Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria.

BACKGROUND: Globally, postpartum depression is one of the most common but often unrecognized complications of childbirth, yearly affecting about 10-15% of postnatal women. This study aimed to determine the prevalence of postpartum depression and its predictors among postnatal women in Lagos. METHODS: A descriptive cross-sectional study was conducted among 250 mothers in Eti-Osa Local Government Area of Lagos State, Nigeria, attending six Primary Health Care centers for infant immunization at six weeks post-delivery. Data was collected using a pretested semi-structured interviewer administered questionnaire which included the Edinburgh Postnatal Depression Scale. Analysis was carried out using SPSS version 23TM. Chi-square and logistic regression analyses were used to determine associations and predictive relationships between various factors and the presence of postpartum depression. The level of significance was set at <0.05. RESULTS: The prevalence of postpartum depression was 35.6%. Multiparity, delivery by cesarean section, mother being unwell after delivery, and not exclusively breastfeeding the baby were the factors linked with postpartum depression. Following multiple logistic regression, having postpartum blues (p=0.000; OR=32.77; 95%CI=7.23-148.58)., not getting help with caring for the baby (p=0.008; OR=2.64; 95%CI=1.29-5.42), experiencing intimate partner violence (p=0.000; OR=5.2; 95%CI=2.23-11.91) and having an unsupportive partner (p=0.018; OR=2.6; 95%CI=1.17-5.78) were identified as predictors of postpartum depression. CONCLUSION: This study revealed a high prevalence of postpartum depression, identifying both the obstetric and psychosocial predictors. Social support for women both in the pre- and postnatal periods and routine screening of women for postpartum depression should be encouraged for early detection and immediate intervention.

Health-Related Quality of Life of the Elderly in Institutional Care and Non-Institutional Care in Southwestern Nigeria: A Comparative Study.

BACKGROUND: The world population is rapidly ageing and people aged 60 years and above are growing faster than any other age group. In Africa, the most rapid growth of older persons is expected in Western and Northern Africa. STUDY DESIGN: This was a comparative cross-sectional study of a total of 360 respondents. A multi-stage sampling method was used in selecting 240 respondents in the non-institutional group while all the respondents (120) in the institutional group were included in the study. The data was collected using a pre-tested, semi-structured, interviewer administered quality of life questionnaire (SF-36). Data analysis was done using SPSS version 17. RESULTS: The respondents in the institutional group were older with a mean age of 78.7±8.8 years as compared to 70.1±8.2 years in the non-institutional group. The mean Health-Related Quality of Life (HRQOL) score was higher (64.5±15.6) in the non-institutional group than in the institutional group (52.6±15.7) and this was statistically significant (p<0.001). After controlling for the effect of other variables, the respondents who belonged to the non-institutional group (OR=2.37, p=0.018); who were female (OR=2.00, p=0.019); engaged in work (OR=4.93, p=0.009) and had no co-morbid condition (OR=7.58, p<0.001) were significantly more likely to have good HRQOL. CONCLUSION: The non-institutional group had better HRQOL than the institutional group in all the domains except in the body pain domain. It is recommended that programs are tailored to the needs of the elderly in institutions and should be targeted towards improving their quality of life and well-being.

Visual acuity, safe/unsafe practices and self-reported road traffic crash experiences among commuter bus drivers from two motor parks in Lagos, Nigeria.

