Ageing in place or stuck in place: Preferred care setting for community-dwelling older persons in a low-resource country in Sub Saharan Africa

BACKGROUND

Ageing in Place is the emerging social policy drive for long-term care coordination of older persons globally. This decision may be the only viable option in many low- and middle-income countries like Nigeria. Nevertheless, the risk of older persons being 'stuck in place' is high if their preferences are not considered or other alternatives are neither acceptable nor available. This study determined factors associated with the preferred care setting among community-dwelling older persons and explored their views about their choices.

METHODS

The study utilised a mixed-methods approach. Participants were older persons (≥ 60 years) in a selected rural and urban community in Oyo State, south-western Nigeria. Quantitative data were collected using an interviewer-administered, semi-structured questionnaire and analysed using Stata version 14 at p<0.05. Qualitative data collection involved 22 Focus Group Discussions (FGD). The discussions were audiotaped, transcribed verbatim and analysed thematically using ATLAS.ti version 8. Selected quotations were used to illustrate themes.

RESULTS

1,180 participants (588 rural vs 592 urban) were interviewed with a mean age of 73.2 ±9.3 years. More rural participants preferred to AIP (61.6%) compared to urban participants (39.2%), p = 0.001. Factors associated with the decision for rural participants were older age [OR:2.07 (95%CI:1.37-3.14)], being male [OR:2.41(95%CI:1.53-3.81)] and having assistance at home [OR:1.79 (95%CI:1.15-2.79)]. In comparison, significant factors for urban participants were older age (≥70years) [OR:1.54(95%CI:1.03-2.31)] and home-ownership [OR:5.83 (95%CI:3.82-8.91)]. The FGD revealed that the traditional expectation of reciprocity of care mostly influenced the desire to AIP. Advantages include improved social connectedness, quality of care, community participation and reduced isolation. Interestingly, participants were not opposed to the option of institutional care.

CONCLUSION

Ageing in place is preferred and influenced by advanced age and home ownership in our setting. Information provided could guide age-friendly housing policies and community-based programmes for the care of older persons.

Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

BACKGROUND

Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.

METHODS

In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.

FINDINGS

Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.

INTERPRETATION

Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.

FUNDING

The Bill & Melinda Gates Foundation.

Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison

BACKGROUND

Older person's attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process.

METHODS

A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05.

RESULTS

A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains.

CONCLUSIONS

Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

Awareness and utilization of female condoms among street youths in Ibadan, an urban setting in South-West Nigeria

Introduction

Female condom awareness and use have been poorly documented in sub-Saharan region especially among street youths. This study assessed its awareness and use among street youths.

Methods

A cross-sectional study was conducted among 964 youths between ages 15 to 24 years old using questionnaires to elicit information. Univariate and multivariate analysis were conducted at 5% level of significance.

Results

More than half (69.9%) were males and between 20-25 years of age (61.2%). More than three-quarter (81.0%) had initiated sexual activity. Almost half (47.9%) of the respondents have heard about female condoms however only 16.8% have ever seen while 4.3% have actually ever used a female condom. Age, education, current sexual activity and experience of rape attempt were predictors of female condom awareness.

Conclusion

Awareness of female condom was a significant predictor of utilization of female condoms. There is therefore a need for proper awareness and education on the effectiveness of female condoms.

A descriptive study of the morbidity pattern of older persons presenting at a Geriatric Centre in Southwestern Nigeria

CONTEXT

Rapid population ageing is a demographic reality in most countries of the world. Old age is associated with changes which may culminate in health problems, necessitating provision of appropriate preventive, curative, and rehabilitative services. However, reports from many low- and middle-income countries have shown lack of preparedness to cater for the healthcare needs of older persons.

AIM

This study described the morbidity profile and its determinants among persons aged 60 years and above who presented at an established geriatric centre in southwestern Nigeria.

MATERIALS AND METHODS

Data were obtained from electronic health records of 4886 patients aged ≥60 years who visited the facility between 1st January 2013 and 31st December 2014. Data were analyzed using Stata version 13 (Texas, USA). Frequency distributions were used for descriptive analysis, and chi-square test was used to test associations.

