Socio-demographic determinants of stigma among patients with pulmonary tuberculosis in Lagos, Nigeria.

BACKGROUND: Patients living with tuberculosis (TB) experience significant disruption of their social life and are exposed to stigma and discrimination. This situation impacts on treatment adherence by individual patients and on disease control especially in developing nations. Different aetiological propositions have been propounded, including the relationship of tuberculosis with the Acquired Immune Deficiency Syndrome (AIDS). OBJECTIVES: We sought to evaluate self-reported stigma experience among TB patients in Lagos and examine its socio-demographic determinants. METHOD: This was a descriptive cross-sectional study, recruiting 205 patients on treatment at two government-owned referral centres for tuberculosis, using self-administered questionnaires to collect each respondent's data. RESULT: Eighteen percent reported a previous stigma experience. Stigma experience was observed to be significantly determined by age, low socio-economic status, level of education below secondary level, disclosure of status, history of weight loss, previous smoking and alcohol history. Also, patients unable to work on clinic days were more likely to experience stigma. Sex, religion, marital status and ethnicity were not significant determinants. CONCLUSION: Experience of stigma among patients with tuberculosis is common and may adversely affect treatment adherence. Healthcare workers and policy makers need to pay closer attention to the identified determinants for effective tuberculosis control.

Maternal and perinatal mortality in ward A, Ikosi-Isheri LCDA in Lagos State, Nigeria: from "guestimates" to near actuals.

BACKGROUND: The problem of authentic statistics on maternal and peri-natal mortality has persisted in Nigeria probably because of inadequate involvement of community members in data management. OBJECTIVE: The objective of this study was to improve the accuracy of information on pregnancy outcome in a ward in Lagos state. METHODS: Residents of Ward A of Ikosi-Isheri Local Council Development Area (LCDA) of Lagos State were educated on the importance of accurate health data. Youths selected based on criteria and community-based health care providers, following refresher training on research methods, assisted with the collection, analysis and presentation of data. RESULTS: The records of churches, mosques, Traditional Birth Attendants, the government owned Primary Health Care (PHC) centre and 7 private health facilities in the ward reported no (0) maternal mortality, but 14 out of 633 live births in the latter died, giving a peri-natal mortality of 22.1 per thousand in one year. However, neither the CDAs, nor LCDA nor the state received regular reports on pregnancy outcome. CONCLUSION: Under-reporting or over-estimation of pregnancy outcome can be reduced by involvement of the leaders of Residents Associations and other relevant community members in data management. Data should be collected by smaller units into which a ward is divided and collated at the ward level for transmission to the LGA/LCDA. Feedback to community members will improve awareness about the importance of appropriate antenatal, natal and peri-natal care. Health care providers are also more likely to take prompt action to prevent maternal and peri-natal mortality.

HIV: knowledge and sexual practices amongst students of a school of communnity health in Lagos, Nigeria.

A cross sectional study was conducted amongst students of a school of health technology in Yaba. Lagos. Nigeria to determine their knowledge about HIV/AIDS and their sexual practices. A self-administered questionnaire was used to collect data. Two hundred and thirty-six students out of 250 participated in the study (94% response rate). The mean age was 24.7+5.2 years, 167 (71%) respondents were females while 69 (29%) were males. One hundred and seventy-seven (75%) students were single and 59 (25%) were married. Knowledge on HIV was graded using twenty-nine items on the questionnaire, each scored one mark. A maximum score of 29 was obtainable and respondents with scores greater than 50% were classified as having a satisfactory level of knowledge. Ninety-nine percent had heard about HIV/AIDS through several sources. Knowledge of symptoms, methods of transmission and prevention were generally satisfactory. One hundred and seventy one (72%) students were sexually active, 48% engaged in casual sex and 9% had multiple partners. Of the 171 who were in sexual relationship with a primary partner, 49 (29%) used condoms all the time. One hundred and fourteen (48%) admitted to having casual sex but 60 (53%) used condoms all the time during casual sex. Partner and personal dislike as well as reduction in sexual pleasure were reasons for non-use of condoms. A significantly higher proportion of students in the higher classes (74/94, 79%) possessed a higher level of knowledge than those in the lower class (78/142, 55%, p=0.0003). One hundred and fifty-two (64%) students possessed a satisfactory level of knowledge on the subject, but many engaged in risky behaviour.

