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Background: Gender-related barriers significantly impede care-seeking for tuberculosis (TB), leading to poor treatment outcomes. This study aimed to assess changes in knowledge and beliefs following a training program on gender-transformative TB programming among stakeholders in Southern Nigeria., Methods: A cross-sectional pretest/posttest design was employed to evaluate the training's effectiveness among participants from September 2023 to March 2024. A 2-day training session was conducted using a standardized training manual. Participants included members of TB civil society organizations and other relevant stakeholders. A standardized questionnaire was administered before and after the training., Results: Of the 304 respondents, 160 (52.6%) were aged 40 years or younger, with a mean age of 39.6 (±10.5) years; 184 (60.5%) were female. The mean pretest knowledge score was 7.20 (±1.16), which increased to 8.44 (±1.12) posttraining (t = -15.20; P < 0.001). Similarly, the mean score for the gender responsiveness to the TB programming scale improved from 30.6 (±5.4) pretest to 32.8 (±4.9) posttest (P < 0.001)., Conclusion: The training significantly enhanced stakeholders' knowledge of TB and their understanding of gender responsiveness in TB programming. These findings underscore the necessity for ongoing sensitization of TB service providers and the promotion of TB education and stigma reduction efforts to ensure gender-responsive and inclusive TB service delivery. Continuous awareness initiatives are essential to challenge deep-rooted negative sociocultural beliefs and gender norms affecting TB programming., (Copyright © 2024 International Journal of Mycobacteriology.)

The objective of this study was to assess whether students' sense of belonging at school was associated with cannabis use among secondary school students in Barbados. This was a cross-sectional study involving a nationally representative weighted sample of 8,538 students drawn from 2 nd to 6 th forms across public and private secondary schools in Barbados in 2013. Descriptive and inferential statistics was performed using SPSS. Students who had a sense of belonging at school, were attending public schools and were in the 2nd form, had higher odds of reporting past-year and past-month cannabis use. We conclude that there was a significant positive association between students' sense of belonging at school and cannabis use.

There is a high and increasing proportion of single-parent families in Jamaica. This has raised concerns about the potential impact of single-parent families on the social, cognitive and behavioural development of children, including their sexual relationships. The aim of this study was to investigate the association between being raised in a single-parent family and age of sexual debut among young people in Jamaica. The study was cross-sectional in design, and based on a multi-stage sampling procedure. The study was conducted in July/September 2016. The study sample comprised 233 respondents (110 males and 123 females) aged from 18 to 35 years (mean 26.37 years; SD 5.46). Respondents completed a self-administered questionnaire with questions on socio-demographic characteristics, family structure, sexual debut and current sexual behaviour. Ninety-seven (41.7%) respondents grew up in single-parent families. A total of 201 (86.3%) had had sex (102 males and 99 females). Their mean age of sexual debut was 15.51 years (SD 3.41). Sixty-five (32.3%) had early sexual debut (&lt;16 years). Respondents from single-parent families were more likely to have had early sexual debut (56.9%; n=37) compared with those from two-parent families (43.1%, n=28; p=0.004). Only 44.6% (n=29) of those who experienced early sexual debut used a condom during their first sexual encounter compared with 73% (n=100) of those who had a later sexual debut (≥16 years; p=&lt;0.001). A single-father family structure was a significant predictor of early sexual debut (AOR 5.5; 95%CI: 1.1-25.8). The study found a significant association between single-parent family structure and age of sexual debut.

Background: Underage alcohol use is a pervasive problem with serious health, social and safety consequences. This study was undertaken to assess alcohol use by primary school children in Trinidad and Tobago, and to identify associated risk factors. Methods: We analysed data collected from 40 primary schools in Trinidad and Tobago by the National Alcohol and Drug Abuse Prevention Programme (NADAPP). The sample comprised of children aged 8 -15 years old, in standards 3, 4 and 5. Result: Out of the 2052 children, 648 (31.6%) have consumed alcohol in their lifetime, and same proportion reported ever being drunk (31.6%). Male gender was significantly associated with lifetime alcohol use (AOR =1.60, 95% CI= 1.25 - 2.05). Children not living with their father (AOR= 2.45, 95% CI=1.86- 3.24) and those whose fathers have either primary or secondary education (AOR = 1.88, 95%CI=1.07 - 3.31; AOR= 1.58, 95%CI=1.12 - 2.23 respectively) were at higher risk for lifetime alcohol consumption. However, age group 8 – 11 years was significantly inversely associated with lifetime alcohol consumption (AOR= 0.67, 95% CI=0.48 - 0.94). Conclusion: Being a male student, not living with father, and father attaining either primary or secondary education level were significantly associated with increased likelihood for lifetime alcohol use. However, children between 8 – 11 years were less likely to consume alcohol., (Creative Commons Attribution License)

