When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BACKGROUND

COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.

METHODS

The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.

RESULTS

Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.

CONCLUSION

COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Medical and Dental Students' Perceptions of the Learning Environment during Anatomic Pathology Placement at Obafemi Awolowo University, Ile-Ife, Nigeria

BACKGROUND

The educational environment is an important factor in nurturing students' learning. Students' experiences of the climate of their learning environment positively correlate with their academic success, achievements and satisfaction.

OBJECTIVES

The study aimed to determine the perceptions of medical and dental students about their learning environment during anatomical pathology clinical placement.

METHODOLOGY

A prospective, cross-sectional study using a guided self-administered Dundee Ready Education Environment Measurement (DREEM) questionnaire was conducted among fourth year medical and fifth-year dental students on anatomical pathology placement at the College of Health Sciences, Obafemi Awolowo University Ile-Ife, Nigeria. One hundred and eleven of 118 students participated in the study.

RESULTS

The age range was 19-35 years. The majority of the students were males ( n= 80, 72.1%). The overall mean score was 115.19 ± 25.6 (maximum obtainable total score = 200), indicating that the students perceived their learning environment as more positive than negative. The mean score for each subscale of the DREEM instrument was: 29.24/48 (60.9%) for perception of learning; 25.67/44 (58.3%) for perception of teaching; 20.89/32 (65.3%) for academic self-perception; 25.61/48(53.4%) for perception of the atmosphere of learning; and 13.52/28 (48.3%) social self-perception. No statistically significant difference was found by sex, age group, and course of study for each DREEM domain.

CONCLUSION

Students' perception regarding the learning environment for anatomical pathology in the focal university shows the need for improvement across various domains. However, academic self-perception and social self-perception are the areas of greatest need.

Realist Evaluation of the "Abiye" Safe Motherhood Initiative in Nigeria: Unveiling the Black-Box of Program Implementation and Health System Strengthening

Introduction

Realist evaluation studies have spanned different aspects of medicine, especially in the field of public health. However, very few of these studies explicitly detailed how program implementation triggered outcomes that could strengthen understanding of its effect on Health System Strengthening in specific settings. In low- and middle-income countries, like Nigeria, there is a paucity of realist evaluation studies, despite the implementation of multiple intervention programs and projects in these countries. This article is aimed at unveiling the black-box of program implementation and Health System Strengthening of the "Abiye" Safe Motherhood Program in Ondo State, Nigeria. Specifically, it identified the role of contextual factors in the "Abiye" program in Ondo State, determined the mechanisms that facilitated or constrained outcomes of the "Abiye" program, and developed a Context Mechanism Outcome (CMO) Configuration from which a Middle Range Theory (MRT) can be framed.

Methodology

This was qualitative research structured along with the realist domains (Context, Mechanism, and Outcome). The Initial Program Theory was validated by the qualitative study, after which a new MRT was developed. The study population comprised key stakeholders, secondary stakeholders, and primary stakeholders in the Abiye safe motherhood program. Data was collected through 10 key informant interviews, 28 in-depth interviews, and six focus group discussions sessions. Thematic analysis was used to analyze all the qualitative data collected, and seven themes with 19 subthemes emerged in the study.

Results

We identified 13 contextual factors under five principal areas, with most of the factors playing enabling roles, some playing inhibitory roles, while very few played both roles. We elicited eight mechanisms, and some of these facilitated the outcomes, while some constrained the outcomes of the program. Health system strengthening was a key feature of the outcome of the program. We developed a middle-range theory based on the 6 CMO configurations we elicited from the study.

Conclusion and Policy Implications

Realist evaluation is an iterative process that looks beyond the surface to generate evidence. By applying the realist approach, we generated pieces of evidence that can be adapted for policymaking in public health interventions in LMIC.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors.

Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors.

Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage.

Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage. Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Women's self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria

OBJECTIVES

This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.

DESIGN

This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.

SETTING

Data were collected in 2018 in six local government areas in Lagos State.

PARTICIPANTS

Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18-49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.

RESULTS

Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.

CONCLUSIONS

Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.

Ethnicity, religious affiliation and girl-child marriage: a cross-sectional study of nationally representative sample of female adolescents in Nigeria

BACKGROUND

The persistently high prevalence of girl-child marriage remains a public health and developmental concern in Nigeria. Despite global campaign against the practice and policy efforts by Nigerian government, the prevalence remains unabated. This study investigates the prevalence and the influence of ethnicity and religious affiliation on the girl-child marriage among female adolescents in Nigeria.

METHODS

Data of 7804 girls aged 15-19 years extracted from the 2013 Nigeria Demographic and Health Survey were used. Ethnic groups were classified into five: major Northern ethnic group (Hausa/Fulani); Northern ethnic minorities; two major Southern ethnic groups (Yoruba and Igbo), and Southern ethnic minorities. The prevalence of girl-child marriage was determined for the five ethnic groups and individually for each ethnic minority group. Relationships between ethnicity and religious affiliation on girl-child marriage were explored using Cox proportional hazard regression models, adjusting for residence, education and wealth quintile.

