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Tuberculosis Knowledge, Attitude and Practice (TBKAP) Follow-up Survey in Nigeria

Did you know that in 2016, there were an estimated 10.4 million new (incident) cases of tuberculosis in the world? That’s 5 times more people than the entire population of Slovenia and a little over 10 times the population of the Bahamas. Did you also know that TB tends to affect more men than women and those in the economic productive age range (15 -59 years) are the most affected?

In Africa currently, Nigeria has the most number of TB incidents, and in order to combat this, the Federal Government through the National Tuberculosis and Leprosy Control Programme (NTBLCP) a body under the Ministry of Health set up to control TB and Leprosy in Nigeria and with the support of organizations like the World Health Organization, and the Global Fund for AIDS, Tuberculosis and Malaria (GF), in 2007/2008 conducted a baseline study to determine the true burden of TB and refine her strategy for improved programme implementation and outcomes. This study was conducted in Benue, Ebonyi and Ondo states. Following this another survey was carried out in 2012, this time to determine the Knowledge, Attitude and Practice of people in urban and rural communities across the country regarding TB. This survey was carried out in 6 states across the 6 geo-political zones of the country.

This report gives a summary of results from a 2017 study conducted by AHEAD in conjunction with the Association for Reproductive and Family Health (ARFH) and NTBLCP, done on the same topic in a bid to compare current levels of knowledge, attitude and practice with the results of the 2012 study. The study was carried out in 48 urban and rural communities and a total of 448 healthcare facilities across Benue, Plateau, Adamawa, Gombe, Katsina, Kaduna, Ebonyi, Imo, Akwa-Ibom, Delta, Ondo and Lagos states were sampled.

Results show that there was no appreciable change in awareness of the general population about TB although Katsina showed an appreciable increase in awareness and Ondo showed a noticeable decline. While there was moderate improvement in the knowledge that persistent cough is a symptom of TB among the general population, there was a decline in other knowledge parameters evaluated.

Among patients with TB, there was an increase in those who self-medicated and a marked decline in patients’ knowledge of risk-factors. Even though, there was only a very slight decline in the proportion of TB patients who know that HIV infection is a risk factor for TB. And the figures show that compared to baseline, some people in Ebonyi state still believe witchcraft is a cause of TB.

Among patients with HIV, there was an improvement in the knowledge of the causes of TB although patients who identified casual contact such as kissing as a cause of TB showed an increase compared to baseline. And there was a 40% jump in the number of patients who were at the facility for follow-up sputum examination.

The proportion of health workers trained in the management of TB cases showed significant increase although knowledge of this management is still low. Also the proportion of health workers with knowledge about the drugs used in the management of TB showed a decline.

Overall, there has been progress in some areas, but there is still some work to be done in the prevention, diagnosis, and management of tuberculosis and the achievement of the goal of a Nigeria free of TB.

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Adolescent Health and Wellbeing: A Key to a Better Future

Adolescence is a transitional period between the childhood and adulthood, it is a period of physical, biological and mental change. As knowledge has accumulated about human development during puberty and beyond, and about the development of the brain in particular, it has become clear that the notion of adolescence as a stage of sexual maturation is far too simple. Many interlinks changes and processes influence adolescent behavior, as well as the way young adults think and make decisions. Understanding these changes and their dynamic extension into early adult life which offers not only an opportunity for new approach to minimizing risks to health and wellbeing but also a moment to engage adolescents for their future adult life and even for the future generations.

There are about 1.2 billion adolescents aged 10-19 years in the world today, 89% of whom live in developing countries. Adolescence is a crucial life stage during which individuals must have the opportunity to develop the capabilities required for realizing their full potential and achieving a prosperous, healthy life.

Transitions from adolescence to adulthood require investments in health information, services provided and tailored to adolescent needs, quality education, vocational training, and healthy lifestyle which needs to be done at every level of stakeholders: the adolescent, the parents, community and the governments.  Especially for the adolescent girls, it is important to put in place targeted interventions to address issues that prevent the realization of their full potential; for example child marriage, violence and abuse, teenage pregnancy, abortion and so on.

