Diagnostic performance of screening methods for urinary schistosomiasis in a school-based control programme, in Ibadan, Nigeria

Background: Indirect diagnostic methods in urinary schistosomiasis are widely used for screening high-risk populations in endemic areas. Their diagnostic performances, however, vary. The objective of this study was to assess their usefulness in the context of a school-based control programme technique (unqualified haematuria, terminal haematuria and dysuria), visual examination of urine and chemical reagent technique were each compared with microscopic examination of urine for schistosome ova. Results: Chemical reagent strip technique was the most sensitive of all indirect methods assessed with sensitivity of 68.3%, followed by unqualified haematuria (41.7%), terminal haematuria (38.2%), dysuria (25.0%) and visual urine examination (16.7%). In terms of specificity, terminal haematuria and visual examination were the most specific with values of 96.1 and 96.0% respectively. Conclusion: The validity of screening methods agreed with previous observations. Their use, however, depends on the endemicity of schistosomiasis in a given area. There is therefore a need to evaluate screening methods on a sample of the target population before being used to estimate prevalence of disease. Keywords: urinary schistosomiasis, diagnostic performance, screening methodsJournal of Community Medicine and Primary Health Care 2005, 17(1): 24-2

Experience and Perpetration of Violent Behaviours among Secondary School Students in Ibadan, Nigeria

Worldwide, adolescents are disproportionately affected by violent behaviours. The nature and extent to which Nigerian adolescents have perpetrated and experienced violence has not been fully investigated. This cross-sectional survey assessed experience and perpetration of physical, sexual and psychological violent behaviours among school-based adolescents. A total of 1366 students (50.4% females and 49.6% males) randomly selected from six public secondary schools in Ibadan, Nigeria were interviewed using a 36-item questionnaire. Respondents answered questions regarding demographic profile, sexual behaviour, and the extent to which they had experienced or perpetrated physical, sexual and psychological violent behaviours. The lifetime experience of at least one of the three forms of violence was 97.9%: physical violence ranked first (94.4%), followed by psychological (77.6%) and sexual violence (34.9%). The most common types of these forms of violent behaviours experienced were slaps (84.5%), unwanted touch of breast and backside (22.7%) and being belittled (63.2%). Approximately 8% of the study group haave had sex and 25% of sexually active respondents claimed that their first sexual encounter occurred in coercive circumstances. The predictors of experience of violence among males were use of alcohol, witnessing domestic violence, involving in work and parental use of alcohol. Among females parental use of alcohol and being young were predictors of violence. Reports of perpetration of physical, sexual and psychological violence among males were 75.3%, 44.9% and 13.3% respectively. Comprehensive interventions targeting students, teachers and parents are recommended to address this problem. Keywords: Adolescents, Nigeria, Sexual behaviours, Violenc

Clinical audit of intra-partum care at secondary health facilities in Nigeria

No Abstract

Patient Satisfaction with Care Provided at the Antiretroviral Clinic of the Federal Medical Centre, Makurdi, Nigeria

Introduction: Patient satisfaction is considered an important indicator of quality of care. In Nigeria, there is a dearth of information on patient satisfaction with HIV/AIDS care. This study sought to assess patient satisfaction; and to identify associated factors.Methodology: A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre, Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, and access/availability/convenience. Data were analyzed using SPSS 16. Associations were tested using chi-square and multivariable logistic regression. Statistical significance was set at 5%.Results: Of 409 respondents, 108 (26.4%) were males and 301 (73.6%) females. Mean age was 35.7 ± 9.4 years, 86 (21%) had primary school education, 210 (51.3%) were married, and 357 (87.3%) were employed. About two-thirds (65.2%) spent less than 60 minutes waiting for the doctor, and 225 (63.6%) spent at least 10 minutes in consultation with the doctor. Satisfaction rates were: 94.9% technical quality, 90.2% communication, 77.8% interpersonal manner, 67.5% general satisfaction, 57% access/availability/convenience, 46% time spent with doctor, and 45.7% financial aspects. Lower education and waiting less than 60 minutes for the doctor were independently associated with satisfaction across multiple dimensions of care.Conclusion: Respondents were satisfied with the seven dimensions of care to varying degrees. Attending to patients promptly would improve satisfaction, and thus, quality of care.Keywords: Patient satisfaction, antiretroviral clinic, quality of car

Tobacco use amongst out of school adolescents in a Local Government Area in Nigeria

Abstract Introduction Out-of-school adolescents are often neglected when planning for tobacco prevention programmes whereas they are more vulnerable. Few studies exist in Nigeria about their pattern of tobacco use to serve as the basis for effective policy formulation. Method A sub sample of 215 out of school adolescents was analyzed from a descriptive cross sectional study on psychoactive substance use amongst youths in two communities in a Local Government Area in Nigeria which used a multi-stage sampling technique. Results Males were 53% and females 47%. Only 20.5% had ever used tobacco while 11.6% were current users. Males accounted for 60% of current users compared to 40% amongst females. Of current users, 84% believed that tobacco is not harmful to health. In addition, the two important sources of introduction to tobacco use were friends 72% and relatives 20%. Use of tobacco amongst significant others were: friends 27%, fathers 8.0%, relatives 4.2% and mothers 0.5%. The most common sources of supply were motor parks 52% and friends 16%. Conclusion The study showed that peer influence is an important source of introduction to tobacco use while selling of tobacco to adolescents in youth aggregation areas is common. We advocate for a theory based approach to designing an appropriate health education intervention targeted at assisting adolescents in appreciating the harmful nature of tobacco use in this locality. A point-of-sale restriction to prevent adolescent access to tobacco in youth aggregation areas within the context of a comprehensive tobacco control policy is also suggested. However, more research would be needed for an in-depth understanding of the tobacco use vulnerability of this group of adolescents.Peer Reviewe