Knowledge, attitudes, beliefs and motivations towards blood donations among blood donors in Lagos, Nigeria.

Summary. interviewed with questionnaires on their knowledge, attitudes, beliefs and motivations about blood donations. It was found that a large number of them (92.9%) donated because of the benefits they will obtain from the hospital. Such benefits include antenatal registration (67.1%) and saving the lives of relations (25.8%). Even though many of the donors are educated (98.9%), majority of whom have university degrees (36.1%) and have heard about blood donation before, 52.4% of them believe they can contact human immunodeficiency virus (HIV) and/or hepatitis infection from blood donation. A good number (47.0%) are afraid of what they regard as side effects, such as weight loss (23.8%), sexual failure (5.9%), high blood pressure (5.2%), sudden death (3.3%), and convulsion (1.47%). About 41.0% prefers certificates as an incentive for donation, whereas 13.6% prefers money; less than 3% will like their names announced or published on the media and 2.58% will donate for nothing. It is recommended that an intensive blood donation campaign should be maintained. This will allow people to be well informed, turning the positive attitude of saving life through blood donation to a regular practice.

Socio demographic profile and career aspirations of medical students in a new medical school.

All fifty-two pioneer medical students in a new medical school (The College of Medicine of Lagos State University), participated in a cross sectional survey to identify their socio-demographic profile and career intentions. A self-administered structured questionnaire was used to collect data. The students were observed to be mature. Their mean age was 23.6 years +/- 3.8. A third were graduates with at least a first degree, while 23% had parents with medical background. Factors influencing their choice of medicine as a career were desire to serve mankind (91%), primary interest in the profession (90%) and parental influence (84%). Sixty-seven per cent of them would want to specialize while the most frequently chosen fields were obstetrics and gynaecology (28.6%) and surgery (25.7%). The main reasons influencing specialisation were primary interest in the specialty (91%), service to humanity (91%) and job satisfaction (85.7%). A desire to specialize was evident even in these medical students who were just starting medical school.

Risk factors of coronary heart disease: attitude and behaviour in family practice in Saudi Arabia.

To study risk factors of attitudes and behaviour towards coronary heart disease (CHD), 280 Saudis > or = 20 years attending a family practice answered a structured health and lifestyle questionnaire and had their weight, height, blood pressure and random total cholesterol measured. Significant difference was found between males and females in the mean number of cardiovascular risk factors (t = -3.03, P < 0.01). Few people with high dietary fat intake, obesity or physical inactivity perceived their behaviour as harmful. The number of people who perceived an associated risk to their health increased with incidence of smoking and obesity but not with high fat intake. Physically inactive people were least likely to perceive their behaviour as harmful.

Risk factors of coronary heart disease: attitude and behaviour in family practice in Saudi Arabia

To study risk factors of attitudes and behaviour towards coronary heart disease [CHD], 280 Saudis > or = 20 years attending a family practice answered a structured health and lifestyle questionnaire and had their weight, height, blood pressure and random total cholesterol measured. Significant difference was found between males and females in the mean number of cardiovascular risk factors [t = -3.03, P < 0.01]. Few people with high dietary fat intake, obesity or physical inactivity perceived their behaviour as harmful. The number of people who perceived an associated risk to their health increased with incidence of smoking and obesity but not with high fat intake. Physically inactive people were least likely to perceive their behaviour as harmful

Smoking habits of King Saud University students in Abha, Saudi Arabia.

