Kikelomo O. Wright

Mammography and mammographic screening: are female patients at a teaching hospital in Lagos, Nigeria, aware of these procedures?

PURPOSE To determine the level of awareness of mammography and mammographic screening amongst women in Lagos, Nigeria. MATERIALS AND METHODS A structured questionnaire was administered to 555 consecutively recruited women who visited various clinics at the Lagos State University Teaching Hospital, Ikeja, between January 2009 and June 2009. RESULTS The mean age of respondents was 38.16 ± 9 years, and the majority (59.6%) had a tertiary education. A family history of breast cancer was present in 33 (6.0%) women, less than 20% of whom had undergone mammography. Only 20% of all subjects were aware of the recommendation that they should receive routine mammography and mammographic screenings on an annual or biannual basis, depending on their age, and of the side effects associated with the procedure. The mass media was womens main source of information regarding these procedures. The majority (67.6%) of participants confirmed that they performed breast self-examinations, though less than 5% of them had had their breasts examined by mammography. CONCLUSION This study revealed a rather low level of awareness about mammography and mammographic screening, indicating the need to educate women about the risk of breast cancer and the importance of screening as a tool for the early detection and treatment of this condition.

Seroprevalence of hepatitis B e antigen (HBe antigen) and B core antibodies (IgG anti-HBcore and IgM anti-HBcore) among hepatitis B surface antigen positive blood donors at a Tertiary Centre in Nigeria

BackgroundHepatitis B virus (HBV) is a common cause of liver disease throughout the world. HBV is transmitted through blood and other body fluids, including semen and saliva. Chronic replication of HBV virons is characterized by persistence circulation of HBsAg, HBeAg and HBV DNA; usually with anti-HBc and occasionally with anti-HBs. Aim: To determine the prevalence of HBeAg, IgG anti-HBcore and IgM anti-HBcore amongst HBsAg positive blood donors. These parameters are reflective of transmissibility and active hepatitis B infection. A cross sectional study was carried out at the blood donor clinics of Lagos State University Teaching Hospital Ikeja and Lagos University Teaching Hospital Idiaraba. A total of 267 donors were recruited to determine HBe antigen, IgG and IgM anti-HBcore antibodies amongst hepatitis BsAg positive donors. Five milliliters of blood was collected from those who tested positive to HBsAg screen during donation. The sera were subjected to enzyme linked immunosorbent assay (ELISA). Pearson chi-squared test was used for the analytical assessment.FindingsA total number of 267 HBsAg positive blood donors were studied. A seroprevalence of 8.2% (22 of 267) HBeAg was obtained, 4 of 267 (1.5%) were indeterminate while 241 (90.3%) tested negative. Only 27 out of 267 donors (10.1%) tested positive to IgM anti-HBcore, 234(87.6%) tested negative, while 6(2.2%) were indeterminate. A higher percentage of 60.7% (162 of 267) tested positive to IgG anti-HBcore, while 39.3% (105 of 267) tested negative.ConclusionThere is a low seroprevalence rate of HBeAg-positive chronic hepatitis and relatively high IgG anti-HBcore and IgM anti-HBcore rates in South West Nigeria.

Awareness and uptake of the Pap smear among market women in Lagos, Nigeria

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos, Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested, interviewer administered, structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently, participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9% and 12.0% of participants in the intervention and control groups, respectively, had heard of Pap smears. Furthermore, less than 10% had correct information on the use of the Pap test. Post-intervention, there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (P<0.05). However, uptake of the test was quite low in the intervention and control groups both pre- and post-intervention and there was no significant change in uptake. We concluded that essential schemes are required to enhance access to screening, as knowledge alone is insufficient to promote acceptance and use of cervical cytological screening tests.

Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines.

Background Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global guideline, referred to as the ‘handbook’, has been used to monitor availability, utilization, and quality of EmOC. Objective To assess application and explore experiences of researchers in LMICs in assessing EmOC. Design Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. Results Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the ‘handbook’ alone, whereas the others combined the ‘handbook’ with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. Conclusions There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision.

Youth friendly health services in a rural community of Lagos, Nigeria: are the youths receptive?

Abstract Background: Globally, the youths constitute a major segment of most societies particularly in developing countries. This study was undertaken to assess the perception and practices related to youth friendly health services (YFHS) by in-school adolescents in a rural community of Lagos, Nigeria. Methods: A descriptive cross-sectional survey was conducted on 400 proportionately selected consenting respondents from the senior classes of the three secondary schools in Agbowa community. A pre-tested interviewer-administered questionnaire was used for data collection and analysis was done with the aid of statistical software. Results: Most of the respondents were in the age range of 12–15 years with mean age being 15.33±1.54 years. About half (46.8%) of the respondents correctly described adolescents as persons between the ages of 10 and 19 years. The majority (83.2%) of the respondents first heard about the Youth Friendly Health facilities from parents, guardians and friends. However, only few of the respondents had ever visited a Youth Friendly Center. A good location, convenient hours and comfortable surroundings were the most appealing aspects of YFHS. The provision of a seminar room and educational materials (60.8% and 70.8%, respectively) are important to the respondents. Reproductive health (56.8%) was the most preferred health education topic chosen by the respondents. Conclusion: Sensitization of the youths in the Agbowa community about youth friendly health services and provision of such services would be useful in reducing risky practices and improving their health.

