Seroprevalence survey of rubella infection in pregnancy at the University of Benin Teaching Hospital, Benin City, Nigeria.

OBJECTIVE: To determine the serosusceptibility of rubella infection in pregnancy and the feasibility of establishing an organized prevention program in a tertiary hospital in Nigeria. MATERIALS AND METHODS: This prospective, cross-sectional, laboratory-based study involved 300 consecutive pregnant women who gave informed consent and were screened for rubella immunoglobulins G (IgG) and M (IgM), using the ELISA-based quantitative assay at the University of Benin Teaching Hospital, Nigeria. Of the cohort, 30 women later withdrew. IgG seropositive samples were screened for IgM antibodies. RESULTS: The mean age and parity of the women were 30.0 ± 4.8 years, 95% CI 29.727-30.873 and 2.0 ± 1.4; 95% CI 1.317-1.661, respectively. IgG seroprevalence was 53%, while 10.0% of all IgG seropositive women were IgM seropositive. Most infections were acquired before the age of 35. None of the women ever had previous rubella vaccination. Rubella vaccine is scarce in Nigeria. CONCLUSIONS: Prevalence of rubella seromarkers for previous and current infection is high. Facilities for routine diagnosis and vaccination are lacking. Initiation of organized screening and vaccination programs is limited by lack of vaccine. We recommend immunization of children and women of child-bearing age as a cost-effective public health intervention strategy for managing the sequelae of the congenital rubella syndrome.

Oral health knowledge, attitude and practices among Nigerian primary school teachers.

BACKGROUND: A multi-disciplinary approach is needed for effective dental education of children. Teachers can be used as oral health educators but only if they have a good knowledge, attitude and practice of oral health. This study's main objective was to compare the oral health knowledge, attitude and practices of public and private primary school teachers and to determine the proportion of teachers presently involved with oral health education of school children. METHOD: The study was carried out on 320 private and 320 public school teachers in Benin-City, Nigeria, using self-administered questionnaire. RESULTS: The result revealed that the teachers involved in this study generally had positive attitude to oral health. Many of the two groups of primary school teachers had poor oral health practices. Only 42.4% of the respondents have ever been to the dentist for routine dental checkup or treatment. About 87.6% of teachers still use potentially traumatic materials for interdental cleaning and 60% of teachers consume regularly various forms of refined sugar. Over 90% of the two groups of teachers are presently involved in teaching their pupils basic oral health education although they have a poor knowledge of the aetiology of the two most common oral diseases. The teachers' major source of oral health information is the dentist. CONCLUSION: Similar pattern of incomplete oral health knowledge, inappropriate oral practices but positive oral health attitude was observed among the two groups of the studied teachers. This observation suggests that the primary school teachers can serve as oral health educators after organized training to heighten their oral health knowledge and perfect their oral practices.

"He does his own and walks away" perceptions about male attitudes and practices regarding safe motherhood in Ekiadolor, Southern Nigeria.

The main study objectives were to highlight male attitudes and practices regarding safe motherhood, and to demonstrate the usefulness of qualitative research methods in studying behaviour-related health problems. The setting was Ekiadolor, a semi-urban Nigerian community with an under-resourced district hospital. The study design was a qualitative research, using Focus Group Discussions (FGDs) with females and the local hospital staff as participants, triangulated with Free Listing Interviews (FLIs) and group interviews of males. The FGD findings showed a consensus that male practices and attitudes were generally unsatisfactory, as exemplified by physical violence against females, delay in enabling access to emergency obstetric care and a general perception that males were uncaring. However, many males paid parts of their partners' routine obstetric care bills. These findings were largely corroborated and enriched by those of the FLIs and group interviews, albeit with differing emphases; they provided vital inputs into health education of the community males. In conclusion, the wide range of attitudes and practices described, and the socioeconomic settings in which they occur, pose challenges and opportunities for behaviour change interventions primarily targeting males, poverty reduction and health service reforms. Health researchers are challenged to draw from the varied strengths of qualitative research methods.

Maternal health-seeking behavior and associated factors in a rural Nigerian community.

OBJECTIVES: To assess maternal health services and health-seeking behavior in a rural community (Ologbo), located in the South-south zone of Nigeria. METHODS: Structured questionnaire was administered to 225 randomly selected mothers (age 15-49 years), and was analyzed using SPSS. Six focus group discussion sessions were also conducted-four for community women and two for health workers. RESULTS: Teenagers constituted 13.3% of the respondents. The average number of children per woman ranged from 2.5 for teenagers to 9.0 for women aged 45-49 years. Eighty percent of respondents knew at least one major medical cause of maternal mortality: the most common causes mentioned were hemorrhage (31.8%) and obstructed labor (17.3%). Private maternity center was the most preferred place for childbirth (37.3%), followed by traditional birth attendants (TBAs) (25.5%). Government facility was preferred by only 15.7%: reasons for the low preference included irregularity of staff at work (31.4%), poor quality of services (24.3%), and high costs (19.2%). Among the 81 women that delivered within a 1-year period, only 9.9% received antenatal care, 6.2% received two doses of tetanus toxoid, while 4.9% attended postnatal clinic. Private midwives and TBAs attended 49.4 and 42.0% of deliveries, respectively. Education was found to be significantly associated with choice of place for delivery (p < 0.05), but no association was found with respect to age and marital status. Only 11.4% of mothers were practicing family planning. CONCLUSIONS: Poor health-seeking behavior is a challenge in rural Nigeria, and interventions are needed to achieve improved maternal health status.

Socio-cultural factors in maternal morbidity and mortality: a study of a semi-urban community in southern Nigeria.

STUDY OBJECTIVE: To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. DESIGN: The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. SETTING: Ekpoma, a semi-urban community with a population of 70,000 in central part of Edo state in southern Nigeria. PARTICIPANTS: Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. RESULTS: There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. CONCLUSIONS: For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them.

Improving obstetric care at the district hospital, Ekpoma, Nigeria. The Benin PMM Team.

PRELIMINARY STUDIES: Facility reviews and focus group discussions revealed several factors at the district hospital contributing to maternal deaths in Ekpoma District, Nigeria. INTERVENTIONS: In response, the necessary equipment for the operating theater, labor suite and laboratory were repaired or purchased. A blood bank and standby generator were repaired. Drugs and consumable material were purchased and a revolving fund established. Refresher courses were held for medical officers, nursing staff and laboratory technicians. At a later stage, community interventions focused on improving access and reducing delay in seeking care. RESULTS: The number of cesarean sections performed increased from zero in 1990-1991 to between seven and 13/year in the period 1992-1995. The number of women with major obstetric complications seen at the hospital increased from seven in 1990 (5% of obstetric admissions) to a high of 29 (20% of obstetric admissions) in 1993. These gains were not sustained, however. In 1995, only 12 women with complications (9% of obstetric admissions) were seen. COSTS: The cost of improvements was approximately US $12,800, of which 41% was paid by the government and the rest by the project. CONCLUSIONS: Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.

Emergency loan funds to improve access to obstetric care in Ekpoma, Nigeria. The Benin PMM Team.

PRELIMINARY STUDIES: Focus group discussions in the community identified difficulties in paying for transport as a major barrier to seeking and reaching emergency care for obstetric complications. INTERVENTIONS: After emergency obstetric services in local health facilities had been upgraded, the clans in Ekpoma were mobilized in 1995 to set up emergency loan funds for women with complications. Funds were managed entirely by the clans, with ongoing monitoring and supervision by project staff. Two percent simple interest was charged. RESULTS: Of the 13 clans contacted, 12 successfully launched loan funds. Total donations amounted to US$793, of which four-fifths were contributed by the community. In the 1st year of the operation, 456 women/families requested loans (ranging from US$7 to US$15), and 380 (83%) were granted. Three-hundred and fifty-four (93%) loans were repaid in full. In addition to being used for transport, loans were used to help pay for drugs, blood and hospital fees. COSTS: The cost of establishing the loan fund was US$1360, including initial donations to the loan funds. The PMM project paid 55% of the total. CONCLUSIONS: With relatively little outside financial input, communities can set up and administer loan funds for emergency obstetric transport and care. However, sustaining the funds over the long term requires continuing effort and involvement with the communities.

Sociocultural aspects of haemorrhage in pregnancy.

The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.

