DSpace Collection: Theses in Preventive and Social Medicine

EFFECTS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE, ATTITUDE AND PRACTICE OF REPRODUCTIVE HEALTH AMONG SELECTED SECONDARY SCHOOL STUDENTS IN OYO STATE, NIGERIA.

Fri, 01 Dec 2000 00:00:00 GMT

Title: EFFECTS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE, ATTITUDE AND PRACTICE OF REPRODUCTIVE HEALTH AMONG SELECTED SECONDARY SCHOOL STUDENTS IN OYO STATE, NIGERIA. Authors: AJUWON, A. J. Abstract: In Nigeria, risky sexual behaviours are widespread among adolescents, placing many in this population at high risk of unwanted pregnancies, sexually transmitted infections and associated complications. Schools provide an opportunity for adolescents to learn new knowledge and acquire relevant skills that will enable them prevent the undesirable consequences of unprotected sex. This can be done by formal teaching of existing curriculum and extra-curricular approach such as peer education. Studies have documented the value of peer education, but none have compared its effects with that of instructions provided by teachers. The goal of this study was to compare the effects of three interventions, peer education, classroom instructions and a combination of both on the knowledge, attitudes and practices of reproductive health among secondary school students in rural Oyo State. The study was quasi-experimental in design and consisted of three experimental and one-control schools. Four schools in Eruwa, Lanlate, Igbo-Ora and lgangan in the lbarapa district were randomly allocated among the study groups. At Akolu High School in Eruwa (El), students received teacher instruction. Students of Oke Aako High School Igangan (E2) were exposed to peer education. Igbo-ora Grammar School (E3) students were provided with both instruction and peer education, while those from Bioku High School in Lanlate served as the control group (C). A baseline questionnaire was administered to a systematic sample of 240 male and female students in each school. The results were used to design the contents of the interventions, which covered one academic year (January 19997 through March 1998). A follow-up survey used the same sampling procedures as baseline. We constructed a 34-point reproductive health knowledge score. There was significant difference in knowledge among the schools at baseline. During the follow-up survey however, all three intervention schools showed significant gains over baseline, while the control school students' mean score increased slightly. The amount of improvement among the intervention schools 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 shift in attitude towards use of contraceptives. The mean increases were 0.6, 0.5. and 0.9 points in E1, E2 and E3 respectively. Scores that measured the students'self-confidence in adopting safe sex practices increased significantly in E1 (from 10.8 to 11.8) and E3 (from 10.4 to 12.6). Reported condom use was significantly higher in E2 (from 16.7% to 62.8%) (p<0.05) and E3 (from 22.8% to 53%) (p<0.05) students compared to E1 (28.6% to 47.4%) (p>0.05) and control (from 25% to 45.8%) (p>0.05). On a ranking of performance, students from the school with the mixed intervention were top with 12 points, followed by those with peer education with 10 points, instructions with 5 points and the control with 2 points. In conclusion, the present study shows that a mixed intervention approach has the greatest potential for influencing the reproductive health practices of in-school adolescents. Description: A thesis in the Department of Health Promotion and Education, submitted to the Faculty of Clinical Sciences and Dentistry, College of Medicine, in partial fulfillment of the requirements of the Degree of Doctor of Philosophy, University of Ibadan, Nigeria.

