Preventive Medicine Primary Care

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    THE DEVELOPMENT OF A SCALE FOR PREDICTING MOTHERS COMPLIANCE IN THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI)
    (1989-08) ADEMOLA, A. H.
    The apparent high drop out rate in Expanded Programme on Immunization (EPI) is constituting a major barrier in the break-through of the child survival programme especially in developing countries of the World (Alakija, 1986). This cross-sectional, descriptive and explorative study was carried out in Obokun Local Government Area (LGA), Oyo State of Nigeria between October, 1987 and July, 1988. The study population consists of mothers who attended EPI clinics for their children’s immunization under the Expanded Programme on Immunization. Respondents were mothers whose children bad taken the first doses of diphtheria, pertussis, tetanus and Oral polio vaccines (DPT/OPV) between October 1987, and January, 1988. These mothers were classified as compliers if by the end of July, 1988 they had completed the three doses of DPT/OPV schedules. Those who had not completed these three doses were termed non-compliers. Out of 121 mothers used in the study, 65 were compilers while 56 were non-compliers. Data gathering tools used included questionnaire to explore demographic, attitudinal and cognitive factors in these mothers which may affect compliance with EPI appointment schedules. In addition, observational check-list was used to probe into factors which may affect compliance due to clinic settings or arrangements. After analysis of the data, the identified compliance factors were scored to form a predicting scale that can be used to identify those that are likely not to comply with appointment schedules among mothers in EPI Programme so that measures that will make them comply can be instituted from the start. The result showed that the respondents in both compilers and non-compilers were similar in such demographic characteristics as age, marital status and parity. They however differ significantly in demographic characteristics such as educational levels, occupation, income and religion. Also, there were more compilers among mothers who attended orthodox form of ante-natal services, those who had institutionalized deliveries and mothers who brought their children to have first contacts of immunization within their six months of lives. The risk factors that can determine non-compliance with appointments in EPI based on the findings of the study are low- educational level, low income, semi-skilled and non-occupation, non attendance of Orthodox ante-natal services in pregnancy, no immunization during pregnancy, non-institutionalized deliveries, long distance from home to EPI centres, giving herbs as protection to children, delaying the first immunization till children reached ages six months and lastly religions of mothers in which case muslims can default more than Christians. Based on the findings from the study, it is recommended that the health education approach in EPI be modified to include local communication system for rural women since effective communication is the key to implementation of health education activities. In addition future studies should focus on production of predictor scale that will enable the identification of non- compliance among urban/cities mothers.
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    POST-TRAINING ASSESSMENT OF DIARRHOEA MANAGEMENT WITH SALT SUGAR SOLUTION BY COMMUNITY-BASED DISTRIBUTION WORKERS IN AKINYELE LOCAL GOVERNMENT AREA, OYO STATE
    (1995) ADEKOLA, O.
    Studies in a number of pilot Community Based Distribution (CBD) programmes have shown that CBD workers can deliver modern contraceptives and safe maternal and child health services (including treatment or management of common childhood diseases such as diarrhoea) in their communities (Weiss, 1985). CBD workers have been active in Akinyele Local Government Area (LGA) and a high number of diarrhoea episodes have been managed by them. Most efforts have been on the general assessment of service delivery and also certain issues such as increasing availability of contraceptives have been addressed by CBD workers. One major problem is lack of specific post-training assessment of CBD workers' skill in preparing and use of some of the innovative training packages especially the use of salt sugar solution (SSS) in the management of children diarrhoea diseases. A descriptive study was carried out in five CBD centres of Akinyele LGA between June 1990 and October 1990. All the CBD workers identified were 91 but after four visits to each home, a sample of 77 was found and was interviewed and observed. Baseline information on CBD workers who had managed diarrhoea cases were obtained from records at CBD office. The ammended final draft of the questionnaire after pretest at Ajia in Afijio Local Government Area was administered to the 77 workers. In addition observation with a checklist was used to assess workers' ability to prepare SSS. The respondents were similar in age, occupation (other than CBD work) religion. Though while all Traditional Birth Attendants (TBAs) were female and aged above 45 years, Village Health Workers (VHWs) included both male and female and some aged less than 45 years. All the workers, irrespective of either VHWs or TBAs recognised diarrhoea as a servere case and could relate the causes and management but only 9.1% (2 TBAs, 5 BHWs) could assert the correct preventive measures. All the categories of workers asserted that they have heard of SSS but 14.3% (6 VHWs, 5 TBAs) of the workers could state the correct measurements of SSS though 72.7% used it in diarrhoea management, however 27.3% workers have never used it. More than one third (36.7%) of the workers stated that SSS stops diarrhoea rather than preventing dehydration which was mentioned by only 16.3%. All the workers (100%) mentioned that the ingredients - salt and sugar are expensive though they will continue to use it in future unless there is a new technological breakthrough. However, the workers (97.4%) do not teach mothers who utilize their services. Results from observation study revealed that all the workers (100%) did not have SSS corner and sugar was readily accessible in 48.1% of the homes. The workers' preparation of SSS revealed inadequacy in the skills. The study has demonstrated that operation research can reveal hidden facts which could have been overlooked if research was on a general scope. Based on findings, the researcher recommends that workers undergo refresher training which will emphasise measurements of SSS ingredients, SSS use and preparation. Workers should also have SSS corner in their homes where they can teach mothers and should be compensated financially or in kind as this will motivate workers to be dedicated. Specifically, future study should focus on the diarrhoea occurrence among under five children in the five CBD centres of Akinyele Local Government.
