Bullying Behavior and its Association with Mental Health Symptoms among Senior Secondary School Students in Calabar, Nigeria

Background: The nature of our psychosocial environment and one’s response to stressful daily events are key determinants of current and future mental health status. The school environment is one of such settings which expose young people to potentially undue  stress, especially through bully-prone interpersonal interaction with peers and older individuals. Although bullying is thought to be prevalent in secondary schools, only a few studies have investigated the association between bullying and the mental health status of secondary school students in developing countries. The present study seeks to obtain data that may be helpful in addressing this research gap. Methodology: This was a cross‑sectional analytic study. Astratified sampling technique was used to select six secondary schools within Calabar metropolis. Proportional allocation using a simple random sampling method was employed to recruit the  required number of senior secondary students from the selected schools. Multidimensional Peer Victimization Scale and Child and Youth Mental Health General Screening Questionnaires were used to assess for presence/degree of bullying and mental health problems, respectively. Mann–Whitney U-test and Spearman’s correlation analysis were used as inferential statistics, and P-value was considered significant if it was < 0.05. Results: Three hundred and four (304) respondents were surveyed, but complete data were obtained from 292. Their ages ranged from 13 to 20 years, with a mean age of 16.5 ± 2.1 years. The male-to-female ratio was 1:0.7. Within the past 12 months, 54.8% of the  respondents had bullied someone, while 62.3% had witnessed someone being bullied. Attack on the property was the most common form of bullying (61%), followed by social manipulation (52.7%), verbal (52.1%), and physical (47.9%) forms of victimization. Moderate-to-severe forms of social manipulation, physical victimization, verbal victimization, and attack on property forms of bullying were found in 26.0%, 26.7%, 28.8%, and 32.2% of respondents, respectively. The most frequently elevated component of mental health score in the respondents was conduct symptoms (50.7%), followed by mood symptoms (34.2%) and symptoms of generalized anxiety (19.2%). Respondents with abnormally elevated scores for hyperactivity/distractibility, conduct, generalized anxiety, and mood symptoms had significantly higher mean scores for each of the components of bullying assessed (P < 0.001). Elevated scores on oppositional defiant symptoms did not significantly influence the mean scores of each component of bullying, except for verbal victimization (P = 0.04). Asignificant positive correlation was observed between each component of bullying and each domain of mental health assessed (P < 0.001). A positive correlation was also observed between the total bullying score and each domain of mental health as well as the total mental health scores (P < 0.001). Of all the domains of mental health assessed, symptoms of hyperactivity/distractibility showed thestrongest positive correlation with a total bully score (r = 0.69, P < 0.001). Conclusion: The results from this study suggest that bullying is prevalent in our secondary schools, with a potential adverse effects on the mental health of affected individuals in the near or remote future. These findings may be useful for improvement in existing policies for school health programs in developing countries. Keywords: Bullying, Nigeria, psychological health, secondary school, senior secondary student

Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria

BACKGROUND: Studies have shown that administration of anthelmintic drugs in pregnancy can reduce the incidence of maternal anaemia; however, data on other maternal and perinatal outcomes are limited.AIM: This study was therefore conducted to evaluate the direct impact of mass deworming on delivery and perinatal outcome.MATERIAL AND METHODS: A total of 560 healthy pregnant women in their second trimester were randomised to receive a single dose of oral mebendazole (500 mg) and placebo. Each participant received the standard dose of iron supplement and malaria prophylaxis. They were followed up to delivery and immediate postpartum period to document the possible impact on maternal and perinatal outcomes.RESULTS: The prevalence of anaemia at term, 37 weeks gestation and above, among the treatment arm was 12.6% compared with 29.9% in the placebo arm (p < 0.001). Caesarean section rates was higher in the treated group and the placebo (p = 0.047).There were no statistically significant differences in incidences of postpartum haemorrhage (p = 0.119), Puerperal, pyrexia (p = 0.943), low birth weight (p = 0.556) asphyxia (p = 0.706) and perinatal death (p = 0.621).CONCLUSION: Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome

International Best Practice: Understanding the Core Difference between Medical Laboratory Science and Clinical Laboratory Medicine in Nigeria

Introduction: International best practice (IBP) in the healthcare sector is an approach that is put in place globally, acceptable  standards to ensure patients’ safety while providing quality healthcare to the community. It achieves such standards by defining the job roles of various professionals in the healthcare sector. In the Nigerian healthcare sector, despite the clear definition of the job roles of the medical laboratory scientist and clinical laboratory physicians (pathologist) by the various Acts of Law of the Federal Republic of Nigeria that established these two professions, there seems to be a misapprehension of the differences between these two  professions. This study aimed to evaluate the knowledge of the health workers as it concerns the IBP on the scope of practice of medical laboratory science (MLS) and clinical laboratory medicine in Nigeria. Materials and Methods: Across-sectional, observational design was used for this prospective study involving 427 health workers from the six geopolitical zones in Nigerian and Abuja, using a proportionate sampling technique. It was facility‑based research usinga validated semi-structured self-administered questionnaire. Results: Over 50% of the participants believed that MLS was the same as clinical laboratory medicine. Two hundred and ten  participants (49.2%) did not know that analyses of samples in a clinical laboratory was the job responsibility of a laboratory physician. Conclusion: There was knowledge gap in the practices of both the MLS and the clinical laboratory medicine by health workers. Therefore, there is a need to create awareness through interprofessional education, workshops, and seminars to ensure understanding of job roles as this may promote harmony between these two professions in the health sector. Keywords: Clinical laboratory medicine, international best practice, medical laboratory scienc

Awareness and Practice of Lassa Fever Prevention among Health Workers in a Tertiary Health Facility in a Southern Nigerian City

Background: The Lassa fever outbreak has claimed the lives of numerous healthcare personnel in recent years and this reflects the poor infection prevention control practices and ill-preparedness for such contagious epidemic. Objective: The aim of the study was to assess the knowledge and quality of practice with regard to prevention of Lassa fever transmission among health workers.Methods: In this cross sectional study 230 health workers including intern nurses & doctors were assessed using pretested self- administered questionnaire adopting the WHO & Nigerian Centre for Disease and Control (NCDC) recommended prevention protocols against the deadly virus. Data were analyzed using Statistical Package for Social Science version 25.Results: Two hundred and twenty-four completed questionnaire (97.4% response rate) were analyzed. A vast majority 172 (76.8%) possessed satisfactory knowledge about Lassa fever transmission and infection prevention whereas only 77(44%) actively practiced the recommended protocols for infection prevention against Lassa fever virus satisfactorily. In the regression analysis, duration of service was the only significant factor positively associated with satisfactory knowledge on Lassa fever infection prevention (X29(0.05) = 19.559, P value= 0.001). Almost all the participants practiced hand washing before and after attending to patients. However, only 1.34% of the respondents utilized full personal protective equipment (PPE) kits consistently while attending to high risk patients. Overall, their infection preventive practices were not significantly influenced by their occupation designation (P=0.586), duration of service or training in years and demographic profile such as: gender (P=0.118), age (P=0.840), marital status (P=0.819) and residing in urban area (P = 0.561). There was a weak positive correlation between knowledge scores and practice scores (r=0.137).Conclusion: It is recommended that the standard infection prevention practice protocols be adopted consistently in caring for patients with suspected or confirmed endemic viral infection like Lassa fever. Hospital management and policy makers should provide adequate PPE to minimize nosocomial infection in healthcare workers. Regular hospital-based seminars on infection prevention is recommended. Keywords: Nosocomial infection, hand washing, personal protective equipment, healthcare workers, endemic viral infection. DOI: 10.7176/JEP/13-7-08 Publication date:March 31st 202

The Prevalence, Pattern, and Predictors of Sleep Disorders Among Pregnant Women Attending Antenatal Clinic in a Southern Nigerian City

Background: Sleep disorders are a common and often undiagnosed chronic health problem associated with an increased incidence of metabolic syndrome and pregnancy complications. Aim: The purpose of this study was to find out how common sleep disturbances are among pregnant women in Calabar, as well as their patterns and risk factors. Materials and Methods: A cross-sectional study was conducted among 360 antenatal attendees in the three major public health facilities in Calabar and 338 completed questionnaires were included in the analysis. Socio-demographic, medical, and obstetrics information were obtained using interviewer-administered questionnaires. Major international sleep classification tools were used to identify the patterns of sleep disturbance. Their weights and heights as well as their blood pressures (BPs) were measured. Data were analyzed using SPSS version 23. The predicting factors were extracted using a logistic regression model. Results: The prevalence of sleep disorder was 44.1%. The most common pattern of sleep disorder was insomnia (34.6%). Nineteen (5.6%) of them reported mixed disorders. On logistic analysis, pregnant women with normal BP (odds ratio [OR]: 0.440, 95% confidence interval [CI]: 0.230–0.843, P = 0.013), normal body mass index (OR: 0.365, 95% CI: 0.133–1.001, P = 0.050) and maternal age 20–30 years, (OR: 0.169, 95% CI: 0.30–0.969, P = 0.046) were significantly less likely to suffer from sleep disorders. Residing in a single a room apartment with family members was an independent social determinant of sleep deprivation (OR: 2.009, 95% CI: 1.003–4.025, P = 0.049). Conclusion: The study suggested that the prevalence of sleep disturbance is high among pregnant women. Counseling on good quality sleep during pregnancy may improve pregnancy outcome by ensuring appropriate weight gain and good BP control