A STUDY OF SOME ASPECTS OF HEALTH MANPOWER ON NIGERIA: THE SUPPLY OF NURSES

Fri, 01 Jan 1988 00:00:00 GMT

Title: A STUDY OF SOME ASPECTS OF HEALTH MANPOWER ON NIGERIA: THE SUPPLY OF NURSES Authors: OYEDEPO, KOLA Abstract: The purpose of this study is to examine the development of some aspects of health manpower in Nigeria. The central theme of the thesis is the supply of nurses. The study objective is to identify and examine the factors which determine and affect supply of nurses in Nigeria. Major problem facing the nurse training institutions which are the main source of supply are examined. Other factors relating to distribution, service conditions and attrition are also examined. According to the World Bank Report 1983, Nigeria has a nurse population ratio of 1:3080. But when questionnaires were sent to the 19 States' Ministries of Health and the Teaching Hospitals that employ and utilize over 75 per cent of all the nurses throughout the Federation, the data from the eleven states and six Teaching Hospitals who responded showed that the nurses in active nursing practice in Nigeria were actually less than half of the number in the register, usually used for planning purposes. At 2.5 percent growth rate the present population of Nigeria will rise to 141.9 minion people by the year 2000 while at 3.2 per cent it will be 155 millions. The population of the three groups of high users of health services (that is, population under 15 years of age,women in the child bearing age of 15-44 years and the older citizens of 65 years and above) alone will reach 100.7 million people by the year 2000 at 2.5 per cent growth rate and 110.1 million at 3.2 per cent growth rate. These rapid increases in the population of high users will create a demand higher than can be met by the present rate of supply. The instrument to assess the implications of rapid development in health technology for nurses' supply focused on the growth in the number of specialist institutions and social welfare services between 1963 and 1986 in response to an increase, in the number of persons requiring specialist care such as the blind, deaf and dumb, the aged, the crippled, the mentally ill, children under 15 years of age, women in child bearing age and people with chronic conditions . Three separate instruments were designed for the training institutions. There was one for the prospective applicants totaling 1,890, one for those currently in training totaling 849 and one for the trainers and the administrators with a total of 62. Another instrument was administered on serving nurses in randomly selected hospitals in Ibadan and those who have left the service to determine the reasons for the high rate of exodus of experienced, nurses. The study shows that rapid development in health technology has implications for nurses supply. In 1963, there were only 4 psychiatric hospitals, 4 tuberculosis hospitals, 18 leprosaria and only 1 teaching hospitals. By 1986 the psychiatric hospitals had increased to 13, tuberculosis hospitals increased to 7, teaching hospitals increased to 12 and leprosaria increased to 41. In addition, Orthopaedic, Ophthalmic, Prisons, Armed Forces and Children Hospitals that were not available in 1963 had by 1986 been established in many parts of the country. More and more nurses are needed to provide nursing services in those institutions. Among the factors that affect the supply of Nurses were increased training period and increase in training costs. Nurses now spend longer periods in training institutions for the post basic education and to specialise in one or more areas of the fourteen specialties now available for nurses in Nigeria. In addition, more and more nurses now pay for their basic nursing education and many post basic such as the tutors' programme in U.C.H. Ibadan, the nurse anaesthetists’ programme in the University of Nigeria Teaching Hospital Enugu and the nurse administrators' programme at Benin now abase between N1,500 and N3,000 for various post basic courses. The increased training periods and increase in the training costs coupled with some new regulations by the Council have resulted in the gradual decline in the admission of students into basic and post basic training institution, for example in Oyo State between 1980 and 1986. As to the reasons for the high percentage of nurses leaving the profession prematurely, there was a 24.8 per cent attrition of nurses in randomly selected hospital in Ibadan. At the University College Hospital Ibadan, where more accurate(s) records were available, the attrition rate was 30.65 per cent, which is 5.85 per cent higher than the attrition rate obtained in randomly selected hospitals in Ibadan. The rate at U.C.H. was found to be similar to the rate obtained in America, (ANA 1966) and in Britain, (Moore et al. 1982.). One of the most important issues in estimating supply of nurses is the determination of the exact number of nurses in active nursing practice. In Nigeria, calculating exact number of nurses has been very difficult because of the lack of accurate data and the method of multiple registration of nurses by the Council. This study examined and identified the various problems associated with the multiple registration of nurses and recommended ways of resolving the problems. Findings on the applicants seeking admission into Schools of Nursing showed that 81.48 per cent of applicants were genuinely interested in nursing and that they were prepared to pay 'for their nursing education if scholarship or bursary was not available. The findings also showed that Schools of Nursing will be able to recruit sufficient number of qualified candidates. 87.98 per cent of students nurses would prefer student status to civil service status and would be prepared to pay for their nursing education. Many student nurses were actually paying for their training at the time of this investigation. The findings also showed that 30.58 per cent of schools belong to voluntary agencies and 31.78 per cent that belong to to Governments can only train a very small number of nurses at a given time. A total of 76.9 per cent of schools lack the organisational structure, facilities and finances for their efficient administration and for coping with a large number of students that may wish to enter nursing. The recommendations of the study include the restructure and re-organization of schools of nursing to the status of a post-secondary institution that is - College status and that the Federal Government should give financial assistance to state governments while the state government take over the responsibilities of voluntary agencies. In planning for future supplies, factors that affect supply must be carefully considered and the accurate population of nurses in active practice urgently ascertained. Description: A Thesis submitted to Department of Preventive and Social Medicine, College of Medicine, University of Ibadan, Nigeria, in conformity with the requirements for the Degree of Doctor of Philosophy (Ph.D)

