Health status of children aged under two years cared for in day-care centres and the home environment in Ibadan, Nigeria

Background: As a result of the increasing numbers of Nigerian women in the labour force and also the gradual disintegration of the extended family system, a demand for alternative means of caring for children is being created. Day-care as an alternative source of childcare has now become a necessity rather than an option. Objectives: To assess and compare the health status of two groups of children under two years old cared for in two different rearing environments, home environment and day-care centres. Methods: A descriptive comparative study design was used. Two groups of children from comparable low socio-economic backgrounds were recruited into the study. Using simple random sampling, 91 under two-year old children attending day-care centres in a middle-high density area of Ibadan and 91 under two-year old children cared for in the home environment in a settlement in the junior staff quarters of the University of Ibadan were enrolled in the study. Anthropometric data, immunisation status and morbidity patterns for various childhood illnesses were obtained for children in both groups in the study. Results: Statistically insignificant higher percentages of children cared for in the day-care centres were underweight and wasted, while significantly more children cared for at home were stunted {Relative risk RR=1.46, (95% Confidence Limit CL = 1.10-1.93), p=0.018}. Except for measles immunisation coverage which was lower in the day-care group, there was comparability in the immunisation status of children in both groups. Day-care attendance was found to be a significant risk factor associated with the occurrence of diarrhoea (RR=1.74, (95% CL =1.34-2.26), p=0.0016) and upper respiratory tract infections (RR=2.31, (95% CL = 1.62-3.30), p=0.0000004) in these children. Measles occurred only in children attending day-care centres and there was an outbreak during the study period. Conclusions: Given the higher risk of infections among children cared for in day-care centres, strategies should be put in place to train the child minders and ensure regular supervision of the Keywords: day-care, home environment, health status immunisation status, morbidity pattern, under two-year old childJournal of Community Medicine and Primary Health Care 2005, 17(1): 33-3

Barriers to use of modern contraceptives among women in an inner city area of Osogbo metropolis, Osun State, Nigeria

EO Asekun-Olarinmoye,1 WO Adebimpe,1 JO Bamidele,2 OO Odu,2 IO Asekun-Olarinmoye,3 EO Ojofeitimi41Department of Community Medicine, Faculty of Clinical Sciences, Osun State University, Osogbo, Osun State, Nigeria; 2Department of Community Medicine, Faculty of Clinical Sciences, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria; 3Department of Community Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria; 4Department of Community Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, NigeriaObjectives: To determine the knowledge and attitudes on modern contraceptive use of women living in an inner city area of Osogbo.Materials and methods: Three hundred and fifty nine women of childbearing age were studied utilizing a community-based, descriptive, cross-sectional study design. A multistage random sampling technique was used in recruiting respondents to the study. A four-part questionnaire was applied dually, by interviewers and by respondents' self administration, and the data was analyzed using the SPSS software version 17.0.Results: The mean age of respondents was 28.6 ± 6.65 years. The majority (90.3%) of respondents were aware of modern methods of family planning (FP), 76.0% claimed awareness of where to obtain FP services, and 74.9% knew of at least five methods. However, only 30.6% had ever used contraceptives, while only 13.1% were current users. The most frequently used method was the male condom. The commonly perceived barriers accounting for low use of FP methods were fear of perceived side effects (44.0%), ignorance (32.6%), misinformation (25.1%), superstition (22.0%), and culture (20.3%). Some reasons were proffered for respondents' nonuse of modern contraception. Predictors of use of modern contraceptives include the awareness of a place of FP service provision, respondents' approval of the use of contraceptives, higher education status, and being married.Conclusion: Most of the barriers reported appeared preventable and removable and may be responsible for the reported low point prevalence of use of contraceptives. It is recommended that community-based behavioral-change communication programs be instituted, aimed at improving the perceptions of women with respect to bridging knowledge gaps about contraceptive methods and to changing deep-seated negative beliefs related to contraceptive use in Nigeria.Keywords: childbearing age, family planning, fertility desires, perception, knowledge, attitude, benefit