BACKGROUND: Road Traffic injuries remain a significant public health problem with serious health and economic implications. This study was conducted to determine visual acuity, safety practices and road traffic crash (RTC) experiences of commercial bus drivers in Lagos, Nigeria. METHODS: This cross-sectional study involved visual acuity screening and interviewer- administered questionnaire survey. Participating motor parks were selected by simple random sampling and all intercity, commercial minibus drivers were included. Data was analyzed with Epi info version 3.5.1. RESULTS: A total of 407 drivers participated with a mean age of 43.4 ± 10.8 years. A total of 68 (16.7%) of the drivers did not meet the minimum VA standard required for driving; 8.6% of them use mobile phones while driving; 97% fasten their seatbelt, out of which almost 98% do so always. Fourteen percent also admitted eating while driving. Sixty two (15.2%) of drivers had been involved in RTC in the past 5 years prior to interview. CONCLUSION: A proportion of commercial minibus drivers did not meet the minimum VA required for driving. Some of them also practiced distracted driving. Free visual acuity screening within the motor park is recommended for commercial drivers at least once a year. There should be awareness campaigns to enlighten commercial drivers on the dangers of distracted driving in addition to strict enforcement of regulations and Highway Code.

Compliance with driver's license laws and illegal licensing among commercial bus drivers in Lagos, Nigeria: policy implications and evidence for action.

AIMS AND OBJECTIVES: To determine the level of compliance with driver's license laws among commercial bus drivers in Lagos, Nigeria. SUBJECTS, MATERIALS AND METHODS: Two intercity motor parks were selected by simple random sampling and all consenting minibus drivers participated in the study. Key Informant Interviews (KIIs) were also conducted with selected officials in the driver training and licensing authorities. RESULTS: Compliance with the minimum age for driving was high (93.6%), so also was having driving test prior to driver's license procurement (83.3%). Formal driver training and VA testing were very low, (26.1% and 32.9% respectively) Overall, only 9.3% of them were found to have fulfilled all the pre-license obligations before obtaining their first driver's license. The odds of a driver with a secondary education having formal driver training is 3.33 times higher than those with no education (OR 3.33, 95% CI 1.01-11.35). Drivers who were 60 years or older were 3.62 times more likely to be compliant than those who were between 20-29 years (OR 3.62, 95% CI 0.56-29.19). For the 98.3% of them who possessed valid licenses, 52.3% of them obtained them illegally. All the key officials saw RTIs as a serious public health problem but faced several challenges in the course of their work. CONCLUSION: Overall compliance with pre-license regulations was very poor. There is need for a review and strict enforcement of driver's license laws to improve compliance. Also vital are fostering inter-sectoral collaboration and improvement in the operations of all establishments involved in driver training and license procurement in Nigeria.

The effect of a sexuality education programme among out- of- school adolescents in Lagos, Nigeria.

AIMS AND OBJECTIVES: This study was conducted to assess the effect of a community based sexuality education programme on the sexual health knowledge and practices of out of school female adolescents. SUBJECTS AND METHODS: This Intervention study was conducted in two markets within Lagos, Nigeria. Representative samples of adolescents were interviewed on their sexual health knowledge and practices. An Education- entertainment programme provided sexuality education to adolescents in Mushin market only (intervention group) followed by post intervention surveys in Mushin market and Sangrouse market (control group). The pre and post intervention surveys were compared 6 months post intervention to detect any changes. RESULTS: Sexual health knowledge and behaviour was similar among respondents in both markets pre intervention. Post intervention, the sexual health knowledge of the respondents in the intervention site improved significantly. (p<0.05) Fewer adolescents initiated sex in the intervention site than in the control site and contraceptive use increased. However among the sexually active, there was no significant change in their condom use and number of sexual partners. CONCLUSION: Community based health education programmes can be used to provide effective sexuality education for out of school adolescents. Provision should be made by government and non-governmental organisations during adolescent reproductive health programming for sexuality education targeted at out of school adolescents.

The effect of a short anti-smoking awareness programme on the knowledge, attitude and practice of cigarette smoking among secondary school students in Lagos state, Nigeria.

