Ci Tobin-West

Prevalence and Risk Factors for Stroke in an Adult Population in a Rural Community in the Niger Delta, South-South Nigeria

Sub-Saharan Africa is experiencing an epidemiologic transition with stroke contributing to the disease burden. However, community-based stroke prevalence studies are sparse. This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south-south Nigeria and to describe known risk factors for stroke among them. A door-to-door stroke prevalence study was conducted in 2008 among randomly selected adults of 18 years or older in rural Kegbara-Dere community in Rivers State, south-south Nigeria. We administered a modified screening tool by the World Health Organization, a stroke-specific questionnaire, and conducted a physical/neurological examination (on persons screening positive) in 3 stages of assessments. The crude prevalence of stroke was 8.51/1000 (95% confidence interval [CI] = 3.9-16.1) representing 9 of 1057 participants. The age-adjusted prevalence was 12.3/1000 using the US Population 2000. Men had higher unadjusted prevalence than women (12.9/1000 versus 5.1/1000) but were not at more risk (unadjusted relative risk = .99; 95% CI = .98-1.00). Stroke prevalence increased with age (Mantel-Haenszel χ(2) P = .00). Hypertension (blood pressure ≥140/90 mm Hg) was present in all stroke cases and diabetes mellitus (fasting blood sugar >126 mg/dL) in 1 person, but none had hypercholesterolemia, obesity (body mass index >30 kg/m(2)), or a history of alcohol intake or smoking. Stroke prevalence was found to be high, commoner among men and the elderly population, and likely to be predisposed by hypertension, in rural south-south Nigeria. The need to conduct follow-up studies on the burden and outcomes of stroke among this study population is acknowledged.

Awareness, acceptability, and use of female condoms among university students in Nigeria: implications for STI/HIV prevention.

Abstract Background: Most university students in Nigeria are sexually active and engage in high risk sexual behaviors. The aim of this study was to assess the acceptability and use of female condoms in the context of HIV prevention in order to provide basic information that can stimulate female condom programming to promote sexually transmitted infection and HIV prevention among youths in tertiary institutions. Materials and methods: A descriptive, cross-sectional study was carried out among 810 undergraduate students of the University of Port Harcourt from October to November 2011, using a stratified sampling method and self-administered questionnaires. Results: Most of the students, 589 (72.7%) were sexually active; 352 (59.7%) reported having just one sexual partner, while 237 (40.3%) had multiple partners. The mean number of sexual partners in the past six months was 2.2±0. Consistent condom use was reported among 388 (79.2%) students, 102 (20.8%) reported occasional usage, while 99 (16.8%) did not use condoms at all. Only 384 (65.2%) of the students had ever been screened for HIV. Although 723 (89.3%) were aware of female condoms, only 64(8.9%) had ever used one due to unavailability, high cost, and difficulty with its insertion. Nevertheless, 389 (53.8%) of the students expressed willingness to use them if offered, while 502 (69.4%) would recommend it to friends/peers. Conclusion: This study highlights significant challenges in the use of female condoms among university students. These include unavailability, high cost, and difficulty with insertion. Therefore, deliberate efforts using social marketing strategies, appropriate youth-friendly publicity, and peer education must be exerted to provide affordable female condoms and promote usage; such efforts should target vulnerable youths in Nigerian tertiary institutions.

Factors influencing the use of malaria prevention methods among women of reproductive age in peri-urban communities of Port harcourt city, Nigeria.

Background: Malaria remains a huge national concern in Nigeria with severe implications for maternal and child health. Aims: This study was aimed at investigating factors that influence malaria prevention among women of reproductive age in line with the National Malaria Control objectives. Subjects and Methods: A descriptive, cross-sectional study design and cluster sampling technique was used to recruit study participants. Respondents had ′correct′ knowledge of malaria if they knew the cause and symptoms of malaria. Otherwise is classified as ′incorrect′. Data were analysed in Epi Info version 7 with the level of statistical significance set at P 0≤ 0.05. Results: Most respondents, 709 (89%) had good knowledge of malaria. Their educational level was significantly associated with this knowledge (χ2 = 3.6993, P = 0.0544). There were, however, some myths and misconceptions about malaria. Of 390 (49.3%) that owned insecticide treated bed nets (ITNs), only 59 (18.2%) used them consistently, while only 31 (50%) of the pregnant women received intermittent preventive treatment (IPTp). Malaria knowledge, ITNs ownership and female education were not significantly associated with ITN and IPTp usage. Married women had 3 times higher odds of ITN usage than the unmarried, (odds ratio [OR] = 2.69, 95% confidence interval [95% CI] = 1.56-4.62), and women with children had 2 times higher odds of usage than those without (OR = 2.42, 95% CI = 1.42-4.12). Conclusions: The use of malaria prevention measures among women of reproductive age is still sub-optimal. We advocate for intensified education of women on malaria in local languages, using role plays and community dialogues. Efforts must also be directed at dispelling myths and misconceptions about malaria for maximum impact.

Effectiveness of trained community volunteers in improving knowledge and management of childhood malaria in a rural area of Rivers State, Nigeria.

INTRODUCTION Malaria accounts for 70% of illnesses and 30% of deaths among children under 5 years in Nigeria. This study was aimed at determining the effectiveness of trained community volunteers in delivering multiple anti-malaria interventions to achieve rapid reduction in morbidity and mortality among under 5 children. MATERIALS AND METHODS A quasi-experimental study was carried out in two rural communities in Rivers State, Nigeria among 368 mothers/caregivers. A set of 184 of the mothers/caregivers (experimental group) were trained on malaria and provided with bed nets and drugs (artemisinin-lumefantrine) to treat children under 5 years who developed fever during the period of the experiment. Another set of 184 mothers/caregivers (controls) did not receive similar training and drugs. Both groups were compared at baseline and after 6 months of the experiment on their knowledge of malaria prevention and treatment. Level of significance was set at P = 0.05. RESULTS In the experimental group: Adequate knowledge about malaria increased from 115 (62.5%) to 175 (95.1%) (P < 0.0001), early commencement of treatment of fever increased from 68 (37.0%) to 131 (75.7%) (P < 0.0001), and children cured of malaria increased from 87 (47.3%) to 146 (84.4%) (P < 0.0001). Insecticide-treated bed nets use also increased from 86 (46.7%) to 161 (87.5%) (P < 0.0001). There were no significant changes in the control group. CONCLUSIONS The study demonstrated the inherent potentials in using community-based volunteers in malaria prevention and control for those in rural areas with poor health service delivery. We advocate its adaptation for far-reaching reduction in childhood morbidity and mortality and rapid attainment of millennium development goals 4.

Identifying barriers and sustainable solution to childhood immunization in Khana local government area of Rivers State, Nigeria.

The aim of this study was to uncover barriers to childhood immunization in order to make recommendations that will address the problem in Rivers State and Nigeria. A descriptive, cross-sectional study was carried out in September 2008, among mothers and caregivers of children aged 0–5 years, to examine the various barriers to childhood immunization in the Khana Local Government Area of the State. Data was analyzed using Epi Info version 6.4d software. A total of 1560 mothers and caregivers were interviewed. Their knowledge about immunization was low. Only 15.2% was able to define immunization and mention six vaccine preventable diseases. Most children (46.8%) did not complete their immunization schedule because of frequent shortage of vaccines in the health facilities. Long-term and advance commitment by the government to vaccine manufacturers to purchase vaccines and engaging communities in dialogue over benefits of immunization is advocated to improve immunization in the State.

Challenges with the establishment of congenital cardiac surgery centers in Nigeria: survey of cardiothoracic surgeons and residents.

BACKGROUND There are gaps in understanding the challenges with the establishment of pediatric cardiac surgical practices in Nigeria. The aim of this study was to examine the prospects and challenges limiting the establishment of pediatric cardiac surgical practices in Nigeria from the perspectives of cardiothoracic surgeons and resident doctors. METHODS A descriptive study was carried out to articulate the views of the cardiothoracic surgeons and cardiothoracic resident doctors in Nigeria. A self-administered questionnaire was used to generate information from the participants between December 2014 and January 2015. Data were analyzed using the SPSS version 21 statistical software package. RESULT Thirty-one of the 51 eligible participants (60.7%) took part in the survey. Twenty-one (67.7%) were specialists/consultants, and 10 (32.3%) were resident doctors in cardiothoracic surgical units. Most of the respondents, 26 (83.9%) acknowledged the enormity of pediatric patients with cardiac problems in Nigeria; however, nearly all such children were referred outside Nigeria for treatment. The dearth of pediatric cardiac surgical centers in Nigeria was attributed to weak health system, absence of skilled manpower, funds, and equipment. Although there was a general consensus on the need for the establishment of open pediatric cardiac surgical centers in the country, their set up mechanisms were not explicit. CONCLUSIONS The obvious necessity and huge potentials for the establishment of pediatric cardiac centers in Nigeria cannot be overemphasized. Nevertheless, weakness of the national health system, including human resources remains a daunting challenge. Therefore, local and international partnerships and collaborations with country leadership are strongly advocated to pioneer this noble service.

