Socio-economic burden of TB and its impact on child contacts in The Gambia.

OBJECTIVE: To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS: This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS: While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001). CONCLUSION: Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.

OBJECTIF: Déterminer l'impact social de la TB de l'adulte sur les contacts familiaux de l'enfant vivant dans la région du Grand Banjul, en Gambie. MÉTHODES: Il s'agissait d'une étude de cohorte observationnelle prospective auprès d'adultes (≥18 ans) commençant un traitement contre la TB pulmonaire sensible aux médicaments entre juin 2019 et juillet 2021 et qui ont déclaré avoir au moins un contact domestique avec un enfant. Nous avons recueilli des données auprès de 51 adultes et 180 enfants contacts au début du traitement contre la TB, puis à nouveau après 6 mois de traitement. Les participants ont été interrogés sur les dépenses liées aux frais de scolarité, aux soins de santé, aux célébrations et à la sécurité alimentaire des enfants contacts. RÉSULTATS: Alors que la fréquentation scolaire des enfants contacts n'a pratiquement pas été affectée, on a constaté une baisse significative des résultats scolaires 6 mois plus tard (P < 0,001). Par ailleurs, les enfants contacts ont été confrontés à une insécurité alimentaire importante en termes de quantité et de variété de nourriture disponible, avec une augmentation d'au moins quatre fois après le traitement de la TB (P < 0,001). CONCLUSION: Les enfants contacts sont confrontés à une baisse potentielle de leurs résultats scolaires et à un risque d'insécurité alimentaire. Alors qu'une multitude de travaux sont entrepris pour réduire les coûts des soins pour les patients atteints de TB, il est nécessaire de mettre davantage l'accent sur la prospérité éducative et sociale des enfants contacts, étant donné que les adultes atteints de TB ont des implications socio-économiques pour l'ensemble du ménage.

Performance of spirometry assessment at TB diagnosis.

BACKGROUND: Spirometry is considered relevant for the diagnosis and monitoring of post-TB lung disease. However, spirometry is rarely done in newly diagnosed TB patients.METHODS: Newly diagnosed, microbiologically confirmed TB patients were recruited for the study. Spirometry was performed within 21 days of TB treatment initiation according to American Thoracic Society/European Respiratory Society guidelines. Spirometry analysis was done using Global Lung Initiative equations for standardisation.RESULTS: Of 1,430 eligible study participants, 24.7% (353/1,430) had no spirometry performed mainly due to contraindications and 23.0% (329/1,430) had invalid results; 52.3% (748/1,430) of participants had a valid result, 82.8% (619/748) of whom had abnormal spirometry. Of participants with abnormal spirometry, 70% (436/619) had low forced vital capacity (FVC), 6.1% (38/619) had a low ratio of forced expiratory volume in 1 sec (FEV1) to FVC, and 19.1% (118/619) had low FVC, as well as low FEV1/FVC ratio. Among those with abnormal spirometry, 26.3% (163/619) had severe lung impairment.CONCLUSIONS: In this population, a high proportion of not performed and invalid spirometry assessments was observed; this was addressed by removing tachycardia as a (relative) contraindication from the study guidance and retraining. The high proportion of patients with severe pulmonary impairment at the time of TB diagnosis suggests a huge morbidity burden and calls for further longitudinal studies on the relevance of spirometry in predicting chronic lung impairment after TB.

Perspectives of TB survivors and policymakers on post-TB disability.

BACKGROUND: An international multistakeholder participatory workshop was hosted in the Gambia, West Africa, in November 2021. OBJECTIVES: To explore the experiences, challenges and recommendations of workshop participants on health and wellbeing after TB treatment. METHODS: An exploratory, descriptive, qualitative approach was used for data collection through facilitator-guided group discussions. Workshop participants included adolescent and adult TB survivors, and representatives of TB advocacy groups and the policy sector. Discussions were audio-recorded and transcribed verbatim, and the data were analysed using a deductive thematic approach. RESULTS: Overall, 38 participants (22 women) from six West African countries participated in the workshop, comprising 33 TB survivors and advocacy group representatives and 5 participants from the policy sector. Although some TB survivors noted improved ability to carry out physical activities, others continued to experience detrimental effects on their family life, social interactions, physical health and ongoing stigma. Policymakers emphasised the lack of data and clear guidelines on post-TB disability. CONCLUSIONS: Some TB survivors continue to suffer detrimental effects of the illness even after treatment completion. However, available data on post-TB disability is inadequate to support policy adoption. Therefore, there is an urgent need for increased advocacy, awareness and research to bridge knowledge gaps.

