Barriers and recommendations for a cervical cancer screening program among women in low-resource settings in Lagos Nigeria: a qualitative study.

BACKGROUND: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. OBJECTIVES: This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women's knowledge about cervical cancer, and their perceived barriers and recommendations for the program. METHOD: Four focus group discussions(FGD) were conducted among 35 women between the ages of 21-65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. RESULTS: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women's poorly perceived susceptibility to cervical cancer. CONCLUSION: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Factors Associated with Choice of Non-Facility Delivery among Women Attending Antenatal Care in Bali Local Government Area of Taraba State, North-Eastern Nigeria.

One intervention that is widely believed to reduce the high maternal mortality in resource-poor countries including Nigeria is delivery in health facilities under skilled birth attendance. However, the practice of non-facility delivery is still common in these countries. Curiously, women who attend ANC in health facilities are also among those who choose to deliver in a non-facility. This was a descriptive cross-sectional study conducted in Bali LGA of Taraba State, Nigeria. Multi-stage sampling technique was used to select 320 women of childbearing age who attended ANC and had had a recent delivery. The objective was to determine the factors associated with choice of non-facility delivery among women attending ANC in the area. Data analysis was done using EPI info computer software version 7.2.1.0 Most of the women (73.1%) delivered in a non-facility. Ethnicity and place of ANC were the predictors of non-facility delivery. The most common reason for non-facility delivery was that labour came without complications (58.8%). Prevalence of non-facility delivery in the area was disturbingly high. Strategies to discourage the practice should include providing adequate skilled personnel and equipment at all levels of healthcare. There should also be active engagement of the traditional and religious institutions in the area.

"Men are the head of the family, the dominant head": A mixed method study of male involvement in maternal and child health in a patriarchal setting, Western Nigeria.

INTRODUCTION: The importance of involving men in reproductive, maternal and child health (RMCH) programs is increasingly recognized globally. In Nigeria, most MCH services do not actively engage fathers. AIM: To assess men's knowledge, involvement in MCH and the barriers in Southwest Nigeria. Predictors of good knowledge and involvement were also assessed. METHODS: This was a community-based cross sectional study. Quantitative and qualitative methods were used in data collection which was done within a period of three months in 2018. Quantitative data were collected with interviewer administered questionnaires from 418 respondents who were selected by multistage sampling methodology. The topic was further explored using focus group discussion (FGD). Quantitative data were analysed using EPI-INFO version 7. Quantitative variables were summarized using means and standard deviations while multivariable analysis was carried out to determine predictors of good knowledge and involvement in MCH. A combination of deductive and inductive analysis was used for the qualitative data. RESULTS: Overall, 65% of men had good knowledge of MCH while 60.8% had good involvement. Predictors of good knowledge were being a Christian (AOR 1.674, 95% CI 1.045-2.679), being of Yoruba tribe (AOR 1.753, 95% CI 1.100-2.796), having post-secondary education (AOR 1.984, 95% CI 1.002-3.928), having more under-fives in the household (AOR 2.162 95% CI 1.365-3.425) and spouse having post-secondary education (AOR 2.755, 95% CI 1.189-6.382). Predictors of good involvement in MCH include higher educational level of spouse: secondary (AOR 2.852, 95% CI 1.214-6.699), post-secondary (AOR 2.270, 95% CI 1.000-5.161) and having good knowledge of MCH (AOR 2.518, 95% CI 1.587-3.994). From the FGD, other factors which influence involvement were related to traditional/cultural orientation, time constraint and finance among others. CONCLUSION: Men's knowledge and their involvement in maternal and child health were sub-optimal. For improvement, community-based intervention programmes should be designed for men and implemented, taking into consideration their traditional/cultural roles, religious orientation, busy schedules, and educational backgrounds. They should be re-oriented on their patriarchally informed belief about their perceived roles in RMCH.

Knowledge and attitude towards mental disorders among adults in an urban community in south-west Nigeria.

BACKGROUND: Mental disorders are one of the most ignored public health issues worldwide. However, the burden associated with mental disorders is ever increasing and poses a major threat to health, social interactions and the economy of both developed and developing countries. AIM: To assess the knowledge of adults residing in an urban local government area in Lagos, south-west Nigeria, with regards to mental health and investigate their attitudes towards this condition. METHODS: This was a descriptive cross-sectional study. Multi-stage sampling was used to select 242 adults who were subsequently interviewed with a structured questionnaire. Data was collected and analysed using Epi Info statistical software version 7. Associations between socio-demographic variables and the knowledge and attitudes of subjects with regards to mental disorders were assessed using chi-square tests at a significance level of 0.05. RESULTS: Almost all respondents (95.5%) in this study were aware of mental disorders while 31.0% were related to someone with a mental disorder. Approximately half of the respondents (51.2%) had poor knowledge of mental disorders while the majority (90.0%) had positive attitudes. There was a significant and positive association between having a relative with a mental disorder and the level of knowledge (P=0.010). CONCLUSION: Analyses identified knowledge gaps in the community in terms of mental disorders in the community. We recommend that health workers should develop ways to educate the community with regards to the causes, symptoms, effects and treatment options for mental disorders.

Satisfaction With Services Among Attendees of Physiotherapy Outpatient Clinics in Tertiary Hospitals in Lagos State.

AIM: To determine outpatients' satisfaction with physiotherapy services in tertiary hospitals in Lagos State, Nigeria. METHOD: This cross-sectional study utilized a simple random sampling method to recruit 284 participants. Participants responded to a 2-part structured questionnaire with 33-items on a 5-point Likert-type scale. Participants were asked questions about their satisfaction with physiotherapy services, staff attitudes, and the accessibility of outpatient physiotherapy clinics. Data were analyzed using descriptive analysis and χ2. RESULTS: About 28.8% of the participants were satisfied or very satisfied with the location of the outpatient physiotherapy clinics. The majority of the participants were satisfied or very satisfied with these physiotherapy services in maintaining privacy (86.2%), scheduling convenient clinic appointments (78.2%), prompt scheduling of the first physiotherapy clinic appointment (74.6%) and subsequent visits (78.9%), and providing a calm/relaxing atmosphere (90.1%). While 22.5% of the participants were satisfied or very satisfied with the waiting time in these physiotherapy clinics, 86.3% and 97.9% were satisfied or very satisfied with staff attitudes and the cost of the therapy, respectively. Almost all (97.9%) the participants reported being satisfied or very satisfied with their overall experience in the physiotherapy clinics. While there was an association between marital and educational status with overall satisfaction scores, age and gender showed no association. CONCLUSION: Our findings suggest that patients attending the outpatient physiotherapy clinics in tertiary hospitals in Lagos State, Nigeria, were satisfied or very satisfied with the domain that measured overall satisfaction. Strategies to reduce the waiting time in these physiotherapy clinics and to enhance physical accessibility of the physiotherapy clinics are encouraged.

Response of patent medicine vendors in rural areas of Lagos state Nigeria to antimalarial policy change.

BACKGROUND: Patent medicine vendors (PMVs) play an important role in the treatment of malaria, especially in the rural areas. Nigeria recently changed her antimalarial treatment policy from chloroquine to artemisinin-based combination therapy (ACT). OBJECTIVES: To determine the response of PMVs to the new policy. METHODS: A baseline study was conducted in two local government areas (LGAs) of Lagos state Nigeria as the first phase in an intervention study aimed at improving the malarial treatment practices of PMVs in rural Lagos. A mixed method design involving a questionnaire survey of 180 PMVs and four key informant interviews were used. An antimalarial drug (AMD) audit was also performed. RESULTS: More than 80% of respondents were aware of the policy change in malaria treatment, but only 23.9% sold an ACT for the last case of malaria treated in an under five child. The main determining factor of the particular AMD sold was PMV's personal choice (70.6%). About half (58.9%) of the shops stocked ACTs, the newly recommended antimalarials. CONCLUSIONS: The high awareness of the policy change did not translate to a commensurate increase in the sale of the new drugs. Factors beyond the PMVs need to be addressed for a successful adoption of the new policy.

