Improving testing capacity for COVID-19: experiences and lessons from Senegal, Uganda, Nigeria, and the Democratic Republic of Congo.

Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC). Methods: The four countries' testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries. Results: The four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden. Conclusion: Although testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria.

BACKGROUND: In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. In spite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria. METHODS: We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance. RESULTS: The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9). CONCLUSION: The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

CONTEXTE: Dans certaines parties de l'Afrique, les patients et ceux qui qui ont survécu au COVID-19 sont stigmatisés et cela a entravé les les activités de réponse mises en place pour contrôler la pandémie. Malgré cela, la plupart des efforts de prévention du COVID-19 ont été orientés vers l'utilisation de mesures non-pharmacologiques sans mesures correspondantes pour dissiper la stigmatisation au sein de la communauté. Par conséquent, cette étude a évalué les facteurs associé à la stigmatisation perçue des patients atteints de COVID-19 parmi les résidents du gouvernement local d'Agege, État de Lagos, Nigeria. MÉTHODES: Nous avons réalisé une enquête transversale auprès de 333 résidents consentants recrutés dans la zone de gouvernement locale (LGA) d'Agege en utilisant une technique d'échantillonnage à plusieurs degrés. Un questionnaire semi-structuré, administré par un intervieweur, adapté de l'indice de stigmatisation des personnes vivant avec le virus de l'immunodéficience humaine (PVVIH). L'index stigmate a été utilisé pour collecter des données sur les caractéristiques sociodémographiques, la connaissance de COVID-19 et la stigmatisation perçue. Une analyse bivariée a été réalisée à l'aide de l'outil Chi-square et une régression logistique binaire a été utilisée pour identifier lesdéterminants de la stigmatisation perçue au niveau de signification de 5%. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 13,6 ans. La sensibilisation à l'épidémie de COVID-19 était de 95,2%. La television (43,5 %) et la radio (36,9 %) étaient les deux principales sources d'information sur l'infection et sa prévention. Les proportions des répondants qui avaient une mauvaise connaissance et stigmatisation perçue des patients atteints de COVID-19 étaient respectivement de 50,0% et de 47,7 % respectivement. Une probabilité plus élevée de perception de stigmatisation perçue a été constatée chez les personnes âgées de 25 à 49 ans (aOR=3,1, IC à 95% = 1,4 - 6,7), > 50 ans (aOR= 2,1, IC à 95% = 1,1 - 3,9)et les répondants mariés (aOR= 1,8, IC 95 % = 1,1 - 2,9). CONCLUSION: L'étude met en évidence le manque de connaissances sur le COVID-19 et un niveau élevé de stigmatisation. Par conséquent, Il est donc urgent de mettre en place des interventions éducatives pour les résidents d'Agege, en particulier parmi les répondants mariés ainsi que les adultes. MOTS CLÉS: Perception, stigmatisation, COVID-19, autodéclaration, Nigeria.

SELF ASSESSMENT OF ORAL HEALTH AND RISK FACTORS AFFECTING ORAL HYGIENE STATUS IN ADOLESCENTS ATTENDING DENTAL CLINIC IN UNIVERSITY COLLEGE HOSPITAL, IBADAN.

Introduction: Globally, there is an increasing incidence of Non-Communicable Diseases (NCDs). Major oral diseases such as caries and periodontal disease which are classified as NCDs, are not left out of this trend. Recent reports are suggestive of increasing prevalence and severity of oral diseases among adolescents, despite accessibility of dental services. Ascertaining the oral health status of adolescents making use of dental services and how they perceive their oral health could help develop preventive and therapeutic strategies. This study therefore aims to determine the self-perception of adolescents utilizing dental services about their oral health and factors affecting their oral hygiene status. Methodology: This clinic-based cross-sectional study was carried out among adolescents attending the Dental Center, University College Hospital, Ibadan Nigeria. A total of 113 adolescents were recruited into this study using a systematic random sampling technique. A WHO Oral health questionnaire was administered to the participants. Questions were asked on socio-demographics, self-perception of oral health and oral hygiene practices. Descriptive statistics such as frequency, percentages, mean, standard deviation were used to present the data. Independent T test and One way ANOVA were used to analyze categorical exposure variables with normally distributed numerical outcomes. A p-value of <0.05 was considered statistically significant. Results: Majority of study participants had positive self-perception of health of their teeth (53.1%) and gingiva (62.8%) respectively, their mean OHI-S was 2.24 with 62.8% of adolescents having a fair oral hygiene. Mean DMFT was 0.96 with 75.2% of participants having a very low DMFT. OHI-S and DMFT were both significantly associated with age of adolescents, with late adolescents having significantly higher mean OHI-S and DMFT scores than early adolescents (p < 0.05). Adolescents who cleaned their teeth at least twice daily had significantly higher DMFT values than those who cleaned once daily (P < 0.05). Conclusion: This study found late adolescents had higher DMFT and OHI-S scores. There might be need to increase oral health awareness in senior secondary schools and tertiary institutions to help improve their oral health status. Its pertinent that adolescents are encouraged and taught good oral hygiene measures when they visit dental clinics, in school and at home. Adolescents utilizing dental services are likely to be more self-conscious about their oral health thus increasing the frequency of their teeth cleaning.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria.

