Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria.

BACKGROUND: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications. OBJECTIVE: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos. METHODOLOGY: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. RESULTS: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10-19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities. CONCLUSIONS: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.

Neonatal mortality and perinatal risk factors in rural southwestern Nigeria: a community-based prospective study.

BACKGROUND: Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may have occurred with recent interventions. OBJECTIVE: To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS: In a community based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS: There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis and fever and maternal deaths and failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW, RR of 4.7; delivery outside a health facility, RR of 3.6; lack of attendant at delivery, RR of 5.01; and Traditional Birth Attendant (TBA) delivering the baby, RR of 2.7. Effect of sex of the neonate, mother and fathers ages were not significant at the 5% level in the model. CONCLUSION: Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having no one in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer. Obstetric and public health services have to be available and made more accessible at the grass root level.

Children not receiving adequate immunization in Ibadan, Nigeria: what reasons and beliefs do their mothers have?

BACKGROUND: Immunization coverage in most areas in Nigeria has remained low with continued high morbidity and mortality from vaccine preventable diseases. OBJECTIVES: To identify the reasons and beliefs about immunization among mothers whose children have not received adequate immunization or not at all. SUBJECTS AND METHODS: The study was a descriptive cross sectional survey that involved mothers trading in a large market in Ibadan who had children between the ages of 12 and 23 months. Data were collected by means of a semi-structured questionnaire. Mothers who did not immunize or failed to completely immunize their children were selected for analysis. RESULTS: A total of 248 mothers were interviewed, their mean age was 27.3 5.5 years (range 16 42 yrs). The commonest reasons for incomplete immunization included: non availability of vaccines (26.2%), not being aware of need for additional doses (16.5%) and inconvenient time/venue (13.7%). Logistic regression analysis showed that Mothers with no formal education were about six times more likely than those with secondary education and higher to give reasons related to lack of motivation (95% CI OR = 1.88 17.93). Analysis of the mothers' beliefs on immunization were as follows; 186 (75.0%) believed it was beneficial, 161 (64.9%) believed that immunization will save the life of the child and 129 (52.0%) believed that taking the child to the clinic for immunization wasted a lot oftime. CONCLUSION: Most mothers in this study agreed that immunization is beneficial. It is therefore recommended that routine immunization be strengthened, vaccines made readily available and mothers educated on the immunization schedule.

Immunization status and its determinants among children of female traders in Ibadan, South-Western Nigeria.

Traders form a large percentage of the female work force in Nigeria and may spend long hours at work, thereby putting their children at risk of inadequate immunization. The study assessed primary immunization completion rate and the determinants of immunization status among the children of female market traders in Ibadan, South-Western Nigeria. A cross-sectional community-based survey was carried out in Bodija market among female traders who had children aged 12 to 23 months. The subjects were selected by systematic random sampling and data collected with an interviewer administered semistructured questionnaire. Logistic regression was used to estimate the predictors of incomplete immunization for the socio-demographic variables. A total of418 women were interviewed. Ninety two percent worked > or = 6 days a week and 78.5% had their children with them in the market all the time. Full immunization by both card and history was recorded in only 40.7% while 8.4% children had never been immunized. The highest vaccine coverage was seen with BCG (91.4%) while Hepatitis B (1%) had the lowest coverage. DPT1 to DPT3 vaccine drop out rate was 32.1%. All the immunizations were received in health facilities. The immunization coverage rate among children of female traders was low. Routine immunization sites should be made available in the markets.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria.

BACKGROUND: The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria. METHODS: A cross-sectional survey was carried out in 2006. RESULTS: Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05). CONCLUSION: The information provided a useful baseline on which subsequent interventions could be based and evaluated.

Adherence to highly active antiretroviral therapy (HAAT) at a Federal Medical Centre.

Highly active antiretroviral therapy (HAART) has proved effective in prolonging survival and improving the quality of life of the people living with HIV/AIDS (PLWHA). For the successful treatment of HIV infection, at least 95% adherence to HAART is required. This study sought to assess adherence to HAART and to identify factors enhancing adherence within the study population. The study was a descriptive cross-sectional survey of 428 patients attending the antiretroviral (ARV) clinic of the Federal Medical Centre, Makurdi. Self-reported adherence and other data were collected using an interviewer-administered questionnaire. Data were analysed using SPSS 11.0 and Epi6; and were exported into Systat 11 for multivariate logistic regression. There were 151 (35.3%) males and 277 (64.7%) females. The mean age was 36.7 +/- 9.6 years. Self-reported adherence rate was 268 (62.6%). The factor most predictive of adherence to HAART was availability of ARVs [OR = 5.2; 95% confidence interval 3.1-8.6; p < 0.001], followed by the ability to afford regular visits to the ARV clinic [OR = 1.7; 95% confidence interval 1.04-2.8; p = 0.034]. A recent diagnosis of HIV made less than 3 years prior to the study period was also significantly associated with adherence to HAART (chi2 = 8.94; p = 0.003). Availability of ARVs and ability to afford to regularly visit the clinic among other factors, positively influenced adherence to HAART among PLWHA. Efforts should be targeted at constant provision of free ARVs and early initiation of therapy for those requiring treatment, as well as ensuring regular adherence-education.

Infant and maternal deaths in rural south west Nigeria: a prospective study.

Baseline data on neonatal, infant and maternal deaths including factors associated with infant mortality in a rural community are needed to assess the progress being made towards achieving lower rates in Nigeria. In this community-based prospective study, baseline data on births and deaths were collected as they occurred for 6 consecutive years and perinatal risk factors associated with these deaths identified. There were 972 live births in the study period. Maternal mortality ratio (MMR) for the period was 2160 per 100,000 and infant and neonatal mortality rates of 65.8 and 32.9 per 1000 live births were obtained. MMR was highest in mothers aged 40 years and above and lower in mothers 15-34 years. Of infants deaths, 18.8% occurred on the first day of life and 32.8% of deaths occurred within one week of birth. Malaria/fever (23.4%), LBW (17.2%), and Vaccine preventable diseases (neonatal tetanus and measles) (12.5%) were the commonest known causes of infant deaths. Perinatal risk factors for infant deaths included being first birth order (RR = 3.1, 2.1-4.7), birth outside the health care facility (RR = 2.5, 1.4-4.3), no attendant at delivery (RR = 2.5, 1.4-4.4); low weight at birth (RR = 2.46 1.01-5.9) and traditional birth attendants at delivery (RR = 1.7, 1.2-2.6). Babies born to fathers who were between the ages of 25-34 years had borderline protection (RR = 0.76, 0.6-1.01). Delivery and perinatal events have a significant impact on infant survival and more needs to be done to integrate infant survival with maternal survival strategies and this should be done at the primary care level. The community must also be educated and empowered to use the facilities for promotive, preventive and curative care.

Epidemiological features of HIV infection among pregnant women in Makurdi, Benue State, Nigeria.

Women in Benue State have for years had the highest HIV rate in the country, but because the sentinel surveys are anonymized and unlinked, not much is known about the socio-demographic, behavioural and other risk factors that predispose these women to the disease. The HIV/AIDS epidemic in Nigeria does not appear to be a single epidemic but rather multiple epidemics of varying magnitude and trends. This cross-sectional study was therefore carried out to identify the risk factors for HIV/AIDS among these women. A total of 404 consecutive consenting mothers enrolled at the booking clinic were followed up until delivery of their babies. They were interviewed using a semi-structured questionnaire and tested for HIV infection using an ELISA-based kit after obtaining informed consent. Mean age of the mothers was 26+/-6.1 years, 94.8% were married while 50.5% had at least secondary level education. Sixty-one (15.1%) mothers were HIV positive with mothers aged 15-24 years being responsible for 50.8% of all infection. Following bivariate analysis, being single, having a partner with low level of formal education, living in a rural location, being in a polygamous/multiple partner union, being a higher order polygamous wife, being married more than once and reporting a history of a sexually transmitted infection were significantly associated with HIV infection. Monogamous women who lived apart from their partners and women who had ever had blood transfusion were also more likely to be HIV positive. Following multivariate logistic regression, a young age of 15-24 years (multivariate OR=3.3, 95 % CI=1.2-8.4, p=0.02); ever had other STIs (OR=1.6, 95% CI 1.1-2.3, p=0.009); no formal maternal education (OR=0.6, 95% CI 0.4-0.9, p=0.021) and having one lifetime sexual partner (OR=0.4, 95% CI 0.3-0.5, p<0.00001) were significantly associated with HIV infection in the study population. Appropriate interventions must be directed at young people and should include STI control and abstinence education. Blood safety must be ensured as well as a general improvement in the level of formal and health education in this community.

A four-year analysis of manuscripts submitted for publication in West African Journal of Medicine (June 2001 to May 2005) (a brief report).

There are various criteria that could be used to rate a tertiary institution. One of these is the productivity of the members of staff which is shown by the research conducted, publications submitted and manuscripts published in indexed journals. Manuscripts submitted and published in one of the highly rated indexedjournals in our locality were analysed with a view to identifying how the institutions add to knowledge by their contributions. Our findings show that the four top-rated institutions in terms of manuscripts published in West African Journal of Medicine (WAJM) are University College Hospital (UCH), lbadan, University of Ilorin Teaching Hospital (UITH), Obafemi Awolowo University Teaching Hospital (OAUTH), and Jos University Teaching Hospital (JUTH).

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.

Risk factors associated with mental illness in Oyo State, Nigeria: a community based study.

BACKGROUND: The main objective of this study was to determine the prevalence and factors associated with mental illness in Oyo State at community level using the general health questionnaire as a screening tool. METHOD: This cross-sectional, community- based survey was carried out among adults in three randomly selected LGAs using multi-stage sampling technique. RESULTS: A total of 1105 respondents were assessed in all. The overall prevalence of psychiatric morbidity in Oyo state Nigeria was found to be 21.9%, (18.4% in the urban areas and 28.4% in the rural areas, p = 0.005). Young age < or = 19 yrs (X2 = 20.41, p = 0.00013), Unemployment (X2 = 11.86 p = 0.0005), living condition below average (X2 = 12.21, p = 0.00047), physical health (X2 = 6.07, p = 0.014), and large family size (X2 = 14.09 p = 0.00017) were associated with increase risk for psychiatric morbidity. Following logistic regression analysis, Unemployment (C.I = 1.18-3.70, OR -2.1) and living conditions perceived to be above average (C.I = 1.99-5.50, OR-3.3) were significant predictors of mental illness while family size less than 6 (C.I = 0.86-0.97, OR-0.91) was protective. CONCLUSION: The teenagers and the rural populations are in greater need of mental health promotional services. Family planning should be made freely available in order to reduce the family size and hence incidence of mental illness in the African population.

STI/HIV co-infections in UCH, Ibadan, Nigeria.

Sexually transmitted infections (STIs) are poorly recognised and inadequately treated in Nigeria in spite of the fact that it constitutes a major risk for HIV transmission. This study was carried out to ascertain STI/HIV co-infection rate and to obtain relevant socio-demographic and reproductive health data associated with STIs. This information is urgently needed for designing STI/HIV control strategies. All consenting patients with history suggestive of STI, who attended STI clinic at the University College Hospital, Ibadan, between March and November 2001 were enrolled in the study. Of the 210 patients seen, 98 (46.7%) were males while 112 (53.3%) were females (p > 0.05). One hundred and fifty six (74.3%) of them were aged 20-39 years while only 10 (5.1%) were adolescents. Twenty (9.5%) had laboratory diagnosis of STIs, out of which 6 (30%) were also HIV positive. Among those with STIs, 8 (40%) had gonorrhoea, 8 (40%) had candidiasis, while 4 (25%) were positive for Trichomonas vaginalis. None of the patients' sera was positive for Treponema palladium antibody HIV prevalence rate in the study was 21.9%. Highest rate was found in patients aged 20-29 years while no adolescent and no one over 50 years old was HIV positive. Five (62.5%) of the patients with gonorrhoea were also HIV positive, a lower percentage (25%) of those with trichomoniasis were positive for HIV, while none of those infected with candidiasis was HIV positive. STI/HIV co-infection rate was 30%. This study reveals a high STI/HIV co-infection rate, indicating that there is a need for proper management of STIs as a way of reducing the spread of HIV infection in Nigeria.

Guidelines for assessment of publications for contribution to scholarship: a view point.

BACKGROUND: There does not seem to be a uniform method of assessment for promotion in the various tertiary institutions in Nigeria. The result of this is that a professor in one institution may just qualify to be a senior lecturer in another in the same country. An attempt is being made in this write-up to devise a method of standardization for promotion in tertiary institutions in Nigeria. METHOD: Literature dealing with peer review process, writing clinical research papers, and assessment were reviewed. Also various methods of assessment for promotion in some tertiary institutions were studied. RESULTS: There are six areas of assessment of the publications of a candidate for academic promotion. They are (a) the quality of the journal where the article were published; (b) the type of research; (c) the scientific quality of the paper; (d) the relevance of the paper to the author's discipline; (e) the numerical position of the authorship of the candidate being assessed; (f) and the number of publications. CONCLUSION: Having a clear-cut and more objective way of grading a prospective candidate will ensure uniformity, allow the candidate to work realistically towards a goal and to aim high, reduce subjective assessment, reduce the chances of injustice, and encourage non-indexed local journals to aspire to get indexed or die a natural death.

HIV as an additional risk factors for anaemia in pregnancy: evidence from primary care level in Ibadan, Southwestern Nigeria.

Anaemia in pregnancy has serious consequences including maternal morbidity and impairment of infant cognitive development. Several authors have however reported inconsistent findings on risk factors for anaemia in pregnancy. This study was carried out to determine risk factors for anaemia in pregnancy among women at primary care level and document the contribution of HIV/AIDS to anaemia in pregnancy in low risk pregnant women at primary care level. A prospective study carried out among pregnant women attending the booking clinics of primary health care centres in Ibadan, Nigeria. HIV positive and HIV negative mothers were followed throughout pregnancy till delivery of their babies. History of use of iron, folate, Vitamin B complex and daraprim were obtained. Haemoglobin, malaria parasitaemia, and HIV serostatus were determined. Use of iron (P < 0.006), folate (P = 0.032), vitamin B complex (P = 0.001) and treatment for malaria (P = 0.05) significantly reduced the risk for anaemia in pregnancy. Malaria parasitaemia (P = 0.0001) significantly increased the risk of anaemia. However, use of daraprim and HIV seropositivity increased the risk of anaemia in pregnancy but not significantly. In a logistic regression analysis, iron (P = 0.001) and folate supplementation (P = 0.015) significantly protected against anaemia in pregnancy while malaria parasitaemia (P = 0.006) and HIV seropositivity (P = 0.015) were significant adverse risk factors. HIV is an additional risk factor for anaemia in pregnancy. Voluntary counseling and testing of pregnant women for HIV is therefore also indicated at primary care level to detect asymptomatic anaemia in pregnancy that may be due to HIV.

Drug use among senior secondary school students in rural Nigeria.

Several studies in Asia, USA and the United Kingdom have shown widespread drug use among adolescents and young adults, thus drawing global attention to this problem. There is however a paucity of data on drug use among youths in rural Nigeria. The target population for this study were adolescents and youths from three out of the 6 senior secondary schools in Igboora, Nigeria, selected by simple random sampling. A cross-sectional study, using interviewer-assisted questionnaire to determine the prevalence of and identify factors associated with drug use. Two hundred and seventy three (69.3%) respodents were currently using one or more drugs of which 123 (45.1%) were single drug users while 150 (54.9%) were multiple drug users. Fourteen different psychoactive substances were reportedly used of which Alabukun, a popular, locally manufactured analgesic (a mixture of acetyl salicylic acid and caffeine) was the most commonly reported drug currently used and ever used. Alcohol was the next commonly reported currently used drug while Kolanut was the next commonly ever-used drug. Tobacco ranked low on the list with only 1.5% current users, while 4.4% reported having ever-used this drug. Following logistic regression analysis, having peers (close friends) and primary caretakers who use drugs, significantly increased the chances of the students using drugs (P < 0.001, P < 0.001). Males compared with females were also significantly more likely to use drugs (P = 0.024). Significant relationship exists between drug use and poor role modeling. Introducing peer counseling, community awareness and working with adults who have adolescents at home would go a long way towards reducing psychoactive drug use at community and household level, particularly among in-school youths.

Characteristics of volunteers and non-volunteers for voluntary counseling and HIV testing among unmarried male undergraduates.

