Esther O. Asekun-Olarinmoye

Knowledge, attitudes to HIV/AIDS and sexual behaviour of students in a tertiary institution in south-western Nigeria

Objective To determine the knowledge, attitude and sexual behaviour of students in a tertiary institution in south western Nigeria with regard to HIV/AIDS. Methods Descriptive cross-sectional survey conducted between January and March 2005. Information was collected from 368 students of a tertiary institution in Ede, Osun State, Nigeria. Participants were selected by a multi-stage sampling method and data obtained using a semi-structured pre-tested questionnaire. Results Most (89.4%) respondents were aware of the existence of HIV/AIDS, and knew the aetiology, routes of transmission, signs and symptoms, and preventive measures against the disease. While a little over half (59.8%) of the respondents revealed that they could hug people with HIV/AIDS, one out of four (27.2%) stated that these persons should be isolated from the community. Less than a quarter (22.3%) of the respondents believed that they were vulnerable to HIV/AIDS. More than half (58.2%) had ever had sex; the mean age at their first sexual exposure (for all respondents) was 16.7 ± 4.4 years. Almost half (48.2%) of the 191 currently sexually active respondents had multiple sexual partners. Of the sexually active respondents, 75.9% claimed to have ever used condoms; among these, male respondents were more likely to have ever used condoms than their female counterparts (p < 0.05). Conclusion The study revealed a gap in the knowledge of HIV/AIDS and an inappropriate sexual behaviour among respondents. Meaningful strategies, such as an innovative and culturally sensitive adolescent sexual and reproductive health programme that focuses on modification of sexual behaviour should be adopted to allow young people to prevent transmission of the HIV/AIDS virus.

The impact of health education on attitudes towards female genital mutilation (FGM) in a rural Nigerian community

Objectives To determine the level of practice of female genital mutilation (FGM) and the impact of a health education intervention in Shao community. Materials and methods Intervention study using a multistage sampling technique. The instrument was a pre-tested, structured questionnaire. The survey was supplemented by an in-depth interview of the traditional excisors. Results Most respondents (88.0%) cited traditional excisors as operators of the procedure, while 7.8% mentioned health workers. Factors found to be statistically significantly associated with the practice of FGM are age, gender and educational status of respondents (p < 0.05). The age at which FGM is usually performed was put at under one year old by 60.3% of respondents. All respondents cited type II FGM as the type practised in the community. Most (88.0%) of the female respondents were excised. A greater proportion of men than women did not want the practice of FGM stopped in the pre-intervention stage; however, there was a statistically significant decrease in the proportion of males who did not want the practice of FGM stopped in the post-intervention stage. Also, there was a statistically significant increase in the proportion of respondents who had no intention to excise future female children in the post-intervention stage (p < 0.05). Legislation, female literacy and empowerment, educating men and provision of alternative vocation for excisors were means suggested by respondents for stopping the practice. Conclusion and recommendations The health education intervention had a positive impact on the attitude of respondents towards FGM. However, for sustainable behavioural changes that will lead to elimination of FGM practice, we recommend placing FGM elimination efforts within a comprehensive development strategy and the larger context of reproductive health and gender education in Nigeria.

Evaluation of the Effectiveness of Peer Education in Improving HIV Knowledge, Attitude, and Sexual Behaviours among In-School Adolescents in Osun State, Nigeria

Introduction. Young people are at the centre of the global HIV/AIDS epidemic. This study therefore aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and preventive practices among in-school adolescents in Osun State, Nigeria. Methods. This was an intervention study that was carried out among in-school adolescents attending mixed secondary schools in Osun State, Nigeria. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using pretested semistructured questionnaires and data analysis was done with SPSS version 16. Results. At the preintervention stage, the study and control groups were similar in their sociodemographic characteristics, HIV knowledge, attitude, and preventive practices, including high risk behaviours for HIV/AIDS transmission. After the peer education intervention, those with good knowledge and positive attitudes towards HIV/AIDS increased significantly from 50.0% to 86.7% and from 49.0% to 85.6%, respectively (P < 0.05). Conclusion. The study showed that peer education is effective in improving knowledge, attitude, and some preventive practices towards HIV/AIDS among in-school adolescents. Educational programmes about HIV/AIDS should therefore be designed to target this age group putting into consideration their unique characteristics.

