Co-occurrence of non-communicable disease risk factors among adolescents in Jos, Nigeria

BACKGROUND

The co-occurrence and clustering of risk factors for non-communicable disease (NCD) is a global public health concern.

AIM

This study aimed to assess the co-occurrence and clustering of risk factors for NCDs among in-school and out-of-school adolescents in Jos North Local Government Area, Plateau State, Nigeria.

SETTING

Secondary schools and markets in Jos North Local Government Area.

METHODS

A comparative cross-sectional study was conducted among 377 in-school and 377 out-of-school adolescents, aged 10-19 years of age. An interviewer-administered questionnaire was used to collect information on behavioural and physical risk factors for NCDs. Chi-square and Mann-Whitney U tests were used for comparisons at a 5% level of significance. Statistical analysis was carried out using Statistical Product and Service Solutions (SPSS) version 23.0.

RESULTS

Of the 754 sampled adolescents, 386 (51.2%) were females and 368 (48.8%) were males. Adolescents aged 10-14 years made up 37.8% of the participants, 15 to 17 years of age accounted for 46.9% and 18-19 years 15.3%. Risk factors with the highest prevalence were a sedentary lifestyle (94.2%) and an unhealthy diet (92.4%). Majority (97.2%) had two or more risk factors while 1.9% of adolescents had no risk factor. More in-school adolescents (24.1%) had two risk factors compared to 14.1% of out-of-school adolescents (p 0.001); 14.1% of out-of-school adolescents had five or more risk factors compared to 2.9% of those in school (p 0.001).

CONCLUSION

Co-occurrence and clustering of behavioural and physical risk factors was found among both in-school and out-of-school adolescents.Contribution: This study highlighted the burden of risk factors for NCDs among both in-school and out-of-school adolescents in the North-Central part of Nigeria. This is especially useful in developing targeted interventions to tackle these risk factors.

Perceptions of Nigerian medical students regarding their preparedness for precision medicine: a cross-sectional survey in Lagos, Nigeria

BACKGROUND

Advances in precision medicine in Nigeria suggest improving genomics education and competency among healthcare practitioners to facilitate clinical translation. Due to the scarcity of research in this area, this study aimed to assess Nigerian medical students' perceptions about their preparedness to integrate precision medicine into their future clinical practice.

METHODS

This was an institution-based cross-sectional study of medicine and surgery students in their clinical years attending the two fully accredited colleges of medicine in Lagos, Nigeria, between April and October 2022 using an adapted tool administered via Google Forms. The survey assessed their awareness, perceptions about knowledge, ability, and attitudes toward precision medicine, ethical concerns, and perceptions about their education in precision medicine. Multivariate linear regression models were used to assess factors associated with students' perceptions of their knowledge, ability, and attitudes.

RESULTS

A total of 300 students completed the questionnaires with a response rate of 40%. Awareness of genomic medicine terminology was high (92.0%). Responses to knowledge and ability questions revealed notable gaps, however, respondents had positive attitude scores overall. Higher medical school year was independently associated with lower knowledge (ptrend = 0.003) and ability (ptrend = 0.005) scores, and knowledge score was independently associated with a higher ability score (β: 0.76 95%CI: 0.67, 0.84; p < 0.001). Attitude scores significantly increased with increasing medical school year (ptrend = 0.04). The respondents mostly indicated concerns about government and corporate bodies' misuse of genomic data (35.7%) and the widening of socioeconomic disparities (34.0%). Although 65.0% of the respondents thought it important to learn about precision medicine, only 11.3% felt that their education had adequately prepared them for precision medicine, knew who to ask questions regarding genomic testing (10.7%), and felt their professors had encouraged the use of precision medicine (10.3%).

CONCLUSION

Despite high awareness of precision medicine terminology and overall positive attitudes, our findings highlight gaps in knowledge and ability to integrate genomics into the care of patients and a need to improve precision medicine education among Nigerian medical students.

POST-OPERATIVE INTENSIVE CARE UNIT ADMISSION FOR ELECTIVE BRAIN TUMOUR SURGERIES: A NIGERIAN NEUROSURGICAL UNIT EXPERIENCE

Background

Patients, post elective brain tumour surgeries, are usually admitted into the Intensive Care Unit (ICU) for quick identification of life-threatening complications or for elective ventilation. The Covid-19 pandemic exerted additional strain on the limited ICU spaces. This study was to probe the need for ICU admission following elective surgery for brain tumour in our environment on the background of enormous constraints.

