Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, Nigeria.

BACKGROUND: Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria. METHODS: A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinion held by the participants towards the TBA. RESULTS: All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108-0.629) and tertiary (aOR = 0.352; 95% CI; 0.162-0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476-6.166) were associated with higher utilization of TBAs. CONCLUSION: Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended.

Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria.

BACKGROUND: The practice of intrapartum use of oxytocin for induction and augmentation of labour is increasing worldwide with documented wide variations in clinical use, especially dose administrations. There is also evidence of intrapartum use by unauthorized cadre of staff. AIM: This study assessed the patterns - frequency of intrapartum use of oxytocin, the doses and routes of administration for induction and augmentation of labour, and identified the predictors of oxytocin use for induction and augmentation of labour by healthcare providers in Nigeria. METHODS: This was a cross-sectional study conducted among healthcare providers - doctors, nurses/midwives and community health workers (CHWs) in public and private healthcare facilities across the country's six geopolitical zones. A multistage sampling technique was used to select 6,299 eligible healthcare providers who use oxytocin for pregnant women during labour and delivery. A self-administered questionnaire was used to collect relevant data and analysed using STATA 17 statistical software. Summary and inferential statistics were done and further analyses using multivariable regression models were performed to ascertain independent predictor variables of correct patterns of intrapartum oxytocin usage. The p-value was set at < 0.05. RESULTS: Of the 6299 respondents who participated in the study, 1179 (18.7%), 3362 (53.4%), and 1758 (27.9%) were doctors, nurses/midwives and CHWs, respectively. Among the respondents, 4200 (66.7%) use oxytocin for augmentation of labour while 3314 (52.6%) use it for induction of labour. Of the 1758 CHWs, 37.8% and 49% use oxytocin for induction and augmentation of labour, respectively. About 10% of the respondents who use oxytocin for the induction or augmentation of labour incorrectly use the intramuscular route of administration and about 8% incorrectly use intravenous push. Being a doctor, and a healthcare provider from government health facilities were independent positive predictors of the administration of correct dose oxytocin for induction and augmentation of labour. The CHWs were most likely to use the wrong route and dose administration of oxytocin for the induction and augmentation of labour. CONCLUSION: Our study unveiled a concerning clinical practice of intrapartum oxytocin use by healthcare providers in Nigeria - prevalence of intrapartum use of oxytocin, inappropriate routes of administration for induction and augmentation of labour, varied and inappropriately high start dose of administration including unauthorized and high intrapartum use of oxytocin among CHWs.

Exposure to tobacco advertisements, promotions, and sponsorships among in-school adolescents in Lagos, Nigeria: A cross-sectional study.

Background: The Nigerian government implemented the National Tobacco Control Act (NTCA) in 2015, which prohibits tobacco advertising, promotion, and sponsorship (TAPS) exposure to children under 18 years of age. This study was conducted to assess the prevalence of attitudes and exposure to TAPS among in-school adolescents in Lagos State, Nigeria, 5 years after the implementation of the Act and to identify the factors associated with TAPS exposure among the adolescents. Materials and Methods: This cross-sectional study was conducted among 968 in-school adolescents selected through multistage random sampling. The data were collected using self-administered questionnaires adapted from the Global Youth Tobacco Survey. Results: Overall, 77% had been exposed to at least one form of TAPS in the past 30 days. The most frequently reported channel of exposure was through product placements, with 62% reporting exposure in films, TV, and videos. Up to 15.2% and 12.6% were exposed to TAPS through promotional activities and sponsorships, respectively. The majority (82.3%) had pro-tobacco attitudes, while about a third (33.1%) had pro-TAPS attitudes. Factors associated with TAPS exposure were having pro-TAPS attitudes (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 2.3-5.3), being female (OR: 2, 95% CI: 1.4-2.7), and residing in a rural area (OR: 1.6, 95% CI: 1.2-2.3). Conclusion: Five years after implementing the NTCA, more than two-thirds of the adolescents reported exposure to TAPS, mainly through films, TV, and videos. This suggests that the NTCA is poorly enforced. Efforts to ensure the effective implementation of comprehensive TAPS bans are warranted. Gender-sensitive strategies that target adolescents' attitudes and school-level factors should be emphasized.

