Taiwo O. Lawoyin

Factors Associated With Exclusive Breastfeeding in Ibadan, Nigeria:

Although nationwide efforts to promote exclusive breastfeeding began in Nigeria in 1992, data on this type of infant feeding are still generally scarce. Current status breastfeeding data were obtained from 2794 mothers, enrolled from randomly selected infant welfare clinics in Ibadan, Nigeria, to evaluate factors that are associated with exclusive breastfeeding. The exclusive breastfeeding rate dropped from 57.4% at 1 month to 23.4% at 6 months. Using multiple regression analysis, younger age of infant (P< .0001), higher maternal occupation (P< .05), and delivery in tertiary (P< .0001) or secondary (P< .0001) health facility were predictive of exclusive breastfeeding. Mothers 24 years or younger and primiparous mothers were less likely to breastfeed their babies exclusively (P< .01 and P< .05, respectively). Additional programs are needed to meet the needs of at-risk mothers, who should be identified and counseled.

Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria

Objective:The aim of this study was to determine the prevalence and distribution of menopausal symptoms among women in Ibadan in the 4-week period preceding the survey and factors associated with these symptoms. Methods:A descriptive cross-sectional, community-based study was carried out on Nigerian women aged 40 to 60 years, using the multistage sampling technique. Quantitative data were collected on sociodemographic, obstetric, and gynecological variables as well as symptom experience in the preceding 4 weeks using a structured questionnaire that included a standardized Menopause Rating Scale (MRS). Eleven symptom groups were scored for each respondent on a scale of 0-4, with increasing severity for each score and a maximal total score of 44. The MRS is made of three subscales (somatovegetative, psychological, and urogenital) with maximal scores of 16, 16, and 12, respectively. Scores for each subscale and the overall total score were calculated for each respondent, and these served as the main outcome measures. The higher the composite score, the greater the severity of menopausal symptoms. Results:In all, 1,189 women with a mean age of 48.1 ± 5.9 years were interviewed. Prevalence of any menopausal symptom was 84.5% during the 4-week period studied. Joint and muscular discomfort was the most common reported symptom among all women in this study (59.0%), followed by physical and mental exhaustion (43.0%), sexual problems (40.4%), and hot flashes (39.0%). Factors predicting the total score on the MRS were age of respondent (P = 0.01; 95% CI, 0.02-0.17), menopause status (P = 0.001; 95% CI, 0.33-1.24), and occupational group (P = 0.02; 95% CI, 0.10-1.42). Age of respondent and menopause status also predicted scores on the somatovegetative and urogenital subscales, but not on the psychological subscale. Occupation was the only predictor on the psychological subscale (P = 0.002; 95% CI, 0.16-0.75). Conclusions:Prevalence of menopausal symptoms was high among women in this study. Although any woman could face challenges associated with menopausal symptoms, those who were older, perimenopausal, and postmenopausal and who had routine or manual occupations had the highest total MRS scores. All women, especially those in these categories, should receive health information and guidance on possible lifestyle adjustments to ease the disruptions that menopausal symptoms can cause.

MALE SEXUAL BEHAVIOUR DURING WIFE'S PREGNANCY AND POSTPARTUM ABSTINENCE PERIOD IN OYO STATE, NIGERIA

The traditional proscription against sex for women during pregnancy, and particularly in the postpartum period, in south-west Nigeria leaves many men without sexual access to their wives for extended periods of time. This practice raises the question whether men abstain or seek other sexual partners. A community-based study was conducted using 3,204 married men from randomly selected local government areas of the state. These men had wives who had delivered a baby in the 36 months prior to the study. Information was obtained on their sexual practices before and during pregnancy and the postpartum period. Male sexual networking was not absent outside the pregnancy and the postpartum periods. However, during pregnancy, a higher percentage of men (43.7%) had other partners compared with the period outside pregnancy and postpartum (42.1%). The difference was not significant (p>0.05). Similarly, in the postpartum abstinence period, more men (48%) had other sexual partners when compared with the period outside pregnancy and postpartum (42.1%; p<0.001). Sexual networking with non-regular and multiple partners was also more commonly observed in the postpartum period than in pregnancy (11.9% vs 10.4%; p<0.05). Significantly more rural than urban men had multiple sexual partners when their wife was pregnant (p=0.01) or in postpartum abstinence (p<0.05). Condom use with regular partners was largely absent, and consistent condom use with extramarital partners was very low among urban and rural men (6.3% vs 1.7%). The vast majority of men were having unprotected vaginal sex. Logistic regression analysis showed that polygamous men, those under 30 years in the urban area, and men with low or no education were more likely to have sex with other women when their wife was pregnant. During a wifes postpartum abstinence period, men in higher status occupations, younger urban men (<49 years), those with more children, the polygamous, and men with a first wife under 40 years in urban area were more likely to have other partners. In light of the heterosexual mode of HIV transmission in Nigeria, there is a dire need to design and implement an intervention programme targeted at married men, which takes into consideration cultural practices. This will hopefully help check the course of the disease in a country thought to be on the verge of an HIV epidemic.

Health Workers’ Support for Breastfeeding in Ibadan, Nigeria

Breastfeeding in Nigeria is universal, and exclusive breastfeeding was introduced in 1992, yet no study has assessed health workers’ support for breastfeeding at the grassroots level. This study assessed health workers’ tangible support for breastfeeding at primary care facilities in Ibadan and factors affecting it, including knowledge of and attitudes toward breastfeeding. Among the 386 workers, there was moderate support for breastfeeding (median score = 15.0, maximum = 20). Following multivariate analysis, young age of worker (20-29 years; odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-6.8), more than 5 years of post-training experience (OR = 2.3, 95% CI: 1.2-4.4), senior profession (OR = 2.1, 95% CI: 1.0-4.4), high breastfeeding knowledge scores (OR = 2.5, 95% CI: 1.4-4.5), and sufficient opportunities to practice tangible breastfeeding support (OR = 4.3, 95% CI: 2.4-7.7) were found to predict tangible breastfeeding support. Deliberate efforts should be made to incorporate continuing education workshops to better prepare health professionals for their role in providing tangible breastfeeding support at the primary care level.

Neonatal mortality and perinatal risk factors in rural southwestern Nigeria: a community-based prospective study.

BACKGROUND Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may have occurred with recent interventions. OBJECTIVE To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS In a community based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis and fever and maternal deaths and failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW, RR of 4.7; delivery outside a health facility, RR of 3.6; lack of attendant at delivery, RR of 5.01; and Traditional Birth Attendant (TBA) delivering the baby, RR of 2.7. Effect of sex of the neonate, mother and fathers ages were not significant at the 5% level in the model. CONCLUSION Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having no one in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer. Obstetric and public health services have to be available and made more accessible at the grass root level.

Cervical cancer risk factors and predictors of cervical dysplasia among women in south-west Nigeria.

AIM This study identified predictors of cervical dysplasia and assessed the prevalence of risk factors for cervical cancer among women of different socioeconomic classes in Ogun State, Nigeria. METHOD In a two-phase study, self-reported information on cervical cancer awareness, risk factors and cervical cancer screening practices was obtained from 278 randomly selected working women. A random subset was screened for dysplasia using visual inspection with acetic acid (VIA). RESULTS Of the 278 women, 126 (45.3%) were semi-skilled while 152 (54.7%) were skilled and professional workers. Median age at first sexual intercourse was 19 years (range 13-29) and lower than the median age at first marriage (25 years). Gonorrhoea and genital warts were the commonest reported sexually transmitted infections. Only 12.2% of the women used male condoms as their primary method of birth control and 4.7% of the women had ever had a Papanicolaou smear, a practice that was significantly higher among the professional/skilled compared with semi-skilled workers (P = 0.031). Of the 125 screened, 20 (16%) had positive VIA. Young age at first sex (< or = 17 years) (OR = 3.7 (95% CI, 1.07-12.8)) and early first marriage (< 25 years) (3.3 (1.00-10.9)) were associated with a positive VIA. Women with lower parity (0-3) had borderline significantly increased risk of having a positive VIA (3.1 (0.9-10.6)). Women currently over 34 years and those without a history of sexually transmitted infections had lower risk of positive VIA (P > 0.05). CONCLUSIONS Acceptable screening services and cervical cancer awareness campaigns that address modifiable risk factors are urgently needed in this community.

Predictors of maternal HIV infection at the primary care level in inner city Ibadan.

National HIV prevalence rate is derived from the sentinel surveys, which are carried out once in two years and remain anonymized. Epidemiological data are largely unavailable on the pregnant HIV-positive mothers particularly at the grass root level. This information is urgently needed when developing a realistic intervention programme. Three hundred and forty-three consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001 were enrolled at booking and followed up till delivery of their babies. Sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. Results showed that about one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level (P =0.046). Christian religion was associated with a lower risk (P =0.038), and mothers who booked late in pregnancy (P =0.025) or had husbands in the lower socio-economic class (P =0.001) were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counselling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer.

