Martin Meremikwu - Academia.edu (original) (raw)

Papers by Martin Meremikwu

Research paper thumbnail of Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

Annals of Global Health, 2020

To assess the effect of emergency transportation interventions on the outcome of labor and delive... more To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low-and middle-income countries (LMICs). Methods: Eleven databases were searched through December 2019: Medline/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), SCIELO, LILACS, JSTOR, POPLINE, Google Scholar, the Cochrane Pregnancy and Childbirth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. Methodological quality of included studies was assessed using the ROBINS-I tool. Results: Nine studies (three in Asia and six in Africa) were included: one cluster randomized controlled trial, three controlled before-and-after (CBA) studies, four uncontrolled before and after studies, and one case-control study. The means of emergency obstetric transportation evaluated by the studies included bicycle (n = 1) or motorcycle ambulances (n = 3), 4-wheel drive vehicles (n = 3), and formal motor-vehicle ambulances (n = 2). Transportation support was offered within multi-component interventions including financial incentives (n = 1), improved communication (n = 7), and community mobilization (n = 2). Two controlled before-and-after studies that implemented interventions including financial support, three-wheeled motorcycles, and use of mobile phones reported reduction of maternal mortality. One cluster-randomized study which involved community mobilization and strengthening of referral, and transportation, and one controlled before-and-after that implemented free-of-charge, 24-hour, 4 × 4 wheel ambulance and a mobile phone showed reductions in stillbirth, perinatal, and neonatal mortality. Six studies reported increases in facility delivery ranging from 12-50%, and one study showed a 19% reduction in home delivery. There was a significant increase of caesarian sections in two studies; use of motorcycle ambulances compared to car ambulance resulted in reduction in referral delay by 2 to 4.5 hours. Only three included studies had low risk of bias on all domains. Conclusion: Integrating emergency obstetric transportation with complimentary maternal health interventions may reduce adverse pregnancy outcomes and increase access to skilled obstetric services for women in LMICs. The strength of evidence is limited by the paucity of high-quality studies.

Research paper thumbnail of Additional file 1: of Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

Multilingual abstracts in the five official working languages of the United Nations. (PDF 259 kb)

Research paper thumbnail of Additional file 1: of Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria -associated anaemia in Nigerian children during seven years of adoption as first-line treatments

Multilingual abstracts in the six official working languages of the United Nations. (PDF 808 kb)

Research paper thumbnail of Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial

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...

Research paper thumbnail of MOESM3 of Intermittent screening and treatment with artemether–lumefantrine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria

Additional file 3. Factors associated with third-trimester anaemia (<11g/dl) in study women (m... more Additional file 3. Factors associated with third-trimester anaemia (<11g/dl) in study women (mITT analyses).

Research paper thumbnail of Comparison of standardised milk‐based, standardised non‐milk based and hospital‐based formulations on the anthropometric indices of under‐fives with moderate acute malnutrition: A randomised clinical trial

Journal of Human Nutrition and Dietetics, 2021

BACKGROUND Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed... more BACKGROUND Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed by supplementary feeding. The present study aimed to compare the effect of a standardised milk-based formulation (SMBF), standardised non-milk based formulation (SNMBF) and hospital-based formulation (HBF) on anthropometric indices of children aged <5 years with MAM. METHODS This was a randomised clinical trial during which eligible children aged 6-59 months with MAM received SMBF, SNMBF or HBF over 4 months. They were followed up on a biweekly basis during which their weight, mid upper arm circumference (MUAC) and length/height were measured. The effect of the formulations was determined at the end of the period by the change in their anthropometric indices using 'per protocol' analysis. p < 0.05 was considered statistically significant. RESULTS There were 157 evaluable participants of whom 54 received the SMBF, 57 received the SNMBF and 46 received the HBF. The overall result showed a significant improvement in the mean weight and MUAC of the children. Subgroup analysis showed a significant improvement in mean weight and MUAC among children aged 6-23 months (p = 0.013) and improvement in MUAC only among those aged 24-59 months (p = 0.03). CONCLUSIONS The formulations significantly improved the mean weight and MUAC of children with MAM.