RESULTS

Child marriage was higher for the Northern majority ethnic group of Hausa/Fulani (54.8%) compared to the two major Southern ethnic groups (3.0-3.6%) and aggregated Northern ethnic minorities (25.7%) and Southern minorities (5.9%). However, overall, the less known Northern ethnic minority groups of Kambari (74.9%) and Fulfude (73.8%) recorded the highest prevalence. Compared to the major Southern ethnic group of Yoruba, the adjusted hazard ratio (AHR) of child marriage was significantly higher for Northern ethnic minorities (AHR = 2.50; 95% C.I. = 1.59-3.95) and Northern major ethnicity (AHR = 3.67, 95% C.I. = 2.33-5.77). No significant difference was recorded among Southern ethnic groups. Girls affiliated to other religions (Muslim and traditionalist) had higher child-marriage risks compared to Christians (AHR = 2.10; 95% C.I. = 1.54-2.86).

CONCLUSION

Ethnicity and religion have independent associations with girl-child marriage in Nigeria; interventions must address culturally-laden social norms that vary by ethnic groups as well as religious-related beliefs.

Factors associated with the desire for companionship during labor in a Nigerian community

OBJECTIVE

To determine preferences for companionship during labor and to identify associated factors.

METHODS

The present prospective cross-sectional survey was conducted at a university teaching hospital in Nigeria between September 1, 2011, and February 28, 2012. Participants included women who underwent the first stage of labor and delivery at the facility, male partners, and healthcare workers from the maternity unit. Data were collected using a pretested questionnaire.

RESULTS

There were 226 parturients, 158 male partners, and 69 healthcare workers included in the final analysis; in all, 50 (22.1%) parturients and 37 (23.4%) male partners approved of companionship during labor, whereas 62 (90%) healthcare workers supported it. Among those who approved, a parturient's male partner was stated to be the preferred companion by 33 (66%) parturients, 32 (86%) male partners, and 58 (94%) healthcare workers. The perception of conduciveness of the labor ward for companionship was associated with approving of companionship among both the parturients (adjusted odds ratio [aOR] 2.74) and male partners (aOR 15.79). Previous home delivery (aOR 31.43) and companionship during a previous delivery (aOR 23.00) were also associated with approval.

CONCLUSION

Most couples had negative attitudes toward companionship during labor. Intensive education programs and restructuring of facilities could enable Nigerian labor wards to improve the delivery experience for both parturients and their male partners.

Integrated oral, mental and sexual health management for adolescents: a call for professional collaboration

BACKGROUND

Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents.

DISCUSSION

Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents.

CONCLUSION

Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents' health needs.

Clustering of behavioural risk factors for non-communicable diseases (NCDs) among rural-based adolescents in south-west Nigeria

BACKGROUND

Non-communicable diseases (NCDs) have become the leading cause of deaths globally and the key associated risk factors - alcohol abuse, physical inactivity, cigarette smoking and poor dietary patterns - are often initiated in adolescence. Co-existence of these risk factors further increase the risk for NCDs. Yet, very little is known about the pattern of co-occurrence of behavioural risk factors for NCDs among Nigerian adolescents, especially those in rural areas. This study aimed to assess the prevalence and determinants of clustering patterns of behavioural risk factors for NCDs among in-school adolescents in rural areas of Osun State, Nigeria.

METHODS

This cross-sectional study involved 476 adolescents recruited through multi-stage sampling across Osun State. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-Based Health Survey (GSHS) instrument. Data were analysed using Stata, with binary logistic regression used to identify determinants.

RESULTS

The mean age of the respondents was 14.7±2.0 years and females constituted 50.2% of them. Among the respondents, 36.1% had reported consuming alcoholic drinks but no one met the criteria for harmful alcohol use, while 8.8% had ever smoked cigarettes and only one respondent (0.2%) was a current smoker. The prevalence of poor diet (89.5%) and physical inactivity (85.9%) was, however, high. Poor diet and physical inactivity co-occurred in 369 (77.5%) respondents, while one respondent (0.2%) had three risk factors (poor diet, physical inactivity and current smoking). Being in a senior secondary school class (odds ratio, OR=1.6; 95% confidence interval, C.I.=1.04-2.39) and living with parents (OR=0.53; 0.33-0.90) were significantly associated with clustering of NCD behavioural risk factors.

CONCLUSION

The prevalence of clustering of modifiable risk factors for NCDs was high among rural-based in-school adolescents in south-west Nigeria, and there is a need to mount effective interventions. Findings from this study have the potential to inform effective school-based NCD control programmes.

Risk and protective factors for adolescent substance use: a comparative study of secondary school students in rural and urban areas of Osun State, Nigeria

BACKGROUND

Substance use is a leading adolescent health problem globally, but little is known regarding associated factors for adolescent substance use in Nigeria. This study compared the prevalence of substance use among in-school adolescents in urban and rural areas of Osun State, Nigeria, and identified risk and protective factors.

METHODS

This cross-sectional study involved 600 randomly selected adolescents (aged 10-19 years) from rural and urban areas of Osun State, Nigeria. Data were collected using the facilitated self-completed questionnaire method. Binary logistic regression was used to examine the association of individual, peer, and parental factors with adolescent substance use. Adjusted odds ratio (OR) and 95% confidence interval (CI) were obtained.

