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Background: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME . Methods: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders . Results: Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. “To examine and treat” (33.6%) and “to ask questions” (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program . Discussion: This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits . [ABSTRACT FROM AUTHOR]

Background: The community-based training of the University of Maiduguri Medical College was expanded in 1990 to cover three rural local government areas (LGAs) located between 25 and 145 km from the University. This study was conducted between March and May 2000 to assess the impact and level of awareness of the training in the three LGAs in promoting the ideals of Primary Health Care (PHC) and community-based medical education, as perceived by community leaders. Method: Focus group discussions (FGDs) were held with community leaders of each of the communities. Results: Consistency in the recollection of what time in the year and for how long the students were in the various communities indicates awareness in all the community leaders. They also indicated that the programme has had a positive impact on their community's health, they would like the students to focus on specific endemic diseases, such as guinea-worm, hypertension, etc, and intensify community outreach programmes, such as home visits and health education. Most participants indicated that their communities participated in the programme by providing accommodation, feeding and other logistics on an ad hoc basis. Community leaders mobilized the communities for health education and other related activities carried out by the students. Conclusion: The community-based medical training of the University of Maiduguri has increased community awareness of preventive aspects for various communicable and non-communicable diseases. In addition it has helped to encourage the communities to participate actively in supporting PHC activities. [ABSTRACT FROM AUTHOR]

This study was carried out to determine the prevalence of antibodies to Helicobacter pylori in northern Nigeria, a region with a low incidence of peptic ulceration. In a random, serological survey of 268 subjects, 228 (85%) of the population studied had IgG antibodies to H. pylori. Fifty-eight of these subjects had experienced dyspepsia in the preceding 6 months. The majority of the population (82%) is infected between the ages of 5 and 10. Despite the high prevalence of antibodies to H. pylori, peptic ulcer is uncommon, suggesting that H. pylori is not important in the etiology of peptic ulcer in this population. Indeed, most patients infected by H. pylori are asymptomatic. The possible reasons for this are discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate potential risk factors for acquisition in seven countries of the meningitis belt., Methods: Households were followed up every 2 weeks for 2 months, then monthly for a further 4 months. Pharyngeal swabs were collected from all available household members at each visit and questionnaires completed. Risks of acquisition over the whole study period and for each visit were analysed by a series of logistic regressions., Results: Over the course of the study, acquisition was higher in: (i) 5-to 14-year olds, as compared with those 30 years or older (OR 3.6, 95% CI 1.4-9.9); (ii) smokers (OR 3.6, 95% CI 0.98-13); and (iii) those exposed to wood smoke at home (OR 2.6 95% CI 1.3-5.6). The risk of acquisition from one visit to the next was higher in those reporting a sore throat during the dry season (OR 3.7, 95% CI 2.0-6.7) and lower in those reporting antibiotic use (OR 0.17, 95% CI 0.03-0.56)., Conclusions: Acquisition of meningococcal carriage peaked in school age children. Recent symptoms of sore throat during the dry season, but not during the rainy season, were associated with a higher risk of acquisition. Upper respiratory tract infections may be an important driver of epidemics in the meningitis belt., (© 2019 John Wiley & Sons Ltd.)

Background: Serum bactericidal antibody titres that correlate with protection against invasive meningococcal disease have been characterised. However, titres that are associated with protection against acquisition of pharyngeal carriage of Neisseria meningitidis are not known., Methods: Sera were obtained from the members of a household in seven countries of the African meningitis belt in which a pharyngeal carrier of N. meningitidis had been identified during a cross-sectional survey. Serum bactericidal antibody titres at baseline were compared between individuals in the household of the carrier who became a carrier of a meningococcus of the same genogroup during six months of subsequent follow-up and household members who did not become a carrier of a meningococcus of this genogroup during this period., Results: Serum bacterial antibody titres were significantly higher in carriers of a serogroup W or Y meningococcus at the time of recruitment than in those who were not a carrier of N. meningitidis of the same genogroup. Serum bactericidal antibody titres to a strain of N. meningitis of the same genogroup as the index cases were no different in individuals who acquired carriage with a meningococcus of the same genogroup as the index case than in those who did not become a carrier during six months of follow-up., Conclusion: Serum bacterial antibody titres to N. meningitidis of genogroup W or Y in the range of those acquired by natural exposure to meningococci of these genogroups, or with cross-reactive bacteria, are not associated with protection against acquisition of carriage with meningococci of either of these genogroups.

The pattern of epidemic meningococcal disease in the African meningitis belt may be influenced by the background level of population immunity but this has been measured infrequently. A standardised enzyme-linked immunosorbent assay (ELISA) for measuring meningococcal serogroup A IgG antibodies was established at five centres within the meningitis belt. Antibody concentrations were then measured in 3930 individuals stratified by age and residence from six countries. Seroprevalence by age was used in a catalytic model to determine the force of infection. Meningococcal serogroup A IgG antibody concentrations were high in each country but showed heterogeneity across the meningitis belt. The geometric mean concentration (GMC) was highest in Ghana (9.09 μg/mL [95% CI 8.29, 9.97]) and lowest in Ethiopia (1.43 μg/mL [95% CI 1.31, 1.57]) on the margins of the belt. The force of infection was lowest in Ethiopia (λ = 0.028). Variables associated with a concentration above the putative protective level of 2 μg/mL were age, urban residence and a history of recent vaccination with a meningococcal vaccine. Prior to vaccination with the serogroup A meningococcal conjugate vaccine, meningococcal serogroup A IgG antibody concentrations were high across the African meningitis belt and yet the region remained susceptible to epidemics.

Background: Tobacco is the leading preventable cause of death in the United States; responsible for more than 400,000 deaths annually. There have been few reports in the literature about the association between these diseases and cigarette smoking from African countries, which may indicate that these diseases are not common in Africans. There is a dearth of knowledge about the smoking habit among adolescents and factors influencing it in Africa. This is a survey of the factors influencing the onset of cigarette smoking among adolescents in Konduga local government area., Methods: A cross-sectional study involving 400 randomly selected subjects from the four districts of the local government who responded to a modified version of the standard WHO questionnaire (WHO/SMO, 1984) for surveying smoking habit., Results: The study showed that friends/peers (57%) as the major factor for initiating the smoking habit in adolescents. Others were pleasure (24%), stress (13%), family members (4%) and cigarette adverts (1%). The study also revealed that the adolescents continued to smoke even though they were aware of the health consequences of smoking. The majority of the respondents (70%) advocated outright ban on tobacco sales by the government as the most effective way to check this world's major preventable health hazard., Conclusion: The study showed that friends/peer groups were the dominant factor influencing the onset of cigarette smoking among adolescents. This underscores the need for targeting the group in behaviour change communication.

Background: The community-based training of the University of Maiduguri Medical College was expanded in 1990 to cover three rural local government areas (LGAs) located between 25 and 145 km from the University. This study was conducted between March and May 2000 to assess the impact and level of awareness of the training in the three LGAs in promoting the ideals of Primary Health Care (PHC) and community-based medical education, as perceived by community leaders., Method: Focus group discussions (FGDs) were held with community leaders of each of the communities., Results: Consistency in the recollection of what time in the year and for how long the students were in the various communities indicates awareness in all the community leaders. They also indicated that the programme has had a positive impact on their community's health, they would like the students to focus on specific endemic diseases, such as guinea-worm, hypertension, etc, and intensify community outreach programmes, such as home visits and health education. Most participants indicated that their communities participated in the programme by providing accommodation, feeding and other logistics on an ad hoc basis. Community leaders mobilized the communities for health education and other related activities carried out by the students., Conclusion: The community-based medical training of the University of Maiduguri has increased community awareness of preventive aspects for various communicable and non-communicable diseases. In addition it has helped to encourage the communities to participate actively in supporting PHC activities.

The aim of this study was to propose an alternative approach to traditional knowledge, attitude and practice (KAP) studies to enhance the quality of data on which educational health programmes are based. The methodology proposed and illustrated involved a triangulation of approaches derived from linguistics, cognitive science, and medical laboratory sciences. Three diarrhoeal health talks (educational messages) as given to mothers in three primary-care facilities in Borno State (Northeast Nigeria) were subjected to a linguistics analysis. Relationships were then sought between the ontology of knowledge in the health talks as revealed by the text analysis and two other kinds of data, namely: (a) mothers' answers to a set of ecologically-sensitive reasoning questions that test how much relevant inferential knowledge the health talks allow for and (b) results of microbiological and biochemical analyses of salt-sugar rehydration solutions prepared by mothers participating in the study. The findings of the study show a relationship between contents/formatting of the health talks and the extent to which relevant inferential competence was supported or demonstrated by mothers. It was also evident that the laboratory analyses could be related either directly to the health talks or indirectly in terms of what the health talks need to emphasize on. The conclusion shows how the methodology proposed addresses shortcomings of traditional KAP studies in respect of the gap between health knowledge and practice.

