Hepatitis B Virus infection and its modes of prevention among clinical students of Obafemi Awolowo University (OAU), Ile-Ife, Nigeria.

BACKGROUND: Hepatitis B is a major global health problem and is a major infectious and occupational hazard for health workers, especially doctors, nurses, dentists and laboratory staff, including those who are under training, because of exposure to patients' body fluids during clinical activities. Clinical students are also at risk of HBV infection during their training in medical school. HBV vaccination status is very low among medical students in Nigeria AIM: This study assessed the knowledge of clinical students of the Obafemi Awolowo University (OAU), Ile-Ife about hepatitis B virus infection and its modes of prevention. METHODS: A descriptive cross-sectional study was conducted among all 594 clinical students of OAU using a pretested, self-administered, semi-structured questionnaire. Data were analysed and summarized using descriptive and inferential statistics (logistic regression). RESULTS: Four hundred and thirty (72.4%) respondents correctly identified four modes of transmission, while 470 (79%) respondents reported vaccination as a mode of prevention of HBV infection. Of all the respondents, 61.6% had ever received Hepatitis B virus vaccine, while only 39.2% of the respondents had received at least three doses of HBV vaccine. At bivariate level, gender (χ2 = 23.685, p < 0.001) and level of study (χ2 = 7.383, p < 0.05) were significantly associated with HBV vaccine uptake. At multivariate level, gender (OR = 2.58, 95% CI = 1.80-3.7 1) and level of study (OR = 1.71, 95% CI =1.14-2.54) remained significantly associated with HBV vaccine uptake. CONCLUSION: The study concluded that clinical students had poor knowledge of safe sexual practices and post-exposure prophylaxis as preventive measures. The uptake of HBV vaccine was also poor. The significant correlates of vaccine uptake were gender and level of study.

Impact of nutritional education on nutritional status of under-five children in two rural communities of south-west Nigeria.

OBJECTIVES: This study evaluated the impact of nutritional education on knowledge, attitude and practices (KAP) of mothers concerning infants and young children feeding and their children's nutritional status in two semi-urban communities of south-west Nigeria. MATERIALS AND METHODS: This is a community intervention study. We recruited 150 mothers of children aged 0-18 months independently from the intervention and control communities through a multi-stage sampling technique. We collected data with the aid of an interviewer-administered questionnaire at baseline and at six months after intervention from both communities to obtain information on feeding of infants and young children. In addition, we measured weights and heights of recruited children. Intervention involved group counselling of mothers and food demonstrations at designated health facilities. Data analysis for quantitative data was done using Epi-Info software, and for qualitative data, content analysis of major themes was used. RESULTS: Before intervention, recruited mothers and their children from the two communities were comparable in terms of all the parameters assessed (P>0.05 in all cases). After six months of intervention, mothers who had nutritional education demonstrated better knowledge and attitudes to key infant and young children feeding recommendations. There was also limited improvement in feeding practices. Mothers from the intervention community exclusively breastfed their infants longer with mean age at introduction of complementary foods at 5.3 months compared to 4.5 months in the control community (P<0.05), breastfed their children longer (P<0.05). However, there was no statistically significant improvement in the weight of their children. CONCLUSION: In this study, nutritional education of mothers only had positive impact on their level of KAP on infant and young children feeding.

Utilization of primary health care facilities: lessons from a rural community in southwest Nigeria.

BACKGROUND: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. METHOD: A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data. RESULTS: Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment, while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P<0.05). Maternal and child health (45.4%), prompt attention (23.0%), and appropriate outpatient (20.5%) services attracted respondents to use PHC services. Poor education about when to seek care, poverty, perceived high cost of PHC services, lack of drugs and basic laboratory services, and a regular physician on site at the facility were identified as barriers to utilisation. CONCLUSION: We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services.

Efficacy of intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine in preventing anaemia in pregnancy among Nigerian women.

OBJECTIVE: To evaluate the efficacy of intermittent preventive treatment of malaria using sulphadoxine-pyrimethamine (SP) in the prevention of anaemia in women of low parity in a low socio-economic, malaria endemic setting. METHOD: The study design was an open randomized control trial comparing anaemia incidence among pregnant women on intermittent presumptive treatment of malaria with SP with those on chloroquine (CQ). A total of 352 primigravid and secondigravid women between 16 and 30 weeks gestation receiving antenatal care at the Primary Health Care Center, Enuwa in Ile-Ife, Osun State, Nigeria were serially recruited and randomly allocated into experimental and control groups of 176 each. The experimental group received SP (to a maximum of three doses depending on the gestational age at enrollment into the study) while the control group had treatment doses of CQ at recruitment and subsequently only if they had symptoms suggestive of malaria. The primary outcome measure was anaemia (haematocrit<30) at 34 weeks of gestation. RESULT: At recruitment and 34 weeks gestation, there was no statistically significant difference between the experimental and control group in terms of socio-demographic characteristics and past medical history. Thirty-three (22.6%) and 52 (37.1%) women in the study and control groups, respectively, had anaemia (protective efficacy 49.5%, p=0.01). With multivariate analysis, controlling for the possible confounding effects of education, parity, haemoglobin level at booking and malaria parasitaemia in peripheral blood, the difference in the incidence of anaemia in the two groups remained significant (p=0.01; odds ratio=0.5; 95% confidence interval=0.29-0.85). CONCLUSION: The IPT regime with sulphadoxine-pyrimethamine is an effective, practicable strategy to decrease risk of anaemia in women of low parity residing in areas endemic for malaria.

Utilization of Primary Health Care Facilities: Lessons from a Rural Community in Southwest Nigeria

Background: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. Method: A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data. Results: Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment; while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P0.05). Maternal and child health (45.4); prompt attention (23.0); and appropriate outpatient (20.5) services attracted respondents to use PHC services. Poor education about when to seek care; poverty; perceived high cost of PHC services; lack of drugs and basic laboratory services; and a regular physician on site at the facility were identified as barriers to utilisation. Conclusion: We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services

Nutritional status and intelligence quotient of primary schoolchildren in Akure community of Ondo State, Nigeria.

A cross-sectional survey was conducted among 402 children (10-15 years) randomly selected from twelve public and private primary schools in Akure community of Ondo State, Nigeria. Self-administered questionnaire was used to collect information on children's demographic features and parent's socio-economic characteristics. The subject's weight, height, height-for-age and weight-for-height z-score were measured and determined respectively. Raven Standard Progressive Matrices consisted of 60 questions was administered in a quiet classroom within 60 minutes to assess intelligence quotient (IQ) of the children. The means of measured parameters were: age, 11.5 +/- 0.08 years; weight, 33.3 +/- 0.35 kg; height, 1.4 +/- 0.0 m; height-for-age z-score, -0.003 +/- 0.04; weight-for-height z-score -7.2E-7 +/- 0.1 and IQ, 20.9 +/- 0.56 (34.8%). The occupations of the children's parents were civil service (43.3%), petty business (21.9%), farming (15.8%), vocational jobs (16.0%) and none (3.2%). The majority of the parents (31.8%) had secondary school education. Parents with no formal education, primary education, tertiary education and higher degrees accounted for 7.2%, 30.6%, 22.9% and 7.4%, respectively. Monthly incomes ranged between $38.5 and 230.8. Weight-for-height z-score of the children showed that 49.8% were normal, 40% mildly wasted, 9.7% moderately wasted and 0.5% severely wasted. Height-for-age z-score was 50% normal, 35.1% mildly stunted, 13.4% moderately stunted and 1.5% severely stunted. IQ scores were 5% superior 11.2% above average, 11.4% average, 8.2% below average and 64.2% intellectual deficit. The interrelationship between height-for-age, IQ and socio-demographic characteristics showed that there were insignificant differences between the age groups, gender and socio-economic status of the pupils. Conclusively, this study showed that the proportion of malnourished and intellectual deficit among the studied population were high. However, it is not clear whether the findings are specific to the studied population alone or applicable to other parts of Nigeria. Further studies are therefore needed to confirm these findings.

Men's knowledge of and attitude with respect to family planning in a suburban Nigerian community.

