Sexual assault against women at Osogbo southwestern Nigeria.

BACKGROUND: Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available. OBJECTIVE: To review the patterns of sexual violence against women treated at the hospital over a 7-year period. MATERIALS AND METHODS: Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test. RESULTS: Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis. CONCLUSION: Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.

Practice and content of sex education among adolescents in a family setting in rural southwest Nigeria.

A descriptive cross-sectional study to assess adolescents' view of the practice and content of sex education within the family setting in a rural Nigerian community and explore whether there is any association between parental communication on sex and adolescents' sexual debut and habits. Simple random sampling was utilized, while a semi-structured questionnaire was used to collect data from 350 respondents. Data analysis was by the Statistical Package for Social Sciences (SPSS version 11). Majority of the respondents (48.8%) were late adolescents, 291 (85.1%) had had sex education, most (45.7%) of whom were exposed between ages 10 and 14 years. The main content of parental sex education was HIV/AIDS prevention (51.9%), avoidance of pregnancy (40.9%), abstinence (38.1%), and basic information about reproduction and biology (35.4%). Poor attitude to parental communication on sex was associated with a higher likelihood of pre-marital sex (p = 0.001). Curiosity was the most common major reason for sexual debut. This emphasizes the importance of early sex education within the family setting and its possible impact in delaying sexual initiation. Promotion of parent-child communication about sexual issues is vital in order to improve the reproductive health of the adolescents in this environment. Community-based health education intervention programs for parents are recommended.

Treatment outcomes among human immunodeficiency virus and tuberculosis co-infected pregnant women in resource poor settings of South-Western Nigeria

The complex interactions between Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) infections may be magnified, in the presence of another potentially stressful condition like pregnancy. Though co-infection among pregnant women is rare, treatment outcomes may depend on accessibility to comprehensive treatment modalities. The objective of this study is to determine treatment outcomes among pregnant HIV and TB co-infected pregnant women in Lagos, South-western Nigeria. This retrospective, analytical study was carried out among ninety four (94) eligible pregnant women co-infected with HIV and TB at selected health-care facilities in Lagos state between January, 2008 and December, 2009. A standard checklist for data collection was used and analysis was carried out using the EPI info software. Mean age of respondents was 30.8 (±3.9) years. Sixteen (17.1%) TB cases were clinically diagnosed for tuberculosis. Among tuberculosis cases identified through sputum microscopy, 60(63.8%) were acid fast bacilli (AFB) positive and 21(22.3%) were identified in the first trimester. The mean percentage adherence to anti-retroviral drugs was 95.9% (±5.3). None of the participant smoked cigarette. Seventy three {73 (77.7%)} had contact with TB infected or suspected person in the last three months. Treatment outcome in mother showed that 74(78.7%) were cured, 8(8.5%) relapsed while 12 (12.8%) had treatment failures. Among the babies, 83(88.3%) were born alive. Women with both poor adherence (<90%) and with positive TB contact, but neither factor alone, were half-fold less likely to be cured compared with women with both good adherence (>95%) and no TB contact (OR=0.59, CI=0.45-0.95 and p=0.014). Cure rate was substantially lower in this study. This calls for extra strategies such as routine TB screening in antenatal clinics, strict adherence to national guidelines in the treatment of HIV/TB co-infections, focused antenatal care and comprehensive Prevention of Mother to Child Transmission (PMTCT) care and treatment

Neonatal mortality and perinatal risk factors in rural south western Nigeria: a community-based prospective study

BACKGROUND: Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may haveoccurred with recent interventions. OBJECTIVE: To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS: In a community-based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS: There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (N=32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis/fever and maternal deaths/failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW {RR=4.7 (1.7-13.1) p=0.03},delivery outside a health facility {RR=3.6 (1.001-13.2) p=0.05},lack of attendant at delivery {RR=5.01 (1.3­19.1) p=0.018} and Traditional Birth Attendant (TBA) delivering the baby {RR=2.7 (1.1­6.4) p=0.03). Effect of sex of the neonate, mother and fathers' ages were not significant at the 5% level in the model. CONCLUSION: Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having noone in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer. Obstetric and public health services have to be available and made more accessible at the grass root level

Subjective assessment of childhood fever by mothers utilizing primary health care facilities in Osogbo, Osun State, Nigeria.

