BackgroundContext-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa.MethodsThis was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence.ResultsA high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART.ConclusionsNon-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

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This study is conceived mainly to assess the impact of the public health expenditure on the infant mortality rate in Nigeria. The study made use of an ex-post facto research design and time series data spanning the period of twenty-four years (1994-2017). The data covered the Health Recurrent Expenditure (HRE), the Health Capital Expenditure (HCE) and Infant Mortality Rate (IMR) in Nigeria sourced the Central Bank of Nigeria statistical bulletin 2016 and the World Bank report. Descriptive statistics were used to analyse the data while Ordinary Least Square (OLS) technique was used to estimate the model. The study revealed that both the HRE and the HCE by the government of Nigeria had a significant negative effect on the Infant Mortality Rate (IMR) for the period of 24 years under review. Similarly, HRE had a more significant negative effect on the infant mortality rate than the HCE in this study. The authors, therefore, concluded that the Nigerian government at various levels should spend adequate funds on all the tiers of health care system in order to promote efficiency and effectiveness of the health sector. By so doing, it might lead to a phenomenal reduction in the current infant mortality rate in the country. Contribution/ Originality: This study contributes to the existing literature by examining jointly and separately both recurrent and capital components of the public healthcare expenditure and their respective impacts on the infant mortality rate in Nigeria. This has also "dove-tailed" into the methodology with respect to the research design and the statistical analysis. 1. INTRODUCTION How a nation funds its health care system tailored towards meeting maternal and child health need reflects on the mortality outcome. In this regard, Infant Mortality rate (IMR), has been used as measures of children"s health (Issa and Ouattara, 2005; Anyanwu and Erhijakpor, 2009). Some pieces of evidence on IMR indicate a significant reduction over the last century globally. However, according to Issa and Ouattara (2005) there exist dichotomous variations between developed and developing countries in this circumstance. Infant mortality is regarded as an important indicator of the availability, utilization and effectiveness of healthcare as it points to social, economic and environmental disparities in several developing countries (Anyanwu and Erhijakpor, 2009). A study conducted by Lawn et al. (2005) accounted for 10.7 million children under the age of five years that died each year. Specifically, 4

Background: As a way of tackling child mortality, many countries in the world depend on their respective health-care system. But governments of most countries in Africa are yet to provide robust funding of their health-care systems as many people still depend on the out-of-pocket payment to receive health services. Against this backdrop, this study used annual panel data to assess the effect of health-care expenditure and immunisation on the under-five mortality rate in 30 selected African countries for the period 2000-2017. Methods: Multiple regression technique was adopted for the data analysis and the robust fixed regression estimator was preferred to the random effects as determined by Hausman test.Results: The findings indicated that domestic government general health expenditure had a significant negative effect on the under-five mortality rate. However, the effect of domestic private health expenditure on under-five mortality was not significant while external health expenditure had a significant negative effect on under-five mortality rate. The impact of diphtheria immunisation on under-five mortality was significant. Conclusions: Except domestic private health expenditure, government and external forms of health expenditure coupled with diphtheria immunisation were significant factors for the reduction of the under-five mortality in the selected countries.

Nigerian hospitals continue to experience evolving roles of physiotherapists in the critical care arena, and there are hurdles to scale to develop high quality of critical care services. The Physiotherapist as a member of the critical care multidisciplinary team manages patients in the critical care unit of hospitals by using multisystem assessment to formulate individualized treatment plan. Such treatments often contributes to decreased Intensive Care Unit (ICU) and hospital stay, and improved physical function of patients. There is therefore, need for Nigerian physiotherapists to consolidate on gains already achieved, by identifying any gaps in their ICU service, closing these gaps, and further improving quality of service. This study examined the challenges faced by physiotherapists in delivering critical care service in Nigerian hospitals. Methods: Structured questionnaires were piloted, modified and administered to the physiotherapists during the annual conference of the Nigerian Society of Physiotherapists, 2016. The questionnaire contained questions regarding staffing, availability of equipment, referral and the like, in Likert scale form. Each challenge item was scored. Scores above the mean score were considered as a challenge to physiotherapy services in the ICU Results: Of the 150 physiotherapists who received the questionnaires, 90 completed the questionnaire (response rate of 60%). Respondents identified poor knowledge of critical care (3 .16±0.98), poor staffing (3.6±1.21), rotation of physiotherapists (3.19±1.08), lack of equipment (3.57±1.19), lack of team work (3.11±1.25), and poor referral (3.41±1.20) as challenges to physiotherapy service in the ICU Conclusion: This study identified many challenges to efficient physiotherapy ICU service in Nigeria. We suggest that hospitals should explore measures and strategies to overcome these challenges, so as to further improve patients' outcome in ICU care.