In Nigeria, there is a paucity of data on the beliefs and practices of traditional healers concerning diarrhoeal diseases. This study was undertaken to provide baseline data for integrating activities of traditional healers into the national Control of Diarrhoeal Diseases (CDD) programme. Interviews of 14 traditional healers, drawn from two large ethnic groups in northeastern Nigeria, were conducted. All but one of them willingly discussed their beliefs and practices. Almost all traditional healers used herbs expecting that it would stop diarrhoea episode. Most traditional healers (n = 11) were, however, aware of the sugar-salt solution (SSS), and six of them had positive impression about it. Ten were willing to be further trained in the preparation/use of SSS, and five reported its past use. Some healers strongly believed that breast-feeding was an important cause of diarrhoea and that, in some cases, diarrhoea was only amenable to traditional treatment. The results of this study suggest that the traditional healers in the region may contribute to promoting the appropriate home management of diarrhoea. However, their perceptions and practices need to be upgraded to ensure success.

Measles is of particular concern in Nigeria because of the high fatality rate, and high morbidity rate, particularly in young children. Measles and its complications are a common reason for hospitalization, indicating very low immunization coverage. This study was carried out to elucidate the contributing factors from attitudes, beliefs and practices of mothers towards measles and its vaccination. A cross-sectional survey was conducted in Konduga Local Government Area. One per cent of the 500 mothers interviewed believed that measles is prevented by immunization, 16% that it is contagious or due to an infectious agent, 26% that it is caused by evil spirits, witchcraft and heat, and 25% had never heard of measles immunization. Twenty-seven per cent said they did not believe immunization was effective and 4% were not allowed to go for immunization by their husbands. Of those mothers whose children had developed measles, only 31% had been treated in formal health facilities. These results indicate an unfavourable attitude and practice by mothers in relation to measles and measles vaccination. There is the need for an intensive health education campaign to improve this state of affairs and to reduce the morbidity and mortality from measles.

Under-fives in 461 households were assessed clinically to determine the prevalence of rickets in sub-urban and rural communities in the Sahel savanna. Overt rickets was found in 11 (2.4%) of households and abnormalities suggestive of rickets in 69 (14.9%). There were significant variations (p < 0.05) in the prevalence of rickets in association with ethnic grouping (higher in southerners and non-Kanuri, non-Hausa-Fulani northerners), religion (more prevalent among Christians), and mother's occupation and educational status (higher with working class mothers and mothers with at least a primary education). A significantly higher prevalence was also associated with late introduction (at more than seven months of age) of cereals to the infant's diet, more than one under-five in a household and presence of under-fives aged 13-43 months. In contrast, no significant variations in prevalence were observed in association with duration of breast feeding, use of multivitamins or cod liver oil, history of convulsions in under-fives, sex, nutritional status, or history of diarrhoea within a recall period of six months. Thus, rickets is common in under-fives in rural and sub-urban communities in the Sahel savanna and may be related more to environmental and dietary factors than to culture and religion. Further studies are required to determine the relative roles of vitamin D or calcium deficiency to facilitate the planning and execution of a community-based intervention programme in the area.

This study was conducted among the four major ethnic groups(Kanuri, Babur, Shuwa and Marghi) of Borno State, North-east Nigeria. The aim of the study was to identify the perceived causes of eclampsia, a leading cause of maternal death in the State. The data were obtained through focus group discussions (FGDs), questionnaires and in-depth interviews. A total of 16 FGDs and 1,167 questionnaire interviews were conducted among the rural populace. In-depth interviews were conducted on relatives of thirty eclamptic patients admitted to the University of Maiduguri Teaching Hospital. The findings revealed that evil spirits/witches and wizards, poor nutrition, heredity early marriage, destiny from God and machinations of co-wives are the perceived causes of eclampsia in the area. These perceptions result in the use of the following as means of treatment: drinks of various concoctions, inhalation of smoked herbs in rooms, potash drinks, and the wearing of talisman around the neck. These perceptions and traditional medications have implications for design of educational and informational messages aimed at reducing maternal mortality from eclampsia in Borno State.

Awareness and knowledge of oral rehydration therapy (ORT) and preparation abilities of salt-sugar solution (SSS) were investigated by means of focus group discussions and complemented by a structured questionnaire survey of mothers in rural and urban areas of north-eastern Nigeria. ORT awareness was high with some intra-regional variations. Perception of ORT function was, however, grossly unrealistic, with a third to four-fifth of mothers expecting ORT to stop diarrhoea. At least one quarter of mothers lacked adequate SSS preparation abilities and the materials and ingredients required for its preparation. Re-evaluation of the content and method of imparting health education messages in ORT promotion is recommended. Such messages should emphasise the function of ORT. It is also recommended that standardised cups for water, salt and sugar measurements be provided to households as a ready means of ensuring the correct preparation of SSS in the home-based management of diarrhoea.

A training workshop was organized for selected members of two village populations in north-eastern Nigeria, whereby they acquired knowledge and skills enabling them to spread the word and practice of oral rehydration therapy for children suffering from diarrhoea in their communities. The difficulties encountered and the gains achieved in this empowerment programme are described below.

Oral Rehydration Therapy (ORT) use in Nigeria is currently far short of the national Control of Diarrhoeal Diseases (CDD) programme goals. Towards designing health education strategies to improve this, maternal lay health concerns during diarrhoea in under-fives were examined among two large ethnic groups, the Kanuris and Buras, in northeastern Nigeria. Over half of the respondents judged the severity of diarrhoea by more than one sign and expected ORT to stop diarrhoea. Severity signs frequently described (averaging from a quarter to a half of respondents) included weakness and refusal of food; frequent stooling and fever were more frequently used by the Kanuris (p < 0.001) compared to Buras and weight loss and dehydration by the Buras (p < 0.01) compared to Kanuris. Generally, rural residents were less concerned with dehydration and weight loss (p < 0.0001 and 0.003 respectively, compared to urban residents) and more concerned with restlessness, including excessive crying (p < 0.07 to 0.0001). Stool characteristics and vomiting were rarely used as severity signs although the Kanuris in focus group discussions related severity to diarrhoea typology. Concerns with persistent diarrhoea, and diarrhoea associated with measles, were rarely expressed by participants, irrespective of ethnic group and domicile, suggesting that health education aimed at increasing awareness in relation to these two serious illnesses is urgently needed in Nigeria. Several of the lay health concerns expressed by participants in the study could form a useful basis for promoting ORT use in Nigeria and elsewhere.

This is a cross-section study based on questionnaire of the students in all the three clinical years of the medical school at the University of Maiduguri, Nigeria. The aim of the study was to explore the dynamics of career and medical specialisation decision and inclinations of the students with the view to seeing how they match the need of medical services in the country, and hence to discover those areas and methods which may be useful in this connection. The study shows that previous (including pre-medical school) exposures to the chosen specialties and ongoing medical school exposures and role models are the most important factors in specialty choices while job opportunities and local trends are important in the career decisions. It is therefore proposed that since medical exposures and role models can be influenced in the medical curriculum, it would be necessary to do this in the specialties of general medical practice (Family Medicine, Primary Medical Care) and the Community Medicine which are vital in the containment of the communicable and poverty/social inequality disease problems of this and other developing countries.

In a randomised household survey of 620 people in rural north eastern Nigeria there was a 26% six month prevalence of dyspepsia in adults and a 6% prevalence amongst teenagers. Dyspepsia was associated with the intake of alcohol (p less than 0.0054) and Cola nut (p less than 0.00013). The prevalence increased with age; the mean length of history was nearly four years and over half of the subjects with dyspepsia had sought medical advice, mainly from traditional healers. 12% of a similar group of hospital patients with dyspepsia were previously found to have peptic ulceration, suggesting that the community prevalence for peptic ulceration is 18/1000. This is lower than found in the 'West'.