<0.0001). Post training mean score of theoretical knowledge was higher among diploma holders trainees than the BSc degree counter parts (p=0.001). The mean scores on practice before and after training were dependent on participation in previous AFB microscopy trainings (p<0.0001). Proportions of participants with both major and minor errors were found to decrease after they were trained. Trainees who have had previous training were found to commit less error than those who have never participated in previous training (p<0.0001). CONCLUSIONS This study established that training improved theoretical and practical performance of Medical Laboratory personnel. Training and continuous training irrespective of lab professional’s qualification, service status and service year and sustainable EQA are highly recommended to ensure quality of AFB microscopy services in all NMOD/USDOD supported health facilities across the country.  
371 Campaigns with Oral Polio Vaccine’s Impact in Eradication of Poliomyelitis in Punjab, Pakistan , Abid Hussain
Global polio eradication initiative launched in Pakistan in 1988 with collaborative efforts of WHO, UNICEFF, Rotary and other allied. With all endeavors, Pakistan is still having high number of cases in the world which is 80% of total. Total 306 polio cases reported in Pakistan in 2014 and 19 cases reported till 20 March in 2015 Pakistan is among one of the three endemic countries. Efforts for eradication started in 1994. The world Health Organization reported that Lahore, Rawalpindi, Peshawar and Karachi have indigenous circulation of poliomyelitis virus as environmental samples came out positive number of times in 2014.  
372 The Prevalence of Malaria Infection Among Secondary School Students in Oba Idemili South Local Government Area, Anambra State Nigeria   , Ogolo B.A; Urindwanayo D.; Obieze, K.O., Ogbuagu C. N, Ekwunife, C.A., Rwanda
A cross sectional study on the prevalence of malaria infection among secondary school students in Oba Idemil South Local Government Area Anambra State, Nigeria was carried out between January and April 2009. A total of 300 students (161 males and 139 females) were involved in the study. Venous blood containing Ethylene Diamine Tetra acetic Acid (EDTA) of the 300 students was screened for malaria parasites using Giemsa-stained thick and thin blood films. Of the 300 blood samples examined, 31 (10.3%) were positive for malaria parasite. Plasmodium falciparum was identified in all the positive cases. Prevalence rate of 16 (9.9%) was recorded in males while prevalence rate in females was 15 (10.8%); this difference was not statistically significant (p=0.809, p> 0.05). The private schools recorded a higher prevalence 23(13.5%) than the public schools 8(6.2%); this difference was statistically significant (p=0.026, p< 0.05). The findings of this study emphasize the need for health education in school, churches and community in order to control malaria in the area. KEYWORDS Malaria, prevalence, Secondary school, students.  
373 Prevalence and Factors Associated with Obesity and Overweight among Pensioners in the Eastern Region of Ghana   , Benjamin Demah Nuertey
BACKGROUND The population of the elderly is seen as one of the fastest growing in the developing world. The elderly population is associated with many challenges. Obesity and overweight have being associated with increased mortality and reduced quality of life in the elderly. The study aimed at obtaining the prevalence and factors associated with obesity the elderly METHOD A cross-sectional studies was conducted among 401 pensioners using questionnaires and physical examination and laboratory examination of blood samples in the eastern regional capital of Ghana. Cross tabulations were used to obtain the prevalence of obesity and overweight. Logistic regression was carried out to find out factors associated with obesity and overweight. FINDINGS The prevalence of obesity among pensioners was 14.2%. Females were more likely to be obese with prevalence of 35.4% for female and 4.4% for males (p-value <0.001). Age, Social class, current marital status and highest educational level were socio-demographic factors associated with obesity/overweight. Hypertension, diabetes, serum total cholesterol, serum Low-density lipoprotein, serum triglyceride and use of eyeglasses were medical factors associated with obesity. CONCLUSION Obesity and overweight are associated with medical conditions even in the elderly population. Reducing obesity must start before pension. KEY WORDS Body Mass Index, Pensioners, elderly, prevalence, associated factors  
374 Knowledge, Attitude and Practice of Physical Activity among Health Professionals in a Nigerian Tertiary Health Institution , Samuel Olufemi Bolarinde, Oladapo Michael Olagbegi, Ebenezer Obi Daniel, Bukunmi Akinrinbola
BACKGROUND The public health campaign on the need for people to undertake physical activity (PA) as a primary way of preventing chronic health problems such as diabetes mellitus, obesity and cardiovascular diseases can be sustained through intensive counseling of patients/clients by health care providers who are vast in the practice of PA. AIM To assess the knowledge, attitude and practice of PA among health professionals at the Federal Medical Centre (FMC), Owo, Nigeria. MATERIALS AND METHODS One hundred and three (103) health professionals (HP) working at the FMC, among whom 24.3%, 22.3% and 19.4% are Medical/Dental Practitioners, Medical Laboratory Scientists, and Nurses respectively participated in the study. They were required to complete a 22 item closed-ended questionnaire which was self-administered. Frequencies and percentages of proportion of respondents were computed, data were also summarized in pie charts. RESULTS 78(75.73%) respondents were found to have awareness of the health benefits of PA, 93 (90.29%) believed they were physically fit, 67(65.05%) were able to adequately define physical fitness, while 79(76.70%) professionals have counseled patients/clients about the health benefits of physical exercises. However, only 25 (24.27%) know the true parameters for assessing physical fitness. CONCLUSION The knowledge of the sampled HPs about PA appears poor, although their attitude is positive. There is need for health care givers to be exposed to educative measures that will enrich their knowledge of PA and how to achieve optimal fitness level through PA. KEY WORDS Physical activity, knowledge, health professionals  
375 Factors Contributing to Non-Adherence to Medical Ethics by Health Workers at Ndola Central Hospital, Ndola, Zambia   , Ellen Mutinta Munyati
AIM Study to determine factors contributing to non-adherence Medical Ethics by health workers. RESEARCH QUESTION Why are health personnel not adhering to Medical Ethics? OBJECTIVE To find out common factors contributing to non-adherence to medical ethics among health workers at Ndola central Hospital HYPOTHESIS There are no factors influencing non-adherence to medical ethics. METHODS The study was conducted at Ndola central hospital which is a 3rd level referral hospital as well as a teaching hospital. A non- interventional descriptive study was done. Health care providers were randomly sampled from the departments at Ndola central hospital. Random selection was done using an existing sampling frame (list of health care providers in each department). Study unit was drawn using simple random probability sampling, all the health care providers from different departments were listed and numbers were assigned to each name. These numbers were picked and were compared to the list. Names against those numbers were picked and were included in the sample. Quantitative data was collected using a self-administered structured questionnaire. Prior to data collection, a formal letter (indicating the title of the study and the objective of the study) was written and submitted to the senior medical superintendent who is the head of the institution at which the study was conducted. Before collecting any data, permission was sort from the participants. They were at liberty either to agree or refuse to take part in the study or not. CONCLUSION On the basis of the findings derived from this study, it is obvious that a lot of factors contributing to non-adherence to medical ethics emanated from this study. The identified factors contributing to non-adherence to medical ethics among health workers at Ndola central Hospital were: Health workers feel they know what is good for the patient and not clients 95%, patients not provided with information 50%, Lack of alternative remedy in some instances 65%, Some conditions like STIs spouse should be aware 90%, Shortage of essential drugs and supplies 60%. The fact that there are factors impeding on adherence, quality of service may be compromised because quality of health service delivery in the country ought to be enhanced through adherence to medical ethics by health workers. After all, adherence to medical ethics by health workers is one of the most critical aspects of quality health service delivery in any country. Indeed, non-adherence to medical ethics affects not only the way through which health workers interact with health service users, but also the quality of health service delivered as it hinders the later from accessing better health services. Ethical standards promote the values that are essential to good communication; in turn patients can have confidence, even reciprocal reverence and unbiased medical care.  
376 A Study of Issues Relating to Communication Problems among Patients and Care Providers in District Hospital   , Sanjay Kumar Singh
SUMMARY Purnia division is an administrative geographical unit of Bihar, state of India. Purnia is the administrative headquarters of the division. Hindi is the principal language of the district. However other than that, people in different areas follow different dialects. Maithili is one of the prime dialect/languages spoken in the area. People also speak Surjapuri, Polia, Chhika-Chhiki or Angika and Santhali. In some parts of Purnia, Bangla is also spoken. Hindi is the main language of the district; however, dialects are in vogue in different parts of the district for day-to-day use. People of Amour and Baisa blocks, speak Surjapuri. In the eastern side of Baisi block people speak Polia. Chhika-Chhiki or Angika is spoken in Rupouli and Bhawanipur and some part of Dhamdaha, K.Nagar and Purnia East Block. In Banmankhi, B.Kothi and some part of Dhamdaha. K.Nagar people speak a mix of Maithili and Chhika-Chhiki. Santhali people speak Santhali. In the east and South Baisi block Bangla is also spoken. Out siders speak their own dialects. PURPOSE The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities Language is the means by which a patient accesses the health care system, learns about services, and makes decisions about her or his health behavior. Language is also the means by which the health care provider accesses a patient’s beliefs about health and illness, and thus creates an opportunity to address and reconcile different belief systems. In essence, communication between nurses and patients is the heart of nursing care. Without effective communication between patients, families and providers, truly adequate healthcare cannot be achieved. Individuals who have difficulty communicating are especially vulnerable in hospital settings where poor communication can lead to unnecessary pain, confusion, medication errors, and even premature death. METHOD The study design involved semi structured face-to-face interviews & filling up questionnaire with the nurses & Paramedical Staffs about their routine work environments and activities, the language problems in which they recently had been involved. The themes reported here emerged from inductive analyses of the data. RESULTS Nurses & Paramedical Staffs reported numerous such incidents occurring daily. Aspects of “communication” and “patient management” were the two most commonly cited contributing factors. Nurses described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of confusion. CONCLUSION The occurrence of everyday confusion in this study is associated with faulty communication. Communication failures are far more complex and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education, training and in health care organizations aimed at improving patient safety.  
377 Quality Assurance and Self-Assessment: Approach Methods by Southern University   , Emmanuel Kooma
The resources required for open distance learning (ODL) are human, physical, financial, and technological supported by cross cutting issues. This paper focuses on quality assurance and self-assessment as part of the cross cutting functional areas at Southern University. The Southern University (SU) envisions being a World Class University for the advancement of humanity, serving as a cradle of knowledge and excellence. To achieve this, the University will endeavour to generate and disseminate significant quality knowledge backed by its core values, upholding unbendable and uncompromising standards that contribute to national and global development. The university`s vision is “To be an icon of academic excellence in all disciplines and natural resource based professions in sub-Saharan Africa”. With the onset of peace in many African countries after many years of instability and insecurity, with the democratization of many African states following decades of totalitarian rule, and following years of corrupt and inept administrations, there is now an acute consciousness of the wasted years of African prosperity. One of the highest casualties of misrule has been education. Education became one of the lowest priorities. Investment in education across the sector diminished. SU like any other Open Distance Learning(ODL) Universities has observed that with peace and democratization in Zambia, there is population growth, rising prosperity, a thirst for knowledge, and a need to bridge the skills gap, all in the context of rising expectations and diminishing resources. For many, however, for whom life circumstances have rendered university attendance a distant dream, have yet another opportunity and this is the reason SU has come into being
378 Improving Access to Health Care in Rural Communities by Re-Orienting and Integrating Patent Medicine Sellers into Primary Health Care Service Delivery in Nigeria , Okumagba Mamodesan
BACKGROUND Good health is fundamental to improved quality of life, and the goal of promoting the health of rural community dwellers in Nigeria is critical in improving the quality of life of a vast majority of Nigerians who reside in rural communities. The objectives of this study were to determine the purpose for patronage of patent medicine shops; determine the reason(s) for preference for patent medicine shops to local health care centres; review the major challenges of patent medicine sellers or patent and proprietary medicine vendors (PPMVs); ascertain the level of uptake of cases in patent medicine shops compared to health centres; and to proffer a functional policy framework involving the patent and proprietary medicine vendors and shops to improve the quality and access to primary health care especially in rural communities in Nigeria. MATERIALS AND METHOD This cross sectional pilot study made use of questionnaires containing semi structured questions, through direct one-on-one interviews, and information was obtained from both PPMVs and individuals who patronize their shops. This study was done in four rural communities of Delta State, Nigeria. Two major primary data sets and a secondary data set were generated. The Statistical Package for Social Sciences (SPSS) version 21 for windows software was used for analysis and a descriptive presentation of the data was given.     RESULTS From a total of 51 patent medicine shop users, 21 (41.2%) males and 30 (58.8%), females, with mean age of 30.2 years, 35 (70.5%) patronize PPMVs to buy medicine, while 14 (27.5%) went for consultation and just one person went to buy condom. Twenty two (43.1%) respondents claimed proximity to place of residence as a major reason for preference for PPMVs, 6 (11.8%), mentioned familiarity with PMS owners, 5 (9.8%) said there was no delay in receiving treatment. All but one of the 14 patent and proprietary medicine vendors that were interviewed was male, with a mean age of 36.43 years. Four (28.6%) PPMVs claimed there was no major challenge in their business, 3 (21.4%) mentioned financial constraint. A comparative look at the total attendance records of both patent medicine shops and the health centres revealed poor level of utilization of health centres. CONCLUSION Patent medicine shops are unique and very important in health care delivery especially in rural communities of Nigeria. There is need for a paradigm shift towards reorienting and integrating PPMVs and other related drug outlets into the mainstream primary health care delivery system. This will serve as an opportunity to improve the coverage and quality of the health system in Nigeria. KEYWORDS Access to health; Rural communities; Patent medicine sellers; Primary health care.  
379 Application of Epidemiology in Diabetes Mellitus in Sub Saharan Africa: Screening of Diabetes Mellitus   , Pasipanodya Ian Machingura
Sub Saharan African is being faced with an increased burden of diabetes mellitus. High levels of undiagnosed diabetes mellitus have been reported which is a cause of concern since diabetes mellitus causes complications which are expensive to manage. However screening for diabetes mellitus has not received much attention due to overwhelming of healthcare facilities with multiple disease burdens. The review sought to address screening of diabetes in Sub Saharan Africa. Published journal articles and grey literature on screening of diabetes mellitus in Sub Saharan Africa were sought from pubmed, google scholar and google. Reports of screening of diabetes mellitus in a general practice setting were found. In a rural setting community based and home based strategies of screening of diabetes mellitus were reported to be feasible. Diabetes mellitus screening was also reported be possible to integrate it with communicable disease screening. Diabetes mellitus screening in Sub Sahara Africa is feasible. The integration of diabetes mellitus screening with communicable diseases is a worthwhile consideration in sub Saharan Africa taking into consideration the communicable disease burden.  
380 Assessing The Awareness And Prevalence Level Of Obesity Among Adolescents And Adults In Ajara– Badagry, Lagos State, Nigeria. , Emmanuel Adewale Ojo  
This project focused on the awareness and prevalence level of obesity among adolescent and adults in Ajara community, Badagry local government area of Lagos State Nigeria. The project was carried out employing a simple survey method and random sampling technique as sampling and data collection tools. Height and weight of study participants were measured to calculate their Body Mass Index (BMI). The World Health Organization (WHO) classification of obesity using BMI was then used to determine the obesity status. A simple pre tested questionnaire was also used to collate information on the awareness of obesity from the respondent. The result shows that about one tenth (13.5%) of the study population were obese, more than half (53.9%) were aware that obesity can lead to death however majorities (90.8%) have not done any test to check their obesity status. The prevalence level (13.5%) from this study is in agreement with the 12% prevalence rate reported by Nkwoka I.J, Egua M.O, et al (2014) as well as within the range of 8.1% - 22.2% defined by Chukwuonye I.I, ChukuA.et al in 2013. Keywords: Obesity, Prevalence, Nigeria.  
381 Analysis Of Anthropometric Risk Factor Profile Correlates Of Hypertension , Eric Gyamfi  
BACKGROUND: Hypertension is an important risk factor for cardiovascular disease (CVD) and has become a major global burden on public health .Obesity and weight gain has been reported in previous studies as the most important determinants of hypertension. Close link between obesity and hypertension forms part of a broader relationship between body weight and blood pressure (BP) among others. OBJECTIVES OF THE STUDY: This call for a study to a analyse the anthropometric risk factor profile correlates of blood pressure (BP) levels in a representative sample of market women in Juaben. MATERIALS AND METHODS: The study was carried out using questionnaire as well as direct measurement within the period of March/April, 2015. RESULTS: The study recorded high levels of prevalence of all the selected anthropometric risk factor profiles of high blood pressure (hypertension). A prevalence rate of 74% was noted for obesity. Among other variables, the following prevalence rates were recorded: 85.1% for excess WHR, 56% for excess abdominal circumference/girth, 84% for sum of various classes of hypertension for systolic and 48% for diastolic. An analysis of correlations of anthropometric profiles of height and BMI on systolic blood pressure were significantly correlated respectively (r=.417 and r=.366, p-value at 0.01). Contrary to this, statistically insignificant correlations were observed on both systolic and diastolic blood pressures respectively for weight r=.140 and r=.183; waist circumference r=.152 and r=.096; hip circumference r=.244 and r=.105; abdominal circumference/girth r= .082 and r=-.042; heart rate r=.187 and r=.141, p-value at 0.01). Among anthropometric variables, waist to hip ratio showed statistically insignificant correlation on BMI (r=.083, p-value at 0.01) whereas weight r=.792; height r= -.405; waist circumference r=.469; abdominal circumference/girth r=.446 were statistically significant on BMI (p-value at 0.01) and hip circumference (r=.371, p-value at 0.05) RECOMMENDATIONS: Against this, this study proposed the following recommendations for consideration; organisation of health talk on weight management practices among market women. There should be an awareness creation on hypertension prevention as well as increased advocacy on vegetable and fruits intake.  
382 A Study Of The Predisposing Factors To Vesico-Vaginal Fistula In Women Of Ebonyi Local Government Area Of Ebonyi State , Johnson Chijindu Diara
Vesico-vaginal fistula is an abnormal hole between the urinary bladder and the vagina leading to involuntary discharge of urine into the vagina. Vesico-vaginal fistula still remains one of the main morbidities of childbirth in developing world and Ebonyi Local Government Area of Ebonyi State is a typical example. The study was aimed at identifying those predisposing factors to VVF in women of Ebonyi local government area of Ebonyi State. It is a cross-sectional descriptive community based study and a total of 386 women of child bearing age were assessed using interviewer administered questionnaires. The study revealed that 80% (309) of the studied population were aware of VVF. The study also revealed that the predisposing factors to VVF were influenced by one’s level of education and employment status as both variables were statistically significant. Level of education and employment status were directly proportional to one’s knowledge and inversely proportional to those predisposing factors to the development of VVF. In conclusion, major breakthrough is still needed in order to get the women of Ebonyi Local Government Area of Ebonyi State to actually know about VVF and those predisposing factors for the development of VVF. To decrease those predisposing factors that can lead to VVF; the study suggested advocacy, health education, economic empowerment of women, girl child education and improving the socio-economic status of women as tools to bringing the desired change.  