RESULTS

About two-thirds of respondents had used substances in both rural (65.7%) and urban areas (66.0%) (p=0.93). Logistic analysis showed private school attendance as a risk factor for substance use (OR=2.32, 95% CI=1.20-4.46) and adolescent disapproval of adult substance use as a protective factor (OR=0.47, 95% CI=0.27-0.82) in rural areas. For urban areas, having friends who use substances (OR=4.04, 95% CI=1.39-11.6) and a mother having had tertiary education (OR=3.34, 95% CI=1.06-10.4) were risk factors while parental disapproval of substance use (OR=0.50, 95% CI=0.28-0.90) was a protective factor.

CONCLUSION

Lifetime prevalence of substances is high among in-school adolescents in Osun State. The risk and protective factors for adolescent substance use somewhat differ for rural and urban areas, and these have implications for designing effective intervention strategies.

Quality of Spousal Relationship on Procurement of Abortion in Peri-Urban Nigeria

The quality of spousal relationship may influence the acceptance of the status of pregnancies and the decision to procure abortion; however, this relationship has largely been unexplored. The objective of this paper is to assess the influence of specific dimensions of relationship quality on abortion procurement. Data from the 2010 Family Health and Wealth Survey site were used to assess the association between relationship quality and induced abortion among 763 ever-pregnant married or cohabiting women in Ipetumodu, South-west Nigeria. Abortion question though not directly related to current time, however, it provides a proxy for the analysis in such context where abortion is highly restrictive with high possibility of underestimation. The association between relationship quality and abortion risk was analyzed using bivariate and multivariate (logistic regression) methods. Only 7.9% of women 15-49 years reported ever having induced abortion. Communication was the only dimension of relationship quality that showed significant association with history of induced abortion (aOR = 0.42; 95% C.I. = 0.24-0.77). The paper concludes that spousal communication is a significant issue that deserves high consideration in efforts to improve maternal health in Nigeria.

What are the factors that interplay from normal pregnancy to near miss maternal morbidity in a Nigerian tertiary health care facility?

Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.

Early neonatal bilirubin, hematocrit, and glucose-6-phosphate dehydrogenase status

OBJECTIVE

To document the patterns of bilirubin and hematocrit values among glucose-6-phosphate dehydrogenase (G6PD)-deficient and G6PD-normal Nigerian neonates in the first week of life, in the absence of exposure to known icterogenic agents.

METHODS

The G6PD status of consecutive term and near-term neonates was determined, and their bilirubin levels and hematocrits were monitored during the first week of life. Infants were stratified into G6PD deficient, intermediate, and normal on the basis of the modified Beutler's fluorescent spot test. Means of total serum bilirubin (TSB) and hematocrits of the 3 groups of infants were compared.

RESULTS

The 644 neonates studied comprised 353 (54.8%) boys and 291 (45.2%) girls and 540 (83.9%) term and 104 (16.1%) near-term infants. They consisted of 129 (20.0%) G6PD-deficient, 69 (10.7%) G6PD-intermediate, and 446 (69.3%) G6PD-normal neonates. The G6PD-deficient and G6PD-intermediate infants had higher mean TSB than their G6PD-normal counterparts at birth and throughout the first week of life (P < .001). Mean peak TSB levels were 14.1 (9.48), 10.2 (3.8), and 6.9 (3.3) mg/dL for G6PD-deficient, G6PD-intermediate, and G6PD-normal neonates, respectively. Peak TSB was attained on approximately day 4 in all 3 groups, and trends in TSB were similar. Mean hematocrits at birth were similar in the 3 G6PD groups. However, G6PD-deficient and -intermediate infants had higher declines in hematocrit, bilirubin levels, and need for phototherapy than G6PD-normal infants (P < .001).

CONCLUSIONS

The G6PD-deficient and G6PD-intermediate neonates had a higher risk of neonatal hyperbilirubinemia and would therefore need greater monitoring in the first week of life, even without exposure to known icterogenic agents.

Sexual behavior of in-school adolescents in Osun State, Southwest Nigeria: a comparative study

OBJECTIVES

The sexual and reproductive health of adolescents is of utmost importance in many nations (especially in developing countries). Sexual behavior varies from location to location and the outcome (when negative) creates great concerns mainly due to the consequential impact on health and development. This study aimed at comparing sexual behavior of in-school adolescents in rural and urban areas of Osun state.

METHODS

A comparative cross sectional study was conducted. A total of 760 in-school adolescents were recruited using multistage sampling technique. Pre-tested questionnaires were administered after ethical considerations. Data were analysed and p-value was placed at 0.05.

RESULTS

A total of 380 rural and 380 urban adolescents participated in this study with a mean age of 14.90 ± 2.44 and 14.34 ± 2.31 years, respectively. About one-fifth (20.1%) had experienced their first sex (66% of rural and 34% of urban). The mean age at first sex was 14.05 years ± 2.3 years (13.89 ± 2.3 years for rural and 14.37 ± 2.3 years for urban). Only 76 (49.7%) sexually experienced respondents had used condom in the past (45.5% of rural, 57.7% of urban). Half of the urban respondents used condom during their first sex while only a quarter of their rural counterparts had done so (p=0.003).

CONCLUSION

Sexual behavior was commoner among the rural respondents than their urban counterpart. There is an urgent need for sexuality education especially among rural adolescents in the study area.

