Capacity-Building for Stroke Genomic Research Data Collection: The African Neurobiobank Ethical, Legal, and Social Implications Project Experience.

Background: The fields of stroke genomics, biobanking, and precision medicine are rapidly expanding in sub-Saharan Africa. However, the ethical, legal, and social implications (ELSI) of emerging neurobiobanking and genomic data resources are unclear in an emerging African scientific landscape with unique cultural, linguistic, and belief systems. Objective: This article documents capacity-building experiences of researchers during the development, pretesting, and validation of data collection instruments of the African Neurobiobank for Precision Stroke Medicine-(ELSI) Project. Methods: The African Neurobiobank for Precision Stroke Medicine-ELSI project is a transnational, multicenter project implemented across seven sites in Ghana and Nigeria. Guided by the Community-Based Participatory Research framework, we conducted three workshops with key stakeholders to review the study protocol, ensure uniformity in implementation; pretest, harmonize, and integrate context-specific feedback to ensure validity and adaptability of data collection instruments. Workshop impact was assessed using an open-ended questionnaire, which included questions on experience with participation in any of the workshops, building capacity in Genetic and Genomic Research (GGR), level of preparedness toward GGR, the genomic mini-dictionary developed by the team, and its impact in enhancing understanding in GGR. Data were analyzed qualitatively using a thematic framework approach. Results: Findings revealed the usefulness of the workshop in improving participants' knowledge and capacity toward GGR implementation. It further identified local, context-specific concerns regarding quality data collection, the need to develop culturally acceptable, genomic/biobanking data collection tools, and a mini-dictionary. Participants-reported perceptions were that the mini-dictionary enhanced understanding, participation, and data collection in GGR. Overall, participants reported increased preparedness and interest in participating in GGR. Conclusion: Capacity-building is a necessary step toward ELSI-related genomic research implementation in African countries where scholarship of ELSI of genomics research is emerging. Our findings may be useful to the design and implementation of ELSI-GGR projects in other African countries.

Exclusive Breastfeeding Intentions Among Adolescents In Urban Communities In Ibadan, Nigeria.

Purpose: During adolescence, a female child makes several decisions, and the choice to breastfeed in the near future is conceivably shaped. But in sub-Saharan Africa where teenage pregnancy and teenage motherhood is on the rise, there is a dearth of information on the intention of adolescents to exclusively breastfeed (EBF) in community settings. Therefore, this study assessed exclusive breastfeeding intentions, knowledge and attitude of adolescents in urban communities in Ibadan, Nigeria. Methods: A descriptive community-based cross-sectional study was carried out, selecting 271 respondents. Data were analysed with the aid of IBM SPSS version 21 at P ≤ .05. Results: Mean age of adolescents was 17.5 ± 1.3 years, and 96.3% would breastfeed their children later in future. However, only 37.6%, 22.5% and 50.2% had the intention to exclusively breastfeed, good knowledge score and positive attitude, respectively. There were significant relationships between respondents' age, educational attainment, parents' educational attainment, level of knowledge, attitude and intention. The coefficient of knowledge and attitude were significant predictors of good intention to practise EBF. Major predictors of good intention were good knowledge [OR = 36.5; 95% CI (9.2, 145.2)] and positive attitude toward EBF [OR = 9.7; 95% CI (3.6, 25.9)]. Conclusions: The EBF intention was influenced by multiple factors and should be considered in determining the effectiveness of interventions targeting this practice. Therefore, coherent EBF education interventions that commence from adolescence to promote the practice by adulthood are urgently needed to improve knowledge, attitude and intention about EBF rate and confer the cancer-risk reducing benefits.

Knowledge, perception and experience of sexual entrapment among undergraduate students of the University of Ibadan, Nigeria.

Background: Deceit into sexual activities without the victim being aware of the intended action is common in tertiary institutions as the environment promote activities that make students vulnerable, especially females, young and new students. The resulting physical, psychological and social consequences, including harassment, sexual assault, non-consensual sex, injury, psychological trauma and suicide attempts, have affected many young people. This study was aimed at exploring the knowledge, perception, experience of sexual entrapment among undergraduate students of the University of Ibadan, Ibadan, Nigeria. Methods: This multi-stage cross-sectional survey involved 422 participants using semi-structured questionnaire and an in-depth interview guide. Quantitative data were analyzed statistically, while Qualitative data was analyzed thematically. Results: Mean age of respondents was 20.5±3.0 years, 52.6% were males, 58.8% and 81% had a good knowledge and perception of sexual entrapment, respectively. Prevalence of sexual entrapment was 18%, affecting more males (55.3%) and first year students (39.5%), 59.2% of the perpetrators are friends of the victim. Students were entrapped on campus through; emotional support (42.1%), money (34.2%), accommodation assistance (7.9%), material things/gifts (21.1%), assignment assistance (10.5%), help with registration (4.0%), religious activities (6.6%), debt repayment (11.8%) and counseling (9.2%). It resulted to; unwanted sex (34%), rape (4%), pregnancy (1.3%), STDs (4%), Injury (13%), psychological trauma (27.6%), loss of trust (52.6%) and attempted suicide (23.7%) among victims. Effective coping mechanisms were adopted by 55.3% of respondents. There was a significant association between knowledge and perception; knowledge and experience; perception and experience (p<0.05). Findings from the in-depth interview revealed care, tutoring, political positions, and pretense to need help as other tactics. Conclusions: Sexual entrapment is common on campus, affecting males and females, knowledge and perception influence experience of sexual entrapment, requiring the need for a holistic approach to reduce its prevalence.

