Epidemiology of neurotrauma in Ife-Ijesha zone of Nigeria.

BACKGROUND AND OBJECTIVE: Trauma remains one of the important causes of severe disability and high mortality. In this study, we looked at the epidemiology of neurotrauma in our region so as to highlight essential factors for trauma prevention program. METHODOLOGY: This is a cross-sectional study of all neurotrauma cases admitted to the neurosurgery service of our hospital over an 18-month period. Information was obtained on patients' demographic data, etiology of injury, duration of injury, site, and cause of accident among others. RESULTS: One hundred forty-three patients were included in the study. The injuries occurred mostly in males and in the third decade. Most of the patients were students and traders. Eighty-one percent of the accidents were due to road traffic crash (RTC), and the most common contributory factors were head-on collision (46.2%) and overtaking (28.6%). Five of six patients who had RTC in the first decade of life were pedestrians. There were more crashes within the cities. None of the patients who had motorcycle accidents used helmet and only four patients used seatbelts at the time of the accident. Transfer to hospital was mostly in vehicles other than ambulance. CONCLUSION: Neurotrauma in our study was mostly due to RTC and it is most common in young male students. Contributory factors were head on collision and overtaking.

Evaluation of a psychometric instrument designed to assess the HIV risk behaviors of ex-prisoners.

This study determined the readability, test-retest reliability, and internal consistency of a questionnaire designed to assess the HIV risk behaviors of ex-prisoners. The questionnaire was administered twice within a 2-week interval to 119 ex-prisoners. The test-retest agreement for the questionnaire's 25 HIV behavior items ranges from 82% to 100%. Of these 25 items, agreement was ''fair'' (k = .20 to .40) for 1, ''moderate'' (k = .40 to .60) for 5, ''substantial'' (k = .60 to .80) for 11, ''almost perfect'' (k = .80 to .99) for 7, and ''perfect'' (k = 1.00) for 1. The overall Cronbach's alpha (Cα) is .81 (p < .001). By subscale, the Cα for tattooing, .89; body piercing, .93; injection drug use, .93; and HIV risk sexual behavior, .79. Based on these findings, the authors conclude that the questionnaire is reliable and internally consistent.

Impact of repeated four-monthly anthelmintic treatment on Plasmodium infection in preschool children: a double-blind placebo-controlled randomized trial.

BACKGROUND: Helminth infections can alter susceptibility to malaria. Studies need to determine whether or not deworming programs can impact on Plasmodium infections in preschool children. METHODS: A double-blind placebo-controlled randomised trial was conducted to investigate the impact of anthelmintic treatment on Plasmodium infection in children aged 12-59 months. Children were randomly assigned to receive either albendazole or placebo every four months for 12 months with a follow-up at 14 months. RESULTS: 320 Children (out of 1228, 26.1%) complied with all the follow-up assessments. Plasmodium prevalence and mean Plasmodium parasite density was significantly higher in the treatment group (44.9% and 2319 ± SE 511) compared to the placebo group (33.3% and 1471 ± 341) at baseline. The odds of having Plasmodium infection increased over time for children in both the placebo and treatment groups, however this increase was significantly slower for children in the treatment group (P = 0.002). By month 14, mean Plasmodium density had increased by 156% in the placebo group and 98% in the treatment group but the rate of change in Plasmodium density was not significantly different between the groups. The change from baseline in haemoglobin had a steeper increase among children in the treatment group when compared to the placebo group but this was not statistically significant. CONCLUSIONS: Repeated four-monthly anthelminthic treatments for 14 months resulted in a significantly lower increase in the prevalence of Plasmodium infection in preschool children which coincided with a reduction in both the prevalence and intensity of A. lumbricoides infections. TRIAL REGISTRATION: Current controlled trials ISRCTN44215995.

New paradigm old thinking: The case for emergency obstetric care in the prevention of maternal mortality in Nigeria.

BACKGROUND: The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria. METHODS: The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics. RESULTS: Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it. CONCLUSION: We concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.

Male involvement in family planning decision making in Ile-Ife, Osun State, Nigeria.

