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Papers by Ekpereonne Esu

The Cochrane library, Feb 15, 2012

Analysis 3.3. Comparison 3 IPTc versus placebo or no IPTc (subgroup analysis: type of antimalaria... more Analysis 3.3. Comparison 3 IPTc versus placebo or no IPTc (subgroup analysis: type of antimalarial drug), Outcome 3 Moderately severe anaemia.

Nigerian Journal of Clinical Practice

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Nigerian Journal of Clinical Practice

Background: One of the major causes of anemia, defined as the reduction in the level of hemoglobi... more Background: One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration. Aims: To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial. Materials and Methods: This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman. Results: The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants. Conclusions: The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.

Scientific Reports

Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and ... more Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group...

Background Low and middle-income countries remain disproportionately affected by high rates of ch... more Background Low and middle-income countries remain disproportionately affected by high rates of childhood mortality, often caused by preventable conditions. Clinical practice guidelines (CPGs) are essential policy tools in supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based CPGs play a key role in improving clinical management aiming to impact child mortality. We aimed to identify and assess the quality of CPGs for newborn and child health published in South Africa, Nigeria and Malawi.Methods We searched relevant websites (June–July 2022), for publicly available national and subnational de novo or adapted CPGs, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible CPGs (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised CPG quality using ...

Public Health Challenges

Neglected tropical diseases (NTDs) are widespread in tropical and subtropical climates and caused... more Neglected tropical diseases (NTDs) are widespread in tropical and subtropical climates and caused by bacteria, fungi, parasites, and viruses. These infections have devastating physical, social, and economic impacts worldwide, especially in underveloped communities. Migrant populations, such as refugees who may carry diseases or are exposed to them for the first time, face poverty, famine, and bad living conditions. The pandemic's twofold burden and long‐term impact on NTDs among African refugees are highlighted in this article. Sub‐Saharan Africa accounts for roughly 90% of the disease burden due to poverty and some NTDs’ special propensity to thrive in its climates. After a disruption, such as displacement due to war, infectious disease transmission will rise until it reaches pre‐intervention levels if treatments are not started. COVID‐19 threatens NTD control and elimination efforts, which are now directly affected by it. Due to high population density, social isolation is dif...

General Psychiatry

BackgroundDisplaced persons in Nigeria experience various difficulties at different stages of the... more BackgroundDisplaced persons in Nigeria experience various difficulties at different stages of their displacement, including mental and physical problems. These experiences have been associated with different types of mental disorders.AimsThis study sought to identify sociodemographic correlates and other factors associated with depression and anxiety among internally displaced adults in Ogoja, Cross River State, Nigeria.MethodsA cross-sectional study was conducted using non-probability and probability sampling techniques. Internally displaced adults (n=335) were identified in Ogoja locations with a high prevalence of internally displaced persons (IDPs). Their mental health symptoms were assessed using the Common Mental Disorder Questionnaire, and a semistructured questionnaire was employed to collect data on sociodemographic and displacement-related characteristics. Data were analysed using descriptive statistics, χ2 analysis and multivariable logistic regression.ResultsThe prevalen...

PLOS ONE, 2021

Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination... more Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).T...

Journal of Public Health, 2021

Background Many low- and middle-income countries (LMICs) are facing a crisis of human resources f... more Background Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. Methods Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done. Results We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resourc...

Journal of Public Health, 2021

Background Globally, one of the major problems facing health systems is an acute deficit of healt... more Background Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resource planning and policies. There is a lack of evaluative research on the capacity of HWRs to improve health systems. This review aims to assess the effectiveness of HWRs for improving health systems in low- and middle-income countries. Methods We searched selected electronic databases from inception to 14 April 2020. Two authors independently screened studies and extracted data from included studies. We presented results as a narrative synthesis. Results We included eight studies of moderate–high quality in this review. The results suggest that HWRs can improve the distribution and skill-mix of the health workforce, quality of health workforce...

Journal of Public Health, 2021

Background Global health workforce shortages exist with disparities in the skill mix and distribu... more Background Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. Methods This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. Results There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rura...

