New trends in under-five mortality determinants and their effects on child survival in Nigeria: A review of childhood mortality data from 1990-2008

Under-five mortality in Nigeria has been reported to be on the decline, but the dynamics are yet to receive adequate attention. Thus the main objective of this study was to assess these factors and quantify their relative contributions to under-five mortality between 1990 and 2008. The Nigeria Demographic and Health Survey data for 1990, 2003 and 2008 were re-analysed to assess the trends in determinants of under-five mortality.Cox Regression model was applied to determine the relative contributions of each factor to the under-five mortality risk.The results showed there were improvements in maternal education (8.6%), childhood vaccination (17.7%), use of oral rehydration therapy (13.9%) and medical treatment of childhood illnesses(17.5%) over the 19-year period. There were declines in proportions with birth interval less than 24months (3.9%), access to improved sources of drinking water (24.2%), improved toilet facilities (9.0%) antenatal care (4.5%), skilled delivery (3.0%) while maternal age at childbirth remained unchanged. These factors increased the death hazards by 4.6% between 1990-2003 but decreased them by 12% between 2003 and 2008. It was concluded that Nigeria has recorded very minimal improvements in birth spacing and antenatal/delivery care. Poor access to potable drinking water and sewage disposal, and short birth intervals,are among the factors fueling childhood mortality risks. Further improvements in these environmental and health practices as well as other factors are recommended as strategies for promoting child survival in Nigeria

Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria

Objective : To assess treatment outcomes and determinants of outcome among tuberculosis patients. Design : A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. Setting : Tuberculosis treatment centers in Ibadan, Nigeria Results : A total of 1,254 patients were followed up with a mean age of 35.0\ub13.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P< 0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively. The mean age of cured patients was 31.2\ub13.1 years, which was significantly lower than the mean age of those with poor treatment outcomes (36.7\ub13.5 years; P< 0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with a good knowledge. Conclusion : Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment

Risk factors for road traffic accidents among drivers of public institutions in Ibadan, Nigeria

Recent studies have shown an increase in the rate of road traffic accident (RTA). Identifying the risk factors for this problem may provide a clue to possible effective intervention. This study aimed to determine the prevalence and risk factors for self reported RTA among drivers of educational institutions and make suggestions to promote safer driving. A cross sectional population study of motor vehicle drivers from the College of Medicine, University of Ibadan and University College Hospital (UCH) Ibadan was undertaken between December 2003 and January 2004. The study comprised of 99 motor vehicle drivers. 67 (67.7%) were from the College of Medicine, and 32 (32.3%) from the UCH. Response rate was 97.1%. All were males, aged 38 to 60 years, mean 50.1 \ub1 (SD= 4.8 years). The prevalence of self reported RTA was 16.2%. The cause of road traffic accidents included, mechanical fault (50%), bad road (12.5%). RTA prevalence was higher among older drivers (OR=1.7, 95%CI=0.5-5.9; P>0,05), drivers who had part time jobs (Odds ratio 2.6, 95% CI 1.1-6.3; X2 =4.5, P=0.03), and drivers with visual impairment (OR=1.6, 95% CI=0-9, X2 0.49, P > 0.05). The prevalence of RTA was lower amongst drivers who did not take alcohol, cola nut and other CNS stimulants while driving (OR 0.9, 95% CI=0.3-2.3, P >0.05). Regular maintenance of official vehicles and examination of drivers\u2019 eyes are recommended. Drivers should be discouraged from drugs and part jobs so as to ensure that they have enough time to rest and therefore prevent fatigue related RTA

Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria

<p>Abstract</p> <p>Background</p> <p>Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine.</p> <p>Methods</p> <p>Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers ("mother trainers") in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. "Mother trainers" disseminated the educational messages about malaria and the use of the guideline to their communities.</p> <p>Results</p> <p>Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4%) of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p < 0.005). Mothers considered the guideline to be explicit and useful. Mother trainers were also considered to be effective and acceptable.</p> <p>Conclusion</p> <p>The use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.</p

