Effect of a novel pilot support group on distress and quality of life in breast cancer patients in Nigeria.

OBJECTIVE: To assess the effect of a new breast cancer support group (BCSG) on breast cancer patients' self-reported distress and quality of life. METHODS: A single arm pre-post trial providing an eight session healthcare provider led BCSG. Primary outcome variables were distress and quality of life assessed using the National Comprehensive Cancer Network Distress Thermometer (DT) and The Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACT-B+4), respectively. Topics in each session addressed a wide range of issues some of which were pre-selected by the patients themselves. DATA ANALYSIS: Paired sample t-test was used for data analysis on International Business Machine Statistical Package for the Social Sciences 21. RESULTS: The participants (N = 18) had a mean age of 51. Most had secondary school level education (54%), were traders (59%) and had stage 3 or 4 disease (67%). A larger proportion (78% or n = 14) of the patients lived in rural areas, while 4 (22%) of the patients lived in Ibadan. Out of the 8 sessions, 12 (67%) of the participants attended 1-3 sessions while 6 (33%) attended 4-8 sessions. There were, significant improvements in emotional wellbeing (t = -4.253; p < 0.05) and functional wellbeing (t = -2.191; p < 0.05) on the FACT-B+4. There was a significant reduction in the DT score (t = 2.345; p < 0.05) but the number of items on the problem list were not significantly reduced (t = 1.191; p > 0.05). Majority (75%) of the patients rated the support group activities as satisfactory. CONCLUSION: These data show that the support group can benefit breast cancer patients in terms of reduced distress levels along with satisfaction and improvement in the functional and emotional wellbeing indices of quality of life.

Epidemiological comparison of the first and second waves of the COVID-19 pandemic in Nigeria, February 2020-April 2021.

BACKGROUND: With reports of surges in COVID-19 case numbers across over 50 countries, country-level epidemiological analysis is required to inform context-appropriate response strategies for containment and mitigation of the outbreak. We aimed to compare the epidemiological features of the first and second waves of COVID-19 in Nigeria. METHODS: We conducted a retrospective analysis of the Surveillance Outbreak Response Management and Analysis System data of the first and second epidemiological waves, which were between 27 February and 24 October 2020, and 25 October 2020 to 3 April 2021, respectively. Descriptive statistical measures including frequencies and percentages, test positivity rate (TPR), cumulative incidence (CI) and case fatality rates (CFRs) were compared. A p value of <0.05 was considered statistically significant. All statistical analyses were carried out in STATA V.13. RESULTS: There were 802 143 tests recorded during the study period (362 550 and 439 593 in the first and second waves, respectively). Of these, 66 121 (18.2%) and 91 644 (20.8%) tested positive in the first and second waves, respectively. There was a 21.3% increase in the number of tests conducted in the second wave with TPR increasing by 14.3%. CI during the first and second waves were 30.3/100 000 and 42.0/100 000 respectively. During the second wave, confirmed COVID-19 cases increased among females and people 30 years old or younger and decreased among urban residents and individuals with travel history within 14 days of sample collection (p value <0.001). Most confirmed cases were asymptomatic at diagnosis during both waves: 74.9% in the first wave; 79.7% in the second wave. CFR decreased during the second wave (0.7%) compared with the first wave (1.8%). CONCLUSION: Nigeria experienced a larger but less severe second wave of COVID-19. Continued implementation of public health and social measures is needed to mitigate the resurgence of another wave.

Experience of intimate partner violence among rural women in Southwest, Nigeria.

Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally. Women's experiences of IPV in rural southwest Nigeria was examined in this study, conducted between July and August, 2019. A total of 677 women participated in this survey which employed a mobile phone application. Results revealed that the prevalence of experience of IPV was 39.4%. Experience of IPV was significantly higher among women who had been married longer (AOR = 2.09, 95% CI: 1.23, 2.93), completed secondary school (AOR = 1.81, 95% CI: 1.07, 3.05), were in the middle or richer wealth tertiles (AOR (95% CI= 1.59, 1.02, 2.51 and 1.84, 1.19, 2.84 respectively), and who justified IPV (AOR = 1.44, 95% CI: 1.00, 2.06). The prevalence of IPV among women in southwest Nigeria is high and determining factors are multi-faceted, hence the need for community sensitization interventions designed to address social norms that justify partner violence.

Determinants of wasting among schoolchildren in a Southwestern state of Nigeria: Implications to strengthen the nutritional component of primary health-care model.

