Open Access Review Article

Health-Seeking Behavior of Rural Dwellers in Southern Nigeria: Implications for Healthcare Professionals

Godfrey B.S. Iyalomhe, Sarah I. Iyalomhe

International Journal of TROPICAL DISEASE & Health, Page 62-71
DOI: 10.9734/IJTDH/2012/973

The Nigerian rural people demonstrate undesirable health-seeking behavior because of their cosmological and nosological notions which ascribe etiology of diseases and ill-health to entities far beyond the realm of the stethoscope. The present review is therefore solicited to enhance the health status of rural dwellers by providing potentially useful guidance that will enhance the knowledge of healthcare professionals with respect to the peculiar health-seeking behavior of rural dwellers so as to promote good patient-physician interaction and to provide empirical basis for rational health policy formulation. A manual literature and internet (Google, Medline, Embase, HINARI and Cochrane data bases) search showed that in a pluralistic medical milieu in which the rural dwellers find themselves, the decision to seek healthcare, where to do this and the form of care perceived as appropriate are all influenced by a multiplicity of factors relating to the person, the facility and the socio-cultural environment.
Primarily, religious beliefs, use of Traditional African Medicine (TAM) and patients’ perception of reality influence health-seeking behavior. In order to adequately and successfully manage the Nigerian rural patients, the healthcare provider must pay attention to patients’ impression of illness and underpinning health beliefs during consultation, in therapeutics and in handling evolving complications of TAM and ethical dilemmas. Improvement of rural infrastructure and behavioral health promotion campaigns among the rural people together with rational health policy formulation and regulation of TAM practice, are imperative.

Open Access Original Research Article

Antimicrobial Properties of Euphorbia hyssopifolia and Euphorbia hirta against Pathogens Complicit in Wound, Typhoid and Urinary Tract Infections

Chinwe S. Alisi, Samuel E. Abanobi

International Journal of TROPICAL DISEASE & Health, Page 72-86
DOI: 10.9734/IJTDH/2012/1050

Dehydrogenase activity (DHA) in Gram-positive Staphylococcus aureus isolated from degenerated wound, Gram-negative Salmonella typhi isolated from stool, and Gram-negative Escherichia coli from a high vaginal swab were assayed. Inhibition of dehydrogenase activity of the test organisms by ethanol extract of Euphorbia hyssopifolia, and Euphorbia hirta, were determined and compared to standard antibiotics (Ciprofloxacin and Gentamycin). The total dehydrogenase assay was done using 2, 3, 5-triphenyl tetrazolium chloride (TTC) as the artificial electron acceptor which was reduced to the red-coloured triphenyl-formazan (TPF). Response of the bacterial isolates varied with extract concentration. Dehydrogenase activity was progressively inhibited in a logistic dose-response fashion in the test organism by the extracts and standard drugs. All extract and standards achieved at least 70% inhibition within the tested doses (0-2000µg/ml), except for Euphorbia hirta against Staphylococcus aureus. Threshold inhibitory concentrations (IC50) for Euphorbia hyssopifolia against Staphylococcus aureusSalmonella typhi and Escherichia coli were 59.92µg/ml, 234.90µg/ml, and 492.46µg/ml respectively, while for Euphorbia hirta IC50 against Salmonella typhi and Escherichia coli was 99.67µg/ml,and 165.90µg/ml with no significant inhibition against Staphylococcus aureus. Inhibition of dehydrogenase activity in the test organism by the extract compared well with the standard antibiotics. Euphorbia hyssopifolia was effective against Gram-positive Staphylococcus aureus implicated in delayed wound healing than Gram-negative Salmonella typhi and Escherichia coli implicated in typhoid fever and urinary tract infections respectively, while Euphorbia hirtawas effective against Gram-negative organisms implicated in typhoid fever and urinary tract infections, but not effective against Gram-positive Staphylococcus aureus. Secondary plant metabolites found in the extracts may be acting in synergy to bring about their pharmacologic functions and may explain reasons for ethno-medical usage.