RESULTS

More than a half, 2919 (59.7%), of the respondents were females and almost three quarters 3501 (71.7%) were aged between 60 and 74 years. Mean number of morbidities was 1.81 ± 0.9, and less than half, 1097 (42.0%), presented with only one morbidity, most commonly, hypertension. There were significant age-related differences for musculoskeletal (P = 0.001), endocrine (P = 0.01), and psychological problems (P = 0.01). In addition, gender differences were observed as a significantly higher proportion of females presented with general symptoms (P = 0.02) and musculoskeletal problems (P = 0.0001) than men.

CONCLUSION

The most common presenting morbidities at this geriatric health centre were mostly noncommunicable diseases. Information obtained will be useful in the design of similar facilities in other parts of the country and region at large.

Behavioural risk factors for sexually transmitted infections and health seeking behaviour of street youths in Ibadan, Nigeria

BACKGROUND

Street youths are faced with a number of health challenges that could be linked to their exposure to the risk elements, accessing medical care including motivation and /or ignorance to utilise available health care.

OBJECTIVE

This qualitative study therefore aimed at determining the behavioural risks for sexually transmitted infections (STIs) and health seeking behaviour of street youths in Ibadan.

METHODS

Sixteen focus group discussion (FGD) sessions were conducted among 160 street youths aged between 15-24 years.

RESULT

The result showed that most of the respondents had low perception of risk of contracting STIs in spite of their risky behaviours which included multiple sexual partnering, sharing of personal effects, malnourishment and sexual harassment. Most of the street youth could not identify the various types however; Gonorrhea and HIV were commonly mentioned by them. The major treatment regimen for STIs was traditional remedies and drugs obtained from patent medicine vendors. Traditional remedies were preferred by most of the participants and considered to be more effective.

CONCLUSION

Majority of the street youths were sexually active, engaged in high risk sexual behaviours and had inappropriately treated sexually transmitted infections. Development of risk reduction and appropriate sexual health interventions targeted at prevention and appropriate treatment is recommended.

Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school

BACKGROUND

Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However, there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self-administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at <0.05.

RESULTS

More than a third (35.5%) of all respondents interviewed had experienced one or more forms of mistreatment during their training, with 38.5% of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5%), and the main perpetrators of these incidents were medical consultants, (18.6%) other cadre of doctors (17.3%) and lecturers (14.4%). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P < 0.05). However, only 8.8% reported these incidents.

CONCLUSION

With more than a third of undergraduate medical trainees experiencing mistreatment, development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended.

Frequency and Pattern of Lower Urinary Tract Symptoms in a screened population of Men above 40 Years in Ibadan, Southwestern Nigeria

BACKGROUND

The epidemiology of lower urinary tract symptoms in adult men in Nigeria is presently not well known.

AIM

To evaluate a screened population of men for lower urinary tract symptoms and their impact on the participants' quality of life.

METHODS

A cohort study was conducted among men aged 40 years and older from 3 selected centres in Ibadan, Southwestern Nigeria. The presence of lower urinary tract symptoms and their impact was determined using the International Prostate Symptom Score (IPSS) administered via standardized questionnaires.

RESULTS

Six hundred and fifty-five men participated in the study. The median age was 56 years with a range of 40 - 92 years. Eight percent (8%) of respondents were asymptomatic, whilst 66%, 20% and 6% had mild, moderate and severe symptoms respectively. Nocturia was the most common symptom and the second most troublesome. Overall storage (irritative) symptoms occurred with the similar frequency to voiding (obstructive) symptoms (91% v 92%), but voiding symptoms were more likely to be severe and thus more troublesome (p = <0.000.1). The severity of the individual symptoms as well as the overall score also increased significantly with age [p = 0.001]. There was a high correlation between IPSS and Quality of Life (QoL) scores (correlation coefficient 'r' = 0.75 [p = <0.0001]. Despite this, 72% of QoL respondents were satisfied with their quality of life.

CONCLUSION

The frequency of non-troublesome lower urinary tract symptoms was high in adult men in this cohort of men in Southwestern Nigeria and that severity was age-related. In addition, whilst storage and voiding symptoms occurred with similar frequency, voiding symptoms were the more severe and troublesome.

