Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria.

BACKGROUND: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications. OBJECTIVE: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos. METHODOLOGY: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. RESULTS: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10-19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities. CONCLUSIONS: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.

Evaluation of hormonal changes in menstrual cycle of women infected with pulmonary tuberculosis in Nnewi, south eastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was designed to evaluate the hormonal changes in menstrual cycle of premenopausal women infected with pulmonary tuberculosis in Nnamdi Azikiwe University Teaching Hospital Nnewi. MATERIAL AND METHODS: A prospective study involving sixty-seven (67) female participants within the child-bearing age were randomly recruited and grouped based on their tuberculosis status as: Symptomatic TB infected females (n=20), Symptomatic TB infected females on ATT (n=20) and Control females (n=27). After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples collected from the participants were used for hormonal assay using immunoenzymometric method. RESULTS: The results showed that the serum levels of FSH and LH (IU/ml) were significantly higher while progesterone and estradiol were significantly lower in Symptomatic TB females compared to Symptomatic TB females on ATT at follicular and luteal phases of menstrual cycle (P<0.05). The serum levels of FSH and LH were significantly reduced in Symptomatic TB females on ATT while progesterone and estradiol were significantly increased at follicular and luteal phases of menstrual cycle (P<0.05). FSH was significantly higher at follicular phase while estradiol was significantly higher at luteal phase of menstrual cycle in Symptomatic TB females on ATT. CONCLUSION: Tuberculosis induced hypogonadism in affected women which seemed to be reversed on treatment. Routine investigation for Tuberculosis should be done for women presenting with infertility, since early treatment can reverse the abnormality.

Experiences from polio supplementary immunization activities in Anambra State, Nigeria.

BACKGROUND: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio-free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization. MATERIALS AND METHODS: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions. RESULTS: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State's cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero-dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV 3 ) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV 3 target. CONCLUSION: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.

Clients' knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria.

BACKGROUND: Clients' knowledge, perception of and satisfaction with the quality of maternal health services (QMHS) enables maternal health programs to assess the impact of their services from the clients' perspective. OBJECTIVE: The objective of this study is to assess the knowledge, perception of and clients' satisfaction with the QMHS at the primary health care (PHC) level in Nnewi, Nigeria. MATERIALS AND METHODS: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from randomly selected PHC facilities in Nnewi, Nigeria were selected for the study. Data were collected using a mix of quantitative and qualitative methods. Quantitative data were analyzed using Statistical Package for Social Sciences version 16, while qualitative data were reported verbatim, analyzed thematically and necessary quotes presented. RESULTS: A total of 280 women were studied. The mean age of the respondents was 29.2 ± 5.9 years. 231 (82.5%) were married. 89 (31.8%) did not report any knowledge about QMHS. Level of satisfaction was not different among women of different socioeconomic groups ( P > 0.05). Sociodemographic characteristics of clients were not found to be associated to the perception of waiting time: ( P > 0.05). The attitude of health care providers toward the clients was reported as good. CONCLUSIONS: Despite the poor quality of services provided, this study showed that client's knowledge of quality of services was good. Furthermore cost, local language used, staff attitude and interaction with clients was acceptable and may be the reason for high level of satisfaction reported.

Determinants of subjective health status of HIV positive mothers in NAUTH Nnewi.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. METHODS: This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire. RESULTS: The mean age of the respondents was 30.46 +/- 4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p<0.001). Also a significantly higher proportion of condom users (99%) than pill users (1%) described their health status as 'excellent' (p<0.02). The same significantly higher proportions of 'excellent' response were given by subjects who engage in social support activities (p<0.001), who practice good feeding (p<0.01) andpersonal hygiene (p<0.01). CONCLUSION: Access to family planning services and HAART, participation in support group activities and positive lifestyle practices tend to improve subjective health status and should be comprehensively encouraged among the HIV positive mothers.

Perception of quality of care in HIV/AIDS programmes among patients in a tertiary health care facility in Anambra State.

BACKGROUND: Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. METHODS: The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. RESULTS: The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent < or = 240 naira (98 versus 52). Similarly, the number of subjects that spent >30 minutes are significantly larger than the number that spent < or = 30 minutes to reach the clinic (142 versus 8). Also significantly greater number of participants spend >750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. CONCLUSION: HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current level of quality of care provided to the patients and if possible improve upon it. However, efforts should be made to further decentralize ART services to make them more accessible to the growing number of PLWHAs needing care and support.

Predictors of road traffic accident, road traffic injury and death among commercial motorcyclists in an urban area of Nigeria.

BACKGROUND: Road traffic accidents, injuries and deaths remain important public health problems in both developed and developing countries. These problems have since escalated with the introduction of the new phenomenon of commercial motorcycle transportation such as is found in the urbanizing slum of Nnewi, Anambra state of Nigeria. METHOD: Using a semi-structured, interviewer-administered questionnaire, relevant data on socio-demographic and motorcycle characteristics were collected from a sample of 291 commercial motorcyclists selected by systematic sampling technique. Data on RTA, RTI and death were also collected from them overa period of three months. RESULT: The result showed that young commercial motorcyclists {<30 years of age}, experienced higher fatal injury rate than older ones {> or =30 years of age}, {p < 0.01}. Motorcyclists with some formal education experienced RTA and RTI incidence rates that were significantly lower than those of motorcyclists with no formal education, {p < 0.01}. In the same vein, medical condition and social vices such as alcohol intake among the motorcyclists were found to be obvious predictors of RTA, RTI and death. Furthermore, motorcyclists who used >100 cc engine capacity motorcycles had significantly higher RTA incidence rate {478.8/100 MCY}, RTI rate {223.2/100 MCY} and FIR {410/100 MCY} than users of <100 cc engine motorcycles who recorded RTA incidence of 258.9/100 MCY, RTI rate of 49/100 MCY and zero fatal injury respectively {p < 0.01, p < 0.001, p < 0.001 respectively}. CONCLUSION: A careful consideration of all these predictors individually and collectively, will enable stakeholders in transport industry plan effective RTA, RTI and death control measures. Rather than an outright ban of motorcycle transportation, evening classes can be organized for the motorcyclists at subsidized rates to improve their literacy levels to run side by side with road safety informational lessons delivered at their places of work.

Predictors of road traffic accident, road traffic injury and death among commercial motorcyclists in an urban area of Nigeria

Background: Road traffic accidents, injuries and deaths remain important public health problems in both developed and developing countries. These problems have since escalated with the introduction of the new phenomenon of commercial motorcycle transportation such as is found in the urbanizing slum of Nnewi, Anambra state of Nigeria. Method: Using a semi-structured, interviewer administered questionnaire, relevant data on socio-demographic and motorcycle characteristics were collected from a sample of 291 commercial motorcyclists selected by systematic sampling technique. Data on RTA, RTI and death were also collected from them over a period of three months. Result: The result showed that young commercial motorcyclists {<30 years of age}, experienced higher fatal injury rate than older ones {>30 years of age}, {p<0.01}. Motorcyclists with some formal education experienced RTA and RTI incidence rates that were significantly lower than those of motorcyclists with no formal education, {p<0.01}. In the same vein, medical condition and social vices such as alcohol intake among the motorcyclists were found to be obvious predictors of RTA, RTI and death. Furthermore, motorcyclists who used >100cc engine capacity motorcycles had significantly higher RTA incidence rate {478.8/100 MCY}, RTI rate {223.2/100MCY}and FIR {410/100MCY} than users of <100cc engine motorcycles who recorded RTA incidence of 258.9/100MCY, RTI rate of 49/100MCY and zero fatal injury respectively {p<0.01, p<0.001, p<0.001 respectively}. Conclusion: A careful consideration of all these predictors individually and collectively, will enable stakeholders in transport industry plan effective RTA, RTI and death control measures. Rather than an outright ban of motorcycle transportation, evening classes can be organized for the motorcyclists at subsidized rates to improve their literacy levels to run side by side with road safety informational lessons delivered at their places of work

Possible biochemical impact of malaria infection in subjects with HIV co-infection in Anambra state, Nigeria.

BACKGROUND & OBJECTIVES: The present study was designed to determine possible contributory impact of malaria infection on some biochemical markers in subjects with HIV co-infection in order to know if they are adverse or protective. METHODS: Participants were recruited at the Voluntary Counseling and Testing Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria and grouped into: (i) Malaria and HIV co-infection group (n = 45); and (ii) HIV infected group without concurrent malaria infection (n = 57). Standard laboratory methods were used for the HIV and Plasmodium falciparum antigen screening, malaria parasite density, CD4+ T-cell count, packed cell volume, white blood cell count, serum iron and albumin concentrations. RESULTS: The results showed that serum iron and albumin were significantly reduced and raised respectively in 'Malaria-HIV co-infection group' compared with 'HIV infection group' (p < 0.05 and p < 0.05). A positive association was observed between age and serum iron concentration in malaria and HIV co-infected group (r = 0.580; p < 0.05) while negative associations were observed between PCV and serum iron (r = - 0.388; p < 0.05) and between CD4+ T-cells and serum iron concentration (r = -0.362; p < 0.05) in malaria and HIV co-infected group. The CD4+ T-cell count, WBC count, PCV were not significantly different between the Malaria-HIV co-infection group and HIV infection group. INTERPRETATION & CONCLUSION: In the present study serum iron and albumin concentrations were the most sensitive indicators that showed the contributory impact of malaria infection on biochemical index in HIV co-infected subjects. The findings suggest that at the defined stage of HIV infection in the present study, malaria co-infection may moderate the impact of HIV infection on iron metabolism and hepatic synthesis of albumin.