International Journal of Gynecology & Obstetrics, 2019

Background: Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recom... more Background: Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recommended for preventing maternal and fetal effects of malaria in pregnancy. Increasing parasite resistance to SP has necessitated the search for an alternative medication. Objective: To compare dihydroartemisinin-piperaquine (DP) and sulphadoxinepyrimethamine in preventing malaria during pregnancy. Search strategy: Databases including CENTRAL, MEDLINE, and ICTRP were searched until August 2018. Selection criteria: Randomized and quasi-randomized controlled trials that compared DP with SP given to pregnant women to prevent adverse maternal or fetal effects of malaria were included. Data collection and analysis: Quality of evidence was determined with GRADE criteria. Effectiveness measures were calculated using odds ratios at 95% confidence intervals. Results: Three randomized controlled trials were included. Compared with IPT-SP, moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy. High certainty evidence showed intermittent screening and treatment with DP did not reduce placental malaria or maternal parasitemia at delivery. Effect of DP on low birth weight and adverse birth outcomes was minimal. Conclusions: Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP, and monthly DP is more effective than SP in reducing placental malaria.

Systematic Reviews, 2018

Background: Transportation interventions seek to decrease delay in reaching a health facility for... more Background: Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low-and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. Methods: The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Discussion: Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. Systematic review registration: PROSPERO CRD42017080092

International Journal of Contemporary Pediatrics, 2016

Background: Diarrhoea is the second leading cause of under-five mortality globally. Proper evalua... more Background: Diarrhoea is the second leading cause of under-five mortality globally. Proper evaluation of children with diarrhoea is important for making right diagnosis, instituting appropriate treatment and invariably reducingrelated childhood deaths. This study was undertaken to determine the extent under five with diarrhoea diseases were evaluated by health workers prior to commencement of treatment. Methods: A clinical audit was conducted from May to June 2013 in 32 health facilities in the Southern region of Cross River State, Nigeria. Trained field workers extracted information related to patient evaluation from case records of under-fives treated diarrhoea diseases for using a validated audit tool. Results: Case records of 370 under-five children treated for diarrhoea diseases were retrieved and audited. The duration of diarrhoea was reported in 242 (65.4%), stool consistency in 189 (51.1%) and vomiting in 177(47.8%). Other relevant information in the history was reported in less than 45%. Information on risk factors for diarrhoea was reported in less than 40%, assessment for skin turgor in 201 (54.3%) while other physical examination findings were reported in less than 25% of the case records. Request for laboratory investigations were recorded in about 10%. Conclusions: The evaluation of under-five with diarrhoea by health workers prior to initiation of treatment was sub optimum. Patients' evaluation declined steadily from the stage of history taking, to physical examination, and laboratory investigation.

Nigerian Journal of Paediatrics, 2015

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks se... more Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective, evidence-based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country. Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation. Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State, Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate, inappropriate, wrong or none, based on prescription on patients' case records. Result: Of the 370 case records audited, prescription for diarrhoea was appropriate in 40 (10.8%), inappropriate in 231 (62.4%), wrong in 82 (22.2%) and no prescription was made in 17 (4.6%). Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended.

International Journal of Food and Fermentation Technology, 2014

Kuwing oil extracted from Irvingia gabonensis seed mash fermented over 6 days in Agoi Ibami commu... more Kuwing oil extracted from Irvingia gabonensis seed mash fermented over 6 days in Agoi Ibami community, Nigeria, was analysed for it's essential oil constituents. Both the fresh seed and the ferment's oil extracts were analysed for fatty acids, organic acids and essential oils, using GC and GC-MS methods of analysis. Six (6) fatty acids: oleic, linoleic, stearic, lauric, behenic acids were found in both samples, while mystiric was found in the fermented product only. Five(5) organic acids constituents citric, glycolic, oxalic, malic and tartaric acids were identified in both the fresh seed and the ferment. while fifty one (51) chemicals were identified as volatiles or essential oils. The main constituents wereα -pinene, δ3-carene, trans-β-ocimene, α-terpinene, Cis-limonene oxide, perillaldehyde, nootkatone, germacrene-D, and bornol, about 75% of the oil and nineteen (19) of the identified volatiles responsible for flavour and aroma, made up to 43% of the oil.

