Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers.

OBJECTIVES: This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates. DESIGN: One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control. SETTING: Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe). PARTICIPANTS: Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey. RESULTS: There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma. CONCLUSIONS: In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa. TRIAL REGISTRATION NUMBER: 269211.

A cross-country qualitative analysis of teachers' perceptions of asthma care in sub-Saharan Africa.

Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.

Body image dissatisfaction, nutritional status and weight control strategies among university undergraduates in Lagos: a descriptive cross-sectional study.

Introduction: body image dissatisfaction has been associated with poor nutritional status and unhealthy weight management strategies. This study determined the prevalence and relationships between body image dissatisfaction, nutritional status, and weight management strategies among university undergraduate students in Lagos, Nigeria. Methods: a descriptive cross-sectional study employed a multi-stage sampling technique to select 865 undergraduates in Lagos. A pretested self-administered questionnaire was used to assess the variables. Stunkard figure rating scale was used to determine body image dissatisfaction. Body mass index (BMI) was calculated to determine nutritional status. A standard weight control strategy scale was adopted to determine weight management strategies. SPSS (version 23) was used for analysis and the association between variables was determined using Chi-square. The level of significance was set at P= <0.05. Results: the prevalence of body image dissatisfaction was high (63.5%) but not associated with gender. The majority (65.1%) had normal BMI, 10.6% were overweight and 7.2% were obese. Majority of the respondents (93.3%) engaged in weight management practices with dietary control being the most employed strategy. The most commonly employed unhealthy practice is strict dieting (37.7%). Body image dissatisfaction was significantly associated with overweight/obesity (P=0.001) but not with weight management practices. Age and overweight/obesity were predictors of BID. Conclusion: prevalence of body image dissatisfaction, overweight and obesity, and unhealthy weight management strategies were high. Body image dissatisfaction was associated with obesity but not associated with weight management strategies. All undergraduates need health education on body image and appropriate weight management strategies.

Sexual knowledge, risk behavior, and access to reproductive health services among orphaned adolescents in Southwest Nigeria: implications for institutionalized care.

Introduction: An orphan has been defined as a child under 18 years of age who has lost one or both parents to any cause. It has been reported that for every 10 Nigerian children, 1 is likely to be an orphan. Adolescents are faced with a serious challenge in meeting their reproductive health need, which oftentimes becomes overwhelming especially when they are orphaned. Objectives: We compared institutionalized and non-institutionalized orphaned adolescents for their knowledge of sexuality, risky sexual practice, and access to reproductive health services. Methods: The study adopted a cross-sectional descriptive study design conducted via structured, pretested, and interviewer-administered questionnaires among 205 orphaned adolescents (140 institutionalized and 65 non-institutionalized). Data were analyzed using the Statistical Product and Service Solution (SPSS version 25.0) and summarized using frequency, mean and percentages, and inferential statistics. All analyses were done at a 95% confidence interval and at a p < 0.05 level of significance. Results: The knowledge levels of a majority of non-institutionalized respondents (73.8%) were good when compared with those in institutions (56.4%) (χ2 = 5.713, p = 0.017). Institutionalized orphans displayed better sexual behavior (80.7%) than non-institutionalized respondents (64.6%) (χ2 = 6.239, p = 0.011). Access to reproductive health services was found to be slightly higher among institutionalized respondents (66.4%) than among their non-institutionalized counterparts (64.6%). Conclusion: Institutionalized and non-institutionalized orphans differed in terms of their knowledge of sexuality, sexual behavior, and risky practices, including access to reproductive health services. This study demonstrated the effectiveness of institutionalized care of orphans toward improved access to reproductive health services and good sexual practices. In the light of this, the government and relevant stakeholders should advocate the need for providing better sexuality education and understanding, make sure that access barriers for orphans are removed and orphans utilize the facilities for reproductive health that are available, and also make sure that adolescent health policies are implemented effectively.

We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria.

Background: Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center. Objective: To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria. Method: A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months. Result: Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers. Conclusion: Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.

Dietary habits, diversity, and predictors among pregnant women attending primary health care centers for antenatal care in Lagos, Nigeria.

BACKGROUND AND AIM: Inadequate nutrition during fetal development resulting from poor dietary habits leads to reprogramming within fetal tissues and poses as a risk factor for non-communicable diseases in later life. This study was conducted to determine the dietary habits, diversity, and predictors among pregnant women in Lagos, Nigeria. METHODS: A descriptive cross-sectional study was conducted using a structured interviewer-administered questionnaire to obtain data from pregnant women attending primary health care centers in Lagos, Nigeria. A multistage sampling method was used to select 350 pregnant women. A food frequency questionnaire was used to assess the dietary habits while dietary diversity was measured using non-quantifiable 24-hour recall. Data were analyzed using Epi-Info version 7.2 computer software. Chi-square and t-test were used to test for associations and P value < 0.05 was considered to be statistically significant. RESULTS: Only 16.7% of respondents consumed five servings of fruits and vegetables daily while the rice was the most frequent meal taken (45.4%). Meat was the commonest animal protein (20.3%) and only 30.8% had a high dietary diversity score (DDS). High DDS was significantly associated with parity of 1-3, living in a duplex or detached house, completion of at least secondary school education, and highly skilled professionals. CONCLUSION: Healthy dietary habits and high DDS were low and associated with low parity and higher socio-economic status. Nutrition intervention that encourages higher dietary diversity is needed especially among women of higher parity and lower socioeconomic status in Lagos.

