Journal of Community Medicine and Primary Health Care

Willingness to Adopt a Modern Contraceptive Method among Pregnant Women attending Antenatal Care in Primary Health Centres of Rivers State, Nigeria

B.O. Osaro, C.K. Edet, N.V. Ben-Osaro, A.I. Wegbom — Tue, 08 Aug 2023 00:00:00 +0000

Background: Modern Contraceptives (MC) use in developing countries is inadequate due to the low involvement of women in decisions on reproduction. This study assessed the willingness to adopt MC methods postpartum by pregnant women attending antenatal care (ANC) in Primary Health Centres (PHCs) of Rivers State Nigeria.

Methodology: A descriptive cross-sectional study was conducted among 379 pregnant women attending ANC in PHCs within Rivers State Nigeria. Participants provided information on socio-demographics, reproductive history, awareness and knowledge of MC, partner communication on MC, and willingness to adopt MC postpartum. Data were analyzed using IBM Statistical Package for the Social Sciences version 23. The chi-square test for associations and multivariate logistic regression analysis for predictors of willingness to adopt MC postpartum were computed (P ≤ 0.05).

Results: Most of the participants (n = 257; 67.8%) were aged 25 – 34 years, married (n = 370; 97.6%) with good knowledge of MC (n = 316; 86.3%). Tubal ligation was the most known MC method followed by condoms and implants. The most desired MC method was injectables (n = 111, 45.3%) while 245 (64.6%) participants were willing to adopt a method postpartum. Prior thought of adopting MC (AOR 24.628; 95%CI = 11.139 – 54.452) and having one living child (AOR = 0.201; 95%CI = 0.045- 0.905) were predictors of willingness to use MC postpartum.

Conclusion: Willingness to adopt MC postpartum was high among women attending ANC in PHCs in Rivers State Nigeria. Reinforcement of MC desires of these women by health workers is recommended.

Knowledge, Attitude and Practices on the Use of Uterine Tamponade in the Management of Severe Postpartum Hemorrhage in Public Health Facilities of Niger State

I.M. Sheshi , U.A. Baba , L.M. Hadiza , S. Anna , G.M. Yinti , B.E. Agbana — Tue, 08 Aug 2023 00:00:00 +0000

Background: Obstetric hemorrhage is a contributor to worldwide maternal morbidity and mortality in low-resource countries. The aim of this study was to assess knowledge, attitude and practices on the use of uterine tamponade in managing severe postpartum hemorrhage (PPH) by healthcare personnel.

Method: The study was descriptive and cross-sectional. A self-administered, structured questionnaire was used to collect data on uterine tamponade from untrained and trained health workers who take deliveries in labour wards of selected health facilities. Respondents were selected by cluster sampling technique. Data was analyzed using SPSS version 20. Frequencies were determined and chi-square was used to test the hypothesis. A p-value of <0.05 was considered statistically significant.

Results: The mean age of the respondents was 35 years ± 11.7. Slightly less than half of the respondents 62 (42.5%) had poor knowledge of uterine tamponade. The majority of respondents 120 (82.2%) had positive attitudes about uterine tamponade. This was associated with point of service, professional group, and previous training on uterine tamponade insertion (p<0.05). About 70% (46; 69.7%) of respondents who had managed cases of refractory postpartum hemorrhage, had never conducted uterine tamponade. Reasons include inadequate knowledge (29; 63.0%) and unavailability of the commodities (9; 19.6%)

Conclusion: Though knowledge about uterine tamponade was poor, attitude towards uterine tamponade in managing severe post- partum hemorrhage was good. However, this did not translate to good practices on the use of uterine tamponade in managing severe PPH. Training and re-training on the application of uterine tamponade should be conducted and commodities made available in every health facility.

From Exploits to Remedy: Sexual Behaviour and Utilisation of Reproductive Health Services among In-School Adolescents in a South-Western Nigerian Town

Tue, 08 Aug 2023 00:00:00 +0000

Background: Adolescents are often involved in risky sexual behaviour. It has been reported that most male adolescents have multiple sexual partners, and most female adolescents use condoms inconsistently. This study assessed sexual behaviour, information sources on Sexual and Reproductive Health (SRH), knowledge of SRH, and utilization of RH services among senior secondary school students in Ile- Ife, Nigeria.

