Nigeria's 2009–2013 malaria strategic plan adopted WHO diagnosis and treatment guidelines, which include the use of rapid diagnostic tests (RDTs) prior to prescribing treatment with artemisinin combination therapies (ACTs). The current study explores accessibility barriers to the use of RDTs in Niger State and makes recommendations for improving the uptake of RDTs. The study employs literature review, review of data from the Niger State Health Management Information System for January–October 2013, and application of Peters' conceptual framework for assessing access to health services. Data showed that 27 percent of public health facilities (HFs) implemented RDTs, with the aid of donor funds. In these facilities, 77 percent of fever cases presented during the study period were tested with RDTs; 53 percent of fever cases were confirmed cases of malaria, while 60 percent of fever cases were treated. Stockouts of RDTs were a major constraint, and severe fever tended to trigger presumptive treatment. We conclude that although implementation of RDTs led to a reduction in the use of ACTs at HFs, more substantial reduction could be achieved if the state government directed more resources towards the acquisition of RDTs as well as raising the level of awareness of potential users.
Nigeria has an estimated 3.5 million human immunodeficiency virus (HIV) positive individuals, ranking third worldwide. This study analyzes the determinants of HIV infection to enable improvements in HIV programming in Nigeria and other developing countries. The methodology used is a literature review of grey and electronic databases of reviewed journals, analyzed in terms of an adapted version of Dahlgren and Whitehead's (1991) determinants of health model. A total of 43 publications (14 reports and 29 articles) were reviewed. Political, work environment, healthcare service, social network, lifestyle, and gender determinants are predominant over others. The level of political commitment to HIV control is extremely low: over 90% of funding is from foreign sources. Stigmatization leads to delayed and inadequate treatment; and economic and social hardships for HIV-positive individuals. New infections are emerging at increasing rates among individuals engaging in sexual relationships such as men having sex with men (MSM) and female sex workers (FSW). HIV control in Nigeria is financially overdependent on foreign intervention. Political action is required to formulate and implement a human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) policy that provides legal, social, and economic support for people infected and affected by HIV/AIDS. Measures are required to inform about scientific safeguards against infection, and to reduce HIV stigma among the general population and healthcare workers in particular. Most-at-risk populations require education, legal and economic support, and access to effective health care without negative repercussions, in order to minimize new infections.
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