Neonatal care - what do mothers in a rural Nigerian community know and practice?

BACKGROUND: Nigeria ranks among developing countries with poor neonatal health indices. This underscores the need for households and healthcare providers to understand the concept of newborn care and react appropriately and timely too. OBJECTIVE: To determine the knowledge and practices of mothers in the Elele community regarding neonatal care. MATERIALS AND METHODS: This was a community-based descriptive cross sectional study of 380 mothers who had a neonate. Mothers were selected using a multistage sampling technique. Data were collected by interview using a semi-structured questionnaire (with closed and open ended questions) and analyzed using a statistical package for social sciences version 22.0. Chi-square test was used to identify statistically significant associations among antenatal care clinic (ANC) attendance cum place of delivery and neonatal care practices. RESULTS: Ninety one (23.9%) of respondents were aware of at least four out of nine danger signs, while all reported wrapping their babies within 10 minutes after birth. Duration less than six hours from birth to first bath, feeding with or discarding of colostrum and timing of first breastfeeding within the first hour of birth were significantly associated with ANC attendance (p = 0.000, p = 0.002 and p = 0.000 respectively). Duration less than six hours to first bath, umbilical cord care and feeding with or discarding of colostrum were significantly associated with health facility delivery (p = 0.043, p = 0.026 and p = 0.003 respectively). CONCLUSIONS: Inadequate knowledge of newborn care among mothers was found, while non-ANC attendance and non-health facility delivery were associated with inappropriate neonatal care practices. We recommend comprehensive behavior change interventions, to promote proper neonatal care practices.

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.

EVALUATION OF MALE SEX HORMONES AND TRACE ELEMENTS IN MALE TYPE 2 DIABETIC PATIENTS ATTENDING NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL DIABETIC CLINICS.

BACKGROUND: There is accumulating evidence that the metabolism of male sex hormones and several trace elements are altered in type 2 diabetic mellitus and may have specific role in the pathogenesis and progression of the disease. AIM: To assess the levels of male sex hormones and trace elements in type 2 diabetic patients and to ascertain an association between male sex hormones and trace elements among diabetic subjects. METHODS: A descriptive cross sectional study was conducted among 125 diabetic and 50 non diabetic subjects. Venous blood samples were collected from all respondents and estimated for fasting blood glucose, male sex hormones and trace elements. The results were subjected to statistical analysis and comparison using Students' test and Pearson correlation analysis. RESULTS: The mean testosterone level was significantly lower in diabetics than in controls (3.9 ± 1.9ng/ml) in comparison with (5.1 ± 1.7ng/ml; P < 0.05). The mean value of Zinc, Manganese, Selenium and Chromium were significantly lower among the diabetics when compared with the controls (Zn;898.7 ± 131.0 µg/l; Mn:0.30 ± 0.06 µg/l;Se:51.3 ± 11.1 µg/l; Cr: 0.04 ± 0.03 µg/I) in comparison with (Zn: 1007.3 ± 85.2 µg/l; Mn: 0.05 ± 0.07µg/l; Se: 62.1 ± 11.1 µg/l; Cr: 0.06 ± 0.01 µg/l; P < 0.05).The mean Fasting Blood Glucose in diabetic subjects was significantly higher when compared with the controls (7.9 ± 3.7 mmol/l) in comparison with (4.6 ± 0.4 mmol/l; P < 0.05).The trace elements showed a positive correlation with testosterone in diabetic subjects (Zn r = 0.359, Ser = 0.443, Mn r = 0.350, P < 0.05). CONCLUSION: This study observed decreased levels of testosterone and trace elements in type 2 diabetics and a positive correlation between low testosterone and low trace elements levels in diabetic subjects. These trace elements are antioxidants and their low levels in diabetic patients may further increase the severity of the disease.

Sexual behaviours and contraceptive use among female secondary school adolescents in a rural town in RiverS state, South-south Nigeria.

