ObjectivesThis study was conducted to assess the concentration of air pollutants at charcoal sites, the dose-response relationship between site-based exposure levels to air pollutants and prevalence of respiratory symptoms among charcoal workers, and the measures these workers employ to safeguard their health.DesignCross-sectional but comparative designSettingCharcoal production kiln sites in Sapele, Delta State, Nigeria.ParticipantsOverall 296 charcoal workers and age-matched, sex-matched and height-matched non-exposed traders (comparison group).Primary and secondary outcome measuresThe primary outcome measure was the prevalence of respiratory symptoms among charcoal workers while secondary outcomes included lung function indices as well as hazard control practices among charcoal workers.ResultsMajority (83.3%) of the sites had PM10 and PM2.5 values five times higher than the WHO standard. Charcoal workers were more likely to have respiratory symptoms; wheeze was statistically significant after adjusting for confounders, (OR 4.22; CI 1.37 to 12.99). The dose-response relationship between site-based exposure levels to air pollutants and the prevalence of respiratory symptoms among charcoal workers was statistically significant for all symptoms except chest tightness (p=0.167). Mean forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were considerably lower among workers with differences of −0.22 (−0.42 to −0.05) L and −0.52 (-0.76 to −0.29) L, respectively, whereas FEV1/FVC ratio and peak expiratory flow rate were higher among workers with mean differences of 5.68 (3.59–8.82)% and 0.31 (-23.70 to 24.43) L/min, respectively; but the mean difference was significant only for the FEV1/FVC ratio. Charcoal workers had poor hazard control practices; only 3.4% reportedly used personal protective equipment.ConclusionAir pollutants at kiln sites were higher than WHO standards. Despite the significantly higher prevalence of wheeze, chest tightness and chronic cough among charcoal workers, their hazard control practices were inadequate. Charcoal workers should adopt appropriate hazard control practices, and use improved devices which emit minimal pollutants.

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Summary Background Malaria is a public health problem compounded with a widespread emergence of drug-resistant Plasmodium falciparum which necessitated the formulation of a new antimalarial drug policy (AMP). Objective This study was designed to assess adherence to the policy among physicians in health facilities in Delta state, Nigeria. Design Cross-sectional, analytic study. Data were collected with a semi-structured questionnaire. Setting Two secondary and one tertiary health facilities in Delta State, Nigeria Participants Physicians selected with a simple random technique from the facilities Main outcome measures Prescribing pattern of antimalarial drugs and adherence to WHO treatment guideline among doctors. Results Majority (90.8%) of respondents believed the antimalarial policy (AMP) should be strictly adhered to, although three-fifth (61.0%) of them rated its performance as poor. The level of adherence to the national antimalarial drug policy was high (78.5%) as most doctors prescribed Arthemeter-Lumefantrine, AL for uncomplicated malaria however barely two-fifth (35.4%) adhered to prescribing injectable Artesunate for complicated malaria. AL, (71.9%) was the most prescribed antimalarial drug for uncomplicated malaria The most prescribed antimalarial drugs for complicated malaria was artesunate (40.0%) followed by quinine (27.6%) and artemether (26.7%); although, chloroquine was also prescribed. Conclusion The level of adherence to AMP among doctors was sub-optimal. Continuous education of doctors on the new AMP is needed to achieve malarial control. Funding No funding was received for this study

Background: Health workers in resource-poor settings have not demonstrated a comprehensive knowledge of visual staining procedures for cervical cancer screening. This study adopted competency-based training (CBT) to determine if it will improve their knowledge, and potentially expand screening coverage.Methods: A quasi-experimental (pretest-posttest) design was adopted in this study conducted among primary health care workers in Ethiope-West Local Government Area of Delta State, Southern Nigeria. The participants had a competency-based training following an initial assessment of their knowledge. Data were analysed using SPSS version 22. The main outcome measures were baseline knowledge of cervical cancer, its prevention, and visual inspection screening techniques, as well as the effect of CBT on knowledge.Results: Participants demonstrated correct knowledge of cervical anatomy/physiology and cervical cancer epidemiology/symptomatology to varying degrees, although their knowledge of visual inspection with acetic acid or Lugol’s iodine (VIA/VILI) was grossly inadequate as only half had adequate knowledge. Knowledge of prevention, performance of VIA and VILI, as well as overall knowledge, improved significantly to 100% post-intervention (p=0.002, p<0.001 and p=0.003 respectively). Mean knowledge scores drastically increased among the PHWs between pre-CBT and post-CBT. The lowest mean difference was recorded for knowledge of cervical anatomy/physiology: 17.58 (CI: 8.16 - 27.00); while the highest was for knowledge of VILI/VIA technique: 41.01 (CI: 29.40 - 52.62).Conclusions: CBT significantly improved knowledge of cervical cancer prevention and visual inspection screening methods (VIA and VILI), indicating a window of opportunity for expanding screening services at primary health care level.

BackgroundTenofovir disoproxil fumarate (TDF) is relatively safe, although renal toxicity has been reported. In Nigeria, there is insufficient data on renal toxicity among patients on TDF. This study assesses TDF-associated tubular dysfunction among human immunodeficiency virus (HIV) patients at a hospital in Nigeria.MethodsIn this cohort study, 104 adult HIV patients were recruited with a simple random technique from the outpatient clinic. Biochemical indices of renal function were estimated from serum and urine at the 16th and 24th week after an initial assessment at baseline.ResultsThere were no significant differences in baseline proteinuria or glycosuria between TDF and non-TDF groups. Mean baseline urine and serum parameters did not differ significantly between the two groups (P > 0.05). In the TDF group, all urine parameters differed significantly between baseline and 24th week values (P < 0.001). After 16 weeks, mean urine phosphate and urine uric acid increased significantly (P < 0.05) by 2.97 mg/dL and 50.9 mg/dL, respectively, in the TDF group. The rise in mean urine glucose from baseline to the 24th week was more marked in the TDF than the non-TDF group (0.25 vs. 0.07 mmol/L). Higher mean differences in urine albumin were also recorded in the TDF group from baseline to the 24th week.ConclusionIndicators of tubular dysfunction were markedly higher among patients on the TDF-based treatment regimen. Biomarkers of tubular dysfunction could be useful for detecting pre-symptomatic nephrotoxicity before marked reduction of glomerular filtration rate in HIV patients on TDF.