BACKGROUND: In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. Inspite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria. METHODS: We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance. RESULTS: The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9). CONCLUSION: The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

CONTEXTE: Dans certaines parties de l'Afrique, les patients et ceux qui qui ont survécu au COVID-19 sont stigmatisés et cela a entravé les les activités de réponse mises en place pour contrôler la pandémie. Malgré cela, la plupart des efforts de prévention du COVID-19 ont été orientés vers l'utilisation de mesures non-pharmacologiques sans mesures correspondantes pour dissiper la stigmatisation au sein de la communauté. Par conséquent, cette étude a évalué les facteurs associé à la stigmatisation perçue des patients atteints de COVID-19 parmi les résidents du gouvernement local d'Agege, État de Lagos, Nigeria. MÉTHODES: Nous avons réalisé une enquête transversale auprès de 333 résidents consentants recrutés dans la zone de gouvernement locale (LGA) d'Agege en utilisant une technique d'échantillonnage à plusieurs degrés. Un questionnaire semi-structuré, administré par un intervieweur, adapté de l'indice de stigmatisation des personnes vivant avec le virus de l'immunodéficience humaine (PVVIH). L'index stigmate a été utilisé pour collecter des données sur les caractéristiques sociodémographiques, la connaissance de COVID-19 et la stigmatisation perçue. Une analyse bivariée a été réalisée à l'aide de l'outil Chi-square et une régression logistique binaire a été utilisée pour identifier lesdéterminants de la stigmatisation perçue au niveau de signification de 5%. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 13,6 ans. La sensibilisation à l'épidémie de COVID-19 était de 95,2%. La television (43,5 %) et la radio (36,9 %) étaient les deux principales sources d'information sur l'infection et sa prévention. Les proportions des répondants qui avaient une mauvaise connaissance et stigmatisation perçue des patients atteints de COVID-19 étaient respectivement de 50,0% et de 47,7 % respectivement. Une probabilité plus élevée de perception de stigmatisation perçue a été constatée chez les personnes âgées de 25 à 49 ans (aOR=3,1, IC à 95% = 1,4 - 6,7), > 50 ans (aOR= 2,1, IC à 95% = 1,1 - 3,9)et les répondants mariés (aOR= 1,8, IC 95 % = 1,1 - 2,9). CONCLUSION: L'étude met en évidence le manque de connaissances sur le COVID-19 et un niveau élevé de stigmatisation. Par conséquent, Il est donc urgent de mettre en place des interventions éducatives pour les résidents d'Agege, en particulier parmi les répondants mariés ainsi que les adultes. MOTS CLÉS: Perception, stigmatisation, COVID-19, autodéclaration, Nigeria.

Quality of Life of HIV Infected Children Attending the Antiretroviral Clinic, University College Hospital, Ibadan.

