Knowledge, Experiences and Coping Mechanisms for Priapism among Persons with Sickle Cell Disease in Ibadan, Nigeria.

BACKGROUND: Priapism is a prolonged, painful penile erection common among males with Sickle Cell Disease (MWSCD) predisposing to erectile dysfunction (ED) when treatment is delayed. Unlike in women with sickle cell disease (SCD), there has been little attention to male reproductive health complications of SCD. OBJECTIVE: To investigate knowledge, experiences and coping mechanisms for priapism among MWSCD in Ibadan, Nigeria. METHODS: This descriptive cross-sectional study employed purposive sampling technique to select 95 consenting MWSCD attending haematology clinics in Ibadan for interview. A semi-structured, interviewer-administered questionnaire was used to collect information on knowledge, coping mechanisms, and experiences of priapism. Knowledge of priapism was measured and categorised as poor and good respectively. Psychosocial Experiences (PEs) were measured and categorised as mild, moderate and severe, while the Sexual Experiences (SEs) were recorded. Coping mechanisms for priapism were grouped into Medical, Psychosocial and Harmful coping mechanisms respectively. Data were analysed using descriptive statistics and Fishers' Exact test at p<0.05. RESULTS: Respondents' mean age was 23.6±8.8 years. Over half (55.8%) had good knowledge of priapism. Thirty-nine respondents (41.1%) had experienced priapism. Sexual Experiences reported include: total ED 10.3% and apathy for sexual intercourse 23.1%. Majority 30(76.9%) developed mild PEs especially fear of reoccurrence of priapism (56.4%) and sleeplessness (43.6%). The most used Medical Coping Mechanism (MCM) was cold shower (46.2%). There was no significant association between age and knowledge of priapism. CONCLUSION: Knowledge of priapism among respondents was good. Psychosocial therapy through appropriate health education, counseling and social support may help improve knowledge among people with SCD.

PREVALENCE, KNOWLEDGE AND PREVENTIVE PRACTICES AGAINST HYPERTENSION AMONG POLICE OFFICERS IN IBADAN.

BACKGROUND: Hypertension is a major global health problem. Armed forces personnel are at increased risk of hypertension due to the nature of their occupation as early responders. There is dearth of data on knowledge and prevalence of hypertension among police officers in Ibadan, Nigeria. This study was conducted to address this gap in knowledge. METHODS: A total of 170 police officers participated in the study. A questionnaire was used to document demographic profile, knowledge and practices to prevent hypertension. Abdominal circumference and blood pressure were measured among study participants. A digital Omron HEM 8712 blood pressure monitor was used to assess BP and a non-stretchable measuring tape was used to determine waist circumference. Hypertension was assessed by ≥140/90 mmHg and abdominal obesity by ≥80cm for female and ≥94cm for male. RESULTS: Mean age of respondents was 36.7±8.4 years; more than half (64.7%) were males. Majority (47.6%) had fair knowledge of hypertension. The prevalence of abdominal obesity and hypertension were 51.7% and 17.5% respectively. About a tenth (11.4%) were both hypertensive and obese. More females than males' respondents had abdominal obesity (p=0.00); while more males (19.3%) than females (14.0%) were hypertensive (p=0.39). About two-third (68.2%) reported involvement in unhealthy preventive practices including consumption of alcohol, foods high in salt and fat content, and tobacco smoking. Older, married and senior officers were significantly at higher risk of being hypertensive than younger, never married, and junior officers. CONCLUSION: Police officers have adequate knowledge of hypertension, but many in this group are hypertensive. Clinical and educational interventions are recommended to address the problem.

ATTITUDE AND WILLINGNESS OF INFERTILE PERSONS TOWARDS THE UPTAKE OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN IBADAN, NIGERIA.

