Community Medicine
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Item Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study(BMJ Publishing Group Ltd, 2023) Bakare, A. A.; Olojede, O. E.; King, C.; Graham, H.; Uchendu, O.; Colbourn, T.; Falade, A. G.; Alvesson, H. M.Objective To explore healthcare seeking practices for children and the context-specific direct and indirect effects of public health interventions during the first two waves of COVID-19 in Lagos State, Nigeria. We also explored decision-making around vaccine acceptance at the start of COVID-19 vaccine roll-out in Nigeria. Design, setting and participants A qualitative explorative study involving 19 semistructured interviews with healthcare providers from public and private primary health facilities and 32 interviews with caregivers of under-five children in Lagos from December 2020 to March 2021. Participants were purposively selected from healthcare facilities to include community health workers, nurses and doctors, and interviews were conducted in quiet locations at facilities. A data-driven reflexive thematic analysis according to Braun and Clark was conducted. Findings Two themes were developed: appropriating COVID-19 in belief systems, and ambiguity about COVID-19 preventive measures. The interpretation of COVID-19 ranged from fearful to considering it as a ‘scam’ or ‘falsification from the government’. Underlying distrust in government fuelled COVID-19 misperceptions. Care seeking for children under five was affected, as facilities were seen as contagious places for COVID-19. Caregivers resorted to alternative care and self-management of childhood illnesses. COVID-19 vaccine hesitancy was a major concern among healthcare providers compared with community members at the time of vaccine roll-out in Lagos, Nigeria. Indirect impacts of COVID-19 lockdown included diminished household income, worsening food insecurity, mental health challenges for caregivers and reduced clinic visits for immunisation. Conclusion The first wave of the COVID-19 pandemic in Lagos was associated with reductions in care seeking for children, clinic attendance for childhood immunizations and household income. Strengthening health and social support systems with context-specific interventions and correcting misinformation is crucial to building adaptive capacity for response to future pandemics.Item Prevalence of pneumonia and malnutrition among children in Jigawa state, Nigeria: a community-based clinical screening study(BMJ Publishing Group Ltd, 2022) King, C.; Siddle, M.; Adams, O.; Ahmar, S.; Ahmed, T.; Bakare, A. A.; Bakare, D.; Burgess, R. A.; Colbourn, T.; McCollum, E. D.; Olowookere, T.; Salako, J.; Uchendu, O.; Graham, H. R.; Falade, A. G.Objective To estimate the point prevalence of pneumonia and malnutrition and explore associations with household socioeconomic factors. Design Community-based cross-sectional study conducted in January–June 2021 among a random sample of households across all villages in the study area. Setting Kiyawa Local Government Area, Jigawa state, Nigeria. Participants Children aged 0–59 months who were permanent residents in Kiyawa and present at home at the time of the survey. Main outcome measures Pneumonia (non-severe and severe) defined using WHO criteria (2014 revision) in children aged 0–59 months. Malnutrition (moderate and severe) defined using mid-upper arm circumference in children aged 6–59 months. Results 9171 children were assessed, with a mean age of 24.8 months (SD=15.8); 48.7% were girls. Overall pneumonia (severe or non-severe) point prevalence was 1.3% (n=121/9171); 0.6% (n=55/9171) had severe pneumonia. Using an alternate definition that did not rely on caregiver-reported cough/difficult breathing revealed higher pneumonia prevalence (n=258, 2.8%, 0.6% severe, 2.2% non-severe). Access to any toilet facility was associated with lower odds of pneumonia (aOR: 0.56; 95% CI: 0.31 to 1.01). The prevalence of malnutrition (moderate or severe) was 15.6% (n=1239/7954) with 4.1% (n=329/7954) were severely malnourished. Being older (aOR: 0.22; 95% CI: 0.17 to 0.27), male (aOR: 0.77; 95% CI: 0.66 to 0.91) and having head of compound a business owner or professional (vs subsistence farmer, aOR 0.71; 95% CI: 0.56 to 0.90) were associated with lower odds of malnutrition. Conclusions In this large, representative community-based