BACKGROUND: HIV infection is still prevalent in Sub-Saharan Africa. The presence of a chronic illness in childhood, such as HIV infection, can affect the health-related quality of life (QoL) negatively. OBJECTIVE: The study compared the QoL of HIV-infected and uninfected children in order to assess the impact of HIV infection and antiretroviral therapy on the QoLof children. METHODS: It was a comparative cross-sectional study in which 150 primary caregivers of both HIV infected and HIV non-infected children were recruited. Data was collected on sociodemographic characteristics, negative life events and QoL domain scores on health perception, physical resilience, functional status, physical functioning, psychological functioning, social/role functioning and HIV-related symptoms from the primary caregiver and analysed. RESULTS: Mean age of HIV infected and non-infected children was 3.0 ± 0.9 years and 2.9±1.0 years respectively. HIV infected children had a greater proportion of their grandparents (15% versus 1%, p<0.05) being their primary caregiver. HIV infected children were associated with significantly worse mean QoLscore compared with HIVnon-infected children (p<0.05). Advanced HIV infection was associated with low QoL. Use of Antiretroviral Therapy (ART) among the HIV infected children was associated with a higher QoL in the general health rating, physical resilience, functional score, symptom, social and role functioning domains (p<0.05) except for physical functioning and psychological functioning. CONCLUSION: HIV infection in children is associated with poor QoL. Advance HIV disease was associated with poor QoL and antiretroviral therapy was associated with improved QoL in HIV infected children.

Survival analysis and prognostic factors of time to first domestic violence after marriage among Nigeria, Kenya, and Mozambique women.

OBJECTIVES: How soon an ever-married woman falls a victim of domestic violence after marriage is not documented in Africa. This study sought to assess the timing of first domestic violence (FDV) against women after marriage and determined the factors associated with the timings in Nigeria, Kenya, and Mozambique. STUDY DESIGN: This is a cross-sectional study. METHODS: Data of 29,793 ever-married women of reproductive age consisting of 21,564, 4237 and 3992 from Demographic and Health Survey conducted in Nigeria (2013), Kenya (2014) and Mozambique (2011), respectively, were used. The timing of FDV was the time interval between marriage date and date of the FDV for those with reported violence but censored as the time interval between marriage date and the survey date for those without domestic violence. Survival analysis techniques were used to assess the timing and the factors influencing the timing at (P = 0.05). RESULTS: The lifetime prevalence of domestic violence among the ever-married women in Nigeria, Kenya and Mozambique was 15.4%, 39.0% and 31.0%, respectively. The overall median time to FDV was 3 years. The risk of FDV was twice higher in Kenya (adjusted hazard ratio (aHR) = 1.934; 95% confidence interval (CI): 1.729-2.132) and 15% higher in Mozambique (aHR = 1.156; 95% CI: 1.156-1.223) than in Nigeria. The hazard of domestic violence was significantly higher among separated/divorced women across the three countries (aHR = 1.326; 95% CI: 1.237-1.801). Other factors associated with the timing of FDV against women were respondents' education, age at first marriage, region and location of residence, religion, ethnicity, employment status, wealth quintile, spouse consuming alcohol and husbands' educational attainment. CONCLUSIONS: Domestic violence against married women by their intimate partners is prevalent across Mozambique, Nigeria and Kenya, with earlier occurrences in Kenya and Mozambique. Age at first marriage, education factors, religion, ethnicity and region of residence in each country affected the timing of the first incidence of domestic violence.

METHODS OF PAYMENT FOR HEALTH CARE AND PERCEPTION OF A PREPAYMENT SCHEME AMONG AUTO-TECHNICIANS IN ABUJA, NIGERIA.

BACKGROUND: The National Health Insurance Scheme (NHIS) in Nigeria has succeeded in enrolling only a minute fraction of the population. Studies on the scheme among informal sector employees are required to plan a scale up of the programme in this group which represents the majority of the working population in the country. OBJECTIVE: This study sought to assess the method of payment for health care, awareness of and the perception about the NHIS among auto-technicians in Abuja, Nigeria. METHODS: A cross-sectional descriptive survey was conducted among auto-technicians in Abuja Municipal Area Council (AMAC), Nigeria. Data was collected using interviewer-administered questionnaire, and analyzed with SPSS version 17. RESULTS: A total of 351 auto-technicians and allied workers participated in the study. Post-secondary education [(Odds Ratio (OR) = 7.78, 95% CI = 1.61 - 37.54, p = 0.01)] and having a spouse who is gainfully employed [(OR = 3.67, 95% CI = 1.04-12.93)] predicted awareness of the NHIS. Older people above forty years of age were significantly less likely to be aware of the NHIS, (OR = 0.27, 95% CI = 0.08 - 0.92, p = 0.036). CONCLUSION: Despite the glaring need and willingness of the participants to enroll in a prepayment scheme for health, workers in the informal sector of the economy may remain unreached by NHIS due to lack of awareness and skepticism. Strategic steps to remove ignorance and dispel doubts is imperative for scale up of the NHIS in the informal sector.

