Exploring the options for alternative means of livelihood for Blind street beggars in Sokoto, Nigeria.

AIM: To explore the readiness of and the options for alternative means of livelihood for Blind Street beggars in Sokoto, Nigeria, with a view to achieving the millennium development goals. MATERIALS AND METHODS: A cross-sectional study was conducted in a Local Government Area (LGA), in Sokoto State over a 6 weeks period (May/June, 2009). Ethical clearance was obtained from the Ethical Committee of University of Ilorin Teaching Hospital. A list of blind persons in these areas was obtained from the local traditional head of the blind (Sarkin Makafi) who gave the general consent for the study and also assisted in mobilizing the subjects. Blind subjects who consented were examined and included in the study. Data were collected with a semistructured questionnaire. The desire for occupational change and the preferred alternative means of sustenance were explored. Data obtained were coded, analyzed, and summarized in form of frequency tables. RESULTS: A total of 216 (94.7%) subjects were examined out of the 228 subjects that were enumerated. However, only 202 of the registered persons that were actually found to be blind on ophthalmic examination were included in the analysis. Majority of the subjects, 201 (99.5%), wanted alternative means of livelihood. About half of the subjects, 100 (49.8%), wanted to be established in farming or trading. CONCLUSION: Most respondents expressed readiness for alternative means of livelihood.

The Sokoto blind beggars: causes of blindness and barriers to rehabilitation services.

PURPOSE: To determine the causes of blindness and the barriers to accessing rehabilitation services (RS) among blind street beggars (bsb) in Sokoto, Nigeria. MATERIALS AND METHODS: A cross-sectional survey of 202 bsb (VA < 3/60) using interviewer administered questionnaire. The causes of blindness were diagnosed by clinical ophthalmic examination. RESULTS: There were 107 (53%) males and 95 (47%) females with a mean age of 49 years (SD 12.2). Most bsb 191 (94.6%) had non-formal education. Of 190 (94.1%) irreversibly bsb, 180/190 (94.7%) had no light perception (NPL) bilaterally. The major causes of blindness were non-trachomatous corneal opacity (60.8%) and trachoma corneal opacity (12.8%). There were 166 (82%) blind from avoidable causes and 190 (94.1%) were irreversibly blind with 76.1% due to avoidable causes. The available sub-standard RS were educational, vocational and financial support. The barriers to RS in the past included non-availability 151 (87.8%), inability to afford 2 (1.2%), unfelt need 4 (2.3%), family refusal 1 (0.6), ignorance 6 (3.5%) and being not linked 8 (4.7%). The barriers to RS during the study period included inability of 72 subjects (35.6%) to access RS and 59 (81.9%) were due to lack of linkage to the existing services. CONCLUSION: Corneal opacification was the major cause of blindness among bsb. The main challenges to RS include the inadequate services available, societal and users factors. Renewed efforts are warranted toward the prevention of avoidable causes of blindness especially corneal opacities. The quality of life of the blind street beggar should be improved through available, accessible and affordable well-maintained and sustained rehabilitation services.

Social Determinants of Depression: Social Cohesion, Negative Life Events, and Depression Among People Living with HIV/Aids in Nigeria, West Africa.

BACKGROUND: People Living with HIV/AIDS (PLWHA) continue to face persistent and deep rooted social barriers. Incidentally, studies in social determinants of depression are very limited, necessitating this study, which examined social determinants of depression and the impact of these determinants on depression. METHODS: This was a hospital based, cross sectional descriptive study of three hundred adult HIV/AIDS patients, attending the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria. Depressive symptoms were measured by the PHQ-9 rating scale. Three variables of social determinants of depression: socio-economic status (years of school and self-reported economic status of family), social cohesion, and negative life events were examined. RESULTS: The self-reported economic status of the family varied from good 35(11.7%), average 162(54%), and poor among 103(34.3%) of the respondents. Social cohesion was low in 199(66.3%), fair in 65(21.7%) and high among 36(12%) of the respondents. There was significant association between social cohesion, negative life events, and depression. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Income was the most significant socio-economic determinant. Majority had very low social cohesion and more negative life events, while those with below average years of schooling were more depressed. These are statistically significant. Social determinants of depression should be given a lot of emphasis, when addressing the issue of depression, if we are to meaningfully tackle this increasing scourge in our society.

Dermatology Quality of Life Impairments among Newly Diagnosed HIV/AIDS-Infected Patients in the University of Ilorin Teaching Hospital (Uith), Ilorin, Nigeria.