CONTEXTE: Un atelier participatif international multipartite a été organisé en Gambie, Afrique de l'Ouest, en novembre 2021. OBJECTIFS: Analyser les expériences, les défis et les recommandations des participants à l'atelier en matière de santé et de bien-être après un traitement antituberculeux. MÉTHODES: Une approche exploratoire, descriptive et qualitative a été utilisée pour le recueil des données par le biais de discussions de groupe encadrées par un animateur. Les participants à l'atelier étaient des adolescents et des adultes ayant survécu à une TB, ainsi que des représentants de groupes de plaidoyer de la TB et du secteur politique. Les discussions ont été enregistrées sur support audio et transcrites textuellement, et les données ont été analysées en utilisant une approche thématique déductive. RÉSULTATS: Au total, 38 participants (22 femmes) de six pays d'Afrique de l'Ouest ont participé à l'atelier, dont 33 représentants de groupes de plaidoyer ayant eux-mêmes survécu à une TB et 5 participants issus du secteur politique. Bien que certaines personnes ayant survécu à une TB aient constaté une amélioration de leur capacité à mener des activités physiques, d'autres ont continué à subir les effets néfastes sur leur vie familiale, leurs interactions sociales, leur santé physique et la stigmatisation permanente. Les responsables politiques ont souligné le manque de données et de directives claires sur le handicap post-TB. CONCLUSIONS: Certaines personnes ayant survécu à une TB continuent de subir les effets néfastes de la maladie, et ce même après la fin du traitement. Cependant, les données disponibles sur le handicap post-TB sont insuffisantes pour soutenir l'adoption de politiques. Il est donc urgent de renforcer le plaidoyer, la sensibilisation et la recherche pour combler les lacunes en matière de connaissances.

FOETUS-IN-FETU, A PAEDIATRIC RARITY IN AN INFANT AT IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA, NIGERIA.

Introduction: Fetus in fetu is a paediatric rarity. It involves the presence of a mass resembling a fetus inside the body of a child or an adult. It is described as a twin growing inside the body of the other. It can be located in different parts of the body but commonly the retroperitoneum. It is usually benign. Case presentation: The patient was a 4 month old male infant who presented to the hospital with complaints of abdominal distention. The distention was noticed two months prior to presenting to our hospital. The distension was generalized and has been progressively increasing until presentation (1). There was no associated abdominal pain and no other abdominal symptoms. Conclusion: Treatment is by complete excision for histological examination.

The household economic burden of drug-susceptible TB diagnosis and treatment in The Gambia.

OBJECTIVE: To determine the costs and catastrophic costs incurred by drug-susceptible (DS) pulmonary TB patients in The Gambia.METHODS: This observational study collected cost and socio-economic data using a micro-costing approach from the household perspective from 244 adult DS-TB patients with pulmonary TB receiving treatment through the national treatment programme in The Gambia. We used data collected between 2017 and 2020 using an adapted version of the WHO generic patient cost survey instrument to estimate costs and the proportion of patients experiencing catastrophic costs (≥20% of household income).RESULTS: The mean total cost of the TB episode was $104.11 (2018 USD). Direct costs were highest before treatment ($22.93). Indirect costs accounted for over 50% of the entire episode costs. Using different income estimation approaches and catastrophic cost thresholds, 0.4-75% of participants encountered catastrophic costs, showing the variability of results given the different assumptions we utilised.CONCLUSIONS: We show that despite the benefits of free TB care and treatment, DS-TB patients still incur substantial direct and indirect costs, and cases of impoverishing expenditure varied vastly depending on the income estimation approaches used.

The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert® MTB/Rif era.

