Improving knowledge about breast cancer and breast self examination in female Nigerian adolescents using peer education: a pre-post interventional study

Background

Prevention of BC of which the cornerstone is creating awareness and early detection is important in adolescents and young women because of their worse outcomes. Early detection strategies such as mammography are currently beyond the reach of most women in sub-Saharan Africa.. Lack of awareness and late presentation contribute to the poor outcomes. Awareness creation among adolescents may result in modification of some risk factors for BC with adoption of healthy life styles including accessing early detection activities. This study determined the effect of peer education as a strategy to create awareness on BC and breast self examination (BSE) among in-school female adolescents in Benin City.

Methods

This was a pre-post interventional study carried out in October –December 2016 on female students of four secondary schools in Benin City. Pre-peer training, using a pre-tested self-administered questionnaire, knowledge about BC and BSE was assessed in about 30% of each school population. This was followed by training of 124 students selected from the schools (one student per class) as peer trainers. The peer trainers provided training on BC and BSE (the intervention) for their classmates. Within two weeks of peer training knowledge about BC and BSE was reassessed in 30% of each school population. Selection of students for assessment pre and post intervention was by systematic sampling. Correct knowledge was scored and presented as percentages. Chi square test, student t test and ANOVA were used to assess associations and test differences with level of significance set at p < 0.05.

Results

There were 1337 and 1201 students who responded to the pre and post-training questionnaires respectively. The mean BC knowledge score (20.61 ± 13.4) prior to training was low and it statistically significantly improved to 55.93 ± 10.86 following training p < 0.0001 Following peer training, statistically significant improvement (p 0.037- < 0.001) occurred in most knowledge domains apart from symptomatology. Pre-peer training 906(67.8%) students knew about BSE but only 67(4.8%). Significantly more students 1134(94.7%) knew about BSE following peer training.

Conclusions

Peer education strategy can be used to improve BC and BSE knowledge in adolescents. This strategy is low cost and could be very useful in low resource settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01466-3.

Effect of Peer Education on Knowledge of Human Papilloma Virus and Cervical Cancer among Female Adolescent Students in Benin City, Nigeria

Introduction:

It is well documented that Human Papilloma Virus (HPV) is the cause of cervical cancer which is a major cause of morbidity and mortality especially in low- and middle-income countries. Vaccines against HPV are available. In developed countries where the vaccines have been deployed, lack of information among the target population (adolescents) is a major contributor to suboptimal uptake. In Nigeria, the vaccine is yet to be provided in the national programme on immunization, which is free, but it is available for a fee. In this study we determined the effect of peer education on the knowledge of female adolescents about HPV, cervical cancer, its treatment and prevention.

Methods:

This was an intervention study. The knowledge and awareness of female students of four secondary schools were assessed using a pre-tested self-administered questionnaire prior to the training of some of the students (peers). The trained students delivered messages on cervical cancer and HPV using fliers containing key information (peer training) to their school mates in formal delivery in a class setting. The knowledge and awareness of students, post-peer training, was then assessed.

Results:

There were 1337 students who responded to the baseline questionnaire while 1201 responded to the post-peer training questionnaire. Awareness of cervical cancer, knowledge of risk factors and cause of cervical cancer was low prior to the peer training. There was statistically significant improvement in awareness about cervical cancer and in the knowledge domains following peer training. Mean knowledge score prior to training was 12.94 ± 9.23 and this increased significantly to 53.74 ± 10.69 following peer training p < 0.0001.

Conclusion:

Peer training is effective in improving knowledge and awareness of secondary school students about HPV and cervical cancer.

Do Caregivers receive Health Information on their children's illnesses from Healthcare Providers while hospitalised?

AIMS AND OBJECTIVES

To assess caregivers' knowledge of their child's illness following hospital admission and to determine whether healthcare workers (physicians and nurses) render health information during their daily routine works.

PATIENTS AND METHODS

This cross-sectional descriptive study was carried out from July to October 2012 in University of Benin Teaching Hospital, Benin City, Nigeria among 108 caregiver and child (ages 0-5 years) pairs admitted in the paediatric wards of the hospital for common childhood illnesses. A semi-structured interviewer-administered questionnaire was used to obtain data from the caregivers. Each child's case note was then reviewed to extract data on child's disease diagnosis and to check and categorize whether the attending physician(s) documented the content of health information provided to the caregivers. Analysis of data was done using Statistical Package for Social Sciences version 16.