Background: The prevalence of cigarette smoking is high among adolescents in the Caribbean, including Jamaica. Age of initiation of cigarette smoking varies among adolescents. A number of factors has been reported to influence early age of initiation of cigarette smoking. The aim of this study was to determine if parental smoking status was associated with early age of onset of cigarette smoking among Jamaican adolescents. Methods: Data from the Jamaican National School Survey (NSS) conducted in 2013 were analysed. The nationally representative sample comprised of 3,365 students enrolled in 8th grade to 12th grade in 38 public and private secondary schools. Descriptive and inferential statistics were computed using SPSS. Results: The mean age of initiation of cigarette smoking among the subjects was 12.4years [SD: 2.69]. There was no significant association between parental cigarette smoking status and the age of initiation of cigarette smoking among the adolescents (female X2 = 0.753, P = 0.861; male X2 = 6.953, P = 0.073). Logistic regression analysis showed that parental smoking status was not a predictor of early age of initiation of cigarette smoking among the adolescents (father/ guardian AOR= 0.81, 95% CI= 0.56- 1.11; mother/guardian AOR= 0.96, 95% CI= 0.44 – 2.10; both parent AOR= 0.49, 95%CI= 0.22- 1.07). However, having a parent with secondary education was a risk factor for early initiation of smoking (AOR= 1.71, 95%CI= 1.13-2.57), while being in 8th grade was a protective factor against early age of initiation of cigarette smoking (AOR= 0.43, 95% CI= 0.23 - 0.80). Conclusion: Parental smoking cigarette smoking status was not a predictor of early age of cigarette smoking initiation among Jamaican adolescents., (Creative Commons Attribution License)

Background: In Barbados and the wider Caribbean region, alcohol is widely consumed by adolescents and young people, including those in secondary schools. The high prevalence of alcohol use, and its potential adverse effects are a source of concern to policy makers and the general population, which calls for better understanding of the drivers of this problem. This study thus aimed at investigating whether parental alcohol drinking habit is a predictor of alcohol use among secondary school students in the country. Methods: The predictor variables and response variables in the study were categorical, and so descriptive, univariate analysis consisted of computation of frequencies and percentages. Bivariate analysis using Pearson’s Chi Square was done to test for significant differences in the response variables among groups. Logistic regression modeling was used in multivariate analysis to determine the predictor variables that were significantly associated with the response variables. Results: Significant associations were seen between students’ age, (P= 0.00), grade (P=0.00), fathers’ drinking habit (P=0.00), mothers’ drinking habit (P=0.00), and both past year and past month alcohol use, in bivariate analysis. Logit model shows that students whose fathers drink only on weekends, sometimes during the week, or every day, respectively, had significantly increased risk of alcohol use in the past month (AOR= 2.62, 95%CI= 1.81- 3.77; AOR= 1.85, 95%CI= 1.19- 2.85; AOR= 2.18, 95%CI= 1.49- 3.18). Students whose mothers drink only on special occasion had significantly higher risk of alcohol use in the past year and past month (AOR= 1.99, 95%CI= 1.06- 3.74; AOR= 2.30, 95%CI= 1.36- 3.89 respectively). Conclusion: Having fathers who drink only on weekend, sometimes during the week and every day were significantly positively associated with alcohol use in the past month. Having mothers who drink only on special occasion was a risk factor for past year and past month alcohol use. However, having mothers who drin, (Creative Commons Attribution License)

