The functional status of disease surveillance and notification system at the local government level in Yobe State, Nigeria.

BACKGROUND: An effective Disease surveillance system provides information that is required for appropriate action. Although evaluated by attributes like sensitivity, predictive value and representativeness, the assessment of its operational status is critical, especially in developing countries. METHODS: We conducted this cross sectional survey among 144 health personnel from facilities and Local Government disease surveillance officers, using pre-tested, semi-structured, self-administered questionnaire and observational checklist. RESULTS: This showed that only 55 (38.2%) of the respondents were aware of the Disease surveillance and notification (DSN) system. Fifty-eight (65.9%) and 7 (8.0%) of the facilities had up-to-date registers and DSN forms respectively. Diagnostic support was lacking in most of the health facilities. Data was not analysed at LGA level, and forms and logistics for supervising disease surveillance activities and feedback were inadequate. CONCLUSION: We recommend training/retraining of health personnel on infectious disease surveillance, provision of logistics, improved supervision and feedback of information.

Maternal health in Northern Nigeria: a far cry from ideal.

OBJECTIVE: To determine the level of maternal care in Northern Nigeria. DESIGN: A cross-sectional descriptive study design was used. SETTING: The Study was Community based and carried out in the ten states that constitute UNICEF D zone in northeast Nigeria. POPULATION: Women who delivered in the 11 months preceding the survey and resident in the study area. METHODS: The WHO cluster sampling methodology was used to draw a sample of 210 eligible women in each of the 10 local government areas (LGAs). MAIN OUTCOME MEASURES: Utilization of antenatal care (ANC) services, tetanous toxoid immunization, skilled attendant at delivery and postnatal care. RESULTS: Majority of the respondents, 73.2%, were between the ages 20 and 34 years. Overall, 50% of the women attended antenatal clinics during their last pregnancy, with a range of ANC coverage by LGA of 14.0-81.0%. The proportion of women who booked in the first, second and third trimesters was 22.8, 63.0 and 14.2%, respectively. The antenatal services offered ranged from 95.7% for abdominal examination to 41.2% for urine examination. Sixty percent of the women received no tetanus toxoid in their last pregnancy, 11% had one dose and 29% had at least two doses. Home delivery was still the norm throughout the zone with 1791 (85.3%) delivering at home. Up to 80.5% of the deliveries were supervised by personnel with no verifiable training in sanitary birthing techniques. Only 11.4% (233) of those who received ANC had postnatal check-up. CONCLUSIONS: Maternal health care as evidenced above is far from the ideal. Likewise, the commitment of the 5th Millennium Development Goal is extremely far-reaching: to reduce the maternal mortality ratio by 75% by the year 2015 with this level of maternal care.

AIDS: Perceptions and Misperceptions among Students of a Nigerian University.

INTRODUCTION: The AIDS pandemic has led to the global clamouring for its control. This work was aimed at assessing the level and factors that determine the awareness of undergraduate Students of Usmanu Dandfodiyo University, Sokoto. METHODOLOGY: In a descriptive cross-sectional study, a total of 450 students were recruited by means of multistage and simple random sampling techniques. RESULTS: Overall, there is a knowledge gap on aetiology, mode of transmission and preventive measures with only 40.2% and 38.5% of the respondents having adequate knowledge and indicated their willingness to learn more about AIDs respectively. Age (P<0.05), Sex (P<0.005) and number of years spent in the University (P<0.025) are important determinants of level of AIDS knowledge. CONCLUSION AND RECOMMENDATIONS: This finding could be as a result of strong interactions between the social environment and human sexuality. Hence, student bodies should be involved in reproductive health programmes. Key words: awareness, university students, AIDS.

Utilization of obstetric care services in a rural community in southwestern Nigeria.