RESULTS

The children were 48 males and 60 females with mean age [SD] 19.6 [15.4] months. The caregivers mean age [SD] was 32.1[7.1] years (range 15-60 years). Majority (38.0%) of the caregivers had at least secondary or tertiary education. Two-thirds of the caregivers correctly mentioned names of diseases of their children; and 25/108(23.1%) received health information from the healthcare providers. Caregivers with primary or no formal education significantly did not know the correct names of the child's disease when compared with caregivers with either secondary or tertiary education (OR=2.8, p=0.03). There was no documentation of the content of health information rendered by the healthcare providers during their routine work.

CONCLUSIONS

Physicians should provide health information to all caregivers especially those with lower level of education. All cadres of health workers should be encouraged to give health information to health seekers utilising their facility.

Trend in asthma severity in steroid naive asthmatic children in Benin city, Nigeria

BACKGROUND

Asthma imposes heavy health burden on children and families worldwide. It is a chronic inflammatory airway disease and as such, treatment of the asthmatics is aimed at relieve of bronchoconstriction and inflammation. Until about a decade ago, emphasis was on the bronchoconstriction rather than the inflammation.

OBJECTIVE

To determine the trend in severity of asthma in steroid naive children, in an era when steroid use in the treatment of asthma was uncommon.

MATERIALS AND METHODS

Case notes of patients managed for asthma from 1985 to 1995 and age 5 - 16 years were retrieved and reviewed (these case notes are usually stored in Prof. O. Oviawe's office). Information extracted included age of onset of asthma, severity of asthma and drug medication at presentation and at 1 year. The GINA Guideline (2006) was used in classifying the asthma severity.

RESULTS

A total of 77 patients satisfied the criteria for the study. Of these, 53 were males and 24 females. Males: Female ratio was 2.3:1; age range 5 - 16 years; mean age ± SD (8.5 ± 3.13 years). At presentation, 48 (62.3%) patient had intermittent, 29 (37.7%) had persistent asthma, of these, 25 (86.2%) had mild persistent and 4 (13.8%) had moderate persistent. None had severe persistent asthma. At 1 year follow-up, 29 (37.7%) now had intermittent asthma, while 44 (57.1%) had persistent asthma, of these, 23 (52.3%) had mild persistent, 20 (45.5%) had moderate persistent, while 1 (2.3%) had severe persistent. Medication therapy was β2-agonist in 72 (93.5%) patients.

CONCLUSION

The study supports progressive pathologic process possibly inflammatory in origin. It is opined that steroid naivity led to the trend seen in this study and judicious use of corticosteroids would have arrested the trend.

Migrating foreign body in the tracheobronchial tree of childen: report of two cases

Tracheobronchial foreign bodies (FBs) especially in infants and children can cause respiratory obstruction and can lead to death if intervention is delayed. Two cases of migrating FBs in the tracheobronchial (T-b) tree with fatal outcome are reported: Case 1 was an 11-year-old girl with a ten-week history of episodes of fever, cough, breathlessness and progressive weight loss. No positive history of FB aspiration. She was cachetic and febrile with short attention span, dyspnoeic, a flattened left upper hemithorax, mediastinal shift and evidence of atelectasis. Case 2, a 5-year-old girl with a three-month history of aspiration of a tiny toy. She developed fever, cough and marked weight loss, developed severe respiratory distress three days prior to presentation. She was febrile, had grade II finger clubbing, markedly dyspnoeic, left mediastinal shift, and evidence of left sided atelectasis. X-ray films in Case 1 showed evidence of FB at various locations in the T-b tree, and complete opacification and atelectasis of left hemithorax in Case 2. Planned bronchoscopy could not be done as both patients were adjudged to be too severely ill for the procedure. Both patients died after 9 days and 8 hours of hospital stay, respectively. Postmortem revealed FB in right main bronchus in both patients (tooth and toy, respectively) and evidence of tuberculosis in Case 2. Fatal outcome is attributed to inappropriate healthcare seeking behaviour, lack of medical expertise and material resources in our health facilities.

Is childhood asthma underdiagnosed and undertreated?

Underdiagnosis of asthma may lead to inappropriate management including undertreatment, and consequently to high morbidity and mortality. This study aimed at determining the rates of diagnosis and treatment of childhood asthma among medical practitioners. Relevant information on 45 asthmatic children was collected using pre-tested questionnaires. There were 30 (66.7%) males and 15 (33.3%) females (M:F, 2:1). Mean age, average ages for onset of symptoms and diagnosis of asthma were 9.4 years, 1.8 years and 6.6 years respectively. An average of 4 previous medical consultations were undertaken for asthma symptoms, but only 11 (24.4%) cases were labeled as asthma. Alternative diagnostic labels including allergy, bronchitis (wheezy), pneumonia (chest infection), and tuberculosis, were used in 29 (64.4%). Five (11.1%) cases were unlabelled. Alternative labeling for asthma was associated with frequent usage of non-bronchodilator medications including antihistamines, antibiotics, antituberculous drugs, cough mixtures, and herbal concoctions. Only 15 (33.3%) cases received bronchodilators, rarely prescribed regularly in the absence of asthma label. This study reveals low diagnosis and treatment rates for asthma, emphasising the need to audit the management of childhood asthma among medical practitioners, with the view of providing information.