Nuances of reproductive decisions by women in a rural community of Lagos, Nigeria.

INTRODUCTION: inadequate utilization of maternal health services due to limited reproductive decision-making capacity could be contributory to high maternal mortality in developing countries. This study sought to assess nuances of reproductive decisions by women in a rural community of Lagos, Nigeria. METHODS: this descriptive, cross-sectional house to house survey was part of a study conducted in April 2015 on females selected from 298 households chosen based on geographical clusters by simple random sampling. The study instrument was adapted from a USAID-funded project and was interviewer-administered. Data entry and analysis were performed with the aid of Epi-info™ 7.0.8.3 statistical software and ethical approval was obtained for the study. RESULTS: spousal age difference was less than 10 years for about half (51.3%) of the respondents. The majority (91.6%) of the respondents had received antenatal care during pregnancy and jointly decided with their spouses on place of care. The most commonly used contraceptives were the pills (23.5%), injectables (16.8%) and condoms (13.8%). Spousal disapproval regarding the use of family planning was almost nil at 1%. Employment status as a socio-economic factor did not significantly affect respondents´ involvement in decision-making. However, there were statistically significant associations between spousal age differences and some indicators of autonomy such as respondents´ involvement in health care decisions and the determinant on choice of antenatal care provider. CONCLUSION: women´s reproductive independence and involvement in health decisions could result in reduction of maternal ill-health and mortality whilst promoting higher male involvement and better maternal health.

Factors affecting utilization of youth friendly health services in Lagos State, Nigeria.

Background Youth friendly health services (YFHS) are services that attract, respond to the needs of and retain young people for continuing care. This study was conducted to determine the factors affecting utilization of government (GYFF) and non-governmental youth friendly facilities (NGYFF) in Lagos state, Nigeria. Methods A descriptive cross-sectional study was conducted. A total of 543 adolescents aged 15-24 years, between August 1, 2014 and October 31, 2014 were consecutively recruited from 10 (five government and five non-governmental) youth friendly health facilities that had been in operation for at least 6 months prior to the study. Logistic regression was used to determine predictors of utilization of youth friendly health facilities. Results Overall, the mean age of respondents was 17.9 ± 2.8. However, the mean age of respondents at GYFF (18.5 ± 3.0) was significantly higher than those at NGYFF (17.1 ± 2.5) (p < 0.001). Of the 567 youths enrolled, 196 (34.6%) had good utilization of youth friendly facilities (YFF) (34% from the GYFF and 35.2% from the NGYFF). Marital status, school attendance, having a baby, satisfaction with visit, perception that information shared was kept confidential and accessibility of the youth friendly services were associated with utilization of YFF (p < 0.05). Confidentiality and access to facilities were predictors of utilization of YFF. Conclusion There is poor utilization of both government and non-governmental youth friendly services in Lagos, Nigeria. There is a need for both the government and private sector to harmonize resources aimed at encouraging utilization of YFF in Lagos, Nigeria.

Dysmenorrhea and Its Effects on School Absenteeism and School Activities among Adolescents in Selected Secondary Schools in Ibadan, Nigeria.

BACKGROUND: Menstruation can be associated with dysmenorrhea that may affect daily activities. This study aimed to determine the prevalence of dysmenorrhea, effects on school activities, and associated school absenteeism among secondary school girls in Ibadan, Nigeria. MATERIALS AND METHODS: This cross-sectional study was among 460 students from all girls' only secondary schools in Ibadan, Nigeria, using a cluster sampling method. Data were collected using questionnaires and focus group discussions. The severity of dysmenorrhea was categorized as mild, moderate, and severe. Data collected were analyzed using descriptive statistics and Chi-square tests performed to determine significant associations. Level of statistical significance was set at 5%. RESULTS: Prevalence of dysmenorrhea and school absenteeism was 73% and 13.1%, with the severity of dysmenorrhea being 37.5%, 43.8%, and 18.8% for mild, moderate, and severe dysmenorrhea. Other school activities affected were as follows: class concentration, class participation, social, and sports activities (17.6%, 12.2%, 10.9%, and 4.6%). Main sources of medication for pain relief were family (15.8%) and self (13.7%). Age and duration of menstruation predicted dysmenorrhea (odds ratio [OR] =3.5, confidence interval [CI] = 1.2-9.7, P = 0.019), (OR = 1.7, CI = 1.1-2.6, P = 0.022), whereas severe dysmenorrhea predicted school absenteeism (OR = 4.2, CI = 1.7-9.9, P = 0.001). Respondents opined that analgesic drugs should be available in school to prevent school absenteeism. CONCLUSION: Prevalence of dysmenorrhea was high and severe dysmenorrhea played a role in school absenteeism. Health education should be provided to address the dangers of self-medication while drugs for pain relief should be available in schools.

A malariometric survey of under-fives residing in indoor residual spraying-implementing and non-implementing communities of Lagos, Nigeria.

BACKGROUND: Indoor residual spraying (IRS) is used as part of the integrated vector management strategy for the control of malaria in Lagos, Nigeria. The purpose of this study was to compare the malariometric indices of children under 5 years old living in IRS-implementing and non-IRS-implementing communities of Lagos, Nigeria. METHODS: The study was a community-based, comparative, cross-sectional study of 480 children under five recruited using a multi-stage sampling method. Data on each child were collected using a household questionnaire administered to the consenting care-giver of each selected child. Each child underwent a comprehensive physical examination. On-the-spot malaria rapid diagnostic testing and haemoglobin estimation to assess parasitaemia and anaemia, respectively, were also carried out. Risk factors for parasitaemia and anaemia were identified using multivariate logistic regression. RESULTS: A total of 238 children were studied in the IRS-implementing group while 242 children were studied in the non-IRS-implementing group. The IRS -implementing community had a lower level of parasitaemia (1.3 %) compared to the non-IRS-implementing community (5.8 %) (p < 0.001). There was no significant difference in anaemia, spleen rate and fever in the IRS-implementing group (10.9, 9.7 and 5 %) and the non-IRS-implementing group (9.9, 8.8 and 8.7 %), respectively. Residing in an IRS-implementing community was associated with lower odds of parasitaemia (OR 0.17, p < 0.01). Sleeping under a bed net was the only factor associated with anaemia (p < 0.01). CONCLUSION: IRS has led to a reduction in the level of parasitaemia in the under-fives in the study areas.

Youth friendly health services in a rural community of Lagos, Nigeria: are the youths receptive?

BACKGROUND: Globally, the youths constitute a major segment of most societies particularly in developing countries. This study was undertaken to assess the perception and practices related to youth friendly health services (YFHS) by in-school adolescents in a rural community of Lagos, Nigeria. METHODS: A descriptive cross-sectional survey was conducted on 400 proportionately selected consenting respondents from the senior classes of the three secondary schools in Agbowa community. A pre-tested interviewer-administered questionnaire was used for data collection and analysis was done with the aid of statistical software. RESULTS: Most of the respondents were in the age range of 12-15 years with mean age being 15.33±1.54 years. About half (46.8%) of the respondents correctly described adolescents as persons between the ages of 10 and 19 years. The majority (83.2%) of the respondents first heard about the Youth Friendly Health facilities from parents, guardians and friends. However, only few of the respondents had ever visited a Youth Friendly Center. A good location, convenient hours and comfortable surroundings were the most appealing aspects of YFHS. The provision of a seminar room and educational materials (60.8% and 70.8%, respectively) are important to the respondents. Reproductive health (56.8%) was the most preferred health education topic chosen by the respondents. CONCLUSION: Sensitization of the youths in the Agbowa community about youth friendly health services and provision of such services would be useful in reducing risky practices and improving their health.

Neonatal Jaundice: Knowledge, Attitude and practices of mothers in Mosan-Okunola community, Lagos, Nigeria.

BACKGROUND: A community-based survey was conducted amongst mothers aged 15-49 years living in Mosan-Okunola, Lagos, Nigeria to determine the knowledge of, attitudes to, preventive and treatment practices towards neonatal jaundice (NNJ). MATERIALS AND METHODS: The mothers were selected using a multi-stage sampling technique. A pre-tested interviewer-administered structured questionnaire was used to obtain data. The knowledge of the mothers was scored and scores lower than 50% were graded as poor, 50-74% as fair and ≥75% as good. The practice was also categorised as appropriate if one correct option was identified and was categorised as inappropriate where an incorrect option(s) was identified singly or in combination with a correct option. RESULTS: Three hundred and fifty-eight mothers were recruited. The mean age was 34.8 ± 9.05 years. Two hundred and seventy (75.4%) mothers had ever heard about the condition. Two hundred and forty-seven (91.4%) mothers correctly identified the condition and infection was the only most common known cause (47%). Only 34% of the mothers knew that NNJ could cause brain damage, and 40% identified refusal of feeds as a danger sign. Up to 64% of the mothers believed attending antenatal care could prevent the condition, and 58% were of the opinion that exposing babies to sunlight could prevent the condition. Sixty-eight percent (68.9%) of the mothers had a poor level of knowledge. Age and educational qualification did not show any statistically significant relationship with knowledge about NNJ (P < 0.05) but increasing maternal age had a significant association with an appropriate treatment practice (P < 0.05), the association was negative (r = -0.32). CONCLUSION: Knowledge about NNJ was low in this community and ineffective preventive practices were utilised. Efforts should be made to increase it, and health workers should play a leading role.