Quality of life in psychosis: prevalence and associated factors in a Nigerian clinical population

Aim of the study was to assess sociodemographic and clinical determinants of quality of life in psychotic patients in a general hospital population in Nigeria. Information was obtained on demography, duration of untreated illness (DUI) and functioning among Schizophrenia (368), schizoaffective disorder (70), and 214 patients with affective psychosis. Functioning was assessed using GAF, severity of psychopathology with PANSS and quality of life using WHOQoL-BREF. In general, the differences in the QoL across the three psychotic disorders were small. Linear regression analysis, showed that high GAF p < 0.001, medication adherence, p = 0.007 were associated with good QoL in schizophrenia, low PANSS p < 0.001 and short DUI p = 0.001 in schizoaffective disorder and low PANSS, high GAF p < 0.001 respectively in affective psychosis. QoL and its determinants in psychosis are not absolutely different. More research is required in this area.

Older persons' views and experience of elder abuse in South Western Nigeria: a community-based qualitative survey

OBJECTIVES

Conventionally, existing information on elder abuse has been institution based, professionally driven, and in high-income countries. This study addresses the prevailing gap in knowledge through direct consultation of older persons in the community about their perceptions of elder abuse.

METHOD

Eight focus group discussions were carried out among males and females aged 60 years and above in a rural and an urban community in south western Nigeria. Data were transcribed and analyzed based on emergent themes.

RESULTS

Findings from the study show that the perception of abuse by the respondents included the standard typologies except sexual abuse as well as societal issues such as disrespect and lack of recognition.

DISCUSSION

Our study revealed a high level of awareness and experience of elder abuse among the participants in both communities. Effective social welfare and health services aided by targeted government policies are needed to improve the quality of life of the elderly.

Sexual practices of deaf and hearing secondary school students in ibadan, Nigeria

Background:

Adolescents and young people with disabilities generally face various forms of discrimination. Inspite of this, they have to deal with similar reproductive health issues encountered by their abled peers. This situation is made worse by misconceptions that they are not sexually active.

Objective:

The objective was to compare the sexual practices of the hearing impaired students with their non-hearing impaired counterparts.

Method:

A cross-sectional survey was conducted. All consenting deaf students and an equal number of hearing students attending a half way school in Ibadan participated. Four of the hearing students did not complete the survey and their responses were excluded from the final analysis.

Results:

A total of 78 deaf students and 74 hearing students with mean ages of 17.1 (S.D. ± 3.0) and 15.8 (S.D. ± 1.9) years respectively participated. Twenty-six (33.3%) deaf and 36 (48.6%) hearing students had ever had sexual intercourse (p = 0.055). Median ages at sexual debut were 16 and 14 years for the deaf and hearing students respectively. The number of sexual partners ever had ranged from 1 to 8 among the deaf and 1 to 6 among the hearing students. Four (15.4%) deaf and 23 (63.9%) hearing students reported that they used a condom the last time they had sexual intercourse.

Conclusion:

The study revealed that hearing-impaired students like their hearing counterparts were sexually active however deaf students were more likely to engage in unsafe sex. There is therefore a pressing need for comprehensive sexuality education for deaf students in the study area.

Knowledge about complications and practice of abortion among female undergraduates in the university of ibadan, Nigeria

Background:

Unwanted pregnancies and unsafe abortion pose major health risks to women in the reproductive age group. Female undergraduates are particularly exposed to these risks. This study was carried out to assess the knowledge about complications and practice of abortion among female undergraduates of the University of Ibadan.

Methods:

A cross-sectional study was conducted using structured, self-administered questionnaires, to collect data on respondents’ socio-demographic characteristics, sexual behaviour, knowledge about various complications of abortion and practice of abortion. Data was analyzed using SPSS version 14.

Results:

A total of 425 students were interviewed, mean age of the undergraduates was 21.5± 2.8 years. Overall, 122 (29%) of the respondents had ever had sexual intercourse. Twenty five percent of those who were sexually active had ever been pregnant and 90% had terminated the pregnancy. The most common reason given for termination was that pregnancy was unplanned for. Most of the respondents 354 (83.3%) had a good knowledge about complications of abortion and mean knowledge score was 4.01±1.58 (range 0-5).

