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The educational environment is an important factor in nurturing students' learning. Students' experiences of the climate of their learning environment positively correlate with their academic success, achievements and satisfaction.The study aimed to determine the perceptions of medical and dental students about their learning environment during anatomical pathology clinical placement.A prospective, cross-sectional study using a guided self-administered Dundee Ready Education Environment Measurement (DREEM) questionnaire was conducted among fourth year medical and fifth-year dental students on anatomical pathology placement at the College of Health Sciences, Obafemi Awolowo University Ile-Ife, Nigeria. One hundred and eleven of 118 students participated in the study.The age range was 19-35 years. The majority of the students were males ( n= 80, 72.1%). The overall mean score was 115.19 ± 25.6 (maximum obtainable total score = 200), indicating that the students perceived their learning environment as more positive than negative. The mean score for each subscale of the DREEM instrument was: 29.24/48 (60.9%) for perception of learning; 25.67/44 (58.3%) for perception of teaching; 20.89/32 (65.3%) for academic self-perception; 25.61/48(53.4%) for perception of the atmosphere of learning; and 13.52/28 (48.3%) social self-perception. No statistically significant difference was found by sex, age group, and course of study for each DREEM domain.Students' perception regarding the learning environment for anatomical pathology in the focal university shows the need for improvement across various domains. However, academic self-perception and social self-perception are the areas of greatest need.L’environnement éducatif est un facteur important pour favoriser l’apprentissage des élèves. Les expériences des étudiants du climat de leur environnement d’apprentissage sont positivement corrélées avec leur réussite scolaire, leurs réalisations et leur satisfaction.Le but de l’étude était de déterminer les perceptions des étudiants en médecine et en médecine dentaire sur leur environnement d’apprentissage lors d’un stage clinique en pathologie anatomique.Une étude prospective transversale à l’aide d’un questionnaire guidé auto-administré Dundee Ready Education Environment Measurement (DREEM) a été menée auprès d’étudiants en médecine et en médecine dentaire de quatrième année en stage de pathologie anatomique au collège des sciences de la santé, Obafemi Awolowo University Ile -Ife, Nigéria. Cent onze des 118 étudiants ont participé à l’étude.La tranche d’âge était de 19 à 35 ans. La majorité des étudiants étaient des hommes ( n = 80, 72,1 %). Le score moyen global au questionnaire DREEM était de 115,19 ± 25,6 (score total = 200), indiquant que les étudiants percevaient leur environnement d’apprentissage comme plus positif que négatif. Le score moyen pour chaque sous-échelle de l’instrument DREEM était : 29,24/48 (60,9 %) pour la perception de l’apprentissage ; 25,67 /44 (58,3%) pour la perception de l’enseignement ; 20,89/32 (65,3 %) pour l’autoperception académique ; 25,61/48' (53,4 %) pour la perception de l’atmosphère d’apprentissage ; et 13,52/28 (48,3%) d’auto-perception sociale. Le domaine de l’auto-perception sociale présentait un problème nécessitant une amélioration significative.La perception des étudiants concernant l’environnement d’apprentissage de la pathologie anatomique dans l’université focale montre le besoin d’amélioration dans divers domaines. Cependant, l’auto-perception académique et l’autoperception sociale sont des domaines dont les besoins sont les plus grands.Milieu d’apprentissage, pathologie, perception des élèves, DREEM.

IntroductionThe perception of mothers about causes of underweight and overweight among children or adolescents and associated cultural beliefs may influence nutritional status. However, data from qualitative studies on this subject and regarding age 6–19 are scarce in Nigeria.ObjectiveThis study aimed to explore mothers’ perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in a northern and a southern Nigerian state.DesignThis was a qualitative study using focus group discussions (FGD). Eight FGD sessions were held. The interviews were transcribed verbatim, and the transcripts were coded and analysed using NVivo V.11, and direct quotations representing the themes generated from the perspectives were cited as appropriate.SettingThe study was carried out in eight randomly selected rural and urban communities in Gombe and Osun states of Nigeria.ParticipantsSeventy-six mothers of children and adolescents aged 6–19 years.ResultsThe mothers identified concepts, causes and community experience of underweight and overweight children and adolescents, however, some gaps and misconceptions were observed. These included perspectives that suggest a limited understanding of the concepts of mild and moderate malnutrition and stunting and citing of ‘witches and wizards’ as causes of malnutrition. The mothers observed that being underweight was more prevalent in rural communities of Osun and Gombe states, while overweight was more prevalent in urban communities in Osun state. The majority of the women reported no known food taboo or restrictions, and no cultural beliefs relating to the nutrition of children and adolescents.ConclusionGaps and misconceptions exist in the perceptions of mothers on underweight and overweight children and adolescents. Food taboos, food restrictions and other cultural beliefs were not reported by majority of the mothers. Educational programmes for mothers on child/adolescent nutrition should target identified gaps and misconceptions.

Background Female Genital Mutilation (FGM) is believed to have a negative effect on sexual and reproductive health but the evidence from nationally representative sample in high-burdened countries like Nigeria is scarce. This study explored the association between FGM and sexual behaviour in a nationally representative sample of Nigerian women. Methods A secondary data analysis was conducted using the Nigeria Demographic Health Survey conducted in 2013 and 2018 among women aged 15–49 years. The descriptive summaries of respondent characteristics by marital status were presented using frequencies and percentages. The proportion and 95% Confidence Interval (CI) of circumcision by sexual behaviour characteristics were computed. A multivariable log-binomial logistic regression was used to determine the association between sexual behaviour and female circumcision while adjusting for other covariates. All analyses were performed using Stata 15.1 (StataCorp, College Station, TX, USA) at the 0.05 level of significance. Results The proportion of circumcised women was 38.6% among those who were ever-married and 32.4% among those unmarried. There were no statistically significant relationship between circumcision status and sexual behaviour among women who were unmarried. However, circumcised women who were ever married had 18% higher risk of having contracted sexually transmitted disease in the last 12 months preceeding the survey and 10% higher risk of engaging in pre-marital sex compared to ever married women who were uncircumcised after adjusting for other covariates. However, the risk of having multiple sexual partners in the last 12 month among uncircumcised ever married women was lower (aRR = 0.80; 95% CI: 0.66–0.97) in the adjusted model. Conclusion Circumcision is not associated with positive sexual behavioural outcomes including delay in sexual debut, virginity and marital fidelity, although there exists some perception behind increasing FGM in Nigeria including prevention of premarital sex and ensuring marital fidelity. While we strongly discourage FGM in all its form, we assert the need for alternative health promoting community measures to address these inherent sexual perceptions toward eliminating FGM and improving sexual and reproductive health across population groups.

