Caesarean delivery rate and indications at a secondary healthcare Facility in Ibadan, South Western Nigeria: a five-year review.

BACKGROUND: Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality. OBJECTIVES: To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area. METHODS: A retrospective review of all caesarean deliveries over a five-year period, January 1st, 2012 to December 31st, 2016. RESULTS: A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean section (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016. CONCLUSION: The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population.

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim: There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria. Materials and Methods: A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0. Result: The most frequent group of caregivers was patients' children (32.0%), aged 30-39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165-7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133-9.853; P = 0.029). Conclusion: The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Effect of malaria preventive education on the use of long-lasting insecticidal nets among pregnant females in a Teaching Hospital in Osun state, south-west Nigeria.

BACKGROUND: Malaria in pregnancy is a major public health problem in Nigeria. Long-Lasting Insecticidal Nets (LLINs) have been advocated as an effective tool against malaria transmission. However, success of this intervention largely depends on the knowledge and practices regarding malaria and its prevention. Unfortunately, few studies have been done on effect of malaria preventive education on use of LLIN in pregnancy. OBJECTIVE: To assess the knowledge of malaria and determine the effect of malaria preventive education on the use of LLINs among pregnant females in a Teaching Hospital in Osun state. METHOD: It was a one group pre-test post-test quasi - experimental hospital based study involving pregnant females attending Ante-Natal Clinic (ANC) of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). A total of 200 respondents were recruited for this study by 2-stage sampling technique. Data was collected using a pretested questionnaire to elicit information on socio-demographic characteristics, use of LLIN in pregnancy, knowledge of malaria and its preventive measures. The data collected was analysed using descriptive and inferential statistics. The descriptive statistics comprised frequency, percentage, means and standard deviations. Bivariate analysis comprised Chi-square test on knowledge of malaria before and after intervention while correlation test assessed strength of relationship between knowledge of malaria preventive education and use of LLINs before and after intervention. Multivariate analysis determined the predictors of LLINs use. Analytical statistics of cross tabulation was conducted considering a p < 0.05 to be statistically significant. RESULTS: There was an increase in the scores of knowledge on malaria transmission after the intervention and this was statistically significant (χ2 = 8.862, p < 0.01). Similarly, the scores of knowledge on malaria prevention increased after the intervention and this was statistically significant (χ2 = 10.023, p < 0.01). Respondents' age, marital status and gravidity were predictors of LLINs use. Biserial correlation showed a statistically positive relationship between knowledge of malaria preventive education and use of LLINs after intervention (r = 0.036, p < 0.01). CONCLUSION: The use of malaria preventive education was found to be effective in increasing the use of LLIN in this study. These findings highlight a need for educational intervention in implementation of LLINs. There is therefore a need to strengthen the policy of malaria prevention education as an integral component with distribution of free LLIN in health care setting to enhance its utilization.

Hepatitis B Infection: A Mixed Methods of Disclosure Pattern and Social Problems in the Nigerian Family.

BACKGROUND: Hepatitis B virus (HBV) infection has a high prevalence rate in Nigeria. Disclosure of infection status to close partner and the public attracts support for infected people. This study looks at disclosure and social challenges of infected persons. METHODS: Mixed methods of patients' administered questionnaire and an in-depth interview conducted on HBV-infected respondents in a hospital in Nigeria were used. The study recruited all participants who satisfied the inclusion criteria. Data were entered into SPSS version 20 and analyzed using simple and inferential statistics and content analysis for the in-depth interview. RESULTS: A total of 205 participants completed the questionnaire study. Mean (standard deviation) age was 35.3 (±11.0) years. There were 121 married, 37 singles with noncohabiting partners and 47 singles without partners with disclosure rates being 96.7% versus 97.9% versus 89.2%, respectively. Singles disclosed infection more to their parents while married respondents disclosed infection more to their spouses. Singles had high rate of denial of sexual relationship (22.6%), emotional trauma (34.5%), broken relationships (11.4%), and surreptitious use of contraception for protection (67.6%). Married respondents had the highest rate of HBV vaccination of their family members (40.1%). Infection prevention and allaying fears of family members were their counseling needs. In-depth interview revealed that infected respondents usually expressed shock and depression at a positive test leading to fear and deception that put close associates at risk. CONCLUSION: Hepatitis B virus-infected respondents have high rate of disclosure. Family problems of these people can therefore be solved through public enlightenment and individual counseling.

Burden of family caregivers of ophthalmic patients in a university teaching hospital in south-west Nigeria.