Knowledge, beliefs, and attitudes to female genital mutilation (FGM) in Shao community of Kwara State, Nigeria.

To determine the level of knowledge, belief, and assess the attitude to female genital mutilation (FGM) and its complications in Shao community, Nigeria, a cross-sectional descriptive study with a health education intervention was used. A majority of respondents (99.5%) understood female circumcision to mean cutting off parts of the female genitals. There was a high level of knowledge regarding most of the complications of FGM as more than 50% of respondents knew at least four complications of FGM. Awareness of the global anti-FGM campaign was also high (78.8%). The most common reasons proffered for the practice of FGM were based on tradition or religion. Paternal grandfathers (50.0%) and fathers (21.0%) were cited as decision makers in the family most often responsible for requesting FGM. Post-intervention results showed that there was a statistically significant increase in the proportion of respondents who know more complications of FGM and who have no intention of circumcising future female children. Despite a high level of knowledge regarding the complications of FGM and a high level of awareness of the global campaign against it, there still exists a high prevalence of practice of FGM in this community. FGM remains a pressing human rights and public health issue. It is our recommendation that this health education intervention strategy be replicated nationwide especially using mass media.

Public perception of climate change and its impact on health and environment in rural southwestern Nigeria

Background: Climate change (CC) has received extensive media attention recently, and it is currently on the international public health agenda. A study of knowledge and attitudes to climate change, most especially from rural Nigerian communities, is important for developing adaptation strategies. This is a study of public perceptions of CC and its impact on health and environment in rural southwestern Nigeria. Methods: This was a community-based descriptive cross-sectional study of 1,019 rural respondents using a multistage sampling method. The research instrument used was a pretested, structured, interviewer-administered questionnaire. Data were analyzed using SPSS software. χ2, Cramér’s V, and Kendall’s τ-c statistics were employed in addition to fitting the data to a logistic regression model to explore associations found significant on bivariate analysis. Results: Mean age of respondents was 36.9 (±12.4) years. About 911 (89.4%) of respondents opined that there has been a change in climate in the last 10 years. Supernatural reasons were prominent among respondent-reported causes of CC. Identified risky behavior contributing to CC included smoking (10.7%), bush burning (33.4%), and tree felling (41.0%). Poor knowledge of causes but good knowledge of effects of CC were found in this study. About two-thirds of respondents had a positive attitude to causes of CC, while half had a positive attitude to the effects of CC. A significant association was found between educational status (P˂0.001, Kendall’s τ-c=−0.042), occupational status (P˂0.01, Kendall’s τ-c=0.088), and attitude to causes of CC. Further analysis using logistic regression showed that occupational status was significantly associated with likelihood of having a positive attitude, but educational status and marital status were not. Conclusion: Rural areas of Nigeria are vulnerable to the adverse effects of CC. Respondents’ poor knowledge but positive attitude to CC calls for dissemination of adequate information on CC in sustained health-promotion programs.

Perceptions and activities of religious leaders on the prevention of HIV/AIDS and care of people living with the HIV infection in Ibadan, Nigeria

