Chukwuma B. Duru

Availability and Continuity of Care for Maternal Health Services in the Primary Health Centres in Nnewi, Nigeria (January - March 2010)

Background: In some primary health care settings, even where the health services are not available, provisions are not made to ensure continuity of care. This study aimed to determine the availability and level of continuity of care for maternal health services in the primary health centers (PHCs) in Nnewi, Nigeria. Methods: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from four randomly selected public PHCs in Nnewi, Nigeria were chosen for the study. Data collection employed a mix of quantitative and qualitative methods. Results: The mean ± standard deviation for age of the respondents was 29.2 ± 5.9 years. The facilities studied provided out-patient services, but the only in-patient services provided was for women who delivered or those in labor. None of the facilities is equipped to provide even basic essential obstetric care services. None had standardized a protocol for referring clients, referral forms, a transport system, or a community loan scheme in place. Forty-four (15.7%) women were referred for care outside of the PHCs for the following reasons: Lack of drugs and supplies (9.1%); lack of equipment (90.9%), lack of skilled personnel (45.5%) among others. Conclusions: This study showed that despite the unavailability of some services, appropriate strategies were not in place to ensure the coherent pattern of services within and between the PHCs and other levels of care. Delivery to the clients of comprehensive and integrated maternal health services, and efficient referral systems are thus recommended.

Sexual Abuse among Female Undergraduates in Tertiary Institutions in IMO State, Southeast Nigeria: Prevalence, Pattern and Determinants

Introduction: Sexual abuse is a global public health problem that cuts across social class, cultures, tribes etc. and has permeated the fabrics of tertiary institutions and many work places as long as humans have reasons to interact. Aim: To determine the prevalence, pattern and determinants of sexual abuse among undergraduates in tertiary institutions in Imo State, Nigeria. Methodology: This study was a descriptive, cross sectional survey of 600 female students in tertiary institutions in Imo State Nigeria. They were selected using the multistage sampling technique and data were collected using a pretested, semi-structural and self-administered questionnaire and analyzed using a computer soft-ware (EPI INFO version 3.3.2). Descriptive statistics was presented using summary indices, frequency tables and percentages. Associations between variables were done using the chi-square and logistic regression. A p-value of less than 0.05 was considered significant. Results: The mean age of the respondents was 21.7 3.2 years. The current and life-time prevalence of sexual abuse among the respondents was 15.2% and 34% respectively and the commonest form of sexual abuse experienced was founding/grabbing of sensitive body parts (52.5%). Factors found to influence current occurrence of sexual abuse among the students were; age (p = 0.010), tribe (p = 0.008), marital status (p < 0.001), type of student in secondary school attended (p = 0.001), faculty of study (p = 0), year in school (p < 0.0001), persons currently shared room with (p < 0.0001) and level of knowledge about sexual abuse (p = 0.007). Conclusion: The prevalence of abuse as revealed in this study was high. There is need to develop appropriated prevention strategies by the universities to curb this menace against our women.

Determinants of gambling among male students in secondary schools in Imo State, Nigeria

ABSTRACT Objective: To assess the prevalence, pattern and determinants of gambling among students in secondary schools in Imo State, Nigeria. Method: This was a school based descriptive cross sectional survey carried out on 507 students in three male only urban Secondary Schools in Owerri. Data was collected using a pre-tested, semi-structured, self-administered sociodemographic questionnaire. Results: Two hundred and ninety (57.2%) had gambled at least once in their lifetime and out of these 225 (77.6%) had gambled in the last 12 months. Students greater than 18 years of age, (OR:3.12;1.27–7.71), whose friends engage in gambling, (OR:2.96; 1.95–4.49), parents gamble, (OR:4.80; 2.85–8.09, siblings gamble, (OR:3.16; 2.08–4.81), friends accept gambling, (OR:9.81; 4.73–20.37), and had problems on account of gambling (OR:9.81; 4.73–20.37) were more likely to currently practice gambling. Having friends that engage in gambling, gambling to be accepted by friends, parental gambling, problems with authorities on account of gambling were the predictors of current gambling [F = (7, 499) = 82.40, p < 0.05, R2 = 0.54)]. Conclusion: Gambling is common among students. It is less likely among students aware of laws on underage gambling. There is an urgent need to implement measures targeted at awareness creation, regulating the activities of gaming centers and on-line gaming operators in the country.