OBJECTIVE: To assess the accuracy of tactile examination by mothers as a method of fever determination in their children and thus determine the reliability of mothers' history about the presence or absence of fever in their children. METHODOLOGY: A descriptive cross-sectional study conducted in four health centers randomly selected in Osogbo metropolis. Three hundred mothers were studied, a semi-structured questionnaire was utilized. RESULTS: The study found the sensitivity and specificity of tactile examination for mothers as a means of detecting fever in their children to be 82.3% and 54.1% respectively. Mother's socio-demographic characteristics and the age of child did not affect mother's subjective assessment of childhood fever (p>0.05). CONCLUSION: Mothers are able to provide accurate information about the presence or absence of fever in their children by palpation without the use of a thermometer. Tactile examination was found to be adequate for mothers as a means of detecting fever in their children. Physicians should accept as reliable mothers' history of fever and give prompt management.

Knowledge, attitudes to HIV/AIDS and sexual behaviour of students in a tertiary institution in south-western Nigeria.

OBJECTIVE: To determine the knowledge, attitude and sexual behaviour of students in a tertiary institution in south western Nigeria with regard to HIV/AIDS. METHODS: Descriptive cross-sectional survey conducted between January and March 2005. Information was collected from 368 students of a tertiary institution in Ede, Osun State, Nigeria. Participants were selected by a multi-stage sampling method and data obtained using a semi-structured pre-tested questionnaire. RESULTS: Most (89.4%) respondents were aware of the existence of HIV/AIDS, and knew the aetiology, routes of transmission, signs and symptoms, and preventive measures against the disease. While a little over half (59.8%) of the respondents revealed that they could hug people with HIV/AIDS, one out of four (27.2%) stated that these persons should be isolated from the community. Less than a quarter (22.3%) of the respondents believed that they were vulnerable to HIV/AIDS. More than half (58.2%) had ever had sex; the mean age at their first sexual exposure (for all respondents) was 16.7 +/- 4.4 years. Almost half (48.2%) of the 191 currently sexually active respondents had multiple sexual partners. Of the sexually active respondents, 75.9% claimed to have ever used condoms; among these, male respondents were more likely to have ever used condoms than their female counterparts (p < 0.05). CONCLUSION: The study revealed a gap in the knowledge of HIV/AIDS and an inappropriate sexual behaviour among respondents. Meaningful strategies, such as an innovative and culturally sensitive adolescent sexual and reproductive health programme that focuses on modification of sexual behaviour should be adopted to allow young people to prevent transmission of the HIV/AIDS virus.

Sociodemographic characteristics and health risk behaviours among students of a tertiary institution in south western Nigeria.

The identification of early risk factors among undergraduate students that impact on health, both mental and physical is a primary focus of this survey. This is more so since people suffering from an illness may not be currently engaging in any health risk behaviours but might have engaged in such behaviours before they developed the illness condition. Therefore the identification of health risk behaviours among this group of people would permit a better understanding of localized patterns of health risk behaviours as well as help to target intervention activities towards this particular group of people.The study is based upon data obtained from a cross-sectional survey of students in a tertiary institution in South Western Nigeria. Participants voluntarily and anonymously completed a baseline semistructured questionnaire which elicited information on demographic information, sexual behaviours and substance use among others. Of the 368 respondents, majority 225 (60.9%) are in the age group of 20-24 years. A total of 152 (41.3%) are either currently or have previously indulged in heavy drinking of alcohol and a statistically significant association (p<0.05) was found between the use of alcohol and having multiple sexual partners and use of commercial sex workers. Ninety-four (25.5%) and 52 (14.1%) are currently smoking or have smoked cigarette and marijuana before respectively; while 56 (15.2%) are currently using or have before used narcotic drugs. The relationship between hard drug use and non use of condom was statistically significant (p<0.05). Ninety-two (25.0%) have more than one sexual partners at the same given period; the male respondents indulged more in having multiple partners than the female and the result was statistically significant (p<0.05). As many as 155 (47.8%) of the 324 (88.0% of the respondents) sexually active respondents had never used condom during sexual intercourse. Also 88 (27.1%) of this group of the respondents have had sexual relationship with commercial sex workers (CSW) at one time or the other. Condom use was low among the sexually active respondents. Only 29.3% of the respondents always use condom when having any sexual relationship. This study has shown that students in this survey indulge in health risk behaviours such as "unsafe sexual practices", alcohol, cigarette smoking and other substance use. The males are more involved in having multiplicity of sexual partners than their female counterpart. The study also revealed a significant association between the use of alcohol and in having multiple sexual partners. Comprehensive health education and intervention programs are needed to influence positive behavioural change among this group of students and this will require working in partnership with schools authorities and other local community groups.