HOMOZYGOUS SICKLE HAEMOGLOBINOPATHY IN NIGERIAN CHILDREN: ITS PSYCHOSOCIAL EFFECTS ON THEIR FAMILIES

Tue, 01 Jan 1991 00:00:00 GMT

Title: HOMOZYGOUS SICKLE HAEMOGLOBINOPATHY IN NIGERIAN CHILDREN: ITS PSYCHOSOCIAL EFFECTS ON THEIR FAMILIES Authors: OKUNADE, A. O. Abstract: The literature is replete with empirical evidence on how parents of Caucasian origin react to hereditary, chronic and disabling diseases in their children. However, there is very little information on the reaction of Nigerian parents (i.e. persons of African descent) to chronic childhood disorders. The present study was therefore designed to bridge the knowledge gap in the response of Nigerian parents to Homozygous sickle haemoglobinopathy (Sickle-cell anaemia), a hereditary, long-term childhood illness, reputed for having high rates of morbidity and mortality. The first section of the thesis gives a global review of Sickle-cell disease, focusing attention on Sickle-cell anaemia. The review includes the incidence of erythrocyte sickling among Nigerians. About 33 percent of Nigerian population is reported to be heterozygous for Haemoglobin S gene, which implies that three percent of all children born has Sickle-cell anaemia. A few other hereditary childhood diseases with a long-term course are reviewed in order to be able to situate the issue of Sickle-cell anaemia as a chronic childhood impairment. A total of 280 parents of children with sickle-cell anaemia (homozygotes) and 170 parents of children with Bronchial asthma were recruited into the study and control groups respectively. There were 90 fathers and 190 mothers in the former group whilst the latter had 58 fathers and 112 mothers. The instruments used to assess the psychosocial sequelae of Sickle cell anaemia were developed by the author, (Appendices 1, II, III). The study reveals that the emotional reaction of Nigerian parents of children with Sickle-cell anaemia was similar to the response of their Caucasian counterparts described in the literature review. Findings show that the presence of the chronically ill child in the family increased the vulnerability of such a family to socio-economic and emotional problems. Assessment of burden of the affected child's condition on family functioning reveals that most respondents in the study group and a significantly less number in the control group reported that they experienced either moderate or severe burden in family interaction, financial commitments of family, social life of family and family health. In each of the four areas of family functioning assessed for burden of the affected child's condition, significantly more mothers than fathers in the study group perceived either moderate or severe burden. Most fathers in the study group reported a reaction of guilt and responsibility for the affected child's hereditary disorder; a large proportion of them resorted to the use of maladaptive behavior such as increased alcohol consumption and absenteeism from home. In spite of the discernable distress reported by respondents in the study groups, there was no statistically significant difference in the separation and divorce rates between the study and control groups. The study also shows that most parents of homozygotes had a good understanding of the cause of Sickle-cell anaemia to the extent that nearly all of them disclosed that they would not marry their current spouses if given another opportunity because of the affected child's chronic impairment. However, majority of the parents of homozygotes associated the long-term course and the frequent exacerbation of Sickle-cell anaemia to the involvement of supernatural forces such as witchcraft, evil spells cast by malevolent persons, divine retribution for parents' sins and the annoyance of the gods. On that premise, most of the parents in the study group gave traditional medicine and spiritual treatment from "Aladura" Churches to the affected child, believing that such therapy would take care of the supernatural component of the child's illness whilst hospital treatment was expected to deal with the physical component of the illness. The absorption of parents, especially mothers of homozygotes, in the care of the chronically iii child was a constraint in giving adequate care of other children in the family. Although most siblings in the study group and nearly all in the control group reacted to the affected child with either sympathy or indifference, a significant number in the former group was reported to react with emotion of either hate or hostility. The high rates of morbidity and mortality associated with Sickle-cell anaemia in the literature were confirmed in the study. Findings reveal that Bronchial asthma also had a high morbidity but the mortality was significantly lower than in Sickle-cell anaemia. The importance of traditional healers and spiritual healers in "Aladura” churches as health care providers is highlighted in the findings. Similarly, findings show that pharmacists and patent medicine dealers constitute a force to reckon with in the treatment of children. The premium position of religion as the most important source of emotional support for the majority of respondents in the study group and as significantly less number in the control group was revealed by the study. The final part of the thesis addresses itself to the policy Implications of the findings which include the need for health care personnel to increase their sensitivity to the needs of clients, new frontiers for research and a concerted national effort for the control of Homozygous sickle haemoglobinopathy Description: A Thesis in the Department of Preventive and Social Medicine submitted to the Faculty of Clinical Sciences and Dentistry, College of Medicine in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Ph.D) of the University of Ibadan, Nigeria.