TREATMENT RESPONSE IN ADULT PATIENTS WITH HYPERTENSION ATTENDING A SECONDARY HEALTH CARE CENTER IN SOUTH-WEST NIGERIA.

BACKGROUND: There has been an increase in prevalence of hypertension worldwide and a trend towards poor control of hypertension. Despite the development of new guidelines on management of hypertension, it remains a difficult disease to control. METHODS: The study was a prospective cohort study of 386 patients aged 18 to 70 years with uncontrolled hypertension. A simple random sampling technique with computer generated random numbers was used for selection. RESULTS: Majority (58.3%) of the respondents who were overweight had diastolic blood pressure of less than 100 mmHg while 55 (41.7%) respondents who were overweight had diastolic blood pressure of 100mmHg to 110mmHg. Forty (42.1%) of the respondents who were obese had diastolic blood pressure of less than 100mmHg while 55 (57.9%) respondents who were obese had diastolic blood pressure of 100mmHg to 110mmHg. The association was statistically significant (χ2 = 9.845, p-value = 0.02). There was a significant difference between the mean first Systolic Blood pressure and the mean third systolic blood pressure. (< 0.001, 95% CI 19.01- 23.04). Also there was a significant difference between the mean first Diastolic Blood pressure and the mean third Diastolic Blood pressure. (p < 0.001, 95% CI 11.13-11.56). CONCLUSION: This study has shown that increasing body weight was associated with high blood pressures and health education on management of hypertension had significant effect in reducing blood pressures and subsequently leading to better control of hypertension.

Characteristics and Determinants of Patients Discontinuation of Breast Cancer Follow-Up Care at the Radiation Oncology Department, University College Hospital, Ibadan, Nigeria.

OBJECTIVES: The aim of this study is to describe the characteristics and predictors of discontinuation during follow-up care among breast cancer patients at the Radiation Oncology Department, University College Hospital (UCH), Ibadan, Nigeria. METHODOLOGY: This is a retrospective cross-sectional study of 504 patients with histological diagnosis of breast cancer referred for radiotherapy to the breast or chest wall. Data extraction form was used to obtain information on sociodemographic and disease related variables and time to discontinuation of care. Discontinuation rates and its predictors were estimated using Kaplan-Meier, Log rank test, and Cox's regression method of analyses. RESULTS: Five hundred and four breast cancer patients were studied. The mean age was 47.7years, 58.2% presented late with advanced stage disease, and 40% and 39% had metastasis and anaemia, respectively. Seventy-seven percent of patients discontinued follow-up care before completion of ten-year period. The 5-year and 10-year discontinuation rates were 69.8% and 92.6%, respectively. The median discontinuation time was 44 months. Discontinuers were more likely to be older than the age of 45years {HR=1.415; 95% CI= 1.044 - 1.917}, have metastasis {HR=1.793; 95% CI=1.396 - 2.302}, be anaemic {HR=1.404; 95% CI = 1.120 - 1.760)}, and have late-stage disease {HR=1.310; 95% CI = 1.407-1.639)}. CONCLUSION: Breast cancer care discontinuation is associated with late presentation and advanced stage of disease. Therefore a system of community follow-up care and public awareness about breast cancer symptoms is recommended to reduce late presentation and discontinuity of care.

PATRONAGE AND COST OF MALARIA TREATMENT IN PRIVATE HOSPITALS IN IBADAN NORTH L.G.A SOUTH WESTERN, NIGERIA.

