Cultural Sensitivities and Health

Culture is that complex whole which includes knowledge, belief, art, morals, law, custom, and other capabilities acquired by man as a member of the society. Its components include knowledge, beliefs, norms, techniques, folkways, mores, laws, values, material culture, and universal culture. Health programs and interventions are more effective when they are “culturally appropriate” for the populations they serve. Each medical encounter provides the opportunity for the interface of several different cultures: the culture of the patient, the culture of the physician, and the culture of medicine. Peripheral, evidential, linguistic, constituent involving, and sociocultural strategies enable the health worker practice culturally sensitive healthcare delivery. Cultural targeting and cultural tailoring are applied to groups and individuals, respectively, by taking their peculiarities into account in making health care available to them. A combination of both approaches is recommended for optimal health outcomes. Cultural competency is the answer to the need for previously lacking cultural consideration in planning and delivering care. It enables the health worker overcome organizational and clinical barriers which continually impede efficient and effective healthcare delivery

Letter to the editor: The Role of Early Amniotomy and The Risk of Vertical Transmission of Hepatitis B Virus

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Burn injuries in pregnancy in a regional burns center in Nigeria: Presentation, maternal and fetal outcome

Introduction: Paucity of published data on the specific problems of burns in pregnancy has made it difficult to determine the incidence, maternal and fetal outcomes, as well as the most effective management program for them, hence this analysis of burns in pregnancy from January 2009–December, 2014 (6 years). Method: A retrospective study of records over 5 years was conducted. The patients’ demographic and burn characteristics, stage of pregnancy, the causes, management, outcome and complications were noted. Results and discussion: Ten mothers were included, with mean age of 30 years (range 17–45 years). The average TBSA was 36.3%, mean gestational age was 18.22 weeks (60% were within the first trimester while 40% were in the third trimester, none was in second trimester). The major cause of burn injuries was flame burns (80%). All dead fetuses were within the first trimester. The most common cause of death of mothers was sepsis. No statistically significant association was found between socio-demographic and burn characteristics and maternal and fetal outcome. The mortality rate of pregnant women is almost three times that of the non pregnant women. Conclusion: Burns in pregnant women have a profound effect on the fetal wellbeing while the outcome of the burn injuries can be affected by the presence of a fetus. Burn injury prevention is essential in reducing the morbidity and mortality associated with these injuries. Keywords: Burns, Pregnancy, Maternal outcome, Fetal outcome

Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria

Abstract Background Although the risk of HIV transmission through breastfeeding is reduced considerably with the use of antiretroviral therapy, infant feeding by HIV positive mothers remains controversial. Weighing risks against benefits generates intense debate among policymakers, program managers and service providers in sub-Saharan Africa, considering that the major causes of infant death of malnutrition and infectious diseases, could be prevented if mothers breastfeed their babies. Whereas breastfeeding involves some risk of HIV transmission, not breastfeeding poses considerable risk to infant survival. This study investigated perceptions and practice of breastfeeding of HIV-exposed infants among HIV positive mothers. Methods A cross-sectional descriptive study was conducted in Enugu metropolis among HIV positive mothers receiving care for prevention of mother-to-child transmission of HIV from two public and two private hospitals. Interviewer-administered questionnaire survey was done with 550 participants as they exited the final point of service delivery. Descriptive statistics of perception and practice variables and cross tabulation of selected variables was performed. Results Most mothers knew that HIV could be transmitted through breast milk. The majority perceived any type of breastfeeding as beneficial to the infant: 230 (83.6%) in private facilities, and 188 (68.4%) public facilities. Over three-quarters of the mothers breastfed their infants and their reasons for breastfeeding included personal choice, cultural norms, fear of HIV status being disclosed and pressure from family members. A statistical significant association was found between; (i) practice of breastfeeding and marital status, (p < 0.01), and (ii) practice of breastfeeding and household income provider (p = 0.02). However, neither marital status (AOR 1.4; 95% CI 0.3, 6.8) nor being the household income provider (AOR 4.9; 95% CI 0.6, 12.9) is a significant predictor of breastfeeding of HIV-exposed infants. Conclusions Breastfeeding remains a common trend among HIV positive women and it is associated with economic independence of women and social support. Fear of stigma negatively affects practice of breastfeeding. Hence, HIV positive mothers need economic independence and the support of family members to practice recommended infant feeding options

Knowledge and Use of Insecticide Treated Nets Among Pregnant Women in Enugu Urban

Background: Malaria in pregnancy has severe negative effects on maternal health and birth outcomes. Avoiding contact with mosquitoes by use of insecticide treated mosquito nets (ITNs) can prevent or reduce disease burden. A recent synthesis of data from national malaria control programmes has shown that levels of knowledge and utilization of ITNs by pregnant women in many sub-Saharan African countries remain far below national and global strategic targets.Objective: To investigate the level of knowledge and use of ITNs in prevention and control of malaria among pregnant women attending antenatal clinics in health facilities in Enugu metropolis.Methodology: A cross-sectional descriptive survey of 350 pregnant women drawn from three Local Government Areas in Enugu metropolis participated in the study. Descriptive statistics, Logistic regression and Spearman’s correlation were used for data analyses.Results: The level of awareness of ITNs among female urban dwellers in Enugu is high (98.3%), with radio and television (178; 50.9%) being the main sources of information. The predominant sources of these nets are health centres (281; 74.6%) and markets (35; 10%). Most women only used the nets when they wish to sleep at night (213; 60.9%) and the nets were only washed when dirty (62; 18.4%). Consistent use of nets was observed among most women (239; 68.3%) and usually when there was increased perceived risk of exposure to mosquitoes. Age, educational level, marital status and number of children were determinants of ITN use (p &lt; 0.05).Conclusion: Majority of the pregnant women totaling 316 (90%) had adequate knowledge of use of ITNs for malaria prevention and control. Knowledge also translated to improved use of ITNs among the respondents. The findings also revealed that knowledge of ITN use and social factors (age, education, ethnicity, marital status and number of children) had significant influences on the use of ITNs. Key Words: Knowledge, Utilization, Insecticide treated nets, Pregnant women, South-East Nigeri

Civilian Penetrating Gunshot Injury to the Neurocranium in Enugu

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high‑velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty‑two patients with civilian penetrating gunshot wounds seen over a 10‑year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty‑two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years.  There was a high correlation (0.983) between the sex of the patients and the  outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was &gt;8; meaning that 87.1% of patients in whom postresuscitation GCS was &gt;8 survived. Thirty‑one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality.Conclusions: Admitting GCS and bullet trajectory were predictive of outcome.Keywords: Glasgow coma score, Glasgow outcome score, Penetrating gunshot injur