Experience of Using an Interdisciplinary Task Force to Develop a Culturally Sensitive Multipronged Tool to Improve Stroke Outcomes in Nigeria.

The burden of stroke is on the rise in Nigeria. A multi-faceted strategy is essential for reducing this growing burden and includes promoting medication adherence, optimizing traditional biomarker risk targets (blood pressure, cholesterol) and encouraging beneficial lifestyle practices. Successful implementation of this strategy is challenged by inadequate patient health literacy, limited patient/medical system resources, and lack of a coordinated interdisciplinary treatment approach. Moreover, the few interventions developed to improve medical care in Nigeria have generally been aimed at physicians (primarily) and nurses (secondarily) with minimal input from other key health care providers, and limited contributions from patients, caregivers, and the community itself. The Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES) study is assessing the efficacy of a culturally sensitive multidimensional intervention for controlling blood pressure in recent stroke survivors. A key component of the intervention development process was the constitution of a project task force comprising various healthcare providers and administrators. This paper describes the unique experience in Sub-Saharan Africa of utilizing of an interdisciplinary Task Force to facilitate the development of the multipronged behavioral intervention aimed at enhancing stroke outcomes in a low-middle income country.

Pretesting Qualitative Data Collection Procedures to Facilitate Methodological Adherence and Team Building in Nigeria.

Qualitative methods are becoming widely used and increasingly accepted in biomedical research involving teams formed by experts from developing and developed practice environments. Resources are rare in offering guidance on how to surmount challenges of team integration and resolution of complicated logistical issues in a global setting. In this article we present a critical reflection of lessons learned and necessary steps taken to achieve methodological coherence and international team synergy. A series of 10 pretest interviews were conducted to assess instrumentation rigor and formulate measures to address any limitations or threats to bias and management procedures before carrying out the formal phase of qualitative research, contributing to an evidence-based stroke-preventive care clinical trial study. The experience of pretesting notably helped to identify obstacles and thus increase the methodological and social reliability central to conducting credible qualitative research, while also ensuring both personal and professional fulfillment of our team members.

Experiences of girls with hearing impairment in accessing reproductive health care services in Ibadan, Nigeria.

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR = 20.29, CI = 1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired.

Why actions for early treatment of febrile illnesses in children are delayed by caregivers.

The study explored why actions for early treatment of febrile illnesses in children are delayed by caregivers of children less than five years in five Local Government Areas (LGAs) of southwestern Nigeria using four indicators: caregivers' perception of illness, notion of causation and seriousness, belief in efficacy of selected pathway, and the decision making process. Seven types of febrile illnesses (yellow fever, typhoid fever, ordinary fever/malaria, hot body fever, rain fever, cold fever, and headache fever) were identified and yellow fever was perceived as the most severe type (60.8%). Only 24.2% correctly identified an infected mosquito bite as the cause of ordinary fever/malaria. Use of leftover drugs at home (55.6%) was the main action taken and fathers were the main decisionmakers in all cases. Empowerment of women for improved knowledge on causation, severity, and importance of prompt action for a healthy outcome is recommended.

Attitude towards mandatory pre-marital HIV testing among unmarried youths in Ibadan northwest local government area, Nigeria.

This study assessed the attitude of unmarried youths towards Mandatory Premarital HIV Testing (MPHT) in Ibadan Northwest Local Government Area. A three-stage sampling technique was used to select 571 unmarried youths from households. A validated questionnaire was used for the collection of the data. Descriptive, Chi-square statistics and logistics regression were used to analyze the data. Mean age of respondents was 20.6 +/- 2.6 years, 52.0% were males and 52.7% had completed their senior secondary education. Though 82.8% believed that MPHT could reduce the spread of HIV, 43.8% stated that it will increase the stigma associated with HIV infection. Attitude towards mandatory pre-marital HIV testing however was positive. Males were about two times more likely to have positive attitude towards mandatory pre-marital HIV testing (OR = 1.507, CI = 1.067-2.129). Positive attitude towards MPHT among study respondents offers a window of opportunity of undergoing HIV testing before marriage.

Potential risk of HIV transmission in barbering practice among professional barbers in Ibadan, Nigeria.