INTRODUCTION: In most developing countries, the joy of every married man and woman is to procreate and raise children of their own. However, this desire does not always find fulfilment among some couples because of primary or secondary infertility. The majority who experience this condition live in developing countries where fertility services including Assisted Reproductive Technologies (ARTs) are not always available. This study, therefore, investigated the attitude and willingness of infertile persons to uptake ARTs. METHODS: The study was a descriptive cross-sectional survey; a three-stage multi-stage sampling technique was adopted to select 202 married persons receiving fertility services at a gynaecological clinic in Ibadan, Nigeria. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data were analysed using SPSS with descriptive and inferential statistics with the level of the significant set at ≤0.05. RESULTS: Respondents' age was 34.3 years (SD ± 6.5); 88.6% were female; 55.5% had tertiary education; 54.5% reported a history of primary infertility. The negative attitude towards ARTs was observed among many of the respondents; however, some were willing to use ART services. In vitro fertilization (IVF) was the most preferred method; only 15.0% were optimistic of non-complications. The cost was the most mentioned barrier to use of ART. Positive association existed between attitude and willingness to use ART. Females are three times more likely than males to have a positive attitude toward the uptake of ART. CONCLUSION: Public enlightenment and advocacy are recommended to influence negative attitude towards ARTs.

Quality-of-life and visual function after manual small incision cataract Surgery in South Western Nigeria.

BACKGROUND: Outcome studies after cataract surgery should focus on functional status and quality of life instead of visual acuity measurement alone. OBJECTIVE: To assess patients' quality of life (QoL) and overall visual function (VF) after manual small incision cataract surgery (SICS) with intraocular lens (IOL) implantation. METHODS: A prospective hospital based study which evaluated the preoperative and postoperative visual function and vision related QoL among patients presenting with first eye cataract at an eye hospital in South Western Nigeria using the VF-14 questionnaire and the vision related QoL questionnaire. RESULTS: One hundred and eighty two patients were enrolled for the study with a mean age of 66.5 ± 10.46. The mean preoperative visual function (VF) score was 40.17 ± 33.59 (range 0 to 82.14) and postoperatively it was 88.79 ± 20.15 (range 0 to 100) p value <0.001. Prior to surgery, 50 (27.6%) patients had visual function score. 75% however after surgery 161 (88.2%) patients had a visual function score of over 75%. (p value <0.001). Using the vision related QoL questionnaire, the highest impact of visual recovery after cataract surgery was improvement with mobility in almost 80% of the patients. CONCLUSION: This study has demonstrated improvement in vision related quality of life and visual function, resulting in rapid recovery of the patient's functional independence and health status following manual SICS. Small incision cataract surgery should therefore be offered to more patients in the African sub-region.

An appraisal of the process of protocol review by an ethics review conmmittee in a tertiary institution in Ibadan.

It is a well established norm that biomedical research involving human participants must conform to acceptable scientific principles and international codes of research ethics. The University of Ibadan/University College Hospital Health Research Ethics Committee (UI/UCH HREC) is the body that plays an oversight role and performs the function of a third party independent review of research protocols submitted by staff and students of the two institutions. A 6-year (2002-2007) retrospective audit of the protocols submitted to the HREC was performed to determine the profile of the lead investigator, sources of funding for the research and the duration for review using a 25 item questionnaire. A total of 752 protocols were submitted, 618 protocols (82%) were approved while 38 protocols were not approved. The principal investigators were mainly postgraduate students (67.1%) while academic staff constituted 21.3%. The average time from submission to approval was approximately 21 weeks (95% CI: 20-23 weeks). The period from submission to approval is significantly affected by the number of revision required and the funding agent (p < 0.05); it took a shorter time to review internationally funded research.

Sexual and reproductive health knowledge, behaviour and education needs of in-school adolescents in northern Nigeria.

Adolescence is marked by progression from the appearance of secondary sexual characteristics to sexual and reproductive maturity. Curiosity about bodily changes is heightened. However, adolescents' perceived sexuality education needs have been poorly documented. A survey of 989 adolescents from 24 North-Eastern Nigerian secondary schools yielded information on socio-demographic characteristics, reproductive health knowledge, sexual activities and sexuality education needs. Of the interviewed respondents, 72% of females had experienced menstruation. Overall, 9% were sexually active, 3.1% knew when ovulation occurs, 47% knew pregnancy could result from first coitus and 56% knew of contraception. 84% opined that adolescents should be given sexuality education but only 48.3% had received any. Sexuality education should be provided for in-school adolescents through their preferred and reliable sources of information.