Knowledge, attitudes and practices of the educated and non-educated women to cancer of the breast in semi-urban and rural areas of SouthWest, Nigeria.

OBJECTIVES: That women with cancer of the breast seek medical help late is a common occurrence in developing countries. We decided to see if education and environment play any role in this and in cancer screening. A semi-structured questionnaire was drawn to inquire about knowledge, attitude (beliefs) and practices of women to breast cancer and available cancer screening methods in their environment- particularly Self and Clinical Breast Examination. PATIENTS AND METHODS: The questionnaires, prepared in English and vernacular, were given to women and women relations seen in the surgical clinics and wards of Ladoke Akintola University Teaching Hospital, Osogbo and some primary health centers, for various ailments. Traders in market places and rural communities were included. RESULTS: Analysis was by SPSS, chi-square, percentage frequency and tested at probability level of 0.05. Eight hundred and thirty two respondents were collected. Six hundred and twenty five (72.2%) were from Semi-urban while 207(27.8%) were from the rural regions. The age range was between 15 and 72 years with a mean age of 30.89+/-11.58. The educational level showed that 304(36.4%) had tertiary education. Six hundred and four (72.6%) have previous knowledge of cancer of the breast, 149(17.4%) offered possible aetiological reasons, and 341(41.1%) have some knowledge of associated symptoms. Available screening methods of Self and Clinical breast examination was practised by 393(47.2%) of the respondents. One hundred and fifty five (32.3%) would give consent to mastectomy while as many as 619(74.4%) have deep fear of the disease. CONCLUSION: Despite a relatively high literate level in the study group, knowledge of aetiological causes of breast cancer, including risk factors is abysmally low; so is knowledge and attitude to symptoms. Because of this poor/inadequate knowledge, as well as available screening methods, efforts should be made to upgrade the knowledge of our women through Information, Education and Communication (I.E.C) on cancer of the Breast and the consequences of late presentation.

Knowledge, beliefs, and attitudes to female genital mutilation (FGM) in Shao community of Kwara State, Nigeria.

To determine the level of knowledge, belief, and assess the attitude to female genital mutilation (FGM) and its complications in Shao community, Nigeria, a cross-sectional descriptive study with a health education intervention was used. A majority of respondents (99.5%) understood female circumcision to mean cutting off parts of the female genitals. There was a high level of knowledge regarding most of the complications of FGM as more than 50% of respondents knew at least four complications of FGM. Awareness of the global anti-FGM campaign was also high (78.8%). The most common reasons proffered for the practice of FGM were based on tradition or religion. Paternal grandfathers (50.0%) and fathers (21.0%) were cited as decision makers in the family most often responsible for requesting FGM. Post-intervention results showed that there was a statistically significant increase in the proportion of respondents who know more complications of FGM and who have no intention of circumcising future female children. Despite a high level of knowledge regarding the complications of FGM and a high level of awareness of the global campaign against it, there still exists a high prevalence of practice of FGM in this community. FGM remains a pressing human rights and public health issue. It is our recommendation that this health education intervention strategy be replicated nationwide especially using mass media.