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    CONTRACEPTION AMONGST SENIOR SECONDARY SCHOOL STUDENTS IN IBADAN NORTH-EAST LOCAL GOVERNMENT AREA OF OYO STATE
    (1995-02) ADEGBENRO, C. A
    Over the recent years, sexual activities among students in Secondary Schools in Nigeria, particularly those in urban areas, are thought to be high and increasing. The resultant unwanted pregnancies and illegal abortions among these young unmarried population are creating social and health problems (Nichols, et al, 1986). According to previous research findings, included in the causative factors responsible for this unfortunate situation, cure the problems of poor knowledge of Family Life (Sex Education) and Reproductive Health Education and Contraception, negative attitude towards contraceptive services, low and ineffective use of contraceptives due to low accessibility to family planning services. Therefore, the present Knowledge, Attitude and Practices (KAP) study was carried out in order to assess the level of contraceptive awareness and utilization amongst Students in Secondary Schools in- Ibadan North-East- Local Government Area of Oyo State. After the pretesting, a total number of 766 questionnaires were finally administered to students in the Senior Classes in four (4) Secondary Schools in the Local Government Area using a combination of proportional stratified and systematic random sampling techniques. The selected four (4) schools consists of one Boys' only, Girls' only and two mixed schools. Out of this number, a total of 744 duly completed questionnaires were subsequently analysed. The result showed that 484(65.1%) respondents had the correct knowledge of some modern methods of contraception, and out of this figure, 183(37.8%) mentioned condom as a popular method of contraception among them. Although, attitudinal disposition of the respondents towards contraceptive use was as high as 76.0%, however, the results showed a very low level of contraceptive utilization among them (15.7%), Based on these findings, it is suggested that Family Life and Reproductive Health Education including contraceptive counselling services should be introduced in the secondary schools in the L.G.A.
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    BREAST SELF-EXAMINATION (BSE) PRACTICES AMONG FEMALE STUDENTS IN HIGHER INSTITUTIONS IN IBADAN: IMPLICATIONS FOR CANCER EDUCATION
    (1992-01) ADEGOKE, F. R.
    This study assessed the knowledge, attitude and existing breast self-examination practices among six hundred and ninety female students of the University of Ibadan and the Ibadan Polytechnic, Oyo State, Nigeria; using a set of questionnaire. Results showed that 66.1% had ever practiced breast self-examination. However, only 77% reportedly carried out monthly examination of their breasts in the last six (6) months, although 84.6% were aware of it and 33.3% knew that it should be carried out monthly. Knowledge of the correct sequence of breast self-examination and the symptoms to look for was low. The major source of information on breast self- examination was through the mass media. There was a generally positive attitude toward the behaviour. In light of these findings, some breast self- examination information packages and progammes are proposed for the students. In addition, suggestion regarding the examination of breast, self-examination materials for completeness, accuracy and appropriateness before dissemination to the public were made.
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    AN ASSESSMENT OF THE TRAINING AND SERVICES OF COMMUNITY-BASED DISTRIBUTION (CBD) WORKERS IN OYO STATE
    (1985-08) ADEDOYIN, E. O. O.