Ameloblastoma is a benign but highly infiltrative tumour, a behaviour that is lacking in adenomatoid odontogenic tumour but partly shared by the odontogenic keratocyst which possesses a unique intrinsic growth potential with marked ability for destroying bone and a high tendency recurrence. High frequency of stromal myofibroblasts (assessed with alpha smooth muscle actin (α-SMA) correlates with aggressive behaviour while p53-cell cycle regulation system is critical in odontogenic tumours with immunoreactivity signifying prognostic status. This study aims to determine and compare the immunoreactivity of these selected tumours to p53 and α-SMA in order to establish if a relationship exists between the frequency and pattern of distribution of myofibroblasts and the behaviour of these lesions.69 blocks of ameloblastoma, and 23 each of adenomatoid odontogenic tumor (AOT), and odontogenic keratocyst (OKC/KCOT) were retrieved. Immunohistochemistry technique was applied for evaluation of these two markers staining with primary antibodies to p53 and -SMA and the frequency and pattern of distribution of myofibroblasts and immunoreactivity to p53 analysed and compared using ANOVA. p was set at0.05.Immunoreactivity to p53 and α-SMA was highest in ameloblastoma (solid compared to unicystic) with highest mean positive cells to α-SMA (29.7±20.1) and p53 (28.3±24.5) in plexiform ameloblastoma. This suggests that ameloblastoma was the most aggressive of tumours studied. Different pharmacological agents that can regulate stromal MF are useful aids to decrease the need for radical surgery in extensive and aggressive odontogenic tumours.L’améloblastome est bénin mais untumeur mes infiltratif, un comportement qui fait défaut dans la tumeur odontogénique adénomatoïde mais en partie partagé par le kératocyste odontogène qui possède un potentiel de croissance intrinsèque unique avec une capacité marquée de destructionet une récidive à forte tendance. Haute fréquence de stromalmyofibroblastes (évalués avec de l’actine musculaire alpha lisse (α-SMA) est en corrélation avec un comportement agressif lors de la régulation du cycle des cellules p53 est essentiel dans les tumeurs odontogènes immunoréactives signifiant le statut pronostique. Cette étude vise à déterminer et comparer activité l’immunoré de ces tumeurs sélectionnées à p53 et α-SMA afin d’établir s’il existe une relation entre le fréquence et schéma de distribution des myofibroblastes et de la comportement de ces lésions.69 blocs d’améloblastome, et 23 chacun de tumeur odontogénique adénomatoïde (AOT) et odontogènedes kératocystes (OKC/KCOT) ont été récupérés. Immunohistochimiela technique a été appliquée pour l’évaluation de ces deux marqueurs de coloration avec des anticorps primaires dirigés contre p53 et α-SMA et la fréquence et schéma de distribution des myofibroblastes et de l’immunoréactivité àp53 analysé et comparé à l’aide de l’ANOVA. p a été fixé à0,05.Immuno réactivité à p53 et α-SMA était la plus élevée dans l’améloblastome (solide par rapport α-SMA (29,7±20,1) et p53(28,3±24,5) dans l’améloblastome plexiforme. Cela suggère que L’améloblastome était la tumeur la plus agressive étudiée. Les agents pharmacologiques différentes peuvent réguler la MF stromale sont des aides utiles pour diminuer le besoin de chirurgie radicale en cas de chirurgie étendue et agressive tumeurs odontogènes.Améloblastome, AOT, OKC/KCOT, p53, α-SMA, myofibroblastes, tumeurs odontogènes, immunoréactivité.

Background: Little evidence exists on the relationship between diet-related factors and child/adolescent malnutrition in Nigeria. This study aimed to assess the associations between household food insecurity (HFI), dietary diversity (DD), and dietary patterns (DP) with the double burden of malnutrition (DBM) among 6–19-year-olds in two Nigerian States. Methods: This community-based cross-sectional study was carried out among 1200 respondents (6–19 years in age) in the Gombe and Osun States of Nigeria. HFI was assessed using the HFI access scale. DD was assessed using a 24-h dietary recall. DP were determined by principal component analysis using a 30-day food frequency questionnaire. DP scores were categorized into quartiles (Q) for statistical analysis. Diet-related predictors of DBM were assessed using logistic regression. Results: HFI was experienced by 568 (47.3%) respondents. The median DD score was 7.0 (maximum of 14). Two DPs were identified, diversified DP (DDP) and traditional DP (TDP). TDP was significantly associated with both thinness (Q4:OR: 2.91; 95% CI: 1.52–5.55; Ptrend: 0.002) and overweight/obesity (Q4:OR: 2.50; 95% CI: 1.43–4.35; Ptrend: 0.007), while DDP was inversely related with thinness (Q4:OR: 0.36; 95% CI: 0.21–0.61; Ptrend: 0.008) as compared to Q1. Conclusions: TDP increased the odds for DBM, while the DDP reduced the odds.

ObjectivesTo estimate age-specific abortion incidence and unintended pregnancy in Kinshasa, Democratic Republic of Congo and compare care experiences between adolescents (15–19 years) and older women (20–49 years).DesignWe used the age-specific variant of the Abortion Incidence Complications Method to estimate abortion and unintended pregnancy, with data from three primary sources: Health Facility Survey (n=361) provided postabortion care (PAC) caseloads; Prospective Morbidity Survey (n=1031) provided the age distribution and characteristics of women presenting for PAC and Health Professional Survey (n=115) provided an estimate of the proportion of abortions resulting in facility-based treatment of complications. Bivariate (χ2, t-test) and multivariable (binary logistic regression, Cox proportional hazard) analyses were used to compare abortion care experiences.SettingHealth facilities proving PAC in Kinshasa.ParticipantsWomen who presented to PAC facilities with abortion complications and their care providers.Primary and secondary outcome measuresThe primary measures were abortion incidence and proportion of pregnancies unintended. The secondary measures were the odd of reporting specific abortion care experiences.ResultsAdolescents had an estimated 27 590 induced abortions, constituting 18.8% of abortions in Kinshasa in 2016. Adolescents had the lowest abortion rate among women less than 35 years (55.2/1000 women) but the highest rate among ever sexually active women (138.4/1000) and recently sexually active women (167.2/1000). Also, adolescents had the highest abortion ratio (82.4/100 live births), proportion of pregnancies unintended (80%) and proportion of unintended pregnancies ending in abortion (49%). Compared with older women, adolescents had higher odds of reporting pregnancy unintendedness (adjusted OR, AOR 1.36, 95% CI 1.75 to 2.24), seeking abortion at later than first trimester (AOR 1.34, 95% CI 1.09 to 1.63) and from non-medical professionals (AOR 1.68, 95% CI 1.31 to 2.14), and not using contraceptives before pregnancy (AOR 2.23, 95% CI 2.77 to 3.43) or postabortion (AOR 2.46, 95% CI 1.87 to 3.29).ConclusionsInterventions are needed to reduce unintended pregnancy among adolescents in Kinshasa and improve their abortion care experiences.