Prevalence of malaria as co-infection in HIV-infected individuals in a malaria endemic area of southeastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was conducted on the prevalence of malaria as co-infection amongst 'asymptomatic HIV' and 'symptomatic HIV' subjects to see if such prevalence deviated from that commonly reported in apparently health individuals in same locality. METHODS: A prospective study that involved 196 participants grouped according to their HIV status as: 'asymptomatic HIV seropositive group' (n = 101); 'symptomatic HIV seropositive group' (n = 48) and 'control HIV-seronegative group (n = 47). Blood samples collected from the participants were used for double HIV screening by rapid immunoassay technique and immunochromatographic technique, and for the diagnosis of Plasmodium falciparum malaria using rapid P. falciparum antigen detection method. RESULTS: The result showed that the prevalence of P. falciparum malaria as a co-infection amongst the asymptomatic HIV seropositive group was 12 (11.8%) and amongst the symptomatic HIV seropositive group was 16 (33.3%). However, the prevalence rate of P. falciparum malaria amongst the control HIV seronegative group was 5 (10.6%) and the combined burden of P. falciparum malaria amongst both groups of HIV seropositives was 28 (18.9%). INTERPRETATION & CONCLUSION: The present study observed different prevalence rates of P. falciparum malaria amongst the three groups. The prevalence was tripled in symptomatic HIV seropositive group. This shows a clear departure from possible obtainable prevalence of malaria infection alone in this malaria endemic area. Due to the mortality rates associated with malaria infection in an endemic area, it may be necessary that routine malaria screening be adopted as part of the management policy to check the co-infection.

Religious leaders' perceptions and support of reproductive health of young people in Anambra State, Nigeria.

OBJECTIVES: This article assesses religious leaders' perceptions of young people's reproductive health in Anambra State. PATIENTS AND METHODS: Through self-administered semi-structured questionnaires, and in depth interviews, religious leaders perceptions of young peoples reproductive health in Anambra State Nigeria was elicited from two hundred and fifty religious leaders selected by multistage random sampling. RESULTS: Over 85% of the religious leaders thought that young people are sexually active, and are involved in high risk behaviour for unintended pregnancy, unsafe abortion, and STD and HIV/AIDS. Eighty five per cent felt that there is need for sexuality education in schools, and that sexuality education will reduce unintended pregnancy, abortion, STDS and HIV/AIDS among young people. However 52.2% felt that sexuality education in school would increase promiscuity. Some religious leaders did not support teaching of contraception and safe abortion in schools. CONCLUSION: Religious leaders in Anambra State have a high awareness of young people's reproductive health problem, and are in support of sexuality education in schools. They differ however in what should be the content of the curriculum. There is need to harmonise and agree on programme contents to minimise sending conflicting and confusing messages to young people.

Knowledge of and attitude towards road traffic codes among commercial motorcycle riders in Anambra State.

Road traffic accidents (rtas) represent a major epidemic of non communicable disease in the country and has since escalated with the introduction of the new phenomenon of commercial motorcycle transportation such as is found in the two urban towns of nnewi and Awka of Anambra state, Nigeria. making use of a pre-tested, semi structured, interviewer administered questionnaire, relevant data on socio demographic and motorcycle characteristics were collected from a sample of commercial motorcyclists selected by systematic sampling technique. their knowledge of and attitude towards road traffic and safety codes were elicited. The result showed that the all-male commercial motorcyclists had a mean age of 30+8.9 years. one hundred and seventy six (32.6%) possessed good knowledge of road traffic codes and safety, while 35 (6.5%) exhibited good attitude towards them. both knowledge of and attitude towards traffic codes and safety improved with increase in educational level (p<0.005, p<0.001 respectively). the younger motorcyclists also possessed statistically significant better knowledge of traffic codes than their older counterparts (p<0.025). attitude to traffic codes and safety had no association with age of the motorcyclists (p>0.25). the study has provided useful information on the knowledge of and attitude towards road traffic and safety codes among commercial motorcyclists in nigeria. pursuit of knowledge through formal and informal education should run pari pasu with efforts to improve the nigerian economy in order to ensure a sustainable positive attitudinal change towards road traffic codes and safety among commercial motorcyclists.

Perception of peers' behaviour regarding sexual health decision making among female undergraduates in Anambra State, Nigeria.