Performance needs assessment of maternal and newborn health service delivery in urban and rural areas of Osun State, South-West, Nigeria

The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.

Teachers' perspectives on sexual and reproductive health interventions for in-school adolescents in Nigeria

High prevalence of early and unprotected sex, resulting in adverse reproductive health outcomes, has been reported among adolescents in Nigeria. While school-based sexual and reproductive health interventions for in-school adolescents is widely recognized, little is known on the kind of involvements desired by teachers and their perceptions of handling students' reproductive health concerns. In this study, the teachers favoured school-based reproductive health education (RHE), but have divers' opinions on what should be included in such RHE. Majority was not willing or comfortable in personal counseling of students but can teach RHE in classroom environment. They support the current approach of expelling pregnant school girls. The article advocates for gender-sensitive and developmental-oriented approaches that will ensure rehabilitation and re-integration of pregnant girls into the school system after their delivery, and recommend the need to build teachers skills and promote students-teachers dialogue in order to optimize school environment for addressing ASRH.

Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study

BACKGROUND

Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria.

METHODS

A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss.

RESULTS

The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 - 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 - 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 - 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 - 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 - 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 - 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 - 13.4)] was the most significant adverse perinatal outcomes associated with near miss event.

CONCLUSIONS

The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria's effort to achieving MDG 4 and 5.

STI treatment-seeking behaviors among youth in Nigeria: are there gender differences?

CONTEXT

There is little research on STIs among young people in Nigeria. It is important to determine gender differences in health-seeking behaviors among youth with self-reported STI symptoms.

METHODS

Data from 538 males and females aged 15-24 with at least one STI symptom were drawn from the 2003 and 2005 National HIV/AIDS and Reproductive Health Surveys. Bivariate and multivariate analyses were conducted to determine gender differences among those who had sought treatment for their STI symptoms, and the factors related to seeking treatment from formal health care sources versus informal sources.

RESULTS

A greater proportion of males than of females had sought treatment for their STIs (64% vs. 48%). Among those who had sought treatment, 60% of females had gone to formal sources, most commonly a government clinic; 54% of males had sought care from informal sources, most commonly a traditional healer. Females had lower odds than males of having sought STI treatment (odds ratio, 0.6). Among both males and females, economic status was positively associated with seeking treatment from a formal source rather than an informal source (2.4-4.2); among females, 22-24-year-olds were more likely than those aged 15-18 to have sought treatment from a formal source (2.5).

CONCLUSION

Programs and policies that aim to increase treatment of STIs among young people in Nigeria need to target males and females differently.

Influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria

Fertility pattern and reproductive behaviours affect infant death in Nigeria. Household food insecurity and poor care practices also place children at risk of morbidity and mortality. The objectives of this study were to assess the influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 423 mothers of under-five children and their children in the households selected through multistage sampling methods. Food-insecure households were five times more likely than secure households to have wasted children (crude OR = 5.707, 95 percent CI = 1.31-24.85). Children with less educated mothers were significantly more likely to be stunted. The prevalence of food insecurity among households in Ile-Ife was high. Households with food insecurity and less educated mothers were more likely to have malnourished children.

Mapping a global agenda for adolescent health

Major changes in health are underway in many low- and middle-income countries that are likely to bring greater focus on adolescents. This commentary, based on a 2009 London meeting, considers the need for strategic information for future global initiatives in adolescent health. Current coverage of adolescent health in global data collections is patchy. There is both the need and scope to extend existing collections into the adolescent years as well as achieve greater harmonization of measures between surveys. The development of a core set of global adolescent health indicators would aid this process. Other important tasks include adapting and testing interventions in low- and middle-income countries, growing research capacity in those settings, better communication of research from those countries, and building structures to implement future global initiatives. A global agenda needs more than good data, but sound information about adolescent health and its social and environmental determinants, will be important in both advocacy and practice.

Musculoskeletal disorders: epidemiology and treatment seeking behavior of secondary school students in a nigerian community

Background:

Epidemiological information paucity exists on musculoskeletal disorders (MSD) among secondary school students in Nigeria. We aimed to determine the prevalence, pattern, and treatment seeking behaviors (TSB) of MSD in Southwest, Nigeria.

Materials and Methods:

A school-based cross-sectional study was conducted in four randomly selected secondary schools in Ile-Ife in 2007. All the students were screened for MSD using an interviewer-administered questionnaire and physical examination, which involved the use of a scoliometer and a goniometer. Affected children were recommended for follow-up treatment and a plain radiography taken.

Results:

A total of 133 students had 204 MSD representing a 3.0% prevalence among the 4,441students screened. Eighty-one (60.9%) students had congenital disorders and 52 (39.1%) were acquired. The lower limbs (93.1%) were most commonly affected and 87 (65.4%) students presented with a knee deformity. Other abnormalities were limb length discrepancy 6.8%, scoliosis 4.4%, Pes planus 3.9%, and poliomyelitis 2.9%. A total of 100 students (75.2%) had no form of treatment, 18.8% receive treatment in the hospital, 3.7% received treatment in a traditional healing home and 2.3% received treatment in a church. Age, family, and school type were significant factors (P<0.05) in health-seeking behavior. The factors affecting treatment outcome were the place of treatment, hospital specific treatment, and reasons for stopping treatment.