383 Diarrhoea In The Under-Fives: Constraints Encountered By Care Providers In Its Management , Bodzewan Emmanuel Fonyuy
Diarrhoea continues to be one of the major causes of dehydration in the under-five population especially in the developing countries; resulting in high infant mortality rate, particularly in sub-Saharan Africa. Diarrhoea resulting to dehydration kills more children under five years of age than malaria, AIDS, measles and tuberculosis. It is actually the second leading cause of death in children under five in the world and responsible for 1.9 million deaths per year, following pneumonia, which kills 2 million per year. As such deaths via diarrhea represent 17% of deaths among children under-five; out of a total of 11 million deaths annually. This mostly results from the consumption of contaminated food and drinking of water from doubted sources. World-wide, around 1 billion people lack access to improve water and 2.5 billion have no access to basic sanitation. The objectives of the study were: To assess the knowledge of care providers in identifying cases with dehydration in the under-fives. To assess their practices toward the adequate management of dehydration in the under-fives. To find out the difficulties encountered in its proper management. To propose practical solutions in order to curb its occurrence. A descriptive cross-sectional design was employed, in which primary data was collected from a sample in the study population in order to collect baseline data to be a representative of the study population during the study period, in order to assess the knowledge of care providers of Mankon Medicalized Health Centre and Nkwen Medicalized Health Centre in the assessment and management of dehydration in the under-fives. Data was collected from care-providers of both Mankon and Nkwen Medicalised Health Centres who had served in these health facilities for at least six months and who are versed with the causes of dehydration in the under-fives, its clinical manifestations and the adequate implementation of proper management. The convenient sampling technique for this study in which all the eight (8) care providers managing clinical cases in the medical ward and the twelve (12) care providers managing clinical cases in the paediatric ward of both Mankon and Nkwen Medicalised Centres were involved in the study and questionnaire administered to them. A structured questionnaire was designed to collect primary data from respondents. This instrument was structured as such to tailor the specific objectives of the study: Results show that; out of the 22 respondents, 11 (50%) were Nursing Assistants (NA), 2.0 (9.09%) were State Enrolled Nurses (SEN), then 8.0 (36.36%) were State Registered Nurses (SRN) and 1.0 (4.54%) a Bachelor in Nursing Science degree (BNSc). Six nurses have worked for between 6-12 months, 7 nurses for between 1-5 years, 3 nurses for between 5-10 years and 4 nurses for between 20 years and above. Out of the 22 Care–providers, 13 (59.09%) suggested that dehydration is excessive loss of fluid from the body, while 9.0 (40.90%) of the respondents thought that dehydration is loss of body fluids and electrolytes. However, all the 22 respondents presented similar causes and clinical pictures and state that dehydration is classified into 3 types in terms of severity. All the 22 respondents identified 3 types of dehydration and offered specific solutions as to each of them. They equally attribute specific length of time required to manage each type of dehydration. The 22 participations also thought that to properly manage this condition, appropriate tools (urinary bag or any calibrated bowl) should be used to estimate the amount of fluid lost. On the clinical manifestations of dehydration, 49 responses were gotten as follows, 11 (23.40%) could not distinguish signs and symptoms as to mild, moderate and severe dehydration, 12 (25.53%) stated difficulties as regard to management approaches, while 24 (51.06%) related their difficulties to mother’s compliancy. All the respondents suggested similar causes and clinical pictures and classified it into three types. All of them above implies that with the knowledge on dehydration, nursing staff can easily reverse this condition with less fatality using specific management approach corresponding to the degree of dehydration, and prevent complications. Health advice offered to mothers by nurses on the management approaches at home fall under four items viz: O.R.S., water and fluid, nutrition and hygiene. 18 (33.96%) provided health talks on hygiene. If faeco-oral infections should be avoided, hygienic measures must be implemented, 14 (26.41%) nurses advocated on the use of O.R.S which should be taken at home.   Keywords: Sanitation, Diarrhoea, Dehydration, Under-fives, Oral Rehydration solution, Hypervolemia, Fluid Replacement Therapy    
384 The Acquisition And Proper Usage Of LLINs As A Primary Preventive Measure Against Malaria In The Batibo Health Area In North West Cameroon , Bodzewan Emmanuel Fonyuy
Each year, there is an estimated 220 million deaths caused by malaria leading to approximately one million deaths mostly among children under five years of age. There is a growing international agreement to use prevention and treatments methods that are available against malaria. The most effective method include; the use of mosquito bed nets treated with long lasting insecticide (LLINs) to avoid mosquito and to kill mosquito and spraying the inside wall of the houses with similar to kill malaria carrying mosquitoes. In 2013 an estimated 136million LLINs were delivered in endemic countries, a major increase over the 70million bed nets were funded for delivery in 2014 and suggesting an even stronger pipeline for 2015. Population access to LLINs remain below the target universal coverage and has not appreciably improved. Malaria being a fatal disease is becoming difficult to prevent and control because of the habit of increasing resistance to the insecticides of the female anopheles mosquito. In Cameroon, malaria remains a public health problem and responsible for 31% of consultations and 44% of hospitalization in health facilities. It is responsible for 18% of deaths occurring in Cameron .In children less than 5 years 31% of deaths are due to malaria. The use of LLINs in Cameroon is still a problem, that is why in world malaria days from 2013-2015 the theme has been “invest in the future, defeat malaria to call attention to the effort to finish the job this 2015 calling for high level commitment to the vision of a world free of malaria”. The general objective was to find out the factors affecting the acquisition and proper usage of LLINs as a primary preventive measure against malaria and to propose possible solutions to identified problems. The specific objectives of the study were: To assess the community’s knowledge on malaria prevention. To assess their practical measures used in preventing malaria through the use of LLINs. To find out the proportion of the community with LLINs properly installed and utilized. To ascertain the constraints encountered by the community in its proper usage and propose possible solution to any identified problems. A descriptive cross-sectional study was employed in which data was collected on the acquisition and proper use of LLINs in the Batibo health area. The study population constituted of the inhabitants of Batibo health area community. A sample of 100 respondents were randomly selected using the systematic random sampling method to represent the entire population of Batibo Health Area). Results show that on the distribution of respondents relative to whether they have LLINs; it was observed that out of the 100 respondents 62% had LLINs while 38% did not have, 12 (19.35%) of the respondents said they have never had LLINs , 28(45.26%) said LLINs are not enough while 22( 35.48%) said the one they had is bad. The reason why LLINs may not be enough maybe because of increase in household members as 46 % of the respondents have more than four members per household. It was equally observed that out of the 38 respondents who had LLINs they were not properly used as only 10(26.5%) said they sleep under LLIN every night,8(21.0%) said when they feel cold and 20(52.6%)said they like. Conversely, out of the 38 respondents who had LLINs 16(42.1%) said everybody in the household sleep under LLINs while 22(57.9%) said not everybody sleep under LLINs. It was observed that not everybody sleep under LLINs because 13(34.3%) of the respondents said they were old, 2(5.2%) said they do not know why and 2(5.2%) said it is because of negligence. In conclusion, from the results obtained it was found out that; most people do not use nets because the nets are insufficient and may be because of increasing number of per household compared to the number of LLINs given per household. In the community the relationship between mosquito and malaria well known but many people are not aware of the night-biting female anopheles mosquito that transmit the malaria parasite may be contributing to the fact that many people still reluctant to use the net properly as a primary preventive measure against malaria. The peripheral level has a great task in the implementation of the proper use of LLINs and to let the net users understand that heat production and not breathing well are minor effects to some people at the beginning of the use of LLIN but after sometime these effects will disappear.   Key words: Long lasting Insecticidal Bednets, Female anopheles mosquitoes, Malaria, Installation, Residual spraying, Prevention, Vulnerable, Under-fives  
385 Community based approach to achieving Universal Access to HIV Testing and Counseling , Ademola Peter Oladipo, Babatunde Ladi-Akinyemi, Bolanle Banigbe, Patrick Akande, Ifeyinwa Onwuatuelo, Toyin Jolayemi, Chidinma Stevens, Bola Thompson, Idoreyin Udosen, Prosper Okonkwo
Introduction: Achieving universal access to HIV services requires a mixture of strategies to increase opportunities for people to know their HIV status. APIN in conjunction with civil society organization and with funding support from Global Fund (GF) and National Agency for AIDS Control (NACA) embarked on community HTC outreach campaigns in Lagos, Plateau and Oyo States of Nigeria. Community entry, advocacy and mobilization were key start up strategies.  Methods/Approach and Result: Partnership with Civil Society Organizations with strong presence leadership roles within the communities was the main approach to a community based approach to increasing uptake of HTC services in the three (3) states of Nigeria where AIDS Prevention Initiative in Nigeria operated. Eighteen (18) LGAs, 189 communities and 154 ANC locations across three states benefited from the outreaches. 54,841(1.2% positivity rates) people among the general population and 36,061 (0.19% positivity rates) pregnant women were provided with HCT services over three weeks. Conclusion: Alternative approaches to facility based HTC are critical to achieving universal access to HTC. Community based approach to HTC that relies on strong partnerships and collaboration with organizations that have commitments and leadership roles in the communities can improve uptake of services. It is a veritable approach for expanding access, availability and coverage of HTC services.   Keywords: Community, Partnership, Access, Uptake, eMTCT, Advocacy, Mobilization  
386 Preventing Obesity In Junior High Schools, Its Consequences And Lessons Learnt , Emmanuel Hakwia Kooma  
Objective: To evaluate the factors leading to the prevalence and secular trends for overweight and obese among the adolescents in junior high schools. Methods: A qualitative study review of literature was conducted on facilitating factors to the prevalence and secular trends, obesity prevention in junior high schools. Theoretical sources of information relevant to obesity (idea-based) were used. Primary, secondary and tertiary sources were used to have a broader overview of obesity. The general approach was a combination of chronological thematic and conceptual concepts. A descriptive analysis of the objectives was done Results: The obesogenic prenatal environment or the physical form of our community play a vital role and that can also promote obesity in young people through epigenic effects Conclusion: It was found that high-fat and energy dense diet has tremendously increased in the 21st century while most young population have increasingly lead sedentary lives. The life style of fast foods and little physical activity have increased the prevalence of obesity among school going children, adolescent and adults too. The related obesity and chronic disease risk factors have become major public health concerns. Multilevel model is related to local ecological model on the principal of preventing obesity. Therefore multilevel is a good model to prevent obesity in school. The risk regulations–health behaviour–genetic factors model approach laid a good ground for strategic prevention of obesity and evaluation of multilevel model practices, food intake, production and physical activities. Key words: Obesity, Junior high schools, Obesogenic prenatal environment, Multi-level model, Risk regulators-Health behaviour-Genetic factors.  
387 Obstetric utilization of blood components at the referral Princess Marina Hospital, Gaborone, Botswana , Tinashe Ashley Sibanda Mutize
Obstetric haemorrhage is the leading cause of maternal mortality and morbidity. Different Obstetric conditions can present as ante- partum haemorrhage or post – partum haemorrhage. Blood supply management and its timely availability have been identified as key interventions. This study retrospectively reviewed the patterns in utilization of blood components by Obstetric units at the referral Princess Marina Hospital, in Gaborone, Botswana. Permission to conduct the study was sought from the relevant Ethics Committees and Review Boards. A total of 422 womenwere transfused in Obstetric wards between 1 January 2014 and 31 December 2014 out of 3258 transfusions in the whole hospital. This means that Obstetric units utilize 13.0% of all blood components. Simple random sampling was performed and random number generators were used to come up with the required sample size of 159. The sample population had an age range (in years) of 15 – 39, with a mean of 26 +/-5.8 and median of 25. Blood groups O Pos (38%), A Pos (28%), B Pos (22%) and AB Pos (5%) accounted for more than 90% of the sample population. The average number of transfused units was 2.2, 3.6 and 3.6 for packed cells, FFPs and platelets respectively. The pre- transfusion Haemoglobin levels (g/dl) ranged from 4.4 to 16 with a mean of 7.97 +/- 2.2. The main reasons for transfusion were anemia (57%), PPH (23%), APH (13%) and HELLP syndrome (7%). The Decision – Transfusion Interval had a range of 55 minutes to 27 hours 45 minutes, median of 4 hours 30 minutes and a trimmed mean of 6 hours 37 minutes +/- 6 hours. There were observed inconsistencies in transfusion practices. It is recommended that there be transfusion protocols to standardize practice. An improvement in supply and follow up of blood for transfusion will also help to shorten the decision – transfusion interval. (Key words: Obstetric, blood components, transfusion)
388 The presence of common risk factors for cervical cancer among women attending the Visual Inspection with Acetic Acid (VIA) Clinic at the Georgetown Public Hospital Co-operation (GPHC) , Cummings, E., Abrams, K., Cox, T, Harris, J. Sukhoo-Pertab, M, Aaron, R. Samuels S, Narine, R and Singh, J
Background: Guyana has the third highest incidence and rate of death from cervical cancer in the Western Hemisphere. The are several predisposing factors including HPV infection, early age of menarche, young age of first sexual experience and first full term pregnancy, multiple sexual partner, smoking, low socioeconomic status,. Aim: to determine the common risk factors for cervical cancer among women attending the GPHC VIA clinic Methodology: A Self-Administered pretested and validated questionnaire which seeks to identify common risk factors for cervical factors among all women between the ages of 16 and 35 that attended The VIA Clinic at GPHC. Data was collected during a 1 week period Monday to Thursday (VIA Clinic Days) , a total of 48 women participated in the Study. Results: There was a 60% response to the study. 25% were of the low socioeconomic status. Only 18.7% of women had a papanicolaou smear in the last three years. 31.25% had a positive family history of cancer (breast and cervical). 18.8% had menarche before the age of 12 years. 95% of the women were sexually active with 47.9% having had their first sexual intercourse between the ages of 17-20. 21.7% of women had multiple sex partners and practice unprotected sexual intercourse . In addition a little less that half of the participants consumed a low fruit diet and a significant majority ate smoked and canned foods regularly Conclusion: Lack and irregular use of condoms at every coitus, multiple partners, inadequate diet among others were the main factors that predisposes the women to become infected with the human papilloma virus and subsequently development of cervical cancer .  
389 Public Health Correlates of Co-Infections of Syphilis and Hepatitis B Among People Living with HIV at the General Hospital, Calabar , Samson Olusegun Aturaka  
Introduction: HBV and Syphilis share certain epidemiological characteristics and route of transmission with HIV, and co-infections are not uncommon. Against the backdrop of the need for understanding of the risk factors as a cornerstone for designing effective prevention and control interventions, this research determined the prevalence and some determinants of co-infection of hepatitis and syphilis among PLHIVs. Methods: Descriptive cross sectional study among 350 PLHIVs seen at the General Hospital Calabar selected using multistage sampling method. Disease screenings were done using standard techniques. Data was analyzed using the SPSS software version 17.0. Results: Prevalence of HBV and Syphilis were 0.014% and 0.086%, with co-infection rate of 1 out of 351 cases. Co-infections was not statistically significantly associated with any of the diseases (X2 of 3.013 and p value of 0.006) despite only 205(58.3%) having low estimated sexual risk scores. Conclusion: Though co-infection prevalence rate is low, HBV and syphilis screening should be included in pre-HAART care, and towards encouragement of sexual behavioural change among PLHIVs. Key words: PLHIVs, Co-infections, Prevalence, Syphilis, HBV.  
390 Sero-Prevalence of Major Transfusion-Transmitted Infections (TTIS) Among Blood Donors Of Nnewi, Southeastern Nigeria , Michael Olugbamila Dada, Kalu Steven Okorafor, Eze T, Onwurah, OW
Background: The field of transfusion medicine has encountered a huge problem in providing safe blood and blood products; therefore there is a need to improve testing for Transfusion transmitted Diseases (TTDs) and the selection of blood donors. Objective: The objective of the present study was to estimate the prevalence of TTIs among healthy blood donors. Methods: A total of 12,326 healthy blood donors reporting to our blood bank in Nnamdi Azikiwe University Teaching Hospital, Nnewi, were screened for Hepatitis B surface Antigen (HBsAg), Hepatitis C virus (HCV), Human Immunodeficiency virus (HIV) and Venereal Disease Research Laboratories (VDRL) tests. Results: A total of 12,326 healthy blood donors aged 18-60 years were screened for TTIs. Out of these 333 donors (2.7%) were seropositive for HBsAg,219 (1.8%) were seropositive for HIV,195 (1.6%) were seropositive for HCV and 57 (0.5%) had shown sero positivity for syphilis. More male donors 660 (5.4%) were infected with TTIs than female donors 144(1.2%).The prevalence of TTIs in this study showed higher prevalence among donors 18 – 40 years of age (5.3%) compared to 41-60 years of age group. The rate of co infectivity in our study was 0.3% (33/12,326. Conclusion: This study reflects that blood transfusion is one of the risk factors of spread of TTIs especially in developing countries where rapid test-based screening protocol tends to be used increasingly in blood banks. Therefore, proper donor selection and public awareness campaign targeting communities in poor countries will be an important measure to curb the spread of TTIs through blood transfusion. Keywords: transfusion; HIV; HBV; HCV; syphilis; seroprevalence  
391 The Antimicrobial Properties of Terminalia Glaucescens and Zanthoxylum Zanthoxyloides Extracts and the Spectrum of their Activity , Mgbe Chinenye Glory, Mgbe Emeka Kevin
The antimicrobial activity of the ethanol extracts of two Nigerian chewing sticks (Terminalia glaucescens and Zanthoxylum zanthoxyloides) against oral bacteria and fungi isolates implicated in dental caries were assessed. The aim of the study is to isolate microbial organisms associated with dental caries and to assess the antimicrobial activity of the ethanol extracts of Zanthoxylum zanthoxyloides and Terminalia glaucescens stem used as chewing sticks. The dental extracts from 20 (twenty) patients with clinical features of dental caries were collected from School of dental technology and therapy clinic, Trans-ekulu, Enugu. The patients comprised of 8 males and 12 females with ages ranging from 16-40 years. The disc diffusion method was used in evaluating sensitivity to the extracts and it was observed that all the isolates were sensitive to T. glaucescens at different levels of concentration with a MIC and MBC of 6.25mg/ml for S. pyogenes. The isolated and tested dental pathogens were Escherisia coli, Pseudomonas aerugenosa, Streptococcus mutans, Streptococcus pyogenes, Staphylococcus aureus and Candida albicans. However, of the all the isolates E. coli proved resistant to Z. zanthoxyloides extract. Conventional antibiotics were used as positive control while distilled water was used as negative control. The ability of T. glaucescens and Z. zanthoxyloides extracts to inhibit the growth of the bacteria and fungi in this study is an indication that the plant can be used as a source for antimicrobial agent in the formulation of toothpaste and mouth wash, thus justifying the use of the plant locally as chewing sticks. Keywords: Dental Caries, Zanthoxylum zanthoxyloides and Terminalia glaucescens.  
392 The Effects of Socio-Behavioral and Environmental Factors on Infant Mortality: A Review of the Literature , Ganiyu Abiodun Adedeji  
Background: Infant mortality is a global problem which the Millennium Development Goals has aimed to reduce by two-third by the year 2015. Several studies have linked social, behavioral and environmental factors to increased infant mortality rates in the past. The objective of this study was to review the existing literature on the effects of socio-behavioral and environmental factors affecting infant mortality. Methods: A search of the literature was carried out. The search was conducted using web browsers like Google scholar, Pub Med, Medline and sociological abstracts. The articles were chosen when they were found to be relevant and were reviewed accordingly. Initially, the search was limited to recent articles not earlier than year 2000. But, when enough materials were not found, the search was extended to older articles because they were found to be highly relevant for the study. Findings: This review revealed that social factors such as poverty, household income, mother’s economic status, nature of care for infants, maternal age, breastfeeding, birth orders, birth intervals, place of delivery, income inequality, social policies, health scheme, mother’s education and postnatal care were found to affect infant mortality. Similarly, environmental factors such as poor residential conditions, nature of water supply, particulate matter air pollution, poor sanitation, heavy metal poisoning and household environmental characteristics were found in the literature to be linked to infant mortality. Behaviors of pregnant women like cigarette smoking, alcohol drinking, sedentary lifestyle, weight gain, utilization of prenatal care facilities and exercises were found to be closely related to infant mortality. Conclusion: It was concluded that many social, environmental and behavioral factors exist in the literature which were found to affect infant mortality. The knowledge of these factors should be utilized by both governmental and non-governmental organizations in the world to swing into action of arresting and preventing the menace of increasing infant mortality especially in the underdeveloped and developing countries. Key words: Infant mortality, Social factors, Behavioral factors, Environmental factors.  
393 Evaluation of HIV Seropositivity Among MDR-TB Adult Patients at Ndola Central Hospital , Vivian Mwiinga
Objective: This paper evaluates HIV sero-positivity among Multi- Drug Resistance Tuberculosis adult patients at Ndola Central Hospital, Ndola, Zambia. Research question: How many patients who were admitted at Ndola Central Hospital had HIV / MDR- TB co-infections, and how many died? Method: A Retrospective Cohort study using the existing data and laboratory results in patient files and MDR TB register (sampling frame) were reviewed for all MDR TB patients whose culture and drug susceptibility test done at Ndola Central Hospital were assessed for HIV sero-status from January 2010 to June 2014. Review of records was done from 15/08//2014 to 22//o8/14 and sample comprised of 114 records which were available during the stated period using convenient sampling. A semi-structured questionnaire was used for data collection on the existing data base on patient’s file and MDR- TB patient register. Data analyzed using Epi data version 3and bivariate analysis. Results: The study revealed that 68.1% of the MDR TB patients were males, compared to 31.9% females; however there was no association between MDR TB and sex. The study showed that 42% of the respondents with MDR TB were co-infected with HIV. It also revealed that mortality among HIV / MDR TB co-infected patients was 36% and those negative accounted 12.7% showing an association between HIV sero status and MDR TB co-infection mortality. Conclusion: HIV / MDR TB co-infection is a major public health problem needing urgent interventions, and proper treatment options for policy direction. Keywords: Evaluation, HIV / MDR-TB co-infection, Ndola, Zambia.  
394 Malnutrition in the Under-Fives: Assessment of the Knowledge And Practices of Mothers in its Prevention -A study carried out in the Bamendankwe Health Area in North West Cameroon , Bodzewan Fonyuy
Introduction: According to the WHO, malnutrition remains the biggest contributor to child mortality with 6 million children dying from hunger each year. In 2010, protein energy malnutrition was estimated to have resulted in 600 000 deaths from 883000 deaths, in 1990 another 8400 deaths resulted from iodine and iron deficiency. The general objective of the study was to find out if mothers of the under-fives leaving in the Bamendakwe Health Area are knowledgeable of the preventive measures against malnutrition. Materials & Methods: A descriptive cross-sectional design was employed in which a structural questionnaire was used for the collection of primary data from a sample of mothers with under-five children on their knowledge in the prevention of malnutrition. Results: Results obtained show that feeding a child with a balanced diet will help prevent malnutrition in children less than 5 years. Discussion: Mothers lacked the means to prevent malnutrition, lacked the knowledge of different foods to feed the child to prevent malnutrition. Ignorance and poverty are associated with malnutrition; according to Kammann (2003), ignorance, lack of adequate funds, unemployment leads a deficit in the means to purchase the right kind of foods rich in proteins. Conclusion: Malnutrition remains a serious paediatric problem in the under-fives as mothers’ deficit on balanced dieting can result to malnutrition. Key words: Malnutrition, Marasmus, Kwashiorkor, Health education, Balanced Diets, Breastfeeding, Sanitation, Behaviour Change Communication  
395 Burden of Childhood Diseases at Baptist Hospital Mutengene: A Retrospective Survey , Edouard Tshimwanga Katayi, Peter Bernard Hesseling
Childhood diseases, pediatric cancer burden, Baptist Hospital Mutengene, Cameroon. The pattern of disease burden has changed worldwide in past decades. Non communicable diseases, including cancers, are the main cause of mortality and morbidity in both high income countries (HICs)and low and middle income countries (LMICs). Pediatric oncology is not seen as a child health priority in most LICs like Cameroon amongst many others where pediatric cancer data are fragmented. The objective of this study was to generate data on childhood diseases at Baptist Hospital Mutengene(BHM) and to measure the burden attributed to pediatric cancerusing incidence, mortality, cancer related admission and quality of life in cancer survivors in order to guide resource allocation to the pediatric ward. A retrospective cohort study and a secondary data analysis were conducted from 2006 to 2013. Communicable diseases (malaria, chest infection and diarrhea) constitute the main burden of childhood diseases at BHM based on incidence and mortality. Pediatric cancers led by Burkitt lymphoma are contributing to an extent to the burden of childhood diseases with a proportionate incidence of 1 to 2 cases per 1000 per year and an admission rate of 31.8 per 1000 per year. 26 (13%) of 193 Burkitt lymphoma patients suffered a disability in the course of their illness and treatment and 2 (7.6% of the 26 but 1% of the 193) had a permanent disability due to Burkitt lymphoma, the leading pediatric cancer at BHM .Pediatric cancers contribute to increasing the burden of childhood diseases at BHM based on incidence, admission rate and quality of life of cancer survivors.  
