Newborn care: A qualitative study of inter-cultural variations and similarities among two ethnic groups in Northeastern Nigeria.

Background: Neonatal mortality remains unacceptably high in most sub-Saharan and Asian communities, where cultural practices and poor antenatal care are common. Newborn care practices play a key role in preventing neonatal deaths. Aims: This study aimed to examine similarities and variations in newborn care between two major ethnic groups in northeast Nigeria. Subjects And Methods: Qualitative methods involving narratives, observations, focus group discussions, and in-depth interviews were used to collect data from recent mothers (ten per ethnic group) and grandmothers from the Babur/Bura and Kanuri ethnic groups in Borno State, Northeast Nigeria. A snowballing sampling technique was used to select the participants within four communities/villages (two for each ethnic group). Results: Babies were bathed within 30 to 45 minutes after delivery by mothers in both groups, except in case of ill health of the child and/or mother. Various substances were applied to the cord even though hygienic cord-cutting practice was reported. With the exception of early bathing, good thermal care practices were observed in both groups. Both groups applied emollients on the skin of the babies, but Bura preferred the use of shea butter to oils and lotion. Various substances were applied to other parts of the body of the baby, such as the fontanelle (Mahogany oil), anus (Neem oil and Mahogany oil), and circumcision wound (engine oil) more so among the Bura than the Kanuri. None of the substances were deemed to be harmful. Conclusion: Similarities and variations in newborn care exist between the two ethnic groups. There is a need for health education and promotion to encourage and facilitate positive behavioral change from old traditional practices to healthy newborn care practices among the Babur/Bura and Kanuri ethnic groups.

Roles and responsibilities in newborn care in four African sites.

OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Factors influencing the onset of cigarette smoking among adolescents in Konduga local government area.

BACKGROUND: Tobacco is the leading preventable cause of death in the United States; responsible for more than 400,000 deaths annually. There have been few reports in the literature about the association between these diseases and cigarette smoking from African countries, which may indicate that these diseases are not common in Africans. There is a dearth of knowledge about the smoking habit among adolescents and factors influencing it in Africa. This is a survey of the factors influencing the onset of cigarette smoking among adolescents in Konduga local government area. METHODS: A cross-sectional study involving 400 randomly selected subjects from the four districts of the local government who responded to a modified version of the standard WHO questionnaire (WHO/SMO, 1984) for surveying smoking habit. RESULTS: The study showed that friends/peers (57%) as the major factor for initiating the smoking habit in adolescents. Others were pleasure (24%), stress (13%), family members (4%) and cigarette adverts (1%). The study also revealed that the adolescents continued to smoke even though they were aware of the health consequences of smoking. The majority of the respondents (70%) advocated outright ban on tobacco sales by the government as the most effective way to check this world's major preventable health hazard. CONCLUSION: The study showed that friends/peer groups were the dominant factor influencing the onset of cigarette smoking among adolescents. This underscores the need for targeting the group in behaviour change communication.

Perceptions of and management practices for Diarrhoeal Diseases by traditional healers in northeastern Nigeria.

In Nigeria, there is a paucity of data on the beliefs and practices of traditional healers concerning diarrhoeal diseases. This study was undertaken to provide baseline data for integrating activities of traditional healers into the national Control of Diarrhoeal Diseases (CDD) programme. Interviews of 14 traditional healers, drawn from two large ethnic groups in northeastern Nigeria, were conducted. All but one of them willingly discussed their beliefs and practices. Almost all traditional healers used herbs expecting that it would stop diarrhoea episode. Most traditional healers (n = 11) were, however, aware of the sugar-salt solution (SSS), and six of them had positive impression about it. Ten were willing to be further trained in the preparation/use of SSS, and five reported its past use. Some healers strongly believed that breast-feeding was an important cause of diarrhoea and that, in some cases, diarrhoea was only amenable to traditional treatment. The results of this study suggest that the traditional healers in the region may contribute to promoting the appropriate home management of diarrhoea. However, their perceptions and practices need to be upgraded to ensure success.

More reliable data for diarrhoeal intervention programmes: rethinking on knowledge, attitude and practice studies.