Conclusion:

Treatable cases constitute a large proportion of MSD among secondary school students, but TSB was generally poor. Parental socio-economic and health services factors were related to the health-seeking behavior. Strengthening of school health services and improved linkage with orthopedic services, community education on MSD, and education of all cadres of health professionals are recommended.

Changes in sexual practices and responses among ante-natal clinic attendees in a Nigerian teaching hospital

A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

Impact of nutritional education on nutritional status of under-five children in two rural communities of south-west Nigeria

OBJECTIVES

This study evaluated the impact of nutritional education on knowledge, attitude and practices (KAP) of mothers concerning infants and young children feeding and their children's nutritional status in two semi-urban communities of south-west Nigeria.

MATERIALS AND METHODS

This is a community intervention study. We recruited 150 mothers of children aged 0-18 months independently from the intervention and control communities through a multi-stage sampling technique. We collected data with the aid of an interviewer-administered questionnaire at baseline and at six months after intervention from both communities to obtain information on feeding of infants and young children. In addition, we measured weights and heights of recruited children. Intervention involved group counselling of mothers and food demonstrations at designated health facilities. Data analysis for quantitative data was done using Epi-Info software, and for qualitative data, content analysis of major themes was used.

RESULTS

Before intervention, recruited mothers and their children from the two communities were comparable in terms of all the parameters assessed (P>0.05 in all cases). After six months of intervention, mothers who had nutritional education demonstrated better knowledge and attitudes to key infant and young children feeding recommendations. There was also limited improvement in feeding practices. Mothers from the intervention community exclusively breastfed their infants longer with mean age at introduction of complementary foods at 5.3 months compared to 4.5 months in the control community (P<0.05), breastfed their children longer (P<0.05). However, there was no statistically significant improvement in the weight of their children.

CONCLUSION

In this study, nutritional education of mothers only had positive impact on their level of KAP on infant and young children feeding.

Determinants of adherence to antiretroviral drugs among people living with HIV/AIDS in the Ife-Ijesa zone of Osun state, Nigeria

Background

The advent of antiretroviral (ARV) drugs has transformed HIV/AIDS into a chronic manageable disease and strict adherence is required for the medication to be effective. However, factors influencing adherence to ARV therapy (ART) vary from country to country.

Method

120 subjects who received ARV drugs at a federal government-designated ART site located within the Obafemi Awolowo University Teaching Hospital complex, (OAUTHC), Ile-Ife, and a community-based non-governmental organisation, Living Hope Care (LIHOC), Ilesa, from February to May 2006 were serially recruited and studied. Relevant data were collected using an interviewer-administered, patient medication adherence questionnaire. Focus group discussions were also held among the subjects to further elicit qualitative information on factors influencing adherence to ART.

Results

The age of participants ranged from 21 to 65 years with a mean age of 40.2 + 10.3 years. Participants had been on ARV drugs for a period ranging between three and 60 months. The overall adherence rate in the study population was 44%. 66% of participants who accessed ARV drugs from LIHOC, Ilesa, had good adherence while only 14% of participants who accessed ARV drugs from OAUTHC, Ile-Ife, had good adherence. Participants with good adherence did not pay funds for the preliminary ARV eligibility investigations and they were also offered regular adherence counselling. These facilities were barely available in the group with poor adherence. Demographic factors such as age, gender and marital status did not seem to have any significant association with adherence level (p > 0.05).

Conclusion

The level of adherence was high in a cohort of PLWHA accessing ARV drugs in Ilesa while it was low among PLWHA receiving ART in Ife. The most important reasons for this difference were lack of funds for investigations and poor psycho-social counselling.

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria

BACKGROUND

Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown.

OBJECTIVE

The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis.

METHODS

Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as "gold" standard.

RESULTS

Males constituted 53.4% of subjects and mean age was 45 years (+/- 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis.

CONCLUSION

The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses.

Maternal complications and perinatal outcomes in booked and unbooked Nigerian mothers

INTRODUCTION

The study aimed to compare the sociodemographical characteristics, obstetrical complications and foetal outcome in delivered booked mothers and delivered unbooked mothers and to determine the correlation of maternal and perinatal outcomes.

METHODS

In a prospective study over a 22-month period, outcomes of pregnancies of women booked for antenatal care were compared with that of unbooked women, who delivered in our unit at the Wesley Guild Hospital, Nigeria.

RESULTS

29 percent of the 1,154 deliveries in the study period comprised unbooked mothers. Compared with booked mothers, unbooked mothers had a higher tendency to be younger (29.3 +/- 6.08 vs. 31.12 +/- 4.80; p-value is less than 0.001), unmarried (9.2 percent vs. 1.8 percent; p-value is less than 0.01), with lower educational status (25.8 percent with postsecondary education vs. 58.7 percent; p-value is less than 0.01), lower social class (25.0 percent in upper class vs. 52.3 percent; p-value is less than 0.001) and with higher proportion of multipara (12.5 percent vs. 5.5 percent; p-value is less than 0.02), higher incidence of antepartum haemorrhage (odds-ratio [OR] 5.96, 95 percent confidence interval [CI] 2.53-14.29, p-value is less than 0.001), anaemia (OR 2.75, 95 percent CI 1.09-4.47, p-value is less than 0.001) and preeclampsia/eclampsia. Unbooked mothers were half as likely as booked mothers to deliver by spontaneous vaginal delivery (OR 0.45, 95 percent CI 0.29-0.71, p-value is less than 0.001) but were twice as likely to deliver preterm babies (OR 2.03, 95 percent CI 1.14-3.59, p-value is less than 0.009) and three times more likely to have babies with birth asphyxia. Perinatal and maternal mortalities were higher in unbooked mothers.

