Seroprevalence survey of rubella infection in pregnancy at the University of Benin Teaching Hospital, Benin City, Nigeria

Objective: To determine the serosusceptibility of rubella infection in pregnancy and the feasibility of establishing an organized prevention program in a tertiary hospital in Nigeria.Materials and Methods: This prospective, cross-sectional, laboratory-based study involved 300 consecutive pregnant women who gave informed consent and were screened for rubella immunoglobulins G (IgG) and M (IgM), using the ELISA-based quantitative assay at the University of Benin Teaching Hospital, Nigeria. Of the cohort, 30 women later withdrew. IgG seropositive samples were screened for IgM antibodies.Results: The mean age and parity of the women were 30.0 ± 4.8 years, 95% CI 29.727-30.873 and 2.0 ± 1.4; 95% CI 1.317-1.661, respectively. IgG seroprevalence was 53%, while 10.0% of all IgG seropositive women were IgM seropositive. Most infections were acquired before the age of 35. None of the women ever had previous rubella vaccination. Rubella vaccine is scarce in Nigeria.Conclusions: Prevalence of rubella seromarkers for previous and current infection is high. Facilities for routine diagnosis and vaccination are lacking. Initiation of organized screening and vaccination programs is limited by lack of vaccine. We recommend immunization of children and women of child-bearing age as a cost-effective public health intervention strategy for managing the sequelae of the congenital rubella syndrome

Female-Led agrarian households and the question of sustainable land and food security in an emerging economy: Evidence from Tula Baule

Purpose: This study examines the nexus between land tenure security (LTS) and food security (FS) in female-led households of Tula Baule agrarian settlements. Design/Methodology/Approach: The study used a qualitative research design based on the constructivist paradigm. The researchers conducted in-depth interviews with female household heads cutting across the three “yaati” (villages) of Tula Baule. Analysis of data collected from the interviews was done employing transcriptions, creating semantic networks and utilising thematic content analysis. Findings: The study revealed that all but a few respondents believed that they had LTS based on “Feloh's” (ancestral gods') supremacy without recourse to documentary evidence of ownership. Similarly, all but a few participants do not have access to three square meals per day throughout the study period. The study also found a strong relationship between LTS and FS in the study area. Participants indicated a lack of motivation to invest in farms that lack LTS, consequently affecting their agricultural productivity and FS. Practical implication: It provides an empirical base to equip policymakers with valuable information for policies relating to females' access to land and food in agrarian settlements. Originality/value: This study is the first to empirically analyse land and food security in female-led agrarian households of Tula Baule in an eclectic context

Analyzing the Dynamics of Residential Properties’ Rent in Ede, Nigeria

Rental movement is an important parameter in real estate investment and can influence the supply of rental accommodations in the property market. This study empirically analyzed the trend in rents and growth rates of five residential property categories comprising tenement room, one room self-contained, room and parlour self-contained, two bedroom flat and three bedroom flat to determine the property with highest trend and growth rate; and whether the growth rates across the five property categories differ significantly in the study area between 2002 and 2017. The study utilized residential properties’ annual rent as primary data.  The primary data was collected through questionnaire administered on landlords who rented their properties within the study period and comprised rental values of five residential property categories between 2002 and 2017. Descriptive and inferential statistical techniques such as frequency table, chart, ANOVA and linear regression were used to analyze the data collected. The results revealed that annual rental values of all the selected residential properties maintained upward trend over the period studied. Three bedroom flat had the highest trend in rent and highest R2 value (0.89) implying it is the property whose rental values can be most ascertained with each successive year under study. The findings furthermore revealed that the average yearly growth rates of the selected residential properties ranged from 17.01% to 20.83% during the study period with three bedroom flat having the highest growth rate. The ANOVA result however suggested that the mean rental growth rates across the selected residential property categories at 95% confidence level were not significantly different F (4, 70) = 0.345 P = .847 > .05. This study brings to fore the localized rental income levels and the impacts they have on rental growth rates, which is necessary in the process of understanding investment returns in the residential submarket

Community involvement in obstetric emergency management in rural areas: a case of Rukungiri district, Western Uganda

