Olanrewaju Onigbogi

The ethical and legal regulation of HIV-vaccine research in Africa: lessons from Cameroon, Malawi, Nigeria, Rwanda and Zambia

Ethical and legal frameworks are important for ensuring that the goals of scientific research are realised while at the same time the rights and welfare of human participants are adequately protected. A balance in attaining these two goals can be achieved if such frameworks provide for legally binding structures and processes to oversee, regulate, and monitor research on human participants according to accepted norms and standards. From 2007 to 2009, an ethical/legal audit, sponsored by the WHO/UNAIDS Ethics, Law and Human Rights Working Group of the African AIDS Vaccine Programme (AAVP ELH), was conducted in regard to five African countries (Cameroon, Malawi, Nigeria, Rwanda and Zambia) to determine whether these countries have adequate laws, ethical guidelines and policies in place to regulate HIV-vaccine research. This article discusses the findings of the audit with a view to highlighting key lessons that can be learnt from these countries. The article provides the context of the audit by highlighting its rationale, aims and methods. We discuss the general findings of the audit and the complex issues arising from HIV-vaccine research, specifically. Lastly, we propose specific ways in which the ethical/legal frameworks guiding research with human participants in these countries can be improved.

Knowledge and Attitude toward Smoke-Free Legislation and Second-Hand Smoking Exposure among Workers in Indoor Bars, Beer Parlors and Discotheques in Osun State of Nigeria

BACKGROUND One of the requirements of the Osun State smoke-free legislation is to ensure smoke-free enclosed and partially enclosed workplaces. This survey was conducted to assess the knowledge and attitude of workers in indoor bars, beer parlors and discotheques to smoke-free legislation in general and the Osun State smoke-free law in particular. METHODS A convenience sampling of 36 hospitality centers was conducted. Interviewer-administered questionnaires were used to elicit responses about the objectives from non-smoking workers. The questionnaires had sections on knowledge of the Osun State smoke-free law, attitude toward the law and smoke-free legislation in general and exposure to second-hand tobacco smoke by the workers. Questions were also asked about the second-hand tobacco smoking status of these workers. The data were analyzed using SPSS version 15.0. RESULTS We had 154 participants recruited into the study. There were 75 males (48.0%) and 79 females (52.0%). On the overall, respondents had a good knowledge of the effects of second-hand smoke on health (70.2%) with 75.0% of them being aware of the general smoke-free law and 67.3% being aware of the Osun State smoke-free law although none of them had ever seen a copy of the law. A high proportion (60.0%) was in support of the Osun smoke-free law although all of them think that the implementation of the law could reduce patronage and jeopardize their income. Attitude toward second-hand smoking was generally positive with 72.0% of them having no tolerance for second-hand tobacco smoke in their homes. Most participants (95.5%) had been exposed to tobacco smoke in the workplace within the past week. CONCLUSION Despite the high level of awareness of the respondents about the dangers of second hand smoke and their positive attitude to smoke-free laws, nearly all were constantly being exposed to second hand smoke at work. This calls for policy level interventions to improve the implementation of the smoke-free law.

Prevalence of cervical and anal warts among HIV patients on ARV Nigerian special treatment center

Background With the introduction of HAART in many HIV treatment centers in Nigeria, there has been a decreased incidence of AIDS-related mortality and growing concern about the incidence of AIDS specific and nonAIDS specific cancers. This study thus sought to investigate patterns and incidence of cervical and anal warts among patients in a Special Treatment Center (SPC) before being diagnosed of having HIV and after starting ARVs.

Doctors’ Attitude and Willingness to Use Electronic Medical Records at the Lagos University Teaching Hospital, Lagos, Nigeria.

Background There have been few studies conducted on Electronic Medical Records (EMR) among medical doctors who practice in resource limited settings. This study aimed to assess the attitude to and willingness of medical doctors at the Lagos University Teaching Hospital to use EMR and to identify the factors that are associated with the willingness to use EMR. Methods A stratified sampling method was used to select medical doctors to participate in the study according to their experience and professional cadre. A pretested self-administered questionnaire was used to collect data which were entered and analyzed using the Epi-info version 7 software. Statistically significant associations were tested using the chi-square and fishers exact tests. Results There were 202 participants in the study. All (100%) had good attitude towards EMR. Nearly all of them (96.54%) were willing to use EMR. There was no significant association between age, gender and willingness to use EMR. However, there was a statistically significant association with work duration and IT skills (p< 0.05). Conclusion Work duration and IT skills are significant factors in determining the willingness to use EMR. There is therefore a need to include IT skills acquisition in medical training so as to increase the chance of use of EMR.

