Differences in Population Dynamics and Uptake of Reproductive Health Services in the Urban and Rural Cohorts of Cross River Health and Demographic Surveillance System of Southern Nigeria

Background: Health and demographic surveillance systems (HDSSs) generate essential health and demographic data from longitudinal surveillance of populations resident in distinctly demarcated enumeration areas. The Cross River HDSS (CRHDSS) located in southern Nigeria includes distinct urban and rural cohorts. Concurrent surveillance of adjacent urban and rural communities provides an opportunity to identify differences in population characteristics and access or utilization of health services. In this paper, we report the result of comparative analysis of rural and urban cohorts of the CRHDSS from November 2012 to December 2018. Methodology: Data was collected through house-to-house interviews performed in 6-monthly cycles through the years. Information obtained included demographic characteristics, pregnancies, child birth, health-seeking behaviour, migration and deaths. Trained field workers collected data from all households in the demographic surveillance area with mobile Android devices (running the ODKCollect). Collected data were transferred electronically to a remote server running on ODKAggregate and further processed by MirthConnect on OpenHDS web application with a MySQL backend database. Data was exported, cleaned and analyzed with the R Statistical Computing Software. Results: Total population undergoing longitudinal health and demographic surveillance was 37,808 persons in 9,452 households with 18,414 males and 19,394 females. The rural cohort made up 47.4% of the population while the urban cohort was 52.6%. Population structure showed that while the rural cohort has a relative depletion of young adults, the urban cohort has preponderance of this population segment indicating the high rate of rural to urban migration. There is also a striking difference in pattern of utilization of reproductive health services by pregnant women. While 68.6% of childbirth in the rural cohort occurred outside the formal health service (at TBAs and at home), 79.1% of childbirth in the urban area occurred in formal health facilities. Both the crude fertility rate, infant mortality and under-five mortality rates were higher in rural than the urban cohorts.Conclusion: Surveillance data showed relative depletion of young adults from rural population cohort, suggesting high rate of rural to urban migration. Majority of childbirths in rural areas still occur outside formal health facilities, which may partly contribute to higher infant mortality rate in the rural cohort. This calls for more efforts to enhance reproductive health services and employment opportunities in rural areas. Keywords: Population, Health characteristics, births, deaths, health and demographic surveillance systems DOI: 10.7176/DCS/9-5-08 Publication date:May 31st 201

Determinants and Differentials of Maternal Reproductive Health Outcomes in Nigeria: A Review of National Demographic Health Survey Data from 1999 to 2013

Women in Sub-Saharan Africa face significant clinical and socio-demographic challenges that translate to poor health outcomes including high maternal morbidity and mortality. Nigeria being the most populous nation in Africa bears a significant burden of both communicable and non-communicable diseases. This study aimed to determine the trends and differentials in indices fuelling poor health outcomes in Nigeria. The study was a review and trend analysis of maternal reproductive health indicators obtained from the Nigeria National Demographic and Health Survey (NDHS) data from 1990 to 2013 including secondary data from WHO, UNICEF and the World Bank. The life expectancy at birth was 54.5 years with an estimated infant mortality rate of 75 per 1000 live births, child mortality rate of 88 per 1,000 live births, under-5 mortality rate of 157 per 1,000 live births and a maternal mortality ratio (MMR) of 545 per 100,000 live births. Contraceptive prevalence was 22% among women in the wealthiest quintile and 3% among those in the poorest quintile.  Only 3% of women with no education used modern contraception as compared to 24% of women with tertiary education. Most of the maternal deaths were due to preventable causes which were largely related to poverty, inimical socio-cultural beliefs and practices as well as clinical factors like haemorrage, hypertension, and indirect causes like inadequate human resource for health, user charges, cultural pregnancy/childbirth beliefs and myths. A community-based participatory research using both qualitative and quantitative methods may shed more light on the non-clinical factors fueling high MMR in Nigeria. Keywords: Maternal and Child Health, maternal mortality, contraceptio

Childbirth Practices in the Akpabuyo Rural Health and Demographic Surveillance System

