Sexual behavioral pattern, consequences and adopted solutions among senior secondary schools students in a military barracks in Nigeria.

PURPOSE: To determine the sexual behavioral pattern, consequences, and adopted solutions among senior secondary schools students in Ojo military barracks, Lagos. MATERIALS AND METHODS: This was a cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using a multistage sampling technique. Data was collected using pre-tested, self-administered semi-structured questionnaires. Data was analysed using statistical package for social sciences version 17. Tests of statistical significance were carried out using χ2-test, and a p-value of <0.05 was considered significant. RESULTS: The majority of them 391 (97.8%), were in the age group (10-19 years) while the mean age was 15±2.4 for males and 15±2.2 for females, respectively. One hundred and fifty four (38.5%) of the respondents have had penetrative sexual intercourse and were influenced mainly by peer pressure (p=0.0000). Their age at first sexual intercourse ranged between 10-19 years. Ten (6.5%) of the respondents (all males) had their sexual debut with a commercial sex worker. More girls 41 (56.2%) than boys 12 (14.8%), were forced into sexual intercourse (p=0.0000). Over half of the sexually active respondents had at least two sexual partners for either sex. CONCLUSION: Findings from this study have shown that young people living in the barracks indulged in sexual activity at very early ages and engaged in risky sexual behavior. We therefore recommend an improved multi-sectoral approach in reproductive health and sexually transmitted infections including HIV/AIDS education.

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.

Place of birth or place of death: an evaluation of 1139 maternal deaths in Nigeria.

OBJECTIVE: to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria. DESIGN: a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method. SETTING: Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural). PARTICIPANTS: 3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies. FINDINGS: 1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25-34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ(2)=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital. KEY CONCLUSIONS: maternal mortality in Nigeria is still unacceptably high. IMPLICATIONS FOR PRACTICE: ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills.

Community Study of maternal mortality in South West Nigeria: how applicable is the sisterhood method.

A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no significant reduction in the maternal mortality ratio (MMR) in Nigeria was recorded. The absence of accurate data on the numbers, causes and local factors influencing adverse maternal outcomes has been identified as a major obstacle hindering appropriate distribution of resources targeted towards improving maternal healthcare. This paper reports the first community based study that measures the incidence of maternal mortality in Ibadan, Nigeria using the indirect sisterhood method and explores the applicability of this method in a community where maternal mortality is not a rare event. A community-based study was conducted in Ibadan using the principles of the sisterhood method developed by Graham et al. for developing countries. Using a multi-stage sampling design with stratification and clustering, 3,028 households were selected. All persons approached agreed to take part in the study (a participation rate of 100%), with 2,877 respondents eligible for analysis. There was a high incidence of maternal mortality in the study setting: 1,324/6,519 (20.3%) sisters of the respondents had died, with 1,139 deaths reportedly related to pregnancy, childbirth or the puerperium. The MMR was 7,778 per 100,000 live births (95% CI 7,326-8,229). Adjusted for a published Total Fertility Rate of 6.0, the MMR was 6,525 per 100,000 live births (95% CI 6,144-6,909). Women in Ibadan were dying more from pregnancy related complications than from other causes. Findings of this study have implications for midwifery education, training and practice and for the first time provide policy makers and planners with information on maternal mortality in the community of Ibadan city and shed light on the causes of maternal mortality in the area.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria.

BACKGROUND: The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria. METHODS: A cross-sectional survey was carried out in 2006. RESULTS: Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05). CONCLUSION: The information provided a useful baseline on which subsequent interventions could be based and evaluated.

Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria.

OBJECTIVE: The aim of this study was to determine the prevalence and distribution of menopausal symptoms among women in Ibadan in the 4-week period preceding the survey and factors associated with these symptoms. METHODS: A descriptive cross-sectional, community-based study was carried out on Nigerian women aged 40 to 60 years, using the multistage sampling technique. Quantitative data were collected on sociodemographic, obstetric, and gynecological variables as well as symptom experience in the preceding 4 weeks using a structured questionnaire that included a standardized Menopause Rating Scale (MRS). Eleven symptom groups were scored for each respondent on a scale of 0-4, with increasing severity for each score and a maximal total score of 44. The MRS is made of three subscales (somatovegetative, psychological, and urogenital) with maximal scores of 16, 16, and 12, respectively. Scores for each subscale and the overall total score were calculated for each respondent, and these served as the main outcome measures. The higher the composite score, the greater the severity of menopausal symptoms. RESULTS: In all, 1,189 women with a mean age of 48.1 +/- 5.9 years were interviewed. Prevalence of any menopausal symptom was 84.5% during the 4-week period studied. Joint and muscular discomfort was the most common reported symptom among all women in this study (59.0%), followed by physical and mental exhaustion (43.0%), sexual problems (40.4%), and hot flashes (39.0%). Factors predicting the total score on the MRS were age of respondent (P = 0.01; 95% CI, 0.02-0.17), menopause status (P = 0.001; 95% CI, 0.33-1.24), and occupational group (P = 0.02; 95% CI, 0.10-1.42). Age of respondent and menopause status also predicted scores on the somatovegetative and urogenital subscales, but not on the psychological subscale. Occupation was the only predictor on the psychological subscale (P = 0.002; 95% CI, 0.16-0.75). CONCLUSIONS: Prevalence of menopausal symptoms was high among women in this study. Although any woman could face challenges associated with menopausal symptoms, those who were older, perimenopausal, and postmenopausal and who had routine or manual occupations had the highest total MRS scores. All women, especially those in these categories, should receive health information and guidance on possible lifestyle adjustments to ease the disruptions that menopausal symptoms can cause.