CONCLUSIONS

The study showed a positive correlation between unbooked mothers and an increased risk of maternal and foetal adverse outcomes.

Utilization of primary health care facilities: lessons from a rural community in southwest Nigeria

BACKGROUND

This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria.

METHOD

A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data.

RESULTS

Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment, while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P<0.05). Maternal and child health (45.4%), prompt attention (23.0%), and appropriate outpatient (20.5%) services attracted respondents to use PHC services. Poor education about when to seek care, poverty, perceived high cost of PHC services, lack of drugs and basic laboratory services, and a regular physician on site at the facility were identified as barriers to utilisation.

CONCLUSION

We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services.

Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents

BACKGROUND

Early sexual debut among adolescents is associated with considerable negative heath and development outcomes. An understanding of the determinants or predictors of the timing of sexual debut is important for effective intervention, but very few studies to date have addressed this issue in the Nigerian context. The aim of the present study is to examine predictors of adolescent sexual initiation among a nationally representative sample of adolescents in Nigeria.

METHODS

Interviewer-collected data of 2,070 never-married adolescents aged 15-19 years were analysed to determine association between age of sexual debut and demographic, psychosocial and community factors. Using Cox proportional hazards regression multivariate analysis was carried out with two different models - one with and the other without psychosocial factors. Hazard ratio (HR) and 95% confidence interval (CI) were calculated separately for males and females.

RESULTS

A fifth of respondents (18% males; 22% females) were sexually experienced. In the South 24.3% males and 28.7% females had initiated sex compared to 12.1% of males and 13.1% females in the North (p < 0.001). In the first model, only region was significantly associated with adolescent sexual initiation among both males and females; however, educational attainment and age were also significant among males. In the second (psychosocial) model factors associated with adolescent sexual debut for both genders included more positive attitudes regarding condom efficacy (males: HR = 1.28, 95% CI = 1.07-1.53; females: HR = 1.24, 95% CI = 1.05-1.46) and more positive attitudes to family planning use (males: HR = 1.19, 95% CI = 1.09-1.31; females: HR = 1.18, 95% CI = 1.07-1.30). A greater perception of condom access (HR = 1.42, 95% CI = 1.14-1.76) and alcohol use (HR = 1.90, 95% CI = 1.38-2.62) among males and positive gender-related attitudes (HR = 1.13, 95% CI = 1.04-1.23) among females were also associated with increased likelihood of adolescent sexual initiation. Conversely, personal attitudes in favour of delayed sexual debut were associated with lower sexual debut among both males (males: HR = 0.36, 95% CI = 0.25-0.52) and females (HR = 0.38, 95% CI = 0.25-0.57). Higher level of religiosity was associated with lower sexual debut rates only among females (HR = 0.59, 95% CI = 0.37-0.94).

CONCLUSION

Given the increased risk for a number of sexually transmitted health problems, understanding the factors that are associated with premarital sexual debut will assist programmes in developing more effective risk prevention interventions.

Evaluation of health workers' training in use of the partogram

OBJECTIVE

To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers.

METHODS

Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months.

RESULTS

A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs.

CONCLUSION

Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants.

Unavailability of essential obstetric care services in a local government area of south-west Nigeria

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area (LGA) of South-West Nigeria. The objectives were to determine the availability of essential obstetric care (EOC) services in the LGA and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. Twenty-one of 26 health facilities surveyed were public facilities, and five were privately owned. None of the facilities met the criteria for a basic EOC facility, while only one private facility met the criteria for a comprehensive EOC facility. Three facilities employed a nurse and/or a midwife, while unskilled health attendants manned 46% of the facilities. No health worker in the LGA had ever been trained in lifesaving skills. There was a widespread lack of basic EOC equipment and supplies. The study concluded that there were major deficiencies in the supply side of obstetric care services in the LGA, and EOC was almost non-existent. This result has implications for interventions for the reduction of maternal mortality in the LGA and in Nigeria.

Multi-media campaign exposure and interpersonal communication on sexual abstinence among young people in Nigeria: a propensity-matched study

A national multi-media campaign (Zip-Up!) was initiated in Nigeria in 2004 to promote sexual abstinence among young people as part of comprehensive efforts to reduce sexually transmitted infection and unwanted pregnancy. This study assessed the effect of the campaign exposure on interpersonal communication about abstinence among a nationally representative sample of never-married young people (15-24 years). A propensity score matching technique was used to create a comparison group statistically equivalent to the group exposed to the campaign and assess the campaign effect. Of the 3,388 people sampled, 29.1% had been exposed to the campaign. Factors significantly associated with campaign exposure included age (OR = 1.08; 95% C.I. = 1.04-1.12), urban location (OR = 1.31; 95% C.I. = 1.04-1.66), and frequency of media use. Compared to the non-exposed group, campaign exposure was associated with a statistically significant adjusted increase of 10.9% in the proportion of young people who engaged in interpersonal communication about abstinence.