BackgroundCompetent and skilled birth attendants are critical in the reduction of maternal and infant morbidity and mortality at delivery. This study aimed to determine the association between knowledge and self-rated confidence in facility birth attendants affiliated with maternal and neonatal health (MNH) interventions.MethodsA descriptive cross-sectional study was conducted in 24 primary healthcare facilities in Osun state, Nigeria among 128 consenting facility birth attendants who were selected via a multi-stage sampling technique. Each attendant received a semi-structured interviewer-administered questionnaire. The dependent variables included the respondent’s level of knowledge in MNH interventions and their self-rated confidence in MNH skills such as the provision of antenatal care service, normal labour, use of a partograph and the management of obstetric complications and post-partum haemorrhage. Bivariate analysis of factors associated with knowledge and self-rated confidence in MNH skills was performed with statistical significance set at p

Little is known about the link between health literacy and women's ability to safely and successfully use misoprostol to self‐induce an abortion. While abortion is only allowed to save a woman's life in Nigeria, misoprostol is widely available from drug sellers. We interviewed 394 women in 2018 in Lagos State, Nigeria, who induced abortion using misoprostol obtained from a drug seller to determine their sexual and reproductive health literacy (SRHL) and misoprostol knowledge levels; and how these were associated with ending the pregnancy successfully or seeking care for (perceived) complications. Our results show that women's misoprostol knowledge (measured both quantitatively and qualitatively) was low, but that almost all women were nevertheless able to use the drug effectively and safely. Higher SRHL was associated with being more likely to end the pregnancy successfully and also seeking postabortion health care. Our study is the first to examine this association and adds to the scarce literature examining the relationship between health literacy and self‐use of misoprostol to induce abortions in restrictive settings.

Context Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. Objective This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria. Data and method We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. Results Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. Conclusion Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

Background The persistently high prevalence of girl-child marriage remains a public health and developmental concern in Nigeria. Despite global campaign against the practice and policy efforts by Nigerian government, the prevalence remains unabated. This study investigates the prevalence and the influence of ethnicity and religious affiliation on the girl-child marriage among female adolescents in Nigeria. Methods Data of 7804 girls aged 15–19 years extracted from the 2013 Nigeria Demographic and Health Survey were used. Ethnic groups were classified into five: major Northern ethnic group (Hausa/Fulani); Northern ethnic minorities; two major Southern ethnic groups (Yoruba and Igbo), and Southern ethnic minorities. The prevalence of girl-child marriage was determined for the five ethnic groups and individually for each ethnic minority group. Relationships between ethnicity and religious affiliation on girl-child marriage were explored using Cox proportional hazard regression models, adjusting for residence, education and wealth quintile. Results Child marriage was higher for the Northern majority ethnic group of Hausa/Fulani (54.8%) compared to the two major Southern ethnic groups (3.0–3.6%) and aggregated Northern ethnic minorities (25.7%) and Southern minorities (5.9%). However, overall, the less known Northern ethnic minority groups of Kambari (74.9%) and Fulfude (73.8%) recorded the highest prevalence. Compared to the major Southern ethnic group of Yoruba, the adjusted hazard ratio (AHR) of child marriage was significantly higher for Northern ethnic minorities (AHR = 2.50; 95% C.I. = 1.59–3.95) and Northern major ethnicity (AHR = 3.67, 95% C.I. = 2.33–5.77). No significant difference was recorded among Southern ethnic groups. Girls affiliated to other religions (Muslim and traditionalist) had higher child-marriage risks compared to Christians (AHR = 2.10; 95% C.I. = 1.54–2.86). Conclusion Ethnicity and religion have independent associations with girl-child marriage in Nigeria; interventions must address culturally-laden social norms that vary by ethnic groups as well as religious-related beliefs.

SummaryBackground The maternal mortality ratio in Nigeria is estimated to be about 814 per 100,000 live births, and deliveries taken outside a health facility have been implicated as a major factor for this high number. Mobile phones interventions are continually being explored in the health field but its usefulness in maternal health in Nigeria has not been widely explored. Objective To determine the impact of SMS (text messages) on maternal health behaviour in Ife-Ijesa zone of Osun State, Nigeria. Methods We conducted an experimental study involving 2 groups of pregnant women and sent text messages to both groups. The control group was sent general health messages while the intervention group was sent specific pregnancy related messages and both groups were followed up till 6 weeks after delivery. Results An increase in facility delivery rates among both groups, between the index pregnancy and their last pregnancies, were recorded for both groups with a higher percentage increase recorded in the intervention group (29%) compared with the control group 13%. Crude and adjusted linear regression coefficients were done to estimate the effect of the intervention on the change in proportion of deliveries in health facilities. After adjusting for other variables, the difference obtained was a significant value of 14% (regression coefficient = 0.14, 95% CI = 0.08–0.20, P value = .005). Most participants in the intervention group (96.6%) expressed support for the use of text message for maternal health promotion. Conclusion The SMS-based intervention has a positive effect on facility delivery, and mothers welcome its use in pregnancy.

Background The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. Methods A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted. Results Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p = 0.007),privacy and confidentiality (p = 0.04) and respect of rights of service recipients (p = 0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p = 0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p = 0.01), confidentiality (p = 0.002), waiting time (p p = 0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p = 0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law. Conclusion Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.

Background There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. Methods This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. Results The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05–0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02–0.21; p

Background Orofacial malignancy is a growing health issue common in developing regions of the world. Presentation patterns are myriad with geographic variations. Advanced stage owing to late presentation constitutes a significant public health burden. The site and type of the lesions are valuable in diagnosis and patient management. Aim This study aims to review cases of primary orofacial malignancies at the OAUTHC Dental Hospital. Objectives The objective of the study was to determine the prevalence of histologically diagnosed orofacial malignancies, the relative frequencies, types and site of distribution. Materials and methods Records of patients with orofacial malignancies at the OAUTHC, Dental Hospital over a period of 10 years (January 2008-December 2017) were reviewed, demographic data (age, gender and site), history of tobacco use were retrieved and entered into a pro forma. The data obtained were analysed with STATA 11. Statistical significance was set at P Results Of 375, 109 cases of neoplasms seen were primary malignant tumours, with prevalence rate of 29.1%. There were 71 (65.1%) males and 38 (34.9%) females (male:female ratio of 1.87:1), mean age (48.7 ± 19.3 years) and range (4-94 years). Affected sites were mandible (41, 37.6%), maxilla (39, 35.8%), palate (17, 15.6%) and others. Lesions were mainly squamous cell carcinomas (SCC: 46, 42.2%), salivary gland adenocarcinomas (SGAs, 25, 22.9%) including 8 (32%) cases of adenoid cystic carcinoma (ACC). Others were odontogenic carcinoma (18, 16.5%) and lymphoma (8, 7.3%). Most specimen analysed were hard tissues (n = 63, 57.8%). Thirty-four (73.9%) cases of SCC and 66 (60.6%) cases of primary malignancies were in the 5th-9th decades of life. This was statistically significant at P = 0.000. Conclusion SCC was more prevalent than salivary and odontogenic carcinomas. ACC and mucoepidermoid carcinoma were two most common SGAs. Metastatic tumours to the jaws are rare.