BACKGROUND: Men's Knowledge of and attitudes to family planning (FP) in suburban and rural Nigeria is still poor despite a global move to increase the involvement of men in reproductive health matters. A cross-sectional survey was conducted to determine men's knowledge of and attitude to family planning at Ganmo, a sub-urban community on the outskirts of Ilorin, Nigeria. METHOD: The study employed an interviewer administered semi-structured questionnaire to elicit information from 360 men in the households. Only males above the age of 15 years resident in the community were selected for interview A proportionate sampling procedure was employed in selecting the required numberof men from each of the 32 compounds that make up the community. RESULTS: Nearly all men (96.5%) were aware of family planning and a majority of them were aware of some common methods of family planning e.g. Oral Contraceptive Pills (OCPs) (72.5%), Injectables (69.2%), Condoms (86.6%) and Traditional methods (70.6%). Knowledge of other alternative female methods was low e.g. Norplant (17.5%), IUCD (26.3%), Diaphragm (39.8%), Vaginal cream (30.2%), Vaginal tablet (37.8%) and Vaginal sponge (16.8%), and Tubal Ligation (51.3%). Knowledge of male controlled FP methods like Withdrawal (49.6%), Rhythm or periodic abstinence (54.6%) and Vasectomy (28.6%) was also poor. The Respondents had low knowledge of common side effects of FP methods e.g. nausea (9.8%), vomiting (13.1%), abnormal menstruation (34.4%), pain (23.2%) and unwanted weight gain (17.0%); some 25.3%% of respondents had no knowledge of any side effects. The attitude of respondents to family planning was also relatively poor as only a moderate proportion of men supported the FP concept (52.7%) and the Nigerian Population Policy (54.8%) of "four children to a woman". Some 54.8% of respondents were in support of men discussing about FP with their spouses. The major reasons for non-approval of FP by men were the fear of side-effects (70.4%) and perception of FP as being against religion (52.1%). The predictors of poor FP attitude were not having formal education, practice of polygyny and to a lesser extent being a Muslim. CONCLUSION: The study concluded that, men at Ganmo have limited knowledge of, and poor attitude to FP An intensive drive at a community based adult reproductive health education was advocated among other recommendations.

Pulmonary functions of wheat flour mill workers and controls in Ibadan, Nigeria.

BACKGROUND: The impact of grain dust exposure on lung functions of grain handlers in Nigeria has remained largely undocumented. Lung functions of wheat flourmill workers and control subjects were assessed, and the prevalence of lung function abnormalities was compared among the occupational groups. METHODS: Study subjects consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flourmill factory and 121 matched external controls. A cross-sectional analytical design is utilized; data were collected using structured interviews, anthropometric measurements, spirometry, and area dust sampling. RESULTS: The flour-millers recorded significantly lower mean lung functions compared with control subjects (P < 0.05), for FEV(1) and FVC, when observed values were expressed as percentages of predicted normal values. Furthermore, 29% of flour-millers, compared with 15% of external controls and 10% of internal controls, presented with at least one abnormal test result of ventilatory function. CONCLUSIONS: The study concluded that wheat flour-mill workers in Nigeria are at an increased risk of developing abnormalities of lung functions compared with control subjects, and the dominant pattern of respiratory disease among them is airway obstruction.

Contraceptive awareness and use among sexually active breast feeding mothers in Ile-Ife, Nigeria.

OBJECTIVE: To assess the level of awareness and correlates of use of family planning services among sexually active breastfeeding mothers attending an infant welfare clinic. DESIGN: Cross-sectional descriptive design. SETTING: Infant welfare clinic of the urban comprehensive health centre, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. SUBJECTS: Mothers of breast feeding infants aged 8-11 months attending the infant welfare clinic. RESULTS: Awareness of family planning was quite high (95.5%) while current family planning use was quite low (13%). Although the proportion of women who planned for future use of family planning in the sample was high (64%), all current non-users (86.6%) met the criteria for unmet need for family planning. Parity and the number of living children were the only socio-demographic correlates of the respondents that significantly influenced family planning acceptance (P < 0.05). CONCLUSION: There is a high level of contraceptive awareness but low contraceptive use among breast feeding mothers in Nigeria, with a majority of non-users depending on the perceived contraceptive effects of breastfeeding.

Assessment of dietary knowledge, practices and control in type 2 diabetes in a Nigerian teaching hospital.

BACKGROUND: In spite of the importance of diet in the management of diabetes mellitus (DM), diabetics are often unaware of its place in ensuring good glycaemic control. Consequently, compliance and adherence with dietary advice remain poor among diabetics. The standard of practice of dietary therapy for DM among physicians is also low. The aim of this study therefore was to assess the dietary knowledge, practices and control of type 2 DM in Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. METHOD: All 33 type 2 diabetes patients that attended the hospital over a three month period were studied to assess knowledge of DM, dietary practice and control. Percentage perceived, correct and accurate knowledge as well as practice were used for comparative analysis. RESULTS: All 33 subjects had truncal obesity and needed to lose weight. This was moderately severe in 60% of subjects. About 52% received dietary advice. The latter had a significantly higher mean dietary knowledge score than those without dietary advice. Significantly higher mean knowledge scores seemed to be associated with better dietary practices and better glycaemic control. Overall, dietary practices improved significantly following diagnosis and counselling. A significant proportion of subjects increased their use of food with low glycaemic index (legumes 48.5%, cereals 90.9%) following diagnosis. CONCLUSION: The findings further emphasize the importance of structured dietary advice and dietary control in Type 2 diabetes. In settings where dieticians are scarce, physicians managing diabetic patients must be skilled in the dietary management of the condition and show commitment to it.