To work effectively for and with the adolescents, it is essential that we engage with stakeholders across the health, education, governance and others ensuring that the marginalized have access to the opportunity. Adolescents can be a key driving force in building a future of dignity for all if we start today.

Credit: Temidayo Adewumi

Institute of Child Health, University of Ibadan, Nigeria

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“Why Weight Matters”: An Exclusive Tweet Chat with Dr. Olaitan Oyedun

Moderator: Dr Olaitan Oyedun is a Public Health Physician and currently Chief Resident at the Department of Community Health, Obafemi Awolowo University Teaching Hospitals’ Complex. He works to get people healthy and help them stay that way!

Weight issues are a spectrum from being too little to being excessive. Today’s conversation will focus on excessive weight, however, all questions on ‘why weight matters’ are welcome. The conversation begins

We are glad to have you on this platform Sir, thank you for honouring our invite, we do hope it will be a very interactive session

Dr. O: Thank you

Moderator: To start with Sir, from a health standpoint, why does body weight matter?

Dr. O: A lot of health issues are linked to your body weight, mostly not good news. Contrary to the popularly held belief that excessive weight gain or being “fat” is a sign of good living or affluence, it causes far-reaching damage to the body, especially the cardiovascular system, which includes the heart, responsible for maintaining blood flow around the body.

Moderator: Thank you. What factors are responsible for excessive weight gain?

Dr. O: Let’s take this from the top. To function normally, our body needs energy, which we take in as food. Usually, when we take more food than the body needs, immediately the body converts the excess food (energy) into a long-term storage form which is fat, which then accumulates in the body over time (just like depositing money in the bank without ever making a withdrawal except that this is bad money!) When this accumulation of fat becomes excessive, it becomes a medical condition called Obesity. In technical terms, the resultant effect of an imbalance between energy intake and expenditure results in excessive weight gain.

Moderator: But some people just don’t seem to gain weight no matter what and some just can’t seem to control it. Why is this so?

Dr. O: I guess your question is whether weight gain is a function of nature or nurture? The straight-up answer is yes, it is a bit of both. While some people do have a higher genetic potential for weight gain than others, nurture, which is largely our lifestyle, including the food we eat and our exercise habits, plays a very big role in determining whether we gain excessive weight or not.

Moderator: Thank you so much for the enlightening discussion so far. What kind of effects does this excessive weight gain have on health, Sir?

Dr. O: There are psychological and physical health effects. The psychological health effects include low self-esteem, poor self-image and stigmatization. This can be quite a serious social problem, especially for adolescents with excessive teasing and body shaming from peers and nicknames like “fattybumbum” or “fatso”. Being the butt end of such jokes can result in grave consequences including suicide and just like any medical condition, obese persons deserve empathy and support in order to make healthier life choices. Physical effects include breathing problems, musculoskeletal issues like pain at the joints and problems with mobility (Osteoarthritis), Importantly, obesity can become a catalyst for other serious health problems like raised blood pressure, stroke, Diabetes mellitus and have has been linked to cancers of the throat, stomach, gallbladder, pancreas, bowels, breast and many other organs.

Moderator: How do you know if you are obese? How do you measure obesity?

Dr. O: There are many available ways to check but a very easy one to calculate is the body mass index known as BMI. This just talks about your weight relative to your height. You can calculate this by getting a weighing scale and checking your weight in Kilograms and dividing this by the square of your height in meters. If you get a figure from 25 and above, you are already considered overweight, and a figure 30 and above means you are already in one of the obese categories. If in doubt, consult a doctor.

Moderator: Sir, what can be done to prevent excessive weight gain?