Summary Background Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10–24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors. Methods The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories. Findings The leading causes of death in 2013 for young people aged 10–14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15–19 years (14·2%) and 20–24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20–24 years (17·1%) and the fourth highest for girls aged 15–19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15–19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20–24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20–24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20–24 years. Alcohol and drug use in those aged 10–24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs. Interpretation Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems. Funding Bill & Melinda Gates Foundation.

Unprecedented global forces are shaping the health and wellbeing of the largest generation of 10 to 24 year olds in human history. Population mobility, global communications, economic development, and the sustainability of ecosystems are setting the future course for this generation and, in turn, humankind. At the same time, we have come to new understandings of adolescence as a critical phase in life for achieving human potential. Adolescence is characterised by dynamic brain development in which the interaction with the social environment shapes the capabilities an individual takes forward into adult life.3 During adolescence, an individual acquires the physical, cognitive, emotional, social, and economic resources that are the foundation for later life health and wellbeing. These same resources define trajectories into the next generation. Investments in adolescent health and wellbeing bring benefits today, for decades to come, and for the next generation. Better childhood health and nutrition, extensions to education, delays in family formation, and new technologies offer the possibility of this being the healthiest generation of adolescents ever. But these are also the ages when new and different health problems related to the onset of sexual activity, emotional control, and behaviour typically emerge. Global trends include those promoting unhealthy lifestyles and commodities, the crisis of youth unemployment, less family stability, environmental degradation, armed conflict, and mass migration, all of which pose major threats to adolescent health and wellbeing. Adolescents and young adults have until recently been overlooked in global health and social policy, one reason why they have had fewer health gains with economic development than other age groups. The UN Secretary-General's Global Strategy for Women's, Children's and Adolescents' Health initiated, in September, 2015, presents an outstanding opportunity for investment in adolescent health and wellbeing. However, because of limits to resources and technical capacities at both the national and the global level, effective response has many challenges. The question of where to make the most effective investments is now pressing for the international development community. This Commission outlines the opportunities and challenges for investment at both country and global levels (panel 1).

ObjectivesThis study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.DesignThis was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.SettingData were collected in 2018 in six local government areas in Lagos State.ParticipantsDrug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.Primary and secondary outcome measuresUsing self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.ResultsAlthough drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.ConclusionsDrug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.

To determine the sleep pattern among Nigerian school-attending adolescents and its association with socioenvironmental factors and the use of electronic devices.Descriptive cross-sectional survey.Public and private secondary schools in Ile-Ife, Osun State, Nigeria.Multistage sampling technique was used to select 346 school-attending adolescents aged 10-19 years.A modified version of the Adolescent Sleep Habits Survey Questionnaire was administered to respondents in the school setting using the facilitated self-administration method.Participants' mean age was 13.5±2.29 years, and the male-female ratio was 1:1.1. The mean total sleep duration on weekends of 9 hours (h) 08 minutes (min) ± 113 min was significantly higher than that of weekdays (7 h 15 min ± 86 min) (P.001). About half of the respondents (48.7 %) had access to a computer. Majority of the respondents (80.9%) use one or more electronic device at bedtime, although cell phone was used by more than half (52.3%) of the respondents at bedtime. The proportion of adolescents with short sleep duration was 44.4% for weekdays and 5.5% for weekends. Lower social class and non-use of computers in the night time were independent predictors of adequate sleep duration on weekdays, whereas female sex, age (early adolescence), and polygamous family setting were independent predictors of sufficient sleep on weekends.A high proportion of school-attending adolescents have insufficient sleep on weekdays and significantly sleep less during weekdays compared to weekends. There is a need to target adolescents, parents, and school authorities with education on sleep issues.

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.

Considering the huge resources -- human and materials -- that are involved in intervention programs the findings in this supplement points to the need to pay greater attention to the quality of program design implementation and evaluation. This is crucial to ensuring that the huge investments made in adolescent and young people’s sexual health interventions in LMICs truly count. On the one hand greater emphasis on the use of evidence-informed approaches and designs underpinned by sound theoretical framework is clearly important. The results of the reviews published in this supplement aptly add to the available evidences on interventions that are effective in addressing specific young people’s SRH challenges in LMICs. On the other hand the case needs to be made strongly for the inclusion of rigorous evaluation approaches in every intervention program to enhance the potential for generating good evidence as well as facilitate opportunities to derive useful lessons for future interventions -- from both successful and nonsuccessful programs alike. Thus on the whole there is the need to ensure that interventions addressing adolescents and young people’s health issues are well grounded scientifically in terms of their design and complemented with effective implementation and rigorous evaluation and the successful projects taken to scale -- only then would the investments in adolescent and young people’s SRH interventions in LMICs truly count. (Excerpt) Copyright: 2016 Society for Adolescent Health and Medicine.

This analysis is based on data from the Global Early Adolescent Study, which aims to understand the factors that predispose young people aged 10-14 years to positive or negative health trajectories. Specifically, interview transcripts from 202 adolescents and 191 parents across six diverse urban sites (Baltimore, Ghent, Nairobi, Ile Ife, Assuit and Shanghai) were analysed to compare the perceived risks associated with entering adolescence and how these risks differed by gender. Findings reveal that in all sites except Ghent, both young people and their parents perceived that girls face greater risks related to their sexual and reproductive health, and because of their sexual development, were perceived to require more protection. In contrast, when boys grow up, they and their parents recognised that their independence broadened, and parents felt that boys were strong enough to protect themselves. This has negative consequences as well, as boys were perceived to be more prone to risks associated with street violence and peer pressure. These differences in perceptions of vulnerability and related mobility are markers of a gender system that separates young women and men's roles, responsibilities and behaviours in ways that widen gender power imbalance with lifelong social and health consequences for people of both sexes.

Objective To determine preferences for companionship during labor and to identify associated factors. Methods The present prospective cross-sectional survey was conducted at a university teaching hospital in Nigeria between September 1, 2011, and February 28, 2012. Participants included women who underwent the first stage of labor and delivery at the facility, male partners, and healthcare workers from the maternity unit. Data were collected using a pretested questionnaire. Results There were 226 parturients, 158 male partners, and 69 healthcare workers included in the final analysis; in all, 50 (22.1%) parturients and 37 (23.4%) male partners approved of companionship during labor, whereas 62 (90%) healthcare workers supported it. Among those who approved, a parturient's male partner was stated to be the preferred companion by 33 (66%) parturients, 32 (86%) male partners, and 58 (94%) healthcare workers. The perception of conduciveness of the labor ward for companionship was associated with approving of companionship among both the parturients (adjusted odds ratio [aOR] 2.74) and male partners (aOR 15.79). Previous home delivery (aOR 31.43) and companionship during a previous delivery (aOR 23.00) were also associated with approval. Conclusion Most couples had negative attitudes toward companionship during labor. Intensive education programs and restructuring of facilities could enable Nigerian labor wards to improve the delivery experience for both parturients and their male partners.

