An Exploratory Study of Menstruation and Menstrual Hygiene Knowledge Among Adolescents in Urban and Rural Secondary Schools in Cross River State, Nigeria

Menstruation and menstrual hygiene knowledge is fundamental to the health and well-being of adolescent females, however little attention is paid to the acquisition of the right knowledge about this important aspect of adolescent reproductive health in developing counties, Nigeria inclusive. The study was aimed at determining menstruation and menstrual hygiene knowledge among secondary school students as a basis for planning an appropriate health promotion intervention. A cross-sectional study conducted in selected urban and rural secondary schools in Cross River State, Nigeria. Using a semi-structured questionnaire, 1,006 adolescent female students from junior secondary to senior secondary in eight schools were surveyed. The research protocol was approved by the Ethical Review Board of the Cross-River State, Ministry of Health. Of the 1,006 respondents, 600(59.6%) were urban-based while 406 (40.4%) were rural-based. Most 556 (55.3%) were from public schools while 450(44.7%) were from private schools. Mean age was 14.2±2.71 while age at menarche was 10.95±4.10. Age at menarche in urban schools was 11.1±0.157 while that of rural schools was 10.71±0.239. On knowledge, 230(56.7%) rural-based adolescent female students had a significantly poor knowledge of menstruation and menstrual hygiene practices compared with their urban-based counterparts 253 (42.2%). Majority 435(72.5%) in urban and 327(80.5%) in rural schools obtained information about menstruation from their mothers. Similarly, 407(67.8%) in urban schools and 318 (78.3%) from rural schools were informed about menstrual hygiene by their mothers. There is an urban-rural gap in knowledge of menstruation and menstrual hygiene. Parental role in menstrual hygiene education is critical

Emergency Contraceptive Use among Female Undergraduate Students at the University of Calabar, Calabar, Nigeria

About 42 million abortions take place annually worldwide with almost 20 million of them unsafe and responsible for 70,000 maternal deaths. Young undergraduate women are especially vulnerable with risky sexual behaviours which lead to unwanted pregnancies, abortions and sexually transmitted infections including HIV/AIDS. Cross River State of which Calabar is the capital, has one of the highest HIV prevalence (7.1%) in Nigeria. The purpose of this study was to determine the knowledge and practice of emergency contraception by female undergraduate students of the University of Calabar. A cross sectional descriptive survey design was used to study 400 full time fourth year female undergraduate students randomly selected from 30 departments at University of Calabar. A semi-structured self-administered questionnaire was used for data collection. Data were analysed using statistical packages for the social sciences version 16.0. The research protocol was approved by the Ethical Review Committee of the Cross River State Ministry of Health. Most of the respondents (69.9%) knew what emergency contraceptive pills (ECPs) were used for, but specific knowledge on timing (51.7%) and dosage (39.1%) were lower. With almost 70% sexually active, single, young people, condom use was 59.8% and ECP use was very low (31%). The commonest reasons for ECP non-use were lack of awareness (42%) and fear of side effects (34.2%).  Reproductive health education including ECP awareness and HIV/AIDS prevention should be part of the general studies course. Peer-to-peer health education should be encouraged at the University Medical Center. Keywords: Emergency contraception, abortions, reproductive health, peer-to-peer communication, client-centere

Ophthalmic Skills Assessment of Primary Health Care Workers at Primary Health Care Facilities in Rural Communities in Cross River State, Nigeria