<p>Abstract</p> <p>Background</p> <p>Maternal mortality is a major public health problem worldwide especially in low income countries. Most causes of maternal deaths are due to direct obstetric complications. Maternal mortality ratio remains high in Rukungiri district, western Uganda estimated at 475 per 100,000 live births. The objectives were to identify types of community involvement and examine factors influencing the level of community involvement in the management of obstetric emergencies.</p> <p>Methods</p> <p>We conducted a descriptive study during 2nd to 28th February 2009 in rural Rukungiri district, western Uganda. A total of 448 heads of households, randomly selected from 6/11 (54.5%) of sub-counties, 21/42 (50.0%) parishes and 32/212 (15.1%) villages (clusters), were interviewed. Data were analysed using STATA version 10.0.</p> <p>Results</p> <p>Community pre-emergency support interventions available included community awareness creation (sensitization) while interventions undertaken when emergency had occurred included transportation and referring women to health facility. Community support programmes towards health care (obstetric emergencies) included establishment of community savings and credit schemes, and insurance schemes. The factors associated with community involvement in obstetric emergency management were community members being employed (AOR = 1.91, 95% CI: 1.02 - 3.54) and rating the quality of maternal health care as good (AOR = 2.22, 95% CI: 1.19 - 4.14).</p> <p>Conclusions</p> <p>Types of community involvement in obstetric emergency management include practices and support programmes. Community involvement in obstetric emergency management is influenced by employment status and perceived quality of health care services. Policies to promote community networks and resource mobilization strategies for health care should be implemented. There is need for promotion of community support initiatives including health insurance schemes and self help associations; further community sensitization by empowered community based resource persons rather than health workers and improvement in quality of health care can contribute towards effective management of obstetric complications.</p

Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change

The burden of maternal mortality in resource limited countries is still huge despite being at the top of the global public health agenda for over the last 20 years. We systematically reviewed the impacts of interventions on maternal health and factors for change in these countries. A systematic review was carried out using the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles published in the English language reporting on implementation of interventions, their impacts and underlying factors for maternal health in resource limited countries in the past 23 years were searched from PubMed, Popline, African Index Medicus, internet sources including reproductive health gateway and Google, hand-searching, reference lists and grey literature. Out of a total of 5084 articles resulting from the search only 58 qualified for systematic review. Programs integrating multiple interventions were more likely to have significant positive impacts on maternal outcomes. Training in emergency obstetric care (EmOC), placement of care providers, refurbishment of existing health facility infrastructure and improved supply of drugs, consumables and equipment for obstetric care were the most frequent interventions integrated in 52%-65% of all 54 reviewed programs. Statistically significant reduction of maternal mortality ratio and case fatality rate were reported in 55% and 40% of the programs respectively. Births in EmOC facilities and caesarean section rates increased significantly in 71%-75% of programs using these indicators. Insufficient implementation of evidence-based interventions in resources limited countries was closely linked to a lack of national resources, leadership skills and end-users factors. This article presents a list of evidenced-based packages of interventions for maternal health, their impacts and factors for change in resource limited countries. It indicates that no single magic bullet intervention exists for reduction of maternal mortality and that all interventional programs should be integrated in order to bring significant changes. State leaders and key actors in the health sectors in these countries and the international community are proposed to translate the lessons learnt into actions and intensify efforts in order to achieve the goals set for maternal health

Empowering members of a rural southern community in Nigeria to plan to take action to prevent maternal mortality: a participatory action research project

Aims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioInterventions to prevent maternal deaths should include community empowerment to have better understanding of their circumstances as well as their collaboration with health professionals

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Traditional Belief Systems and Maternal Mortality in a Semi-Urban Community in Southern Nigeria

Many factors are implicated in the poor maternal health condition in sub-Saharan Africa. Among the more popular focus are weak political and financial commitment, deteriorating institutional infrastructure, rapid population growth rates, pervasive poverty, and gender inequalities. Because of these and other related problems, pregnant women often face dangers, especially in emergencies. In a study conducted in Ekpoma, a semi-urban community in Edo State of southern Nigeria, it became evident that traditional beliefs and practices contribute immensely to the poor health status of pregnant women. These beliefs and practices are outlined in this study and possible ways out of the identified problems suggested. There is the need for a thorough investigation of extra medical factors in the design of any medical intervention program. A broader definition of maternal health, in line with the proposals of the global Safe Motherhood Initiative, is advocated. (Afr J Reprod Health 2001; 5[1]: 75-82) RÉSUMÉ Le Système de croyances traditionnelles et la mortalite maternelle dans une communauté semi-urbaine au sud du Nigéria. Beaucoup de facteurs sont impliqués dans la mauvaise santé maternelle en Afrique sub-saharienne. Parmi les raisons les plus communes sont un faible engagement politique financier, une infrastructure institutionnelle qui se dégrade, les taux de croissance de la population rapides, une pauvreté envahissante et les inégalités entre hommes et femmes. A cause de ces problèmes et ceux qui y sont liés, les femmes enceintes font face aux dangers surtout dans les cas d'urgence. Dans une étude effectuée à Ekpoma, une communauté semi-urbaine dans l'Etat d'Edo au sud du Nigéria, il est devenu évident que les croyances et les pratiques traditionnelles contribuent en grande mesure à la mauvaise santé des femmes enceintes. Un aperçu de ces croyances et pratiques est donné dans cette étude et les manières qui permettront probablement de résoudre les problèmes identifiés ont été proposées. Il est nécessaire d'entreprendre une enquête compréhensive sur les facteurs extra-médicaux quant au dessein de n'importe quel programme d'intervention médicale. Une définition plus large de la santé maternelle qui correspond aux propositions de l'initiative globale de la maternité sans risque est préconisée. (Rev Afr Santé Reprod 2001; 5[1]: 75-82