Introduction The epidemic of human immunodeficiency virus (HIV) continues in Nigeria despite efforts to control it. Meaningful efforts aimed at combating this disease must be multisectoral. However, despite the major influence religious leaders have in this society, their role has not been well studied. The aim of the study was to assess the perceptions and activities of religious leaders on prevention of HIV/acquired immunodeficiency syndrome (AIDS) and care of people living with the virus in Ibadan, Nigeria. Materials and methods In a cross-sectional study, 336 leaders from eight religious denominations in Ibadan were surveyed utilizing a self-administered, semi-structured questionnaire. Respondents were selected by cluster sampling technique. Data was analyzed using the Statistical Package for Social Sciences software version 15. Results The mean age of respondents was 37.9 (± 13.5) years. The majority (97.6%) were aware of the HIV/AIDS scourge, and most had good knowledge of routes of transmission and modes of prevention (85.7%). Attitudes to people living with HIV/AIDS were positive in 84.2% respondents, and many practiced preventive measures (94.9%). One hundred and ninety (56.5%) respondents had ever preached about HIV/AIDS transmission and treatment to their congregations, while 257 (76.5%) used their position as a medium of educating their congregation about the dangers of HIV/AIDS and how to prevent it. Further analysis showed that respondents who were Christians (P = 0.026), had ever been married (P = 0.004), and were males (P = 0.002) were more likely to have ever preached about health issues to their congregations (individual role). Conclusion The study concluded that the religious leaders are well informed about HIV/AIDS and have adequate knowledge and positive attitudes towards people living with AIDS. However, they need encouragement and training to enable them to more effectively harness their position for HIV prevention and to control programs and activities among their congregation to thereby play a crucial role in the war against HIV/AIDS in Nigeria.

Sexual assault against women at Osogbo southwestern Nigeria

BACKGROUND Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available. OBJECTIVE To review the patterns of sexual violence against women treated at the hospital over a 7-year period. MATERIALS AND METHODS Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test. RESULTS Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis. CONCLUSION Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.

Risk factors for neonatal tetanus in Ibadan, Nigeria

This case-control study identified risk factors for neonatal tetanus in this population and indicates that the problem has not yet received adequate attention. The incidence of neonatal tetanus can be greatly reduced by providing the masses with appropriate health education as well as formal education especially at the grass roots level; ensuring access to antenatal services, improving the quality of such services, and extending efforts to provide tetanus immunisation to mothers. Tetanus, listed among the major causes of neonatal death in many tropical countries including Nigeria, is a major public health problem. Although neonatal tetanus (NNT) death toll has reduced by a third in the last decade worldwide, there is a noticeable surge in deaths from this killer disease in Nigeria, giving the country the largest absolute increase worldwide, up by 62% [5,6]. This study sought to obtain more recent information on major risk factors associated with NNT in this community and to make suggestions for reducing its incidence. The study was conducted in all secondary and tertiary hospitals in Ibadan, Nigeria, a city with a projected population of over 4 million [1]. All NNT cases diagnosed by standard criteria were admitted into the study until the total required sample size was met and matched 1:1 with controls. The minimum sample size was calculated after correcting for design effect. The instrument used was a pre-tested structured questionnaire administered to mothers of cases and controls. Subjects enrolled in the study were140 cases and 140 controls with a male/female ratio of 1.4:1 and 1.1:1 respectively. All 19 neonates with onset of illness within the first 4 days of life died, giving a case fatality of 100%. The younger the babies at onset of illness the more likely they were to die (x 2 =41.7, P <0.0001). The overall case fatality rate was 79.4% with a male/female death ratio of 1.3:1. Teenage mothers, fathers with no education, primiparity, low socio-economic class, late antenatal (ANC) booking, none/incomplete maternal tetanus immunisation, delivery outside the health facility, untrained personnel at delivery, use of non-sterile cord-cutting tool, and the presence of animals within the residence were significantly associated with NNT (Table 1). ANC was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunisation. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunisation. The main reason for failure to receive full immunisation was ignorance on the mothers’ part, which reflects inadequate health education by the system. The study identified major risk factors associated with the occurrence of NNT in Ibadan and the surrounding district and indicated that NNT continues to be a common and serious problem in this community because NNT constituted more than one third (38.5%) of the total neonatal admissions in the study sites during the study period. In this study, 40% of the NNT cases were delivered in health facilities in contrast to Tompkins series in which none was delivered in a health facility [4]. The NNT rate in facility delivery is, however, higher than the 15% reported by Grange [2]. Though health facility delivery was associated with significantly lower risk for NNT, the risk was not totally absent suggesting that there is need to look more critically at the role the health facilities play in the transmission of NNT.