Cervical cancer risk factors and predictors of cervical dysplasia among women in south-west Nigeria.

AIM: This study identified predictors of cervical dysplasia and assessed the prevalence of risk factors for cervical cancer among women of different socioeconomic classes in Ogun State, Nigeria. METHOD: In a two-phase study, self-reported information on cervical cancer awareness, risk factors and cervical cancer screening practices was obtained from 278 randomly selected working women. A random subset was screened for dysplasia using visual inspection with acetic acid (VIA). RESULTS: Of the 278 women, 126 (45.3%) were semi-skilled while 152 (54.7%) were skilled and professional workers. Median age at first sexual intercourse was 19 years (range 13-29) and lower than the median age at first marriage (25 years). Gonorrhoea and genital warts were the commonest reported sexually transmitted infections. Only 12.2% of the women used male condoms as their primary method of birth control and 4.7% of the women had ever had a Papanicolaou smear, a practice that was significantly higher among the professional/skilled compared with semi-skilled workers (P = 0.031). Of the 125 screened, 20 (16%) had positive VIA. Young age at first sex (< or = 17 years) (OR = 3.7 (95% CI, 1.07-12.8)) and early first marriage (< 25 years) (3.3 (1.00-10.9)) were associated with a positive VIA. Women with lower parity (0-3) had borderline significantly increased risk of having a positive VIA (3.1 (0.9-10.6)). Women currently over 34 years and those without a history of sexually transmitted infections had lower risk of positive VIA (P > 0.05). CONCLUSIONS: Acceptable screening services and cervical cancer awareness campaigns that address modifiable risk factors are urgently needed in this community.

A community-based investigation of the avoidable factors of maternal mortality in Nigeria: the pilot experience.

BACKGROUND: Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals. However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult in some countries. Reliable baseline data are crucial to effectively track progress and measure that targets or goals of reducing maternal mortality have been met. OBJECTIVES: The objectives of this pilot study were: to test adequacy of research instruments; to improve research techniques; to determine an appropriate workload; to determine the time required for interviews; and to assess the feasibility of a (full-scale) study/survey. METHODS: This pilot study was conducted between 11(th) April and 22(nd) April 2005. 420 houses were visited and interviews of 420 respondents between the ages of 15-49 were conducted in a randomly pre-selected Local Government Area of Oyo state using a structured instrument developed using the principles of the Sisterhood Method. RESULTS: There was willingness of the public to participate in the study. The response rate was 100%. There was no issue raised as regards the structure, wording and translation of the questionnaire. This pilot study uncovered local political problems and other issues that may be encountered during the main study. CONCLUSIONS: The pilot raised a number of fundamental issues related to the process of designing the research instrument, identifying and recruiting Data Collectors, training and supervision of Data Collectors and the research project, gaining access to respondents and obtaining support and approval from "gatekeepers". This paper highlights the lessons learned and reports practical issues that occurred during pilot study.

Pregnancy prevention practices among women with multiple partners in an HIV prevention trial.

BACKGROUND: Women enrolled in microbicide and pre-exposure prophylaxis (PrEP) HIV prevention trials are not allowed to continue use of study products when pregnant because of fetal safety concerns. High pregnancy rates among women in trials can undermine statistical measures of safety and effectiveness. METHODS: Women enrolled in a PrEP trial in Ghana, Nigeria, and Cameroon had an overall pregnancy rate of 52 per 100 person-years of observation. In-depth interviews were conducted with 67 women who were asked to describe any changes made in their pregnancy prevention practices after enrolling in the trial. RESULTS: Most women (n = 44, 65%) reported changing pregnancy prevention practices after enrolling in the trial. Twice as many reported using condoms for pregnancy prevention after enrollment (n = 56, 84%) than before (n = 27, 40%). Cluster analysis identified site-specific patterns. Nigerian women tended to report using condoms for dual protection before and after trial enrollment. Cameroonian women tended to rely on natural methods before and after trial enrollment. Ghanaian women tended to switch from hormonal methods to condoms. CONCLUSIONS: The role of condoms in HIV prevention trials must not be diminished. Their use-effectiveness for contraception is likely too low for microbicide and PrEP trial needs, however. HIV prevention trials with women should be appropriately staffed to provide effective contraceptive counseling and, if needed, direct provision of contraceptives. This must be done without undermining women's reproductive rights.

Men's perception of maternal mortality in Nigeria.

Innovative and effective options toward reducing maternal mortality rates in African nations must include the active participation of all stakeholders. This study was carried out to assess men's level of knowledge and attitude to preventing maternal deaths. In a cross-sectional, community-based survey complemented with exploratory in-depth interviews, data were collected from men from different socio-economic areas using a two-stage cluster sampling technique. Mean age of the 316 respondents was 39.9 years (range 19-66). Nearly half (47.8%) knew someone who had died at childbirth. They blamed maternal deaths on healthcare workers not being skilled enough, financial barriers, failure to use family planning, emergency, antenatal, and delivery care services. Factors associated with knowledge and attitude to preventing maternal mortality are discussed. Healthcare reforms must be coupled with socio-economic improvements and efforts made to improve men's attitudes and knowledge in such a way as to make them active stakeholders, more supportive of preventing maternal mortality.

Prevalence of depression among adults in Oyo State, Nigeria: a comparative study of rural and urban communities.

OBJECTIVE: This study was designed to assess the current prevalence of depression in Oyo State, Nigeria and the rural-urban variation in prevalence. SETTING: This is a two-phase community-based cross-sectional study. The urban areas selected for the study are the Ibadan North-West and Egbeda local government areas. The rural area selected was the Saki-East local government area. PARTICIPANTS: A total of 1105 participants were recruited into the study. Multistage sampling technique was used to obtain a representative sample of the participants from the communities in Oyo State. The study was conducted using an interviewer-administered structured questionnaire, and the general health questionnaire (GHQ 12) as a screening tool. The second phase of the interview was conducted only for those participants with a score of more than 3 using the GHQ 12. These participants were then clinically examined using the Structured Clinical Interview DSM IV for assessment of clinical depression. MAIN OUTCOME MEASURE: Prevalence of depression. RESULTS: A total of 721 (65.2%) were from urban communities, while 384 (34.8%) were from the rural community. The overall prevalence of depression was found to be 5.2%. Depression was more prevalent among women than men (5.7% vs 4.8%, chi(2) = 0.36 P = 0.55), and among adolescents (9.6%, P = 0.04). Furthermore, depression was more common in the rural areas than in the urban areas (7.3% vs 4.2%, chi(2) = 4.94 P = 0.02). CONCLUSION: Depression is more common in rural than urban areas in the Nigerian population. Mental health education for adolescents and secondary school students should be encouraged in rural communities.

Health workers' support for breastfeeding in Ibadan, Nigeria.

Breastfeeding in Nigeria is universal, and exclusive breastfeeding was introduced in 1992, yet no study has assessed health workers' support for breastfeeding at the grassroots level. This study assessed health workers' tangible support for breastfeeding at primary care facilities in Ibadan and factors affecting it, including knowledge of and attitudes toward breastfeeding. Among the 386 workers, there was moderate support for breastfeeding (median score = 15.0, maximum = 20). Following multivariate analysis, young age of worker (20-29 years; odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-6.8), more than 5 years of post-training experience (OR = 2.3, 95% CI: 1.2-4.4), senior profession (OR = 2.1, 95% CI: 1.0-4.4), high breastfeeding knowledge scores (OR = 2.5, 95% CI: 1.4-4.5), and sufficient opportunities to practice tangible breastfeeding support (OR = 4.3, 95% CI: 2.4-7.7) were found to predict tangible breastfeeding support. Deliberate efforts should be made to incorporate continuing education workshops to better prepare health professionals for their role in providing tangible breastfeeding support at the primary care level.

Prevalence of STI/HIV co-infections among special treatment clinic attendees in Ibadan, Nigeria.