FACTORS INFLUENCING THE DISTRIBUTION OF NURSES AND COMMUNITY HEALTH WORKERS IN SELECTED LOCAL GOVERNMENT AREAS IN OYO AND BENDEL STATES

Fri, 01 Mar 1991 00:00:00 GMT

Title: FACTORS INFLUENCING THE DISTRIBUTION OF NURSES AND COMMUNITY HEALTH WORKERS IN SELECTED LOCAL GOVERNMENT AREAS IN OYO AND BENDEL STATES Authors: OGBIMI, R. I. Abstract: A study of the factors associated with the mal-distribution of health service personnel between rural and urban areas was undertaken with a focus on Nurses and Community Health Workers (CHWs). The opinion of health managers was also sought. The study covered four local government areas of Oyo and Bendel States of Nigeria. The nurses and CHWs as units of inquiry were selected by simple random sampling procedure. The management staff as study units were selected by virtue of their position as top level managers of the health services. The samples were made up of 497 nurses, 205 CHWs and 132 managers. The response rate was satisfactory at 78.0% nurses, 81.0% CHWs and 76.0% management staff for analysis. The hospitals and health centres which required selection were chosen by stratified random sampling. The tools for data collection were questionnaires and relevant organisational records of information. Two questionnaires were constructed, one for nurses and CHWs and the other for management staff. The data were collected by the investigator personally. The data collection period lasted for four months in 1989. The responses were put in sets of positive, negative and neutral responses to questions asked. The variables were coded and weights assigned to response categories. The data were analysed by computer. Frequency distribution, chi-square tests and t-test of the Statistical Package for Social Sciences sub-programmes were employed to analyse the data. Included in the findings were that more males than females preferred rural areas for health service. Although married persons preferred rural service than single persons, the single persons were more in the rural areas for health service. Nearness of spouse to staff work place had strong association with personnel location for service, and staff without spouses were more in the rural areas for service. The staff who were predominantly reared in the rural areas preferred rural health service more than those with urban background. Age was neither associated with rural service nor with preference of service location. CHWs were not better distributed between rural and urban areas for service than nurses. Both nurses and CHWs in the rural areas, unlike their urban counterparts were dissatisfied with the availability of basic social facilities in their work environment. Staff influence on management to be left to work in their preferred service location, management staff inability to apply the rules for compliance with posting, and management staff feeling that rural service required special incentives were administrative factors associated with relative scarcity of personnel for health service in the rural areas. Funds for staff employment, manpower status in the labour market, working materials and equipment, and shortage of staff on employment were not associated with relative scarcity of health service personnel in rural areas. More infrastructure in the rural areas did not necessarily concentrate the expected categories of staff in them. Whereas the rural areas were grossly short of nurses and CHWs, the urban areas had comparatively high ratios of staff to population. There was however surplus manpower in the labour market. Most of the managers were not trained in management skills. More males were managers in the predominantly female occupations, although there was some degree of decentralisation in the administration of the health services, the personnel departments were still centralised. The recommendations include decentralisation of personnel departments and rural development to improve personnel distribution between rural and urban areas. Description: A Thesis in the Department of Preventive and Social Medicine submitted to the College of Medicine in partial fulfillment of the requirements for the degree of Doctor of Philosophy of the University of Ibadan, Nigeria.