BACKGROUND: The aim of this study was to estimate the prevalence of smoking among university students of King Saud University in Abha City, to determine ecological factors for the problem, and to assess the studentsâ knowledge about the health effects of smoking, and attitudes towards public action against smoking. MATERIALS AND METHODS: All medical students at the University College of Medicine (MC) (n=202), and a representative sample of students of the College of Education (CE) (n=300), were subjected to a modified Arabic version of the World Health Organization standard questionnaire for young people to study their knowledge, attitudes and practices of smoking. RESULTS: The study revealed the following results among students of the CE and those of the MC, respectively. Prevalence of regular smoking (17.5% vs. 13.6%; P=0.25); heavy smokers (39.5% vs. 27.8%; P=0.38); smokers of moderate- to high-nicotine yield (92.7% vs. 50%, P=0.0004), and tar yield (48.8% vs. 16.7%, P=0.02). Curiosity was the main reason for initiation of smoking (41.2% vs. 51.9%), followed by the desire to show off (27.5% vs. 51.9%, P=0.03), and peer pressure (27.5% vs. 7.4%, P=0.04). Friends were the main source of the first cigarette (53.1% vs. 55.6%), followed by parents (2% vs. 40.7%, P=0.0001). Most students were knowledgeable about smoking and had favorable attitudes against it. However, MC students were significantly more knowledgeable than those of the CE. CONCLUSION: Smoking still constitutes a major problem among university students in Abha, in spite of their knowledge of its hazards. This may be due to the addictive effect of smoking, peer pressure, negative parental attitudes and other reasons. There is a need to implement an anti-smoking program for college students, and possibly legislation to limit the amount of tar and nicotine in cigarettes.

Cerebro-spinal lactate status in childhood pyogenic meningitis in Nigeria.

This study was undertaken to ascertain the status of cerebrospinal (CSF) lactate level in Nigerian children with pyogenic meningitis. Forty patients aged from 1 month to 12 years with proven meningitis were the subjects in the study which lasted 8 months. All the patients who had pyogenic meningitis had mean cerebrospinal lactate level over 25 mg/dl. The patients who recovered with neurological deficit had higher level of cerebrospinal lactate than those who recovered without any neurological deficit, on admission and on-discharge, although the differences were not statistically significant. The patients who died had persistently high mean CSF lactate on admission and at death. The study suggests that persistently elevated CSF lactate in cases of pyogenic meningitis receiving adequate antibiotic therapy might indicate poor prognosis with increased mortality. It is not being suggested that CSF lactate determination should replace the conventional tests for meningitis. However, it can provide pertinent, rapid, and reliable diagnostic information, and can also provide useful evaluation information at different stages of treatment of proven meningitis with appropriate antibiotics.

Cerebrospinal fluid/serum lactic acid in Nigerian children with febrile convulsions.

Cerebrospinal fluid (CSF) and serum lactic acid levels were prospectively assayed in 42 children less than 5 years old with febrile convulsions who were divided into two groups for analytical purposes, irrespective of aetiology of pyrexia. One group (24 children) had brief febrile seizures and the remaining 18 children had prolonged febrile seizures. CSF and serum lactic acid values were obtained for brief and prolonged seizures. On admission, the mean CSF lactic acid was significantly higher (p < 0.05) in children with prolonged than with brief seizures, but the mean serum lactic acid was not significantly different between the two groups. Twelve of the 18 children (67%) with prolonged seizures and elevated CSF lactate had seizure recurrence. There were no recurrences of seizures in children with a brief initial seizure and low CSF lactate. CSF lactic acid is elevated in children with prolonged seizures and this may be useful in detecting those with a prolonged seizure where the history of the duration of the seizure is not clear. Prolonged seizure has been associated with the risk of recurrence and therefore such children with elevated CSF lactic acid levels might benefit from long-term anticonvulsant therapy.

Knowledge and attitudes towards AIDS among primary health care physicians in the Asir Region, Saudi Arabia.

