Health Promotion & Education
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Item Emergency contraceptive pill knowledge, attitudes and dispensing practices of pharmacists in Ibadan and Lagos metropolis, Nigeria(2010) Omotoso, O; Ajuwon, A. JUse of Emergency Contraceptive Pills (ECP) is desirable in Nigeria where there is high rate of unwanted pregnancy. Pharmacists are expected to play important role in promoting use of ECP but few studies have assessed their knowledge, attitude and dispensing practice of this product in Nigeria. A total of 211 randomly selected pharmacists practicing in Ibadan and Lagos metropolis completed a questionnaire that assessed knowledge about ECP, attitude towards this contraceptive and actual dispensing practices. The results showed that the mean age of the respondents was 38.8 (±10.9) years. There were more male (57.3%) than female respondents (42.7%). The overall mean knowledge scores for the sample was 8.9 (SD: 2.6) out of 18. No significant difference was found in mean knowledge score of male (9.0) (± 2.6) and female respondents (8.9) (±2.8) (p>0.05). Respondents who had practiced for up to 30 years had significantly higher score (9.1) than those with less years of experience (7.7) (p< 0.05). Forty-three percent claimed they had religious or moral (46.9%) objection to dispensing ECP. The majority (79.1%) had ever dispensed ECP whereas 21.9% had never done so. Of the 167 respondents who had ever dispensed, 94.6% had a stock of ECP on the day of their interview. More respondents from Ibadan than Lagos had ever dispensed ECP (p<0.05). More community (80%) than hospital based (60%) pharmacists had dispensed ECP (p<0.05). Only 17.5% of those who had ever dispensed ECP had ever received a formal training on the mode of action of this drug. Although majority had dispensed ECP, their knowledge of the drug is limited. There is need for pharmacists to receive continue education on ECP to enable them serve better the clients who need this service.Item Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel(2004-06) Nwokoji, U. A.; Ajuwon, A.Background: The epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria. Methods: Four hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions. Results: The mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1 % of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%). The majority (88.1 %) had had lifetime multiple partners ranging from 1-40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol. Conclusion: Many naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and interact freely with civilian population and are potential bridging group for disseminating HIV into the larger population. Interventions including sustained educational program, promotion of condoms, changes in transfer policies are recommended to address this problem.Item The structure and function of research ethics committes in Africa: a case study(2007-01) Kass, N. E.; Hyder, A. A.; Ajuwon, A.; Appiah-Poku, J.; Barsdorf, N.; Elsayed, D. E.; Mokhachane, M.; Mupenda, B.; Ndebele, P.; Ndossi, G.; Sikateyo, B.; Tangwa, G.; Tindana, P.Item Perception of blindness and blinding eye conditions in rural communities(2006-06) Ashaye, A.; Ajuwon, A. J.; Adeoti, C.Purpose: The purpose of this qualitative study was to explore the causes and management of blindness and blinding eye conditions as perceived by rural dwellers of two Yoruba communities in Oyo State, Nigeria. Methods: Four focus group discussions were conducted among residents of Iddo and Isale Oyo, two rural Yoruba communities in Oyo State, Nigeria. Participants consisted of sighted, those who were partially or totally blind and community leaders. Ten patent medicine sellers and 12 traditional healers were also interviewed on their perception of the causes and management of blindness in their communities. Findings: Blindness was perceived as an increasing problem among the communities. Multiple factors were perceived to cause blindness, including germs, onchocerciasis and supernatural forces. Traditional healers believed that blindness could be cured, with many claiming that they had previously cured blindness in the past. However, all agreed that patience was an important requirement for the cure of blindness. The patent medicine sellers' reports were similar to those of the traditional healers. The barriers to use of orthodox medicine were mainly fear, misconception and perceived high costs of care. There was a consensus of opinion among group discussants and informants that there are severe social and economic consequences of blindness, including not been able to see and assess the quality of what the sufferer eats, perpetual sadness, loss of sleep and dependence on other persons for daily activities. Conclusion: Local beliefs associated with causation, symptoms and management of blindness and blinding eye conditions among rural Yoruba communities identified have provided a bridge for understanding local perspectives and basis for implementing appropriate primary eye care programs.Item Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria(2006-12) Ajuwon, A.J.; Olaleye, A.; Faromoju, B.; Ladipo, O.Background: Interest in the reproductive health of adolescents continues to grow throughout the world. Few studies had explored the reproductive health knowledge, sexual behavior and experience of sexual coercion among secondary school students in North Eastern states of Nigeria. The objectives of this descriptive survey were to