Ethical issues in HIV/AIDS research, counselling and testing in Nigeria.

HIV/AIDS is a major pubic health problem in Nigeria. This paper identifies the ethical issues involved in HIV/AIDS biomedical and behavioural research, counselling and testing in the country. These concerns are discussed in the context of the three universal ethical principles of respect for persons, beneficence, and justice. Written informed consent, which is a component of respect for persons, is a challenge in Nigeria because of skepticism to documentation, sensitivity of sexual practices often explored in behavioural research, and a tradition that discourages patients from questioning medical authority. Although monetary inducement of research participants is ethically acceptable, the high levels of poverty in Nigeria raise concerns that payment of money may unduly induce indigent participants to enroll in research. The disclosure of results in situations when married HIV positive persons insist that their status should not be revealed to their spouse illustrate the dilemma that health workers face in adhering to the ethical norm of keeping confidentiality and the public health obligation of preventing HIV transmission in a third party. Some recommendations are offered to address these concerns.

Outcome of interventions to improve the quality of reproductive health services provided by private health facilities in selected states in Nigeria.

In Nigeria, as in many developing countries, the private health sector provides a significant proportion of reproductive health services. However, there are concerns about the quality of the reproductive health services provided by personnel operating in this sector. Few interventions exist to improve the quality of reproductive health services being provided by private practitioners. This three year intervention project, which was implemented in Oyo, Ogun and Gombe States, was designed to improve the capacity of personnel working in the private sector to deliver quality reproductive health services to their clients. One hundred and thirty nine privately owned health facilities participated in the project. Baseline data were collected from staff and clients using these facilities through self-completed questionnaires. A total of 458 nurses/auxiliaries were trained to improve their counseling and service delivery skills; 138 proprietors/proprietresses were trained on total quality management to enhance the quality of reproductive health services; and 84 physicians' knowledge were updated on reproductive health/family planning, and post-abortion care. Provision of contraceptives, drugs for treatment of sexually transmitted infections, supply of equipment and development of educational materials were the other components of the intervention. A follow-up survey was conducted three years after implementing the interventions to gauge outcomes. At baseline, only 35.2% managed postpartum sepsis compared to 97.8% at follow-up. Thirty-nine percent provided post-abortion care at baseline; the figure rose to 97.2% at follow-up. The proportion of respondents who reportedly provided family planning services increased from 39.5% at baseline to 43.0% at follow-up. Report of management of persons living with HIV/AIDS increased from 16.0% to 24.3% while counseling services increased from 36.1% to 37.6%. At baseline, only 55% of the health workers reported that they had male condoms in stock, the figure rose to 88.2% at follow-up. Sixty-one percent of clients reported that it took 1- 5 minutes before being attended at follow-up, compared to 95% who claimed they spent about an hour before receiving care at baseline. The interventions improved availability and quality of reproductive health services provided by private health facilities. Similar interventions should be replicated to scale up the proportion of private health facilities that provide quality reproductive health services in the country.

Reproductive health knowledge and use of contraceptives among adolescent mothers in a sub-urban community in Oyo State, Nigeria.

This survey explored the reproductive health knowledge and use of contraceptives among 316 young mothers in Ogbere, a sub-urban community in Oyo State, Nigeria. A cluster sampling technique was used to recruit the respondents and data were collected from them through face-to-face interviews using questionnaires. The ages of the respondents ranged from 17-20 with a mean of 18.9. The majority (76.9%) of the respondents were married and had primary school education (72.8%). Fivepercent had lost a pregnancy due to abortion, miscarriage or still birth. Forty-three percent had fair, 34.5% poor, and 22.5% good knowledge of contraceptives; 53% did not know any of the routes for HIV transmission. A large majority (70%) had never used any contraceptives, 29% had done so. Eighty percent of those who had ever used any contraceptive were using one at the time of the survey. The most popular contraceptives used were condoms (44.4%) and pills (16.1%). Interventions to improve the economic status and promote use of contraceptives are recommended for this population.

