Factors Associated with Delay in Presentation of Symptomatic Cancers among HIV Infected Persons in Plateau State, Nigeria

There is increased incidence of cancer worldwide but much of the burden of morbidity and mortality will occur in the developing world because of cancer associated infectious diseases of which HIV infection carries a large proportion. Site-based studies show that proportion of late stage cancer presentation range between 60% - 92% in the last 10 years. There is paucity of information on reasons for the late presentation. This study is aimed to find out the factors associated with delay in presentation of symptomatic cancers among HIV infected persons in Plateau State, Nigeria. A mixed method study consists of quantitative and qualitative component. Participants were sampled from HIV infected persons diagnosed with cancer and referred to the Oncology unit. Variables on Patient and health service factors associated with late presentation of cancers were collected. Quantitative data was analyzed using Epi info version 3.5.3 and Microsoft Excel while thematic analysis was done for qualitative data. There were 503 respondents and the mean age was 48.7 ± 13.5 years. Male sex OR 2.5, (P = 0.002);Farming occupation OR 1.7, (P = 0.0005) and Primary education OR 2.0, (P = 0.0005) were associated with delay. Majority of respondents 349(69%) presented more than six months after onset of symptom. Common symptoms were pain 462(45.70%), swelling 237(23.44%) and skin discoloration 210(20.77). Their Initial reaction was mainly the use of alternative remedies 234(46.5) CI 42.1 - 51.0. Up to 274(54.47%) of participants obtained diagnosis 3 months after presenting to a health facility. Laboratory related issues 199(39.56%) and long booking time 163(32.40%) were the most common reasons for delay. Delay was found to be both patient and services related. The study also suggests that cancer symptom awareness is poor among the participants. There is no tangible cancer prevention program in the HIV/AIDs treatment program. A more in-depth knowledge of cancer is required for both the sufferer and the care giver.

Evaluation of malaria surveillance system in Kano State,Nigeria,2013–2016

Background:Malaria surveillance system strengthening is essential in the progress towards malaria elimination.In Nigeria,more attention is being given to this recently as the country is striving towards achieving elimination.However,the surveillance system performance is fraught with challenges including poor data quality with varying magnitude by state.This study evaluated the operation of the Kano State malaria surveillance system and assessed its key attributes.Methods:An observational study design comprising a survey,record review and secondary data analysis,and mixed methods data collection approach were used.Four key stakeholders’and 35 Roll Back Malaria Focal Persons(RBMs)semi-structured interviews on operation of the system and attributes of the surveillance system,were conducted.We analyzed the abstracted 2013–2016 National Health Management Information System web-based malaria datasets.The surveillance system was evaluated using the“2001 United States Centers for Disease Control’s updated guidelines for Evaluating Public Health Surveillance Systems”.Data were described using means,standard deviation,frequencies and proportions.Chi-squared for linear trends was used.Results:Overall,24 RBMs(68.6%)had≤15-year experience on malaria surveillance,29(82.9%)had formal training on malaria surveillance;32 RBMs(91.4%)reported case definitions were easy-to-use,reporting forms were easy-to-fill and data flow channels were clearly defined.Twenty-seven respondents(69.2%)reported data tools could accommodate changes and all RBMs understood malaria case definitions.All respondents(4 stakeholders and 34 RBMs[97.1%])expressed willingness to continue using the system and 33(84.6%)reported analyzed data were used for decision-making.Public health facilities constituted the main data source.Overall,65.0%of funding were from partner agencies.Trend of malaria cases showed significant decline(χ2 trend=7.49;P=0.0006).Timeliness of reporting was below the target(≥80%),except being 82%in 2012.Conclusions:Malaria surveillance system in Kano State was simple,flexible,acceptable,useful and donor-driven but the data were not representative of all health facilities.Timeliness of reporting was suboptimal.We recommended reporting from private health facilities,strengthening human resource capacity for supportive supervision and ensuring adequate government funding to enhance the system’s representativeness and improve data quality.