collect data to plan appropriate interventions that meet the reproductive health knowledge, service and skills needs of students in Bauchi, Borno and Gombe states. Methods: Face-to-face interviews were conducted for 624 consenting students who were randomly selected from eighteen secondary schools using an 83-item structured questionnaire. Data were collected on demographic profile, reproductive health knowledge, sexual behavior and experience of sexual coercion. Results: The mean age of the respondents was 16.5 years. There were slightly more males (52%) than females (48%). Students' knowledge about, reproductive health was generally low even though girls had better knowledge than boys. Thirteen percent of the entire students had sexual experience; significantly more males (19%) than females (6%) had done so (p < 0.001). Among boys the age at sexual debut ranged from 10-26 with a mean of 15.7 and median of 16. By contrast, the age at first sex among girls ranged from 10 to 18 years with a mean and median of 16.1 and 17 years respectively. Only 24% of those who were sexually active used a condom during their last sexual encounter. Overall 11% of the students reported that they had been tricked into having sex, 9% had experienced unwanted touch of breast and backside, and 5% reported rape. Conclusion: Students low reproductive health knowledge and involvement in risky sexual activities predispose them to undesirable reproductive health outcomes.Item Outcome of a research ethics training workshop among clinicians and scientists in a Nigerian university(2008-01) Ajuwon, A. J.; Kass, N.Background: In Nigeria, as in other developing countries, access to training in research ethics is limited, due to weak social, economic, and health infrastructure. The project described in this article was designed to develop the capacity of academic staff of the College of Medicine, University of Ibadan, Nigeria to conduct ethically acceptable research involving human participants. Methods: Three in-depth interviews and one focus group discussion were conducted to assess the training needs of participants. A research ethics training workshop was then conducted with College of Medicine faculty. A 23-item questionnaire that assessed knowledge of research ethics, application of principles of ethics, operations of the Institutional Review Board (IRB) and ethics reasoning was developed to be a pre-post test evaluation of the training workshop. Ninety-seven workshop participants completed the questionnaire before and after the workshop; 59 of them completed a second post-test questionnaire one month after the workshop. Results: The trainees came from a multi-disciplinary background including medicine, nursing, pharmacy, social science and laboratory science. The mean scores for knowledge of the principles of research ethics rose from 0.67 out of 3 points at pre-test to 2.25 at post-test (p < 0.05). Also, 42% correctly mentioned one international guideline or regulation at pretest, with most of those knowing of the Declaration of Helsinki. Trainees' knowledge of the operations of an IRB increased from 6.05 at pre-test to 6.29 at post test out of 7 points. Overall, participants retained much of the knowledge acquired from the workshop one month after its completion. Conclusion: The training improved participants' knowledge of principles of research ethics, international guidelines and regulations and operations of IRBs. It thus provided an opportunity for research ethics capacity development among academic staff in a developing country institution.Item Outcome of interventions to improve the quality of reproductive health services provided by private health facilities in selected states in Nigeria(2006) Ajuwon, A. J.; Okuribido, B.; Sadiq, A.; Ajibola, A; Delano, G. E.In Nigeria, as in many developing countries, the private health sector provides a significant proportion of reproductive health services. However, there are concerns about the quality of the reproductive health services provided by personnel operating in this sector. Few interventions exist to improve the quality of reproductive health services being provided by private practitioners. This three year intervention project, which was implemented in Oyo, Ogun and Gombe States, was designed to improve the capacity of personnel working in the private sector to deliver quality reproductive health service to their clients. One hundred and thirty nine privately owned health facilities participated in the project. Baseline data were collected from staff and clients using these facilities through self-completed questionnaires. A total of 458 nurses/auxiliaries were trained to improve their counseling and service delivery skills; 138 proprietors/proprietresses were trained on total quality management to enhance the quality of reproductive health service; and 84 physicians' knowledge were updated on reproductive health/family planning, and post-abortion care. Provision of contraceptive, drugs for treatment of sexually transmitted infections, supply of equipment and development of educational materials were the other components of the intervention. A follow-up survey was conducted three years after implementing the interventions to gauge outcome. At baseline, only 35.2% managed postpartum sepsis compared to 97.8% at follow-up. Thirty-nine percent provided post-abortion care at baseline the figure rose to 97.2% at follow-up. The proportion of respondents who reportedly provided family planning services