Dr. O: Good question. The most important prevention is a change in behaviour and lifestyle. The journey towards a healthier lifestyle and improved self-image can be quite fun and immensely rewarding. Diet and exercise is a double defence against obesity. It is best to only, always, eat just what you need and not more and to avoid foods that contain a lot of fats and oil, (what we really want to avoid are saturated fats found in animal fats and poultry skin). In fact, it’s best to just avoid fast food and oily snacks. A great alternative is to take more fruits and veggies, (most of which are good for you anyway) and encourage young people to pick-up these good habits early. On exercising, a lot of young people and adults spend a considerable amount of time, sitting down all day, at work, at home, at school and even at leisure, in front of computers, in front of TVs reading for this and that. This is not good for their health. Less TV and more activity are very useful, take a walk, jog with friends, cycle, pick up an active sport find an outdoor hobby like gardening; take the stairs, park far from doors, if you can walk there, don’t drive! Moderate to vigorous physical activities, that raise your heart rate and breathing from a little bit to a lot, is very beneficial.

Moderator: For those who are already obese or overweight, what can be done to shed the weight Sir?

Dr. O: If very troubling, a physician should be consulted for medical or surgical treatment. If not so, a disciplined approach to the selecting the kind of foods we eat and getting active just like the tips the prevention earlier shared will work fine. Remember, the journey to a healthier lifestyle can and should be fun!

Moderator: Thank you so much for the enlightening discussion, Sir. Now we would like to take questions from our audience.

Question 1: Great discussion! Thanks Doc. I’d like to ask… when someone engages in physical exercises to shed weight, and stops, is it true that the person will gain more weight at a faster rate than before?

Dr. O: Lol, this is not true. However, it is easy to lose the gains of an effective exercise regimen if not maintained through a healthy diet and regular exercise. Proper diet and routine exercise are a double defence against obesity. You just have to keep at it!

Question 2: Self-image is an important issue for adolescents, how can we pragmatically work with obese adolescents to lead healthy lifestyle?

Dr. O: Excellent question. As mentioned during the conversation, adolescents are a very important group of people who are most affected by the psychological consequences of excessive weight gain. The good news is that, many are also quite energetic and willing to learn new positive behaviours towards achieving an improved self-image. As exercise and diet are an excellent dual pronged approach to controlling body weight a very practical approach includes finding a partner or partners willing to support an exercise schedule and diet plan. Having support helps a lot, especially for adolescents. An aerobics class can be quite fun and rewarding too. Other activities like cycling, jogging, and group sports can help a lot too. If the self-image is already badly damaged, seeking professional counselling is important for adolescents. A caveat though, starvation is not dieting! The body always needs basic nutrients to function.

Question 3: I once heard that it is necessary to go to the hospital to check the state of one’s heart before deciding on what form of exercise to embark on. Sir, is this necessary?

Dr. O: Moderate to vigorous physical activity, which puts your heart to more work than light physical activity, is actually more useful from a health point of view. Normally, most people can perform these activities without any worries for a limited time, longer for athletes, but there are health conditions including heart diseases that may limit the duration or intensity of exercise activity for those who have some of these medical conditions, If you suspect you have a limitation, or get tired easily after just a little exertion, see a Doctor for an assessment.

Moderator: We want to thank our Guest, Dr Olaitan Oyedun for the enlightening discussion on “Why Weight Matters” and also a big thank you to everyone for joining the conversation.

This conversation can be found on Twitter using the following hashtags #AHEADHealthTalk #whyweightmatters #weightmatters

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AHEAD Organises a Workshop on Using Reference Managers and ATLAS.ti 8 Windows for Literature Reviews