This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive design using a structured household questionnaire to collect information from 402 male study participants. A multistage sampling procedure was employed. Eighty-nine percent of men approved of the use of family planning while only about 11 percent disapproved of it. Eighty percent of men had ever used contraception while 56 percent of them were current users. Spousal communication about family planning and other family reproductive goals was quite poor. The socio-demographic correlates of men's opinions included religion, marriage type, educational attainment, and occupation (p < 0.05). The study concluded that male involvement in family planning decision making was poor and their patronage of family planning services was low.

Development and evaluation of a psychometric instrument designed to assess HIV risk behaviors of prison inmates.

Clinicians and researchers interested in HIV interventions for prisoners lack an appropriate psychometric instrument to assess HIV risk behaviors. This study evaluated the readability and internal consistency of a questionnaire designed to assess such behaviors. The questionnaire was administered to 277 inmates. The Flesch Reading Ease score was 78.3 with a Flesch-Kincaid grade level of 3.7, suggesting limited comprehension difficulties. Internal consistency was evaluated by determining Cronbach's alpha (Calpha) for total items and for each subscale. Following factor analyses, 25 items converged into five subscales and combined they account for 72% of the variance. The overall Calpha was .86 and the subscales Calpha ranged from .82 to .98. Findings reveal that the questionnaire is internally consistent and suitable for use with prisoners with low literacy skills. The use of this instrument for intervention studies in prisons has the potential to reduce inmates' HIV risk behaviors.

Body art practices among inmates: Implications for transmission of bloodborne infections.

BACKGROUND: Unsterile body art practices among inmates in prison have been implicated in the transmission of bloodborne viruses. The objectives of this study were to determine the prevalence of tattooing and body piercing among inmates, identify factors associated with receiving a tattoo in prison, and explore the contexts of tattooing and body piercing in prison. METHODS: A cross-sectional survey was conducted among randomly selected inmates in 17 state prisons in Illinois; a convenient sample of recently released exprisoners in Chicago, IL, participated in focus group discussions (FGDs). RESULTS: A total of 1819 (1293 men and 526 women) inmates participated in the survey, and 47 exprisoners participated in the FGDs. Sixty-seven percent of the survey sample had tattoos, and 60% had body piercings. More men (19.3%) than women (8.7%) had received tattoos in prison (odds ratio, 0.40; 95% confidence interval: 0.29-0.56); prevalence of body piercing in prison was low (1.3%) and similar for men and women. Factors associated with tattooing in prison include incarceration for 1 year or longer and having had sex in prison among both men and women; nonheterosexual identity for women only; and for men, being 30-39 years old; incarcerated 4 or more times; having a history of sharing needles, multiple vaginal sex partners, and inconsistent condom use in the 6 months before arrest. Focus groups provided information on body art practices in prison. Inmates had a variety of reasons for getting body art, equipment was often shared, and cleansing agents were not readily available. CONCLUSION: Tattooing and body piercing practices exist in prison and could constitute risks for transmission of bloodborne viral infections. Interventions to reduce these risks are discussed.

Male involvement in family planning decision making in Ile-Ife, Osun State, Nigeria

This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive design using a structured household questionnaire to collect information from 402 male study participants. A multistage sampling procedure was employed. Eighty-nine percent of men approved of the use of family planning while only about 11 percent disapproved of it. Eighty percent of men had ever used contraception while 56 percent of them were current users. Spousal communication about family planning and other family reproductive goals was quite poor. The socio-demographic correlates of men's opinions included religion, marriage type, educational attainment, and occupation (p<0.05). The study concluded that male involvement in family planning decision making was poor and their patronage of family planning services was low (Afr J Reprod Health 2010; 14[4]: 45-52)

HIV sexual risk behaviors and perception of risk among college students: implications for planning interventions.

