Papers by Timothy Akinmurele
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Journal of Public Health Policy, 2021
The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: lea... more The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: learning from the field. While ‘the field’ often denotes people, patients, communities, and healthcare workers, we challenge the notion and its usage. A group of like-minded conference participants set up a working group to examine the term ‘the field’ and look at questions related to language, power, participation, and rights. By highlighting deficiencies of existing terms and jargon, we explain why language is a form of power that matters in public health. We describe global, regional, and national case studies that facilitate full participation to achieve more equitable health outcomes. By concluding with concrete recommendations, we hope to contribute to these shared goals: to correct power imbalances between health authorities and the people that they intend, and are expected, to serve. The authors are all members of the working group.
International Journal of Sciences, 2017
Introduction: In Nigeria, the annual number of pregnancies is estimated at over 6 million. Of thi... more Introduction: In Nigeria, the annual number of pregnancies is estimated at over 6 million. Of this number, about 58% of pregnant women attended antenatal care at least once while 45% visited antenatal clinics at least 4 times. Also only about 35% of births occurred in health facilities (20% and 15% in public and private sector facilities respectively). About 62% of births occur outside the health facility, majority of which are in the rural areas. Overall, 39% of births are delivered by skilled personnel, 41% by Traditional Birth attendants (TBAs) and relatives while 20% had unassisted delivery). Traditional Birth attendants are traditional, independent (of the health system), nonformally trained and community-based providers of care during pregnancy, childbirth, and the postnatal period. When trained, TBAs can augment their traditional function of conducting delivery with risk assessment in the prenatal period and referring mothers to health centers if complications are anticipated or in emergency. Trained TBAs can also perform deliveries and cord care hygienically and use appropriate methods to prevent and control post-partum haemorrhage. This study was conducted to show the presence or absence of some essential components ANC care at TBA and use their availability to measure the quality of care available at the TBA centers. Methods: This was a cross sectional questionnaire-based study conducted in 3 southern Nigerian states over a 6 months period. Data were collected from 450 TBAs using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: There was wide gap in the accessibility of pregnant women attending care at TBA to blood investigations. These gaps ranged from as high as 92% for Hepatitis B test, 87% for blood genotype, 80% for Packed Cell volume(PCV),74% for syphilis infection test(VDRL) to as low as 50% for HIV antibody blood rapid test and 30% for blood group investigation. Tetanus toxoid immunization service was also very low at 38% availability among the TBAs. The commonest service among the TBA was referral services, which was provided by about 94% of the TBAs.Other less common service were group health talks, monitoring of blood pressure, weight measurement , antimalarial prophylaxis and local concoction mixture. Recommendations: There is need to work with TBAs to plug the gaps in the quality of services they provide to their clients.
Journal of Public Health Policy, 2021
The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: lea... more The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: learning from the field. While ‘the field’ often denotes people, patients, communities, and healthcare workers, we challenge the notion and its usage. A group of like-minded conference participants set up a working group to examine the term ‘the field’ and look at questions related to language, power, participation, and rights. By highlighting deficiencies of existing terms and jargon, we explain why language is a form of power that matters in public health. We describe global, regional, and national case studies that facilitate full participation to achieve more equitable health outcomes. By concluding with concrete recommendations, we hope to contribute to these shared goals: to correct power imbalances between health authorities and the people that they intend, and are expected, to serve. The authors are all members of the working group.
Objectives: 1) To raise awareness on seroconversion among ANC clients and nursing mothers with re... more Objectives: 1) To raise awareness on seroconversion among ANC clients and nursing mothers with respect to vertical transmission of HIV infection. 2) To advocate for regular repeat HIV testing among women during the risky period of mother to child trans-mission of HIV especially in high burden countries. Methods: A case series reports of 4 women who sero-converted while still in anti-natal care and during breast-feeding in 2 public hospitals in southwest Nigeria. Results: Three out of the five babies whose mothers seroconverted were HIV infected as confirmed by HIV DNA PCR test. Conclusion: Re-screening for HIV during the course of pregnancy, delivery and breastfeeding is therefore rec-ommended to identify pregnant and nursing mothers who may seroconvert or get newly infected especially during this risky period of mother to child transmission of HIV. This would allow the necessary PMTCT inter-ventions to be initiated early and protect children from HIV infection.
African Journal of Clinical and Experimental Microbiology, 2018
Background : HIV pandemic has continued to be a huge challenge in Nigeria, with the problem of st... more Background : HIV pandemic has continued to be a huge challenge in Nigeria, with the problem of stigmatization reducing the chances of early determination of the HIV status of pregnant women, which may increase the chances of transmission to the child from the mother. Hypotheses tested were the influence of maternal antiretroviral therapy (ART) use and infant’s feeding option on baby’s final early infant diagnosis (EID) outcome. The study was aimed at determining the trend as well as diagnosis of HIV infection in exposed infants. It will also determine among infants the factors associated with the transmission of the infection from their mothers. Methods : This study was a prospective cohort study of HIV-exposed infants conducted in Ekiti State, South Western Nigeria, between June 2015 and June 2017. Dried Blood Spots (DBS) were analyzed using polymerase chain reaction technique. All data were statistically analyzed, using statistical package for the social sciences (SPSS) and statis...
A multicenter retrospective case-control study. Study subjects were HIV positive pregnant women e... more A multicenter retrospective case-control study. Study subjects were HIV positive pregnant women enrolled in a prevention of mother to child transmission of HIV(PMTCT) programme in southwest Nigeria. The objective was to see if the introduction of ‘Test- and -Treat strategy’ would lead to placing higher number of HIV-POSITIVE pregnant women on antiretroviral drugs. There was a significant difference (OR=1.4;CI=1.35-1.55,P=0.0) in the proportions of HIV-POSITIVE pregnant women initiated on ARV between the control arm(60%) and the case group(81%)with the implementation of the strategy. In other words, an HIV POSITIVE woman in a PMTCT setting has a 40% greater chance of being placed on ARV with test-and-treat strategy than without the strategy.The test- and -treat strategy is a treatment approach in which HIV positive clients are initiated on prophylactic antiretroviral drugs immediately after HIV diagnosis without waiting for the CD4 count test result. Hence, implementing Test and Trea...
