Evaluation of the effectiveness of deworming and participatory hygiene education strategy in controlling anemia among children aged 6-15 years in Gadagau community, Giwa LGA, Kaduna, Nigeria.

BACKGROUND: Anemia is one of the most common and most serious health disorders worldwide. The World Health Organization (WHO) estimated that about 40% of the total world's population (more than 2 billion individuals) suffer from anemia. In developing countries, the prevalence rate of anemia is about 20% in school-aged children. More than 10 million African children are thought to be anemic (Hb < 11 g/dl). Also, in Africa, it is estimated that more than half of all children over 5 years and pregnant women are anemic. Community-based estimates of anemia prevalence in settings where malaria is endemic range between 49% and 76%. In Nigeria, the prevalence rate for anemia among children was 29.4%. It was highest in the South-East (49.7%) and lowest in the North-East (11.1%). OBJECTIVE: The study aimed at evaluating the effectiveness of deworming and participatory hygiene education strategy in controlling anemia among children aged 6-15 years in the Gadagau community, north-western Nigeria. MATERIALS AND METHODS: A cross-sectional descriptive study of 306 children aged 6-15 years selected from two rural communities (Gadagau, which was the study group and Karau-Karau, which was the control group) in the Giwa Local Government Area of Kaduna State Nigeria using a multistage sampling technique. The studies involved parasitological examination and anemia evaluation before and at 3 months after the children were dewormed. RESULTS: Only 301 children (150 children in study group and 151 children in control group) were studied. The results showed that those who were dewormed and had participatory hygiene education lectures (study group) had significantly higher mean hemoglobin, from an initial 10.4 g/dl to a post-intervention of 12.4 g/dl (paired t-test = 13.96; P = 0.00). Also, there was a rise in the mean hemoglobin of the control group, but not as much as in the study group, from an initial mean hemoglobin of 10.5 g/dl to a post-intervention of 11.2 g/dl (paired t-test = 2.89; P = 0.004). Comparing the study and the control groups, those who were dewormed and also had participatory hygiene education lectures (study group) had a significantly higher reduction in the level of children who had ova of intestinal helminthes present in their stool than those in the control group (Χ 2 = 31.61; df = 1, P = 0.00). CONCLUSION: This study therefore concludes that including participatory hygiene education to deworming programmes will greatly improve the hemoglobin level of children in areas where there is a high prevalence of hookworm infections, especially as a short-term preventive measure for anemia in children.

Domestic refuse management practice in Sokoto: the effect of health education.

AIMS AND OBJECTIVES: Domestic refuse remains a major environmental concern in large cities around the world. Its management also continues to be a major challenge. The aim of this study was to assess the effect of health education on the knowledge, attitude and practices of domestic refuse management (DRM) among community members in Sokoto metropolis. MATERIALS AND METHODS: A quasi experimental study design was employed to investigate two sampled (intervention and control groups) population of 225 subjects in the study areas. RESULTS: The mean knowledge score (%) of the study subjects was high and similar (p=0.82), in both the intervention and control groups at baseline, but differed significantly (p<0.0001) at post-intervention. The mean attitude score (%) was high and similar (p=0.38), in both the intervention and control groups at baseline, but differed significantly (p=0.008) at post intervention. The mean observed practice score (%) was low and similar (p=0.42), in both the intervention and control groups at baseline, but differed significantly (p<0.0001) at post-intervention. CONCLUSION: This study has identified the underlying problem of our DRM system to be inherent in the practice component in the triangulation of knowledge, attitude and practice of DRM. The implications of the study findings for healthcare policy, planning and implementation cannot be over-emphasised.

Mortality and cause of death in abuth, zaria: 1999 - 2005.

