Nkiru Nwamaka Ezeama

The Epidemiology of Dependence in Older People in Nigeria: Prevalence, Determinants, Informal Care, and Health Service Utilization. A 10/66 Dementia Research Group Cross‐Sectional Survey

OBJECTIVES: To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization.

Clinical presentation of uterine fibroids in Nnewi, Nigeria: A 5-year review

Background: Uterine leiomyomas are the commonest benign tumors in women, with a higher preponderance amongst Africans. Several etiological factors have been suggested, with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7%, 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7%, 79/103) and 51.5% (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9%, 67/103) and the least was recurrent abortion (1%, 1/103). Surgery was employed in all cases, with myomectomy being the commonest modality used in 90.3% (93/103) of cases. The common postoperative complications were prolonged pain (49.5%, 51/103) and postoperative pyrexia (34.9%, 36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment.

Socio-demographic determinants of maternal health-care service utilization among rural women in Anambra state, south east Nigeria

Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2 -test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively . Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits.

Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria

Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4–98.4%) and natal services (92.7%; 95% CI 89.2–95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X2 = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services.

A comparison of prophylactic intramuscular ergometrine and oxytocin for women in the third stage of labor.

To compare the efficacy and adverse effects of ergometrine and oxytocin given intramuscularly for the prevention of postpartum hemorrhage during the third stage of labor.

Parents' Perceptions of Timing of Initiation of Sexuality Discussion with Adolescents in Anambra State, South Eastern Nigeria

STUDY OBJECTIVE This study was aimed at determining the perception of the timing and practice of sexuality discussion among parents in South Eastern Nigeria. DESIGN A cross-sectional, descriptive, community-based study. SETTING The study was carried out in 3 randomly selected Local Government Areas in Anambra State, South Eastern Nigeria. PARTICIPANTS The study participants were parents with adolescent children resident in the study areas for at least 2 years. RESULTS Most parents opined that sexuality discussion should be initiated after puberty. Only 20% of them discussed reproductive health issues often with their adolescents, while another 20% never discussed such issues with their adolescent children. Topics most commonly discussed bordered on the adverse consequences of sex rather than measures for preventing them. About half of parents were willing to discuss contraception with their adolescent child. Predictors of parent-child communication were age, gender, and educational status. CONCLUSION Common reasons for low parental involvement in sexuality discussions were due to their lack of capacity and the perception that discussing such issues before puberty is ill timed. Therefore, measures should be taken to improve the capacity of parents to engage in such conversations to provide sexuality information to their teens.

Emotional distress, physical illness and functional impairment in community dwelling older adults in South Eastern Nigeria--a report from the 1066 group.

Africa remains the only world region where maternal and childhood communicable diseases still account for much of the mortality and morbidity. Although previous reports indicate that the age specific dementia prevalence in Nigeria is lower than in developed countries, the population and epidemiological transition is envisaged to create a double burden with chronic medical diseases assuming greater public health importance in Africa. Co-morbid physical and mental disorders in older people may affect their functioning and quality of life as assessed by self health rating. In this report we present the sociodemographic profile, self reported physical health, emotional distress and basic activities of daily living and how these variables interact. Data were obtained from older adults who make use of a village social centre in rural Nigeria. A total of 162 older persons (63.6% females), mean age 71.6 6.9 years, 47.5%widowed, 8.6% living alone and 59.3%without any formal education) participated in the study. The GHQ 12 (Goldberg et al., 1997) and Katz index of independence in activities of daily living, KADL (Katz et al., 1963) were used to measure the emotional distress and impairment of functioning respectively. Self reported physical health conditions as symptoms or diseases and self heath rating, SHR, were obtained. Subjective memory loss was assessed with the GMS items of difficulty with remembering things.

An assessment of reproductive health services in selected health facilities, Anambra State, Nigeria

Abstract The national figure for skilled attendance at delivery in Nigeria is 38.1 percent, with some observed regional difference. In Anambra State for instance, 87.6 percent of deliveries are taken by skilled providers. However, the

Comparative Analysis of the Nutritional Status of Under - five Children and their Mothers in Rural and Urban Areas of Anambra State, Nigeria

Aim: Ma lnutrition in the form of under - nutrition is still a major public health problem in developing countries of sub - Saharan Africa including Nigeria. This study compares the nutritional status of under - five children and their mothers in rural and urban areas o f Anambra State Nigeria. Methodology: This was a comparative cross - sectional study carried out in one urban and two rural local government areas of Anambra State, Nigeria namely Awka South, Dunukofia and Anaocha respectively. A total of 657 mother - child p airs were selected from eligible households using the multistage sampling technique. Data on household food security was obtained from the mothers using semi - structured, interviewer - administered questionnaires while anthropometric measurements were carried out on the children and their mothers using weighing scales and height boards. Results: The overall prevalence of stunting, wasting and underweight among the under - five children in this study were 15.1%, 18.1% and 10.4% respectively, and the proportions were higher in the rural area than in the urban. The prevalence of stunting (height < 152 cm) in the mothers was 7.9% in the rural area compared to 9.1% in the urban area. Majority of the women were overweight (BMI ≥ 25.0), more in the urban (69.3%) than i n the rural (59.2%).