STUDY OBJECTIVES: To assess the knowledge and attitudes towards AIDS among practicing physicians in the Asir Region, Saudi Arabia. DESIGN AND PARTICIPANTS: A survey was carried out among primary health care (PHC) physicians working in the 238 PHC centers in the region. Self administered questionnaires were distributed to the 361 physicians working in these centers. Three hundred and twenty-eight responded (90.1%) and were included in the study. Non-respondents were found not to differ significantly from respondents with regards to sex, age and qualifications. MAIN RESULTS: The study revealed several gaps in their knowledge regarding AIDS. Of particular concern are those who are to be considered at high risk and models of transmission of the disease. CONCLUSIONS: These results indicate an urgent need to develop AIDS specific continuing medical education program to deal with erroneous ideas to convey the message properly to the public.

PIP: Although acquired immunodeficiency syndrome (AIDS) has not yet emerged as a major public health problem in Saudi Arabia, a survey of primary health care physicians in the Asir Region revealed serious gaps in knowledge among those are central to AIDS prevention and control. Analyzed were questionnaires completed by 328 physicians from 118 urban and 210 rural primary health care centers in 1993 in this southwestern region of the country. 74% of physicians were male; their mean age was 36.5 years. Although 82.9% agreed that AIDS is a global health problem, only 6.7% felt it was of concern to Saudi Arabians. 19.5% acknowledged having extremely limited knowledge about AIDS, and 97.2% were interested in professional education on this topic. Not only did many physicians have misinformation about modes of transmission (e.g., 13.8% identified mosquito bites and 49.7% implicated casual kissing), 33.8% were unaware that tatooing is a known mode of transmission. Also inadequate was knowledge of groups at risk of human immunodeficiency virus (HIV); infants of HIV-infected women, those with multiple sex partners, patients with repeated blood transfusions, drug addicts, and homosexuals were identified by only 7.9%, 43.0%, 43.1%, 66.1%, and 63.7% of physicians, respectively. 7.9% thought that vaccines against HIV were available and 11% claimed AIDS was curable. None of the physicians had treated a person with AIDS and only 5.2% reported any personal contact with an AIDS victim. On the other hand, 89% were aware of the signs and symptoms of AIDS. 49% of physicians felt AIDS patients should be isolated; only 25.1% favored home-based care.

Continuing medical education needs regarding AIDS among Egyptian physicians in Alexandria, Egypt and in the Asir Region, Saudi Arabia.

A study was carried out on two groups of Egyptian physicians to assess their continuing medical education (CME) needs regarding AIDS. The first group comprised 330 physicians working in Alexandria, Egypt, in Mother and Child Health Care Units, School Health Units and Health Offices. The second group included 144 physicians working in Primary Health Care Centres in the Asir Region, southwestern Saudi Arabia. The demographic and socio-cultural background of both groups was similar. The results revealed similar deficiencies in their knowledge about the disease, especially modes of transmission. These results indicate the urgent need to develop an AIDS-specific CME programme to deal with erroneous ideas. Lectures and periodicals ranked first as the preferred educational strategy.

