FACULTY OF PUBLIC HEALTH
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Item Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria(Springer Nature, 2023) Adebayo, A. M.; Oluwasanu, M. M.; Okunade, F. T.; Ajayi, O. O.; Akindele, A. O.; Ajuwon, A. J.Background Patent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage.Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria. Methods This was a qualitative study guided by the UK Medical Research Council’s Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software. Results The contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors’ interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system. Conclusions This study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.Item Intention and Concerns about HPV Vaccination among In-School Adolescents in Ibadan, Oyo State, Nigeria(Nigerian Medical Association, 2023) Adeniyi, F. I.; John‑Akinola, Y. O.; Oluwasanu, M. M.; Oluwasanu, M. M.Background: Human papillomavirus (HPV) is a very common sexually transmitted infection responsible for some cancers including cervical cancer. Despite nearly half of the Nigerian population being at risk (women <25), vaccination uptake against the infection is still less than 5%. Methodology: This cross-sectional descriptive survey was conducted using a multi-stage sampling technique. A semi-structured questionnaire was administered to 300 in-school adolescents aged 15-19 years, across 15 private and public secondary schools in Ibadan-North and Ibadan North-West of Oyo State, whose parents gave consent. The data was analysed using descriptive and inferential statistics in SPSS v21. Cronbach’s alpha coefficient was used to measure internal consistency reliability while categorical tables were compared using chi-square and regression analysis with a p-value <0.05. Results: The mean age of respondents was 15.8 ± 0.84 years. Half of them were females (52.3%) and also attended private schools (56.3%). Very few of the respondents had heard about HPV (21.0%) and HPV vaccine (12.7%), however, more than half had heard about cervical cancer (55.3%). Few respondents had good knowledge (11.0%) and positive perception (27.0%) of HPV, cervical cancer and HPV vaccine. The major source of information was social media (46.2%). Half of the respondents reported intention to take the vaccine if recommended by their family doctor (56.3%) and if given parental approval (52.0%), however, many (60.7%) were concerned about the vaccine’s side effects.Conclusion: Findings show that parents and health workers influence adolescents’ HPV vaccination uptake.The study thus recommends the prioritization of parental involvement in HPV vaccination. Parents and health workers should therefore be targeted as key stakeholders in driving the awareness of HPV and uptake of HPV vaccine among adolescents.Item Temporal trends in overweight and obesity and chronic dease risks among adolescents and young adults: A ten-year review at a tertiary institution in Nigeria(Public Library of Science (PLoS), 2023) Oluwasanu, A. O.; Akinyemi. J. O.; Oluwasanu, M. M.; Oseghe, O. B.; Oladoyinbo, O. L.; Bello, J.; Ajuwon, A. J.; Jegede, A. S.; Danaei, G.; Akingbola, O.There is an increasing prevalence of obesity among college/university students in low- and middle-income countries, similar to the trend observed in high-income countries. This study aimed to describe the trend and burden of overweight/obesity and emerging associated chronic disease risks among students at the University of Ibadan (UI), Nigeria. This is a ten-year retrospective review of medical records of students (undergraduate and post-graduate) admitted between 2009 and 2018 at UI. Records of 60,168 participants were analysed. The Body Mass Index (BMI) categories were determined according to WHO standard definitions, and blood pressure was classified according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The mean age of the participants was 24.8, SD 8.4 years. The majority were ≤ 40 years (95.1%). There was a slight male preponderance (51.5%) with a male-to-female ratio of 1.1:1; undergraduate students constituted 51.9%. The prevalence of underweight, overweight, and obesity were 10.5%, 18.7% and 7.2%, respectively. We found a significant association between overweight/obesity and older age, being female and undergoing postgraduate study (p = 0.001). Furthermore, females had a higher burden of coexisting abnormal BMI characterised by underweight (11.7%), overweight (20.2%) and obese (10.4%). Hypertension was the most prevalent obesity-associated non-communicable disease in the study population, with a prevalence of 8.1%. Also, a third of the study population (35.1%) had prehypertension. Hypertension was significantly associated with older age, male sex, overweight/obesity and family history of hypertension (p = 0.001). This study identified a higher prevalence of overweight and obesity than underweight among the participants, a double burden of malnutrition and the emergence of non-communicable disease risks with potential lifelong implications on their health and the healthcare system. To address these issues, cost-effective interventions are urgently needed at secondary and tertiary-level educational institutions.Item Cervical cancer and human papillomavirus vaccine knowledge, utilisation, prevention educational interventions and policy response in Nigeria: a scoping review(SAGE Publishing, 2022) John-Akinola, Y. O.; Ndikom, C. M.; Oluwasanu, M. M.; Adebisi, T.; Odukoya, O.Purpose: This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer. Methods: A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. Results: Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control. Conclusion: Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.Item