Oyindamola B. Yusuf

Poverty and fever vulnerability in Nigeria: a multilevel analysis

BackgroundMalaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels.MethodsDeterminants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted.ResultsAbout 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6months), whereas the effect of wealth no longer reached statistical significance.ConclusionWhile, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation.

Age-related hearing loss, vitamin B12, and folate in the elderly.

OBJECTIVE: Determine the correlation between the hearing threshold and the serum levels of vitamin B12 (cobalamin) and folic acid among elderly subjects (> 60 years) with age-related hearing loss (ARHL). STUDY DESIGN: Cross-sectional. SETTING: Community. SUBJECTS AND METHODS: Subjects included elderly who were found apparently healthy following repeated examination by physicians. The pure tone average (PTA) for the speech and high frequencies, and the serum folate and cobalamin were determined and the correlation found. RESULTS: The mean ± SD values of serum folate among the subjects with normal PTA in the speech frequencies (0-30 dB) was 412.3 nmol/L ± 17.6 nmol/L, while among those with hearing loss (HL), it was 279.1 nmol/L ± 17.2 nmol/L (P = 0.01). In the high frequencies, the mean ± SD values among the subjects with normal PTA was 426.3 nmol/L ± 17.6 nmol/L, while among those with HL, it was 279.14 nmol/L ± 171.2 nmol/L. The serum cobalamin among the subjects with normal PTA within the speech frequencies was 49.7 pmol/L ± 9.4 pmol/L, while among those with speech-frequency HL, it was 42.6 pmol/L ± 10.2 pmol/L. However, for high frequencies, the mean ± SD values among the subjects with normal PTA was 47.4 pmol/L ± 7.3 pmol/L, while among those with HL, it was 41.3 pmol/L ± 9.2 pmol/L. Spearmans correlation revealed that low folate (correlation coefficient = −0.27, P = 0.01) and cyanocobalamin (correlation coefficient = −0.35, P = 0.02) were significantly associated with increasing hearing threshold in the high frequencies. After adjusting for age, serum folate (correlation coefficient = −0.01, P = 0.01) was significant, while vitamin B12 (correlation coefficient = −0.01, P = 0.74) was not. CONCLUSION: Serum folate was significantly lower among elderly with ARHL. Trials on nutritional supplementation may substantiate the role of serum folate in ARHL.

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study.

Background. Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication. Methods. In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)–based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention. Results. A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9–2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2–127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Students t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59–.78; P < .0001). Conclusions. Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management. Clinical Trials Registration. ISRCTN13858170.

Malaria Rapid Diagnostic Tests and Malaria Microscopy for Guiding Malaria Treatment of Uncomplicated Fevers in Nigeria and Prereferral Cases in 3 African Countries

Background. The World Health Organization recommends that malaria treatment be based on demonstration of the infecting Plasmodium parasite specie. Malaria rapid diagnostic tests (RDTs) are recommended at community points of care because they are accurate and rapid. We report on parasitological results in a malaria study in selected rural communities in 3 African countries. Methods. In Nigeria, community health workers (CHWs) performed RDTs (SD-Bioline) and thick blood smears on all children suspected to have malaria. Malaria RDT-positive children able to swallow received artemisinin-based combination therapy (Coartem). In all countries, children unable to take oral drugs received prereferral rectal artesunate irrespective of RDT result and were referred to the nearest health facility. Thick blood smears and RDTs were usually taken at hospital admission. In Nigeria and Burkina Faso, RDT cassettes and blood smears were re-read by an experienced investigator at study end. Results. Trained CHWs enrolled 2148 children in Nigeria. Complete parasitological data of 1860 (86.6%) enrollees were analyzed. The mean age of enrollees was 30.4 ± 15.7 months. The prevalence of malaria parasitemia in the study population was 77.8% (1447/1860), 77.6% (1439/1855), and 54.1% (862/1593) by RDT performed by CHWs vs an expert clinical research assistant vs microscopy (gold standard), respectively. Geometric mean parasite density was 6946/µL (range, 40–436 450/µL). There were 49 cases of RDT false-negative results with a parasite density range of 40–54 059/µL. False-negative RDT results with high parasitemia could be due to non-falciparum infection or result from a prozone effect. Sensitivity and specificity of SD-Bioline RDT results as read by CHWs were 94.3% and 41.6%, respectively, while the negative and positive predictive values were 86.1% and 65.6%, respectively. The level of agreement in RDT reading by the CHWs and experienced research staff was 86.04% and κ statistic of 0.60. The malaria parasite positivity rate by RDT and microscopy among children with danger signs in the 3 countries was 67.9% and 41.8%, respectively. Conclusions. RDTs are useful in guiding malaria management and were successfully used for diagnosis by trained CHWs. However, false-negative RDT results were identified and can undermine confidence in results and control efforts.