Résumé Contexte: Le gouvernement nigérian a mis en œuvre la loi nationale sur le contrôle du tabac (NTCA) en 2015, qui interdit la publicité pour le tabac, exposition à la promotion et au parrainage (TAPS) des enfants de moins de 18 ans. Cette étude a été menée pour évaluer la prévalence des attitudes et l'exposition au TAPS chez les adolescents scolarisés dans l'État de Lagos, au Nigéria, 5 ans après la mise en œuvre de la loi et d'identifier les facteurs associés à l'exposition aux TAPS chez les adolescents. Matériels et méthodes: Cette étude transversale a été menée auprès de 968 adolescents scolarisés sélectionnés par chantillonnage aléatoire à plusieurs degrés. Les données ont été recueillies à l'aide de questionnaires auto-administrés adaptés de l'Enquête mondiale sur le tabagisme chez les jeunes. Résultats: Dans l'ensemble, 77 % avaient été exposés à au moins une forme de TAPS au cours des 30 derniers jours. Le plus Le canal d'exposition le plus souvent signalé était le placement de produits, 62 % d'entre eux déclarant avoir été exposés dans les films, la télévision et les vidéos. Jusqu'à 15,2 % et 12,6 % ont été exposés à TAPS par le biais d'activités promotionnelles et de parrainages, respectivement. La majorité (82,3 %) avaient des attitudes pro-tabac, tandis qu'environ un tiers (33,1 %) avaient des attitudes pro-TAPS. Les facteurs associés à l'exposition au TAPS étaient les attitudes pro-TAPS (rapport de cotes [OR]: 3,5, intervalle de confiance [IC] à 95 % : 2,3 à 5,3), être une femme (OR : 2, IC à 95 % : 1,4 à 2,7) et résider dans une zone rurale (OR: 1,6, IC à 95 % : 1,2 à 2,3). Conclusion: Cinq ans après la mise en œuvre de la NTCA, plus des deux tiers des adolescents ont déclaré avoir été exposés aux TAPS, principalement par films, télévision et vidéos. Cela suggère que la NTCA est mal appliquée. Efforts pour assurer la mise en œuvre effective de TAPS complets les interdictions sont justifiées. Il convient de mettre l'accent sur les stratégies sensibles au genre qui ciblent les attitudes des adolescents et les facteurs au niveau de l'école. Mots-clés: Adolescents, promotion et parrainage, publicité au tabac.

Male involvement in female partners' screening for breast and cervical cancers in Southwest Nigeria.

BACKGROUND: Breast and cervical cancers are in the top 10 most common cancers in women globally and the most common cancers in Nigerian women. The incidences have been rising steadily over the years. Involvement of men as key players in reproductive health issues has been receiving global attention especially in low and middle-income countries. AIM: To assess male involvement in their female partners' screening for breast and cervical cancers in Southwest, Nigeria. METHOD: This was a community-based, cross-sectional study that employed a multi-stage sampling method to select 254 men who were married or in steady relationships in Lagos State, Southwest Nigeria. Data were collected from June to October 2018 using a semi-structured interviewer-administered questionnaire, analyzed using Epi Info version 3.5.1 and summarized with mean and standard deviation. Chi-square test was used for bivariate statistics, and the p-value of ≤0.05 was considered statistically significant. Multivariable logistic regression was used for predictor variables of male involvement in screening. RESULTS: 29.5% of the respondents had good knowledge of breast and cervical cancers and screening and majority (85.5%) had a positive attitude towards screening. Only few, 19.3% and 15.7% had provided money for breast and cervical cancer screening respectively. Most men, 75% and 87.4% respectively had not accompanied their wife/female partner for breast and cervical cancer screening, while almost half (49.2%) and one-third (33.5%) respectively, had encouraged their female partners to screen for breast and cervical cancers. Overall, only about half, 138 (54.3%) of the men were considered 'involved' in their female partners' screening for breast and cervical cancers. Male involvement was significantly associated with screening for female cancers (χ2 = 77.62, p = 0.001). Older age group (AOR = 2.64, 95% CI: 1.3-4.9), higher educational attainment (AOR = 3.51, 95% CI: 1.14-10.73), and positive attitude (AOR = 2.48, 95% CI:1.16-5.33) were found to be the predictors of male involvement. CONCLUSION: Community-based programs for males, especially the younger and less educated, should be implemented to increase their involvement. It is also suggested that mass media messages be spread and online platforms be explored in order to increase men's awareness and participation in female cancer screening.

Depression and suicidal ideation among undergraduates in state tertiary institutions in Lagos Nigeria.