Sexual Behavior and Abuse: A Case Study of University Undergraduates in Tertiary Institutions in Imo State, Nigeria

Introduction: In young people including adolescents, risky sexual behavior has been recognized as an important health, social and demographic concern in the developing world. Aim: To assess sexual behaviors and their association with current and life-time occurrence of sexual abuse among female undergraduates in tertiary institutions in Imo State, Nigeria. Methodology: This was a school based cross sectional study involving 600 female students selected from tertiary institutions in Imo State Nigeria, using the multistage sampling technique. Data was collected using a semi-structured, self-administered questionnaire and analyzed using a data software (EPI-INFO version 3.3.2). Descriptive variables were presented using summary indices, frequency tables/percentages, and graph while associations between variables were done using the Chi-square and binary regression. A p-value of < 0.05 was considered significant. Results: The mean age of the students was 21.7+3.2 years. About 65.2% of the respondents have initiated sexual intercourse and of this proportion, 75.6% were sexually active in the last one year preceding survey. The mean age at initiation of sexual debut among the students was 18.9+3.8 years and the commonest form of sexual act practiced was penile/vaginal sex. About 15.2% of the students had been currently abused. Predictors of current sexual abuse were; ever had sexual intercourse (OR.4.63), being within 14-19 years of age at first sexual initiation, (OR: 0.42), had first sexual exposure with a casual partner (OR: 12.38), and being sexually active in the last 1 year preceding study, (OR: 2.16). Conclusion: Risky sexual behaviors were prevalent and were found to influence the occurrence of sexual abuse, among the students. Thus, there is need to institute appropriate prevention strategies to limit risky sexual behaviors and it consequences among adolescents and young adults.

Clinical implication of smoking among patients with schizophrenia at a Tertiary Institution in South East Nigeria

Background The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Smoking in schizophrenia appears to be associated with increased psychopathology and disability. Objective The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability and psychopathology. Materials and methods This was a cross-sectional descriptive study in which 367 out-patients with International Classification of Diseases (ICD) 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination (PSE) 10, Positive And Negative Syndrome Scale (PANSS) and World Health Organization Disability Assessment Schedule (WHODAS) were administered. Data was analyzed using a software package SPSS version 15. Results There was no significant difference in the mean PANSS scores of smokers and non-smokers. Current smoking was associated with increased disability (F=5.39, p=0.02). Total PANSS score significantly predicted disability F(3,71=5.60, p=0.002, R2=0.19). There was no significant association between positive or negative symptoms and being a smoker or non-smoker. Conclusion The results of this study revealed that smoking in Nigerian schizophrenia patients is associated with significant disability. Measures should be put in place to discourage cigarette smoking among Nigerian patients with schizophrenia.

Experience of intimate partner violence among female health workers in South East Nigeria

ABSTRACT Intimate partner violence (IPV) is one of the most pervasive forms of violence against women with few studies documenting the magnitude of the problem among female health workers. This was a descriptive cross-sectional study of 392 female health workers. A pre-tested semi-structured self-administered questionnaire was used to collect data. Data were analysed using SPSS Version 15. About 56.6% of the health workers had a lifetime experience of abuse. Verbal (100%) and sexual abuse (71.7%) were the commonest forms of abuse. Most (85.5%) of those who had ever been abused justified it (X² = 86.5, p = .00, OR; 2.3; 1.9–2.7). Respondents >40 years (OR = 8.9, p = .00) and Protestants (X² = 9.1, p = .00, OR: 1.9; 1.3–2.9 had the highest likelihood of ever experiencing any form of abuse. Only 94 (46.8%) of the currently abused have ever complained about their experience. In view of the high level of justification of abuse, female health workers should be educated on IPV.

Socio-Demographic Determinants of Psychoactive Substance Use among Students of Tertiary Institutions in Imo State, Nigeria

Background: Psychoactive substance use among undergraduate students is a major public health problem globally and over 29 million people worldwide suffer from drug use disorders. Methodology: This study was carried out in February 2017 and the study design was an institution based descriptive cross-sectional type. The study population comprised undergraduate students in selected tertiary institutions of the state. A multistage sampling technique was used in the selection of study subjects. Data was collected using a pretested, semi-structured and self-administered questionnaire and analysis was done using IBM SPSS version 20. The level of statistical significance was set at p-value of ≤ 0.05. Results: The mean age of the respondents was 22.2 ± 3.8 years. The prevalence of the life time and current use of stimulants were 45.3% and 29.1% respectively and tobacco was the commonest stimulant used both in the past (50.3%) and currently (48.0%). Peer group influence was the commonest reason for initiating use of psychoactive substances. Factors significantly associated with current use of stimulants among the students were; gender (p<0.0001), level of study (p=0.012), accommodation statues (p<0.0001) and status of parents union (p=0.007). Conclusion: This study showed a high prevalence of psychoactive substance use among the respondents thus appropriate preventive measures should be adopted to minimise this menace.

