PRINCIPALS QUALITY ASSURANCE PRACTICES IN THE MANAGEMENT OF SECONDARY SCHOOLS IN ANAMBRA STATE

This study investigated the extent of implementation of quality assurance practices in the management of secondary schools in Anambra State. Three research questions guided the study. Descriptive research design was adopted for the study. A total of 153 prinigbozuruikecipals and 3,259 teachers from the three education zones out of the six in Anambra State constituted the population. Out of this number 44 principals and 264 teachers were sampled using proportionate stratified random sampling technique. A 20 item self-constructed questionnaire was used to elicit information from the respondent. Data collected were analyzed using mean score and standard deviation. The findings of the study showed that principals do not maintain and provide adequate infrastructures and that most principals exhibit poor leadership skills as they fail to enforce discipline in their schools. Based on the findings recommendations were made, which include among others that principals should maintain and provide adequate infrastructure and to adequately motivate teachers

Preparing for and executing a randomised controlled trial of podoconiosis treatment in Northern Ethiopia: the utility of rapid ethical assessment

Background Community-based randomized controlled trials are often complex pieces of research with significant challenges around the approach to the community, information provision, and decision-making, all of which are fundamental to the informed consent process. We conducted a rapid ethical assessment to guide the preparation for and conduct of a randomized controlled trial of podoconiosis treatment in northern Ethiopia. Methods A qualitative study was carried out in Aneded woreda, East Gojjam Zone, Amhara Regional State from August to September, 2013. A total of 14 In-depth Interviews (IDIs) with researchers, experts, and leaders, and 8 Focus Group Discussions (FGDs) involving 80 participants (people of both gender, with and without podoconiosis), were conducted. Interviews were carried out in Amharic. Data analysis was started alongside collection. Final data analysis used a thematic approach based on themes identified a priori and those that emerged during the analysis. Results Respondents made a range of specific suggestions, including that sensitisation meetings were called by woreda or kebele leaders or the police; that Health Extension Workers were asked to accompany the research team to patients’ houses; that detailed trial information was explained by someone with deep local knowledge; that analogies from agriculture and local social organisations be used to explain randomisation; that participants in the ‘delayed’ intervention arm be given small incentives to continue in the trial; and that key community members be asked to quell rumours arising in the course of the trial. Conclusion Many of these recommendations were incorporated into the preparatory phases of the trial, or were used during the course of the trial itself. This demonstrates the utility of rapid ethical assessment preceding a complex piece of research in a relatively research-naive setting

Changes in blood counts, serum lactate dehydrogenase activity and haptoglobin level in malaria infected subjects in Nnewi, Anambra state, Nigeria

Background: Malaria is a mosquito-borne public health problem which alters the blood counts, haptoglobin level and serum lactate dehydrogenase (sLDH) activity of the infected individuals. Some of the alterations are associated risk factors in malaria pathology. This study aims at elucidating changes in blood counts, sLDH activity and haptoglobin level in malaria infected subjects seen in a Tertiary Health Institution in Nnewi, as search for associated risk factors in malaria pathology.Methods: This cross sectional study enrolled 270 age matched subjects between 18-65 years. The test group (200) who tested positive to P. falciparium was placed into two groups based on their parasite counts with cut-off of  ≥1000 parasites x 109/L. Group one (100) had counts above the cut-off and group two (100) below. The control (70) was aparasitemic. The demographic data were noted and 4mls of blood drawn. 2mls in K3EDTA was for FBC testing using Mythic 22 hematology analyzer, and remaining dispensed into plain tubes was for sLDH assay by kinetic method and haptoglobin by ELISA technique.Results: The HCT, Hb, RBC and Platelet count of test were progressively significantly lowered (p=0.001) compared to control, with an intra-significant difference among the 3 groups (p<0.05), also the parameters were found to have an inverse significant relationship (p=0.001) to the parasite counts. This trend was also seen with haptoglobin while reverse was the case with LDH activity which rather increased significantly (p = 0.000) at opposite direction as parasite density increases.Conclusions: This study show that the degree of intravascular haemolysis is directly influenced by the parasite density, this portends that high endemicity and perennial parasiteamia in the study area could cause chronic anaemia and thrombocytopenia in the population studied