Sexual assault against women at Osogbo Southwestern Nigeria

Background: Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available.Objective: To review the patterns of sexual violence against women treated at the hospital over a 7‑year period.Materials and Methods: Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test.Results: Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis.Conclusion: Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.&#160

Treatment Outcomes among Human Immunodeficiency Virus and Tuberculosis Co-Infected Pregnant Women in Resource Poor Settings of South-western Nigeria

The complex interactions between Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) infections may be magnified, in the presence of another potentially stressful condition like pregnancy. Though co-infection among pregnant women is rare, treatment outcomes may depend on accessibility to comprehensive treatment modalities. The objective of this study is to determine treatment outcomes among pregnant HIV and TB co-infected pregnant women in Lagos, South-western Nigeria. This retrospective, analytical study was carried out among ninety four (94) eligible pregnant women co-infected with HIV and TB at selected health-care facilities in Lagos state between January, 2008 and December, 2009. A standard checklist for data collection was used and analysis was carried out using the EPI info software. Mean age of respondents was 30.8 (±3.9) years. Sixteen (17.1%) TB cases were clinically diagnosed for tuberculosis. Among tuberculosis cases identified through sputum microscopy, 60(63.8%) were acid fast bacilli (AFB) positive and 21(22.3%) were identified in the first trimester. The mean percentage adherence to anti-retroviral drugs was 95.9% (±5.3). None of the participant smoked cigarette. Seventy three {73 (77.7%)} had contact with TB infected or suspected person in the last three months. Treatment outcome in mother showed that 74(78.7%) were cured, 8(8.5%) relapsed while 12 (12.8%) had treatment failures. Among the babies, 83(88.3%) were born alive. Women with both poor adherence (<90%) and with positive TB contact, but neither factor alone, were half-fold less likely to be cured compared with women with both good adherence (>95%) and no TB contact (OR=0.59, CI=0.45-0.95 and p=0.014). Cure rate was substantially lower in this study. This calls for extra strategies such as routine TB screening in antenatal clinics, strict adherence to national guidelines in the treatment of HIV/TB co-infections, focused antenatal care and comprehensive Prevention of Mother to Child Transmission (PMTCT) care and treatment

Prevalence of hypertension in the rural adult population of Osun State, southwestern Nigeria

EO Asekun-Olarinmoye,1 PO Akinwusi,2 WO Adebimpe,1 MA Isawumi,3 MB Hassan,3 OA Olowe,4 OB Makanjuola,4 CO Alebiosu,2 TA Adewole51Department of Community Medicine, 2Department of Medicine, 3Department of Surgery, 4Department of Microbiology, 5Department of Chemical Pathology, College of Health Sciences, Osun State University, Osogbo, Osun State, NigeriaBackground: The purpose of this study was to determine the prevalence of hypertension in two rural communities of Osun State, Nigeria.Methods: A consenting adult population of the Alajue and Obokun rural communities in southwestern Nigeria that presented for the screening exercise participated in this community-based cross-sectional descriptive study. Two hundred and fifty-nine respondents aged older than 18 years completed a standardized, pretested, structured questionnaire as part of activities celebrating World Kidney Day and World Glaucoma Day in 2011. Anthropometric data and blood pressure were recorded, and the data were analyzed using the Statistical Package for Social Sciences version 17.Results: The mean age of the respondents was 49.7 &plusmn; 1.6 years, 100 (38.6%) were males, 84 (32.4%) were farmers, and 111 (42.9%) were traders. The prevalence of hypertension was 13.16% (present in 34 respondents). Seventeen (6.6%) had isolated systolic hypertension, while 11 (4.2%) had isolated diastolic hypertension. Two hundred and thirty-six (91.1%) undertook daily exercise lasting at least 30 minutes and 48 (18.5%) had ever taken antihypertensive drugs on a regular basis. Four respondents (1.6%) claimed a family history of hypertension. The average body mass index (BMI) among respondents was 23.4 &plusmn; 4.9 kg/m2, 51 (19.6%) had a BMI of 25.0&ndash;29.9, and 30 (11.5%) had a BMI &ge; 30. A significant association existed between age older than 40 years and having hypertension (P < 0.05), while no relationship existed between age and BMI or between gender and hypertension (P > 0.05). Rates of older age and high BMI were significantly higher among hypertensives than among normotensives. Respondents with BMI < 25 had at least a three times greater likelihood of developing hypertension than those with BMI < 25 (odds ratio 2.9, 95% confidence interval 0.007&ndash;0.056, P = 0.011).Conclusion: The prevalence of hypertension is high in this study population and we recommend scaling up primary prevention efforts to reduce this in Nigerian communities.Keywords: prevalence, hypertension, anthropometry, body mass index, rural communit