Conclusion:

This group of students were aware of the risks associated with unsafe abortion; however, the abortion rate was still high. Sexual reproductive health interventions are needed on campus in order to equip female undergraduates with comprehensive knowledge and skills to reduce the likelihood of unplanned pregnancies

Knowledge and Perception of Nigerian Men 40 years and above Regarding Prostate Cancer

BACKGROUND

Carcinoma of the prostate is now the most commonly diagnosed male cancer worldwide. However, knowledge and perception of Nigerian men about the disease has not been fully investigated.

AIM

To determine the level of awareness about prostate cancer among men 40 years and older in Ibadan, Southwestern Nigeria.

METHOD

Four focus group discussions were used to obtain information from 29 randomly- selected Nigerian men, aged 40 years and above, about their knowledge of the common causes of morbidity and mortality among men of their age group as well as prostatic diseases and their perceived causes. In-depth interviews were then conducted among 656 participants using questionnaires.

RESULTS

Generally, the respondents and discussants were unaware of the prostate gland and its diseases; whilst relatively few knew about carcinoma of the prostate and most were ignorant of the symptoms of the disease. Among discussants and respondents who knew about the gland, most thought that benign and malignant prostatic diseases were long-term complications of promiscuity and sexually transmitted infections. All the participants were interested in receiving information about all aspects of carcinoma of the prostate.

CONCLUSION

. These results indicate that a large proportion of adult Nigerian men are ignorant of the prostate gland and its diseases in general, and carcinoma of the prostate in particular. There is therefore the need for community awareness programs on prostatic diseases in our locality.

HIV/AIDS stigma among primary health care workers in Ilorin, Nigeria

BACKGROUND

Stigma and discrimination pose major obstacles to accessing care and support by People Living With HIV/AIDS (PLWHA). Information on HIV stigma and discrimination towards PLWHA among Nigerian health workers has mainly been at higher levels of care. This paper examined HIV stigma and discrimination at the primary health care level with the objective of identifying its occurrence and determinants among health workers at this level.

METHODS

A total sample of all health care workers (341) at the primary health care level in Ilorin, Kwara State were surveyed via questionnaire between July and August 2007 to obtain information on their sociodemographic characteristics and the four domains of stigma viz: fear of casual transmission of HIV, shame and blame, discrimination and disclosure.

RESULTS

Majority of the respondents had fear of casual transmission of HIV (87.7%), exhibited shame and blame (89.4%), reported observing discrimination against PLWHA by other health workers in their facilities (97.7%) and believed that disclosure of patients HIV status to health workers was imperative. Nurses/midwives were more likely to have fear of casual transmission of HIV and believe that disclosure of HIV status of patients was imperative. Respondents who had received in service training were less likely to exhibit shame and blame (p < 0.05).

CONCLUSION

Stigma occurred in all stigma domains among this group of health workers but previous training was found to play a role in the reduction of shame and blame. Training of health care workers within the context of the various stigma domains is advocated.

Non communicable disease and risky behaviour in an urban university community Nigeria

BACKGROUND

Most developing countries have only limited information on the burden of Non Communicable Diseases (NCDs) even though rapid transitions in these NCDs have been predicted.

OBJECTIVES

To describe the burden of selected NCDs and associated risk behaviours in an urban university community in Nigeria.

METHODS

A cross-sectional survey of 525 representative staff of a University in a large city in Nigeria was conducted.

RESULTS

In all, 27.6% were already diagnosed with at least one NCD (hypertension-21.5%, diabetes-11%, cancer 2.9%) while 67.4% reported at least one risk behaviour (unhealthy diet- 96%, sedentary living- 27.4% excessive alcohol use-5.1% and smoking- 1.9%). Multiple risk behaviours were observed in 29.9% with no significant variation by sex or age. Those 40 years and above had significantly higher prevalence of NCD, particularly for hypertension (p<0.05). Only 7%, considered themselves to be at risk of NCDs. Those whose parents had NCDs OR: 5.9 (2.4-14.5) and those who currently had NCDs OR: 3.9(1.8-8.1) perceived themselves at risk of one or more NCDs, but not those with multiple risk behaviours.

CONCLUSION

The high burden of NCDs and risk behaviours in the face of limited self-perceived risk has been demonstrated and calls for urgent intervention.