BACKGROUND: The college environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. While the overall incidence of HIV infection has seen some decline in recent years, rates of HIV infection among young adults have not seen a proportionate decline. As in the general population, African American young adults have been disproportionately affected by the HIV/AIDS epidemic. This study examined the sexual risk behaviors and perception of HIV risk of students in a predominantly African American commuter urban university in the Midwest. METHODS: Students enrolled in randomly selected general education courses completed a paper and pencil survey. Data were collected in Fall 2007, and univariate, bivariate, and multivariate analyses were conducted using SPSS for Windows v.16. RESULTS: The sample included 390 students, the majority (83%) of whom were never married and 87% were sexually experienced. Among males reporting male partnerships those who used marijuana (OR = 17.5, p = 0.01) and those who used alcohol along with illegal drugs (OR = 8.8, p = 0.03) were significantly more likely to report multiple partnerships. Among females reporting male partnerships, those 30 years and older were significantly less likely (OR = 0.09, p = 0.03) to report having multiple male partners. There were significant differences in condom use last sex (p = 0.01) and consistent condom use (p = 0.002) among the different age groups. Older students were less likely to report condom use. Females age 30 years and older (OR = 3.74, p = 0.05) and respondents age 2029 years (OR = 2.41, p = 0.03) were more likely to report inconsistent condom use than those below 20 years. Marijuana use was correlated with inconsistent condom use (p = 0.02) and alcohol with not using condom last sex among females. Perception of HIV risk was generally poor with 54% of those age 30 years and older, 48.1% of 2029 year olds, and 57.9% of those below the age of 20 years perceived themselves as not having any chance of being infected with HIV. Predictors of moderate/good perception of HIV risk were drug and alcohol use, inconsistent condom use, and multiple partnerships. CONCLUSION: Students in the study sample engaged in various HIV risk behaviors but have a poor appreciation of their risk of HIV infection. While low rates of condom use was a problem among older students (30 years and older), multiple partnerships were more common among younger students, and marijuana and alcohol use were related to low condom use among females. Our findings support the need for targeted HIV prevention interventions on college campuses.

Relationship between incarceration frequency and human immunodeficiency virus risk behaviors of African American inmates.

OBJECTIVE: We examined the relationship between frequency of incarceration and preincarceration risk behaviors and determined the demographic factors associated with risk behaviors among a sample of African American inmates. METHODS: We surveyed 229 (102 female and 127 male) randomly selected inmates. Risk behaviors between inmates serving their first prison sentence and those who had been incarcerated in prison more than once were compared using the chi2 test. Multivariate logistic regression analysis was used to determine factors associated with risk behaviors. RESULTS: For most risk behaviors, there were no significant differences between inmates serving their first prison sentence and inmates incarcerated more than once; however, male inmates who had been incarcerated more than once were more likely to report having had multiple vaginal sex partners (OR, 2.42; 95% CI, 1.10-5.32; P = .03). No demographic variable was found to be independently associated with risk behaviors. CONCLUSIONS: Frequency of incarceration did not affect preincarceration human immunodeficiency virus (HIV) risk behaviors among this sample of African American inmates. HIV prevention efforts should be directed at addressing the individual and structural factors associated with high-risk behaviors among African Americans.

Patterns of soil-transmitted helminth infection and impact of four-monthly albendazole treatments in preschool children from semi-urban communities in Nigeria: a double-blind placebo-controlled randomised trial.

BACKGROUND: Children aged between one and five years are particularly vulnerable to disease caused by soil-transmitted helminths (STH). Periodic deworming has been shown to improve growth, micronutrient status (iron and vitamin A), and motor and language development in preschool children and justifies the inclusion of this age group in deworming programmes. Our objectives were to describe the prevalence and intensity of STH infection and to investigate the effectiveness of repeated four-monthly albendazole treatments on STH infection in children aged one to four years. METHODS: The study was carried out in four semi-urban villages situated near Ile-Ife, Osun State, Nigeria. The study was a double-blind placebo-controlled randomised trial. Children aged one to four years were randomly assigned to receive either albendazole or placebo every four months for 12 months with a follow-up at 14 months. RESULTS: The results presented here revealed that 50% of the preschool children in these semi-urban communities were infected by one or more helminths, the most prevalent STH being Ascaris lumbricoides (47.6%). Our study demonstrated that repeated four-monthly anthelminthic treatments with albendazole were successful in reducing prevalence and intensity of A. lumbricoides infections. At the end of the follow-up period, 12% and 43% of the children were infected with A. lumbricoides and mean epg was 117 (S.E. 50) and 1740 (S.E. 291) in the treatment and placebo groups respectively compared to 45% and 45% of the children being infected with Ascaris and mean epg being 1095 (S.E. 237) and 1126 (S.E. 182) in the treatment and placebo group respectively at baseline. CONCLUSION: Results from this study show that the moderate prevalence and low intensity of STH infection in these preschool children necessitates systematic treatment of the children in child health programmes.