Introduction : Medical and dental students are a high-risk group for hepatitis B virus (HBV) infection which is an occupational hazard for them and a leading cause of death globally. Prevention strategies include vaccination and observance of standard precaution. However, available reports claim utilization of the prevention strategies is low. This study evaluated the attitude of the students towards HBV vaccine and cross-infection practices. Methods : This study was a cross-sectional study carried out at the College of Health Sciences, Obafemi Awolowo University, Nigeria. Using the convenience sampling method, anonymous self-administered questionnaires were distributed to the first 120 participants that volunteered to participate in the study. Data analysis was done using IBM's Statistical Package (SPSS) version 20 software. Statistical level of significance was set at p < 0.05. Results : Over eighty percent (83.2%) of the participants had at least a dose of the HBV vaccine while 79.65% completed the three doses. Majority (94.7%) of the students that did not receive the vaccine cited their busy schedule as the reason for their failure to be vaccinated. Taking every patient as a contagious disease risk (86.5%), washing hands after contact with patients' body fluids (82.1%) and wearing gloves before touching mucous membranes and non-intact skin (74.1%) were the most practiced universal standard precaution items. Conclusion : The uptake rate of HBV vaccination and practice of standard precaution among the students are commendable. However, there is need for improvement considering the level of HBV infection in Nigeria. Key words : Medical and dental students, hepatitis B vaccine, universal precaution, Nigeria

Purpose This qualitative study assesses the cross-cultural and intergenerational reactions of young adolescents and parents to puberty in Ile-Ife, Nigeria, and Nairobi, Kenya. Methods Sixty-six boys and girls (aged 11–13 years) and their parents participated in narrative interviews conducted in English or local languages in two urban poor settings in Ile-Ife and Nairobi. All interviews were recorded, transcribed, translated, and uploaded into Atlas.ti software for coding and analysis. Results Reactions of parents and adolescents to puberty were similar across both sites, with few exceptions. Adolescents' reactions to bodily changes varied from anxiety to pride. Adolescents generally tend to desire greater privacy; trying to hide their developing bodies from others. Most female adolescents emphasized breast development as compared with menstruation as the mark for pubertal initiation, while males emphasized voice changes. Among some ethnic groups in Nairobi, parents and adolescents view male circumcision as the hallmark of adolescence. Parents in both sites reported that with pubertal changes, adolescents tend to become arrogant and engaged in sexual relationships. Parents' reported responses to puberty include: educating adolescents on bodily changes; counseling on sexual relationships; and, provision of sanitary towels to females. Parents' responses are generally focused more on daughters. Approaches used by mothers in educating adolescents varied from the provision of factual information to fear/scare tactics. Compared with their own generation, parents perceive that their own children achieve pubertal development earlier, receive more puberty-related education from mothers, and are more exposed to and influenced by media and information technologies. Conclusions Adolescents' responses to their pubertal bodily changes include anxiety, shame, and pride. Adolescents desire greater privacy. Parents' reactions were broadly supportive of their children's pubertal transition, but mothers' communication approaches may sometimes be inappropriate in terms of using fear/scare tactics.

Summary The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10–24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young people's daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.

Major changes in health are underway in many low- and middle-income countries that are likely to bring greater focus on adolescents. This commentary, based on a 2009 London meeting, considers the need for strategic information for future global initiatives in adolescent health. Current coverage of adolescent health in global data collections is patchy. There is both the need and scope to extend existing collections into the adolescent years as well as achieve greater harmonization of measures between surveys. The development of a core set of global adolescent health indicators would aid this process. Other important tasks include adapting and testing interventions in low- and middle-income countries, growing research capacity in those settings, better communication of research from those countries, and building structures to implement future global initiatives. A global agenda needs more than good data, but sound information about adolescent health and its social and environmental determinants, will be important in both advocacy and practice.

Poor reproductive health constitutes one of the leading public health problems in the world, particularly in sub-Saharan Africa (SSA). We report here an academic partnership that commenced in 2003 between a US institution and six universities in SSA. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health (PRH) outcomes in low-resource settings. The partnership's core activities focused on increasing access to quality education, strengthening health research capacity and translating scholarship and science into policy and practices. Partnership programmes focused on the educational dimension of the human resources equation provide students with improved learning facilities and enhanced work environments and also provide faculty with opportunities for professional development and an enhanced capacity for curriculum delivery. By 2007, 48 faculty members from the six universities in SSA attended PRH courses at Johns Hopkins University, 93 PRH courses were offered across the six universities, 625 of their master's students elected PRH concentrations and 158 had graduated. With the graduation of these and future student cohorts, the universities in SSA will systematically be expanding the number of public health practitioners and strengthening programme effectiveness to resolve reproductive health needs. Some challenges facing the partnership are described in this article.

Background: The study investigated the common dental conditions of children seen in a Nigerian tertiary hospital. The referral patterns were also determined to know how many of the patients had sought care at the lower levels of health before visiting a tertiary hospital. Methods: All the children aged 0–15 years seen at the Dental hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 4-year period were included in the study. Information retrieved from their case notes including patterns of referral, presenting complaints, diagnosis, and treatment were extracted from the case records of the patients. Treatment plans for patients seen at this tertiary hospital were categorized into primary, secondary, and tertiary health-care services. Results: A total of 1,866 children sought treatment over a 4-year period at this tertiary hospital of which 1715 (91.9%) sought treatment without referral from lower levels of care. Only 102 (5.4%) children were referred from primary health care (PHC) centers. Six hundred and seventy-five (36.2%) children presented with pain while 502 (26.9%) attended for a “check-up.” Furthermore, 779 (41.8%) children were diagnosed with periodontal disease (including gingivitis) and 539 (28.9%) with dental caries. Scaling and polishing with oral hygiene instruction was the most common treatment recommended. Only 5% of children seen at this tertiary health facility required specialized oral health-care services provided by tertiary health institutions. Conclusions: The range of oral health care needed and service provided by and for patients who visited this tertiary health-care institution can be effectively provided in a primary or secondary oral health-care delivery center. The poor integration of oral health care into PHC services in Osun State burdens the tertiary health-care institutions to provide nonspecialized oral health-care services.

A national multi-media campaign ( Zip-Up!) was initiated in Nigeria in 2004 to promote sexual abstinence among young people as part of comprehensive efforts to reduce sexually transmitted infection and unwanted pregnancy. This study assessed the effect of the campaign exposure on interpersonal communication about abstinence among a nationally representative sample of never-married young people (15–24 years). A propensity score matching technique was used to create a comparison group statistically equivalent to the group exposed to the campaign and assess the campaign effect. Of the 3,388 people sampled, 29.1% had been exposed to the campaign. Factors significantly associated with campaign exposure included age (OR = 1.08; 95% C.I. = 1.04–1.12), urban location (OR = 1.31; 95% C.I. = 1.04–1.66), and frequency of media use. Compared to the non-exposed group, campaign exposure was associated with a statistically significant adjusted increase of 10.9% in the proportion of young people who engaged in interpersonal communication about abstinence.

