FEEDING PRACTICES AND NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN A PERI-URBAN SETTING IN IBADAN, SOUTHWEST NIGERIA: A COMPARATIVE CROSS-SECTIONAL STUDY.

Background: Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential. This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan. Methods: We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers' sociodemographic details, 24-hour dietary recall of the child's feeding, and anthropometric measurements were obtained. Results: Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father's education, caregiver's occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 - months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings. Conclusion: Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

Awareness and Knowledge of Birth Defects among Antenatal Clinic Attendees at the University College Hospital, Ibadan, South-West, Nigeria.

BACKGROUND: The burden of birth defects is disproportionately higher in developing countries. OBJECTIVES: This study assessed the knowledge of risk factors and prevention of birth defects among ante-natal clinic attendees at the University College Hospital, Ibadan, Oyo State, Nigeria. METHODS: This was a cross-sectional study among 415 mothers who presented at the antenatal clinic. A semi-structured questionnaire was used to obtain information on respondents' socio-demographic profile, pregnancy, birth history, knowledge on prevention and risk factors for birth defects. Descriptive statistics was used to present results, independent t-test and ANOVA were used to determine the factors associated with mean of overall knowledge of birth defects. Test statistics was done at a 5% level of statistical significance. RESULTS: The mean age of the women was 31.7 ± 4.8 years. Overall, 93 (22.4%) of the women were above 35 years, 118 (29.9%) were skilled workers and 343 (84.9%) had tertiary education. More than half (219, 52.8%) of the respondents had good knowledge of birth defects (56.4% had good knowledge of prevention and 66.0% had good knowledge of risk factors). Antenatal clinic attendees in their first trimester had higher mean overall knowledge score (8.3 ± 4.9) compared to those in second (7.9 ± 4.5) and third (7.9 ± 4.9) trimesters but this was not statistically significant (p=0.873). However, respondents in skilled/ semi-skilled occupation (8.62) had a significantly higher mean knowledge score compared with those in unskilled occupation/ unemployed (7.33) (p=0.005). CONCLUSION: Knowledge of birth defects is relatively low among women. To reduce the occurrence and severity of birth defects, there is a need to educate mothers on the knowledge, prevention and importance of screening for birth defects.

CONTEXTE: Le fardeau des malformations congénitales est disproportionnellement plus élevé dans les pays en développement. OBJECTIFS: Cette étude a évalué les connaissances sur les facteurs de risque et la prévention des malformations congénitales chez les patientes des consultations prénatales de l'University College Hospital, Ibadan, État d'Oyo, Nigéria. MÉTHODES: Il s'agissait d'une étude transversale auprès de 415 mères qui se sont présentées à la clinique prénatale. Un questionnaire semi-structuré a été utilisé pour obtenir des informations sur le profil sociodémographique des répondantes, la grossesse, l'histoire de la naissance, les connaissances sur la prévention et les facteurs de risque de malformations congénitales. Des statistiques descriptives ont été utilisées pour présenter les résultats, un test indépendant et une ANOVA ont été utilisés pour déterminer les facteurs associés à la moyenne de la connaissance globale des malformations congénitales. Les statistiques du test ont été effectuées à un niveau de signification statistique de 5 %. Soins prénatals, Santé de l'enfant, Connaissances. RÉSULTATS: L'âge moyen des femmes était de 31,7 ± 4,8 ans. Dans l'ensemble, 93 (22,4%) des femmes avaient plus de 35 ans, 118 (29,9%) étaient des travailleurs qualifiés et 343 (84,9%) avaient un diplôme de l'enseignement supérieur. Plus de la moitié (219, 52,8%) des répondants avaient une bonne connaissance des malformations congénitales (56,4% avaient une bonne connaissance de la prévention et 66,0% avaient une bonne connaissance des facteurs de risque). Les patientes en consultation prénatale au cours de leur premier trimestre avaient un score de connaissance global moyen plus élevé (8,3 ± 4,9) par rapport à celles des deuxième (7,9 ± 4,5) et troisième (7,9 ± 4,9) trimestres, mais cela n'était pas statistiquement significatif (p = 0,873). Cependant, les répondants exerçant une profession qualifiée/semi-spécialisée (8,62) avaient un score moyen de connaissances significativement plus élevé que ceux exerçant une profession non qualifiée/chômeur (7,33) (p=0,005). CONCLUSION: La connaissance des malformations congénitales est relativement faible chez les femmes. Pour réduire l'occurrence et la gravité des malformations congénitales, il est nécessaire d'éduquer les mères sur les connaissances, la prévention et l'importance du dépistage des malformations congénitales. MOTS-CLÉS: Malformations congénitales.