survey, there was a considerable pneumonia and malnutrition morbidity burden. We noted challenges in the diagnosis of Integrated Management of Childhood Illness-defined pneumonia in this context.Item The prospective COVID-19 vaccine: willingness to pay and perception of community members in Ibadan, Nigeria(Peer J Inc, 2021) Ilesanmi, O.; Afolabi, A.; Uchendu, O.Background: The introduction of the COVID-19 vaccine necessitates the assessment of individual perception regarding the vaccine. This study aimed to assess the perception of community members and willingness to pay for the prospective COVID-19 vaccine in Ibadan, Nigeria. Methods: A descriptive cross-sectional study design was used. Data were collected using an interviewer-administered questionnaire in September 2020. We studied community members aged 15 years and above using a multi-stage sampling technique. The perceptions of respondents about the COVID-19 vaccine were assessed on eight questions using the five-point Likert scale with a score point of “1” assigned for “Strongly Agree”, “2” for “Agree”, “3” for “Not decided”, “4” for “Disagree”, and “5” for “Strongly disagree”. During analysis, we reverse-coded the options by assigning a point of “1” for “Strongly disagree”, “2” for “Disagree”, “3” for “Not decided”, “4” for “Agree”, and “5” for “Strongly disagree”. However, questions asked in the negative directions were not reverse-coded during analysis. Eight questions were used to assess the perception of community members regarding the prospective COVID-19 vaccine, and overall, the maximum point was 40. Points greater than or equal to 32 points (80%) implied positive perception. Descriptive statistics were done. Chi-square tests were used for the assessment of associations between sociodemographic characteristics and willingness to pay for the prospective COVID-19 vaccine. We conducted logistic regression tests on statistically significant variables at p-values <0.05. Results: The mean age of the 440 respondents studied was 37.22 ± 15.36 years, 193 (49.00%) were males, and 292 (67.30%) of the respondents had heard of the prospective COVID-19 vaccine. Among them, 232 (79.50%) respondents had positive perception regarding COVID-19 vaccine. Individuals in the fifth wealth quintile were ten times more likely to be willing to pay for the prospective COVID-19 vaccine compared to those in the first wealth quintile (Adjusted Odds Ratio = 9.57, 95% CI [2.88–31.82], p = <0.01). Conclusion: The prospective COVID-19 vaccine should be subsidized or made freely available to everyone.Item Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria(AOSIS (Pty) Ltd, 2019) Uchendu, O.; Ige, O.; Adeyera, O.Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries. Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years. Setting: Abebi community, Ibadan, Oyo State, Nigeria. Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5 years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance. Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers’ educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425–0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273–0.758) had lower odds of having good knowledge of measles, respectively. Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers.Item Health‑Related quality of life of patients on antiretroviral therapy at the Federal Medical Center, Makurdi, Nigeria(Thieme Medical and Scientifuc Publishers Pvt. Ltd., 2019) Shaahu, V. N.; Adebimpe, W. O.; Asuzu, M. C.; Belabo, D. A.; Popoola, O. A.; Uchendu, O.Context: Health related quality of life (HRQL) indices could provide information about the effects of disease progression and the effectiveness of medical interventions that cannot be obtained using objective clinical measures. Aim: The aim of this study is to assess HRQL of patients on highly active antiretroviral therapy (HAART) at the Federal Medical Center, Makurdi in North Central Nigeria. Settings and Design: The study was a cross‑sectional survey among people living with HIV/AIDs (PLWHAs) on HAART. Methods: The 546 PLWHAs on HAART were selected using systematic sampling technique. A modification of the 36‑Item Short‑Form Health Survey Version 2 questionnaire was used to assess respondents’ HRQL in eight dimensions: Physical functioning (PF), role‑physical (RP), role‑emotional (RE), social functioning (SF), bodily