Empowering traditional birth attendants as agents of maternal and neonatal immunization uptake in Nigeria: a repeated measures design.

BACKGROUND: Adequate immunization coverage in rural communities remain a challenge in Nigeria. Traditional birth attendants (TBAs) form an integral part of the social, cultural and religious fabric in most rural communities in Nigeria. Despite their limitations in handling the complications of childbirth, TBAs are widely accepted and patronized, especially in rural areas. The objectives of the project were to empower TBAs and assess the use of a culturally adapted audio-visual workshop intervention to change their knowledge, attitude and willingness to promote immunization uptake. METHODS: A repeated-measures design that used a convenience sampling technique to select 90 TBAs from the three geopolitical zones of Imo State, Nigeria. The TBAs were engaged through a culturally adapted audio-visual workshop. Data were collected before and immediately after intervention using a pretested questionnaire. Chi square test was done to determine any significant association with the zone of practice and paired sample t-test analysis to determine any significant pre and post intervention change. Level of significance was set at p ≤ ·05. RESULTS: More than half of the TBAs had at most, a secondary level of education (54·4%). The average length of time they practiced as TBAs was 16 years with an average of ten birth deliveries per month. After the intervention, all the respondents (100%) reported a willingness to always promote immunization uptake and also, there was a statistically significant increase in Knowledge (p < ·000). Similarly, the level of knowledge in the post intervention period appeared to be significantly associated with the zone of practice (p = ·027). CONCLUSION: The workshop intervention empowered the TBAs irrespective of their zones of residence by successfully improving their knowledge, though at varying levels; and consequently, their willingness to always promote immunization uptake.

Clinical implication of smoking among patients with schizophrenia at a Tertiary Institution in South East Nigeria.

BACKGROUND: The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Smoking in schizophrenia appears to be associated with increased psychopathology and disability. OBJECTIVE: The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability and psychopathology. MATERIALS AND METHODS: This was a cross-sectional descriptive study in which 367 out-patients with International Classification of Diseases (ICD) 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination (PSE) 10, Positive And Negative Syndrome Scale (PANSS) and World Health Organization Disability Assessment Schedule (WHODAS) were administered. Data was analyzed using a software package SPSS version 15. RESULTS: There was no significant difference in the mean PANSS scores of smokers and non-smokers. Current smoking was associated with increased disability (F=5.39, p=0.02). Total PANSS score significantly predicted disability F(3,71=5.60, p=0.002, R2=0.19). There was no significant association between positive or negative symptoms and being a smoker or non-smoker. CONCLUSION: The results of this study revealed that smoking in Nigerian schizophrenia patients is associated with significant disability. Measures should be put in place to discourage cigarette smoking among Nigerian patients with schizophrenia.

Awareness, gender variations, consequences of sexual risk behavior and adopted solutions among senior secondary schools adolescents in Owerri, Nigeria

In our area, there is dearth of accurate sex education that could equip adolescents in making informed decisions on sexual issues. This scenario has been linked to a high prevalence of sexual risk behaviors, consequences and poor choices with regard to solutions. Objective: To determine the awareness, gender variations, consequences of sexual risk behavior, and adopted solutions among senior secondary school adolescents in Owerri, Nigeria. Methodology: This was a cross sectional survey of 384 in-school adolescents in Owerri, Nigeria, selected using a multistage sampling technique. Data were collected using pretested self-administered semi- structured questionnaires. Data were analyzed using SPSS v.22 (p<0.05). Results: The majority of adolescents, i.e. 306 (82.5%), were aware of sexual risk behaviors, 340 (91.6%) had received some sex education, and 296 (79.8%) were aware of contraceptives. Key sources of information on sexuality were schools and parents. In total, 54 (14.1%) participants were sexually active, 12 (22.2%) reported ever having an STI, and 9 (75%) had been treated in hospital. Also, 8 (14.8%) of the 54 had dealt with a pregnancy; 7 (87.5%) had undergone an abortion, 3 (42.9%) in a hospital. Sexual risk behaviors among males were associated with age (p=0.002), school type (p=0.002), and alcohol intake (p=0.000), while the residence of the parents had a stronger influence among females (p=0.014). Conclusions: This study found high awareness of sexual issues, mainly sourced from schools and parents. Associations were made between sexual risk behaviors and gender differences (age, school type, and alcohol intake in males, parental residence among females). The consequences of sexual risk behaviors were early pregnancy and STIs, with poor solutions adopted.

Availability and Continuity of Care for Maternal Health Services in the Primary Health Centres in Nnewi, Nigeria (January - March 2010).

BACKGROUND: In some primary health care settings, even where the health services are not available, provisions are not made to ensure continuity of care. This study aimed to determine the availability and level of continuity of care for maternal health services in the primary health centers (PHCs) in Nnewi, Nigeria. METHODS: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from four randomly selected public PHCs in Nnewi, Nigeria were chosen for the study. Data collection employed a mix of quantitative and qualitative methods. RESULTS: The mean ± standard deviation for age of the respondents was 29.2 ± 5.9 years. The facilities studied provided out-patient services, but the only in-patient services provided was for women who delivered or those in labor. None of the facilities is equipped to provide even basic essential obstetric care services. None had standardized a protocol for referring clients, referral forms, a transport system, or a community loan scheme in place. Forty-four (15.7%) women were referred for care outside of the PHCs for the following reasons: Lack of drugs and supplies (9.1%); lack of equipment (90.9%), lack of skilled personnel (45.5%) among others. CONCLUSIONS: This study showed that despite the unavailability of some services, appropriate strategies were not in place to ensure the coherent pattern of services within and between the PHCs and other levels of care. Delivery to the clients of comprehensive and integrated maternal health services, and efficient referral systems are thus recommended.

Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria.

OBJECTIVE: Knowing tuberculosis (TB) patients' satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients' satisfaction with TB services in southern Nigeria. MATERIALS AND METHODS: A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. RESULTS: Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. CONCLUSION: Patient- and health system-related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing.

Patterns of Utilization of Orthodox and/or Traditional Healthcare Services among Pregnant Women and Mothers of Under-Five Children in a Rural community: Case Study of Njaba; Imo State; Nigeria

Background: It has been stated that poor utilization of quality reproductive health service continues to contribute to maternal morbidity and mortality in Nigeria. Objective: The objective was to investigate the pattern of orthodox and/or traditional healthcare utilization among pregnant women and mothers of under.five children in Njaba and associated factors. Materials and Methods: A. cross.sectional survey of 422 women using multi.stage sampling; data collection instrument was a semi.structured interviewer.administered questionnaire. Data were analyzed with SPSS. (16.0) and Mathcad 7 professional. Frequency distributions and percentages were tabulated; Z.test was applied as a test of significance; and confidence intervals. (CIs) calculated. P 0.05 was considered significant. Results: Ante.natal choice of care for 83.65 of them was orthodox healthcare; while 11.37 used traditional healthcare. Experienced/trained staff. (Z-score