PIP: Recent observations in southern Nigeria revealed that there was a lack of knowledge of the warning signs and risk factors associated with hemorrhage during pregnancy, delivery, and the postnatal period; certain food taboos were disadvantageous to pregnant women; there was a belief that supernatural forces caused some cases of maternal hemorrhage and precluded effective modern treatment; and women suffering from hemorrhage continued to seek care from traditional sources. Therefore, focus groups were convened with women, men, and traditional birth attendants in the Ekpoma group of 13 villages from March 1989 to June 1990 to discuss local ideas about hemorrhage and the situations when a pregnant woman may bleed, use and accessibility of interventions, and strategies for community health education. After analyzing the findings, the following actions were taken by the end of 1992: facilities in the first referral hospital were upgraded; a revolving drug fund was established; an emergency transport loan scheme was established; medical officers, nursing staff, medical records officers, and laboratory technicians were given retraining and refresher courses; and the hospital staff was mobilized and reoriented. In addition, and community education and mobilization efforts were continued until 1995. Additional focus group discussions were held between 1993 and 1995. Comparison of the results of the first and second series of focus groups revealed that age, sex, and education had no effect on knowledge, attitudes, and practices. A marginal decline in traditional beliefs had occurred, but postpartum bleeding continued to be induced. The use of modern obstetric care facilities increased threefold from 1993 to 1995. In addition, midwives began referring patients for hemorrhage more readily. Sustained community educational efforts could build on these modest results.

Causes of maternal mortality in a semi-urban Nigerian setting.

Focus group discussions with people in Ekpoma, Nigeria, revealed them to be quite knowledgeable about haemorrhage in pregnancy and delivery. However, because of their inability to recognize early warning signs they continued traditional treatment even when clear evidence of danger existed. Furthermore, they tended not to seek help in clinics and hospitals because of sociocultural conditioning and a negative perception of the quality of care available. There were shortages of materials and adequately trained and committed personnel in the modern health institutions serving the community. An outline is given of the kinds of intervention needed in order to overcome these deficiencies.

PIP: Fifteen focus groups were conducted among a sample of persons, who were from the semi-urban community of Ekpoma, Nigeria. One focus group involved only traditional birth attendants. The aim was to examine the factors responsible for delaying or preventing effective care and treatment for women with pregnancy-related complications. In general, this population had a degree of knowledge about the dangers of hemorrhage during pregnancy and delivery and about the risk of mortality. However, knowledge was lacking about the warning signs for hemorrhage and the potential danger for bleeding after delivery. Women did not know about when to seek help from modern obstetric services. Some practices such as food taboos put pregnant women at risk. Some believed that supernatural forces caused some forms of hemorrhage in pregnancy and delivery. Use of modern facilities for treatment of hemorrhage was constrained by continued use of traditional birth attendants, transportation difficulties, and negative perceptions of quality of care in modern obstetric institutions. There was a lack of coordination between different levels of care. The study area contained 14 modern health institutions. The two state controlled hospitals at Iruekpen and Ubiaja were too far from where patients lived, and transportation was expensive and inadequate. Obstetric staffing was inadequate at Iruekpen hospital and the primary centers. Only the zonal tertiary hospital at Ubiaja had an obstetrician on staff for handling emergencies. Supplies were inadequate at all institutions. The private health institutions were evenly distributed throughout the community, but the quality of equipment and staff was difficult to evaluate. It was assumed that quality of care was the same at the secondary referral hospital. Women need to be educated about the warning signs of hemorrhage during pregnancy and delivery and the importance of seeking care early. Obstetric institutions must improve equipment, drug availability, and sufficiency of supplies. Staff need to receive training including training that enhances awareness about the importance of a friendly attitude toward patients. Evaluations are needed in order to assure improvement in care. Village chiefs and other opinion leaders should be informed about the changes.

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".

Traditional practitioners are here to stay

The majority of people of Nigeria use traditional rather than Western medicine for reasons of culture, cost and availability. If the harmful aspects of traditional medicine could be eliminated, and if the two systems were to collaborate with one another, the population would undoubtedly be better served than at present. Surveys conducted among members of the traditional and orthodox professions have revealed a large measure of support in each for the idea of integration