BACKGROUND: Depression is a common mental illness affecting majority of the world's population. However, evidence has shown that undergraduates are at an even higher risk compared to the general population, of developing depression due to the various challenges they face during that period. Suicide has been discovered to be the second leading cause of death among young people. Suicide ideation has been proven to be a predictor for not only suicide attempts but also completed suicides. Therefore, the aim of this study was to assess depression and suicidal ideation among undergraduates in the state tertiary institutions in Lagos, Nigeria. METHOD: This study was a descriptive, cross-sectional study carried out among undergraduates in two state tertiary institutions in Lagos, Nigeria using self-administered questionnaire. A total of 750 respondents were recruited using the multistage sampling technique. Data was analysed using SPSS version 27 and the level of significance was set at p -value < 0.05. RESULTS: The survey was conducted among undergraduates in the two state tertiary institutions in Lagos State: Lagos State University (48.3%) and Lagos State Polytechnic (51.7%). The mean age of the respondents was 21.5 (2.7) years. Majority of the respondents were females (54%), single (98.1%), Christians (70.3%), and the source of income of majority of the students was parents (72.8%). From the case vignette used in the questionnaire, 47.6% of the respondents were able to correctly identify depression. The prevalence of depression and suicidal ideation in this study was 22.5% and 21.6% respectively. Depression was statistically significantly associated with suicidal ideation (p < .001). Risk factors that were statistically significantly associated with depression and suicidal ideation were low self-esteem (p < .001), intake of recreational drugs (p < .001), alcohol dependence (p < .001), and positive history of bullying (p < .001). CONCLUSION AND RECOMMENDATIONS: The proportion of respondents with good knowledge of depression was not satisfactory. A strong relationship was found between depression and suicidal ideation indicating that people with depression are at a high risk of having suicidal ideation. Risk factors that were associated with depression and suicidal ideation were bullying, low self-esteem, intake of recreational drugs, alcohol dependence, poor academic performance, sexual assault and being hit by a partner. More works need to be done by the government and non-governmental organisations, school administration and parents to increase the awareness on the symptoms and manifestations of depression and reduce the burden created by some of the risk factors identified in this study to combat depression and suicidal ideation.

Determinants of health facility delivery among young mothers aged 15 - 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey.

BACKGROUND: Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS: A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS: Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION: Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

Exposure to tobacco advertisements, promotions, and sponsorships among in­school adolescents in Lagos, Nigeria: A cross­sectional study

Background: The Nigerian government implemented the National Tobacco Control Act (NTCA) in 2015, which prohibits tobacco advertising, promotion, and sponsorship (TAPS) exposure to children under 18 years of age. This study was conducted to assess the prevalence of attitudes and exposure to TAPS among in school adolescents in Lagos State, Nigeria, 5 years after the implementation of the Act and to identify the factors associated with TAPS exposure among the adolescents. Materials and Methods: This cross-sectional study was conducted among 968 in school adolescents selected through multistage random sampling. The data were collected using self-administered questionnaires adapted from the Global Youth Tobacco Survey. Results: Overall, 77% had been exposed to at least one form of TAPS in the past 30 days. The most frequently reported channel of exposure was through product placements, with 62% reporting exposure in films, TV, and videos. Up to 15.2% and 12.6% were exposed to TAPS through promotional activities and sponsorships, respectively. The majority (82.3%) had pro tobacco attitudes, while about a third (33.1%) had pro TAPS attitudes. Factors associated with TAPS exposure were having pro TAPS attitudes (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 2.3­5.3), being female (OR: 2, 95% CI: 1.4­2.7), and residing in a rural area (OR: 1.6, 95% CI: 1.2­2.3). Conclusion: Five years after implementing the NTCA, more than two thirds of the adolescents reported exposure to TAPS, mainly through films, TV, and videos. This suggests that the NTCA is poorly enforced. Efforts to ensure the effective implementation of comprehensive TAPS bans are warranted. Gender sensitive strategies that target adolescents' attitudes and school level factors should be emphasized.

Barriers and recommendations for a cervical cancer screening program among women in low-resource settings in Lagos Nigeria: a qualitative study.

BACKGROUND: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. OBJECTIVES: This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women's knowledge about cervical cancer, and their perceived barriers and recommendations for the program. METHOD: Four focus group discussions(FGD) were conducted among 35 women between the ages of 21-65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. RESULTS: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women's poorly perceived susceptibility to cervical cancer. CONCLUSION: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Role of traditional beliefs in the knowledge and perceptions of mental health and illness amongst rural-dwelling women in western Nigeria.

BACKGROUND: Globally, the public health importance of mental health has gained significant attention in recent years. In Africa, many traditional belief systems impact the perceptions, attitude and management of mental illness. Women are usually the primary caregivers of mentally ill persons, but they have lower mental health literacy. AIM: To assess rural women's knowledge, perceptions and attitudes regarding mental illnesses and the role of traditional beliefs in their management. SETTING: Epe Local Government Area of Lagos State, Nigeria. METHODS: This was a cross-sectional study with a total of 295 rural women recruited through a multistage sampling method. A pretested interviewer-administered questionnaire was used to collect data. Summary and inferential statistics were measured using Epi Info version 7. The level of significance was predetermined at 5%. RESULTS: A total of 253 questionnaires were adequately filled and analysed. Overall, just over one-third (35%) of respondents had good knowledge and only 26% had positive attitudes towards mental health and illness. About 45% reported that mental illness should first be treated in 'the traditional way', whilst 47% felt that there was no need for collaboration between orthodox and unorthodox healthcare for mental illness. Sociodemographic variables were significantly associated with knowledge (educational level p = 0.001) and attitude (marital status p = 0.001 and ethnicity p = 0.001). CONCLUSION: Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.

