Perception and practices relating to hepatitis B Infection among in-school adolescents in Ogun State, Nigeria

Objective: This study examined the perception and practices relating to Hepatitis B infection among In-school adolescents in Ogun State, Nigeria.Methods: A cross-sectional study of 300 in-school adolescents selected by a multi-stage sampling method. Data were elicited using a pretested self-administered questionnaire which included questions relating to respondents' risky practices, and a 35-point Hepatitis B perception scale. Descriptive statistics, as well as Chi-square statistics, were generated using IBM SPSS Version 23, and the significance level was set at 0.05.Results: The mean age of the respondents was14.31 ± 1.73years and slightly over half (51.7%) were females. Less than half (45%) of the adolescents perceived themselves to be susceptible to Hepatitis B infection, while 31% perceived Hepatitis B infection to be a serious disease. Almost half (49%) of the adolescents had unfavorable perceptions. The most common risky practices among the respondents were sharing skin-piercing instruments with their family members (79%) and friends (68.7%). There are significant associations between sex (gender) and risky practices such as the practices of unsafe sex (X2= 9.11; p=0.10); having multiple sexual partners (X2= 12.08;p =0.02); and sharing skin-piercing instruments (X2= 5.52;p=0.01) with more males reporting the above practices than females. Conclusion/Recommendation: To minimize the identified risky practices and unfavorable perception, educational intervention programs aimed at promoting Hepatitis B virus preventive behaviors and increasing the level of perception of vulnerability and seriousness of HBV infection among in-school adolescents should be conducted.

Effects of peer education on the knowledge and use of HIV counselling and testing services among young persons in Ibadan, Nigeria

Although HIV counselling and testing (HCT) service plays important roles in prevention and control of AIDS; many young Nigerians under-utilize it. A peer education intervention was implemented to promote use of HCT among secondary school students and apprentices in Ibadan; Nigeria. Baseline data were collected from 1281 students from six schools and 100 apprentice workshops in four Local Government Areas of Ibadan. A total of 897 students from four schools and apprentices from 25 workshops were assigned as experimental group while 682 students from two schools and apprentices from 25 workshops were the controls. Three intervention activities were implemented: a one-day sensitization workshop for 31 apprentice instructors and 20 secondary school teacher-supervisors; training of 75 students and 46 apprentices as Peer Educators (PE); and development of Behaviour Change Communication (BCC) materials including posters and handbills. Six months after implementing these interventions; a follow-up survey was conducted to assess the effects of the PE on young person's knowledge of HIV and HCT and reported use of HCT services. Follow-up data were collected from 760 respondents from the experimental sites and 298 from the control areas using the same questionnaire administered during the baseline survey. PE educated a total of 1;917 persons with information on HIV/HCT-related issues. In addition; at follow-up; records of use of HCT services were obtained from two HCT centres situated in the experimental sites and one from the control. Data were analysed using descriptive statistics and t-tests. The results showed significant increase in knowledge of HCT among experimental (1.3 to 7.5) (p0.05) and control groups (0.6 to 6.8) (p0.05) at follow-up. At baseline; 29.0% of the experimental and 36.0% of control knew of the location of a HCT centre; at follow-up the percentage of experimental groups who could do so increased to 62.0%; while the number dropped to 34.0% among controls. Records at HCT centres showed that a greater number (309) of experimental groups used HCT services than control (43). PE were successful in influencing behaviour of their peers to use HCT services

Determinants of cigarette smoking among senior secondary school students in a rural community of southwest Nigeria.

