Ita B. Okokon

Adherence to antiretroviral therapy in Nigeria: an overview of research studies and implications for policy and practice

Both Human Immunodeficiency Virus (HIV) infection and AIDS remain major public health crises in Nigeria, a country which harbors more people living with HIV/AIDS than any country in the world, with the exception of South Africa and India. In response to the HIV pandemic, global and international health initiatives have targeted several countries, including Nigeria, for the expansion of antiretroviral therapy (ART) programs for the increasing number of affected patients. The success of these expanded ART initiatives depends on the treated individual’s continual adherence to antiretroviral (ARV) drugs. Thirteen peer-reviewed studies concerning adherence to ART in Nigeria were reviewed with very few pediatric and adolescent studies being found. Methodologies of adherence measurement were analyzed and reasons for nonadherence were identified in the geopolitical zones in the federal republic of Nigeria. The results of the literature review indicate that adherence to ART is mixed (both high and low adherence) with patient self-recall identified as the common method of assessment. The most common reasons identified for patient nonadherence include the cost of therapy (even when the drugs are heavily subsidized), medication side effects, nonavailability of ARV drugs, and the stigma of taking the drugs. This manuscript highlights the policy and practice implications from these studies and provides recommendations for future ART program management.

An Evaluation of the Knowledge and Utilization of the Partogragh in Primary, Secondary, and Tertiary Care Settings in Calabar, South-South Nigeria

The challenge to maternal well-being with associated maternal wastages especially in labor has remained unsurmountable across the three tiers of health care delivery in Nigeria. This study aimed to determine and compare the factors that influence utilization of the partograph in primary, secondary, and tertiary health care delivery levels in Calabar, Nigeria. This was a descriptive study, using a self-administered semistructured questionnaire on 290 consenting nonphysician obstetric care workers, purposively recruited. The mean age of the respondents was 40.25 ± 8.68 with a preponderance of females (92.4%). Knowledge of the partograph and previous partograph training had statistically significant relationship with its utilization among respondents from the tertiary and general hospitals. The level of knowledge was higher among workers in the general hospital than those working in the university teaching hospital. Nurses/midwives in the three levels of care were significantly more knowledgeable in partograph use than other nonphysician obstetric care workers. Lack of detailed knowledge of the partograph, its nonavailability and poor staff strength in the study centers were factors militating against its ease of utilization. The authors recommend periodic in-service training and provision of partograph in labor rooms in all maternity wards in our environment.

Respiratory symptoms amongst females in a fishing settlement in the Niger Delta, Nigeria

Abstract Background Approximately half of the earths population in the rural areas of developing countries uses energy obtained from biomass burning, which is harmful to people. Objectives This study is aimed at determining which respiratory symptoms can be associated with biomass burning amongst fish smokers in the Oyorokoto fishing settlement. Method A community-based, cross-sectional questionnaire, which employed a modified cluster sampling technique, was used. Results A total of 300 subjects were recruited for the study, of which 210 (70%) were fish smokers. The mean age was 31.46 ± 13.03 years, with the majority (42.0%) having only primary school education. The prevalence of respiratory symptoms amongst the subjects was 86.7%, the most frequent of which were catarrh (30.48%) and a cough (28.57%). The respiratory symptom occurring least frequently was breathlessness (2.38%). The symptoms most often experienced during fish smoking were those of catarrh (75.5%) and sneezing (73.0%), whereas breathlessness occurred the least, in only 7 (3.3%) of the participants. Sneezing stopped in 64.2% of the subjects after fish smoking had ceased. Most of the fish smoking took place indoors. Conclusion Health promotion featuring preventive interventions, such as the wearing of face-masks and the use of modern fish smoking methods, which is associated with fewer health risks, is essential to improving the quality of life of fish smokers. The governments provision of certain social services, including better education opportunities for the young, is advocated, and should be especially targeted at improving the lot of the girl child.