PIP: Control of the AIDS epidemic depends upon preventing HIV infection through education, information, and the curtailment or avoidance of known risk behaviors. Physicians are in an uniquely good position to provide the information and education needed to help limit the spread of HIV, with several studies having demonstrated the ability of physician counseling to promote health behaviors among patients. The curricula of faculties of medicine in Egypt, however, were only recently changed to include AIDS. It is clear that the overwhelming majority of physicians in Egypt graduated and have specialized without formal education about the disease. Continuing medical education (CME) programs are provided to physicians in Egypt and other Gulf countries. To plan for such programs, however, the extent of the knowledge and needs among physicians must be determined. This paper reports findings from an assessment of the AIDS education needs of two groups of physicians. One group was comprised of 330 physicians working in Alexandria, Egypt, in maternal-child healthcare units, school health units, and health offices. The second group included 144 physicians working in primary health care centers in the Asir Region of southwestern Saudi Arabia. The demographic and sociocultural background of both groups was similar; respondents were of mean age 36 years and approximately 65% were male. Similar deficiencies were found in their knowledge about AIDS, especially modes of transmission. 20% of the physicians considered themselves to have only minimal knowledge about AIDS and 97% of both groups were very interested to learn more about the disease. 8.2% and 13.2%, respectively, believed that a cure exists for AIDS, while 5.5% and 6.9%, respectively, thought that vaccines are available against the disease. Only 16.7% and 11.8% of physicians, respectively, recommended keeping identified cases of AIDS in the community, with the remainder endorsing confining people with AIDS to hospitals or elsewhere in isolation. These results highlight the urgent need to develop an AIDS-specific CME program for medical practitioners in Egypt and Saudi Arabia. 62.5% of the physicians preferred to receive CME from lecturers, 50.3% from books and periodicals, 44.8% in conferences, and 42.1% in workshops.

A study of maternal and child health care services and private sector in urban Asir Region.

The differences in the maternal and child health care services offered by government and private sector in Abha and Khamis Mushayt cities in Asir Region of Saudi Arabia were compared. Self administered questionnaires and observation sheet were used for the study. It was found that the government clinics were more involved in the running of under 5 clinics and giving health education to patients. The private clinics took more care of women general health care but lacked the continuous domiciliary visit to pregnant women. The catchment area which served the government PHCCs made accessibility to service easier to government patients and this was thought to be the reason why government patients kept regular appointments. On the other hand, private patients who have the freedom to choose where they get service have been found to be irregular in keeping clinic appointment. It was suggested that there should be geographical spread in the location of private clinics to facilitate accessibility and that the health education and under 5 clinics should be well incorporated into the services offered by private clinics.

Anemia among pregnant women in the Asir region, Saudi Arabia: an epidemiologic study.

A cross sectional study was conducted during August 1992, on a representative sample of 6,539 pregnant women attending 69 primary health care centers in the Asir region, southwestern Saudi Arabia for the assessment of their hemoglobin level. The overall prevalence of anemia (Hb < 11 g/dl) was found to be 31.9%. It was found that the prevalence was affected by age (37.3% among those who were less than 20 years old), parity (34.9% among those who had 7 and more deliveries), inter-pregnancy spacing (35.2% among those whose birth spacing was less than 1 year), gestational age, and education (35.1% among illiterates). Health education programs at primary health care level in the region should be revised to stress the importance of balanced diet, compliance with iron medication and sufficient spacing between subsequent pregnancies.

Altitude and socio-biological determinants of pregnancy-associated hypertension.

OBJECTIVES: To study the prevalence of gestation-associated hypertension and to determine the effect of altitude and related socio-biological factors. METHODS: A stratified random sample of 3988 pregnant women living at high altitude and 2744 at sea level in the Asir region, Saudi Arabia was interviewed for socio-biological conditions and examined for blood pressure, proteinuria and body mass. RESULTS: An overall prevalence of 2.4% was found. Certain groups of pregnant women are at high risk of developing hypertension. They include women who are over 40 years, high multipara, having short inter-pregnancy spacing, are overweight, are illiterate and those living at high altitude. Multivariate analysis showed that high altitude is a strong risk factor (adjusted odds ratio (OR), 1.879; 95% confidence interval (CI), 1.123-2.819) and cannot be masked when other variables are controlled. CONCLUSIONS: Special health education and more frequent screening programs at primary health care level should be given to pregnant women living at high altitude.

Childhood febrile seizures (Benin City experience).

About 20% of children admitted during the study period had febrile convulsions, of which 5% were aged below 5 months or above 5 years. The study confirms the view that there is a strong familial predisposition in febrile seizures. Major causes of the rise in temperature in those studied included malaria, which accounted for 32.7%, followed by bronchopneumonia (16.8%), measles (15.4%), otitis media (13.4%) and tonsillitis (10.5%). The morbidity and mortality could be attributable to the socio-cultural background of the community which practices modes of therapy that are often detrimental to the health of patients.