396 Nurses and Physicians’ Perceptions towards Physical Activity Promotion in Kanye Health Facilities – Bots , Sophonie Ndahayo, Monique Mukanyandwi-Ndahayo, Akeem T. Ketlogetswe, Messina, Gofamodimo
This study on perceptions, practices, and levels of physical activity (PA) promotion by nurses and physicians in Kanye health facilities is a quantitative cross-sectional research. The population comprised 220 prospective respondents (205 nurses and 15 physicians). Of those who agreed to participate, data were collected using a self-administered structured questionnaire after a pilot study. Simple random sampling was used in data collection. Data were analyzed using STATA. Findings were presented in the form of tables and graphs. Results showed 98.4% perceive PA as promoting health, while 92.3% said PA promotion is a daily duty of nurses and physicians. Of the total respondents, 61.3% were engaged in PA. A major finding of this research is that 89.2% of respondents perceive that PA promotion should be a requirement for contemporary health facilities. Results showed that a good number of respondents (67.6%) reported that they promote physical activity. Thus, hypothesis number two that there is a high proportion of nurses and physicians who do not promote PA was rejected at 0.05 level of significance. The study recommended the inclusion of PA promotion and skills in the curriculum of nurses and physicians. Key words: physical activity (PA), PA promotion, general practice, moderate-intensity PA, engaged in PA.  
397 Prevalence of multi-drug resistant tuberculosis among adult patients at Ndola Central Hospital, Ndola, Zambia , Vivian Mwiinga
Study aimed at determining prevalence of Multi Drug Resistance Tuberculosis at Ndola Central Hospital among Adults, Ndola, Zambia. A retrospective cohort study review was conducted among adult MDR-TB patients at Ndola Central Hospital from 15th August to 22nd August 2014. All records for MDR TB patients from MDR TB ward were reviewed (January 2010 up to June 2014). Sample size was 114, Convenient sampling was done using MDR- TB treatment register and laboratory results. Data was analyzed using Epi Data version 3, and Pearson Chi square. The findings revealed that 48.2% of the patients with MDR TB had sputum positive results for culture, compared to 6.6% whose sputum was negative. The study also found that, of all (114) MDR TB patients who were admitted in MDR TB ward at Ndola Central Hospital, only 44% had Multi drug resistance , 33% had Mono resistance, while 22.6% had Poly resistance. The findings revealed that 29.8% were new cases, 23.7% treatment failure, and 4.9% relapse. Discussion of findings shows that; almost 50% of the respondents had MDR TB which was confirmed by sputum culture results and others had poly resistance and mono resistance. The respondents were either new cases, treatment failure or relapse cases, which showed that there could be other factors associated with drug resistance. Conclusion: prevalence rate of MDR TB was 44% and is major threat for TB control measures and proper treatment options. Keywords: Prevalence, MDR-TB Resistance, Ndola, Zambia.  
398 Association of HIV to Pulmonary Tuberculosis in Chest Clinic of a General Hospital in Lagos, Nigeria , Maclawrence Kolapo Famuyiwa
Objective: To determine the prevalence rate of Human Immuno-deficiency Virus(HIV) among tuberculosis (TB) patients in a general hospital in Lagos, Nigeria. Methods: This is a cross-sectional study. Demographic information was retrieved from the register of TB patients, HIV testing was done through rapid testing and confirmation by the hospital laboratory. Descriptive statistics was used to get the characteristics of the study participants. Bivariate analysis was performed for estimation of odd ratio (OR) and 95% confidence interval (CI). Chi square was utilized for the determination of the relationships that exists between study variables. P-values <0.05 were considered significant. Results: All the 130 patients gave consent to be tested for HIV. Eighty-eight (88) of the patients were male representing 67.7% of the patients and 85.4% of the patients had sputum smear positive pulmonary tuberculosis (TB) while the rest were sputum smear negative, 20 (15.4%) were HIV-positive. HIV prevalence among male patients was 13.6% (p value=0.42), but 19.1% (p value=0.42)among female patients. Prevalence of HIV among sputum smear positive pulmonary TB patients was 13.5% (p value=0.15) and 26.3% (p value=0.15) among sputum smear negative patients. Conclusions: This study revealed that HIV prevalence is higher among pulmonary TB patients than among the general population in Nigeria. It further lays credence to the close link that exists between active TB and HIV/AIDS infection in Nigeria, and the higher proportion of sputum smear negativity is found in HIV positive patients. There is a need therefore for a program to address HIV/TB co-infection. Keywords: Tuberculosis, HIV, co-infection, Lagos, Nigeria.  
399     A One-Year Study of The Epidemiology and Outcomes of Various Birth Defects in Pediatric Patients at Georgetown Public Hospital Cooperation , Dr. Unarain
BACKGROUND Although, birth defects are one of the leading causes of infant deaths and long term disabilities and have contributed significantly to the global burden of diseases, extensive researches have not been carried out in Guyana. METHODS A retrospective study, of 138 patients, diagnosed with Congenital Malformations at Georgetown Public Hospital Cooperation, between January 2007- December 2007was carried out. These patients’ medical records; inclusive of infant, neonatal intensive care and postnatal; were located and information was recorded in the form of a questionnaire which had structured and detailed parameters. Exclusion criteria were records for all stillborns, pregnanciesterminated at or after 20 weeks of gestation, out- patients and or patients in specialized clinics / institutions. Analysis on various variables (demographic distribution, clinical outcomes, clinical presentation, Apgar score, birth weight, maternal age, sex, ethnicity, previous infant with a birth defect, family history of a birth defect, known teratogenic exposure, maternal medical history, lack of folic acid supplementation and average length of hospital stay) was done using Microsoft Office Excel version 2003 for information on the epidemiology, management and clinical outcomes of the condition in the Guyanese population. RESULTS I found an estimate incidence 2240 cases of birth defects occurring annually in Guyana. The majority of cases were from Regions 4 (46.8%) and 3 (10.9%). The majority (73.9 %) of cases was seen in the age group birth-5 months, followed by (9.4%) > 50 months (>12 years old), 6-10 month (5 %) and 21-25 month (4.4 %). There was a male to female ratio of 1.3: 1 of having a birth defect. Afro-Guyanese accounted for almost one half (48%) of the cases followed by Indo-Guyanese, Mixed and Amerindians. The most common types of birth defects were congenital heart disease, Hirshsprung disease, hypospadia, cryptorchidism, accessory breast, club feet and syndactyl. The average length of stay was 6.5 days. One mother used alcohol and another used an abortificient during the current pregnancy. 82% of patients underwent surgery while 18% had medical interventions. Few patients had laboratory testing done. Patients generally had excellent clinical outcomes given a mortality rate of 0 %. CONCLUSION My findings highlight the clinical and public health importance that should be placed on Congenital Malformations in Guyana and to re-evaluate our approach to the condition and to introduce nation-wide screening practices.
400 A Review of Community Tb Care Intervention in Nigeria – A Care Study of Ngo Intervention – A Capstone Project   , Kingsley Chinedum Ochei,
Global burden of TB (1 Frequently asked questions about TB and HIV - http://data.unaids.org/pub/FactSheet/2006/TB_HIV_QA One third of the world’s population is infected with Mycobacterium tuberculosis,the bacterium that causes tuberculosis (TB). The vast majority of these people never develop active disease; only 5-10% of people infected with TB actually develop TB disease during their lifetimes. However, co-infection with HIV makes TB disease much more likely and 10% of people with TB and HIV co-infection will develop TB disease each year. In its Global TB Control Report for 2008, WHO estimated global TB prevalence of 14.4 million and incidence (new cases) of 9.2 million (139 per 100,000 population) for 2006. The Africa Region has the highest incidence rate per capita of 363 per 100,000 population. It is noteworthy that only 5.1 million (55%) of the estimated new cases were notified to WHO. Sub-Sahara Africa, South East Asia, and Western Pacific regions accounted for 83% of the notifications. Nigeria and South Africa were ranked 5th and 4th respectively among the top five of the 22 high burden countries with India, China, and Indonesia occupying the top three places in that order. There were an estimated 1.5 million deaths from TB in HIV-negative people and 0.2 million among people infected with HIV.
401 A Study of The Knowledge, Awareness, Perceptions and Beliefs (Kapb) On Hiv/Aids of Teenagers in The Lower East Coast Demerara (Guyana)   , Chakravarty Rajcoomar Narine, Dr. Emanuel Cummings, Mr. Shawn Jagnandan, Ms. Suraiya Ramkissoon
The purpose of this study is to investigate the Knowledge, Awareness, Perceptions and Beliefs (KAPB) of teenagers aged between 15 and 19 living on the Lower East Coast of Demerara (Cummings Lodge to Mon Repos) on HIV/AIDS. Randomly selected sixty Lower East Coast of Demerara teenagers were interviewed using a four page questionnaire and twenty one questions. The questionnaire was selected from the module on HIV/AIDS in the UNICEF End Decade Multiple Indicator Cluster Survey (MICS). In response to a planned 2000 World Summit for Children, the United Nations Children Fund (UNICEF) developed the Multiple Indicator Cluster Survey as a useful tool for collecting data on primarily women and children. The following organizations worked together to develop the first MICS - UNICEF, World Health Organization (WHO), the United Nations Statistics Division, the London School of Hygiene and Tropical Medicine and the United States Centers for Disease Control and Prevention (CDC). Five rounds of MICS were done globally in 1995, 2000, 2006, 2009 and 2012 – 2014. The results are presented in a manner that is consistent with UNICEF End Decade MICS Model Report. The results of the study will summarize key findings associated with teenagers aged between 15 and 19 living on the Lower East Coast of Demerara knowledge of the modes transmission of HIV/AIDS from mother to child, discriminatory attitudes towards people living with HIV/AIDS, knowledge on three means of preventing HIV transmission, their beliefs/misconceptions about HIV transmission. This study will calculate the percentage of teenagers who have ‘sufficient knowledge’ of HIV/AIDS transmission Given that Guyana has a high rate of teenage pregnancy. It is important that these issues be examined. This study is particularly relevant at this time when HIV/AIDS has emerged as an important health issue.
402 Active TB Case Finding Through HIV Testing and Counseling Centers in Zimbabwe   , Stephano Gudukeya
Zimbabwe is ranked 17th among the 22 high burden TB countries (HBC) in the world and has the second highest TB mortality rate in the world. Tuberculosis is one of the top 10 causes of infant and maternal mortality, and top five causes of death in children 1 – 4 years old (Zimbabwe National Health Profile, 2008). In 2008 pulmonary tuberculosis was the leading cause of death in the age group 5 years and above and the second most common cause of death in hospitals in all ages, after acute respiratory infection (National Health Profile). The crude death rate is 20 per 1000 and is mainly attributed to the high co-morbidity with HIV. The single most significant contributing factor to the TB epidemic is the HIV and AIDS epidemic. In the 1980s, tuberculosis notifications had declined to such a level that TB had ceased to be a public health problem. The rise in HIV and AIDS cases preceded the rise in TB cases by about 6 years. TB remains the commonest cause of death among people living with HIV and AIDS (PLWHA). Although the HIV prevalence has declined from a high of 24.6% in 2003 to 13.7% in 2009, HIV continues to fuel the TB epidemic. According to the 2009 TB cohort analysis (WHO Global Report 2010), the proportion of all TB patients tested for HIV was 61% of whom 78% were HIV-infected. The proportion of HIV-positive TB patients on Cotrimoxazole prophylaxis is 79%, the proportion of HIV-positive TB patients on ART is 31%. Data is now easily available following the revision of the TB M&E tools to capture information on HIV.
403 Assessing Factors Associated with CD4 Cell Absolute Count in Patients at Gulu Regional Referral Hospital   , Marc Sam Opollo
Background: This study is set to assess individual, enviromental and medication factors associated with Cd4 cell count in patients attending HIV/AIDS treatment and care clinic in Gulu Regional Referral Hospital. Gulu Regional referral hospital is located in the northern district of Gulu in Uganda. Gulu regional referal hospital performs CD4 cell counts to monitor HIV +ve patients Methodology: A cross sectional study, with study population of Gulu and target population being HIV +ve Patients attending HIV clinic in Gulu regional referal hospital. Systematic random sampling will be used. Questionaires will be administered to patients after informed consent. Results: will be presented in Texts, Tables, Graphs.
404 Assessment of Knowledge and Use of Rainwater Harvesting in a Rural Community of Edo State   , Dr Ekaete Alice Tobin
In areas of low rainfall or high altitude, rain water harvesting (RWH) becomes an important source of water supply for domestic use. The study assessed the practice of rain water harvesting in a rural community in Edo state Nigeria. Using a cross sectional study design , a pre-tested structured interviewer administered questionnaire was administered to selected households. A structured observational checklist was used for assessment of quality of rainwater harvesting system. Data was analysed using SPSS version 20, results were presented as frequencies, with statistical test applied where appropriate. Ethical clearance was obtained from the Ethical review board of the Irrua Specialist Teaching Hospital, Irrua. Findings show that RWH was practiced by over 80% of households, with the roof top as the catchment area. Stored water was most commonly used for personal hygiene purposed. RWH practice was found to be unsatisfactory in the majority of households. Health education should focus on informing households on appropriate design and maintenance of RWH systems.
405 Can Environment Control Measure and Laboratory Diagnostic Technique Be Used to Control the Spread of Salmonella Infection   , Floris R Gordon
Salmonella infection is the one of the most common foodborne diseases in the world and is caused by a bacterial infection. There are many serotypes of Salmonella bacteria which may cause salmonellosis in animals and human. The two most commonly found types of Salmonella are S. typhimurium and S. enteritidis, however, the frequency of Salmonella serotypes varies between countries. 1Approximately 40,000 cases of salmonellosis are reported annually in the U.S., 400 of these end in death, often as a result of dehydration from chronic diarrhea. 1 It is also estimated that the actual number may be at least 30 times the number reported by the CDC since milder cases of salmonella are not diagnosed or reported.1 Any person can contract salmonellosis, however, it is most often found in children below the age of ten years old. Those with impaired immune systems such as young children and old adults, as well as people with illnesses are most likely to have severe infections. Additionally, people with AIDS are especially vulnerable, not only suffering from the most severe infections but also from episodes that are likely to recur. In the last decade salmonella infections have been shown to be decreasing in the United States, however, some types are still increasing. Although this disease can be found across the world, cases occurring in North America and Europe are most often reported by health experts. 2 A number of Salmonella serotypes have developed resistance to several antibiotics most often used in salmonella treatment, this presents a potentially serious public health threat.
406 Communication Strategies for Marketing Health Products and Services   , Inegbenebor Ute
the individuals, families and the community. Like every product, tangible or intangible, an optimum marketing mix involving pricing, product quality, product promotion and product packaging or merchandising, can improve consumer satisfaction and their patronage of health products and services. Apart from training of trainers’ programs and specialized health education programs, the audience for a health service is generally heterogeneous, uncontrolled and diverse. There is a need for marketing research in order to select or segment an audience so that health services and products can be, designed in such a way that they are, affordable, accessible, comprehensible, user-friendly and attractive to consumers. Research must be targeted at defining community needs and perspectives while messages concerning health services and products must have clearly defined objectives. In addition, expected benefits from the health products and services must be clearly stated to the target audience. However, marketing policies should be implemented against the background of the humanitarian nature of health services and fundamental human rights. KEYWORDS Communication Strategies, Marketing, Health Products, Services
407 Epidemiological Aspect of Patient Consulting at Dental Clinic at Hlotse, Leribe, Lesotho   , Dr Jonathan Tshimwanga Lukusa
A descriptive study has been conducted between March and August 2013 on 196 patients consulting the oral clinic at Motebang Hospital aimed at to determine their epidemiological patterns. The findings are as follow: - The dental cavity is the most common oral disease with 40.0% and 34,8 % of which in severe clinical form; - the range of age between 6-10 years is consulting more than all others ranges the oral clinic with 17,7 %; - The dental care (brushing) is performed once a day with 72.2% and horizontally with 64.1%. The children less than 5 years and between 6-10 years do not perform any dental care per day in 28, 6 %( CI=28,6±3,9) - The intake of sugar (especially free sugar) is highest than any with 80.8% and the patients with high intake of sugar developed dental cavity in 81,8%; - The odds ratio between the sugars’ intake and the development of the dental cavity is 2,19 (OR 2,19; CI=44,3±6,7) - The frequency of jobless was 42.4% - The facial trauma especially fractures and dislocations of teeth represent 22.7% and are highly more frequent than periodontal diseases which represent 9.5%. - The frequency of congenital malformations was 4.0%
408 Factors Affecting Disclosure of HIV Status to Sexual Partners Among Women Attending Antenatal Clinic in State Specialist Hospital, Ikere-Ekiti , Dr Akinyemi Patrick Ayodeji
BACKGROUND: In this study, the factors affecting level of disclosure of HIV staus to sexual partners was studied among HIV positive women in Ikere Ekiti. PATIENTS AND METHODS: An interviewer administered questionnnaire was administered to 50 female respondent attending care and support group meeting. The degree of correlation between disclosure of HIV status to sexual partner and level of education was studied using chi square method at level of significance of α = 0.05. other factors were also compared e.g. stigmatisation, fear of divorce etc. RESULT: Despite effort and resources available for HIV care including counselling service, 76% of patient who have not disclosed their status are not ready for disclosure. The study also shows that there is no relationship between level of education and significance. Stigmatization is still a big challenge in the fight against the scourge as majority attached non disclosure to fear of stigma. CONCLUSION: Much effort is still required in the aspect of disclosure of HIV status among sexual partners through improvement of counselling section, legislation against non disclosure that is harmful to others and adoption of contract referal system into our health policy.
409 Bridging the Gap Between Concept and Reality in the Nigerian Midwives Service Scheme   , Inegbenebor, Ute,
Health programs are often instituted to prevent diseases and to restore or promote health. In many cases, there are gaps between anticipated and attained goals. A case in point is the Nigerian Midwives Service Scheme, where the concept of providing 24 hour coverage of the primary health centers by skilled birth attendants is currently failing to meet the desired targets in certain parts of Nigeria, predominantly the North Eastern and North Western Zones. This is in spite of adequate funding and organization. This article discusses the barriers to effective implementation of the program and suggests that the gap between goals anticipated during program conceptualization and goals attained after program implementation can be bridged by optimizing innovative health communications to the target audience and applying social marketing techniques to health care delivery in the affected zones. This is in addition to inter-sectoral coordination and collaboration between relevant government ministries and stakeholders. KEYWORDS: Bridging Gaps, Concepts, Reality, Nigerian, Midwives Service Scheme
410 Current Levels of Lead in Paint Sold in Nigeria   , N.C.Ahamefuna, O.Osibanjo, A.A.Sunday,  E.C.Ogoko
Serious health effects of lead poisoning have elicited global campaign to eliminate lead use in paint. The major challenge is the dearth of data on lead levels in paints from developing countries. Thus lead levels of paints manufactured and sold in Nigerian market were studied. Lead concentrations from 59 paint samples involving 10 different shades were determined using flame atomic absorption spectrophotometer (AAS). It was found that 83 % of the enamel paints had higher than the approved levels of lead in some countries which are 90μg/g and 600μg/g. The lead concentrations in the paint obtained ranged from 22.5μg/g to 74175μg/g, with mean value of 6442.88μg/g and median value of 1685μg/g. The concentration of lead was very high in almost all the enamel paints which make up over 80 % of the paint samples. Plastic paints (emulsion paint)generally contained low lead levels (22.5 μg/g -80.5 μg/g). Analysis shows that there is no significant difference between the concentration of lead and the colours of the paint sampled. Thus all the paint manufacturers are still using lead containing pigment in their paint production. Efforts should be made by regulatory authority to spearhead campaign to phase out lead use in paint. KEYWORDS: Lead level, Paint, regulation, Heavy metal Nigeria
411 Knowledge Attitude and Practices of Persons Diagnosed with Type II Diabetes Mellitus with Regards to Nephropathy as a Complication   , E Cummings , Alam Khan , J Singh, V Raja, A Defreitas
Diabetes mellitus (DM) is the most common disorder of the endocrine glands caused by an inability to produce or use insulin. It is the fourth leading cause of death in the World according to World Health Organization., in Guyana it is among the leading cause of death. (MOH Bulletin) KEYWORDS:- Diabetes, Dialysis, Kidney Disease, Blood Disease, Arteries, Diabetic Neuropathy
412 Estimates of Health Care Professional Shortages in Sub-Saharan Africa by 2015: A Critical Review   , Talkmore Maruta
The article by Richard M Scheffler; et all titled; Estimates Of Health Care Professional Shortages In Sub-Saharan Africa By 2015 published in the Health Affairs Journal volume 28, issue 5 of 5 2009 is reviewed. The review considers how the article is written in terms of structure, content and its effectiveness on addressing the issue of shortage of human resources in public. The issue of human resource shortage and brain drain especially in the developing world has been widely discussed, therefore, the relevancy, accuracy, objectivity, clarity of this article with respect to this subject area will be reviewed. KEYWORDS:- Health, Forecasting Model, Health Workers, Laboratory Scientists, Medicine
413 Knowledge, Attitude and Practices Towards Voluntary Counselling and Testing for HIV Among Rural Dwellers in Kogi State   , Dr Okebugwu Andrew Nwachimere-Eze  
One of the indispensible components in the war against HIV/AIDS is the voluntary counseling and testing and this has acquired global recognition. This study was done to ascertain the knowledge, attitudes and practices of VCT among rural dwellers in Kogi State Nigeria. Data were obtained through questionnaires administered to 250 participants who were selected through quota and convenience sampling and were analyzed manually. Finding shows that the awareness of VCT in this area is 79% with the highest source of information as mass media (79%). 52% agreed to receive VCT if offered.. 14% have accessed VCT services before this study. KEYWORDS:- HIV, Drugs, Disease, Virus, Cure, Testing, VCT
414 National Health Insurance Scheme in Ghana: Health Care Providers and Clients Perceptions and Experiences in The Upper East Region of Ghana   , Francis Abugri Akum
The Ghana National Health Insurance Scheme (NHIS) is to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential health care services without out-of pocket payment. The objective of this study is to examine the perceptions and experiences of health care providers and clients in the Upper East Region of Ghana regarding the NHIS. The study was cross-sectional and Patient exit interviews, in-depth interviews and focus group discussions (FGDs) were used to collect data. The NHIS was seen by all participants of the study to be beneficial. It led to an increase in the utilization of health care services for the insured and mobilized health resources for facilities. Insured clients reported verbal abuse, long waiting times, not being physically examined and discrimination in favour of the uninsured and the rich. Providers think that the insured were abusing their services by frequenting the facilities, and sometimes faking illness to collect drugs for their uninsured relatives. The biggest challenge was the delay in reimbursement of claims as a result; providers were not able to purchase drugs and non-drug supplies threatening the sustainability of the NHIS. KEYWORDS: National Health Insurance, Upper Region, Perception, Zebilla, Bawku Municipal.
