Aniekan Etokidem

Awareness of Birth Preparedness and Complication Readiness in Southeastern Nigeria

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ 2 = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ 2 = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted.

Malaria: knowledge and prevention practices among school adolescents in a coastal community in Calabar, Nigeria.

ABSTRACT Background Malaria prevention and treatment constitute an unbearable economic burden to most African countries, especially south of the Sahara, where about 500 million cases occur annually. The problem of malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children. Attention to malaria among adolescents has also been diverted by the huge burden of HIV/AIDS among adolescents. Some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on school children, who could be used as change agents and as role models for their siblings and peers in the malaria control strategy. Objectives To determine the malaria prevention practices of school adolescents in the coastal community of Calabar, Nigeria. Method This was a cross-sectional survey involving secondary schools in southern Calabar. Four hundred adolescents were randomly selected from the 4565 learners in 5 out of 17 secondary schools in southern Calabar, Cross River State, Nigeria. A self-administered, semi-structured questionnaire was administered to the respondents. Results Most respondents (77.5%) were aware that the vector transmits the malaria parasite through biting. Fewer respondents would prevent malaria attacks by clearing the vegetation in the peri-domestic environment (13.5%), filling up potholes (16.9%), opening up drainage (11%), using insecticide-treated nets (25.7%) or using antimalarial drugs (11.2%). Less than one-tenth (8%) would use various other methods such as not accepting unscreened blood, while only 11% obtained the information from their teachers. Conclusion The study identified knowledge gaps among school children. There is a need to empower teachers with information about the cause of malaria and prevention strategies.

Factors associated with contraceptive use and initiation of coital activity after childbirth

The aim of the study is to identify the factors influencing contraceptive use and initiation of sexual intercourse after childbirth. This was a cross-sectional descriptive survey involving 256 consecutive women who delivered between April and October 2007 presenting at the Immunization Clinic University of Calabar Teaching Hospital Nigeria in April 2008. Data was obtained using an interviewer-administered structured questionnaire. Women who had antenatal and postnatal counseling were significantly more likely to use contraceptives than those who did not have counseling (odds ratio (OR) 0.29; 95% confidence interval (CI) 0.14-0.59; P = 0.0002 and OR 0.18; 95% CI 0.08-0.38; P = 0.0000002 respectively). Other variables significantly associated with contraceptive use included education (P = 0.0470) and reproductive goal (P = 0.0303). Linear regression analysis showed direct relationship between caesarean section and episiotomy as modes of delivery and initiation of coitus (r² = 0.439 and 0.45 respectively). Concerning residence after childbirth staying at home and with in-laws showed direct relationship with initiation of coitus (r² = 0.208 and 10.750 respectively). The number of women abstaining from intercourse showed a decreasing trend with increasing months after childbirth. Initiation of coitus was significantly associated with resumption of menstruation (P < 0.0001) and non-contraceptive use (P = 0.0089). In conclusion this study shows the need for use of postpartum contraception before fecund women become susceptible to pregnancy.

Setting agenda for quality improvement in a public hospital in Nigeria using the consumers' judgement

Background: The paradigm shift in the locus of control in many health systems brought about by consumerism, makes it imperative for consumers of health services to be involved in setting agenda for quality improvement.. This study sought to identify service quality gaps in a public hospital using the clients’ judgement. Methodology: Sixty-eight consenting clients attending the State House Hospital, Yenagoa, were administered an adapted version of the SERVQUAL instrument to rate their expectation before and perception after the encounter with the practice. Negative gap scores indicated that the actual service (the perceived score) was less than what was expected (the expectation score) and thus requires some form of quality improvement. Criteria having high expectation scores from the clients were also of importance to the administrators of the facility. Result: Majority of the raters were married (71.2%) and female (55.9%). Significant gaps were elicited in clients’ desire for up-to-date equipment for patient care (-1.15); desire to be able to trust staff (-1.06) and feel safe with hospital’s employees (-1.11). All 5 dimensions showed some degree of inadequacies but none crossed the pre-set critical line. Majority of the clients showed general satisfaction with the performance of the hospital (88.4%), a likelihood of return (76.3%) and recommending to others (81.0%) Conclusion: The identification of symptoms of dysfunction in this organization through this instrument provided a starting point for the examination of underlying problems that inhibit the provision of quality service.

Influenza A H1NI (Pandemic 2009): How prepared are healthcare providers in Calabar, Nigeria?

In April 2009, an outbreak of influenza was reported in Mexico and California and within months, it spread to all continents of the world. An influenza pandemic has always posed a threat to global public health. The objective of this study was to assess the knowledge, attitude, reported practice and preparedness of health care providers in Calabar, Nigeria, regarding the H1N1 pandemic. This was a prospective study. A semi-structured questionnaire was administered on health care providers in Calabar, Nigeria. One hundred and forty-five (41.6%) respondents reported that the infection was transmitted from pigs to humans whereas 53 (15.1%) reported that it was transmitted from humans to humans. Two hundred and thirty-one (66.0%) respondents were not willing to work in a hospital unit where patients with Influenza A H1N1 are treated. One hundred and thirty-eight (39.4%) respondents were willing to receive vaccination against Influenza A H1N1 while majority, 212 (60.6%) were not willing. There are gaps in knowledge of respondents regarding H1N1 infection and their level of preparedness is low. Capacity building in emergency preparedness for infectious disease epidemic is recommended. Key words: Influenza, H1N1, pandemic, infections, Calabar, Nigeria. INTRODUCTION The Black Death of the 14

Ebola virus disease: assessment of knowledge, attitude and practice of nursing students of a Nigerian University