Background: The family provides support in the care of their ill members and suffers some burden during caregiving. This study assessed the burden of family caregivers and associated factors in an ophthalmic clinic situated in a university teaching hospital in southwest Nigeria. Methods: This was a descriptive cross-sectional study where consenting family caregivers of ophthalmic patients completed a semi-structured questionnaire containing information on their socio-demographic characteristics and caregiving burden using the Zarit burden interview. Descriptive and inferential statistics analyses were done. Results: A total of 273 caregivers completed the study. The caregivers were parents (23.5%), spouses (20.1%), siblings (3.3%), children (35.9%) and other relatives (14.2%) with mean age (SD) of 38.9 (14.9) years (range 8-79 years). Majority (81.2%) experienced caregiver burden with prayer (89%) as a coping strategy. Financial support (56%) was a major caregiver need with majority (59.3%) satisfied with their relatives' hospital care. Neither the patients nor their caregivers were on health insurance scheme. Statistical significant factors associated with caregivers' burden included young age (AOR=4.63, 95%CI=1.55-13.90; p=0.01), higher education (AOR=5.51, 95%CI=2.30-13.2, p=0.01), being employed (AOR=1.72, 95CI=1.30-4.76, p=0.04), longer caregiving (AOR=3.37, 95%CI=1.27-7.02, p=0.02), and having patient on hospital admission (AOR=1.90, 95%CI=1.26-3.09, p=0.02). Conclusion: Family caregivers of ophthalmic patients experienced significant burden. Hence, they need more assistance from the health care institutions and community, including policy makers, so that they can cope with their caregiving activities. Enrollment in the social health insurance scheme will reduce out of pocket payment of hospital bills.

Determinants of Quality of Life of Elderly Patients Attending a General Practice Clinic in Southwest Nigeria.

BACKGROUND: Aging is associated with change in health status and decreasing functional capacity affecting the general well-being of individuals with increase in the prevalence of chronic noncommunicable diseases. OBJECTIVE: This study aimed to assess the quality of life (QoL) and its determinants in elderly patients attending a general practice clinic in Southwest Nigeria. METHOD: Descriptive cross-sectional study of consenting elderly patients completed an interviewer-administered questionnaire on QoL and its determinants. Data were analyzed using descriptive and inferential analysis. Logistic regression was done to identify predictors of QoL. RESULTS: A total of 216 older adults were interviewed. Only 25% had good QoL with majority having multiple morbidities which was associated with poorer QoL. Predictors of QoL were family support (odds ratio = 0.249, 95% confidence interval [0.079, 0.850], p = .026) and socioeconomic class (odds ratio = 3.66, 95% confidence interval [1.47, 7.87], p = .004) of the respondents. CONCLUSION: QoL was found to be poor among the study population and worst in those with multiple morbidities. There is a need for policy direction to advocate for preventive strategies for risk of chronic diseases as well as provide better access to primary care through National Health Insurance Scheme (NHIS).

Determinants of Skilled Care Utilization among Pregnant Women Residents in an Urban Community in Kwara State, Northcentral Nigeria.

BACKGROUND: Skilled attendant at delivery (SBA) is one of the key indicators used in assessing progress towards improved maternal health. This study aimed at identifying factors influencing SBA utilization in Ilorin, Nigeria. METHODS: This cross-sectional study was carried out using multi-stage sampling technique among 400 participants in Ilorin, Northcentral Nigeria. A pre-tested questionnaire was used for data collection, and data analysis was done using descriptive and inferential statistics. RESULTS: SBA supervised 73.8% births. Determinants of skilled birth attendance at delivery include higher education (AOR; 10.94, 95% CI; 3.60-33.26), having only one child (AOR; 4.33, 95% CI; 1.18-15.82), having at least 4 ANC attendance (AOR; 18.84, 95% CI; 8.95-55.82) and residing near delivery sites (AOR; 11.49, 95% CI; 2.43-55.56). CONCLUSION: The proportion of births supervised by SBA needs improvement in Northcentral Nigeria. Full implementation of reproductive health policies will enhance skilled births in Nigeria.

Willingness to participate in Ebola viral disease vaccine trials and receive vaccination by health workers in a tertiary hospital in Ile-Ife, Southwest Nigeria.