increased from 39.5% at baseline to 43.0% at follow-up. Report of managernent of persons living with HIV/AIDS increased from 16.0% to 24.3% while counseling services increased from 36.1 % to 37.6%. At baseline, only 55% of the health workers reported that they had male condoms in stock, the figure rose to 88.2% at follow-up. Sixty-one percent of clients reported that it took 1- 5 minutes before being attended at follow-up, compared to 95% who claimed they spent about an hour before receiving care at baseline. The interventions improved availability and quality of reproductive health services provided by private health facilities. Similar interventions should be replicated to scale up the proportion of private health facilities that provide quality reproductive health services in the country.Item Indigenous surgical practices in rural southwestern Nigeria: implications for disease prevention(Oxford University Press, 1995) Ajuwon, A. J.; ||Brieger, W. R.; ||Oladepo, O.; Adeniyi, J. D.A qualitative, community-based study was conducted in the rural community of Ago Are in southwestern Nigeria to learn about indigenous surgical practices and their potential for disease transmission. Community leaders as key informants assisted in identifying two types of indigenous practitioner whose work involved blood contact, whose work was observed. The olola are surgeons who specialize in circumcision and making traditional facial-markings, while the generic term for healer, onisegun, performed gbeere, that is making incisions into which medicinal herbs are rubbed. Although the onisegun used a clean blade for his procedures, he rubbed the herbs into the cuts with his bare hands. The olola used the same knife for all operations and cleaned it simply by rinsing it in a bowl of water. The potential for HIV transmission between practitioner and clients and among clients during these procedures is discussed-as is the potential of health education for reducing the demand for female circumcision and training indigenous healers in hygienic methods.Item HIV risk-related behavior, sexual coercion, and implications for prevention strategies among female fpprentice failors, Ibadan, Nigeria(2002-09) Ajuwon, J. A.; McFarland, W.; Hudes, E. S.; Adedapo, S.; Okikiolu, T.; Lurie, P.We describe a survey of 300 young female apprentice tailors in a periurban community in Ibadan, Nigeria. The objectives were to assess HIV risk-related behavior in order to plan appropriate prevention interventions. Most apprentice tailors were 18-21 years old (68%), single (95%), and had not completed secondary school (98%). History of sexual intercourse was reported by 53 %; 42% had ever experienced unwanted touching of the breast, backside, shoulder, or waist; 4% reported being raped in the last 6 months. Of sexually active women, 57% reported sexual debut with an instructor; 21% had exchanged sex for money or gifts and only 27% had used a condom during their most recent sexual intercourse. Instability of employment and lack of instructor support were primary barriers to implementing a pilot peer education HIV prevention project. The poor social and economic conditions of apprentice tailors make them vulnerable to sexual exploitation and, in turn, to HIV infection. A peer education intervention within the context of a microcredit economic development program may reduce risk for HIV among women in Nigeria's informal economy.Item Evaluation of a school-based reproductive health education program in rural South Western,Nigeria(2007) Ajuwon, A. J.; Brieger, W. R.This quasi-experimental study compared the relative efficacy of teacher instructions alone, peer education alone, and a combination of these two on reproductive health knowledge, attitude, perceived self-efficacy and sexual practices among secondary schools students in the lbarapa district of Southwestern Nigeria. A baseline questionnaire was administered to a systematic sample of students in four schools that were randomized into four treatment arms: teacher instructions alone (E1), peer education alone (E2), combination of teacher instruction and peer education (E3), and control, The results were used to design the contents of the interventions, which were implemented for one academic session. A follow-up survey using the same sampling procedures as baseline was conducted to measure the outcome of the intervention. The control group had superior reproductive health knowledge at baseline. By follow-up survey however, all three intervention schools showed significant knowledge gains, while the control school students' mean score increased slightly. Increase in knowledge was greatest among E3 (+5.0 points), followed by E2 (+3.4), E1 (+1.4) and C (0.3). The intervention schools showed a significant positive shift in attitude towards use of contraceptives with mean increase of 0.6, 0.5, and 0.9 points in E1, E2 and E3 respectively. Scores that measured the students' perceived self-efficacy for safe sex increased significantly among E1 (from 10.8 to 11.8) and E3 (from 10.4 to 12.6). Reported condom use was significantly higher among E2 (from 16.7 % to 62.8%) (p<0.05) and E3 (from 22.8% to 53%) (p<0.05) compared to E1 (28.6% to 47.4%) (p>0.05) and control (from 25% to 45.8%) (p>O.05). Overall, the students from E3 showed more improvement in knowledge, attitude and self-efficacy, than their counterparts from E2 and E3 and control. Multiple intervention strategies have greater potential of improving reproductive health of students