EFFECT OF TRAINING ON KNOWLEDGE AND ATTITUDE TO STANDARD PRECAUTION AMONG WORKERS EXPOSED TO BODY FLUIDS IN A TERTIARY INSTITUTION IN SOUTH-WEST NIGERIA.

INTRODUCTION: Standard precaution in the workplace reduces the risk of occupational hazards among workers exposed to body fluids of humans and animals. Training on standard precaution has been recommended as a strategy to improve knowledge, attitude and compliance to these guidelines. This study therefore determine the effect of training on knowledge and attitude to standard precaution among workers exposed to body fluids of humans and animals in the University of Ibadan, South-west, Nigeria. METHODS: This was an interventional study among workers exposed to body fluids of humans and animals. A total survey of all faculties where staff and student come in contact with human and animal body fluid was done. Selected staff were trained for two days on standard precaution. A self-administered questionnaire was used to obtain information on socio-demographic information, knowledge and perception of staff on standard precaution. The maximum obtainable knowledge and attitude scores were 27 and 6 points respectively. The mean knowledge and attitude score were determined at pre-test and post-test. Frequency, proportion, mean and standard deviation were used for summary statistics and an independent t-test was performed to test for association. Statistical significance was set at 5%. RESULTS: A total of 136 and 123 responses were obtained at pre-test and posttest respectively. A little over half of the respondents were females (51.5%) and below 40 years (54.4%). The mean knowledge score among the workers increased from 22.59 ± 3.4 at pre-test to 22.83 ± 3.2 at post-test, but it was not statistically significant. However, the mean post-test attitude score (5.10 ± 1.4) was significantly different from the pre-test attitude score (4.49 ± 1.5). CONCLUSION: Training improved the knowledge and attitude of workers exposed to body fluids of humans and animals working in the University of Ibadan on standard precaution. Periodic training on standard precaution is therefore recommended to sustain a proper attitude to standard precaution guidelines.

Validation and Reliability of the 12-item Zarit Burden Interview among Informal Caregivers of Elderly Persons in Nigeria.

Research on ageing in Nigeria has shown that informal care places economic and psychological strain on the caregivers of the elderly persons. However, objective method of assessment of the burden of care for the elderly among caregivers is lacking. This study was aimed at validating the 12-item Zarit Burden Interview (ZBI) among caregivers of elderly persons in Nigeria in correlation with the Katz Index of Independence in Activities of Daily Living (Katz-ADL), the General Health Questionnaire (GHQ-12) and the Modified Conflicts Tactics Scale for Elder Abuse (MCTS). Eighty primary caregivers of community-dwelling elders were selected using a two-stage cluster sampling from two communities. Principal component analysis with varimax rotation was used to determine the factor structure of the ZBI. Construct validity was assessed using Spearman's correlations between the ZBI, the GHQ-12, Katz ADL and MCTS. Internal consistency and instrument reliability were examined with the Cronbach's alpha split-half correlation. Three factors with eigenvalues greater than 1.0 were extracted on the exploratory factor analysis comprising all 12 items accounting for 68.0% of the total item variance. The reliability analysis gave a Cronbach's α of 0.90 and a split-half correlation coefficient of 0.84. Spearman's correlation (rs) showed good correlation between the ZBI scores and GHQ-12 (rs=0.44, p<0.001), MCTS (rs=0.43, p<0.001) and Katz ADL (rs= -0.50, p <0.001). The 12-item ZBI is a valid and reliable tool for assessing burden in informal settings among caregivers of elderly persons. The tool can be used to assess burden of care among caregivers of elderly persons in community settings.

Perceived effectiveness of graphic health warnings as a deterrent for smoking initiation among adolescents in selected schools in southwest Nigeria.