Alcohol consumption has significant health, social and economic implications. Alcohol is the most prevalent psychoactive substance used by Jamaican adolescents. The aim of this study was to determine whether alcohol is associated with sexual risk behaviour among Jamaican adolescents. Methods: The data from National Secondary School Survey (NSS) conducted in 2013 was analysed. Descriptive statistics consisting of frequencies, percentages and Pearson’s Chi square was done. Multivariate analysis was done using binary logistic regression. Result: The mean age of alcohol initiation among the participants was 12.3years [SD: 2.74]. There were significant associations between gender (X2= 14.56; p= 0.000), relationship with father/guardian (X2: 10.71; P= 0.03), relationship with mother (X2= 15.16; P= 0.004) and conversation with parents/ guardians about dangers of drug abuse (X2= 8.16; P=0.004). Adolescents who were males (AOR= 0.62, 95% CI= 0.43 - 0.88), in the 8th grade (AOR= 0.51, 95% CI= 0.26 - 0.98) or in the 10th grade (AOR: 0.52, 95% CI: 0.32 - 0.85) were less likely to engage in sexual risk behaviour. Lifetime alcohol consumption, past year alcohol consumption and past month alcohol consumption were not significantly associated with sexual risk behaviour (AOR= 0.35, 95% CI= 0.04 - 3.46; AOR= 1.75, 95% CI= 0.59 - 5.09, AOR= 0.78 95% CI= 0.56 - 1.11 respectively). Conclusion: Lifetime, past one year and past one month alcohol consumption among the students were not risk factors for sexual risk behavior (non-condom use) among Jamaican adolescents., (Creative Commons Attribution License)

The aim of this study was to examine the potential relationship between Jamaican secondary students’ alcohol drinking habits and their family structure. Methods: Data collected from a nationally representative survey of 3,365 students were analysed. Descriptive and inferential statistics were performed. Results: Out of the 3,365 students, 1,044 (31.0%) were from single-parent families. Single-parent families, married-parent families and common law-parent families were significantly associated with lifetime use of alcohol (AOR= 1.72, 95% CI= 1.06 - 2.79; AOR= 1.73, 95% CI= 1.07- 2.81, AOR= 1.94, 95%CI= 1.17- 3.21 respectively). However, family structure was not significantly associated with past year and past month alcohol use. Students whose parents “sometimes” knew their whereabouts were significantly less likely to use alcohol in their lifetime compared to students whose parents “Always” knew where the students were. Conclusion: Family structure is an independent predictor of alcohol use among high school students in Jamaica. Being from single-parent families, married-parent and common- law parent families were significantly associated with increased likelihood for lifetime alcohol use., (Creative Commons Attribution License)

Background: Cigarette is one of the most widely used addictive substances and a leading cause of death. Prevalence of cigarette smoking has been reported to be high in the Caribbean, including Jamaica. The aim of this study was to determine whether students’ relationship with teachers influences their cigarette smoking behaviour in Jamaica. Methods: This was a statistical analysis of data based on a nationally representative sample of 3,365 secondary school students drawn from 8th to 12th grade across 38 secondary schools in Jamaica in 2013. Descriptive and inferential statistics were performed using SPSS. Results: There were significant differences in the past year and past month cigarette smoking respectively among students who had very good, good, average, bad and very bad relationship with their teachers (X2 = 11.67, p = 0.02; X2 = 9.61, p = 0.04) respectively. Students with very good relationship with teachers, were significantly less likely to report smoking cigarette in the past month (AOR= 0.09, 95% CI= 0.01- 0.88). Students who were 2 - 10 years, had very good relationship with teacher and father, and whose parents knew friends very well, were 0.96, 0.69, 0.70 and 0.94 times as likely to report smoking cigarette in the past year. However, these associations were not significant after controlling for other factors. Conclusion: Students’ relationship with their teachers has a strong influence on cigarette smoking. Students with very good relationship with teachers were significantly less likely to report smoking cigarette in the past month., (Creative Commons Attribution License)