Violence and HIV/AIDS prevention among female out-of-school youths in southwestern Nigeria: lessons learnt from interventions targeted at hawkers and apprentices.

Between 1997 and 2003, four studies on hawkers and apprentices in motor parks and work shops in south west, Nigeria were carried out to evaluate the effectiveness of interventions aimed at preventing HIV infection and gender based violence (GBV). The studies were in 3 phases namely baseline survey, intervention and end line survey. Interventions consisting of:--development and distribution of education materials and training programmes for the police, judiciary, instructors, drivers, traders and apprentices/hawkers, including micro-credit facilities were implemented in some of the studies. The major lessons learnt were that: Young girls working in the informal sector of the Nigerian economy face dual risks of HIV infection and GBV and yet they are seldom targets of intervention; Many had been victims of GBV and did not seek redress either because they accept it is their lot, are afraid of being stigmatized or are put off the prolonged legal system; Perpetrators tend to deny their involvement in violence; Despite the challenges involved, interventions implemented among female apprentices and hawkers, especially those that involve multiple stakeholders, made a difference in protecting this group from dual risks of GBV and HIV/AIDS infection. We recommend more intervention programmes for this population, and regulation of activities in the informal sector of the Nigerian economy.

Beliefs and perceptions of ear, nose and throat-related conditions among residents of a traditional community in Ibadan, Nigeria.

ENT-related conditions constitute a major burden of disease in Nigeria. The bulk of the available studies on these conditions are derived from hospital-based studies that underestimate the extent of the problem. Few studies have explored the perceptions of community residents on the causes and treatment of these conditions. This article describes findings of a qualitative study that explored the perception of residents of Foko, a traditional community in Ibadan, Nigeria. Five traditional healers were interviewed in-depth while four focus group discussions were conducted for men and women to determine perception of types, causation and treatment modalities for ENT-related conditions. The healers mentioned seven ENT-related conditions including ear discharge, deafness, epistaxis, nasal catarrh, sore throat, neck swelling and hoarseness. Informants and discussants attributed mainly spiritual attack as the cause of many of these conditions. Many of the treatment remedies used are topical, including use of effirin leaf (Occimum gratissium) for nose bleeding and using cold red oil or honey to treat ear discharge. These procedures are dangerous and could aggravate the conditions. We discuss the implications of these findings for further research and clinical practice.

Perceptions of sexual coercion: learning from young people in Ibadan, Nigeria.

This study explored the problem of sexual coercion from the perspectives of 77 young people aged 14-21 in Ibadan, Nigeria, the behaviours they perceive to be sexually coercive and the contexts in which these occur through four narrative workshops. Participants were drawn from two secondary schools and 15 apprentice workshops. All four groups identified similar coercive behaviours and developed narratives of the events that typically lead up to them. Behaviours included rape, unwanted touching, incest, assault, verbal abuse, threats, unwanted kissing; forced exposure to pornographic films, use of drugs for sedation and traditional charms for seduction, and insistence on abortion if unwanted pregnancy occurs. Men were typically the perpetrators and young women the victims. Perpetrators included acquaintances, boyfriends, neighbours, parents and relatives. All the narratives revealed the inability of young people to communicate effectively with each other and resolve differences. The results suggest the need for life-skills training that facilitates communication, seeks to redress gender power imbalances, teaches alternatives to coercion as a means of resolving conflict over sexual relations and respect for sexual and reproductive rights, and provides victims with information on appropriate services, support and referral.

Experience of sexual coercion among adolescents in Ibadan, Nigeria.

This study surveyed 1,025 adolescent students and apprentices in Ibadan, Nigeria, to document their sexual behaviour and experience of sexual coercion including verbal threats, unwanted touch, unwanted kiss, assault, deception, drugging, attempted rape, and rape. Sixty five per cent of male and 48% of female apprentices were sexually experienced, compared to 32% of male and 24% of female students. More males than females reported sex with multiple partners and contact with a sex worker while females had exchanged sex for money and gifts. Fifty five per cent of all the subjects had been victims of at least one type of sexual coercion, the commonest being unwanted kiss and touch of breasts (47%). Although both males and females were victims of coercion, females were disproportionately affected--68% of female students and 70% of apprentices had experienced one coercive behaviour, compared to 42% of male students and 40% of apprentices. Female apprentices fared worst, with 19% of them raped. The main perpetrators of the coercion were persons well known to the victims including neighbours, peers and boy/girlfriends. We recommend multiple intervention programs including skills training for young persons, sensitisation workshop for training health workers, and media advocacy for the public to challenge stereotypes that favour sexual coercion of adolescents.

