Socioeconomic Parameters and Well Being of Sickle Cell Anaemic Patients in Southwestern Nigeria.

BACKGROUND: The financial and educational status of individuals living with sickle-cell anaemia contributes to their general well-being. It is widely known that education is closely linked with positive health-seeking behaviors i.e., the more educated a person is, the better the person is likely to seek medical attention when needed, and take care of themselves before the crisis. It is considered that a relatively well-educated person with a means of livelihood would purchase the required drugs for prophylactic use. In most African countries where poverty is acute, it becomes a problem when the resource for education and finance needed for the treatment is not available. This study assessed the socioeconomic parameters (financial and educational status) of individuals living with the disorder within the Ibadan metropolis, southwest Nigeria. METHODS: This study is a descriptive cross-sectional study using quantitative methods that assessed individuals' financial and educational status with sickle cell anaemia. Respondents were recruited from federal and state hospitals, non-governmental foundations, worship centers, and schools. The individuals' educational and financial statuses were accessed using standardized data collection and assessment tools, while the data were analyzed using SPSS (v22). Presentation of inferential statistics was done at a 5% level of significance. RESULTS: The study recruited 253 participants, of which more than half (58.1%) were females. Those between 12-28 years were 64.4%, and the mean age was approximately 27.7±10.3 years. Also, 67.2% had tertiary education, 74.7% were neither engaged nor married at the time of this study, 88.5% were Yoruba, 73.5% of the participants were from a monogamous family, and 73.1% were Christians. A significant directly proportional association was found between financial status, educational status, and general well-being. CONCLUSION: Sociodemographic, as well as educational factors, contributed to the general well-being of the individual participants. Thus, finance, level of exposure, and the environment were found to contribute significantly to well-being. More than half of the participants had tertiary education or are currently in school compared to those without tertiary education. There is an association between those with tertiary education and the number of hospital visits in the selected participants. While no association exists between those with buoyant financial status compared to those without a stable source of income.

CONTEXTE: La situation financière et le niveau d'instruction des personnes vivant avec la drépanocytose contribue à leur bien-être général. Il est largement connu que l'éducation est étroitement liée à des comportements positifs de recherche de santé, c'est-à-dire que plus une personne est éduquée, plus elle est susceptible de rechercher des soins médicaux en cas de besoin et de prendre soin d'elle-même avant la crise. On considère qu'une personne relativementinstruite et disposant de moyens de subsistance achèterait les médicaments nécessaires à des fins prophylactiques. Dans la plupart des pays africains où la pauvreté est aiguë, cela devient un problème lorsque les ressources pour l'éducation et les moyens financiers nécessaires au traitement ne sont pas disponibles. Cette étude a évalué les paramètres socio-économiques (situation financière et d'éducation) des personnes vivant avec la maladie dans la métropole d'Ibadan, au sud-ouest du Nigeria. MÉTHODES: Il s'agit d'une étude transversale descriptive utilisant des méthodes quantitatives qui ont permis d'évaluer la situation financière et éducative des personnes atteintes de drépanocytose. Les personnes interrogées ont été recrutés dans des hôpitaux fédéraux et d'État, des fondations non gouvernementales, des centres de culte et des écoles. La situation éducative et financière des individus a été vérifiée à l'aide d'une collecte de données qui est standardisée et des outils d'evaluation tandis que les données ont été analysées à l'aide de SPSS (v22). Les statistiques inférentielles ont été présentées à un niveau de signification de 5%. RÉSULTATS: L'étude a recruté 253 participants, dont plus de la moitié (58,1 %) étaient des femmes. Les participants âgés de 12 à 28 ans représentaient 64,4 % et l'âge moyen était d'environ 27,7±10,3 ans. En outre, 67,2 % des participants avaient fait des études supérieures, 74,7 % n'étaient ni fiancés ni mariés au moment de l'étude, 88,5 % étaient Yoruba, 73,5 % des participants étaient issus d'une famille monogame et 73,1 % étaient chrétiens. Une association significative directement proportionnelle a été trouvée entre la situation financière, le niveau d'éducation et le bien-être général. CONCLUSION: Les facteurs sociodémographiques et éducatifs, ont contribué au bien-être général des participants. Ainsi, les finances, le niveau d'exposition et l'environnement ont contribué de manière significative au bien-être. Plus de la moitié des participants ont fait des études supérieures ou sont actuellement scolarisés par rapport à ceux qui ne sont pas scolarisés. Il existe un lien entre les participants de l'enseignement supérieur et le nombre de visites à l'hôpital chez les participants sélectionnés. Bien qu'il n'y ait pas d'association entre les personnes ayant une financière par rapport à ceux qui n'ont pas de source de revenus stable. Mots-clés: Anémie drépanocytaire, Éducation, Situation financière, Visites à l'Hôpital, Bilans de santé, Bien-Être.

