Implementing antiretroviral therapy programs in resource-constrained settings: lessons from Monze, Zambia.

We describe the impact of an antiretroviral therapy program on human resource utilization and service delivery in a rural hospital in Monze, Zambia, using qualitative data. We assess project impact on staff capacity utilization, service delivery, and community perception of care. Increased workload resulted in fatigue, low staff morale, and exacerbated critical manpower shortages, but also an increase in users of antiretroviral therapy, improvement in hospital infrastructure and funding, and an overall community satisfaction with service delivery.

Retention of health workers in Malawi: perspectives of health workers and district management.

Background: Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population.

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice.

The migration of doctors and nurses from low- to high-income countries has left many countries relying on mid-level cadres as the mainstay of their health delivery system, Malawi being an example. Although an extremely important resource, little attention has been paid to the management and further development of these cadres. In this paper we use the concept of organisational justice - fairness of treatment, procedures and communication on the part of managers - to explore through a questionnaire how mid-level cadres in jobs traditionally done by higher-level cadres self-assessed their level of job satisfaction.

Measuring and managing the work environment of the mid-level provider--the neglected human resource.

Background: Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers.

Informed consent in an antiretroviral trial in Nigeria.

We examined the process of informed consent in an antiretroviral trial in Nigeria. A semi-structured questionnaire was administered to 88 out of 180 people enrolled in the trial. This covered all aspects of the information disclosed in the leaflet of the antiretroviral trial.

Post-intervention Survey on the Knowledge, Attitude, Beliefs and Practices of People in Lagos State, Nigeria about HIV/AIDS.

The purpose of this study was to evaluate the impact of a mass-education campaign on knowledge, attitudes and practice of people leaving in Lagos State, Nigeria. A pre- and post-intervention survey was conducted among 6000 respondents from 116 administrative wards randomly selected from all the 20 Local Government Areas (LGA) in Lagos State (300 respondents per LGA) in January 2002 to document the effect of a series of communication interventions on the prevention of HIV/AIDS implemented between May and December 2001 in the state and to describe the changes that may have occurred in the knowledge base, attitude, beliefs and practices. The result showed that the level of knowledge is relatively high as indicated in both the pre- and post-intervention survey, though there was a gain in knowledge in some areas after the intervention.

An assessment of parent-child communication on sexuality in lagos, Nigeria.

This study is the first phase of a project designed to help parents acquire skills necessary for comfortable and effective communication about adolescents' sexuality. It assessed parent-child communication on sexuality among the in-school adolescents in Lagos, Nigeria. It was observed that a high proportion of the adolescents interviewed receive information on sexuality from friends and the mass media and also communicate more with their friends on sexuality than with their parents.

Height as a substitute for weight for estimating praziquantel dosage.

The study evaluated height and weight measurements of 750 school children from five rural communities in western Nigeria. The measurements were taken by 12 trained community members designated as distributors in determining treatment dose with praziquantel for these children. A very strong correlation value, r=0.

Sociocultural aspects of mass delivery of praziquantel in schistosomiasis control: the Abeokuta experience.

Background: Schistosomiasis is a public health problem in Nigeria. Although there is an ongoing national program for its control, disease control programs in other countries have shown the need to understand the sociocultural aspects of disease transmission, prevention, and treatment in endemic communities before control efforts are undertaken.

Objective: To describe sociocultural factors that influence the distribution process of praziquantel for the mass treatment of schistosomiasis infection.

Distribution of the molecular forms of Anopheles gambiae and pyrethroid knock down resistance gene in Nigeria.

We investigated the distribution of the molecular M and S forms of Anopheles gambiae and the knock down resistance (kdr) gene associated with pyrethroid and DDT resistance in A. gambiae s.s.

Effectiveness of different approaches to mass delivery of praziquantel among school-aged children in rural communities in Nigeria.

Schistosomiasis is hyperendemic in Nigeria. The national policy on schistosomiasis control has adopted praziquantel as the main drug of use in the control strategy aimed at reducing morbidity. However, the best delivery channel for praziquantel in schistosomiasis control in Nigeria is yet to be determined.

Local knowledge and attitudes about onchocerciasis in Oji-River local government area of Enugu State, Nigeria.

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure.

Knowledge and beliefs about causes, transmission, treatment and control of human onchocerciasis in rural communities in south western Nigeria.

Descriptive and quantitative information on onchocerciasis transmission and control were collected using focus group discussions and structured questionnaire to determine what changes if introduced, could upset the established human-vector-parasite relationship in limiting transmission. People's knowledge of cause of infection and transmission was very poor. Of the 1012 people interviewed, only 3% related the clinical manifestations of onchocerciasis to Simulium bites.