Maternal health-seeking behavior and associated factors in a rural Nigerian community

OBJECTIVES

To assess maternal health services and health-seeking behavior in a rural community (Ologbo), located in the South-south zone of Nigeria.

METHODS

Structured questionnaire was administered to 225 randomly selected mothers (age 15-49 years), and was analyzed using SPSS. Six focus group discussion sessions were also conducted-four for community women and two for health workers.

RESULTS

Teenagers constituted 13.3% of the respondents. The average number of children per woman ranged from 2.5 for teenagers to 9.0 for women aged 45-49 years. Eighty percent of respondents knew at least one major medical cause of maternal mortality: the most common causes mentioned were hemorrhage (31.8%) and obstructed labor (17.3%). Private maternity center was the most preferred place for childbirth (37.3%), followed by traditional birth attendants (TBAs) (25.5%). Government facility was preferred by only 15.7%: reasons for the low preference included irregularity of staff at work (31.4%), poor quality of services (24.3%), and high costs (19.2%). Among the 81 women that delivered within a 1-year period, only 9.9% received antenatal care, 6.2% received two doses of tetanus toxoid, while 4.9% attended postnatal clinic. Private midwives and TBAs attended 49.4 and 42.0% of deliveries, respectively. Education was found to be significantly associated with choice of place for delivery (p < 0.05), but no association was found with respect to age and marital status. Only 11.4% of mothers were practicing family planning.

CONCLUSIONS

Poor health-seeking behavior is a challenge in rural Nigeria, and interventions are needed to achieve improved maternal health status.

Management Outcome and Associated Factors in Burn Injuries With and Without Facial Involvement in a Nigerian Population

There is a high potential for the occurrence of burns in Nigeria, yet very little is known about factors that are associated with management outcomes (death/survivorship) in burns affecting facial or other body areas among Nigerian populations. This study aimed at determining patterns of occurrences of burn injuries with and without facial involvement and the factors that are associated with mortality. A standardized data-collection instrument was designed and used to extract relevant information about burn patients that were seen at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between 1998 and 2003. During the study period, fuel-related flames constituted the leading type of agent in both facial (71.1%) and nonfacial involved burns (65.3%). There was no significant difference in the incidence of contracture and inhalation injury between burns with facial involvement and burns without facial involvement, but cases of facial involvement have significantly lower incidences of wound infections. No significant difference was seen in the incidence of mortality between burns with facial involvement (31.6 %) and burns without facial involvement (30.7%). Significant bivariate correlates for mortality were age, flame as the agent of burns, depth of the burns and wound infections. Two correlates remained significant in the multivariate analysis (binary logistic regression): BSA involved and wound infection.

Pulmonary functions of wheat flour mill workers and controls in Ibadan, Nigeria

BACKGROUND

The impact of grain dust exposure on lung functions of grain handlers in Nigeria has remained largely undocumented. Lung functions of wheat flourmill workers and control subjects were assessed, and the prevalence of lung function abnormalities was compared among the occupational groups.

METHODS

Study subjects consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flourmill factory and 121 matched external controls. A cross-sectional analytical design is utilized; data were collected using structured interviews, anthropometric measurements, spirometry, and area dust sampling.

RESULTS

The flour-millers recorded significantly lower mean lung functions compared with control subjects (P < 0.05), for FEV(1) and FVC, when observed values were expressed as percentages of predicted normal values. Furthermore, 29% of flour-millers, compared with 15% of external controls and 10% of internal controls, presented with at least one abnormal test result of ventilatory function.

CONCLUSIONS

The study concluded that wheat flour-mill workers in Nigeria are at an increased risk of developing abnormalities of lung functions compared with control subjects, and the dominant pattern of respiratory disease among them is airway obstruction.

Perception of peers' behaviour regarding sexual health decision making among female undergraduates in Anambra State, Nigeria

BACKGROUND

High-risk sexual behaviours are prevalent in tertiary educational institutions in Nigeria, but little is known about the social influences that bear on the reproductive health decision-making and behaviour of the undergraduates. On the other hand, perceptions regarding the behaviour and influence of peers have been documented to be key social factors associated with reproductive health behaviour of young people.

OBJECTIVE

This study aimed to assess the perception of Nigerian female undergraduate about sexual behaviours of their peers and the type of influence their peers tend to exert on them.

METHOD

The study was cross-sectional in nature and involved 588 randomly selected unmarried female undergraduates in two tertiary institutions in Anambra state, Nigeria. The study instrument was a self-administered questionnaire. Data was analysed using Epi-Info statistical package.

RESULTS

Three-quarters of respondents were between 15 and 24 years and the majority were from homes with formally educated parents (91.2 % of mothers and 93.9 % of fathers). Regarding sexual behaviour, 80.1% of respondents indicated that their age mates were already sexually active, and 92 % indicated that most of their friends had regular sexual partners. The use of condoms by sexually active friends was reported by 58.5 % of respondents. Almost half (47.1 %) of respondents indicated that they were under pressure by friends to engage in pre-marital sex, and 22.1 % indicated that the pressure was moderate or severe in degree. However, 64.6 % of respondents indicated that they would receive moderate or lots of support for their friends if they made the decision to abstain from sex.