International Journal of Mycobacteriology, 2015

utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and su... more utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and supervised the treatment. Results: The 916 responses to the questionnaires showed that 65.3% (549/841) correctly identified that TB is airborne, and 86% (749/871) were aware that TB could be cured by anti-TB medication. Responses to care-seeking attitudes were provided by 123 respondents. Of this number, fear of stigmatization was the reason for 31% (38) seeking care in unorthodox facilities, while 43.1% (53) did not believe that orthodox medicine could cure their symptoms. Of the 374 detected cases, 9 did not commence treatment. Hence, 365 were placed on DOTS; 36 defaulted, while 11 either died or failed to convert after the seventh month. At the end of month 8, cure was achieved for 87.1% (318). Conclusion: Although the previous intervention may have contributed to the good knowledge about TB and care-seeking attitudes displayed by respondents in the communities, sustaining active case finding through public-private partnership can go a long way to reduce TB burden, especially in rural communities where healthcare systems are generally weak or inadequate. Adequate funding of TB control activities is critical in eliminating TB as a public health problem, and the private sector participation such as this is a welcome development.

PLOS ONE, 2021

Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% targe... more Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccinati...

Calabar Journal of Health Sciences

Objectives: Ectopic pregnancy is a leading cause of maternal death during the first trimester of ... more Objectives: Ectopic pregnancy is a leading cause of maternal death during the first trimester of pregnancy, accounting for approximately one in ten pregnancy-related deaths. Knowledge of potential risk factors can improve early detection and avoid morbidity and complications. This cross-sectional study determined the knowledge level and prevalence of risk factors of ectopic pregnancy among female undergraduates. Material and Methods: Three hundred and ninety female students were randomly selected from the various hostels through multistage sampling. Results: The study found that 234 (60%) respondents were aware of ectopic pregnancy. The majority of the respondents (72.1%) had moderate to a good knowledge level of ectopic pregnancy and the risk factors. There was no significant difference in knowledge level based on marital status of the respondents (P = 0.642). Predominant risk factors for ectopic pregnancy identified among respondents were use of oral contraceptives – 151 (38.8%), ...

The Cochrane library, Feb 15, 2012

Analysis 3.3. Comparison 3 IPTc versus placebo or no IPTc (subgroup analysis: type of antimalaria... more Analysis 3.3. Comparison 3 IPTc versus placebo or no IPTc (subgroup analysis: type of antimalarial drug), Outcome 3 Moderately severe anaemia.

Nigerian Journal of Clinical Practice

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Nigerian Journal of Clinical Practice

Background: One of the major causes of anemia, defined as the reduction in the level of hemoglobi... more Background: One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration. Aims: To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial. Materials and Methods: This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman. Results: The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants. Conclusions: The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.

Scientific Reports

Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and ... more Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group...

Background Low and middle-income countries remain disproportionately affected by high rates of ch... more Background Low and middle-income countries remain disproportionately affected by high rates of childhood mortality, often caused by preventable conditions. Clinical practice guidelines (CPGs) are essential policy tools in supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based CPGs play a key role in improving clinical management aiming to impact child mortality. We aimed to identify and assess the quality of CPGs for newborn and child health published in South Africa, Nigeria and Malawi.Methods We searched relevant websites (June–July 2022), for publicly available national and subnational de novo or adapted CPGs, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible CPGs (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised CPG quality using ...

Public Health Challenges

Neglected tropical diseases (NTDs) are widespread in tropical and subtropical climates and caused... more Neglected tropical diseases (NTDs) are widespread in tropical and subtropical climates and caused by bacteria, fungi, parasites, and viruses. These infections have devastating physical, social, and economic impacts worldwide, especially in underveloped communities. Migrant populations, such as refugees who may carry diseases or are exposed to them for the first time, face poverty, famine, and bad living conditions. The pandemic's twofold burden and long‐term impact on NTDs among African refugees are highlighted in this article. Sub‐Saharan Africa accounts for roughly 90% of the disease burden due to poverty and some NTDs’ special propensity to thrive in its climates. After a disruption, such as displacement due to war, infectious disease transmission will rise until it reaches pre‐intervention levels if treatments are not started. COVID‐19 threatens NTD control and elimination efforts, which are now directly affected by it. Due to high population density, social isolation is dif...

