Relationships as determinants of substance use amongst street children in a local

Background: Unrestrained exposure to street life often makes the street child vulnerable to psychoactive substances. In other settings, the social relationships of the substance user with those around him or her and family norms of parenting have been docu-mented to modulate use. However, there is a dearth of literature on the role of relationships in substance use in Nigeria. Methods: A cross-sectional analytical study of street children was conducted in a local government area of south-western Nigeria between November 2004 and March 2005, with data analysis being undertaken in April 2005 and November 2006. A cluster sampling method was used to recruit 360 consenting street children into the study. Information was collected on socio-demographic characteristics, parental and friend connectedness, familial stress and current psychoactive substance use. Results: The mean age was 16.2 ± 1.3 years, and there were more males (58.3%) than females. Most of the respondents (65%) were still living with their parents. Fifty-three per cent of the respondents were current psychoactive substance users and the five commonest substances used were kola nut (58.6%), alcohol (43.6%), tobacco (41.4%), marijuana (25.4%) and “sokudaye” (24.9%). Of the respondents who live alone and of those whose fathers work outside of the town, 84% and 57.9% respectively were more likely to be current users at P < 0.05. Similarly, low connectedness with mother and friends and low parental presence were significantly associated with current substance use (75.7%, 77.5% and 58.3% respectively at P < 0.05). On logistic regression, only low con- nectedness with mother (OR 2.4, 95% CI 1.194.98) and friend (OR 3.1, 95% CI 1.705.72) predicted current substance use. Conclusion: The study documented the important role of positive relationships between street children and their friends/mothers in preventing psychoactive substance use South African Family Practice Vol. 50 (5) 2008: pp. 47-47

Incidence of road traffic accidents and pattern of injury among commercial motorcyclists in a rural community in south western Nigeria

Background and Objective: Motorcyclists are at high risk of road traffic accidents and the attendant injuries, but few community-based studies have investigated the problem in Nigeria. Therefore, this study was conducted to determine the incidence of accidents and patterns of non-fatal injury among commercial motorcyclists in a rural community in Oyo State, Nigeria. Methodology: A total sample of all the commercial motorcyclists registered in the motor parks of Igbo-Ora, Oyo State was surveyed. An interviewer administered questionnaire was used to collect information on the respondents\' socio-demographic characteristics, occurrence of accidents in the year preceding the study, type of injury sustained, motorcycle riding experience, substance use and other characteristics. Results: Two hundred and ninety nine motorcyclists were interviewed, 136(45.3%) had been involved in a road traffic accident; of these 85 (62.5%) were involved in a single accident, while 51(37.5%) were involved in 2 or more accidents. Motorcycle accident risk factors included age of the motorcyclist, between 20-29 and 30-39 years, OR 10.1 and OR 9.6 respectively, alcohol use, OR 1.18, and visual impairment, OR 1.62. The collisions occurred mainly with cars (28.7%) and other motorcyclists (27.9%). The commonest types of injuries sustained were abrasions and cuts (67 .6%) and fractures of the upper and lower limbs (16.2%). Conclusion: Road traffic accidents occur frequently among commercial motorcyclists in this community. Introduction of road safety education targeted at discouraging alcohol use among these motorcyclists while riding and ensuring periodic visual acuity assessment is recommended. Keywords: commercial motorcyclists, accidents, injuries, risk factors, rural community, NigeriaJournal of Community Medicine and Primary Health Care 2005, 17(1): 7-1

A community-based intervention for improving utilization of medical services by rape survivors in refugee camps in Zambia

Background: Rape is the most common form of violence in conflict and refugee situations but because of the associated stigma few cases are reported. This study assessed the outcome of an intervention targeted at women groups on the utilization of medical services by rape survivors in refugee camps in Zambia.Methods: A prospective quasi-experimental community-based intervention study was carried out in two refugee camps allocated into intervention and comparison areas. The intervention was participatory education sessions for women groups. Data was collected using the clinic records and the main outcome was the number of rape survivors who utilized and completed medical services provided at the camp clinics. Univariate, bivariate and multivariate analyses were carried out with level of significance set at 5%.Results: The proportion of the rape survivors who accessed medical care within 72 hours increased significantly from 41.2% to 84.8% in the intervention area but from 31.1% to 38.9% in the comparison area, (p=0.005). Those who completed their medical treatment and the follow-up visits increased significantly from 42.8% to 94.8% in intervention area but reduced from 38.5% to 21.4% in the comparison area, (p=0.002). Being resident in the intervention area predicted the utilization of medical services, [OR: 3.15; 95%CI: 1.955-5.681], p=0.002.Conclusion: Community-based intervention using participatory women’s group discussion had a significant impact on increasing the utilization of medical services by rape survivors and should be considered for scaling up as a key intervention for increasing utilization of medical services for rape survivors especially in refugee situations.Keywords: Rape survivors, Participatory group discussion, Medical services, Zambi