Oral contraceptive marketing in Ibadan, Nigeria

The demographic transition in Nigeria is gradually moving towards the second stage. There is clear evidence of a declining mortality but the fertility rate remains exceptionally high. A realistic approach towards reducing fertility rate is the use of oral contraceptive. This study assesses the distribution system of oral contraceptive in Ibadan, the second largest city in Nigeria. The findings revealed that the people are aware of modern oral contraceptives as they purchase them freely at chemist shops. But effective distribution is hampered by existing channels and high costs. A local source recommended is the proprietary medicine stores, often at convenient locations to the potential users of contraceptives. The current cost which is between $1.3 and$19.5 per couple-years of protection is exorbitant, consuming 0.5-7.8% of the gross annual income of the average individual. Therefore, the government should subsidize the prices of oral contraceptives, to facilitate freedom from the tyranny of excessive fertility.fertility rate contraceptives distribution costs

Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria

Background: In view of sociocultural norms surrounding marriage and childbearing in South West Nigeria, fertility desire may be stronger among remarried women living with HIV. This article describes the characteristics of remarriage and its relationship to fertility desire.Method: A cross-sectional study was conducted among HIV-positive women aged 18–49 years at the Antiretroviral Treatment (ART) clinic, College of Medicine/University College Hospital, Ibadan, Nigeria between November and December 2015. Data were analysed using descriptive statistics and generalised linear models.Results: Overall, 123 (17.3%) of 711 women had experienced remarriage. Significant factors among remarried women were a lack of formal education (ORadj = 3.35, CI: 1.46–7.72); polygamous family (ORadj = 2.65, CI: 1.71–4.12), and serodiscordant union (ORadj = 1.97, CI: 1.14–3.41). Fertility desire was expressed by 410 women (57.7%). After controlling for demographic, socio-economic, and HIV-care characteristics, remarried women were 2.5 times as likely to have fertility desire compared to their counterparts who never remarried (ORadj = 2.49, CI: 1.43–4.33). Younger age was significantly associated with higher odds of fertility desire. Other factors negatively associated with fertility desire were education (ORadj = 0.30, CI: 0.12–0.74) and number of surviving children (ORadj = 0.28,CI: 0.22–0.34).Conclusion: HIV-care and treatment programmes need to pay attention to reproductive concerns, especially among women in second and higher order marriages. Keywords: childbearing, fertility intention, HIV/AIDS, marital dissolution, marriage orde

Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria

Objective : To assess treatment outcomes and determinants of outcome among tuberculosis patients. Design : A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. Setting : Tuberculosis treatment centers in Ibadan, Nigeria Results : A total of 1,254 patients were followed up with a mean age of 35.0±3.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P< 0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively. The mean age of cured patients was 31.2±3.1 years, which was significantly lower than the mean age of those with poor treatment outcomes (36.7±3.5 years; P< 0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with a good knowledge. Conclusion : Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment

Risk factors for road traffic accidents among drivers of public institutions in Ibadan, Nigeria

Recent studies have shown an increase in the rate of road traffic accident (RTA). Identifying the risk factors for this problem may provide a clue to possible effective intervention. This study aimed to determine the prevalence and risk factors for self reported RTA among drivers of educational institutions and make suggestions to promote safer driving. A cross sectional population study of motor vehicle drivers from the College of Medicine, University of Ibadan and University College Hospital (UCH) Ibadan was undertaken between December 2003 and January 2004. The study comprised of 99 motor vehicle drivers. 67 (67.7%) were from the College of Medicine, and 32 (32.3%) from the UCH. Response rate was 97.1%. All were males, aged 38 to 60 years, mean 50.1 ± (SD= 4.8 years). The prevalence of self reported RTA was 16.2%. The cause of road traffic accidents included, mechanical fault (50%), bad road (12.5%). RTA prevalence was higher among older drivers (OR=1.7, 95%CI=0.5-5.9; P>0,05), drivers who had part time jobs (Odds ratio 2.6, 95% CI 1.1-6.3; X2 =4.5, P=0.03), and drivers with visual impairment (OR=1.6, 95% CI=0-9, X2 0.49, P > 0.05). The prevalence of RTA was lower amongst drivers who did not take alcohol, cola nut and other CNS stimulants while driving (OR 0.9, 95% CI=0.3-2.3, P >0.05). Regular maintenance of official vehicles and examination of drivers’ eyes are recommended. Drivers should be discouraged from drugs and part jobs so as to ensure that they have enough time to rest and therefore prevent fatigue related RTA