BACKGROUND: Malaria accounts for about 60% of all clinic attendance in Nigeria. About 300,000 children die of malaria annually while an estimated 4,500 pregnant women are lost annually on account of malaria in Nigeria alone. High cost of treatment is a barrier to the uptake of health services in low resource settings, therefore an exploration of the cost of malaria management will reveal possible components that may benefit from intervention and thus reveal important clues for improving access to malaria treatment. Objective of this study therefore is to describe patronage and cost of malaria treatment in private hospitals in Ibadan. METHOD: This was a descriptive cross sectional study, carried out in private hospitals in Ibadan, South Western Nigeria. A self-administered questionnaire with open and close-ended questions was used to collect data on patronage and cost of treatment in adults, children and pregnant women attending private health facilities in Ibadan, Nigeria. Data were presented using tables of frequencies and proportions while analysis was by descriptive statistics. RESULTS: A total of 40 doctors and hospitals participated in the study. Average patronage for malaria, both complicated and uncomplicated per month was 153 patients per hospital. Malaria cases accounts for 331 (46.2%) of total clinic cases seen in private hospitals in a month. About 121 (78%) of malaria cases seen were uncomplicated while 32 (21%) of cases were complicated malaria. Average amount charged patient for treating uncomplicated malaria in private hospitals was N3,941. Average amount spent on antimalarial drugs was about N2,443 (62%) while N1,064 (27.7%) was spent on laboratory investigation and N406.00 (10.3%) for medical consultation. CONCLUSION: Drugs cost constitute the bulk of expenses on malaria treatment. Policy makers may improve access to malaria treatment by subsidizing the cost of anti-malaria drugs for pregnant women and children, who might not be able to afford treatment.

Sexual behaviour and use of electronic media among undergraduates in the University of Ibadan.

BACKGROUND: Sexual behaviour among the youth contributes largely to the burden of reproductive health problems in Nigeria. This may have been worsened by the introduction of electronic media like internet and television (TV). However, little is known about the effects of electronic media on sexual behaviour of youth in Nigeria. Therefore, exploring the influence of effect of electronic media on sexual behaviour of youth may help policy maker to provide interventions to these problems. Thus, this study was aimed at assessing the effect of electronic media on sexual behaviour of Undergraduates in the University of Ibadan. METHOD: This was an analytical cross-sectional study, using a multistage sampling method and data were collected through self-administered semi-structured questionnaire. Variables measured are socio-demographic characteristics, exposure to electronic media and sexual practices of youths. Frequency tables were generated, and data analyzed by logistic regression. RESULTS: Four hundred and thirty three questionnaires were returned out of 456 distributed, giving a response rate of 95%. Mean age of respondents was 18.75 (SD = 2.5) years. About 58.4% of males use the internet and 58.6% watch TV while 41.6% of female use the Internet and 41.4% watch TV. Watching sexually explicit program on internet increases risk of having premarital sex (OR = 3.1; CI = 1.2-7.7) while watching non sexually explicit programmes on T.V protects from having premarital sex (OR = 0.4 CI = 0.2-0.8). CONCLUSION: These observed influence of exposure to sexually charged materials on the internet and electronic media indicates the need for efforts to be directed to controlling access, of youths to these sexually explicit programmes on the internet and television programmes.

Nutritional status of older persons presenting in a primary care clinic in Nigeria.

The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional Assessment (MNA) tool and body mass index were used to assess undernutrition and overweight, respectively. The prevalence of nutritional problems was 61.9% (undernutrition = 7.8% and overweight = 54.1%). Being unmarried (P < 0.001), engagement in a job after the age of 60 years (P < 0.001), constipation (P = 0.009), rectal bleeding (P = 0.008), and oral problems (mouth, teeth, and tongue) were significantly (P < 0.001) associated with undernutrition. Younger age (P = 0.050) and female gender (P = 0.011) were significantly associated with being overweight. Logistic regression analysis showed being unmarried OR = 1.355 (95%CI 1.075-1.708) to be the most important factor for the development of undernutrition. The high prevalence of nutritional problems in this study underscores the need for intervention in this population. Correlation analysis (Pearson's) showed a positive association between BMI and MNA scores (r = 0.152, P = 0.001).

Reliability of the Mid Upper Arm Circumference for the Assessment of Wasting among Children Aged 12-59 Months in Urban Ibadan, Nigeria.

Although the mid upper arm circumference (MUAC) is used as a proxy to assess wasting in children, its validity abounds in controversies. This study therefore assessed the validity of MUAC as a measure of nutritional status among children aged 12-59 months in urban setting in western Nigeria. A cross sectional study of children aged 12-59 months in selected nursery schools in Moniya, Akinyele local government area, Oyo state was carried out between February to April 2010. The age, weight, length and MUAC, were obtained from the school children who were selected through total sampling. The sensitivity, specificity, positive predictive value, and negative predictive values of the MUAC were determined using weight for age as gold standard (underweight). Z-Scores for anthropometric indicators were calculated using EPI-NUT programme. Receivers operating curve was prepared to determine the optimal cut off of MUAC for the sensitivity and specificity. The overall prevalence of under nutrition among the respondents was 5.6%. The mean mid upper arm circumference was 15.47 ± 1.4 cm and appears to increase with age from 11.49 ± 3.0 at 12-23 months and peaks at age five with a value of 18.05 ± 3.5. At 13.5 cm cut off, the sensitivity of MUAC is 20%, and the specificity is 95.3%, with a Kappa of 16.7%. The receivers operating curve reveals an optimum cut off of 15.5 cm with optimal but improved MUAC sensitivity of 80% and specificity of 53.5%. Thus MUAC was a poorly sensitive indicator of under nutrition at a cut-off below 13.5 cm but highly sensitive at 15.5 cm. A higher cut off value is therefore for recommended for screening for acute malnutrition among under five children.