Sexual Behaviour, Sero-Status Disclosure and Willingness to DiscloseStatus among HIV Positive Male Patients Receiving Care in Hospitals inImo State, Nigeria

Background: The non-disclosure of HIV positive status has most often been accompanied by risky sexual behaviours which is a complex relationship that facilitates the transmission of sexually transmitted diseases such as HIV. Objective: To determine sexual behaviour, levels of sero-status disclose and willingness to disclose; and the socio-demographic determinants of disclosure and willingness to disclose among HIV positive male patients receiving care in hospitals in Imo State, Nigeria. Methods: A cross sectional analytical design using a simple random sampling technique to select 422 HIV male patients attending the adult HIV clinics of two major hospitals. Data was collected using a pretested, semi structured questionnaire. Descriptive statistics were presented using frequencies and summary indices. Chi square statistics were computed to determine significant relationships and binary logistic regression was used to determine predictors of disclosure and willingness to disclose. A p-value of ≤ 0.05 was considered significant. Results: A majority of the respondents were either traders or artisans (54.6%) with a mean age of 32.0 ± 2.0 years. The results revealed that more than one third of the respondents had two or more sexual partners (35.5%), less than one quarter correctly and consistently use condoms (23.3%) and close to one third had not disclosed their HIV positive status (31.7%); of which, less than two fifths are now willing to disclose (37.8%). It was further revealed that married HIV positive male patients who are traders or artisans above the age of 30 years with monthly income levels less than N40,000 (

Stigmatization and the Predictors of Reported Discrimination among HIV Positive Patients Receiving Care in Hospitals in Imo State, Nigeria

110) and living in an urban or semi urban area with family members or other people, were significantly more likely to have disclosed their HIV positive status. Similarly, HIV positive male patients who had not disclosed their status, but are artisans aged above 30 years, were significantly more likely to be willing now to disclose their HIV positive status. Conclusion: To be successful in our efforts of HIV prevention with respect to facilitating disclosure, it is important to design and implement interventions that are tailored to the specific circumstances and characteristics of the individual.

Patterns of utilization of orthodox and/or traditional healthcare services among pregnant women and mothers of under-five children in a rural community: Case study of Njaba, Imo State, Nigeria

Background: HIV related Stigma and discrimination is a reflection of fear of the unknown, driven by ignorance and helplessness that results in negative attitude, beliefs and unfair treatment towards those living with HIV. Objective: To assess knowledge of stigmatization, prevalence of reported discrimination and the socio-demographic and care predictors of discrimination among HIV positive patients receiving care in Health Care Institutions in Imo State, Nigeria. Methods: A cross sectional analytical design using a simple random sampling technique to select 422 HIV positive patients attending the adult HIV clinics from two public health care institutions in Imo State. Data was collected using a pretested semi structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant relationships and simple binary logistic regression was used to determine predictors of HIV related discrimination. The p-value was set at 0.05 significance level. Results: The mean age of the respondents was 37 ± 6.3 with a male to female ratio of 1:1.7. The overall level of knowledge of stigmatization and discrimination was poor in more than half of the respondents (55.2%). The prevalence of stigmatization and reported discrimination was 33.2% of which, close to two thirds of it occurred among the females (62.9%). The main source of discrimination was from family and relatives (45.0%) with close to half of the respondents having suicidal thoughts after experiencing discrimination (46.4%). The predictors of HIV related discrimination and stigmatization reported in this study were; being within the ages of 26-35 years, (OR 2.16), having at least one or more children (OR: 3.72), residing in their community of origin (2.00), residing in Orlu (OR: 3.77) or Okigwe (OR: 3.29) zones of Imo State, receiving advice to do the HIV test from a health personnel (OR: 2.52) and doing a HIV test and receiving a positive result from a private hospital (OR:2.22) or health centre OR: 2.11). Conclusion: Stigmatization and discrimination of people living with HIV/AIDS are created by individuals and communities influenced by socio-demographic and care factors which continues to perpetuate the transmission of HIV; and therefore, it remains an important issue of public health concern that must be addressed.