Sexually transmitted infections (STIs) are poorly recognised and inadequately treated in Nigeria despite the fact that they constitute a major risk factor for sexual transmission of HIV infection. This study was carried out to ascertain STI/HIV co-infection rates and also to obtain relevant socio-demographic and reproductive health data associated with STI/HIV infections among special treatment clinic (STC) attendees. This information is urgently needed for designing STI/HIV control strategies. All consenting patients who attended the STC clinic from March to November 2001 were interviewed to obtain their socio-demographic and reproductive health data. Urethral, high vaginal and endocervical swabs and urine specimens were obtained and processed by standard methods. HIV screening was done by double ELISA tests. Of the 210 patients seen, 98 (46.7%) were male and 112 (53.3%) were female (p > 0.05). The majority, 171 (81.4%) were aged 20-39 years, while only ten (4.8%) were adolescents. One-hundred-and-eighty (85.7%) had an STI, of which 41 (22.8%) were co-infected with HIV. Thirty (16.7%) patients with nongonococcal urethritis/cervicitis and five (2.8%) with gonorrhoea were also positive for HIV. Five patients were HIV positive but had no other STI. Patients with gonorrhoea, non-gonococcal urethritis/cervicitis, trichomoniasis and bacterial vaginosis were more likely than those with warts, candidiasis and herpes to have co-infection (chi2 = 12.5, p = 0.04). The study's HIV prevalence rate was 21.9%. STI/HIV co-infection rate was significantly higher among unskilled and unemployed patients compared with professional and skilled workers (p < 0.05). This study shows a high STI/HIV co-infection rate indicating that there is need for proper management of STI, as this will help curb the spread of HIV infection in Nigeria.

Condom use with sex workers and abstinence behaviour among men in Nigeria.

Non-regular, non-cohabiting relationships and condom neglect are known to fuel the HIV/AIDS epidemic in Africa. Reproductive health needs of the men, the major decision-makers in this community, have been grossly neglected in this regard. This exploratory, community-based study assessed condom use among married men when with commercial sex workers (CSWs) and abstinent behaviour when their wives were unavailable for sex. (A CSW is one known to receive payment for sex.) Out of the 3,178 married respondents, 1,755 (55.2%) had ever used condoms. Of this number, 1,296 (73.8%) resided in urban locations while 459 (26.2%) resided in rural areas. Of these men, 137 had used CSWs in the six months prior to the study. Only 63 (46%) of these had used a condom at the last visit. Young age (<30 years) was the only predictor of condom use when with CSWs (p=0.03). Predictors of abstinence behaviour when the wife was unavailable for sex included: primary and secondary education, young age of the wife, low occupational status and monogamy. National HIV/AIDS control programmes should address men's risk-taking behaviour, empowering women to negotiate condom use and reduce long abstinence periods. Continued efforts should be made to reach sex workers and to make condoms much more widely available, acceptable and affordable, especially in rural areas.

Male sexual behaviour during wife's pregnancy and postpartum abstinence period in Oyo State, Nigeria.

The traditional proscription against sex for women during pregnancy, and particularly in the postpartum period, in south-west Nigeria leaves many men without sexual access to their wives for extended periods of time. This practice raises the question whether men abstain or seek other sexual partners. A community-based study was conducted using 3,204 married men from randomly selected local government areas of the state. These men had wives who had delivered a baby in the 36 months prior to the study. Information was obtained on their sexual practices before and during pregnancy and the postpartum period. Male sexual networking was not absent outside the pregnancy and the postpartum periods. However, during pregnancy, a higher percentage of men (43.7%) had other partners compared with the period outside pregnancy and postpartum (42.1%). The difference was not significant (p>0.05). Similarly, in the postpartum abstinence period, more men (48%) had other sexual partners when compared with the period outside pregnancy and postpartum (42.1%; p<0.001). Sexual networking with non-regular and multiple partners was also more commonly observed in the postpartum period than in pregnancy (11.9% vs 10.4%; p<0.05). Significantly more rural than urban men had multiple sexual partners when their wife was pregnant (p=0.01) or in postpartum abstinence (p<0.05). Condom use with regular partners was largely absent, and consistent condom use with extramarital partners was very low among urban and rural men (6.3% vs 1.7%). The vast majority of men were having unprotected vaginal sex. Logistic regression analysis showed that polygamous men, those under 30 years in the urban area, and men with low or no education were more likely to have sex with other women when their wife was pregnant. During a wife's postpartum abstinence period, men in higher status occupations, younger urban men (<49 years), those with more children, the polygamous, and men with a first wife under 40 years in urban area were more likely to have other partners. In light of the heterosexual mode of HIV transmission in Nigeria, there is a dire need to design and implement an intervention programme targeted at married men, which takes into consideration cultural practices. This will hopefully help check the course of the disease in a country thought to be on the verge of an HIV epidemic.