public health

Background: Pre-eclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality. Based on the inverse relationship between serum 1,25(OH)2D3 levels and plasma renin activity found previously, it is speculated that 1,25(OH)2D3 might be a negative endocrine regulator of renin production in vivo. During pregnancy, vitamin D may play a role in implantation and placental function potentially due to angiogenic, immunomodulatory, and antiinflammatory effects. Vitamin Ddeficiency can affect the health of both mother and fetus by increasing the production of inflammatory cytokines and stimulating the activity of T-regulating cells. Vitamin D is emerging as a promising agent for pre-eclampsia prevention. Aims and objectives: The objective of this study is to compare the vitamin D levels in pre-eclamptic and healthy non-pre-eclamptic pregnant women in labor and find out the relationship between vitamin D levels and pre-eclampsia. Methodology: The present cross-sectional study was carried out on pregnant women with pre-eclampsia in labor. For each case with pre-eclampsia, one uncomplicated, normotensive pregnant woman in labor was taken as control. On admission to the labor room detailed history, physical examination followed by thorough obstetrics and systemic examination was done. Required investigations were done including vitamin D and calcium levels. Maternal and fetal condition was monitored during labor/cesarean section, mode of delivery, maternal and fetal outcomes were recorded. After delivery, 2cc of cord blood was collected in a serum tube and sent for vitamin D levels. Data was collected and analyzed statistically using Epi-info version 7.1.Results: It was observed that the patients in both groups were comparable with respect to demographic and obstetrics characteristics except for significantly high BP in group I. Vitamin Ddeficiency (i.e. < 20 ng/ml) was significantly more in group I as compared to group II and the difference was highly significant (p < 0.0001). Similarly, the mean maternal calcium levels were significantly lower in group I in comparison to group II (p < 0.0001) i.e. the mean maternal calcium level in group I and group II were 8.03 ± 0.94 and 9.19 ± 0.67 respectively. It was also observed that the level of 25-OH-D in neonates of preeclamptic women was significantly lower than for those of the normal pregnant women (p < 0.0001). Conclusion: Vitamin D deficiency is highly prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Preeclampsia is indeed associated with lower vitamin D levels and the pathophysiology of pre-eclampsia involves vitamin D and calcium metabolism through their role in immunomodulation, angiogenesis and anti-inflammatory effects. From the present study, it was observed that vitamin D and calcium levels were significantly lowered in women with pre-eclampsia as compared to those of the normotensive pregnant women. So early detection of vitamin D and calcium deficiencies may be helpful in preventing occurrence of PET and its complications.

Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.

The effect of the novel coronavirus (SARS-CoV-2) pandemic has produced significant health concerns negatively impacting individuals. As the ongoing and constantly changing nature of SARS-CoV-2 continues, the unique characteristics of this pandemic trend toward anxiety and loneliness as significant behavioral health outcomes. Furthermore, the SARS-CoV-2 pandemic has significantly impacted the utilization of social media platforms such as Twitter. Utilizing over 1.6 million tweets from approximately 988,760 Twitter users geolocated in Washington state from the University of Pennsylvania’s publicly available Twitter database (from March 2020 to March 2021), this study evaluated the impact of SARS-CoV-2 by using expressions of loneliness and anxiety to predict mental and physical symptoms. Bivariate correlations revealed expressions of loneliness were correlated to trouble breathing while expressions of anxiety were correlated to skin lesions, body aches, flu-like, seasonal cold, trouble breathing, nausea or diarrhea, fever, chills, and cough. Multiple multivariate linear regressions were completed, and a significant regression equation was found in predicting trouble breathing symptoms on expressions of loneliness and anxiety, however, the proportion of variance was 8% of the observed variation in the model. Further implications revealed the importance of understanding mental and physical well-being during a public health crisis as well as the use of social media platforms as primary and supplementary stimuli.