Open Access Original Research Article

Self-Esteem and Attitudes of Girls Orphaned to HIV/AIDS towards Education in Kampala, Uganda

Hellen Christine Amongin, Joseph C. Oonyu, Peter K. Baguma, David Lagoro Kitara

International Journal of TROPICAL DISEASE & Health, Page 87-99
DOI: 10.9734/IJTDH/2012/1194

Aims: To examine the relationship between self-esteem and attitudes to education among orphaned and non-orphaned adolescent secondary school girls in Kampala. 
Study Design: Cross-sectional study.
Place and Duration of Study: Institute of Psychology, School of Education, Makerere University, Kampala, Uganda between June and October 2005.
Methodology: Questionnaire including the socio-economic indicators, Rosenberg General Self-Esteem Scale and the Attitude Scale were administered to 225 students who were selected by simple random sampling in six secondary schools in Kampala, Uganda.
Results: Orphaned girls had lower self-esteem and most had a negative attitude to education compared to non-orphans. However, girls orphaned to HIV/AIDS had a higher self-esteem compared to those orphaned by other causes and there was a positive correlationship between self-esteem and attitude towards education among orphaned adolescent girls in Kampala, Uganda. 
Conclusion: Non-orphaned girls have a higher self-esteem than orphaned girls. Non-orphaned girls have a more positive attitude to education compared to orphaned girls. Girls orphaned to HIV/AIDS have slightly higher self-esteem than those orphaned by other causes, but had the worst attitude to education. 
Recommendations: A special needs program should be designed to support orphan girls in secondary school so as to enable them perform better in their education. Additional study should be conducted among secondary school boys to compare the effects of orphan hood to their education and to see whether there are some disparities in the two genders of the same age group.

Open Access Original Research Article

Cutaneous Leishmainasis: A Ten-Year Study of the Epidemiology and Clinical Features in Salfit District (2001-2010)

Shadi Hilmi Abd Allah Adawi

International Journal of TROPICAL DISEASE & Health, Page 100-111
DOI: 10.9734/IJTDH/2012/1204

Aim: This study was conducted in order to provide information and evaluate the epidemiology of cutaneous leishmaniasis, incidence, geographical distribution and clinical spectrum of the disease for the period 2001- 2010 in Salfit district (Northwestern West Bank).
Study Design: A retrospective study.
Methods: Fifty patients with positive cutaneous leishmaniasis (23 males and 27 females) in Salfit district were recorded in Salfit Primary Health Care Center from 2001 to 2010. 
Results: The results show that the incidence of disease increased from 0.2 in 2001to 2.5 per 10000 person in 2010 and the disease distributed in 13 localities in Salfit district with more prevalence in Der ballut locality (24%). According to the history of CL medical reports which consist of time of the emersion of signs, the time of seeking of medical care taking in to consideration the incubation period for the leishmania parasite in cases, the results show that the frequency of main infection period took place during March. The disease affects both males and females in different age groups with more prevalence of cases occurred in patients ages 6-21 years (36.0%). The lesions were commonly single and nodules (60.5%), (54%) respectively and more prevalence in upper limbs (48%) especially in females (30.2%) and the duration of treatment of CL infection with sodium stibugluconate (pentostam) took mainly form 1-20 days.
Limitations of Study: This was a retrospective study to evaluate the epidemiology of 50 positive CL cases in Salfit district recorded at Salfit Primary Health Care center (SPHC) for the period 2001 to 2010 and The data recorded at (SPHC) did not include the Suspected CL cases or species of Leishmaina parasite and possible species of vector and reservoir.
Conclusion: The results show that CL is increasing in number year by year and spread over the localities in salfit district and become endemic area, so more studies are needed to determine the vectors and reservoirs as well as species of leishmania to help the decision makers put suitable strategies to control the disease.

Open Access Original Research Article

Attitudes and Barriers to Post Graduate Education among Radiographers in South Eastern Nigeria

Anthony Chukwudi Ugwu, Okechukwu Felix Erondu, Chinedu T. Onwuazombe

International Journal of TROPICAL DISEASE & Health, Page 112-122
DOI: 10.9734/IJTDH/2012/651