BACKGROUND: Accurate mortality statistics are needed for policy formulation, implementation and monitoring of health intervention that are aimed at improving the health status of the people. Mortality level is one of the indicators of the quality of life and status of health of a population. However, accurate collection, collation, analysis and interpretation of such data is poorly organised in developing nations, including Nigeria leading to a gap in health policy formulation, implementation and monitoring. Therefore, policies and strategies for disease prevention are based on empirical evidence rather than on data primarily collected to formulate disease specific interventions. Though, hospital data have inherent deficiency in its use to design prevention. However, when accurately generated and adequately managed would provide both qualitative and quantitative information on morbidity and mortality if not for the entire society at least for a segment of the population utilizing it. We implemented a system of death certification to determine causes and pattern of mortality in Ahmadu Bello University Teaching Hospital, Zaria. METHODS: From May 1999 to November 2005, all case folders of deceased patients were retrieved from the central library of health information management department of the hospital; case folders of deceased patients are required to have in them a completed IFMCCD (International Form of Medical Certification of Cause of Death). All case folders of deceased patients after relevant information were extracted by the staff of health management information department, were passed on to the staff of department of Community Medicine directly involved in this study. The completed cause of death certificates received in the department of Community Medicine (between May 1999 and November 2005), were examined. Coding rules were employed to select the appropriate code for those certificates that were incorrectly completed. The underlying cause of death as identified from the correctly completed IFMCCDS is coded according to ICD-10. RESULTS: For the period under study, there were 4019 deaths: 2212 males and 1807 females. Total of 2914 (72.5%) deaths were certified, using the IFMCCD of which 1641 of them were males and 1273 females and formed the basis of this analysis. Coverage rates ranges from 56.2% in 2001 to 85% in 1999. The proportion of garbage codes ranges from 0% to 2.4% while the three leading causes of death are HIV infection, road traffic accident (RTA), and cardiovascular diseases among the ten. The time-trend of the leading causes of death show RTA maintaining steady upward climb while malaria, septicemia, PEM, sepsis in the neonatal period shows unsteady fluctuation. CONCLUSION: This study assessed the pattern of mortality and causes of death in ABU Teaching Hospital, Zaria; it also provided information on leading causes of death.

Contraceptive knowledge, attitudes and practice among married women in Samaru community, Zaria, Nigeria.

Contraceptive use and fertility rates vary substantially among developing countries. In some sub-Saharan African countries, fewer than 10% of married women use contraception. Despite all efforts by governments to ensure availability of the products, prevalence has remained low. We conducted a community-based study to examine contraceptive knowledge, attitude and practice of family planning among married women in Samaru, Zaria, Nigeria. Multi-stage random sampling technique was used to study 200 women in Samaru community of Zaria, Nigeria. Mean age of the respondents was 30.6 +/- 1.5 years. In this study contraceptive prevalence was 12.5% and respondents had a positive attitude towards family planning. Thirty years after Alma Ata of which one of the components is to ensure maternal and child health (MCH) and family planning, contraceptive use in most of the communities in Northern Nigeria is low. There is urgent need to step-up public awareness campaigns on family planning to ensure wide spread acceptability and utilization among women within reproductive age group.

Mortality and Cause of Death in Abuth; Zaria: 1999-2005

Background: Accurate mortality statistics are needed for policy formulation; implementation and monitoring of health intervention that are aimed at improving the health status of the people. Mortality level is one of the indicators of the quality of life and status of health of a population. However; accurate collection; collation; analysis and interpretation of such data is poorly organised in developing nations; including Nigeria leading to a gap in health policy formulation; implementation and monitoring. Therefore; policies and strategies for disease prevention are based on empirical evidence rather than on data primarily collected to formulate disease specific interventions.Though; hospital data have inherent deficiency in its use to design prevention. However; when accurately generated and adequately managed would provide both qualitative and quantitative information on morbidity and mortality if not for the entire society at least for a segment of the population utilizing it. We implemented a system of death certification to determine causes and pattern of mortality in Ahmadu Bello University Teaching Hospital; Zaria Methods: From May 1999 to November 2005; all case folders of deceased patients were retrieved from the central library of health information management department of the hospital; case folders of deceased patients are required to have in them a completed IFMCCD(International Form of Medical Certification of Cause of Death). All case folders of deceased patients after relevant information were extracted by the staff of health management information department; were passed on to the staff of department of Community Medicine directly involved in this study. The completed cause of death certificates received in the department of Community Medicine (between May 1999 and November 2005); were examined. Coding rules were employed to select the appropriate code for those certificates that were incorrectly completed. The underlying cause of death as identified from the correctly completed IFMCCDS is coded according to ICD-10. Results: For the period under study; there were 4019 deaths: 2212 males and 1807 females. Total of 2914 (72.5) deaths were certified; using the IFMCCD of which 1641 of them were males and 1273 females and formed the basis of this analysis. Coverage rates ranges from 56.2in 2001 to 85in 1999. The proportion of garbage codes ranges from 0to 2.4while the three leading causes of death are HIV infection; road traffic accident (RTA); and cardiovascular diseases among the ten. The time-trend of the leading causes of death show RTA maintaining steady upward climb while malaria; septicemia; PEM; sepsis in the neonatal period shows unsteady fluctuation. Conclusion: This study assessed the pattern of mortality and causes of death in ABU Teaching Hospital; Zaria; it also provided information on leading causes of death

Awareness of occupational hazards and utilization of safety measures among welders in Kaduna metropolis, northern Nigeria.