BACKGROUND: There has been a sustained increment in young people initiating smoking in low middle income countries like Nigeria. Health warnings on cigarette packages are a prominent source of health information and an effective means of communicating specific disease risks to adolescents and young adults alike. This study evaluated the perceived effectiveness of selected graphic warnings on smoking initiation amongst in-school adolescents. METHODS: This was a cross-sectional study conducted amongst secondary school students aged 13-17years in Igbo-Ora, Nigeria. A two-stage sampling technique with the school classes as the final sampling unit was used to select the students. An interviewer assisted questionnaire was used to obtain information on students demographic characteristics and their perception of graphic warnings using four images from the pictorial health warning galleries of the World Health Organization showing: 'cigarette smoking causes cancer of the airways, harms children, causes stroke and causes impotence respectively'. RESULTS: A total of 544 senior secondary students were included in this study with a male female ratio of 0.8:1. Of those interviewed, 40 (7.4 %) indicated that they had ever considered smoking, nine (1.7 %) responded that they had ever smoked and two students indicated that they were current smokers. With all the images, fear was the dominant emotion expressed by the respondents. This was expressed by 307 (56.4), 215 (39.5), 203 (37.3) and 228 (41.9 %) respondents to images 1, 2, 3, and 4 respectively. Furthermore, 76.7, 44.7, 58.5 and 62.1 % of respondents felt Images 1, 2, 3 and 4 respectively will to a large extent prevent people from initiating smoking. There was no association between perceived effectiveness and gender. However, those younger than 15 years rated images on cancer of the airway and impotence as probably effective to a larger extent than did those who were 15 years and older (p = 0.032). CONCLUSION: Introduction of graphic health warnings, especially with an imagery depicting cancer and impotence may influence non-smokers to remain abstinent. Therefore, this study provides a template for a future policy-relevant study on graphic health warning in Nigeria.

Evaluation of the haemodynamic and metabolic effects of local anaesthetic agent in routine dental extractions.

INTRODUCTION: The systemic effects of adrenaline administered during dental local anesthesia have been the subject of many studies. The purpose of this study was to investigate the haemodynamic and metabolic effects attributable to adrenaline injected during local anesthesia in dental extraction patients. METHODS: Apparently medically fit patients were included and randomized into two groups. Participants had breakfast before coming in for tooth extraction. The weight, height, blood pressure and pulse rate were measured and blood sample taken before administration of local anaesthetic injections. Blood pressure, pulse and blood sample were again taken at 15 and 30 min. RESULTS: While the adrenaline group showed a modest increase between pre- and post-drug administration states, the control group showed no difference in median systolic blood pressures. Both groups showed a slight increase in diastolic blood pressure observed between pre- and post-drug administration states. Also both groups showed no significant difference in median pulse rate throughout. Although blood glucose values were widely dispersed in the pre-drug administration state in both groups, the control group showed no difference in median values throughout. However, a modest increase was observed in the adrenaline group between pre- and post-drug administration states, which persisted beyond 30 min. CONCLUSION: The patients treated with local anesthesia with adrenaline showed a response similar to that observed in the control group.

Factors influencing the choice of health care providing facility among workers in a local government secretariat in South Western Nigeria.

BACKGROUND: There is increasing interest in the choice of health care providing facility in Nigeria. OBJECTIVES: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local government staff. METHODS: A cross sectional survey of all 312 workers in a Local Government Secretariat in South West Nigeria was done. Chi Square and logistic regression analysis was done. RESULTS: The mean age was 38.6 ± 7.5 years, 55% were females and 71.7% had tertiary education. The median monthly family income of the respondents was N 28, 000 (N3,000 - N500,000), with 24.4% earning a monthly income of N21, 000 to N30, 000. Many (72.3%) utilized public health facilities attributing the choice to the low cost of services. Respondents who are satisfied with their usual care providing facilities are 12.2 times more likely to have used public facilities than private facilities (95%, CI 3.431 - 43.114). Respondents who described the quality with ease of getting care/short waiting times as being good are 3.9 times more likely to have private facilities as their chosen health care providing facility (95%, CI 1.755 - 8.742). Cost/payment for service is 2.9 times more likely to predict the use of public health facility as the usual health care provider. CONCLUSION: Private facilities though costlier do not appear to be providing better services than public facilities. To increase access to health care the cost of services and the waiting time are important factors to address.

Experiences of mistreatment among medical students in a university in south west Nigeria.

OBJECTIVE: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. MATERIALS AND METHODS: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. RESULTS: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. CONCLUSION: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.

Perception and practice of child labour among parents of school-aged children in Ibadan, southwest Nigeria.