Community attitude towards the reproductive rights and sexual life of people living with HIV/AIDS in Olorunda Local Government Area, Osogbo, Nigeria

Background Globally, the Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic remains a major public health problem. In most countries in sub-Saharan Africa, HIV/AIDS has already reversed the post-independence developmental gains. Purpose This study assessed community attitudes regarding the reproductive rights and sexual life of people living with HIV/AIDS (PLWHA) in Olorunda Local Government Area of Osun State, Southwestern Nigeria. Design and methods In a community-based descriptive cross-sectional study, the sample size calculation was based on the assumption that 67% of the target population has a negative attitude regarding the reproductive rights of PLWHA; a confidence interval (CI) of 95% was used. A minimum sample size of 340 was obtained using the formula n = Z2pq/d2. An anticipated 10% nonresponse rate was added to obtain a sample size of 374; a multistage sampling technique was utilized to select a total of 450 respondents. Data collected through a semistructured standardized and pretested questionnaire were analyzed using Statistical Package for Social Sciences software, version 15. Results The study revealed that 283 (66.6%) and 142 (33.4%) of respondents were urban and rural dwellers, respectively. Mean age of respondents was 28.7 years ± 2.2 years. Four hundred and two (94.6%) respondents were aware of HIV/AIDS, and 88.7% had knowledge of at least six different modes of HIV/AIDS transmission. About 30.7% of respondents had discriminatory and stigmatizing attitudes towards PLWHA, and 50.9% and 44.8% had negative attitudes towards their sexual and reproductive rights, respectively. There were significant associations between gender, marital status, educational status, occupation, and residential area of respondents and their attitude towards the reproductive and sexual right of PLWHA (P < 0.05). Conclusion and recommendation Discriminatory and stigmatizing attitudes to PLWHA found among respondents translated into a negative attitude regarding the reproductive and sexual rights of PLWHA. There is an urgent need to institute programs for raising community awareness about the rights of PLWHA, especially in rural areas, and to strengthen legislative provisions for protecting and preserving the reproductive rights of PLWHA.

Prevalence and causes of ocular morbidity seen among rural adult population of Osun State, southwest Nigeria

Context: World Glaucoma and Kidney Days were planned for community eye/health screening. Aims: To assess the prevalence and causes of common eye disorders and visual impairment (VI) in two rural communities of Osun State. Settings and Design: Descriptive cross-sectional. Materials and Methods: Ethical clearance was obtained. Serial recruitment of all consenting adults presenting at Alajue and Ibokun communities over 2 days was done. Sociodemographic data were obtained. Visual acuity and anterior and posterior segment examinations were done. Refraction was done as necessary. Intraocular pressures (IOPs) were checked for cup:disc ratio >0.6 and perimetry done at base hospital for glaucoma suspects. VI was classified according to the World Health Organization ICD.10. Descriptive analysis was carried out. Chi-square with P-values and 95% confidence intervals (CIs) were used to test for significance. Results: In all, 259 subjects-100 males (38.6%) and 159 females (61.4%)-participated. Mean age was 39.73 years (standard deviation [SD] 16.6). The commonest eye disorders were cataract 67 (25.9% CI: 20.5-31.2), refractive error 66 (25.5% CI: 20.2-30.8), glaucoma 17 (6.6% CI: 3.5-9.6), pterygium 14 (5.4%), conjunctivitis 11 (4.2%), hypertensive retinopathies 10 (3.9%, 95% CI 1.5-6.2), cornea opacities 3 (1.2%), and di glaucoma was abetic retinopathy 2 (0.8%). Glaucoma and IOPs were significantly correlated (P = 0.039). CVF changes and glaucoma was significantly associated (P < 0.001). Prevalence of moderate VI was 73 (28.2%, CI: 22.7-33.7), severe VI 9 (3.5%, CI: 1.2-5.7), and blindness 5 (1.9%, CI: 0.2-3.6). Conclusions: There is need to establish community eye-outreach centres to identify cases for cost-effective cataract, refractive error, and glaucoma services. This could reduce the occurrence of these vision and life-threatening disorders.