PA 18-3-0681 Prevalence, pattern and risk factors for elder abuse in urban and rural areas of lagos state, nigeria

Elder abuse is gradually emerging as a significant public health and social problem in developing countries. Changing family and community support structures, economic environments, urbanization and shifts in values are influencing the way elders are treated in the society. This study was conducted to determine and compare the prevalence, pattern, determinants and effects of elder abuse among the elderly in an urban and a rural Local Government Area (LGA) of Lagos State. Using a multistage sampling technique, 500 elderly respondents were selected from Surulere and Ikorodu LGA. Data was collected through quantitative methods. Data was analyzed with IBM SPSS 20 and summarized using frequencies and proportions. Chi-square was used to test for associations between variables and independent t-test was used for comparison of means with p-value assumed to be significant at p≤0.05. Logistic regression was used to predict the outcome of dependent variables. The prevalence of elder abuse was 22.8% in the last 12 months. The prevalence of elder abuse was higher among the urban (29.6%) than the rural respondents (16%), p<0.001. Psychological abuse was the most prevalent form of elder abuse and its prevalence was higher among the urban (25.6%) than the rural respondents (8.8%), p<0.001. The prevalence of financial and physical abuse in this study was 7.0% and 3.4% in both locations. Sexual abuse and neglect were the least reported forms of elder abuse. The predictors of elder abuse among urban respondents include presence of financial dependents {OR: 2.19 (95% CI: 1.21 to 3.94) and lack of satisfaction with level of involvement in social activities {OR: 2.15 (95% CI: 1.20 to 3.84)} and reduced social support. The predictor of elder abuse among rural respondents was the absence of financial support {OR: 2.88 (95% CI: 1.04 to 7.97)}. Recommendations include creating social interaction opportunities, establishing welfare programs and improving community attitudes towards the elderly through awareness creation.

Occupational exposure, attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria

Abstract Health care workers (HCWs) are at risk of occupational exposure to HIV. Their attitude to HIV-positive patients influences patients’ willingness and ability to access quality care. HIV counselling and testing (HCT) services are available to inform HCWs and patients about their status. There is little information about HCT uptake and attitude to HIV-positive patients among HCWs in tertiary health facilities in Nigeria. The aim of this study was to determine occupational exposure and attitude to HIV-positive patients and level of uptake of HCT services among HCWs in a tertiary hospital in Nigeria. A cross-sectional design was utilized. A total of 977 HCWs were surveyed using semi-structured, self-administered questionnaires. Nurses and doctors comprised 78.2% of the respondents. Their mean age was 35 ± 8.4 years. Almost half, 47.0%, reported accidental exposure to blood and body fluids (BBFs) in the preceding year. The main predictor of accidental exposure to BBFs in the last year was working in a surgical department, OR = 1.7, 95% CI (1.1–2.6). HCWs aged <40 years, OR = 5.5, 95% CI (1.9–15.9), who had worked for >5 years, OR = 3.6, 95% CI (1.4–9.3) and who work in nursing department, OR = 6.8, 95% CI (1.7–27.1) were more likely to be exposed to BBFs. Almost half, 52.9%, had accessed HCT services. Predictors for HCT uptake were age <40 years OR = 1.6, 95% CI (1.1–2.4), having worked for >5 years OR = 1.5, 95% CI (1.03–2.2) and working in medical department OR = 1.7, 95% CI (1.1–2.8). Respondents in nursing departments were more likely to require routine HIV test for all patients, OR = 3.9, 95% CI (2.4–6.2). HCWs in the laboratory departments were more likely to believe that HIV patients should be on separate wards, OR = 3.6, 95% CI (1.9–7.0). HCWs should be protected and encouraged to access HCT services in order to be effective role models in the prevention of HIV/AIDS.

Second-hand smoke exposure among workers of restaurants, bars, and nightclubs in Lagos State

Background: The Lagos State Regulation of Smoking Law was passed in February 2014 and stipulates the total restriction of tobacco smoking in listed public places. Workers in hospitality venues are at a high risk of exposure to second-hand smoke (SHS). Therefore, their awareness of the health risks, attitudes toward SHS and their reported levels of exposure may play a crucial role in developing an effective monitoring, implementation, and enforcement mechanism. Methods: We conducted a cross-sectional, descriptive study among workers in restaurants, bars, and nightclubs registered with the Lagos State Ministry of Tourism in the second quarter of the year 2014. We used a multistage sampling technique to select one respondent each from the 300 centers randomly selected to participate in the survey. Data were collected using a modified version of the World Health Organization Global tobacco surveillance system tools. Univariate and bivariate analysis were carried out. Exposure to SHS in the workplace and in other public places was treated as the outcome variable in the bivariate analysis. Results: Majority (75.3%) of the respondents were aged between 21 and 40 years with a mean age of 27.7 + 8.6 years. Many (66%) were waiters/waitresses and spent more than 8 h a day. Most (60.6%) of the venues were indoor only establishments, and 26.8% had no form of smoking restrictions. Majority of the respondents were exposed to SHS at work, and this was higher in bars and nightclubs. A bivariate analysis of results showed that workers were exposed to SHS at work irrespective of workplace smoking restrictions or respondents smoking status. Conclusion: Our study demonstrates that second-hand smoke exposure is very high (65% in smokers; 65.6% in nonsmokers) among workers in restaurants, bars, and nightclubs in Lagos State. We are therefore of the opinion that strict enforcement of law would ensure the protection of these workers.

