Social consequences of COVID-19 on fertility preference consistency and contraceptive use among Nigerian women: insights from population-based data.

BACKGROUND: Emerging evidence from high income countries showed that the COVID-19 pandemic has had negative effects on population and reproductive health behaviour. This study provides a sub-Saharan Africa perspective by documenting the social consequences of COVID-19 and its relationship to fertility preference stability and modern contraceptive use in Nigeria. METHOD: We analysed panel data collected by Performance Monitoring for Action in Nigeria. Baseline and Follow-up surveys were conducted before the COVID-19 outbreak (November 2019-February 2020) and during the lockdown respectively (May-July 2020). Analysis was restricted to married non-pregnant women during follow-up (n = 774). Descriptive statistics and generalized linear models were employed to explore the relationship between selected social consequences of COVID-19 and fertility preferences stability (between baseline and follow-up) as well as modern contraceptives use. RESULTS: Reported social consequences of the pandemic lockdown include total loss of household income (31.3%), food insecurity (16.5%), and greater economic reliance on partner (43.0%). Sixty-eight women (8.8%) changed their minds about pregnancy and this was associated with age groups, higher wealth quintile (AOR = 0.38, CI: 0.15-0.97) and household food insecurity (AOR = 2.72, CI: 1.23-5.99). Fertility preference was inconsistent among 26.1%. Women aged 30-34 years (AOR = 4.46, CI:1.29-15.39) were more likely of inconsistent fertility preference compared to 15-24 years. The likelihood was also higher among women with three children compared to those with only one child (AOR = 3.88, CI: 1.36-11.08). During follow-up survey, 59.4% reported they would feel unhappy if pregnant. This was more common among women with tertiary education (AOR = 2.99, CI: 1.41-6.33). The odds increased with parity. The prevalence of modern contraceptive use was 32.8%. Women aged 45-49 years (AOR = 0.24, CI: 0.10-0.56) were less likely to use modern contraceptives than those aged 15-24 years. In contrast, the odds of contraceptive use were significantly higher among those with three (AOR = 1.82, CI: 1.03-3.20), four (AOR = 2.45, CI: 1.36-4.39) and at least five (AOR = 2.89, CI: 1.25-6.74) children. Unhappy disposition towards pregnancy (AOR = 2.48, CI: 1.724-3.58) was also a significant predictor of modern contraceptive use. CONCLUSION: Some social consequences of COVID-19 affected pregnancy intention and stability of fertility preference but showed no independent association with modern contraceptive use.

Prevalence and Pattern of Internet Addiction Among Adolescents in Ibadan, Nigeria: A Cross-Sectional Study.

Background and objective Despite the potential benefits the Internet offers, it is prone to excessive and uncontrolled use, thus resulting in a condition called Internet addiction (IA). This study aimed to describe the prevalence of Internet addiction (IA) among in-school adolescents in Ibadan, Southwest Nigeria. Materials and methods A descriptive cross-sectional study was conducted among 632 adolescents using a two-stage sampling technique. IA was assessed using the 20-question Internet addiction test (IAT). Responses to each question ranged from "0" (i.e., "never") to "5" (i.e., "always"). Cumulative IAT scores > 50% suggested the presence of IA. Chi-square tests were conducted to determine the association between adolescents' characteristics and IA. Statistically significant variables were pooled into the binary logistic regression model. P-values < 0.05 were statistically significant. Results The mean age of the adolescents was 16.03 ± 1.26 years, and 347 (54.9%) were males. A total of 284 (44.9%) adolescents had IA: 174 (42%) accessed the Internet in both home and school settings (ᵡ2 = 4.103, p = 0.043), and 174 (42%) accessed the Internet at home only (ᵡ2 = 5.003, p = 0.025). Adolescents who accessed the Internet from both home and school settings had higher odds of developing IA (adjusted odds ratio (AOR) = 1.408, 95% confidence interval (CI) = 0.986-2.012, p = 0.060), as well as those who accessed the Internet from home settings only (AOR = 1.404, 95%CI = 1.010-1.953, p = 0.043). Adolescents who gained four to six hours of Internet connection weekly had two times odds of developing IA (AOR = 1.404, 95%CI = 1.010-1.953, p = 0.043), and those who gained more than six hours of Internet connection had more than three times odds of developing IA (AOR = 3.424, 95%CI = 1.937-6.053, p = 0.043). Conclusion To prevent IA, adolescents should develop self-control skills and self-regulation of Internet use. Likewise, Internet access should be restricted from both home and school settings, and adolescents' Internet access should be monitored and regulated from both home and school settings.

