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

Effect of Fermentation on the Anti-Nutritional Factors and

The effect of fermentation on the anti-nutritional factors and mineral composition of melon seed varieties for Ogiri production was studied. Melon seed varieties such as Citrullus vulgaris, Citrulluslanatus, Colocynthiscitrullus, Cucurbita pepo, Cucurmeropisedulis were respectively sorted, washed, boiled wrapped seed were then boiled again for 2 hours, drained, cooled and allowed to ferment naturally for 86 hours (primary fermentation). The primary fermented sees were then pounded and wrapped in little portions with “ofoala” leaf (Icacinatrichantha olive) and kept in wire mesh near a heat source for another 144 hours (secondary fermentation). Samples were drawn from the raw, boiled and fermented melon seed varieties for the quantitative analysis of mineral content and anti-nutritional prepared with the raw and primary fermented samples. Raw seed of Citrulluslanatus had the highest mineral analysis showed a decline in the boiled samples and secondary fermented sample, compared with the raw and mineral composition ranging from potassium, magnesium, cacium, iron and zinc of 1.21, 1.06, 0.89, 0.45 and 0.41mg/100g respectively followed by raw Citrullus Vulgaris with potassium, magenesium, calcium, iron and zinc of 1.18, 1.02, 0.55, 0.44 and 0.38 mg/100g respectively and 1.11, 0.94, 0.81, 0.38 and 0.31 mg/100gof potassium, magenesium, calcium, iron and zinc respectively in the primary fermented product. Statistical analysis of anti-nutrients revealed a significant reduction (p<0.05) in all the processed melon. There was a significant difference in all the processed melon with lowest anti-nutrient content ranging from alkaloid, saponin, HCN, phytate, tannin and flavonoid (0.00, 0.00, 0.00, 0.00, 0.03and 0.09 respectively) and Colocynthiscitrullus had the highest anti-nutrient content in the secondary fermentation. Keywords:Fermentation, anti-nutritional factors, Ogiri, mineral content,melon seed varieties

Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.

Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period. Methods: A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17. Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TBHIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%. Conclusion: Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important

International Journal of Research in Arts and Social Sciences

Abstract Whenever Christianity is professed, there is a constant dialectic arising from its relationship with the cultural presupposition and practices of the cultures where it is located. A philosophical look at the Christianization of Igboland shows that the response of the Igbo to Christianity has been as interesting as it is ambivalent. On one score, there is the success story of the phenomenological movement of the vast majority of Igbo population to Christianity. Church buildings and related institutions have displaced former sites of powerful local deities and reserved sacred places, forest and groves. However, turning to the other side of the coin, one finds a bewildering array of ambivalent practices, a mix-up of Christian elements and traditional religious beliefs and practices among professing Igbo Christians. Guidance through dreams and visions, miraculous healing, prayer that expects immediate and concrete answers, and so on now constitute the main features of Igbo Christian practices. Critics had condemned this form of Christianity as "neo paganism" or syncretism. However, this paper has reflected on the nature of syncretism and its meaning in Igbo situation and concluded that what obtains in Igboland is a synthesis

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

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

No Abstrac

Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria

Abstract Background Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. Methods The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8–10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs. Results The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073–0.986) and number of children (OR: 1.196, p < 0.01,CI: 1.563–7.000) were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244–2.164) and age (OR: 0.115, p < 0.001, CI: 0.838–0.948) determined better use of delivery and family planning services respectively. Conclusions Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality. Behavioral change programs with high local content need to be implemented within rural areas especially among younger, illiterate women

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