Harmful traditional practices among market women in ojuwoye market mushin, South West, Nigeria.

Traditions are the long-established patterns of actions or behaviors, often handed down within a community over many generations. Harmful traditional practices (HTPs) are customs that are known to have deleterious effects on people's health and obstruct the goals of equality, political, and social rights. They include female genital mutilation, intimate partner violence, male preference, child marriage, and food taboos. This study was carried out to assess the knowledge, attitude, and practice of HTPs among market women in Mushin Local Government Area (LGA) of Lagos, Nigeria. This cross-sectional, descriptive study was carried out among 235 market women in Ojuwoye market, Mushin LGA, Lagos. Respondents were selected using the systematic sampling method, and the data were collected using pretested interviewer-administered questionnaires. Data were analyzed using Epi info version 7. Proportions, mean, and standard deviation were generated and Chi-square test was used to explore the associations. Binary logistic regression was used to determine the predictors of HTP. Majority (66.8%) of the respondents had fair knowledge of HTPs. Overall attitude was generally good as 86% had an opposing attitude toward HTPs. About one-third of respondents (35.3%) practiced at least one form of HTP. Supportive attitude toward HTP was a predictor of HTP. Respondents with supportive attitude toward HTPs were 15.5 times more likely to practice HTPs than respondents with opposing attitude (adjusted odds ratio 15.51 confidence interval 4.22-57.07). Behavioral change programs should be geared toward improving the attitude of women against HTP and reducing the practice of HTP.

Résumé Les traditions sont des modèles d'actions ou de comportements établis de longue date, souvent transmis au sein d'une communauté sur plusieurs générations. Nuisible les pratiques traditionnelles sont des coutumes connues pour avoir des effets délétères sur la santé des personnes et entraver les objectifs d'égalité, politiques, et les droits sociaux. Ils comprennent les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants et les tabous alimentaires. Cette étude a été menée pour évaluer la connaissance, l'attitude et la pratique des pratiques traditionnelles parmi les femmes du marché dans la zone de gouvernement local de Mushin de Lagos, Nigéria. Cette étude descriptive transversale a été menée auprès de 235 marchandes du marché d'Ojuwoye, zone de gouvernement local de Mushin, Lagos. Les répondants ont été sélectionnés à l'aide de la méthode d'échantillonnage systématique, et les données ont été recueillies à l'aide d'intervieweurs prétestés administrés questionnaires. Les données ont été analysées à l'aide d'Epi info version 7. Les proportions, la moyenne et l'écart type ont été générés et le chi carré test a été utilisé pour explorer les associations. Une régression logistique binaire a été utilisée pour déterminer les prédicteurs de pratiques traditionnelles. La majorité (66,8 %) des les répondants avaient une bonne connaissance des pratiques traditionnelles. L'attitude globale était généralement bonne puisque 86% avaient une attitude opposée à l'égard pratiques traditionnelles. Environ un tiers des répondants (35,3 %) pratiquaient au moins une forme de pratiques traditionnelles. Attitude de soutien envers les nuisibles les pratiques traditionnelles étaient un prédicteur de pratiques traditionnelles. Les répondants avec attitude de soutien envers les nuisibles les pratiques traditionnelles étaient 15,5 fois plus susceptibles de pratiquer des pratiques nuisibles pratiques traditionnelles que les répondants ayant une attitude opposée (rapport de cotes ajusté intervalle de confiance de 15,51 4,22 à 57,07). Les programmes de changement de comportement devraient viser à améliorer l'attitude des femmes contre les pratiques traditionnelles et réduire la pratique des pratiques traditionnelles. Mots-clés: les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants, les tabous alimentaires, Les pratiques traditionnelles néfastes, Nigeria.

"Men are the head of the family, the dominant head": A mixed method study of male involvement in maternal and child health in a patriarchal setting, Western Nigeria.