The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria

Background Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in Nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. The use of the partograph would engender a remarkable reduction in the number of these deaths since abnormal markers in the progress of labor would be identified early on. Objective This study aimed to evaluate the non-physician obstetric caregivers’ (OCGs) knowledge of partograph use, assess the extent of its use, determine the factors that impede its usage, and unravel the relationship between years of experience and partograph use among the respondents (OCGs) in General Hospital, Calabar, Nigeria. Methodology Using a self-administered semi-structured questionnaire, a cross-sectional descriptive study was conducted among 130 purposely selected and consenting OCGs working in the General Hospital, Calabar, Nigeria. Results The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in-depth knowledge of the component parts of the partograph. Knowledge of partograph (χ2=12.05, P=0.0001) and partograph availability (χ2=56.5, P=0.0001) had a significant relationship with its utilization. Previous training (χ2=9.43, P=0.002) was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70%), shortage of staff (61.5%), and the fact that it is time-consuming to use (30%). Conclusion Lack of detailed knowledge of the partograph, nonavailability of the partograph, poor staff numbers, and inadequate training are factors that work against the effective utilization of the partograph in the study facility. Usage of this tool for labor monitoring can be enhanced by periodic training, making partographs available in labor wards, provision of reasonable staff numbers, and mandatory institutional policy.

Assessment of the Knowledge and Utilization of the Partograph among Non-physician Obstetric Care Givers in the University of Calabar Teaching Hospital, Calabar, Nigeria

Thomas U. Agan, Ubong Akpan, Ita B. Okokon, Afiong O. Oku, Udeme E. Asibong, Margaret M. Opiah, Ekere J. Essien and Emmanuel Monjok Department of Obstetrics and Gynaecology, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Family Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Community Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Maternal and Child Health Nursing, Faculty of Nursing, College of Health Sciences, Niger Delta University, Bayelsa State, Nigeria. University of Houston, Institute of Community Health, Texas Medical Center, Houston Texas, USA.

A Comparison Study of Traumatic Occupational Injury Burden by Departments in an Industrial Establishment in South-South Nigeria

Objective: This study aimed to compare traumatic occupational injury burden by departments in an industrial establishment in the South-South geo-political zone of Nigeria. Materials and methods: This was a 12-month descriptive longitudinal study of traumatic occupational injuries among workers in all the Departments of a paper-producing company in Nigeria. All workers traumatically injured at work were coded and enlisted into the study with their workers’ identification numbers. Data obtained were analysed using the Statistical Package for Social Sciences for windows version 16.0. Regressional statistics was used to compare categorical variables while descriptive statistics were used to summarize other variables. Results: The results show that the specific incidence rates for the two departments that were most injury-prone: Mechanical Engineering and Logging Departments were 77.4 traumatic injuries/1000 workers and 214.3 traumatic injuries/1,000 workers, with proportions of 3.8% and 5.7% involvement of the workers in the affected departments respectively, for severe injuries. The burden of injury in Logging department was statistically significant over that in Mechanical Engineering Department for all the traumatically injured (p<0.05). Conclusion: Regular training of workers on the job regarding safety measures in general is recommended along with the use of ergonomic-oriented enhancements nationally, to forestall the occurrence of avoidable accidents. The opening of a National Occupational Injury Register in Nigeria is also recommended to keep track and stem the occurrences of injuries in workplaces. Currently, the services of Family Physicians in the face of critically few Occupational Health Physicians remain invaluable in industrial settings in the country.

The Consultation in Primary Care: Physician Attributes that Influence Patients' Satisfaction in Calabar, Nigeria

Background: The Consultation is of immense importance in primary care. This study aimed to utilize physician attributes in the patient-care process in determining the proportion of patients who were satisfied or otherwise with the consultation at their doctor-patient interaction. Method: This was a cross-sectional descriptive study undertaken in the Family Medicine Clinic of the University of Calabar Teaching Hospital in the Niger Delta Region of Nigeria. A modified post consultation version of the General Practice Assessment Questionnaire was administered to 430 patients aged 18 to 67 years, who were selected through a process of systematic random sampling over a period of three weeks. Data generated in this study was analyzed using the statistical package for social sciences version 11. Results: Of the 430 subjects studied, 46.74% were males and 53.26% females. The physician attributes shown to positively affect patients’ satisfaction with the consultation included: manner of asking the patients about their feeling regarding their illnesses, detailed enquiry about the patients’ symptoms, discussing the origin of the patients’ illnesses, involving the patients in decisions about the care and explaining the patients’ problems and any treatment needed. Others were: making the patients feel at ease during the examination, showing care and concern and addressing their main presenting problems. Conclusion: The study demonstrated clearly that physician attributes greatly influence the outcome of the Consultation in Primary Care.

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

Respiratory effects of biomass fuel combustion on rural fish smokers in a Nigerian fishing settlement: a case control study

BACKGROUD The aim was to study the prevalence of respiratory symptoms and assess the lung function of fish smokers in Nigeria. METHODS A case control study was done among fish smokers in Nigeria. Women aged 15 years or older (n=210) involved in fish smoking and equal number of matched controls were interviewed on respiratory symptoms and their peak expiratory flow rate (PEFR) measured. Data was analysed using chi square test, students t-test and odd ratios. RESULTS Both groups were similar in their personal characteristics. The test group had significantly increased occurrence of sneezing (153; 72.86%), catarrh (159; 75.71%), cough (138; 65.71%) and chest pain (59; 28.10%) compared with the control group, odds ratio (OR) 2.49, 95% confidence interval CI (1.62-3.82), P < 0.001), OR 3.77,95% CI (2.44- 5.85), P < 0.001, OR 3.38, 95% CI (2.22-5.15), P < 0.001, and OR 6.45,95% CI (3.22-13.15), P < 0.001, respectively. The mean PEFR of 321±58.93 L/min among the fish smokers was significantly lower than 400±42.92 L/min among the controls (p = 0.0001). CONCLUSION Fish smokers have increased risk of respiratory symptoms and reduced pulmonary function. There is a need for protective equipment and periodic evaluation.

Work-Related Traumatic Injury in the Paper-Producing Industry in Nigeria: ACase Study of the Nigerian Newsprint Manufacturing Company Limited, Oku-Iboku, Akwa Ibom State

Introduction: This research aimed to determine the characteristics of work-related traumatic injuries in a paper-producing company over a 12-month period, as a case study of the traumatic injury picture in the industry in Nigeria. Materials and Methods: This was a longitudinal descriptive study using a structured questionnaire to collect information from permanent employees of the Nigerian Newsprint Manufacturing Company Limited, upon presentation to the Company Medical Service. The identification number of each affected employee was noted. All traumatic injuries sustained by employees while on duty were examined, classified and coded following the World Health Organisation’s guidelines. Data gathered were analysed using tables and percentages. The chi-square test was employed in the comparison of the burden of injury in the two major divisions of the Company with the level of statistical significance set at 0.05. Results: Affected workers were all males with a mean age of 32.14±3.23 years. The Crude Incidence rate of severe injury for the whole Company was 50.7 injuries per 1000 employees, and the Specific Incidence rate for the producing divisions of the Company was 71.7 injuries per 1000 employees. The majority of cases were superficial traumatic injuries (65.1%) requiring only first-aid care and the leading cause of severe injury in forest work was “struck by falling object” (22.86%), while “contact with powered hand tool”, the chainsaw (15.50%) was commonest equipment in causation of severe traumatic injury. The burden of Injury in the Forestry division was statistically significant over that in Operations division of the Company (p< 0.05). Conclusion: This study recommends the opening of a National work-related Injury register in Nigeria, for the ease of tracking such injuries in workplaces in the country. Family Physicians are enjoined to work together with the few occupational health physicians to strengthen industrial safety in the emerging factories nationally.