Background: Religion sometimes shapes behaviours and experiences of its members including alcohol consumption. The aim of this study was to examine the possible influence of religious affiliation on alcohol consumption in Jamaica since they are predominantly Christians. Methods: Using a cross-sectional study design, we analysed data from National Household Survey 2,016 of 4,623 participants. Descriptive and inferential statistics were performed using SPSS. Results: Out of the 4,623 participants, majority 3,244 (70.2%) were above the age of 26 years and of Christian religion 3,737 (80.8%). Christian religious affiliation was significantly associated with past year and past month use of alcohol (AOR= 1.44, 95% CI=1.14-1.82 and AOR =1.34, 95% CI=1.03- 1.74 respectively). Being a male (AOR= 2.95, 95% CI=2.51- 3.47), and employed (AOR= 2.11, 95% CI= 1.49- 2.98) were significant risk factors for lifetime alcohol consumption. Age 12 – 17 years (AOR= 0.30, 95% CI=0.21- 0.43) and attaining primary education level (AOR=0.60, 95% CI=0.45-0.80) were protective factors against lifetime alcohol consumption. Conclusion: Being of Christian religion was significantly, positively associated with past year and past month alcohol consumption. Male gender and being employed were also risk factors for lifetime alcohol consumption., (Creative Commons Attribution License)

Background: The prevalence of alcohol use is quite high in the Caribbean region, and specifically, in Barbados. Alcohol use has been documented to negatively affect the way students behave within and outside school. This study set out to examine the role alcohol plays in students’ behavioural problems at school. Methods: An analysis of crosssectional data collected during the National Secondary Schools Survey was done. Mean (and standard deviation), frequencies and percentages were computed, and differences in proportions among the groups were assessed using Pearson’s Chi Square. Multivariate analysis using binary logistic regression was done to determine the association between explanatory variables and outcome variables. Results: In bivariate analysis, behavioural problems at school were significantly associated with age (p= 0.001), grade (p= 0.000), sense of belonging at school (p= 0.000), relationship with teachers (p= 0.000), and past month alcohol use (p= 0.007). In multivariate analysis, students’ having frequent behavioural problems at school was significantly associated with neither past year nor past month alcohol use (AOR= 1.13, 95% CI= 0.91- 1.40, AOR= 1.02, 95% CI= 0.83- 1.24 respectively). Significant inverse associations were found between students’ behavioural problems and age (11- 14 years: AOR= 0.53, 95% CI= 0.33- 0.84; AOR= 0.51, 95% CI= 0.32- 0.82 for models 1 and 2 respectively), and relationship with teachers (very good: AOR= 0.10, 95% CI= 0.07- 0.16; AOR= 0.13, 95% CI= 0.09- 0.20 for models 1 and 2 respectively). Conclusion: Neither past year nor past month alcohol consumption by students was associated with frequent behavioural problems at school. Students who were younger than 17 years, and who had a relationship with their teachers that was not very bad were significantly less likely to engage in frequent behavioural problems., (Creative Commons Attribution License)

Background: Alcohol consumption among young people is a major public health problem world-wide and in Jamaica. A number of factors have been reported to affect alcohol use among high school students. The aim of this study was to investigate the influence of perception of the harmfulness of alcohol on alcohol use among secondary school students in Jamaica. Methods: Data collected from a nationally representative sample of 3,365 students were analyzed. Descriptive and inferential statistics were performed using SPSS. Results: Students’ perception of risk of drinking alcohol frequently and getting drunk respectively had positive and significant associations with past month alcohol use (AOR= 1.44, 95% CI= 1.09- 1.88 and AOR= 1.38, 95% CI= 1.02- 1.86, respectively) compared to students who felt that drinking alcohol frequently and getting drunk were very harmful. Males, 12 years or younger were significantly less likely to use alcohol in the past month (AOR= 0.77, 95% CI=0.60- 0.97; AOR= 0.68, 95% CI= 0.53-0.97 respectively). Students with good relationship with their mothers were less likely to use alcohol in the past year and past month (AOR= 0.55, 95% CI= 0.35-0.87; AOR= 0.50, 95% CI= 0.32- 0.78). Conclusion: Risk perception of the harmfulness of alcohol significantly affects alcohol use among secondary school students in Jamaica. Males, 12 years or younger, who had good relationship with mothers, were significantly less likely to use alcohol in past month, (Creative Commons Attribution License)