Maternal and neonatal mortality remain high in Nigeria. The State and Federal governments have adopted several strategies to prevent maternal and infant deaths such as the Cross River State Free Health Services to pregnant women and infants, and the National Midwives’ Service Scheme. This study assessed pregnancy and childbirth practices of Nigerian women in rural communities located in Akpabuyo in the Niger Delta region of Nigeria. Women who were pregnant or had recently given birth in a population of 5,668 people under surveillance in some rural communities of Akpabuyo were interviewed to obtain information on pregnancy and childbirth practices. Validated semi-structured questionnaires were administered by well-trained field workers. Completed questionnaires were entered into electronic data forms in OpenHDS software and exported to STATA for analysis. Results showed that, 39.5% of women reported that they had sought prenatal care from a traditional birth attendant (TBA). 84.6% of all births occurred outside the formal health system with the majority attended by TBAs. Only 15.4% of births occurred in hospitals or health centres. The implements used to cut the umbilical cord were knives (46.2%), new razor blades, old razor blades, sharp stone and scissors. The materials used for treating the umbilical cord were mostly methylated spirit (63.1%); other treatment materials were“western medicine”, “black powder” and others including herbs and earth. The study concluded that, childbirth practices that pose significant risk to maternal and newborn health remain common in these rural communities. Majority of births were attended by TBAs despite free delivery services available at the formal health facilities. TBAs should be assisted to enhance their role in health care delivery. Effort should be made to increase public awareness and interest in facility-based services. Keywords: Maternal health, neonatal infection, longitudinal data, pregnancy

Optimum hardware, software and personnel requirements for a paperless health and demographic surveillance system: a case study of Cross River HDSS, Nigeria

Health and Demographic Surveillance Systems (HDSS) are a robust and rigorous data collection, validation, storage, analysis and reporting platforms for community-based data on vital events. These processes make high demands on paper and man-hours with attendant implications on running costs and environmental impact. However, with the rapid development of ICT and increasing affordability of computing devices, some of the manual processes can be replaced with ICT tools. This paper presents a case study of the Cross River HDSS in Akpabuyo Southern Nigeria with a view to highlighting the essential personnel, hardware and software requirements for running an IT-based paperless HDSS in low income settings. The DSA comprised of 22 contiguous EAs of 1370 households. The case study entailed four update rounds, each of which involved field workers visiting households and obtaining information on vital events. The first update round was purely paper-based involving the use of large collections of paper forms for interviews. The last three rounds were IT-based, devoid of paper questionnaires and ran on web-based open source software. Hardware was a set of high-end servers, desktops, tablet PCs and android phones for data collection.   The case study demonstrated the feasibility of running a paperless IT-based HDSS in a resource-poor setting using free and open source software, such as the web-based OpenHDS, MySQL, ODK, MirthConnect, etc. This overcomes the limitations of the popular HRS2 in terms of costs, complexities, and lack of compatibility with changing hardware and system software configurations. However, running IT-based paperless HDSS threw up some challenges, such as cases of poor internet connectivity, absence of GSM network connectivity using mobile devices, and having the right mix of staff with sufficient IT skills. This paper recommended solution strategies for overcoming these challenges. The need for the development of new set of protocols for data quality in a paperless HDSS is also discussed.   Keywords: Health, demographic surveillance system, information technology, paper, environment, enumeration area

Can Africa achieve herd immunity?

The World Health Organization described herd immunity, also known as population immunity, as the indirect fortification from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous exposure to infection. The emergence of COVID-19 vaccine is a step towards the achievement of herd immunity. Over one billion people across the globe have been vaccinated and Africa recorded only 2%. The objective of this article was to develop a forecast of the number of people to be vaccinated to achieve herd immunity in the 13 WHO-identified priority African countries for COVID-19. Herd immunity is achieved when one infected person in a population causes less than one secondary case on average, corresponding to the effective basic reproduction number (R0). Vaccine delivery and distribution infrastructure including the cold chain remains weak. Vaccine hesitancy is also one of the limiting factors that may hinder herd immunity in Africa. In order to achieve herd immunity globally, African countries should not be excluded in fair and equal distribution of vaccines. Relevant stakeholders should foster commitment as well as community sensitization on COVID-19 vaccines and integration of COVID-19 vaccines in existing healthcare services

Management of Uncomplicated Malaria in Underfives in Private and Public Health Facilities in South-Eastern Nigeria: A Clinical Audit of Current Practices