    The study attempted to assess the effectiveness of the Community Based Distribution (CBD) programme of low-cost Family Planning, Maternal and Child Health Services. This was established in 1979 by the Fertility Research Unit of the Department of Obstetric and Gynaecology, University College Hospital, Ibadan in collaboration with Oyo State Ministry of Health the Pathfinder Fund of Boston; and the Centre for Population and Family, Columbia University both in the United States of America, The C.B.D., an innovative programme, consists of the training and utilization of Traditional Birth Attendants (TBAs) and Voluntary Health Workers (VHWs) to provide Primary Health Care to the door steps of the rural communities who live on the out-skirts of the main stream of sophisticated health technology. The pilot project site was Akinyele Local Government, a rural area, North of Ibadan with a population of 89,900. It was found that the programme was successful because within two years of its implementation, the population served increased from an initial 89,900 to 238,696 and the number of Zones from one to five. At the request of the Oyo State Ministry of Health officials, the project was extended to other Health Zones in Oyo State: Oyo, Oshun, Ife/ljesha Health Zones. The study assessed the training of the CBD workers with particular emphasis on the educational components of the training curriculum and also the educational activities of the CBD workers and their impact on their client community. The CBD training curriculum findings indicate that as designed presently, has enough contents which are relevant to the training objectives. However, it will be more useful, if it is developed into a standard training manual with clearly stated objectives, training methodologies and an evaluation instrument which will set an acceptable level of attainment for a trainee to qualify as a CBD worker. In relation to the application of the training, most of the CBD workers to a large extent were found to perform well on what they were taught to do - knowledge of educational tasks, performance of educational task and effectiveness of educational task. The response and support of the community members especially the clients, to the educational activities of the CBD workers was found to be positive. However, the CBD workers advocate that the government should re—introduce the monthly incentives because the CBD workers in carrying out their activities, incur tangible and intangible cost.
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    FOOD WRAPPING PRACTICES AND THE REFUSE DISPOSAL PROBLEM IN A RURAL SETTING
    (1982-07) ADEBAYO, O.
    It is the aim of this study to investigate the food wrapping methods of the people in Igbo-Ora (a developing rural area). It has been observed that often, the type of materials used in wrapping food determines the nature of refuse being generated. The food wrapping materials form a great bulk of the refuse. The traditional method of food wrapping consists of wrapping the food in leaves. It is well documented in the literature that the bulk of refuse being generated in rural and urban areas consist mainly of leaves. This fact has contributed immensely to poor environmental sanitation, the consequence of which may include disease endemicity, occasional epidemics, and a contributing factor to flood and fire disasters. In order to combat refuse disposal problem both local and state governments have been spending large sum of money, but with little or no positive effect. Furthermore, policy makers e.g. state governors and many authorities have made remarks about the refuse components, i.e. that leaves used for wrapping food constitute the major component of the refuse. Co-incidentally this study endeavours to investigate the opinions of the people on the different types of materials used to wrap food and their preferences in using them. This study would be useful to Waste Disposal Boards, Plastic/Polyethylene manufacturing Industries and all organizations or individuals interested in better environmental sanitation in our communities.
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    A STUDY OF LEADERSHIP STRUCTURES IN AIYEDADE AND IMPLICATIONS FOR LOCAL INVOLVEMENT AND PARTICIPATION IN COMMUNITY DEVELOPMENT PROGRAMMES FOR HEALTH PROMOTION
    (1981-09) ABABIO, E. N. K.
    The power and influence of traditional leaders over their subjects need to receive attention if they (the tradional leaders) are to assume new leadership roles as agents of comn1unity health workers in rallying general participation in community based programmes. The effectiveness of traditional leaders in these roles would vary from community to community. It would also depend to a large extent on how close or how remote they are connected w.ith decision-making in the community and the nature of community participation required. This is because the amount of power leaders exercise over their followers can be measured by their ability to make or influence decisions that affect the day-today activities of the subjects. Also, if participation of the general community is the goal of a community based health programme, then, the chiefs must be popular with more than half the population of the community. With regard to the power of the chiefs, one thing is important. It is this, new decision-making structures have been established in the Aiyedade community. But as power and influence have come to depend on other variables, (education, wealth, occupation) and the chiefs position is based on the traditional kinship relations, the power and influence of the chief will depend on his possession of some of these new variables. In the Aiyedade community, the chiefs almost match other leaders on occupational and social background but to the extent that he sometimes lacks the more modern forms of power base such as education and wealth his traditional monopoly of leadership is open to serious challenges. In the final analysis the degree of popularity a leader enjoys is a function of individual qualities of the leader as opposed to his position or status, qualities such as trustworthiness, service to the community and identification with the wishes and aspirations of the people lead to an individual's popularity with community members. But it is one thing being identified with these qualities and another thing being in a position to direct government resources to satisfy the needs of the people. The latter is the function of the key decision makers in the community. In the Aiyedade community the traditional leadership was not found to constitute the key decision - making body representing the central government. It was also observed that even though the traditional ruling elite was still popular, it had no monopoly of this popularity in the community. As the traditional leadership roles have been eroded by the newly emerged leaders it is no longer appropriate to organize popular following around the chiefs alone. Also as community based programmes may need resources other than the resources of community members alone, it is essential that persons controlling outside resources are involved jointly and simultaneously with other community members. This study then shows that if general community participation is the goal of the health educator in Aiyedade then the chief is only one of the leaders around whom popular Loll owing could be rallied.