Roles and responsibilities in newborn care in four African sites.

OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Parental HIV serodiscordance: implications for the care of the HIV seropositive child in a resource-poor setting.

This prospective study compared the care and support provided for symptomatic HIV seropositive children of HIV serodiscordant parents (only the mother of the child is HIV infected) with children of seroconcordant parents (both parents are HIV infected) during admission and after discharge from a tertiary health institution in southwestern Nigeria. Information was collected from parents of eligible children by semi-structured questionnaires and observation of the children and their parents while on admission and at home. Of the 51 couples who met the study criteria, there were 27 seroconcordant couples and 24 serodiscordant couples. The children from serodiscordant couples were more frequently discharged against medical advice, abandoned, lost to follow-up, cared for by their mothers alone and were not up-to-date with their immunization schedule when compared with children from seroconcordant parents. These were statistically significant (p < 0.05). There was a higher mortality among these children and their mothers (p < 0.05). Paternal reasons for not providing adequate care for the children from serodiscordant parents included fear of being infected, doubt of child's paternity and waste of family resources on a 'child who is dying'. None of the children from both groups received support from governmental and non-governmental agencies. It is concluded that the care of sick HIV seropositive children of serodiscordant parents poses special challenges for clinicians working in Nigeria where there is no social support system.

Who's at risk? Men's STD experience and condom use in southwest Nigeria.

Many STD/HIV-prevention programs worldwide assume that individuals' risk of acquiring sexually transmitted diseases, including HIV infection, is highest in the context of commercial sex. To address this assumption, research conducted in urban Southwest Nigeria combined qualitative and quantitative methods to examine men's sexual behavior, condom use, and STD experience in different types of sexual relationships (marital, casual, and commercial). Logistic regression analysis of survey data indicates that number of sexual partners and sex with sex workers are positively and significantly related to STD experience. Follow-up in-depth interviews with clients of sex workers indicate, however, that these men are actually more likely to report having contracted an STD from a casual sex partner than from a sex worker. Men are most uncertain about their vulnerability to STDs with casual partners. Men's condom use is highest in commercial sex, inconsistent in casual relationships, and lowest in marriage. STD/HIV-prevention programs need to address the range of sexual relationships and the meanings and behaviors associated with them.

Acceptability of prenatal diagnosis of sickle cell anaemia by a sample of the Nigerian population.

The acceptability of prenatal diagnosis (PND) as a means of controlling sickle cell anaemia (SCA) in Nigeria was examined using a semi-structured questionnaire. The aim of the study was to examine the attitudes of well-informed, educated Nigerians to the use of PND and abortion of confirmed HbSS pregnancies in the control of SCA. There were 433 respondents comprising 204 males and 210 females (gender was not recorded for 19 respondents). They were aged 15-50 (31 +/- 18) years. Forty percent had HbAA, 15% HbAS, 1.6% HbAC, 2% HbSS, and 0.2% HbSC; 153 (35%) had no knowledge of their haemoglobin electrophoretic patterns "genotypes". The majority of the respondents (69.5%) appreciated the role of both parents in the transmission of the disease. Only 45 (18%) of the respondents heard of SCA for the first time through sickle cell counsellors, 23% through newsmedia, 29% through friends and relations, 21% obtained the information through health workers, while 5% had never heard of sickle cell disease before the interview. As many as 192 (44%) of the respondents were aware that SCA could be diagnosed in pregnancy; 45% would opt for termination of the affected pregnancies. Avoidance of the problems associated with managing SCA children was the most important reason for approving pregnancy termination, whereas 73% of those rejecting pregnancy termination did so for religious and moral reasons. Seventy-eight percent of those interviewed would want PND started in Nigeria. The two approved control measure for SCA by most of the respondents were genetic counselling and PND; both should, therefore, be considered in implementing control measures for SCA in this country.

Acceptability of prenatal diagnosis of sickle cell anaemia (SCA) by female patients and parents of SCA patients in Nigeria.