Examination malpractice in our medical schools: prevalence and import on tomorrow's doctors.

UNLABELLED: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors. MATERIALS AND METHODS: Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11. RESULTS: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked. CONCLUSION: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.

Practice and content of sex education among adolescents in a family setting in rural southwest Nigeria.

A descriptive cross-sectional study to assess adolescents' view of the practice and content of sex education within the family setting in a rural Nigerian community and explore whether there is any association between parental communication on sex and adolescents' sexual debut and habits. Simple random sampling was utilized, while a semi-structured questionnaire was used to collect data from 350 respondents. Data analysis was by the Statistical Package for Social Sciences (SPSS version 11). Majority of the respondents (48.8%) were late adolescents, 291 (85.1%) had had sex education, most (45.7%) of whom were exposed between ages 10 and 14 years. The main content of parental sex education was HIV/AIDS prevention (51.9%), avoidance of pregnancy (40.9%), abstinence (38.1%), and basic information about reproduction and biology (35.4%). Poor attitude to parental communication on sex was associated with a higher likelihood of pre-marital sex (p = 0.001). Curiosity was the most common major reason for sexual debut. This emphasizes the importance of early sex education within the family setting and its possible impact in delaying sexual initiation. Promotion of parent-child communication about sexual issues is vital in order to improve the reproductive health of the adolescents in this environment. Community-based health education intervention programs for parents are recommended.

Supplementation of micronutrient in community micronutrient deficiency prevention programmes.

Micronutrient deficiency affects about 2 billion people all over the world. The major micronutrient deficiencies which are of public health importance include vitamin A, iron and iodine deficiencies. The deficiencies of these micronutrients cause a variety of morbidities and increased mortality which are most severe in children, adolescent girls and pregnant women. Despite the magnitude of these deficiencies, research has shown that they are correctable using simple strategies. This review examines the strategies employed to reduce micronutrient deficiencies worldwide by reviewing bibliographic databases, monograms and journals up to the year 2007. These strategies include food based and micronutrient supplementation. Although micronutrient supplementation is widely embraced as a strategy to combat micronutrient deficiencies, they are most suitable when used as a measure to combat severe deficiencies. Food based strategies such as food fortification and dietary diversification are more effective than micronutrient supplementation which should only be used as a short term measure. Supplementation programmes should be evidence based, multi-nutrient in approach and backed up with other complementary public health interventions.

Attitude of general public to risks associated with anaesthesia.

OBJECTIVE: To identify specific fears being entertained about general anaesthesia. METHODS: People who do work in any medical facility were targeted in this prospective questionnaire-based study. All respondents were literate. The questionnaire was divided into two sections; (a) The baseline information, which included age, sex, marital status, occupation, previous exposure to anaesthesia and patient preference for anaesthesia technique. (b) Fear about risks associated with general anaesthesia; respondents were expected to pick one of four options (very concerned, somewhat concerned, not concerned and not sure), to indicate how they feel about each of the eight risks listed in the questionnaire. The data obtained was analyzed using SSPS version 10 for Windows. RESULTS: In a bivariate analysis, marital status, occupation and previous exposure to anaesthesia are not associated with the expressed fear by the respondents. Respondents had the highest concern for the fear of death (82%), followed by fear of postoperative pain (75.4%). Least concern was for awareness during anaesthesia (37.7%). The mean age of those who expressed concern about being aware during operation is 37.0 +/- 8.6 years while those not concerned is 31.8 +/- 8.5 years (p=0.034). More of those who are concerned with nakedness preferred general anaesthesia (p = 0.023). Also, more females (95.7%) than males (70.6%) expressed fear about pain during general anaesthesia (p = 0.019). CONCLUSION: Fear of death is a great concern for our patients coming for general anaesthesia and it is followed closely by fear of postoperative pain, the later was of greater concern to females. Finally, more of those who were concerned about nakedness preferred general anaesthesia.