UNLABELLED: This study aimed to assess the effect of a short school-based anti-smoking program on the knowledge, attitude and practice of cigarette smoking among students in secondary schools in Lagos State. SUBJECTS AND METHODS: A non-randomized, controlled intervention study was done among respondents selected using multi-stage sampling. Baseline data was collected using self-administered questionnaires. An anti-smoking awareness programme was carried out among students in the intervention group using health talks, information leaflets and posters. Post-intervention data collection took place three months later. RESULTS: There were significant increments in the mean knowledge and attitude scores after the intervention. There was however no statistically significant change in the current smoking habits of respondents (4% vs. 3%; p=0.41)in the intervention group. Nevertheless, in the intervention group, the number of never- smokers who reported that they were likely to initiate cigarette smoking within the next year significantly reduced. There was also a significant increase in the proportion of current smokers who desired to quit smoking. CONCLUSION: Even brief anti-smoking programs of this nature are effective at improving the knowledge and modifying the attitude of the respondents but do not improve smoking habits. It however motivated the desire to quit among current smokers. Health education sessions and periodic anti-smoking programmes should be introduced into the secondary school curriculum. More intensive approaches may be needed to influence the smoking behaviour of adolescent smokers.

Use of insecticide-treated mosquito nets for children under five years in an urban area of Lagos State, Nigeria.

BACKGROUND: Insecticide-treated nets (ITNs) have proven to be one of the most effective means of reducing malaria morbidity and mortality in children and pregnant women. This study is carried out to determine the practice and determinants of ITN use for children under five years among care givers in an urban area of Lagos State. MATERIALS AND METHODS: A community-based, cross sectional study was carried out in Lagos State in April 2007 among three hundred and forty (340) care givers primarily responsible for child care at home. They were selected by a multi-stage sampling method using a pre-tested, interviewer-administered, structured questionnaire. RESULTS: ITN use rate for under-fives was high (61.8%) and this was significantly determined by care giver's marital status (P < 0.001) and the number of children under five years in the household (P = 0.006). Educational level of care giver and occupation of head of the household were not significant determinants. CONCLUSION: There is need for health campaigns on ITNs targeted at unmarried care givers of young children. In addition, we also recommend social marketing of modern family planning methods to reduce family size, thereby increasing chances of ITN use among children less than five years to reduce malaria burden.

Nutritional status of urban and rural primary school pupils in Lagos State, Nigeria.

BACKGROUND: This study was carried out in Lagos State in Ikorodu LGA (rural), a largely agrarian area producing raw materials for agro-allied industries and Ikeja LGA (urban), a highly-developed metropolis and commercial centre. Hitherto, studies showed that undernutrition had been the main form of malnutrition among Nigerian children. However with influences from urbanization, westernization and globalization in cosmopolitan Lagos, it is imperative to find out if the global epidemic of overweight and obesity has caught on. OBJECTIVES: To compare the nutritional status of primary school pupils in urban and rural LGAs in Lagos State, Nigeria. METHODS: This was a cross , sectional comparative study. A multistage sampling method was adopted. Data were collected from 529 pupils with an interviewer administered questionnaire. Their weight and height were recorded in pre-designed proforma and converted to nutritional indices. RESULTS: The prevalence rates of underweight, stunting and wasting in the rural area were 49.6%, 50.8% and 24.2% respectively; while it was 15.1%, 16.6% and 13.6% in the urban area respectively. There was overnutrition in the urban area: 15.1% were overweight and 13.2% were obese. The mean nutritional indices were significantly lower among the rural pupils than urban pupils (p<0.001) in each case. CONCLUSION: Undernutrition is still a major health problem among school children in Lagos State, Nigeria, more so in the rural area. There is an emergence of overweight and obesity in the urban area. A comprehensive programme to improve nutritional status is recommended as part of a well funded school health programme.

An observational survey of child car safety practices in private pre-primary and primary schools in two local government areas of Lagos State, Nigeria.