The acceptability of prenatal diagnosis (PND) of sickle cell anaemia (SCA) as a means of controlling sickle cell disorder in Nigeria was examined using a structured questionnaire. The respondents were comprised of 92 adult female patients with SCA, aged 15-20 (23 +/- 6) years; 53 HbAS mothers, aged 20-61 (37 +/- 11) years and 48 HbAS fathers, aged 33-65 (46 +/- 8) years. More than 85% of the respondents would like PND to be offered in Nigeria and 92% of the HbAS mothers as well as 86% of the fathers would like to have the investigation or allow their wives to go through the procedure, respectively. Only 35% of the patients as compared to 63% of the mothers and 51% of the fathers would opt for termination of an affected pregnancy. Fear of the complications of abortion and religious convictions were the two most frequently cited reasons for opposing pregnancy termination. The high percentage of parents who would opt for termination of an affected pregnancy was associated with the societal emphasis on perfection and on previous experience in management of SCA patients. It is interesting that most of the respondents still favoured effective genetic counselling as the best means of controlling SCA.

Female involvement in intervention programmes: the EPI experience in Saradidi, Kenya.

The paper addressed itself to the issue of community participation in intervention programme and that if the beneficiaries are women, then the category of people to be involved in the programme should be women. In buttressing this, the nursing superintendent of an Expanded Programme on Immunization (EPI) programme in Saradidi, rural Kenya together with 184 mothers attending the clinic were interviewed. The majority (89%) were of the view that in Maternal and Child health (MCH) programmes, it is only ideal that women should be involved because this tend to blend with their traditional roles of child bearing and nurturing and moreover, in such matters, women would tend to relate better to other women rather than men; women would again tend to show greater willingness and commitment to help other women. This was even butressed by the fact that the majority of the mothers interviewed were prepared to participate in such programmes geared towards helping other women. The women explained that contrary to the belief that rural women are so preoccupied with survival that they hardly have time for relaxation, they do have the time to visit friends, especially in the evenings, participate in church activities and knit. A case was thus made for greater female involvement in intervention programmes where the target population is women. If maximum success is to be achieved, there is need for greater female involvement in intervention programmes geared towards improving the lot of women and children.

PIP: A survey of nursing superintendents and 184 mothers attending a rural Expanded Program on Immunization (EPI) program in Saradidi, Kenya, confirmed the hypothesis that female involvement in program planning and implementation is crucial to the success of projects targeted at women and children. 136 (75%) mothers considered the EPI successful; 89% felt that women should participate fully in programs affecting rural women and 61% of these women indicated they were personally willing to become so involved. 78% had brought friends to the EPI project and 63% had informed friends about the service. Female friends and relatives were by far the primary source of knowledge (113 mothers) about the EPI, followed by female neighbors (36 mothers); community health workers were cited by only 30 mothers. Most mothers were of the opinion that women are more suitable than men for maternal-child health outreach and delivery because of their personal familiarity with the issues, ability to relate to other women about sensitive matters, and family role as nurturer and health provider. Nursing staff echoed these views. The success of the Saradidi rural health program (5427 child visits, 3560 immunizations, and 972 maternal health visits in 1991) may, in large part, reflect the fact that six of the seven community nurses are female.

Conception of AIDS and its prevention among students in a Nigerian university.

