Predictors of current tobacco smoking by adolescents in Nigeria: Interaction between school location and socioeconomic status.

INTRODUCTION: Tobacco smoking is the largest preventable cause of global mortality, with its prevalence increasing in Sub-Saharan Africa, particularly among adolescents. We sought to determine the factors associated with tobacco smoking among Nigerian school adolescents and investigate the interaction between school location and socioeconomic status (SES). METHODS: Using a cross-sectional study design, 4332 eighth to tenth grade students in rural and urban secondary schools in Enugu State, Nigeria, were selected by stratified two-stage cluster sampling. We collected data using a modified Global Youth Tobacco Survey (GYTS) Core Questionnaire. Outcome measures were current smoking of cigarettes and other smoked tobacco. Multilevel mixed effects logistic regression models were used to determine factors associated with current tobacco smoking and were considered statistically significant at p<0.05. RESULTS: Prevalences of current smoking of cigarettes and other smoked tobacco were 13.3% (95% CI: 11.3-15.7) and 5.8% (95% CI: 4.6-7.2), respectively. Possession of higher weekly allowance, exposure to secondhand smoke or tobacco advertisements, having smoking parents, friends or classmates who smoke, and sale of cigarettes near school, were positively associated with current smoking of tobacco. Female sex, having both parents employed and being exposed to tobacco teaching in school were negatively associated with current cigarette smoking while increasing age and high father's SES were negatively associated with current smoking of other tobacco products. There was an interaction between school location and father's SES in the association with cigarette smoking. The higher odds of smoking in rural versus urban schools were much higher for students with fathers of high SES compared to low SES. In rural schools, high SES was associated with higher odds of smoking, but in urban schools low SES was associated with higher odds of smoking. CONCLUSIONS Environmental factors are associated with adolescent tobacco smoking. Tobacco control programs should use targeted strategies that vary depending on the local context.

Knowledge, Misperceptions, Preparedness, and Barriers towards Lassa Fever Control among Health Care Workers in a Tertiary Institution in Enugu, Nigeria.

BACKGROUND: Lassa fever outbreaks are common in Nigeria. The study aimed to assess knowledge, misperception, preparedness and barriers towards Lassa fever among health care workers (HCWs) in a tertiary hospital in Enugu. METHODS: A descriptive cross-sectional study among 400 HCWs of a Teaching Hospital in Nigeria. RESULTS: The study showed that 56.5% had fair knowledge while 42.0% and 1.5% had poor and good knowledge, respectively. Over 84% had good risk perception of acquiring Lassa fever while 15.8% had poor risk perception. Only 13% received training on emergency preparedness while 90.3% desired this training. Associations between occupation and knowledge were significant. Barriers to Lassa fever control were non-availability of infection control tools, lack of training on preparedness, absence of local laboratory, and non-availability of ribavirin. CONCLUSION: The study showed poor level of preparedness for Lassa fever and recommended routine training of HCWs on emergency preparedness.

Psychosocial impacts of communal conflicts in a sample of secondary school youths from two conflict communities in south east Nigeria.

In Nigeria, communal conflicts arise due to misunderstanding from ownership of land for farming, oil deposits, solid minerals or water for fishing activities. It may also arise in defence of community pride and properties or even in defence of the people involved in the conflict. The General Health Questionnaire (GHQ-12), The Short Screening Scale for Post traumatic stress disorder, The Generalized Anxiety Disorder Scale (GAD-7) and the Beck Depression Inventory (BDI-2) were used to assess psychosocial impacts of communal conflicts among 560 secondary school youths from two communities in south east Nigeria. Result revealed various forms of psychosocial impacts of communal conflicts among the youths.

Efficacy and Safety of 'Fixed Dose' versus 'Loose' Drug Regimens for Treatment of Pulmonary Tuberculosis in Two High TB-Burden African Countries: A Randomized Controlled Trial.

BACKGROUND: There are limited data on the performance of the use of fixed-dose combination (FDC) TB drugs when used under programmatic settings in high TB-endemic countries. We evaluated the efficacy and safety of FDC versus loose formulation (LF) TB treatment regimens for treatment of pulmonary TB (PTB) in the context of actual medical practice in prevailing conditions within programmatic settings in five sites in two high TB-burden African countries. METHODS: A two-arm, single-blind, randomized clinical trial comparing FDCs with separate LFs involving 1000 adults newly diagnosed with culture positive PTB was conducted at five sites in two African countries between 2007 and 2011. Participants were randomized to receive daily treatment with anti-TB drugs given as either FDC or separate LFs for 24 weeks (intensive phase- 8 weeks of isoniazid, rifampicin, ethambutol and pyrazinamide; continuation phase- 16 weeks of rifampicin and isoniazid). Primary outcome measures were microbiological cure and safety at the end of six months' treatment; pre-specified non-inferiority margin for difference in cure rate was 4%. The primary efficacy analysis was based on the modified intent to treat (mITT) cohort comprising all randomized patients with a positive baseline culture result for TB and who received at least one dose of study treatment. Patients missing end of treatment culture results were considered failures. Further analyses were done in which mITT patients without an end of treatment (EOT) culture were excluded in a complete case analysis (mITTcc) and a per protocol cohort analysis defined as mITTcc patients who received at least 95% of their intended doses and had an EOT culture result. RESULTS: In the mITT analysis, the cure rate in the FDC group was 86.7% (398/459) and in the LF group 85.2% (396/465) (difference 1.5-% (90% confidence interval (CI) (-2.2%- 5.3%)). Per Protocol analysis showed similar results: FDC 98.9% (359/363) versus LF 96.9% (345/356), (difference 2.0% (90% CI: 0.1%- 3.8%)). The two arms showed no significant differences in terms of safety, early culture conversion and patient adherence to treatment. INTERPRETATION: The comparison of the two drug regimens satisfied the pre-specified non-inferiority criterion. Our results support the WHO recommendations for the use of FDC in the context of actual medical practice within health services in high TB-endemic countries. TRIAL REGISTRATION: ISRCTN Registry 95204603.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria.

