A test of the reliability and validity of a diabetes specific quality of life scale in a Nigerian hospital.

The purpose of this study was to test the reliability of the Well-being and Diabetes Treatment Satisfaction Questionnaires among clinic patients with type 2 diabetes as well as determine the clinical correlates of these measures. A cross-sectional survey was conducted using the Well-being Questionnaire and the Diabetes Treatment Satisfaction Questionnaire. Other demographic and clinical indices of age, sex, body mass index, disease duration and blood glucose levels were also recorded. 83 responses were analysed. Subjects were aged between 25 and 75 years, mean 55.5+/-11.1 years. 50.6% were males while 49.4% were females. Mean diabetes duration was 4.9+/-6.5 years. 67 (80.7%) were receiving oral agents and dietary modification while 16 (19.3%) were on insulin therapy. The internal consistency for responses to the well-being subscales and treatment satisfaction scale produced satisfactory alpha coefficients ranging from 0.73 to 0.88 and 0.74 respectively. Inter-item correlations were ranged between 0.19 and 0.45 for depression subscale; 0.22-0.78 for anxiety subscale; 0.33-0.58 for energy subscale; 0.33-0.79 for positive well-being subscale; and -0.22 to 0.79 for the treatment satisfaction scale. Item-total correlations ranged between 0.39 and 0.87 across the two scales: well-being (0.59-0.87) and treatment satisfaction (0.39-0.78). Mean scale scores were similar in both insulin and oral hypoglycaemic drug treated patients. Positive well-being was higher in males 13.4+/-4.1 vs. 11.5+/-4.3 in females p = 0.04. None of the well-being subscale scores, or treatment satisfaction correlated with age, disease duration, body mass index or glycaemic control. The well-being and treatment satisfaction scales are reliable instruments for the measurement of diabetes specific quality of life and treatment satisfaction in Nigerians although they were originally designed and developed among a UK population. It is hoped that our data would provide the basis for future comparisons and improving diabetes care.

Breastfeeding training improves health worker performance in rural Nigeria.

The training of health workers in breastfeeding and lactation management is to enable them make correct breastfeeding recommendations to mothers. This study aims to provide answers to two research questions: what components of breastfeeding training are easily achieved with extension health workers, and what health worker variables affect these outcomes. Multivariable analysis of the outcomes of a controlled breastfeeding training programme for community health workers (CHW) in rural communities of Osun State, Nigeria, was performed by logistic regression. The results show that the training was the most powerful predictor of correct CHW recommendations on breastfeeding (OR = 60.25, p-0.0000), and of 'perfect' breastfeeding knowledge (OR = 192.49, p = 0.0000). Younger CHWs (in the age bracket 20 to 29 years) were significantly more likely to make correct recommendations on exclusive breastfeeding (OR = 3.02, p = 0.0304). Other CHW variables such as sex, experience, job status, and marital status did not make consistently significant independent contributions to the outcomes. The results suggest that breastfeeding education can enhance CHW professional recommendations on breastfeeding and should be extended to all categories of health workers.

PIP: Health worker training is a key component of Nigeria's National Breast Feeding Program. Problematic, however, have been situations where the current recommendation of exclusive breast feeding conflicts with local knowledge and practices. This conflict can be resolved only by convincing rural community health workers (CHWs) of the legitimacy and benefits of exclusive breast feeding. A study conducted in the Ife South Local Government area of Nigeria's Osun State evaluated the impact of intensive breast feeding training on CHWs. The intervention was guided by focus group discussions among health workers, lactating mothers, and grandmothers. A total of 66 CHWs received the Ife South Breast Feeding Project (ISBFP); another 67 CHWs were not exposed to the training. Logistic regression analyses indicated that ISBFP training was the strongest predictor of CHW recommendations of exclusive breast feeding and against early supplementation (odds ratio, 60.25). Younger CHWs (20-29 years) were 3.02 times more likely than their older counterparts to promote exclusive breast feeding, but no other sociodemographic characteristics of health workers were significant. Recommended, in light of these findings, is expansion of health worker training to include breast feeding and lactation management and on-the-job retraining of current CHW cadres. If outreach to pregnant women is handled in a culturally sensitive way, clients of trained CSWs should be able to overcome the constraints of local tradition.

Breast-feeding promotion in a diarrhoea programme in rural communities.

Breast-feeding promotion is an important intervention for the control of infant diarrhoea. This study assesses the impact of a breast-feeding counselling programme on the prevalence of exclusive breast feeding in rural communities in Nigeria. Mothers attending primary care facilities because their infants had acute diarrhoea were randomised into two groups. The study group (n = 82) received individual, focused breast-feeding counselling, while the controls (n = 79) had routine advice for diarrhoea. Both groups were monitored and followed with home visits to determine infant-feeding practices. The results showed marked increases in exclusive breast-feeding prevalence for the intervention group at day 7 (49% vs. 6% control; p < 0.0001) and day 21 (46% vs. 8%; p < 0.0001). Moreover, diarrhoea re-occurrence at day 21 was less in the intervention group (12%) than controls (18%). It is concluded that focused breast-feeding counselling can increase exclusive breast feeding and reduce the prevalence of diarrhoea in rural communities.

Urinary schistosomiasis: options for control within endemic rural communities: a case study in south-west Nigeria.

A preliminary investigation was conducted into factors that may bring about control of morbidity due to endemic urinary schistosomiasis in rural communities. A Knowledge, Attitudes, Practices and Beliefs (KAPB) study was conducted among primary schoolchildren (those with more than four years elementary education) in Ogbagba village, Osun State, Nigeria, from October 1990 to December 1993, to ascertain their understanding of urinary schistosomiasis. The study further assessed the potential of subjective haematuria, i.e. asking children with haematuria in the recent past to so indicate, in detecting urinary schistosomiasis. It was established that subjective haematuria is both sensitive and specific for detecting urinary schistosomiasis in endemic communities. The study also established that subjective haematuria offers a valid, easy to recognize target for morbidity control in endemic situation. It is proposed that with appropriate health education; availability of safe, effective, easy-to-administer drugs, such as praziquantel, morbidity control of urinary schistosomiasis is feasible within the primary health care system with the lower cadre health worker or even a volunteer village health worker (VVHW) at the centre of the control effort.

PIP: During October 1990 to December 1993, in Ife-Central Local Government Area of Osun State, Nigeria, interviews with and physical and laboratory examinations of 106 grade 4-6 pupils aged 8-16 were conducted in Ogbagba village so the researchers could determine their knowledge, attitudes, practices, and beliefs about urinary schistosomiasis as well as the factors that offer opportunities for morbidity control of urinary schistosomiasis in an endemic area. There was no health facility in Ogbagba. 89.5% of the children had urinary schistosomiasis. 75.5% of all pupils knew the local name for urinary schistosomiasis. 66% had previously passed blood in their urine. 85.7% of these pupils believed hematuria was serious. 70.8% gave a positive history of current episode of hematuria. 62.7% of these pupils did not seek any treatment. Symptoms associated with past hematuria included abdominal pain, weakness, weight loss, and fever. 65.7% of all pupils did not know what causes urinary schistosomiasis. 67.1% believed that urinary schistosomiasis was acquired via some form of contact with water, especially swimming (57.1%). The leading types of water contact included washing clothes (95.3%), fetching water (94.3%), bathing (87.7%), and swimming (74.5%). 74.5% of all pupils urinated deliberately in the river. The sensitivity, specificity, predictive values, and efficiency of alternative methods of detecting urinary schistosomiasis revealed that subjective hematuria was comparable to gross/microscopic hematuria. These findings will be used to design information, education, and communication materials for a health education program on urinary schistosomiasis using the primary health control approach. The researchers propose that both subjective and gross hematuria be used as the basis for treating children aged 4-19 living in areas endemic for urinary schistosomiasis. Praziquantel should be used as the only drug for treating urinary schistosomiasis. Health education in the schools' curriculum and information, education, and communication developed by health authorities should promote better water contact practices. Teachers need to regularly ask their pupils about hematuria and encourage them to seek medical treatment.

An assessment of the knowledge of AIDS of undergraduates of Obafemi Awolowo University, Ile-Ife, Nigeria.

PIP: Questionnaire data were collected from 528 randomly sampled undergraduate students from various university faculties at Obafemi Awolowo University, Ile-Ife, Nigeria to determine what they knew about HIV and AIDS. The 1986 undergraduate population at the university was 12,128. 68.2% of the study participants were aged 20-24 years. 31.8% had first heard of AIDS in 1987, with newspapers and magazines being the source of information for 59.1% of students. All but 1.5% of the sample had heard of AIDS between 1982 and 1986. 95.5% of students identified sexual contact as a mode of HIV transmission, although only 64.9% and 68.2% identified the avoidance of multiple sex partners and condom use, respectively, as ways to prevent the transmission of HIV. 10.6% of the students did not know that AIDS kills. On the basis of these study findings, a comprehensive AIDS education program should be included in the undergraduate general studies curriculum.^ieng

Childhood diarrhoea in rural Nigeria. I. Studies on prevalence, mortality and socio-environmental factors.

This population-based study was conducted to determine the prevalence, mortality, and socio-environmental determinants of diarrhoeal diseases in children less than 5-years of age in a rural area of Akoko North, Ondo State, Nigeria. A total of 856 households with children less than 5-years old were randomly selected for the questionnaire and observational investigations. A two-week prevalence rate of the diseases among the children was 8.1%. The rate was highest among children 0-11 months old and slightly higher among the boys than girls. The infant mortality rate was 102/1000 and the mortality rate in less than 5-year old children was 62.1/1000 in the area. The majority of these deaths took place in the homes and health centres and were never reported. Social and environmental factors including dirty feeding bottles and utensils, inadequate disposal of faeces and household refuse, and poor storage of drinking water were found to be significantly related to the high incidence of the diseases. Educational interventions recommended for the control of the disease focused on these factors.

Health education in Nigerian secondary schools.

A survey of 600 secondary school teachers and 120 secondary school administrators was conducted in Oyo State, Nigeria, to identify their attitudes and practices regarding school health education. Nearly all teachers and administrators felt that health education is important and should be an integral part of the curriculum. Nonetheless, there were few resources and little curriculum time devoted to health education. Since many of the health problems of developing countries can be addressed by enhancing the health knowledge of the populace, health education in the schools of such countries deserves more emphasis.

The health knowledge of ninth grade students in Oyo State, Nigeria.

A stratified random sample of 540 ninth grade (Class 3) students in Oyo State, Nigeria, were administered the 60-item Health Education Test Form 3A. The purpose of the study was to obtain baseline data concerning the health knowledge of the students for use in the development of Health Education curricula in Oyo State. Subjects from the metropolitan area, from medium-size towns, and from rural areas recorded composite mean scores of 29.02, 24.78, and 25.01, respectively; indicating a general deficiency of health knowledge among the subjects. Recommendations are offered concerning curriculum, teacher preparation, and international cooperation to assist in the development of quality Health Education programs for Nigerian students.