In some low and middle-income countries, 10-20% of patients presenting with a persistent cough have tuberculosis (TB). Once TB is excluded, health service provision for alternative diagnoses is limited. We prospectively studied patients with two Xpert-negative sputum results presenting to a TB clinic in The Gambia. Of 239 patients, 108 did not have TB; 65/102 (6 were lost to follow-up) had alternative diagnoses, 24.6% of which were non-respiratory; 37/102 had no diagnosis, 27.0% of whom were HIV-1-positive; 37.8% had a history of TB and 24.3% smoked. We highlight the need for general health service integration with TB platforms and exploration of non-TB patients with chronic respiratory symptoms.

Dans certains pays à revenu faible et moyen, 10­20% des patients se présentant avec une toux persistante ont une tuberculose (TB). Une fois que la TB est exclue, la prise en charge des diagnostics alternatifs est limitée. Nous avons étudié de façon prospective les patients ayant eu deux tests de crachats négatifs à l'Xpert® MTB/RIF se présentant à un dispensaire TB en Gambie. Des 239 patients, 108 n'avaient pas de TB ; 65/102 (6 perdus de vue) ont eu un autre diagnostic (non respiratoire dans 24,6% des cas) ; 37/102 n'ont pas eu de diagnostic, dont 27,0% ont été positifs à l'infection par le virus de l'immunodéficience humaine 1, 37,8% avaient des antécédents de TB et 24,3% fumaient. Nous mettons l'accent sur le besoin d'intégration générale des services de santé avec des plateformes TB et une exploration des patients non TB ayant des symptômes respiratoires chroniques.

En algunos países de recursos bajos y medianos, 10­20% de pacientes que acuden a la consulta con tos persistente presentan tuberculosis (TB). Una vez que se ha excluido el diagnóstico de TB, la provisión de servicios de salud para otras afecciones es escasa. En el presente estudio se analizaron de manera prospectiva los pacientes con dos resultados negativos de la prueba Xpert® MTB/RIF en muestras de esputo, que acudían a un consultorio de TB en Gambia. Ciento ocho de los 239 pacientes no presentaban TB. En 65 de 102 pacientes (seis perdidos durante el seguimiento) se definió un diagnóstico diferente de TB y en 24,6% de los casos se trataba de una afección no respiratoria. En 37 de los 102 pacientes no se formuló un diagnóstico y de estos el 27,0% eran positivos frente al virus de la inmunodeficiencia humana, 37,8% tenían antecedente de TB y 24,3% eran fumadores. Los resultados del estudio destacan la necesidad de integrar los servicios generales de salud con las plataformas de atención de la TB y de explorar a los pacientes con síntomas respiratorios crónicos que no presentan TB.

Achieving accountability through maternal death reviews in Nigeria: a process analysis.

Maternal death reviews (MDRs) are part of the drive to increase accountability for maternal deaths and reduce their occurrence by identifying barriers to effective, quality care. However, conducting MDRs well is difficult; staff commitment and establishing a blame free environment are key challenges. By examining the communication strategies used in MDRs this study sought to understand how MDR members implement policy imperatives (e.g. 'no blame, no name') and manage the inevitable sensitivities of discussing a client's death in a multidisciplinary team. We observed and recorded four MDRs in Nigerian teaching hospitals and used conversation and discourse analysis to identify patterns in verbal and non-verbal interactions. MDRs were conducted in a structured way and had multidisciplinary representation. We grouped discursive strategies observed into three overlapping clusters: 'doing' no-name no-blame; fostering participation; and managing personal accountability. Within these clusters, explicit reminders, gentle enquiries and instilling a sense of togetherness were used in doing no-name, no-blame. Strategies such as questioning and invoking protocol were only partially successful in fostering participation. Regarding managing accountability, forms of communication which limit personal responsibility ('pass the buck') and resist passing the buck were observed. Detailed, lengthy eye witness accounts of dramatic events appeared to reduce staff's personal accountability. We conclude that interactional processes affect the meaningfulness of MDRs. In-depth, critical analysis depends on resisting 'passing the buck' by practitioners and chairs especially, who are also key to fostering participation and extracting value from multidisciplinary representation. Our innovative methods provide detailed insights into MDRs as an interactional process, which can inform design of training aimed at enhancing MDR members' skills. However, given the multitude of systemic challenges we should also adjust our expectations of MDRs and the individual practitioners tasked to perform them in the name of enhancing accountability for maternal death reduction.