Experiences of discrimination among youth with HIV/AIDS in Ibadan, Nigeria

Nigerian youth currently bear a disproportionate burden of the HIV epidemic. This paper presents findings on the occurrence of HIVrelated discrimination among youth with HIV accessing care in Ibadan, Nigeria. A cross-sectional study was conducted and information on history of discrimination experienced by 170 youth with HIV was obtained. About 80% of respondents had disclosed their HIV status. The majority had informed their spouses (66.3%), mothers (47.1%), fathers (39.1%) and siblings (37.7%). Sixteen (11.5%) respondents [15 (93.8%) females and one (6.2%) male] had suffered discrimination since disclosure of their status. Of these, 25.0% respondents were sent out of their matrimonial homes by their husbands, 25.0% were abandoned by their spouses and 12.5% indicated their fiancé broke up their relationship. A higher proportion of females (12.9%) than males (4.3%) had suffered discrimination. In addition, a significant proportion of respondents who were separated/divorced (73.3%) had been victims of discrimination compared with those who were widowed (10.5%) or single (5.9%) (P<0.05). The study confirmed that young people living with HIV/AIDS, especially women experience extreme forms of discrimination. More efforts aimed at addressing HIV/AIDS-related discrimination are required especially as it is a known barrier to HIV prevention and treatment efforts

Incidence and pattern of injuries among residents of a rural area in South-Western Nigeria: a community-based study

<p>Abstract</p> <p>Background</p> <p>Despite the high incidence of infectious diseases in developing countries, injuries still contribute significantly to the health burden. There are few reports of rural, community-based injury surveys in Nigeria. This study describes the incidence and pattern of injuries among the residents of a rural area in South-Western Nigeria.</p> <p>Methods</p> <p>It was a community based cross-sectional study. Two of six census areas were randomly selected and all households in the two areas visited. Information on the sociodemographic characteristics, individual injury events and outcomes was obtained with a questionnaire. Data were analyzed using SPSS version 11.</p> <p>Results</p> <p>Information was obtained on the 1,766 persons in 395 households. Fifty-nine injuries were recorded by 54 people, giving an injury incidence of 100 per 1,000 per year (95% CI = 91.4–106.9). Injury incidence among <30 years was 81.6 per 1,000 per year (95% CI = 62.3–83.1); and 126 per 1,000 per year (95% CI = 98.2–137.4) for those ≥ 30 years (p = 0.013). Injury incidence for females was 46 per 1,000 per year; and 159 per 1,000 per year (p = 0.000) for males. A significantly higher proportion of males (5%) sustained injury compared to females (2%) (p = 0.043). Falls and traffic injures, 15 (25%) each, were the leading causes of injury; followed by cuts/stabs 12 (21%), and blunt injuries, 9 (15%). Traffic injuries were the leading cause of injuries in all age groups except among the 5–14 years where falls were the leading cause of injury. In thirty-four (58%) of those injuries, treatment was at a hospital/health centre; while in two (3%), treatment was by untrained traditional practitioners. Thirty-nine (66%) of the injuries were fully recovered from, and 19 (32%) resulted in disability. There were 2 fatalities in the 5-year period, one (2%) within the study period.</p> <p>Conclusion</p> <p>Injuries were common in Igbo-Ora, though resultant disability and fatality were low. Males and those aged ≥ 30 years had significantly higher proportions of the injured. Falls and traffic injuries were the most commonly reported injuries. Appropriate interventions to reduce the occurrences of injuries should be instituted by the local authorities. There is also need to educate the community members on how to prevent injuries.</p

Development of a video-observation method for examining doctors’ clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

Background: Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients’ department in Nigeria. We also develop measurement procedures and examine measurement characteristics. Methods Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. Results: We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was ‘above standard’ (or 4 on a scale of 1–5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen’s kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. Conclusions: Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score

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

Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study

BACKGROUND: Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women’s compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria. METHODS: A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population. RESULTS: Use of SP-IPTp was self-reported by 41 % of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83 %). Other barriers were stock-outs of free SP (33 %) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33 %). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95 % CI: 1.70–3.73) and SP (OR = 22.13, 95 % CI: 8.10–43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95 % CI: 1.24–12.31). CONCLUSIONS: Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0883-2) contains supplementary material, which is available to authorized users