Experiences of mistreatment among medical students in a university in south west Nigeria

OBJECTIVE

This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school.

MATERIALS AND METHODS

A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria.

RESULTS

Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression.

CONCLUSION

Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.

Effect of health education on the riding habits of commercial motorcyclists in Uyo, southern Nigeria

BACKGROUND

The increasing number of motorcyclists in Nigeria has led to a rise in poor road safety practices leading to increased rate of accidents. This study was conducted to implement and evaluate the effect of safety education on riding habits of motorcyclists in Uyo, Nigeria.

METHODS

The intervention study was conducted among commercial motorcyclists in Uyo with controls from another town in Akwa Ibom State. Baseline information was collected from both groups on their riding habits. Motorcyclists in Uyo were educated on appropriate road safety practices. Data was collected from both groups three months later and analysed using the Statistical Package for Social Sciences version 11.

RESULTS

A total of 200 respondents participated in the study, 100 per group. At 3 months post-intervention, those riding when tired reduced in the intervention group from 69% at baseline to 42% (p < 0.05), while in the control group it increased from 74% to 79%. Furthermore, those who rested during riding hours increased from 30% at baseline to 93% (p < 0.05) in the intervention group, while it reduced from 40% to 36% in the control group. Those riding within speed limit in the intervention group increased from 37.5% at baseline to 56.6% (p < 0.05), while in the control group, it remained the same. Use of psycho-active substances reduced in the intervention group, though the changes were not statistically significant at p < 0.05.

CONCLUSION

Safety education improved many riding habits of motorcyclists in the intervention group. Road safety education is recommended for all motorcyclists to ensure safer road use.

Economic costs of motorcycle injury among crash-involved commercial motorcyclists in Oyo State, Nigeria

OBJECTIVE

This study presents the costs of injury from road crashes sustained by commercial motorcyclists in Oyo state, Nigeria.

METHODS

Across-sectional survey of 373 commercial motorcyclists selected using a multi-stage sampling technique was conducted. Information on injury costs for 44 (11.8%) of them who were reportedly involved in a road crash in the 12-month preceding the survey are presented.

RESULTS

The mean age of the 44 crash-involved motorcyclists was 33.6 +/- 9.1 years. Daily income ranged from N300.00 ($2.31) - N1, 500.00 ($11.54). Thirty-three (75.0%) of those involved in crashes sustained injuries and 7 (21.2%) of them were admitted. Common injuries sustained were bruises (75.8%), fractures (12.1%), cuts (6.1%) and burns (6.1%). Median number of days away from work was 14 (range: 1 - 150). Median number of days on admission was 60 (range 7 - 90). The median cost of treatment was N2, 000.00 ($15.38), range: N20.00 (about 16 cents) - N25, 000.00 ($192.31) and this was paid by the injured motorcyclist alone in about 47% of cases. Median productivity costs lost was N7, 000.00 ($53.85), range N300 ($2.31) - N72, 000.00 ($553.85).

CONCLUSION

The study showed that the costs of injuries were considerable. Efforts to prevent road crashes must be intensified to reduce the ensuing economic losses.

Economic problems of youth with hiv/aids in ibadan, Nigeria

BACKGROUND

HIV/AIDS has emerged as one of the major global public health problems and it also has substantial economic impact on individuals and their families.

OBJECTIVES

This paper describes the economic problems of youth with HIV in Ibadan, Nigeria.

METHODS

A cross-sectional survey of PLWHA attending two HIV/AIDS support groups in Ibadan and the University College Hospital (UCH) antiretroviral (ARV) clinic was carried out. Information was obtained on socio-demographic characteristics and economic problems.

RESULTS

One hundred and seventy youth aged 18-35 years were interviewed; 140 (82.4%) were female. One hundred and eight (63.5%) respondents were currently employed, 57 (52.8%) of whom were traders. Reasons for unemployment were that respondent's business capital had been used up to pay for healthcare (38.3%) and ill health (23.4%); while 38.3% were currently schooling. Common economic problems experienced by the respondents were significant increase in healthcare expenses (38.8%) and loss of employment (22.0%). Coping strategies employed to mitigate these problems included depletion of savings 61.1%, borrowing (18.8%) and sale of property (9.4%). Loss of employment was significantly higher among respondents who were symptomatic prior to diagnosis and among those who had a health complaint at the time of the study. Female respondents were also more likely to have lost their jobs compared to male.