INTRODUCTION: The importance of involving men in reproductive, maternal and child health (RMCH) programs is increasingly recognized globally. In Nigeria, most MCH services do not actively engage fathers. AIM: To assess men's knowledge, involvement in MCH and the barriers in Southwest Nigeria. Predictors of good knowledge and involvement were also assessed. METHODS: This was a community-based cross sectional study. Quantitative and qualitative methods were used in data collection which was done within a period of three months in 2018. Quantitative data were collected with interviewer administered questionnaires from 418 respondents who were selected by multistage sampling methodology. The topic was further explored using focus group discussion (FGD). Quantitative data were analysed using EPI-INFO version 7. Quantitative variables were summarized using means and standard deviations while multivariable analysis was carried out to determine predictors of good knowledge and involvement in MCH. A combination of deductive and inductive analysis was used for the qualitative data. RESULTS: Overall, 65% of men had good knowledge of MCH while 60.8% had good involvement. Predictors of good knowledge were being a Christian (AOR 1.674, 95% CI 1.045-2.679), being of Yoruba tribe (AOR 1.753, 95% CI 1.100-2.796), having post-secondary education (AOR 1.984, 95% CI 1.002-3.928), having more under-fives in the household (AOR 2.162 95% CI 1.365-3.425) and spouse having post-secondary education (AOR 2.755, 95% CI 1.189-6.382). Predictors of good involvement in MCH include higher educational level of spouse: secondary (AOR 2.852, 95% CI 1.214-6.699), post-secondary (AOR 2.270, 95% CI 1.000-5.161) and having good knowledge of MCH (AOR 2.518, 95% CI 1.587-3.994). From the FGD, other factors which influence involvement were related to traditional/cultural orientation, time constraint and finance among others. CONCLUSION: Men's knowledge and their involvement in maternal and child health were sub-optimal. For improvement, community-based intervention programmes should be designed for men and implemented, taking into consideration their traditional/cultural roles, religious orientation, busy schedules, and educational backgrounds. They should be re-oriented on their patriarchally informed belief about their perceived roles in RMCH.

Childhood diarrhoea: a cross-sectional survey on maternal knowledge, hygienic practices and use of oral zinc for home management in a Nigerian community.

Introduction: diarrhoea is the second leading cause of morbidity and mortality in young children. The aim was to assess maternal knowledge, hygienic practices and home management (HM) of diarrhoea with oral rehyrdation therapy (ORT) and oral zinc in children aged 6-23 months in western Nigeria. Predictors of good knowledge and practice were also assessed. Methods: this was a community based analytic cross-sectional study. Multistage sampling was used to select mothers of children 6-23 months of age. Data were collected using pre-tested, interviewer administered questionnaires and analyzed using SPSS version 20. Bivariate analysis and multiple logistic regression for predictor variables were done. Level of significance was set at 0.05. Results: three hundred and seventy one (371) respondents were interviewed (mean age 30.4 ± 5.02 years). 305 (82.2%) had good knowledge of diarrhoeal diseases, 208(56.1%) had good knowledge of home management of childhood diarrhoea, 274 (73.9%) had good maternal hygienic practices and 161 (61.2%) of the 263 mothers who had managed diarrhoea in their children, had good practice. Only 34 (12.9%) of them used zinc tablets and 11 (32.4%) did not complete the full course. Maternal age 30-39 years predicted good knowledge (AOR 3.19 CI 2-6.05). Predictors of good home management practices were: maternal age 30-39 years (AOR 2.78 CI 1.44-5.37), >40 years (AOR 5.55 CI 1.54-20.01) and younger age of the index child, 6-11 months (AOR 4.83 CI 2.29-10.18). Conclusion: mothers had poor knowledge of the role of zinc supplementation in childhood diarrhoea and use of zinc tablets for diarrhoea was very low. Community based health education should be carried out.

Osteopathic medical students' understanding of race-based medicine.

CONTEXT: Race is a social construct, not a biological or genetic construct, utilized to categorize people based on observable traits, behaviors, and geographic location. Findings from the Human Genome Project demonstrated that humans share 99.9% of their DNA; despite this evidence, race is frequently utilized as a risk factor for diagnosis and prescribing practices. Diagnosing and treating people based on race is known as race-based medicine. Race-based medicine perpetuates biases and diverts attention and resources from the social determinants of health that cause racial health inequities. Minimal research has examined medical students' understanding of race-based medicine. OBJECTIVES: The purpose of this study was to assess osteopathic medical students' knowledge, beliefs, and experiences with race-based medicine. METHODS: We conducted a descriptive, cross-sectional survey study to assess osteopathic medical students' knowledge, beliefs, and experiences with race-based medicine. An electronic, anonymous survey was distributed to all osteopathic medical students enrolled at a medical school in the Midwest with three campuses during the 2019-2020 academic year. Participants completed a brief demographic questionnaire and the Race-Based Medicine Questionnaire. Descriptive and inferential statistics were conducted utilizing SPSS statistical software version 28.0, and statistical significance was defined as a p<0.05. Open-ended questions were analyzed utilizing content and thematic analyses. RESULTS: A total of 438 of the 995 osteopathic medical students consented to participate in the study, for a response rate of 44.0%. Among those participants, 221 (52.0%) reported that they had heard of the term "race-based medicine." Familiarity with the term differed by racial background (χ [2] = 24.598, p<0.001), with Black or African American participants indicating greater familiarity with the term compared to all other races. Of the participants familiar with race-based medicine, 79 (44.4%) provided the correct definition for the term; this finding did not differ by any sociodemographic variable. Part of the way through the questionnaire, all participants were provided the correct definition of "race-based medicine" and asked if they thought medical schools should teach race-based medicine. The majority of participants (n=231, 61.4%) supported the teaching of race-based medicine. Qualitative findings elaborated on participants' support or opposition for teaching race-based medicine in medical school. Those in support explained the importance of teaching historical perspectives of race-based medicine as well as race as a data point in epidemiology and its presence on board examinations, whereas those in opposition believed it contradicted osteopathic principles and practice. CONCLUSIONS: Findings showed half of the participants were familiar with race-based medicine, and among those, less than half knew the definition of the term. Highlighting osteopathic philosophy and its focus on the whole person may be one approach to educating osteopathic medical students about race-based medicine.