BACKGROUND: According to World Health Organization (WHO), adolescents are persons aged 10-19 years. They comprise nearly half of the world's population of about 7 billion and 85% of them live in developing countries. AIM: The aim of this study is to assess the sexual behaviours, practices and contraceptive use among secondary school adolescents in Elele, Rivers State, Nigeria. METHOD: A cross-sectional descriptive study of 300 in-school adolescents in a rural community in Rivers State, South-South Nigeria, selected using multi-stage random sampling technique. RESULTS: There was a high awareness of contraception among respondents, 235 (78.3%), with condom, 207 (88.1%), having the highest awareness. About forty-five percent of respondents, (134), in this survey have had their first sexual debut and 84.3% of this number was sexually active in the last six months preceding this survey. The mean, median and the modal age of first sexual debut were; 12.0 + 2.8, 12.6, and 12.4 years respectively with the youngest age of initiation of sexual activity being 5 years. About two-thirds of those sexually active have multiple sexual partners. Contraceptive use was statistically higher among the sexually active respondents, (74.3%), than the sample study population, (30.3%), (Χ2 = 65.08, p = 0.000). Condom use at their last sexual debut, (58.2%), was significantly higher than use in their first sexual debut (31.3%), (Χ2 = 16.17, p = 0.000). The most commonly used contraceptive method was condom, (81.7%). CoNCLUSION: High risk sexual behaviour and increased sexual activity was prevalent in this age group. Efforts to promote sexuality education and contraceptive awareness should be intensified.

Clients' knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria.

BACKGROUND: Clients' knowledge, perception of and satisfaction with the quality of maternal health services (QMHS) enables maternal health programs to assess the impact of their services from the clients' perspective. OBJECTIVE: The objective of this study is to assess the knowledge, perception of and clients' satisfaction with the QMHS at the primary health care (PHC) level in Nnewi, Nigeria. MATERIALS AND METHODS: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from randomly selected PHC facilities in Nnewi, Nigeria were selected for the study. Data were collected using a mix of quantitative and qualitative methods. Quantitative data were analyzed using Statistical Package for Social Sciences version 16, while qualitative data were reported verbatim, analyzed thematically and necessary quotes presented. RESULTS: A total of 280 women were studied. The mean age of the respondents was 29.2 ± 5.9 years. 231 (82.5%) were married. 89 (31.8%) did not report any knowledge about QMHS. Level of satisfaction was not different among women of different socioeconomic groups ( P > 0.05). Sociodemographic characteristics of clients were not found to be associated to the perception of waiting time: ( P > 0.05). The attitude of health care providers toward the clients was reported as good. CONCLUSIONS: Despite the poor quality of services provided, this study showed that client's knowledge of quality of services was good. Furthermore cost, local language used, staff attitude and interaction with clients was acceptable and may be the reason for high level of satisfaction reported.

Utilization of maternal health services in urban and rural communities of Anambra State, Nigeria.

OBJECTIVE: This study determined and compared the level and pattern of utilization of maternal services in urban and rural communities in Anambra State. DESIGN AND METHOD: A comparative cross-sectional study was carried out in two local government areas (LGA); Nnewi North (urban) and Dunukofia (rural). A total of 338 mothers of children aged 0-59 months in each of the two LGAs selected by multistage cluster sampling technique were studied. Data were collected using an interviewer administered questionnaire, analyzed and tests of significance performed with the p-value set at 0.05. RESULTS: Women in the rural area had higher fertility rate (t = 4.53, p < 0.05) and more children than their urban counterparts (t = 4.79, p < 0.05). The mean number of antenatal care (ANC) before delivery in urban and rural areas were 8.0 +/- 4.2 and 5.9 +/- 2.4 respectively and the difference was statistically significant (t = 7.52, p < 0.05). Half of the urban respondents delivered in private hospitals while 43.8% of rural respondents delivered in maternity homes. There was no significant difference in the pattern of post natal care utilization in both localities (chi2 = 0.695, p = 0.405), as most of the women in both localities went for post natal consultation within 6 weeks of delivery. CONCLUSION: Measures to improve maternal health service utilization especially in rural areas should not only address the issue of access to care, but also improvement in quality of care and women empowerment.