Methods

Data was collected prospectively from patients who had elective brain tumour surgery over 12-months at the University College Hospital, Ibadan. Data included the indications for ICU admission and outcome. Chi-square test and Student t-test were used for analysis at α ≤ 0.05.

Results

There were 56 patients with a mean age of 44.6 years and M:F ratio of 1:1. 61.8% of the patients were admitted into the ICU for observation. Patients who had open surgeries were 2 times more likely to be admitted (p<0.01; OR = 2.2, CI: 2.0 - 36.8) than those who had endoscopic surgeries. Awake craniotomy patients did not require ICU care compared with the 63% of the patients who had General Anaesthesia + Endo Tracheal Tube (GA+ETT). Patients with skull base and posterior fossa tumours were more likely to be admitted into the ICU (p=0.036). Of the 34 patients admitted into the ICU, 11(19.6%) had prolonged ICU stay and were 2 times more likely to die compared with those with short admissions (p<0.01; OR = 2.5, CI: 2.29 - 70.02).

Conclusion

Observation is the main reason patients are admitted into the ICU. The endoscopic and awake surgery approaches appear to preclude the need for ICU admission, thus capable of cutting costs.

CHALLENGES OF RENAL REPLACEMENT THERAPY IN NIGERIA: SOLUTIONS FROM MEDICAL STUDENTS' PERSPECTIVES

Introduction

During our posting at the Renal Unit, Department of Medicine, University College Hospital, Ibadan, we observed numerous difficulties encountered by patients requiring renal replacement therapy and the family members/caregivers of these patients. These are broadly categorized into patents' related challenges, institutional inadequacies, infrastructural challenges, policy, and funding issues.

Perspective

Patients' challenges are poor health-seeking habits culminating in late diagnosis in advanced uremic state and poor economic status resulting in catastrophic out-of-pocket spending. Institutional and infrastructural challenges include epileptic power supply in the dialysis unit, a lack of necessary materials needed for dialysis, among others. Policy issues included the absence of an organ donor system and regulations guiding them. More importantly, there is insufficient support from the government concerning patients with end-stage kidney disease.

Conclusion

Tackling the management of end-stage kidney disease would require paying attention to and addressing these challenges.

Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria

BACKGROUND

Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship.

AIM

This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria.

SETTING

This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria.

METHODS

After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice.

RESULTS

The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life.

CONCLUSION

This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function.Contribution: This study contributes to holistic approaches to patient care.

Investigating physician self-referral in public hospitals in South East Nigeria: Insights from stakeholders

BACKGROUND

Physician self-referral occurs where a full-time paid doctor diverts patients from one hospital to another in which he or she has financial interest.

AIM

This study is aimed at investigating the views of service users, physicians and policymakers on physician self-referral practice in public hospitals in Nigeria.

SETTING

The study was carried out in Enugu urban area of South East Nigeria.

METHODS

A mix of qualitative and quantitative methods was used to collect information from different categories of stakeholders. Service user views were explored through analysis of four focus group discussions involving 26 participants and 407 questionnaires completed with household members who had recently visited a public hospital and then gone to private hospitals. In-depth interviews were completed with 15 public sector doctors not involved in dual practice and eight key policymakers.

RESULTS

Thirty-four of 407 respondents (8.4%) visiting a public hospital were diverted to a private facility associated with the attending public hospital doctor. The research examined age, gender and socio-economic status (SES) as factors that might influence the likelihood of patient diversion. Advice to transfer to a private clinic usually came directly from the doctor involved but might also come from nurses.

CONCLUSION

Physician self-referral in Nigeria could take different forms. It was found that both direct and indirect forms of diversion exist, suggesting that this is an organised practice in which dual-practice doctors and supporting hospital staff members cooperate. The study recommends, among other things, that service users should be adequately protected from any form of diversion to private practice by the public system employee doctors.Contribution: This study contributes to understanding the extent and pattern of patient diversion in public hospitals in Nigeria. The findings reveal coordinated tactics for diverting public hospital patients and provide a direction for future research in negative behaviour among healthcare professionals in Nigeria.

CIVILIAN GUNSHOT OROFACIAL INJURY IN A NIGERIAN TERTIARY HOSPITAL: A 10-YEAR RETROSPECTIVE REVIEW

Background

Gunshot related injuries to the face are relatively rare in peacetime. This study reported the pattern of presentation and management of orofacial civilian gunshot injuries at a Nigerian tertiary hospital.

Methodology

Medical records of 25 patients who sustained gunshot injuries to the face and were managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife between 2010 and 2019 were reviewed. Patients' demographics, wounding mechanisms, clinical presentations and treatment administered were retrieved from the patients' case record. Patient records with incomplete information were excluded. Data generated were inputed into IBM-SPSS version 26 and analysed.