Partnering with broadcast and print media for risk communication: EVD control in Rivers State, Nigeria

In August 2014, the World Health Organization (WHO)1 declared the outbreak of Ebola Virus Disease (EVD) to be a public health emergency of international concern. Disease outbreaks are unique events in public health. They are typically sudden, frequently unpredictable and fraught with setbacks and surprises. Therefore, there is need, under most circumstances, for an emergency response.2 Outbreaks are eminently newsworthy. The public has a right to be informed and the media are key partners in the communication triangle with health officials.The role of the media is critically important, particularly at the start of an outbreak, to create an informed public who are equipped to protect themselves and others. Community media, particularly radio stations, often play a critical role in reaching rural residents.2,3 The media may also exert pressure on those in authority to act rapidly and positively. The EVD outbreak in Port Harcourt, Nigeria, brought to the fore the important role of the media in imparting positive and negative influences on the population.The Nigerian outbreak was first reported in Lagos in July 2014 and later spread to Port Harcourt, Rivers State on 20 August 2014. The outbreak in Nigeria is the first of its kind in the country, and its occurrence in two of its densely populated urban cities posed peculiar challenges to containment.4 A total of 19 confirmed cases, one probable case and eight deaths were recorded in Nigeria. Rivers State contributed four cases (one probable and three confirmed) and two deaths. In addition, contact tracing teams identified and followed up 530 contacts in Port Harcourt.Port Harcourt is home to 11 radio stations, five television stations with local and national coverage and several more cable/satellite television stations. A rapid community survey conducted by the Ebola Emergency Operations Centre (EOC) found that the majority of the population got their information about Ebola primarily from radio and television, with newspaper and social media platforms also being significant sources. The media took centre stage in the Lagos and Port Harcourt outbreaks. Early media reports evoked panic and irrational behaviour among the population; for instance, the media were awash with rumours of drinking concentrated salt water for the prevention of Ebola. In addition, on some occasions during the early stages of the outbreak, the media released confidential information about names and locations of some cases and contacts. These actions negatively impacted on surveillance efforts as it created distrust.The Rivers State Ebola EOC was set up in Port Harcourt with the purpose of mobilising resources for a rapid and coordinated response to the outbreak: the Communication and Social Mobilisation unit was part of this structure. Its objective was to use risk communication strategies to foster the adoption of practices that would facilitate the breaking of the chain of transmission of the virus. The unit quickly took advantage of the key role the media could play in achieving this objective.It went on to build partnerships with broadcast and print media agencies and supported them to relay balanced and accurate information to the public. This is in line with the key principles identified by the WHO5 to govern outbreak communications: announcing early, transparency, listening and planning. Two stakeholder meetings of the Rivers State EOC and top media executives were held within the first two weeks of the response. The result was commitments secured for continuous media public education programmes at state and local government area (LGA) levels. Trainings on ethical reporting of EVD issues, EVD prevention and control and appropriate EVD messaging were held for media correspondents. Following these meetings and trainings, health professionals working in the EOCs were granted daily slots for recorded and live interviews on various radio and television stations at no cost. …

Barriers to HIV Treatment Adherence: Findings from a Treatment Center in South-South, Nigeria.

Aims: Non-adherence to treatment represents a significant challenge to anti-retroviral treatment goals. This study aimed to identify and explore perceived barriers to adherence in non-adherent HIV patients attending the University of Port Harcourt Teaching Hospital. Study Design: This was a descriptive, cross-sectional study of HAART experienced patients who had less than 95% adherence to their HAART medication. Place and Duration of Study: The study was carried out between May and June 2011 at the Antiretroviral treatment center of the University of Port Harcourt Teaching Hospital in the Southern part of Nigeria Original Research Article International Journal of TROPICAL DISEASE & Health, 4(12): 1233-1244, 2015 1234 Methodology: Data collection was via quantitative and qualitative methods. A structured interviewer administered questionnaire adapted from the Adult Antiretroviral Clinical Trials Group (AACTG) study was used to identify barriers to adherence. In addition, four focus group discussions (FGDs) were held with 27 purposively selected participants. Quantitative data was analyzed with SPSS version 18, while the FGDs were analyzed using thematic content analysis. Results: Ninety-six (96) patients, 39 (40.6%) males and 57 (59.4%) females with median age of 35.5 years participated in the study. Identified barriers to adherence included; being away from home during medication times 41 (42.7%), being busy with other things 35 (36.5%), forgetfulness 33 (34.4%), running out of pills 25 (26%), difficulty taking pills at specified times 25 (26.0%), the need to avoid side effects 16 (16.7%), and lack of a social support system 15 (15.6%). Barriers identified by the FGDs were fear of taking HIV drugs in front of others, sharing drugs with infected spouse, alcohol use, financial challenges, poor understanding about the effects of the drugs, forgetfulness, long clinic hours and poor attitude of health workers. Conclusion: Adherence counseling, use of reminder systems and treatment supporters are useful Public Health interventions for improving adherence and should be integrated into service delivery at this and other centers. In addition, better organization of the clinic, increasing staff strength and training will go a long way to address these barriers. Decentralization of HIV treatment centers to secondary and primary health facilities needs consideration.