Effectiveness of data collection and information transmission process for disease notification in Anambra State, Nigeria.

BACKGROUND: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria, thus, its inability to promptly detect and control epidemics. OBJECTIVE: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state. MATERIALS AND METHODS: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review. RESULTS: One hundred (43.9%) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms, 25% and 16.2% reported it was irregular and usually out of stock, respectively. Most facilities (81.5%) returned completed forms monthly. Secondary health facilities were less likely to submit completed forms, while majority of primary health facilities submitted theirs monthly ( X 2 = 4.42, P = 0.035). With respect to correctness of records, Health Management Information System records (55.6%) were the least correct, while out-patient register (88.9%) was the most correct. Only 10.0% of health facilities submitted completed forms 5 days after completion, 88.9% of them submitted completed IDSR002 forms within 2 days of completion, while the remainder was submitted 4 days later. CONCLUSION: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN, improved funding, provision of logistics, improved supervision, and feedback of information.

Effectiveness of Data Collection and Information Transmission Process for Disease Notification in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria; thus; its inability to promptly detect and control epidemics.Objective: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state.Materials and Methods: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review.Results: One hundred (43.9) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms; 25 and 16.2 reported it was irregular and usually out of stock; respectively. Most facilities (81.5) were the least correct; while out-patient register (88.9) was the most correct. Only 10.0 of health facilities submitted completed forms 5 days after completion; 88.9 of them submitted completed IDSR002 forms within 2 days of completion; while the remainder was submitted 4 days later.Conclusion: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN; improved funding; provision of logistics; improved supervision; and feedback of information

Determinants of subjective health status of HIV positive mothers in NAUTH Nnewi.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. METHODS: This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire. RESULTS: The mean age of the respondents was 30.46 +/- 4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p<0.001). Also a significantly higher proportion of condom users (99%) than pill users (1%) described their health status as 'excellent' (p<0.02). The same significantly higher proportions of 'excellent' response were given by subjects who engage in social support activities (p<0.001), who practice good feeding (p<0.01) andpersonal hygiene (p<0.01). CONCLUSION: Access to family planning services and HAART, participation in support group activities and positive lifestyle practices tend to improve subjective health status and should be comprehensively encouraged among the HIV positive mothers.

Proximate determinants of antenatal care utilization among women in southeastern Nigeria.

BACKGROUND: In order to scale up Antenatal services, there is need to determine the factors that deter women from accessing antenatal care. AIM: To determine the proximate factors that affect utilization of antenatal care among market women in Nnewi, southeastern Nigeria. MATERIALS/METHOD: A cross sectional survey of 400 market women using semi structured questionnaires and focus group discussions. RESULT: Out of the 398 studied women, 97.2% attended antenatal care in their last pregnancy. Most (64.5%) of them booked after the third trimester and majority of the women received antenatal care from the private specialist hospitals (37.4%), followed by the private general practice hospitals (34.7%) and government hospitals (17.8%). The main reasons for choosing antenatal care facilities were the perceived friendliness of the staff (33.9%), availability of staff always (27.4%) and proximity of the facility (17.4%). Financial considerations accounted for 4.5% of the reasons for the choice of facility. There was no significant influence of age, parity and religion on the utilization of antenatal care. However, the likelihood of ANC attendance was significantly lower among the house wives (x2 = 14.2; p = 0.0). There was no association between choice of facility for ANC and age, parity, occupation or religion. The main reasons identified by the FGD discussants for preferring the private hospitals were more friendly and available staff. Also late booking was mainly attributed to wrong advice from friends and husbands refusal to provide money. Antenatal care attendance rate was high among the studied women and most of the women utilize private hospitals for care. Staff friendliness and availability at all times were the main reasons for choice of ANC facilities. There is the need to address the negative attitudes of the staff in government hospitals.