BACKGROUND: Welders are exposed to a variety of occupational hazards with untoward health effects. However, little is known of welders' awareness of health hazards and their adherence to safety precautions in developing countries. This study assessed the awareness of occupational hazards and adherence to safety measures among welders in Kaduna metropolis in northern Nigeria. METHODS: A structured questionnaire was administered on a cross-section of 330 welders in Kaduna metropolis in northern Nigeria. Information was sought on their socio-demographic characteristics, their awareness of occupational hazards and adherence to safety measures. RESULTS: All welders were males with a mean age of 35.7 +/- 8.4 years. The illiteracy rate was 7.6%. Overall, 257 (77.9%) of the welders were aware of one or more workplace hazards. This was positively influenced by educational attainment, age, nature of training and work experience. Of the 330 respondents, 282 (85.3%) had experienced one or more work-related accidents in the preceding year. The most common injuries sustained were cut/injuries to the hands and fingers (38.0%), back/waist pain (19%), arc eye injuries/foreign bodies (17.0%), burns (14.0%), hearing impairment (7.0%), fractures (4.0%) and amputation (1.0%). Only 113 (34.2%) welders used one or more types of protective device with eye goggles (60.9%), hand gloves (50.3%) and boots (34.5%) being more frequently used. Regular use of safety device, shorter working hours and increasing experience were protective of occupational accidents. CONCLUSIONS: The level of awareness of occupational hazards was high with sub optimal utilization of protective measures against the hazards. There is therefore need for health and safety education of these workers for health and increased productivity.

Knowledge and practice of breast-self examination among female undergraduate students of Ahmadu Bello University Zaria, northwestern Nigeria.

BACKGROUND: Carcinoma of the breast is an important public health problem in Nigeria and studies have reported low levels of awareness and practice of breast self examination as an important method of prevention. Breast self examination is a cost-effective method of early detection of cancer of the breast especially in resource poor countries. We assessed knowledge and practice of breast-self examination (BSE) among female undergraduate students of Ahmadu Bello University Zaria, Nigeria. METHOD: In this study, knowledge and practice of BSE were examined among 221 female students aged 16-28 years old studying at Ahmadu Bello University Zaria using self administered questionnaires. RESULTS: It was found that despite nearly three quarter of the respondents (87.7%) had heard of BSE, only 19.0% of them were performing this examination monthly. Regarding the sources of information about BSE among respondents, media was found to be most common followed by health workers accounting for 45.5% and 32.2% respectively. Regular performance of BSE was significantly correlated with duration of stay in the University (X2 = 81.9, df = 3, P 2 = 17.4, df = 2, P CONCLUSION: We observed a disparity between high levels of knowledge of BSE compared to a low level of practice. Public health education using the media could significantly reduce the knowledge-practice gap and early detection of breast lump.

An assessment of knowledge of HIV/AIDS and associated risky behavior among inmates of Kaduna convict prison: the implications for Prevention Programmes in Nigerian Prisons.

BACKGROUND: Prisoners worldwide have a significantly higher prevalence of human immunodeficiency virus (HIV). Despite this, little is known of inmates' knowledge, behaviour and access to services, especially in developing countries. This study assessed the characteristics, HIV/AIDS knowledge, attitude and associated risky behavior among inmates of a prison in northern Nigeria. METHODS: A structured interviewer-administered questionnaire was administered on a cross-section of 374 inmates of Kaduna convict prison in northern Nigeria. Information was elicited on their sociodemographic characteristics, knowledge of HIV/AIDS, attitude and indulgence in risky behaviour. RESULTS: About 96.1% of the inmates had heard about AIDS. Majority of them (70%) were ignorant of the causative agent; however, knowledge of route of disease transmission was high, with 91%, 67% and 46.7% of inmates mentioning sexual activity, unscreened blood transfusion and sharing unsterilized blades, respectively. They listed abstinence, faithfulness, use of condoms, new needles, syringes and blades as protective measures. Overall, 39.5%, 48.7% and 11.8% of the respondents had good, fair and poor knowledge of HIV/AIDS, respectively. Only 64 (14.9%) inmates reported having sexual intercourse in prison. These sexual encounters were homosexual in 56.2% of cases and heterosexual in 43.8% of cases. Only 28 (43.8%) of the sexually active inmates claimed to have used condoms regularly. Respectively, 72.3% and 70.8% of inmates shared barbing clippers and razor blades. There was a strong association between educational attainment and knowledge of HIV/AIDS (2 = 28.3 df = 6 P < 0.0001). CONCLUSION: Although more than two thirds of the inmates had adequate knowledge of HIV/AIDS, there were gaps, misconceptions and high-risk behaviour. Well-designed information, education an communication (IEC) programmes on AIDS should be developed for inmates of prisons nationwide.