This study examines AIDS awareness, knowledge of transmission and prevention among students, who not only belong to the sexually active age bracket, but who are the future leaders of the nation. The student population was stratified into those in the health and non-health disciplines and an accidental sampling technique was used to obtain the respondents from the 2 strata. 60 students were interviewed from each stratum. A majority of the medical students, 58.3% as against 48.3% of the non-medical students, perceived AIDS as a dreadful disease that is sexually transmitted. Next among the non-medical students were those who felt that AIDS was God's punishment for man's sexual excesses (20.0%), while only 3.3% of the medical students gave that response. Of importance in the study is that none of the students attributed AIDS to mystical forces, an issue which could be linked to their educational exposure. Some students associated the disease with affluence, an issue that had been documented by other researchers. Another point worthy of note in the study is the fact that even though 89% and 61.2% of the medical and non-medical students, respectively, believed that AIDS can be prevented by the use of condoms, most of them were not favourably disposed towards the use of condoms. This study thus reveals an area that needs attention, ie that apart from emphasising the level of awareness, there should be a focus on how to effect behavioural change among a knowledgeable population.

PIP: HIV and AIDS are rapidly invading parts of Africa. To prevent the continued spread of the pandemic, sex and health education interventions aim to increase awareness about AIDS and HIV transmission, and condom use is promoted as a specific preventive tool. Increased awareness, however, does not necessarily promote and lead to individual behavioral change. This study explores AIDS awareness, HIV transmission knowledge, and prevention among 2 samples of university students in the continent's most populated country, Nigeria. 2 sample groups of 60 each were identified in 1989, via accidental sampling technique. 1 group was comprised of medical students, while the other was comprised of students studying non health disciplines. Knowledge level and perceptions generally differed between groups. 58.3% an 48.3% of medical students and non medical students, respectively considered AIDS to be a dreadful sexually transmitted disease. 3.3% and 20.0% of medical students and nonmedical students held AIDS to be God's punishment for man's sexual excesses. While 89% and 61.2% of medical students and nonmedical students, respectively, believed that condoms could prevent AIDS, few favored their use. None of the students attributed AIDS to mystical forces, while some associated it with affluence. These results demonstrate the failure of knowledge alone to effect behavioral change away from risky sexual activities. Instead of trying to further increase knowledge levels, and in spite of the sociocultural factors that work against effective disease control in Nigeria, greater effort must be given to directly bringing about behavioral change.

Western trained nurses' assessment of the different categories of traditional healers in southwestern Nigeria.

Different categories of traditional healers were assessed by randomly selected Western trained nurses. Traditional birth attendants were rated as the most effective type of healers, followed by traditional psychiatrists and herbalists respectively. The least rated were the diviners, traditional bone setters and pharmacists. The majority of the nurses believe that traditional healers are effective, but the degree of effectiveness varies with the specialization of the healers. A large percentage of the nurses (44%) favoured formal collaboration between practitioners of the two medical systems. All the nurses who perceived some healers as effective also stated that they would be prepared to work with them, although as their superiors. Of particular importance is the issue that all the categories of traditional healers should not be classed together--there are different types and each type has its own peculiarities and usefulness.

Food taboos in maternal and child health: the views of traditional healers in Ile-Ife, Nigeria.

This paper reports the interviews with 82 randomly selected healers in Ile-Ife about food taboos in relation to maternal and child health. The healers were asked to list the childhood ailments they treat most often and the food proscriptions and prescriptions associated with these ailments. Of particular interest in the study was the fact that these food proscriptions and prescriptions form an integral part of traditional medical procedures in that relapses or slow rate of recovery are sometimes attributed to a break of these food norms. Moreover, these proscriptions and prescriptions reflect: (i) the healers' concept of the various childhood diseases and (ii) the healers' belief in the respect for the traditional Yoruba gods in health matters. It was further noted that although these taboos reinforce the beliefs in traditional medicine, their relevance from the point of view of the health of the clientele needs further investigation.

Concepts and management of deafness in the Yoruba medical system: a case study of traditional healers in Ile-Ife, Nigeria.