The aim of this study was to propose an alternative approach to traditional knowledge, attitude and practice (KAP) studies to enhance the quality of data on which educational health programmes are based. The methodology proposed and illustrated involved a triangulation of approaches derived from linguistics, cognitive science, and medical laboratory sciences. Three diarrhoeal health talks (educational messages) as given to mothers in three primary-care facilities in Borno State (Northeast Nigeria) were subjected to a linguistics analysis. Relationships were then sought between the ontology of knowledge in the health talks as revealed by the text analysis and two other kinds of data, namely: (a) mothers' answers to a set of ecologically-sensitive reasoning questions that test how much relevant inferential knowledge the health talks allow for and (b) results of microbiological and biochemical analyses of salt-sugar rehydration solutions prepared by mothers participating in the study. The findings of the study show a relationship between contents/formatting of the health talks and the extent to which relevant inferential competence was supported or demonstrated by mothers. It was also evident that the laboratory analyses could be related either directly to the health talks or indirectly in terms of what the health talks need to emphasize on. The conclusion shows how the methodology proposed addresses shortcomings of traditional KAP studies in respect of the gap between health knowledge and practice.

The dynamics of medical students career and medical specialty choices, and their implication for medical education in developing countries: a Maiduguri Medical School study.

This is a cross-section study based on questionnaire of the students in all the three clinical years of the medical school at the University of Maiduguri, Nigeria. The aim of the study was to explore the dynamics of career and medical specialisation decision and inclinations of the students with the view to seeing how they match the need of medical services in the country, and hence to discover those areas and methods which may be useful in this connection. The study shows that previous (including pre-medical school) exposures to the chosen specialties and ongoing medical school exposures and role models are the most important factors in specialty choices while job opportunities and local trends are important in the career decisions. It is therefore proposed that since medical exposures and role models can be influenced in the medical curriculum, it would be necessary to do this in the specialties of general medical practice (Family Medicine, Primary Medical Care) and the Community Medicine which are vital in the containment of the communicable and poverty/social inequality disease problems of this and other developing countries.

Nutritional rickets in young Nigerian children in the Sahel savanna.

OBJECTIVES: To determine the prevalence of clinical and biochemical rickets in an under-five out-patient population, relate the prevalence of biochemical rickets (BR) to the sociocultural characteristics of families and determine the response of nutritional rickets to vitamin D therapy. DESIGN: Prospective cross-sectional and retrospective case-series surveys. SETTING: Paediatric general out-patient and consultant clinics. SUBJECTS: One hundred and ninety eight out-patients and twenty two patients aged >1 to 60 months treated for nutritional rickets. INTERVENTIONS: Clinical examination, interview with mothers and determination of biochemical abnormalities of under-fives and management of patients with rickets using stosstherapy. MAIN OUTCOME MEASURES: Prevalence of BR and response to stosstherapy. RESULTS: Eight (4%) patients in the survey had clinical and biochemical rickets while 33 (17%) had biochemical rickets only; 92 (47%) other patients had isolated hypocalcaemia and/or hypophosphataemia. The prevalence of BR was higher in males (p <0.05), and increased with age (p <0.001). The prevalence was lower in families who were indigenous to the area (p <0.05), children of Moslem families (p <0.05) and children whose mothers were full-time housewives, unskilled or traders (p <0.01), and who lacked any formal western education (p = 0.157). Three of the seven evaluable patients who received stosstherapy responded late. CONCLUSION: The results support the hypothesis that deficiency or reduced availability of dietary calcium may be of at least equal importance with vitamin D deficiency in the aetiology of nutritional rickets in the Sahel savanna.

Rickets and deprivation: a Nigerian study.

Under-fives in 461 households were assessed clinically to determine the prevalence of rickets in sub-urban and rural communities in the Sahel savanna. Overt rickets was found in 11 (2.4%) of households and abnormalities suggestive of rickets in 69 (14.9%). There were significant variations (p < 0.05) in the prevalence of rickets in association with ethnic grouping (higher in southerners and non-Kanuri, non-Hausa-Fulani northerners), religion (more prevalent among Christians), and mother's occupation and educational status (higher with working class mothers and mothers with at least a primary education). A significantly higher prevalence was also associated with late introduction (at more than seven months of age) of cereals to the infant's diet, more than one under-five in a household and presence of under-fives aged 13-43 months. In contrast, no significant variations in prevalence were observed in association with duration of breast feeding, use of multivitamins or cod liver oil, history of convulsions in under-fives, sex, nutritional status, or history of diarrhoea within a recall period of six months. Thus, rickets is common in under-fives in rural and sub-urban communities in the Sahel savanna and may be related more to environmental and dietary factors than to culture and religion. Further studies are required to determine the relative roles of vitamin D or calcium deficiency to facilitate the planning and execution of a community-based intervention programme in the area.