Research paper thumbnail of Hypocalcemia and vaso-occlusive painful crises in pediatric sickle cell anaemia

Nigerian Journal of Medicine, 2021

Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concom... more Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC). Aim: The aim of the study was to determine the relationship between hypocalcemia and VOC. Methods: It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation. Results: The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), ...

Research paper thumbnail of Coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) influences delivery outcomes among women with obstetric referrals at the district level in Ghana

Malaria Journal, 2020

Background The aim of the study was to determine the coverage of intermittent preventive treatmen... more Background The aim of the study was to determine the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) and its relationship with delivery outcomes among obstetric referral cases at the district level of healthcare. Methods An implementation research within three districts of the Greater Accra region was conducted from May 2017 to February 2018, to assess the role of an enhanced inter-facility communication system on processes and outcomes of obstetric referrals. A cross-sectional analysis of the data on IPTp coverage as well as delivery outcomes for the period of study was conducted, for all the referrals ending up in deliveries. Primary outcomes were maternal and neonatal complications at delivery. IPTp coverage was determined as percentages and classified as adequate or inadequate. Associated factors were determined using Chi square. Odds ratios (OR, 95% CI) were estimated for predictors of adequate IPTp dose coverage for associations with delivery outco...

Research paper thumbnail of Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

Nigerian Journal of Paediatrics, 2015

Research paper thumbnail of Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria

Research paper thumbnail of Sickle Cell Disease

American Journal of Preventive Medicine, 2011

Research paper thumbnail of Patterns of cord, placental and post-delivery maternal malaria parasitemia

Acta Obstetricia et Gynecologica Scandinavica, 2010

Research paper thumbnail of Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria

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...

Research paper thumbnail of The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies

Environment International

Research paper thumbnail of Trust, community health workers and delivery of intermittent preventive treatment of malaria in pregnancy: a comparative qualitative analysis of four sub-Saharan countries

Global Public Health

This qualitative study is part of a project aiming to evaluate a communitybased approach to the d... more This qualitative study is part of a project aiming to evaluate a communitybased approach to the delivery of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) through community health workers (CHWs) in four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. The study aimed to understand the factors that influence the anticipated acceptability of this intervention. A total of 216 in-depth interviews and 62 focus group discussions were carried out in the four country sites with pregnant women, women of reproductive age, community leaders, pregnant women's relatives, CHWs, formal and informal health providers. Grounded theory guided the study design and data collection, and content and thematic analysis was performed through a comparative lens. This paper focuses on one crosscutting theme: trust-building. Two mechanisms that underpin communities' trust in delivery of IPTp via CHWs were identified: 'perceived competence' and 'community and healthcare system integration'. Communities' perception of CHWs' competence shapes their trust in them, which suggests that CHWs' credentials should be made public and that specialised training in maternal health is required for them. Integration depends on the promotion of socially embedded practices and the involvement of formal healthcare systems in CHWs' work.

Research paper thumbnail of Cochrane Africa: a network of evidence-informed health-care decision making across sub-saharan Africa

Pan African Medical Journal

is a network of researchers and health stakeholders who aim to support the use of high quality Co... more is a network of researchers and health stakeholders who aim to support the use of high quality Cochrane evidence to improve health outcomes in Africa. It comprises a coordinating centre in South Africa, a Francophone hub directed from Cameroon, a Southern and Eastern Africa Hub directed from South Africa and a West Africa Hub directed from Nigeria. The network supports the engagement with healthcare decision makers to guide priorities, production of high quality context-relevant Cochrane systematic reviews, capacity building to conduct and use reviews, dissemination of evidence, knowledge translation, partnerships for evidence-informed healthcare and the creation of opportunities to expand the network.