Results

A total of 2,847 patients were admitted through our department over the study period and 28 of them sustained orofacial gunshot injuries, giving a prevalence of 0.98%. Twenty-five out of the 28 retrieved case files met the inclusion criteria. There were 22 males and 3 females; with a male to female ratio of 7.3:1. The mean age was 37.60 ± 11.86 years with highest prevalence at fourth decade of life. About two-thirds of these injuries were intentionally inflicted by others with the use of Dane guns on highways. Majority (64%) of these injuries involved the middle third of the face. Definitive treatments ranged from simple to complex reconstructive procedures to restore pre-injury form and functions.

Conclusion

Gunshot injury involving the maxillofacial region is uncommon during peace time. The male gender was predominantly affected and the middle third facial skeleton was the most involved anatomic site. Most of the injuries were intentionally inflicted by others using Dane gun.

REOPENING OF EDUCATIONAL INSTITUTIONS AMID THE COVID-19 OUTBREAK: NIGERIA'S PREPARATION FOR THE MITIGATION OF SCHOOL-ASSOCIATED COVID-19 RISKS

The global spread of the novel Coronavirus disease (COVID-19) has necessitated the implementation of non-pharmaceutical public health measures globally, including school closure. After five months of school closures, the Nigerian government is planning towards the suspension of school lockdown. However, in a bid to ensure that schoolchildren are academically equipped, and measures such as adequate ventilation, handwashing, social distancing, and increased infrastructure need to be implemented to ensure that school reopening does not result to a spike in COVID-19 cases and fatalities in Nigeria.

KNOWLEDGE, ATTITUDE AND PRACTICE OF NIGERIAN MEDICAL STUDENTS TOWARDS COMPLEMENTARY AND ALTERNATIVE MEDICINE IN COVID-19 MANAGEMENT

OBJECTIVE

Complementary and alternative medicine (CAM) is commonly used, but many physicians have limited knowledge of CAM despite its widespread use. Therefore, this study sought to assess the knowledge, attitude, and practice of medical students on complementary and alternative medicine in the management of COVID-19.

METHODOLOGY

A descriptive cross-sectional study was conducted among 150 medical students from three Federal Universities in South West, Nigeria. A self-administered semi-structured online Google Forms questionnaire was used to collect information. Chi-squared and Fisher's exact test was used to analyze the bivariate relationship between KAP status and sociodemographic characteristics. Spearman's correlation coefficient matrix was computed to determine the association between knowledge, attitude, CAM, age, and religiosity practice.

RESULTS

The median age was 22 years (interquartile range: [IQR]: 21-23 years). Median self-rated score for religion was 4.00 (IQR: 3.00-4.25). Median knowledge score was 4.00 (IQR: 3.75-5.00), median attitude score 2.75 (IQR: 2.38-3.00) and median practice score 2.00 (IQR: 1.00-2.00). Thirty-seven respondents (24.7%) were considered to have poor knowledge about CAM use in COVID-19 while the rest (75.3%) had good knowledge. Thirty-eight (25.3%) had a poor attitude towards using CAM in COVID-19 and 112 (74.7%) had a good attitude.

CONCLUSION

Medical students have good knowledge and a positive attitude towards CAM modalities as adjunct management for COVID-19. However, their practices do not reflect wide acceptability. There is a need for clinical trials on the efficacy of CAM as an adjunct treatment for COVID-19 to further inform its use.

EFFICACY AND SAFETY OF LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY FOR TREATMENT OF VASCULAR ERECTILE DYSFUNCTION IN NIGERIAN MEN: REPORT OF A STUDY IN IBADAN, SOUTH-WEST NIGERIA

Background

Low Intensity Extracorporeal Shock Wave Therapy (LI-SWT) has been found to be effective in men with vascular erectile dysfunction (ED) but its efficacy and safety has not been investigated in a predominantly black population so we sought to study this.

Materials and Methods

Men with vascular erectile dysfunction (ED) were assessed using the five-item International Index of Erectile Function (IIEF) score after which they were treated with 12 sessions of LI-SWT. Treatment efficacy was evaluated immediately after treatment, at 1 month and 6 months after using the IIEF questionnaire. 30 persons were recruited out of which 22 completed the study.

Results

Mean IIEF score improved from 8.27±2.741 at baseline (pre-treatment) to 10.43±8.43 one month post treatment and was sustained six months post treatment at mean IIEF score of 10.70 ± 8.84. A larger no (86.4%) had an improvement of at least 5 in the IIEF score from baseline to 6 months -post treatment. None of the participants reported any adverse effects of treatment.