Background: The novel coronavirus is a rapidly spreading respiratory disease that has been declared a pandemic by the World Health Organization (WHO) and a global public health emergency. The use of face masks has been recommended by the WHO and the Centers for Disease Control (CDC) as a standard prevention method for transmission of COVID-19.Objective: The objective of this study is to determine face mask utilization and associated factors in combating the COVID-19 pandemic among government employees in Akaki district administration offices in Akaki District, Oromia, Ethiopia, 2022Methods: A quantitative cross-sectional study was conducted from December 1, 2021, to February 15, 2022, on 385 government employees working in Akaki district administration offices. After obtaining consent from the study participants, data were collected using pretested, self-administered, and standardized questionnaires adapted from other studies. After the data was collected, it was entered into Epi info version 7.2.6, cleaned, and analyzed using SPSS version 26. A logistic regression model was computed to measure the association between the predictor and outcome variables. A p - value of.05 with a 95% CI was used as the cut-off point to declare the level of statistical significance. Results: The study showed that the magnitude of good practice for facemask utilization was 213 (53.5%) (95% CI: 1.50, 1.60) for preventing COVID-19. In the multivariate logistic regression analysis, the odds of using face masks among male employees (AOR = 0.275; 95% CI: 0.137, 0.555), employees aged 20-29 (AOR = 0.17; 95% CI: 0.065, 0.481 ), employees aged 30-39 (AOR = 0.260, 95% CI: 0.109, 0.623), employees of less than five family size (AOR = 0.549, 95% CI: 0.303, 0.995), work experience at 6-12 (AOR = 0, 32, 95 CI: 0.120, 0.450), poor knowledge about face mask use (AOR = 0.504, 95% CI: 0.302, 0.844), and employees with a negative attitude (AOR = 0.430, 95% CI: 0.256, 0.721) were factors significantly associated with face mask utilization.Conclusion: The magnitude of facemask utilization was low (53.5%) compared to other studies. The results of the study showed that age, sex, household family size, work experience, poor knowledge, and the negative attitude of employees toward facemask utilization were among the factors significantly associated with facemask utilization.

Background: Iron deficiency anemia is common during pregnancy since the overall iron requirement is greater than non-pregnant women and is associated with adverse outcomes. Iron deficiency (ID) is a state of insufficient iron to maintain normal physiological functions of tissues and leads to anemia.Objectives: To assess factors associated with the utilization of Iron with Folic acid supplement Among Pregnant Women Attending Antenatal care at Government Health Facilities and Family Guidance Clinic in Hawassa City, South Ethiopia.Methods: Institutional-based cross-sectional study design was conducted among 412 health providers who are working at public health institutes in Hawassa city from March to April 2015. Pretested Self-administered questionnaires were used to collect the data. The data was entered into Epi-data and analysed by SPSS version 26.0. Bivariate and multivariate regression analysis was used to see the significant association between the outcome and independent variables. Odds ratios and 95% CI will be computed to measure the strength of the association, p - value of ˂ 0.05 will be considered a statistically significant.Results: A total of 412 pregnant women who came to attend ANC at least for the second time were interviewed in seven health facilities. Our study showed that 333 (81%, 95% CI: 77.2 - 84.8) pregnant women reported taking IFA supplements and high compliance was 37.7% (95% CI: 32.5 - 42.9). In multivariable analysis, side effects and low acceptance of the supplement were significantly associated with compliance to IFA supplementation (p < 0.05).Conclusion: There is a relatively better level of compliance towards IFA supplementation compared to other national data. Pregnant women should be counseled regarding how to manage the side effects of IFA supplements during ANC. Further research has to be done on the acceptability of the supplements.