Sexual behaviour and negotiation of the male condom by female students of the University of Ibadan, Nigeria.

This study explored the sexual behaviour of unmarried female students of the University of Ibadan, Nigeria, and assessed the extent to which those who were sexually active negotiated and used the male condom. Four focus group discussions were conducted followed by a survey of 354 students. The results show that the mean age of the students was 22.5 years 55.1% had had sexual intercourse; the mean age at first intercourse was 16.5 years. The number of lifetime sexual partners ranged from 1 to 20 with a mean of 3.4; 75% of those who had had sex reported ever using condom; 16.9% and 39% used it during their first and last sexual episodes respectively; only 34.3% used it consistently. Seventy-three per cent had ever negotiated condom use with a partner, but only 41% did so during their last sexual encounter. A significant association was found between condom negotiation and number of sexual partners: Students with fewer life time partners (3.2) had less frequently negotiated condom use than those with more partners (4.3) (P<0.05). Condom negotiators also scored significantly higher (4.6) on a 6-point AIDS Knowledge Score than those who had never done so (4.0) (P<0.05). About a quarter (26.7%) had ever bought a condom, while 38.5% had ever carried it. We conclude that although many female students had sometimes used a condom only a few used it consistently and are therefore at risk of the unintended outcomes of unprotected sex. We propose appropriate interventions to address the problem.

Post operative nausea and vomiting in Nigerians.

A retrospective survey of postoperative nausea and vomiting (PONV) in the recovery room over a five year period was conducted, followed by a prospective study of 200 adult patients to estimate the incidence and predisposing factors to nausea and vomiting during the first 24 hours after anaesthesia and surgery in Nigerians. In the retrospective study only records of 61 patients (0.79%) out of the 7714 post anaesthetic recovery room charts reviewed revealed documentation of vomiting. These were 20 males (32.8%) and 41 females (67.2%). In the prospective study, the incidence of post operative nausea and vomiting within twenty four hours of surgery was 41.6% and 19.6%, respectively. But only two out of 39 patients (one per cent) vomited within the first three hours in postoperative period. The frequency of vomiting varied from one to 15 times and women had significantly more emetic symptoms than men (p < 0.05). Preoperative administration of pethidine and morphine was associated with postoperative nausea and vomiting. It is suggested that Nigerian women should be considered for prophylactic anti-emetic therapy, especially when narcotic analgesic are to be employed in their anaesthetic management.

Job stress associated with surgical training in Nigeria.

Surgical residency training is acknowledged as being stressful, however the degree of stress, factors causing it, methods of coping with it, and the incidence of substance abuse has not been previously studied in our environment. We therefore used a self-administered questionnaire to survey 100 Nigerian Surgical Residents of whom 72 responded in September 1995. Our result shows that our residents spend 39.8, 36.8 and 23.3 percent of their time on patient care, educational activities and ancillary care, respectively. Eighty-nine percent of them considered their work to be stressful mainly because of lack of facilities and the unstructured nature of the program. Physical exhaustion, irresponsible behavior and sleep disorders were some of the abnormalities suffered as a result of this. In all, 5.6% rated the stress as severe, while 69.4% considered it moderate. Examinations produced the most stress, followed by operating sessions and patient care. Overall, substance abuse was uncommon with 16.7% claiming to have used alcohol in the one month preceding the study, but 8.3% claimed to need alcohol in order to function. Tobacco, benzodiazepine and barbiturates are some of the substances that our respondents have abused. There was no reported abuse of cannabis, heroin, cocaine, LSD or other psychotropic drugs. We conclude that though stress is inevitable during surgical training, some of the causes can be ameliorated. There is need to reduce the amount of time residents spend on ancillary care, while the current methods of examinations should be reconsidered to incorporate current adult learning theories. Residents should get adequate time for rest and recreation while exposure to modern surgical training in better-endowed centers should be incorporated into the training programme.