Client perception of service quality at the outpatient clinics of a General hospital in Lagos, Nigeria.

INTRODUCTION: Service quality assessments have assumed increasing importance in the last two decades. They are useful in identifying gaps in services been provided with the ultimate aim of guaranteeing quality assurance. The objective of this study was to assess the client perception of service quality at the outpatient clinics of Randle General hospital, Lagos. METHODS: A descriptive cross sectional study was conducted from March to May 2013. A multistage sampling technique was used to select respondents and data was collected with the aid of modified SERVQUAL questionnaires. The data was analysed with aid of EPI-INFO 2002 and statistical significance was set at a P value 0.05 for statistical significance. RESULTS: Total of 400 respondents were interviewed. The mean age was 40 years with a standard deviation of 15.2 yrs. The highest mean score of 4.35 out of a possible maximum of 5 was recorded in assurance domain while the lowest mean score of 4.00 was recorded in the responsiveness domain. The overall mean score of all the domains was 4.20 with standard deviation of 0.51. Overall majority (80.8%) of respondents rated the overall service quality as good/ very good. After linear regression, the assurance domain was the most important predictor of the overall perceived service quality (p< 0.001). CONCLUSION: The overall perceived service quality was good. The major deficiencies were in the responsiveness domain and especially the waiting time. The hospital management should implement measures to improve the responsiveness of services by ensuring prompt delivery of services.

Exposure to blood among mortuary workers in teaching hospitals in south-west Nigeria.

BACKGROUND: Mortuary workers like other health workers are exposed to blood borne pathogens at work. A baseline assessment is important to plan for programmes to safeguard the health of workers. The aim of this study is to determine exposure rates to blood among mortuary workers in teaching hospitals in South West Nigeria. METHODS: A descriptive cross sectional study was carried out between March and May 2008. All mortuary workers working in six (6) teaching hospitals, 80 in total were included in the study. Data was collected with the aid of a 15- item self administered questionnaire. Data was analysed with the aid of EPI-INFO 2002. Statistical associations were explored using odds ratio and confidence intervals. RESULTS: A total of 76 respondents completed questionnaire giving a response rate of 95%; 3 males and 1 female declined to participate, the mean age of respondents was 38.2 years, 48(72.6%), 53(85.5%) and 50(73.5%) of the workers had been exposed to blood through cuts, blood splash and needle stick injury. Duration at work was significantly associated with blood splash. Workers who had worked 5 years and above were 0.10 times (95% confidence interval 0.00-.0.78) as likely to experience blood splash compared to those who had worked under 5 years. Only 5(10.4%) of workers with needle stick injury had completed three doses of Hepatitis B vaccine. The specific confirmation by antibody titre was however not done in this study. CONCLUSION: Exposure to blood was very common with blood splash emerging as the most common route of exposure. There is a need for vaccination of all mortuary workers with three doses of Hepatitis B Vaccine to protect their health. In addition, education of workers on risks and institution of standard operating procedure are crucial to safeguard the health of mortuary workers.

Awareness of occupational health hazards and the practice of universal safety precautions among mortuary workers in South West Nigeria.

