An exploration of male participation in a PMTCT programme in West Itam, Akwa Ibom State, Nigeria

Magister Public Health - MPHSince the introduction in 2005 of prevention of mother-to-child transmission of HIV (PMTCT) services in Akwa Ibom State in Nigeria the PMTCT programme has faced several challenges including that of poor male participation in the PMTCT programme. To date no research has focused on the issue of male participation in PMTCT programmes in Akwa Ibom State, and there is thus a limited understanding of why so few male partners of HIVpositive pregnant women participate in the State's PMTCT programme. It is therefore important to explore the factors affecting male involvement in PMTCT programmes in Akwa Ibom State, so that strategies can be put in place to help improve the overall health of their families and themselves. The overall aim of the study was thus to explore the factors affecting male participation in the PMTCT programme at a primary health care center in West Itam, Akwa Ibom State, in Nigeria. This explorative study was conducted using a descriptive qualitative research approach. The research study approach helped to understand the perspectives of the male partners of HIV positive pregnant women who received the PMTCT intervention, as well as key informants in the Primary Health Care (PHC) facility where these PMTCT services are offered. The study population consisted of all males living within the catchment area of the West Itam PHC, Akwa Ibom State, Nigeria. In the research study, 11 men were purposively sampled: five of whom were the partners of HIV-positive women who had attended, or were currently attending the PMTCT services at the West Itam PHC with their partner. The other six interviewees were local male community members – who would be eligible to potentially accompany their partner to PMTCT services at the facility. The data was collected through individual, in-depth interviews with the male partners and community members using a semi-structured interview guide. One focus group discussion (FGD) was conducted with key personnel working in the West Itam PHC using a semistructured interview guide. All interviews and the FGD were tape-recorded and transcribed. Thematic analysis was used to analyse the data. Ethical approval was first obtained from the UWC Research Ethics Committee and the Ethics Committee of the Akwa Ibom State Ministry of Health before proceeding with the study. From this study, it is suggested that most of the respondents knew that PMTCT services are offered at the PHC West Itam. They knew their partner's next antenatal appointment, but only very few accompany their pregnant partners to the antenatal clinic. The striking reason being a lack of time/being busy. The key means of support of the partners' antenatal visits was giving their pregnant partners money for transport, and money for food/snacks (at the clinic). Inter-spousal communication was found to be good, and there appeared to be a perception by the men that antenatal clinic (ANC)/PMTCT is not only for women, with most of the men agreeing that it is useful for men to participate in PMTCT. The barriers to male participation in the PMTCT programme that were elicited in this study include lack of belief about HIV/AIDS and lack of awareness about PMTCT and the perception of PMTCT as a "women's affair". Another barrier to male participation in the PMTCT programme was the men being busy with their jobs/lack of time, and fear. Facility-based barriers include delays/time wasting at the clinic, and the nurses, who were identified as having an unaccommodating attitude towards the clients. Finally, the fact that the nurses and counsellors at the PHC West Itam were all female was a problem for men. It is recommended that there is need for advocacy and education to raise awareness about HIV/AIDS, and encourage male participation in PMTCT. It is also important to encourage the disclosure of HIV status by the women to their male partners. Furthermore, a separate male counselling unit needs to be created, as well as ensuring the employment of male nurses and counsellors. Additionally, the female nurses at the facility need to be trained/re-trained on proper attitude and confidentiality, and efforts must be made to avoid delays at the clinic

Mortality audit in the paediatrics department of the University of Uyo teaching hospital, Uyo, Nigeria

Background: There has been a world-wide reduction in under-five mortality rate since 1990 by almost half. Despite this global reduction, about 17,000 children under the age of five years die daily, and a significant proportion of these deaths occur in sub-Saharan Africa, with Nigeria having an U5MR of 117/1,000 live births. The study aims to identify the age at death and cause of death of hospitalized children in this center, as well as describe the pattern of mortality.Methods: The study was conducted at the Department of Paediatrics of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria, and it was a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1st January 2009 to 31st December 2014. Case files of all in-patient deaths during the period under review were studied.Results: A total of 772 deaths were recorded during the period under review. Of these 772 deaths, 453 (58.7%) were males and 319 (41.3%). Four hundred and thirty nine deaths (56.9%) were among children aged less than one month. More of the deaths occurred at about the month of March, while cumulative deaths were highest in the 15th hour of the day. The leading causes of death were prematurity, asphyxia, bronchopneumonia, septicaemia, severe malaria and malignancies.Conclusions: This study demonstrates that childhood mortality is still high, with the common causes of death being the preventable and treatable infectious diseases.

Prevalence of attention deficit hyperactivity disorder symptoms among primary school children in Nigeria: a comparison of teachers and parent reports

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neuro-behavioral disorders of childhood.Though ADHD is the most extensively studied neuro-behavioral disorder in childhood, its prevalence rate has not been documented in our environment. Aim of the current study was to determine the prevalence and subtypes of ADHD among primary school pupils living in Ikot-Ekpene, a semi-urban area in Nigeria’s rainforest.Methods: This was a cross-sectional study conducted among 1174 primary school pupils aged 6-12 years selected from twelve primary schools in Ikot Ekpene local government area of Akwa Ibom state. The Vanderbilt rating scale for both teachers and parents were administered by teachers and parents of the pupils and the prevalence rate of ADHD was determined.Results:  One hundred and forty-six pupils met the rating scale criteria for probable ADHD using the teacher’s scale with a prevalence of 12.4%, while 8.5% met the criteria using the parent’s scale.  Of the three different subtypes of ADHD, the hyperactive subtype was the most prevalent subtype on both the teacher’s and parent’s scales (52.7% and 46% respectively). The inattentive subtype was 32.9% and 33.0% on the teachers and parents scale respectively. The combined subtype was the least prevalent on both scales.Conclusions: Prevalence rate of ADHD in children is significant in our environment. Policies should be put in place to implement the screening test for ADHD under the school health program for the early identification of pupils with ADHD

Post-Neonatal tetanus from broomstick injuries: a word of caution for caregivers

Tetanus is a vaccine-preventable disease that is acquired through exposure to the spores of the bacterium Clostridium tetani which are ubiquitous in the soil. Post-neonatal tetanus is an increasing problem in developing countries, including Nigeria. This is mainly as a result of inadequate immunization coverage, unsustainable immunization programmes, and non-administration of booster doses of tetanus toxoid at appropriate periods to eligible children. The spores of the bacterium can get into the body through broken skin, commonly through injuries from contaminated objects. There have also been reports of broomstick injury as the portal of entry. Indeed, it has been reported to be the commonest portal of entry in a center in Nigeria. This is important because flogging (of children) with brooms is common in parts of Nigeria, despite it being forbidden in several cultures in the country. Two cases of post-neonatal tetanus arising from broomstick injuries in Uyo, Nigeria, are herein reported, to illustrate the inherent dangers and implications of broomstick injuries in children. It is hoped that advocacy campaigns will be conducted at different public health fora to raise awareness of the general population concerning post-neonatal tetanus from broomstick injuries. Furthermore, there is urgent need to institutionalize the administration of booster doses of tetanus toxoid at primary and secondary school entry