Oncology Training Needs Assessment Among Health Care Professionals in Nigeria(American Society of Clinical Oncology (ASCO), 2022) Adejumo, P. O.; Oluwasanu, M. M.; Ntekim, A.; Awolude. O. A.; Kotila, O. A.; Aniagwu T.; Brown B. J.; Dzekem, B. S.; Duncan, S.; Tito Ilori, M.; Ajani O.; Lee, S. M.; Babalola. C. P.; Ojengbede, O.; Huo. D.; Hammad, N.; Olopade, O. I.PURPOSE This study investigated the status of training and preparedness for oncology practice and research and degree of interprofessional collaboration among health care professionals in the six geopolitical regions of Nigeria. METHODS A convergent parallel mixed methods design was used. Three hundred seventeen respondents completed a three-part, online questionnaire. Self-rated competencies in oncology research (26 items), oncology practice (16 items), and interprofessional collaboration (nine items) were assessed with a one- to fivepoint Likert scale. Six key informant and 24 in-depth interviews were conducted. Descriptive statistics, analysis of variance, and pairwise t-test were used to analyze the quantitative data, whereas thematic analysis was used for the qualitative data. RESULTS Respondents were mostly female (65.6%) with a mean age of 40.5 6 8.3 years. Respondents include 178 nurses (56.2%), 93 medical doctors (29.3%), and 46 pharmacists (14.5%). Self-assessed competencies in oncology practice differed significantly across the three groups of health care professionals (F = 4.789, P = .009). However, there was no significant difference across professions for competency in oncology research (F = 1.256, P = .286) and interprofessional collaboration (F = 1.120, P = .327). The majority of respondents (267, 82.4%) felt that educational opportunities in oncology-associated research in the country are inadequate and that this has implications for practice. Key training gaps reported include poor preparedness in data analysis and bioinformatics (138, 43.5%), writing clinical trials (119, 37.5%), and writing grant/research proposals (105, 33.1%). Challenges contributing to gaps in cancer research include few trained oncology specialists, low funding for research, and inadequate interprofessional collaboration. CONCLUSION This study highlights gaps in oncology training and practice and an urgent need for interventions to enhance interprofessional training to improve quality of cancer care in Nigeria. These would accelerate progress toward strengthening the health care system and reducing global disparities in cancer outcomes.Item A cross-sectional study of the knowledge and screening practices of diabetes among adults in a south western Nigerian city(Pacini Editore SRL, Pisa, Italy, 2021) Osiberu, A. A.; Oluwasanu, M. M.; Omobowale, M.; John Akinola, Y.; Oladepo, O.Introduction. The control of diabetes depends largely on preventive actions often influenced by knowledge and awareness of the condition, its risk factors, complication, and management. This study assessed the awareness, knowledge, and practices regarding diabetes among adults in two communities in Ibadan, Nigeria. Methods. A community-based cross-sectional study was conducted among five hundred randomly selected non-diabetic respondents, aged 18 to 65 years. Data was collected using the pretested, modified version of the WHO STEPS instrument translated into Yoruba language. Data collected were analysed using descriptive and inferential analysis and the level of significance was set at p < 0.05. Results. Majority of the respondents (89.6%) had previously heard about diabetes. Of these (n = 448), 31.8% were knowledgeable about diabetes and only 28% have ever had their blood glucose level measured by a doctor or other health professionals. Sex and monthly income were statistically associated with respondents’diabetes knowledge while age, religion, monthly income, employment status, marital status, ethnicity and level of education were statistically associated with screening practices (p < 0.05). Monthly income was found to be a significant predictor of the level of knowledge adjusted by sex. Earning N20,000 ($ 52.60) or less had higher odds of being knowledgeable compared to earning no income (OR 0.54, CI 0.35, 0.83). Conclusion. Though Diabetes awareness is high, knowledge gaps and poor screening practices is of concern. This calls for tailored multi-component, community-based, health education interventions.Item Qualitative views of Nigerian school principals and teachers on the barriers and opportunities for promoting students’ physical activity behaviours within the school settings(Springer Nature (BioMed Central), 2021) Oluwasanu, M. M.; Oladepo, O,; Ibitoye, S. E.Background: Insufficient physical activity (PA) is a growing public health challenge among Nigerian adolescents. Significant information gap exists on the school-related factors which influence the participation of adolescents in school-based physical activity programmes in Nigeria. This study was conducted to document the qualitative views of school principals and teachers on the barriers and opportunities for promoting the physical activity behaviours of adolescents within the school settings in light of the socio-ecological model. Methods: This was a qualitative study conducted in 12 public and private schools in two local government areas of Oyo state, Nigeria. Two key sources and data collection methods (i.e key informant interviews and focus group discussions) were used. Six key informant interviews were held with school principals and six focus group discussions with classroom teachers using pre-tested guides. Data was analysed using thematic analysis. Results: Fourteen sub-themes were identified as barriers to PA and linked to different levels of the socio-ecological model. Three themes were categorised as parental factors, three themes as socio-cultural and religious factors while the school-related factors had eight sub-themes. Specifically, the school-related barriers were the declining numberof trained physical health education teachers, limited opportunities for continuing education and low prioritisation of physical health education. Other school-related factors such as increasing demand for classroom academic time, negative attitudinal dispositions of other teachers and inadequate funding for schools which hampered the provision of facilities and equipment were identified as factors that limit the effective implementation of policies and programmes for physical activity in schools. Opportunities to promote PA within the school settings during assemblies, breaktime, after-school and inter-house sports competition exist. However, these opportunities are hampered by competing academic time, security threats, fear of causalities to students due to poor supervision after school, poor funding and brawling associated with competitive school-based sporting events. Conclusions: Factors that contribute to insufficient physical activity among in-school adolescents in the school settings are multi-factorial. Implementation of holistic, multi-component interventions which address the social-cultural and school-level factors and enhance students’ opportunities for physical activity in schools are recommended.Item Urban Poor Community Settings’ Knowledge and Screening Practices for Cervical Cancer in Ibadan, Nigeria(American Society of Clinical Oncology, 2021) John-Akinola, Y. O.; Oluwasanu, M. M.; Oladepo, O.PURPOSE This study investigated knowledge and screening practices for cervical cancer among two urban poor community settings in Ibadan, Nigeria. METHODS A cross-sectional design was used. ODK tool was used to collect quantitative data among a sample size of 500 respondents. Data were analyzed using IBM SPSS version 21 for descriptive and inferential statistics. Scores for knowledge were on a scale of 0-39 points (0-18 low, 19-23 fair, and 24-39 high knowledge). RESULTS A majority of respondents (77.2%) had low knowledge of cervical cancer and were not aware (93.6%) of the Papanicolaou test (Pap smear test) or cervical cancer screening (91.2%). Very few women (10%) were aware of the human papillomavirus vaccine for the prevention of cervical cancer, 4% had been screened with the Papanicolaou test, and one woman (0.3%) with visual inspection with acetic acid. Four (1.1%) women had taken human papillomavirus vaccine before. CONCLUSION The findings of this study have underscored a necessity for increased awareness creation through health promotion interventions and strategies to alleviate low knowledge, prevention, and screening practices for cervical cancer in poor community settings in Nigeria.Item General and tuberculosis-specific service readiness in two states in Nigeria(Springer nature, 2020) Oluwasanu, M. M.; Hassan, A.; Adebayo, A. M.; Ogbuji , Q. C.; Adeniyi, B. O.; Adewole, D. A.; Ladipo, O. A.; Ajuwon, G. A.; Ajuwon, A.Background: Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. Methods: This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service. Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. Results: The domain score for basic amenities in both states was 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [− 15.29, 7.56]. In Oyo, only half of the facilities (50%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p = 0.56). The domain score for availability of staff and TB guidelines was 57.1% for both states with 95% confidence interval [− 13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management. Conclusions: The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.Item Experience of Stress and Coping Mechanism Among Police Officers in South Western Nigeria(sage, 2020) John-Akinola, Y. O.; Ajayi, A. O.; Oluwasanu, M. M.Prior research on stress among police officers in Nigeria is limited. Most researchers have focused on the predictors of workplace stress among the police officer, and fewer still have examined their coping mechanisms. This study assessed the stress experienced and coping mechanism among police officers in Ibadan Metropolis, Oyo State, Nigeria. The study was a descriptive cross-sectional study, which utilized a pretested self-administered questionnaire. The study population included 342 selected respondents using a multistage sampling technique from police stations in Ibadan North Local Government, Oyo State, Nigeria. The data were analyzed using descriptive statistics, v2 test, and Fisher’s exact test at p ¼.05. Results revealed that majority (92.5%) of the respondents had poor knowledge of stress with a mean knowledge of 5.4 " 1.7. Majority (80.1%) of the respondents reported experience of stress such as feeling depressed sometimes at work, while 60.5% said that they usually have headache and body ache. In addition, 36.9% had good coping mechanism and more than half (58.8%) had a fair coping mechanism with a mean coping score of 5.0 " 3.0. This study showed that knowledge of stressors was poor and respondents perceived that they experienced stress and its symptoms. Strategies such as training using teaching, discussion, and explanation to educate the police officers about stress and its coping mechanism and policy interventions to facilitate the construction of standard stress management centers would be appropriate strategies to reduce stress, increase the knowledge of police officers on stressors, and enhance their coping mechanism.