A smartphone dongle for diagnosis of infectious diseases at the point of care.

This work demonstrates that a full laboratory-quality immunoassay can be run on a smartphone accessory. This low-cost dongle replicates all mechanical, optical, and electronic functions of a laboratory-based enzyme-linked immunosorbent assay (ELISA) without requiring any stored energy; all necessary power is drawn from a smartphone. Rwandan health care workers used the dongle to test whole blood obtained via fingerprick from 96 patients enrolling into care at prevention of mother-to-child transmission clinics or voluntary counseling and testing centers. The dongle performed a triplexed immunoassay not currently available in a single test format: HIV antibody, treponemal-specific antibody for syphilis, and nontreponemal antibody for active syphilis infection. In a blinded experiment, health care workers obtained diagnostic results in 15 min from our triplex test that rivaled the gold standard of laboratory-based HIV ELISA and rapid plasma reagin (a screening test for syphilis), with sensitivity of 92 to 100% and specificity of 79 to 100%, consistent with needs of current clinical algorithms. Patient preference for the dongle was 97% compared to laboratory-based tests, with most pointing to the convenience of obtaining quick results with a single fingerprick. This work suggests that coupling microfluidics with recent advances in consumer electronics can make certain laboratory-based diagnostics accessible to almost any population with access to smartphones.

A new TB vaccine, MVA85A, induces durable antigen-specific responses 14 months after vaccination in African infants.

This study aimed to evaluate the durability of the immunogenicity of MVA85A beyond infancy. Participants in an immunogenicity study of MVA85A administered at age of 4 months had additional evaluation 14 months after initial vaccination for IFN-γ ELISPOT responses to Ag85A peptide and ESAT6/CFP-10 and tuberculin skin test (TST). 112 children participated in this study. The anthropometry, biochemical and haematological safety profile were similar between the MVA85A recipients and controls. MVA85A recipients still had significantly higher immune responses to Ag85A compared to the controls. The majority of these children had negative responses to the TST as well as the ESAT6/CFP-10 antigens. In summary, MVA85A-vaccinated children had a persistently higher Ag85A immune response 14 months following vaccination than controls. All the children had negligible evidence of latent infection with M. tuberculosis (Mtb), suggesting that deploying a prophylactic vaccine against Mtb infection at this age could still be effective in this setting.

Antibody and T-cell responses during acute and convalescent stages of invasive pneumococcal disease.

OBJECTIVE: To understand the pattern of immune responses to pneumococcal proteins during invasive disease as a guide to their development as vaccine candidates. METHODS: The antibody concentration and avidity, as well as frequency of interferon-gamma (IFN-γ)-, interleukin-10 (IL-10)-, and tumor necrosis factor-alpha (TNF-α)-containing CD4+ T-lymphocytes in response to pneumolysin, pneumococcal surface protein A (PspA), and choline-binding protein A (CbpA), during and after invasive pneumococcal disease (IPD) in 20 children were compared to those of 20 healthy matched controls. RESULTS: During the acute phase of IPD, the concentrations of antibodies against these three pneumococcal proteins were lower, whereas the frequencies of IL-10- and TNF-α-producing CD4+ T-cells were higher, compared to values obtained during convalescence and in healthy controls (p < 0.01). In addition, the concentrations of antibodies against the capsular polysaccharides for the serotypes isolated from these patients, were all below the detection level of the assay during both the acute and convalescent phases of IPD. CONCLUSION: These data indicate that the recognition of these antigens by the immune system occurs in variable proportions according to the stage of infection, implying the important role of these in the pathogenesis of IPD, and support their usefulness in vaccine development.

Antidiarrheal evaluation of the ethanol extract of Nauclea latifolia root bark.