This paper examines the concept and management of deafness among 98 randomly selected healers in Ile-Ife. We are concerned with deafness because in an earlier study mothers of deaf children reported that they had consulted these practitioners. All of the healers distinguished congenital and non-congenital deafness, and in their efforts to cure patients they were guided by experience and specialist knowledge. A higher proportion of the herbalists associated congenital deafness with natural causes than did the other type of healers. The babalawos and indigenous faith healers who mentioned a natural cause of congenital deafness believed that the primary causative agents were supernatural. Half of the indigenous faith healers and more than half of the babalawos we interviewed attributed non-congenital deafness to malevolent forces, while only 12.5% of the herbalists made this attribution. Treatment procedures and preventive techniques were based on conceptions of causality. While the majority of the herbalists prescribed a herbal ear drop, a majority of the babalawos and the indigenous faith healers prescribed sacrifices to appease the aggrieved parties. Some interesting points that emanated from the study include the healers' explanation that a person's essence is transmitted to his personal effects, which are used with incantation to inflict the deaf person. Closely associated with this is the healers' warning that patients need to maintain good-neighbourliness to avoid further harm. The paper further highlights the adherence to pregnancy taboos to avoid congenital deafness.

Child-rearing practices among nursing mothers in Ile-Ife, Nigeria.

This study attempts to highlight the relationship between the educational status of mothers in Ile-Ife and their child-rearing practices. It was observed that the educated mothers in good jobs spent less time at home with the children than the illiterates who have their children with them at the farms and in the market places. Thus, a higher proportion of the educated mothers admitted to using more bottle feeding than breast feeding, and forced hand-feeding which was practised by all the illiterate women interviewed. Only one educated woman still practices female circumcision. Of interest in the study is the fact that the children of the different categories of women are exposed to different types of health hazards; while the children of the educated suffer neglect and are deprived of the advantages of breast feeding, the children of the illiterate suffer from undue exposure to unhygienic conditions in the farms and market places and from the implications of forced hand-feeding and female circumcision.

Influence of Yoruba beliefs about abnormality on the socialization of deaf children: a research note.

The study examines patterns of communication modes of guidance and discipline and affectional bonds between 176 Yoruba hearing mothers and their deaf children. Results relating to communication support earlier findings about the frustrations inherent in such endeavour. Contrary to other published reports, the Yoruba mothers studied perceived expressive linguistic abilities of deaf children more negatively than receptive abilities. Communication difficulties affected mothers' guidance and discipline, particularly since the culturally preferred modes of discipline rely very heavily on children's age-related language competence. Mothers' verbal claims of affectional bonds were not supported by evidence from other sources close to and including the deaf children.

Cultural influences and patient behaviour: some experiences in the paediatric ward of a Nigerian hospital.

In this paper an attempt is made to analyse the incompatibilities between the professional and the layman's ideology in terms of models of illness and their treatment. From an interview with paediatricians at the Ile-Ife Teaching Hospitals Complex in Nigeria, we found out that the conflicting encounters experienced could be divided into 2 groups: opposition as a result of religious ideology, held especially from the Jehovah's Witnesses Sect; and opposition as a result of some child-rearing practices that were being strictly upheld by the mothers of the patients. From the cases cited, we noted that the adherence to some religious ideology was so strong that some patients were willing to withdraw from hospital treatment when it conflicted with a tenet of their religion. Of particular relevance here, was the fact that a religious leader of this sect agreed to a transfusion after he had been assured of secrecy. In this particular case, it was obvious that he feared 'losing face' among his followers. We felt that a more flexible relationship between the doctor and patient would reduce the tension; hence a case was made for a transcultural perspective based on an adequate knowledge of behavioural sciences.

Mothers' concept of measles and attitudes towards the measles vaccine in Ile-Ife, Nigeria.

The attitude of Nigerian mothers, mainly Yoruba, towards measles vaccine and other aspects of prevention are influenced by different perceptions of the cause of measles. There is a significant correlation between the literacy of mothers and their belief in the efficacy of measles vaccine but not between their ages and belief. The mothers' perception of measles is a function of their socioeconomic characteristics, with the lower socioeconomic group tending more to define measles within the supernatural context. The findings indicate the necessity for health education to be based on local culture when promoting vaccination.