Breast cancer knowledge and screening practices among undergraduates in a Nigerian tertiary institution, Southwest Region.

Introduction: Breast cancer is the most diagnosed female malignancy in Nigeria. This study aimed to assess the knowledge and practice of breast cancer screening among female undergraduates in a tertiary institution in Southwest Nigeria. Methods: This cross-sectional study recruited 350 female undergraduates of a public university in southwest Nigeria using a multi-stage sampling method involving simple random sampling. A structured self-administered questionnaire was used for data collection. Epi info 7 was used for data analysis, level of significance was set at 5% (p<0.05). Results: The majority, 316(90.3%) had poor knowledge of breast cancer and screening and 340(97.1%) had positive attitude towards screening. Only 185(52.9%) had done breast self-examination and 16(4.6%) had done clinical breast examination. The student's year of study was significantly associated with knowledge of breast cancer (p = 0.002) Marital status (p=0.039) and attitude towards breast cancer screening (p<0.001) were significantly associated with breast self-examination. Students in their third year were 6 (2 - 16) times more likely to have good knowledge of breast cancer (Adjusted Odds Ratio 5.87, Confidence Interval 2.17 - 15.86). Conclusion: Overall knowledge and practice of breast cancer screening were poor, but students' attitude towards screening was positive. Health education on breast cancer and screening is recommended.

Pre-natal nutrition education: Health care providers' knowledge and quality of services in primary health care centres in Lagos, Nigeria.

INTRODUCTION: A healthy and balanced diet is very important during pregnancy. By enhancing maternal nutritional status, healthcare providers can lower the risks of pregnancy complications and adverse birth outcomes. OBJECTIVES: To assess the pre-natal nutrition knowledge and services rendered by healthcare providers in antenatal clinics at Primary Health care Centres in Lagos, Nigeria. METHODOLOGY: This was a cross-sectional study carried out in June-September 2019. Self-administered questionnaires were used to collect data on nutritional knowledge from 391 nurses and midwives who provided pre-natal nutrition education. Direct observation with checklist was used to assess the nutrition education services at the ANC clinics and covered: adequacy of the venue, availability/use of nutrition education resources, education content and teaching strategies. EPi-Info version 3.5 was used for data analysis. Inferential statistics such as chi square and multiple logistic regression were used to determine associated factors and predictors of nutrition knowledge. The level of significance was set at 5% (p<0.05). RESULTS: The mean age of respondents was 41.71±10.33years, all were females; 44.8% were Registered Nurses, 12.0% were Registered Midwives, and 23.8% had a B.Sc. in Nursing. Majority (81.3%) had taken a nutrition course in nursing training program, 62.1% as elective classes. Majority (81.1%) had good knowledge of prenatal nutrition. Respondents who were older (51-60years) (p<0.001), single (p<0.001) and Christian (p = 0.001) had significantly better knowledge. Nurses who had University degrees (p<0.001), of higher cadre (p<0.001), more years of practice (p<0.001) and involved in treating severely malnourished children (p = 0.013) were also significantly more knowledgeable. Respondents below 40 years (OR 0.104, CI 0.049-0.218) and those with 10 years or less of practice (OR 0.189, CI 0.092-0.387) had less odds of having good nutrition knowledge. Being single (OR 8.791, CI 3.125-24.731), and Christian (OR = 5.810, CI: 3.321-10.164) predict good nutrition knowledge. In 39% of the 41 PHCs observed, quality of nutrition education services was inadequate. Gaps were mainly in availability of certain nutrition education facilities/resources and teaching strategies. CONCLUSION: The majority of the respondents had good knowledge of pre-natal nutrition. Overall, however, nutrition education services provided by two-fifths of the facilities were inadequate. Interventions to improve prenatal nutrition knowledge of nurses/midwives should be focused more on those who are younger and have less work experience. All necessary equipment required for health service providers to execute their roles as nutrition counselors and educators should also be provided by the government.