Maternal and Child Healthcare Delivery in Secondary Healthcare Facilities in Oyo State, Nigeria: Working Towards Sustainable Development Goal 3.

BACKGROUND: The Millennium Development Goals (MDGs) were not achieved by most Sub-Saharan countries including Nigeria. This further led to the proposition of Sustainable Development Goals (SDGs) to run from 2015-2030, to make up for the deficiencies. There is a need to assess the Maternal and Child Healthcare (MCH) delivery, to work towards achieving SDG 3. OBJECTIVES: To evaluate the MCH delivery practices and to identify the related challenges at the secondary care level in Oyo State, southwest Nigeria. METHODS: The study was cross-sectional in design. Twenty-two healthcare facilities were selected by simple random sampling and were assessed using an adapted semi-structured checklist of the WHO manual on Integrated Management of Pregnancy and Childbirth Series. The analysis was done, using Statistical Package for Social Sciences (SPSS) version 21. RESULTS: All the facilities offered normal delivery services and 81.8% offered the three basic child health services (sick childcare, vaccination, and growth monitoring). All the facilities had essential supplies for antenatal and newborn care, and essential drugs for antenatal and childcare. However, only 36.4% had essential delivery medications. Also, 18.2% had available guidelines for MCH delivery, and 42.0% of the staff were present at the time of the survey. The major challenges identified were small staff size (50.0%), lack of equipment (31.8%), and (18.2%) for lack of equipment, medicine, hands-on training, and supervision. CONCLUSION: There is a need for continuous monitoring and evaluation of the MCH services and to improve on the identified challenges. This would help in working towards achieving SDG 3 by the year 2030. Mots clés: Soins prénataux, Soins de santé infantile, Évaluation, Établissement de santé, soins de santé maternelle, soins de santé secondaire, ODD.

CONTEXTE: Les Objectifs du Millénaire pour le développement (OMD) n'ont pas été atteints par la plupart des pays subsahariens, y compris le Nigeria. Cela a conduit à la proposition d'objectifs de développement durable (ODD) qui s'appliqueront à partir de 2010. (SDGs) qui s'étendent de 2015 à 2030, afin de combler les lacunes. Il est nécessaire d'évaluer la prestation des soins de santé maternelle et infantile (SMI) afin d'atteindre l'objectif de développement durable 3. OBJECTIFS: Évaluer les pratiques de prestation de soins de santé maternelle et infantile et identifier les défis connexes au niveau des soins secondaires dans l'État d'Oyo, au sud-ouest du Nigeria. MÉTHODES: L'étude était de type transversal. Vingt-deux établissements de santé ont été sélectionnés par échantillonnage aléatoire simple et ont été évalués à l'aide d'une liste de contrôle semi-structurée adaptée sur la prise en charge intégrée de la grossesse et de l'accouchement. L'analyse a été réalisée à l'aide du progiciel de statistiques pour les sciences sociales (SPSS) version 21. RÉSULTATS: Tous les établissements offraient des services d'accouchement normal et 81,8% offraient les trois services de santé infantile de base (soins aux enfants malades, vaccination et suivi de la croissance),Toutes les structures disposaient des fournitures essentiels pour les soins prénatals et néonatals, et de médicaments essentiels pour les soins prénatals et infantiles. Cependant, seuls 36,4% disposaient de médicaments essentiels pour l'accouchement. De plus, 18,2% avaient des directives disponibles pour l'accouchement en SMI, et 42,0% du personnel était présent au moment de l'enquête. Le site principaux défis identifiés étaient la petite taille du personnel (50,0%), le manque ded'équipement (31,8%), et (18,2%) pour lemanque d'équipement, de médicaments, de formation pratique et de supervision. CONCLUSION: Il est nécessaire d'assurer un suivi et une évaluation pour continuer des services de SMI et d'améliorer les défis identifiés. Cela contribuerait à la réalisation de l'ODD 3 par l'année 2030. Mots clés: Soins prénataux, Soins de santé infantile, Évaluation, Établissement de santé, soins de santé maternelle, soins de santé secondaire, ODD.

