Alcohol consumption among pregnant women attending the ante-natal clinic of a tertiary hospital in South-South Nigeria.

BACKGROUND: As efforts to reduce maternal and childhood mortality rates continue to yield results in Nigeria, it is time to put more emphases on the health of children. Alcohol consumption is one of the few modifiable risk factors for poor pregnancy outcome. This study assessed the consumption of alcohol among pregnant women attending the antenatal clinic of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. MATERIALS AND METHODS: This study was carried out using a descriptive cross-sectional study design, with data collected using an interviewer-administered questionnaire. The questionnaire was used to collect information on the knowledge of the harmful effects of alcohol on the fetus, attitudes toward alcohol use by pregnant women, and alcohol use by the respondents. RESULTS: A total of 221 subjects were studied. The respondents had an average age of 29.5 ± 4.6 years, were mostly married (96.83%), Christians (94.57%), and had tertiary education (73.76%). Only, 51.58% of the respondents knew of the harmful effects of alcohol on the fetus; of whom, 62.29% were told by a health professional. More than half (59.28%) of the respondents had taken alcohol during the index pregnancy, about a third (39.40%) of whom drank alcohol on a regular basis, whereas 25.79% were binge drinkers. There were no statistically significant differences in the marital (P = 0.16) and educational status (P = 0.15) of the respondents who abstained from alcohol in the index pregnancy, compared with those who drank alcohol; although, statistically significant differences were observed in the age (P < 0.001), parity (P = 0.02) and religion (P < 0.001) of the respondents. CONCLUSION: The level of alcohol consumption among the pregnant women is high. Health education is, therefore, required to change the attitude of the public and the knowledge and behavior of the pregnant women.

Knowledge; Attitude; and Infection Control Practices of two Tertiary Hospitals in Port-Harcourt; Nigeria

Background: Surgical site infections (SSIs) are a significant cause of morbidity; emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt; Nigeria. Materials and Methods: A cross-sectional; comparative study design was used for the study; with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However; 63.64 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 and 69.69 respectively of the respondents in UPTH; compared with 22.86 (P = 0.00) and 0.00 (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39) and lack of in-service training (21.21); while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29) and absence of a hospital's policy on infection control (22.88). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices

Sources of healthcare financing among surgical patients in a rural Niger Delta practice in Nigeria.

INTRODUCTION: The environmental degradation following crude oil exploration in the Niger Delta has resulted in poverty for local rural dwellers. For those who are ill, if herbal treatments and/or self-medication with orthodox drugs are unsuccessful, the only alternative is expensive medical treatment in clinics. Surgical patients in a rural clinic may have to stay beyond than the normal 7 days if they are unable to pay their hospital bill; because this limits bed availability, there is an impacts on the hospital's economic management. This study aimed to determine the pattern of hospital bill payment among rural surgical patients in a rural Nigerian community, including the sources of finance for bill payment, in order to determine ways to resolve this issue. METHOD: This cross-sectional study was conducted in a rural community in the Niger Delta area (Bethesda Clinic Ngo) over 5 years (2005-2009). RESULTS: In the 5 year study period, 3712 patients were seen, of which 229 were surgical patients who consented to the study. Their ages ranged from 4 to 97 years (mean 45.6 ± 13.5 years) and most were fish farmers (79.91%), secondary-school leavers (56.33%) and of the Christian religion (86.03%). The association of these characteristics with a greater than 7 day hospital stay was statistically significant (p < 0.05). The most prevalent surgical procedure was herniorrhaphy but the longest staying patients were those who had an ectopic pregnancy (23.32 ± 7.52 days), cesarean section (19.51 ± 6.73 days), appendectomy (18.46 ± 6.82 days) and exploratory laparotomy (17.33 ± 8.32 days). The hospital bill ranged from US$33.3 to $500, with a mean of $105.7 ± 0.043. Their sources of finance for the hospital bill were multiple but mainly personal savings (71.18%). Few (3.06%) had knowledge of the National Health Insurance Scheme, but when informed about it 84.28% were willing to enroll. CONCLUSION: The sources of finance for payment of hospital bills were multiple but the most common were personal savings and family members.

Socio-Demographic Characteristics of Alcohol Abusers in a Rural Ijaw Community in Bayelsa State; South-South Nigeria

Background: Causal relationship has been established between alcohol and more than 60 types of disease and injury. Despite this, alcohol is still widely consumed in several communities in Nigeria, and sometimes considered a health tonic. This study described the pattern, prevalence, and factors associated with alcohol abuse in a typical Ijaw community, where alcohol is produced and consumed in large quantities. Materials and Methods: The study was carried out in Okoloba, a rural community in Bayelsa State, South-South Nigeria using an analytical cross-sectional study design. The data were collected from members of the community aged 16 to 65 years, using the Alcohol Use Disorders Identification Test questionnaire and clinical examination for hepatomegaly, tongue tremor, and hand tremor. Results: A total of 322 subjects, comprising 166 men and 156 women were studied. They had an average age of 41.4 ± 2.5 years, were mostly farmers (43.17%), married (66.15%), and had at most primary school education (62.42%). More than 90% of the subjects took alcohol in the preceding year, with more of them (43%) preferring the locally produced drinks. About 33% of the subjects had harmful drinking, while 12.73% had alcohol dependence problem. There is no significant age difference between the alcohol abusers and abstainers/social drinkers (P > 0.05), but alcohol abusers were significantly more likely to be males (P < 0.001), in polygamous marriages (P < 0.00001), had lower educational status (P < 0.0001), likely to be practitioners of the traditional religion (P < 0.0001), and more likely to be engaged in palm wine tapping. Conclusion: Alcohol is widely consumed in the community, but the prevalence of abuse was moderate, mainly due to cultural restrictions. Sales restrictions might be needed as the drinking habits of members of the community change with urbanization

Does the Nigeria Health Care System Need a Primary Gate-Keeper?