In an effort to build capacity for research and action – which is part of the organization’s mission,the first edition of a workshop on “Using Reference Managers and ATLAS.ti 8 Windows for Literature Review”came up in March, 2018, at the Academy for Health Development. The aim of this workshop was to impart the participants on how to conduct a good literature review with the aid of reference managers (EndNote and Mendeley) and ATLAS.ti 8 windows software.This was achieved through exposing participants to the fundamentals of doing rigorous literature reviews with the use of reference managers such as EndNote and Mendeley, as well as providing the participants with the basic knowledge and the use of ATLAS.ti 8 windows software in preparing literature review by following an approach emphasizing data integration, organization and constant documentation of the process.The participants were first taken on Fundamentals of Writing Literature Review as well as the Ethics of Effective Writing (approach and styles), before they were introduced to the use of the softwares. The workshop featured many hands-on sessions in which the participants had first-hand experience with the software. The participants included Resident Doctors, University Lecturers, Civil Servants and students.

At the end of the workshop, a raffle draw was done with a prize of ATLAS.ti software, courtesy of ATLAS.ti.


Testimonies from Participants:

“The workshop was excellent on my overall analysis”

“A job well done. Please keep it up”

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Site Sustainability and Close-Out Strategic Meeting

The Centre for Integrated Health Programs (CIHP) is working to be able to successfully respond to the changing landscape in the healthcare sector and donor environment in order to achieve greater impact, through the strengthening of the organization. To accomplish this, the Academy for Health Development (AHEAD) was invited to facilitate a Site sustainability and Close-Out Strategic meeting for her staff. The goal of the meeting was to build competencies of her senior-level managers in the Lagos and Nasarrawa branches of the organization.

As there is a difference between leadership and management, the meeting served to expose the managers to the different skills required for each, the convergence of both and how to deploy significant and effective leading and managing strategies in organizational practice in order to be better equipped healthcare professionals.

The objectives of the meeting as set by CIHP were to:

  • improve the knowledge of senior level managers on key leadership and management issues,
  • facilitate the ascension of new managers to management,
  • assist CIHP Managers to be well-rounded executives, and
  • develop the skills of managers in the areas of managing people, organizing teams, supervising and delegating.

The themes explored at the meeting include ‘Leadership-Management soft skills’, ‘Leadership Management hard skills’, and ‘Leadership dynamics for effective growth and change management’. PowerPoint Presentations, case-studies on real life scenarios, role plays and team-building activities were some of the tools employed by the seasoned health leadership and programme management specialists from AHEAD to further explain and dissect these themes.

While participants were able to fill out an evaluation form on the last day, daily evaluations were taken and reported and on the last day, a session was allotted to discussing feedback.

The 34 members of staff from both locations who participated in the training were very satisfied with its outcome based on their assessments, and suggested topics like ‘Team Dynamics’, ‘Performance Appraisal’ and Financial Management amongst others be included in subsequent trainings.

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Introduction to Grant writing and Essentials of Project Management

As part of the relationship fostered between Academy for Health Development and Heartland Alliance International (HAI), and their commitment to grow healthcare systems that are efficient and reliable, AHEAD was once again called in to organize a 5-day seminar for the mid-level staff of HAI on the topics of grant writing and project management. Richman’s principle that successful health care for the 21st century calls for diversification of leadership capabilities and management styles that will enrich abilities to respond to the needs of all groups was the underlying foundation upon which the training was held.

It was expected that at the end of the workshop, the participants would;

  • Be familiar with basics of grant writing.
  • Understand effective project management principles and practices.
  • Acquire skills in key field management practices.
  • Develop greater teamwork, communication and self-management competences, and
  • be knowledgeable and prepared for effective crisis management.

The workshop was divided into 3 parts to promote an effective learning process and engagement for the participants.

Under the Overview of Grant application, participants were exposed to the concept of grant application, effective writing tips and how to justify, implement and report a good budget for grant application. They were also able to put their skills to the test by working on a genuine call for research proposals.

In Project Management and Implementation, participants encountered project management tools and were taught how to identify and respond to ethical and non-ethical issues that may arise on the job.

People Management Skills was an opportunity for participants to learn the relationship between the technical and leadership skills required for effective management. Crises management competencies and strategies, Emotional intelligence and crises management, and the Role of team work in project operations were just a few of the topics that were discussed in this section.