General Psychiatry

BackgroundDisplaced persons in Nigeria experience various difficulties at different stages of the... more BackgroundDisplaced persons in Nigeria experience various difficulties at different stages of their displacement, including mental and physical problems. These experiences have been associated with different types of mental disorders.AimsThis study sought to identify sociodemographic correlates and other factors associated with depression and anxiety among internally displaced adults in Ogoja, Cross River State, Nigeria.MethodsA cross-sectional study was conducted using non-probability and probability sampling techniques. Internally displaced adults (n=335) were identified in Ogoja locations with a high prevalence of internally displaced persons (IDPs). Their mental health symptoms were assessed using the Common Mental Disorder Questionnaire, and a semistructured questionnaire was employed to collect data on sociodemographic and displacement-related characteristics. Data were analysed using descriptive statistics, χ2 analysis and multivariable logistic regression.ResultsThe prevalen...

PLOS ONE, 2021

Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination... more Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).T...

Journal of Public Health, 2021

Background Many low- and middle-income countries (LMICs) are facing a crisis of human resources f... more Background Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. Methods Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done. Results We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resourc...

Journal of Public Health, 2021

Background Globally, one of the major problems facing health systems is an acute deficit of healt... more Background Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resource planning and policies. There is a lack of evaluative research on the capacity of HWRs to improve health systems. This review aims to assess the effectiveness of HWRs for improving health systems in low- and middle-income countries. Methods We searched selected electronic databases from inception to 14 April 2020. Two authors independently screened studies and extracted data from included studies. We presented results as a narrative synthesis. Results We included eight studies of moderate–high quality in this review. The results suggest that HWRs can improve the distribution and skill-mix of the health workforce, quality of health workforce...

Journal of Public Health, 2021

Background Global health workforce shortages exist with disparities in the skill mix and distribu... more Background Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. Methods This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. Results There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rura...

International Journal of Gynecology & Obstetrics, 2019

Background: Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recom... more Background: Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recommended for preventing maternal and fetal effects of malaria in pregnancy. Increasing parasite resistance to SP has necessitated the search for an alternative medication. Objective: To compare dihydroartemisinin-piperaquine (DP) and sulphadoxinepyrimethamine in preventing malaria during pregnancy. Search strategy: Databases including CENTRAL, MEDLINE, and ICTRP were searched until August 2018. Selection criteria: Randomized and quasi-randomized controlled trials that compared DP with SP given to pregnant women to prevent adverse maternal or fetal effects of malaria were included. Data collection and analysis: Quality of evidence was determined with GRADE criteria. Effectiveness measures were calculated using odds ratios at 95% confidence intervals. Results: Three randomized controlled trials were included. Compared with IPT-SP, moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy. High certainty evidence showed intermittent screening and treatment with DP did not reduce placental malaria or maternal parasitemia at delivery. Effect of DP on low birth weight and adverse birth outcomes was minimal. Conclusions: Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP, and monthly DP is more effective than SP in reducing placental malaria.

Systematic Reviews, 2018

Background: Transportation interventions seek to decrease delay in reaching a health facility for... more Background: Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low-and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. Methods: The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Discussion: Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. Systematic review registration: PROSPERO CRD42017080092

International Journal of Contemporary Pediatrics, 2016

Background: Diarrhoea is the second leading cause of under-five mortality globally. Proper evalua... more Background: Diarrhoea is the second leading cause of under-five mortality globally. Proper evaluation of children with diarrhoea is important for making right diagnosis, instituting appropriate treatment and invariably reducingrelated childhood deaths. This study was undertaken to determine the extent under five with diarrhoea diseases were evaluated by health workers prior to commencement of treatment. Methods: A clinical audit was conducted from May to June 2013 in 32 health facilities in the Southern region of Cross River State, Nigeria. Trained field workers extracted information related to patient evaluation from case records of under-fives treated diarrhoea diseases for using a validated audit tool. Results: Case records of 370 under-five children treated for diarrhoea diseases were retrieved and audited. The duration of diarrhoea was reported in 242 (65.4%), stool consistency in 189 (51.1%) and vomiting in 177(47.8%). Other relevant information in the history was reported in less than 45%. Information on risk factors for diarrhoea was reported in less than 40%, assessment for skin turgor in 201 (54.3%) while other physical examination findings were reported in less than 25% of the case records. Request for laboratory investigations were recorded in about 10%. Conclusions: The evaluation of under-five with diarrhoea by health workers prior to initiation of treatment was sub optimum. Patients' evaluation declined steadily from the stage of history taking, to physical examination, and laboratory investigation.