Neonatal tetanus in Turkey; what has changed in the last decade?

dikici, bunyamin/0000-0001-7572-6525WOS: 000259222800001PubMed: 18713452Background: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination

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

Provider and lay perspectives on intra-uterine contraception: a global review

BACKGROUND: Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion. METHODS: A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications. RESULTS: Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes. CONCLUSION: Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

Effect of mass media and Internet on sexual behavior of undergraduates in Osogbo metropolis, Southwestern Nigeria

Olusesan S Asekun-Olarinmoye,1 Esther O Asekun-Olarinmoye,2 Wasiu O Adebimpe,2 Akin G Omisore21Department of Mass Communication, Babcock Business School, Babcock University, Ilisan-Remo, Ogun State, Nigeria; 2Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Osun State University, Osogbo, Osun State, NigeriaIntroduction: The influence of media portrayals of sexual attitudes and normative expectations of young people at a critical developmental stage is of public health concern.Objectives: To examine the role of mass media and Internet utilization in shaping the sexual health attitudes and behaviors of young undergraduates in Osogbo metropolis, Osun State, Nigeria.Materials and methods: In a descriptive cross-sectional study, 400 undergraduates were selected using a multistage random sampling technique. Four hundred and fifty pretested, semistructured questionnaires were distributed; of these, 400 were returned properly filled. Data were analyzed using SPSS statistical software version 16.Results: Mean age of respondents &plusmn; standard deviation was 23.6&plusmn;2.99 years. Most were aware of the various forms of mass media (&gt;95%). Most (64.0%) respondents spent 1&ndash;5 hours watching television, daily, and most used the Internet often. About 38.3% and 24.2% of respondents used the Internet and radio/television, respectively, as sources of information on sexual issues. Most respondents used the Internet for school assignments (83.0%, n=332), electronic mail (89.0%, n=356), and for accessing sexually explicit materials (74.5%, n=298). Most of the respondents (73.5%) opined that the Internet has a bad influence on youths&#39; sexual behavior, although accessing the Internet for sexual material or movies was acceptable to 25.3% of them. Of the 226 respondents who had ever had sex, 226 (100%), 37 (16.4%), 31 (13.7%), and 10 (4.4%) practiced coitus, oral sex, masturbation, and anal sex, respectively; 122 (54.0%) always used condoms, whereas 90 (40.0%) never used condoms during sexual activity; 33 (14.6%) had had sex with commercial sex workers. Further analysis showed that those who were yet to marry (single) were less likely to be sexually experienced than those who were married (adjusted odds ratio [AOR] =0.075, 95% confidence interval [CI] =0.008&ndash;0.679), and those who said accessing the Internet for sexual material is not acceptable to them were also less likely to be sexually experienced than those to whom it was acceptable (AOR =0.043, 95% CI =0.016&ndash;0.122). Predictors of having multiple sexual partners include the sex of the respondent and the frequency of Internet use, with females (AOR =0.308, 95% CI =0.113&ndash;0.843) and those who rarely use the Internet less likely to have multiple sexual partners.Conclusion: We conclude that uncontrolled exposure to mass media and Internet could negatively influence the sexual patterns and behavior of youths.Keywords: mass media, Internet, sexual behavior, undergraduate