BACKGROUND: Wasting is linked to about one-third of mortality among school-age children. More studies have centered on stunting among under-five children, with few documented studies exploring comparability and determinants of wasting among school pupils in southwestern Nigeria. This study aimed to investigate the comparability and determinants of wasting among schoolchildren in rural and urban communities of Obafemi-Owode local government area, Ogun State, Nigeria. METHODS: A cross-sectional study utilizing a quantitative approach was carried out among children both in rural and urban primary schools. Data were collected through interviewer-administered questionnaires. EPI-INFO version 6.03 was used, children were classified as wasted if weight-for-height Z-scores were <2 standard deviations below the National Center for Health Statistics/World Health Organization median. Associations were tested using t-tests and Chi-square test, while predictors were examined with logistic regression at 95% level of significance. RESULTS: Male gender was predominant (54.6%). Significantly more pupils from rural areas lived with grandparents and other guardians (60.3%) compared to their urban counterparts (39.7% P = 0.005). Pupils from rural schools were four times more likely to be wasted compared to those located in urban regions (odds ratio [OR]: 4.2; 95 confidence interval [CI] = 2.24-7.69). Male pupils were twice likely to be wasted compared to the female pupils (OR: 2.08; 95 CI = 1.22-3.55). CONCLUSION: Conclusively, the study revealed that the prevalence of wasting was higher among children from rural schools than in urban schools. There is an urgent need to implement viable interventions and policies that address nutritional deficiencies in primary school pupils, particularly in rural areas.

Managerial dynamics influencing doctor-nurse conflicts in two Nigerian hospitals.

BACKGROUND: In the hospital, authority does not usually comes from a single person nor is it exercised in a single chain of command as is obtainable in most formal organizations. Doctors exercise substantial authority within the organizational structure of the hospital and therefore enjoy high autonomy in the hospital setting. This nature of autonomy within the medical and its allied professions has the propensity to incite conflicts within the hospital settings. The study thus sought to examine how the relationship of authority and influence between doctors and nurses within the hospital organization generates conflicts and to evaluate the effectiveness of managerial procedures utilized to resolve doctor-nurse conflict in the selected hospitals. METHODS: Semi-structured questionnaires were self-administered to 323 health workers who were sampled from one secondary and the only one tertiary hospital in the state at the time. Focus group discussions (FGDs) were conducted with three groups each of doctors and nurses in the selected hospitals. The organograms of both organizations were also reviewed to evaluate structural relationships of authority between doctors and nurses. Data were analyzed using unadjusted odd ratios at 95% level of significance. RESULTS: Respondents were also twice likely to attest that the command structure and its ability to resolve conflicts was below average in assessment (odds ratio [OR] - 2.05; 95% confidence interval [CI] - 1.27-3.29). Undue advantage (partisan approach) for a particular group by management to conflict resolution was thrice likely to be practiced in both hospitals but more in state hospital compared to the federal medical center (OR - 2.93; 95% CI - 1.54-5.58). Some findings from respondents in the FGDs revealed lackadaisical approach by the management in tackling conflicts among health workers. CONCLUSION: Doctor-nurse conflict is caused by several organizational and managerial factors. Hospital management must understand the interplay of these factors and institute appropriate managerial policies to tackle the problem appropriately.

Acquisition, maintenance and adaptation of invasion inhibitory antibodies against Plasmodium falciparum invasion ligands involved in immune evasion.

Erythrocyte-binding antigens (EBAs) and P. falciparum reticulocyte-binding homologue proteins (PfRhs) are two important protein families that can vary in expression and utilization by P. falciparum to evade inhibitory antibodies. We evaluated antibodies at repeated time-points among individuals living in an endemic region in Nigeria over almost one year against these vaccine candidates. Antibody levels against EBA140, EBA175, EBA181, PfRh2, PfRh4, and MSP2, were measured by ELISA. We also used parasites with disrupted EBA140, EBA175 and EBA181 genes to show that all these were targets of invasion inhibitory antibodies. However, antigenic targets of inhibitory antibodies were not stable and changed substantially over time in most individuals, independent of age. Antibodies levels measured by ELISA also varied within and between individuals over time and the antibodies against EBA181, PfRh2 and MSP2 declined more rapidly in younger individuals (≤15 years) compared with older (>15). The breadth of high antibody responses over time was more influenced by age than by the frequency of infection. High antibody levels were associated with a more stable invasion inhibitory response, which could indicate that during the long process of formation of immunity, many changes not only in levels but also in functional responses are needed. This is an important finding in understanding natural immunity against malaria, which is essential for making an efficacious vaccine.