Need assessment for postgraduate training in public health in Nigeria

No Abstract. Annals of Ibadan Postgraduate Medicine Vol. 1 (1) 2003: pp. 58-5

ONCHOCERCIASIS – A PUBLIC HEALTH PERSPECTIVE

Onchocerciasis is a chronic parasitic disease with a wide range of cutaneous and ocular manifestations. It is caused by the tissue nematode, Onchocerca volvulus, and it is transmitted by the bite of a female black fly, Simulium damnosum. Onchocerciasis is a serious public health and socio-economic problem with 95% of all cases being found in Africa south of the Sahara. The WHO Expert Committee has estimated that over 80 million people are at the risk of infection worldwide, some 18 million infected, and 1 million people visually impaired of which some 340,000 are blind. Nigeria is highly endemic for this disease, to the extent that 40% of all cases worldwide are believed to occur in the country. The prevalence of blindness in villages near to fast flowing rivers may reach 15%, often, affecting males (of working age, perhaps 30-40 years old) more frequently than females. In spite of these ravaging consequences of this disease however, remarkable successes have been achieved by the control effort of the Onchocerciasis Control Programme (OCP), which uses chemical and biological larvicides with low environmental impact to kill black fly larvae flies. Other methods of effecting Onchocerciasis control include: (i) Reducing the number of bites by the Simulium fly on man; (ii) Killing the microfilariae with microfilaricides; and (iii) Killing the adult worms. The social and economic consequences of the disease in Nigeria and other African countries are huge, with considerable human suffering. It thus demands unrelenting intensive and concerted effort at the international, national and community levels, making optimal use of the identified modes of control for effective control of this disease which has serious public health and economic consequences. Key Words: Onchocerciasis, Public Health, Control Afr. J. Clin. Exper. Microbiol. 2004; 5(2): 165 – 172

Cost-effectiveness analysis of Mectizan treatment Programmes for Onchocerciasis Control: Operational Experiences in two districts of Southwestern Nigeria

Objectives: This study analyzed the operational costs of two Mectizan treatment strategies in relation to their effectiveness.Methods: The study was conducted in 24 communities located in Irewole and Egbeda districts of Osun and Oyo State, Nigeria respectively. Cost-effectiveness analysis included retrospective analysis of cost of treatment, review of records of distributors, estimation of overall cost-effectiveness ratios of treatment and distribution, calculation of mean cost-effectiveness ratios and statistical comparison of the mean cost-effectiveness ratios.Results: Overall cost of treatment per person through mobile distribution was N27.39 (USD1.16) while the corresponding overall cost through community-directed distribution was N14.35 (USD0.61). Overallcost of distribution per tablet through mobile distribution was N20.97 (USD0.89) while the corresponding overall cost through community-directed distribution was N8.39 (USD0.36). The difference between the mean cost-effectiveness ratios for treatments through mobile distribution, 56.79, and communitydirected distribution, 32.53, was not statistically significant (p=0.120265). Similarly, the difference between the mean cost-effectiveness ratios for distribution of tablets through mobile distribution, 40.83, and community-directed distribution, 19.17, was not statistically significant (p=0.167249). Treatment coverages were 59% and 80%, and 2,376 and 4,148 tablets were respectively distributed,Conclusion: Distribution of Mectizan tablets by community-directed distributors was more cost-effective than by mobile health staff, but the differences in cost were not statistically significant. However, thiscould ensure self-reliance and sustainability of treatment programmes, which are prerequisites for decision making on treatment strategies

Social Health Insurance in Nigeria: Policy Implications in A Rural Community

Social health insurance was introduced in Nigeria in 1999 and had since been restricted to workers in the formal public sector. There are plans for scaling up to include rural populations in a foreseeable future. Information on willingness to participate and pay a premium in the programme by rural populations is dearth. This study sought to document willingness to participate and pay a premium in a social health insurance among indigenous members of a rural community in Nigeria. Adescriptive cross-sectional survey was conducted among heads of households in two randomly selected clusters in Igbo-Ora community. Interviews were conducted using a pre-tested semistructured questionnaire by trained interviewers. The questionnaire sought information on socio-demographic characteristics of the respondents, their awareness about social health insurance and willingness to participate and pay in the scheme. Monthly income was estimated by bidding game approach.Atotal of 410 heads of households were interviewed; their mean age was 45.2 ± 2.2 years. Of the 410 respondents, 66 (16.1%) were aware of an existing social health insurance; 344 (83.9%) were willing to participate, whereas 314 (76.6%) were willing to pay a premium. Respondents who were less than 40 years of age were 1.8 times more likely to be aware of the social health insurance (p = 0.04, OR = 1.83, 95% CI = 1.04 - 3.22) and 2.4 times more likely to participate in it (p = 0.01, OR = 2.42, 95% CI = 1.29 - 4.53) than those aged 40 years and above. Those who had at least secondary education were 2.1 times more likely to be aware than those who had either no formal or at most primary education (p = 0.01,OR= 2.1,95%CI = 1.17 - 3.79). However, those who had either no formal or at most primary education were 3.7 times more likely to be willing to participate than those with at least secondary education (