Gender differences in HIV risk behaviors of inmates.

BACKGROUND: Incarcerated men and women differ in their views on HIV prevalence rates and susceptibility and their ability to prevent HIV infection. The objective of this study was to assess sex and gender differences in HIV risk behaviors of inmates in order to better support the consideration of gender in the development of HIV prevention interventions for the incarcerated population. METHODS: A survey of 1819 inmates was conducted using a structured questionnaire. Self-reported HIV risk behaviors of 526 women and 1293 men during incarceration were compared. Bivariate analyses were done to identify gender differences in demographic characteristics and HIV risk behaviors. Logistic regression was used to determine factors associated with engaging in sexual intercourse in prison. RESULTS: Mean age was higher for women than men (p = 0.05), and >50% of participants were African Americans. More women than men reported that they engaged in sexual intercourse (p < 0.001); however, men were more likely to report anal sex (p < 0.001). There were no sex differences in injection drug use. Women who identified as bisexual or lesbian, those who had been currently incarcerated for at least 1 year, and those who received tattoos in prison were more likely to report sexual intercourse. The only independent risk factor identified for men was being currently incarcerated for at least 7 years. CONCLUSIONS: There are gender differences in HIV risk behaviors of inmates during incarceration. The findings in this study suggest that inmates may benefit from gender-specific HIV interventions while incarcerated and in the community subsequent to release.

College students in Nigeria underestimate their risk of contracting HIV/AIDS infection.

OBJECTIVES: To assess the perceptions of personal risk of acquiring HIV/AIDS infection among students of selected tertiary institutions in Osun State, Nigeria and to determine the correlates of perceptions of personal risk of infection. METHODS: The study employed a cross-sectional descriptive design. An interviewer-administered questionnaire was applied to the 405 study participants and correlates of perceptions of personal risk of HIV infection were evaluated using multiple logistic regression analysis, confidence intervals and odd ratios. RESULTS: Only 15% of the students perceived themselves to be at moderate-to-high risk of acquiring HIV infection compared with 85% who perceived themselves to be at little or no risk. Investigators' assessment of risk status of the participants revealed that 77% of the participants were actually at high risk of infection and only 23% at low risk. The sensitivity, specificity and negative predictive value of the students' self-perception of personal risk compared with their assessed risk were 7, 58 and 16%, respectively, with a Kappa statistic of 0.178. The only significant correlate of self-perception of personal risk was a recent symptom of sexually transmitted infections. CONCLUSIONS: College students exhibited an 'optimism bias' associating high rates of HIV risk indicators with low levels of perceived personal risk of infection. This has implications for HIV/AIDS control in Nigeria.

Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria.

OBJECTIVES: The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria. METHODS: A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted. RESULTS: Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p < 0.05). CONCLUSIONS: Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.

Acceptability, feasibility and affordability of infant feeding options for HIV-infected women: a qualitative study in south-west Nigeria.

The objective of this study was to explore the acceptability, feasibility, affordability, safety and sustainability of replacement feeding options for HIV-infected mothers in Ile-Ife, in south-west Nigeria. Six focus group discussions were conducted with a purposive sample of mothers, fathers and grandmothers. The HIV status of all participants was unknown to investigators. All text data were analysed using the Text-based Beta Software program. With regard to the acceptability of replacement feeds, respondents perceived the stigma associated with not breastfeeding to be an important consideration. In this community, breastfeeding is the norm--even though it is not necessarily exclusive. For infected mothers who choose to breastfeed exclusively and then to wean their infants before 6 months of age, respondents did not anticipate early cessation of breastfeeding to be problematic. Respondents noted that acceptable replacement foods included infant formula, soy milk and cow's milk. Barriers to replacement feeding that were mentioned included: the high costs of replacement foods and fuel for cooking; an unreliable supply of electrical power; poor access to safe water; and poor access to storage facilities. The research confirms the difficulty of replacement feeding for HIV-infected mothers in sub-Saharan Africa. The results also provide the basis for new issues and hypothesis for future research in other communities with similar socio-cultural and economic characteristics.

Clinical lactation practice: 20 years of evidence.

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.