Methods: A cross-sectional study was conducted on 424 students randomly selected from six public secondary schools in Ile-Ife. The instrument was a pretested, self-administered questionnaire. The median score was used to categorise SRH knowledge into good and poor. Respondents who did not use condoms consistently, or had multiple sexual partners, or engaged in transactional sex were categorized as having engaged in risky sexual behaviour. Respondents who sought any RH service in a health facility were categorized as having utilized SRH services. ChiSquare was used for associations between categorical variables, while binary logistic regression was used to test for the predictors of utilization of SRH services.

Results: Over a quarter (26.9%) of the respondents had experienced a sexual debut, with 52.6% doing so before 14 years. Teachers were the most reported information source on pubertal changes (65.1%) and sexually transmitted infections (STIs) (71.7%). About 60.8% of respondents had good knowledge of SRH; 55.3% of respondents had multiple sexual partners and 55.9% of respondents had utilized RH services.

Conclusion: A good proportion of the respondents had good SRH knowledge; however, the prevalence of risky sexual behaviour was high. Adolescents need adequate SRH education and promotion.

Prevalence and Factors Associated with Generalized Anxiety Disorder During Covid19 Pandemic among Healthcare Workers in a Tertiary Facility in Edo State, Nigeria

Samuel O. Osasona , Kehinde O. Oderinde — Tue, 08 Aug 2023 00:00:00 +0000

Background: The potential risk of the Coronavirus disease-2019 (COVID-19) pandemic and the psychological challenges that accompanied the pandemic posed a major threat and evoked high levels of anxiety among healthcare workers (HCWs) in Nigeria. Thus, this study aimed to assess healthcare workers' perceived threat of COVID-19, determine the prevalence of generalized anxiety disorder (GAD) among respondents and elucidate the factors associated with GAD.

Methods: A cross-sectional study that used the 7-item Generalized Anxiety Disorder (GAD-7) Scale, 8-item Perceived Threat Scale, and a socio-demographic data collection sheet was used to obtain information from eligible healthcare workers who were selected using a convenience sampling technique. Data analysis was done using SPSS version 21, at a statistical significance level of p <0.05.

Results: Two hundred and thirteen HCWs participated in the study. COVID-19 posed moderatesevere threats to 57.3% of the participants, and the prevalence of GAD among respondents was 25.4%. Having a moderate-severe perception of threat by COVID-19 (p=0.039), being unmarried (p= .026), being previously suspected to have COVID-19 (p=0.018) and being directly involved in the care of COVID-19 patients (p=0.031) were significantly associated with anxiety disorder after adjusting for other variables.

Conclusion: COVID-19 posed a substantial threat to HCWs and the prevalence of GAD among the study group was high. Government, public health institutions and non-governmental organizations have the responsibility to practically demonstrate concern for the mental well-being of HCWs by investing in mental health resources and providing adequate physical, material and psychological support for HCWs to guarantee their well-being.

A Four-year Retrospective Review of Buruli Ulcer Disease in Delta State, Nigeria

Ejiroghene Clitt Ucho, Oboratare Ochei — Tue, 08 Aug 2023 00:00:00 +0000

Background: Buruli Ulcer (BU) is a debilitating necrotic cutaneous infection, scattered across the universe, but has received less attention when compared with other infectious diseases. It is endemic in some Nigeria states including Delta State, but there is a dearth of published data on BU in Delta State. This knowledge gap necessitated this study, which aimed to ascertain the pattern, distribution and clinical characteristics of BU cases in Delta State, Nigeria.

Methods: This study is a four-year retrospective review from 2018 – 2021. A proforma was designed to retrieve all records of suspected and confirmed cases of BU in the Delta State BU registry from 2018 – 2021. Data obtained were entered and analysed using SPSS version 23.0.

Results: Among the 163 suspected BU cases retrieved from the register, 52 (32%) were confirmed positive using the Polymerase Chain Reaction (PCR) technique. The confirmed cases were distributed in 16 (64%) of the 25 Local Government Areas (LGAs) in the state. There was a marked decline in the number of cases from 2018 to 2020 and a slight increase in 2021. Nearly all confirmed cases (98.1%) presented as ulcers and were mainly located in the lower limbs (80.8%). The lesions were mostly the category III type (63.5%), while 90.4% of those affected had limitations of movement in the affected area.