Evaluation was assessed through the daily verbal and written feedback that the participants gave. They gave their assessments on a number of things including; the learning environment, the course content, the quality of instruction and their level of satisfaction.

Suggestions like the addition of themes like ‘Conflict at the workplace’ to the curriculum and a longer training duration were suggested.

Apart from being armed with new knowledge and skills, participants were also certified at the end of the training.

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“Leading and Managing for Results” Training Workshop

As part of her mission to build capacity and translate knowledge into effective programmes, the Academy for Health Development (AHEAD) organized a three-day workshop for the Nigeria office of Heartland Alliance International (HAI). The workshop which was themed “Leading and Managing for Results” focused on improving the proficiency of the manager and reinforcing the strength of the organization in order to stay abreast of the changes in the health sector and donor environment, and to have greater impact as an organization.

The objectives of the training included:

  • Improving the knowledge of middle-to-senior level managers on key leadership and management issues
  • Developing the skills of managers in the areas of managing people, organizing teams, supervising and delegating, among others.

The philosophy of this workshop developed and implemented by AHEAD is to position professionals in the health sector and their organization to achieve tangible results through a skill-focused approach that would enable them to interact with the health better and to ably integrate key leading and managing practices. This philosophy was emphasized at the workshop through the application of presentations, case-studies, team-building activities and role-playing amongst other things, facilitated by health leadership and programme management specialists.

Leadership-Management soft and hard skills such as concepts and tools that facilitate effectiveness in the healthcare systems were discussed and topics like ‘Leading and Management Framework’, ‘Emotional Intelligence and Setting Work Climate’ and ‘Monitoring Performance for Impact’ were also explored.

Daily evaluation was carried out by the participants and an end-of-workshop evaluation was also done. The 35 members of staff of HAI who participated in the workshop assessed the workshop as excellent based on its content and the quality of instruction.

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Report of the Workshop on Programme Management and Leadership for Health Professionals in Lagos, Oyo and Plateau States, Nigeria

I don’t care if we ran out of supplies yesterday evening, you are stupid to have waited until today to tell me. Get out of my office!

This statement and many others like it, shows the way Mr. John speaks and relates with his staff at the Primary Health Centre he oversees.

Academy for Health Development (AHEAD) seeks to improve health systems and health development through capacity building and knowledge generation and translation. To tackle workplace scenarios like the one painted above, we conducted a capacity-building workshop to improve the leadership and programme management skills of health professionals in Lagos, Oyo and Plateau states, on behalf of the AIDS Prevention Initiative in Nigeria (APIN). There was a total of 98 participants across the 3 states. Mr. John was one of them.

It was expected that by the end of the training, he and his colleagues would be able to:

  • demonstrate knowledge of core leadership and programme management issues;
  • apply emotional intelligence and other key competencies in their daily work; and,
  • apply the leading and managing practices for improved work performance and better health outcomes.

The sessions were interactive and the methods innovative and skill-focused, with the application of various facilitative methods such as case studies and role plays. Facilitators were health leadership and programme management specialists and seasoned trainers.

In order to evaluate the impact of the training on Mr. John and his peers, evaluation was conducted through a mixture of approaches: pre-test – post-test methods, administration of daily evaluation forms and an end-of-workshop evaluation form. The median figures show that the participants rated the training as excellent in the areas of Course content, Quality of Instruction and Overall Satisfaction.

In response to how the workshop had motivated change in them, some of his colleagues had this to say:

  • The workshop inspired me to change in terms of communication as an effective leader. I can now delegate with confidence and give my subordinate full support”.
  • It has improved my knowledge of Conceptual skill and Emotional Intelligence which could be useful at work and everyday life”

Since returning to work, Mr. John has become a better boss. He still has occasional outbursts, but his subordinates report that his communication skills are better and they like how he manages the Health Centre now.

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