Trend in childhood tuberculosis in Benin City, Nigeria

In order to determine the trend in childhood tuberculosis, case records of children diagnosed and treated for tuberculosis between January 1981 and December 1995 at the paediatric tuberculosis clinic of the University of Benin Teaching Hospital were reviewed. Of 8,829 paediatric medical cases, 1,026 (11.6%) were managed as tuberculosis. The proportion of tuberculosis cases increased steadily over the study period from 6.9% in 1981 to 22.1% in 1995. An apparent decrease in the number of cases in 1985 (6.6%) was attributable to a strike by medical personnel. The clinical pattern of tuberculosis during the study period shifted toward the adult type with disseminated and cavitating lesions predominating in later years. Additionally, the severity of the disease increased with the incidence of both haemoptysis and finger clubbing increasing from 1.6% in 1981 to 14.2% and 18.2%, respectively, in 1995. Possible reasons for these findings include increased prevalence of malnutrition in childhood, increasing tuberculosis in the adult population and the effects of HIV/AIDS.

Orbitocephalic metastases from neuroblastoma: report on three cases

Three unusual cases of Neuroblastoma with metastasis to the skull and orbit are presented. The bizarre clinical features which make diagnosis and subsequent management difficult are highlighted, suggesting the need for a multi-disciplinary approach.

The problem of non-attendance at a paediatric tuberculosis outpatient clinic

A total of 146 children receiving treatment for pulmonary tuberculosis at the University of Benin Teaching Hospital over a 5-year period were studied in order to determine the pattern of attendance, factors responsible for non-completion of treatment and the health status of non-attenders. There were 70 (48%) non-attenders and the mean duration of treatment before default was 20 weeks (range: 4-60). The factors mitigating against treatment completion included low maternal education level, disruptive family events and equating disappearance of the tuberculosis symptoms with cure of the disease. Of the non-attenders, 51 (72.9%) practised self-medication with the anti-tuberculosis drugs, often given intermittently and beyond the period otherwise allowable. Nineteen of the 70 patients who defaulted still had major health problems at the time of home visit. Of these, five were later hospitalized while the others were given fresh appointments. We conclude that supervision of treatment at home will minimize non-attendance but at the moment this service is not available at the study locale because of inadequate resources and the magnitude of the tuberculosis problem.

Polypharmacy: its cost burden and barrier to medical care in a drug-oriented health care system

In order to determine the economic and therapeutic implications of the prescriber habit in a drug-oriented health care system, data were collected on the provisional diagnosis, prescribed drugs, and their cost and procurement pattern among 1450 pediatric outpatients in a Nigerian University Teaching Hospital. It was found that on average, about five drugs were prescribed for each patient, and there was a tendency to prescribe more expensive and sometimes unnecessary drugs. The more the number or higher the cost of drugs prescribed, the less patients procured them. It is therefore recommended that health care authorities and physicians in similar settings should review their drug policies and prescribing habits in order to discourage polypharmacy and the high cost of chemotherapy, with their attendant barrier to medical care.

The changing pattern of post-partum sexual abstinence in a Nigerian rural community

With a structured interview schedule, this study surveyed the pattern of post-partum sexual abstinence in a Nigerian rural community where facilities for active contraception were absent. It was found that the younger generation observed significantly shorter abstinence period (P less than 0.01). Without contraception, the resultant increased period of sexual contact among couples may considerably raise the fertility of the population. The need for family planning services is therefore indicated, preferably integrated into primary health care programmes designed to reach rural communities.

Pneumatocoeles associated with pneumonia: incidence and clinical course in Nigerian children

One hundred and twenty cases of pneumatocoele, admitted, treated and followed-up at the Lagos University Teaching Hospital in 1981 are presented. Radiologically the pneumatocoele cases were associated with either the bronchopneumonic or lobar/segmental pattern of pneumonia. There were significant differences between these patterns in respect of the time of occurrence, size and number of pneumatocoeles and associated bacterial agents. The contribution of measles infection to the development of pneumatocoele is noted. Although the ultimate course of pneumatocoele was towards spontaneous resorption, the process was slow in most of our patients. This was attributed to the poor nutritional status of the majority of them.