Determinants of Choice of Facility-Based Delivery among Mothers in Kwara State, Nigeria.

BACKGROUND: Nigeria has the highest number of maternal deaths in the world, which is a major public health problem. One of the major contributory factors is high prevalence of unskilled birth attendance from low facility delivery. However, the reasons for and against facility delivery are complex and not fully understood. OBJECTIVE: The objective of this study was to identify the facilitators and barriers to facility based deliveries (FBD) among mothers in Kwara state, Nigeria. METHODS: The study was carried out among 495 mothers that delivered in the five years prior to the study in three selected communities from the three senatorial districts of Kwara state using mixed methods. The study design consisted of a cross-sectional study with mixed data collection involving qualitative and quantitative methods. Multistage sampling technique was employed. Primary outcome measures were place of delivery, reasons for and against FBD. RESULTS: Of the 495 respondents that had their last delivery during the study period, 410 respondents delivered in the hospital (83%). Common reasons for hospital delivery were ease and convenience (87.1%), safe delivery (73.6%) and faith in healthcare providers (22.4%). The common barriers to FBD included high cost of hospital delivery (85.9%), sudden birth (58.8%) and distance (18.8%). Other important barriers were availability of cheaper alternatives (traditional birth attendants and community health extension workers practising at home), unavailability of community health insurance and lack of family support. Parity, level of education of respondents and husband had significant influence on choice of delivery (p<0.05). CONCLUSION: These findings provided a good insight into the reasons for and against facility delivery among Kwara women, which can assist policy makers and program interventions that can improve facility deliveries and ultimately improve skilled birth attendance, reduce maternal and newborn morbidity and mortality.

CONTEXTE: Le Nigeria compte le plus grand nombre de décès maternels au monde, ce qui constitue un problème majeur de santé publique. L'un des principaux facteurs contributifs est la forte prévalence de l'assistance à l'accouchement non qualifiée due à un accouchement dans des établissements de faible qualité. Cependant, les raisons pour et contre la prestation en établissement sont complexes et ne sont pas entièrement comprises. OBJECTIF: L'objectif de cette étude était d'identifier les facilitateurs et les obstacles aux accouchements en établissement (FBD) chez les mères de l'État de Kwara, au Nigeria. METHODES: L'étude a été menée auprès de 495 mères qui ont accouché au cours des cinq dernières années précédant l'étude dans trois communautés sélectionnées des trois districts sénatoriaux de l'État de Kwara en utilisant des méthodes mixtes. La conception de l'étude consistait en un entretien avec des informateurs clés et une étude transversale avec une collecte de données mixte impliquant des méthodes qualitatives et quantitatives. La technique d'échantillonnage à plusieurs degrés a été employée. Les principaux critères de jugement étaient le lieu d'accouchement, les raisons pour et contre le FBD. RESULTATS: Parmi les 495 répondantes qui ont eu leur dernier accouchement au cours de la période d'étude, 410 répondantes ont accouché à l'hôpital (83 %). Les raisons courantes de l'accouchement à l'hôpital étaient la facilité et la commodité (87,1 %), la sécurité de l'accouchement (73,6 %) et la confiance dans les prestataires de soins de santé (22,4 %). Les obstacles courants à la FBD comprenaient le coût élevé de l'accouchement à l'hôpital (85,9 %), l'accouchement soudain (58,8 %) et la distance (18,8 %). D'autres obstacles importants étaient la disponibilité d'alternatives moins chères (accoucheuses traditionnelles et agents de vulgarisation de la santé communautaire exerçant à domicile), l'absence d'assurance maladie communautaire et le manque de soutien familial. La parité, le niveau d'éducation des répondants et le mari ont une influence significative sur le choix de l'accouchement (p<0,05). CONCLUSION: Ces résultats ont fourni un bon aperçu des raisons pour et contre l'accouchement en établissement chez les femmes Kwara, ce qui peut aider les décideurs politiques et les interventions de programme qui peuvent améliorer les accouchements en établissement et, en fin de compte, améliorer l'assistance qualifiée à l'accouchement, réduire la morbidité et la mortalité maternelles et néonatales. Mots clés: Prestation en établissement; Facilitateurs; Barrières; État de Kwara; Nigeria.

Social isolation impairs feed intake, growth and behavioural patterns of catfish under culture conditions.