BACKGROUND: There is a growing concern that barbering procedures could create opportunities for HIV transmission. However, little is known about Nigerian barbers' practices relating to the prevention of HIV. OBJECTIVES: This study assessed the precautionary measures for the prevention of HIV among commercial barbers in Ibadan, Nigeria. METHODS: Data were collected using validated checklist to directly observe ninety barbering procedures in forty-five barber shops randomly selected from three communities that have been categorized as inner-core, transitory and peripheral. RESULTS: Respondents were all males with mean age of 36(±10.2) years. Ninety-eight percent had at least primary school education and all of them learnt barbering through apprenticeship. The instruments used were razor blades (11.1%), manual clippers (8.9%) and electric clippers (80%). Clippers were sterilized in 10% and disinfected in 72.5%, while no decontamination was carried out in 17.5% of the sessions. Fifty two percent of the disinfections involved the use of kerosene, a disinfectant not recommended for HIV inactivation; 48.3% of the disinfectants were not in the original containers while 53.4% of the sessions involved the use of same brush for cleaning clipper and brushing hair. Hand-held flame and Ultra-violet light sterilizer were used in 50% of the sterilization process. Barbers in the high-class peripheral communities were more likely to practice appropriate equipment decontamination than those from lower-class inner-core communities. There was blade-to-skin contact in all and accidental cuts occurred in three of the sessions and none was properly managed. CONCLUSION: The risk of transmitting HIV is high in the barbershops in the study area. Health education strategies such as training, supportive supervision and peer education are needed to facilitate the adoption of effective precautionary measures against HIV infection among barbers.

Community gate keepers' awareness and perception of prevention of mother-to-child transmission of HIV services in Ibadan, Nigeria.

Each year, around half a million children aged under 15 become infected with HIV and more than 90% are the result of mother-to-child transmission. Services to prevent mother-to-child HIV transmission (PMTCT) are therefore important entry points for HIV/AIDS prevention, treatment and care services for women, their children and families. The study aimed at identifying level of awareness and knowledge of PMTCT services that can be utilized in improving access. The methodology consisted of 20 individual in-depth interviews spread over Adabeji, Adeoyo/Agbadagbudu, Jakiru/Onipasan and Eleta communities, in Ibadan among household heads, religious and community based leaders. Key factors identified were low knowledge of mother to child transmission, lack of knowledge of the PMTCT services, inadequate community sensitization, inadequate healthcare facilities. The success of PMTCT programmes demands a shift towards a more community-based approach which calls for strong advocacy, enlightenment and community mobilization for improved awareness and utilization of PMTCT services.

Knowledge dissemination and evaluation in a cervical cancer screening implementation program in Nigeria.

OBJECTIVES: Our goals were to train health professionals in Nigeria using the text, "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers", and then evaluate the knowledge dissemination process using a pre- and post-test assessment. The manual was developed by the ACCP, WHO, IARC, PATH, Engender Health, JHPIEGO, and PAHO with funding from the Gates Foundation. It is an inclusive guide to implementation and maintenance of screen-and-treat cervical cancer prevention clinics and is ideally suited for programs operating in the developing world. METHODS: Training took place at a conference in Ibadan, Nigeria. Participants included teams of physicians, nurses, bioengineers, data managers, and administrators who met in joint and parallel sessions to "train the trainers". This meeting was designed to provide both training and equipment to personnel to be involved in the implementation of a cervical cancer control initiative in Nigeria. A 36 item pre-test was administered prior to a group study sessions. A slide presentation summarized salient points before the post-test was given. The results were entered into an MS Excel spreadsheet for descriptive statistics about (1) the participants, (2) the test, (3) an examination of profession, years of work experience, years of education, and gender as predictors of two outcomes (low pre-test score and large difference between pre- and post-tests) and (4) overall performance on the exam. RESULTS: There were 70 participants and trainers, of which 53 took the exam. Most of the examinees were physicians. Some participants did not fill out the post-test, leaving their tests inevaluable. A closer look at the test revealed eight questions that were confusing and nine that were too easy. All participant subgroups performed better on the post-test than the pre-test; the improvements were statistically significant. While profession impacted the results, profession was not statistically significant. Years of work experience, years of education, and gender did not affect test results. CONCLUSIONS: While the study suffers from a small sample size, a few ambiguous questions, and the need for pilot testing the instrument prior to the meeting, the report evaluates the manual very favorably. The authors showed a significant gain in knowledge. The manual gives "the big picture" and does so with clarity. The text and supplementary material outline the work that needs to proceed in an organized program, and the material was easily understandable in Nigeria. Future evaluations could benefit from more participants and varied learning structures.

Case management of childhood fever by traditional healers in southwest Nigeria: identification of training and collaborative needs.

Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ("agbo"; 72%), ground herbs ("agunmu"; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever.