Management of erectile dysfunction: perceptions and practices of Nigerian primary care clinicians

Erectile dysfunction (ED) is a prevalent health problem in many societies, but the diagnosis is seldom documented in primary care. The objective of this study was to investigate the perception and practices of clinicians regarding the management of ED in primary care settings in Nigeria. Methods A self-administered semi-structured questionnaire was applied to a purposive sample of clinicians attending conferences/workshops organised by the Society of Family Physicians of Nigeria and Update Courses of the Faculties of Family Medicine of the National Postgraduate Medical College of Nigeria and the West African College of Physicians. Information was obtained on their professional characteristics, experiences with the management of ED and possible barriers to the effective management of ED. Results A total of 187 completed questionnaires were analysed. Most (87.2%) of the respondents were general practitioners, while the rest were specialists in various fields (excluding sexual health) who worked at the primary care level. One hundred and forty-seven respondents (76%) reported that ED was common in their clinical practice. Over half (56.2%) of the respondents ascribed a high priority to ED management in their day-to-day clinical practice, while 33.2% and 10.6% of them ascribed medium and low priority to ED management respectively. Although 80.8% of the respondents agreed that ED patients could benefit from orthodox treatments, only 18% of them had ever prescribed any medication for affected patients; most (82%) of them either counselled or referred ED patients to secondary or tertiary care level for further management. Most of the clinicians (62%) would not take a sexual history unless the patient brought it up. The reported barriers to the management of ED include lack of a standardised protocol (64.2%), inadequate experience in ED management (85.6%), preference of patients for native medication (42.3%), and the high cost of modern medication (48.1%). Conclusion The clinicians acknowledged the high prevalence of ED in the primary care setting and recognised that they had a role to play in managing affected patients. The identified barriers to the management of the condition point to the need for education of both clinicians and patients, as well as the provision of guidelines for the management of ED in primary care settings.South African Family Practice Vol. 49 (9) 2007: pp. 1

How Mistimed and Unwanted Pregnancies Affect Timing of Antenatal Care Initiation in three Districts in Tanzania

Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 910 women of reproductive age who had given birth in the past two years. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chisquare was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies affect timing of ANC initiation. Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10‒2.58) and 2.00 (95% CI 1.05‒3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41‒5.59) and 4.10 (95% CI 1.68‒10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.\u

Plasma and whole brain cholinesterase activities in three wild bird species in Mosul, IRAQ: In vitro inhibition by insecticides

Plasma and brain cholinesterase activities were determined in three wild bird species to assess their exposure to organophosphate and carbamate insecticides which are used in agriculture and public health. In the present study, we used an electrometric method for measurement of cholinesterase activities in the plasma and whole brain of three indigenous wild birds commonly found in northern Iraq. The birds used were apparently healthy adults of both sexes (8 birds/species, comprising 3–5 from each sex) of quail (Coturnix coturnix), collard dove (Streptopelia decaocto) and rock dove (Columba livia gaddi), which were captured in Mosul, Iraq. The mean respective cholinesterase activities (Δ pH/30 minutes) in the plasma and whole brain of the birds were as follows: quail (0.96 and 0.29), collard dove (0.97and 0.82) and rock dove (1.44 and 1.42). We examined the potential susceptibility of the plasma or whole brain cholinesterases to inhibition by selected insecticides. The technique of in vitro cholinesterase inhibition for 10 minutes by the organophosphate insecticides dichlorvos, malathion and monocrotophos (0.5 and 1.0 µM) and the carbamate insecticide carbaryl (5 and10 µM) in the enzyme reaction mixtures showed significant inhibition of plasma and whole brain cholinesterase activities to various extents. The data further support and add to the reported cholinesterase activities determined electrometrically in wild birds in northern Iraq. The plasma and whole brain cholinesterases of the birds are highly susceptible to inhibition by organophosphate and carbamate insecticides as determined by the described electrometric method, and the results further suggest the usefulness of the method in biomonitoring wild bird cholinesterases

ORIGINAL ARTICLES - Attitude of teachers to school based adolescent reproductive health interventions

Adults may facilitate or obstruct healthy sexual behaviours by adolescents; hence information on their attitude towards adolescent sexual behaviour, including contraceptive use is important. The attitude of teachers to school-based adolescent reproductive health services was assessed among two hundred and twenty three teachers in Sagamu. Forty seven percent of them were trained family life educators while 52.9% had not received any training in adolescent reproductive health. Many of the teachers were aware of the common sexual and reproductive health problems of young people. Eighty seven percent approved of teaching sex education to adolescents in schools, 55.6% approved of contraceptive use by the adolescents and 52.9% approved of condom use. However, 52% of them believed contraceptive use should be initiated within marriage or after 18 years of age. Ninety-one percent of the teachers disapproved of condom demonstration and provision in schools. Only 36.2% were willing to counsel the sexually active adolescents about contraceptive use. Teachers indicated an interest in being involved in promoting the sexual health of their students but they preferred to counsel about abstinence. The family life educators had a more positive attitude to condom use than the other teachers; however this difference was not statistically significant. There is a need to educate teachers about adolescent contraception and why it is important for the sexually active adolescent to use contraceptives so as to protect their health and future, which the teachers also want to protect

Utilisation des services prénatals et d’accouchements à Sagamu, au sud-ouest du Nigéria

A survey of 392 women who had carried at least one pregnancy to term in Sagamu, South-Western Nigeria was conducted to determine the pattern of use of maternity services and assess factors that may influence the observed pattern. Majority of the women received antenatal care (84.6%) during their last pregnancy. Four-fifth of those who received ANC first attended the clinic during the second trimester (79.6%). The places of delivery were government facilities (54.8%), private hospital (24.5%), traditional birth attendants (13.5%) and spiritual healing homes (5.6%). Higher educational status and higher level of income positively affected the pattern of use of these services (p<0.05). Perceived quality of service was the most important factor which influenced the choice of facility for obstetric care. A considerable proportion of those who used traditional birth attendants (36.1%) used it to please their husbands. Our findings suggest that improving the socioeconomic status of men and women in the community is a key factor to improving utilization of maternity care services (Afr J Reprod Health 2009; 13[3]:111-122).Une enquête sur 392 femmes qui ont eu au moins un accouchement à terme à Sagamu au sud-ouest du Nigéria a été menée. Ceci pour déterminer la tendance de l’utilisation des services de gynécologieobstétrique et pour évaluer les tendances observées. La plupart des femmes ont obtenu des soins prénatals (84,6%) pendant leur grossesse. 4/5 de celles qui ont obtenu les soins prénatals se sont présentées à la Clinique pour la première fois au cours du second trimestre (79,6%). Les lieux d’accouchement étaient des établissements gouvernementaux (54,8%), les hôpitaux privés (24,5%), chez les sages-femmes traditionnelles (13,5%) et dans les maisons de guérison spirituelle (5,6%). L’utilisation de ces services est influencée positivement par le niveau supérieur de l’instruction acquise et un niveau élevé de revenu (p<0,05). La qualité perçue du service était le facteur le plus important qui a influencé le choix de l’établissement pour les soins obstétriques. Une proportion considérable de celles qui se sont servies des sages-femmes traditionnelles (36,1%) le faisant pour faire plaisir à leurs maris. Notre étude a montré que si la situation socio-économique des hommes et des femmes dans la communauté est améliorée, cela sera un facteur clé pour l’utilisation des services des soins gynécologie-obstétrique (Afr J Reprod Health 2009; 13[3]:111-122)

Attitude of Youths to Sexual Abstinence as a Strategy for HIV Prevention

No Abstract. Nigerian Medical Practitioner Vol. 52 (2) 2007: pp. 33-3

Quantifying the impact of COVID-19 control measures using a Bayesian model of physical distancing

Extensive non-pharmaceutical and physical distancing measures are currently the primary interventions against coronavirus disease 2019 (COVID-19) worldwide. It is therefore urgent to estimate the impact such measures are having. We introduce a Bayesian epidemiological model in which a proportion of individuals are willing and able to participate in distancing, with the timing of distancing measures informed by survey data on attitudes to distancing and COVID-19. We fit our model to reported COVID-19 cases in British Columbia (BC), Canada, and five other jurisdictions, using an observation model that accounts for both underestimation and the delay between symptom onset and reporting. We estimated the impact that physical distancing (social distancing) has had on the contact rate and examined the projected impact of relaxing distancing measures. We found that, as of April 11 2020, distancing had a strong impact in BC, consistent with declines in reported cases and in hospitalization and intensive care unit numbers; individuals practising physical distancing experienced approximately 0.22 (0.11–0.34 90% CI [credible interval]) of their normal contact rate. The threshold above which prevalence was expected to grow was 0.55. We define the “contact ratio” to be the ratio of the estimated contact rate to the threshold rate at which cases are expected to grow; we estimated this contact ratio to be 0.40 (0.19–0.60) in BC. We developed an R package ‘covidseir’ to make our model available, and used it to quantify the impact of distancing in five additional jurisdictions. As of May 7, 2020, we estimated that New Zealand was well below its threshold value (contact ratio of 0.22 [0.11–0.34]), New York (0.60 [0.43–0.74]), Washington (0.84 [0.79–0.90]) and Florida (0.86 [0.76–0.96]) were progressively closer to theirs yet still below, but California (1.15 [1.07–1.23]) was above its threshold overall, with cases still rising. Accordingly, we found that BC, New Zealand, and New York may have had more room to relax distancing measures than the other jurisdictions, though this would need to be done cautiously and with total case volumes in mind. Our projections indicate that intermittent distancing measures—if sufficiently strong and robustly followed—could control COVID-19 transmission. This approach provides a useful tool for jurisdictions to monitor and assess current levels of distancing relative to their threshold, which will continue to be essential through subsequent waves of this pandemic.Medicine, Faculty ofScience, Faculty ofNon UBCMathematics, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherPostdoctoralGraduat

Development of a countergradient parking system for gradient liquid chromatography with online biochemical detection of serine protease inhibitors

A gradient HPLC approach in combination with a countergradient system for online biochemical detection (BCD) to screen for inhibitors of serine proteases is described. For gradient separations, this novel countergradient system was developed to produce a biocompatible constant solvent composition in the BCD. The countergradient system is based on retaining complete gradients in an additional preparative HPLC column, followed by subsequent and reversible elution to the separation column effluent. Major advantages compared with existing countergradient systems are that no additional LC pumps are needed and enhanced stability. The developed countergradient system was systematically characterized applying different gradient programs. Inhibitors eluting in a post-column continuous flow analysis interfere with the enzymatic release of fluorescent 7-amino-4-methylcoumarin (AMC) from an AMC-labeled peptide. The inhibitory activity of eluting substances is sensitively detected as the degree of reduced fluorescence intensity. This biochemical detection system (BCD) for proteases was validated with three known inhibitors of the benzamidine type. Their I