Internalization of stigma among parents of children with autism spectrum disorder in Nigeria: a mixed method study.

BACKGROUND: Autism Spectrum disorder (ASD) has uniquely stigmatizing aspects because children with ASD have no physical markers of their condition. Parents are usually blamed and judgment from others is often internalized (felt stigma). AIM: This study was conducted to determine knowledge about ASD, negative experiences (enacted stigma), internalization of stigma (felt or self stigma) and its correlates among parents of children with ASD in Lagos, Nigeria. METHODS: This was a cross-sectional study of 230 parents in Lagos, Nigeria employing mixed-method data collection methods. Quantitative data were collected using a structured interviewer-administered questionnaire and analyzed with Epi- Info™ version 7.0 statistical package. Data were summarized with proportions, mean and standard deviation. Chi square and Spearman's correlation tests were done, and the level of significance was pre-determined at 5% (p < 0.05). In-depth interviews were also conducted among six parents to further explore the topic. The interviews were analyzed narratively. RESULTS: The proportion of mothers and fathers were 175 (76.1%) and 55 (23.9%) respectively. The mean age of respondents was 42 ± 8.5 years. Overall knowledge of ASD was very poor as only 3(1.3%) had good knowledge. Overall, 122(53%) usually had negative experience of parenting a child with ASD (enacted stigma), mothers (17.1%) more than fathers (9.1%). Majority 192(83.5%) internalized stigma. There was a low-moderate correlation between 'enacted' stigma and 'internalized' stigma (ρ- 0.400, p < 0.001). From in-depth interviews, many parents revealed that their child's condition had negative effects on the family. Many also recounted negative experience of stigma. CONCLUSION: Overall, parents of children with ASD had poor knowledge of the condition. Majority internalized stigma and this increases with negative treatment from others. Parents should be properly educated about ASD. Community-based education to increase awareness about ASD in addition to encouraging people to show empathy and reduce stigmatizing behaviour towards parents of children with ASD are recommended.

Prevalence and determinants of intimate partner violence among adult women in an urban community in Lagos, Southwest Nigeria.

INTRODUCTION: intimate partner violence (IPV) is a global public health problem of human rights concern. It is a global issue, regardless of social, economic, religious or cultural group. Ever experienced IPV is a risk factor for many acute and chronic diseases and or stress-related conditions among women. This study determined the prevalence and predictors of lifetime IPV among women in an urban community in Lagos, Nigeria. METHODS: a descriptive cross-sectional study was conducted among 400 respondents from April to September 2019. An interviewer-administered questionnaire was used to obtain information from respondents. Data analysis was done using SPSS Version 22. Descriptive analyses were performed. Associations were explored with Chi-square test; multivariate analysis was done with logistic regression at p≤5% level of significance (95% CI). RESULTS: a total of 400 adult women aged 18-73 years who have been in an intimate relationship for at least 1 year participated in this study. The mean ± SD age of the respondents was 36.72 ± 11.74 years. Lifetime prevalence of IPV was 73.3%. The significant predictors for IPV were; being employed (OR=0.461; 95% CI=0.230-0.924); witnessed parental violence (OR=1.909; 95% CI=1.023-3.563); partner consuming alcohol (OR=1.669; 95% CI=0.999-2.788) and partner having other sexual partners (OR=2.104; 95% CI=1.174-3.771). CONCLUSION: community-based interventions by government and other stakeholders are needed to empower women, reduce exposure of children to IPV at home and provide enlightenment education on IPV in communities.

Physical activity prevents acute inflammation in a gout model by downregulation of TLR2 on circulating neutrophils as well as inhibition of serum CXCL1 and is associated with decreased pain and inflammation in gout patients.