Prevalence of respiratory symptoms among wheat flour mill workers in Ibadan, Nigeria.

BACKGROUND: While investigations into occupational health problems of various groups of workers have been conducted in Nigeria, so far, very little attention has been paid to the health status of workers in the grain industry. The prevalence of respiratory symptoms among wheat flour mill workers and control groups in a medium size industrial setting in Nigeria was studied. METHODS: The study employed a cross-sectional analytical design. Data were collected using structured interviews, work-site observations, and physical examination. Respondents consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flour mill factory, and 121 matched external controls. RESULTS: Fifty-four percent of the flour-millers reported at least one respiratory symptom compared with 30% of the internal controls (P < 0.05) and 19% of the external controls (P < 0.001). Most symptoms were significantly more prevalent among the flour-millers compared with control subjects, and this trend was more evident amongst non-smokers than ex-smokers. CONCLUSIONS: The study concluded that wheat flour mill workers in Nigeria, like grain workers elsewhere, were at an increased risk of developing both pulmonary and non-pulmonary symptoms compared with control subjects. The result has implications for improved dust control measures in the grain industry in Nigeria.

The influence of sociodemographic factors on awareness, knowledge and attitude toward andropause among health professionals in Ile-Ife, Nigeria.

A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.

A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.

A comparative study was conducted to demonstrate the difference, if any, in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate. Sixty pregnant women with iron deficiency anaemia were assigned randomly to either group and treated for 6 weeks. The age and parity distributions with mean packed cell volumes (PCVs) and gestational age at onset of treatment in the two groups were comparable. Comparing the mean PCVs at week 2, week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs (P<0.001). Thirty-six per cent of patients in the iron dextran group compared to 3.3% in the oral iron group (P=0.004) had their anaemia corrected by the sixth week. No significant side effects accompanied the use of intramuscular iron dextran. It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate. Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients.

Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria.

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Perceptions of occupational hazards amongst office workers at the Obafemi Awolowo University, Ile-Ife.

BACKGROUND: A Survey of 350 office workers at the Obafemi Awolowo University (OAU), Ile-Ife was conducted to determine respondents' perceptions of the occurrence of work-related hazards and to characterize the pattern of hazards found prevalent in the population. METHODS: The survey employed a descriptive cross-sectional design. Data were generated through the use of a structured self-administered questionnaire and a non-participant observation checklist. RESULTS: Between 39% and 47% of the respondents expressed dissatisfaction with the level of control of the factors of the work environment (heat, noise, illumination, space, ergonomics). Two-thirds of respondents presented with work-related low backache, and this was more so for respondents who had spent at least 10 years on the job than those who had spent less. Of the 227 keyboard operators interviewed, 130 (57%) experienced symptoms suggestive of the overuse syndrome and 70% of the 82 computer operators interviewed had experienced varying degrees of visual fatigue since their appointments. CONCLUSION: The study concluded that the present design and layout of offices/workstations and access to equipment at the Obafemi Awolowo University, Ile-Ife is not optimal and tend to promote unnecessary physical efforts. This, in turn, might reduce efficiency and productivity. Suggestions for improvement were made as a way forward.

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife, Osun State, Nigeria.

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.

Modification and improvement of nutritive quality of cornpap "Ogi" with cowpea and groundnut milk.

The study aimed at improving the nutritive quality of cornpap, "Ogi", the most popular infant feed in Nigeria. Milk samples of cowpea, groundnut and soyabean and their complementations with cornpap were assessed chemically, organoleptically and anthropometrically. The protein contents of milk from cowpea, groundnut and soyabean were 1.18, 1.6, and 1.23% respectively. On separate complementation of the milk sources with cornpap, the low protein content of "ogi" was increased from 0.3% to 2.79% with cowpea; 3.0% with groundnut and 3.64% with soyabean. The fat content of the complementary feeds also increased remarkably. The anthropometric study revealed that there were significant differences P = 0.001 between the mean weight of children aged 13 to 18 (92 +/- 1.2) and 19 to 24 months (9.9 +/- 1.3) who were fed the three sources of milk with cornpap, and the control group of the same age groups (8.5 + 1.5; 9.3 + 1.11) who received nutrition education and no complementary feeds. Of the three sources of milk, groundnut milk was ranked as the most likeable, the easiest to prepare and the least costly by the nursing mothers. This study has shown that some of the deep rooted cultural food taboos that prohibit locally available and nutritious feeds to infants could be changed through practical food demonstrations.