Research paper thumbnail of High prevalence of Plasmodium malariae from hospital and communities in a high malaria transmission setting of Southern Nigeria

Background: Plasmodium malariae is one of five malaria parasite species prevalent across sub-Saha... more Background: Plasmodium malariae is one of five malaria parasite species prevalent across sub-Saharan Africa, but with limited data on its prevalence and epidemiology across most endemic settings. Specific clinical diagnosis of P. malariae and other non-falciparum malaria parasites is uncommon and the most widely used malaria diagnostic tool, rapid diagnostic tests (RDTs), predominantly targets P. falciparum while nonspecifically identifying co-infecting species as pan-species. Moreover, undetectable submicroscopic infections of these non-falciparum infections are likely and constitute a reservoir that could sustain transmission and challenge the achievement of elimination goals. This study aimed to explore prevalence of P. malariae infections in a high malaria transmission setting in Nigeria. Methods: A preliminary survey was first carried out in two sites to compare prevalence of non-falciparum species in southern Nigeria, results of which informed subsequent sample collection. Stu...

Research paper thumbnail of Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

Infectious Diseases of Poverty

Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in ... more Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in

Research paper thumbnail of Priority setting for new systematic reviews: processes and lessons learned in three regions in Africa

BMJ Global Health

Priority setting to identify topical and context relevant questions for systematic reviews involv... more Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effe...

Research paper thumbnail of Intermittent screening and treatment with artemether–lumefantrine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria

Malaria Journal

Background The spread of SP resistance may compromise the effectiveness of intermittent preventiv... more Background The spread of SP resistance may compromise the effectiveness of intermittent preventive treatment of malaria in pregnancy (MiP) with sulfadoxine–pyrimethamine (IPTp-SP) across Africa. However, there is no recommended alternative medicine for IPTp or alternative strategy for prevention of MiP. This poses problems for the prevention of MiP. This study investigated, whether screening with a rapid diagnostic test for malaria at routine antenatal clinic attendances and treatment of only those who are positive (intermittent screening and treatment) with artemether–lumefantrine is as effective and safe as IPTp-SP in pregnant women. Methods During antenatal clinic sessions at the General Hospital Calabar, Nigeria, held between October 2013 and November 2014, 459 pregnant women were randomized into either the current standard IPTp-SP or intermittent screening and treatment with artemether–lumefantrine (ISTp-AL). All women received a long-lasting insecticide-treated net at enrolmen...

Research paper thumbnail of Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

Annals of Global Health, 2020

To assess the effect of emergency transportation interventions on the outcome of labor and delive... more To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low-and middle-income countries (LMICs). Methods: Eleven databases were searched through December 2019: Medline/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), SCIELO, LILACS, JSTOR, POPLINE, Google Scholar, the Cochrane Pregnancy and Childbirth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. Methodological quality of included studies was assessed using the ROBINS-I tool. Results: Nine studies (three in Asia and six in Africa) were included: one cluster randomized controlled trial, three controlled before-and-after (CBA) studies, four uncontrolled before and after studies, and one case-control study. The means of emergency obstetric transportation evaluated by the studies included bicycle (n = 1) or motorcycle ambulances (n = 3), 4-wheel drive vehicles (n = 3), and formal motor-vehicle ambulances (n = 2). Transportation support was offered within multi-component interventions including financial incentives (n = 1), improved communication (n = 7), and community mobilization (n = 2). Two controlled before-and-after studies that implemented interventions including financial support, three-wheeled motorcycles, and use of mobile phones reported reduction of maternal mortality. One cluster-randomized study which involved community mobilization and strengthening of referral, and transportation, and one controlled before-and-after that implemented free-of-charge, 24-hour, 4 × 4 wheel ambulance and a mobile phone showed reductions in stillbirth, perinatal, and neonatal mortality. Six studies reported increases in facility delivery ranging from 12-50%, and one study showed a 19% reduction in home delivery. There was a significant increase of caesarian sections in two studies; use of motorcycle ambulances compared to car ambulance resulted in reduction in referral delay by 2 to 4.5 hours. Only three included studies had low risk of bias on all domains. Conclusion: Integrating emergency obstetric transportation with complimentary maternal health interventions may reduce adverse pregnancy outcomes and increase access to skilled obstetric services for women in LMICs. The strength of evidence is limited by the paucity of high-quality studies.

Research paper thumbnail of Additional file 1: of Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

Multilingual abstracts in the five official working languages of the United Nations. (PDF 259 kb)

Research paper thumbnail of Additional file 1: of Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria -associated anaemia in Nigerian children during seven years of adoption as first-line treatments

Multilingual abstracts in the six official working languages of the United Nations. (PDF 808 kb)

Research paper thumbnail of Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial

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...

Research paper thumbnail of MOESM3 of Intermittent screening and treatment with artemether–lumefantrine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria

Additional file 3. Factors associated with third-trimester anaemia (<11g/dl) in study women (m... more Additional file 3. Factors associated with third-trimester anaemia (<11g/dl) in study women (mITT analyses).

Research paper thumbnail of Comparison of standardised milk‐based, standardised non‐milk based and hospital‐based formulations on the anthropometric indices of under‐fives with moderate acute malnutrition: A randomised clinical trial

Journal of Human Nutrition and Dietetics, 2021

BACKGROUND Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed... more BACKGROUND Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed by supplementary feeding. The present study aimed to compare the effect of a standardised milk-based formulation (SMBF), standardised non-milk based formulation (SNMBF) and hospital-based formulation (HBF) on anthropometric indices of children aged <5 years with MAM. METHODS This was a randomised clinical trial during which eligible children aged 6-59 months with MAM received SMBF, SNMBF or HBF over 4 months. They were followed up on a biweekly basis during which their weight, mid upper arm circumference (MUAC) and length/height were measured. The effect of the formulations was determined at the end of the period by the change in their anthropometric indices using 'per protocol' analysis. p < 0.05 was considered statistically significant. RESULTS There were 157 evaluable participants of whom 54 received the SMBF, 57 received the SNMBF and 46 received the HBF. The overall result showed a significant improvement in the mean weight and MUAC of the children. Subgroup analysis showed a significant improvement in mean weight and MUAC among children aged 6-23 months (p = 0.013) and improvement in MUAC only among those aged 24-59 months (p = 0.03). CONCLUSIONS The formulations significantly improved the mean weight and MUAC of children with MAM.

Research paper thumbnail of Hypocalcemia and vaso-occlusive painful crises in pediatric sickle cell anaemia

Nigerian Journal of Medicine, 2021

Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concom... more Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC). Aim: The aim of the study was to determine the relationship between hypocalcemia and VOC. Methods: It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation. Results: The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), ...

Research paper thumbnail of Coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) influences delivery outcomes among women with obstetric referrals at the district level in Ghana

Malaria Journal, 2020

Background The aim of the study was to determine the coverage of intermittent preventive treatmen... more Background The aim of the study was to determine the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) and its relationship with delivery outcomes among obstetric referral cases at the district level of healthcare. Methods An implementation research within three districts of the Greater Accra region was conducted from May 2017 to February 2018, to assess the role of an enhanced inter-facility communication system on processes and outcomes of obstetric referrals. A cross-sectional analysis of the data on IPTp coverage as well as delivery outcomes for the period of study was conducted, for all the referrals ending up in deliveries. Primary outcomes were maternal and neonatal complications at delivery. IPTp coverage was determined as percentages and classified as adequate or inadequate. Associated factors were determined using Chi square. Odds ratios (OR, 95% CI) were estimated for predictors of adequate IPTp dose coverage for associations with delivery outco...

Research paper thumbnail of Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

Nigerian Journal of Paediatrics, 2015

Research paper thumbnail of Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria

Research paper thumbnail of Sickle Cell Disease

American Journal of Preventive Medicine, 2011

Research paper thumbnail of Patterns of cord, placental and post-delivery maternal malaria parasitemia

Acta Obstetricia et Gynecologica Scandinavica, 2010

Research paper thumbnail of Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria

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...