The study sought to describe the quality-of-life impairments in newly diagnosed HIV/AIDS-infected adult patients with cutaneous lesions. This was a hospital-based, cross-sectional, descriptive study of 160 newly diagnosed HIV/AIDS-infected adult patients attending the HIV/AIDS clinic of University of Ilorin Teaching Hospital (UITH). Systemic random sampling technique was used in recruiting respondents for the study. The Dermatology Life Quality Index (DLQI) was used to gauge the quality-of-life impairments. The study showed high prevalence of cutaneous lesions in HIV/AIDS-infected patients. Majority of the respondents (83.7%) scored more than 10 in DLQI score. This signifies that the skin lesions had large negative effects on their quality of life. The assessment of the impact of dermatoses on patients' quality of life is important for clinical management. It is pertinent to detect patients at higher risk of experiencing worse quality of life in order to treat them holistically.

Prevalence and pattern of cutaneous lesions in relationship to CD4 cell counts among newly diagnosed HIV patients in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.

BACKGROUND: Oral lesions are among the earliest clinical manifestation of HIV infection. In developing countries like Nigeria, were sophisticated diagnostic apparatus used to monitor the immunologic status of HIV/AIDS patients is not readily available, early recognition of the commonest and specific HIV-related oral lesions can be used for diagnosis so that prompt treatment can be provided to reduce morbidity. OBJECTIVES: To assess the prevalence and spectrum of oral lesions in relationship to CD4 cell counts among newly diagnosed HIV patients in University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State, Nigeria. METHODS: This was a hospital based, cross sectional, descriptive study of 160 newly diagnosed adult patients attending the HIV/AIDS clinic of UITH, Ilorin. The study protocol was approved by the Ethics committee of the UITH. Informed consent from all the patients was also obtained prior to data collection. All the HIV patients were treatment naïve. A questionnaire guided interview and clinical oral assessment were used. RESULTS: The prevalence of oral lesions was 31%. The commonest oral lesion was of fungal origin (53.1%) followed by viral (36.7%). Oral lesions of inflammatory origin (6.7%) were relatively rare while those of bacterial origin (4.1%) were not very common. None of the oral lesions detected was of neoplastic origin. Most of the oral lesions occurred when the CD4 cell counts were less than 200 cells/µl. CONCLUSION: Oral lesions are common in people with HIV with very low CD4 cell counts (≤ 200 cells/µl). Oral Candidiasis is the commonest lesion in Ilorin, Kwara State, Nigeria.

Cataract blindness in Osun state, Nigeria: results of a survey.

PURPOSE: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. MATERIALS AND METHODS: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. RESULTS: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6-2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3-3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. "Lack of awareness" (30.4%), "no need for surgery" (17.6%), cost (14.6%), fear (10.2%), "waiting for cataract to mature" (8.8%), AND "surgical services not available" (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. CONCLUSIONS: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free.

Survey of the attitudes of nigerian ophthalmologists to and resources for ophthalmic research.

AIM: To study the views of ophthalmologists on their attitude to and the resources for ophthalmic health research in Nigeria and draw appropriate policy implications. MATERIALS AND METHODS: Structured questionnaires were distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. Data were collected on background information, importance attributed to research, motivation for conducting research, funding, ethical oversight, literature search, and statistical support. The coded responses were statistically analyzed. P < 0.05 was statistically significant. RESULTS: Eighty-nine of the 120 questionnaires were returned giving a response rate of 74.2%. Research function was rated a distant last by 49.5% of the respondents after clinical service (93.2%), teaching (63.1%), and community service (62.8%). Advancement of knowledge was the strongest motivating factor for conducting research (78.2 %). Securing funding (91.8%) and finding time (78.8%) were the major constraints. The ethical review committees were considered suboptimal by the respondents. Literature searches for research were conducted on the internet (79.3%) and was independent of age (P = 0.465). Research data were stored and analyzed on commonly available statistical software. CONCLUSIONS: Although study respondents regarded research highly, they were severely constrained in conducting research due to lack of access to funds and finding time away from the clinical workload. We recommend periodic (re)training on conducting good research including preparation of successful applications for research grants and allotting protected research time for ophthalmologists in Nigeria.

Ophthalmic research priorities and practices in Nigeria: an assessment of the views of nigerian ophthalmologists.