415 Obesity and Health: A Review   , Ogbu C E and Ogbu C S  
Obesity is an urgent and growing global health problem of critical concern. The causes of this epidemic are complex and multifactorial, but fundamentally lead to an excess calorie intake and inadequate energy expenditure. Modern lifestyles, incorporating altered eating patterns, access to cheap, highly palatable, energy-dense yet nutritionally-poor foods, sedentary life-style and labour-saving devices which reduce physical activity have hugely accelerated the problem during the latter part of the 20th century. Obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups . The health consequences range from increased risk of premature death, to serious chronic conditions that reduce the overall quality of life. Of special concern is the increasing incidence of childhood obesity. The literature has been extensively reviewed to give an overview of the causes, the health problems associated with this disorder, the mode of assessment of the degree of obesity, its consequences, various methods of managing obesity with particular emphasis on dieting, exercise and the possible use of drugs (anorexiants) as well as surgery. KEYWORDS: Obesity, anorexiants, nutritionally-poor, multifactorial. 
416 Relationship Between Socio-Economic Status and Out-of-Pocket Expenses on Healthcare in Rural Nigeria   , Oluwakemi Tomori Edet-Utan
 The socio-economic status of individuals, households and community play a key role in their health status especially for those in rural areas amongst which the pauper dwells. The fact that out-of-pocket(OOPs)expenses especially amongst the rural poor leads to more poverty/impoverishment, indebtedness and or death calls for strategic and highly efficient health financing measures to resolves issues around OOPs. This study thus, seeks to understand the relationship between the socio-economic status of rural dwellers in Ejigbo LGA and out-of-pocket expenses made on their healthcare. This cross sectional study was carried out Utilizing an interviewer administered questionnaire to 1280 respondents who were selected using stratified random sampling of respondents in structures and households. SPSS version 21 was used to analyse the data obtained. Level of Educational attainment, income/earnings per month and occupation were scaled and cumulated to obtain the socio-economic scale/status. Majority of respondents belong to the lower socio-economic class, and had up to secondary level education. More than half of the rural dwellers earn between ₦10,000 ($62.5 US). In this study, 64.4% of respondents spent ₦5,000 ($31.25 US) or less on their health through out-of-pocket spending (OOPs) in 3 months consequently about ₦1,666.66 ($10.41 US) in a month. A statistically significant correlation was found between SES of respondents in rural area and their OOPs on healthcare. An increase in SES revealed an increase in OOPs. A significant relationship was found between the SES of respondents and the OOPs on healthcare which was a reflection of educational status, occupation and income/earnings of community members. This survey also reveals that the poorer the people, the less they spend on their healthcare owing to the fact that they have low earnings/income. Hence, there is need for more efficient risk pooling mechanisms in order to assure equity in healthcare service delivery. KEYWORDS:- Healthcare, Socio-Economic Class, Education, Statistic, Community, Expenses
417 The Theoretical Approach to the Discourse on Sexuality in Ghana: Law, Power, And Cultural Resistance: The Case of Minority Groups (Homosexuals)   , Elijah Tukwarlba Yin
This paper presents a critical discourse on sexuality in Ghana. It examines the religious, constitutional and legal arguments on sexuality. It also examines the issue of sexuality (Homosexuality) as a normal or an abnormal behaviour, private or public matter, as well as the place of morality in sexual matters. All these were examined in respect of power relations and law. The study used a letter written by the Christian Council of Ghana, internet news sources, and some responses that were gathered via informal discussions. The study used various theoretical tools such as perspectives of queer theorists, Foucault, and Brock’s writing on sexuality to interpret and interrogate the data. The paper explores the clashes in the legal orders i.e. it shows how the Ghana Criminal Code and other traditional norms criminalize ‘Unnatural Carnal Knowledge’ intercourse whilst at the same time the constitution and other international laws guarantee the right to freedom from discrimination. These legal ordersbring into sharp focus issues of legal pluralism as the normative orders contradicts a statutory order whilst at the same time the statutory orders clash each other. The study also shows that whilst the dominant group considers homosexuality as an abnormal sexual behaviour homosexuals through the theoretical perspectives consider their sexual orientation as one of the terrain towards sexual citizenship. The study further shows how ‘power’ permeate the whole sexual discourse as to who even determines morality. The paper concludes by settling on recommending a balanced approach to dealing with homosexuality rather than adopting an abusive approach. KEYWORDS: Theoretical approach; Homosexuality; Human Rights; Power; Morality
418 Understanding the Risk of Exposure to Occupational Hazards and Safety Measures for Nigerian Workers   , Okechukwu, Edith Chinenye  
To have a vibrant and productive economy in any nation, it becomes imperative that the health and safety of her workers must be given priority attention by the worker himself, employer and the government. Because of the increasing industrialization, infrastructural developments and modernization taking place in developing countries particularly like Nigeria. These factors have not only increased the job opportunities in and around the country but at the same time increased the incidence of morbidity and mortality of workers. And so it is important that the worker has an in depth knowledge and understanding of the nature of the job with regards to the health hazard exposures peculiar to the job and the safety measures to be undertaken even before accepting the job. More so, safety officers, factory and industrial managers etc. need to appreciate the need to know all that is involved in the job in order to make the workplace a safe and conducive one for the worker and achieve high productivity. This paper attempts to highlight a lot of occupational hazards that occur among both the formal and informal Nigerian workers, reasons for their occurrences, safety measures, lapses on the part of the employer and reveals the laxity on the part of government to enact and enforce occupational safety and health laws. KEYWORDS:- Occupation, Health, Workplace, Hazards, Nigeria, Safety
419 How Condom Social Marketing is Effective Tool to Improve the Health of Vulnerable   , Neeraj Sharma, Kapil D. Sharma
In response to the HIV/AIDS epidemic, social marketing programmes have made condoms accessible, affordable and acceptable to low-income populations and high-risk groups. Corporate marketing is used for social purpose then it’s called social marketing. In some areas this has become successful but in other few areas it given negative effect. This primary study has been done to First measure the effect of social marketing and second if social marketing, specially what type of media, would be an effective way to disseminate the information of HIV/AIDS, RTI/STI and condoms to the vulnerable population. This has been done on truckers (n=200), MSM (n=30), FSW (n=30). Questionnaire was made and FGDs were conducted. It was found that career is the priority of truckers & FSW and friends were priority of MSM. Truckers have radio as source of information. MSM and FSW were having Cellular phone to get information of their clients and friends. Approximately 78% truckers, 70% MSM, 48% FSW were aware about condom through social marketing (See Table 1). Only 63% truckers, 47% MSM, 12% FSW were aware of HIV/AIDS, and 58% trucker, 41% MSM, 5% FSW were using condom for prevention of HIV/AIDS, rest were for any other purpose. Social marketing programmes do not operate in air; government support is a key component of a successful programme. So government should support to MSM, FSW in legal. There is urgent need to have more social marketing of female condom & its use, and public private partnership model to improve health of vulnerable group. Corporate sector should provide support to Government as their Corporate Social Responsibility (CSR). KEYWORDS:- Condom Social Marketing, HIV/AIDS, Vulnerable, Government  
420 Improving Health Systems in Nigeria   , Nwuba Chioma Onyinye  
Nigeria, with a population of 140 million people accounting for 47% of the population of West Africa, has a moral responsibility to lead the continent towards achieving the Millennium Development Goals (MDGs). Yet its health system is ranked 187th of 191 WHO member states. Lending credence to this ranking are health indices such as an infant mortality rate of 101 per 1000; maternal mortality rates ranging from 500 per 100,000 in the South West to 800 per 100,000 in the North East, perinatal mortality rate of 48 per 1000 and child mortality rate of 205 per 1000. There is thus an urgent need to foster effective collaboration and partnership with all relevant stakeholders to improve the health systems in Nigeria. This paper explores challenges and possible solutions relating to health systems strengthening in Nigeria including health policies, governance, organization and financing of health services, health workforce production and health service delivery. KEYWORDS:- Goals, Stakeholders, Health System, Health Service, Organization
421 Screening of Primary School Children for Refractive Error in an Urban School in Lagos State   , Imade Priscilia Uhuanmwen  
BACKGROUND Refractive errors such as myopia, hyperopia and astigmatism has been implicated as the major causes of treatable but undetected eye defects in school age children. Vision screening is a veritable tool in detecting and preventing these visual impairments in children. This vision screening in primary school children was done in an urban school in Lagos state, Nigeria. This study was conducted to screen primary school children for refractive error and to find out the pattern of visual defects in school age children in an urban city. METHODS A cross sectional study on screening for refractive error in school children was carried out in a primary school in Ikeja Local Government Area of Lagos State between November and December, 2012. The study population were school age children from primary 1-6 and the pupils age was 5–11 years. Near acuity was done at 40cm and distance visual acuity for each eye was assessed by an intern Optometrist at 6 meters distance. Those with visual acuity of 6/12 or less were presented with a pinhole and the test repeated. Improvement of visual acuity with pinhole was considered refractive error. Penlight examination was carried out to check for external examination and opthalmoscopy was done under dim illumination to check the internal status of the eye. The isihara chart was used to assess the color vision. RESULTS A total of 580 (340 females and 240 males) Pupils were examined. Of these, 506 pupils (87.24%) had no refractive error but 74 pupils ( 12.76%) had refractive errors including amblyopia and color vision defects. Myopia was found to be highest refractive 51.35%, followed by hyperopia 29.73%, astigmatism 10.81%, amblyopia 2.70% and color vision 5.41%. CONCLUSION A significant refractive errors was observed among primary school children aged 5-11years at a prevalence of 12 .76%. Refractive errors can affect a child academic performance in school and could lead to permanent visual disabilities in adult life if not detected and treated early. Therefore, there is a need to have regular and timely vision screening in primary school children at least at the commencement of school so as to defect those who may suffer from visual impairment. Eye health education and regular vision screening are very crucial in the prevention of visual impairments among school age children. KEYWORDS: Refractive error, Screening, School children
422 Causes and Consequences of Air Pollution in Nigeria   , Ukemenam Obianuju Sarah  
Air pollution is a significant cause of morbidity and mortality. The greatest health impacts from air pollution worldwide occur among the poorest and most vulnerable populations. The amount of exposure in terms of the number of people, exposure intensity and time spent exposed is far greater in the developing world (Smith, 1993); approximately 76% of all global particulate matter air pollution occurs indoors in the developing world
423 Comparative Study of Qualities of Sachet and Bottle Water Sold on the Streets of Abuja, Nigeria   , Ibemesim Augustine Obinna
A total of one hundred (100) brands of sachets and one hundred (100) brands of bottle water samples were collected from different locations in Abuja Metropolis and were analyzed physico-chemically and microbiologically. The total count of most of the sachet water samples ranges between 0.32 x 102 and 1.95 x 102 CFU/ml, exceeding the limit of 1.0 x 102 CFU/ml. The MPN of coliform counts ranged from 1 to 16 cfu /100 ml of sample. Total number of isolates 502, 201 (40.04%) Escherichia coli, 52 (10.36%) Streptococcus faecalis, 50(9.36%) Pseudomonas aeruginosa and 199 (39.64%) Klebsiella Species. The dominant bacteria isolates were Escherichia coli, Streptococcus faecalis, Pseudomonas aeruginosa and Klebsiella Species. The entire bottle water samples analyzed showed no bacterial growth. Bacteriological analysis showed that 10/100 (10%) of the samples of sachet water tested showed positive coliform counts. These contaminants could be as a result of improper sterilization of the water before packaging or contamination due to poor handling during production, transportation or sales of such products. There were no traces of Heavy metals and all other chemical parameters were within permissible limits. KEYWORDS Unsafe Water, TSIA Test, Packaged water in Abuja, Water-borne diseases, NAFDAC, Oxidase Test.
424 Maternal Mortality in the Chadian Ouaddai Region Health Facilities Compared to the whole Country   , Dr.Paluku Kapitula Augustin
Maternal mortality is one of Chad’s most pressing issues. Chad’s maternal mortality ratio is 1,200 per 100,000 live births, the third highest in the world (WHO 2010). A woman’s lifetime risk of maternal death is 1 in 14, one of highest in the world (Country statistics; “Unicef”). The Ouaddai region being one of the Chadian regions beneficiating from humanitarian assistance due to the Darfuri Sudanese refugees’ presence since 2004, this region is not sharing the alarming statistics as hereby presented. This study aims first to examine and analyze maternal mortality ratio in Ouaddai health facilities in comparison to all the country, second to light the disparities between MoH health facilities and the ONGs supported health facilities (refugee camps) within Ouaddai region. Using three years data extracted from the UNHCR Health Information system and the MoH health information database in the region, we ran a retrospective MMR study to estimate the difference relevant to each location in the Region. The results show that the Maternal Mortality is statistically different in each of the two locations within Ouaddai and different comparing Ouaddai region to the whole country. The differences noticed is likely due to the quality health provided in the refugee camps which contribute to improve the health of women in the host communities who are benefiting for a free of charge health services in the refugee camps. KEYWORDS Maternal mortality, Chad, Maternal death, Qouaddai region, HGRN, Neonatal mortality.
425 Attitude and Behaviour of Users of Motorcycle Towards the Use of Crash Helmet in Ado-Ekiti, Nigeria   , Dr. Pius Izundu Okpoko
OBJECTIVE - To determine the attitude and behaviour of users of motorcycle towards the use of crash helmet in Ado-Ekiti, Nigeria. STUDY DESIGN - this is a cross-sectional study design that made use of quantitative survey method involving data collection and analysis. PARTICIPANTS - 283 voluntary adults who were randomly recruited within Ado-Ekiti metropolis. METHOD - a semi-structured questionnaire was administered to participants who also consented to the survey. A cross-sectional study was employed in this research to enable any desired data to be collected at one point in time. RESULTS – There were 283 returned and analyzable questionnaires out of 321 questionnaires administered. The modal age group was 21-30 years (42%). There were more males, 209 (73.9%), than females, 74(26.1%). Majority of the respondents were single (55.1%).This was followed by respondents who were married (41.0%). A total number of 16(5.7%) respondents only had primary education, 126(44.5%) secondary education, 113(39.9%) tertiary, while 28(9.9%) had no formal education. Students, 92(32.5%), were the majority of the respondents. Two hundred and forty respondents (84.8%) believed that it is necessary to use crash helmet, while 43(15.2%) did not believe that it is necessary. The frequency of self-reported helmet use was 171(60.4%), while 112(39.6%) had never used helmet. Seventy percent of respondents believed that helmet use should be made compulsory for users of motorcycle. Various reasons for non use of helmet include too heavy 99(35.0%), fear of contracting disease 93(32.9%), not protective 24(8.5%), and other reasons not included in the options 6.7(23.7%). CONCLUSIONS – This study highlighted that a far greater number of respondents believed that the use of crash helmet is necessary for safety and should be made compulsory. Nevertheless, the discomfort which is associated with wearing a crash helmet and perceived risk of contracting infection from helmet usage were the main negative factors militating against helmet usage.
426 Road Traffic Accidents, National Development and Public Health in Contemporary Nigeria: Analytical Study of Plateau State 2006-2013.   , Mr.Edward Eziokwu Egede
The increasing level of road traffic accidents in Plateau State and the consequent injuries and deaths strengthened the case for its regular analysis. There is a generally increasing incidence, morbidity and mortality rates of road traffic accidents. Majority of mortalities and morbidities occur in developing Countries. Worldwide, road traffic accidents lead to deaths and disability as well as financial cost to both society and the individual involved. The causes of road traffic accidents are not just human error or driver negligence. Unfortunately, Nigerian highways are arguably one of the worst and most dangerous in the world. Road traffic accident in Plateau State, Nigeria has not received the attention warranted. Reviewing literature on road traffic accidents and their impact and using the time-series description method, road traffic accidents showed an upward trend and significant seasonal influences. Using chi-square test showed there were significant differences among the various causes of accidents and accident cases (Minor, fatal and serious) with respect to types of vehicles involved over the years. Articles were sort from public libraries, as well as online through internet search engines and relevant information extracted. There is need to view road traffic accident as an issue that needs urgent attention aimed at reducing the health, social and economic impacts. Data on recorded cases of road traffic accidents was collected from the Motor Traffic Division (MTD), Divisional Headquarters, Jos, Plateau State Police Command. Out of 5921 accident cases, reckless driving, inexperience and mechanical fault and road defects accounted for 30.3, 21.5 and 21.1%, respectively. Two motorcycles, motorcycle-vehicle and vehicle-vehicle crashes are the lead types and have resulted in 38.9, 37.5 and 14.9% of the 855 deaths recorded within the period of study. Furthermore, the study showed that private cars, minibuses and taxis accounted for most of the accidents with 94.7% of the total accidents. KEYWORDS Road traffic accidents, Vehicle, Uncontrolled accidents, Plateau State, Traffic laws in Nigeria, Nigeria Police Force(NPF).
427 Knowledge of Public Health Ethics Among Medical Doctors in Nigeria   , Dr. Maclawrence Kolapo Famuyiwa
This study is about the level of knowledge of medical practitioners in Nigeria on the principles of Public health ethics and the existence of national code of health research ethics in Nigeria. It is a cross-sectional questionnaire-based study in which 158 medical doctors were involved. Data analysis of the study showed that one hundred and forty (140) respondents completely filled and returned the Questionnaires, which represents a response rate of 88.9%. One hundred and twenty seven (127) Respondents (90.7%) claimed to have had medical ethics as part of their medical education. The Median duration of formal education or exposure to public health ethics was 5 hours (range:0-20\ hours). Eighty four (84) respondents representing 60% of the respondents claimed to be aware of the body saddled with supervising of health research ethics in Nigeria, but only forty seven (47) representing 33.8% of the respondent were able to mention the name of the committee responsible for medical ethics in Nigeria as the National Health Research Ethics Committee NHREC). Sixty eight respondents (48.6%) have a good knowledge of public health ethics. Analysis of the identified public health ethics dilemma shows that end of life was the highest mentioned (77.1%) followed by discharge against medical advice (61.4%) and confidentiality by 60% of the respondent. The study thus concluded that there is obvious inadequacies in public health ethics knowledge among Nigerian medical doctors, and a clarion call should be directed at policy makers to overhaul the present medical education curriculum in Nigeria to include public health ethics at both the undergraduate and post graduate levels. KEYWORDS Public Health Ethics, Bio ethics, Nigerian Doctors, NHREC, Ethics Committee, Health researches.
428 The Opinions of Pharmacists in Ondo State, Nigeria, Towards the Inclusion of HIV Services Into Community Pharmacies   , Olatoun Adefunke Adeola
The purpose of this study is to ascertain opinion of pharmacists on the inclusion of HIV interventions into community pharmacy. This includes their willingness to deliver HCT and ARV services, their perceived knowledge of HIV management and the adequacy of personnel and infrastructure at community pharmacies. In the course of this study, the survey method of descriptive research was used. It was implemented through the collaboration of the Ondo State branch of the Pharmaceutical Society of Nigeria (PSN) during the celebration of the World Pharmacy Day 2013. This afforded the opportunity of having pharmacists working in various health fields together under one roof. The main instrument of data collection was a pre tested questionnaire. The responses were entered into an excel data base with the data analysis done using tables and percentages. The result of the analysis revealed the readiness of pharmacists to accept the incorporation of HIV services into community pharmacy. It also revealed that Community Pharmacists in Ondo State are enthusiastic and willing to be included in HIV service provision. Integrating HIV services into their services would support an increased uptake of prevention services, expansion of access to HCT, PMTCT, and ART services. KEYWORDS HIV, AIDS, pharmacists, Community Pharmacy, Ondo State, Anti-Retroviral drugs.
429 A Study on Socio-Economic Status and Social Capital of Rural Community Members in South-West Nigeria   , Mrs.Oluwakemi Tomori Edet-Utan
The relationship which exists between social capital and socio-economic status of dwellers in rural Nigeria has been poorly researched. This study aims to determine the level of social capital and social support available to rural community dwellers in relation to their health needs and to explore the relationship which exists between social capital and socio-economic status of respondents. Stratified random sampling technique was used to select 1280 respondents from 4 rural communities in South-West Nigeria (Ejigbo LGA). Data was obtained using an interviewer administered questionnaire in local dialect (Yoruba). Socio-economic status was determined using the Kuppuswamy’s method of Social Classification. Chi square was used to test associations between social capital and socio-economic status and level of significant association set at p<0.05. Male and female respondents were 51.0% and 49.0% respectively within the age range of 15 and 90 years. Majority of the rural dwellers in Ejigbo community belong to the lower socioeconomic status. This study clearly revealed that rural dwellers have strong social support as well as large social capital to fall back on in times of crisis. Majority of the rural dwellers had family members, close relatives, friends, religious leaders and social group to fall back to when faced with health challenges/problems. Though rural dwellers in Ejigbo community (South-West Nigeria) may have a strong social support and large social capital, it is not a reflection of socio-economic status of the community members. KEYWORDS Rural dwellers, Community members, Social capital, Social support, Sociologists, Rural community.  