Correlation between Serum Immunoglobulin G and Hearing Threshold among Elderly Subjects with Age-Related Hearing Loss

Background and Purpose: This study was based on the hypothesis that suboptimal immune response and low serum immunoglobulin G (IgG) may predispose to age-related hearing loss (ARHL), and the objective was to determine the serum levels of IgG and hearing thresholds of apparently healthy elderly subjects and assess their correlation. Method: This prospective study involved 126 participants ≧60 years old who were found to be free of any medical conditions. Pure-tone averages for both the speech (500–2,000 Hz) and high frequencies (3,000–8,000 Hz) and serum IgG levels were determined. Using 30 dB as cut-off for hearing loss, the correlation with serum IgG was assessed. Results: There were 59 males and 67 females with a mean age ± SD of 67.0 ± 2.7 years. Speech frequency hearing loss was seen in 30.2%, while high-frequency hearing loss accounted for 74.6%. In the speech frequencies, the mean ± SD of serum IgG among subjects with normal hearing was 11.3 ± 3.9 g/l, while among those with hearing loss it was 8.3 ± 3.3 g/l (p = 0.01). In the high frequencies, the mean ± SD values of serum IgG among the subjects with normal hearing was 11.1 ± 2.3 g/l, while among those with hearing loss it was 8.7 ± 1.9 g/l (p = 0.01). Conclusion: Low serum IgG may be a contributory factor to the development of ARHL among the elderly. However, a longitudinal study involving intervention with immunoglobulin supplementation may further confirm this role.

Knowledge of birth defects among nursing mothers in a developing country

BACKGROUND In the absence of established guidelines, where formal screening is unavailable for birth defects, a lot of responsibility is placed on parents in the recognition of these defects. OBJECTIVES The aim of the study was to determine the awareness of mothers about birth effects in a developing country and assess what they know about the prevention, detection and treatment of children with birth defects. METHODS This was a descriptive cross-sectional study of 714 mothers consecutively selected at two major hospitals in Nigeria between May and December, 2012. Data were collected with interviewer administered questionnaires. Descriptive and inferential statistics were performed using SPSS and statistical significance set at p <0.05. RESULTS The participants were aged 17 to 42 years. Only 183 (25.6%) were aware of birth defects. Factors associated with awareness of birth defects were older age, religious belief, better education, higher socioeconomic class, early age at booking and registering at a tertiary care facility. Education, socioeconomic class as well as month and location of booking were found to be independent predictors of awareness of birth defects. CONCLUSION Mothers in Ibadan, Nigeria, a country without a formal newborn screening programme, have a poor level of awareness about birth defects.

School absenteeism among orphans and vulnerable children in Lagos State, Nigeria: a situational analysis

ABSTRACT Knowledge of factors associated with school absenteeism among orphans and vulnerable children (OVC) who are at greater risk could facilitate effective policies to mitigate school dropouts. This study assessed the level of school absenteeism and its associated factors among OVC in five local government areas (LGAs) in Lagos State, Nigeria. A cross-sectional study of OVC households in purposively selected five LGAs in Lagos State was conducted. Enrolled vulnerable households were based on the National Household Vulnerability Assessment criteria. School absenteeism was measured by whether the OVC missed any school day, for any reason in the last school week. Data were collected by personal interview using a semi-structured questionnaire. IBM SPSS Statistics, version 20, was used for all analysis of data collected on schooling of OVC aged 10–17 years. Chi-square test and logistic regression model were used to determine significance of associations at 5% level. The 757 OVC participants were aged 13.1±2.2 years and their caregivers were aged 43.1±13.9 years from 1300 households. There was high proportion of school enrolment (85.7%) as well as absenteeism (20%). The rate of absenteeism among OVC was significantly higher among those who involved in household chores (31.2%) and who often sleep at night without food (40.0%). The odds of absenteeism were almost twice higher among OVC who involved in household chores (odds ratio [OR]: 1.93, 95% confidence interval [CI]: 1.14–3.27), whose guardian could not pay unexpected expenses (OR: 1.78, 95% CI: 1.05–3.02) and those from households where there was often no food (OR: 1.84, 95% CI: 1.04–3.27). A high rate of OVC school enrolment might not translate to regular school attendance. Also, a high proportion of school absenteeism can be attributed to OVC engagement in house chores, poor economy and food insecurity. Economic empowerment of OVC caregivers may improve school attendance.

