BackgroundDespite massive anti-malaria campaigns across the subcontinent, effective access to intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) among pregnant women remain low in large parts of sub-Saharan Africa. The slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities.MethodsA recent community-based programme in Akwa Ibom State, Nigeria, is analysed to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy. Six local government areas in Southern Nigeria were selected for a malaria in pregnancy prevention intervention. Three of these local government areas were selected for a complementary community-directed intervention (CDI) programme. Under the CDI programme, volunteer community-directed distributors (CDDs) were appointed by each village and kindred in the treatment areas and trained to deliver ITNs and IPTp drugs as well as basic counseling services to pregnant women.FindingsRelative to women in the control area, an additional 7.4 percent of women slept under a net during pregnancy in the treatment areas (95% CI [0.035, 0.115], p-value < 0.01), and an additional 8.5 percent of women slept under an ITN after delivery and prior to the interview (95% CI [0.045, 0.122], p-value < 0.001). The effects of the CDI programme were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two SP doses during pregnancy by 35.3 percentage points [95% CI: 0.280, 0.425], p-value < 0.001) relative to the control group. No effects on antenatal care attendance were found.ConclusionThe presented results suggest that the inclusion of community-based programmes can substantially increase effective access to malaria prevention, and also increase access to formal health care access in general, and antenatal care attendance in particular in combination with supply side interventions. Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention; the participatory approach underlying CDI programmes also promises to strengthen ties between the formal health sector and local communities.

We analyzed a sample of 112714 children from the 2015–2016 Indian National Fertility and Health Survey with available data on hemoglobin. Multinomial logistic regression models were used to establish associations between parent anemia, household characteristics and nutritional intake of children. Linear regression analysis was also conducted to see the link between the household characteristic and childhood nutritional intake on one hand and hemoglobin levels on the other hand. A number of socio-demographic factors, namely maternal age, type of residence and maternal education, as well as wealth index, among others correlate with incidence of childhood anemia. For instance, whereas 52.9% of children in the richest households were anemic, 63.2% of children in the poorest household were anemic (p < 0.001). Mean Vitamin A intake in the last six months was 0.63 (0.626–0.634) which was 0.18% of the recommended intake. Mean iron intake, from sources other than breast milk, in the last 24 hours was 0.29 (0.286–0.294) and 2.42% of the recommended daily intake. Fifty-nine percent (58.5%) of the children surveyed were anemic (Hb level: 9.75 g/dL [9.59–9.91]). Children with anemia were more prone to being iron deficient (odds ratio [OR]: 0.981 (0.961–1.001), Vitamin A deficient (OR: 0.813 (0.794–0.833)), and have lower maternal hemoglobin level (OR: 1.992 (1.957–2.027)). Combining nutritional supplementation and food-fortification programmes with reduction in maternal anemia and family poverty may yield optimal improvement of childhood anemia in India.

Abstract:Urinary schistosomiasis, which is one of the commonest forms of the parasitic disease is a major debilitating disease characterized by blood in urine. The main objective of the study reported here was to assess the knowledge, attitude/perception and practices of the people in Oshimili South and Ndokwa Northeast Local Government Areas of Delta State in Nigeria. A cross-sectional study of 400 randomly selected persons aged ≥15 years was undertaken using a uniform set of structured interview schedule administered by trained field assistants. This was supported with some qualitative data collected from in-depth interview with community leaders and school teachers as well as focus group discussions with community members. One-third of the people interviewed were aware of the schistosomiasis. For a majority however, the perceived causes of the disease included witchcraft and sexual or body contact with infected persons. For some of the respondents, the disease is not serious since it does not harm or prevent the victim from eating. In many cases the disease was not treated because of the belief that there is no effective cure for it and that it reoccurs after treatment. But perhaps more importantly, the infection is not treated because it is considered a normal growing up process, which the infected person outgrows. A very high proportion of people depended on the schistosomiasis-infected river for all the domestic needs even where there are alternative sources of water. People argued that the river/ stream give them purer water than the hand dug wells. Furthermore, swimming is a popular activity in the river during all seasons, irrespective of sex and age. In conclusion, the study has identified gaps in the knowledge of the cause and means of transmission, poor perception and management practices, which calls for systematic health education on schistosomiasis in the communities

BackgroundThe relationship between people’s perception and utilization of public health serviceswas investigated.MethodsA survey of 840 households across selected urban, peri urban and rural communities, in the Southeast of Nigeria, was conducted using the mixed methods approach.ResultsOf the nine (9) demographic variables, only the locality and status of the health system (strong or weak in terms of child immunization) was found to influence both the poor rating and utilization of public health services. Individuals from states with strong health system rated relatively higher and used public health services more (p < 0.001), than their counterparts from states with weak health care system. Similarly, those in the urban or peri-urban localities used public health services more (p = 0.013). The two perceptual variables significantly influence the rating and use of public health services. Those with a good perception of the quality of health service provided, rated and patronized them more (p < 0.001). Also, health centres that provide a high number of services enjoyed greater rating and patronage (p < 0.001 and p = 0.0524 respectively). The results of the structured questionnaire survey were confirmed by qualitative enquiry,based on in-depth interviews and focus group discussions.ConclusionsIt will be necessary to create a more responsive atmosphere in the health facilities, with culturally-sensitive and friendly health workers, and provision of affordable drug to improve the perceptions of the primary health care system, for it to succeed in providing health services for all.