Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison.

BACKGROUND: Older person's attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process. METHODS: A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05. RESULTS: A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains. CONCLUSIONS: Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

A descriptive study of the morbidity pattern of older persons presenting at a Geriatric Centre in Southwestern Nigeria.

CONTEXT: Rapid population ageing is a demographic reality in most countries of the world. Old age is associated with changes which may culminate in health problems, necessitating provision of appropriate preventive, curative, and rehabilitative services. However, reports from many low- and middle-income countries have shown lack of preparedness to cater for the healthcare needs of older persons. AIM: This study described the morbidity profile and its determinants among persons aged 60 years and above who presented at an established geriatric centre in southwestern Nigeria. MATERIALS AND METHODS: Data were obtained from electronic health records of 4886 patients aged ≥60 years who visited the facility between 1st January 2013 and 31st December 2014. Data were analyzed using Stata version 13 (Texas, USA). Frequency distributions were used for descriptive analysis, and chi-square test was used to test associations. RESULTS: More than a half, 2919 (59.7%), of the respondents were females and almost three quarters 3501 (71.7%) were aged between 60 and 74 years. Mean number of morbidities was 1.81 ± 0.9, and less than half, 1097 (42.0%), presented with only one morbidity, most commonly, hypertension. There were significant age-related differences for musculoskeletal (P = 0.001), endocrine (P = 0.01), and psychological problems (P = 0.01). In addition, gender differences were observed as a significantly higher proportion of females presented with general symptoms (P = 0.02) and musculoskeletal problems (P = 0.0001) than men. CONCLUSION: The most common presenting morbidities at this geriatric health centre were mostly noncommunicable diseases. Information obtained will be useful in the design of similar facilities in other parts of the country and region at large.

Quality of life in psychosis: prevalence and associated factors in a Nigerian clinical population.

Aim of the study was to assess sociodemographic and clinical determinants of quality of life in psychotic patients in a general hospital population in Nigeria. Information was obtained on demography, duration of untreated illness (DUI) and functioning among Schizophrenia (368), schizoaffective disorder (70), and 214 patients with affective psychosis. Functioning was assessed using GAF, severity of psychopathology with PANSS and quality of life using WHOQoL-BREF. In general, the differences in the QoL across the three psychotic disorders were small. Linear regression analysis, showed that high GAF p < 0.001, medication adherence, p = 0.007 were associated with good QoL in schizophrenia, low PANSS p < 0.001 and short DUI p = 0.001 in schizoaffective disorder and low PANSS, high GAF p < 0.001 respectively in affective psychosis. QoL and its determinants in psychosis are not absolutely different. More research is required in this area.

Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school.

BACKGROUND: Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However, there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self-administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at <0.05. RESULTS: More than a third (35.5%) of all respondents interviewed had experienced one or more forms of mistreatment during their training, with 38.5% of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5%), and the main perpetrators of these incidents were medical consultants, (18.6%) other cadre of doctors (17.3%) and lecturers (14.4%). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P < 0.05). However, only 8.8% reported these incidents. CONCLUSION: With more than a third of undergraduate medical trainees experiencing mistreatment, development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended.

HIV/AIDS stigma among primary health care workers in Ilorin, Nigeria.

BACKGROUND: Stigma and discrimination pose major obstacles to accessing care and support by People Living With HIV/AIDS (PLWHA). Information on HIV stigma and discrimination towards PLWHA among Nigerian health workers has mainly been at higher levels of care. This paper examined HIV stigma and discrimination at the primary health care level with the objective of identifying its occurrence and determinants among health workers at this level. METHODS: A total sample of all health care workers (341) at the primary health care level in Ilorin, Kwara State were surveyed via questionnaire between July and August 2007 to obtain information on their sociodemographic characteristics and the four domains of stigma viz: fear of casual transmission of HIV, shame and blame, discrimination and disclosure. RESULTS: Majority of the respondents had fear of casual transmission of HIV (87.7%), exhibited shame and blame (89.4%), reported observing discrimination against PLWHA by other health workers in their facilities (97.7%) and believed that disclosure of patients HIV status to health workers was imperative. Nurses/midwives were more likely to have fear of casual transmission of HIV and believe that disclosure of HIV status of patients was imperative. Respondents who had received in service training were less likely to exhibit shame and blame (p < 0.05). CONCLUSION: Stigma occurred in all stigma domains among this group of health workers but previous training was found to play a role in the reduction of shame and blame. Training of health care workers within the context of the various stigma domains is advocated.

Effect of health education on the riding habits of commercial motorcyclists in Uyo, southern Nigeria.

BACKGROUND: The increasing number of motorcyclists in Nigeria has led to a rise in poor road safety practices leading to increased rate of accidents. This study was conducted to implement and evaluate the effect of safety education on riding habits of motorcyclists in Uyo, Nigeria. METHODS: The intervention study was conducted among commercial motorcyclists in Uyo with controls from another town in Akwa Ibom State. Baseline information was collected from both groups on their riding habits. Motorcyclists in Uyo were educated on appropriate road safety practices. Data was collected from both groups three months later and analysed using the Statistical Package for Social Sciences version 11. RESULTS: A total of 200 respondents participated in the study, 100 per group. At 3 months post-intervention, those riding when tired reduced in the intervention group from 69% at baseline to 42% (p < 0.05), while in the control group it increased from 74% to 79%. Furthermore, those who rested during riding hours increased from 30% at baseline to 93% (p < 0.05) in the intervention group, while it reduced from 40% to 36% in the control group. Those riding within speed limit in the intervention group increased from 37.5% at baseline to 56.6% (p < 0.05), while in the control group, it remained the same. Use of psycho-active substances reduced in the intervention group, though the changes were not statistically significant at p < 0.05. CONCLUSION: Safety education improved many riding habits of motorcyclists in the intervention group. Road safety education is recommended for all motorcyclists to ensure safer road use.

Experiences of mistreatment among medical students in a university in south west Nigeria.

OBJECTIVE: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. MATERIALS AND METHODS: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. RESULTS: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. CONCLUSION: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.

Visual morbidities among elderly patients presenting at a primary care clinic in Nigeria.

BACKGROUND: Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in Nigeria. OBJECTIVE: To describe the visual problems among elderly subjects in a hospital setting. METHODS: Five hundred consecutive patients (311 females and 189 males) aged 60 years and above were interviewed using a structured questionnaire based on the World Organization of Family Doctors (Wonca) format between September 2004 and April 2005. The main outcome measurements were sociodemographic characteristics, visual acuity and ocular problems. RESULTS: The main visual problems reported by the elderly were impaired vision 224 (44.8%) and abnormal sensations in the eyes 64 (12.8%). Cataract 198 (39.7%) was the commonest eye disorder diagnosed by the Family Physician, followed by pterygium 32 (6.4%). Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age. CONCLUSION: Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made to detect these conditions early and institute treatment promptly.

Sexual risk behaviours and HIV knowledge of migrant farm workers in a rural community in Nigeria.

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6% (males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1% (12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted.

Economic costs of motorcycle injury among crash-involved commercial motorcyclists in Oyo State, Nigeria.

OBJECTIVE: This study presents the costs of injury from road crashes sustained by commercial motorcyclists in Oyo state, Nigeria. METHODS: Across-sectional survey of 373 commercial motorcyclists selected using a multi-stage sampling technique was conducted. Information on injury costs for 44 (11.8%) of them who were reportedly involved in a road crash in the 12-month preceding the survey are presented. RESULTS: The mean age of the 44 crash-involved motorcyclists was 33.6 +/- 9.1 years. Daily income ranged from N300.00 ($2.31) - N1, 500.00 ($11.54). Thirty-three (75.0%) of those involved in crashes sustained injuries and 7 (21.2%) of them were admitted. Common injuries sustained were bruises (75.8%), fractures (12.1%), cuts (6.1%) and burns (6.1%). Median number of days away from work was 14 (range: 1 - 150). Median number of days on admission was 60 (range 7 - 90). The median cost of treatment was N2, 000.00 ($15.38), range: N20.00 (about 16 cents) - N25, 000.00 ($192.31) and this was paid by the injured motorcyclist alone in about 47% of cases. Median productivity costs lost was N7, 000.00 ($53.85), range N300 ($2.31) - N72, 000.00 ($553.85). CONCLUSION: The study showed that the costs of injuries were considerable. Efforts to prevent road crashes must be intensified to reduce the ensuing economic losses.

Clinical audit of intra-partum care at secondary health facilities in Nigeria.

OBJECTIVE: Intra-partum care has a significant influence on birth outcomes. Gap however exists between evidence and practice. This study documented pattern of intra-partum monitoring among birth attendants in public secondary healthcare facilities and related findings to quality of care provided. METHOD: Intra-partum monitoring records of vaginal examination, fetal heart and blood pressure were reviewed. Research assistants extracted information and documented same in appropriate section of Safe Motherhood Needs Assessment forms. Monitoring records were categorized into optimal and sub-optimal care. Proportions were calculated for parturients who received either optimal or sub-optimal care. Chi-square test of statistics was used to explore differences. Level of significance was p < 0.05. RESULT: Areview of 349 records of paturients was carried out. Their mean age was 23.4 +/- 3.3 years. Pregnancy outcome was a live-birth in 329 (97.3%). Optimal care of vaginal examination, fetal heart monitoring and blood pressure measurement was provided in 243 (71.9%), 73 (21.6%) and 52 (15.4%) parturients respectively and diminished significantly as labour progressed. CONCLUSION: Intra-partum care provided by birth attendants was generally sub-optimal and use of the monitoring records to influence birth outcome is doubtful. Improvement in record keeping practices and skills in intra-partum monitoring for decision making, are suggested.

A comparative study of HIV/AIDS knowledge and attitudes of hearing-impaired and non-hearing-impaired secondary school students in Ibadan.

OBJECTIVE: This study was conducted to compare HIV/AIDS knowledge and attitudes of hearing-impaired and non-hearing-impaired secondary school students in Ibadan, South-Western Nigeria. METHOD: A cross-sectional survey of all the hearing impaired students and an equal number of non-hearing-impaired students enrolled in a half way school in Ibadan was conducted. Four non-hearing-impaired students did not complete the survey and their responses were excluded from the final analysis. Data was analysed using the Statistical Package for the Social Sciences (version 11.0). RESULTS: Seventy-eight hearing-impaired and non 74 non-hearing impaired students completed the survey. Thirty (38.5%) hearing-impaired and 67 (90.5%) and non-hearing-impaired students knew that HIV could be transmitted via semen, vaginal fluid and blood, (p < 0.001). HIV/AIDS knowledge scores were calculated giving minimum and maximum scores of 0 and 15 respectively. Mean knowledge score for hearing-impaired students was 4.7(±2.1) compared with 8.7(±2.3) among non-hearing-impaired students (t-test=11.307, p < 0.001). Generally, the students' attitudes to HIV/AIDS prevention and PLWHA were not favorable with only hearing-impaired and 44 (59.5%) non-hearing-impaired students agreeing that it would be alright for them to be in the same class with someone who had AIDS. CONCLUSIONS: The study showed that the hearing-impaired students had poorer knowledge and attitudes to HIV/AIDS compared with their non-hearing-impaired counterparts. There is a pressing need for development of HIV/AIDS education programmes specially designed to meet the needs of hearing impaired students.

EFFECT OF TRAINING ON KNOWLEDGE AND ATTITUDE TO STANDARD PRECAUTION AMONG WORKERS EXPOSED TO BODY FLUIDS IN A TERTIARY INSTITUTION IN SOUTH-WEST NIGERIA.

INTRODUCTION: Standard precaution in the workplace reduces the risk of occupational hazards among workers exposed to body fluids of humans and animals. Training on standard precaution has been recommended as a strategy to improve knowledge, attitude and compliance to these guidelines. This study therefore determine the effect of training on knowledge and attitude to standard precaution among workers exposed to body fluids of humans and animals in the University of Ibadan, South-west, Nigeria. METHODS: This was an interventional study among workers exposed to body fluids of humans and animals. A total survey of all faculties where staff and student come in contact with human and animal body fluid was done. Selected staff were trained for two days on standard precaution. A self-administered questionnaire was used to obtain information on socio-demographic information, knowledge and perception of staff on standard precaution. The maximum obtainable knowledge and attitude scores were 27 and 6 points respectively. The mean knowledge and attitude score were determined at pre-test and post-test. Frequency, proportion, mean and standard deviation were used for summary statistics and an independent t-test was performed to test for association. Statistical significance was set at 5%. RESULTS: A total of 136 and 123 responses were obtained at pre-test and posttest respectively. A little over half of the respondents were females (51.5%) and below 40 years (54.4%). The mean knowledge score among the workers increased from 22.59 ± 3.4 at pre-test to 22.83 ± 3.2 at post-test, but it was not statistically significant. However, the mean post-test attitude score (5.10 ± 1.4) was significantly different from the pre-test attitude score (4.49 ± 1.5). CONCLUSION: Training improved the knowledge and attitude of workers exposed to body fluids of humans and animals working in the University of Ibadan on standard precaution. Periodic training on standard precaution is therefore recommended to sustain a proper attitude to standard precaution guidelines.

Work conditions and health problems of female traders in Ibadan, Nigeria.