CONCLUSION

The study highlights the economic impact HIV as a chronic disease has on those infected. Care and support programs thus need to have a strong economic component in order to adequately meet the needs of PLWHA.

Visual morbidities among elderly patients presenting at a primary care clinic in Nigeria

BACKGROUND

Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in Nigeria.

OBJECTIVE

To describe the visual problems among elderly subjects in a hospital setting.

METHODS

Five hundred consecutive patients (311 females and 189 males) aged 60 years and above were interviewed using a structured questionnaire based on the World Organization of Family Doctors (Wonca) format between September 2004 and April 2005. The main outcome measurements were sociodemographic characteristics, visual acuity and ocular problems.

RESULTS

The main visual problems reported by the elderly were impaired vision 224 (44.8%) and abnormal sensations in the eyes 64 (12.8%). Cataract 198 (39.7%) was the commonest eye disorder diagnosed by the Family Physician, followed by pterygium 32 (6.4%). Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age.

CONCLUSION

Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made to detect these conditions early and institute treatment promptly.

Sexual risk behaviours and HIV knowledge of migrant farm workers in a rural community in Nigeria

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6% (males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1% (12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted.

A comparative study of HIV/AIDS knowledge and attitudes of hearing-impaired and non-hearing-impaired secondary school students in Ibadan

OBJECTIVE

This study was conducted to compare HIV/AIDS knowledge and attitudes of hearing-impaired and non-hearing-impaired secondary school students in Ibadan, South-Western Nigeria.

METHOD

A cross-sectional survey of all the hearing impaired students and an equal number of non-hearing-impaired students enrolled in a half way school in Ibadan was conducted. Four non-hearing-impaired students did not complete the survey and their responses were excluded from the final analysis. Data was analysed using the Statistical Package for the Social Sciences (version 11.0).

RESULTS

Seventy-eight hearing-impaired and non 74 non-hearing impaired students completed the survey. Thirty (38.5%) hearing-impaired and 67 (90.5%) and non-hearing-impaired students knew that HIV could be transmitted via semen, vaginal fluid and blood, (p < 0.001). HIV/AIDS knowledge scores were calculated giving minimum and maximum scores of 0 and 15 respectively. Mean knowledge score for hearing-impaired students was 4.7(±2.1) compared with 8.7(±2.3) among non-hearing-impaired students (t-test=11.307, p < 0.001). Generally, the students' attitudes to HIV/AIDS prevention and PLWHA were not favorable with only hearing-impaired and 44 (59.5%) non-hearing-impaired students agreeing that it would be alright for them to be in the same class with someone who had AIDS.

CONCLUSIONS

The study showed that the hearing-impaired students had poorer knowledge and attitudes to HIV/AIDS compared with their non-hearing-impaired counterparts. There is a pressing need for development of HIV/AIDS education programmes specially designed to meet the needs of hearing impaired students.

Clinical audit of intra-partum care at secondary health facilities in Nigeria

OBJECTIVE

Intra-partum care has a significant influence on birth outcomes. Gap however exists between evidence and practice. This study documented pattern of intra-partum monitoring among birth attendants in public secondary healthcare facilities and related findings to quality of care provided.

METHOD

Intra-partum monitoring records of vaginal examination, fetal heart and blood pressure were reviewed. Research assistants extracted information and documented same in appropriate section of Safe Motherhood Needs Assessment forms. Monitoring records were categorized into optimal and sub-optimal care. Proportions were calculated for parturients who received either optimal or sub-optimal care. Chi-square test of statistics was used to explore differences. Level of significance was p < 0.05.

RESULT

Areview of 349 records of paturients was carried out. Their mean age was 23.4 +/- 3.3 years. Pregnancy outcome was a live-birth in 329 (97.3%). Optimal care of vaginal examination, fetal heart monitoring and blood pressure measurement was provided in 243 (71.9%), 73 (21.6%) and 52 (15.4%) parturients respectively and diminished significantly as labour progressed.