OBJECTIVE/BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies. METHODS: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations. RESULTS: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive (NSP), although the increasing trend was not statistically significant (χ(2)=1.8; p<.179)]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant (χ(2)=1.48; p<.224). Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% (all forms). Compared to the baseline, there was an increase of 31% (all forms) and 22% (NSP) in the evaluation population. CONCLUSION: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification.

Awareness and Utilization of Welders' Personal Protective Eye Devices and Associated Factors: Findings and Lessons From a Nigerian Population.

This study assessed commercial welders' awareness and utilization of personal protective eye devices (PPEDs), and their associations, in Enugu, Nigeria, between January and March, 2011. The participants included 343 males, age 33.9 years±10.0 SD years. The participants reported high awareness of welding-associated ocular hazards (99.4%) and PPEDs (75.2%-98.3%), but low PPED possession and utilization rates. Cost and "presumed lack of utility" were the leading barriers to PPED possession; non-utilization was mainly attributed to "user inconvenience" and "presumed lack of protective benefit." PPED utilization was significantly associated with lower educational status (p=.030) and electric welding (p<.0001). The underlying causes are amenable to preventive occupational eye health education, enhanced ergonomics and affordability of PPEDs, and legislative enforcement of their use.

Sputum conversion at the end of 8weeks among category 1 tuberculosis patients: How reliable are the peripheral laboratory results?

OBJECTIVE: To assess the quality of week 8 sputum smear AFB microscopy performed by peripheral TB laboratories in Nigeria. METHOD: A cross-sectional review was performed of all week 8 tuberculosis sputum smear slides reported for the first quarter of 2009 by peripheral laboratories in five States of Nigeria. Each slide was reviewed by two independent external slide readers as external quality check and also crosschecked with fluorescent microscopy. RESULTS: In Akwa Ibom, Anambra, Enugu, Kogi and Ogun States, a total of 415, 315, 231, 206 and 428week 8 slides respectively were studied (a grand total of 1595 slides studied). The wide range of conversion rates between the different States as reported by peripheral labs (83.8% in Anambra State to 98.1% in Kogi State) was also observed by the external quality check (68.4% in Kogi State to 88.0% in Akwa Ibom State). In all the States, the studied sputum conversion rates reported by the peripheral labs were significantly higher than values obtained from external quality check and fluorescent microscopy (P=0.000). CONCLUSION/RECOMMENDATION: There is a wide range of sputum conversion rates between States, but the conversion rate in each State is significantly higher than those of external quality check possibly indicating many false negative reports by peripheral labs. It is recommended that training and re-training of laboratory persons be continued. Internal and external quality checks should also continue to be practiced in the national TB program.

Flare-up incidence and related factors in Nigerian adults.

AIM: To determine the incidence of flare-up and the effect of age, gender, visit type, treatment duration, preoperative pain and intraoperative pain on flare-up in Nigerian adults. MATERIALS AND METHODS: A total of 175 participants, aged 18 to 60 years with a necrotic central incisor, with or without preoperative pain, participated. They received postoperative paracetamol tablets and were asked to report back if unbearable pain/swelling developed. RESULTS: A 10% flare-up rate was recorded, while none of the studied factors had a significant relationship with flare-up. CONCLUSION: The relationships between flare-up and studied related factors were not proven. CLINICAL SIGNIFICANCE: Age, gender, visit type, treatment duration, preoperative pain and intraoperative pain have no effect on flare-up incidence.

Appropriate electrode placement site for electric pulp testing of anterior teeth in Nigerian adults: a clinical study.

Electric pulp testing is one of the pulp vitality tests which aid dentists in diagnosis of the pulp status. This test is technique sensitive and hence may elicit false responses. There are some concerns regarding the optimal placement of the probe tip. The threshold value (the lowest electric current at which sensation is perceived) is reached when an adequate number of nerve fibers are stimulated, so the sensation would be greatest where the density of neural distribution is the highest. The purpose of this study was to identify the optimum site for electrode placement in anterior teeth of adults, the threshold values of these teeth using an electric pulp test, and to determine the influence of sex, age, and arch on the outcome. The optimum electrode placement sites and threshold values varied with type of tooth and arch. The maxillary teeth, canines, male gender and increasing age required higher electric current to evoke a sensation, while incisal edges required lower current to evoke a sensation.