430 Factors Affecting Utilization of Postnatal Care Services in Kenya   , Mr.Peter Muturi Kinuthia
Approximately 30-40% of direct maternal deaths in Africa are due to hemorrhage, mostly in the postpartum period both in the hospital and in the community levels. In sub Saharan Africa only 13 % of the mothers attend postnatal care .Adequate utilization of postnatal care can help reduce mortality and morbidity among mothers and their babies. This study was carried out in Province General Hospital Nyeri, Kenya with the objective of determining the factors affecting the utilization of postnatal services. It was a descriptive survey and convenience sampling method was used to identify the required sample population and a data was analyzed using descriptive statistics. A total of 240 women successfully completed the survey. The questionnaire generated demographic information about the mothers’ knowledge about postnatal services awareness and demographic characteristics that were found to influence the uptake of postnatal services included age, marital status, and parity. Its was found that most women lacked awareness about the services given in postnatal clinic and long waiting time and cultural beliefs were among factors that affected utilization of postnatal care. From the study the utilization of the postnatal services at the hospital in 14.2% which is quite low considering the need for postnatal services. The research recommends enhanced advocacy and communication to the mothers on the need for use of postnatal services in the hospital. KEYWORDS Postnatal care, Provincial General Hospital Nyeri Kenya, Maternal mortality, Parity, Post partum period
431 A Study to Explore the Effectiveness of a Newly Developed SES Scale as a Tool for Measuring SES of the Family in Rural and Urban Areas and to Compare with Commonly Used SES Scale   , Mrs.Shalini Baskaran
Socioeconomic status is commonly conceptualized as the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation. Socio economic status (SES) of the people in a country is very essential as it is one of the important factor determining the health, education, mortality, morbidity and nutritional status of an individual. Socioeconomic status also determines the people’s ability to access, afford, accept and utilize the health care services available in the society. The socioeconomic status (SES) is widely recognized as one of the important factors affecting the health condition of an individual or a family. India is the second largest populated country and Minister of State for Planning and Parliamentary Affairs Rajeev Shukla in a written statement to RajyaSabha has stated that 27 crore people live below the poverty line in the country. (India Today). The Planning commission said that the number of those below the poverty line declined to 21.9% of the population in 2011-12, from 29.8% in 2009-10 and 37.2% in 2004-05.The estimate, based on a survey of household consumer expenditure, showed rural poverty declined to 25.7% from 41.8% in 2004-05, while in urban areas it fell to 13.7% from 25.7%. (Economic Times – 2013) India as a vast democratic country, there is a need in identifying the actual beneficiaries who will be benefitted by the government programs/subsidies. Socio economic status scales are widely used to classify the SES and it is important to analyze that these tools are effective in identifying the SES of the family. Many different scales are available to measure the SES of a family and most widely used scale in urban community is Kuppuswamy scale (Modified) and it is based 3 categories – education, occupation of the head of the family and Income from all the sources. Modified Prasad scale has been widely used in India and it is mainly based on per capita monthly income. Pareek SES classification scale is used in rural areas and it is based on nine charecteristics caste, occupation, education, level of social participation of head of the family, landholding, housing, farm power, material possession and total members in the family.A conversion factor is calculated based on current All India Consumer Price Index (AICPI) to get current income group. The Government of India in the National Family Health Survey (NFHS - II) had used the Standard of Living Index (SLI) scale which contains 11 items viz. house type, source of lighting, toilet facility, main fuel for cooking, source of drinking water, separate room for cooking, ownership of the house, ownership of agricultural land, ownership of irrigated land, ownership of livestock, ownership of durable goods for measuring the SES both urban and rural areas for the entire country. However each of these scales available for measurement have their own advantages and disadvantages. The present study had explored the reliability of a newly developed scale which need replication to assess the validity of the tool. It can be used in both urban and rural. KEYWORDS SES, Healthcare, Poor health, Social measures, Academic Achievement, Risk factors.
432 Social and Behavioral Change Communication: Programming and Barriers to Implementation in Developing Countries   , Dr. Chidimma Ezenwa Anyanwu
This study examines determinants of health and explores how these interact to help man attain or defer from the desired health outcomes. It further examines the role communication plays in an attempt to “influence” the actions of man towards attaining the desired health outcomes emphasizing man’s interaction with his natural environment. Challenges that ensue in this context were analyzed from a programmatic point of view as seen in developing countries and recommendations made based on this hindsight. KEYWORDS: Behavior change, Barriers, Social communication, Developing countries, IEC, SBCC
433 Evaluation of National Health Insurance Scheme: Benefits and Challenges in Eastern Nigeria   , Mgbe Chinenye Glory , Dr. Kevin E. M  
National health Insurance Scheme (NHIS) is a health care scheme that was by established by the Federal Government of Nigeria in 2005 for better healthcare delivery to its populace. The aim of this study was to determine the proportion of Enugu East Federal Government Staff in Nigerian enrolled in the scheme, their satisfaction with the quality and availability of services rendered within the scheme and the factors that were responsible for the dismal health indices in the country despite the use of the scheme. Indebt Questionnaires were administered randomly to 200 out of 212 respondents that access healthcare in Esut Teaching Hospital in Enugu East metropolis. The findings show that only 57% of adults were enrolled in the scheme, 87% were satisfied with their health improvement with the scheme. Notably, 93% of enrolled respondents were aware of NHIS. There was some level of dissatisfaction in the scheme (26% of enrollees). Sources of dissatisfaction included delays in receiving required services and unavailability or non coverage of some required services. It was statistically determined using Chi Square tool of analysis that there was a direct relationship between the percentage of enrollees and the poor health indices of the populace. We strongly recommend for an improvement in accessibility and availability of quality drugs for a better health to NHIS client and as well as improved coverage quality of Services within the scheme. Also there should be a modification in the existing policy by improve NHIS through creating special hospital for the scheme’s patient. This may further improve the undue protocol encountered by this research.  
434 Knowledge of Diabetes Management and Control among Diabetic Patients Attending Federal Polytechnic Clinic,Kaura – Namoda, North West, Nigeria   , Mr.Belloliman
This review critically reviews the article ‘Knowledge of diabetes management and control among diabetic patients attending Federal polytechnic clinic, Kaura – Namoda, North west, Nigeria in the journal South American Journal of Public Health. Diabetes mellitus or simply diabetes may be defined as the deficiency or diminished effectiveness of insulin. Patients with excessive blood glucose (hyperglucosuria) will actually experience what is called polyuria (frequent urination), thirsty (polydipsia) and hungry (polyphagia). KEYWORDS: Diabetes, Patients, Federal polytechnic clinic, Insulin, Kaura – Namoda, Diabetes management.  
435 Assessing Factors Influencing The 4 Times Ante Natal Attendencies At Tororo Hospital, Uganda   , Dr Buyinza Godfrey Kagawa
Background: Tororo district hospital has been offering goal oriented ante natal care services in line with ministry of health strategy for improving on maternal and child health, however 4 time ante natal visits have been low since its implementation as it stands at 9.9% (Tororo, 2005/6) The aim of the focused ANC attendances was to offer optimum care to the mother during any one ANC visit. The 4 times ANC visits being low (9.9%) implied that there are factors hindering mothers from attending ante natal care services hence the need to study and document these factors. The study was conducted to identify factors hindering 4 time ANC attendances. KEYWORDS: Ante natal care services, Maternal, child health, Attendancies, Pregnancy, Tororo district hospital.
436 Knowledge and Perception of Rural Communities in Abuja Nigeria on Community Based Health Insurance Scheme   , Ms.Christiana Ogben
Accessing the knowledge and perception of healthcare consumers towards community based health insurance scheme (CBHIS) is valuable in investigating the implementation of the scheme. This study aims to evaluate the knowledge and perception of healthcare consumers towards CBHIS since its inception in FCT. A cross-sectional survey was used on a sample size of 287 for this study. Data was collected through paper-based questionnaire and analyzed through SPSS. Findings imply that there was a high level of awareness of CBHIS among the study population but little knowledge of how the scheme is financed. Satisfaction level was significant to household size (p<0.001). KEYWORDS Rural Communities, Health insurance, Abuja, Consumer, Federal Ministry of Health, Perception  
437 Attitudes and Practices of Health Care Workers Towards HIV Positive Patients at the Federal Medical Centre Owo Ondo State Nigeria , Mr. Ebenezer Obi Daniel
PROBLEM: Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every11 people with HIV/AIDS worldwide. In Nigeria, as elsewhere, AIDS is perceived as a disease of “others” – of people living on the margins of society, whose lifestyles are considered “perverted” and “sinful.” Discrimination, stigmatization, and denial are the expected outcomes of such values, affecting life in families, communities, workplaces, schools, and health care settings. OBJECTIVE: The study was designed to determine the attitude and practices of health care workers towards HIV positive patients at the Federal Medical Centre Owo , Ondo State, Nigeria. METHODS: The study was carried out at Federal Medical Centre Owo in Ondo State, Nigeria. A descriptive cross sectional survey of all seven categories of health-care workers in the centre was conducted. Each category of health care workers; Doctors, Nurses, Pharmacists, Physiotherapists, Medical Laboratory Scientists, Health Information Managers and Medical Imaging Scientists was taken as a sample unit. Sample size proportional to the size of each unit was selected using simple random sampling in order to make the calculated overall sample size. Data was obtained through the use of structured, self-administered questionnaire. Summated scores were used to assess respondents’ attitudes and practices towards HIV positive patients. Data analysis was done using the Statistical package for Social Science (SPSS) version 17. Data were presented using descriptive statistics of frequencies, percentages, pie and bar charts. Inferential statistics of Chi-square was used to test for associations between various factors and the attitude and practices of health care workers towards care for patients with HIV. Statistical level of significance was set at P-value <0.05. An approval to conduct the study was obtained from Research Ethics Committee of Federal Medical Centre, Owo. Participants were allowed to give their consent in writing before participating in the study. OUTCOME: A considerable percentage (31.8%) of 252 respondents has varying degrees of poor attitude, while almost half (48.8%) have poor practices towards HIV positive patients. Exposure to blood and other body fluids or injury as a result of work in the last one year, was found to be significantly associated with the attitude of health care workers towards HIV positive patients (P<0.05). It was also revealed in this study that, there is a statistically significant association between sex, professional status of health care workers and practices towards HIV positive patients (P<0.05). This study also showed that 37.7% gave varying degrees of poor responses to the preventive measures towards discrimination against HIV positive patients. This study recommended the inclusion of HIV/AIDS education in the training curriculum of schools attended by all health care workers, continuous education/counsel of health care workers on HIV/AIDS, creation of HIV/AIDS policies in all hospitals, further research on the study, and that all health care workers should serve as examples in the crusade against discrimination of HIV positive patients. KEYWORDS Healthcare workers, Federal Medical Centre, Ondo State, AIDS, HIV, Patients.
438 Measuring Satisfaction of Health Service Provision Among Primary Health Care Seekers in The City Of Johannesburg, South Africa   , Mr. Keith Hudson Muloongo
BACKGROUND: Customer satisfaction is an important element for assessing the quality of patient care services. There is a need to assess the health care systems to assess customer satisfaction as often as possible. OBJECTIVES: To assess customer satisfaction on services provided in City of Johannesburg healthcare facilities, the study will: Assess patient satisfaction levels on Patient rights, comprising of values and attitudes, waiting times and cleanliness. Assess patient satisfaction levels on Patient safety, infection prevention and control. Assess patient satisfaction levels on Clinical support services, comprising of availability of medicines and supplies. METHODOLOGY: The survey was a descriptive cross-sectional study. A structured close-ended questionnaire will be used to collect data from 9 965 respondents in 80 COJ health facilities over a period of two weeks.   KEYWORDS Health service, Satisfaction, Patients, Johannesburg, Clinicians,Population.
439 Perceptions of Risk of Noncommunicable Diseases Associated with Overweight and Obesity Among Individuals Living in Diepsloot Informal Settlement, Johannesburg, South Africa   , Mr.Ndumiso Tshuma
Chronic non-communicable diseases are a major contributor to the burden of disease in developed countries, and are increasing rapidly in developing countries. The purpose of the study was to explain and predict health behavior by focusing on the attitudes and beliefs of informal settlement dwellers. KEYWORDS Non Communicable Diseases, Overweight, Chronic, Global health challenge, Diepsloot,Unhealthy.
440 Change in Health Status in Long-Term Conditions Over A One Year Period: A Cohort Survey using Patient-Reported Outcome Measures   , Mr. Patrick Anibbe Ikani
This article studied quality of life of patients or clients with long-term conditions with focus on self-reported outcome and also reviewing differences between different long-term disease outcomes using variance analysis. This review will specifically summarize the study objective, whether it was effective, design, accuracy, authority, the structure used in analysis, study population and location as well as target selection using an objective critique and finally draw up a conclusion. KEYWORDS Health status, Cohort survey, Patients, PROM, Michele Peters, Patient outcom
441 HIV Counselling and Testing Services: What Determines the Participation of Young People in A Community, South West Nigeria?   , Mr. Olayinka Stephen Ilesanm
HIV Counselling and Testing (HCT) has been shown to have preventive effects on HIV/AIDS. Despite its importance, participation remains low in some places where the service is obtainable. This study was carried out to determine the utilization of HTC services among young persons in Yemetu, Ibadan and South West Nigeria. METHODS: The study was a cross sectional survey of 221 residents aged 15 to 24 years. Semi-structured interviewer administered questionnaires were used to obtain information on socio-demographic characteristics and utilization of HCT services. Descriptive statistics were done. Associations were explored with the chi square test and predictors of knowing ones status was determined using logistic regression analysis at 5% level of significance. RESULTS: The mean age of the respondents was 17.8+3.9 years, about half, 54.3% were female, 45.7%  were male (m: f = 1: 1.2), 83.3% were single, only 6.8% had tertiary education. Only 24% know their HIV status, 33.6% of respondents > 18 years know their status compared to 15.8% of those who were ≥ 18 years (p=0.002). Among the respondents who were aware of a place to carry out HIV test, only 49.4% know their HIV status compared to 10.6% who do not (p<0.001). Those that were aware of a place to get tested were about 8 times likely to know their status [OR=8.18 (3.66-18.30)] P<0.001.   CONCLUSION AND RECOMMENDATION: The common belief that services will be utilized when they are available was not evident in this study. Sustainable HIV responses targeting young people should not be limited by assumed availability of services. Periodic awareness programmes should be undertaken in the community   KEY WORDS: Human Immunodeficiency Virus, HIV counselling and testing, young people, HCT, HIV awareness, HIV treatment  
442 Drinking Water Radiological Quality Determination Based on Gross Alpha And Gross Beta Using Liquid Scintillation Counting (LSC)   , Mr. Reynold V. Luna , Mr. Jose Paolo O. Bantang, Mr. William D Agagas Jr
BACKGROUND OF THE STUDY Water is very ample and covers about two-thirds of the planet. However, most of it is saline water and only 2.5% is fresh water. In this small percentage, two thirds of it is locked in polar ice caps, 20% can be found in remote areas and only 0.08% is accessible for daily use [1]. Potable water is essential for the survival of human life. Without water, our existence is threatened. However, potable water coming directly from ground water should undergo different purifying techniques to ensure contaminant free water. The Philippine Government targets in 2010 to provide 92 to 96 percent of the people of safe drinking water [2]. One of the possible contaminants present in water is radioactive substances. Radioactive substances such as radium, uranium and thorium occur naturally in the environment [3]. This study aims to determine the radiological quality of potable water using liquid scintillation counting. This assesses the gross alpha and beta particles, known to be internal hazards, present in water. KEYWORDS Drinking water, Contaminants, Radioactive substances, Environment, Liquid Scintillation Counting (LSC), Groundwater.  
443 Global Health and Health Programs, Implication in Practice - A Review   , Ms Grace Atieno Jalang’o
Health is gaining greater attention on the global scenario. There has been an overall change that has seen a shift from global nation-based health-policy-making structures towards more diversity and greater emphasis on private sector actors. The not for profit civil society and non-governmental organization are now seen as a vital heath partner especially for health campaigns. Funding for global health is also changing as pressure mounts against vertical disease focused funding in favor of horizontal funding aimed at strengthening health systems. Players in the global health scene are also changing to include public private partnerships as well as a greater appreciation and inclusion of civil society. For global health to be effective worldwide and especially in Africa, the focus must be towards a broader system of funding that is not disease specific but also has an emphasis on strengthening the health system. Building and maintaining capacity for healthcare provision is also critical for effective action against health threats. Focus must also be on enabling partnerships while taking care that the broader public sector agenda is not overridden by vested interests especially in public- private partnerships Global health must also widen its focus from communicable disease to address threats posed by widespread increase in risk factors for non- communicable disease and broader social and economic factors that impact health in this era of rapid globalization. The trend must be towards using an evidence base to employ strategies that will in the long run provide cost effective interventions while ensuring appropriate and sustainable technologies are utilized to address health concerns.
444 Article Review on “Rational Emotive Behavior Therapy and Narrative Therapy”   , R.Santhanakrishnan
The study and application of Rational Emotive Behavior Therapy (REBT) and Narrative Therapy (NT) are essential and employed in enhancing one’s self-esteem and reducing the depression and other problems, which are fundamental aspects in Guidance and Counseling. Hence an Article Review has been done on “Rational Emotive Behavior Therapy and Narrative Therapy” on the thesis submitted to Osmania University for the degree of Doctor of Philosophy in “Psychology” in March 2009. The Article begins with one’s significant period of adolescence in one’s life time and the teenage problems in the recent years. This has caused the necessity of the present day adolescents coming for counseling for depression, sexual problems, drug and alcohol, the problems that were not heard of a few decades ago. The present day nuclear families increased independence, and exploration of their limits. According to Owen (1995) most of the adolescents begin to feel that they know themselves better than others, often creating conflicts with parents and peer expectations. Many adolescents have low self-esteem, the main reasons being drugs, alcohol, multiple relationships, anxiety, suicidal ideation, and underperformance. Self-esteem refers to an individual’s sense of his or her value or worth, or the extent to which a person values, approves of, appreciates or like him or herself. Self-esteem is considered the valuation component of the self concept. It encompasses an individual’s beliefs, behaviors and emotions. Self-esteem plays a crucial role in the development of personality of college students.
445  Understanding Global Health, and How It is Reshaping Health Training - A Review   , Ms Atieno Jalang’o
Global health though seen by a few authors as a bid by the WHO to reposition itself and survive changing times, is now being grasped as critical to addressing existing and emerging global health threats as a result of globalization. The world is increasingly “shrinking” as migration and trade patterns take a dimension that makes the world seem like a global village. While this has it economic benefits it is creating new threats as communicable infections are transmitted from region to region sometimes in a matter of a day. Health threats in a region can be a global concern at any given time; it is therefore necessary that health personnel are effectively equipped to handle such scenario as and when they occur. It is important that training programs are responsive to the changing health challenges and position themselves to offer health training programs that ensurehealth professionals are adequately prepared to address contemporary health threats. In a “shrinking world” health threats can end up being major catastrophe without timely intervention. This review delves into the need to ensure that health care professionals are equipped to effectively handle conditions that previously were not akin to their country. Training of health care workers must therefore be responsive to changing global trends with the realization that even in the developed nations, health promotion will only be successful if the health threats and shared risks from less developed nations are adequately addressed. Furthermore health action must be executed with an understanding of intricate cultural practice and other psychosocial economic factors that impact health. In essence it is not so much what Global health is defined as that matters but the realization that globalization is a powerful force that is impacting the health scenario and we must ensure health programs equip health workers by changes that address curricula, exposure to international training, collaborations, funding and relevant programs. These will not only provoke interest in global heath practice but ensure that we are adequately prepared to face the contemporary global health challenges.
446 Modifying Health Behavior in a Legal Environment   , Inegbenebor Ute
Though legislation is a quick and easy method of preventing behavioral lifestyle that is injurious to health, many failures may occur in a legal environment, which promotes fundamental human right. Besides, the coercive approach involved in this regulatory approach to health behavioral modification is against the ethics of health education. Health education is practiced in a legal environment of human rights and freedom of choice between health promoting and health disruptive life styles. It is therefore important to device ethically permissible strategies for modifying health behavior in order to achieve success in an environment of counteracting legal considerations and compelling need for healthy lifestyle in the community KEY WORDS: Behavioral, Modification, Legal, Environment
447 Conceptualizing and Implementing the Fifth Millennium Development Goal Through the Nigerian Midwives Service Scheme   , Inegbenebor Ute
The objective of the fifth Millennium Development Goal is to reduce maternal mortality by three quarters by the year 2015. All 189 member countries of the United Nations were expected to develop their own strategy for implementing this objective. The Federal Ministry of Health in Nigeria developed the Midwives Service Scheme in 2009, which mirrored a model earlier conceptualized and published in Tropical Doctor 2007. Since the outset of the Midwives Service Scheme, several economic and health benefits have been realized. These include gainful employment for all newly qualified, unemployed and retired midwives, improvement in the health care delivery to erstwhile medically underserved areas, a yet to be estimated reduction in maternal mortality ratio and a better utilization of the facilities in the primary health care centers. KEY WORDS: Conceptualizing, Implementing, Nigerian, Midwives, Service, Scheme
448 Does Heroin Use Disorder Intervention ‘Work’? A Critical Review   , Monika dos Santos
Abstract Of all the vice problems confronting South Africa and many other countries, the heroin dependence syndrome and its consequences pose some of the most serious challenges. While the treatment and management of heroin use disorders continues to be characterized by new developments, altering perspectives, and by controversies of one kind or another, the literature findings suggest that different treatment settings may be appropriate for different heroin users. People who are treated for heroin use disorders achieve a continuum of outcomes with respect to their heroin-taking behaviour and their heroin-related problems. Treatment response is thus not a simple matter of success or failure. As with many treatments, the assessment of outcome involves degrees of improvement, and these may have different meanings for different individual cases. Although there is a general acceptance of such goals as improved health, or reduction or elimination of heroin consumption, it is also necessary to be aware of the need for flexible goals that can be adapted to individual circumstances.
449 A Meaningful Psychometric Test Or A Deceptive Ouija Board? A Critical Analytical Review of the Rorschach Inkblot Test   , Monika dos Santos
Controversy has surrounded the Rorschach throughout most of its history, not because it is worthless, but because it has so often been used for the wrong purposes. Psychlit, PEP, PubMed, Google scholar, CAB Abstracts and article references were searched to identify critical commentaries and published globally in English between 1921and 2012. Findings of the review suggest that the virtues of the Rorschach are modest but genuine.
450 Seasonal Variation in Heavy Metal Contamination of African Spinach , Oche Joseph Otorkpa, Abiodun Paul Olaiya, Stephen Emmanuel
Access to sufficient amounts of safe and nutritious food is vital to sustaining life and promoting good health. Seasonal variation in disease causing agents such as dietary heavy metals can negatively influence morbidity and mortality. The purpose of this study was to investigate the seasonal variation in lead, cadmium, manganese, copper, chromium, cobalt, nickel, and zinc in African Spinach a staple food in Nigeria. The method employed was atomic absorption spectrophotometry and the results indicates that the mean concentration of levels of Cd, Cu, Mn in the food crop increased during the rainy season while the mean concentration of Cr, Co, Pb, Ni, and Zinc were either higher or vary slightly during the dry season. With the exception of Cd and Co all other heavy metals were within maximum permissible limits set by the Joint FAO/WHO Expert Committee on Food Additives and the Agency for toxic substance disease registry (ATSDR), although slightly higher levels of lead were recorded in some dry seasons samples they still fell within permissible limits. Understanding the seasonal variation of heavy metal contamination in staple foods can possibly explain the seasonal variation in prevalence of some non communicable diseases, save lives and reduce healthcare costs. Keywords: Dietary exposure, Heavy metal, Contamination, Vegetables, Food Additives.
451 Factors Influencing Solid Waste Management in Nansana Municipal Division Council- Nansana Municipality, Wakiso District-Uganda , Evan Nuwamanya, Topher Byamukama
Background: Poor solid waste management is still a great challenge being faced by urban authorities in Uganda includingNansana Municipality where in particular there is still a challenge of indiscriminate and open dumping of solid waste along the streets that has led to other related health challenges currently affecting the Municipality. Purpose: Assessing factors influencing solid waste management in Nansana Municipal division in order to provide stakeholders with information that would be used to design appropriate interventions towards proper solid waste management. Methodology: A descriptive cross-sectional study design was used to collect both qualitative and quantitative data. Stratified cluster sampling procedure was used to obtain the households of respondents while the Purposive sampling was used to obtain the key informants. Results: Majority of the respondents, 55.6 % (151/272) had moderate knowledge about solid waste, 29.6% (80/272) of the respondents had high knowledge on solid waste management. While 14.8% (40/272) had low knowledge on proper solid waste management. 73.5% (200/272) of the waste is generated in form of food remains while solid waste in form of plastics and raw vegetables compose 52.2% (142/272). 84.2% (229/272) store waste before disposing it off but only 40.2% (92/229) of them store it in refuse bins. Majority 82.2% (222/272) of the respondents were disposing off waste at the road side. Majority of the respondents, 91.5% (249/272) of the respondents were not engaged in segregating solid waste. Keywords: solid waste, segregation, refuse bins, households.  
452 Empirical Review of the Role of Social Determinants in Treatment Outcomes in Drug-Resistant Tuberculosis Patients , Orekoya, O. Oyepeju, Nnodimele O. Atulomah
Background: Globally, success rate recorded for the treatment of drug-resistant TB remains low. About half of all patients with TB, often, do not complete their treatment schedule with consequent prolonged infectivity, drug resistance, relapse and death. Social determinants of health among several factors have been implicated as responsible for poor treatment outcomes. Objective: This paper reviewed published empirical studies related to drug-resistant TB treatment outcomes and examined social factors that may explain the dynamics involved in treatment failures that are likely to be responsible for poor treatment outcomes among DR-TB patients. Methodology: A review of empirical studies published in the available databases was conducted through a systematic search of articles indexed in Pub Med, Google Scholar and EMBASE databases. Pooled estimates of treatment success were computed and factors responsible were reported. Results: The review revealed that DR-TB treatment success rate varied from between 34.5% to 78.4%. A total of 252 articles were identified through electronic search, 52 were duplicated while 16 were eligible and included in the review. Mainly, resistance to second line drugs, co-morbid conditions such as HIV, Diabetes Mellitus, male sex, older age, being underweight, positive sputum smear, presence of cavities in chest X-ray, longer duration of treatment, non-adherence, previous treatment, were frequently identified factors associated with poor treatment outcome in MDR-TB patients. Conclusion: There was a dearth of studies involving social determinants in explaining the dynamics of poor treatment outcomes among DR-TB patients. Keywords: Drug-resistance, Treatment Outcomes, Tuberculosis, Social determinants.  
453 Information Need, Health Literacy, and Preventive-Health Behaviour among Individuals in a Rural Community of Ikenne Local Government Area, Nigeria , Nnodimele Onuigbo Atulomah, Bola Christie Atulomah
Objective: This study sort to ascertain the levels of information need, health literacy, and preventive-health behaviour among individuals in a rural community of Ikenne Local Government area in Nigeria and determine most significantly predictor of preventive-health behaviour. Methodology: This was a cross-sectional study that utilized interviewer-administered validated 52-item questionnaire for data collection. Measures were information need on 51-point rating scale, health literacy on 27-point, and preventive-health behaviour on 48-point reference scales respectively. Study subjects were 268 consenting individuals selected by a multistage sampling technique in a rural community of Ikenne Local Government area, Nigeria. Data analysis was by computations of means and standard deviations and test of associations to determination predictor of the outcome variable. All statistical tests were at 5% level of significance. Results: Majority (67.2%) of participants were females with 63.8% reporting appreciable level of formal education. Mean age of respondents was 32.2±13.11 years. Level of acquired information was 25.7±5.65 with a prevalence of 50.4%, health literacy mean score was 14.97±4.23 with a prevalence of 55.4%, while mean score of preventive-health behaviour was 23.37±7.27 with a prevalence of 48.7%. All levels of variables measured were considered average scores. Regression analysis showed that preventive-health behaviour was significantly dependent on health literacy (β = 0.397; t=5.07; p<0.001), and level of acquired information (β= -0.211; t= -2.696; p<0.008). Conclusion: The study concludes that levels of acquired information, health literacy, and preventive-health behaviour observed are low. The observed high information-deficit would explain the observed inadequate preventive-health behaviour reported in the study. Keywords: Health literacy, Information need, health-choices, Preventive-health practices.
454 Access to Anti-Retroviral Therapy and Post Antitherapy Sexual Behaviour among HIV+ Persons in Ondo State , Femi Rufus Tinuola
Since the discovery of HIV/AIDS, its morbidity and mortality in Nigeria has risen proportionately, posing significant threats to population health and survival. The increased pressures on the existing health infrastructure and financial burden have negative consequences on the social and economic development of the nation. Several surveys and available records indicate that the main route of over 65% infection with HIV is unprotected and illicit sexual activities, making the sexually active segment the Most at Risk Population (MARPS). Voluntary Counseling and Testing (VCT) and administration of Anti-Retroviral to boost the immunity of PLWH offers a relief in the management of HIV, Research on post VCT and ART sexual activities are relatively rare in Nigeria. The study examined HIV+ Status history and access to ART among PLWHIV in Ondo State, Nigeria. Data were obtained using a formal questionnaire, from a sample 315 PLWHIV accessing ART in the selected health facilities in Ikare Akoko, Ondo, Owo, Ilaje, Akure and Okitipupa. The instrument was divided into socio-demographic characteristics, HIV+ Status history, Access to ART and Post ART Sexual behaviour. Data were analyzed using SPSS at the univariate and bivariate levels. Findings revealed that about 70% confirmed their HIV+ Status ≥ 3 years prior to the survey, the mean period in years of access to ART was 2.2 years, about 90% ever engaged in unprotected sexual intercourse and the mean number of sexual partners was 2. Some social, political and economic factors determined ease of access to ART. The need to remove all social and economic impediments to access to ART services and intensified post ART counseling will address the increase in secondary infection with HIV among PLWH. Keywords: Sexuality, Infections, Behavior, Anti-retroviral & Counseling.  
455 Substance Use Disorder and Self Esteem: Self Esteem in Substance Use Disorder Clients in Recovery , Heba W. Kostandy
Substance Use Disorder (SUD) is a growing problem which has an adverse impact on individuals, families and entire societies. The present literature review is part of a study the purpose of which is to identify the possible effect of drug rehabilitation on building Self-Esteem among SUD clients in recovery. The literature review aims to shed light on various aspects related to SUD, and to examine what has already been published in a body of studies examining the relationship between low Self-Esteem and SUD. In the cross-sectional study affiliated with the literature review, a convenience sample of residents of four drug rehabilitation facilities in Cairo Egypt, under Freedom Drug Rehabilitation Program, was approached in order to solicit volunteers to participate in the study. A demographic sheet was used to collect the personal information of participants; additionally, Rosenberg Self-Esteem Scale (Rosenberg, 1989) was administered to measure the participants’ levels of Self-Esteem, where each participant has spent a different time span in rehabilitation. Keywords: Substance Use Disorder, Self-Esteem, Rehabilitation, Recovery.  
456 Assessment of Health - Seeking Behaviour among Snakebite Victims in a Rural Community of Kaltungo Local Government Area, Gombe State, Nigeria   , Rabiu Ibrahim, Karat D. I, Ismail Y. Y, Danladi U. M
Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the health-seeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population. Keywords: health-seeking; behaviour; neglected tropical diseases; snakebite victims; outcome; rural.
457 A Systematic Review of Factors Affecting Uptake of Health Insurance in the Informal Sector in Lusaka Province, Zambia , Nkomba Chamileke
The current Social Health Insurance (SHI) model as implemented in Zambia has focused on those in formal employment. This may not favor the SHI model as currently implemented in the Zambian health sector due to extremely low proportion of those employed in the formal sector especially that the current model does not include financial contribution from the informal sector. The paper therefore conducts a systematic review of factors that would be associated with sustainable prepayment in the informal sector. The study was a quantitative cross-sectional study. Multivariate logistic regression was performed to identify factors associated with sustainable prepayment. A total of 426 respondents were interviewed in the study and 56.8 percent were female and 43.2 percent were female. The study revealed that 37.1 percent of respondents supported the idea of making contributions to raise funds for health. 75 percent of those interviewed disagreed that the monthly premium was a good way to collect contributions. The results of the multivariate analysis found that showed that from the factors studied, the one that were associated with sustainable prepayment of health services were higher number of children(OR,0.1;p<0.05),monthly income above 1000 (OR,0.1;p<0.05),monthly expenditure on health needs above K1000(OR,37.6; p<0.05)and nature of business. Those in the nonfood business were more likely to sustainably prepay than those in food business (OR, 2.2; p<0.05). The study recommended expanded coverage through involvement of local and revenue authorities in the collection of levies and reducing high premium costs associated with insurance contributions. Keywords: informal sector; health prepayment; insurance; contributory; non-contributory.  
458 Prevalence and Risk Factors for Fall in Older Adults in a Nigerian Urban Community , Abdulraheem I. S, Salami S. K, Bawa M. K, Abdulrahem K. S
Background: Fall represents a major public health problem among older adults in Nigeria. There is a need for information on the prevalence and the risk factors of fall to ascertain the magnitude of the problem among the elderly in Nigeria. Objective: To determine the prevalence and factors associated with falls among older adults in Nigerian Urban Community. Methodology: The study was conducted among older adults in a Nigerian Urban Community. A multi-stage stratified sampling method was used to select persons aged 60 years and above in Ilorin Metropolis, North Central Nigeria. Result: Falls were reported by 24.2% (prevalence) of the sample (n=1750). The prevalence of falls was 18.6% in males and 25.2 % in females. Among fallers, females were more likely than males to sustain injuries, including fractures (46.8% vs. 33.7%; p < 0.05). Moreover, a gradual and linear increase in the prevalence of falls was seen as the number of risk factors increased. In the multivariate model, women, subjects with cognitive impairment, those reporting urinary incontinence, and those being physically active during the previous year were found to be independently associated with increased risk of falling among older adults. Conclusion: The present study identified potential risk factors for falls in a representative pop­ulation-based sample of older adults in a Nigerian Urban Community. It is therefore recommended that these risk factors should be addressed in public health policies through awareness and fall prevention programme. The fall prevention program must focus on females and those with chronic health conditions. Keywords: Falls; Prevalence; Risk Factors; Older persons; Nigeria.  
459 Treatment of Hepatitis B (HBV) and C Virus (HCV) and Challenges in the Treatment in Rwanda: Ruli District Hospital , Munezero Patrick
It is estimated that 3% and 4% of Rwandans living with hepatitis B and C respectively. Both HBV and HCV are more infectious than HIV and untreated chronic hepatitis B and C infection can result in liver cirrhosis and liver cancer. Despite to severity of these diseases numerous challenges exist for effective management of chronic HBV and HCV infections, particularly in resource-limited regions. The aim of this study was to explore the treatment of hepatitis B and C infection as well as challenges related to its treatment at Ruli District Hospital. A non-experimental quantitative descriptive cross-sectional was used and sampling strategy was total population sampling (TPS). Of all participants 22% to 68.3% and 22% to 61% reported that people in risk groups are screened routinely for HBV and HCV respectively, the percentage vary according to each specific category. Lamivudine and Tenofovir were selected by the majority 58.5% and 61% respectively, as very commonly used drugs for HBV while most of participants reported that they’re not sure about the usage of treatment on WHO essential list for HCV. Numeral challenges and barriers for the treatment of HBV and HCV were found; these include difficulties to reach specialized care, lack of Accurate Statistics Regarding the Burden of HBV and HCV Infections, low public Awareness and Education and Limited knowledge of health care providers on viral hepatitis B/C. There are still numerals challenges to be addressed for improvement of the treatment viral hepatitis infections. Keywords: Hepatitis B, Hepatitis C, Treatment, Challenges.  
460 National HIV Testing Algorithm in Ghana – Efficiency and Public Health Implications , Paul Owusu-Oduro
Testing and diagnosis of HIV infection is considered an important component of the fight against the pandemic. To achieve this, an algorithm which uses highly sensitive and specific tests must be employed. To assess the efficiency and public health implications of the national testing algorithm used for the screening and diagnosis of HIV in Ghana, a systematic review of the literature on the performances of the First Response and Oraquick Advance HIV-1-2 test kits was conducted. Searches in online journals, credible websites and institutions were done to access evaluation reports on the rapid kits to determine their suitability for use in the algorithm in Ghana. The First Response showed varied sensitivities ranging from 88% – 100% in post- market evaluations done in Ghana. The average specificity was 87.4% (range 82. 56%– 92%) when serum was used as the specimen of choice. One study which used whole blood reported a specificity of 100%, significantly better than those obtained with serum. The only report on the OraQuick produced a sensitivity of 98% and a specificity of 94%, falling short of the WHO’s recommended performance characteristics for HIV rapid kits. This study has revealed that the current testing algorithm in Ghana may not be efficient for screening and diagnoses of HIV infections. Keywords: HIV, Rapid tests, Testing algorithm, Sensitivity, Specificity.  
461 Knowledge and Perceived Health Risk on Cosmetic Lip Products amongst Female Undergraduate Students: A Mixed Method Study , Aienobe Agbonisan Charity, Oyediran Emmanuel Oyewole
The use of Cosmetic Lip Products (CLPs) has historically been a fashion statement for women. However, the health risk associated with CLPs has not been thoroughly investigated given that chemical analysis show that CLPs may contain heavy metals injurious to health. This study is aimed at investigating the knowledge and perception of the possible health risks associated with the use of CLPs. The study adopted a mixed method study design. The descriptive cross-sectional study involved 390 participants drawn randomly from five female hostels. The qualitative method involved four focus group discussions with ≥6 discussants per FGD recruited by snowballing method and conducted using an FGD guide. Data were collected using a pre tested semi-structured questionnaire which contained an 11-item knowledge scale and a 12-item perception scale. A 22-points knowledge scale and 24 points perception scale were utilized for the study. A Knowledge score  11 and perception score  12 were categorized as poor knowledge and poor perception. Data collected were analyzed using descriptive and inferential statistics at p= 0.05 level of significance. Age of respondents was 19.7±1.2 years. Most discussants reported the potential health risk would not sway them from using CLPs as they did not see CLPs as a threat to their health. Majority (83.3%) had poor knowledge and poor perception (59.2%) of the possible health risks associated with using CLPs. It is recommended that campaigns using the internet to buttress possible health risk associated with CLPs are embarked on by health advocacy groups. Keywords: Cosmetic Lip Products, Female, Undergraduates, Health Risk.
462 Knowledge and Perception of Health Consequences of Obesity in a Nigerian Secondary School , Arilewola Abosede Omotola, Adegbenro Caleb Ademola, Oyelese Olubukola Babatunde
Background: Obesity has created a global burden for public health. Adolescents seem to be ignorant of the risk factors and complications associated with obesity. Proper knowledge, perception and practice in terms of behavioural modification, physical activity and nutrition seem lacking amidst these young ones. The aim of this study was to assess the knowledge and perception of health consequences of obesity of secondary school students of Excel Kings and Queens College, Ile Ife, Nigeria. Methods: It was a cross sectional study that made used of 66 pre-tested, self-administered questionnaires to assess the knowledge and perception of health consequences of obesity. Collated data were analysed with descriptive and inferential statistics. Results: The result showed that the most secondary school students’ knowledge about obesity is still low and below average and their perception about health consequences of obesity is still poor. Conclusion: We concluded that, there is need to improve on this aspect as to reduce the increase in obesity high prevalence noticed in the world today. This then can reduce the burden of public health as regards the problems associated with obesity. Keywords: Obesity, Perception and Knowledge.  
463 Oral Health Literacy and Psychosocial Factors and its Relation with the Dental Behavior of Child Carers , Irin Hossain
The main objective of the study was to assess the relation of oral health literacy and psychosocial factors with dental behavior of child carers. This cross-sectional study conducted among the carers of the child studying class V of Mohammadpur Preparatory and model school of Dhaka, during January to December 2015. The sample size was 370, selected by Purposive sampling. Data collected through face to face interview by using semi structured questionnaire. Oral health literacy was measured by Oral Health Literacy adult questionnaire and Psychosocial factors with additional questions to determine dental-efficacy, oral health competency and activation measure. Data analyzed with SPSS 17.0 software. The study found that all the carers were female. (46.8%) of the carer were in an age group of 31-35 years, and (83.2%) of them were housewife. (64.4%) had adequate oral health literacy, 28.6% had marginal literacy and 7.0% of the carers had inadequate literacy. These findings indicate that most of the carers had adequate literacy about oral health. Those who had more literacy about oral health their tooth brushing frequency twice a day was more (P<.05). Young aged carers (P<.05) and those were housewives in occupation (P=.05) were brushed their child teeth twice a day more than other carers. Low carer oral health competency showed more brushing frequency twice a day (P<.05). High carer activation measure -knowledge showed more dental visit by carers (P<.05) and high CAM-skill showed more brushing frequency twice a day (P<.05). High carer activation measure -confidence showed more dental visit by carers (P=.05). Keywords: Oral health literacy, psychosocial factor, dental behavior, child carers.  
464 HIV/TB Co-Infection in People Living with HIV/AIDS - A Study on ART out-Patient Clinic of Seti Provincial Hospital at Dhangadhi , Shuresh Raman Puri
TB-HIV co-infection is common in People Living with HIV/AIDS (PLHIV). Tuberculosis is an opportunistic infection (OI). OIS are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. Human Immune Virus Infection (HIV) weakens the immune system, increasing the risk of TB in people with HIV. Infection with both HIV and TB is called TB-HIV co-infection. It is hospital based descriptive study conducted among the cases with TB-HIV co-infection. All the Patients consulting the investigating Physician of a department of medicine at a Seti provincial hospital in Far-western province of Nepal within study period were enrolled after informed consent. Out of 597 cases of ART taking patient were studied. Among them 54 were diagnosed TB-HIV co-infection, 74% (40) were married and 26% (14) were Unmarried. Among them 50% (27) were male and 50% (27) were female. Most of the cases were from village and semi-urban settings. TB-HIV co-infection is common opportunistic infection in patient with people living with HIV/AIDS (PLHIV). Keywords: TB-HIV co-infection, high prevalence in Nepal.  
465 Effectiveness of Influenza Vaccination on Work Absenteeism among Healthcare Workers in Tertiary Hospitals in Perak, Malaysia , Rosidah Omar, Mas Ayu Said, Nasrin Agha Mohammadi
Objective: Influenza is a major health problem worldwide. Healthcare workers are at increased risk of contracting influenza and spread the disease to their patients and family members. Influenza vaccination is an important public health preventive action to stop the transmission of the disease. However, the uptake remains low due to doubt in the effectiveness of the influenza vaccine. Therefore, the aim of this study is to determine the effectiveness of influenza vaccination in reducing influenza-related work absenteeism among HCWs in Malaysia. Study Design: This is a cross-sectional study. Methods: The study was conducted at two specialist hospitals in Perak, involved 774 nurses and assistant medical officers who were selected using multistage random sampling. It used a self-administered questionnaire that contained a section on sociodemographic characteristics, and numbers of influenza-related sick leaves in the year of 2017. The influenza vaccination uptake was based on immunization record for the period between 1st November 2016 and 31st December 2016. Results: The result shows the non-vaccinated HCWs reported more often influenza-related sick leave (18.1%, mean 0.39 ±1.03) than by vaccinated HCWs (16.2%, mean 0.27 ± 0.75), although the difference was found to not be statistically significant (p=0.388). However, notably, the total number of workdays lost due to influenza among non-vaccinated HCWs was 1.44 times higher than that among the vaccinated group in the studied hospitals. Conclusions: These findings could motivate policy makers to strengthen the implementation of an influenza vaccination programme among HCWs and to encourage HCWs to be immunized against influenza. Keywords: absenteeism, effectiveness, healthcare worker, hospital, influenza, vaccination.  
466 Immunization Coverage and Factors Associated with the Non-Completeness of Vaccination of Children from 12 to 23 Months of the Health District of Djoungolo-Cameroon in 2012 , Ekanga Mvele Dominique Arnaud
In 2011 the health district of Djoungolo experienced two measles epidemics with a 69% vaccination completion rate according to district data. The objective of this study was to determine immunization coverage and factors associated with the non-completeness of vaccination of children aged 12-23 months in Djoungolo district in 2012. We used a cross-sectional, community-based study was conducted in 2012. A total of 210 mothers / nannies of 12 to 23-month-old children from Djoungolo district, selected according to the WHO 30 X 7 cluster survey method, were interviewed about vaccines; received by the child before the age of one and the reasons for non-vaccination using a structured questionnaire. Vaccine completeness was 64.3%, ranging from 85.7% for BCG to 66.2% for measles Vaccine. Multivariate logistic regression showed that mothers who were afraid of side effects (P = 0.0454), who did not know the importance of vaccination (P = 0.0139), had missed opportunities for vaccination (P = 0.0055), who took more than one hour to vaccinate their child (P = 0.0005) and who did not master the vaccination schedule (P = 0.00001) were significantly associated with vaccine non-completeness children. Keywords: Immunization coverage, factors, non-completeness, children from 12 to 23 months.  