BACKGROUND: The problem of child labour has lingered on in many countries because of the complex combination of social, cultural and economic factors involved. Parents play a critical role in child labour as it provides much needed extra income for the family. This study was carried out among parents of school-aged children in an urban, low-income community to determine the factors associated with child labour and attitudes to child labour in the community. METHODS: A cross-sectional study was carried out in an urban community in Ibadan, southwest Nigeria. Questionnaires were administered to parents of school-aged children. RESULTS: A total of 473 parents were interviewed. They were aged between 23 and 56 years, mean 37.9 years. Thirty-nine per cent of parents indicated that they thought their school-aged children should work. More women than men, those from polygamous homes and those with lower educational status held this view. Reasons given for wanting their children to work were to supplement family income, 45%, to gain experience, 35% and to help in family business, 10%. In all, 236 (50%) respondents reported that their school-aged children were working. Parental factors associated with practice of child labour were polygamous marriage, low educational status, unskilled or partly skilled occupation and large family size. Seventeen per cent of parents with working children were not satisfied with their children's work conditions and complained of low earnings, long working hours, work on school days and unsafe work environment. Measures suggested to control child labour include addressing the issue of household poverty, public enlightenment about the ills of child labour and free education up to junior secondary level. Enforcement of child labour laws was the least mentioned. CONCLUSION: We conclude that control of child labour should be a multifaceted approach involving poverty alleviation, family planning to reduce family size and free, compulsory education up to junior secondary level. Public enlightenment especially for mothers will be of additional benefit.

Falls and outcomes amongst old people in rural dwellings.

BACKGROUND: Falls are the leading cause of injury deaths among people 65 years and older. This study gives an insight into the prevalence of falls among older people and how they occur in a rural setting in Nigeria. METHODS: A community based survey of 210 consenting old people aged 65 years and above selected using a multi-stage sampling technique was done. Study instrument was a semi-structured interviewer administered questionnaire and visual acuity was tested using Snellens chart. RESULTS: Incidence of falls was 21.4%. Of those who had falls, 86.7% were walking while 11.1% were either sitting or running when it occurred. The nature of the fall was tripping in 44.4%, slipping in 35.6% and hitting an object in 17.8% of cases. Consequences of falls included pain 48.9%, bruises 22.2%, lacerations 13.3% and fractures 11.1%. Females had more falls than males; 23.8% vs 19.0%, p = 0.40. Major injuries resulting from falls also occurred more frequently amongst females than males; 30.7% vs. 15.0%, p = 0.3. History of diabetes and alcohol use increased the odds of falling (OR 4.1, 95% CI 1.0 - 16.0; OR 2.2, 95% CI 1.0 - 4.6 respectively). Being in a monogamous marriage and having normal sight were protective of having falls (OR 0.4, 95% CI 0.2 - 0.9; OR 0.4, 95% CI 0.2 - 0.9 respectively). CONCLUSION: Falls often occur from tripping and slipping while females are more likely to have major injuries. Risk factors for falls were alcohol use and diabetes while having normal sight and being monogamous were protective. Prevention should aim at a life course approach to addressing these intrinsic and extrinsic factors.

Sexual risk behaviour of street youths in south west Nigeria.

OBJECTIVES: Previous studies have mainly focused on sexual behaviour of in-school Nigerian youths with little attention to those on the street. This survey was conducted to determine the sexual risk behaviours of young people on the streets of Ibadan, Nigeria. METHODOLOGY: A cross sectional survey was conducted among youths aged 15-24 years in the major markets, motor parks and commercial areas in two local government areas in Ibadan. Participants in the study areas were identified in groups based on their occupational activity and all consenting young people were interviewed. A semi-structured questionnaire was used to obtain information on sexual behaviours, condom use and history of sexually transmitted infections. Data was managed using SPSS version 11. RESULTS: Most (68.8%) were males, 79.0%, were sexually experienced, the median age at sexual debut for males was 15 years and 16 years for females. More females (53.9%) compared to (34.5%) males reported that their first partners were five or more years older, p < 0.01. Condom use during the first sexual intercourse was reported by only 32.2%. Sex with a commercial sex worker or exchange of sex for money was reported by 18.2% (20.6% of males versus 12.2% of females, p = 0.01). Factors significantly associated with history of transactional sex were; male gender; older age (20-24 years); being out of school and regular alcohol use. Multiple sexual partnering was reported by 58.2%, the significant predictors were male gender; early age at sexual debut; regular alcohol use and history of transactional sex. Inconsistent condom use was reported by 44.8%, the predictors were female gender; regular alcohol use and history of transactional sex in the previous year. CONCLUSION: Majority of these young people on the streets are sexually active and many engage in high risk sexual behaviours. Development of appropriate sexual and reproductive health interventions is recommended.