NATIONAL HEALTH INSURANCE SCHEME: PERCEPTION AND PARTICIPATION OF FEDERAL CIVIL SERVANTS IN IBADAN.

Introduction: The National Health Insurance Scheme is a social health insurance programme designed by the Federal Government of Nigeria to complement sources of financing the health sector and to improve access to health care for the majority of Nigerians. Presently, the enrolment level on the Scheme is majorly among those in the formal sector and user experiences have been different. This study seeks to determine the perception and participation of Civil Servants regarding the National Health Insurance Scheme in Ibadan. Methods: A descriptive cross-sectional study was conducted among 273 civil servants working at the Federal Secretariat, Ikolaba, between October and November 2015. An interviewer-administered questionnaire was used to collect information on socio-demographic characteristics, awareness, and membership of the NHIS, perception of NHIS, and health-seeking behaviour. Participation was defined as the number of civil servants registered or enrolled under the scheme, in other words, members of the scheme. Information on perceptions was sought using a 3-point Likert scale. Descriptive statistics and chi-square tests were used for data analysis at a 5% level of significance. Results: About 60.1% of the respondents were males. The average age was 39.7±9.1 years, with 85.0% of the respondents being married. The majority (65.2%) of the respondents were mid-level cadre workers, 17.62% were working as senior-level workers and the remaining 17.6% were low cadre workers. The majority (88.9%) completed tertiary education, while just 11.1% completed basic education. The mean household size was 2.5±0.6. Awareness of the National Health Insurance Scheme was very high (95.2%) with 83.5% enrolled under the scheme. About (50%) of the respondents joined the scheme because it is cheap and affordable. There was a significant association between awareness, level of education, knowledge of NHIS, and registration into the scheme by respondents. The majority of the respondents (87.3%) claimed that NHIS is a better means of settling healthcare costs than Out-of-pocket-payment. The majority of the respondents thought that health insurance is a viable programme. Conclusion: The perception of health insurance among civil servants was varied while participation was high. Relevant intervention should be introduced to remove bottlenecks to accessing and operating the scheme.

PREDICTORS OF WILLINGNESS TO TASK SHIFT AMONG FAMILY PLANNING PROVIDERS IN A SOUTH-WESTERN NIGERIAN STATE.

BACKGROUND: Task shifting, the balanced reallocation of tasks usually from a higher cadre to a lower cadre among the health workforce team, has been proposed as a possible solution to the serious shortage of human resource in the health sector is being experienced in many developing countries. This study aimed to assess the views and experiences of nurses on task shifting in family planning services in Ibadan, Southwest Nigeria. METHODOS: A descriptive cross-sectional study of 400 nurses with at least a year experience in providing family planning services at purposively selected tetiary, secondary and primary facilities in Ibadan was carried out using an intervieweradministered questionnaire. Chi-square test was used to determine association between categorical variables at 5% level of significance. RESULTS: Mean age of the respondents was 41.1±8.7 years and 62% of the respondents were registered nurses/registered midwives. Although majority (91.5%) of the respondents were aware of the concept of task shifting, only 52.2% were willing to task shift family planning services to lower cadre staff and only 38.5% have actually task shifted family planning services to lower cadre staff. Age, educational status and awareness about task shifting were predictors of willingness to task shift family planning services. CONCLUSION: Older registered nurses or registered midwives who were aware of the concept of task shifting were more willing to task shift family planning services. Also, a combination of both awareness and willingness to task shift among married women enhances the practice of task shifting of family planning services.

FACTORS INFLUENCING HEALTH-SEEKING BEHAVIOUR AMONG CIVIL SERVANTS IN IBADAN, NIGERIA.