Evaluation of the diagnostic utility of leucocyte in comparison to other biomarkers in the management of patients with pulmonary tuberculosis

Background: Pulmonary tuberculosis (PTB) is an infectious and debilitating disease that affects millions of people each year. Simple, reliable and cost effective biomarkers are vital to fore-stall the morbidity and mortality that is hallmark of the infection especially in resource poor economy.Methods: This comparative study enlisted 140 subjects: 80 had PTB and 60 do not. Blood of 8mls was collected; 3mls in K2-EDTA for FBC testing with XE-2100 Sysmex and ESR by Westergreen method. The remainder was used for serum CRP assay by ELISA. The radiological extent was determined from Chest X ray report and disease severity using modified Bandim TB scoring was extracted from the case note. The aim of the study is to investigate the relationship and diagnostic utility between leucocyte with CRP, ESR, radiological extent of disease and disease severity in PTB.Results: Mean Lymphocyte count was lower while TWBC, Neutrophil and Monocyte counts were higher in subjects compared to control (p<0.05). Median CRP, ESR, NLR, NMR and MLR were higher in subjects compared to control (p<0.05), NLR and MLR showed strong positive significant correlation with ESR, disease severity, and radiological extend of disease. NMR (p= 0.00) had a negative correlation with ESR (p<0.05) and inverse correlation with disease severity and radiological extent.Conclusions: This study found NLR, MLR and NMR as a readily, easily available and inexpensive indices that are as efficient and comparable to known biomarkers in PTB infection, therefore could serve as valuable predictive biomarker in areas of high disease burden with weak economy

TOTAL LYMPHOCYTE COUNT AS A PROGNOSTIC MARKER FOR CD4 COUNT IN RESOURCE LIMITED SETTINGS

Understanding the Total lymphocyte count (TLC) and CD4 relationship could aid design predictive instruments for making clinical decisions during antiretroviral therapy. The aim of this study was to determine the predictive ability of TLC for CD4 count less than or equal to 350cells/mm3.A cross sectional study involving 432 HIV-I infected persons randomly recruited from the HIV Clinics of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, NAUTH Oba and St Charles Borromeo Hospital Onitsha was conducted. Ethical approval was obtained and blood samples were collected. The following were determined; HIV- screening and confirmation using serial testing algorithm with ELISA rapid test kits, CD4 count using Cyflow partec machine and Haematological profile using Sysmex KX21N. Data analysis was carried out using SPSS version 17.Out of the 432 HIV patients involved in this study, females dominated with a population of 274(63.4%) against the males numbering 158(36.6%). The relationship between the TLC cut offs and CD4 count ≤350 cells/mm3 were all statistically significant (P&lt;0.05) except for a TLC value of 2600cells per mm3. At a value of 1200 cells/mm3, TLC had a sensitivity of 25% and specificity of 96% while at 2400 cells/mm3, TLC had a sensitivity of 76% and specificity of 39% for CD4 count of ≤350cells/mm3.TLC was found to have the most significant relationship with CD4 count of all parameters tested using regression analysis. Finally, TLC could serve as a surrogate for CD4 count for monitoring treatment in resource poor areas where facilities for CD4 count may not be available

Assessment of Alpha Fetoprotein Levels and Gamma Glutamyl Transferase Activity in Hepatitis B and Hepatitis C Seropositive Subjects in Nnewi, Nigeria

Hepatitis B and hepatitis C viral infections are the leading cause of liver cirrhosis and hepatocellular carcinoma worldwide. These conditions, which mar the hepatic functional integrity, are characterized by alterations in the liver function markers such as alpha fetoprotein (AFP) and gamma glutamyl tranferase (GGT). In the present study, a total of 90 subjects were recruited. Out of this number, 30 were hepatitis B seropositive subjects, 30 hepatitis C seropositive individuals and the remaining 30 were apparently healthy individuals. The last group served as the control. Serum alpha fetoprotein levels were estimated by the Enzyme Linked Immunosorbent Assay (ELISA) technique and the method adopted for the determination of gamma glutamyl transferase activity was the kinetic-spectrophotometric procedure. The mean serum level of alpha fetoprotein was significantly higher in hepatitis B seropositive subjects compared with the control (P&lt;0.05). The same pattern was observed when the mean serum activity of GGT of the hepatitis B seropositive subjects was compared with that of the control (P&lt;0.05). Furthermore, the mean serum level of AFP and the mean serum GGT activity were significantly higher in hepatitis C seropositive individuals compared with the control (P&lt;0.05). In contrast, no significant difference was observed in the mean serum levels of alpha fetoprotein in hepatitis B seropositive individuals compared with that of hepatitis C seropositive subjects (P&gt;0.05). A positive correlation existed between AFP levels and GGT activity in hepatitis B seropositive subjects (r=0.31) and between AFP levels and GGT activity in hepatitis C seropositive subjects (r=0.25). These findings suggest that evaluation of serum alpha fetoprotein levels and gamma glutamyl transferase activity may be a valuable adjunct in the assessment of disease progression in hepatitis B and hepatitis C seropositive individuals. Keywords: Hepatitis, alpha fetoprotein, glatamyl transferase, disease progression