\"He Does his own and Walks Away\"Perceptions About Male Attitudes and Practices Regarding Safe Motherhood in Ekiadolor, Southern Nigeria

The main study objectives were to highlight male attitudes and practices regarding safe motherhood, and to demonstrate the usefulness of qualitative research methods in studying behaviour-related health problems. The setting was Ekiadolor, a semi-urban Nigerian community with an under-resourced district hospital. The study design was a qualitative research, using Focus Group Discussions (FGDs) with females and the local hospital staff as participants, triangulated with Free Listing Interviews (FLIs) and group interviews of males. The FGD findings showed a consensus that male practices and attitudes were generally unsatisfactory, as exemplified by physical violence against females, delay in enabling access to emergency obstetric care and a general perception that males were uncaring. However, many males paid parts of their partners\' routine obstetric care bills. These findings were largely corroborated and enriched by those of the FLIs and group interviews, albeit with differing emphases; they provided vital inputs into health education of the community males. In conclusion, the wide range of attitudes and practices described, and the socioeconomic settings in which they occur, pose challenges and opportunities for behaviour change interventions primarily targeting males, poverty reduction and health service reforms. Health researchers are challenged to draw from the varied strengths of qualitative research methods. \"IL FAIT LE SIEN ET IL S\'EN VA\". Perceptions à l\'égard des attitudes et des pratiques des hommes concernant la maternité sans danger à Ekiadolor, au sud du Nigéria Les objectifs principaux de l\'étude étaient de mettre l\'accent sur les attitudes et les pratiques des hommes concernant la maternité sans danger et de démontrer les bénéfices des méthodes de la recherche qualitative dans l\'étude des problèmes de santé liés au comportement. Le cadre était Ekiadolor, une communauté semi-urbaine nigériane qui dispose d\'un hôpital régional qui ne dispose pas de ressources nécessaires. La conception de l\'étude était une recherche qualitative, à l\'aide des Discussions à Groupe Cible (DGC) ayant les femmes et le personnel local de l\'hôpital comme participants, triangulé avec les interviews libres (IL) et les interviews en groupe pour les hommes. Les résultats du DGC ont montré un consensus sur le fait que les pratiques et les attitudes des hommes étaient dans l\'ensemble peu satisfaisantes, comme elles ont été manifestées par la violence physique contre les femmes, le retard par rapport à l\'accès aux soins obstétriques d\'urgence et une perception générale que les hommes sont insensibles. Néanmoins, beaucoup d\'hommes ont payé une partie des facteurs de routine de leurs partenaires pour les soins obstétriques. Ces résultats ont été largement corroborés et enrichis par ceux des ILs et des interviews en groupes, quoique avec des accents différents; ils ont donné des apports importants à l\'éducation de la santé des hommes dans la société. En conclusion, les grandes varieties d\'attitudes et des pratiques décrites et les cadres socio-économiques dans lesquels elles se présentment, posent des défis et des opportunités pour des intervention dans les modifications dans le comportement qui visent essentiellement les cibles masculins, la réduction de la pauvreté et les réformes des services de santé. Les chercheurs dans le domaine de la santé sont défiés de profiter des divers points forts des méthodes de la recherche qualititative. Keywords: Safe motherhood; male attitudes and practices; Focus Group Discussion; Free Listing Interview; Nigeria African Journal of Reproductive Health Vol. 11 (1) 2007: pp. 76-8