BACKGROUND: Ebola viral disease (EVD) epidemic need to be contained through means which include vaccination of susceptible population. Vaccination has eradicated major killer diseases. OBJECTIVE: The study determined the health workers willingness to participate in EVD vaccine clinical trials and receive EVD vaccine. MATERIALS AND METHODS: A descriptive cross-sectional study design involving 370 consenting health workers of Obafemi Awolowo University, Ile-Ife that completed a self administered semi-structured questionnaire. Data analysed using descriptive and inferential statistics. RESULTS: Mean age was 34.4±8.6years (range, 19-60years). Most were females (60.3%), and had worked <10years (74.3%). The health workers were mostly medical doctors (22.7%) and nurses (52.4%). EVD awareness (84.9%) was high among respondents with radio (37.2%) as major source of information. A higher proportion of respondents willing to participate in clinical trials were willing to receive vaccine (93% vs. 68%, p=0.0001). The significant variables associated with willingness to participate in EVD vaccine trials include being male [AOR 1.58, 95%CI 1.04-2.40, p=0.033], medical doctor [AOR 2.28, 95%CI 1.31-3.96, p=0.003] and having safe vaccine [AOR 2.10, 95% 1.58-3.98, p=0.0001] while the significant variable associated with willingness to receive EVD vaccine was vaccine safety [AOR 3.19, 95%CI 2.13-6.03, p=0.029]. CONCLUSION: Male gender, medical doctor and vaccine safety determine willingness to participate in Ebola vaccine trials while vaccine safety determines willingness to receive vaccine when ready. Researchers should ensure gender equality and vaccine safety in vaccine trials.

PENTAZOCINE VERSUS PENTAZOCINE WITH RECTAL DICLOFENAC FOR POSTOPERATIVE PAIN RELIEF AFTER CESAREAN SECTION- A DOUBLE BLIND RANDOMIZED PLACEBO CONTROLLED TRIAL IN A LOW RESOURCE AREA.

BACKGROUND: The unimodal approach of using pentazocine as post-cesarean section pain relief is inadequate, hence the need for a safer, easily available and more effective multimodal approach. AIM: To evaluate the effectiveness of rectal diclofenac combined with intramuscular pentazocine for postoperative pain following cesarean section. METHODS: In this double blind clinical trial, 130 pregnant women scheduled for cesarean section under spinal anesthesia were randomly assigned to two groups. Group A received 100mg diclofenac suppository and group B received placebo suppository immediately following surgery, 12 and 24h later. Both groups also received intramuscular pentazocine 30mg immediately following surgery and 6 hourly postoperatively in the first 24 h. Postoperative pain was assessed by visual analogue scale at end of surgery and 2, 12 and 24 h after surgery. Patient satisfaction scores were also assessed. RESULTS: One hundred and sixteen patients completed the study. Combining diclofenac and pentazocine had statistically significant reduction in pain intensity at 2, 12, and 24 hours postoperatively compared to pentazocine alone (p <0.05). No significant side effects were noted in both groups. The combined group also had significantly better patient satisfaction scores. CONCLUSION: The addition of diclofenac suppository to intramuscular pentazocine provides better pain relief after cesarean section and increased patient satisfaction.

Patterns and Correlates of Intimate Partner Violence to Women Living With HIV/AIDS in Osogbo, Southwest Nigeria.

We assessed the prevalence and correlates of intimate partner violence (IPV) to women living with HIV/AIDS in an antiretroviral clinic in Nigeria. Three hundred sixty respondents were interviewed using a structured questionnaire. Sixty percent were married, of which 24% had disclosed HIV status to their partner. About a quarter (23.6%) had experienced IPV since HIV diagnosis. Types of violence experienced were physical violence (17%), emotional violence (21%), and sexual violence (2%). Predictors of IPV included having a younger aged partner, disclosing status, and partner's alcohol use (p = .001). Suggestions to prevent IPV include increasing public awareness and family counseling.

Pattern of condom use among clients at a Nigerian HIV Counseling and Testing Centre.

BACKGROUND: Studies in Nigeria have shown that the main route of HIV transmission is sexual intercourse and that effective condom use protects people against infection. The objective of this study was to determine the pattern of condom use among clients of a friendly HIV Counseling and Testing (HCT) Centre in Osogbo southwestern Nigeria. METHODS: This was a review of the HCT Centre records from 2006 to 2010 retrieving socio-demographic information, sexual behaviour, condom use and result of HIV testing. Data obtained were analyzed using descriptive and inferential statistics. RESULTS: One thousand nine hundred and twenty-one client records were reviewed. The mean age of the study population was 35.4 (SD 10.5) years. The majority (53%) of the respondents were females, 232 (12%) were HIV positive, and 38.2% had multiple sexual partners. Only heterosexual vaginal sex was reported among the clients. Overall 45.2% of the clients did not use a condom in their last sexual act. Factors identified to be significantly associated with non-use of condoms were; younger age, having had higher education and positive HIV status. CONCLUSION: Unprotected heterosexual intercourse was common among the study population, indicating a need to step up HIV preventive programme through behavioural change communication strategy.

A population based study on the prevalence of cigarette smoking and smokers' characteristics at osogbo, Nigeria.