Purpose The study assessed the prevalence and the clinical and histologic pattern of soft tissue lesions associated with extracted teeth and determined the validity of clinical diagnoses in comparison with histologic diagnosis. Patients and Methods Soft tissue from the apices of 100 teeth extracted by the intra-alveolar approach and from the follicle of 50 teeth extracted by the transalveolar approach was examined histologically subsequent to clinical diagnosis. The subjects were seen within a 2-year period at the Oral Surgery unit of a Nigerian teaching hospital. Association between age, gender, and the histopathologic diagnosis was assessed, and the clinical presumptive diagnoses were compared with the histopathologic diagnoses using the epidemiologic parameters of sensitivity, specificity, and positive and negative predictive values. Results There were 76 (50.7%) males and 74 (49.3%) females, with age range of 17 to 77 years (33 ± 14 years). Although clinical diagnosis indicated that all the cases were inflammatory in origin, histopathologic diagnosis reported 84% to be of inflammatory origin, 10% to be normal tissue, and 6% to be noninflammatory in nature. The noninflammatory lesions included dentigerous cyst (4%), central giant cell granuloma (1.3%), and ameloblastoma (0.7%). Gender and age were not associated statistically with type and frequency of pathology. Inflammatory conditions showed the highest sensitivity (98%). Conclusions The study showed that the probability of clinical misdiagnosis of pathologically significant lesions associated with extracted teeth is lowest with inflammation and highest with cysts and neoplasms. Thus, routine histopathologic examination of all recoverable soft tissues associated with extracted teeth would contribute to improve management of cases although the cost and related implications of this need to be investigated further.

Objective To evaluate the efficacy of intermittent preventive treatment of malaria using sulphadoxine-pyrimethamine (SP) in the prevention of anaemia in women of low parity in a low socio-economic, malaria endemic setting. Method The study design was an open randomized control trial comparing anaemia incidence among pregnant women on intermittent presumptive treatment of malaria with SP with those on chloroquine (CQ). A total of 352 primigravid and secondigravid women between 16 and 30 weeks gestation receiving antenatal care at the Primary Health Care Center, Enuwa in Ile-Ife, Osun State, Nigeria were serially recruited and randomly allocated into experimental and control groups of 176 each. The experimental group received SP (to a maximum of three doses depending on the gestational age at enrollment into the study) while the control group had treatment doses of CQ at recruitment and subsequently only if they had symptoms suggestive of malaria. The primary outcome measure was anaemia (haematocrit

The Aging Males' Symptoms scale (AMS) is an internationally used scale to analyse health related quality of life (HRQoL). The aim of this paper is to provide evidence that the Nigerian AMS scale measures HRQoL with similar accuracy as in other language versions. We also intended to show the severity of complaints of aging in males in advanced old age. More generally, we aim to demonstrate that the Nigerian AMS scale is an applicable, validated, sensitive instrument to measure HRQoL in Nigeria.We performed a representative survey in Nigeria to get data of the AMS scale in a group of males in old age. The survey was a household-based population sample conducted in March 2006. The Nigerian data were compared with existing data from other European countries. Only community-based data were used for this comparison.The internal structure of the AMS (factorial analysis) was sufficiently similar with the comparison group of other countries in Europe to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.4-0.8). This suggests that the domains are not fully independent. The reliability (consistency) was found to be good and almost identical with European countries. Mean scores of the Nigerian AMS did systematically differ from data of other European studies. There were much higher because of older age. The same applies for the population reference values obtained in Nigeria. It is the first time that population norm values are available for very old age.The Nigerian AMS scale is a standardized HRQoL scale that showed good psychometric characteristics (reliability, validity) similar to other international versions. We suggest that the results obtained with the Nigerian AMS scale should be used preliminarily as reference for 'norm values' for highest age, i.e. in absence of other data. Confirmation in future studies is needed.

Objective: To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers. Methods: Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months. Results: A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs. Conclusion: Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants.

Interest in addressing the ethical issues related to adolescents’ engagement in research, especially sexual and reproductive health and rights (SRHR) research is increasing in view of the need to design and implement research that address peculiar SRHR needs of adolescents. These needs include issues of sexually transmitted infections, HIV, AIDS, adverse pregnancy outcomes, community, family and relationship violence and mental health. Unfortunately, adolescents’ voluntary participation in research has been limited due to their perceived potential to be coerced into participation, and concerns that they may not fully comprehend the issues related to research risks. As such, many of the regulations for engaging research participants have been defined by age rather than due consideration of psychological development. This paper examines the various potential ethical issues that may impact on decision making when adolescents are engaged in research. These include the need to minimise therapeutic misconception, considerations for recruitment and retention, types and amounts for reimbursement, and engagement of communities of adolescents on advisory boards of studies that involve their population. The potential challenges associated with recruitment of adolescents in early child marriages were also highlighted. (Afr J Reprod Health 2014; 18[3]: 118-126)Keywords: Adolescents, ethics, sexual and reproductive health, research L’intérêt dans le traitement des questions éthiques liées à l'engagement des adolescents dans la recherche, la santé et les droits en particulier sexuelle et reproductive (SSR) de recherche est en augmentation en raison de la nécessité de concevoir et mettre en oeuvre des recherches qui répondent à des besoins particuliers de la SSR des adolescents. Ces besoins comprennent les questions d'infections sexuellement transmissibles, le VIH, le sida, les résultats défavorables de la grossesse, la communauté, la famille et la violence dans les relations et la santé mentale. Malheureusement, la participation volontaire des adolescents en matière de recherche a été limitée en raison de leur potentiel perçu d'être forcée à la participation, et les préoccupations qu’ils ne peuvent pas comprendre pleinement les questions liées à la recherche des risques. En tant que tel, de nombreux règlements pour engager participants à la recherche ont été définis par l'âge plutôt que tenant compte du développement psychologique. Ce document examine les diverses questions éthiques potentiels qui pourraient avoir une incidence sur la prise de décision lorsque les adolescents sont engagés dans la recherche. Il s'agit notamment de la nécessité de minimiser le malentendu thérapeutique, les considérations en matière de recrutement et de rétention, les types et les montants de remboursement, et l'engagement des communautés des adolescents au sein des conseils consultatifs des études qui impliquent leur population. Les défis potentiels liés au recrutement des adolescents dans les mariages précoces des enfants ont également été soulignés. (Afr J Reprod Health 2014; 18[3]: 118-126)Mots-clés: adolescents, l'éthique, la santé sexuelle et reproductive, de la recherche

Aims and objectives The study determined the relationship between chronic kidney disease (CKD) and changes in salivary flow and the complications of reduced salivary flow among African subjects with CKD compared with the controls. Materials and methods One hundred and eighty patients, 90 CKD and 90 controls were recruited, interviewed and examined. Stimulated and unstimulated saliva collection was done with standardized spitting method. Urinalysis and blood creatinine levels were determined and glomerular filtration rate (GFR) of each patient was calculated from the blood creatinine using Cockcroft and Gault formula. Statistical analysis was done using STATA 11 software. Results The mean stimulated and unstimulated whole salivary flow rate among CKD subjects were 4.07 ± 1.91 and 2.34 ± 0.99 ml/5 min respectively and is significantly lower than that of the controls which were 8.05 ± 3.95 ml/5 min and 3.82 ± 2.27 ml/5 min for stimulated and unstimulated flow rates. Oral signs of reduced salivary flow were found in 80% of CKD patients. The commonest oral finding was taste abnormalities others are burning sensation, halitosis and difficulty in mastication. Conclusion Patients with CKD had reduced stimulated and unstimulated salivary flow rate. Reduced salivary flow was associated with oral lesions in majority (80%) of CKD patients, the commonest finding being taste abnormalities. How to cite this article Oyetola EO, Owotade FJ, Agbelusi GA, Fatusi O, Sanusi A, Adesina OM. Salivary Flow Rates of Nigerian Patients with Chronic Kidney Disease: A Case-control Study. J Contemp Dent Pract 2015;16(4):264-269.