467 Prevalence of Road Traffic Accidents, and Associated Factors among Taxi Drivers in Jigjiga Town, Ethiopian Somali Regional State, Eastern Ethiopia , Mahamed Hussen, Abdiwahab Hashi, Wubarag Seifu, Muktar Omer
Background: Globally injury and deaths due to road traffic accidents (RTA) are a major public health problem more so in developing countries; as lives and disability adjusted life years were lost from road traffic accidents. In Ethiopia numerous problems are related to road traffic accidents. Objective: To determine the prevalence of road traffic accidents and associated factors among taxi drivers in jigjiga town, Eastern Ethiopia. Methodology: A community based cross sectional study was conducted among randomly selected taxi drivers living in jigjiga town, using a simple random sampling technique to randomly select 378 taxi drivers. The data was collected using a pre-tested, interviewer-administered questionnaire and entered using Epidata version 3.1 and analyzed by SPSS version 20 to identify associated factors of road traffic accidents. Results: The prevalence of road traffic accidents in past three years was found to be 32.8% (29.0, 34.8) among taxi drivers in the study area. Vehicle ownership (AOR=2.7, CI: 1.64, 4.4), chewing Khat while driving, (AOR= 5.0, CI: 1.1, 22.9), age of the taxi drivers (AOR=2.38, CI: 1.23, 4.59), having own residence (AOR=0.55, CI: 0.33, 0.92) and punishment by traffic police (AOR=0.23, CI: 0.087, 0.47), were significantly associated with road traffic accidents. Conclusion: the result of this, study show that taxi drivers in Jigjiga town inconstant placed themselves increase risk of road traffic accidents by violating traffic laws, especially related to vehicle ownership, chewing Khat while driving, and punishment by traffic police. There is a need for awareness campaigns on road safety rules. Keywords: Road Traffic Accidents, Prevalence, Associated Factors, Jigjiga Town, Somali Region, Ethiopia.  
468 Family  and  Social  Support  in  Treatment  Adherence  of  MDR  TB  Patient  in  Nepal , Anita  Dhungana  Shah
Background: Multidrug resistance is one of the emerging public health issue around the world as the treatment is challenging due to loss to follow up and side effects. Multiple factors are responsible for the adherence of treatment. Side effects of drugs, lengthy treatment duration, and complicated treatment procedures are major hindrances in treatment of MDR TB. Similarly, family and social support have prime role in maintaining the treatment adherence among the patients. Objective: The objective of this study was to find out the role of family and social support in treatment adherence of MDR patients. Methods and material: Focus Group Discussion and group discussion were conducted in 2 treatment centers NTC and GENETUP. The information collected through FGD and group discussion were translated, transcribed and then respective themes were constructed under which analysis was performed. Results: Majority of the respondents had received family support for their treatment. Respondents reported that main reasons behind non-adherence of TB was due to side effects of the drugs. Almost 1/3rd of the respondents felt discrimination from the society while many of them are not engaged in any income generation due to weakness and physical symptoms. The disease status has been disclosed to only close ones in most of the cases rather than the neighbors. Social stigma and discrimination are the reasons behind not disclosing their status.  Conclusion: This study shows that family are the one who are close to the patient and their support plays a crucial role for treatment adherence. Societal support is also necessary but the various stigmas associated with the disease have resulted to hide the disease in community. Keywords: Adherence, Family and social support, MDR TB, Resistance, Nepal.  
469 Sources of Contraceptive Information as Predictors of Contraceptive Use among Women in Tarauni Local Government Area of Kano State, Nigeria , Muhammad Murtala Ibrahim
This study is conducted to assess the influence of radio, poster/billboard/leaflet and healthcare workers as media for contraceptive messages on the use of family planning by women of reproductive age in Tarauni Local Government Area of Kano State, Nigeria. The study used descriptive survey research design. Questionnaires was used to collect data from one hundred and twenty respondents, selected using simple and systematic random sampling technique. The study used frequency tables and percentage to analyses the data, while chi-square was used to answer the research questions at a 0.05 level of significance. The findings of this study indicate that listening to contraceptive messages on radio; reading or seeing contraceptive messages on posters, billboards and/or leaflets and meeting and talking with health care worker on contraceptives strongly influenced use of family planning. The study recommends that Government and other implementing agencies should use the mass media especially radio and posters/billboards/leaflets as the main source of Family planning information at the community level to ensure wider reach and depth of information. All Healthcare workers should be trained on basic family planning method and should offer family planning services routinely to all women of reproductive age who visit hospitals and clinics. Keywords: Family planning, contraceptives, information, messages, Communication.  
470 Know your HIV Epidemic (KYE) in Somali Region, Ethiopia , Ahmed Tahir Ahmed, Biniyam Bogale lakew, Mawlid Abdirahman, Abdulahi Haji Abas, Abdikadir Mohamed
Background: In 2016, an estimated 718,500 of people living with HIV and about 19,743 AIDS related deaths has occurred in Ethiopia. The current national HIV/AIDS strategic plan [2015-2020] capitalizes on implementing targeted prevention interventions to reach those at risk and vulnerable population groups and preparing district based epidemiologic synthesis using routine data. Methods: Know Your Epidemic (KYE) method was used to come up with know your epidemic synthesis. Primary and secondary data also used for triangulation of the synthesis in order to identify an updated picture of the HIV epidemic and its drivers of epidemic in Somali region, Ethiopia. The study was conducted in Somali region between May to August 2017. Result: HIV epidemic scenario in Somali region is relatively low (0.75%) in prevalence according to 2017 EPHI projection. However, it is more heterogeneous among zones, ranges from 6.88% in Sitti zone to 0% in many zones in Somali region, and even more heterogeneous between districts, ranging from 18.86% in Dekasuftu to 0% in many districts. It also various among settings: rural (3.8%) highest figure nationally and Urban (3.5%) according to ANC sentinel surveillance. Majority of the data shows increasing HIV prevalence trends in Somali region over time in both sex groups. Somali region has responded the diseases both institutionally and program levels, which is more centralized. Conclusions: The overall HIV prevalence in Somali region, Ethiopia is relatively low (0.75%, 2016 EPHI) but more varied significantly among zones and districts. Keywords: Drivers of HIV epidemic, Know epidemic.
471 Information-Adequacy, Motivation and Behavioral-Skills as Determinants of Substance-Use Prevention among Undergraduates in Babcock University, Ilishan – Remo, Nigeria , Peter C. Ikonta, Bola C. Atulomah, Ogechukwu E. Okondu, Nnodimele O. Atulomah
Objective: This study investigated the dynamics of information-adequacy, motivation and behavioral skills towards substance-Use prevention among undergraduates in a selected tertiary educational institution in Ogun State, Nigeria. Methods: This was a theory-driven cross-sectional design which use a 45-item validated questionnaire to collect data from 604 consenting students by multistage sampling procedure. Variables of information-adequacy regarding substance-use consequences, motivation, Self-Efficacy Behavioral Skills (SEBS) and substance-use were measured. Data collected were analyzed using IBM SPSS version 24 to compute means and standard deviations and test associations between variables and determine path analysis of best predictors of substance-use prevention, at 5% level of significance. Results: Mean age of respondents was 19.92 ± 3.20 with 56% females and majority (31% ) of final year students participated. Levels of information-adequacy regarding substance-use consequences (6.41±2.51), motivation (23.26±5.76), SEBS (11.67±4.10) and Substance-Use (4.01±7.19) were generally good respectively. There was a significant relationship between information-adequacy and Motivation (r = 0.259; p<0.05), and with self-efficacy behavioral skills (r = 0.341; p <0.05). Information-adequacy (r = -0.10; p<0.05), and SEBS (r = -0.286; p <0.05) and motivation (r = -0.246; p<0.05) were significantly negatively correlated with substance-use. Stepwise Logistic regression analysis showed that SEBS (B= -0.119; OR =0.890; 95%CI: 0.803 – 0.982; p=0.021) was best predictor of substance-use prevention Conclusion: Self-efficacy behavioral skills of individuals was found to best predict substance-use prevention. Other variables contributed in strengthening behavioral skills and may be useful in designing substance-use prevention intervention as this would strengthen drug use reduction among students. Keywords: Information-Adequacy, self-efficacy, motivation, behavioral skills, substance-use reduction.  
472 Financial Flow Factors Associated with Sustainable Health Sector Prepayment among the Urban Informal Sector in Lusaka District, Zambia , Nkomba Chamileke
In 2018, Zambia implemented the Social Health Insurance act as a way of sustainable health care financing and reducing out of pocket expenditures. However, the Social Health Insurance has focused mainly on those in formal employment and has not outlined a clear approach towards the informal sector. A total of 213 research participants were selected in Lusaka district. The study design was a quantitative cross-sectional study and subjects were selected by multistage sampling. The respondents were selected from each of the 5 primary health facility catchment areas from Lusaka district. Multivariate analysis using logistic regression was used to identify financial flow factors associated with sustainable prepayment. The study found that the majority of the respondent were in the non-food business and had run the business for more than 5years. The study found that half of the respondent felt that insurance was beneficial and that contributions should be contributed as an indirect levy. Results of the multivariate analysis found that monthly income greater than K1000 (OR, 0.1, p<0.05) and expenditure on health-related needs above K1000 (OR, 44.1, P<0.05) was associated with sustainable prepayment. The study concluded that monthly income and expenditure on health needs were sustainable predictors of health sector prepayment among the urban informal sector. There is need for the stakeholders to make efforts to design and implement health insurance schemes that will incorporate the different strata of the socio-economic groups. There is need to ensure that insurance contributions are collected as an indirect levy rather than as a direct premium. Keywords: health insurance, financial flow, prepayment, sustainable, informal sector, policy.  
473 Knowledge and Attitude on STIs and HIV/AIDS among Hotel Workers at Dhangadhi, Kailali in Far-Western Province of Nepal , Shuresh Raman Puri
Background: "Health is not only the absence of disease but a state of complete physical, mental and social well-being" (WHO, 1946). From this statement the idea about health could be draw that health is as much as a social as a biological issue or health as state of relative, physical, mental and social well-being. Nepal is also developing country. Nepal is driven by many factors such as poverty, low literacy levels, low levels of male and female condom use, cultural and religious factors, stigma and discrimination for the transmission of HIV. Methods: This study is based on the descriptive and quantitative types of design. Descriptive methods will be used for analysis and interpretations of the collected data. Results: All the hotel workers of dhangadhi were respondents of the study. There were 20 hotels and 105 hotel workers. Among them 65 male and 40 were female and they were the source of primary data. All 105 respondents were main source of data and the study was conducted at Dhangadhi, Kailai in Far-western province of Nepal. Conclusion: This is a small-scale study in the area of knowledge, transmission, prevention and influence of STIs among the hotel workers which was performed 2019 at Dhangadhi, Kailai in Far-western province of Nepal. The conclusion derived from the above findings which tried to meet the objectives of the research. Keywords: To measure the knowledge, attitude and skills of Hotel workers about STIs and HIV/AIDS.  
474 Factors that Led to Third Delays in the Management of Obstetric Emergencies in Midigo Health Centre IV - Yumbe District, Uganda , Storia Nyeta, Kizito Omona
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. A number of factors are attributable to this delay. Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV. Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers). Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%). Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV. Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).  
475 The Attitude of UAE Mothers towards Breastfeeding in Abu Dhabi , Jewel Abraham, Reeja Raju
Department of Health (DOH) the regulator of Abu Dhabi region in UAE launched its Baby Friendly Hospital Initiative (BFHI) on March 21, 2016. There has been little success to this program in transforming the breastfeeding experience of Abu Dhabi mothers. This paper tries to analyze the attitude of Abu Dhabi mothers towards breastfeeding and to explore the factors that modulates maternal attitude. A quasi experimental design has been with mixed methods approach to guide this study. A convenient sampling of 384 women visiting maternal clinics were recruited to answer an IOWA questionnaire. The overall breastfeeding experience of UAE mothers are suboptimal. The UAE mother prefers formal feeding over breastfeeding due to their processional commitments. Multiple factors modulate maternal attitude to breastfeeding. Keywords: breastfeeding, attitude, breastfeeding attitude, breastfeeding factors, breastfeeding practices.  
476 HCV Diagnosis in Ghana – Limitations and Public Health Implications , Paul Owusu-Oduro
Hepatitis C infections have become public health concern globally and in Ghana, 1 in14 cases of cirrhosis is caused by HCV. Diagnosis and treatment remain crucial in the control and prevention of this epidemic. The purpose of this study was to examine the types of rapid assays and testing algorithms used for the screening and diagnosis of HCV in Ghana. Structured questionnaires were sent to selected public and private laboratories across the country to elicit responses on the types of rapid assays and testing algorithms used for the screening and diagnosis of HCV. Searches in online journals, credible websites and institutions were done to access evaluation reports on the rapid kits in Ghana to determine their suitability for use and the efficiency of the algorithms. Seventeen different rapid kits were found to be in use in the facilities sampled. Only 2 out of the 17 were WHO prequalified. DiaSpot, the most widely used test kit was neither WHO pre-qualified nor FDA approved. Very limited information on evaluations was found in Ghana. All the facilities sampled use a single assay testing strategy. This study revealed that the reliability of the rapid kits used in the testing algorithms in Ghana cannot be guaranteed and thus may not be efficient for screening and diagnoses of HCV infections in Ghana. There was also no public or private facility sampled which does Nucleic Acid Testing, making the definitive diagnosis of HCV very difficult. Keywords: Rapid assays, Suitability, HCV, NAT.  
477 A Case-Control Study to Identify Risk Factors Related to Cholera Outbreak in Kasai Oriental Province, Democratic Republic of Congo, 2018 , Article by Dongmo, N.T., Mutombo, M.B., Ateudjieu, J., Folefack, T.G., Gabo, P., Miwanda, N.B., Akilimali, L., Tshizemba M.A, Diwampovesa, M.C.G., Nkweshieu, A.S., Mbopi-Keou F.X.
Cholera remains the major public health problem in the world. Democratic Republic of Congo is frequently affected by cholera since the introduction of 7th pandemic in the country in 1974. The 2018 cholera outbreak which was the second major one affecting the Kasai oriental (KOR) province started on the week7 and was still persistent on the week40, when it was decided to conduct a matched cases-controls study to identify its risk factors so that to readjust responses activities on going on the field. 80 cases were randomly selected in the line-listing among patients investigated in the treatment centres or units during cholera response activities and 80 controls were selected according to matching criteria. Bivariate and multivariate analyses were performed using Epi-info 7 software. The study identified as risk factors: Living in a household with more than five persons (Adjusted Odds Ratio (AOR):2.99; 95%CI[1.88-6.22]); drinking water sold along the street (AOR: 4.29; 95%CI[1.85-10.30]); Had been in contact with persons suffering of diarrhoea (AOR: 7.15; 95%CI[2.10-17.21]); Participated in funerals (5.16; 95%CI[3.02-29.95]); peoples ignoring how to contract cholera (5.78; 95%CI[2.38-18.10] and participants ignoring how to protect themselves from contracting cholera (2.49; 95%CI[1.73-5.20]). Cholera vaccination was not tested as risk factors during this study. Keywords: Risk factors, cholera, Kasai Oriental, Democratic Republic of Congo.  
478 Level of Mental Stress of Postmenopausal Women , Irin Hossain, Ajmari Sharmin
Objectives: To assess the level of mental stress of postmenopausal women. Materials and methods: A cross-sectional study was conducted to assess the level of mental stress of postmenopausal women. Among 213 postmenopausal women in selected areas of Bogra. Data was collected by semi-structured questionnaire after taking written consent. Mental stress of postmenopausal women was measured by Perceived Stress Scale. Data processing and analysis was done using SPSS (Statistical Package for Social Sciences) version 20. The test statistics was used to analyze the data is descriptive statistics and inferential statistic according to the demand of the study with 95% confidence interval. Level of significance was set at 0.05. Place and period of study: The study was conducted at Bogra Sadar, Bogra. The period of study was from January 2017 to December 2017. Results: Among 213 respondents 66.2% are in the age group 45-50 years with the mean age of 50.16 years and SD of ± 3.725 years are from nuclear family and 56.3% had only primary educational background and 42.7% respondent’s monthly family income is in between 0-10000 TK. Most of the respondents 73.2% are moderately stressed, 24.4% are highly stressed and only 2.3% are low stressed. Mental stress is associated with education (P=0.004) and monthly family income (P= 0.031) but not associated with age, marital status, type of family, occupation after menopause (p=>0.05). Conclusion: Mental stress present among most of the post-menopausal women irrespective of their age, education, occupation, monthly income of their family. Keywords: Mental stress, postmenopausal women.  
479 Knowledge, Attitudes and Perception of Caretakers towards Control and Preventive Practices of Malnutrition and Diarrhoeal Diseases in Under-Five Children in Pemba Districts of Zambia , Israel Ndayambaje, Dorothy Osigwe Chanda2, Benius Kaliyangile
Malnutrition and Diarrhoeal diseases pose a significant threat to the health, well-being, and survival of under-five year old children in resource constrained world. It is estimated that (25%) out of the total mortality of under-five year old children die worldwide as a result of diarrhoea (UNICEF, 2012) and more than half of these deaths in developing world particularly in Zambia has an underlying association with malnutrition (UNICEF, 2015). The objective of this study was to assess the levels of Knowledge, Attitudes, and Perceptions towards malnutrition and diarrhoeal diseases preventive and control practices among caretakers of under-five children of Pemba District. This study used a Cross section study design. The study population was adult care-takers of children aged between 4 months to 5 years. The sample size comprised of 210 caretakers. Health Centers in Pemba District were selected conveniently; 210 households were selected using a simple random sampling technique, and respondents from each sampled household were picked purposively. Data collection was conducted using a semi-structured interview questionnaire. Data was analyzed using SPSS version 24, and X2 test and Correlations were used and conclusion done at 0.05 significance level. The study revealed that majority (76.6%) of caretakers demonstrated low levels of knowledge, with 51% demonstrating poor attitudes towards control of malnutrition and diarrhoeal diseases, and some (57.1%) demonstrated fair practices, among the HBM variables, Perceived benefits towards diarrhoeal disease prevention showed a moderate correlation (Pearson’s) of 0.30 at 0.01 level (2-tailed). The poor result identified in this study reveals the reasons for the current diseases burden especially malnutrition and diarrhoeal disease trends in the district. Perceived benefits, therefore, was established to be moderately correlated and should be used to design any intervention measures aimed at correcting the situation. Keywords: Knowledge, Attitudes, Perceptions, Practices, Diarrhoea, Malnutrition and Caretakers.  
480 Roles of Local Languages on Effective Public Healthcare Delivery in the Gambia: Implications for Psychological Assessment , Olubiyi Simeon Kayode, Muraina K. Olanrewaju, Bukola Ibitoye
Objectives: The purpose of this study was to examine the roles of local languages on effective public healthcare delivery in the Gambia and its implications for psychological assessment. Study design: Descriptive research design of ex-post facto type was used in the study. Methods: One hundred and seven patients were selected randomly from 5 local government areas in the Gambia. The respondents were measured with a self-developed validated scale of 0.79 reliability coefficient and the data obtained was analyzed using simple percentage statistical analysis. Three research questions were raised and answered in the study. Results: The result showed local languages contributed to effective quality of service delivery, treatment compliance of patients and health improvements of patients. Conclusions: In view of these findings, the study recommended that stakeholders in the health sectors should always work towards improving quality of service delivery. Hospital/healthcare centres should have at least one professional counsellor who will be saddled with the responsibility of administering guidance and counselling services to the health workers, patients and others workers in the hospital. Keywords: Roles, languages, effective, public, healthcare delivery.  
481 Knowledge, Attitude of Health Professional Towards Health Care Waste Management in South East Nigeria , Ironkwe Okechukwu, Okwuoma Abanobi
Adequate knowledge and attitude towards the collection/disposal of health care waste (HCW) are important factors in the prevention of the spread of infectious agents that may be of health risks to both the public and the environment. Data on knowledge and attitude to healthcare waste management were scored based on their respective questionnaire information obtained with a 5-point Likert scale from strongly disagree to strongly agree (ie.1 to 5). Statistical analysis was performed at 5% significant level. A probability value (p) and 95% confidence interval (CI) were used to interpret the analysis results. The study found the 248 respondents, 71.8% are female while 28.2% were males with an average age of 37.4 years. Generally, the waste handlers studied showed high knowledge of health care waste management, with an overall mean score of 4.0 (out of 5). Knowledge of Medical waste management showed a significant influence in patterns of healthcare waste management practices (p = 0.0001, 95% CI = 0.0004 to 0.08). Many of the waste handlers showed a strong positive attitude. There was no evidence however, of significant influence of attitude towards healthcare waste management and pattern of healthcare waste management practices in the study (p=0.131). Keywords: Knowledge, Attitude, health care waste, Health professionals, waste disposal.  
482 Religiosity, Personality Traits and Christian Clergies’ Sexual Behaviours , Promisen E. Nwaka, Olutope E. Akinnawo, Bede Chinonye Akpunne
The associations between Religiosity, personality traits and sexual behaviours have been widely studied in the general population and among university students; however, less is known about this relationship among Christian spiritual leaders (Pastors). This study explores the predicting influence of religiosity, facets of personality and sexual behaviour of Christian clergy in south western Nigeria. One hundred and sixty-three (163) participants (112 males, 51 female), mean age 34.7± 0.1 were purposively selected and responded to Big-five Inventory (BFI), a Religious Orientation Test (ROT) and Brief Sexual Attitudes Scale (BSAS). Religiosity significantly predicts sexual behaviour, personality traits jointly predicted sexual behaviour, religiosity and personality traits significantly jointly predicted sexual behaviour, and denomination and sex had no significant influence on sexual behaviours of the Christian clergies. Findings demonstrate that religiosity and personality constructs influence several dimensions of sexuality in unique ways. Keywords: Religiosity, personality traits, sexual behaviour, Christian clergy.  