Globally, the culture of fishes is important for food production. There is a growing interest in understanding and improving the welfare of cultured fish from both ethical and production perspectives. Social isolation is a common practice in catfish farming. This study assessed how social interactions affect the feeding behaviour, growth performance, and behavioural pattern of Clarias gariepinus under different social conditions. Juveniles of African catfish with a mean weight of 23.6 ± 1.09 g were stocked in 20L-aquaria (1.7 m × 1.2 m × 1.0 m) and fed twice daily in isolated (one fish/tank; N = 6 replicates) and non-isolated (six fish/tank; N = 6 replicates) conditions for a 36-day experimental period. Feed intake and growth response were monitored, while behavioural patterns were observed twice per week using focal sampling techniques for a total of 40 minutes per day. Wilcoxon two-sample tests and GLMs were used to analyse the data. Social context significantly (P < 0.001) affected the feed intake, feeding duration, and other observed behavioural patterns. However, the time of feeding (P > 0.001) did not affect the feed intake or the duration of feeding. Fish cultured in non-isolated conditions consumed more pellets (63 ± 2.36). The duration of feeding was longer in isolated conditions (431 s) while the latency to feed increased significantly (P < 0.001) from the first and fifth day of the experiment for the non-isolated and isolated, respectively. Behaviourally, isolated groups were inactive (Ws = 446.34, z = 5.397; P < 0.01) and displayed fewer aggressive acts (Ws = 0.95, z = 1.19; P < 0.01), while non-isolated groups were more active (Ws = 564.39, z = -5.397; P < 0.01) and displayed more escape attempts (Ws = 11.56, z =  -5.47; P < 0.01). Non-isolated groups had higher (Ws = 23.41, z = 1.06; P < 0.01) number of scars and bruises. Furthermore, non-isolated fish had a higher specific growth rate (2.36 ± 0.12), feed conversion ratio (1.27 ± 0.01) and a better condition factor (1.01 ± 0.08). Conclusively, these findings are relevant to African catfish welfare as social isolation changes the behavioural attributes, feeding pattern and growth rate of C. gariepinus. However, social context should be monitored since it resulted in more scars and bruises, which might affect the acceptability and welfare of this aquatic fish species.

Prevalence and Correlates of Physical Disability and Functional Limitation among Elderly Rural Population in Nigeria.

Background. The number of people surviving into old age is increasing, and it has now become a global phenomenon. Studies on the prevalence and correlates of physical disability and functional limitation among elderly Nigerians are scanty. Methodology. This is a community-based cross-sectional study conducted in 3 local government areas (LGAs) in Nigeria, using a multistage sampling technique. Functional limitations of 1824 elderly persons were tested using Tinetti performance-oriented mobility assessment tool (TPOMAT) and self-reported activities of daily living (ADL). ADL disability of ten, six, and five basic items were compared. Results. The prevalence ratios (PRs) of physical disability using the ten, six, and five basic ADL items were 28.3 (95% CI 25.2-31. 5), 15.7 (95% CI 13.4-19.8), and 12.1 (95% CI 9.8-15.3), respectively, while functional limitation was 22.5 (95% CI 18.1-24.4). Increased risk of disability was independently associated with female gender PR 3.6 (95% CI 1.5-7.4), advanced age ≥75 years; PR 22.2 (95% CI 14.5, 36.8), arthritis PR 3.7 (95% CI 2.6-4.6), stroke PR 4.8 (95% CI 3.7-7.9) and diabetes PR 6.1 (95% CI 4.3-7.1). Conclusions. The findings from this study are pointers to unmet needs of the elderly disabled Nigerians.

Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: a house-hold survey.

BACKGROUND: In the last decade the number of elderly citizens in Nigeria has increased and their health needs are becoming popularly recognized. A number of factors have also been recognized to determine health care seeking behaviour in these elderly. METHODS: The sample consisted of 756 households that had at least one resident who was aged 60 years and above (35% of 2160 households). Multistage and proportionate sampling techniques were employed to select the study subjects. Structured interview were conducted to elicit information on health needs and determinants of health care seeking behaviour of household members aged 60 years and above. RESULTS: The most frequently reported illnesses were body pain (89.5%), joint pain (86.4%), generalized body weakness and fatigue (81.5%), poor sight (78.2%), fever (71.3%), irritability, anger, and nervous tension (70%), listlessness, depression, and headaches (60%),and decreased mobility (65.8%). More than two-thirds (68.8%) of respondents had never visited health facilities in the last one year even for ordinary medical check-up. Family care/Family consultation was the first choice (44.6%) of treatment for the most frequently reported illnesses irrespective of age group and sex. Less than one-third (28.7%) of the subjects were aware of their health needs. Receiving treatment when sick was the health needs mentioned by the majority (89.4%) of the elderly. Poverty emerged as a major (50.3%) determinant of health care seeking behaviour followed by nature of illness (28.5%). The odds ratio that elderly from poor households will seek health care from unqualified health care practitioners was 0.7 (95% confidence interval (CI) = 0.38-0.67); while the odds ratio that elderly from poor households will seek health care from qualified health care practitioners was 0.8 (95% CI = 0.57-0.89). Self treatment had odds ratio of 1.7 (95% CI = 0.38-0.67). After controlling the household's poverty status, there was still a significance difference (P < 0.05) in age group and gender in terms of health care seeking behaviour. CONCLUSION: Socio-economic indicators and nature of illness were the most pervasive determinants of health care seeking behaviour among the elderly, overriding age and sex, and in terms of health-care expenditure, the nature of illness and quality of service provided ranked the major determinants.