Profile of institutional infrastructure for implementing universal precautions in primary health care facilities in Sokoto State, Nigeria: Implication for occupational safety

Background: The adoption of primary health care in Nigeria has led to the expansion of health care delivery frontiers especially at the rural level. At this level is the most critical health services delivery point, with an attendant increase in contact between primary health care providers and patients. There is however also a simultaneous increased exposure to occupational and related health risks and hazards. Methods: The objectives of this study were to assess the universal precaution profile of primary health care facilities and determine those factors that inform their prevailing safety status. Using a structured checklist, 23 representative primary health care facilities from the 23 local government areas in Sokoto State were randomly selected for the study, one from each of the local government areas. Results: The facilities were found to have poor universal precaution profile that could guarantee effective control of infection transmission and safety of their personnel. The facilities' mean score on measures and frameworks for ensuring the implementation of Universal Precautions was 53.12% ± 21.68% with only 56.52% scoring above 50%. Conclusion: Safety protocol and facilities for ensuring safe environment were inadequate and poorly developed. None of the facilities had full complement of facilities or resources for ensuring safety of working environment and for personnel's implementation of Universal Precautions. Policy for safety practice was poor, and post exposure intervention programmes for staff in event of accidental exposure grossly underdeveloped. Interventions to improve safety environment and creation of safe climate are essential to protect primary health care workers against occupational hazards

Knowledge and Practice of Breast-Self Examination among Female Undergraduate Students of Ahmadu Bello University Zaria; Northwestern Nigeria

Background: Carcinoma of the breast is an important public health problem in Nigeria and studies have reported low levels of awareness and practice of breast self examination as an important method of prevention. Breast self examination is a cost-effective method of early detection of cancer of the breast especially in resource poor countries. We assessed knowledge and practice of breast-self examination (BSE) among female undergraduate students of Ahmadu Bello University Zaria; Nigeria. Method: In this study; knowledge and practice of BSE were examined among 221 female students aged 16 - 28 years old studying at Ahmadu Bello University Zaria using self administered questionnaires. Results: It was found that despite nearly three quarter of the respondents (87.7) had heard of BSE; only 19.0of them were performing this examination monthly. Regarding the sources of information about BSE among respondents; media was found to be most common followed by health workers accounting for 45.5and 32.2respectively. Regular performance of BSE was significantly correlated with duration of stay in the University (X2 = 81.9; df = 3; P .05) and family history of breast cancer (X2

Essential drugs in primary health centres of north central Nigeria; where is Bamako initiative?

OBJECTIVE: To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. METHODS: Checklist consisting of minimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development Agency (NPHCDA) was adopted and used to assess drugs availability, while Focus Group Discussions were conducted to determine the perceptions of clients on drugs situation in the health centres. RESULTS: Results show that, all the 3 primary health centres in Tafa LGA do not implement Bamako initiative (BI) and none was operating Drug Revolving Fund (DRF) system. Out of the minimum recommended score of 54 points for the availability and adequacy of drugs and consumables, New Wuse primary health centre in the LGAheadquarters scored highest points of 19, while New Bwari and Iku primary health centres scored 13 points each. All these are far below the minimum requirement. Similarly, the results of the FGDs confirmed poor availability of drugs and clients dissatisfactions with the drugs situation in the primary health centres. CONCLUSION: This study has revealed that despite Bamako Initiatives put in place in late 80s essentials drugs are still mirages in many of the primary health care facilities in the study area. It is therefore recommended that, any effort aimed at reforming or repositioning primary health care must take into account resuscitating Bamako Initiative by ensuring functional DRF system in all the primary care facilities.

Sexual behaviour and predictors of condom use among students of a Nigerian tertiary institution.