BACKGROUND: Cigarette smoking has been linked to several cancers worldwide. The characteristics of smokers have not been well documented among Nigerians. OBJECTIVE: This study assessed the prevalence and characteristics of cigarette smokers among the residents of Osogbo, in southwestern Nigeria. METHOD: The study, a population based cross-sectional study of randomly selected consenting adult residents of Osogbo, was conducted in September of 2011. Data was collected using a semi-structured interviewer administered questionnaire on cigarette smoking. RESULTS: A total of 759 respondents were interviewed. Mean age was 42.1 ± 12.5 years. There were 364 (48%) males and 395 (52%) females. About 22% had ever smoked while 8.7% were current smokers, smoking an average of 22.9 ± 10.1 cigarettes per day. Males constituted the majority of current smokers. Most smokers (71%) were introduced to smoking by friends and ill health was the most often reported reason for quitting. CONCLUSION: Cigarette smoking is commonly practiced among males in the studied population and awareness creation and advocacy should be conducted throughout the city in order to inform current smokers about the hazards and cumulative effects inherent in smoking.

Human immunodeficiency virus postexposure prophylaxis at IBadan, Nigeria.

HIV infection from occupational and nonoccupational exposures can be prevented through risk assessment and management with antiretroviral drug therapy (ART). This study sought to examine the pattern of presentation and outcome of clients who were given postexposure prophylaxis (PEP) at the University College Hospital, Ibadan, Nigeria. A retrospective review of case notes of clients presenting for HIV PEP from January 2005 to December 2006 was carried out. A total of 48 clients with a mean age of 27.9 +/- 12.3 years underwent PEP during the period under review. Rape constituted 50% of reasons for PEP, while needle pricks and blood splash into mucous membranes constituted 25% each. Among those who received therapy, 10 (23.8%) could not complete drug therapy because of side effects. Although no client was HIV positive after the recommended 6 months of follow-up, 8 (16.7%) clients did not complete attendance to the clinic during the period.

Awareness and attitude of health workers at a Nigerian HIV treatment clinic toward HIV/AIDS and HAART adherence.

OBJECTIVE: To assess the awareness and attitude of antiretroviral clinic workers to HIV/AIDS and highly active antiretroviral therapy (HAART). METHODS: A descriptive cross-sectional study design using a self-administered questionnaire was used. RESULTS: Of the 43 staff, 39 (92.5%) completed the questionnaire. Their mean age was 35.1 + 7.6 years. There were 19 (48.7%) males and 20 (51.7%) females. The majority (87.2%) had tertiary education. More than three fifths (61.5%) were married. There were 20 (51.3%) professional staff and 19 (48.7%) support staff. Only 28.2% of staff members had ever received on-the-job training in HIV/AIDS care. None of the adherence counselors had ever received any training in HIV/AIDS care and HAART adherence counseling. Despite this lack of training, this majority of the clinic staff had good knowledge about and a positive attitude to HIV/AIDS and HAART adherence. CONCLUSION: Adherence counselors and support staff required on-the-job training for optimum job performance.

Prevalence and determinants of nonadherence to highly active antiretroviral therapy among people living with HIV/AIDS in Ibadan, Nigeria.

OBJECTIVE: To determine the level of nonadherence to highly active antiretroviral therapy (HAART) and to explore the association of factors militating against adherence and nonadherence to therapy among people living with HIV/AIDS (PLWHA) at an Antiretroviral Clinic in Ibadan, Nigeria. DESIGN: A cross-sectional survey was employed to determine the prevalence of nonadherence. METHODOLOGY: A structured interviewer-administered questionnaire was applied to consecutive PLWHA who had been on therapy for a minimum of three months. The completed questionnaires were entered into a computer and analyzed. Multivariate logistic regression was used to determine factors associated with nonadherence. RESULTS: Three hundred and eighteen people living with HIV/AIDS completed the questionnaire. Their mean age was 39.1+/-9.6 years. There were 173 (54.4%) females and 145 (45.6%) males. The median duration on HAART was 19 months (Range 3 to 28 months) and the prevalence of nonadherence was 118 (37.1%) using the less than 95% adherence profile. About a third (31.5%) of those missing therapy reportedly missed their medication because of fasting. Multiple logistic regression analysis revealed that patients who felt healthy or simply forgot to take their drugs and those not willing to disclose their HIV status were independently, significantly associated with less than 95% adherence. CONCLUSION: The study showed that nonadherence to HAART is a problem in the ARV clinic and that the feeling of being healthy, forgetfulness, and unwillingness to disclose HIV status by PLWHA were significant barriers to adherence. Efforts to improve adherence in the clinic will have to address these issues among others.