High fluoride level in drinking water is an endemic public health concern in East Africa. Unlike in Kenya where it is absent, the Nalgonda technique, a defluoridation method that uses two chemicals, alum, and CaO, has seen mixed results in its application and adoption in Ethiopia and Tanzania. This has been due to the low capacity of communities to manage the process and the breakdown in the supply chain of chemicals used in the technique. In the present study, we attempted to bridge the gap in the chemical deficit by investigating the possible substitution of CaO with leachate from wood ash, a by-product of wood combustion commonly found in Kenya. The leachate was prepared from one part of wood ash mixed with two parts of distilled water and stirred for 24 hours followed by decantation. The new technique, the Homa method, using alum and wood ash leachate was then tested on H2O samples from three areas in Kenya with high F- concentrations ranging from 5.1 mg L-1, 9.1 mg L-1 to 91.0 mg L-1. The determination of F- concentration by SPADNS Spectrophotometry was applied throughout the experiment. Four levels of alum i.e. 1%, 2%, 3%, and 4% were dosed on five volumes of water i.e. 100, 200, 300, 400, and 500 ml raw water at 5.1 and 9.1 mg L-1 F-. For water samples at 91.0 mg L-1 F-, the same volumes were treated with 5 higher alum levels i.e. 5%, 6%, 7%, 8%, and 9%. The final pH was then adjusted to 7 with ash leachate for defluoridation. The set-up was a factorial design experiment where the final F- concentration was the dependent variable and the volume of raw water, the percentages, and volume of alum and wood ash leachate constituted the different factors. A fitted multivariate regression model of the general form; where Y = Residual fluoride, X = wood Leachate volume, W = alum Concentration, X*W = Interaction α, β, γ were regression coefficients, ε = error term, showed that only in the Baringo area did we have an interaction between wood ash leachate and alum concentration significant (p < 0.05). Defluoridation occurred (p < 0.05) at as low as 10% and as high as 99%, depending on the initial F- content. Total coliform decreased from 310, 290 and 270 count/l respectively to zero. Unfortunately, high chemical and TDS (from 558 mg L-1 to more than 9,000 mg L-1) enrichment were recorded in addition to the mixed data on turbidity. The overall results show that wood ash can substitute CaO in the Nalgonda process. Further investigation is however required to make it applicable for potable water production.

Over the past 20 years, there has been a surge of clinical investigations and useful trials on heart failure (HF) with preserved ejection fraction (HFpEF). HFpEF represents the largest phenotype of HF, a public health concern for its link with high mortality and rates of morbidity.

Neonatal sepsis is a systemic infection that causes high morbidity and mortality rates in newborns during the first month of life. Although there is abundant literature on the subject, it remains a fundamental public health problem due to its high prevalence in underdeveloped countries. This article aims to highlight the importance of the approach in investigating neonatal sepsis using causality research questions, which generate knowledge to promote better care and reduce the complications associated with neonatal sepsis in newborns.

Background: Hepatitis B is a major public health issue worldwide. Immunization of infants against this disease has been effective in Morocco since 1999. However, evaluation of post-vaccination response is rarely performed in our setting. The purpose of this study was to evaluate immunity against HBV in fully vaccinated children in the city of Marrakech in Morocco and to investigate the factors influencing the level of post-vaccination immunity. Methods: A descriptive cross-sectional study was conducted on fully vaccinated children who have medical and vaccination records, from three primary healthcare centers in Marrakech. Children with anti-HBs antibody levels between 10 and 100 IU/L were considered moderately immune, and those with antibody levels above 100 IU/L as highly immune, while those with antibody levels below 10 IU/L were considered non-immune. Results: Of the 123 children recruited, 114 (92.7%) had protective anti-HBs antibody titers, of which 37 (30%) were moderately immunized and 77 (62.7%) were highly immunized, and nine (7.3%) were non-immune. Age, birth weight, vaccine type, and time since the previous dose have all been significantly associated with the degree of post-vaccination immunity. Anti-HBs antibody levels were not significantly related to factors potentially linked to post-vaccination non-response, such as chronic disease, immunosuppressive medication and others.Conclusion: Our findings denote that the HBV vaccine used in The Moroccan Expanded Program on Immunization (EPI) is effective against HBV. Nevertheless, in non-responders, corrective actions such as re-vaccination and monitoring of post-vaccination anti-HBs antibody levels should be implemented.

Background: Public health policies in the area of food and diets tend to separate recommendations on food safety and nutrition. However, food products can simultaneously have risks and benefits. Risk-benefit assessment (RBA) seeks to integrate the assessment of both risks and benefits to aid complex decision-making using a multidisciplinary approach. In this study, a systematic literature review of recent RBA studies was performed, focusing on food consumption and human health following earlier reviews by Boué, et al. (2015) and Thomsen, et al. (2021). Results: A total of 50 new RBA studies were reviewed since 20 May 2014. Our current literature review shows that the majority of RBA studies conducted in recent years remain focused on seafood, with studies on fish alone comprising 34% of all studies; the focus being on the benefits of fish consumption versus contaminant exposure. Most of the studies have been conducted in Europe (n = 31) and Asia (n = 11). Conclusion: RBA has the potential to be applied more widely to other food choices such as alternative proteins, yet application remains limited to specific applications and contaminant/nutrient case studies. In recent years, a few RBA studies have been reported on less mainstream food sources and one specifically on novel foods. Novel foods offer a unique application space for RBA as their development is focused heavily on the benefits to the consumer, society, and environment, yet there remains uncertainty as to their safety. 