BMC Health Services Research
Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of w... more Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria. Method Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, ...
Background: In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of ... more Background: In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria.Method: Attendees at the Nigeria Implementation Science Alliance (NISA)’s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-minutes phases followed by a 30-minute plenary session. Data analysis proceeded in four steps: transcription, col...
International STD Research & Reviews
Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of... more Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of patient's adherence to a lifelong regimen of antiretroviral (ARV) which is beneficial in reducing the risk of emergence of HIV resistant strains. This adherence is however influenced by several Original Research Article
Annals of Global Health
Introduction Biomedical research emanating from low-and middleincome countries (LMICs), especiall... more Introduction Biomedical research emanating from low-and middleincome countries (LMICs), especially in sub-Saharan Africa, remains disproportionately low despite recent growth in global health research [1]. Published estimates suggest that only about 1% of biomedical publications originate from Africa [2, 3]. Given that sub-Saharan African countries and other LMICs still carry the highest burden of morbidity and mortality due to preventable and treatable diseases [4], there is a critical need to enhance
Research and Reviews on Healthcare: Open Access Journal
Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult t... more Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services. Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service? Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria. Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%) .The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%). Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole.
Health research policy and systems, Jan 12, 2018
Despite being disproportionately burdened by preventable diseases than more advanced countries, l... more Despite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps. A 1-hour structured group exercise was conducted with 15 groups of 2-9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used....
International STD Research & Reviews
Background: In resource-limited settings, where genotypic drug resistance testing is rarely perfo... more Background: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is regarded as the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study is thus aimed at determining and monitoring HIV/AIDS disease progression using viral load to provide prognostic information and evaluate all patients for viral suppression using the World Health Organization (WHO) guideline strategies.
International Journal of Sciences, 2017
Introduction: In Nigeria, the annual number of pregnancies is estimated at over 6 million. Of thi... more Introduction: In Nigeria, the annual number of pregnancies is estimated at over 6 million. Of this number, about 58% of pregnant women attended antenatal care at least once while 45% visited antenatal clinics at least 4 times. Also only about 35% of births occurred in health facilities (20% and 15% in public and private sector facilities respectively). About 62% of births occur outside the health facility, majority of which are in the rural areas. Overall, 39% of births are delivered by skilled personnel, 41% by Traditional Birth attendants (TBAs) and relatives while 20% had unassisted delivery). Traditional Birth attendants are traditional, independent (of the health system), non-formally trained and community-based providers of care during pregnancy, childbirth, and the postnatal period. When trained, TBAs can augment their traditional function of conducting delivery with risk assessment in the prenatal period and referring mothers to health centers if complications are anticipated or in emergency. Trained TBAs can also perform deliveries and cord care hygienically and use appropriate methods to prevent and control post-partum haemorrhage. This study was conducted to show the presence or absence of some essential components ANC care at TBA and use their availability to measure the quality of care available at the TBA centers. Methods: This was a cross sectional questionnaire-based study conducted in 3 southern Nigerian states over a 6 months period. Data were collected from 450 TBAs using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: There was wide gap in the accessibility of pregnant women attending care at TBA to blood investigations. These gaps ranged from as high as 92% for Hepatitis B test, 87% for blood genotype, 80% for Packed Cell volume(PCV),74% for syphilis infection test(VDRL) to as low as 50% for HIV antibody blood rapid test and 30% for blood group investigation. Tetanus toxoid immunization service was also very low at 38% availability among the TBAs. The commonest service among the TBA was referral services, which was provided by about 94% of the TBAs.Other less common service were group health talks, monitoring of blood pressure, weight measurement , antimalarial prophylaxis and local concoction mixture.
Recommendations: There is need to work with TBAs to plug the gaps in the quality of services they provide to their clients.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Sahar... more In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges. Two 1-hour structured group exercises were conducted with 10 groups of 14-15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care. Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum. The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.
Science Journal of Public Health, 2014
A multicenter retrospective case-control study. Study subjects were HIV positive pregnant women e... more A multicenter retrospective case-control study. Study subjects were HIV positive pregnant women enrolled in a prevention of mother to child transmission of HIV(PMTCT) programme in southwest Nigeria. The objective was to see if the introduction of 'Test-and -Treat strategy' would lead to placing higher number of HIV-POSITIVE pregnant women on antiretroviral drugs. There was a significant difference (OR=1.4;CI=1.35-1.55,P=0.0) in the proportions of HIV-POSITIVE pregnant women initiated on ARV between the control arm(60%) and the case group(81%)with the implementation of the strategy. In other words, an HIV POSITIVE woman in a PMTCT setting has a 40% greater chance of being placed on ARV with test-and-treat strategy than without the strategy.The test-and -treat strategy is a treatment approach in which HIV positive clients are initiated on prophylactic antiretroviral drugs immediately after HIV diagnosis without waiting for the CD4 count test result. Hence, implementing Test and Treat Strategy in a PMTCT programme increases the antiretroviral drug uptake by HIV-POSITIVE women which in turn could lead to a reduced rate of vertical transmission of HIV, as a result of the suppressed maternal viral load.
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Papers by Timothy Akinmurele
Recommendations: There is need to work with TBAs to plug the gaps in the quality of services they provide to their clients.
Recommendations: There is need to work with TBAs to plug the gaps in the quality of services they provide to their clients.