Effect of First Aid Education on First Aid Knowledge and Skills of Commercial Drivers in South West Nigeria.

BACKGROUND: Prompt prehospital care is essential for improving outcomes of road crash victims; however, this service is sub-optimal in developing countries because Emergency Medical Services (EMS) are not readily available. Training of lay responders in first aid has been suggested as a means of filling this gap in settings with inadequate EMS. This study was conducted to determine the effect of first aid training on the first aid knowledge and skills of commercial drivers. METHODS: A before-and-after study was conducted among 128 commercial drivers (62 intervention and 66 controls) selected by multi-stage sampling. Drivers' first aid knowledge and skills were assessed at baseline, immediate, and three months post-intervention. The intervention involved a 2-day training session in first aid. Repeated measures ANOVA was used to test for differences in respondents' pre- and post-intervention scores over the three assessment points. RESULTS: Mean first aid knowledge scores for intervention drivers were 48.9% (SD=12.0), 57.8% (SD=11.2), and 59.2% (SD=9.0) at baseline, immediate, and three months post-intervention. Corresponding scores for the controls were 48.3% (SD=12.8), 39.2% (SD=15.3), and 46.8% (SD=15.3). Mean first aid skill scores for intervention drivers were 17.5% (SD=3.8), 80.7% (SD=8.3), and 72.3% (SD=16.8). Scores for control drivers were 16.5% (SD=4.5), 16.3% (SD=4.7), and 20.4% (SD=9.1), respectively. Repeated measures ANOVA showed significant differences in first aid knowledge and skills scores over the three phases. Independent t-test revealed significant differences in scores between the intervention and control groups post-intervention. CONCLUSION: The training led to significant improvement in first aid knowledge and skills of intervention drivers. This confirms that lay responders can be trained in provision of first aid. The slight drop in skills scores, which occurred three months post-intervention, highlights the need for periodic refresher trainings to be conducted for the drivers in order to maintain the knowledge and skills acquired.

Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria.

BACKGROUND: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. AIM: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria. SETTINGS: A low-income community in Ibadan North West Local Government Area of Oyo State. METHODS: A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. RESULTS: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. CONCLUSION: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.

HIV/AIDS-related knowledge and misconceptions among women attending government-owned antenatal clinics in Gwagwalada Area Council of Abuja, Nigeria.

This study assessed the level of knowledge and misconceptions about HIV/AIDS transmission and prevention among women. Using a semi-structured pretested questionnaire we obtained relevant data from 420 respondents in five randomly selected antenatal clinics (ANCs) in Gwagwalada Area Council (GAC) of Abuja, Nigeria. Knowledge about the existence of HIV/AIDS was high (92.8%). Only 52.1% knew the cause of AIDS and 58.6% were aware that AIDS had no cure. About twenty percent of respondents believed that breast-milk could not transmit HIV and 27.9% were unaware that condom protects against HIV. Only 33.3% were aware that HIV infected persons may look and feel healthy. Mothers with at least secondary level education had significantly higher knowledge scores on HIV/AIDS transmission (X2 = 14.8, p = 0.01) than less educated mothers and less educated mothers were more likely to relate HIV infection to past misdeeds (X2 = 13.6, p = 0.01). Significant misconception concerning HIV transmission existed in the study population. More community outreach programmes to intensify HIV education and counseling in GAC is required.

Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital.

OBJECTIVE: The main objectives of the study were to determine the relationship between social network and pathway to service utilization among psychotic patients. MATERIALS AND METHODS: This descriptive study was carried out in a psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients' use of services, controlling for sociodemographics, health and functional status. RESULTS: Mean age of the respondents was 29.0 ± 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of psychological distress. CONCLUSIONS: Findings indicate that social support and social network enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria.

A rural-urban comparison of client-provider interactions in patent medicine shops in South west Nigeria.

The increasing prominence of patent medicine vendors (PMVs) in healthcare provision makes information about how they operate of interest. This study assessed consumers' behavior and PMVs' performance in the treatment of childhood illnesses in rural and urban communities in South West Nigeria. Non-participatory observations were carried out in 163 licensed patent medicine stores in Oyo State, Nigeria. Many PMV shops (70.6% rural and 61.9% urban; p = 0.141); stocked non proprietary drugs. Clients often requested for drugs by name (75.4% urban versus 62.2% rural; p = 0.002) and PMVs mostly sold drugs as requested without questions (65.3% urban 57.8% rural; p = 0.07). Inappropriate treatment practices and invasive procedures were observed more often in urban PMVs shops (p < 0.001). PMVs functioned mostly as sales persons supplying clients' drug requests. Strategies to improve PMV treatment practices should include caregiver education to be effective.