OBJECTIVE: To describe child car safety practices among children aged 0-8 years. Eight schools from two local government areas (LGAs) were selected by simple random sampling. Passenger cars were observed for child seating position and restraint use at each selected school as children were being dropped off in the morning. RESULTS: Observed child restraint use was very low, as was the rate of appropriate restraint for age (10.8% and 4.2%, respectively, in Eti-Osa, and 7.0% and 1.8% in Ikeja). Child restraint use decreased with increasing age group from 25% in those below 1 year, to 12% in those aged 1-3 years, and 7.4% in those aged 4-8 years. A large proportion of restrained passengers were inappropriately restrained in a seatbelt alone. Front seating among observed child passengers was not as high as in studies from similar environments (9.4% and 17.5% in Eti-Osa and Ikeja, respectively). Factors associated with child restraint use were number of child passengers in car, and whether or not the driver wore a seatbelt. Seating position of the child was significantly associated with the relationship of the driver to the child, and driver's gender. CONCLUSION: The level of child restraint use observed in this study is unacceptably low. The relatively low prevalence of front seating while riding in cars should however be further reduced. The study recommends the enactment of specific country legislation on the use of child restraints, accompanied by multifaceted intervention programmes to improve the availability and use of child car safety seats and booster seats.

Knowledge and attitude of women to exclusive breastfeeding in Ikosi District of Ikosi - Isheri Local Government Area, Lagos State.

BACKGROUND: Infant malnutrition is a public health problem in developing countries. OBJECTIVE: To determine the knowledge and attitude of women to exclusive breastfeeding in Ikosi district of Ikosi/Isheri Local GovernmentArea. METHODS: This was a descriptive cross sectional study which employed a multistage sampling technique to select four hundred female participants. Data was collected using structured interviewer-administered questionnaires. A woman was included if she was within the reproductive age group and her last confinement was not more than five years. RESULTS: Awareness was high (98.3%) but only about one third (39%) had good knowledge of exclusive breastfeeding. Almost all respondents (98.8%) felt that breastfeeding was important. Majority (73.3%) believed that breast milk alone is sufficient for the baby in the first six months of life while more than half (61%) believed in the appropriateness of breastfeeding in public. CONCLUSION: Given that a relatively high proportion of women had positive attitudes despite the poor knowledge of exclusive breastfeeding, public enlightenment and continued health education especially in the antenatal clinics are pertinent to maternal and child care to attain the recommendation of 90% practice in developing countries.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria.

Summary Estimates of maternal mortality are crucial to inform the planning of reproductive health programmes and guide advocacy. The aim of this study was to obtain a population-based estimate of maternal mortality in Lagos State, Nigeria. The sisterhood method was used in 2008 to carry out the survey using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within 6 weeks after childbirth. The survey involved 4,315 respondents who provided information on 9,910 ever married sisters. The life-time likelihood (risk) of maternal death for women aged 15-49 years was found to be 0.0239 or 1 in 42. The estimated maternal mortality ratio was 450 per 100,000 live births with a 95% CI of 360 and 530. Out of 111 reported deaths, 35 (31.5%) occurred during pregnancy, 49 (44.1%) occurred during delivery and 27 (24.3%) within 6 weeks of delivery.

The Prevalence and Predictors of Cigarette Smoking among Secondary School Students in Nigeria.

OBJECTIVES: This study was carried out to determine the prevalence of smoking among secondary school students and identify factors that influence smoking amongst them. METHODS: This descriptive and explorative study was conducted among 1,183 secondary school students, selected by multistage sampling from each of the 6 geopolitical zones in Nigeria. Data was collected by using interviewer administered structured questionnaires. RESULTS: This study recorded a lifetime smoking prevalence of 26.4% and current smoking prevalence of 17.1% among secondary school students in Nigeria. Most (82%) of the students had seen warnings against smoking and most of them were aware that it is possible for cigarette smoking to damage body organs. Unfortunately, however, seeing such warnings had no significant effect on their decision to smoke or not. The students who smoke were introduced to smoking mainly by their friends (67.4 %), and the television (13.4%). Smoking habits of the respondents were influenced by parents' educational status (p<0.05), having friends who smoke (p<0.05) and living with a smoker (p<0.05). CONCLUSION: Over a quarter of secondary school students had ever smoked. Peer pressure was the main reason cited by respondents for initiating smoking. It is suggested that our smoking prevention programmes be reviewed and appropriate health education and smoking cessation programmes be developed and implemented in order to prevent and control smoking among Nigerian students.