Informed consent in a tertiary hospital in Nigeria: how involved is the nurse?

INTRODUCTION: We reviewed the nurse's involvement and role perception on informed consent in LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria OBJECTIVES: The study aimed at determining the nurses' knowledge, attitude and perception of role in informed consent and the level of participation in the procedure. METHODS: A descriptive cross sectional study of the nurses in the medical and surgical units of LAUTECH Teaching Hospital was carried out using semi structured questionnaire. RESULTS: Sixty five nurses participated in the study. A high proportion - 60 (92.3%) had heard of informed consent but only 26(40%) had correct and adequate knowledge of informed consent. Forty (61.5%) had participated as witnesses to the procedure of seeking informed consent. Participation was only sometimes in 38 (58.5%) of respondents. Forty seven (86.2%) nurses wanted nurses to be involved in obtaining informed consent because it improves quality of patient care while 38(58.5%) nurses believed that involvement of nurses should be because it is the nurses' statutory responsibility. CONCLUSION: It would appear that the knowledge of informed consent among nurses was inadequate and nurses were not adequately carried along in the process. Training of nurses in this important procedure would greatly enhance the quality of patient care.

Effect of breastfeeding during venepuncture in neonates.

BACKGROUND: Evidence suggests that infants feel pain, and painful experiences may lead to subsequent increased pain sensitivity. Owing to concerns regarding the potential adverse effects of pharmacological interventions in newborns, effective alternatives for pain control are being sought. AIM: The Neonatal Infant Pain Scale (NIPS) was used to determine the analgesic effect of breastfeeding during venepuncture. METHODS: The study was of cross-over design where each neonate served as his/her own control. Median pain scores during venepuncture when neonates were being breastfed (BF) were compared with those when neonates were not being breastfed (NBF). The site of venepuncture and number of previous venepunctures were noted. Pain was assessed using NIPS. RESULTS: In all, 38 term neonates (25 male, 13 female) were recruited. Mean (SD) age and weight were 8.42 (8.74) days and 2.89 (0.67) kg, respectively. The median pain score (interquartile range) of the neonates when breastfed was 1.50 (1-2), and 4.00 (2-6) when not breastfed (p=0.0001). The Kruskal-Wallis H-test did not show statistically significant differences between the BF and NBF groups when the number of previous punctures (p=0.57, p=0.27) and site of venepuncture (p=0.71, p=0.77) were considered. CONCLUSION: Using NIPS, it has been demonstrated that breastfeeding is analgesic in neonates during venepuncture and previous venepuncture/s and site of venepuncture do not seem to affect pain scores. Breastfeeding should be the first-choice analgesic during painful procedures in neonates.

Demographic factors determining compliance to iron supplementation in pregnancy in Oyo State, Nigeria.

BACKGROUND: Iron deficiency anaemia in pregnancy has irreversible negative consequence on infant cognitive development and increases maternal morbidity and mortality. Iron supplementation ameliorates this effect. The salutary effect of iron supplementation on improvement of haemoglobin levels in pregnancy has been documented in various studies. However factors affecting the compliance of women with prescribed iron supplements are yet to be well studied, particularly at primary care levels. This study describes the compliance rate and demographic factors influencing use of iron supplements among pregnant women at primary care level. METHOD: This is a cross sectional descriptive study. Five hundred and ninety seven women attending randomly selected primary care centres were studied. Demographic characteristics and information on use of iron supplements were collected. Haemoglobin level was also determined for each woman. RESULTS: Compliance rate was 37.5%. Prevalence of anaemia was higher among noncompliant women than those complying (18% v 15%, chi2 7.5, p = 0.006). Haemoglobin level was higher among women complying with iron supplements compared with those not complying (11.4 g/dl v 11.0 g/dl, t = 9.3, p = 0.002). Single and teenage mothers and those aged 35 years and above were less likely to be compliant. Married women, those in urban location, and those aged 20-29 years were more compliant with iron supplementation. CONCLUSIONS: Pregnancy among teenage and single mothers is associated with a significantly higher risk of non-compliance with iron supplementation. Further studies are recommended to understand the reasons for non-compliance among these groups of women.