Perceived causes of eclampsia in four ethnic groups in Borno State, Nigeria.

This study was conducted among the four major ethnic groups(Kanuri, Babur, Shuwa and Marghi) of Borno State, North-east Nigeria. The aim of the study was to identify the perceived causes of eclampsia, a leading cause of maternal death in the State. The data were obtained through focus group discussions (FGDs), questionnaires and in-depth interviews. A total of 16 FGDs and 1,167 questionnaire interviews were conducted among the rural populace. In-depth interviews were conducted on relatives of thirty eclamptic patients admitted to the University of Maiduguri Teaching Hospital. The findings revealed that evil spirits/witches and wizards, poor nutrition, heredity early marriage, destiny from God and machinations of co-wives are the perceived causes of eclampsia in the area. These perceptions result in the use of the following as means of treatment: drinks of various concoctions, inhalation of smoked herbs in rooms, potash drinks, and the wearing of talisman around the neck. These perceptions and traditional medications have implications for design of educational and informational messages aimed at reducing maternal mortality from eclampsia in Borno State.

Risk factors of vesico-vaginal fistulae in Maiduguri, Nigeria: a case-control study.

PIP: Vesicovaginal fistula (VVF)--a direct communication between the bladder and the vagina--is a major gynecological problem in Nigeria resulting in leakage of urine into the vagina. The major cause of VVF in West Africa is pressure necrosis due to prolonged labor. In Nigeria, VVF has social, economic, and religious implications. Many women with VVF are regarded as social outcasts and marriages have dissolved as a result. In this study epidemiological pattern of VVF as it presents to tertiary hospitals in Maiduguri, Northern Nigeria is explored, along with recommendations for lowering mortality. A retrospective study of 241 cases of VVF was done. 148 patients without the disease were controls. Interviews were undertaken and 2 years of records were reviewed. Information collected included demographic variables. Specific information on the history of VVF was also collected. Aspects of traditional practices and customs were noted. Prolonged labor constituted 75.9% of the total cases. "Gishiri cut," an incision commonly done is the 2nd most common cause (6.2%). Other causes included cervical carcinoma (1.7%), surgical trauma (3.1%), and infection (2.1%). No cause could be found in 10.4%. Earlier age at marriage for VVF patients was significant with a chi square value of 27.0 (P0.001). More than 1.4 (26.9%) of the fistulae occurred in women 15 years; more than 1.2 (58.8%) of them were 18 years. Height was found to be related to fistulae: 51.9% had a height of below 150 cm but only 37.1% of the controls had the same height measurement (t=4.52; P0.001). The relative risk for VVF when the height was 150 cm was calculated to be 1.83 for this study. Of the women who had VVF, 49.9% were married, compared to 85.3% of the controls (P0.001). A much higher proportion of fistula patients were divorced than controls. For the short term, the problem can be helped by health education. In the long run, it will be reduced by less pregnancies in girls under 18, a situation which will occur with more widespread formal education of girls.^ieng

Perceptions, beliefs and practices of mothers in sub-urban and rural areas towards measles and measles vaccination in Northern Nigeria.

Measles is of particular concern in Nigeria because of the high fatality rate, and high morbidity rate, particularly in young children. Measles and its complications are a common reason for hospitalization, indicating very low immunization coverage. This study was carried out to elucidate the contributing factors from attitudes, beliefs and practices of mothers towards measles and its vaccination. A cross-sectional survey was conducted in Konduga Local Government Area. One per cent of the 500 mothers interviewed believed that measles is prevented by immunization, 16% that it is contagious or due to an infectious agent, 26% that it is caused by evil spirits, witchcraft and heat, and 25% had never heard of measles immunization. Twenty-seven per cent said they did not believe immunization was effective and 4% were not allowed to go for immunization by their husbands. Of those mothers whose children had developed measles, only 31% had been treated in formal health facilities. These results indicate an unfavourable attitude and practice by mothers in relation to measles and measles vaccination. There is the need for an intensive health education campaign to improve this state of affairs and to reduce the morbidity and mortality from measles.