BACKGROUND: Health-seeking behaviours (HSB) are closely linked with the health status of a nation and thus its economic development. Several studies have described HSB within the context of various diseases. However, knowledge of HSB among population sub-groups is still scanty. This study aims to determine factors most important to civil servants when seeking health care. METHODS: A descriptive cross-sectional study was conducted among 337 civil servants working in the Federal Secretariat, Ibadan, Nigeria. An intervieweradministered semi-structured questionnaire was used to collect information. Chi-square tests were used to test for associations while binary logistic regression test was used for determining predictors. All data analysis were done at 5% level of significance. RESULTS: Members of the poorest quartile were 6 times more likely to have inappropriate HSB than the richest quartile (Q4:Q1= 5.83;O.R: 16.12, 95% C.I: 2.61-11.03). Visits to the hospital or clinic (62.2%) was the most common source of healthcare sought. This was followed by visits to the chemist (33.0%), traditional healers (4.3%). A little more than one-third (34.5%) of respondents considered good service delivery as the most important factor affecting HSB. This was followed by proximity (23.9%), affordability (20.4%), prompt attention (8.8%) and readily-available drugs (7.1%). Completing only basic education [O.R: 0.24 (0.06, 0.96)] and out of pocket payment [O.R: 0.04 (9.16, 82.45)] were associated with a reduction in the likelihood of seeking healthcare from formal sources. CONCLUSION: Appropriate health-seeking behaviour was found to be high among civil servants. However, lower cadre workers and those with lower levels of education need to be targeted during policy formulation to improve health-seeking behaviour. In addition, health insurance schemes should be extended to cover more of the population in order to improve health-seeking behaviour.

IS THE CHILD-TO-CHILD APPROACH USEFUL IN IMPROVING UPTAKE OF EYE CARE SERVICES IN DIFFICULT-TO-REACH RURAL COMMUNITIES? EXPERIENCE FROM SOUTHWEST NIGERIA.

BACKGROUND: To determine if primary school pupils aged 9-14 years can be satisfactorily trained, using the child-to- parent approach, to assess vision, refer and motivate people to attend screening eye camps. METHOD: Ninety pupils aged 9-14 years attending two purposively-selected primary schools were selected by simple random sampling. Using the child-to-parent approach and Snellens 6/60 illiterate E-chart, participants had a three-day knowledge and skill-based training followed by 2 days of community-based vision assessment and referral of those assessed. The adequacy and success of the training were assessed by comparing preand post-test scores. RESULTS: Three hundred and thirty-six persons were referred and examined; of these, 142 (42.3%) persons were reviewed. Overall, there was significant improvement in knowledge. The accuracy of assessments was 82.1% for Right Eyes (RE), 83.3% for Left Eyes (LE) and 72.1% for presbyopia. The sensitivities for the RE, LE and presbyopia were 84.8%, 86.1% and 76.3% respectively. Similarly, the specificities were 44.4% for RE, 50.0% for LE and 68.6% for presbyopia. The performances were not significantly influenced by age, sex and locality. CONCLUSION: Children aged 9-14 years in primary schools can be empowered, using the child-to-child approach, to assess vision and motivate members of their communities to utilize available eye care services.

Awareness and distribution of ABO, Rhesus blood groups and haemoglobin phenotypes among medical undergraduates in a Nigerian university.

BACKGROUND: In the past two decades the Nigerian government and religious organisations have put more emphasis on knowing the haemoglobin electrophoresis of school children and intending couples respectively. Knowledge of the distribution of blood groups and haemoglobin electrophoretic patterns among young people is vital for the prevention of haemoglobinopathies in the population and for providing effective blood banking services. Therefore, this study was designed to assess the frequency and awareness of blood group and haemoglobinphenotypes among a new set of fourth year clinical medical and dental students of the University of Ibadan, Nigeria. METHODS: Data, including socio-demographics, self- reported blood group and haemoglobin phenotypes, were obtained from 155 students using a self-administered questionnaire. The ABO, Rhesus (Rh) blood groups and haemoglobin electrophoresis were determined by the tile (slide) technique and cellulose acetate at alkaline phrespectively. RESULTS: Only 43.9% of the participants knew their blood groups while less than a third (29.7%) knew their haemoglobin phenotypes. knowledge of both their blood groups and haemoglobin phenotypes was documented in as low as 20.6% of the respondents. The frequency of haemoglobin AA, AS, AC and. CC were 78.0%, 16.8%, 3.9% and 1.3% respectively. Similarly, the distribution of blood groups were: 0 RhD positive - 47.8%;0 RhD negative- 1.9%;ARhD positive- 21.9%; A RhD negative - 1.3%; B RhD positive - 23.2%; B RhD negative -1.3% and AB RhD positive - 2.6%. No participant was AB RhD negative. Participants who bad previously donated blood and those who were females were more likely to know their blood groups and haemoglobin phenotypes respectively (p<0.05). CONCLUSION: Awareness of blood groups and haemoglobin phenotypes among the medical and dental students was poor. Documentation and routine screening for haemoglobinphenotypes as well as blood grouping, accompanied by appropriate counseling should be institutionalised in Nigeriantertiary institutions.

Suicidal ideation: Are refugees more at risk compared to host population? Findings from a preliminary assessment in a refugee community in Nigeria.

Among the serious mental health problems that may be associated with being a refugee is suicidal behavior. This study aimed to assess the prevalence and correlates of suicidal ideation among African refugees in Oru-Ijebu Nigeria. Suicidal ideation was assessed using appropriate section in the Mini-International Neuropsychiatric Interview while the brief version of the WHO Quality of Life was used to assess quality of life as a clinical variable. Study involved 444 refugees and 527 non-refugee member of host community. Result showed that the prevalence of suicidal ideation was significantly higher among the refugees than the non-refugee comparison group (27.3% vs. 17.3%; p<0.001). Social status and quality of life was significantly poorer among the refugees compared with their non-refugee members of same community. Quality of life was the only factor independently associated with suicidal ideations among refugees. In conclusion, the study shows that the prevalence of suicidal ideation is significantly higher among the refugees than the non-refugee members of the host community and calls for innovative ways of extending mental health services to refugees at the study site.

Ownership and utilisation of insecticide-treated mosquito nets among caregivers of under-five children and pregnant women in a rural community in southwest Nigeria.

INTRODUCTION: Malaria still constitutes a serious public health problem in Nigeria despite control efforts. The use of Insecticide Treated Net (ITN) has been proven to be an effective preventive modality in the control of malaria but its utilisation has been shown to be low. This study assessed the ownership and utilisation of ITN in Igbo-Ora, a rural community in Ibarapa Central Local Government Area (LGA) of Oyo State, Southwest Nigeria. METHODS: A descriptive cross-sectional survey among female caregivers of under-five children and pregnant women was conducted using semi-structured interviewer-administered questionnaire. Data were analyzed using SPSS version 16. RESULTS: Among 631 respondents that participated, 84.9% were caregivers of under-five children. Mean age was 27.7 ± 6.3 years with 53.4% between 20-29 age group. Majority, 91.1% had at least primary education, 60.2% were traders and 69.7% were married. Most respondents, 71.8% had at least one type of mosquito nets. Among those that had, 85.4% had window/door net, 25.2% untreated mosquito net while only 15.5% had ITN. Overall, 11.1% of the respondents had ITN among which 78.6% had ever slept under an ITN. Among those that had ever slept under an ITN, slightly less than half 49.1% slept under an ITN the previous night. Less educated respondents were five times more likely to use ITN (95% CI = 1.24-21.28). CONCLUSIONS: This study revealed very low ownership and utilisation of lTNs. There is need to improve on the knowledge of community members of the relevance of ownership and utilisation of ITN in malaria prevention.

Quality of life and associated factors among adults in a community in South west Nigeria.