Severe Life-Threatening Pregnancy Complications, “Near Miss” and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study

Background. Investigating severe life-threatening pregnancy complications that women encounter and the maternal morbidities (near miss) may help to evaluate the quality of care in health facility and recommend ways to improve maternal and infant survival especially in low-income countries. The aim of this review was to identify, classify, and determine the frequency and nature of maternal near miss events and the maternal and perinatal outcomes. Methods. A retrospective facility-based review of cases of near miss and maternal mortality occurring between 1st January 2012 and 31st December 2016 at the University of Calabar Teaching Hospital was conducted. Near miss case definition was based on the WHO disease specific criteria. The main outcomes included the maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality index, maternal morbidities, and perinatal outcome. Results. There were 10,111 pregnancy-related admissions, 790 life-threatening pregnancy complications that resulted in 99 maternal deaths, and 691 near miss cases. The maternal mortality ratio was 979 maternal deaths per 100,000 live births, and the maternal near miss ratio was 6,834 per 100,000 maternities. The MMR to MNMR ratio was 1 : 8. Sepsis and severe anaemia had high case-specific mortality indices of 0.4 and 0.53, respectively. The perinatal outcome was poor compared to that of uncomplicated pregnancies: perinatal mortality rate (PMR) 266 per 1000 live births (OR 7.74); neonatal intensive care (NIC) admissions 11.6 percent (OR 1.83); and low birth weight (LBW) (<2.5 kg) 12.19 percent (OR 1.89). Conclusion. Antenatal care and early recognition of danger signs in pregnancy as well as prompt referral and early institution of essential obstetrics care are important for maternal and infant survival

Comparison of cold water sponging and acetaminophen in control of fever among children attending a tertiary hospital in South Nigeria

Background: A wide range of childhood illnesses are accompanied by fever, leading to varied attempts at treatment by caregivers at home before coming to a hospital. Common modalities of treatment include use of antipyretics and physical methods such as cold water sponging, fanning and removal of clothing. These treatment modalities have been received with varied attitudes among physicians and the scientific community. This study was to assess the efficacy of both modalities in first-line management of fever in our area. Objectives: The main aim of the study is to compare the effectiveness of cold water sponging with that of oral paracetamol in the treatment of fever in children attending the University of Calabar Teaching Hospital, Calabar. Subjects and Methods: This is a randomized clinical trial. Eighty-eight children aged 12-120 months who presented to the Children Outpatient Clinic (CHOP) and the Children Emergency Room (CHER) of University of Calabar Teaching Hospital, Calabar, with acute febrile illness and axillary temperatures spanning ≥ 38.0-40.0°C. All children within the age limit whose caregivers gave consent were recruited into the study and were randomized to receive either cold water sponging or oral paracetamol. Axillary temperature, pulse rate, respiratory rate and assessment of discomforts (crying, shivering, goose pimples and convulsions) were recorded every 30 min for 2 h. The results were analyzed using the SPSS statistical software and have been presented in the tables. Results: Cold water sponging was very effective in temperature reduction within the first 30 min, with 29 (70.73%) having their temperature reduced to within normal limits. This declined to 12 (29.26%) at 60 min and 4 (10.53%) at 120 min, with the mean temperature differences from the baseline value following the same trends (1.63°C by 30 min, 0.91°C by 60 min and 0.39°C by 120 min). When compared with paracetamol, cold water sponging was more effective in temperature reduction within the first 30 min ( P = 0.000), with the difference in effect at 60 min less significant between these two groups ( P = 0.229). Paracetamol demonstrated a gradual and sustained reduction in temperature with the proportions of afebrile children in this group increasing from 7 (16.27%) at 30 min to 33 (78.57%) at 120 min. The mean temperature differences from the baseline value also showed the same trend. Children who received cold water sponging had more discomforts compared with those who received only oral paracetamol. Conclusions: It is concluded that cold water sponging, although producing rapid reduction in temperature compared with paracetamol, has effects that last only for a short time. Paracetamol on the other hand produces a gradual but sustained effect. The discomforts experienced should not be a limiting factor to the use of cold water sponging in reducing the body temperature of febrile children. Cold water sponging is safe and its use by mothers and primary caregivers should be encouraged while preparing to take the child to the nearest health facility for definitive treatment of the underlying cause of the fever