Frederick O. Oshiname

Stigma associated with onchocercal skin disease among those affected near the Ofiki and Oyan rivers in Western Nigeria

Skin diseases have been a major source of social stigma, whether they be infectious or not. The potential stigamtizing effect of skin disease associated with onchocerciasis is currently receiving attention because half of the 17 million victims of onchocerciasis in Africa live where the non-blinding form of the disease is prevalent. Some reports are available that onchocercal skin disease (OSD) is associated with social stigma including problems in finding a marriage partner. Previous studies have also implied positive effects of ivermectin treatment on OSD. Therefore a multi-country trial of ivermectin is underway to test the hypothesis that ivermectin treatment might affect perceptions of stigma associated with OSD. This paper presents the baseline stigma findings from the study site located in southwestern Nigeria. A total of 1032 persons living in villages near the Ofiki and Oyan Rivers were screened and interviewed and 500 (48%) were found to have an onchocercal skin lesion. A 13-item, 39-point stigma scale was used in interviews with affected persons. A mean score of 16.8 was obtained. No personal characteristics or disease factors were found to be associated with stigma score. The highest ranking items focused on issues of self-esteem such as feeling embarrassed, feelings of being pitied, thinking less of oneself, feeling that scratching annoys others, feeling that others thought less of the person and feeling that others had avoided the person. During the interviews it was discovered that only about half of those clinically diagnosed as having OSD labeled their own condition as onchocerciasis. Those who said their lesion was OSD had a lower stigma score than those who did not, conforming with previous studies wherein affected persons perceived less stigma from OSD than those without the disease. A broader community perspective on OSD was obtained through 50 interviews using paired comparisons of five skin-related local illnesses. Onchocerciasis placed midway in aversive responses between the higher end represented by leprosy and chicken pox and lower scoring papular rashes known locally as eela and ring worm. In-depth village based interviews yielded several case studies of how onchocerciasis had a negative social impact on its victims. While study on the cultural perceptions of OSD is recommended, the results indicate that with a fairly high prevalence of OSD, the community level effects of social stigma should be regarded as serious.

Factors associated with coverage in community‐directed treatment with ivermectin for onchocerciasis control in Oyo State, Nigeria

Community‐directed distribution with ivermectin (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) as its main strategy for achieving sustained high coverage in endemic communities. This article describes the coverage results achieved when CDTI was introduced in four local government areas of Oyo State, Nigeria. Using a household survey after the second distribution, researchers documented that 68.6% of the community overall received the drug, and as did 85.0% of those who were eligible (not pregnant, not sick and at least 5 years of age). Six factors were associated with having received ivermectin. Four were personal characteristics: being male, being at least 35 years of age, belonging to the Fulani ethnic minority, having taken the drug at a previous distribution. Two village characteristics were smaller size, as measured by number of houses, and use of the central place mode of distribution as opposed to house‐to‐house. In‐depth interviews with village leaders and volunteer community‐directed distributors (CDDs) and focus group discussions among villagers provided qualitative data to help interpret the findings. Women in many villages felt excluded from decision making. The concerns of migrant farm workers living in Yoruba farm settlements were not well understood by health staff or the majority population. The main factor associated with receiving the ivermectin was having received it before, and qualitative comments about side‐effects and beliefs about orthodox drugs indicated that issues of personal preferences, not addressed in a household coverage survey, need to be explored further. The findings can provide guidance in re‐orienting health workers to the importance of fostering participation and cohesion among all segments of the community, especially the inclusion of women and minority groups.

Gender and ethnic differences in onchocercal skin disease in Oyo State, Nigeria

During preparation for a study on the effects of ivermectin treatment on onchocercal skin disease in the Ifeloju Local Government Area of Oyo State, Nigeria, 1032 adults aged20 years and older were examined for skin lesions and palpable nodules. It was found thatfor 4 types of skin lesions, acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD) and depigmentation (leopard skin), as well as for subcutaneous nodules, females had a significantly higher prevalence than males. Although the area is inhabited primarily by the Yoruba people, the study also included some of the cattle‐herding Fulani ethnic group. The reactive skin lesions, APOD, CPOD and LOD, were found to be more common among the Fulani, although there were no significant differences in leopard skin and nodules between both groups. While there is need for further research on both immunological and behavioural factors that may lead to these differences in disease. The need to achieve equity in health programming by ensuring that women and ethnic minorities receive full disease control services is of more immediate concern.

Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis.

Two patient education methods, Information Media (IM) and Social Network (SN), were compared to determine their relative effectiveness on recruitment and subsequent compliance behavior of people infected with onchocerciasis in respect of appointment keeping and ivermectin consumption in existing primary health care facilities in six communities in southwestern Nigeria. Two communities each were randomly assigned to the IM intervention group, two of the SN group, and two served as controls. A total of 1265 persons out of an estimated target population of 5033 infected individuals were enrolled in the study. Coverage rates were higher in the intervention communities (30.3% for SN and 29.9% for IM) than control (7.3%), but the differences between intervention groups was not significant. A drop-off was seen in attendance at the second round of ivermectin distribution. Nearly equal proportions of the intervention groups returned (43.3% for SN and 47.4% for IM), while few control patients came back for their second dose (12.3%). Factors responsible for the low turnout were thought to include the content of educational messages, mobility of community members and limited time available to collect the drugs. Cost considerations led to recommendations to maintain facility based distribution and the SN approach, with greater emphasis on mobilization to increase coverage and compliance.

Exclusive breastfeeding and related antecedent factors among lactating mothers in a rural community in Southwest Nigeria

This study explored the antecedent factors influencing the practice of exclusive breast feeding (EBF) among lactating mothers in Ayete, a rural community in Southwest Nigeria. A three-stage random sampling technique was used to select 410 mothers of newborns and infants less than six months from households. A pretested semi-structured questionnaire which included a 14-point knowledge scale was used for data collection. Data were analyzed using descriptive statistics, Chi-square test and analysis of variance (ANOVA). Mean age was 27.4±5.9 years and 67.1% respondents were aware that EBF should be initiated immediately after birth. Mean knowledge score on EBF was 8.2±2.9. Age, educational level and occupation were significantly associated with knowledge of EBF (p<0.05). Main perceived challenges associated with EBF were loss of essential nutrients by mothers (87.6%) and inducement of hunger (26.2%). Only 10.2% of respondents were practicing EBF as at the time of the study. Reasons for not practicing EBF included baby needs herbs for strength and vitality (31.3%), baby needed water to quench thirst (23.9%) and non-satisfaction with breast milk alone (20.8%). Practice of EBF was significantly more among respondents earning less than N5000.00 monthly (p<0.05). Continuous sensitization activities are needed to promote breast feeding among lactating mothers. Key words: Exclusive breastfeeding, lactating mothers, antecedent factors.

A Qualitative Exploration of Date Rape Survivors’ Physical and Psycho-Social Experiences in a Nigerian University

Date rape (DR) is a serious but under-recognized public health problem that affects female university undergraduates. The burden of the problem in Nigerian universities is, however, yet to be fully investigated. The study was designed to explore the physical and psycho-social experiences of DR female survivors at the University of Ibadan. The study was qualitative in nature and involved eight consenting DR survivors. A pre-tested In-Depth Interview (IDI) guide that included questions relating to survivors’ personal profile, context of DR experienced, factors that promoted survivors’ vulnerability, reported adverse health consequences, help-seeking behaviors, and effects of the rape episode on dating relationship was used to facilitate the conduct of the narrative interview. The interviews were conducted in accordance to the protocol approved by the Joint University of Ibadan and University College Hospital Ethics Review Committee, and were taped-recorded and subjected to content analysis. Participants’ mean age was 17.3 ± 2.3 years. All the participants were teenagers when they were first raped. Coercive and deceptive means were used to perpetrate the act of rape. Participants’ use of verbal appeals, crying, and physical resistance to prevent being raped proved abortive. The experienced adverse physical health consequences included vaginal bleeding and injury. Major psycho-social effects of the experienced DR included self-blame, depression, hatred for men, and suicidal feelings. DR experiences occurred mainly in isolated settings, and most participants could not seek for medical help and other forms of care due to fear of being stigmatized. Some of the DR survivors continued their dating relationships when apologies were tendered by the perpetrators. DR is a traumatic experience, which is characterized by physical and psycho-social adverse effects. DR survivors, however, rarely seek for help as a result of the fear of being stigmatized. Multiple behavioral change interventions are needed to address the phenomenon.