Stigma and underutilization of facility-based sexually transmitted infection services undermine human immunodeficiency virus testing in rural communities of Rivers State, Nigeria

Context: Human immunodeficiency virus (HIV) testing is a critical step in limiting the spread of the virus and ensuring access to prevention, treatment, care and support. Aims: The study examines the consequences of stigma and underutilization of facility-based sexually transmitted infection (STI) services on the uptake of HIV testing in rural communities of Rivers State, Nigeria, in other to provide information necessary to address the problem. Materials and Methods: A cross-sectional study was conducted between the 1 st and 30 th July 2011 among men and women of reproductive age living in rural communities of Rivers State, Nigeria, using a multistage sampling technique. Data were analyzed using the Epi-info version 6.04d, with confidence limit set at 95%. Results: A total of 596 participants: 270 men (45.3%) and 326 women (54.7%) were interviewed. Their mean age was 26.59 ± 7.77 years. Only 226 (37.9%) of them had ever tested for HIV. Most had stigmatizing attitudes towards HIV positive persons, 164 (71.6%) and had not tested for HIV (χ 2 = 8.85, df = 1, P = 0.003). Of those who reported STIs, only 45.7% received treatment from a health facility, against 188 (54.3%) who did not. Consequently, only 90 (67.2%) of them were tested for HIV compared to 44 (32.8%) who received treatment from informal care providers (χ 2 = 8.41, df = 1, P = 0.000). Conclusions: Stigma and low patronage of facility-based STI services undermine HIV testing. Anti-HIV campaigns must be consciously designed to prevent and correct stigmatization, emphasize the relationship between HIV and STIs and the significance of seeking appropriate care from health facilities.

Is living in a gas-flaring host community associated with being hypertensive? Evidence from the Niger Delta region of Nigeria

Background Researchers have linked gas flaring to climate change, the hastening of the epidemiological transition and an upsurge in the prevalence of non-communicable diseases. We sought to determine if a relationship exists between residing in a gas-flaring host community and hypertension. Methods We conducted an analytical cross-sectional household survey among residents of 600 households in three gas-flaring and three non-gas-flaring host communities in the Niger Delta region of Nigeria. We took geo-coordinates, administered a modified WHO-STEPS questionnaire and built on Android mobile phones using Open-Data-Kit (ODK) software. We also took biological measurements and carried out descriptive and inferential statistical analysis using SPSS and STATA. Results We interviewed a total of 912 adults: 437 (47.9%) from non-gas-flaring and 475 (52.1%) from gas-flaring host communities. There were differences in level of education (x2=42.99; p=0.00), occupation category (x2=25.42; p=0.00) and BMI category (x2=15.37; 0.003) among the two groups. The overall prevalence of hypertension was 23.7%: 20.7% among persons living in non-gas-flaring host communities compared with 25.3% among persons living in gas-flaring host communities (x2=2.89; p=0.89). Residence in a gas-flaring host community, (AdjOR=1.75; 95% CI=1.11 to 2.74) and mean age (AdjOR=1.05; 95% CI=1.03 to 1.07) were identified as the predictors of hypertension. There was a significant association between hypertension and age, 1.05 (1.04–1.06) while the probability of being hypertensive was higher among residents of gas-flaring host communities between 20 to 40 years and 60 to 80 years. Conclusion There is a need for the relevant agencies to scale up environmental and biological monitoring of air pollutants. The implication of a possible relationship between gas-flaring and hypertension brings to the fore the need for interventions to regulate gas-flaring activities.