Too few staff, too many patients: A qualitative study of the impact on obstetric care providers and on quality of care in Malawi

Background: Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi's efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers' perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi's women. Methods: A qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants' experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions a in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software. Results: Eighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care. Conclusion: This study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi

Active case finding and evaluation of IL-6 production among household contacts of pulmonary tuberculosis patients in a high disease setting

Background: Tuberculosis (TB) is a top infectious disease killer worldwide and remains a huge public health concern. However, most TB case findings are limited to self-referral (passive case finding), when individuals develop symptoms of TB. Only 15% of disease burden in Nigeria are reported. In view of this, it is important to assess the latent and active disease burden amongst HHC of TB patients suffering from pulmonary TB. In addition, it has been suggested that IL-6 levels could be used as a prognostic marker in exposed individuals. IL-6 levels were assessed in this cohort. Methods: A total of 205 subjects participated in this study, comprising 62 pulmonary TB index cases and 143 of their household contacts. Also, 54 apparently healthy subjects were recruited to serve as controls. Active case finding was performed amongst the HHC, using sputum and blood samples; they were tested for active TB. Blood samples were also collected for measuring IL-6 levels. Results: Findings reveal 6.3% previously undiagnosed active TB among the HHC of the TB patients and a significantly higher number of latently infected TB cases compared to the control population (p=0.0078). There were significant differences when comparing HIV co-infected index group to their HIV negative counterparts (P=0.032). Significantly different IL-6 levels were found among the study groups and sub-groups (p&lt;0.0001), with significantly higher levels in TB mono-infection compared to in TB/HIV co-infection (p=0.031).Conclusions: These results demonstrate the importance of active TB case finding for TB control and the possible role of IL-6 as a diagnostic marker in TB control.Unfunde

Active case finding and evaluation of IL-6 production among household contacts of pulmonary tuberculosis patients in a high disease setting

Background: Tuberculosis (TB) is a top infectious disease killer worldwide and remains a huge public health concern. However, most TB case findings are limited to self-referral (passive case finding), when individuals develop symptoms of TB. Only 15% of disease burden in Nigeria are reported. In view of this, it is important to assess the latent and active disease burden amongst HHC of TB patients suffering from pulmonary TB. In addition, it has been suggested that IL-6 levels could be used as a prognostic marker in exposed individuals. IL-6 levels were assessed in this cohort.Methods: A total of 205 subjects participated in this study, comprising 62 pulmonary TB index cases and 143 of their household contacts. Also, 54 apparently healthy subjects were recruited to serve as controls. Active case finding was performed amongst the HHC, using sputum and blood samples; they were tested for active TB. Blood samples were also collected for measuring IL-6 levels.Results: Findings reveal 6.3% previously undiagnosed active TB among the HHC of the TB patients and a significantly higher number of latently infected TB cases compared to the control population (p=0.0078). There were significant differences when comparing HIV co-infected index group to their HIV negative counterparts (P=0.032). Significantly different IL-6 levels were found among the study groups and sub-groups (p<0.0001), with significantly higher levels in TB mono-infection compared to in TB/HIV co-infection (p=0.031).Conclusions: These results demonstrate the importance of active TB case finding for TB control and the possible role of IL-6 as a diagnostic marker in TB control

Working relationships between obstetric care staff and their managers: a critical incident analysis

Background Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi’s disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. Methods A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres’ providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Results Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers’ lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Conclusions Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers’ job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi