Population-based prevalence of hepatitis B and C virus, HIV, syphilis, gonorrhoea and chlamydia in male injection drug users in Lagos, Nigeria.

There is little research on injecting drug use in Nigeria. We investigated the prevalence of HIV, hepatitis B and C, and sexually transmitted infections (STIs) among male injection drug users (IDUs) in Lagos. Male IDUs (N = 328) were recruited through respondent-driven sampling. Participants completed an interview about their sexual and injecting risk behaviours and were tested for hepatitis B surface antigen (HBV), hepatitis C antibody (HCV), HIV and syphilis, as well as genital chlamydia and gonorrhoea infections. Three-quarters of IDUs (74%) reported injecting drugs in the past one month although most did not share needles (92%) and the majority obtained sterile needles from pharmacists (87%). Estimated HBV, HCV, HIV, syphilis, gonorrhoea and chlamydia prevalences were 7.8%, 7.7%, 0.9%, 1.9%, 0.0%, and 3.7%, respectively. The burden of HIV is presently low among IDUs in Lagos. Changes in accessibility to sterile needles at pharmacists would likely have a deleterious effect on IDUs' health. HBV vaccination and HCV prevention programmes for IDUs are urgently needed.

OS033. Correlates of maternal health outcomes associated with a low-costintervention in secondary facilities across Kano state, Nigeria.

INTRODUCTION: Nigeria has one of the highest rates of maternal mortality in the world. Eclampsia is a major contributor to the deaths especially in Northern Nigeria where the culture of teenage marriage is common. Kano is the state with the highest population in Nigeria. Despite its effectiveness, magnesium sulphate was been used to treat eclampsia and severe preclampsia in only one of 35 general hospitals inthe state as at 2007. OBJECTIVES: In 2008, magnesium sulphate was introduced in 10 General Hospitals in Kano state of Northern Nigeria in a Population Council project funded by the MacArthur Foundation. The aim of the study was to determine if the maternal outcomes improved. METHODS: Doctors and midwives from the 10 hospitals were trained on the use of magnesium sulphate. The trained health workers later conducted step down trainings at their health facilities. Magnesium sulphate, treatment protocol, patella hammer and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analysed using SPSS. RESULTS: Within a year of the project, 1045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9% (95% CI 18.7-23.2) recorded before the project to 2.3% (95%CI 1.5-3.5) after the project. The perinatal mortality rate in those that received magnesium sulphate was 12.3% (CI 10.4-14.5) while the 5min APGAR score for 72.9% of the babies was 7 or more. CONCLUSION: Training of health workers on updated evidence based interventions and providing an enabling environment for their practice are key components to the attainment of the Millennium Development Goals in developing countries.

Age variations in the proximate determinants of child mortality in south-west Nigeria.

Age variations in the influences of three sets of proximate factors on child survival in Ondo State, Nigeria, during 1981-86 are described. Biodemographic factors covary very strongly with mortality risks during the first month of life, weakly during months 1-11, and imperceptibly beyond infancy. Microenvironmental factors progressively strongly covary with mortality after the neonatal period, while health services accessibility and care factors broadly covary strongly with mortality throughout early childhood. Patterns in the size of the hypothetical population-level impacts of these factors suggest that promoting assisted use of toilet facilities within households by under-5s and wider provision of dispensaries and hospitals would yield cost-effective and notable reductions in overall childhood mortality levels in the study setting.

PIP: Proximate determinants of neonatal, infant, and child mortality were examined based on birth history data (1981-86) from the 1986 Nigerian Demographic and Health Survey for Ondo State. Child survival was determined to be affected by maternal/biodemographic factors, sanitation and water supply factors, and health services use and access factors. 15.4% of births were high-risk births due to short birth intervals, 1st or higher than 5th order births, and births to teenagers. Almost 75% of children under 5 years old in homes with toilet facilities were not allowed to use them. Almost 50% of young children obtained drinking water from wells, ponds, and rains. 9.4% of children lacked access to soap. 71.2% of mothers had received tetanus vaccinations. Findings indicated that males were 1.64 times more likely to die in the first month of life than females. 1st births and higher than 5th order births had a higher probability of dying in the first month of life. Neonatal mortality risk was higher for births among teenagers. The risk of infant mortality remained high for births to teenagers (1.67) compared to mothers 20-34 years old (0.77). Births following a short birth interval (24 months) had at least a 33% higher infant mortality risk. Sanitation and safe drinking water in the home was a minor determinant of neonatal mortality; the impact was determined by the extent to which infants were given drinking water in the third week of life. Survival gains were lost by keeping children's toilet facilities separate from adults: a common practice. Access and use of modern health services was positively associated with survival at all ages under 5 years. In general, biodemographic factors had stronger associations with infant mortality and weak associations with mortality at 12-47 months. Environmental conditions in the home contributed more the mortality risk at 12-47 months. Health care use and access broadly affected risk at all age groups. Public health campaigns should encourage use of sanitary toilet facilities by children under 5 years old. Policy for improving child survival could focus on increased birth spacing, discouragement of first births to teenagers, and a renewed focus on greater provision of health services.

Gender relations, demographic change and the prospects for sustainable development in Africa.

PIP: The author explores the interrelationships between gender relations, demographic change, and Africa's prospects for sustainable development in the larger context of the ecological, economic, and sociopolitical forces which shape living conditions in the region. To make the analysis manageable, the author adopts the concept of sustainable development as the organizing and selecting principle in the exploration of issues central to the development of his argument. Rapid and uneven population growth is just one of many factors implicated in Africa's econo-environmental crisis. However, its strong synergism with gender relations and the limited scope for overcoming the externally derived problems suggests that a transition to lower fertility and higher women's status may be Africa's most realistic road to sustainable development. Discussion is presented under the following headings: concept of sustainable development as an analytical framework, salient aspects of Africa's demography, environmental degradation in Africa, economic stagnation and decline, gender considerations common to the key aspects of Africa's development crisis, and movement toward an enhanced prospect for sustainable development in Africa.^ieng

Components of stably high fertility in three areas of west Africa.

The constancy of fertility levels in Ghana, Senegal and southwest Nigeria since 1970 is separated into its nuptiality and marital fertility elements. The age-specific changes in the two components are examined and these show that the apparent stability in observed total fertility rates is essentially the outcome of the offsetting impact of increased marital fertility below age 25 and above age 40, over the effect of the increasing proportion of women remaining single up to 25 yr of age. Continuity in traditional fertility behaviour and stable nuptiality has remained operative over the broad middle segment of the reproductive lifespan of women in the three areas. The paper thus concludes that West Africa is likely to continue to display stably high fertility for many years into the next century. The social and cultural conditions behind this trend are discussed with special reference to the continued high demand for children and the low and only slowly rising contraceptive prevalence level.