Working School Children in a Nigerian Community: Revisiting the Issues

Purpose: The prevalence, risk factors and effects of work on school performance and health consequences of child labour among school children in a rapidly urbanising community in south west Nigeria was assessed. Methods: A descriptive cross-sectional study of 386 Junior Secondary School students was conducted. Questionnaires were used to obtain information on the students’ socio-demographic characteristics, history of child labour activities, and recent history of illness. The academic records of the students were also reviewed. Results: The prevalence of child labour was 72.5%, the median number of hours spent working per week was 18 hours (range 2- 56 hours). The main reason for working was to augment the family income (37.6%). Child labour was commoner among those: whose mothers were not educated; who had four to eight siblings, and who had a working sibling. Higher proportions of working children had repeated a class and had failed the previous term’s examinations. More of the working children reported being ill and injured in the previous term. Conclusion: Child labour is quite common in this area and is associated with negative academic and health outcomes. Multidisciplinary programmes targeted at reducing the practice should be developed.Keywords: Child labour, secondary school students, south west Nigeri

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

Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school

Background: Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However, there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar.Materials and Methods: A descriptive cross‑sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self‑administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at <0.05.Results: More than a third (35.5%) of all respondents interviewed had experienced one or more forms of mistreatment during their training, with 38.5% of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5%), and the main perpetrators of these incidents were medical consultants, (18.6%) other cadre of doctors (17.3%) and lecturers (14.4%). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P < 0.05). However, only 8.8% reported these incidents.Conclusion: With more than a third of undergraduate medical trainees experiencing mistreatment, development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended.Keywords: Abuse, medical students, mistreatment, Nigeri

Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents : evidence from Nigeria

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32–50) versus 38 (IQR:29–50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the “prompt and urgent” levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services

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

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan : results of pre-COVID and COVID-19 lockdown stakeholder engagements

Abstract Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered

Association between TCF7L2 gene polymorphisms and susceptibility to Type 2 Diabetes Mellitus: a large Human Genome Epidemiology (HuGE) review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Transcription factor 7-like 2 (<it>TCF7L2</it>) has been shown to be associated with type 2 diabetes mellitus (T2MD) in multiple ethnic groups in the past two years, but, contradictory results were reported for Chinese and Pima Indian populations. The authors then performed a large meta-analysis of 36 studies examining the association of type 2 diabetes mellitus (T2DM) with polymorphisms in the <it>TCF7L2 </it>gene in various ethnicities, containing rs7903146 C-to-T (IVS3C>T), rs7901695 T-to-C (IVS3T>C), a rs12255372 G-to-T (IVS4G>T), and rs11196205 G-to-C (IVS4G>C) polymorphisms and to evaluate the size of gene effect and the possible genetic mode of action.</p> <p>Methods</p> <p>Literature-based searching was conducted to collect data and three methods, that is, fixed-effects, random-effects and Bayesian multivariate mete-analysis, were performed to pool the odds ratio (<it>OR</it>). Publication bias and study-between heterogeneity were also examined.</p> <p>Results</p> <p>The studies included 35,843 cases of T2DM and 39,123 controls, using mainly primary data. For T2DM and IVS3C>T polymorphism, the Bayesian <it>OR </it>for TT homozygotes and TC heterozygotes versus CC homozygote was 1.968 (95% credible interval (<it>CrI</it>): 1.790, 2.157), 1.406 (95% <it>CrI</it>: 1.341, 1.476), respectively, and the population attributable risk (PAR) for the TT/TC genotypes of this variant is 16.9% for overall. For T2DM and IVS4G>T polymorphism, TT homozygotes and TG heterozygotes versus GG homozygote was 1.885 (95%<it>CrI</it>: 1.698, 2.088), 1.360 (95% <it>CrI</it>: 1.291, 1.433), respectively. Four <it>OR</it>s among these two polymorphisms all yielded significant between-study heterogeneity (P < 0.05) and the main source of heterogeneity was ethnic differences. Data also showed significant associations between T2DM and the other two polymorphisms, but with low heterogeneity (<it>P </it>> 0.10). Pooled <it>OR</it>s fit a codominant, multiplicative genetic model for all the four polymorphisms of <it>TCF7L2 </it>gene, and this model was also confirmed in different ethnic populations when stratification of IVS3C>T and IVS4G>T polymorphisms except for Africans, where a dominant, additive genetic mode is suggested for IVS3C>T polymorphism.</p> <p>Conclusion</p> <p>This meta-analysis demonstrates that four variants of <it>TCF7L2 </it>gene are all associated with T2DM, and indicates a multiplicative genetic model for all the four polymorphisms, as well as suggests the <it>TCF7L2 </it>gene involved in near 1/5 of all T2MD. Potential gene-gene and gene-environmental interactions by which common variants in the <it>TCF7L2 </it>gene influence the risk of T2MD need further exploration.</p