BACKGROUND: Smoking remains an increasing high-risk behaviour among the youth, despite its harmful effects on health. This study sought to find out the determinants of cigarette smoking among youth of a rural Nigerian community and suggested intervention measures which have potential for the control of smoking among in-school population. METHODS: It was a cross-sectional study carried out among 416 students selected through a multi-stage sampling procedure. Determinants of smoking among the study participants and their knowledge were assessed with the aid of a pre-tested structured questionnaire. RESULTS: The proportions of ever-smokers who could associate cigarette smoking with known health problems were generally low compared to the never-smokers. The mean knowledge score, 4.05 +/- 0.4, obtained by the ever-smokers was also lower than the mean score, 6.41 +/- 0.2, obtained by the never-smokers. This was found statistically significant (p < 0.05). Smoking behaviour was significantly associated with friends (p = 0.00518) and parents (p = 0.002856) who smoke, and with cigarette advertisement (p = 0.032989). CONCLUSION: Low level of knowledge, peer and parental influence as well as exposure to cigarette advertisement played significant roles in the adoption of smoking behaviour by the youth. Anti-smoking education and other prevention strategies targeted at the youth, their parents and the media are desirable.

Prevalence and perception of nocturnal enuresis in children of a rural community in southwestern Nigeria.

Nocturnal enuresis after the fifth year of life is a distressing problem. In Nigeria, there is a dearth of information about the condition. This cross-sectional study was carried out to determine the prevalence and perception of the condition among children in Igbo-Ora, a rural community in southwestern Nigeria. Four hundred parents/guardians were interviewed and information obtained on 644 children aged 6-12 years. Overall enuresis prevalence was 17.6% (19.9% among boys and 14.9% among girls). The reported causes of nocturnal enuresis included urinary tract infection (33.5%), excessive play (27.5%) and deep sleep (25%). A majority (74.5%) of the respondents would use herbs or traditional medicine to treat enuresis, while only 6.8% of the respondents sought orthodox healthcare facilities for its management. Only 18 (25%) of the 71 parents/guardians with enuretic children had ever consulted a health worker. The misconceptions and inappropriate enuresis management methods among the parents/guardians require health education intervention.

Stigma associated with onchocercal skin disease among those affected near the Ofiki and Oyan Rivers in western Nigeria.

Skin diseases have been a major source of social stigma, whether they be infectious or not. The potential stigamtizing effect of skin disease associated with onchocerciasis is currently receiving attention because half of the 17 million victims of onchocerciasis in Africa live where the non-blinding form of the disease is prevalent. Some reports are available that onchocercal skin disease (OSD) is associated with social stigma including problems in finding a marriage partner. Previous studies have also implied positive effects of ivermectin treatment on OSD. Therefore a multi-country trial of ivermectin is underway to test the hypothesis that ivermectin treatment might affect perceptions of stigma associated with OSD. This paper presents the baseline stigma findings from the study site located in southwestern Nigeria. A total of 1032 persons living in villages near the Ofiki and Oyan Rivers were screened and interviewed and 500 (48%) were found to have an onchocercal skin lesion. A 13-item, 39-point stigma scale was used in interviews with affected persons. A mean score of 16.8 was obtained. No personal characteristics or disease factors were found to be associated with stigma score. The highest ranking items focused on issues of self-esteem such as feeling embarrassed, feelings of being pitied, thinking less of oneself, feeling that scratching annoys others, feeling that others thought less of the person and feeling that others had avoided the person. During the interviews it was discovered that only about half of those clinically diagnosed as having OSD labeled their own condition as onchocerciasis. Those who said their lesion was OSD had a lower stigma score than those who did not, conforming with previous studies wherein affected persons perceived less stigma from OSD than those without the disease. A broader community perspective on OSD was obtained through 50 interviews using paired comparisons of five skin-related local illnesses. Onchocerciasis placed midway in aversive responses between the higher end represented by leprosy and chicken pox and lower scoring papular rashes known locally as eela and ring worm. In-depth village based interviews yielded several case studies of how onchocerciasis had a negative social impact on its victims. While study on the cultural perceptions of OSD is recommended, the results indicate that with a fairly high prevalence of OSD, the community level effects of social stigma should be regarded as serious.

Gender and ethnic differences in onchocercal skin disease in Oyo State, Nigeria.