Severity signs of childhood diarrhoea in north eastern Nigeria.

Oral Rehydration Therapy (ORT) use in Nigeria is currently far short of the national Control of Diarrhoeal Diseases (CDD) programme goals. Towards designing health education strategies to improve this, maternal lay health concerns during diarrhoea in under-fives were examined among two large ethnic groups, the Kanuris and Buras, in northeastern Nigeria. Over half of the respondents judged the severity of diarrhoea by more than one sign and expected ORT to stop diarrhoea. Severity signs frequently described (averaging from a quarter to a half of respondents) included weakness and refusal of food; frequent stooling and fever were more frequently used by the Kanuris (p < 0.001) compared to Buras and weight loss and dehydration by the Buras (p < 0.01) compared to Kanuris. Generally, rural residents were less concerned with dehydration and weight loss (p < 0.0001 and 0.003 respectively, compared to urban residents) and more concerned with restlessness, including excessive crying (p < 0.07 to 0.0001). Stool characteristics and vomiting were rarely used as severity signs although the Kanuris in focus group discussions related severity to diarrhoea typology. Concerns with persistent diarrhoea, and diarrhoea associated with measles, were rarely expressed by participants, irrespective of ethnic group and domicile, suggesting that health education aimed at increasing awareness in relation to these two serious illnesses is urgently needed in Nigeria. Several of the lay health concerns expressed by participants in the study could form a useful basis for promoting ORT use in Nigeria and elsewhere.

PIP: To strengthen the oral rehydration therapy (ORT) program in northeastern Nigeria, cultural variations in perceptions of the severity of diarrhea were investigated in a 1993-94 study involving Kanuris and Buras mothers. Diarrhea may not be identified as an illness by mothers unless it is accompanied by symptoms that serve as prompts for help-seeking. Study methods included 17 focus group discussions and a cross-sectional survey of 518 rural and urban women from both ethnic groups. Half the respondents judged the severity of diarrhea by more than one sign and expected ORT to stop diarrhea. Kanuris were most likely to identify frequent stools and fever as signs of severity, while Buras mothers more often identified weight loss and dehydration. In general, rural residents were less concerned with dehydration and weight loss than urban mothers and more concerned with excessive crying. Rural Kanuris--and, to a lesser extent, Buras--tended to seek medical care at a late stage of diarrhea, after a series of home remedies had failed. Participants from both ethnic groups rarely expressed concerns about persistent diarrhea or diarrhea associated with measles--two conditions in need of serious attention.

Communities' awareness, perception and participation in the Community-Based Medical Education of the University of Maiduguri.

BACKGROUND: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. METHODS: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. RESULTS: Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. "To examine and treat" (33.6%) and "to ask questions" (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. DISCUSSION: This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.

Oral rehydration at home--with a little help from friends.

A training workshop was organized for selected members of two village populations in north-eastern Nigeria, whereby they acquired knowledge and skills enabling them to spread the word and practice of oral rehydration therapy for children suffering from diarrhoea in their communities. The difficulties encountered and the gains achieved in this empowerment programme are described below.

Awareness claims versus actual knowledge of oral rehydration therapy and the salt sugar solution in northeastern Nigeria.

Focus group discussions involving rural and urban residents drawn from Kanuri and Bura settlements, were conducted as part of an on-going survey of the perception and treatment of diarrhoea among major ethnic groups in northeastern Nigeria. Awareness of oral rehydration therapy (ORT) was universal among participants, but knowledge of its function and the preparation of the sugar salt solution (SSS) was markedly deficient among the Kanuris, especially in rural areas. Reported SSS use parallel the knowledge of ORT function/SSS preparation and seemed heightened by church-fellowship activities among the rural Buras. Surprisingly, tasting was apparently not realised by participants to be an important step in SSS preparation. These preliminary results suggest that knowledge of ORT function and SSS preparation need further emphasis in ORT awareness campaigns, and that religion-based activities could be a potent and actualizable method of ORT promotion.

Assessment of the impact of community-based medical education of the University of Maiduguri on communities in three local government areas of Borno State, Nigeria: community leaders' perspectives.