Improving attitude towards elderly people: Evaluation of an intervention programme for caregivers.

There is yet no specific Government policy on care of the elderly in Nigeria despite increase in its awareness as well as the number of people reaching old age. This study was carried out to assess the attitude of caregivers in seven out of the eleven wards in Ilorin metropolis. The caregivers consisted of daughters (44.4%), sons (18.3%), family-relation (24.6%), employees (1.4%), neighbors (4.5%) and community members (6.8%). The data collection toll was a structured questionnaire consisting of three parts designed to determine the socio-demographic characteristics, general and specific attitude to the care of the elderly. Effect of Health Education on attitude of caregivers concerning the care of the elderly was also evaluated. Based on the scoring system, the attitude of the caregivers was found to be fairly positive and after the Health Education intervention, a significant improvement in the attitude of caregivers was recorded. The Mean (SD) score increased significantly from 78.4 +/- (14.6) pre-intervention to 96.8 +/-(15.2), post-intervention, p-value < 0.05. Religious teaching (35.9%), traditional/customary obligation (28.7%) and personal feeling (21.1%) were the most influencing factors of attitude of caregivers towards the care of the elderly. The influence of educational status of caregivers on where the elderly should be taken care of was found to be non statistically significant (p > 0.05). Gender had overall positive effect on attitudinal measurement. The deduction from this study is that care of the elderly is still being valued despite lack of specific government policy and support. The negative attitude of caregivers to institutional care may be difficult to change through health education intervention because care of the elderly at home is still being greatly valued in this country as it is seen as a responsibility of children and other family members. Institutional care is also considered as an abomination and irresponsibility by some caregivers Keywords: attitude, caregivers, elderly, intervention and health education.

An opinion survey of caregivers concerning caring for the elderly in Ilorin metropolis, Nigeria.

The aim of this study was to determine the opinions of caregivers towards caring for the elderly in Ilorin. The caring patterns and relationships that exist between the elderly and caregivers, caregivers' attitudes, and ways to improve care of the elderly were also examined. This cross-sectional study using structured questionnaires was conducted in seven of 11 wards within Ilorin metropolis over a 6-month period. Of the respondents, 44.4% were daughters, 18.3% were sons and only 1.4% were employees to the elderly. The majority (90.7%) of respondents chose home as the place of care, and only 9.3% opted for institutional care. The majority (98.1%) of caregivers had a positive attitude towards caring for the elderly. Religious teaching was an important influence on this positive attitude. The difference between respondents with and without formal education concerning where to care for the elderly was not statistically significant (P > 0.05).

Oral health care practice and socio-demographic findings among the physicians in Ilorin, Nigeria.

BACKGROUND: In most developing countries, physicians attend to patients with oral health problems more than dentists usually because physicians are easily available. The aim of this study is to assess the level of practice of oral health care by physicians and make recommendations on how oral health care practice can be improved among the physicians. METHODS: This is a descriptive cross-sectional study carried out among 173 physicians who were randomly selected using their various health facilities. The study was carried out in Ilorin, the capital of Kwara State, Nigeria, over a period of six months. A well-structured questionnaire served as data collection tool while EPI-INFO version 6 software packages were used for analyzing data after being coded. RESULTS: There was a high level (74.1%) of practice of oral health care among the physicians and the major reasons for this were limited number of qualified dentists in the study area as well as lack of awareness by the patients concerning the treatment of oral health problems by dentists. Toothache and trauma were the most (68.2%) and least (2.3%) prevalent oral health problems respectively seen by physicians in this study. Antibiotics and analgesics were the medications used by the majority (58.1%) of the physicians to treat oral health problems. Almost all (97.7%) the respondents referred oral health problems to dentists while only 2.3% claimed never referred patients to a dentist. CONCLUSION: The available dental services in the study area cannot meet the oral health needs of the populace considering the fact that there are fewer dentists than physicians. Since this study showed a high level of practice of oral health care among the physicians, it is therefore necessary to include dentistry in the curricular of all medical schools in Nigeria and such curricula need to place more emphasis on promotive and preventive aspects of oral health as well as community participation.