How well equipped are healthcare facilities to manage childhood malaria? The situation in selected local government areas in South Western Nigeria.

Using a structured questionnaire, surveys were conducted in 55 of 123 primary and secondary healthcare facilities in 4 selected local government areas in Southwestern Nigeria. Heads of healthcare facilities (HCFs) surveyed include nurses (41.8%), medical officers (21.8%) and community extension workers (21.8%). Twenty five (45.5%) HCFs run special clinics for children. About one fifth (20.3%) of staff had received continuing education on management of malaria. Forty seven (85%) HCFs possessed and used national guidelines for management of malaria. Although 48.9% of HCFs had microscopes, fewer had microscope slides, lancets and Giemsa stain which are also required items for definitive diagnosis of malaria. Healthcare workers were not well informed on some aspects in the management of malaria. Selected healthcare workers from various categories attended a workshop where they were trained to correct inadequate knowledge, attitude and practice in the management of malaria. These workers were to train their colleagues on their return to their respective HCFs.

Effect of training programme on secondary schools teachers' knowledge and attitude towards reproductive health education in rural schools Ile-Ife, Nigeria.

This study assessed the effect of training programme on teachers' knowledge of and attitude towards reproductive health education /sexuality education [RHE/SE] in five randomly selected rural schools in Ife-North local government area [IFLGA], Southwest, Nigeria. All the 84 teachers in the selected schools in the LGA were recruited for the study. They [84 teachers] were all given training in RHE/SE for one month. Their knowledge and attitude towards RHE/SE were assessed pre-and post-training programme. The results show a significant increase in percentage of those who had good knowledge in general areas of RHE/SE at post-training assessment compared with pre-training assessment[from 14.3% to 53.6%, p=0.0001].Also, pre-post attitudinal disposition assessments show that there was an increase in percentage of those who were favourably disposed to the teaching of RHE/SE in Nigeria Schools at post-training assessment [from 17.9% to 45.2%, p=0.0011]. The study suggests that RHE/SE should be included and made compulsory in all training programme for all teachers in Nigeria.

Eradicating guinea worm without wells: unrealized hopes of the Water Decade.

At the start of the United Nations International Drinking Water Supply and Sanitation Decade in the 1980s, guinea worm disease was targeted as the major indicator of the success of the Decade's efforts to promote safe water. By the late 1980s, most of the guinea worm endemic countries in Africa and South Asia had established guinea worm eradication programmes that included water supply as one of their main technical strategies. By surveying the water supply situation in Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, in June 1996, as a case study, it was possible to determine the role that water supply has played in the eradication effort. Although two major agencies, the former Directorate for Food, Roads and Rural Infrastructure and UNICEF, provided hand dug and bore-hole wells respectively in many parts of the LGA, coverage of the smaller farm hamlets has been minor compared to efforts in the larger towns. This is ironic because the farm hamlets served as a reservoir for the disease in the 1980s, such that when the piped water system in the towns broke down, guinea worm was easily reintroduced into the towns. The survey of 188 ever-endemic hamlets with an estimated population of 23,556 found that 74.3% of the people still drink only pond water. Another 11.3% have wells that have become dysfunctional. Only 14.4% of this rural population has access' to functioning wells. Guinea worm was eliminated from 107 of the hamlets mainly by the use of cloth filters and chemical treatment of ponds. While this proves that it is possible to eradicate guinea worm, it fails to leave behind the legacy of reliable, safe water supplies that was the hope of the Water Decade.

PIP: The 1980s were designated by the UN as the International Drinking Water Supply and Sanitation Decade, and guinea worm disease was targeted as the major indicator of the campaign's success. The campaign conceptualized guinea worm disease as a symbol of the isolation of poor rural residents from national development programs such as water supply, education, and health care. The Nigerian Guinea Worm Eradication Program, launched in 1987, committed to provide drinkable treated water to areas with endemic guinea worm disease. However, less expensive interventions such as monofilament nylon cloth filters were given priority over water supply provision. This article examines the eradication program in Ifeloju Local Government Area in Oyo State, Nigeria. The former Directorate for Food, Roads, and Rural Infrastructure provided hand-dug wells in several settlements, but made no provisions for maintenance and repairs. UNICEF assisted in the drilling of bore-hole wells, but restricted this intervention to settlements with more than 250 people. A 1996 survey of 188 ever-endemic hamlets with an estimated population of 23,556 found that 74.3% of residents drank only pond water. Another 11.3% had wells that had become dysfunctional. Only 14.4% of these rural residents had access to functioning wells. Guinea worm was eliminated from 107 of the hamlets, chiefly through use of cloth filters and chemical treatment of ponds. These results show a striking lack of commitment to the eradication of guinea worm disease through the safe water strategy. In 1995, only 43% of Nigeria's population had access to safe water. There is a need for financial investment in less expensive and more appropriate hamlet-level technologies, as well as community mobilization to dig and maintain hand-dug wells.