During preparation for a study on the effects of ivermectin treatment on onchocercal skin disease in the Ifeloju Local Government Area of Oyo State, Nigeria, 1032 adults aged 20 years and older were examined for skin lesions and palpable nodules. It was found that for 4 types of skin lesions, acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD) and depigmentation (leopard skin), as well as for subcutaneous nodules, females had a significantly higher prevalence than males. Although the area is inhabited primarily by the Yoruba people, the study also included some of the cattle-herding Fulani ethnic group. The reactive skin lesions, APOD, CPOD and LOD, were found to be more common among the Fulani, although there were no significant differences in leopard skin and nodules between both groups. While there is need for further research on both immunological and behavioural factors that may lead to these differences in disease. The need to achieve equity in health programming by ensuring that women and ethnic minorities receive full disease control services is of more immediate concern.

Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis.

Two patient education methods, Information Media (IM) and Social Network (SN), were compared to determine their relative effectiveness on recruitment and subsequent compliance behavior of people infected with onchocerciasis in respect of appointment keeping and ivermectin consumption in existing primary health care facilities in six communities in southwestern Nigeria. Two communities each were randomly assigned to the IM intervention group, two of the SN group, and two served as controls. A total of 1265 persons out of an estimated target population of 5033 infected individuals were enrolled in the study. Coverage rates were higher in the intervention communities (30.3% for SN and 29.9% for IM) than control (7.3%), but the differences between intervention groups was not significant. A drop-off was seen in attendance at the second round of ivermectin distribution. Nearly equal proportions of the intervention groups returned (43.3% for SN and 47.4% for IM), while few control patients came back for their second dose (12.3%). Factors responsible for the low turnout were thought to include the content of educational messages, mobility of community members and limited time available to collect the drugs. Cost considerations led to recommendations to maintain facility based distribution and the SN approach, with greater emphasis on mobilization to increase coverage and compliance.

The role of community health workers in the management of essential drugs.

The ability to provide essential drugs not only fulfills part of the primary health care (PHC) duties of the community health worker (CHW), but also helps legitimize the role of the CHW in the community. Essential drugs are often routed through relatively inefficient government structures before reaching the CHW, thus creating problems of regular supplies and timely distribution. Few examples are said to exist where CHWs take charge of essential drug programs to the fullest: planning, purchasing, and maintaining their own stocks. An association of CHWs in Idere Nigeria has been doing just that since 1986-87. Self-assessment of this scheme was stimulated by several factors including rising wholesale prices and subsequent community member reluctance to pay for medicines. In addition, the local government had begun its own CHW training in line with national PHC guidelines and priorities. It became possible to examine the two systems side by side. The main variable used to determine system functioning was whether CHWs had replenished their village drug box stocks in the previous year. Among five factors tested, group (Idere CHW association member or local government trainee) sex, age, residence (town or hamlet), and perceived willingness to pay by villagers, only group was shown to be significantly associated with stock replenishment purchases. Most (63%) of the independent Idere group had replenished their stocks compared to 35 percent of local government CHWs. Cultural factors such as elders' predisposition to provide free service to those in need were also identified. The Idere association used this information to suggest ways of improving supervision, support, and purchasing so as to strengthen their service to the community.

Primary care training for patent medicine vendors in rural Nigeria.

The provision of essential drugs and the involvement of various potential and existing health care providers (e.g. teachers and traditional healers) are two important primary health care strategies. One local group that is already actively supplying the medication needs of the community is the patent medicine vendors (PMVs), but the formal health establishment often views their activities with alarm. One way to improve the quality of the PMVs' contribution to primary care is through training, since no formal course is required of them before they are issued a license by government. Primary care training was offered to the 49 members of the Patent Medicine Sellers Association of Igbo-Ora, a small town in western Nigeria. Baseline information was gathered through interview, observation and pre-test. A training committee of Association members helped prioritize training needs and manage training logistics. Thirty-seven members and their apprentices underwent the 8 weekly 2-hr sessions on recognition and treatment (including non-drug therapies) for malaria, diarrhoea, guinea worm, sexually transmitted diseases, respiratory infections, and malnutrition, plus sessions on reading doctor's prescriptions and medication counseling. The group scored significantly higher at post-test and also showed significant gains over a control group of PMVs from another town in the district. The Igbo-Ora experience shows that PMVs can improve their health care knowledge and thus increase their potential value as primary health care team members.