Knowledge, attitude, and practices related to hepatitis B virus infection among Nigerian obstetricians and midwives.

Obstetricians and midwives are exposed to the blood, vaginal secretions and amniotic fluid of their patients during vaginal examinations, deliveries, intracavity procedures and resuscitation of the newborn. They are therefore at risk of hepatitis B virus (HBV) infection that is endemic in developing countries. We studied the knowledge, attitude, and practices of obstetricians and midwives in four teaching hospitals in Southwestern Nigeria with respect to HBV infection. A self-administered questionnaire was used to elicit information about their demographic characteristics, knowledge about, and immunisation against HBV and the use of barrier methods. There were 83 respondents with a mean age of 34.9 years, 45 were midwives while 38 were obstetricians. The former had practised for a range of 2-26 years while the latter had practised for 1-16 years. In a test of knowledge about HBV infection, obstetricians had a mean score of 2.4 while midwives scored 1.8 marks out of five. Only 18.1% had received HBV immunisation and 8.4% always screen their patients for HBV antigens; 33.7% always use barrier methods with the commonest reason for non-use being non-availability. The difference in knowledge between obstetricians and midwives was statistically significant. In conclusion, we make recommendations about reducing the risk of occupationally acquired HBV infection in the labour ward.

Sexual behavior and knowledge of AIDS among female trade apprentices in a yoruba town in South-Western Nigeria.

This exploratory study was carried out among unmarried female trade apprentices in Ikorodu, a Yoruba town in south-western Nigeria, to identify sexual risk behaviors, assess knowledge on HIV/AIDS, and recommend an appropriate AIDS education program. Four focus groups were conducted to gain insight into the social-cultural and economic factors influencing sexual risk behaviors, followed by a survey involving 280 randomly selected respondents. Findings showed that many group discussants approved of premarital sex and believed that sex with multiple partners occurred mainly because of the economic difficulties encountered by female apprentices. Most of the survey respondents (70.9%) were sexually experienced, with age of first sexual intercourse ranging from eleven to twenty-two years. One hundred and fifty-five (78.2%) were sexually active; of these, 37.4 percent said that their last sexual encounter occurred because they could not resist the pressure put on them by their male partners, were under the influence of alcohol, were in need of money, and raped. Sixty percent of the sexually active respondents did not take any action to prevent STD or pregnancy during their last sexual encounter. Of the fifty-eight who did, 37.9 percent used the condom. Of those sexually experienced (45.3%) have had at least one STD symptom in the year before, half of them did not do anything about their condition; 37 percent practiced self-medication or received injections from quacks. Although 70.9 percent had heard about AIDS, many had limited knowledge about the non-sexual routes of HIV transmission. Appropriate intervention strategies were recommended to educate the apprentices.

Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis.

Two patient education methods, Information Media (IM) and Social Network (SN), were compared to determine their relative effectiveness on recruitment and subsequent compliance behavior of people infected with onchocerciasis in respect of appointment keeping and ivermectin consumption in existing primary health care facilities in six communities in southwestern Nigeria. Two communities each were randomly assigned to the IM intervention group, two of the SN group, and two served as controls. A total of 1265 persons out of an estimated target population of 5033 infected individuals were enrolled in the study. Coverage rates were higher in the intervention communities (30.3% for SN and 29.9% for IM) than control (7.3%), but the differences between intervention groups was not significant. A drop-off was seen in attendance at the second round of ivermectin distribution. Nearly equal proportions of the intervention groups returned (43.3% for SN and 47.4% for IM), while few control patients came back for their second dose (12.3%). Factors responsible for the low turnout were thought to include the content of educational messages, mobility of community members and limited time available to collect the drugs. Cost considerations led to recommendations to maintain facility based distribution and the SN approach, with greater emphasis on mobilization to increase coverage and compliance.