Objective: Alcohol is one of the most commonly consumed substances in Jamaica, despite the many health problems associated with excessive alcohol use. The aim of this study was to identify potential risk factors for alcohol binge drinking among Jamaicans, and determine if there were significant gender differences in the associations between identified risk factors and frequent binge drinking. Methods: Data collected from the 2016 National Household Survey Jamaica were analysed. Descriptive and inferential statistics were computed using SPSS. Binary logistic regression analysis was used to determine factors associated with frequent binge drinking. Results: The total number of respondents was 4623. Females were 2,535 (54.8%) compared to males 2088 (45.2%). In bivariate analysis, there was a significant association between age and frequent binge drinking among males (X2 = 11.11, p =0.004), but not among females (X2 = 2.03, p = 0.36). Similarly, there was a significant association between employment and frequent binge drinking for males but not for females (X2= 12.85, p= 0.002; X2= 2.49, p= 0.29 respectively). In multivariate analysis, age 12- 17 years was significantly, inversely associated with frequent binge drinking in the crude logit model but not in the adjusted logit model (crude odds ratio [COR] 0.21, 95%CI= 0.6- 0.66; adjusted odds ratio [AOR] = 0.51, 95%CI= 0.12- 2.13 respectively). Employment was significantly, positively associated with frequent binge drinking in the adjusted logit model (employed: AOR= 3.63, 95% CI= 1.05- 12.59) among males. Among females, age showed no significant association with frequent binge drinking. Only having primary/ lower education was significantly, positively associated with frequent binge drinking among females (AOR= 5.17, 95%CI= 1.36- 19.65). Conclusion: Risk factors for frequent binge drinking differed by gender; being employed was a risk factor for males while having primary (or lower) education was a risk factor for females., (Creative Commons Attribution License)

Background: National tuberculosis (TB) programmes globally rely heavily on passive case finding for detecting TB in the community as advocated by the World Health Organization (WHO). TB case detection is low in Nigeria despite improvement in TB services and coverage., Methods: A retrospective evaluation of an active case-finding intervention utilizing community-based approaches and targeted systematic TB screening in Ebonyi State, Nigeria was done. The analysis was performed using Epi Info., Results: Using community-based and health-facility-based systematic screening strategies, 218,751 persons were screened, with 19.7% of them being presumptive TB cases. Among these, 23,729 (55.1%) submitted sputum samples for microscopy, and 764 (3.2%) had smear-positive TB. In addition, 683 individuals were diagnosed with other forms of TB using X-ray and clinical evaluation giving a total of 1447 all forms of TB cases. The overall number needed to screen (NNS) to find one person with all forms of TB through the project was 151. The NNS was 53 for general outpatients, 88 through contact tracing, and 110 among HIV-infected persons., Conclusions: Active case-finding strategies achieved good yields though early loss to follow-up was high. Active case finding is recommended for integration into national TB control policy and practice.

Setting: A secondary care hospital in rural Nigeria., Objective: To investigate the feasibility of providing financial incentives to tuberculosis (TB) patients under routine conditions, and to determine their impact on TB treatment outcomes in a low-resource setting., Design: A prospective, non-randomised intervention study., Results: A total of 294 TB patients (respectively 173 and 121 in the control and intervention periods of 3 months' duration each) were registered in the study. The patients did not differ in terms of their demographic or clinical characteristics (P not significant). The treatment success rate was 104/121 (86.0%) during the intervention, and 123/173 (71.1%) during the control period (P = 0.003). The proportion of patients who were lost to follow-up significantly decreased during the intervention period (20.2% vs. 5.0%, P <0.001). There were no differences in deaths (P = 0.8) or treatment failure rates (P = 0.5) in the intervention and control periods. There was also no difference in the rate of sputum smear conversion after the intensive phase of treatment (88.1% vs. 91.5%, P = 0.5). Independent determinants of treatment success were female sex (adjusted odds ratio [aOR] 1.9), human immunodeficiency virus negativity (aOR 2.5) and receiving financial incentives (aOR 2.3)., Conclusions: Financial incentives proved to be effective in improving treatment success and reducing loss to follow-up among poor TB patients in Nigeria.

Implementation studies are recommended to assess the feasibility and effectiveness of programmes. In Nigeria, little is known about the burden of diabetes mellitus (DM) among tuberculosis (TB) patients. The objective of this study was to determine screening efficacy, prevalence of DM and determinants of DM among TB patients. We report on a multi-centre implementation study carried-out in 13 health facilities in six States of Southern Nigeria. All newly diagnosed TB patients registered from March to October 2015 were screened for DM using current World Health Organisation guidelines. Overall, 2094 TB patients were evaluated, 196 (9.4%) were found to have DM. The prevalence of newly diagnosed DM was 5.5% (115/2094). DM prevalence varied according to age group; occurring in 2.2% of patients aged ≤ 25 years and 16.9% in patients aged (56-65) years. The additional yield of DM was 59% while the number needed to screen to detect a new case of DM was 18. Factors associated with DM were; age >40 years (aOR2.8, CI 2.1-3.9), rural residence (aOR2.3, 1.6-3.2), private health facility care (aOR2.0, 1.4-2.7), and having an occupation that engages in vigorous activity (aOR0.6, 0.4-0.9). The burden of DM among TB patients is high. Prioritization of DM screening for TB patients is indicated.