Common mental health problems and associated factors among medical students of University of Ibadan, Nigeria.

BACKGROUND: The burden of mental health problems among medical students is on the increase especially when compared with their counterparts in other disciplines. This has counterproductive impact on the society. Understanding the prevalence and predictors of common mental health problems can inform early intervention to curb this menace. AIMS: This study was conducted to determine the prevalence, pattern and correlates of common mental health problems (anxiety and depression) amongst medical students of the University of Ibadan, Nigeria. METHODOLOGY: A descriptive cross-sectional survey was conducted among 690 pre-clinical and clinical medical students of the University of Ibadan. Data were analyzed using descriptive statistics, Chi-square test and binary logistic regression at p < 0.05. RESULTS: The prevalence of anxiety and depression were 26.5% and 10.1%, respectively, with 6.8% having both. Perceived risk factors included overwhelming academic workload (65.2%) and failure to meet up with academic expectations (64.1%). The predictors of comorbid anxiety and depression were: polygamous family setting (OR 2.7: 95% CI: 1.156-6.536) and preclinical studentship (OR: 6.2; 95% CI: 2.282-16.868). CONCLUSION: This study shows that the prevalence of mental health problems is high among medical students.

Prevalence and Factors Associated With Vaginal Douching Among Secondary School Girls in a Metropolitan City in Ogun State, Nigeria.

STUDY OBJECTIVE: This study was designed to determine the prevalence and factors associated with vaginal douching among secondary school girls in a metropolitan city in Ogun State, Nigeria. DESIGN: A descriptive cross-sectional study was carried out using a semi-structured interviewer-assisted questionnaire adapted from previous studies. SETTING: Eight secondary schools in a metropolitan city of Ogun State. PARTICIPANTS: A total of 818 secondary school girls aged 10-19 years. MAIN OUTCOME MEASURE: The outcome of interest was the association between vaginal douching (lifetime) with demographic characteristics, socioeconomic characteristics of respondents' parents, source of information on douching (eg, family members, teachers), and perception about douching and its health consequences. RESULTS: Mean age of the respondents was 13.9 ± 1.9 years. Most (72.7%) respondents were from co-educational schools; 62.5% were from public schools; 53.2% were day students; and majority (82.0%) were from nuclear families. Prevalence of vaginal douching was 63.8% and the predictors of the practice were respondents' age (OR, 0.2; 95% CI = 0.063-0.603), family setting (OR = 0.4; 95% CI = 0.221-0.819), fathers' occupation (OR = 0.6; 95% CI = 0.312-0.953), main source of douching information (OR = 2.4; 95% CI = 1.370-4.192), and perception about douching and its health consequences (OR = 2.2; 95% CI = 1.403-3.523 and OR = 2.0; 95% CI = 1.236-3.187 respectively). CONCLUSION: Vaginal douching was prevalent among secondary school adolescent girls in the study area. Factors associated with the practice include age, family setting, fathers' occupation, source of information on douching, perception about douching practice, and perceived health consequences of the practice.

Community perceptions on causes of high dizygotic twinning rate in Igbo-Ora, South-west Nigeria: A qualitative study.

BACKGROUND: Dizygotic (DZ, non-identical) twinning rates vary widely across different regions in the world. With a DZ twinning rate of 45 per 1000 live births, Igbo-Ora Community in South-west Nigeria has the highest dizygotic (DZ) twinning rate in the world. Although several postulations exist on the causes of high DZ twinning rates in Igbo-Ora, no study has yet been conclusive on a definite causative agent. OBJECTIVE: Using qualitative methods, this study explored the perceptions and beliefs of Igbo-Ora residents about the causes of high DZ twinning rates. METHODS: Focus group discussion sessions and key informant interviews were organized among fathers and mothers of twins, those without twins, and health care providers. Key informant interviews were also held with persons considered to be custodians of culture who may have knowledge relevant to twinning such as traditional rulers, and traditional birth attendants; as well as health care providers, mothers and fathers of twins, and adult twins. RESULTS: The results showed three factors featuring as the leading perceived causes of twinning in the community. These included twinning being an act of God, hereditary, and being due to certain foods consumed in the community. Contrary to reports that the consumption of a species of yam (Dioscorea rotundata) may be responsible for the DZ twinning in this Community; yam was not prioritized by the respondents as associated with twinning. In contrast, participants repeatedly mentioned the consumption of "ilasa" a soup prepared with okra leaves (Abelmoschus esculenta) with water that is obtained from the community, and "amala" a local delicacy produced from cassava (Manihot esculenta) as the most likely dietary factors responsible for twinning in the community. CONCLUSION: Since the same foods are consumed in neighboring communities that have lower rates of twinning, we conjecture that nutritional and other environmental factors may produce epigenetic modifications that influence high DZ twinning rates in Igbo-Ora community. We conclude that more directed scientific studies based on these findings are required to further elucidate the etiology of the high rate of DZ twinning in Igbo-Ora.

Perception (of) and Willingness to Choose a Neurosurgery Career Among Final-Year Medical Students in Ibadan, Nigeria.

BACKGROUND: The deficit in access to neurosurgical care worldwide remains a challenge, particularly in the developing economies such as Nigeria, where the neurosurgeon density is low. The concern that arguably subsists in sub-Saharan Africa is the decline in the number of recruited candidates into surgical specialty training programs, including neurosurgery, despite increasing burden of surgical cases. This study assessed the perception and willingness of medical undergraduates regarding neurosurgery career and determined the factors influencing their choice. This understanding will be critical to advancing ways of motivating them toward a neurosurgery career. METHODS: A cross-sectional study was conducted among 256 consenting final-year medical students of the College of Medicine, University of Ibadan, Nigeria. Data on the perception (of) and willingness to choose neurosurgery career were obtained. Data were analyzed with descriptive statistics and χ2 test at P < 0.05. RESULTS: The mean age of respondents was 24.9 ± 1.9 years. Within the duration of their clinical trainings, almost all (96.1%) the respondents had 1-2 neurosurgical postings. Although surgery was the most preferred specialty, only 7.8% of the respondents reported a willingness to choose neurosurgery as a career. Proffered reasons for dissatisfaction with neurosurgical postings were unfriendly teaching environment (52.6%) and incessant industrial strikes, coupled with stress among trainers and residents (27.7%). More male than female students were willing to choose neurosurgery career (P = 0.027). CONCLUSIONS: Our study indicated that the proportion of final-year medical students willing to choose neurosurgery career was low and there was sex disparity in the willingness to pursue a neurosurgical career.

Knowledge of spacer device, peak flow meter and inhaler technique (MDIs) among health care providers: an evaluation of doctors and nurses.

BACKGROUND: Metered dose inhalers are cornerstone in effective management of bronchial asthma when correctly used. Most studies hitherto have focused on assessing patient's knowledge of inhaler technique. We sought to assess the knowledge of inhaler technique, spacer device and peak flow meter among doctors and nurses in a tertiary healthcare institution in Nigeria. METHOD: A cross sectional survey of nurses and doctors from emergency department, family and internal medicine; who were attending a continuous professional development lecture, was carried out. From a total of 100 questionnaires administered, we retrieved 87 of which 75 were completed, giving a response rate of 75%. It was a self-administered questionnaire. Data was analysed with SPSS version 21.0. Descriptive statistics were done. Association was examined using chi-square test. RESULT: Mean age of respondent was 35.8 years ± 8.7, 47(62.7%) were < 40 years, 33(44%) were male, nurses were 30(40.0%). Only 28(37.3%) had ever used a peak flow meter. Only 4(14.3%) used peak flow meter frequently, while 12(26.7%) checked patient's inhaler technique often. Only 9 out of the 75 (12%) participants all of who are doctors knew at least 3 essential steps of the techniques in using the metered dose inhaler correctly. None of the participants got all the steps for the use of pMDI totally correct. CONCLUSION: Knowledge regarding the use of the metered dose inhaler and spacer device was poor. Health practitioners should have constant reminders in the form of continuous medical education to update their knowledge regarding correct inhaler technique. FUNDING: self-funded.

Family functionality and parental characteristics as determinants of sexual decision-making of in-school youths in a semi-urban area of Southwest Nigeria.

BACKGROUND: Though research findings have indicated that family characteristics have a bearing on sexual behavior, there is a paucity of published literature on the role of family functionality and parental characteristics on adolescent sexual decision-making. This study was designed to assess the role of family function and parental influence on sexual behavior of in-school youths in secondary schools in a sub-urban area of Southwest Nigeria. METHODS: A descriptive cross-sectional study was conducted among secondary school students using semi-structured interviewer-assisted questionnaire. Information was obtained on the sexual behavior and parent-child characteristics. Family functionality was assessed using family APGAR standardized instrument. Association was established using χ2-test for qualitative variables and t-test for quantitative variables at p=0.05. RESULTS: Mean age of respondents was 14.8±2.2 years. Majority were from monogamous family setting (70.7%) and lived with their families (75.6%). About a quarter (26.8%) was from dysfunctional families and 9.2% had ever had sexual intercourse. Recent sexual engagement in the preceding 1 month was reported (47.4%). The mean score for parental monitoring, father-child communication, mother-child communication, and parental disapproval of sex were 10.4±2.2, 9.3±2.3, 9.8±2.4, and 10.4±2.3, respectively. There was a significant association between parental monitoring (t=3.9, p≤0.001), mother-child communication (t=3.03, p=0.003), and parental disapproval of sex (t=5, p≤0.001); and sexual experience. CONCLUSION: This study showed that parental influence had a vital role in the sexual behavior of young persons. Advocacy and health education interventions are needed among parents regarding their role in the sexual behavior of in-school youths.

Knowledge of School Health Programme among Public Primary School Teachers in Oyo State, South-West Nigeria: A Rural-Urban Comparative Study.

Teachers are in a vantage position to facilitate positive health among school-age children through the School Health Programme (SHP). Lack of basic knowledge of the programme among them will hinder its effective implementation. Studies to gauge teachers' knowledge of SHP are needed to improve the current suboptimal level of implementation in Nigeria. This study was conducted to assess and compare the knowledge of SHP among public primary school teachers in rural and urban areas of Oyo State, South-West Nigeria. A comparative cross-sectional survey was conducted among teachers in selected rural and urban public primary schools using a 2-stage cluster sampling technique. Knowledge scores were computed giving minimum and maximum obtainable scores of 0 and 33 respectively. Respondents were reported as having inadequate knowledge if aggregate score was < 16.5 and adequate if ≥16.5. Associations were tested using Chi-square and t-test for qualitative and quantitative variables respectively at p=0.05. Majority (84.6%) of the teachers had inadequate knowledge of SHP with similar proportions in the rural (84.2%) and urban (84.9%) schools. Higher proportions of those aged ≥40 years, that were ever married and had 2 qualifications and had adequate knowledge compared with their counterparts (p< (0.05). Majority of the teachers had inadequate knowledge of SHP. Further study to assess teachers' training in SHP is needed. This may inform training intervention to upgrade their knowledge of the programme in the study area.

Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria.

BACKGROUND: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. AIM: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria. SETTINGS: A low-income community in Ibadan North West Local Government Area of Oyo State. METHODS: A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. RESULTS: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. CONCLUSION: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.

Profile and correlates of functional status in elderly patients presenting at a primary care clinic in Nigeria.

BACKGROUND: Assessing the functional status of elderly patients is central in measuring their health outcome. Little is known about the functional status of elderly patients attending our primary care clinic in Nigeria. OBJECTIVE: To assess the correlates of functional status in elderly patients presenting at the General Outpatient Clinic of the University College Hospital, Ibadan, Nigeria. METHOD: A cross-sectional study of 360 randomly selected patients aged 60 years and above was undertaken to assess their functional status by scoring their basic activities of daily living (BADL) using the Modified Bathel Index. An interviewer-administered questionnaire was used to obtain the socio-demographic data, anthropometric measurements and morbidities of each patient. RESULTS: The mean age was 69.1 ± 6.6 years with a female-to-male ratio of 1.9: 1. The prevalence of overall functional disability (defined as when assistance was sought in the performance of at least one of the components of BADL) was 88.3%. The highest prevalence of functional disability was experienced in the area of personal hygiene and grooming (95.3%) and transferring from bed to chair (95.3%). Overall functional disability significantly increased with increasing age (χ2 for trend=14.004, p < 0.0001), living in a polygamous family unit (p = 0.025), and lack of formal education (p = 0.020). CONCLUSION: Functional disability was high amongst the elderly in this setting. Age, education, and living in a polygamous type of family unit had significant influence on the functional status. High premium should, therefore, be placed on considering these factors in reducing functional disability in the elderly.

Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria.

Health insurance coverage of the informal sector is a challenge in Nigeria. This study assessed the methods of payment for health care and awareness about the National Health Insurance Scheme (NHIS) among members of selected households in a rural area in the southwest of Nigeria. Using a multistage sampling technique, a semi-structured, pretested interviewer-administered questionnaire was used to collect data from 345 households. The majority of the people still pay for health care by out-of-pocket (OOP) method. Awareness about the NHIS in Nigeria was poor, but attitude to it was encouraging; and from the responses obtained, the people implied that they were willing to enroll in the scheme if the opportunity is offered. However, lack of trust in government social policies, religious belief, and poverty were some of the factors that might impede the implementation and expansion of the NHIS in the informal sector. Stakeholders should promote socioculturally appropriate awareness program about the NHIS and its benefits. Factors that might present challenges to the scheme should be adequately addressed by the government and other stakeholders associated with prepayment schemes in Nigeria.

Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria.

Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria. Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%. Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs. Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.

Knowledge of School Health Programme among Public Primary School Teachers in Oyo State, South-West Nigeria: A Rural-Urban Comparative Study.

Teachers are in a vantage position to facilitate positive health among school-age children through the School Health Programme (SHP). Lack of basic knowledge of the programme among them will hinder its effective implementation. Studies to gauge teachers' knowledge of SHP are needed to improve the current suboptimal level of implementation in Nigeria. This study was conducted to assess and compare the knowledge of SHP among public primary school teachers in rural and urban areas of Oyo State, South-West Nigeria. A comparative cross-sectional survey was conducted among teachers in selected rural and urban public primary schools using a 2-stage cluster sampling technique. Knowledge scores were computed giving minimum and maximum obtainable scores of 0 and 33 respectively. Respondents were reported as having inadequate knowledge if aggregate score "was <16.5 and adequate if ≥ 16.5. Associations were tested using Chi-square and t-test for qualitative and quantitative variables respectively at p = 0.05. Majority (84.6%) of the teachers had inadequate knowledge of SHP with similar proportions in the rural (84.2%) and urban (84.9%) schools. Higher proportions of those aged 40 years, that were ever married and had 2 qualifications had adequate knowledge compared with their counterparts (p < 0.05). Majority of the teachers had inadequate knowledge of SHP. Further study to assess teachers' training in SHP is needed. This may inform training intervention to upgrade their knowledge of the programme in the study area.