Determinants of good oral hygiene among pregnant women in ibadan, South-Western Nigeria.

BACKGROUND AND OBJECTIVES: The need to attain and maintain good oral hygiene among pregnant women cannot be over emphasized as periodontal diseases in pregnancy have been linked with poor pregnancy outcomes. This study assessed the variables that affect oral hygiene status among pregnant women in a south-western Nigerian locality. METHODOLOGY: Four hundred and five pregnant Nigerian women were assessed for their oral hygiene status using the Oral Hygiene Index-Simplified. Demographic and pregnancy statistics were also obtained and the relationships between these and oral hygiene status were determined. RESULTS: The mean age was 25.35 ± 5.02 years. Most of the women (96.0%) had never visited a dentist or any other oral health care provider and only 12.5% of those who had been attended by dental care givers have ever had professional dental cleaning. The oral hygiene status appeared to worsen as parity increased (p=0.047) while the use of the toothbrush and paste was associated with good oral hygiene (p=0.007). Higher education was associated with use of the tooth brush and paste (p=0.046) and good oral hygiene (p= 0.001). CONCLUSION: The positive effect of education on oral hygiene practices is highlighted in this study. However there is still need for proper health enlightenment in this population with regards to use of the available oral health care facilities.

Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria.

PURPOSE: One of the greatest challenges facing school nurses is that of identifying and using appropriate strategies to meet the health education needs of adolescents in regard to prevention of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). This study examined the effects of HIV/AIDS preventive health education with parental involvement on students' attitude toward HIV/AIDS prevention in Akwa Ibom State, Nigeria. METHODS: The study population comprised students from three of nine secondary schools in the study area. The three schools were randomly assigned as Intervention Group 1 (IG1), involving nurses only; Intervention Group 2 (IG2), involving both nurses and parents (IG2); and a control group. A pretest/post-test intervention design was used. A 29-item, validated questionnaire was the instrument for data collection. Sampling involved multistage and stratified random technique to select 120 subjects from each of the three selected schools, with a total of 360 subjects representing 8.3% of the study population. From this number, 339 (94.2%) provided sufficient data for analysis. Data analysis involved analysis of covariance and the Scheffé post hoc test determined at the .05 significance level. RESULTS: Results show significant effect of intervention on students attitudes toward preventive measures (F = 234.27, p < .001 *). The intervention that involved nurses only was found to be a more potent strategy in providing favorable attitudes toward HIV/AIDS prevention (IG1 mean, 20.59; IG2 mean, 19.20; control mean, 12.34). Attitudes were influenced by older age but not by gender. CONCLUSION: Health education efforts aimed at improving HIV/AIDS-related attitudes should not only focus on children but also on parents so that they in turn could assist to improve on health workers' efforts in educating the children.

Relationship between blood pressure and body mass index in lean populations

Associations between body mass index (BMI) and blood pressure (BP) have been consistently observed, but remain poorly understood. One unresolved question is whether there is a linear relationship across the entire BMI range. We investigated this question among 11235 adult men and women from seven low-BMI populations in Africa and the Caribbean. We used kernel smoothing and multivariate linear and spline regression modeling to examine gender differences in the relationship and to test for a threshold. Age-adjusted slopes of BP on BMI were uniformly higher in men than women, with pooled slopes ratios of 2.00 and 2.20 for systolic and diastolic BPs, respectively. Men displayed no evidence of age modification or nonlinearity in the relationship, and the age-adjusted slope of systolic BP on BMI was 0.90 (95 percent confidence interval [CI], 0.76 to 1.04). Women demonstrated both age modification and nonlinearity. For both younger (<45 years) and older (45+ years) women, the optimal change point for a single threshold model was found to be 21kg/m. Slopes of systolic BP on BMI above this threshold were positive and significant: 0.68 (95 percent CI, 0.54 to 0.81) and 0.53 (95 percent CI, 0.29 to 0.76) for younger and older women, respectively. Slopes below the threshold were essentially zero for both groups of women, and difference between the slopes above and below the threshold was significant for younger women (P=.018). In summary, we observed a threshold at 21kg/m in the relationship between BMI and BP for women but not for men. This contributes to the effort to identify the mechanism that underlie this relationship and how they differ by gender.(AU)