Conclusion: BU is present in Delta State of Nigeria, with the majority of cases presenting to health facilities late. Thus, active surveillance activities by BU control agencies to enhance early case detection is recommended.

Comparison of prevalence of mental distress, help-seeking behaviour of undergraduates in public and private Universities in Osun State, Nigeria

B.O. Odia , O.A. Esimai , M.Y. Ijadunola , R.O. Opeloye , O.T. Elugbaju — Tue, 08 Aug 2023 00:00:00 +0000

Objective: Mental distress is prevalent and increasing in tertiary institutions. This study compared the prevalence of mental distress and help-seeking behaviour among undergraduates in public and private universities in Osun State, Nigeria.

Methods: A comparative cross-sectional design was used to collect data from 910 respondents in one public and one private university of Osun State, using a multistage sampling technique. Data was collected with pre-tested, semi-structured, self-administered questionnaires. Data were analysed using IBM SPSS version 22. Univariate and bivariate analyses were conducted with a level of statistical significance set at p < 0.05. Ethical clearance was obtained from the Institute of Public Health Obafemi Awolowo University.

Results: The mean age and standard deviation for public university students was 20.74 ± 2.19 years and 19.02 ± 2.27 years for private university students (p<0.001). The prevalence of mental distress was 40.4% in the public university and 43.6% in the private university (p=0.324). All respondents with mental distress in both universities sought help in the preceding 12 months. Respondents in both institutions commonly sought informal sources of help from parents and friends. A significantly higher proportion of respondents in the private university (62.9%) sought help from formal sources in the 12 months prior to the study compared with respondents in the public university (37.1%) (p=0.012).

Conclusion: The prevalence of mental distress is high in both universities with informal sources of help- seeking frequently reported. There is a need for university authorities to promote professional help-seeking in these universities.

Promotions, Information Asymmetry and Usage of Traditional Medicine in Central Uganda: A Qualitative Perspective

S. Nabachwa , N. Kamukama, O.J. Owino — Tue, 08 Aug 2023 00:00:00 +0000

Background: While extant literature highlights several motivations for Traditional Medicine (TM) usage; few studies have examined how promotions and information asymmetries influence traditional medicine usage behaviors. This study aimed to map out information biases underlying the marketing and promotion of Traditional Medicines in Central Uganda and explored the dimensions of attitudes and usage behaviors of TM users.

Methods: The study utilized a qualitative approach by conducting in-depth face-to-face semistructured interviews with TM users in the metropolitan parts of Central Uganda. The study participants were recruited from the Traditional Health Practitioners (THPs) clinics with the help of community development officers under the guidance of the National Council for Traditional Healers and Herbalists' Association (NACOTHA). Study participants gave their written consent, and their identities have since been kept confidential. Saturation point was reached at 34 respondents. Data was recorded and transcribed verbatim and analyzed using content analysis.

Results: The study indicates that incomplete, inadequate and inconsistent information especially from TM promotions leads users to overly buy and use TM. Identified themes related to information asymmetry include unverifiable information, usage side effects, and absence of expiry dates on the labels, naturalness of TM, unclear dosage rates, limited diagnosis, limited usage guidelines, and lack of authentic approvals by regulatory bodies among others.

Conclusions: The findings raise the need for policy guidelines in the alternative health segment and multi-agency regulation of THPs in Uganda. Further, massive community sensitization and customer education are recommended since the potential for information asymmetries in TM promotions is quite large.

A Comparative Study of Health-Related Quality of Life among Adults with Pulmonary Tuberculosis in Southwest Nigeria

Bisola I. Adebayo, Olumuyiwa O. Odusanya — Tue, 08 Aug 2023 00:00:00 +0000

Background: Current models of care for tuberculosis (TB) focus on bacteriological cures with less emphasis on the effect of TB on physical, mental, and social well-being. There is also a paucity of data on normative values for Nigeria against which health-related quality of life (HRQOL) measures of TB patients could be assessed. The objective of this study was to compare HRQOL of adults diagnosed with TB against a comparator group from similar socio-demographic backgrounds.