Background: This study is aimed assessing the attitudes of radiographers and perceived barriers to postgraduate radiography education in south-eastern Nigeria.
Methods: The study utilized a self administered pre-tested questionnaire with structured and semi-structured questions. Respondents were practicing radiographers working in private, general and teaching hospitals in south-eastern Nigeria. A total of forty-one (41) radiographers participated in the study. This study was carried out in South-Eastern Nigeria made up of five states namely; Anambra, Enugu, Imo Abia and Ebonyi states. All radiographers in South-Eastern Nigeria who agreed to participate in the study were included. The following categories of registered radiographers where included in the study, Intern radiographers (fresh graduates), Youth corper radiographers (those undergoing one-year mandatory post-qualification national service) and radiographers currently in practice with or without post graduate certificate.
Results: Physical, attitudinal and structural barriers were identified as obstacles to postgraduate radiography education. No significant correlation existed between attitude and all the categories of barriers in this study. A set of numerical scores ranging from 1.0 to 5.0 were assigned to the attitudes, otherwise called ‘attitude scores’. A score of 1.0 represents a less positive attitude, while a score of 5.0 represents a very positive attitude. Attitude scores to organizational barrier ranging from 2.70 to 3.67 were recorded among administrative cadre radiographers (chief and assistant chief). Environmental barrier score was found to be the least among M.Sc radiographers (2.46) and highest among radiographers in private establishments (3.58). Organizational barrier was noted to be significantly higher than other barriers. This study has shown a very positive attitude of radiographers towards postgraduate education. Organizational (university) barrier is perceived as the most dominant bottleneck. The study recommends the establishment of more post-graduate radiography programs in Nigerian Universities, recruitment of more lecturers as well as reduction in the duration and cost of undertaking such programs. 
Conclusion: The authors recognize that achieving a higher level of competence and professional expertise through post-graduate education requires commitment and cooperation between the individual radiographer, the employing organization and the tertiary institution. Furthermore, recognizing the dynamics and complexity of health-care systems, it would not be sufficient to make broad suggestions indicating that identified barriers to continuing formal education can be solved by implementing short-term plans.

Open Access Original Research Article

Clinical Presentation of Infertility in an Outpatient Clinic of a Resource Poor Setting, South-East Nigeria

J. A. Obuna, E. O. Ndukwe, H. A. A. Ugboma, B. N. Ejikeme, E. W. Ugboma

International Journal of TROPICAL DISEASE & Health, Page 123-131
DOI: 10.9734/IJTDH/2012/1170

Aim: To identify the prevalence, common symptoms, signs, partner contribution, common diagnosis and outcome of infertility in a resource poor setting.
Study Design: Descriptive retrospective study.
Place and Duration of Study: Ebonyi state University teaching Hospital, Abakaliki south-east, Nigeria, in two years (1st January 2009 to 31st December 2010).
Method: Case notes of patients who attended the infertility clinic over the study period were retrieved from the health services department of the hospital and analysed.
Results: Infertility patients were 295 out of 1,913 new gynaecological cases during the period under review, forming 15.4% of the study population. The number of folders with complete information was 266 which were 90.2%. Primary infertility patients were 94(35.3%) of all infertility cases) while 172(64.7%) were secondary infertility. The age range was 19 to 47 years, with a mean value of 30.9±2.3 of two standard deviations across the mean. The mean parity was 1.4±0.8 and ranged between 0 – 7 children. Among those with previous deliveries, 68.2% had no living child. The predominant symptoms in the females were insomnia, inadequate coital exposure, galactorrhoea and vaginal discharge. The commonest demonstrable signs were galactorrhoea in 92(34.6%) patients, cervical excitation tenderness in 54(20.3%) and uterine mass in 65(24.4%).Some 44(16.5%) persons had no remarkable findings.
Partner contributions were: 93 (34.9%) for females; 60(22.6%) males; 64(24.1%) both partners. Pelvic infections (75.5%) and tubal occlusion (16.9%) were the commonest aetiologic factors. Others were: endocrine disorders including polycystic ovarian diseases, uterine myoma, uterine synaechiae and tubo ovarian masses. The outcome of treatment was: 40(15.0%) pregnancies; 112(42.1%) still on treatment and counseling; 75(28.2%) referrals and 39(14.6%) patients lost to follow up. 
Conclusion: Astute history taking and physical examination helped in elucidating the cause of infertility in many of our patients. Secondary infertility as in other parts of our country takes upper hand thereby reinforcing the need for prevention of pelvic infection in women of reproductive age. Total cares of infertility couples require the cooperation of men, laboratory scientists, radiologists, and even clinical psychologists (it is multidisciplinary). Treatment outcome is still poor and may be improved through increased priority in public funding, equipment supply, and manpower training as well as health education.