The World Health Organisation (WHO) defines anemia as a global public health problem. It is a medical condition in which the number of red blood cells or the hemoglobin concentration within them is below the physiological range. We present a case of a 40-year-old woman with Abnormal Uterine Bleeding (AUB) accompanied by malaise, weakness, and tachycardia. The patient reported heavy menstrual bleeding for the past 14 days. Speculum examination revealed that the bleeding was from the uterus. There were no pathological findings during a gynecological and transvaginal ultrasound examination. A complete blood count performed at the time of her arrival showed a low hemoglobin level of 24 g/L, a low hematocrit level of 7,4%, a mean corpuscular volume of 98,7 fL and a number of red blood cells 0,75 x 1012/L. Due to the severity of the anemia, she was given 6 units of red blood cell transfusion, 2 fresh frozen plasmas and tranexamic acid accompanied with calcium carbonate. The curettage was performed. The pathohistological finding was endometrium in proliferation. Afterward, the hemoglobin level increased to 90 g/L. Their past medical history revealed that she abused alcohol. On an abdominal CT scan, Alcohol-Related Liver Disease (ARLD) was confirmed. We should keep in mind that coagulopathy could be the underlying cause of abnormal uterine bleeding and that anemia must be analyzed for successful treatment. A multidisciplinary approach to anemia caused by AUB is required in cases of severe anemia.

Background: Having claimed lives, HIV/AIDS is still a significant global public health concern. Antiretroviral therapy (ART) is now widely available, and this rapid expansion of access is dramatically improving HIV epidemic survival rates worldwide.Objectives: The aim of this study was to identify the mortality risk factors and survival status of ART patients attending Hawassa Comprehensive Specialized Hospital in 2020.Methods: In a five-year retrospective cohort research, all patients seen between January 2015 and December 2019 were analyzed. The data were analyzed with SPSS 25.0. The Kaplan-Meier Log-rank model was employed to gauge the survival time of ART patients based on explanatory variables. Both bivariate and multivariate Cox proportional hazards regression models were employed to identify the independent causes of mortality.Results: Patients on ART had a 74% overall survival probability. With a median survival of 34 months, there are 0.135 deaths for every 100 person-years. Hemoglobin level (HR = 2.38; 95% CI = 3.3-6.3), WHO clinical stage III and IV (HR = 3; 95% CI = 2.2-9.5, p = 0.04), Age >=60 (HR = 1.6; 95% CI = 1.3-2, p = 0.04) and Functional status bed ridden (HR = 3.1; 95% CI = 1.2-9.4,p = 0.04) were all independent predictors of death among RVI patients.Conclusion: In comparison to trials conducted in wealthy countries, the survival rate of ART patients in this study was low. Patients who are anemic; WHO advanced clinical stage; old age, and functional status bedridden should be closely followed and monitored.

Although emotion management is essential to mental health, public health has not paid much attention to emotional conditions or disorders. By analyzing a nine-year diagnostic trend and sociodemographic characteristics of two mental disorders: Hwabyung and Intermittent Explosive Disorder (IED), this study demonstrated the importance of managing emotions precautionarily.Data reconstructed from the National Health Insurance Service were used to analyze the yearly diagnostic trend in the two mental disorders characterized by anger.Hwabyung was more common among women and middle-aged individuals, despite the varied number of diagnoses by year. Between 2010 and 2018, IED diagnoses gradually rose, with the average rate of increase the highest in the 20s for male IED diagnoses in 2017. The low prevalence of the IED in Korea compared to other Western countries and the gender and age differences in both Hwabyung and IED diagnoses suggest the role of cultural influences related to emotions (or emotional management).Especially in light of the world’s emphasis on resilience to COVID-19, these results indicate how public emotional management is essential during stressful situations. The results also highlight the need for community mental health programs tailored to gender and age.

The main focus of this study concentrates on evaluating the quality of groundwater in and around the zone of pattamadai where the production of the mat in this region is a landmark industry, which is using dyes in a larger volume. The primary work starts with the collection of water samples from 13 boreholes and 13 hand-dug wells in different time intervals in the month of March 2021, which is a dry season. As per standards the water quality parameters have been evaluated and observed to be within the range. All the physico-chemical parameters for the samples have been studied for boreholes and hand-dug wells as all the values are observed to be within the range and are highlighted in the results.