Background The importance of oral health care in the management of patients with systemic diseases including chronic kidney disease (CKD) has been affirmed. Many CKD patients have related oral lesions, however, attention to oral health care has been lacking, especially in the developing countries with higher burden of renal diseases. Methods One hundred and eighty patients, 90 cases and 90 controls were recruited, interviewed and examined. Oral mucosa assessment was based on the WHO Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. Urinalysis and blood creatinine levels were determined. Glomerular filtration rate (GFR) of each patient was calculated from the blood creatinine using Cockcroft and Gault formula. Results Oral lesions were present in 86 out of 90 (96.5%) CKD patients compared with 15 out of 90 (16.7%) controls (p < 0.001). Abnormal lip hyperpigmentation was the most frequently seen lesion in 81 out of 90 (90%) CKD patients. Other significant findings were gum bleeding, xerostomia, candidiasis, burning mouth and abnormal taste. In the controls (without CKD), the mean GFR was lower in subjects with oral lesions compared with those without oral lesions p < 0.001. Conclusions CKD and reduced GFR in subjects without CKD are risk factors for oral lesions. The higher prevalence of oral lesions in CKD patients necessitates mandatory oral screening to identify patients with deteriorating renal function. The management of such lesions will enhance the overall well-being of CKD patients in developing countries.

Objective To compare the artesunate-amodiaquine and artemether-lumefantrine combinations in the treatment of acute uncomplicated falciparum malaria during pregnancy. Methods Between January and July, 2013, a double-blind randomized trial was undertaken of symptomatic pregnant women (second/third trimester) with malaria parasitemia who attended a center in Ile-Ife, Nigeria. Participants were assigned to receive artesunate-amodiaquine or artemether-lumefantrine (twice daily on days 1–3) according to a computer-generated randomization sequence. Participants and investigators were masked to group allocation. Clinical evaluations and malaria parasite counts were performed at baseline and on days 2, 3, 7, and 28. Mean interval to symptomatic relief, day-3 parasite clearance, day-28 cure rate, and adverse effects were assessed. Results Of 75 women assigned to each group, 65 in the artesunate-amodiaquine group and 71 in the artemether-lumefantrine group completed the study. No significant differences between the artesunate-amodiaquine and artemether-lumefantrine groups were recorded for mean interval to symptomatic relief (2.2 ± 1.0 days vs 2.0 ± 0.8 days; P = 0.090), day-3 parasite clearance (58/65 [89.2%] vs 66/71 [93.0%]; P = 0.444), and day-28 cure rate (64/65 [98.5%] vs 67/71 [94.4%]; P = 0.138). Adverse effects (body weakness and pruritus) were more common among women assigned to artesunate-amodiaquine (30/75 [40.0%]) than among those assigned to artemether-lumefantrine (2/75 [2.7%]; P Conclusion Efficacies of the regimens are similar among pregnant women. However, adverse effects are more common with artesunate-amodiaquine. Pan-African Clinical Trial Registry: PACTR201310000484185.

Objectives: To assess maternal health services and health-seeking behavior in a rural community (Ologbo), located in the South–south zone of Nigeria. Methods: Structured questionnaire was administered to 225 randomly selected mothers (age 15–49 years), and was analyzed using SPSS. Six focus group discussion sessions were also conducted—four for community women and two for health workers. Results: Teenagers constituted 13.3% of the respondents. The average number of children per woman ranged from 2.5 for teenagers to 9.0 for women aged 45–49 years. Eighty percent of respondents knew at least one major medical cause of maternal mortality: the most common causes mentioned were hemorrhage (31.8%) and obstructed labor (17.3%). Private maternity center was the most preferred place for childbirth (37.3%), followed by traditional birth attendants (TBAs) (25.5%). Government facility was preferred by only 15.7%: reasons for the low preference included irregularity of staff at work (31.4%), poor quality of services (24.3%), and high costs (19.2%). Among the 81 women that delivered within a 1-year period, only 9.9% received antenatal care, 6.2% received two doses of tetanus toxoid, while 4.9% attended postnatal clinic. Private midwives and TBAs attended 49.4 and 42.0% of deliveries, respectively. Education was found to be significantly associated with choice of place for delivery (p < 0.05), but no association was found with respect to age and marital status. Only 11.4% of mothers were practicing family planning. Conclusions: Poor health-seeking behavior is a challenge in rural Nigeria, and interventions are needed to achieve improved maternal health status.

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration. This culture is firmly rooted, and does not simply fail to discourage medical migration but actually encourages it. Medical school faculty are role models for the benefits of migration (and subsequent return), and they are proud of their students who successfully emigrate.

The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p=0.009). However, no statistically significant difference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p=0.009).

A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

While investigations into occupational health problems of various groups of workers have been conducted in Nigeria, so far, very little attention has been paid to the health status of workers in the grain industry. The prevalence of respiratory symptoms among wheat flour mill workers and control groups in a medium size industrial setting in Nigeria was studied.The study employed a cross-sectional analytical design. Data were collected using structured interviews, work-site observations, and physical examination. Respondents consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flour mill factory, and 121 matched external controls.Fifty-four percent of the flour-millers reported at least one respiratory symptom compared with 30% of the internal controls (P0.05) and 19% of the external controls (P0.001). Most symptoms were significantly more prevalent among the flour-millers compared with control subjects, and this trend was more evident amongst non-smokers than ex-smokers.The study concluded that wheat flour mill workers in Nigeria, like grain workers elsewhere, were at an increased risk of developing both pulmonary and non-pulmonary symptoms compared with control subjects. The result has implications for improved dust control measures in the grain industry in Nigeria.

Purpose: We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients’ demographic pattern, predisposing factors, the treatment given, and treatment outcome. Patients and Methods: A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome. Results: Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients’ mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth ( P = .00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed. Conclusion: The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.