Background: The World Health Organization (WHO) is presently focusing more attention on how health systems will become more effective and efficient. Introduction of primary gate-keepers into healthcare systems by some countries has revolutionized their healthcare system. It clearly alters the channels by which patients receive care particularly in countries where specialists are in short supply. Aim: To discuss the role of primary gate-keeping in healthcare systems and to use the experience of some countries with and without a primary gate-keeper function to evaluate the Nigerian healthcare system. Methods: A search of some standard books and relevant articles on primary 'gate-keeping' and healthcare systems using the Google and Yahoo search engine facilities helped to gain access to general information on the title. We also searched the EMBASE and OVIDMEDLINE data bases using the HMIC search strategy template. Results: Healthcare services are delivered within three distinct but increasingly overlapping and fluid subsystems namely; primary; secondary and tertiary care. In the UK and Netherlands healthcare systems; the general practitioner (GP) serves as the primary gate-keeper to other professionals. On the contrary; France; Germany and Nigeria don't have effective primary gate-keeping system. However; in Nigeria family physicians run the general out-patient clinics and serve as a point of first contact and referrals. Conclusion: Gate-keepers are mainly geared towards helping a healthcare system to achieve better health levels. Unlike in the UK and Netherlands; there is no effective primary gate-keeping in the Nigerian healthcare system. Government should make efforts to address this anomaly to allow every person have effective and efficient healthcare services

Experiences and Attitudes of Young Men towards Abortion in a Semi-Urban Community in Rivers State; Nigeria

Background: Most of the studies on abortion focused on the roles and responsibility of women; with very little attention given to the role played by men. Aim: To assess the experiences and attitudes of young men towards abortion in Mgbede Egbema; a semi-urban community in Rivers State; south-south Nigeria. Methods: A descriptive cross-sectional study design was employed; using a structured questionnaire and focus group discussion as study methods. The questionnaire was administered to all the registered male members of the community's youth association; while the focus group discussion was held with members of the youth association's vigilante committee; to gain more insight into the responses contained in the answered questionnaires. Results: A total of 181 questionnaires were administered and retrieved. The average age of the respondents was 23.1 years; and they were mostly single (77.9); with secondary school education (65.8); and combined Christianity with traditional religion (71.3). Almost all (93.4) had a girl friend; but the responsibility of preventing unwanted pregnancy rested almost entirely on the girl (75.7); and in the event of an unwanted pregnancy; 85.1of the respondents would recourse to abortion. Most of the respondents (74.6) would advice their sister to procure an abortion in the event of an out-of-wedlock pregnancy; but only 20.0of them would like to be actively involved in the process of procuring the abortion. All the respondents knew that abortion was illegal in Nigeria; but 47.5thought that the offence did not include the woman; while 29.8thought the offence was committed by the abortion provider alone. Most (64.6) of the respondents felt abortion should not be freely available; but 90.6of them would want the offenders to be prosecuted only in the event of serious complications; or death. Conclusion: There is a broad support for abortion among the respondents; but fears still exists that liberalization might lead to increase demand for the procedure. A review of the nation's abortion law is therefore recommended

Clandestine abortion in Port Harcourt: providers' motivations and experiences.

BACKGROUND: Abortion is illegal in Nigeria. It is a crime to perform or obtain an abortion except to save a woman's life. In spite of this, several medical practitioners working in profit-oriented private clinics still provide abortion services on demand and on a fee for service basis. This study is to find out the motivations and experiences of these practitioners. METHODS: The study was carried out in 15 clinics in Port Harcourt that were known to provide abortion services, using a descriptive, cross-sectional study design. Data were collected using a semi-structured, self-administered questionnaire, followed a few days later by in-depth interview to further explore responses in the questionnaire. RESULTS: A total of 34 doctors, 29 males and 5 females that routinely provide abortion services in the clinics were interviewed. Most of them (79.42%) were below the age of 40 years, married (76.47%), non-specialist doctors (55.88%), and had practiced for less than fifteen years (88.24%). All the owners/Medical Directors of the clinics were actively engaged in providing abortion services, and most of the clinics (86.67%) had less than ten in-patient beds. All the providers were Christians, but most (85.29%) provided abortion services mainly for the financial benefit. Expertise for the abortion procedures were acquired in private clinics, but most of the providers (61.76%) restricted themselves to terminating pregnancies in which they felt were firmly within their level of competence. All the respondents used manual vacuum aspiration for the termination of pregnancies less than 12 weeks and charge an average of five thousand naira (N5,000.00) for an 8-week pregnancy CONCLUSIONS: Most abortion providers in Nigeria are lured by the large market and the huge fees collected for the services. Abortion should be formally legalized in Nigeria to at least force down the service charge, and hence make safe abortion accessible to women of low socio-economic class.