Conclusion

Low intensity shock wave treatment is a useful addition to the medical armamentarium for the treatment of vascular ED.

PATTERN OF SPEECH ARTICULATION ERRORS IN NIGERIAN INDIVIDUALS WITH CLEFT LIP AND OR PALATE ANOMALIES FOLLOWING REPAIR

The occurrence of cleft lip and palate anomaly can impact on an affected individual's quality of life. Cleft of the palate particularly significantly affects the production of speech. This article aims to describe the speech errors following palatoplasty procedures observed from cleft centres within Nigeria. Ability to produce high pressure sounds, frequencies of speech errors and speech intelligibility were analysed from data collated from five cleft centres. The speech services in these centres were provided in partnership with Smile Train, a nongovernmental organization based in the United States of America. Glottal stop was the commonest speech error while the speech intelligibility was considered mild in the majority of cases. This report serves as a form of preliminary overview of the speech pattern of individuals with repaired cleft palate in our environment.

Knowledge and factors influencing long-acting reversible contraceptives use among women of reproductive age in Nigeria

Background: Approximately 48% of unintended pregnancies occur as a result of contraceptives failure around the world, which is mostly due to incorrect use, poor adherence, and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap. The main aim of this study is to identify factors associated with the use of LARCs among women of reproductive age and to examine the relationship between knowledge of LARCs and the current use of LARCs in Nigeria. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. The survey was conducted out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women that met the inclusion criteria was 1927. The data were analyzed using frequency distribution, chi-square, and logistic regression at a 5% level of significance. Results: The results showed that 21.0% of women were using traditional methods. 14.8% of the sampled women were using LARCs methods. Findings further showed that at both levels of analyses, there is a significant relationship (P<0.05 and P=0.00 for binary and logistic regression, respectively) between knowledge of LARCs and the use of LARCs. This means that knowledge of LARCs and socio-demographic variables among women of reproductive age in Nigeria can influence the use of LARCs. Conclusions: We concluded in this study that 14.8% of women using contraception were using LARCs. Additionally, the level of education, age of women, household wealth, and the number of living children were significantly associated with using LARCs in Nigeria. Also, when discussing contraception with women, health care practitioners should discuss the risks and benefits of LARCs with women of reproductive age and recommend them as a first-line method.

Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Background: Approximately 48% of unintended pregnancies occur as a result of contraceptive failure around the world, which is largely due to incorrect use, poor adherence and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap because it's not dependent on compliance with a pill-taking regimen; remembering to change patch or ring; or fixing an appointment with physicians. The main aim of this study is to identify the factors influencing the women associated with use of LARC and to examine the relationship between knowledge of LARC and its current use. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. PMA 2016 was a survey carried out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women meeting inclusion criteria in this study was 1927. The data were analyzed using frequency distribution, chi-square and logistic regression at 5% level of significant. Results: The results showed that 21.0% of women were using traditional methods. Concerning LARC methods, the table showed that 14.8% of the sampled women were using LARC methods. Findings further showed that at both levels of analyses there is a significant relationship (P<0.05 and P=0.00 for binary and multivariable logistic regression, respectively) between knowledge of LARCs and uses in this study. This means that knowledge of LARC & other socio-demographic variables among women of reproductive age in Nigeria can influence the use of it. Conclusions: From the result of the study we concluded that 14.8% of women using contraception were using LARC. Additionally, level of education, age of women, household wealth and number of living children were significantly associated with using LARC.

PERCEPTION OF IN-SCHOOL ADOLESCENTS ABOUT ADOLESCENTFRIENDLY CHARACTERISTICS OF HEALTHCARE SERVICES RECEIVED IN IBADAN METROPOLIS, NIGERIA

INTRODUCTION

Adolescence was previously assumed to be a diseases free stage of life. It is however now known that adolescents are not only involved in risky health behaviours but they also have their own share of health problems that other age groups face. The adolescent-friendly model helps to create adolescent-responsive health systems, Nigeria currently has no country-specific report on the adolescent-friendly characteristics of the health services rendered to her adolescents. This study identified various health problems for which in-school adolescents in Ibadan North- East Local Government Area sought healthcare and determined their perception of received healthcare services with regards to its "adolescent-friendliness".

METHODS

This was a school-based cross-sectional study that utilized quantitative method of data collection. A multi-stage systematic random sampling technique was employed to select 500 students for school survey. Self-administered, semistructured questionnaire was used to collect data. Descriptive statistics and Chisquare test at α=0.05 were used for data analysis.

RESULTS

Perceived malaria (52.4%), acne (36.2%), menstrual pain (17.0%) and depression (3.0%) were the common health problems adolescents sought health care for. Majority of the adolescents perceived the health services received as being adolescent-friendly. These health services were perceived to be accessible by (87%), acceptable by (93.2%), appropriate by (81.4%), effective by (91.4%), and equitable by (82.2%) of the respondents. Adolescents who sought mental care perceived least adolescent-friendliness of received healthcare services.

CONCLUSION

Adolescents in Ibadan currently view received health services as adolescent-friendly. However, the management of mental health problems in adolescents should incorporate adolescent friendly elements entrenched at every level of the health system.

REFRACTIVE ERRORS AMONG CHILDREN ATTENDING A TERTIARY EYE FACILITY IN IBADAN, NIGERIA: HIGHLIGHTING THE NEED FOR SCHOOL EYE HEALTH PROGRAMS

BACKGROUND

It is estimated that 19 million children aged below 15 years are visually impaired globally. Twelve million of these are due to uncorrected refractive errors. The aim of this study was to describe the pattern of refractive errors seen in children attending the eye clinic of the University College Hospital, Ibadan, Nigeria.

METHODS

A descriptive retrospective study of children with refractive errors seen between January 2011 and December 2012 was conducted. Information on the age, sex, type of refractive error, degree of error (spherical equivalent), presenting complaint, previous spectacle use and return for follow-up visit were retrieved and analyzed using SPSS version 20.

RESULTS

Three hundred and sixty-six children diagnosed with refractive errors accounted for 34.6% of all children seen. Of these, 267 (73%) records were successfully retrieved. The mean age was 10.58 (± 3.14) years, with 156 (58.5%) aged between 11 and 15 years. The male to female ratio was 1:2. The commonest refractive error was myopia, found in 124 (23.2%) of 534 eyes followed by simple myopic astigmatism and compound myopic astigmatism found in 117 (21.9%) and 111 (20.8%) eyes respectively. Majority, 229 (85.8%) had never worn spectacles previously and only 80(30%) children returned for a follow up visit.

CONCLUSION

Refractive errors constitute a common diagnosis among children seen in our tertiary eye facility. Late presentation and poor follow up among our patients are a cause for concern. Public enlightenment, health education and school eye programs are recommended to reverse this trend.

Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Background: Over a month when contraception is used, approximately 48% of unintended pregnancies occur as a result of human error, which is largely due to incorrect use, poor adherence and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to bridge this gap because it's not dependent on compliance with a pill-taking regimen; remembering to change patch or ring; or fixing an appointment with physicians. The main aim of this study is to examine the characteristics of women associated with use of LARC and also to examine the relationship between knowledge of LARC and its current use. Methods: This study assessed the PMA2020 secondary dataset using female datasets from PMA 2016 (Round 3) exercise. PMA 2016 was a survey carried out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using any method of contraception prior to the survey. The weighted sample size of women meeting inclusion criteria in this study is 1927. The data were analyzed using frequency distribution, chi-square and logistic regression. Results: The results showed that 21.0% of women were using traditional methods. Concerning LARC methods, the table showed that 14.8% of the sampled women were using LARC methods. Findings further revealed that at both levels of analysis there is a significant relationship (P<0.05 and P=0.00 for binary and multivariable logistic regression, respectively) between knowledge of LARCs and uses in this study. This means that the use of LARC is being influenced by its knowledge among women of reproductive age in Nigeria. Conclusions: This study concludes that 14.8% of women using any methods of contraceptive were using LARC. Additionally, after controlling for other confounding factors, level of education, age of women, household wealth and number of living children were significantly associated with using LARC.

MISSED OPPORTUNITIES FOR INTERMITTENT PREVENTIVE TREATMENT FOR MALARIA IN PREGNANCY IN NIGERIA: EVIDENCE FROM DEMOGRAPHIC AND HEALTH SURVEY IN NIGERIA 2013

BACKGROUND

Malaria is of global health concern particularly among pregnant women. Nigeria contributes largely to global burden but coverage of Intermittent Preventive Treatment of malaria in pregnancy using Sulphadoxine pyrimethamine remains low. This study was conducted to determine the national situation of missed opportunity for IPTp-SP and attempted to look at correlates and predictors.

METHOD

The study used secondary data analysis of the Nigeria Demographic Health Survey, 2013. Data on socio-demographics, ANC characteristics and IPTp-SP use during pregnancy among 6,910 women aged 15-49 years who delivered in the last two years with at least 4 ANC visits were analyzed. Missed opportunity for IPTp delivery was defined as an ANC visit where IPTp was not delivered as per the policy. Data was analyzed using SPSS version 21. Associations used Chi-square test and significant variables were fit into multi-variate logistic regression model. All analyses were performed at 5% level of significance.

RESULTS

National prevalence for missed opportunity for IPTp-SP was high (73.4%). Predictors of missed opportunity are being of poorer, middle and richer wealth index (OR=0.737, CI 0.566-0.960); (OR=0.659, CI 0.521-0.833); (OR=0.686, CI 0.550-0.857), residence in South East OR=0.549, CI (0.415-0.726) and in the North West (OR=0.176, CI 0.133-0.232). Other predictors are having a primary and secondary education and presenting for the first ANC visit in the second trimester OR=0.739, p=0.024, CI (0.569-0.961).

CONCLUSION

Missed opportunity for IPTp-SP was high. The need for stronger governmental commitment to upscale uptake of IPTp-SP by incorporating the knowledge of socio-economic, cultural and demographic barriers to accessing IPTp is paramount.

Sero-epidemiological survey and risk factors associated with bovine brucellosis among slaughtered cattle in Nigeria

Bovine brucellosis is endemic in Nigeria; however, limited data exist on nationwide studies and risk factors associated with the disease. Using a cross-sectional sero-epidemiological survey, we determined the prevalence of and risk factors for brucellosis in slaughtered cattle in three geographical regions of Nigeria. Serum samples from randomly selected unvaccinated cattle slaughtered over a period of 3 years (between December 2010 and September 2013) from northern, southern and south-western Nigeria were tested for antibodies to Brucella abortus using the Rose Bengal test. Data associated with risk factors of brucellosis were analysed by Stata Version 12. In all, 8105 cattle were screened. An overall seroprevalence of 3.9% (315/8105) was recorded by the Rose Bengal test, with 3.8%, 3.4% and 4.0% from the northern, southern and south-western regions, respectively. Bivariate analysis showed that cattle screened in northern Nigeria were less likely to be seropositive for antibodies to Brucella spp. than those from south-western Nigeria (odds ratio = 0.94; 95% confidence interval: 0.73–1.22). However, logistic regression analysis revealed that breed ( p = 0.04) and sex ( p £ 0.0001) of cattle were statistically significant for seropositivity to Brucella spp. The study found that brucellosis was endemic at a low prevalence among slaughtered cattle in Nigeria, with sex and breed of cattle being significant risk factors. Considering the public health implications of brucellosis, we advocate coordinated surveillance for the disease among diverse cattle populations in Nigeria, as is carried out in most developed countries.

EXPERIENCE OF INTIMATE PARTNER VIOLENCE AS A PREDICTOR OF SEXUALLY TRANSMITTED INFECTIONS AMONG MARRIED WOMEN IN NIGERIA

BACKGROUND

Intimate partner violence (IPV) is an important public health issue that is associated with adverse sexual and reproductive health outcomes including sexually transmitted infections (STIs). STIs have recently gained more recognition worldwide because they increase the risk for HIVinfection. However, there is dearth of information on the association between IPV and STIs particularly among married women in Nigeria.

OBJECTIVE

To determine the association between IPV and STIs among married women in Nigeria.

METHOD

This was a secondary data analysis of the 2008 Nigeria Demographic and Health Survey (NDHS) dataset. A total of 18,402 married women aged between 15 and 49 years were included. Questions about intimate partner violence were adapted from the Conflict Tactic Scale (CTS). Multiple logistic regression models were used to determine relationship between IPV and self-reported STIs.

RESULTS

The prevalence of IPV among married women in Nigeria was 29.3%. Majority of the women experienced emotional violence (22.1%), 17.3% of the women experienced physical violence while the least experienced form of violence was sexual IPV (4.4%). Majority (60.1%) of the women experienced just one type of IPV, 30.0% two types, 9.9% all three types. The prevalence of self-reported sexually transmitted infections was 7.2%. Logistic regression demonstrated that after controlling for other covariates, women who experienced any form of IPV were found to be more likely to report STI than women who did not [OR 1.357 (95% CI 1.188-1.551)]. In addition, experience of physical and sexual IPV was significantly associated with history of STIs [OR 1.699 (95% CI 1.420-2.034); OR 1.414 (95% CI 1.085-1.843) respectively]. Experiencing two or more types of IPV was significantly associated with history of STIs [OR 1.759 (95% CI 1.446-2.139); OR 2.193 (95% CI 1.636-2.941) respectively].

CONCLUSION

There is a need to incorporate IPV screening and services in STI clinics. Also, it is important to screen for STIs among women who present with IPV particularly those with multiple types of violence.

Awareness of family planning amongst antenatal patients in a nigerian community: an exploratory study

AIM

This study aimed at determining the awareness about family planning amongst pregnant women presenting to the antenatal clinic of Federal Medical Centre, Owo, Ondo State, Nigeria.

METHODOLOGY

The study was conducted between December, 2007 and February, 2008 at the antenatal clinic of the hospital. Ethical clearance was obtained from the Ethical Review Committee of the hospital prior to commencement of the study. The information was obtained from the respondents with the aid of a pre-tested semi-structured questionnaire which included their bio-data, awareness and the sources of awareness about family planning .Other information obtained were reasons for family planning as well as knowledge about the different methods of family planning. The information obtained with the study instrument (questionnaire) was collated and analyzed with SPSS statistical software version 12.0.1.

RESULTS

Most respondents (89%) were aware of family planning. The majority of the respondents:42 (47.2%) received information about family planning from health workers while 21(23.6%) received the information through the media. Most of the respondents (74%) knew about condom. The level of education significantly affected the awareness about family planning with a p value of 0.017.

CONCLUSION

Most respondents were aware of family planning. The media should play a more prominent role in creating awareness amongst the populace about family panning.

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

Measles case-based surveillance and outbreak response in Nigeria; an update for clinicians and public health professionals

The Federal Ministry of Health recommendations for response during measles epidemics in Nigeria previously focused on case management using antibiotics and Vitamin. A supplements and did not include outbreak response immunization (ORI) campaigns. However, with the revision of the existing national technical guideline on measles casebased surveillance and outbreak response in Nigeria in 2012 in line with the World Health Organization recommendation on response to measles outbreak in measles mortality reduction settings, there is a need to update members of the Nigerian public health community on these revisions to ensure appropriate implementation and compliance. This article therefore seeks to provide clinicians and other public health professionals in Nigeria with updates on recent developments in measles case-based surveillance and outbreak response in Nigeria.

Prevention of sexual assault in Nigeria

Sexual assault occurs commonly worldwide and is particularly pervasive in the developing world. The background to sexual violence is important in the understanding of the ramifications of the problem. Some elements that offer the means to the prevention of sexual assault in the community are important highlights especially where the means - expertise and facilities - for managing cases of sexual assault is grossly inadequate. These concepts, though are applicable universally, are however discussed in the context of the developing world and with particular emphasis on the Nigerian situation. Their applicability in sexual assault prevention is derived from previous studies in different parts of the world that highlight the viability of these interventions. Therefore if one posits that sexual assault can be prevented, certain responsibilities are imperative; some challenges must be anticipated; and special needs/circumstances should be catered for.

HIV and HBsAg Seropositivity Amongst Patients Presenting for Ocular Surgery at a Tertiary Eye Care Hospital in Nigeria

BACKGROUND

The prevalence of HIV/AIDS and HBsAg sero-positivity is very high in sub-Saharan African. There is a risk of horizontal transmission of these diseases amongst ophthalmic patients.

AIM

To determine the proportion patients for eye surgery who are HIV/AIDS and HBsAg sero-positive at the National Eye Centre, Kaduna, Nigeria.

METHODS

Patients selected for eye surgery during a surgical camp at the National Eye Centre, Kaduna were counseled for Voluntary Counseling and Testing (VCT) and HBsAg to determine their viral status.

RESULTS

A total of 650 patients who were selected were screened. The distributions of the indications for selection were as follows: cataract 483 (74.3%); glaucoma 44 (6.8%) and pterygium 123 (18.9%). Two patients (0.2%) were found to be HIV seropositive while 11 (1.5%) were HbsAg positive.

CONCLUSION

Pre-operative screening of all patients going for ophthalmic surgery for HIV and HbsAg may be desirable in our environment.

Perceptions of Nigerian medical specialists on research

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed.

Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely “always” involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to “always” publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy.

Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

Reduction of client waiting time using task shifting in an anti-retroviral clinic at Specialist Hospital Bauchi, Nigeria

Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was −2.13 h, with 95% CI: −2.44:−1.82 hours and the test of significance by unpaired t-test P<0.0001.

Reduction of client waiting time using task shifting in an anti-retroviral clinic at Specialist Hospital Bauchi, Nigeria

Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001.

Evidence-based dentistry in a developing economy - the Nigerian example

BACKGROUND

Evidence-based dentistry (EBD) is becoming popular all over the world with the increasing global involvement of dental practitioners in the debates on the relevance or otherwise of EBD. However, very little has been known on the evolutionary trend of EBD in the developing countries of the world.