483 Involvement of Parents in Sexuality and Reproductive Health Education of Adolescents and Associated Factors in Hoima Municipality, Uganda , Mugumya Ivan, Omona Kizito
Introduction: Many adolescents often lack strong and stable relationships with their parents to openly discuss reproductive health concerns. Parents often have the power to guide children’s development in sexual health matters, encouraging them to practice reasonable sexual behaviours. Objective: The study aimed at ascertaining the level of involvement of parents in sexuality education of their adolescents in Hoima municipality and the associated factors. Methodology: It was both descriptive and analytical across-sectional study and used both qualitative and quantitative methods. 213 Participants were randomly selected and interviewed using semi structured questionnaires. Results: Most of the parents (81.7%) reported to be involved in sexuality and reproductive health education of their adolescents. Females were 1.18 times more likely to be involved in sexuality education (CPR=1.18; CI= 1.02-1.37; p-value 0.02). Parents were 1.56 times more likely to be actively involved in talking to their adolescents about sexuality education compared to other people (APR=1.56; CI= 1.22-1.99; p-value < 0.001). Having both parents were 1.22 times more likely to equally talk to their children about sexuality and reproductive health (CPR=1.22; CI=1.07-1.40; p-value= 0.004). Mothers were 1.64 times more likely to be involved in teaching their children on this subject matter than fathers (APR=1.64; CI=1.15-2.34; p-value 0.006). Conclusion: Factors associated with parents’ involvement in sexuality education were; female headship of family, being a traditional believer and widow/widower. SRH services should, therefore, be availed in all the health units, where both adolescents and parents can easily access. Keywords: Sexuality education, Sexual Reproductive Health (SRH) services.  
484 The Effect of Knowledge on Breastfeeding among Mothers’ in Abu Dhabi , Jewel Abraham, Reeja Raju
Department of Health (DOH) the regulator of Abu Dhabi region in UAE launched its Baby Friendly Hospital Initiative (BFHI) on March 21, 2016. Despite this drive for last 3 years, there has been no noticeable changes or initiatives in private health sector. There are different factors that affect the breastfeeding behaviors that may result in sluggish response from private healthcare sector. The purpose of this article is to analyze the impact of knowledge and factors that modulates knowledge among breastfeeding mothers of Abu Dhabi. A mixed methods research design with a survey-based questionnaire was used to guide this research. Knowledge impacts breastfeeding practices (P=0.001) and is influenced by maternal age, educational preparedness, employer, employment, salaries and number of children. The sluggish progress of BFHI initiatives in Abu Dhabi is related to factors outside of the health system. Mothers are often faced with competing personal and professional decisions. This compels most mothers to adopt mixed feeding methodologies. Keywords: breastfeeding, knowledge, breastfeeding knowledge, breastfeeding factors, breastfeeding practices.  
485 The Effect of Sociocultural Factors on HIV/AIDS Prevalence amongst Adolescents and Youths in Niger State, Nigeria , Norbert Tanke Dongmo
This review of the article titled "The effect of sociocultural factors on HIV/AIDS prevalence amongst adolescents and youths in Niger State, Nigeria”, authored by Otojareri Kohwo started with introduction and then was focused on aspects such as literature review, structure, critique, authority, currency, accuracy, relevance, objectivity and stability. Furthermore, appraisal of tables, recent advances related to the topic, credibility and accessibility. The objective of the original article was “to examine the effect of socio-cultural factors on the prevalence of HIV/AIDs amongst adolescent and youths attending the antiretroviral clinics of four general hospitals in Niger State, Nigeria.” HIV/AIDS remains a public health problem in Nigeria where its prevalence does not decline among young adolescents despite policies in place, due to several socio-cultural factors. Hence the interest such research topic. The author employed a hospital base descriptive study in selected hospitals targeting young and adolescent population with positive HIV statues. Sampling technic used was “multistage” Structured questionnaire was administered, analysis was performed and all ethical issues were addressed. Overall, this was a less objectively written article, with some relative credibility. However, the article has contributed but slightly to de body of knowledge on the topic especially this area of Nigeria. The great weakness in this article is that it would require significant improvement in its methodology. However, the article is very accessible, with a very current public health topic and relevant for students. Further research with very adapted methodology could be very interesting. Keywords: Review, HIV/AIDS, adolescents and youth, sociocultural factors.  
486 Examining Breastfeeding Practice among Newly Delivered Mothers in Tamale Central District , Sukerazu Alhassan Ahmad
Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant need in the first six months of life. Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also have longer-term health benefits for the mother and child. Purpose: Despite several interventions implemented for the improvement of infant breastfeeding in the study area, early initiation of breastfeeding of infant remained relatively low. The purpose of this study is therefore to monitor adherence to early initiation of breastfeeding such that mothers who come to the hospital to deliver are assisted to initiate breastfeeding within 30 minutes of birth. Method: Cross sectional studies is the chosen study design, since the aim was to find out the attitude towards compliance to early initiation of breast feeding 30 minutes of birth.  Results: Those without formal education were about 3.8 times likely to initiate breastfeeding within the first 30 minutes of delivery (AOR=3.762, 95% C.I., p=0.001). Delivery through caesarian section (C/S) was found to have protection against late initiation of breastfeeding. C/S delivery was found to have about 77% protection against late initiation of breastfeeding (AOR=0.23, 95% C.I., p=0.031). Conclusion: Educational status of women and mode of delivery were found to be the most important factors that influenced early initiation of breastfeeding. In a multivariate analysis, only educational status of women and mode of delivery were found to be the most important factors that influenced early initiation of breastfeeding. Keywords: Delivery Practices, Breastfeeding Initiation, Breastfeeding Practice, Early breastfeeding, Birth.  
487 Pattern of Health Care Waste Management Practices among Health Professional in South East Nigeria , Ironkwe Okechukwu
Health care waste management is fast becoming an area of interest in public health. It involves waste generation, handling, use of personnel protective equipment, decontamination of reusable cleaning devices after use, segregation, transportation of medical wastes. Pattern of practice is investigated as an important precursor to the synthesis of appropriate methods of proper handling of health care waste. This study specifically sought to investigate the pattern of health care waste management among health professionals working at Health care centers in South-east Nigeria. Based on data analyzed, the study found a reasonably strong pattern of Healthcare Waste management practice at 64.1%, compared to a weak pattern of 35.9%. Decontamination of reusable cleaning devices after every use, show a reasonable pattern of practice at 66.5%. Similar results were obtained in other health care waste practices assessed. The pattern for overall health care waste management practices in South-eastern Nigeria showed some reasonable level of practices with existing identifiable gaps that could hamper effective health care waste management among healthcare facilities within southeast Nigeria. Keywords: South east Nigeria, health care waste, Health professionals, waste disposal, practice.  
488 Treatment Adherence among MDR TB Patients in Nepal , Anita Dhungana Shah
Background: Tuberculosis usually strikes most vulnerable people of society. Treatment Adherence plays vital role for restricting the development of resistance against any disease. Patients always describe the needs of psychological supports to mitigate the difficulties of regular clinic visit, performing family and personal responsibility while on treatment. So, this study examines the role of family and social support contributing the treatment adherence. Objective: The study aims to find out the status of adherence among MDR TB patients and also the role of family and social support contributing to treatment adherence of the disease. Methods and material: A descriptive cross-sectional study was conducted in 3 different DR-TB management centers (NTC, GENETUP and TB Nepal), which were purposively selected. A total of 100 patients were taken as sample population through sampling technique and data was collected using a semi structured questionnaire. Results: Out of 100 respondents, 5% did not followed the instructions provided by health workers. The main reason was side effects of drug (2 out of 5) whereas feeling of cured was also one reason along with alcohol and smoking. 96% received family support during the treatment while more than 3/4th of the respondents disclosed their status. About 24% had experienced unusual behavior from the community and 20% are only engaged in income generating activities. A significant association was seen between family support and treatment adherence. Conclusion: Hence, this study concludes that family support is very crucial for the treatment adherence but there are other determinants which cause non adherence. High level of depression is seen among the patients to disclose their status due to stigma and discrimination. Keywords: Treatment adherence, MDR TB, family support, social support.  
489 Knowledge and Attitude of Nigerian Undergraduates on Healthy Diet: Outcome of a Nutrition Education and Mobile Phone Communication Intervention , Ademola Mufutau Amosu
Undergraduates May Lower Their Risk Of Developing Chronic Non-Communicable Diseases (NCDs) Such As; Diabetes, Cardiovascular Diseases, And Cancer Which Are Consistently Among The Top Eight Leading Causes Of Death Globally By Improving Their Nutrition Knowledge And Attitude Towards Nutrition. The Study Evaluated The Effect Of Nutrition Education And Mobile Phone Communication Intervention On Undergraduates’ Knowledge And Attitude Of A Healthy Diet In Oyo-State, Nigeria. This Study Employed A Quasi-Experimental Research Design Among 100 Undergraduate Students Selected Through A Multistage Sampling Technique From Four Universities. There Were Four Groups: Control, Nutrition Education Alone, Mobile Phone Communication Alone, And Nutrition Education And Mobile Phone Communication Intervention. An 8-Week Follow-Up Was Done After The Study Implementation. Data Were Analysed Using Descriptive And Inferential Statistics To Test The Effectiveness Of The Interventions. All Statistical Tests Were At 5% Level Of Significance. All The Respondents Were Single (100%). Mean Age Of Respondents Was 19.80 ± 2.22, Knowledge About Healthy Diet And Attitude Towards Healthy Diet Among Respondents In All Four Groups At Baseline Was Poor. A Combination Of The Nutrition Education And Mobile Phone Communication Intervention Exhibited Significant Increase In The Respondents’ Knowledge Of Healthy Diet By 19.93% From Baseline (13.91 ± 3.48) To Endline (19.69 ± 2.73), With A Big Level Of Effect (ES = 0.602), This Is The Highest Effect Size Of All The Groups. Mobile Phone Communication Alone Had The Highest Increase In Attitude Mean Score By 20.33%. A Combination Of Educational Program With Reminder Strategies Improves Knowledge Retention And Attitude Of Respondents. Keywords: Knowledge, Attitude, Healthy Diet, Undergraduates, Intervention, Nigeria.
490 Effectiveness of Peer and Parent-led Intervention to Improve the Perception of In-School Adolescents towards HIV Prevention , Elebiju Oluwatoyin Juliana
Background: Adolescents Represent A Growing Share of People Living with HIV Worldwide. The Number of Adolescents Dying from HIV Related Illnesses Is Estimated to Have Tripled Over the Last Two Decades. AIDS Is the Leading Cause of Death Among Adolescents in Africa with 85% Of Them Living In Developing Countries. Ogun State Has A Prevalence Of 1.6%, The Highest in The South-West. Developing an Optimistic Perception Of HIV/AIDS Toward Sexual Health Or HIV/AIDS Preventive Measures Could Produce Tangible Desirable Behaviour Changes In HIV-Risk Behaviours. Objective: The Objective of The Study Was to Assess the Effectiveness Of Peer And Parent-Led Intervention To Improve The Perception Of In-School Adolescents Towards HIV Prevention In Ogun State Nigeria Based On The Health Belief Model (HBM). The Study Population Were Selected In-School Adolescents. Methods: The Study Utilized A Quasi-Experimental Design. A Validated 22-Itemed Questionnaire Measured on A 66-Point Rating Scale Was Used for Data Collection. The Multistage Sampling Technique Was Used in Selecting Participants. Results: The Mean Age of Adolescents Was 14.90±1.836. The Majority of The Respondents Had A Moderate Level of Perception. The Educational Intervention Effected A Change In The Level Of Perception Of The Adolescents Between Baseline And 8-Weeks Follow-Up Indicating A Mean Difference Of 7.891 (P<0.01) For The Peer-Led, 16.618 (P<0.01) Parent-Led, 13.982 (P<0.01) Peer And Parent-Led And A Reduction In Mean In The Control Group (-0.545; P<0.01). Conclusion: In Conclusion, The Parent-Led Intervention Had A Higher Impact on Adolescents’ Perception Compared to The Other Intervention. This Is an Indication That Parent-Child Communication Should Be Reinforced Through Further Interventions. Keywords: HIV, Adolescents, Perception, Peer-Led, Parent-Led, Education Intervention, Health Belief Model.    
491 Factors Influencing Management of Post-Abortion Care by Doctors and Nurses in Health Facilities in South West Nigeria , Ayomide Rachael Afolabi
Background: Unsafe abortion practices are of great public health concern as they remain a leading cause of maternal mortality worldwide. Post-abortion care and management especially post-abortion contraception have been identified as a cost-effective method of preventing unintended pregnancies from occurring thus improving maternal health. Objective: This study sort to investigate how information, motivation and behavioral constructs influence the management of post-abortion care specifically contraception care giving by healthcare providers (doctors and nurses) in South Western, Nigeria. Methodology: A descriptive cross-sectional design was conducted among 420 participants using a 44-item validated structured questionnaire. Descriptive statistics, and correlation analysis was conducted to give statistical responses to the research questions and hypotheses using SPSS version 25. Results: Respondents level of information was 9.44 ± 2.351 with a prevalence score of 52.4%, mean score for motivation was 24.62 ± 3.628 with a prevalence of 68.4%, mean score for self-efficacy was 15.76 ± 3.640 with prevalence of 75.0% while mean score for practice was 10.55 ± 2.502 with a prevalence of 70.3%. Motivation level and Self-efficacy level is significantly associated with practice of post abortion contraception (r^2 = 0.23, P <0.001; r^2 = 0.34, P <0.001). Conclusion: There is need for more sensitization and dissemination of information on post-abortion contraception especially on early return to fertility after an abortion, counselling, importance of ensuring the woman leaves the facility with a method/referral and eliminating provider bias.
492 Predictors of Male Involvement in Post-Natal Care Services of their Partners in a Metropolitan City in North-Central Nigeria , Aderibigbe SA, Otuyemi OO, Akande OW, Alao ME, Ladapo JE, Adaramola OS, S.K. Olubiyi
Background: Men’s behaviour influences the reproductive health of both men and women as well as the health of their children. Yet, men are often unable to make informed decision because they have not been involved in Maternal health services and education. Objective: This study assessed male involvement in Post-Natal healthcare services of their partners and its predictors in Ilorin metropolis, Nigeria. Methods: Multistage sampling technique was used to recruit 350 married adult males whose wives had given birth at least once in the last three years. Descriptive cross-sectional study design was employed. Pretested interview administered semi-structured questionnaires were used for the study. Data was analyzed using SPSS version 21.0 software. A p-value of less than 0.05 was considered as statistically significant. Results: Two-thirds of the respondents (66.6%) had good knowledge of Post-Natal healthcare while a little more than half of the respondents (56.3%) were graded as having high overall involvement in the Post-Natal healthcare of their wives. The predictors of male involvement in postnatal care include the employment status (p=0.01) and educational status (p=0.028) of respondents. Conclusion: Male involvement in postnatal care in Ilorin is fair though it could be better. Being unemployed and not being educated are predictors of male involvement in post-natal care services in Ilorin. There should be increased public enlightenment on the vital roles of men in Post-Natal healthcare services to encourage male involvement, effective service utilization and continuation.
493 Perceived Psychosocial and Health Effects of Herdsmen Attacks among Internally Displaced Persons in Benue State, Nigeria , Se-ember Emily Oteyi, Musah K. Toyin  
This study sought to assess the psychosocial and health effects of Herdsmen attacks among Internally Displaced Persons (IDPs) in Benue State, Nigeria. Six hundred and twenty-nine (male=305; female 324) internally displaced persons were used as sample. Their age range was between 18 and 65 years respectively with a mean age of 37.5. Instrument used for data collection was the Beck Depression Inventory (BDI) which is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression. The internal consistency for the BDI ranges from .73 to .92 with a mean of .86. BDI was administered to the participants to measure the psychosocial effects of herdsmen attacks on the victims. Also, standardized General Health Questionnaire (GHQ) was adopted to measure the effects of the herdsmen attacks on the health of IDPs in Benue State, Nigeria. Data analysis involved the use of Chi-square and multiple regressions. The study however revealed that victims of herdsmen attacks suffered from psychological trauma including stress, depression, mood swings and health related problems. On the basis of the findings, it was recommended that the Government should work to provide psychosocial support services to victims as well as set up treatment centers to test and treat victims’ ailments and where possible, counseling sessions.  
494 Factors Militating against Lassa Fever Preventive Measures among Market Traders of Owo Local Government Area, Southwest Nigeria , Olaide M. Adewale-Aro, Dr Motunrayo F. Olanrewaju, Abosede A. Olorunnisola, John I. Akinoye, Nwachukwu I. Chiamaka  
Objective: This study sort to assess the factors militating against Lassa fever prevention programs among market traders of Owo LGA Southwest, Nigeria. Methodology This study employed descriptive cross-sectional design guided by Precede model. A multistage sampling technique was used for the study. A total number of three hundred and sixty-two respondents were involved in the study. A validated semi-structured questionnaire with Cronbach’s alpha of 0.72 was used to collect data. Frequency table, mean, standard deviation correlation, multiple and binary logistic regression analysis were conducted to give statistical responses to the research question and hypotheses using SPSS version 23. Results: Majority of the respondents involved in this study were females 240 (66.6%) while males, 122 (33.7%) responded to the questionnaire. The respondent’s level of knowledge about Lassa fever and lassa fever transmission was 6.558±1.87658. The respondent’s level of attitudinal disposition towards Lassa Fever was 10.041±3.40782. Respondents’ Lassa Fever preventive measures was high with a mean of 31.05±14.698. There was a significant relationship between’ level of knowledge (r=0.219; p <0.05), attitude (r=0.0354; p <0.05) and adherence to Lassa fever prevention program in Owo LGA. Conclusion: Findings from the study show market traders exhibit predisposing factors of religious believe and enabling factors such Lassa fever preventive measures like dispose and burn waste on daily basis, food items stored in a container at the end of each market day, regular handwashing, ensuring food is properly cooked and preserved, and fruits and drink properly washed before eating.  
495 Determinants of Psycho-active Substance Abuse among Commercial Motor Drivers in Kawo motor park Kaduna, Kaduna State, Nigeria , Giwa, H. K, Akinboye, D. O, Ugwu, E. O, Baduka A. P  
Objective: The study investigated the determinants of psychoactive substance abuse among commercial motor drivers in Kawo motor park Kaduna, Kaduna State, Nigeria. Materials and Methods: The study is a cross-sectional design guided by Social Cognitive Theory. It used 37-item validated questionnaire to collect data from 270 respondents who consented and multistage sampling technique was adopted. Variables of environmental, cognitive and behavioral factors of substance abuse were measured. Data collected were analyzed using SPSS version 23 to compute mean, frequencies, standard deviation and way of variance analysis was used to answer the research questions. The null hypotheses were tested at 0.05 significance level using Pearson’s correlation. Results: Majority of respondents were male drivers 98.8%, female 1.2%, most respondents are within 31 – 40 years (35.5%) and in their productive age. Environmental factors showed mean ±SD of 5.43±2.55, cognitive factors showed mean ±SD of 12.34±3.88, behavioral factors revealed mean ±SD of 16.64±2.95 while the level of practice showed mean ±SD of 1.575±1.42. Conclusion: Environmental determinants of psychoactive abuse such as peer pressure, parental influence, availability of drugs within the park contribute to drug abuse by commercial drivers. It was discovered that despite awareness of negative consequences of substance abuse, drivers have not been able to refrain from abuse of substances. Urgent attention of government to enact laws and enforce it to control the production and availability of such substances.  
496 Social Determinants: Reinforcing and Enabling Factors as Predictors of Treatment-Adherence in Community-Based Drug Resistant Tuberculosis Patients in South-West, Nigeria , Oyepeju O. Orekoya1, Nnodimele O. Atulomah2
Background: Medication Non-adherence in the treatment of patients with Tuberculosis (TB) is a major challenge in community-based clinical therapeutics. This has been attributed, in part, to duration and complexity of treatment regimens and toxic side-effects, which facilitates disease transmission with emerging resistance to anti-TB drugs. This study was undertaken to assess level of adherence to treatment and identify social determinants moderating medication-adherence guided by the PRECEDE framework among patients receiving treatment in South-west zone of Nigeria. Method: This was a cross-sectional survey design conducted as a community-based study with 226 consenting patients receiving second-line drug treatment based on data obtained from all DR-TB OPD Health facilities within South-west, Nigeria. The study adopted total enumeration sampling technique. Data analysis was performed using IBM SPSS version 22. Univariate and multivariate Regression analysis was conducted to validate the association between the independent variables (Reinforcing and Enabling factors) and outcome variables (medication- adherence and appointment keeping behavior). The test of significance was set at 5% for all statistical procedures. Results: Male participants in this study was 61.3%. Mean treatment-adherence prevalence was 84.75% (20.34±3.37 measured on 24-point scale). Social/Environmental factors correlated positively with treatment -adherence (r=0.165; p<0.01). Enabling factors with OR=1.44 (95% CI=1.08-1.92, p=0.013) predicted treatment-adherence more significantly than reinforcing factors for participants in this study. Conclusion: Patients’ level of treatment-adherence was fair. Special attention should be given to enabling and reinforcing factors during patient education through social learning and structural support, which the study identified as inadequate, to optimize treatment-adherence in DR-TB patients.  
497 The Phenomenon of Vaccine Resistance, Refusals, and Boycott in Cameroon: A Perspective Analysis , Ndipowa James Attangeur Chimfutumba
For several decades Cameroon has been experiencing massive challenges with regards to infection prevention and control, as well as the fight against vaccine-preventable diseases and epidemics. The resistance, refusal, and boycott of vaccines by some populations has marred the efficiency and efficacy of vaccination campaigns against diseases of epidemic potential such as Measles, Yellow Fever, Tetanus, Poliomyelitis, and Cholera. This phenomenon has been observed in many regions of Cameroon, particularly the North West, Littoral, Centre, East and West Regions of the country. Recently there have been massive anti-campaigns leading to the boycott of the Ebola Trial Vaccine in Bamenda and Yaoundé. Effective vaccination and immunization coverage in Cameroon, therefore, needs to be reviewed and the root issues addressed.