pain (BP), vitality (VT), mental health (MH), and general health (GH). Data generated after measuring and scoring HRQL using standard methods were analyzed using the SPSS 17. Results: Good HRQL ratings included: PF (98.9%), RE (98.7%), SF (98.2%), VT (96.9%), RP (96.5%), MH (96.3%), BP (94.1%), and GH (93.4%). Predictors of good HRQL were as follows: Age <40 years (odds ratio [OR] = 4.26, confidence interval [CI] = 1.49–12.11) and being currently employed (OR = 3.20, CI = 1.08–9.49) (RP); and having a caregiver (OR = 4.94, CI = 1.33–18.27). Predictors of less likelihood of good HRQL were: Enjoying social support (OR = 0.12, CI = 0.03–0.55) (RP; MH); being without spouse/partner (OR = 0.43, CI = 0.21–0.91) (GH). Conclusions: HAART improves HRQL of HIV patients. Clinicians need to be responsive to factors related to disclosure, having a caregiver, and social support as a means of improving HRQL.Item After obstetric fistula repair; willingness of women in Northern Nigeria to use family planning(Informa Healthcare, 2018) Uchendu, O.; Adeoti, H.; Adeyera, O.; Olabumuyi, O.Utilisation of modern family planning (FP) is important for women with obstetric fistula (OF). Preventing pregnancy ensures a proper healing and the success of fistula repair. In Northern Nigeria, prevalence of OF is high while the prevalence of FP utilisation is low. This study assessed the willingness to use family planning among 420 women receiving care at obstetric fistula centres in three northern Nigerian States using a semi-structured questionnaire. Concerning family planning methods, 56.7% were aware, only three (1.3%) had ever utilised any method and 63.8% were willing to use a family planning method in the near future. Age, type of marriage and the presence of surviving children were the significant predictors of willingness to use family planning among women with fistula. There is a moderate awareness of family planning with very low utilisation rates. However, a high proportion of these women are willing to use FP. Therefore, there is a need for integration of FP services with OF services.Item Resilience among secondary school students in South-Western Nigeria; association with abuse and neglect(Walter de Gruyter GmbH, 2018) Adeyera, O.; Uchendu, O.; Owoaje, E.Introduction: Resilience, which aids coping and adjustment, prevents the development of mental health issues for individuals exposed to adversities. Abuse and neglect are some of the adversities that affect the health of adolescents. This study examined the relationship between abuse, neglect and resilience of adolescents. Methods: The study adopted a cross-sectional design among 522 secondary school adolescents using interviewer-administered semi-structured questionnaires. Information on socio-demographics, abuse, neglect and resilience were elicited. Associations were tested with significance set at 5%. Results: The mean age of respondents was 15.9 ± 1.5, 301 (57.7%) were females and 144 (27.6%) were from polygamous homes. Two hundred and forty-three (46.4%) had high resilience, 141 (27.0%) moderate resilience and 138 (26.6%) had low resilience. Psychological, physical and sexual abuse were reported among 238 (45.7%), 168 (32.1%) and 45 (8.6%) adolescents, respectively, while 71 (13.6%) and 134 (25.8%) experienced psychological and physical neglect, respectively. Adolescents who experienced physical abuse and sexual abuse were about 2 and 2.5 times less likely, respectively, to have high resilience than those who did not experience physical and sexual abuse. Conclusion: Abuse and neglect negatively influence resilience of adolescents. Interventions targeted at reducing abuse and neglect should be incorporated in adolescent health protocols to increase their resilience.Item Willingness of tobacco retailers in Oyo State to participate in tobacco control programmes(E.U. European Publishing, 2018) Uchendu, O.; Adebiyi, A. O.; Adeyera, O.INTRODUCTION Tobacco control strategies have not incorporated retailers, despite being the focus by the tobacco industry to promote its products. Few studies exist on their possible roles in tobacco control. This study, therefore, assessed retailer awareness of tobacco control laws and willingness to be involved in control activities. METHODS A cross sectional study was carried out on all 218 tobacco retailers in Ibarapa Central and Ibarapa East Local