The 2001 HIV sero-prevalence survey in Nigeria revealed a rate of 5.8 percent with those under the age of 25 years having the highest prevalence rate. Most University students fall within this age group. This study is part of a larger study on the sexual behavior of youths and young adults and was designed to compare the characteristics of volunteers and non-volunteers for voluntary confidential counseling and HIV testing (VCT) among males. Six hundred and nine male undergraduate students were randomly selected and enrolled for the study. Data were collected using a pre-tested questionnaire. Of the 609, 51 (8.3%) volunteered to have their blood screened for HIV. All volunteers who received pre-test counseling went for the HIV test. Volunteers were significantly older than the non-volunteers (P<0.0001), and were more likely to be sexually experienced (P=0.002). Among the sexually experienced, the volunteers were older at first sexual intercourse (FSI) (P<0.0001), and were more likely to have used a condom at FSI (P=0.001). Volunteers had significantly higher knowledge scores for HIV/AIDS (P=0.006), and the attitude to HIV/AIDS in both groups was positive. The marriage pattern of their parents with regard to polygyny was similar, and fewer volunteers had fathers in the higher socio-economic class and mothers who had completed secondary education (P<0.00001, (P=0.02). Among the 51 volunteers, 8 (15.7%) tested positive. Those who tested positive were less likely to have lived with parents, and were all sexually experienced. Those who screened positive were also more likely to be currently sexually active and to have fathers with low level of education. Three (5.9%) of volunteers did not return for results and posttest counseling. One of the three was positive for HIV. Of those who tested positive, 3 (37.5%) reported not using the condom at all, while the rest were using it only occasionally. VCT among the youths is possible however, small numbers encountered in the study is a limitation and there is a need to replicate this study using larger numbers. Tertiary institutions should provide VCT services for the students where they can be counseled appropriately and continuously throughout their stay in the institution. This hopefully will reduce the number of new HIV cases seen.

Oro-facial lesions and CD4 counts associated with HIV/AIDS in an adult population in Oyo State, Nigeria.

OBJECTIVE: The objective of this study was to define the oro-facial lesions associated with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in an adult population in Oyo state, Nigeria and to relate these with the level of immune suppression as measured by the CD4 counts. MATERIALS AND METHOD: The study population consisted of 679 consecutive subjects who were seen at the state-owned blood bank. Information on demography, medical and medication histories were obtained. Oro-facial examinations were carried out according to Greenspan et al [Oral Surg Oral Med Oral Pathol (1992)73:142-144]. HIV sero-prevalence status was determined for all patients. CD4+ T-lymphocyte count was carried out for those sero-positive for HIV and 31 randomly selected HIV-negative subjects. Data were analyzed using the chi-square test, Fisher's exact test, Student's t-test and odds ratio where appropriate. RESULTS: Eighty-one (11.9%) of the entire study sample were confirmed HIV positive. The prevalence of specific oral lesions by HIV sero-status revealed that pseudomembranous oral candidiasis and angular cheilitis occurred significantly and more frequently in HIV-positive subjects (33.3 and 21% respectively) than those who were HIV negative (4.3 and 1.8% respectively, P < 0.05). The mean CD4 count of the HIV-positive subjects was 452 cells mm(-3), s.d. 137, while it was 602 cells mm(-3), s.d. 251, for the HIV negatives. The difference was statistically significant (P = 0.000). Forty-four (66.7%) subjects with CD4 counts <500 cells mm(-3) had oro-facial lesions whereas among those with CD4 counts >500 cells mm(-3) only 22 (33.3%) had oro-facial lesions (OR = 4.57). CONCLUSION: The type of oro-facial lesions most commonly associated with HIV/AIDS in Oyo state, Nigeria, has been shown to be pseudomembranous oral candidiasis. This was followed by angular cheilitis. These lesions, although found in HIV-negative subjects, were in a lower proportion as compared with HIV-positive subjects. Mean CD4 counts were lower in HIV-positive subjects and this was associated with greater prevalence of oro-facial candidiasis and angular cheilitis.

Using verbal autopsy to identify and proportionally assign cause of death in Ibadan, southwest Nigeria.

Reliable and accurate data remain scarce on the cause and rates of mortality among adults in sub-Saharan Africa. The Idikan Adult Mortality Study, a prospective community-based study was initiated in order to obtain the overall as well as cause-specific mortality data for a community of adults (15 years and above). Standardised verbal autopsy questionnaire was used to investigate and assign the mode and cause of death. There were 232 reported deaths in the baseline population of 4127 adults over 5 years, giving an unadjusted death rate of 11.2 per 1000 per year. Thirty-nine (16.8% ) of these death occurred suddenly. The commonest known cause of death was due to cardiovascular disease, which was responsible for 43 (18.5% ) of all deaths. It was also the commonest known cause of sudden death accounting for 30.8% of such deaths. Infection was responsible for 28 (12.1% ) deaths while injury accounted for 7 (2.6% ) deaths. Subjects, 50 years and above were more likely to die and also die suddenly than were the younger subject (p<0.0001, p<0.0001) and significantly more death occurred in males than females (6.9% versus 4.7% ) (P<0.01). Deaths were also more likely to have occurred at home and outside the hospital, increasing the probability of these deaths being underreported. Following multivariate logistic regression analysis, respondents between the age of 20 -49 years had significantly reduced risk of dying (p=0.029), while cigarette smoking significantly increased the risk of dying (p=0.012). In the absence of the urgently needed vital statistics, use of verbal autopsies is a potentially useful investigative method for identifying and assigning cause of adult deaths in a community.

Predictors of maternal HIV infection at the primary care level in inner city Ibadan.

National HIV prevalence rate is derived from the sentinel surveys, which are carried out once in two years and remain anonymized. Epidemiological data are largely unavailable on the pregnant HIV-positive mothers particularly at the grass root level. This information is urgently needed when developing a realistic intervention programme. Three hundred and forty-three consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001 were enrolled at booking and followed up till delivery of their babies. Sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. Results showed that about one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level (P =0.046). Christian religion was associated with a lower risk (P =0.038), and mothers who booked late in pregnancy (P =0.025) or had husbands in the lower socio-economic class (P =0.001) were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counselling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer.

Sexual networking among married men with wives of child bearing age in Ibadan City, Nigeria: report of a pilot study.

Following the Beijing Conference, it is desirable to empower men to play a more active and responsive role in promoting the health of family members and preventing disease. This cross sectional, community-based, ex-post factor, pilot study was designed to find out if traditional norms affect marital sexuality and also to identify sociodemographic factors associated with sexual networking among men. A total of 416 married men whose wives had delivered a baby in the last 36 months prior to the study were interviewed from randomly selected clusters in Ibadan, Nigeria. Of this number, the majority 336 (80.8%) had sex with pregnant wife in the last pregnancy and proportion of married men who had sex in the pregnancy with wives reduced modestly with increasing age of the men. With regards to sexual networking in pregnancy, 207 (49.8%) men reported having sex with someone else when wife was pregnant. Of this number 95 (45.9%) had it with steady girl friends, 56 (27.0%) with new girl friends, 50 (24.2%) with another wife and 6 (2.9%) with commercial sex workers. The prevalence for having sex with someone else in this period was lower in men from the higher socio-economic class (HSEC) when compared with the lower socio-economic class (LSEC)(chi2 = -9.89, P < 0.001). The middle socio-economic class also had a lower rate than the lower socio-economic class (chi2 = 6.28, P < 0.01). In addition, men with post secondary/University education had significantly lower rates for networking when their wives were pregnant compared with men of lower educational attainment (P < 0.05). Three hundred and eleven men (74.8%) reported that they observed some period ofpostpartum abstinence (PPA) with recently delivered wife, which ranged from 5 days to 72 months (Median was 7.5 months). The highest PPA rates were seen in men with no formal education, those from lower SEC and in men who embraced traditional religions. Issues that have to be addressed in more detail in the follow up study include understanding why men network as traditional proscriptions are generally not adhered to. Determining the relationship between length of postpartum abstinence and sexual networking and implication of this behaviour in the spread of sexually transmitted diseases and fertility control if postpartum abstinence period is significantly reduced or increased. In this regard, qualitative research as well as quantitative research should be carried out so that the entire study is not left within the realm of a quantitative study, which may be inadequate for explaining social and demographic data.