OBJECTIVES: Gout is the most prevalent inflammatory arthritis. To study the effects of regular physical activity and exercise intensity on inflammation and clinical outcome, we examined inflammatory pathogenesis in an acute model of murine gout and analyzed human gout patient clinical data as a function of physical activity. METHODS: NF-κB-luciferase reporter mice were organized into four groups and exercised at 0 m/min (non-exercise), 8 m/min (low-intensity), 11 m/min (moderate-intensity), and 15 m/min (high-intensity) for two weeks. Mice subsequently received intra-articular monosodium urate (MSU) crystal injections (0.5mg) and the inflammatory response was analyzed 15 hours later. Ankle swelling, NF-κB activity, histopathology, and tissue infiltration by macrophages and neutrophils were measured. Toll-like receptor (TLR)2 was quantified on peripheral monocytes/neutrophils by flow cytometry and both cytokines and chemokines were measured in serum or synovial aspirates. Clinical data and questionnaires accessing overall physical activity levels were collected from gout patients. RESULTS: Injection of MSU crystals produced a robust inflammatory response with increased ankle swelling, NF-κB activity, and synovial infiltration by macrophages and neutrophils. These effects were partially mitigated by low and moderate-intensity exercise. Furthermore, IL-1ß was decreased at the site of MSU crystal injection, TLR2 expression on peripheral neutrophils was downregulated, and expression of CXCL1 in serum was suppressed with low and moderate-intensity exercise. Conversely, the high-intensity exercise group closely resembled the non-exercised control group by nearly all metrics of inflammation measured in this study. Physically active gout patients had significantly less flares/yr, decreased C-reactive protein (CRP) levels, and lower pain scores relative to physically inactive patients. CONCLUSIONS: Regular, moderate physical activity can produce a quantifiable anti-inflammatory effect capable of partially mitigating the pathologic response induced by intra-articular MSU crystals by downregulating TLR2 expression on circulating neutrophils and suppressing systemic CXCL1. Low and moderate-intensity exercise produces this anti-inflammatory effect to varying degrees, while high-intensity exercise provides no significant difference in inflammation compared to non-exercising controls. Consistent with the animal model, gout patients with higher levels of physical activity have more favorable prognostic data. Collectively, these data suggest the need for further research and may be the foundation to a future paradigm-shift in conventional exercise recommendations provided by Rheumatologists to gout patients.

Pathological manifestation of autoimmune myocarditis is detected prior to glomerulonephritis in a murine model of lupus nephritis.

OBJECTIVE: Since enhanced cardiac magnetic resonance imaging (cMRI) signals have been associated with lupus disease activity in humans prior to renal failure and novel, cardiac-focused therapeutic strategies could be investigated with an associated animal model, autoimmune myocarditis was characterized in murine lupus nephritis (NZM2410). METHODS: Weekly blood urea nitrogen (BUN) levels and weights were recorded. Cardiac function was assessed by echocardiogram. Myocardial edema was measured with quantitative T2 cMRI mapping. Endpoint serum and cardiac tissue were collected for histopathological analysis and cytokine measurements. RESULTS: Despite showing no signs of significant renal disease, mice displayed evidence of myocarditis and fibrosis histologically at 30-35 weeks. Moreover, T2 cMRI mapping displayed robust signals and analysis of sagittal heart sections showed significant myocardium thickening. Cytokine expression levels of IL-2, IL-10, TNF-α, CXCL1, and IL-6 were significantly enhanced in serum. Echocardiograms demonstrated significantly increased ventricular diameters and reduced ejection fractions, while immunohistochemical staining identified CD4+ and CD8+ T cells, and IL-17 in cardiac infiltrates. Human lupus cardiac tissue showed similar histopathology with enhanced infiltrates by H&E, fibrosis, and CD4+ detection. CONCLUSIONS: Histopathology, functional abnormalities, and enhanced cMRI signals indicative of myocarditis are detected in NZM2410 mice without glomerulonephritis, which supports the primary pathological role of autoimmune-mediated, cardiac-targeted inflammation in lupus.

Ebola virus disease in the eyes of a rural, agrarian community in Western Nigeria: a mixed method study.

BACKGROUND: Ebola virus disease (EVD) is a severe hemorrhagic disease caused by Ebola virus. Several outbreaks have been reported in Africa and often originated from remote agrarian communities where there are enormous misconceptions of the disease, refusal of early isolation and quarantine, and unsafe burial rites practices which aggravates the epidemics. It is on this basis that this study was conducted to (assess) the knowledge, perceptions, beliefs and preventive practices against EVD in a predominantly agrarian rural community in Southwest Nigeria. METHODS: This was a cross-sectional study conducted in Igbogila town, Yewa North Local Government Area of Ogun State, Southwest Nigeria in the latter part of 2014 during the EVD outbreak. Mixed methods were used for data collection. Quantitative data collection was done using a pre-tested interviewer administered questionnaire. Four hundred and seven respondents selected by multi-stage sampling technique were interviewed. Descriptive and inferential statistics were done, and the level of significance was set at 0.05. Qualitative data collection involved four focus group discussions a year after the epidemic was declared over in the country. The discussions were recorded, transcribed and analyzed along major themes. RESULTS: All respondents were aware of EVD with radio and television being the major sources of information. Knowledge of the disease was however very poor with many misconceptions and it was significantly influenced by educational level of respondent. EVD survivors will be welcomed back into the community by few residents (36.8%) and a much fewer proportion (27.2%) will freely entertain a survivor in their house. Most would prefer local herbalists over orthodox medical practitioners to care for their loved one in case they contract EVD. Although respondents knew that burying a victim is dangerous, they opposed cremation. CONCLUSION: There was poor knowledge of EVD with a lot of misconceptions. Community members were not pro-active about prevention with dire consequences in the event of an outbreak. Continuous public education should be done via mass media, traditional institutions and other community-based channels as part of emergency preparedness.