Nauclea latifolia (Rubiaceae) is a medicinal plant used in Nigeria folk medicine for the treatment of gastrointestinal disorders. The root bark of the plant was extracted with 70% ethanol and the extract screened for antidiarrheal activity by investigating castor oil-induced diarrhea and small intestinal motility in mice. The effects of the extract on isolated rat ileum were also investigated. The extract (125, 250 and 500 mg/kg) caused a significant decrease in the frequency of diarrhea and conferred protection following castor oil administration (P < 0.05). It also significantly (P < 0.0001) inhibited small intestinal motility in mice at the same doses. Its activity was dose-dependent and when compared to atropine, its antidiarrheal effects at 500 mg/kg were 179% and 165% respectively, in castor oil-induced diarrhea and small intestinal motility experiments. Extract effects on rat ileum revealed a significant (P < 0.0001) inhibition of acetylcholine-induced contractions at 0.2 and 2 mg/mL final bath concentrations used. These findings confirm the antidiarrheal activity of the root bark extract of N. latifolia.

Antidiarrheal evaluation of the ethanol extract of Musanga cecropioides stem bark.

The ethnomedicinal uses of Musanga cecropioides R. Apud Tedlie (Cecropiaceae) as a hypotensive agent have been scientifically investigated and reported. This work examines its effect on various models of diarrhea based on the ethnomedicinal use of the plant for this indication. The stem bark of the plant, used locally by soaking in gin (alcoholic), was treated with absolute ethanol and the extract screened for antidiarrheal activity using the castor oil-induced diarrhea and small intestinal motility models in mice. Its effects on the isolated rat ileum were also investigated. In the castor oil-induced diarrhea, the extract at 100, 200, and 400 mg/kg significantly (P < 0.05 at all doses) showed dose-related antidiarrheal effects as indicated by reduction in the number and weight of fecal material produced. The extract at all doses used also significantly (P < 0.05, P < 0.0001 and P < 0.0001 at 100, 200, and 400 mg/kg doses, respectively) decreased the intestinal motility of the treated mice as compared to controls and inhibited acetylcholine-induced contractions (P < 0.0001). In the isolated rat ileum the extract at 5 and 10 mg/mL, remarkably inhibited acetylcholine induced contractions, indicating a probable antimuscarinic effect of the extract. The results obtained confirmed that the stem bark of M cecropioides has antidiarrheal activity as used in folkloric medicine.

Assessment of delays in receiving delivery care at a tertiary healthcare delivery centre in Nigeria.

This study reviewed the causes of delays when patients were admitted with obstetric emergencies in Ife-Ife, Nigeria.

A randomized trial of pain relief in termination of pregnancy in South Africa.

The aim of this prospective trial was to evaluate and compare paracervical block with diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii) diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL). There was a significant difference in pain scores during the procedure between groups (i) and (ii) (P < 0.001), and between groups (i) and (iii) (P < 0.001) in pain scores during the procedure. There was no difference in pain score between groups (ii) and (iii) (P = 0.144). Post procedure analysis of pain score also showed significant difference between group (i) on one hand, and groups (ii) and (iii) (P < 0.001), but no significant difference between groups (ii) and (iii)(P = 0.029). The local anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac and paracervical block provides better pain relief during and after the MVA.

The under utilization of honey in a deprived environment.

The study investigated the utilization of honey in the treatment and prevention of illness amongst 400 respondents in Oranfe Community, Ile-Ife, Osun State Nigeria. Data were collected by employing a structured and pretested open ended questionnaire. The data indicated that 21%, 17% and less than 5% of the respondents had used honey for wounds, respiratory tract infections and gastroenteritis respectively. Neither educational nor professional status had any significant influence on the usage of honey in the treatment and prevention of common illness (p > 0.05). The vast majority (55%) preferred refined sugar to honey. The study has some policy implications. The first is the need for an intensive nutrition education programme that will disseminate the health benefits of honey as a source of energy, essential nutrients and its antioxidant properties. The second is the need to promote its usage in clinical trials because of its antibacterial properties.

Assessment of knowledge and practice of nutritional and life style risk factors associated with cancer among hospital workers at two university teaching hospitals in Osun State, Nigeria.