Prevalence and pattern of bacteria and intestinal parasites among food handlers in the Federal Capital Territory of Nigeria.

BACKGROUND: In developing countries, biological contaminants largely bacteria and other parasites constitute the major causes of food-borne diseases often transmitted through food, water, nails, and fingers contaminated with faeces. Accordingly, food-handlers with poor personal hygiene could be potential sources of infections by these micro-organisms. OBJECTIVE: This study was aimed at determining the prevalence and pattern of bacteria and intestinal parasites among food handlers in the Federal Capital Territory. MATERIALS AND METHODS: The study was a descriptive one in which a multistage sampling technique was employed to select 168 food handlers of various types. Subjects' stool, urine, and fingernail analyses were carried out and the result scientifically scrutinized. RESULTS: FINGERNAIL BACTERIA ISOLATES INCLUDE: E. Coli (1.8%), coagulase-negative staphylococcus (17.9%), Staphylococcus aureus(7.1%), Klebsiella species (2.4%), Serratia species (1.2%), Citrobacter species (1.2%), and Enterococcus species (1.8%). The subjects' stool samples tested positive: For A. lumbricoides (14.9%), T. trichuria (1.8%), S. starcolaris (3.0%), E. histolytica (10.7%), G. lambilia (1.8%), S. mansoni (1.2%), and Taenia species (4.8%). Furthermore, 42.3% and 15.5% of the stool specimen tested positive for Salmonella and Shigella species, respectively. CONCLUSION: Food establishments should screen and treat staff with active illness, and regularly train them on good personal and workplace hygiene practices.

Prevalence and Pattern of Bacteria and Intestinal Parasites among Food Handlers in the Federal Capital Territory of Nigeria

Background: In developing countries; biological contaminants largely bacteria and other parasites constitute the major causes of food-borne diseases often transmitted through food; water; nails; and fingers contaminated with faeces. Accordingly; food-handlers with poor personal hygiene could be potential sources of infections by these micro-organisms. Objective: This study was aimed at determining the prevalence and pattern of bacteria and intestinal parasites among food handlers in the Federal Capital Territory. Materials and Methods: The study was a descriptive one in which a multistage sampling technique was employed to select 168 food handlers of various types. Subjects' stool; urine; and fingernail analyses were carried out and the result scientifically scrutinized. Results: Fingernail bacteria isolates include: E. Coli (1.8); coagulase-negative staphylococcus (17.9); Staphylococcus aureus(7.1); Klebsiella species (2.4); Serratia species (1.2); Serratia species (1.2); Citrobacter species (1.2); and Enterococcus species (1.8). The subjects' stool samples tested positive: For A. lumbricoides (14.9); T. trichuria (1.8); S. starcolaris (3.0); E. histolytica (10.7); G. lambilia (1.8); S. mansoni (1.2); and Taenia species (4.8). Furthermore; 42.3 and 15.5 of the stool specimen tested positive for Salmonella and Shigella species; respectively. Conclusion: Food establishments should screen and treat staff with active illness; and regularly train them on good personal and workplace hygiene practices

Contraceptive choices and practices among urban women in southeastern Nigeria.

BACKGROUND: Determining the contraceptive choices among the women is the first step in scaling up family planning methods. OBJECTIVE: To determine the contraceptive choices and practices as well as the underlining factors among market women in Nnewi, southeastern Nigeria. SUBJECTS/METHOD: This is a cross sectional descriptive study of market women, that assessed their contraceptive choices and practices. RESULT: Knowledge about family planning was 96.5%. One hundred and seventy five (44.0%) of the interviewed women were currently using a family planning method while 59.0% had ever used a method. The common methods in use were the natural method (24.1%), withdrawal method (7.5%) and the IUCDs (6.1%). The commonest ever used method was the natural method (26.7%) followed by withdrawal method (10.6%) and condom (7.8%). Fear of family planning commodities interfering with future fertility was the commonest reason for non use of family planning services (14.6), followed by the fear of the side effects (10.6%). Seventy one (17.8%) of the non-users had no reason. The use of family planning services was significantly high among the women aged 35 and above (x2 = 9.98; P = 0.04) and the (x2 = 23.8; P = 0.00). Focus group discussions indicated that husband's refusal, fear of side effects, cancer and delayed fertility were the main barriers to the use of family planning methods. CONCLUSION: The contraceptive prevalence rate among Nnewi market women is high and cuts across all religions and social classes. However, the methods in common use are associated with high failure rates. The use of the more reliable methods should be encouraged.