Prevalence of generalized anxiety disorder and major depression among correctional officers in a Nigerian prison

Abstract The psychological well-being of Nigerian correctional officers had been scarcely examined despite its health and socio-legal implications. This descriptive cross-sectional study among 302 Nigerian prison officers aimed to determine the prevalence of generalized anxiety disorder and major depression, as well as their socio-demographic and work-related correlates. The 6-month prevalence rate of generalized anxiety disorder and 12-month prevalence rate of major depression were 2.3 and 4.0%, respectively. These prevalence rates were higher than those found in the general population. Respondents who participated frequently in religious activities were less likely to experience major depression than those who participated in festivals/ceremonies. These findings suggest the need to focus on strategies to prevent and treat anxiety and depressive disorders among correctional officers. It also raises the possibility of exploring helpful coping styles such as religious activities in preventing these disorders among this sampled population as well as other vulnerable occupational groups.

The economic strength of caregivers of orphans and vulnerable children in Akwa Ibom and Rivers States, Nigeria

The true statistics of orphans and vulnerable children (OVC) in Nigeria is not well known. Therefore, a lack of empirical data on the economic conditions of OVC in Nigeria has hampered the development of effective intervention strategies to mitigate their economic needs. This study assessed the economic activities and capabilities of caregivers in enrolled vulnerable households in Akwa Ibom and Rivers States into a project being undertaken by Association for Reproductive and Family Health (ARFH) on OVC. A cross sectional survey was conducted in 8 Local Government Areas in Akwa Ibom and Rivers States. Information on demographic and socio-economic characteristics of caregivers or heads of the households were collected. Descriptive statistics, T-test and X2- test were used for data analyses. There were 13,631 respondents/caregivers from both Local Government Areas. The commonest economic activity was petty business. The respondents did not have any prior training on other income generating activities. A sizeable proportion of caregivers saw finance as a major constraint to their business climate. The majority of caregivers of OVC in these states did not earn a living wage. Therefore, they will require vocational, business and financial literacy training for effective household economic strengthening program as an intervention strategy of any project. Key words: Association for reproductive and family health (ARFH), orphans and vulnerable children (OVC), intervention strategy, business and financial literacy training.

Trends and drivers of skilled birth attendant use in Nigeria (1990–2013): policy implications for child and maternal health

Introduction While Nigeria accounts for only 2% of the world population, it regrettably shares 14% of global maternal death burden. Whether its reported increase in antenatal care utilization is accompanied by increased use of skilled birth attendants (SBAs) is not known. This study assessed trends in utilization of SBAs in Nigeria between 1990 and 2013 and identified its determinants. Methods Data from four consecutive Nigerian Demographic and Health Survey reports between 1990 and 2013 were pooled. We used basic descriptive statistics, test of association, and logistic regression to assess the prevalence, relative change, and determinants of SBA use at 5% significance level. Sample weights were applied, and adjustment was made for survey design and sampling errors. Results Nearly half (46.7%) of the respondents were aged 25–34 years, while half (50.3%) of the respondents had no formal education. The prevalence of SBA use increased only marginally across the years and characteristics studied, from 32.4% in 1990 to 38.5% in 2013, an insignificant 6% increase. Educated women used SBA more than women with no education (92.4% vs 13.1%), and their odds ratio of using SBA were thrice that of uneducated women (odds ratio =3.09, 95% confidence interval =2.17–4.38). Women involved in decisions regarding their use of health facility were 12% more likely to use SBAs than others who do not. Educational attainment, religion, tribe, rural/urban residence, and zone of residence were significant to the use of SBA. Conclusion The use of SBA was very low throughout the study period, barely at one third usage with insignificant changes over the studied period. Women empowerment, including decision-making power and residence, were the strongest determinants of SBA use. To overturn poor child and maternal health outcomes in Nigeria through SBA use, efforts should be targeted at educating girls, sexual and reproductive health education, and accessible and improved health care facility services.