CONCLUSION

Perception of sexual behaviour of peers and the nature of the pressure that peers exert support pre-marital sex. It appears peers would also respect and support the decision of those that choose to practice sexual abstinence.

The influence of sociodemographic factors on awareness, knowledge and attitude toward andropause among health professionals in Ile-Ife, Nigeria

A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.

Sudden cardiac death in Nigerians--the Ile-Ife experience

OBJECTIVE

To determine the clinico-pathologic features, circumstances of death and related epidemiological variables in cases of sudden cardiac death among Nigerians.

METHODS

A review of all cases of medico-legal autopsies performed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, on cases of sudden unexpected deaths over a ten-year period (1987-1997).

RESULTS

The records of 2,529 medico-legal autopsies were reviewed, of which 79 were found to be cases of sudden cardiac deaths (SCD). The SCD cases consisted of 59 males (74.7%) and 20 females (25.3%), with age ranging from 27 to 80 years. The mean age (and standard deviation) was 53.7 (+11.2) and 52.2 (+10.9) for males and females respectively. A total of 68 cases (86.1%) were brought dead into the hospital and 38 (55.1%) of these were apparently healthy prior to death. The nature of activities associated with SCD, where such was documented, was passive in 90% of cases. Hypertensive heart disease was the cause of death in 66 cases (83.5%), of which only 20 (30.3%) were previously diagnosed. Ischaemic heart disease and cardiomyopathies ranked next as the most common cause of death with 5 cases (6.3%) each.

CONCLUSION

Hypertensive heart disease is the most common cause of sudden cardiac death in Nigerians, and many of hypertensive cases were previously undiagnosed. Cases of coronary heart disease and myocardial infarction played significant roles as causes of sudden cardiac death, indicating that their incidence may not be as rare among Nigerians as previously thought.

Prevalence of respiratory symptoms among wheat flour mill workers in Ibadan, Nigeria

BACKGROUND

While investigations into occupational health problems of various groups of workers have been conducted in Nigeria, so far, very little attention has been paid to the health status of workers in the grain industry. The prevalence of respiratory symptoms among wheat flour mill workers and control groups in a medium size industrial setting in Nigeria was studied.

METHODS

The study employed a cross-sectional analytical design. Data were collected using structured interviews, work-site observations, and physical examination. Respondents consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flour mill factory, and 121 matched external controls.

RESULTS

Fifty-four percent of the flour-millers reported at least one respiratory symptom compared with 30% of the internal controls (P < 0.05) and 19% of the external controls (P < 0.001). Most symptoms were significantly more prevalent among the flour-millers compared with control subjects, and this trend was more evident amongst non-smokers than ex-smokers.

CONCLUSIONS

The study concluded that wheat flour mill workers in Nigeria, like grain workers elsewhere, were at an increased risk of developing both pulmonary and non-pulmonary symptoms compared with control subjects. The result has implications for improved dust control measures in the grain industry in Nigeria.

Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Acceptance of hepatitis B vaccine by workers in a Nigerian teaching hospital

OBJECTIVES

To determine the pattern of vaccine uptake by hospital personnel in a specifically designed pioneer hepatitis B vaccination programme and to highlight major lessons for ensuring success in future programmes.

DESIGN

A review of vaccination and employment records for a forty four-month period and comparative analysis on the basis of professional grouping and work units.

SETTING

Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.

SUBJECTS

A total of 2,548 employees of the teaching hospital that have worked for a minimum of one year on a continuous basis between April 1992 and December 1995.

INTERVENTIONS

Procurement of recombinant hepatitis B vaccine (Engerix, SmithKline Beecham) by the hospital management and provision of the same to all interested employees of the teaching hospital at no cost under a vaccination programme which was conducted on an on-site basis.

MAIN OUTCOME MEASURES

'Participation' in the vaccination programme was defined as the uptake of at least one dose of hepatitis B vaccine, and 'compliance' defined as the receipt of the three prescribed doses of the hepatitis B vaccine.

RESULTS

The level of participation in the vaccination programme was high with 91.9% of the target population of hospital workers receiving at least a dose of the vaccine, while only about half (53.8%) of the group complied with receiving the required three doses of the vaccine. In terms of participation, by professional grouping, laboratory workers and nurses recorded the lowest rates (82.5% and 84% respectively), while 100% participation was recorded in respect of the staff of engineering, medical records, pharmacy and physiotherapy departments. The highest rate of compliance (receipt of three doses) was also found among non-clinical workers (medical record personnel--76.3% and engineering staff--69.5%) while the lowest rate was found among nurses (39.7%) and doctors (40.3%).

CONCLUSION

Workers with the highest possibility of knowledge of, and exposure to hepatitis B infection within the hospital setting--doctors, nurses, and laboratory workers--showed the greatest apathy to the vaccination programme. Reasons for this trend demand close examination, and subsequently, identification of specific action that needs to be taken to improve the uptake of the vaccine by the target population, particularly the high-risk groups, in future programmes. Among others, targeting all groups of workers with appropriate education on the infection; active involvement of professional groups in the planning and execution of the vaccination programme; and review of the implementation logistics are some of the key points to note for future programmes.