Preferences, Utilization and Factors affecting Use of Contraceptives among Women attending Primary Health Care Facilities in Delta State, Southern Nigeria.

BACKGROUND: Contraceptive use has numerous benefits for the family and the nation that can be maximized with its consistent use. However, many women have preferences for certain contraceptives with implications for continued use. OBJECTIVE: To determine the contraceptive preferences of women, their utilization pattern and factors affecting utilization of the preferred contraceptive choices. METHODS: This cross-sectional study was conducted among 426 women of reproductive age selected from 32 primary health facilities using multistage sampling technique. Data was collected using a semi-structured interviewer-administered questionnaire. Descriptive and inferential analysis of data collected was carried out using IBM SPSS version 22 software. P-value was set at 0.05. RESULTS: Close to half of the respondents 211 (49.5%) preferred injectable contraceptives, 79 (18.6%) selected implants and 27 (6.3%) chose condoms. The majority 212 (49.8%) of respondents used injectable contraceptives, followed by implants 66 (15.5%), condoms 33 (7.7%), IUCD 54 (12.7%) and OCP 61 (14.3%). Age (p<0.001), number of children (p<0.001), clients' employment status (p<0.001), husband support (p<0.021) and desire for more children (p<0.001) were all statistically associated with the utilization of preferred contraceptives. CONCLUSION: Even though respondents preferred the injectable contraceptives, implants and IUCD in that order, their utilization pattern followed the order of Injectable, implants and OCP. Several factors were identified to be statistically associated with the utilization of preferred contraceptives. Health education on contraceptive use among women, spousal support and health workers training to highlight those factors influencing women's contraceptive preferences and utilization are recommended.

CONTEXTE: L'utilisation de la contraception présente de nombreux avantages pour la famille et la nation qui peuvent être maximisés par son utilisation régulière. Cependant, de nombreuses femmes ont des préférences pour certains contraceptifs, ce qui a des conséquences sur leur utilisation continue. OBJECTIF: Déterminer les préférences des femmes en matière de contraception, leurs habitudes d'utilisation et les facteurs qui influent sur l'utilisation des choix contraceptifs préférés. MÉTHODES: Cette étude transversale a été menée auprès de 426 femmes en âge de procréer, sélectionnées dans 32 établissements de santé primaire en utilisant une technique d'échantillonnage à plusieurs degrés. Les données ont été recueillies à l'aide d'un questionnaire semi-structuré administré par un enquêteur. L'analyse descriptive et inférentielle des données recueillies a été réalisée à l'aide du logiciel IBM SPSS version 22. La valeur P a été fixée à 0,05. RÉSULTATS: Près de la moitié des répondants 211 (49,5%) ont préféré les contraceptifs injectables, 79 (18,6%) ont choisi les implants et 27 (6,3%) les préservatifs. La majorité 212 (49,8%) des répondants ont utilisé des contraceptifs injectables, suivis par les implants 66 (15,5%), les préservatifs 33 (7,7%), les UICD 54 (12,7%) et les COC 61 (14,3%). L'âge (p<0,001), le nombre d'enfants (p<0,001), la situation professionnelle des clientes (p<0,001), les croyances religieuses (p<0,053), le soutien du mari (p<0,021) et le désir d'avoir plus d'enfants (p<0,001) étaient tous statistiquement associés à l'utilisation des contraceptifs préférés. CONCLUSION: Bien que les répondants aient préféré les contraceptifs injectables, les implants et les DIU dans cet ordre, leur utilisation a suivi l'ordre suivant : injectables, implants et COC. Plusieurs facteurs ont été identifiés comme étant statistiquement associés à l'utilisation des contraceptifs préférés. Il est recommandé de mettre en place une éducation sanitaire sur l'utilisation des contraceptifs par les femmes, de soutenir les conjoints et de former les agents de santé afin de mettre en évidence les facteurs qui influencent les préférences et l'utilisation des contraceptifs par les femmes. Mots clés: Contraceptifs, Planning familial, Préférence, Utilisation.