Open Access Original Research Article

Evaluation of the Effectiveness of Oseltamivir for the Treatment of 2009 Pandemic Influenza A (H1N1)

Luana Lenzi, Mônica H. C. Grochocki, Lineu R. Silva, Astrid Wiens, Angela M. Mello, Roberto Pontarolo

International Journal of TROPICAL DISEASE & Health, Page 132-144
DOI: 10.9734/IJTDH/2012/1310

Aims: Evaluate retrospectively the effectiveness of treatment with oseltamivir in a Brazilian subpopulation infected during the 2009 pandemic influenza A(H1N1) and compare drug activity based on the presence or absence of other disease risk factors and also the time from onset of symptoms to initiation of treatment.
Study Design: Observational and retrospective.
Place and Duration of Study: Federal University of Paraná and Parana State Secretary of Health, between April 2009 and December 2010.
Methodology: 1,917 patients were included (842 men, 1,075 women; age range 0-90 years) with positive diagnosis for the 2009 influenza virus A (H1N1) characterized by RT-PCR, whose notification forms were available at the time of data collection and that contained information of the use or not of oseltamivir. The patients were categorized by age, gender, symptoms, presence or absence of co morbidities, outcomes (cure or death) and treated or untreated with oseltamivir. The odds ratio (OR) was estimated using a multivariate logistic regression analysis. Kaplan-Meier method was used to determine if differences existed between the survival of untreated patients and oseltamivir treated patients.
Results: Out of 1,917 patients, 1,644 had cleared the infection and 273 patients died. Age, education level, cardiopathies, nephropathies, immunodepression, smoking, diabetes, systemic arterial hypertension, obesity, diarrhea, dyspnea, hemoptysis and pneumonia were considered risk factors. The use of oseltamivir provided about 32.3 times more likely to clear the infection compared with untreated patients. Moreover, the effectiveness of oseltamivir is reduced by approximately 7-fold in smoking patients. For each day that passed to initiate treatment after the onset of symptoms, the risk of death increased by 32.3%. 
Conclusion: The findings suggest that treatment with oseltamivir was effective in producing favorable patient outcomes in those who contracted the 2009 influenza A (H1N1) strain.

Open Access Original Research Article

Egyptian Women’s Satisfaction and Perception of Antenatal Care

Nadia Abd El-Hamed Montasser, Randah Mohamad Helal, Walaa Mohamed Megahed, Sally Khairat Amin, Adel Mohemed Saad, Talaat Refaat Ibrahim, Haitham Mohemed Abd Elmoneem

International Journal of TROPICAL DISEASE & Health, Page 145-156
DOI: 10.9734/IJTDH/2012/1312

Aim: to assess pregnant women perception of ANC (antenatal care) and their satisfaction with different aspects of care.
Study Design: A Cross sectional study was conducted on 600 pregnant females. 
Place and Duration of Study: Shawa family medicine center in Shawa village in Mansoura, Dakahlia governorate from March 2010 to September 2010. 
Methodology: Our target group completed the questionnaire including socio-demographic data, duration of pregnancy and number of their antenatal visit, questions to assess; satisfaction about different aspects of quality of the care, to assess women perception for ANC components. 
Results: High satisfaction (>90%) was reported for waiting time for laboratory results, answering inquiries and help by staff, trust the doctor followed by cleanness of the center, privacy, most of accessibility items, most of physician performance items. Satisfaction (<30%) reported for location of the center, health education methods, explanation of the problems by physician. All females who came for repeated visits confirmed the application of follow up measures in each visit by doctors. The majority of the female (>75%) received proper nutritional care and fetal examination, performed ultrasound examination and only 65% actually received tetanus toxoid. <40% reported home visits, familial participation in care, had blood and stool analysis. Pregnant females were satisfied with most of the health education messages. Information about teeth care, breast care and clothing achieved lowest satisfaction (<20%). 
Conclusions: The majority of the females was satisfied by the quality of care and reported the perception of ANC components however; low satisfaction with health education components indicates a need for strategies to improve this important aspect of care.