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

EFFECT OF A ROAD SAFETY EDUCATION INTERVENTION ON ROAD SAFETY KNOWLEDGE OF UNIVERSITY DRIVERS IN IBADAN, NIGERIA.

BACKGROUND: It is essential for drivers employed in the formal sector to have good knowledge of road safety in order to safeguard their lives and those of the staff they are employed to drive. The study was conducted to determine the effect of a road safety education intervention on road safety knowledge of drivers employed in the University of Ibadan, Nigeria. METHOD: A quasi-experimental study of 98 intervention and 78 control drivers selected using a cluster sampling technique was conducted. The intervention comprised a two-day training on road safety and first aid. The drivers' knowledge of road safety was measured at baseline, immediately and 4-months post-intervention. Aggregate scores of road safety knowledge were computed giving minimum and maximum obtainable scores of 0 and 16 respectively. Change in mean scores over the three measurement periods was assessed using Repeated Measures Analysis of Variance (ANOVA). Independent t-test was used to compare the scores between intervention and control drivers at each of the assessment periods. Twenty-nine drivers did not complete the study (attrition rate = 16.5%). RESULTS: At baseline, mean road safety knowledge scores for the intervention and control drivers were 12.7±2.2 and 12.9± 2.3 (p = 0.510) respectively. Immediately and four months post intervention, the scores of the intervention drivers were 13.8±1.9 and 12.8±1.6; while scores for the controls were 13.3±2.0 and 13.2±1.8. Repeated measures ANOVA revealed that the increase in knowledge over the three assessment periods was not statistically significant. CONCLUSION: The intervention resulted in an initial increase in road safety knowledge of the intervention drivers. However, this was not sustained to the forth month post-intervention. This finding suggests periodic refresher trainings to sustain the knowledge acquired.

HOW ACCEPTABLE ARE THE PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV SERVICES AMONG PREGNANT WOMEN IN A SECONDARY HEALTH FACILITY IN IBADAN, NIGERIA?

BACKGROUND: Prevention of mother to child transmission of HIV (PMTCT) programme was designed to reduce mother to child transmission (MTCT) of HIV and it has been shown to be effective. However, the uptake of the services is still very low in Nigeria. OBJECTIVE: This study was designed to determine how acceptable the different services of PMTCT are to pregnant women in Ibadan, Nigeria. METHOD: Systematic random sampling was used to recruit 500 pregnant women attending antenatal clinic in a secondary health facility. Questionnaires were used to obtain data regarding socio-demographic characteristics, knowledge about MTCT of HIV and prevention, the awareness and attitude towards infant feeding options for HIV positive mothers. Data were analysed using student's t test and Chi-square test with p set at 0.05. RESULTS: Mean age of respondents was 27.4±6.1years. Most known routes of MTCT of HIV were during pregnancy (86.0%) and from breastfeeding (86.0%). More than 80% knew that having good antenatal care, appropriate supervised delivery, taking antiretroviral drugs and not breast feeding a baby are ways of PMTCT. About two thirds had a positive attitude towards HIV testing and counselling (HTC). Only 18.4% were aware of the exclusive breast feeding option for feeding infants of HIV positive mothers while 52.2% would not comply if asked not to breast feed. Women aged 35 years and above had better attitude towards non breast feeding. CONCLUSION: Intensified health education on the importance of HTC and promotion of exclusive breast feeding for infants of HIV positive mothers is recommended.

Frequency and Pattern of Lower Urinary Tract Symptoms in a screened population of Men above 40 Years in Ibadan, Southwestern Nigeria.

BACKGROUND: The epidemiology of lower urinary tract symptoms in adult men in Nigeria is presently not well known. AIM: To evaluate a screened population of men for lower urinary tract symptoms and their impact on the participants' quality of life. METHODS: A cohort study was conducted among men aged 40 years and older from 3 selected centres in Ibadan, Southwestern Nigeria. The presence of lower urinary tract symptoms and their impact was determined using the International Prostate Symptom Score (IPSS) administered via standardized questionnaires. RESULTS: Six hundred and fifty-five men participated in the study. The median age was 56 years with a range of 40 - 92 years. Eight percent (8%) of respondents were asymptomatic, whilst 66%, 20% and 6% had mild, moderate and severe symptoms respectively. Nocturia was the most common symptom and the second most troublesome. Overall storage (irritative) symptoms occurred with the similar frequency to voiding (obstructive) symptoms (91% v 92%), but voiding symptoms were more likely to be severe and thus more troublesome (p = <0.000.1). The severity of the individual symptoms as well as the overall score also increased significantly with age [p = 0.001]. There was a high correlation between IPSS and Quality of Life (QoL) scores (correlation coefficient 'r' = 0.75 [p = <0.0001]. Despite this, 72% of QoL respondents were satisfied with their quality of life. CONCLUSION: The frequency of non-troublesome lower urinary tract symptoms was high in adult men in this cohort of men in Southwestern Nigeria and that severity was age-related. In addition, whilst storage and voiding symptoms occurred with similar frequency, voiding symptoms were the more severe and troublesome.

Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria.

INTRODUCTION: Upper urinary tract stones are relatively uncommon in Nigeria and they are most often seen in men in their 4th and 5th decades. There is however no recent report on this disease from our locality. This retrospective study was done to evaluate the pattern of presentation of upper tract urolithiasis in our institution. PATIENTS AND METHODS: We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period. RESULTS: Twenty cases of renal calculi presented within the study period. All patients presented with sudden onset of loin or back pain, and the diagnosis was confirmed radiologically. The mean age of our patients was 27 years (age range 13-38 years), and the male to female ratio was 1.5: 1. Nineteen patients (95%) reported poor fluid intake (<1.5L/day), and 17/20 (85%) frequently total fasted totally (no water or food intake) for religious reasons. Serum calcium was normal in 15 of 16 patients (94%) and only marginally raised in the remaining patient. All patients were treated with a high fluid intake (3L/day) and analgesics, and 16 of the patients (80%) passed their stones spontaneously. The other four are currently pain free, one of whom is awaiting surgery. CONCLUSION: This (uncommon) occurrence of upper tract urolithiasis in young adults in Ibadan may be related to chronic dehydration exacerbated by religious fasting. Further studies are required to explore this relationship,

Previous BFHI training and nurses' knowledge, attitudes and practices regarding exclusive breastfeeding.

The UNICEF/WHO Baby Friendly Hospital Initiative (BFHI) programme was developed to train health workers and equip them with the required knowledge and skills to protect, promote and support breastfeeding among mothers through the implementation of the "Ten Steps to Successful Breastfeeding". This study was conducted to assess the effect of BFHI training on knowledge, attitudes and support practices of nurses with regards to exclusive breastfeeding. A total of 298 nurses in maternal and child health care units were interviewed, of these 113 (37.1%) had participated in the BFHI training workshop. Significantly higher proportions of the BFHI trained nurses had the correct knowledge regarding the causes and management of common breastfeeding problems. The overall knowledge scores of the BFHI trained nurses was significantly higher than that of the untrained (11.9 +/- 1.8 versus 10.7 +/- 2.4 P < 0.01). Higher proportions of BFHI trained nurses reported correct support practices for the initiation and establishment of exclusive breastfeeding among mothers. The findings show that nurses who had participated in the BFHI training workshop were significantly more knowledgeable about some aspects of exclusive breastfeeding, they had more positive attitudes and were more likely to employ correct practices for the promotion of exclusive breastfeeding.

Trabeculectomy in young Nigerian patients.

The results of 89 trabeculectomies performed on 56 patients under the age of 30 years were reviewed. Data collected included age, sex, type of glaucoma, number of years of glaucoma before surgery, visual acuity, intraocular pressure, complications of surgery, presence of a filtering bleb and follow-up period. Complete success, denoted by a postoperative IOP of 21 mmHg or less without medical therapy, occurred in 50 eyes (56.2%). Qualified success, in which IOP was 21 mmHg or less with additional medical therapy occurred in 31 eyes (34.9%) and failure, in which IOP was greater than 21 mmHg in spite of medical treatment occurred in 8 eyes (8.9%). Success was therefore achieved in 91.1% attaining an IOP of 21 mmHg or less, with or without additional medical therapy. The most statistically significant factor was age groups in which the highest success rate of 100% was achieved in the age group 20-29 years. The difference in the success rate across the age groups was statistically significant (x2 = 8.04, p = 0.01). Fornix based conjunctival flaps were also found to be associated with a statistically significant higher success rate (97.9%) as opposed to limbal based flaps (85.4%), x2 = 4.81, p = 0.03. Males in the study group had a significantly higher success rate (97%) than females (78.3%), x2 = 5.86, p = 0.011. A success rate of 100% was recorded in patients with developmental glaucoma, 86.1% in congenital glaucoma and 33.3% in secondary glaucoma. All the repeat trabeculectomies had congenital glaucoma. The presence of a bleb, although it had a higher success rate (93.4%) compared with the absence of a bleb (84.6%), was not statistically significant (x2 = 1.19, p = 0.27). Complications of surgery were mostly transient.