Are rural pregnant women disadvantaged in accessing intermittent preventive treatment in pregnancy in Ebonyi State, Nigeria?

INTRODUCTION: Adequate intermittent preventive treatment (IPTp) uptake (≥3 doses) routinely delivered at antenatal clinics is effective in preventing malaria during pregnancy. Whereas, low IPTp uptake (24.0%) had been reported among pregnant women in Ebonyi State, there is paucity of studies comparing the uptake and its predictors in the urban and rural areas of Ebonyi State. We determined IPTp uptake and its predictors in the urban and rural areas of Ebonyi State. METHODS: We conducted a cross-sectional comparative study among 864 reproductive age women selected using multistage sampling. Using a structured interviewer-administered questionnaire, we collected data on respondent's socio-demographic characteristics and IPTp uptake. Uptake was adjudged adequate if ≥3 doses were taken, otherwise inadequate. We estimated the proportion of women with adequate IPTp uptake and determined the factors associated with adequate uptake in rural and urban areas using chi square and multiple logistic regression at 5% level of significance. RESULTS: The mean ages of respondents in the urban and rural areas were 28.5±4.6 and 27.4±5.0 years respectively. Adequate IPTp uptake was 82.5% and 60.8% in the urban and rural respectively (p<0.001). In the urban area, women whose husbands had attained ≥ secondary education (aOR:2.9; 95%CI:1.2-7.4; p = 0.02) and those who paid for sulfadoxine/pyrimethamime (aOR:0.2; 95%CI: 0.1-0.6; p = 0.01) were 2.9 times more likely and 5 times less likely to take adequate IPTp respectively compared to respondents whose husbands had attained ≤ primary education and those who had sulfadoxine/pyrimethamine free. In the rural area, women who had attended ANC <4 times (aOR:0.4; 95%CI: 0.3-0.7; p<0.001) were 2.5 times less likely to take adequate IPTp compared to women that had attended ANC ≥4 times. CONCLUSION: Uptake of IPTp was more in the urban than rural areas of Ebonyi State. Interventions that reinforce the importance of health professionals carrying out actions aimed at pregnant women and their partners (spousal) in order to guide them on preventive actions against malaria and other diseases are recommended in Ebonyi State.

What factors are associated with forms of mistreatment during facility-based childbirth? A survey of referral health facilities in south-east Nigeria.

Mistreatment during childbirth in health facilities contributes significantly to suboptimal levels of skilled birth attendance. This study determined the factors associated with mistreatment during facility-based childbirth in two referral facilities in south-east Nigeria. A survey of 620 women whose childbirth occurred in two high-patronage referral hospitals of Ebonyi, Nigeria, was conducted in July-September 2018 using interviewer-administered questionnaires. Data analysis was performed using SPSS version 20. Logistic regression was used to identify predictors. The mean age of the respondents was 29.86 ± 4.4 years. Most had post-secondary education (71.0%), and had attended at least four antenatal visits (83.4%). The prevalence of any mistreatment during childbirth was 56%. Rural residence (adjusted odds ratio [AOR]: 0.53; CI: 0.35, 0.78, p = 0.002) and childbirth facilitated by a doctor (AOR: 1.7; CI: 1.14, 2.39, p = 0.007) were predictors of reporting at least one form of mistreatment during childbirth. Childbirth facilitated by a doctor (AOR: 1.66; CI: 1.05, 2.63, p = 0.031) and unemployment (AOR: 1.84; CI: 1.01, 3.07, p = 0.011) increased the odds of non-consented and non-dignified care, respectively. Rural residence (AOR: 0.57; CI: 0.37, 0.88, p = 0.011) and childbirth facilitated by a doctor (AOR: 0.65; CI: 0.45, 0.94, p = 0.020) were protective against abandonment/neglect. Vaginal birth (AOR: 0.33; CI: 0.16, 0.69, p = 0.003) reduced the odds of detention in the health facility following childbirth. Almost three-fifths of the women whose childbirths occurred in the surveyed facilities experienced at least one form of mistreatment during childbirth. Place of residence, health professional type, mode of childbirth, employment status and frequency of antenatal attendance were predictors of mistreatment during childbirth. Rights-based sensitization for women, especially in the rural areas, female empowerment, provider capacity-building on respectful client care and provision of subsidized maternal health services are recommended.

Human immunodeficiency virus status disclosure among people living with human immunodeficiency virus receiving care in Enugu, Nigeria: A mixed method study.

BACKGROUND: Disclosure of human immunodeficiency virus (HIV) status has potential benefits for both the individual and society. OBJECTIVES: This study aimed to determine the disclosure rate and its associated factors in people living with HIV receiving care in Enugu, Nigeria. METHODS: A cross-sectional study using mixed methods was carried out in 5 comprehensive treatment facilities in Enugu, Nigeria during March to August 2019. 300 participants for the quantitative aspect were selected using a simple random sampling method and 30 participants for the qualitative aspect were selected purposively. Interviewer administered questionnaire and focus group discussion were applied for data collection. The quantitative data was analyzed using Epi info version 7; Chi-square test and multivariable logistic regression were applied and a level of statistical significance was set at P < 0.05. The qualitative data were analyzed using thematic analysis. RESULTS: Among 300 participants, 241 (80.3%) had voluntarily disclosed their status to someone within their social network. 228 respondents had sexual partners and 122 (52.4%) had disclosed to their sexual partners. Twenty-five (11.0%) disclosed to their partners on the day of diagnosis. Predictors of disclosure were being female, having a formal education and being 35 years or more. CONCLUSION: This study revealed high voluntary disclosure rate to someone within the social network, but lower and delayed disclosure rate to sexual partners.

Determinants, reasons for choice and willingness to recommend birthing facility among mothers in public and private health facilities in Ebonyi, Nigeria.

INTRODUCTION: facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria. METHODS: this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection. RESULTS: the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others. CONCLUSION: regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.

Practices toward presumptive tuberculosis clients among patent medicine vendors in Ebonyi State Nigeria.

Background: Tuberculosis (TB) is a major cause of ill-health and death globally but a serious challenge to its control is low case notification. In low- and middle-income countries, most patients with symptoms of the disease first seek care from patent medicine vendors (PMVs) who are not formerly trained to manage TB. The practices of PMVs toward presumptive TB are pivotal to control of TB. Aim: The aim of this study was to describe the pattern of practices toward presumptive TB and assess their determinants among PMVs. Method: The study was carried out in Ebonyi State Nigeria using descriptive cross-sectional design. Through a multistage sampling, 250 PMVs were selected and interviewed. Data were collected using pretested interviewer-administered questionnaire and analyzed with IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Chi-square test and binary logistic regression were used to determine factors associated with practices toward presumptive TB with P value set at 0.05 for statistical significance. Results: Almost half (48.8%) of the respondents engaged in poor practices by inadequate referral of clients (45.2%), delayed referral (69.6%), and unstandardized treatment with antibiotics (56.4%). There was no statistically significant association between independent variables and practice and none of the variables significantly predicted practice. Conclusions: There were poor practices toward presumptive TB shown in inadequate referral, delayed referral, and unstandardized treatment of clients. We recommend that PMVs should be trained and regularly sensitized about TB to improve their practices and that regulatory authorities should enforce policies on antibiotics distribution and sale.

Does disrespect and abuse during childbirth differ between public and private hospitals in Southeast Nigeria.

BACKGROUND: Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utilization, indicating a problem with quality of care and a violation of women's human rights. This study compared prevalence of D&A during childbirth in a public and a private hospital in Southeast Nigeria. METHODS: This study was a cross-sectional study among women who gave birth in two specialized health facilities: a public teaching and a private-for-profit faith-based hospital in Southeast Nigeria. In each facility, systematic random sampling was used to select 310 mothers who had given birth in the facility and were between 0-14 weeks after birth. Study participants were recruited through the immunization clinics. Semi-structured, interviewer-administered questionnaires using the Bowser and Hills classification of D&A during childbirth were used for data collection. Data were analyzed using SPSS version 20 at 95% significance level. RESULTS: Mean age of the participants in the public hospital was 30.41 ± 4.4 and 29.31 ± 4.4 in the private hospital. Over three-fifths (191; 61.6%) in the public and 156 women (50.3%) in the private hospital had experienced at least one form of D&A during childbirth [cOR1.58; 95% CI 1.15, 2.18]. Abandonment and neglect [Public153 (49.4%) vs. Private: 91 (29.4%); cOR2.35; 95% CI. 1.69, 3.26] and non-consented care [Public 45 (14.5%) vs. Private 67(21.6%): cOR0.62; 95% CI. 0.41, 0.93] were the major types of D&A during childbirth. Denial of companionship was the most reported subtype of D&A during childbirth in both facilities [Public 135 (43.5%) vs. Private66 (21.3%); cOR2.85; 95% CI. 2.00, 4.06]. Rural residents were less likely to report at least one form of D&A during childbirth (aOR 0.53; CI 0.35-0.79). CONCLUSION: Although prevalence was high in both facilities, overall prevalence of D&A during childbirth and most subtypes were higher in the public health facility. There is a need to identify contextual factors enabling D&A during childbirth in public and private health care settings.

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.

Role of community resource persons in improving use of modern family planning methods among women of reproductive age in a rural area in Ebonyi State, Nigeria.

BACKGROUND: The study set out to determine the role of community resource persons in improving uptake of modern family planning methods among women of reproductive age in Ebonyi State. METHODS: A non-randomized intervention study with control was done. A multistage sampling technique was used to select a sample of 484 in union women of reproductive age. Data were collected using a pretested structured questionnaire. Community resource persons were trained to provide culturally appropriate information on family planning to men and women in the community. Postintervention data were collected after a waiting period of 3 months. RESULT: In the intervention arm, use of modern methods of family planning increased significantly by 7.4% at 3 months postintervention (P = 0.01) compared with the control arm. The most commonly used modern methods of family planning were pills, injectables, and barrier methods in the intervention arm and implant in the control arm. The major source of modern methods of family planning was health facility both before and after the intervention in both arms. Number of living children, increasing age and husband's education were predictors of current use of modern family planning methods. CONCLUSION: Community-driven strategies are useful for increasing uptake of modern methods of family planning and are recommended.

Community-based self-management of chronic low back pain in a rural African primary care setting: a feasibility study.

A small pragmatic non-randomised controlled study investigated the feasibility and acceptability of a novel theory-informed community-based self-management programme targeting the biopsychosocial factors associated with chronic low back pain disability in a rural Nigerian primary care centre. Participants either received the programme, once weekly for 6 weeks, or usual care. The programme combined group exercise sessions with group/individual discussion sessions, informed by cognitive behavioural therapy and motivational interviewing. Recruitment rate, intervention delivery, proportion of planned treatment attended, retention/dropout rate, adherence to recommended self-management strategies and biopsychosocial outcomes were used to determine feasibility. Structured qualitative exit feedback interviews ascertained acceptability. Recruitment rate was 100%, treatment uptake was 83% and loss to follow-up was 8%. Greater benefits for the self-management group compared with control were observed for primary and secondary biopsychosocial outcomes. Although the programme appears promising, the exploratory design of this study warrants more rigorous intervention testing following suggested programme improvement.

Disparities in tobacco use by adolescents in southeast, Nigeria using Global Youth Tobacco Survey (GYTS) approach.

BACKGROUND: Tobacco use during adolescence is a substantial problem and adolescents are at higher risk of addiction and prolonged use. To reduce the burden of tobacco-related morbidity and mortality, monitoring of adolescent tobacco use is imperative. We aimed to determine the prevalence of tobacco use among adolescents in urban and rural secondary schools in Enugu State, southeast Nigeria. METHODS: A cross-sectional study of 4332 adolescents in 8th to 10th grades in 25 urban and 24 rural secondary schools in Enugu, Nigeria was done using Global Youth Tobacco Survey (GYTS) methodology. Students were asked about previous and current tobacco use, smoking cessation, and susceptibility to smoking initiation among non-smokers. Geographical, age and sex prevalence differences were examined. Analyses were performed for all adolescents (10-19 years) and for a subset of students, 13-15 years of age for comparison with previous GYTS surveys. All analyses were weighted to account for the complex survey design and for differential non-response at school, class and student levels. RESULTS: About 28.9% of students reported ever smoking cigarettes; 19.4% reported current tobacco use among all adolescents (13.3, 5.8 and 7.8% for cigarettes, other smoked tobacco, and smokeless tobacco, respectively) while 18.6% reported current tobacco use among 13-15 year olds (12.6, 5.2 and 7.5% for cigarettes, other smoked tobacco and smokeless tobacco respectively). Prevalence of all types of tobacco use was higher in rural schools (vs. urban schools), and among boys (vs. girls). Susceptibility to smoking initiation among non-smokers was 9.3% (95% CI: 8.1-10.7) among all adolescents, and 9% (95% CI: 7.6-10.7) among 13-15 year olds. About 88.1% of all adolescent smokers desired to quit and 57.9% of them had never received help to quit smoking. CONCLUSIONS: Nearly one in every five school-going adolescents currently uses at least one type of tobacco in Enugu State, southeast Nigeria. Prevalence of tobacco use is higher in rural schools and among boys in this setting. Most adolescent current smokers desire to quit and need smoking cessation support.

Biopsychosocial factors associated with chronic low back pain disability in rural Nigeria: a population-based cross-sectional study.

INTRODUCTION: Many people in Nigeria are living with disability due to chronic low back pain (CLBP), with the greatest burden accounted for by people living in rural Nigeria. However, factors associated with disability in rural Nigeria have not yet been established. We investigated the biomechanical and psychosocial predictors of CLBP disability in a rural Nigerian population. METHODS: A cross-sectional study of adults with non-specific CLBP recruited from rural communities in Enugu State, South-eastern Nigeria. Measures of self-reported and performance-based disability, pain intensity, anxiety and depression, coping strategies, social support, occupational biomechanical factors, illness perceptions and fear avoidance beliefs were collected by trained community health workers. We used univariate and multivariate analyses. RESULTS: 200 individuals were recruited. Psychosocial factors were the most important factors associated with CLBP disability, and accounted for 62.5% and 49.1% of the variance in self-reported and performance-based disability, respectively. The significant predictors of self-reported disability were: illness perceptions (ß=0.289; p<0.0005), pain intensity (ß=0.230; p<0.0005), catastrophising (ß=0.210; p=0.001), fear avoidance beliefs (ß=0.198; p=0.001) and anxiety (ß=0.154; p=0.023). The significant predictors of performance-based disability were: illness perceptions (ß=0.366; p<0.0005), social support (ß=0.290; p<0.0005), fear avoidance beliefs (ß=0.189; p<0.01) and female gender (ß=0.184; p<0.01). Illness concern was the most salient dimension of illness perceptions predicting self-reported and performance-based disability. CONCLUSIONS: These results provide evidence which can be used to inform the development of interventions to reduce CLBP disability in rural Nigeria, and may have relevance in other rural African contexts.

Prevalence of presbyopia in a rural African community.

INTRODUCTION: When presbyopia (loss of accommodation of the crystalline lens with increasing age) sets in, doing near work becomes associated with headache and eye strain. Reading and writing become a challenge. Literacy levels may be low in rural communities; nevertheless some work other than reading, like sewing, sorting stone from grain and operating mobile phones, is done with dissatisfaction. This study aims to determine the prevalence of presbyopia, the unmet presbyopia need and the presbyopia correction coverage in a rural African community. METHODS: A population-based cross-sectional study was carried out in a rural population aged 35 years and greater, selected by cluster random sampling. Information was sought on biodata of the participants and they were subsequently examined. Distance visual acuity for each participant was determined. Anterior and posterior segments of the eyes were examined. Objective refraction with subjective refinement was done on all subjects with distant visual acuity less than 6/6. Near visual acuity was assessed at 40 cm with distant correction in place if required. Presbyopia was defined as inability to read N8 at 40 cm or requiring an addition of at least +1.00DS to improve near vision to at least N8. Questionnaires were administered to those identified as presbyopic on source of procurement of spectacles (if they had one) and on reasons for non-procurement of presbyopic spectacles. They were also asked to rate their difficulty with various listed near work. Data entry and analysis were done using Statistical Package for the Social Sciences v16.0 and Program for Epidemiologist v4.01 software. RESULTS: A total of 585 subjects (participation rate 81.1%) aged 35 years and greater were interviewed and examined. The prevalence of presbyopia was 63.4% (95% confidence interval (CI) 62.6-64.2%). There was increasing prevalence with increasing age. The met presbyopia need was 17.6%, unmet need was 45.8% and presbyopic correction coverage was 27.8%. The commonest reasons for not procuring presbyopic correction were 'not a priority' (21.5%) and 'cost' (21.2%). CONCLUSIONS: The prevalence of presbyopia in this rural African community is high. Many who need presbyopic correction do not have corrective spectacles.

Awareness and knowledge of disease surveillance and notification by health-care workers and availability of facility records in Anambra state, Nigeria.

BACKGROUND: Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases, personnel, and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases. OBJECTIVE: The aim of this study is to examine the awareness and knowledge of health-care workers about DSN, and availability of facility records in Anambra State, Nigeria. MATERIALS AND METHODS: The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews, whereas an observational checklist, preceded by a desk review was used to examine the availability of facility records. RESULTS: Although 89.8% of the health-care workers were aware of the DSN system, only 33.3, 31.1, and 33.7% of them knew the specific uses of forms IDSR 001, IDSR 002, and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response), respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low, although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (χ(2)=7.67, P=0.005). CONCLUSIONS: Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms, copies of the standard case definitions, and other necessary logistics to the health-care facilities by the local and state governments.

Awareness and Knowledge of Disease Surveillance and Notification by Health-Care Workers and Availability of Facility Records in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases; personnel; and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases. Objective: The aim of this study is to examine the awareness and knowledge of health-care workers about DSN; and availability of facility records in Anambra State; Nigeria. Materials and Methods: The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews; whereas an observational checklist; preceded by a desk review was used to examine the availability of facility records. Results: Although 89.8 of the health-care workers were aware of the DSN system; only 33.3; 31.1; and 33.7 of them knew the specific uses of forms IDSR 001; IDSR 002; and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response); respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low; although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (?[2]=7.67; P=0.005). Conclusions: Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms; copies of the standard case definitions; and other necessary logistics to the health-care facilities by the local and state governments

Childhood Malignancy in Abakaliki: A Growing Concern

Aim: To determine (a) the prevalence of malignancies in children in Abakaliki as well as the outcome of therapy. (b) Compare findings with data from other parts of Nigeria. Patients and Methods: A 4-year descriptive retrospective review of childhood malignancies was carried out based on data collected from case notes of patients attending the Paediatrics clinics of Ebonyi State University Teaching Hospital (EBSUTH) and Federal Medical Centre (FMC) Abakaliki. Results: A total of 38;802 cases were reviewed out of which 53 had various types of malignancies; giving a prevalence rate of 0.14; with a male to female ratio of 2.1:1. The mean age of patients was 8.14 years with a standard deviation of 3.77 years. This constituted 1.7 of the 3088 Ward admissions. Burkitts lymphoma was the commonest malignancy (60.5) followed in order of frequency by hepatocellular carcinoma (9.2 ) and retinoblastoma (7). Leukemia; rhabdomyosarcoma and Wilm's tumour had a prevalence of 4.7each. A review of the Burkitts lymphoma cases showed a male dominance with a male to female ratio of 3:1; though this is not statistically significant. There was a preponderance of abdominal tumours. Most of the patients had chemotherapy but outcome was poor. Conclusions: Prevalence of childhood malignancies in Abakaliki is high with a high frequency of Burkitt's lymphoma. Outcome of therapy was poor. Late presentation; absence of proper diagnostic machinery; inadequacy of chemotherapy; poverty and ignorance were some of the factors responsible for the poor outcome of the various malignancies