Modifying sexual behaviour of patients attending human immunodeficiency virus treatment centres in lagos

Aims and Objectives: This study was carried out among patients attending human immunodeficiency virus (HIV) treatment centres in Lagos to assess their sexual behaviour, conduct a health education intervention on safe sexual behaviour among the patients in the study group and re-assessing the sexual behaviour in both control and study groups. Subjects and Methods: A multi-stage sampling method was used to recruit 253 control and 256 intervention patients. The study sites selected were HIV treatment centres in Lagos State University Teaching Hospital (control), and Ifako-Ijaiye and Isolo General Hospitals (intervention). A pre-tested interviewer-administered questionnaire was used for data collection. The study site intervention consisted of health education seminars. Post-intervention data were collected after 3 and 6 months. Total study duration was about 10 months. Results: At baseline, there was no statistically significant difference in the sexual behaviour of respondents in both groups. Post-intervention, the notable effects of this intervention on the sexual behaviour of the study group were a 37.7% rise in condom use at last sexual exposure, a 74.3% increase in consistent condom use in the last 3 months, a 74.3% rise in consistent condom use with regular partners and a 39.0% rise in consistent condom use with casual partners. Conclusion: The modification of sexual behaviour of respondents achieved in this study has shown that dedicated interventions to increase the practice of safer sex can be effective. More of such interventions are required to stem the spread of HIV in Nigeria.

Histopathological study of surgical cervical biopsies in Lagos, Nigeria

Introduction: Benign lesions of the cervix such as hyperplasia, endometriosis, cervicitis and endocervical polyps are health concerns for women globally. Meanwhile, Cervical cancer is the fourth most common cancer among women in the world, with developing countries bearing the brunt of the burden in terms of morbidity and mortality. This study examines the histopathological pattern of cervical biopsies in a tertiary health institution in Lagos, Nigeria. Materials and Methods: This was a retrospective study of all cervical biopsies received in a government-owned tertiary health institution and a private pathology laboratory both in Ikeja over an 8-year period. All the slides were retrieved and reviewed while socio-demographic and clinical details were obtained from request and clinical notes. Data analysis was conducted using the Statistical Package for Social Science version 20. Results: A total of 901 biopsies were retrieved, representing 4.8% of the total biopsies conducted. The age range of patients was 19–87 years with a mean age of 49 ± 13.0 years. The benign tumours accounted for 58.8% of the cases, with a benign to malignant ratio of 1.5:1. Squamous cell carcinoma (SCC), endocervical polyps, and cervical intraepithelial neoplasm accounted for 36.1%, 30.9%, and 15.1% of the total cervical biopsies, respectively. The benign tumours were statistically related to the younger age groups (P = 0.00), however, malignant tumours showed no relationship with age group (P = 0.325). Conclusion: SCC and endocervical polyps were the most common malignant and benign cervical biopsies, respectively. The benign tumours were seen more in the younger age group. Early detection of some of these benign conditions may provide an opportunity for appropriate interventions to prevent further complications.

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancyrelated morbidities and mortalities. This mixed-methods study quantitatively assessed women’s satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available.

Opinion of women on emergency obstetric care provided in public facilities in Lagos, Nigeria: A qualitative study

ABSTRACT Limited attention has been given to opinions of women receiving emergency obstetric care (EmOC) in developing countries. We organized focus groups with 39 women who received this care from Lagos public facilities. Availability of competent personnel and equipment were two positive opinions highlighted. Contrarily, women expressed concerns regarding the seeming unresponsiveness of the service to nonmedical aspects of care, associated stress of service utilization, and high treatment costs. There is a need to leverage the positive perception of women regarding the available technical resources while improving institutional care components like administrative processes, basic amenities, and costs toward increasing utilization and preventing complications.

Perception and practices of Lagos state residents on the prevention and control of malaria in Lagos, Nigeria

Background: Malaria remains one of the major public health problems worldwide. It is an important cause of death and illness in children and adults in sub-Saharan Africa accounting for over a million deaths per year. The purpose of this study was to determine the perception and practices of the Lagos state residents on malaria. Materials and Methods: A descriptive cross-sectional study was conducted in five of the 20 local government areas (LGAs) in Lagos Nigeria. Using a multistaged sampling method, 5 LGAs and 12, 500 study participants were selected. The survey instrument was a structured, pretested, interviewer-administered questionnaire which sought for information on knowledge, attitude, and practices of the respondents on malaria. Data analysis was done using Epi-info V6.04d software. Results: The mean age was 35.5 ± 10.5 years. There were 8697 females (69.7%) and 3786 (30.3%) males. About 84% of the respondents correctly knew that malaria is transmitted by mosquitoes. Headache was the most recognized symptom (56.6%), while vomiting was the least (17.9%). About half of the participants recognized cleaning the environment as a primary preventive measure and the same number claimed to do so. Approximately, half of respondents claimed usage of insecticide-treated bed nets. Sulphadoxime-pyrimethamine (Fansidar) was the most frequently used (32.7%) antimalarial agent and the use of artemisinin combination therapy was low. Conclusion: Knowledge of malaria symptoms was average and the use of preventive measures was suboptimal. Increasing awareness of all stakeholders on traditional and contemporary preventive measures may enhance the control of this health condition.