CONCLUSION

Intra-partum care provided by birth attendants was generally sub-optimal and use of the monitoring records to influence birth outcome is doubtful. Improvement in record keeping practices and skills in intra-partum monitoring for decision making, are suggested.

Sexual risk behaviour of street youths in south west Nigeria

OBJECTIVES

Previous studies have mainly focused on sexual behaviour of in-school Nigerian youths with little attention to those on the street. This survey was conducted to determine the sexual risk behaviours of young people on the streets of Ibadan, Nigeria.

METHODOLOGY

A cross sectional survey was conducted among youths aged 15-24 years in the major markets, motor parks and commercial areas in two local government areas in Ibadan. Participants in the study areas were identified in groups based on their occupational activity and all consenting young people were interviewed. A semi-structured questionnaire was used to obtain information on sexual behaviours, condom use and history of sexually transmitted infections. Data was managed using SPSS version 11.

RESULTS

Most (68.8%) were males, 79.0%, were sexually experienced, the median age at sexual debut for males was 15 years and 16 years for females. More females (53.9%) compared to (34.5%) males reported that their first partners were five or more years older, p < 0.01. Condom use during the first sexual intercourse was reported by only 32.2%. Sex with a commercial sex worker or exchange of sex for money was reported by 18.2% (20.6% of males versus 12.2% of females, p = 0.01). Factors significantly associated with history of transactional sex were; male gender; older age (20-24 years); being out of school and regular alcohol use. Multiple sexual partnering was reported by 58.2%, the significant predictors were male gender; early age at sexual debut; regular alcohol use and history of transactional sex. Inconsistent condom use was reported by 44.8%, the predictors were female gender; regular alcohol use and history of transactional sex in the previous year.

CONCLUSION

Majority of these young people on the streets are sexually active and many engage in high risk sexual behaviours. Development of appropriate sexual and reproductive health interventions is recommended.

Work conditions and health problems of female traders in Ibadan, Nigeria

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria

INTRODUCTION

Upper urinary tract stones are relatively uncommon in Nigeria and they are most often seen in men in their 4th and 5th decades. There is however no recent report on this disease from our locality. This retrospective study was done to evaluate the pattern of presentation of upper tract urolithiasis in our institution.

PATIENTS AND METHODS

We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period.

RESULTS

Twenty cases of renal calculi presented within the study period. All patients presented with sudden onset of loin or back pain, and the diagnosis was confirmed radiologically. The mean age of our patients was 27 years (age range 13-38 years), and the male to female ratio was 1.5: 1. Nineteen patients (95%) reported poor fluid intake (<1.5L/day), and 17/20 (85%) frequently total fasted totally (no water or food intake) for religious reasons. Serum calcium was normal in 15 of 16 patients (94%) and only marginally raised in the remaining patient. All patients were treated with a high fluid intake (3L/day) and analgesics, and 16 of the patients (80%) passed their stones spontaneously. The other four are currently pain free, one of whom is awaiting surgery.

CONCLUSION

This (uncommon) occurrence of upper tract urolithiasis in young adults in Ibadan may be related to chronic dehydration exacerbated by religious fasting. Further studies are required to explore this relationship,

Previous BFHI training and nurses' knowledge, attitudes and practices regarding exclusive breastfeeding

The UNICEF/WHO Baby Friendly Hospital Initiative (BFHI) programme was developed to train health workers and equip them with the required knowledge and skills to protect, promote and support breastfeeding among mothers through the implementation of the "Ten Steps to Successful Breastfeeding". This study was conducted to assess the effect of BFHI training on knowledge, attitudes and support practices of nurses with regards to exclusive breastfeeding. A total of 298 nurses in maternal and child health care units were interviewed, of these 113 (37.1%) had participated in the BFHI training workshop. Significantly higher proportions of the BFHI trained nurses had the correct knowledge regarding the causes and management of common breastfeeding problems. The overall knowledge scores of the BFHI trained nurses was significantly higher than that of the untrained (11.9 +/- 1.8 versus 10.7 +/- 2.4 P < 0.01). Higher proportions of BFHI trained nurses reported correct support practices for the initiation and establishment of exclusive breastfeeding among mothers. The findings show that nurses who had participated in the BFHI training workshop were significantly more knowledgeable about some aspects of exclusive breastfeeding, they had more positive attitudes and were more likely to employ correct practices for the promotion of exclusive breastfeeding.