Sexual Practices That May Favor the Transmission of HIV in a Rural Community in Nigeria.

The Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) have been documented as a primarily urban phenomenon in Nigeria. The risk of spread to rural communities, where the largest portion of the population still lives, exists. This article presents a qualitative research study that was designed to explore sexual practices in a rural Nigerian community that held potential risk for introducing HIV into the community and for enabling HIV transmission should an infected person enters local sexual networks, in the small town of Ago-Are, Oyo State. Seven key informant interviews, in-depth interviews and observations with five commercial sex workers (CSWs), and focus group discussions (FGD) with married and single male and female residents were held. CSWs were found to be the most likely route whereby HIV could enter the community, both because of their own mobility, being resident in the community on average only nine months, and because of the mobility of their main clients, migrant farm laborers and commercial drivers. This did not preclude local patronage, which was more discrete. Another possible point of entry for HIV was through casual sexual relations during ceremonies, holidays and festivals, when towns' people working in the large urban centers came home. Within the community, extramarital sexual relations were posited as a likely route for spread within the community. The continued existence of a taboo against sexual intercourse while a mother is breastfeeding, frequent informal divorces and a tendency toward polygamy were identified by FGD members as factors that encourage extra-marital sex. The strong role that social and religious associations play in the community was identified as an ideal mechanism for health education to prevent HIV/AIDS.

Guineaworm control case study: planning a multi-strategy approach.

The planned global eradication of guineaworm (dracunculiasis) offers opportunities to learn about relatively complicated disease control situations. Unlike smallpox, which was eradicated over 10 years ago through immunization, the guineaworm problem has no one solution, but must rely on a variety of technologies to protect, treat or replace existing unsafe community water supplies which harbour the disease. Experiences in rural Nigeria have shown that a multi-strategy approach is necessary to account for differences in geographical settlement patterns, local culture and beliefs, geology of the area, economy of the villages and political clout of town leaders among the five major segments of the community. Through a self-help primary health care programme, residents of the Idere community were able to dig wells, produce and distribute cloth water filters bringing a reduction in disease incidence in some areas. It was also seen that generally low standards of living exacerbated by scattered outlying settlements made self-help difficult. Unfortunately occasional government and private efforts did not succeed because of a lack of community participation. Programme planners must involve the consumers in diagnosing these community characteristics and in planning, supervising and maintaining the resulting projects. The multi-strategy approach will help avoid wasted resources and false expectations that arise when project staff attempt to apply a "magic bullet" solution to a complex problem.

Monitoring use of monofilament nylon water filters for guineaworm control in a rural nigerian community.

Guineaworm, a disabling waterborne helminthic disease, has been targeted for eradication from endemic areas of Africa and South Asia. One short-term intervention consists of filtering pond water through a clean cloth. Monofilament nylon cloth has been found to be more effective in straining out the vector-various species of the small crustacean, cyclops-than local cotton cloth, though the former is more expensive. A concern with any new technique is whether the community will accept the idea and subsequently use it properly. Previous reports in this series have documented the process by which the rural community of Idere, Nigeria, through its volunteer primary health workers, was involved in production, distribution, and education concerning filters. One-third of households in monitored sections of the community bought filters, while others thought that filters could not prevent the disease, cost too much, or were inferior to other solutions (e.g., wells). This report looks at filter use and factors associated with use and durability. Monthly monitoring visits by a field assistant served to identify problems and reinforce correct and continued filtration. Mobility of the population between farm and town hampered regular use. Difficulty in understanding the nature of the nearly invisible vectors meant that users did not perceive tiny holes in their filters as dangerous. While filters were ultimately seen as useful in guineaworm eradication efforts, they should not take the place of more long-term community water supply interventions which will have a greater impact on community and women's development.

Community response to social marketing: filters for guineaworm control.

Guineaworm is a tropical helminthic disease which is responsible for much disability in rural areas from African to South Asia. Control interventions focus mainly on improving the quality of water supply at the health promotion level of prevention. This includes such technologies as dug wells, cloth filters, and chemicals added to pond water. Each technology has an appropriate health education strategy to aid in its promotion. The community of Idere in rural Nigeria was chosen to test the social acceptability of a new monofilament nylon cloth water filter. A social marketing strategy was used that built upon an existing primary health care program that utilized volunteer primary health workers (PHWs). The PHWs proved effective in marketing the filters in Idere as one-third of households in monitored areas purchased a filter during the six-month sales period in 1985-86. Those who bought filters were more likely to live in hamlets/family compounds where PHWs resided, belong to a modern religion, and have a preventive orientation toward health. Those who did not buy complained mostly of lack of money, but other overt and inferred reasons included attitudes that filters were inferior to wells, traditional beliefs that guinea-worm cannot be prevented and availability of cheaper but ineffective alternatives. Filters were found to be a particularly useful technology in the smaller, isolated farm hamlets surrounding the main town. Recommendations are made to improve the marketing strategy through modifications in filter design, price, distribution, and promotion.

