Health transition research in Nigeria in the era of the structural adjustment program

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Women's role in reproductive health decision making and vulnerability to STD and HIV/AIDS in Ekiti, Nigeria

An exploratory study of women’s role in reproductive decision making in Ekiti shows that women in the state are increasingly taking active decisions on matters affecting their daily lives. More women than ever before believed that they could take decisions on family size, when to have a baby and choice of spacing period. The cultural barrier against short postpartum abstinence appeared to have diminished and sex during lactation was not considered a major cultural and religious taboo. Knowledge of contraception has become universal in recent years, and the majority of women take decisions on the method and timing of family planning. All women who used family planning considered their decision in this regard very important. The ability of women to take decisions on these issues may not only enhance their bargaining power but also reduce their vulnerability to STDs including AIDS from diseased or high-risk partners

A note on suspect practices during the AIDS epidemic: vaginal drying and scarification in southwest Nigeria

Vaginal drying and scarification have been reported as possible risk factors. Published research on the former has been confined to East and Middle Africa. This paper reports on research in West Africa employing a survey of 1,976 females in southwest Nigeria, where they reported on their own vaginal drying, the scarification of their sons, and their participation in blood oaths. It was concluded that vaginal drying is not a risk-factor for AIDS in southwest Nigeria, and probably more broadly in West Africa, that scarification may be in the few cases when group scarification is practised, and that the practice of blood oaths probably puts those involved in danger

Intervention strategies suggested by the Nigerian segment of the SAREC program on sexual networking, STDs and AIDS

The primary purpose of this paper is to survey the behavioural findings of the Nigerian program and to draw conclusions about the most needed interventions, and those most likely to be successful, in combating sexually transmitted diseases and HIV/AIDS. The emphasis is on the reduction of transmission of these diseases, partly because the number of Nigerian AIDS cases is as yet much smaller than was feared when the research program began. The Nigerian program began in 1989. It has always had two components. The first is a field research program, largely but not entirely focused on Ondo State; it was originally based in the Faculty of Social Science, Ondo State University, Ado-Ekiti, and has since been transferred to the University's Centre for Population and Health Research. Parallel to this work, there had been developed a research program initiated by the West African Research Group on Sexual Networking (WARGSN). This Group has comprised 20 researchers based in 15 institutions, mostly in Nigeria and Ghana. Finally, the paper refers briefly to experience reported by the SAREC programs in Ghana and Uganda which have as yet no parallel in Nigeria, but which are important for a comprehensive examination of the situation

Men's sexual behaviour in urban and rural Southwest Nigeria: its cultural, social and attitudinal context

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The cultural, social and attitudinal context of male sexual behaviour in urban south-west Nigeria

From 1989 onward a research program based at Ondo State University, Nigeria, investigated the social and behavioural context of the sexually transmitted disease and AIDS epidemics (Orubuloye et al. 1994). Between 1989 and 1993 the researchers reached the conclusion that premarital and extramarital sexual activities were on a sufficient scale in Ondo State to maintain an STD epidemic and possibly to maintain an AIDS epidemic. The reason for caution with regard to AIDS arose from an awareness of the current relatively low seroprevalence levels in Nigeria and the demonstration by the program that much of the premarital and extramarital sexual activity was not with prostitutes but diffused more widely. The researchers also concluded that the economic returns to young women from commercial sex were so substantial and the current and later social sanctions so weak that no government intervention was likely to reduce the inflow of recruits to the occupation sufficiently to stem the STD epidemic or reduce the risk of a major AIDS epidemic. Clearly something would be achieved by a program aimed at increasing the practice of safe sex, especially the use of condoms, by everyone participating in sexual networking, particularly prostitution. There was little evidence that specific planned intervention was already achieving much, although some evidence that government and media AIDS publicity was raising the level of condom use in prostitution. There also seemed to be a need for STD education and curative interventions on a much greater scale. Nevertheless, until the achievement of decisive biomedical breakthroughs to halt the AIDS epidemic, the research increasingly suggested that the best chance of halting the AIDS epidemic and mitigating the impact of STDs was a change in male sexual behaviour

Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria

Truck drivers, female hawkers and prostitutes are generally regarded as high-risk groups because they have a high rate of partner change, run abnormally high risks of being infected with sexually transmitted diseases (STDs) including HIV/AIDS, and are capable of transmitting them to the general population who live around them (Orubuloye, Caldwell and Caldwell 1993; Orubuloye 1995). Recent experience has shown that the prison population runs a high risk of being engulfed by AIDS. By late 1992, HIV-positive prisoners had been detected in at least one of the prisons in Nigeria and there was beginning to be concern for the safety of the prison population. Therefore a study of the prison population was planned as part of a larger continuing research program of the Ondo State University, Ado-Ekiti, Nigeria, on Sexual Networking, STDs and HIV/AIDS Transmission, supported by a grant from the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The aim of the prison study was to investigate the attitudes and activities that are likely to facilitate the spread of sexually transmitted diseases, HIV and AIDS; and to develop an intervention program for the prison population and any population that may be in a similar situation

African families and AIDS : context, reactions and potential interventions

This paper reviews publications and research reports on how sub-Saharan African families have been affected by, and reacted to, the AIDS epidemic. The nature of the African family and its variation across the regions is shown to be basic to both an understanding of how the epidemic spread and of its impact. The volume of good social science research undertaken until now on the disease in Africa is shown to be extremely small relative to the need

African families and AIDS : context, reactions and potential interventions

This paper reviews publications and research reports on how sub-Saharan African families have been affected by, and reacted to, the AIDS epidemic. The nature of the African family and its variation across the regions is shown to be basic to both an understanding of how the epidemic spread and of its impact. The volume of good social science research undertaken until now on the disease in Africa is shown to be extremely small relative to the need

"I never had the money for blood testing" – Caretakers' experiences of care-seeking for fatal childhood fevers in rural Uganda – a mixed methods study

<p>Abstract</p> <p>Background</p> <p>The main killer diseases of children all manifest as acute febrile illness, yet are curable with timely and adequate management. To avoid a fatal outcome, three essential steps must be completed: caretakers must recognize illness, decide to seek care and reach an appropriate source of care, and then receive appropriate treatment. In a fatal outcome some or all of these steps have failed and it remains to be elucidated to what extent these fatal outcomes are caused by local disease perceptions, inappropriate care-seeking or inadequate resources in the family or health system. This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care.</p> <p>Methods</p> <p>A mixed methods approach using structured Verbal/Social autopsy interviews and in-depth interviews was employed with 26 caretakers living in Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. In-depth interviews were analysed using content analysis with deductive category application.</p> <p>Results</p> <p>Final categories of barriers to care were: 1) "Illness interpretation barriers" involving children who received delayed or inappropriate care due to caretakers' labelling of the illness, 2) "Barriers to seeking care" with gender roles and household financial constraints hindering adequate care and 3) "Barriers to receiving adequate treatment" revealing discontents with providers and possible deficiencies in quality of care. Resource constraints were identified as the underlying theme for adequate management, both at individual and at health system levels.</p> <p>Conclusion</p> <p>The management of severely ill children in this rural setting has several shortcomings. However, the majority of children were seen by an allopathic health care provider during the final illness. Improvements of basic health care for children suffering from acute febrile illness are likely to contribute to a substantial reduction of fatal outcomes. Health care providers at all levels and private as well as public should receive training, support, equipment and supplies to enable basic health care for children suffering from common illnesses.</p