The objectives of this study were to assess both the predisposing and precipitating risk factors in the aetiology of any form of cancer among hospital workers at two teaching Hospitals in Osun State, Nigeria. Pre-tested and modified questionnaires were administered to 250 respondents. One hundred and seventy questionnaires were duly filled and completed. Less than 9% of the respondents consumed fruits and vegetables on a daily basis; while the highest percentage (65%) regularly consumed butter/margarine, followed with consumption of red meat. Twenty nine percent (29%) from both locations were classified as overweight and obese. Half did physical exercise twice a week. Of the 168 respondents. 34 (20.2%) did meet the criteria for completely emptying their bowels within a specified time of three minutes. It is concluded that whilst predisposing risk factors do not pose a threat to the onset of any form of cancer among respondents, precipitating factors are real major factors that need to be addressed through information, education and communication (I.E.C). Such an I.E.C. should be geared towards promotion of healthy eating and life style strategies. Alter all, 'the first step in cancer prevention is knowing the risk profile'.

A study on under five nutritional status and its determinants in a semi-rural community of Ile-Ife, Osun State, Nigeria.

Ten variables were assessed as they influence the under five (U5) nutritional status of children at Oranfe, a semi-rural community in Ife East Local Government Area of Osun state, Nigeria. The two types of protein energy malnutrition (PEM) that are prevalent in the community are stunting and wasting. Of the 230 children assessed using Waterlow's technique, 23% and 22.6% were stunted and wasted respectively. The results confirmed that mothers' educational level, age, parity, types of family and children's immunization status and age are some of the key determinants of nutritional status of U5 children. The intensification of exclusive breast feeding, female education, a compulsory food demonstration unit in all health centres, use of complementary feeds from 7 months upwards, growth monitoring and promotion are some of the strategies to reduce the high prevalence of PEM in both rural and urban areas of developing countries.

Cyclooxygenase-2 expression in human gliomas: prognostic significance and molecular correlations.

Cyclooxygenase (COX)-2, the inducible isoform of prostaglandin H synthase, has been implicated in the growth and progression of a variety of human cancers. Although COX-2 overexpression has been observed in human gliomas, the prognostic or clinical relevance of this overexpression has not been investigated to date. In addition, no study has analyzed the relationship between COX-2 expression and other molecular alterations in gliomas. Consequently, we examined COX-2 expression by immunohistochemistry in tumor specimens from 66 patients with low- and high-grade astrocytomas and correlated the percentage of COX-2 expression with patient survival. We also analyzed the relative importance of COX-2 expression in comparison with other clinicopathological features (age and tumor grade) and other molecular alterations commonly found in gliomas (high MIB-1 level, p53 alteration, loss of retinoblastoma (Rb) protein or p16, and high bcl-2 level). Kaplan-Meier analyses demonstrated that high COX-2 expression (>50% of cells stained positive) correlated with poor survival for the study group as a whole (P < 0.0001) and for those with glioblastoma multiforme in particular (P < 0.03). Cox regression analyses demonstrated that COX-2 expression was the strongest predictor of outcome, independent of all other variables. In addition, high COX-2 expression correlated with increasing histological grade but did not correlate with positive p53 immunostaining, bcl-2 expression, loss of p16 or retinoblastoma protein expression, or high MIB-1 expression. These findings indicate that high COX-2 expression in tumor cells is associated with clinically more aggressive gliomas and is a strong predictor of poor survival.

Promotion of exclusive breastfeeding (EBF): the need to focus on the adolescents.

This study was designed to assess the knowledge and attitude towards exclusive breast feeding among 377 female students of School of Health Technology, Ilesha and to compare their responses with 60 primigravidae attending antenatal clinic in Ile-Ife, Nigeria. The ages of the subjects ranged from 15 to 34 years. Data were collected using pretested structured questionnaire. Approximately 47% of the total population were grouped under low level of knowledge of exclusive breastfeeding. There was no significant relationship in terms of knowledge between the two groups. There was, however, a significant relationship between the age of subjects and increased level of knowledge about EBF. Seventy percent of the primigravidae were graded as having poor attitudes as compared with 18% of the female students. About 42% of the total population would give water and glucose D water to neonates within 72 hours after delivery. These findings further suggest that planners of the Baby Friendly Initiative need to focus more on adolescents and the primigravidae in the promotion of breastfeeding.