Background: The clinical manifestations of Corona Virus Disease of 2019 (COVID-19) varied from patient to patient with evidence of multi-organ involvement. Many patients continue to have a wide range of symptoms for variable periods of time. The long-term effects of COVID-19 infection (post-COVID-19 illness or syndrome) are not yet been fully explored.This study aims to highlight the clinical manifestations of the acute COVID-19 infection and the longer-term manifestations of the disease among the attendants to a private GP clinic in the Urban Amman Area, Jordan.Methods: A clinical case-series study was conducted on a sample of 300 COVID-19-positive cases among patients attending my private GP clinic in the Urban Amman Area, Jordan. We used the structured questionnaire based mainly on World Health Organization (WHO) Case Report Form (CRF) verified tool for post-COVID-19. All patients with COVID-19 were included in the study. Data collection was conducted through phone calls and analyzed using the Statistical Package for Social Sciences (SPSS) software. Results: The incidence of COVID-19 among patients attending the clinic during the period of this study was 25%. Females were 135 (45%) of the study population and males were 165 (55%). The mean (SD) of age was 34.2 (5.0) years. Most of the infected staff (90%) were symptomatic and developed acute COVID-19 symptoms. Fever, Cough, Fatigue, joint pain and loss of smell and taste were the most common symptoms. 72% of the study population had fully recovered from the infection, while 28% of them continued to suffer from many long symptoms. Fatigue (28%), shortness of breath on activity (18%), Social withdrawal (18%), anxiety (17%), forgetfulness (16%), trouble concentrating (15) and depressed mood (14%) were the most frequently reported long symptoms.Conclusion: The prevalence of Post COVID-19 illness was 28% with a high public health burden calling for the public health system to address the medical and psychological needs of affected persons. Mental health and psychosocial support are recommended elements for the management of patients.

Introduction: Self-harm and depression are two related mental health issues that often co-occur and can have serious impacts on individuals and their well-being. Major Depressive Disorder (MDD) is a complex and multifaceted mental health condition that is prevalent among young adults. It is a significant public health concern that affects individuals, families and society as a whole, contributing to considerable social, economic, and health-related costs. Despite the high prevalence of depression in young adults, there is a lack of understanding of its etiology, risk factors, and optimal treatment strategies. Self-harm behavior is a concerning manifestation of MDD that can have serious consequences, including injury, infection, or even death.Methods: In this article, we report a case of an MDD patient with self-harm behavior and discuss the assessment method and treatment options. Our aim is to raise awareness of these pathologies among psychiatrists and the general population and to highlight the importance of early diagnosis and effective treatment in reducing the risk of self-harm behavior and suicide.Conclusion: In light of the case presented, it is evident that early detection and targeted intervention are crucial in mitigating the risk of self-injurious behavior in MDD patients. The utilization of a comprehensive assessment methodology, inclusive of a thorough review of the patient’s clinical history and utilization of standardized rating scales, proved indispensable in the tailoring of an individualized treatment regimen. The amalgamation of pharmacotherapy and psychotherapy proved to be a successful strategy in the amelioration of depressive symptoms and consequent self-harm behavior. As such, we trust that this case report will serve to sensitize clinicians to the importance of early identification and prompt management of these pathologies, in the quest for enhanced mental health outcomes.

The emergence of dramatic urinary tract infections (UTIs) caused by the members of the Enterobacteriales is an important public health problem in the community as well as in Tunisian hospitals. This study aims to investigate the prevalence of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing uropathogenic isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). Based on decreased susceptibility to β-lactams antibiotics and analyzed for the presence of ESBL and carbapenemase genes by Real Time- polymerase chain reaction (RT-PCR), 56 uropathogenic isolates of E. coli (n = 36) and K. pneumoniae (n = 20) were confirmed positive for ESBLs. The CTX-M-type β-lactamases were mostly detected in E. coli isolates (21 strains, 58.33% [95% CI 38.09% - 72.06%]) followed by blaSHV-like (18 strains, 50% [95% CI 32.92% - 67.07%]), blaTEM-like and blaCMY-2-like simultaneously (15 strains, 41.67% [95% CI 25.51% - 59.24%]). Furthermore, the RT-PCR system on the K. pneumoniae strains demonstrated that blaSHV-12-like was the most predominant (16 strains, 80% [95% CI 56.33% - 94.26%]) followed by blaTEM-like (14 strains, 70% [95% CI 45.72% - 88.10%]), blaCTX-M belonging to groups 9 and 1 (11 strains, 55% [95% CI 31.52% - 76.94%]) and finally blaCMY-2-like (10 strains, 50% [95% CI 27.19% - 72.80%]). In addition, E. coli and K. pneumoniae strains harbored a carbapenemase gene blaOXA-48-like with 22.2% [95% CI 10.11% - 39.15%]; 20% [95% CI 12.83% - 43.66%], respectively.Our results confirm the need to monitor the resistance to extended-spectrum β-lactams and to carbapenems among enterobacteria in Tunisia.