AIMS AND OBJECTIVES

This pilot study was designed to assess the state of EBD in the accredited dental schools in Nigeria as an example of a developing economy.

METHODOLOGY

An electronic search was conducted for articles on the subject of EBD emanating into the world dental literature from Nigeria as a measure of activities in the field of EBD in the country. Further investigation was done by way of interviews of faculty members and resident doctors in the four fully accredited dental schools in Nigeria. The subject of the interview was premised around the evaluation of activities in the field of EBD.

RESULTS

Only 6 relevant articles were found in the search. The interviews however revealed an increasing awareness but low level of knowledge of the principles of EBD in the dental schools. Major obstacles were infrastructural limitations and lack of personal motivations. The enthusiasm of the younger faculties and resident doctors was notable.

CONCLUSION

It was obvious that EBD is yet to assume the desired momentum in the 21(st) century in Nigeria. It is however gladdening that there is a promising future for EBD with the rising enthusiasm noted among the younger generation of clinicians.

Prevalence and determinants of pre-term deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria

In Nigeria, over 900,000 children under the age of five years die every year. Early neonatal death is responsible for a little over 20% of these deaths. Prematurity remains a significant cause of these early neonatal deaths. In some series, it is reported to be responsible for 60-70% of these deaths. This study aimed to determine the prevalence and determinants of pre-term deliveries at the University of Ilorin Teaching Hospital, Ilorin. This was a prospective cohort study conducted over a 9-month period at the University of Ilorin Teaching Hospital. Records of deliveries and data on maternal socio-biological and antenatal variables were collected during this period in order to determine the prevalence and determinants of pre-term deliveries. Out of the 2,489 deliveries that took place over a 9-month period, there were 293 pre-terms, giving a pre-term delivery rate of 120 per 1,000 deliveries. Of the total deliveries, 1,522 singleton deliveries that satisfied inclusion criteria were recruited; 185 of them were pre-term deliveries giving a case:control ratio of 1:7. Significant determinants of pre-term delivery identified were previous pre-term delivery (P=0.001; OR=3.55; 95% CI=1.71-7.30), antepartum hemorrhage (P=0.000; OR=8.95; 95%CI=4.06-19.78), premature rupture of the membranes (P=0.000; OR=6.48; 95%CI=4.33-9.67), maternal urinary tract infection (P=0.006; OR=5.89; 95%CI=1.16-27.57), pregnancy induced hypertension (P=0.007; OR=3.23; 95%CI=2.09-4.99), type of labor (P=0.000; OR=6.44; 95%CI=4.42-9.38) and booking status (P=0.000; OR=4.67; 95%CI=3.33-6.56). The prevalence of pre-term delivery was 120 per 1,000 live births. Factors significantly associated with pre-term delivery were low socio-economic class, previous pre-term delivery, antepartum hemorrhage, premature rupture of fetal membranes, urinary tract infection, pregnancy induced hypertension, induced labor, and booking elsewhere outside the teaching hospital.

Causes of blindness and visual impairment at the school for the blind owo, Nigeria

AIM

This study was designed to determine the causes of blindness amongst the pupils of the School for the blind ,Owo and also identify treatable causes of blindness in the study population.

METHODOLOGY

This study was conducted between November and December,2007 at the School for the blind, Owo. Ethical clearance was obtained from the Ethical Committee of Federal Medical Centre, Owo prior to carrying out this study. Sixty two pupils of the School for the blind and blind students in Owo High school were enrolled in this study. The subjects were interviewed and examined by the authors with the aid of WHO'S recording form for blindness and visual impairment in children. The data obtained with the study instrument was collated and analyzed with SPSS 12.0.1.

RESULTS

MAJORITY OF THE SUBJECTS: 55 (88.7%) were blind while the remaining 7 (11.3%) had low vision. Lens ranked highest amongst the anatomical sites of visual loss accounting for 24.2%,followed by retina (14.5%),optic nerve (12.9%) and glaucoma (12.9%).The main aetiological factors were intrauterine (37.1%) and hereditary factors (21%). The commonest single diagnosis was cataract (21%) followed by glaucoma (12.9%). Twenty seven respondents (43.6%) had treatable causes of blindness.

CONCLUSION

The lens ranked highest amongst the anatomical sites of blindness and visual impairment. The main aetiological factors were intrauterine and hereditary factors. The commonest single diagnosis was cataract. Less than half of the respondents had treatable causes of blindness and visual impairment.