Preferences, Utilization and Factors affecting Use of Contraceptives amongWomen attending Primary Health Care Facilities in Delta State,Southern Nigeria

Contraceptive use has numerous benefits for thefamily and the nation that can be maximized with its consistent use.However, many women have preferences for certain contraceptiveswith implications for continued use.OBJECTIVE: To determine the contraceptive preferences of women,their utilization pattern and factors affecting utilization of the preferredcontraceptive choices.METHODS: This cross-sectional study was conducted among 426women of reproductive age selected from 32 primary health facilitiesusing multistage sampling technique. Data was collected using a semi-structured interviewer-administered questionnaire. Descriptive andinferential analysis of data collected was carried out using IBM SPSSversion 22 software. P-value was set at 0.05.RESULTS: Close to half of the respondents 211 (49.5%) preferredinjectable contraceptives, 79 (18.6%) selected implants and 27 (6.3%)chose condoms. The majority 212 (49.8%) of respondents usedinjectable contraceptives, followed by implants 66 (15.5%), condoms33 (7.7%), IUCD 54 (12.7%) and OCP 61 (14.3%). Age (p<0.001),number of children (p<0.001), clients' employment status (p<0.001),husband support (p<0.021) and desire for more children (p<0.001)were all statistically associated with the utilization of preferredcontraceptives.CONCLUSION: Even though respondents preferred the injectablecontraceptives, implants and IUCD in that order, their utilizationpattern followed the order of Injectable, implants and OCP. Severalfactors were identified to be statistically associated with the utilizationof preferred contraceptives. Health education on contraceptive useamong women, spousal support and health workers training tohighlight those factors influencing women's contraceptive preferencesand utilization are recommended

Promotion of health sector reforms for health systems strengthening in Nigeria: perceptions of policy makers versus the general public on the Nigeria health systems performance.

The objectives of this cross-sectional intervention study were to improve policy makers' understanding of health sector reforms through a training workshop and to assess the perception of policy makers and the general public about health systems performance in Nigeria. Health systems performance was generally rated low by respondents (< 2.5 out of 4). Health service delivery and health workforce were the lowest rated health systems components (< 2.2 out of 4). Efforts need to be intensified to enhance competencies of policy makers to adopt an evidence-informed process in health reform programs. Inputs from the public must be given adequate consideration in addressing the challenges of health systems.

Health Survey of Primary School Children: Outcome and Implication for Strengthening School Health Inspection in Abraka; Delta State; Nigeria

Background: Health inspection involves physical observation of the general appearance; mouth and teeth; nose and throat; skin; ears; eyes; scalp and hair; and behavior of children at play. The objective of this study was therefore to conduct a health survey of primary school children with a view to providing relevant information with policy implication for strengthening school health inspection in Abraka; Delta State; Nigeria. Method: This is a school based cross-sectional descriptive study conducted from September 2009 to February 2010 among primary school children in Abraka selected by multistage sampling technique. The studyinstrument was a pro-forma with twenty items subdivided into two sections.Results : The outcome of health inspection of the children revealed that over half (57.1) of them had dirty nails; while 45.0; 29.8; 21.2; 18.6and 1.8of them had dirty uniform; dental caries; skin infections; dirty hair and ear discharge respectively. The association between the occurrence of dirty nails; dirty uniform; dirty hair and dental caries with the type of primary school (private or public) were statistically significant (P0.05); while the association between the occurrence of ear discharge and skin infection with the type of primary school were not statistically significant (P0.05). Conclusion: This study has revealed the poor state of affairs as regards school health inspection of primary school children in Abraka

The status of tuberculosis infection control measures in health care facilities rendering joint TB/HIV services in "German Leprosy and Tuberculosis Relief Association" supported states in Nigeria.