Utilization of Obstetric Services in Nigeria is very low with only a third of the deliveries being conducted under supervision of trained health personnel. Consequently maternal and infant mortality rates are unacceptably high at 1000/100,000 and 100/1000 live births per year respectively. We conducted a cross-sectional survey of 100 randomly sampled women in a rural community in Oyo State in Nigeria to study the pattern of utilization of antenatal, delivery and postnatal care services in the community. Results showed that utilization of antenatal care services to be relatively high but most of the respondents delivered at home without the supervision of trained health personnel. This poor utilization of delivery services was attributed to advanced labour and perceived poor quality of the health facilities in the community. Although postnatal care was given to the respondents, it did not include advice on family planning/child spacing. The variables found to have statistically significant association with seeking antenatal care were age and educational attainment (P < 0.0005). Educational attainment also significantly affects the respondents' choice of the place of delivery (P < 0.005). We recommend operations research to assess and improve the quality of existing health facilities and training/retraining of antenatal care providers on interpersonal communication skills, early recognition of labour and seeking delivery care. This training should also include providing advice on child spacing and use of obstetrics services provided.

The knowledge, attitude and practices of the reporting of notifiable diseases among health workers in Yobe State, Nigeria.

Effective surveillance is the key to effective disease control in the community. In Nigeria, it is weak with duplication of data collection and multiple reporting channels. There is also lack of clarity with regards to data submission responsibilities. However, the knowledge of reporting requirements and responsibilities among health personnel has not been examined adequately as a cause of under reporting. This study was designed to assess the knowledge of health workers about disease surveillance. A cross sectional study was conducted in six randomly selected local government areas in Yobe State, North Eastern Nigeria. A total of 144 health personnel from 88 health facilities were administered a pre-tested semi-structured questionnaire and a checklist by trained research assistants. The result showed that only fifty-five (38.2%) of the respondents were aware of the national disease surveillance system. Their mean score regarding immediate notifiable diseases was 0.8 +/- 1.23 SD (maximum of 10). Thirty nine (70.9%) reported to have ever reported, while 16 (29.1%) have never reported any of the notifiable conditions. Only 12 (21.8%) of the respondents claimed to have ever received feedback on the reports they forward to higher authorities and more than 92% of the health facilities lack the DSN 001 and 002 forms. Most of the respondents 47 (85.5%) that were aware of the reporting requirements listed lack of training on disease surveillance as one of the factors affecting disease reporting. This shows that lack of knowledge of reporting requirement was identified as a major factor affecting disease surveillance among the respondents. The training and retraining of health workers responsible for data generation, collection and forwarding in health facilities on disease notification, regular feedback on diseases reported and provision of forms were recommended in order to improve the disease surveillance system.

Village health workers' and traditional birth attendants' record keeping practices in two rural LGAs in Oyo State, Nigeria.

Village health workers (VHWs) and Traditional Birth attendants (TBAs) provide health care services to the communities in which they live, improving access to health care as well as serving as an important link between the periphery (the communities) and the health sector. The data this category of workers generates about their communities will strengthen primary health care management information system in Nigeria. The objective of this study was to assess the knowledge, attitude and practices of VHWs and TBAs regarding record keeping in Ibarapa Central and Akinyele local government areas (LGAs) of Oyo State, Nigeria. Using a pre-tested, semi structured questionnaire and an observation checklist, trained research assistants visited and interviewed all the active, registered VHWs and TBAs in the two LGAs. Results showed that there were a total of 62 and 102 active VHWs/TBAs in Ibarapa Central and Akinyele LGAs respectively with most of them being farmers aged between 30-59 years. Over two-thirds in both LGAs knew the uses of record keeping for monitoring and evaluation purposes and most of them felt that keeping records was easy. Sixty-one percent of the respondents in Ibarapa Central and 96% of those in Akinyele LGA reported keeping records of their health activities. Of those who kept records, two thirds in Ibarapa Central and almost all (96%) in Akinyele LGA reported forwarding the records they keep. The type of records they keep was mostly on patients' treatment and (in Akinyele) delivery records using an exercise book. Most did not have the VHW/TBA record of work or the community profiles (wall chats) developed and recommended by the Federal Ministry of Health (FMOH) because they were not supplied. The factors associated with record keeping included duration as a VHW/TBA, previous training on record keeping, receiving feedback. Recommendations made included ensuring availability of materials and periodic training and re-training of the VHWs/TBAs by the LGAs, and regular provision of feedback by the National Primary Health Care Development Agency (NPHCDA).

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience.

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

Penicillinase producing Neisseria gonnorhoeae: the review of the present situation in Ibadan, Nigeria.

All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Voluntary health workers' knowledge, attitude and practices regarding record keeping in Akinyele LGA of Oyo State, Nigeria.

Lack of basic health data for monitoring and evaluation of health services continue to affect the planning, implementation and evaluation of health services in Nigeria. This has contributed to the poor health status and inefficient health services in the country. In the primary health care management information system (PHCMIS), Voluntary Village Health Workers (VHWs) and Traditional Birth Attendants (TBAs) are responsible for collecting information at the community/village level. Trained research assistants administered a pretested semi structured questionnaire and filled an observation checklist to all the voluntary health workers in Akinyele LGA of Oyo State in a cross-sectional survey conducted to assess their record keeping practices as well as their knowledge of and attitude towards it. Results showed that almost half of the respondents had no formal education and a similar proportion had been VHWs for between over 10 years. Over eighty per cent knew the uses of record keeping for monitoring and evaluation purposes. Their attitude towards it was positive and almost all felt it was easy to keep records. Ninety six percent keep records of their health activities and most forward them. It was observed that only 11 (10.8%) respondents had the VHW/TBA record of work produced and recommended by the Federal Ministry of Health because they were reportedly not supplied to them. The factors that were associated with record keeping practices were positive attitude towards record keeping, duration of work as a VHW/TBA, prior training on record keeping and receiving feedback on records kept. Recommendations made included periodic training and retraining of the VHWs on record keeping, ensuring consistent supply of record forms and providing regular feedback on records kept to the VHWs.

Morbidity in rural southwestern Nigeria: a one year follow up of voluntary health worker consultations in Idere, Oyo State, Nigeria.

There is paucity of information on morbidity pattern at the community level in Nigeria. Available literature shows that most are based on hospital data from which rates cannot be generated. In addition, the low access to hospitals in the country especially in rural areas, coupled with inappropriate health care seeking behaviour in the community limits the usefulness of information derived from hospital data. This study was aimed at determining disease patterns in a rural community in Nigeria using the records of voluntary health workers. We followed up a well-defined rural community for one year and collated records of active voluntary health workers (VHWs) who provide health care to these communities. Results showed that Malaria, upper respiratory tract infections (URTI), diarrhoea, measles and accidents were the most common ailments for which the community members sought health care. The annual morbidity rates were malaria 25.4%, URTI 6.0%, accidents 3.2%, and diarrhoea 2.7%. Rates generally decrease with increasing age, except for accidents, for which the rates were highest amongst school-aged children (5-14 years) and lowest amongst adults. Recommendations made include strengthening malaria control efforts, improving routine immunization coverage and providing health education regarding accident prevention.

Non-gonococcal urethritis due to Chlamydia trachomatis: the Ibadan experience.

Using a qualitative amplified enzyme-linked immunoassay, two hundred and eighty-nine male patients with symptoms and signs suggestive of urethritis were investigated for Chlamydia trachomatis as a cause of non-gonococcal urethritis (NGU). Ninety-one (31.49%) of the 289 male patients investigated had gonococcal urethritis whilst 198 (68.51%) had NGU out of which 112 (56.60%) had chlamydial urethritis and 14 (7.1%) had Trichomonal urethritis. Two (6.7%) of the control subjects had C. trachomatis in their urethral swabs. The difference in the occurrence of C. trachomatis between the patients and the controls was highly statistically significant (P<0.001). The age range of peak incidence among the patients investigated was 20-29 years. Thirteen of the men treated for gonorrhoea still had watery urethral discharge and irritation and were diagnosed as having post-gonococcal urethritis (PGU), eleven (84.6%) of whom had C. trachomatis demonstrated in their urethral swabs. We were able to demonstrate a significant difference in clinical symptoms in men with gonorrhoea and NGU but only a slight difference between men with chlamydia-positive NGU and chlamydia-negative NGU.

Pattern of sexually transmitted diseases among commercial sex workers (CSWs) in Ibadan, Nigeria.

The purpose of this study was to determine the pattern of STDs among commercial sex workers (CSWs) in Ibadan, Nigeria. The subjects were 169 CSWs randomly selected from 18 brothels, majority of who were examined and investigated in their rooms. Another 136 women without symptoms who visited the special treatment clinic, University College Hospital, Ibadan were selected as a normal control group. Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control group. The other STDs in their order of frequency were HIV infection 34.3%, non-specific vaginosis 24.9%, trichomoniasis 21.9% and gonorrhoea and "genital ulcers" had an incidence of 16.6% each. Other important conditions were tinea cruris 18.9%, scabies 7.7% genital warts 6.5% and 4.1% of them had syphilis sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with "genital ulcers" had HIV infection. While there was no significant difference between the CSWs with vaginal candidiasis, gonorrhoea, trichomoniasis and the control group, the HIV positivity was significantly higher (P < 0.001) in CSWs than in the control subjects. These findings suggest that women who exchange sexual services for money can no longer be ignored, and should therefore be identified and made to participate in STD prevention and control programmes.

Non-penicillinase producing Neisseria gonnorhoeae: are they still in existence in Ibadan, Nigeria?

In an attempt to evaluate the current prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) and whether non-PPNG strains are still in existence in Ibadan, Nigeria, all isolates of Neisseria gonorrhoeae from patients that attended our clinic between January and December 1997 were studied. Of the 155 patients that had gonococcal infections, 118 were male (76.1%) and 37 (23.9%) were female with 31 (83.8%) being the partners of infected men. Sixty-four (54.2%) of the male and 19 (51.4%) of the female were aged between 20 and29 years while 21.2% of the male and 16.2% of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=1.47,P=-0.69). The present study revealed that non-PPNG strains have reduced considerably to 5.4% from 100% in 1977. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Pattern of condom use among commercial sex workers in Ibadan, Nigeria.

Regular condom use has been proven to remarkably reduce the transmission of sexually transmitted diseases (STDs) and its regular use for casual and commercial sex is important for the success of any STD/AIDS control programme. We studied the pattern of condom use among commercial sex workers in Ibadan, Nigeria in an attempt to identify the factors associated with it. Two hundred and ninety-five commercial sex workers in 21 brothels were randomly selected, using a multi-stage sampling technique, from a total of 31 identified in the 5 local government areas that make up Ibadan municipality. They were administered a pre-tested, semi-structured questionnaire by trained research assistants. Results showed that over half (53.2%) of the respondents were in the 20-29 year age group and most (71.5%) had been in the profession for less than a year. Sixty-five (22.0%) had no formal education, 29.8 % had some secondary education whilst 22.4 % had completed secondary school. Their overall knowledge of sexually transmitted diseases (STDs) was rated as poor (20.7%), moderate (64.1%) and good (15.2%). Their perceived risk of contracting HIV/AIDS was low (21.7%) although 87.8% regard it as a health problem in Nigeria. Eighty-three percent of the respondents always insisted that their clients used condoms, 13.2% did so frequently whilst 1.4% only occasionally. Of those who asked clients to use condoms, 69.5% of the women would refuse sex without condoms, 49 (16.6%) would do nothing and have sex without condoms, but 4.4% would charge extra money. No factor was found to have a significant association with the practice of asking clients to use condoms or of refusing sex without condoms. We concluded that consistent condom use was high among sex workers in brothels in Ibadan and was independent of the sex workers knowledge and perception of STDs.

Prevalence of low back pain among staff in a rural hospital in Nigeria.

A cross-sectional study was carried out in a rural hospital in south-western Nigeria to determine the prevalence of low back pain among its staff. The questionnaire administered to staff sought information on social and demographic characteristics, job history, smoking status, frequency and severity of low back pain and factors predisposing to low back pain. Seventy-four out of a total of 80 workers participated in the study. The prevalence of low back pain among staff was 46%. The highest prevalence of back pain (69%) was recorded among nursing staff, followed by secretaries/administrative staff (55%) and cleaners/aides (47%). Heavy physical work (45%), poor posture (20%) and prolonged standing or sitting (20%) were the most frequent activities reported to be associated with low back pain among these workers. The prevalence of low back pain among these workers is comparable to that of workers in high income countries. Health education on posture and correct lifting techniques can be introduced to reduce the burden of low back pain among these workers.