Methods: A comparative cross-sectional study was undertaken with 210 patients with pulmonary TB and a comparator group of 285 individuals from catchment communities. The World Health Organization Quality of Life Questionnaire-Short Version (WHOQOL-BREF) was used to assess HRQOL. Patients were selected using a multi-stage sampling technique. Data were analysed using IBM-SPSS version 23. A multiple linear regression model was used to identify potential predictors of HRQOL. Ethical approval was obtained from the Lagos State University Teaching Hospital health research ethics committee.

Results: More than half of the TB patients and those in the comparator group were men (63.3% and 59.0%, respectively), and their mean ages were 36.40±11.76 years and 36.69±12.30 years, respectively. Respondents with TB had significantly lower HRQOL domain scores across all domains (p<0.001). Domain scores for HRQOL ranged between 45.3 ±14.5 (environmental domain) and 50.9±17.3 (social relationships). Independent predictors of quality of life among TB patients included education, employment, and socio-economic status.

Conclusion: Tuberculosis was significantly associated with an impairment in health-related quality of life. The environment domain was most affected among respondents with PTB. Employment status, socio-economic class and educational level were predictive of HRQOL.

Knowledge, Perception, and Uptake of Mandatory COVID-19 Vaccination among Nigerian Civil Servants: Implications for Evidence-Based Policies

Tue, 08 Aug 2023 00:00:00 +0000

Background: In 2021, some state governments in Nigeria made it compulsory for all civil servants to get vaccinated against COVID-19. Subsequently, the federal government adopted this policy which was met with mixed reactions. This study assessed knowledge, perception, willingness to be vaccinated, uptake, and determinants of full vaccination among Nigerian civil servants.

Methods: A descriptive cross-sectional study was conducted among 622 civil servants from Ministries across the six geopolitical zones and the Federal Capital Territory using selfadministered structured questionnaires. Ethical approval was obtained from the National Health Research Ethics Committee and analyses done using IBM SPSS v.26.

Results: The mean age of the respondents was 41.6 ± 9.1 years with most respondents (486; 78.1%) having good knowledge of COVID-19. Two-fifths (252; 40.5%) agreed that there should be no blanket policy for mandatory vaccination. Most of the respondents (463; 74.4%) had been vaccinated and about two-fifths (269; 43.2%) had been fully vaccinated while about a quarter 146 (23.5%) had not been vaccinated at all. Of those (n=159) who had not been vaccinated or were unwilling to disclose their status, the majority 116 (73.0%) were unwilling to be vaccinated. Respondents with a good knowledge of COVID-19 achieved full vaccination status (p = 0.007).

Conclusion: Since the majority of the respondents who are Nigerian civil servants had a good knowledge of COVID-19 and had been vaccinated, this study recommends that the government continues its health promotional campaigns towards improved uptake of vaccination against COVID-19 in the populace.

A Case Report of Female Genital Schistosomiasis in a 29-Year-Old Patient From a Teaching Hospital in North-Eastern Nigeria

Aminu Mohammed Chubado Dahiru , Ibrahim Rabiu, Nasiru Raheem , Isaac Peter — Tue, 08 Aug 2023 00:00:00 +0000

Schistosomiasis is a chronic parasitic infection that affects more than 220 million people worldwide, particularly in sub-Saharan Africa (SSA). One of the complications of urogenital Schistosomiasis is female genital Schistosomiasis (FGS) which is associated with the presence of S. haematobium eggs and related pathologies in the genitals of women living in or visiting schistosomiasis-endemic areas. FGS is a neglected and misdiagnosed gynaecological disease with un-specific clinical symptoms and signs. It adversely affects the quality of sexual and reproductive health of women and is a risk factor for HIV and HPV infections in affected women. Diagnosis of upper genital tracts FGS is mostly accidental from histological examination of excised tissues. This is a case description of a rare incidence of female genital Schistosomiasis of the upper genital tract in a 29-year-old, single woman from a Schistosomiasis-endemic area of Adamawa State, Nigeria who presented with a history of lower abdominal pain of a month duration and abdominal swelling. Physical examination revealed a pelvic mass of 16 weeks' gestation size and histological examination confirmed the presence of Schistosome ova in the excised ovarian cyst. Clinicians should have a high index of suspicion of female genital Schistosomiasis (FGS) in women and girls in Schistosomiasis-endemic areas. Deliberate programs for healthcare workers and outreach programs for the communities must be designed and implemented to raise awareness about genital Schistosomiasis.