Reproductive health care disparity is a significant public health issue that affects many populations. This disparity stems from various factors, including race, ethnicity, socioeconomic status, geographic location, and education level. Such inequality results in adverse health outcomes such as unintended pregnancy, infertility and sexually transmitted infections among certain populations. Therefore, addressing reproductive health care disparities requires increasing access to affordable and comprehensive reproductive health services, promoting culturally competent care, improving access to family planning services and addressing barriers to care. Furthermore, promoting comprehensive sexuality education and addressing the root causes of inequality are also crucial in eliminating reproductive health care disparities. By addressing these disparities, we can ensure that all individuals have equal access to quality reproductive health care and services, leading to improved health outcomes for everyone.

Background: The socioeconomic impact of drug and substance abuse on secondary school students in Nigeria is yet to be fully evaluated even in the face of the current surge in abuse of substances among the younger folks who constitute more than half of the entire population.Objective: This study narratively reviewed the studies on the socioeconomic impacts of drug and substance abuse on secondary school students and studies by researchers in Nigeria. Methods: The study was a narrative review of the literature covering the socioeconomic impacts of drug and substance abuse on secondary school students in Nigeria from 1980 to 2023. Data were extracted and summarized with descriptive statistics. Results: All the studies took place between 2012 and 2023; 6 (100%). The studies carried out were all observational studies 6 (100%). All the studies fell below average in the benchmark for the hierarchy of evidence-based studies. The studies mostly took place in the South-West 3 (50.00%), while 1 (16.67%) took place in the South-East, North-West, and North-Central respective regions of Nigeria.Conclusion: The available studies done on the impacts of drug and substance abuse focused more on the social impacts, with little or no attention to the economic effect. The available studies however remain at the observational level in the evidence-based ladder. Future Research on the reviewed theme should focus on the economic implications of the social effects of drug and substance abuse on secondary school students in Nigeria.

Background: Exclusive breastfeeding has great benefits for both the mother and the child. Few studies have been carried out on interventions to improve Exclusive Breastfeeding (EBF) practice by childbearing mothers. No study has formulated and/or implemented a hospital-based maternal counseling guide intervention to improve EBF practice. This baseline study assessed the knowledge, attitude, and practice of EBF on mothers who were enrolled in antenatal clinics for a cluster randomized trial and the disparity in the knowledge of EBF based on lactation, age, sex, and source of income.Methods: We formulated a hospital-based counseling guide on exclusive breastfeeding, which is under implementation by prenatal and nursing mothers, to promote EBF practice in the study area. A cross-sectional study was conducted in two hospitals randomly selected from twelve hospitals in Anambra State. The study was among pregnant women who were in their second trimester. The data collection took place from March to April 2022. The data were analyzed using descriptive statistics and Chi-Square. The test of significance was set at p < 0.05.Results: The control and the intervention arms had an equal number of enrolees (144) each and more than half of the participants were between the ages of 23 – 32 years. The majority of the participants showed adequate knowledge of exclusive breastfeeding as over 90% knew that EBF is important and capable of improving their baby's immunity. The participants demonstrated a positive attitude to exclusive breastfeeding and they had a significantly high level of practice of daily consumption of galactagogues. The study suggested that the majority did not practice breast milk extraction mainly because the process of extraction is painful and some do not know how to carry out the extraction.Conclusion: The mothers have the requisite knowledge of the benefits of exclusive breastfeeding to their infants and themselves. However, they do not practice EBF. Interventions to improve EBF practice should focus on educating mothers on proper breast milk extraction and storage techniques.