PIP: A febrile convulsion is a generalized seizure occurring during a febrile illness whose cause is extracranial. Most scholars agree that strong evidence exists of familial predisposition to febrile seizures. The events are more common among men, with the pattern of such convulsions in Europe and North America apparently different from that in Africa. The authors report their findings from an examination of the pattern of febrile seizures at the Children's Emergency Room of the University of Benin Teaching Hospital in Benin City, Nigeria. 1046 children were admitted over the course of the study conducted January-September, 1988. Seven of the 202 patients with febrile convulsions died, five from aspiration pneumonia and two from tetanus following traditional treatment. 5% of patients with febrile convulsions were younger than 5 months or older than 5 years. The male:female ratio was 1.3:1. 140 children had a family history of febrile convulsion; in 55% the relative was a close family member. The authors point out that the number of families with a positive history of febrile convulsions may have been underreported because the average Nigerian family is loathe to admit that any member suffers from a socially stigmatized illness. These findings confirm the view that a strong familial predisposition exists for febrile seizures. Major causes of the rise in temperature in those studied included malaria, which accounted for 32.7%, followed by bronchopneumonia among 16.8%, measles at 15.4%, otitis media at 13.4%, and tonsillitis at 10.5%. Observed morbidity and mortality could be attributed to the sociocultural background of this community which practices modes of therapy which are often detrimental to patient health.

Referral system in the Asir Region, Saudi Arabia: knowledge, attitude, and practice of physicians working in urban areas--a comparative study of governmental and private health sectors.

A comparative study of knowledge, attitude and practice regarding referral system was undertaken among all governmental primary health care and private dispensary physicians (56 and 50 respectively) in Abha and Kamis, Asir Region. Results show that knowledge about referral is adequate in both groups, but the attitudes and practice of both groups need to be positively modified specially among the private sector physicians. The paper recommends more orientation programs for both groups of physicians and urges the private sector physicians to be more involved in Ministry of Health training programs and activities. Cooperation in referral between the private sector and government hospitals is seen as one way of improving health care in Saudi Arabia.

Continuing medical education in primary health care in Saudi Arabia: an epidemiologic study of physicians' needs in the Asir region.

A cross sectional survey was carried out among doctors working in all the 238 Primary Health Care Centers in the Asir Region, Southwestern Saudi Arabia using self administered questionnaire. The response rate was 90.1%. The highly needed aspects of clinical practice include emergency skills (82.3%), diagnostic skills (74.4%) and management of common diseases (65.2%). Aspects that rated low include physical examination techniques, prescription skills, history taking and referral. Areas in medicine that rated high on the doctors' list of needs include critical care (60.7%), obstetrics and gynecology (52.7%) and family and community medicine (52.8%). The most highly preferred means of fulfilling these needs include clinical rounds (73.2%), consultation with specialists (69.8%) and regular lectures (62.5%). The objective of establishing baseline data which are essential for future continuing medical education (CME) planning in the Asir region was achieved in this study. Based on the doctors needs, it was recommended that regional CME units be established and related organizations and institutions that will jointly plan a program of CME be identified.

Ventilatory function of workers at Okpella cement factory in Nigeria.

Simple ventilatory function tests were done in 447 cement factory workers. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were higher in males than females and correlated well with age and height. FEV1 was smaller in workers who were in closer contact with cement dust. The three measured indices of ventilatory function decreased with years of service and the fall was neither accounted for by age nor height. Eleven chronic bronchitics were found, but these were heavy smokers. Overall, the lung volumes obtained were within the normal range for Nigerians. However, the nature of job done in the cement factory, and duration of service may well be important in the aetiology of "cement factory lung disease".