Malaria remains a leading cause of underfive morbidity and mortality in sub-Saharan Africa. Effective case management is a strategy recommended by the World Health Organization for its control. A clinical audit of case management of uncomplicated malaria in underfives in health facilities in Cross River State, Nigeria, was conducted from January to March 2012. Data was extracted from patients’ case records by trained medical personnel using pretested data extraction forms. Of the 463 case records reviewed, age, gender, and weight were reported in 98.1%, 97.3%, and 49.7% of the children, respectively. A history of fever was obtained in 89.6% and a record of temperature in 74.1% of the children. General examination was performed in 203 (43.8%) children. Malaria parasite test was requested in 132 (28.5%) while Packed cell volume or haemoglobin was requested in 107 (23.1%) children. Appropriate dose of Artemisinin Combination Therapy (ACT) was instituted in 300 (64.8%), wrong dose in 109 (23.5%), and inappropriate treatment in 41 (8.9%). The utilization of ACTs for treating uncomplicated malaria in the State has improved but clinical assessment of patients and laboratory confirmation of diagnosis are suboptimum.</jats:p

Impact of COVID-19 pandemic on antenatal healthcare services in Sub-Saharan Africa

Many Sub-Saharan African countries have been known to suffer various challenges which threaten the quality of health services that are offered to the population. With the emergence of COVID-19 outbreak, it is not impossible that access to quality antenatal care services would be further threatened in the region due to the competition for limited health care resources. This paper seeks to highlight the impact of COVID-19 pandemic on antenatal healthcare services in Sub-Saharan Africa. It is imperative for all African countries to put up measures to ensure antenatal care services, which are just as important and needed, are not disrupted due to the urgent need to shift limited resources to contain the COVID-19 pandemic

Is differential cleaning needed for SARS-CoV-2 beyond standard procedures? A systematic review.

BACKGROUND: There is a substantial risk of indirect transmission of SARS-CoV-2 from contaminated surfaces and objects in healthcare settings. AIM: To evaluate the effectiveness of enhanced cleaning protocols for high-touch surfaces during COVID-19, focusing on cleaning products, concentrations, contact time, and recommended frequency. SETTING: We focused on research conducted in healthcare settings or where samples were obtained from healthcare environments. METHOD: We assessed studies that compared different cleaning, disinfection, sterilisation, or decontamination procedures and cleaning frequency with standard or routine procedures. We prioritised randomised trials, non-randomised controlled trials, controlled before-and-after studies, and interrupted time series analyses carried out between 01 January 2020 and 31 August 2022. RESULTS: Three studies met our criteria from 2139 references searched. These studies, which took place in Iran, China and the United States, found that routine terminal cleaning and enhanced terminal cleaning with different cleaning enhancements significantly reduced SARS-CoV-2 surface contamination. One of the studies tested residual SARS-CoV-2 levels after routine and terminal cleaning with varying strengths of disinfectant and evaluated the efficacy of two common types of disinfectants in inactivating SARS-CoV-2 on inanimate surfaces in different hospital wards. CONCLUSION: Limited evidence supports cleaning strategies that can reduce the transmission of SARS-CoV-2 from surfaces in healthcare settings. Combining various cleaning methods and using multiple disinfectants can effectively reduce surface contamination. CONTRIBUTION: Randomised controlled trials are crucial for evaluating cleaning effectiveness. They must outline cleaning protocols, detailing frequency, product concentration and volume, application methods, soil and surface types, and environmental conditions, to provide strong evidence

Soap and water cleaning versus bleach-based cleaners for eliminating SARS-CoV-2 infection

Background: Households and community settings are important hubs for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As understanding ofviral transmission improves, infection prevention and control (IPC) policies need to beupdated. Aim: To compare the effectiveness of soap and water alone to bleach-based cleaners in eliminating SARS-CoV-2 infection in households and community settings. Setting: We conducted a virtual search through the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane database of systematic reviews, PubMed, EMBASE, and Effective Practice and Organisation of Care (EPOC). Methods: We assessed studies which compared the effect of soap and water cleaning on SARS-CoV-2 among humans to that of bleach-based cleaning, both in households and communities. We prioritised systematic reviews and randomised studies and only included other study designs, such as laboratory studies, which had interventions of relevant interest. Results: We retrieved 1192 articles from the search. We summarised evidence from three laboratory studies as there were no randomised controlled trials (RCTs) or comparative effectiveness studies that met our inclusion criteria. Indirect evidence suggests that soap and bleach-based cleaners were effective at different concentrations. Substantial heterogeneity between the cited studies precludes any inference on effectiveness in reducing risk of SARS-CoV-2 infection in humans. Both interventions remain important components of IPC measures. Conclusion: There was no evidence for comparison of soap and water versus bleach-based cleaners against SARS-CoV-2 in humans in household and community settings. Indirect evidence shows both interventions to be effective against the virus

Malariometric indices among Nigerian children in a rural setting

Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2-10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4%) had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%). The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8%) than in those ≥5 years (32.8%). The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR = 1.95 [1.19-3.18]). Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children