PURPOSE: To study the views of ophthalmologists on research priorities and outcomes in Nigeria. MATERIALS AND METHODS: A structured questionnaire was distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. The participants' background information, relative research priorities, frequency of publications, research types, publication media, challenges faced in publishing and impact on health practice or policy were collected. RESULTS: Eighty-nine (74.2%) of the 120 questionnaires were returned. Childhood blindness was given the highest priority for ophthalmic research by 42.9% of the respondents, and genetic studies had the least priority (19.8%). About two-thirds of the respondents had either never been involved or only involved occasionally in any type of ophthalmic research. Clinical trials (13.1%) and basic science studies (12%) were the least-performed types of research. About 51% of the respondents indicated that they had never published in journals nor did so "occasionally"; only 9% quarterly and 43% published less than once a year. They also indicated that their research very rarely resulted in change of clinical practice or health policy (20%). CONCLUSIONS: Research works conducted by respondents were largely simple low-budget ones that rarely had significant impacts and outcomes, including publication. There is a need to retrain and emphasize the importance of research during undergraduate and postgraduate medical education. Adequate resources and research infrastructure should be provided for ophthalmic research in Nigeria.

Survey of medical specialists on their attitudes to and resources for health research in Nigeria.

AIM: To study the views of medical specialists on their attitude to and the resources for health research in Nigeria and draw appropriate policy implications. MATERIALS AND METHODS: Structured questionnaires were distributed to consenting 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, importance attached to research, motivations for conducting research, funding, ethical oversight, literature search, and statistical support were probed. The coded responses were stored and analyzed using the statistical SPSS software. RESULTS: Fifty-one out of the 90 questionnaires distributed were returned, giving a response rate of 63.3%. Research function was rated third by 64.7% of the respondents after hospital service (72.5%) and teaching (66.0%). Advancement of knowledge was the strongest motivating factor for conducting research (78.4%). Securing funding (94%) and finding time (80%) were their major constraints. Only a minority of the respondents, 20% and 14%, respectfully, positively rated the quality and promptness of the decisions of their institutions' ethical organs in the highest category. Most of their literature search was conducted on the internet (96.1%) and they stored and analyzed their research data with commonly available statistical software. CONCLUSION: Our study respondents regarded research highly but were severely constrained in conducting research by lack of access to sources of funding from within and outside Nigeria and finding time from core hospital functions. We recommend periodic (re)training in research particularly on how to apply for research grants and giving some protected research time for Nigerian medical specialists in order to boost their research function.

Perceptions of Nigerian medical specialists on research.

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely "always" involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to "always" publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

Awareness and knowledge of ocular cancers in a resource-limited economy.

AIMS: To determine awareness and knowledge of ocular cancers in a resource-limited setting. MATERIAL AND METHODS: A descriptive cross-sectional survey (2009) of 1,887 Nigerians using interviewer-administered questionnaire. RESULTS: Respondents were 55.6% males, and mean age was 30 years, SD 9.5. Most respondents (77.8%) had at least secondary education. Fewer respondents were aware of eye cancers (57.1%) compared to cancers in general (73.7%) (P<.001). Despite the male preponderance there were no associations between gender and awareness of ocular cancers (P=0.07) and cancers in general (P=0.85). However, education was associated with awareness of ocular cancers (P<.001) and cancers in general (P<.001). Ocular cancers were thought to be caused by corrosives 33.2%, trauma 21.4%, witchcraft 18.6%, genetic transmission 15.7%, sunlight 8.0%, radiations 2.5% and infections 0.6% (n = 883). Of 280 respondents, 41.1% based their knowledge of patients having ocular cancers on sources other than hospital diagnosis. Of 148 respondents, 16.2% were related to 'patients' they knew had ocular cancers. There were 202 respondents who indicated challenges to accessing orthodox medical eye care services by ocular cancer patients as high cost 55.5%, long waiting period 23.3%, long distance 15.4% and poor attitude of health workers 5.9%. CONCLUSION: Awareness of ocular cancers compared to other cancers is low. Misconceptions on the causes of ocular cancers exist. Public ocular cancers health education can enhance awareness. The need to address barriers to accessing eye care is underscored.

Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles.

BACKGROUND: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. AIM: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. MATERIAL AND METHODS: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents' bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians' involvement in health managerial roles, probable influence of some physicians' characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. RESULTS: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role "strongly important" (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. CONCLUSIONS: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

Perceptions of Nigerian Medical Specialists on Research

"The current research aimed at collating the views of medical specialists on disease priorities; class and outcomes of health research in Nigeria; and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information; relative disease priority; research types and class; type and class of publication media; frequency of publications; challenges faced in publishing research; impact of their research on health practice or policy; and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely ""always"" involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8) and over a third (37.5) had never been involved in clinical trials. They largely preferred to ""always"" publish in PubMed indexed journals that are foreign-based (65.0). They also indicated that their research works very rarely resulted in inventions (4) and change (4) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula."