Maternal mortality ratio in selected rural communities in Kebbi State,Northwest Nigeria

Background

Maternal mortality remains a topical issue in Nigeria. Dearth of data on vital events posed a huge challenge to policy formulation and design of interventions to address the scourge. This study estimated the lifetime risk (LTR) of maternal death and maternal mortality ratio (MMR) in rural areas of Kebbi State, northwest Nigeria, using the sisterhood method.

Methods

Using the sisterhood method, data was collected from 2917 women aged 15–49?years from randomly selected rural communities in 6 randomly selected local government area of Kebbi State. Retrospective cohort of their female siblings who had reached the childbearing age of 15?years was constructed. Using the most recent total fertility rate for Kebbi State, the lifetime risk and associated MMR were estimated.

Result

A total of 2917 women reported 8233 female siblings of whom 409 had died and of whom 204 (49.8%) were maternal deaths. This corresponds to an LTR of 6% (referring to 11?years before the study) and an estimated MMR of 890 deaths/100,000 live births (95% CI, 504–1281).

Conclusion

The findings provide baseline information on the MMR in rural areas of the State. It underscores the need to urgently address the bane of high maternity mortality, if Kebbi State and Nigeria in general, will achieve the health for all by year 2030 as stated in the Sustainable Development Goals (SDGs).

     

Meeting the challenges of North-South collaboration: the case of HIV prevention for rural youth, Edo State, Nigeria

Despite the significant contributions of the various North-South research partnerships during the past five decades to enhancing research capacity in the South, they have faced a number of challenges associated with the various partnerships. There have been limited attempts to critically examine the successes and challenges associated with these partnerships. Based on the experiences of implementing the 'HIV Prevention for Rural Youth' programme by a Canadian-Nigerian partnership during a four year period, this paper outlines the successes achieved and the challenges faced. The paper reviews the context of contemporary North-South research collaboration which provided the framework for the implementation of the HIV Prevention for Rural Youth. It then examines the benefits which the implementation of the programme have stimulated as well as the various challenges which confronted the partnership and how they were handled. The implications of the project's implementation experiences for future North-South collaborative research programmes are highlighted.     

Women's experience of menopause in rural communities in Orlu, Eastern Nigeria

ObjectiveTo document women's experience of menopause in rural communities in Orlu, Eastern Nigeria, and to compare this with urban centers in Nigeria and worldwide.MethodsA total of 349 women who had not menstruated for at least 12 months were included in a questionnaire-based study. The questionnaire included questions on sociodemographic characteristics, age at menarche and menopause, attitude to menopause, and knowledge and use of hormone replacement therapy. Questionnaires were administered in 13 communities by medical students during the Annual Convention of Christian Women in August 2009.ResultsThe mean age at menopause of the women was 47 ± 4.2 years. Menopausal symptoms were prevalent, and bone and joint pain were the most prevalent symptoms. Knowledge and use of hormone replacement therapy were poor. Most of the women considered the menopause to be beneficial.ConclusionAge at menopause and associated postmenopausal symptoms were similar to those seen in urban centers in Nigeria, but age at menopause was lower than in studies of white women. Despite the apparent positive attitude of Nigerian women to menopause, a program of information and education, and use of hormone replacement therapy will improve quality of life for women in Eastern Nigeria.     

Empowering teachers to change youth practices: evaluating teacher delivery and responses to the FLHE programme in Edo State, Nigeria

School-based programming is one of the most common approaches to HIV/AIDS prevention among youth. This paper presents the history and development of the Family Life and HIV Education (FLHE) programme in Edo State, Nigeria and results of evaluation of teacher actions and responses to training in its delivery. Results indicate that teachers benefited from the training, were aware of new and/or existing teaching resources and began to teach about HIV/AIDS. Teachers expressed that the programme facilitated open dialogue about HIV/AIDS. However, given limited human resources, FLHE was viewed as additional work to already overloaded teaching schedules. It is recommended that the Ministry of Education channel resources to enhance teachers' efforts towards combating HIV/AIDS. To facilitate learning about sexual health and family life, it is recommended that FLHE-based training be viewed as the first rather than the only step towards teacher professional development in this area.     

Evaluation of school- and community-based HIV prevention interventions with junior secondary school students in Edo State, Nigeria

This study examined the impact of two interventions delivered in rural communities and schools in Edo State, Nigeria designed to decrease youth vulnerability to HIV infection. The Ministry of Education approved Family Life and HIV Education (FLHE) programme delivered in Junior Secondary Schools and a community-based initiative to raise AIDS Competency of rural communities were evaluated using a clustered randomized control trial and mixed qualitative-quantitative methods. Ten schools were assigned to each of three research arms: FLHE programme only, FLHE and community programme, and control. Results demonstrated positive effects on rejection of myths, attitudes related to abstinence and use of condoms, and sexual activity. Confidence in these results is supported by both levels of statistical significance and consistency in patterns of results across different levels of schooling. Results support expansion of delivery of the FLHE programme and development of community-based initiatives as effective methods of reducing youth vulnerability to HIV infection.     

Assessing the role of traditional birth attendants (TBAs) in health care delivery in Edo State,Nigeria

This study was conducted to assess the role of traditional birth attendants (TBAs) in modern health care delivery in Edo State, Nigeria. A total of 391 respondents comprising 48 TBAs, 309 childbearing mothers and 34 medical and para-medical professionals constituted the study sample. In-depth interviews and focus group discussions as well as validated questionnaires were the tools used for data collection. The results reveal that respondents believe that TBAs can play meaningful roles in family planning, screening of high-risk pregnant mothers, fertility/infertility treatment and maternal and child care services. Rural dwellers prefer to use the services of TBAs, as compared to their urban counterparts. Reasons for the preference included TBAs, availability, accessibility, cheap services and rural dwellers' faith in the efficacy of their services. There is, therefore, the need to restructure the training of TBAs as well as to fully integrate their services into the Nigerian orthodox healthcare delivery system especially as they affect rural settings.     

Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria

IntroductionThe majority of human immunodeficiency virus (HIV) infections are acquired through unprotected sex between partners; only male or female condoms can reduce the chances of infection with HIV during a sexual act.AimThis study was therefore designed to describe sexual risk history and identify factors associated with condom use among people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHAs) in Ogun State, Nigeria.Main Outcome MeasuresMain outcome measures are sexual and HIV risk history, safe sex practices, and condom use.MethodsThis study is an analytical cross‐sectional study. A total sample of all people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study.ResultA total of 637 were interviewed; median age at first sexual intercourse among the study participants was 19 years (mean age = 18.95, standard deviation [SD] = 4.148) with a median of two lifetime sexual partners (mean = 3.22, SD = 3.57). Majority (71.4%) of the respondents had not been diagnosed with a sexually transmitted infection other than HIV. Precisely 47.7% of men and 52.3% of women had two or more sexual partners in the last 6 months. Men were statistically significantly more likely to have multiple sexual partners when compared with women (P = 0.00). Significantly more women (69.8%) than men (30%) had sexual partners whose HIV status they did not know (P = 0.006). Predictors of condom use were individuals who had multiple sexual partners (odds ratio [OR] = 1.41, confidence interval [CI] = 1.05–1.83) and married (OR = 3.13, CI = 1.15–8.51) with higher level of education (OR = 2.78, CI = 1.39–5.79), with knowledge of partner's serostatus (OR = 2.53, CI = 1.50–4.28), and awareness of reinfection (OR = 1.90, CI = 1.22–2.95).ConclusionThe study indicates that the establishment of effective safe sex practices and condom use behavior among PLWHAs in low‐income countries such as the study population requires adequate health education on the transmission of HIV/AIDS and the understanding of the dynamics of family life and gender issues. Amoran O and Ladi‐Akinyemi T. Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria. J Sex Med 12;9:997–1004.     

Attitudes of health care providers to persons living with HIV/AIDS in Lagos State,Nigeria

This study was conducted to examine the knowledge, beliefs and attitudes of nurses and laboratory technologists towards people living with HIV/AIDS (PLWA) and the factors responsible for these attitudes. Information was elicited from 254 randomly selected nurses and laboratory technologists from 15 government owned health facilities in Lagos State with the use of a structured questionnaire. Results indicate that most of the respondents (96.3%) had moderate to good knowledge of HIV/AIDS. Respondents' level of knowledge was influenced by the level of formal education attained, length of practice, gender and attendance at refresher courses on HIV/AIDS (p < 0.05). In contrast, respondents' age, occupation and religion did not significantly influence their level of knowledge (p > 0.05). Attitude towards PLWA was poor. Some (55.9%) of the health workers felt that PLWAs are responsible for their illness, while 35.4% felt that they deserve the punishment for their sexual misbehaviours. Only 52.8% of the respondents expressed willingness to work in the same office with a PLWA, while only 18.0% would accept to visit or encourage their children to visit a PLWA, probably because of the fear of contagion. It is, therefore, essential that health care providers be properly informed in order to improve their quality of care for PLWAs.     

Prevalence,patterns and correlates of domestic violence in selected Igbo communities of Imo State,Nigeria

Three hundred and eight Igbo women were randomly selected to respond to a number of questions on experiences, patterns and attitudes to domestic violence. Data was collected using structured questionnaires that were complemented with focus group discussions. The results show that 78.8% of the women have ever been battered by their male counterparts, out of which 58.9% reported battery during pregnancy, while 21.3% reported having been forced to have sexual intercourse. The study further revealed that the practice of female circumcision is still common among this Igbo population, and 52.6% were of the view that it should be continued. Multivariate logistic regression identified the correlates of these forms of violence such as age, place of residence, age at first marriage, type of marital union, level of income of women, and level of education of husband against women in Imo State. While wife battery is more pronounced in the urban area, forced sexual relationship and female genital mutilation are more pronounced in the rural areas. We recommend education of women and integration of services in reproductive health care service delivery as appropriate measures to eradicate these practice.     

Availability and use of services for maternal and child health care in rural Nigeria.

A personal in-home interview was conducted in four rural towns in Nigeria. The aims of the interview were to describe the content of Maternal and Child Health (MCH) care in these rural towns and to assess how patterns of prenatal, delivery and postnatal service use are related to a variety of demographic and socioeconomic variables in the population. Findings from data analysis indicate that services available are deficient in terms of the number of centers and content of care. Variables found to be statistically significant (P less than 0.01) for use of services are maternal education, occupation, distance and previous use of a physician. Husband's occupation was significant only for prenatal registration, but not for subsequent use of services. Recommendations include a reorganization of rural MCH services and an introduction of female literacy programs, especially at the rural level.     

Reproductive knowledge,sexual behaviour and contraceptive use among adolescents in Niger State of Nigeria

Eight hundred and ninety six adolescents aged 11-25 years were recruited into this study using a multi-stage random sampling method. Overall, about 33% of them had already had first sexual experience but more males than females reported having experienced first sexual encounter. Only 3.6% of the respondents were married. One half of the sexually experienced adolescents had more than one sexual partner at the time of the study. Majority of the respondents (91.9%) had heard about HIV/AIDS and at least a STD. A wide disparity was found in knowledge and use of the contraceptive methods studied, ranging from 41.9% to 63.8% for knowledge and from 0.7% to 12.5% for use. Knowledge and use of condom was highest. For prevention of HIV/AIDS, more males than females thought condom was useful. More Gwari and Hausa respondents claimed that they did not use any family planning method during their first sexual relationship than Yoruba and Igbo respondents. There is need for reproductive health programmes to intensify efforts towards improving adolescents' attitudes to risky sexual behaviours and motivate them to undertake behaviours that would limit such risks.     

The role of men in family planning decision-making in rural and urban Nigeria

Objectives To determine the role of men in family planning decision-making in both rural and urban areas of Nigeria.

Methods A total number of 370 married men (244 rural and 126 urban) were interviewed using a pre-tested, semi-structured interviewer based questionnaire. The study was conducted in the Iwaro community in Atakumosa West Local Government area (rural men) and the Oranfe Community in Ife East Local government area (urban men), both in Osun State, South West Nigeria.

Results The results showed a high level of awareness of family planning among both study groups (98.3% rural and 98.4% urban). Most men in both groups believe that a decision about family planning should be made jointly by the spouses instead of being the prerogative of either. This contrasts with the generally held belief that men are opposed to family planning and a take predominant role in contraceptive decision-making. The condom was the most commonly known and used method with a preponderance among urban (81.1%) over rural men (69.4%). Many men would use family planning if their wives demanded it. However, most respondents in both study groups believed that men should not accompany their wives to the family planning centre to obtain contraceptive supplies and advice.

Conclusion Deciding about contraception should be done jointly by men and women in South West Nigeria.     

The use of the laparoscope in rural Thailand

A survey of the use of laparoscopy in rural Thailand was undertaken between June 1974 and December 1977. All the physicians were trained at either Ramathibodi Hospital, Bangkok, or The Johns Hopkins Program for International Education in Gynecology and Obstetrics and the USA; about 30% and 46% of the physicians, respectively, were endoscopically inactive. The complication rate of rural laparoscopy was high and was inversely proportional to the degree of utilization. It is concluded that for a developing country with limited resources, laparoscopic sterilization in rural areas is not cost-effective; a technique using simpler and hardier equipment should be chosen.     

The role of men in family planning decision-making in rural and urban Nigeria.

OBJECTIVES: To determine the role of men in family planning decision-making in both rural and urban areas of Nigeria. METHODS: A total number of 370 married men (244 rural and 126 urban) were interviewed using a pre-tested, semi-structured interviewer based questionnaire. The study was conducted in the Iwaro community in Atakumosa West Local Government area (rural men) and the Oranfe Community in Ife East Local government area (urban men), both in Osun State, South West Nigeria. RESULTS: The results showed a high level of awareness of family planning among both study groups (98.3% rural and 98.4% urban). Most men in both groups believe that a decision about family planning should be made jointly by the spouses instead of being the prerogative of either. This contrasts with the generally held belief that men are opposed to family planning and a take predominant role in contraceptive decision-making. The condom was the most commonly known and used method with a preponderance among urban (81.1%) over rural men (69.4%). Many men would use family planning if their wives demanded it. However, most respondents in both study groups believed that men should not accompany their wives to the family planning centre to obtain contraceptive supplies and advice. CONCLUSION: Deciding about contraception should be done jointly by men and women in South West Nigeria.     

Factors hindering acceptance of HIV/AIDS voluntary counseling and testing (VCT) among youth in Kwara State, Nigeria

HIV/AIDS has become a source of concern all over the world. The concern cannot be isolated from the devastating effects of HIV/AIDS on economic, social, political and technological development of any nation with a high prevalence rate Nigeria is one of the countries with HIV/AIDS prevalence rate of over 4%. Despite this challenge, the patronage of Voluntary Counseling and Testing (VCT) is still very low. This study therefore examined the factors hindering the acceptance of VCT as expressed by youths in Kwara State. A total of 600 youths from the three Senatorial districts in the State were involved in the study. A survey instrument designed by the researchers was used to collect relevant information from the respondents. Among others, the study identified ignorance, poverty, inadequate number of VCT centres, stigma and discrimination as major factors responsible for the low patronage of VCT centres in Kwara State. Gender and religion had no significant influence on the respondents' views while place of residence had significant influence. The implications of the findings to medical practice and counseling were identified and discussed.     

Journalists' knowledge of AIDS and attitude to persons living with HIV in Ibadan, Nigeria

This study surveyed 254 journalists from the seven media organisations in Ibadan, Nigeria, to assess their knowledge of acquired immune deficiency syndrome (AIDS), attitude to persons living with HIV/AIDS (PLWA) and reports of AIDS-related issues. The journalists' overall mean AIDS knowledge score was 10.6 out of 14 points. About one third (29%) believed that the bite of a mosquito could transmit HIV and 28% thought that AIDS could be cured if detected early. Although 75.2% agreed that the rights of PLWAs to employment should be protected, 49.6% believed AIDS patients should be detained in hospital to prevent the spread of HIV. About a quarter (25.2%) had received training about HIV/AIDS, while 74.8% had not. The majority (65.4%) had never written any report on HIV/AIDS-related issues, while 35.6% had done so. Journalists in Ibadan do not have adequate knowledge of AIDS, and many of them show negative attitude to PLWAs, thus undermining their potential ability to educate the public about AIDS. Advocacy and training workshops are recommended to address this problem.     

Assessing the level of preparedness of private health providers for clinical management of HIV/AIDS epidemic in Nassarawa State, Nigeria

Very little information is available on the extent to which the private health sector is involved in clinical management of HIV/AIDS in Nigeria. This study assessed the potentials and existing capacity of 15 private health facilities in Nassarawa state for clinical management of HIV/AIDS. Information was obtained from 25 staff (15 proprietors and 10 professionals) of the randomly selected health facilities in the state using structured questionnaire. Of the 15 health facilities, three provided voluntary counselling and testing (VCT), seven had never admitted persons living with HIV/AIDS (PLWHA), two provided laboratory services, none provided home-based care for PLWHAs, two had anti-retro-viral drugs in stock, two had rooms for counselling, three had full-time doctors, and six had registered nurses. Of the 25 health workers, 5 had skills/training in conducting VCT, 15 had skills in the treatment of opportunistic infections, 14 were aware of anti-retro-viral drugs and 13 did not feel comfortable attending to PLWHAs. The study recommended capacity building on HIV/AIDS related services for the private health-workers.