Objectives : To determine the pattern of vaccine uptake by hospital personnel in a specifically designed pioneer hepatitis B vaccination programme and to highlight major lessons for ensuring success in future programmes. Design : A review of vaccination and employment records for a forty four-month period and comparative analysis on the basis of professional grouping and work units. Setting : Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Subjects : A total of 2,548 employees of the teaching hospital that have worked for a minimum of one year on a continuous basis between April 1992 and December 1995. Interventions : Procurement of recombinant hepatitis B vaccine (Engerix®, SmithKline Beecham) by the hospital management and provision of the same to all interested employees of the teaching hospital at no cost under a vaccination programme which was conducted on an on-site basis. Main outcome measures : ‘Participation’ in the vaccination programme was defined as the uptake of at least one dose of hepatitis B vaccine, and ‘compliance’ defined as the receipt of the three prescribed doses of the hepatitis B vaccine. Results : The level of participation in the vaccination programme was high with 91.9 % of the target population of hospital workers receiving at least a dose of the vaccine, while only about half (53. 8%) of the group complied with receiving the required three doses of the vaccine. In terms of participation, by professional grouping, laboratory workers and nurses recorded the lowest rates (82.5% and 84% respectively), while 100% participation was recorded in respect of the staff of engineering, medical records, pharmacy and physiotherapy departments. The highest rate of compliance (receipt of three doses) was also found among non-clinical workers (medical record personnel - 76.3% and engineering staff - 69.5%) while the lowest rate was found among nurses (39.7%) and doctors (40.3%) Conclusion : Workers with the highest possibility of knowledge of, and exposure to hepatitis B infection within the hospital setting - doctors, nurses, and laboratory workers - showed the greatest apathy to the vaccination programme. Reasons for this trend demand close examination, and subsequently, identification of specific action that needs to be taken to improve the uptake of the vaccine by the target population, particularly the high-risk groups, in future programmes. Among others, targeting all groups of workers with appropriate education on the infection; active involvement of professional groups in the planning and execution of the vaccination programme; and review of the implementation logistics are some of the key points to note for future programmes.

Background The study of dental anomalies is important because it generates information that is important for both the anthropological and clinical management of patients. The objective of this study is to determine the prevalence and pattern of presentation of dental hard-tissue developmental anomalies in the mix dentition of children residing in Ile-Ife, a suburban region of Nigeria. Methods Information on age, sex and socioeconomic status was collected from 1,036 children aged four months to 12 years through a household survey. Clinical examination was conducted to assess the presence of dental anomalies. Associations between age, sex, socioeconomic status, prevalence, and pattern of presentation of the developmental hard-tissue dental anomalies were determined. Result Two hundred and seventy six (26.6%) children had dental anomalies. Of these, 23.8% had one anomaly, 2.5% had two anomalies, and 0.3% had more than two anomalies. Of the children with anomalies, 49.3%were male, 50.7%were female, and 47.8%, 28.6% and 23.6% were children from low, middle and high socioeconomic classes, respectively. More anomalies were seen in permanent than primary dentition. Anomalies of tooth structure were most prevalent (16.1%); anomalies which affect tooth number were least prevalent (1.3%). Dens evaginatus, peg-shaped lateral, macrodontia, and talon cusp were more prevalent in the permanent dentition, and dens evaginatus peg-shaped lateral and macrodontia were more prevalent in the maxilla. There were significantly more macrodontia anomalies in males and in children of high socioeconomic status. Conclusion This large survey of dental hard-tissue anomalies found in the primary dentition and mixed dentition of children in Nigeria provides anthropological and clinical data that may aid the detection and management of dental problems of children in Nigeria.

OBJECTIVE: To document the patterns of bilirubin and hematocrit values among glucose-6-phosphate dehydrogenase (G6PD)-deficient and G6PD-normal Nigerian neonates in the first week of life, in the absence of exposure to known icterogenic agents. METHODS: The G6PD status of consecutive term and near-term neonates was determined, and their bilirubin levels and hematocrits were monitored during the first week of life. Infants were stratified into G6PD deficient, intermediate, and normal on the basis of the modified Beutler’s fluorescent spot test. Means of total serum bilirubin (TSB) and hematocrits of the 3 groups of infants were compared. RESULTS: The 644 neonates studied comprised 353 (54.8%) boys and 291 (45.2%) girls and 540 (83.9%) term and 104 (16.1%) near-term infants. They consisted of 129 (20.0%) G6PD-deficient, 69 (10.7%) G6PD-intermediate, and 446 (69.3%) G6PD-normal neonates. The G6PD-deficient and G6PD-intermediate infants had higher mean TSB than their G6PD-normal counterparts at birth and throughout the first week of life (P < .001). Mean peak TSB levels were 14.1 (9.48), 10.2 (3.8), and 6.9 (3.3) mg/dL for G6PD-deficient, G6PD-intermediate, and G6PD-normal neonates, respectively. Peak TSB was attained on approximately day 4 in all 3 groups, and trends in TSB were similar. Mean hematocrits at birth were similar in the 3 G6PD groups. However, G6PD-deficient and -intermediate infants had higher declines in hematocrit, bilirubin levels, and need for phototherapy than G6PD-normal infants (P < .001). CONCLUSIONS: The G6PD-deficient and G6PD-intermediate neonates had a higher risk of neonatal hyperbilirubinemia and would therefore need greater monitoring in the first week of life, even without exposure to known icterogenic agents.

Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.

Background Nigeria is one of the countries where significant progress has not been recorded in contraceptive uptake despite decades of family planning programs while there are indications that slum dwellers may differ significantly from other urban dwellers in their sexual and reproductive behavior, including family planning uptake. This study therefore examined local notions regarding male partners’ involvement in family planning (FP) adoption by women in two selected urban slums areas in Nigeria – Ibadan (Southwest region) and Kaduna (Northwest region). Specifically, the study investigated women’s narratives about FP, perceived barriers from male partners regarding FP adoption by the women and how women negotiate male partners' cooperation for FP use. Methods Sixteen FGD sessions were conducted with selected groups of men and women, stratified by sex, age group, and FP experience using a vignette to generate discussions. Sessions were facilitated by experienced social scientists and audio-taped, with note-taker also present. The transcribed data were analyzed with Atlas.ti software version 7. Inductive approach was employed to analyze the data. Reasons given for FP attitudes and use are presented in a network format while critical discourse analysis was also used in generating relevant tables. Results The finding shows that women in the selected communities expressed desire for FP adoption. Three main reasons largely accounted for the desire to use FP: perceived need to space childbirth, family’s financial condition and the potential adverse effect of high fertility on the woman’s health. Male partners’ support for the use of FP by women was perceived to be low, which is due to misconceptions about FP and traditional pro-natalistic beliefs and tendencies. Mechanisms by which women negotiate their male-partner’s cooperation for FP adoption include seeking the support of the partner’s significant others and advice from older women. Conclusion To significantly improve family planning adoption rates among urban slum dwellers in Nigeria, there is the need to specifically and specially target men alongside their female partners as well as other stakeholders who have significant influences at family and community level. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-869) contains supplementary material, which is available to authorized users.

The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.