Background Ebola virus disease has a high case fatality rate. Health care providers have a key role to play in its management and prevention. Objectives The aim of this study was to determine the knowledge, attitude and practice regarding Ebola virus disease (EVD) among students of Nursing in the University of Calabar, Calabar, Nigeria. Methods This was a descriptive cross-sectional study. A semi-structured,self-administered questionnaire was administered to 178 nursing students. The respondents were selected using systematic random sampling. Results Lecturers were the commonest source of information regarding EVD as reported by 84.5% of the respondents followed by television (76.3%). Nearly 27% of respondents indicated that the fear of EVD had dampened their interest and enthusiasm in the nursing profession. Nearly 12 % indicated that they would not take part as theatre nurses in the surgical operation of a patient who had been certified cured of EVD. A similar proportion indicated their unwillingness to attend to a woman in labour even if she had been certified cured of EVD. Conclusion Majority of the students were knowledgeable about EVD. Although majority of them had favorable attitude towards EVD patients, there was evidence of stigmatizing and discriminatory attitude that needs to be addressed.

Family planning practices of rural community dwellers in cross River State, Nigeria

Background: Nigeria is the most populous nation in Africa and the seventh most populous in the world. Despite a high fertility rate of 5.5 per woman and a high population growth rate of 3.2%, Nigerias contraceptive prevalence is 15%, which is one of the lowest in the world. The objective of this study was to determine the knowledge of family planning and family planning preferences and practices of rural community women in Cross River State of Nigeria. Materials and Methods: This was a cross-sectional study involving 291 rural women. Convenience sampling method was used. The women were assembled in a hall and a semi-structured questionnaire was administered to every consenting woman until the sample size was attained. Data obtained from the study were analyzed using the Statistical Package for the Social Sciences version 20 and presented in tables as frequencies and percentages as well as figures. Association between categorical variables was explored using chi-square test. Binary logistic regression was also performed to determine predictors of use of at least one family planning method at some point in time. Results: Fifty (17.2%) respondents were using at least one family planning method. One hundred and ninety-eight (68.3%) respondents had used at least one family planning method at some point in time. Reasons given for not using any family planning method included “Family planning is against my religious beliefs” (56%); “it is against our culture” (43.8%); “I need more children” (64.9%); “my partner would not agree” (35.3%); “family planning does not work” (42.9%); “it reduces sexual enjoyment” (76%); and “it promotes unfaithfulness/infidelity” (59%). Binary logistic regression conducted to predict the use of at least one family planning method at some point in time using some independent variables showed that who makes the decision regarding family planning use was the strongest predictor of family planning use (OR = 0.567; 95% CI = 0.391–0.821). This suggests that family planning uptake is more likely when couples make a joint decision. Conclusion: The proportion of respondents who were currently using at least one family planning method was low. The findings of this study suggest that family planning uptake would increase if couples make joint decisions in this regard.

Factors responsible for disclosure of HIV seropositivity among residents of Cross River State, Nigeria

Context: Disclosure of HIV-positive status to sex partners is viewed as a preventive measure and as a social and legal responsibility for HIV-infected individuals. Aims: The aim of this study is to determine the proportions and factors responsible for disclosure of HIV seropositivity among residents of Cross River State, Nigeria. Settings and Design: This was a cross-sectional comparative study. Subjects and Methods: It involved 320 HIV-positive individuals equally selected from the urban and rural settings of Cross River State and use questionnaires. Statistical Analysis Used: Data analysis used SPSS version 20.0. Chi-square test and logistic regression were used to identify determinants of HIV status disclosure. Results: Among urban respondents, 93.8% had disclosed compared with 79.4% among rural respondents, the difference was statistically significant (P < 0.001). There was a statistically significant association between HIV status disclosure and age (P = 0.008), marital status (P = 0.027), number of nonspousal sexual partner (P = 0.006), and area of residence (P < 0.001). There was no statistically significant association between HIV status disclosure and gender (P = 0.622), between occupation (P = 0.495) or income (P = 0.351 and head of household (P = 0.241). There was statistically significant association between HIV status disclosure and level of education (P = 0.015), house ownership (P = 0.008), time from diagnosis (P = 0.003), and duration of treatment (P = 0.002). Conclusions: This study has shown that HIV seropositive status disclosure was higher when compared with other local studies, and age, marital status, and area of residence were factors associated with HIV seropositive status disclosure.

Child Survival Strategies: Assessment of Knowledge and Practice of Rural Women of Reproductive Age in Cross River State, Nigeria

Introduction. Nigeria is one of the five countries that account for about 50% of under-five mortality in the world. The objective of this study was to assess the knowledge and practice of child survival strategies among rural community caregivers in Cross River State of Nigeria. Materials and Methods. This descriptive cross-sectional survey used a pretested questionnaire to obtain information from 150 women of reproductive age. Data analysis was done using SPSS version 20. Results. The child survival strategy known to most of the respondents was oral rehydration therapy as indicated by 98% followed by female education by 73.3% and immunization by 67.3%. Only 20% of the respondents had adequate knowledge of frequency of weighing a child while only 32.7% knew that breastfeeding should be continued even if the child had diarrhea. More respondents with nonformal education (83.3%) practiced exclusive breastfeeding of their last children compared to respondents with primary education (77.3%), secondary education (74.2%), and tertiary education (72.2%). Conclusion. Although respondents demonstrated adequate knowledge and practice of most of the strategies, there was evidence of gaps, including myths and misconceptions that could mar efforts towards reducing child morbidity and mortality in the state.