Primary eye care is at the frontline in the elimination of the avoidable causes of blindness. Proficiency in the basic ophthalmic skills is a critical factor in the effective delivery of eye care services at the primary level of care. The aim of the study was to assess the ability of the primary health care workers to provide basic ophthalmic services at primary health care facilities. A semi-structured questionnaire was administered to 146 health providers in twelve primary health care facilities in Cross River State. Multi-stage random sampling technique was used in the selection of respondents for this study. The ability of the health providers to carry out visual acuity test and correctly identify cataract and conjunctivitis using pictures of eye conditions and patients complaints was also assessed and scored. Ethical approval was obtained from the ethics committee, Ministry of Health, Cross River State. Data were analysed using SPSS version 20.0.1. Majority of the participants could not perform the visual acuity test 126(86%). Their ability to correctly identify cataract and conjunctivitis were 78(53%) and 45(31%) respectively. Majority of those who showed the ability to perform some of the tests had previous training in primary eye care. The workers attributed the high failure rate/low score to lack of follow-up and inadequate duration of training on eye care, which was just for one day. The ophthalmic skills and knowledge of the primary health care providers were generally poor. This calls for a review of the strategy for the integration of primary eye care services into the existing primary health care system.Key words: primary, skills, eye care, assessment, ophthalmi

Malaria in Pregnancy in Nigeria: A Literature Review

Malaria is caused by the parasite plasmodium which can be spread to humans through the bite of an infected mosquito. Of the five types of plasmodium (P. Falciparium, P.Ovale, P. Malaria, P. Vivax and P. Knowlesi), the plasmodium falciparium is the deadliest and affects the lives of almost  40 per cent of the world’s population with pregnant women and children  under-five years of age being the most affected. This mini-review involved the collation of findings from recent studies in regards to the prevalence of malaria infection among pregnant women and infants. A systematic analysis of recent literature on the  prevalence of malaria in pregnancy from many authors was carried out and the facts synthesized to make an easy read. From the analysis of literature, Ten Thousand women and 200,000 babies were reported to be dying annually from complications of malaria in pregnancy which recorded a prevalence of 85 per cent in sub-Saharan Africa. More so, Fifty per cent of pregnant women  were discovered to be carrying plasmodium falciparium in their placenta without even experiencing malaria signs/ symptoms, and this development was reported to have been responsible for Twenty per cent of stillbirths and 11 per cent of all maternal deaths. Malaria infection is considered a major threat to the lives and well-being of pregnant women and infants. Therefore, stakeholders should ensure that every clinical diagnosis of malaria in pregnancy is confirmed with a laboratory plasmodium falciparium-based diagnosis before the administration of antimalarial drugs. Furthermore there should be a  stepping –up on the distribution of insecticide treated nets alongside enlightenment of pregnant women on ways of preventing mosquito bite. Instituting the aforementioned approaches is key to improving the health- seeking behaviour of pregnant women in particular and the wider population in general thus enabling them to stay malaria free throughout the period of pregnancy and infancy

Geospatial clustering of newly diagnosed HIV infected adults in Cross River State helps define new “hotspots”

Introduction: A hotspot is a geographical location having evidence of high STIs/HIV prevalence, and/or behaviors that put people at high risk of becoming infected. Therefore, Nigeria, with almost two million people living with HIV, could be considered a giant “hotspot.” The main aim was to describe how the geospatial clustering of newly diagnosed HIV-infected adults in Cross River State helps define new “hotspots.”Methods: Secondary data collected between January 2020 and March 2020, identified and mapped around a presumed hotspot’s radius of influence (ROI), were analyzed using a “Hotspot Analysis” plugin in QGIS software. With a sample size of 3019, both seropositive and seronegative results were geo-referenced and the resultant map was analyzed to determine HIV-positive clusters.Results: From the 3019 spatial locations mapped, 720 (23.9%) were positive cases. Of these, 328 (45.6%) were thus estimated as being associated with the presumed hotspots. The remaining 392 (54.4%) were positive cases identified outside of the ROI of the originally presumed hotspots. The total number of mapped HIV testing services (HTS) points (both negative and positive cases) within the hotspot ROI was 1319, while those outside of the hotspot ROI were 1700.Conclusion: Unique hotspots where social gatherings occur tended to have a wider ROI. Targeted testing in these hard-to-reach communities is recommended

Determinants and Differentials of Maternal Reproductive Health Outcomes in Nigeria: A Review of National Demographic Health Survey Data from 1999 to 2013