Government Areas of Oyo State. The willingness of tobacco retailers to participate in tobacco-use control was evaluated using a questionnaire. RESULTS The majority of the respondents were females (95%), and 30-39 years old with respect to age. Almost two-thirds (65%) of the respondents reported the sale of tobacco as a profitable business, and a third reported that their income would decrease if they stopped tobacco sales. Up to 35% of retailers were aware of laws restricting smoking in public places and 45% aware of a ban on the sale of tobacco products to minors. Retailers were willing to: support anti-tobacco legislations (84%), counsel smokers to quit smoking (84%), and display anti-tobacco messages in their shops (77%). CONCLUSIONS The sale of tobacco products is a profitable venture for retailers. Willingness to participate in tobacco control was high among the retailers. There is a need to raise awareness and co-opt tobacco retailers as change agents in tobacco control efforts.Item Urinary schistosomiasis among vulnerable children in a rehabilitation home in Ibadan, Oyo state, Nigeria(BioMed Central Ltd, 2017) Uchendu, O.; Oladoyin, V.; Idowu, M.; Adeyera, O.; Olabisi, O.; Oluwatosin, O.; Leigh, G.Background: Schistosomiasis is a disease of public health importance with long term complications mostly common among children, rural dwellers, poor and migrant workers. Studies have not documented the burden among migrant workers and their families. The study aimed to describe the burden of schistosomiasis and demographic characteristics among children of migrant workers residing in a rehabilitation home in Ibadan, Nigeria. Methods: A cross-sectional study using sixty six children, who were tested following complaints of haematuria by six of them. An interviewer-administered questionnaire was used to collect information on demographic and environmental characteristics of the children and urine microscopy, was conducted. Data was analysed using descriptive statistics and correlation. Statistical significance was set at 5%. Results: Mean age of respondents was 11.8 ± 4.0 years and 57.6% were males. The prevalence of schistosomiasis was 19.7% with preponderance among males (64.3%) and children aged 12 years and above (71.4%); 85.7% of infected children were from Kwara State; 78.6% waded in water body and 92.9% had red blood cells and pus cells on urine microscopy. Conclusions: The burden of schistosomiasis is high among children of migrant workers and they serve as reservoirs for transmission of the disease. Government needs to work synergistically with NGOs, FBOs and other partners to achieve schistosomiasis prevention and control among this particular group.Item Gender and HIV testing service uptake: trend in Northern Nigeria(OMICS Publishing Group, 2016) Anthony, O. K.; Towolawi, A.; Oluwasina, F.; Onu, E. A.; Uchendu, O.; Nwakanma, I.; Ogbang, D.HIV counseling and testing remains a fundamental entry point of care in limiting transmission of HIV/AIDS. Community outreaches serves the dual function of improving access to service and outcome of care through early linkages and subsequent initiation of Anti-Retroviral Therapy (ART). Gender and socio-cultural factors affects uptake of screening services and ultimately early treatment. This study therefore assessed gender-related HIV counseling and testing uptake and linkage to care among those who were tested. A review of data from 423 community outreaches conducted between August 2012 to July 2015 by AHF Nigeria in which information on socio-demographic characteristics, HIV counseling and testing and time to accessing care was obtained. Means and proportions were used to document the results. With a monthly Mean of 2650 [male 68.8% female 38%] clients counselled, tested and received results, 2.6% (SD 0.7) were positive; male 33.5% (SD 10) female 60.8% (SD 9). An average of 64% of positive clients were linked to care; male 40% (SD 10) female 60% (SD 10). Male predominance in testing uptake with more female positive results and early linkage to care forms a persisting trend. HIV testing activities aimed at increasing female participation by addressing social and cultural barriers limiting their participation through advocacy and community dialogue approaches would increase case detection and early linkages to care and help reduce gaps in prevention and treatment in HIV.