Nigerian Journal of Paediatrics, 2015

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks se... more Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective, evidence-based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country. Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation. Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State, Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate, inappropriate, wrong or none, based on prescription on patients' case records. Result: Of the 370 case records audited, prescription for diarrhoea was appropriate in 40 (10.8%), inappropriate in 231 (62.4%), wrong in 82 (22.2%) and no prescription was made in 17 (4.6%). Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended.

International Journal of Food and Fermentation Technology, 2014

Kuwing oil extracted from Irvingia gabonensis seed mash fermented over 6 days in Agoi Ibami commu... more Kuwing oil extracted from Irvingia gabonensis seed mash fermented over 6 days in Agoi Ibami community, Nigeria, was analysed for it's essential oil constituents. Both the fresh seed and the ferment's oil extracts were analysed for fatty acids, organic acids and essential oils, using GC and GC-MS methods of analysis. Six (6) fatty acids: oleic, linoleic, stearic, lauric, behenic acids were found in both samples, while mystiric was found in the fermented product only. Five(5) organic acids constituents citric, glycolic, oxalic, malic and tartaric acids were identified in both the fresh seed and the ferment. while fifty one (51) chemicals were identified as volatiles or essential oils. The main constituents wereα -pinene, δ3-carene, trans-β-ocimene, α-terpinene, Cis-limonene oxide, perillaldehyde, nootkatone, germacrene-D, and bornol, about 75% of the oil and nineteen (19) of the identified volatiles responsible for flavour and aroma, made up to 43% of the oil.

International Journal of Mycobacteriology, 2015

utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and su... more utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and supervised the treatment. Results: The 916 responses to the questionnaires showed that 65.3% (549/841) correctly identified that TB is airborne, and 86% (749/871) were aware that TB could be cured by anti-TB medication. Responses to care-seeking attitudes were provided by 123 respondents. Of this number, fear of stigmatization was the reason for 31% (38) seeking care in unorthodox facilities, while 43.1% (53) did not believe that orthodox medicine could cure their symptoms. Of the 374 detected cases, 9 did not commence treatment. Hence, 365 were placed on DOTS; 36 defaulted, while 11 either died or failed to convert after the seventh month. At the end of month 8, cure was achieved for 87.1% (318). Conclusion: Although the previous intervention may have contributed to the good knowledge about TB and care-seeking attitudes displayed by respondents in the communities, sustaining active case finding through public-private partnership can go a long way to reduce TB burden, especially in rural communities where healthcare systems are generally weak or inadequate. Adequate funding of TB control activities is critical in eliminating TB as a public health problem, and the private sector participation such as this is a welcome development.

PLOS ONE, 2021

Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% targe... more Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccinati...

Calabar Journal of Health Sciences

Objectives: Ectopic pregnancy is a leading cause of maternal death during the first trimester of ... more Objectives: Ectopic pregnancy is a leading cause of maternal death during the first trimester of pregnancy, accounting for approximately one in ten pregnancy-related deaths. Knowledge of potential risk factors can improve early detection and avoid morbidity and complications. This cross-sectional study determined the knowledge level and prevalence of risk factors of ectopic pregnancy among female undergraduates. Material and Methods: Three hundred and ninety female students were randomly selected from the various hostels through multistage sampling. Results: The study found that 234 (60%) respondents were aware of ectopic pregnancy. The majority of the respondents (72.1%) had moderate to a good knowledge level of ectopic pregnancy and the risk factors. There was no significant difference in knowledge level based on marital status of the respondents (P = 0.642). Predominant risk factors for ectopic pregnancy identified among respondents were use of oral contraceptives – 151 (38.8%), ...