Home management of malaria by care givers of under-five children in an urban area in Lagos, Nigeria.

BACKGROUND: One of the key interventions proposed under the Roll back malaria initiative is improvement of case management of malaria at the home and community levels to reduce malaria burden. This study was conducted to determine the practice and determinants of Home Management of Malaria (HMM) among care givers of children below 5 years old in an urban community in Lagos State, Nigeria. METHODS: This was a cross-sectional study conducted in 2007. A multi-stage sampling method was used to select the 340 respondents who participated in this study. Data was collected using interviewer administered questionnaires and analysed with Epi-info software. A care giver was included in the study if he/she takes care of a child/children less than 5 years old. RESULTS: The commonest treatment practice by caregivers for their young children with malaria was home treatment with antimalarial drugs [51.5%]. HMM was not significantly determined by care givers' age nor educational level. Most children were treated with chloroquine and only a few [4.2%] of the children were treated with the recommended drug [ACT]. Overall, only 1.24% received adequate treatment. CONCLUSION: Few respondents correctly practice HMM. There is need to educate care givers of young children on the proper management of malaria at home.

Home Management of Malaria by Care Givers of Under-Five Children in an Urban Area in Lagos; Nigeria

Background:One of the key interventions proposed under the Roll back malaria initiative is improvement of case management of malaria at the home and community levels to reduce malaria burden. This study was conducted to determine the practice and determinants of Home Management of Malaria (HMM) among care givers of children below 5 years old in an urban community in Lagos State; Nigeria. Mehods: This was a cross-sectional study conducted in 2007. A multi-stage sampling method was used to select the 340 respondents who participated in this study. Data was collected using interviewer administered questionnaires and analysed with Epi-info software. A care giver was included in the study if he/she takes care of a child/ children less than 5 years old. Results: The commonest treatment practice by caregivers for their young children with malaria was home treatment with antimalarial drugs [51.5]. HMM was not significantly determined by care givers' age nor educational level. Most children were treated with chloroquine and only a few [4.2] of the children were treated with the recommended drug [ACT]. Overall; only 1.24received adequate treatment. Conclusion: Few respondents correctly practice HMM. There is need to educate care givers of young children on the proper management of malaria at home

Sexual behaviour and associated risk factors among adolescent/ young adult male transport workers at yaba bus stop, lagos.

OBJECTIVES: Sexual activity is increasing among young people with negative consequences and out of school males are a vulnerable segment of the population. This study was carried out to examine the sexual behaviour of young males who are out of school and identify factors that influence their behaviour. METHODS: This descriptive study was conducted among all the three hundred and ninety one young male bus conductors and drivers at Yaba bus stop Lagos. They were interviewed using a structured questionnaire. RESULTS: Almost all the respondents (93.4%) have had sexual intercourse and many of them with multiple partners. Less than half of them used condoms at every intercourse. Their main reasons for initiating sexual intercourse were peer pressure and curiosity. There was a significant relationship between early initiation of sexual intercourse and use of drugs and alcohol(p<0.05).Respondents who have resided with their parents initiated intercourse at an older age than those residing with other people.(p<0.05) CONCLUSION: Many young out of school males are sexually active and engage in high-risk sexual behaviour. Provision of sexuality education programmes, co-habitation of parents with their young children and the control of use of alcohol and drugs are important in delaying sexual initiation and reducing sexual risk taking among young people.

Contraceptive prevalence among young women in Nigeria.

In almost all societies in the world there is an increase in sexual activity among young persons (10-24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies. This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years. Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p<0.05) among the single sexually active women (38.5%) than among the married women (7.7%). Only 7.3% of respondents are currently using a contraceptive method. The main methods in use were condoms and pills. There is an unmet need for contraceptives among young women in Nigeria. It is necessary to improve these young women's abilities to protect themselves against unwanted pregnancies.