BACKGROUND: Quality of life (QoL) is an important measure in the assessment of population well being and health status. However despite locally validated measuring tools, little is known about the quality of life and associated factors in Nigerian adults. OBJECTIVE: This study therefore aimed to assess QoL and contributory factors among adults residing in a sub urban Nigerian community. METHODS: A descriptive cross-sectional study of 527 adults, in Oru community was conducted. An interviewer-administered questionnaire adapted from the WHO quality of life (WHOQOL-BREF) questionnaire was used to obtain information from respondents. Associations were explored with the chi square test; multivariate analysis was done with logistic regression at 5% level of significance. RESULTS: Respondents mean age was 33.3 ±8.1 years. In all, 46.5 % were currently married or cohabiting. Christianity was the dominant religion, 72.7%. In all, 81.6% had good QoL. Predictors of good QoL were respondents less than 25 years [OR: 3.5 (1.264-9.508)], having educational level that is secondary and above [OR: 4.2 (1.810-9.762)]. Being Unemployed [OR: 1.9 (1.099- 3.351)], living in flats and other bigger apartments [OR: 1.8 (1.121- 3.04)], currently ill [OR: 3.7 (2.096- 6.509)], and lack of involvement in religious activities [OR: 3.1 (1.166- 8.045)] were also shown to be predictors of good QoL. CONCLUSION: The majority of those evaluated had good QoL. Further surveys involving larger samples sizes are required to explore the QoL in distinct sub-populations and in currently ill patients to strengthen the results of this study.

Metabolic response to anaesthesia and lower abdominal surgery in Nigerians. Changes in plasma cortisol and blood sugar.

In ten Nigerian patients undergoing prostatectomy, plasma cortisol was slightly decreased by pre-medication with atropine and pethidine and during general anaesthesia without surgery. This decrease was not statistically significant. There was, however, a statistically significant increase in plasma cortisol after 1 h of surgery and also in the post-operative period. The blood sugar was elevated by pre-medication and surgery though the rise was not significant. There was a significant rise of blood sugar after 30 min of surgery and in the post-operative period. These findings in general are similar to those observed in ten Nigerian patients undergoing upper abdominal surgery, although the rise in plasma cortisol was higher following upper abdominal surgery, and the rise in blood sugar higher following lower abdominal surgery.

Metabolic response to anaesthesia and prostatectomy in Nigerians. Changes in plasma cortisol and blood sugar.

In ten Nigerian patients undergoing prostatectomy, plasma cortisol was slightly decreased by pre-medication with atropine and pethidine and during general anaesthesia without surgery. This decrease was not statistically significant. There was, however, a statistically significant increase in plasma cortisol after 1 h of surgery and also in the post-operative period. The blood sugar was elevated by pre-medication and surgery though the rise was not significant. There was a significant rise of blood sugar after 30 min of surgery and in the post-operative period. These findings in general are similar to those observed in ten Nigerian patients undergoing upper abdominal surgery, although the rise in plasma cortisol was higher following upper abdominal surgery, and the rise in blood sugar higher following lower abdominal surgery.

Pre-operative blood volume in surgical cancer patients.

In order to aid intra-operative management, blood volume was measured in eighteen pre-operative surgical patients who had clinical and/or radiological diagnosis of various forms of malignancy, using the 'Volemetron' and radio-iodinated human serum albumin (RIHSA). After correction for F-cell ratio, the plasma volume and red cell volume were derived. In both sexes, the mean values of total blood volume, plasma volume and red cell volume were not significantly different from those of non-cancer patients. But mean values/kg. body weight in males were significantly higher than their non-cancer counterparts. The total blood volume/kg. in each cancer-patient who had lost weight was higher than the mean value/kg. in the non-cancer patients in both sexes. From this study, there appears to be a trend for patients with malignancy to have higher blood volumes than patients without; this difference reaches significant level if weight loss has occurred. Replacement of blood loss during surgery should probably err on the generous side in such patients.

Difficult laryngoscopy and tracheal intubation due to calcified stylohyoid ligaments.

Two cases of difficult laryngoscopy and tracheal intubation caused by calcified stylohyoid ligaments are presented. Neither patient exhibited a skin crease over the hyoid bone. It is suggested that inability to lift up the epiglottis from the posterior pharyngeal wall be taken as a more useful sign of this condition than the presence of the skin crease.

Open pulmonary valvotomy: report of the first successful open heart surgery at the University College Hospital, Ibadan, Nigeria.

Although cardiac surgery has become the standard procedure for management of intracardiac and extracardiac defects in developed countries, it is still relatively new in Africa. This report describes our first successful open heart surgery on a 16-year-old Nigerian boy who underwent open pulmonary valvotomy under cardiopulmonary bypass for congenital pulmonary stenosis at the University College Hospital, Ibadan, Nigeria, on September 18, 1979.