BACKGROUND: Mortuary workers face hazards at work such as infectious diseases, chemical and psychosocial hazards among others. If workers are to participate in activities to safeguard their health, they must be aware of the risks at work. OBJECTIVE: The objective of the study is to assess the awareness of occupational health hazards and to determine their practice of universal safety precautions. METHODS: A descriptive, cross sectional study was carried out among all the mortuary workers in teaching hospitals in South West Nigeria. The study material was a self administered questionnaire used for Data collection between March and May 2008. Data was analyzed by EPI-INFO 2002. The Chi-square test was used for statistical association with a p-value of 0.05. RESULTS: A total of 76 mortuary workers was surveyed with a mean age of 38.2 yrs. They were mostly male (92%). Forty-five (59.2%) of the respondents were aware of hazards at work. The hazards identified were HIV/AIDS (97.7%), tuberculosis (82%) and formalin related morbidity. 14 (18.4%) rated the risk faced at work as moderate/high risk. Only 36.8% always used face masks. About 40 (53.3%) had received at least one dose of Hepatitis B vaccine. There was no association between awareness of hazards and practice of universal safety precautions CONCLUSION: The awareness of occupational hazards among the workers was fair while the practice of universal safety precautions was suboptimal. There is a need for periodic training programmes on occupational hazards as well as the vaccination of all workers with three doses of Hepatitis B Vaccine.

The Pattern of Antibiotic Use in an Urban Slum in Lagos State; Nigeria

Background: Misuse of antibiotics has the potential of promoting the development of resistant strains ofinfective agents; thus resulting in increased morbidity and mortality as well as healthcare costs. Objectives: To assess the patterns of antibiotic use and the impact of socio-demographic variables on theobserved patterns in Itedo community in Lagos State; Nigeria.Methods: The research involved a cross-sectional survey among adults 15 years and above in Itedo; an urbanslum in Lagos state; Nigeria. Close-ended; structured questionnaires were used for the study. Data collection involved a multi-stage sampling method. Data analyses were done with the aid of SPSS version 15.0 software.Chi-squared test of association was used to test for associations between variables at 95 CI Results: The level of self-medication ranged from 44.3-79.2 (for the four most commonly used antibiotics inthe community); while the level of non-adherence to antibiotic therapy was found to be 63.4 . Reasons mentioned for non-adherence included lack of understanding of dosage instructions by dispensers from thevarious sources of purchase (86.9) and improvement in respondent's health condition(41.2). The level ofeducation of the respondent was found to be statistically significant in the determination of the source ofantibiotic purchase.Conclusion: Self-medication and a high level of non-adherence to antibiotic regimen were common in Itedocommunity. The documentation of the irrational use of antibiotics by adults in Itedo provides a basis forintervention on more rational use of antibiotics in this community

Exposure to Blood among Mortuary Workers in Teaching Hospitals in South-West Nigeria

Background: Mortuary workers like other health workers are exposed to blood borne pathogens at work. A baseline assessment is important to plan for programmes to safeguard the health of workers. The aim of this study is to determine exposure rates to blood among mortuary workers in teaching hospitals in South West Nigeria. Methods: A descriptive cross sectional study was carried out between March and May 2008. All mortuary workers working in six (6) teaching hospitals; 80 in total were included in the study. Data was collected with the aid of a 15- item self administered questionnaire. Data was analysed with the aid of EPI-INFO 2002. Statistical associations were explored using odds ratio and confidence intervals. Results: A total of 76 respondents completed questionnaire giving a response rate of 95; 3 males and 1 female declined to participate; the mean age of respondents was 38.2 years; 48(72.6); 53(85.5) and 50(73.5) of the workers had been exposed to blood through cuts; blood splash and needle stick injury. Duration at work was significantly associated with blood splash. Workers who had worked 5years and above were 0.10 times (95confidence interval 0.00-.0.78) as likely to experience blood splash compared to those who had worked under 5 years. Only 5(10.4) of workers with needle stick injury had completed three doses of Hepatitis B vaccine. The specific confirmation by antibody titre was however not done in this study. Conclusion: Exposure to blood was very common with blood splash emerging as the most common route of exposure. There is a need for vaccination of all mortuary workers with three doses of Hepatitis B Vaccine to protect their health. In addition; education of workers on risks and institution of standard operating procedure are crucial to safeguard the health of mortuary workers