Risk factors for neonatal tetanus in Ibadan, Nigeria

This case-control study identified risk factors for neonatal tetanus in this population and indicates that the problem has not yet received adequate attention. The incidence of neonatal tetanus can be greatly reduced by providing the masses with appropriate health education as well as formal education especially at the grass roots level; ensuring access to antenatal services, improving the quality of such services, and extending efforts to provide tetanus immunisation to mothers. Tetanus, listed among the major causes of neonatal death in many tropical countries including Nigeria, is a major public health problem. Although neonatal tetanus (NNT) death toll has reduced by a third in the last decade worldwide, there is a noticeable surge in deaths from this killer disease in Nigeria, giving the country the largest absolute increase worldwide, up by 62% [5,6]. This study sought to obtain more recent information on major risk factors associated with NNT in this community and to make suggestions for reducing its incidence. The study was conducted in all secondary and tertiary hospitals in Ibadan, Nigeria, a city with a projected population of over 4 million [1]. All NNT cases diagnosed by standard criteria were admitted into the study until the total required sample size was met and matched 1:1 with controls. The minimum sample size was calculated after correcting for design effect. The instrument used was a pre-tested structured questionnaire administered to mothers of cases and controls. Subjects enrolled in the study were140 cases and 140 controls with a male/female ratio of 1.4:1 and 1.1:1 respectively. All 19 neonates with onset of illness within the first 4 days of life died, giving a case fatality of 100%. The younger the babies at onset of illness the more likely they were to die (x 2 =41.7, P <0.0001). The overall case fatality rate was 79.4% with a male/female death ratio of 1.3:1. Teenage mothers, fathers with no education, primiparity, low socio-economic class, late antenatal (ANC) booking, none/incomplete maternal tetanus immunisation, delivery outside the health facility, untrained personnel at delivery, use of non-sterile cord-cutting tool, and the presence of animals within the residence were significantly associated with NNT (Table 1). ANC was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunisation. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunisation. The main reason for failure to receive full immunisation was ignorance on the mothers’ part, which reflects inadequate health education by the system. The study identified major risk factors associated with the occurrence of NNT in Ibadan and the surrounding district and indicated that NNT continues to be a common and serious problem in this community because NNT constituted more than one third (38.5%) of the total neonatal admissions in the study sites during the study period. In this study, 40% of the NNT cases were delivered in health facilities in contrast to Tompkins series in which none was delivered in a health facility [4]. The NNT rate in facility delivery is, however, higher than the 15% reported by Grange [2]. Though health facility delivery was associated with significantly lower risk for NNT, the risk was not totally absent suggesting that there is need to look more critically at the role the health facilities play in the transmission of NNT.

Guidelines for assessment of publications for contribution to scholarship: a view point

BACKGROUND There does not seem to be a uniform method of assessment for promotion in the various tertiary institutions in Nigeria. The result of this is that a professor in one institution may just qualify to be a senior lecturer in another in the same country. An attempt is being made in this write-up to devise a method of standardization for promotion in tertiary institutions in Nigeria. METHOD Literature dealing with peer review process, writing clinical research papers, and assessment were reviewed. Also various methods of assessment for promotion in some tertiary institutions were studied. RESULTS There are six areas of assessment of the publications of a candidate for academic promotion. They are (a) the quality of the journal where the article were published; (b) the type of research; (c) the scientific quality of the paper; (d) the relevance of the paper to the authors discipline; (e) the numerical position of the authorship of the candidate being assessed; (f) and the number of publications. CONCLUSION Having a clear-cut and more objective way of grading a prospective candidate will ensure uniformity, allow the candidate to work realistically towards a goal and to aim high, reduce subjective assessment, reduce the chances of injustice, and encourage non-indexed local journals to aspire to get indexed or die a natural death.

Effect of rearing environment on the feeding pattern of under two years old Nigerian children

With economic pressures on families increasing, more women are working outside the home leaving their children in day care centres. In a community-based, descriptive cross-sectional study, the feeding pattern in two groups of children under two years old, cared for in two different rearing environments: home environment and day care centres, was compared, and the effect of rearing environment on their feeding pattern was assessed. Two groups of children from lower-middle socio-economic backgrounds were recruited into the study. Using simple random sampling, 250 under two years old children attending day care centres in a medium-high density area of Osogbo metropolis and 250 under two years old children cared for in the home environment in the same area were enrolled in the study. Information was collected by use of a pre-tested and structured questionnaire administered to the parents of the children, the proprietors and the attendants of the day care centres. The feeding pattern of the children in both groups revealed a low level of breast-feeding practices, early initiation of complementary feeding and short total duration of breast-feeding. The study also showed that putting children in day care centres may militate against the mother being able to practise exclusive breast-feeding and may also affect total duration of breast-feeding. The study concluded that rearing environment has an effect on the feeding patterns of children. Health education of both mothers and health professionals and provision of crèches or day care centres by companies, institutions, hospitals and schools in their premises are recommendations for improving the situation.