BACKGROUND: Increasing sexual networking among university students exposes them to the risk of sexually transmitted infections (STIs) including HIV/AIDS. Despite this, the level of condom use and sexual abstinence is low. OBJECTIVE: The objective of the study was to describe sexual behavior and identify predictors of condom use among students in a Nigerian university. METHODS: A cross sectional survey was conducted using self-administered questionnaires among 404 students of the Federal university of Technology, Minna in northern Nigeria. FINDINGS: A total of 328 (81.2%) questionnaires were completed and returned. There were 230 male and 98 female respondents giving a sex ratio of 1:2.3. The respondent's ages ranged from 16 to 38 years with an overall mean of 23.53.51 years. A significantly higher proportion of males 184 (80.0%) reported being sexually experienced compared to 64 (65.0%) females (chi2 = 8.05 P < 0.05). The mean age of first sexual experience was also significantly higher among male students [18.92.1 years] compared to female students [16.41.7 years] (t = 11.36, P < 0.01). Similarly, a significantly higher proportion (56.2%) of sexually active males had multiple partners compared to females (38.1%) (chi2 = 11.9, P = 0.001). In addition, the mean number of lifetime sexual partners was significantly higher (5.3) for males compared to females (2.6) [t = 12.0, P < 0.001]. Condom was consistently used by 38.3% (n=95) of sexually active students in both genders. A higher proportion (44.6%) (n=82) of male students reported regular use of condoms compared to (20.3%) (n=13) of (partners of) sexually active female students (chi2 = 11.8 P = 0.001). Significant predictors of regular condom use include (male) gender, (higher) level of study and (single) marital status. CONCLUSION: Most students were sexually active and many practiced unsafe sex. This indicates the need for youth friendly reproductive health programmes targeting these students.

Improving the quality of obstetric care at the teaching hospital, Zaria, Nigeria.

PRELIMINARY STUDIES: Research at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, showed delay in treating women with obstetric complications and highlighted multiple contributing factors. INTERVENTIONS: In response, a surgical theater was restored to working order, the maternity ward renovated, resident physicians trained in obstetrics and an emergency drug pack system instituted. A system of blood donation from families of women attending antenatal clinics was introduced. Later, community interventions focused on improving access and reducing delay in seeking care. RESULTS: Mean admission-to-treatment interval was reduced by 57%, from 3.7 h in 1990 to 1.6 h in 1995. The proportion of women treated in less than 30 min increased from 39% in mid-1993 to 87% in late 1995. Case fatality rate (CFR) among women with major obstetric complications fell from 14% in 1990 to 11% in 1995. The annual number of women with complications seen, however, declined from 326 in 1990 to 65 in 1995. COSTS: Cost of material improvements was approximately US$135,000, of which 65% was provided by government. An additional $8000 per year in new staff salaries was paid by the government. CONCLUSIONS: Hospital obstetric services can be improved and government can be mobilized to contribute. Treatment delay and obstetric CFR can be reduced. Deteriorating economic conditions, however, may diminish utilization of services despite improvements.

The effect of improving maternity services in a secondary facility, Zaria, Nigeria. The Zaria PMM Team.

PRELIMINARY STUDIES: Facility review at the secondary hospital in Makarfi revealed a lack of drugs and skilled personnel and delays in treating and referring women with obstetric complications. INTERVENTIONS: In 1994, maternity facilities were renovated, a revolving drug fund was introduced, midwives were trained and an ambulance was restored to service. Attempts to secure a physician with skills in treating obstetric emergencies were unsuccessful. Prior to these activities, obstetric services at the referral hospital were improved. Community interventions focused on improving utilization by women with complications. RESULTS: Between 1990 and 1995, substantial increases occurred in antenatal attendance (2517 to 5565 per year) and deliveries (325 to 1952 per year). The number of women with complications seeking care at this facility, however, dropped from 85 in 1990 to 28 in 1995. Referrals to higher level facilities increased from four in 1990 to 17 in 1995. COSTS: The cost of the interventions was approximately US $32,000. Ninety-eight percent was paid by the government and 2% by PMM. CONCLUSIONS: Improving the quality of maternity services can increase utilization by women with uncomplicated pregnancies. However, utilization of emergency services appears to be influenced by other factors, such as the ability to treat obstetric complications and prevailing economic conditions.

Community loan funds and transport services for obstetric emergencies in northern Nigeria.

PRELIMINARY STUDIES: Focus group discussions and a community survey indicated that inadequate funds and transport caused delays in deciding to seek emergency obstetric care and in reaching facilities. INTERVENTIONS: Following improvements in the quality of obstetric services, a community loan program was established in early 1995. Community members determined its features: compulsory contributions; community administration; loans for obstetric complications only; no interest; a 6-month grace period; and 24-month repayment. A transport system was also established, in which private vehicle drivers agreed to respond to calls for emergency transport and charge a set fee. RESULTS: The equivalent of US $20,500 was collected from 81 annual and 2273 one-time contributors. Eighteen loans were approved in 9 months. Repayment data are not yet available. For the transport system, 23 drivers pledged permanent participation and 58 pledged to take part in 6-month rotations. They transported 18 women. COSTS: The cost of these interventions was $3409 for the loan fund and $2272 for the transport system. Sixty percent of the cost was paid by the community and the rest by the PMM project. CONCLUSIONS: Community-managed loan and transport systems for women with obstetric emergencies can be established and may contribute to reducing delay in obtaining emergency obstetric care.