BACKGROUND: The community-based training of the University of Maiduguri Medical College was expanded in 1990 to cover three rural local government areas (LGAs) located between 25 and 145 km from the University. This study was conducted between March and May 2000 to assess the impact and level of awareness of the training in the three LGAs in promoting the ideals of Primary Health Care (PHC) and community-based medical education, as perceived by community leaders. METHOD: Focus group discussions (FGDs) were held with community leaders of each of the communities. RESULTS: Consistency in the recollection of what time in the year and for how long the students were in the various communities indicates awareness in all the community leaders. They also indicated that the programme has had a positive impact on their community's health, they would like the students to focus on specific endemic diseases, such as guinea-worm, hypertension, etc, and intensify community outreach programmes, such as home visits and health education. Most participants indicated that their communities participated in the programme by providing accommodation, feeding and other logistics on an ad hoc basis. Community leaders mobilized the communities for health education and other related activities carried out by the students. CONCLUSION: The community-based medical training of the University of Maiduguri has increased community awareness of preventive aspects for various communicable and non-communicable diseases. In addition it has helped to encourage the communities to participate actively in supporting PHC activities.

The prevalence of symptoms of dyspepsia in north eastern Nigeria. A random community based survey.

In a randomised household survey of 620 people in rural north eastern Nigeria there was a 26% six month prevalence of dyspepsia in adults and a 6% prevalence amongst teenagers. Dyspepsia was associated with the intake of alcohol (p less than 0.0054) and Cola nut (p less than 0.00013). The prevalence increased with age; the mean length of history was nearly four years and over half of the subjects with dyspepsia had sought medical advice, mainly from traditional healers. 12% of a similar group of hospital patients with dyspepsia were previously found to have peptic ulceration, suggesting that the community prevalence for peptic ulceration is 18/1000. This is lower than found in the 'West'.

Caretakers' knowledge and preparation abilities of salt-sugar solution in north-eastern Nigeria.

Awareness and knowledge of oral rehydration therapy (ORT) and preparation abilities of salt-sugar solution (SSS) were investigated by means of focus group discussions and complemented by a structured questionnaire survey of mothers in rural and urban areas of north-eastern Nigeria. ORT awareness was high with some intra-regional variations. Perception of ORT function was, however, grossly unrealistic, with a third to four-fifth of mothers expecting ORT to stop diarrhoea. At least one quarter of mothers lacked adequate SSS preparation abilities and the materials and ingredients required for its preparation. Re-evaluation of the content and method of imparting health education messages in ORT promotion is recommended. Such messages should emphasise the function of ORT. It is also recommended that standardised cups for water, salt and sugar measurements be provided to households as a ready means of ensuring the correct preparation of SSS in the home-based management of diarrhoea.

PIP: Public education campaigns in northeastern Nigeria have since 1986 promoted the awareness, preparation, and use of oral rehydration therapy (ORT) against diarrhea and the prevention of dehydration and related deaths. The awareness and knowledge of ORT and preparation abilities of sugar-salt solution (SSS) were investigated between March 1993 and April 1994 through focus group discussions and surveys of mothers in rural and urban areas of northeastern Nigeria. The Kanuris and Buras comprised the body of study respondents sampled in Bama, Hawul, and Maiduguri. 260 respondents from each ethnic group were interviewed. In the survey, 77% of the Kanuri mothers and 84% of the Bura mothers were aware of ORT/SSS; some intraregional variations were observed. 64% of Kanuri mothers and 29% of Bura mothers expected ORT to stop diarrhea. At least 25% of mothers were unable to properly prepare SSS and the materials and ingredients required for its preparation. These results point to the need to re-consider the content and method of disseminating health education messages in ORT promotion. Messages should stress the function of ORT. In addition, standardized cups for water, salt, and sugar measurements should be provided to households to ensure the correct preparation of SSS in the home-based management of diarrhea.

H. pylori, the most common bacterial infection in Africa: a random serological study.

This study was carried out to determine the prevalence of antibodies to Helicobacter pylori in northern Nigeria, a region with a low incidence of peptic ulceration. In a random, serological survey of 268 subjects, 228 (85%) of the population studied had IgG antibodies to H. pylori. Fifty-eight of these subjects had experienced dyspepsia in the preceding 6 months. The majority of the population (82%) is infected between the ages of 5 and 10. Despite the high prevalence of antibodies to H. pylori, peptic ulcer is uncommon, suggesting that H. pylori is not important in the etiology of peptic ulcer in this population. Indeed, most patients infected by H. pylori are asymptomatic. The possible reasons for this are discussed.