Pilot study on multidrug resistant tuberculosis in Nigeria.

BACKGROUND: Drug resistant tuberculosis (TB) has lately emerged and it represents a serious public health problem. We set out to determine drug resistance among TB patients. METHODS: Using automated BACTEC cultures, multidrug resistant-tuberculosis (MDR-TB) was investigated in 117 diagnosed cases in Abuja, Nigeria. RESULTS: Ten (31%) of 32 culture-positive patients were resistant to at least one and four (13%) to all of the four drugs tested. No association between drug resistance and human immunodeficiency virus (HIV) infection was found. CONCLUSIONS: MDR-TB is present in Nigeria and larger studies are urgently required. TB clinical management and control efforts should be improved.

Has a fertility transition begun in West Africa?

PIP: Data from 4 World Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) in Senegal and Ghana are used to examine whether fertility decline has occurred and whether a decline is consistent with changes in proximate determinants of fertility. The 1980s were a period marked by initiation of fertility decline throughout southern Africa and in most of eastern Africa where war or civil strife were absent. In Senegal evidence suggests a slight decline in fertility by age 40 years from 6.5 to 5.7 children during 1975-77 and 1986. In Ghana separate analysis of each survey suggests a slight decline in fertility, however, between survey periods there appears to be a slight increase in fertility. Senegal experienced a period of stability in fertility rates in the 15 years prior to 1978 and a change in rates in only the 5 years prior to 1986. Fertility decline was apparent among older age groups. In Ghana the reported cohort-period fertility rates were fairly constant in the 5-30 years prior to 1979-80 and showed a slight decline in the 5 years just before the survey in 1979-80, particularly among older women. Prior to 1988 rates declined steadily over time, except for rates among women around 30 years old. Findings support a decline in Senegal appearing around 1980 and an earlier decline in Ghana that suggests a fertility rate of about 6.4 by the mid-1980s. Parity progression ratios suggest limitation of births among women in their 30s with 6 children. Gaps between urban and rural fertility are apparent. Declines occurred among urban women and better educated women. Mean age at marriage increased, particularly among middle school educated women. Educated Ghanian women married earlier than Senegalese educated women. Contraceptive use was low in both countries, and use of traditional methods was high. Proximate determinants predicted a decline of 1 child in Senegal and confirmed the importance of secondary education and the rise in marriage age, and predicted a decline of 0.44 child in Ghana. Sustained fertility decline was not supported, and evidence was equivocal about the impact of economic conditions on fertility decline.^ieng

Nuptiality patterns in two west African states.

PIP: Data on age at marriage for 4415 Senegal and 4488 Ghana women of reproductive age are used to analyze the differences in marriage patterns and the effects of residence, urban or rural, and educational status. Singulate mean age at marriage and the proportion ever married are identified. There were fewer Ghana women married before the age of 20 years, but more Ghana women married by ages 25-34 years. By age 35 and older all Senegal women reported themselves as ever married, and by 45 years and older all Ghana women reported the same. The proportion ever married is higher among the less educated of both countries, but differences are greater in Senegal. Rural women in Senegal at all ages have a higher proportion ever married. Urban Ghana women aged 20-34 years show a higher proportion ever married than urban Senegal women aged 20-34 years. Ghana women have a higher singulate mean age at marriage (20.2 years compared with 19.5 years for Senegal women), except for women with a primary education or an urban residence. Women with a secondary education married 5 years later in Senegal and 5.4 years later in Ghana. Senegal women with a primary education were more like secondarily educated women, while Ghana primary educated women were more similar to no education women. The findings support the notion that all African women do not marry young; there is variation by age in marriage patterns by residence and educational status. The policy implications are that secondary education should be made attractive to women in both countries and the concept of rural-urban development should be pursued vigorously.^ieng

Contributions of the proximate determinants to fertility change in Senegal.

The 1978 World Fertility Survey (WFS) and the 1986 Demographic and Health Survey (DHS) data are used to examine the relative contributions of three proximate determinants (nuptiality or marriage, contraception and post-partum infecundability) to fertility change in Senegal. The aim is to identify the important variables that is amenable for policy towards fertility reduction. Analysis shows that there are increases in the absolute measures of all three determinants. The magnitude of change is greatest in contraceptive use, moderate in marriage but least in duration of breast-feeding. However, the index of contraceptive use exerts the least impact on fertility reduction while that of post-partum infecundability makes the strongest impact on fertility. The impact of the nuptiality index on fertility change lies in-between contraception and breast-feeding.