Women in Sub-Saharan Africa face significant clinical and socio-demographic challenges that translate to poor health outcomes including high maternal morbidity and mortality. Nigeria being the most populous nation in Africa bears a significant burden of both communicable and non-communicable diseases. This study aimed to determine the trends and differentials in indices fuelling poor health outcomes in Nigeria. The study was a review and trend analysis of maternal reproductive health indicators obtained from the Nigeria National Demographic and Health Survey (NDHS) data from 1990 to 2013 including secondary data from WHO, UNICEF and the World Bank. The life expectancy at birth was 54.5 years with an estimated infant mortality rate of 75 per 1000 live births, child mortality rate of 88 per 1,000 live births, under-5 mortality rate of 157 per 1,000 live births and a maternal mortality ratio (MMR) of 545 per 100,000 live births. Contraceptive prevalence was 22% among women in the wealthiest quintile and 3% among those in the poorest quintile.  Only 3% of women with no education used modern contraception as compared to 24% of women with tertiary education. Most of the maternal deaths were due to preventable causes which were largely related to poverty, inimical socio-cultural beliefs and practices as well as clinical factors like haemorrage, hypertension, and indirect causes like inadequate human resource for health, user charges, cultural pregnancy/childbirth beliefs and myths. A community-based participatory research using both qualitative and quantitative methods may shed more light on the non-clinical factors fueling high MMR in Nigeria. Keywords: Maternal and Child Health, maternal mortality, contraceptio

Work-Overload and Work-place Stress on Hospital Staff in Ugep-Urban of Yakurr Local Government Area, Cross River State, Nigeria

Work-overload in hospital settings has contributed to poor work performance and poor job satisfaction. Selye’s Theory of Systematic Stress and Person-Environment Fit Theoretical Model were used to design a cross sectional descriptive study to determine the relationship between work-overload and work-place stress among hospital staff. A semi-structured self-administered questionnaire and an interview guide were used to collect data from 198 staff in 11 hospitals in Yakurr. Data were coded and analyzed using SPSS version 20 and results were presented using descriptive statistics. Results show 151 (76.3%) female and 47 (23.7%) male staff. However, 34 (72.3%) males and 119 (78.8%) females affirmed that they ‘very often’ feel stressed resulting from work-overload. Women are also more likely to be vocal about stress than men and better at applying coping strategies that work (55.6%) when compared to males (19.1%). The Chi-square (X2) analysis, testing the relation between work-overload and work-place stress among hospital staff, was significant at 0.05 with calculated X2=8.505. There was a significant relationship between work-overload and work-place stress at critical X2=7.82.  Result of hypothesis tested showed that there is a statistically significant difference between work-overload and increase in work stress on hospital staff. Following the results and findings of the study, it is recommended that work-place stress among hospital staff can be reduced and managed by considering and maintaining a balance between the following variables: (i) the task requirement (patient influx, proportion of ailments, etc) and staff ability (technical-no-how, skills, etc), and (ii) staff ability (technical-no-how, skills, etc), needs, expectations and satisfaction with resources provided (both human and material). Keywords: Work-overload, work stress, hospital staff, Presenteeism, Key Informant Interview