Cigarette purchase and accessibility among children in a developing country. A study among in-school youth in Lagos state, Nigeria

INTRODUCTION Tobacco use among youth remains a significant global public health challenge especially in low and middle Income countries (LMICs). The vast majority of smokers begin using tobacco products well before the age of 18 years.If current trends continue, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in low-and middle-income countries (LMICs). In recent years, the tobacco control community has shifted its focus to LMICs, which are becoming a major market for tobacco companies seeking to expand their profits and compensate for dwindling markets in higher-income countries. Many countries in sub-Saharan Africa are in the first stage of the tobacco epidemic .Nigeria, the most populous country in Africa, with an estimated 44% of her population under the age of 18 years, remains an attractive market for the tobacco industry. The 2008 Global Youth Tobacco Survey (GYTS) conducted among children aged 13-15 years in five sites across Nigeria showed rates of smoking experimentation ranging from 4.7% in Ibadan (South Western region) to 16.1% in Kano (North central region), while current smoking rates ranged from 0.3% to 11.4% among girls and boys in Kano state respectively.6 Furthermore, 2.9% of girls in Ibadan and up to 17.8% of girls in Lagos state who had never smoked cigarettes reported that they were likely to initiate cigarette smoking within the next year . Availability and accessibility of different types of tobacco products to youth have been identified as an important determinant of tobacco use. Reducing the availability and accessibility of cigarettes to young people can significantly reduce youth smoking. While there is paucity of data from many African countries, studies in more developed countries showed that youth who perceived cigarettes as Cigarette purchase and accessibility among children in a developing country. A study among in-school youth in Lagos state, Nigeria Oluwakemi Ololade Odukoya1, Olanrewaju Onigbogi1, Chife Jacob1, Kolawole Okuyemi2

Uptake of hepatitis B vaccination among staff of an accident and emergency facility in Lagos, southwest Nigeria

Background: Hepatitis B vaccine has been available since 1982; it is safe and 95% effective in the prevention of chronic infection in adults and children. People with reasonable exposure to blood and blood products (health workers and those in accident and emergency facilities) ought to be vaccinated against Hepatitis B. Materials and Methods: A descriptive cross-sectional study was carried out among the staff of an accident and emergency facility in Lagos, southwest Nigeria. A pretested, structured, and self-administered questionnaire was used for collection of data on the sociodemographic characteristics and the uptake of hepatitis B vaccination among the respondents. The uptake was based on whether the respondents had received the vaccine, the number of doses received (i.e., whether complete or not), and whether they were undergoing a postvaccination test. The responses on the uptake of hepatitis B vaccination was scored and graded as good (≥50%) and poor (<50%). Results: A total of 84 respondents participated in the study. The majority of them (84.5%) had poor uptake of hepatitis B vaccination and the mean uptake score (%) was 24.2 ± 25.0. Among the respondents, 47 (56.0%) had received at least a dose of the hepatitis B vaccine, 11 (13.1%) received the three complete doses, while only 7 (9.9%) did a postvaccination test to check immune status. Among the 37 respondents who did not receive any dose of the vaccine before the study was carried out, a majority of them (67.6%) cited nonavailability of the vaccine as the reason for this while four (10.8%) cited cost as the reason. Conclusion: The uptake of hepatitis B vaccination among the staff of the accident and emergency facility was poor mainly due to nonavailability of the vaccine. There is, therefore, a need for the government to provide this vaccine and make it available at an affordable cost for workers. In addition, an immunization policy should be put in place at the facility, and implementation and monitoring should be done to ensure that the staff are immunized and protected against the hepatitis B virus (HBV).

Exploring Cigarette Use Among Male Migrant Workers in Nigeria

BACKGROUND There is limited knowledge about the use of cigarettes by blacks outside the United States (U.S). Nigeria creates an opportunity to explore smoking behaviours, smoking cessation (nicotine dependence) and use of cigarettes in a country that has a large black population outside the U.S. METHODS We conducted three Focus Group Discussions (FGDs) involving twenty-four male migrant workers who reported that they were current cigarette smokers. Interviews were audio-taped and transcribed. RESULTS Four major themes namely: reasons for initiating and continuing to smoke cigarettes, factors affecting brand choice, barriers to quitting, effect of smoking mentholated cigarette brands were identified. CONCLUSION This study provides insight into the use of mentholated and non-mentholated cigarettes and suggests the need for further studies to explore smoking behavior among Nigerians.