Research paper thumbnail of The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies

Environment International

Research paper thumbnail of Trust, community health workers and delivery of intermittent preventive treatment of malaria in pregnancy: a comparative qualitative analysis of four sub-Saharan countries

Global Public Health

This qualitative study is part of a project aiming to evaluate a communitybased approach to the d... more This qualitative study is part of a project aiming to evaluate a communitybased approach to the delivery of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) through community health workers (CHWs) in four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. The study aimed to understand the factors that influence the anticipated acceptability of this intervention. A total of 216 in-depth interviews and 62 focus group discussions were carried out in the four country sites with pregnant women, women of reproductive age, community leaders, pregnant women's relatives, CHWs, formal and informal health providers. Grounded theory guided the study design and data collection, and content and thematic analysis was performed through a comparative lens. This paper focuses on one crosscutting theme: trust-building. Two mechanisms that underpin communities' trust in delivery of IPTp via CHWs were identified: 'perceived competence' and 'community and healthcare system integration'. Communities' perception of CHWs' competence shapes their trust in them, which suggests that CHWs' credentials should be made public and that specialised training in maternal health is required for them. Integration depends on the promotion of socially embedded practices and the involvement of formal healthcare systems in CHWs' work.

Research paper thumbnail of Cochrane Africa: a network of evidence-informed health-care decision making across sub-saharan Africa

Pan African Medical Journal

is a network of researchers and health stakeholders who aim to support the use of high quality Co... more is a network of researchers and health stakeholders who aim to support the use of high quality Cochrane evidence to improve health outcomes in Africa. It comprises a coordinating centre in South Africa, a Francophone hub directed from Cameroon, a Southern and Eastern Africa Hub directed from South Africa and a West Africa Hub directed from Nigeria. The network supports the engagement with healthcare decision makers to guide priorities, production of high quality context-relevant Cochrane systematic reviews, capacity building to conduct and use reviews, dissemination of evidence, knowledge translation, partnerships for evidence-informed healthcare and the creation of opportunities to expand the network.

Research paper thumbnail of High prevalence of Plasmodium malariae from hospital and communities in a high malaria transmission setting of Southern Nigeria

Background: Plasmodium malariae is one of five malaria parasite species prevalent across sub-Saha... more Background: Plasmodium malariae is one of five malaria parasite species prevalent across sub-Saharan Africa, but with limited data on its prevalence and epidemiology across most endemic settings. Specific clinical diagnosis of P. malariae and other non-falciparum malaria parasites is uncommon and the most widely used malaria diagnostic tool, rapid diagnostic tests (RDTs), predominantly targets P. falciparum while nonspecifically identifying co-infecting species as pan-species. Moreover, undetectable submicroscopic infections of these non-falciparum infections are likely and constitute a reservoir that could sustain transmission and challenge the achievement of elimination goals. This study aimed to explore prevalence of P. malariae infections in a high malaria transmission setting in Nigeria. Methods: A preliminary survey was first carried out in two sites to compare prevalence of non-falciparum species in southern Nigeria, results of which informed subsequent sample collection. Stu...

Research paper thumbnail of Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

Infectious Diseases of Poverty

Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in ... more Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in

Research paper thumbnail of Priority setting for new systematic reviews: processes and lessons learned in three regions in Africa

BMJ Global Health

Priority setting to identify topical and context relevant questions for systematic reviews involv... more Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effe...

Research paper thumbnail of Intermittent screening and treatment with artemether–lumefantrine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria

Malaria Journal

Background The spread of SP resistance may compromise the effectiveness of intermittent preventiv... more Background The spread of SP resistance may compromise the effectiveness of intermittent preventive treatment of malaria in pregnancy (MiP) with sulfadoxine–pyrimethamine (IPTp-SP) across Africa. However, there is no recommended alternative medicine for IPTp or alternative strategy for prevention of MiP. This poses problems for the prevention of MiP. This study investigated, whether screening with a rapid diagnostic test for malaria at routine antenatal clinic attendances and treatment of only those who are positive (intermittent screening and treatment) with artemether–lumefantrine is as effective and safe as IPTp-SP in pregnant women. Methods During antenatal clinic sessions at the General Hospital Calabar, Nigeria, held between October 2013 and November 2014, 459 pregnant women were randomized into either the current standard IPTp-SP or intermittent screening and treatment with artemether–lumefantrine (ISTp-AL). All women received a long-lasting insecticide-treated net at enrolmen...