Trabeculectomy in young Nigerian patients

The results of 89 trabeculectomies performed on 56 patients under the age of 30 years were reviewed. Data collected included age, sex, type of glaucoma, number of years of glaucoma before surgery, visual acuity, intraocular pressure, complications of surgery, presence of a filtering bleb and follow-up period. Complete success, denoted by a postoperative IOP of 21 mmHg or less without medical therapy, occurred in 50 eyes (56.2%). Qualified success, in which IOP was 21 mmHg or less with additional medical therapy occurred in 31 eyes (34.9%) and failure, in which IOP was greater than 21 mmHg in spite of medical treatment occurred in 8 eyes (8.9%). Success was therefore achieved in 91.1% attaining an IOP of 21 mmHg or less, with or without additional medical therapy. The most statistically significant factor was age groups in which the highest success rate of 100% was achieved in the age group 20-29 years. The difference in the success rate across the age groups was statistically significant (x2 = 8.04, p = 0.01). Fornix based conjunctival flaps were also found to be associated with a statistically significant higher success rate (97.9%) as opposed to limbal based flaps (85.4%), x2 = 4.81, p = 0.03. Males in the study group had a significantly higher success rate (97%) than females (78.3%), x2 = 5.86, p = 0.011. A success rate of 100% was recorded in patients with developmental glaucoma, 86.1% in congenital glaucoma and 33.3% in secondary glaucoma. All the repeat trabeculectomies had congenital glaucoma. The presence of a bleb, although it had a higher success rate (93.4%) compared with the absence of a bleb (84.6%), was not statistically significant (x2 = 1.19, p = 0.27). Complications of surgery were mostly transient.

Effectiveness of trabeculectomy on glaucoma patients in Ibadan

This study was designed to determine the effectiveness of trabeculectomy on African patients. All patients who underwent trabeculectomy over a 10-year period, January 1987 to December 1996 were included in the study. Information extracted from their case notes sex, included age, type of glaucoma, number of years of glaucoma before surgery, eye involved, and visual acuity pre-operatively and post-operatively. Intraocular pressures at presentation, pre-operatively and post-operatively (2 days, 1 week, 3 months, 6 months, 12 months and last clinic visit) were also recorded. Other data collected included pre-operative antiglaucoma therapy, additional techniques at surgery, complications of surgery, presence of a filtering bleb and follow-up period post operatively. A success rate of 91.2% was obtained from 433 eyes operated upon. The most significant outcome was the presence of a filtering blob which had a better success rate than the absence of a bleb. High success rates were recorded in the age groups "> 60 years and 20-40 years", the lowest success rate was in the "less than 20 years of age". All the patients with developmental glaucoma had a successful outcome (100%) while only 50% of the secondary glaucoma were successful. Patients with open angle glaucoma had 92% success rate. Complications of surgery were mostly transient. It was concluded that the presence of a bleb was a good indication of the control of intraocular pressure and that early surgery gave a more successful outcome than late surgery.

The Idikan adult mortality study

The Idikan adult mortality study is designed to explore the usefulness of the verbal autopsy methodology in the determination of cause-specific adult mortality. Such data have been largely unavailable in developing countries. Members of a stable urban community (4333 adults) were registered in their family units and followed up every 3 months to ascertain deaths, exits and new entries to the study population. Deaths were investigated by means of a verbal autopsy, which was administered by a trained interviewer to the relative closest to the decedent. Two physicians independently studied the results and assigned a cause of death, and these were then confirmed or resolved by a senior physician colleague. Hospitals where deaths occurred were visited and assignable cause of death was obtained where available and compared with the cause assigned by verbal autopsy. Only 8 of the 60 investigated deaths were confirmed to have occurred in a hospital in the first 2 years of the study. The cause of death assigned by verbal autopsy agreed moderately both between the independent coders as well as with the hospital assigned cause of death using the Kappa statistics for agreement beyond chance. We therefore concluded that verbal autopsies appear moderately useful for adult death statistics (Kappa = 0.23 to 0.1). Accumulation of more hospital deaths is needed, however, to make more definite conclusions about the validity of the technique.