OBJECTIVE: To assess the status of tuberculosis (TB) infection control practice in health care facilities implementing joint TB/HIV activities. MATERIALS AND METHODS: A descriptive survey triangulating self-administered questionnaire (facility survey to Infection Control Officer, individual health worker to general health workers), review of facility case notes and participant observation techniques was carried out. Twelve health facilities from southern Nigeria were assessed. RESULTS: (1) Administrative and work practice control measure: Only 1 (8.3%) facility had a documented TB Infection control policy; 2 (16.7%) facilities had Infection Control Committee; 5 (41.7%) facilities had Infection Control Officer; 2 (16.7%) asked questions at the health records about cough; 1 (8.3%) facility had health workers intermittently checking for patients with cough in the waiting hall; and 2 (16.7%) facilities had Infection Control Officers who have attended some training on infection control. No facility had Information, Education and Communication (IEC) materials reminding patients and health workers of the possibility of TB transmission in the health care setting. While 86.4% of TB patients were screened for HIV, only 54.7% of HIV patients were tested for TB. (2) Environmental control measures: All the waiting halls were well ventilated. Though 66.7% of the consulting rooms were well ventilated, 25% of them were over crowded; 58.3% of the facilities managed sputum smear positive TB patients in the same ward with HIV-positive and other vulnerable patients; no facility had air cleaners. CONCLUSION: Implementation of the different aspects of the administrative control and work practice component of TB infection control measure range from 8.3% to 41.7% of the facilities. Urgent measures should be taken to reverse this trend in the face of TB burden due to HIV.

Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi State, south east Nigeria.

BACKGROUND: Each year, 100 million people are impoverished globally as a result of expenditure on health. OBJECTIVE: To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. METHOD: This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. RESULTS: Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a pre-payment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. CONCLUSION: This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.

Bacteriological assessment of stethoscopes used by medical students in Nigeria: implications for nosocomial infection control.

Our study assessed bacteria on swabs taken from the surface of the diaphragm of stethoscopes used by medical students in Nigeria. We found bacterial contamination on 80.1% of the stethoscopes. Staphylococcus aureus and Pseudomonas aeruginosa were major isolates. Bacterial colonization was highest among stethoscopes cleaned with only water and those never cleaned with any agent or never cleaned at all. The difference was statistically significant (chi2 = 31.9, p < .05). Stethoscopes from students who cleaned them after use on each patient and from those who practised handwashing after contact with each patient had significantly lower bacterial contamination (chi2 = 26.9; p < .05 and chi2=31.9, p < 0.05, respectively). Isolates of Staphylococcus aureus showed the highest susceptibility to antibiotics, while the most effective antibiotics were Ciproflox and Erythromycin. Integration of stethoscope care in the training curriculum of medical schools will enhance the control nosocomial infections.

Radiological features of pulmonary tuberculosis in HIV-positive and HIV-negative adult patients in south-eastern Nigeria

Pulmonary tuberculosis (PTB) is the most common clinical presentation of tuberculosis. This study was carried out to appraise the radiological features of PTB in adult HIV-positive and HIV-negative pa-tients. The chest radiographs of the patients were evaluated in the tuberculosis, leprosy, and endemic disease (TBL) clinic, Ebonyi State University Teach-ing Hospital (EBSUTH), Abakaliki, south-eastern Nigeria, from April 2004 to June 2006. Of the total of 117 individuals studied, 68 (58.1) were males and 49 (41.8%) females, indicating a male preponderance of 1.4:1. Up to 49.6% of the subjects had PTB/HIV co-infection. The highest prevalence of PTB/HIV co-infection was recorded among males aged 31­40 (12.8%), and females aged 21­30 (11.1%). The com-monest radiological features observed were cavitory lesions (64.1%), patchy opacities (44.4%), and hilar opacities (38.5%). Bilateral cavitory lesions, patchy opacities and hilar opacities were more prominent than the right-sided or left-sided ones and appeared more frequently among individuals with PTB/HIV co-infection. Perihilar patchy opacities, consolidation and pleural effusion were seen in 19.6%, 6.0%, and 4.3% of all cases, respectively. There was no statisti-cally significant difference in the association between the radiological features and patient category (χ2 = 17.74, df = 18, p = 0.47). The chest radiography re-mains an important tool in the diagnosis of PTB and will continue to provide essential information for the management and follow-up of patients