Eye Care Seeking Behaviours of Patients in Rural Cross River State, Nigeria

The major causes of blindness in Cross River State, Nigeria are refractive error, glaucoma and cataract. The World Health Organization had estimated that about 145 million people have significant distance refractive errors and at least 13 million of these were children. About 80% of these causes of blindness are avoidable at the primary level of care. The aim of this study was to determine factors responsible for the eye care seeking behaviour of patients in three rural communities of Cross River State, Nigeria. A 39-item structured questionnaire was used to interview 290 patients who visited selected primary health centers (PHC). Most patients, 40.7% were 20 – 29 years and 44% walked to the center. Reasons for clinic visit included, fever, 44.5%; immunization, 30.7%; antenatal care, 13.1%; and eye care, 4.5%. About 51% had a history of eye problems, of these; only 29.7% visited a hospital while 42% visited either a patent medicine vendor or traditional healers. About 49% had family history of spectacle use, of these; 34.5% got glasses from lay eyeglass sellers, 33.8% from hospital/eye clinic, 25.4% from outreach eye screening, and only 4.2% from PHC. Due to reported unavailability of eye care services at the PHC, patients tend to use available albeit questionable eye care services closest to them before visiting secondary health facilities when symptoms persist. The PHC’s proximity to the patients may likely increase access to blindness prevention services if made available at the primary care level. Keywords: Eye-care, health seeking behaviour, rural health, primary health car

Comparative Analysis of Satisfaction with the Use of Ready-Made Spectacles and Custom-Made Spectacles among School Children in Nigeria: A Randomised Controlled Trial

Refractive error is an important cause of visual impairment in Cross River State (CRS), Nigeria. Optical services and spectacles are not readily available to school children for the treatment. The aim of this study was to compare satisfaction with the use of ready-made spectacles and custom-made spectacles in the treatment of refractive error for school eye health programme. A one month double-blinded randomised controlled trial was used to evaluate satisfaction, symptoms, vision and planned continued use of ready-made and custom-made spectacles in school children 6 -17 years with ≥ 1 diopter of uncorrected refractive error. The sample size for each arm was 63. This research was funded by African Vision Research Institute (AVRI). Full ethical approval was obtained from the ethics committee CRS Ministry of Health, Nigeria. Data was analysed using SPSS and EPI info. Out of the 2110 children refracted with non-cycloplegic method, 243 (11.5%) has significant refractive error and only 104(82.5% response rate) met the inclusion criteria for the intervention study. There was no difference (p >0.05) in satisfaction (96.2% vs 96.2%) and  symptoms ( headache 5.8% vs7.7%; eye strain 3.8% vs 1.9%  ) in the use of ready-made vs custom-made spectacles to the 1 month follow up. Ready-made spectacles are recommended for eye health programmes in schools because it is a cost effective strategy for treatment of refractive errors. The ready-made spectacles should be available in different frame pupillary distance for various powers to reduce discomfort associated with frame induced prismatic effect. Keywords: Eye health, vision care, school-aged children, ready-made spectacles, custom-made spectacle

Prevalence of Presbyopia, Spectacle Correction Coverage and Unmet Need, among Adults in Cross River State, Nigeria.

Purpose: To determine the prevalence of presbyopia, spectacle correction coverage and its unmet needs among adults 35 years and above in the study area.Methods: This cross-sectional descriptive study design used multistage cluster random sampling procedure to select the 616 adults. Data was collected using an interviewer administered semi-structured questionnaire. Visual acuity at distance and near was tested with Snellen’s chart at 6m and 40cm respectively. This was followed by eye examination. Presbyopia was defined as near visual acuity of N8 or worse. Relationship between variables were determined using chi square and multivariate analysis at 5% significant level.Results: The average age of participants was 48.1 years ± 10.4 (range, 35-88 years) and 330 (53.6 %) were males. The prevalence of presbyopia was 73.2% (95% Confidence interval [CI]: 69.5, 76.7). Multiple regression analysis showed that, female sex (Adjusted odds ratio [AOR] =1.58 (95% CI: 1.02, 2.38), older age (AOR =3.29 (95% CI: 1.02, 13.6), unemployment (β = 0.47, p = 0.016, AOR =1.59 (95% CI: 1.26, 4.55), lack of formal education (β = -3.67, p < 0.001, AOR =0.03 (95% CI: 0.007, 0.09) were significantly associated with presbyopia. The spectacle correction coverage and unmet presbyopic need were 40.8%, and 59.2% respectively.Conclusion: The Prevalence of presbyopia and unmet presbyopic correction were high among the participants. This can be addressed through awareness creation and provision of accessible and affordable primary eye care services in the communities