BACKGROUND: High-risk sexual behaviours are prevalent in tertiary educational institutions in Nigeria, but little is known about the social influences that bear on the reproductive health decision-making and behaviour of the undergraduates. On the other hand, perceptions regarding the behaviour and influence of peers have been documented to be key social factors associated with reproductive health behaviour of young people. OBJECTIVE: This study aimed to assess the perception of Nigerian female undergraduate about sexual behaviours of their peers and the type of influence their peers tend to exert on them. METHOD: The study was cross-sectional in nature and involved 588 randomly selected unmarried female undergraduates in two tertiary institutions in Anambra state, Nigeria. The study instrument was a self-administered questionnaire. Data was analysed using Epi-Info statistical package. RESULTS: Three-quarters of respondents were between 15 and 24 years and the majority were from homes with formally educated parents (91.2 % of mothers and 93.9 % of fathers). Regarding sexual behaviour, 80.1% of respondents indicated that their age mates were already sexually active, and 92 % indicated that most of their friends had regular sexual partners. The use of condoms by sexually active friends was reported by 58.5 % of respondents. Almost half (47.1 %) of respondents indicated that they were under pressure by friends to engage in pre-marital sex, and 22.1 % indicated that the pressure was moderate or severe in degree. However, 64.6 % of respondents indicated that they would receive moderate or lots of support for their friends if they made the decision to abstain from sex. CONCLUSION: Perception of sexual behaviour of peers and the nature of the pressure that peers exert support pre-marital sex. It appears peers would also respect and support the decision of those that choose to practice sexual abstinence.

Knowledge and perceptions of HIV/AIDS and mother to child transmission among antenatal mothers at Nnamdi Azikiwe University Teaching hospital, Nnewi.

OBJECTIVE: Knowledge of HIV/AIDS by pregnant mothers is very important in the prevention of mother to child transmission. This study evaluates the knowledge and perceptions of HIV/AIDS and mother to child transmission among pregnant women attending antenatal clinic at a University Teaching Hospital. METHODOLOGY: Pre-tested questionnaires were interviewer administered to 312 pregnant women randomly selected at the antenatal clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi. RESULTS: The level of awareness of HIV/AIDS among antenatal mothers was very high (99%) and the main sources of information were radio (44.7%), television (38.8%), and print media (34.0%). Though majority (94.2%) was aware HIV infection can coexist with pregnancy, only 76.9% were aware of mother to child transmission. Transplacental (46.1%), breastfeeding (31.7%), and vaginal delivery (16.3%) were the commonly identified routes of vertical transmission. Surprisingly, eighteen respondents (5.8%) indicated that caesarean section is a possible route of vertical transmission. CONCLUSION: Though the percentage of HIV/AIDS knowledge is high, the level of knowledge and perceptions of mother to child transmission is inadequate. This suggests the need to scale up health education about mother to child transmission in our health facilities.

Maternal attitudes and values to youth sexuality-related activities in Delta State, Nigeria.

This descriptive study assessed maternal attitudes to youth-related activities in Delta State. Using an adapted questionnaire, 300 women with adolescent children were chosen through a multistage sampling technique and relevant data obtained regarding their socio-economic status, perceptions and values as well as their knowledge of basic reproductive health concerns. Most of the women interviewed (95%), believed it was very important that young people completed secondary education and another 72% said they would normally set rules in their homes regarding what young people should read or watch. Sixty-seven percent of those studied, discussed sexuality issues regularly with their adolescent children, though only 46.4% of them were comfortable discussing these issue and about 50% admitted having enough information in such discussions. Another 76% of the women would approve of their children receiving reproductive health information and service including contraceptive condoms. The mothers studied believed that guided reproductive health information and services should be routinely provided for young people. The findings strongly suggest that the mothers who are important stakeholders in Adolescent Health would most likely be supportive of youth programmes. Most of the findings differ from those of other studies, and a qualitative study would be carried out to identify the reasons for these interesting findings.

Personal hygiene practice and school-based health education of children in Anambra State, Nigeria.

This study assessed the effect of school-based health education on the practice of personal hygiene by children in primary schools in Anambra State, Nigeria. Three hundred and ninety-five (395) and three hundred and ninety-eight (398) primary school pupils randomly recruited as intervention and control groups were rated on five key personal hygiene practices before, immediately after and three months after school-based hygiene health education. Less than 45% were rated clean before health education in both groups. Immediately after health education, more than 65% in the intervention group were rated clean. There was no change in the control group. The difference was statistically significant. However, there was a statistically insignificant decline in those rated clean three months after cessation of health education. The school-based health education improved the personal hygiene practice of the pupils. There is a need for regular reinforcement to sustain the gains.