Health education strategies for tropical disease control in school children.

This study was concerned with the demonstration of the outcome of health education in the control of malaria, schistosomiasis, dracontiasis and onchocerciasis in rural secondary schools in Nigeria using a simplified version of Green's antecedent model. Green identified three factors which could contribute to the prevalence of a disease or health problem and they are 'predisposing', 'enabling' and 'reinforcing' factors. Thus educational activities were planned in this project that would affect these three factors. The study was of a quasinon equivalent before and after experimental design. It was carried out in 10 secondary schools grouped into two equal clusters (five each) to form experimental and control groups. The post-intervention findings revealed that there was a significant increase in the knowledge of the four diseases among those in the experimental group over those in the control group. The results also showed that when knowledge was supported by enabling and reinforcing factors, desirable changes could result in the school setting among students.

Treatment of malaria and febrile convulsions: an educational diagnosis of yoruba beliefs.

An understanding of community perceptions of illness, especially disease definitions that are unique to a particular culture, is essential for developing culturally appropriate primary health care programs. Malaria is endemic in the Ibarapa District of Oyo State, Nigeria, and one of its major complications, febrile convulsions, affects nearly one-third of preschool children at least once in their lifetime. Perceptions among the local Yoruba people categorize malaria and convulsions as part of two different disease processes. Ideas of causation, severity, seasonality, and treatment are in many ways opposites. This means that parents do not perceive the dangers of convulsions when their children suffer malaria. Unfortunately the small children themselves cannot be part of the decision-making process which involves potentially toxic treatment practices. Based on an understanding of Yoruba beliefs, primary health care and health education interventions have been designed that encourage parents to take prompt action when they recognize that their child has malaria.

Organizational Development as a Health Education Strategy to Maintain Community Involvement in PHC Management.

Primary Health Care programs should not stop with the training of PHWs. Not only do these village-based workers need regular supervision; they also need continual access to the resources required for them to carry out their duties. Formal health agencies have had difficulties in meeting these demands for supervision and management on the scale required to bring health to all in even the remotest hamlet. There is consequently a need to look for ways that a community can manage its own PHC program. Efforts to develop a PHW Association in Idere, Nigeria, have shown that self-management is a realistic goal. They have also shown the need for health educators to focus on organizational and leadership development as part of their contribution to primary health care.

Targeting school children for tropical diseases control: preliminary findings from a socio-behaviour research in Nigeria.

This paper reports one study carried out among school children in Nigeria to investigate some of the social and behaviour factors contributing to the transmission of malaria, guineaworm, schistosomiasis and onchocerciasis. Data were gathered from 1310 secondary school children in a rural community. Analysis of data revealed that 70% of students wash and fetch water in the streams and ponds for domestic purposes. More than 70% claimed that their drinking water was pipe borne even though we knew that the taps had been dry for months. Only 29% specified streams, wells, ponds and water holes as sources of water supply. More than 30% claimed to treat their water before drinking in their homes. There is evidence from home visits in the community that a large proportion of the population do very little to improve the quality of drinking water before consumption. With the exception of malaria, the student's knowledge on the causes and prevention of schistosomiasis, onchocerciasis and guineaworm is virtually nil. All of these had implications for an educational intervention plan which was the next phase of the project.

Community involvement in social marketing: guineaworm control.

Social marketing as a health education strategy has the potential for encouraging the adoption of new health technologies. The focus on the individual, though, holds the risk of victim blaming. This can be overcome if the consumers/community are involved in the four major components of the marketing strategy-product design, price, distribution and promotion. The community of Idere, Nigeria, has recently been involved in marketing a monofilament nylon cloth filter to prevent the water-borne helminthic disease, guineaworm. Local tailors produced the filters. Volunteer primary health workers debated pricing, sold the product and educated each consumer. Coverage in those neighborhoods and farm settlements where primary health workers were resident was nearly double that of other sections showing the value of local action to market health changes.

Promoting primary health care in contiguous urban and rural populations: Nigeria.

The World Health Organization's goal of "Health for All by Year 2000" through Primary Health Care (PHC) is commendable, but can only be attained with the involvement and collaboration of the non-health sectors as well as the health community. Thirteen rural and urban communities in Nigeria were assessed to develop social, health and primary health care profiles. A model for introducing PCH applicable to these communities was prepared.