HIV as an additional risk factors for anaemia in pregnancy: evidence from primary care level in Ibadan, Southwestern Nigeria.

Anaemia in pregnancy has serious consequences including maternal morbidity and impairment of infant cognitive development. Several authors have however reported inconsistent findings on risk factors for anaemia in pregnancy. This study was carried out to determine risk factors for anaemia in pregnancy among women at primary care level and document the contribution of HIV/AIDS to anaemia in pregnancy in low risk pregnant women at primary care level. A prospective study carried out among pregnant women attending the booking clinics of primary health care centres in Ibadan, Nigeria. HIV positive and HIV negative mothers were followed throughout pregnancy till delivery of their babies. History of use of iron, folate, Vitamin B complex and daraprim were obtained. Haemoglobin, malaria parasitaemia, and HIV serostatus were determined. Use of iron (P < 0.006), folate (P = 0.032), vitamin B complex (P = 0.001) and treatment for malaria (P = 0.05) significantly reduced the risk for anaemia in pregnancy. Malaria parasitaemia (P = 0.0001) significantly increased the risk of anaemia. However, use of daraprim and HIV seropositivity increased the risk of anaemia in pregnancy but not significantly. In a logistic regression analysis, iron (P = 0.001) and folate supplementation (P = 0.015) significantly protected against anaemia in pregnancy while malaria parasitaemia (P = 0.006) and HIV seropositivity (P = 0.015) were significant adverse risk factors. HIV is an additional risk factor for anaemia in pregnancy. Voluntary counseling and testing of pregnant women for HIV is therefore also indicated at primary care level to detect asymptomatic anaemia in pregnancy that may be due to HIV.

Prevalence of scoliosis in secondary school children in Osogbo, Osun State, Nigeria.

In order to determine the prevalence and distribution of various parameters associated with scoliosis in school children in Osogbo, Osun State, Nigeria, a two-year prospective study was carried out. The study was carried out in selected secondary schools in Osogbo township, Osun state, Nigeria. A team consisting of one consultant orthopeadic surgeon, one consultant epidemiologist, community health consultant, two laboratory scientists and one clerk performed the school screening. Simple random sampling was used to select the study population. Informed consent was obtained from the school principals, the students, and the parents of the students. A total of 410 children 190(46.3%) males and 220(53.7%) females aged 9-14 years old were screened. Thirty (7.31%) children had signs of scoliosis but only five (1.21%) had radiological evidence of scoliosis. Prevalence of scoliosis in the study group was 1.2%. A sensitive test for detection of scoliosis was forward bending test. Thoracic curve was most common. Cost of screening was affordable. School screening is simple, and cost effective. This study found that scoliosis is not common in school children in Osogbo, Osun state, Nigeria and therefore does not pose as a major public health problem. However, all the children who had radiological evidence of scoliosis were not aware of this prior to the screening exercise. Early detection has implication for choice of management--an advantage of the screening programme.

Risk factors associated with neonatal tetanus in Ibadan, Nigeria--a revisit.

To identify major risk factors associated with recent occurrence of neonatal tetanus (NNT) in Ibadan Nigeria, 140 cases matched 1:1 with controls were recruited into the study from the major referral hospitals. Maternal age (<20 years), low paternal education, low socio-economic status, primiparity and delivery outside health facilities were associated with significantly increased risk for NNT. Lack of trained attendant at delivery, the type of instrument used to cut the cord and the presence of livestock within the family compound also significantly increased the risk for NNT. Antenatal clinic (ANC) was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunization. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunization. Data also suggest that the main reason for failure to receive full immunization was ignorance on the mothers' part, which reflects inadequate health education by the health system. The study case fatality rate was 79.4 percent. Risk factors observed in this population are generally known, indicating that the problem has not yet received adequate attention. Effort needs to be made towards providing the masses with formal education as well as health education, targeting the population at grass root level. Improving access to antenatal care services as well as improving the quality of these services; outreach efforts on immunization would contribute in no small measure to reducing the incidence of neonatal tetanus in this community.