Perception and care-seekling behaviour for post partum morbidity among mothers in Enugu south east, Nigeria.

BACKGROUND: Postpartum Care is necessary to monitor and ensure return to normal of some physiological changes that occurred during pregnancy and delivery, and any abnormalities detected should be treated. The aim of this study is to describe the perception of and care seeking behaviour for maternal morbidity following childbirth among mothers in Enugu, Nigeria and determine if they depend on the socio-demographic characteristics ofmothers. METHODS: A cross-sectional survey of women who had recent deliveries was done. Quantitative and qualitative methods of data collection were used. Data analysis was by descriptive and inferential statistics at 95% level of confidence and manual content analysis. RESULTS: Three hundred and seventy-one respondents who had, at least, one self-reported morbidity following childbirth were studied. Only approximately 43.1% perceived their symptoms as abnormal and 39.5% sought medical attention for their symptoms. Inaccurate perception was influenced by the severity of symptoms as well as cultural beliefs on what constitutes abnormal symptoms following childbirth. Correct perception of morbidity was dependent on maternal age (p = 0.002) and educational status (p = 0.004) whereas positive care seeking behaviour was dependent on area of residence (p = 0.03). A greater proportion of mothers aged 30 years or below had accurate perception compared to older mothers (p = 0.02). A greater proportion of rural dwellers sought medical attention for their symptoms compared to urban dwellers. CONCLUSION: Inaccurate perception of, and poor care seeking behaviour for postpartum morbidity were common among a sample of women with recent deliveries in Enugu due largely to cultural beliefs about morbidity following childbirth. Correct perception and positive care seeking behaviour were not enhanced by older age, greater educational attainment of mothers or residence in urban areas.

The epidemiological transition: policy and planning implications for developing countries.

BACKGROUND: Medical Scientists are beginning to understand better some of the trends in the changing disease and mortality patterns but policymakers need to know how to use this information to make decisions about the priorities for the health sector. This Paper is aimed at x-raying this shift in morbidity and mortality patterns and make recommendations for possible shift in planning and policies. METHOD: Relevant literatures were reviewed from medical journals, library search and internet source using Google search engine as well as international, national and local journals. The key words employed were: Epidemiological Transition with particular emphasis on policy and planning implications in developing countries. RESULT: Several studies have outlined definitions, stages and historical perspectives of epidemiological transition, as well as the scenarios in developed and developing countries. The impending challenges and policy and planning implications in the developing countries were suggested and outlined in this paper. CONCLUSION: It is very obvious that epidemiological transition is here with us as there are transformations in the age, cause, and sex structure of death in developing world. Yet not much progress has been made towards averting the dire consequences. A fundamental policy shift therefore needs to be put in place.

Gender perspectives of sexual and reproductive practices of people living with HIV/AIDS in Enugu, South East Nigeria.

BACKGROUND: a major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality. The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu, South-East Nigeria. METHOD: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done. RESULTS: A total of 146 males (30.8%) and 328 females (61.9%) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes, the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males. CONCLUSION: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.

Gender Perspectives of Sexual and Reproductive Practices of People Living With HIV/AIDS in Enugu; South East Nigeria

Nigerian major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality.1; 2 The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu; South-East Nigeria. Method: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done. Results: A total of 146 males (30.8) and 328 females (61.9) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes; the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males. Conclusion: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.: