Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. MATERIALS AND METHODS: A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. RESULTS: There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. CONCLUSION: The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Tetrapleura tetraptera: molluscicidal activity and chemical constituents.

Tetrapleura tetraptera (Schumach. And Thonn) Taub, Mimosaceae, commonly known as Aridan (fruit), A single stemmed, robust, perennial tree of about 30 m. It has a grey/brown, smooth/rough bark with glabrous yound branchlets. The flower is yellow/pink and racemes white the fruit has dark brown, four winged pods 12-25 x 3.5-6.5 cm. It is generally found in the lowland forest of tropical Africa. The fruit consists of a fleshy pulp with small, brownish-black seeds. The fruit possesses a fragrant, characteristically pungent aromatic odour, which is attributed to its insect repellent property. It is used as spices and aroma (exotic tropical scents) and fish poisoning. It is one of the molluscicidal medicinal plants of Nigeria, also useful in the management of convulsions, leprosy, inflammation and/or rheumatoid pains. The documented biological and-or pharmacological activities are found to be molluscicidal, cardio-vascular, neuromuscular, hypotensive, anti-convulsant, trypanocidal, hirudinicidal, schistosomiasis control, anti-ulcerative, ectoxicity, anti-inflammatory, hypoglycaemic, anti-microbial, emulsifying property, birth control, food value and the control of intestinal parasites. Activity-guided fractionation of the methanol extract of the fruits of T. tetraptera led to the isolation of a saponin glycoside with an oleanolic acid aglycone, a monodesmosidic diglycoside of the rare sapogenin 27-hydroxyolean-12 (13)-en-28-oic acid; echinocystic acid-3-0-sodium sulfate from the stembark, umbelliferone and ferulic acid from the leaves and branches respectively. Also isolated from the fruits were aridanin and three of its olean-12-en-28-oic acid derivatives. All the compounds isolated either from the fruits or other parts were found to exhibit strong molluscicidal properties against the schistosomiasis-transmitting snails Biomphalaria glabrata.

Consistency in condom use in the context of HIV/AIDS in Zimbabwe.

Against the backdrop of a high prevalence of the human immunodeficiency virus infection in Zimbabwe, this paper analyses data from the 1997 Zimbabwe Sexual Behaviour and Condom Use Survey to throw light on the degree to which sexually active adults consistently use condoms in high-risk sexual situations. The multivariate results indicate that at the time of the survey, consistent condom use in non-marital relationships is significantly higher for males than females, higher among those who had access to information about condoms from multiple sources than among those with limited access, and higher among those who have positive attitudes to condoms than among those with negative attitudes. Even though consistent condom use with non-marital partners is higher for those who know a source where condoms can be obtained, this effect is due to the fact that these respondents have more positive attitudes towards condoms. Likewise, the higher levels of consistent condom use exhibited by those who are aware of the efficacy of condoms are due to the fact that men have higher awareness of this, and men use condoms more consistently than women. In sum, the results suggest that the effects of the respondents' sex and their knowledge of the prophylactic importance of condoms and where condoms might be obtained are a function of other socioeconomic advantages they have. It is, therefore, concluded that programmes that use mass media information, education and communication campaigns to reduce shyness, embarrassment and stigma about condom use can help increase consistent use of condoms in non-marital relationships in Zimbabwe.

HIV/AIDS and young age widowhood in sub-Saharan Africa.

This article investigates a probable hidden consequence of high rates of HIV infection and AIDS deaths-an apparently rising proportion of women aged below 50 years who are widowed. It is assumed that young widows who remain unmarried and are sexually active may widely disseminate HIV infection if they are seropositive and do not use condoms. Data from eight nationally representative social surveys in sub-Saharan Africa are analyzed. Four of the surveys are from countries with high HIV prevalence rates (about 10% of adults are HIV positive) and the other four surveys are from countries with relatively low prevalence rates (about 2% of adults are HIV positive). The proportion of young widows in six countries with relevant data are calculated and compared over time. The results show that the proportion of young widows is higher in countries with high HIV prevalence rates than in countries with low prevalence rates. Moreover, while the proportion of young widows decreased in countries with low HIV prevalence rates, the proportion increased in high-prevalence countries. The implications of these results for research policy in Sub-Saharan Africa are discussed.

Trends in under-5 mortality rates and the HIV/AIDS epidemic.

INTRODUCTION: The prevalence of human immunodeficiency virus (HIV) among adults and mortality rates among under-5-year-olds have increased or stagnated in many countries. The objective of this study was to investigate whether there is a link between under-5 mortality trends and the prevalence of HIV among adults and, if so, to assess the magnitude of the effect of adult HIV prevalence on under-5 mortality rates. METHOD: Data from Demographic and Health Surveys were used to establish the trends in under-5 mortality rates for 25 countries for which there are data for at least two points in time. Countries were ranked according to the most recent adult HIV prevalence data and grouped in three categories: those with very high HIV prevalence (> or = 5%); those with moderately high prevalence (1-4.9%); and those with low prevalence (< 1%). A mathematical model was fitted to obtain an estimate of the contribution of HIV/AIDS to the level of under-5 mortality in each country. RESULTS: Under-5 mortality rates showed an increase in most countries with high adult HIV prevalence, but a decrease in almost every country with moderately high or low prevalence. The estimated contribution of adult HIV prevalence to the observed level of under-5 mortality was highest (up to 61%) in Zimbabwe (where HIV prevalence was highest) and tended to decrease with the level of HIV prevalence. DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe.

Preserving the pot and water: a traditional concept of reproductive health in a Yoruba community, Nigeria.

Within the background of the outcome of the 1994 Cairo Conference, this paper describes a traditional conceptualization of prenatal care in a Nigerian community and draws their implication for effective delivery of reproductive health services in the area. The data used were from qualitative interviews during 2 field trips to the community in 1988-89 and 1991. The finding of the study highlights a local metaphor that likened the risks of pregnancy and child birth to a group of women that trekked to a local brook to fetch water with their earthen pots: some fell, broke their pots; some missed steps and spilt their water but kept their pots, and others returned without any mishap. The first group represented cases of maternal mortality; the second group were cases of miscarriage, still-births or infant deaths, and the third group represented successful outcomes for both pregnancy and the resultant baby. Various steps that were traditionally taken to ensure that the mother neither lost her pot nor spilled her water are described. The implications of these findings for policy and research are discussed in the paper.

Infant mortality levels in Africa: does method of estimation matter?

"Using data from 13 Demographic and Health Surveys in Africa, this paper compares estimates of infant mortality directly calculated from data with those indirectly calculated using the Trussell (1975) and Feeney (1980) techniques. The results indicate that, on average, the directly calculated infant mortality rates were significantly lower than those estimated from indirect methods. Data errors alone can not plausibly explain such differences. Such series could in fact show increases or decreases in infant mortality rates that would result mainly from differences in methods of calculation." (SUMMARY IN ITA AND FRE)

Infant mortality and mother's education in Ondo State, Nigeria.

A bivariate analysis of infant mortality in the 1986/87 Ondo State Demographic and Health Survey data indicates that children of secondary school graduates experienced a higher rate of infant mortality than children of less educated mothers. Although this pattern has also been shown in a few other Demographic and Health Surveys, this paper explores the Ondo State data to explain why infant mortality showed such a counterintuitive pattern in relation to maternal education. This search for an explanation of the pattern started with an examination of the data for errors and then proceeded to examine the importance of some intermediate mechanisms that had been suggested for the education-child survival relationship. The results suggested that data errors, use of health services and quality of maternal care were not enough to explain the relationship. Rather, results of a logistic regression analysis showed that breastfeeding duration and maternal age at childbirth were statistically the most significant variables for predicting infant survival in Ondo State. The inverse relationship between mother's education and infant mortality rates that was not shown by bivariate analysis came out clearly only after controlling for the effect of breastfeeding duration. The linkage between these findings and broader social and economic realities of Nigeria was provided through reviews of available information. The conclusion from the study was that, although breastfeeding and maternal age showed up as the most statistically significant variables, they apparently are just the variables that effectively captured the effects of the harsh economic conditions, especially among secondary school graduates, that prevent most young mothers from translating their child-rearing ideals into reality.

Infant mortality in Nigeria: effects of place of birth, mother's education and region of residence.

This paper examines the effects of a child's place of birth, mother's education, region of residence and rural and urban residence on infant mortality in Nigeria between 1965 and 1979, using data from the 1981/82 Nigeria Fertility Survey. Infant mortality rates declined in all regions between 1965 and 1979. Children born in modern health facilities, irrespective of their mothers' place of residence, experienced significantly lower rates of infant mortality than those born elsewhere. Logistic regression analysis showed that all other variables tested were also significant, although some to a lesser degree. Efforts to reduce infant mortality in Nigeria should include policies that rectify rural and urban differentials in the distribution of health facilities and encourage their use.

PIP: Infant mortality in Nigeria has varied with region of residence. Logistic models were used to examine the factors related to infant mortality in Nigeria. Data was obtained from the 1981/82 World Fertility Survey for Nigeria. Place of delivery, modern or traditional, was used to measure extent of use of health services. The assumption was that infant mortality would be higher for babies not delivered in a modern health care center. Anomalies in the data were the low infant mortality rate among home deliveries in the southwest between 1965 and 1969 and the lack of mortality differentials among hospital deliveries during the 1970s. The proportions of home and hospital deliveries between the study period of 1965 and 1979 was stable. Analysis of three periods, 1965-69, 1970-74, and 1975-79, showed that there was slight improvement in mortality risks among children born in hospitals, except those born in hospitals in the northwest. There was also a slight decline in risk for home births in the south. The logistic analysis suggested that infant and child mortality rates tended to be significantly higher for children of mothers who did not use modern health facilities for delivery. All variables were significantly associated with infant mortality: region, period, rural-urban residence, place of delivery, and mother's education. Each variable was reduced in level of significance with the control for the other variables. Infant mortality risks were lowest in the 1975-79 period. Risks were highest in rural areas and among home births. There was an inverse relationship with maternal education, except for infant mortality among women with incomplete or primary or Koranic education, which was higher than among women with no education. The odds ratios did not change much when place of delivery was controlled. The odds ratio of infant mortality was lowest in the southwest, with controls for maternal education. The implication was that better distribution of health facilities in rural areas was needed in order to influence a decline in infant mortality.

Use of alternative medicine by patients with epilepsy: a survey of 265 epileptic patients in a developing country.

We evaluated the use of alternative treatment methods, in various forms, by epileptic patients who had used these forms of treatment before seeking hospital treatment. Among the 265 epileptic patients, 47.6% used African traditional medicine alone: 24.1% combined traditional medicine with spiritual healing, 20.4% used spiritual healing alone, and 7.5% used other forms of alternative medicine. Patients used the alternative treatments for < 1 year to > 5 years before seeking hospital treatment, presumably when alternative medicine failed to control seizures. Relatives, friends, and neighbors had marked influence on the health-seeking behavior of these epileptic patients: 86% of them were influenced to use alternative medicine. After initiation of hospital treatment, only 14.6% of patients who had earlier used African traditional medicine continued with such treatment; more than two thirds of the patients who had earlier used spiritual healing continued using such treatment, suggesting that many of these patients perceived some continuing benefits from these alternative treatments. This observation suggests that alternative medicine, especially spiritual healing, cannot be considered irrelevant in management of epilepsy in Africa. Further investigations are required to determine the efficacy, supportive role, and limitation of alternative medicine in management of epilepsy in developing countries.

Church-based obstetric care in a Yoruba community, Nigeria.

The analysis of data from available delivery registers in a Yoruba community, Nigeria suggests that about a half of recorded births between 1983 and 1990 were delivered in 'faith clinics' and not in a maternity centre. This paper reports on the mode of operation of these faith clinics in the town. It was observed that the faith clinics were under the control of mission-trained midwives all of whom claimed divine call as the reason for taking up the job. The midwives also listed prayer, fasting and guidance from the Holy Spirit as their main tools of trade. They offered no medicine to their clients and would not recommend any other treatment for them. Pregnant women that come for prenatal care are required to attend weekly prayer meetings for expectant mothers, take weekly baths in a particular river and maintain inward and outward cleanliness in their behaviour. The reasons for the relative success of these midwives in the town are discussed using a combination of economic, symbolic interactionist and pragmatic approaches. Recommendations on how best to tap their resourcefulness for a more effective health services delivery in the area include making them educators on and communicators of modern preventive health.

Lead and other metals distribution in local cooking salt from the Fofi salt- spring in Akwana, Middle Benue Trough, Nigeria.

Energy Dispersive X-ray Fluorescence (EDXRF) technique has been used to determine the concentrations of lead(Pb) and other heavy metals in local cooking salts (LCS) from Akwana village, Middle Benue Trough, Nigeria. The comparison of the distribution of these metals in LCS, 'fake' salt (FS) and the usual common salts (CS) are given. Lead was found to be enriched in LCS by factor exceeding 200 times compared to the other salts. The origin of Pb contamination in the LCS is examined and its effects on the inhabitants of the village are considered.

Response of parents to five killer diseases among children in a Yoruba community, Nigeria.

This paper examines the various ways through which adults' health beliefs and attitudes affect their responses to five major killer diseases during childhood. The data for the study were derived from in-depth interviews conducted between December 1988 and January 1989 in a Yoruba community, Nigeria. The diseases covered in the study include diarrhoea, measles, tetanus, pertussis and fever. It was observed that teething and food related causes were believed to be responsible for diarrhoea; the cause of measles and pertussis was generally unknown; tetanus was usually associated with convulsions; and fever was believed to be caused by roaming in the sun and by constipation. Herbal tea, modern drugs and prayers were the most commonly prescribed treatments for these diseases. It was observed that most mothers used alternative sources of health care, rather than hospitals, clinics and maternity centres, in their treatment of diseases among children. Prominent among the alternative sources were patent medicine stores where there were personalistic social interaction between clients and operators, free consultancy and flexible pricing. Parents' location at the time of a child's sickness, access to good advisers, the perceived seriousness of the sickness and religious beliefs of mothers were important determinants of their response. Avoidance of blame was noted to be a major motivating force in parents' search for potential sources of health care. The paper concludes that although some of the practices might have negative health implications, they could be usefully adapted to the goal of self-reliance in medical care as a strategy for attaining health for all by the year 2000.