Background: Social protection for TB patients can lower patient costs and improve adherence. The aim of this study was to explore patients' and health workers' experiences of a social protection intervention for TB in order to inform a more patient-centred approach for the Nigeria National TB Programme strategy., Methods: This was a qualitative study consisting of 103 in-depth interviews and two focus group discussions with patients who received the intervention, and 10 key informant interviews with health workers. A thematic content analysis of the interviews was performed., Results: Of those who completed the interviews, 53 (51.5%) were male, and 69 (67.0%) were below 40 years. Most of the participants received care and support from their families but delayed access to TB services due to lack of funds for transportation, nutritional supplementation and non-TB drugs. The intervention had a high level of acceptability and uptake; particularly clear benefits emerged for most patients who used the social protection funds to purchase food and supplements, other drugs, transportation and additional personal necessities. Some patients assert that the financial incentive package increased their awareness of timing of their follow-up visits. In addition, health workers observed increased enthusiasm to treatment and improvement in adherence among participants., Conclusions: Patients and health workers reported positive experiences with the financial incentives provided for TB treatment., (© The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The economic burden of Buruli ulcer for patients has not been well-documented. This study assessed the costs of Buruli ulcer care to patients from the onset of illness to diagnosis and to the end of treatment., Methods: This was a cross-sectional cost of illness study conducted among patients with Buruli ulcer in four States in Nigeria between July and September 2015. A structured questionnaire was used to collect data on the patients' characteristics, household income and out-of-pocket costs of care., Results: Of 92 patients surveyed, 54 (59%) were older than 15years, 49 (53%) were males, and 86 (93%) resided in a rural area. The median (IQR) direct medical and non-medical cost per patient was US$124 (50-282) and US$3 (3-6); corresponding to 149% and 4% of the patients' median monthly household income, respectively. The overall direct costs per patient was US$135 (58-327), which corresponded to 162% of median monthly household income, with pre-diagnosis costs accounting for 94.8% of the total costs. The direct costs of Buruli ulcer care were catastrophic for 50% of all patients/households - the rates of catastrophic costs for Buruli ulcer care was 66% and 19% for patients belonging to the lowest and highest income quartiles, respectively., Conclusions: Direct costs of Buruli ulcer diagnosis and treatment are catastrophic to a substantial proportion of patients and their families., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Introduction:: Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria., Methods: A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed., Results: Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus., Conclusions: Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country.

Background: Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria., Methods: This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients' clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected., Results: Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003)., Conclusions: Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Poor competence of clinicians may be a critical factor responsible for the under-diagnosis of childhood TB in high-burden settings. Our objective was to assess the current practices of management of childhood TB among clinicians in Nigeria., Methods: A cross-sectional survey was conducted among clinicians recruited through a three-stage sampling technique from 76 health facilities in Southern Nigeria. A semi-structured questionnaire was administered to all participants., Results: Of 106 clinicians who completed the survey, 73 (68.9%) were <40 years and 67 (63.2%) were males. Also, 14 (13.2%) were paediatricians, 22 (20.8%) were paediatric specialist trainees and 70 (66%) were medical officers in primary and secondary care health facilities. About 94% of the respondents perceived diagnosis of childhood TB a challenge in Nigeria. The overall mean (SD) knowledge score was 3.8±0.9 (maximum 5), and 68 (64.2%) had good knowledge of childhood TB. The mean (SD) appropriate practice score was 4.0±1.7 (maximum 10) and, only 8 (7.5%) of them were considered to have adopted appropriate practices regarding childhood TB care., Conclusions: There are gaps in practices adopted by frontline clinicians in the management of childhood TB in Nigeria. Focused training of health workers on childhood TB care is urgently recommended., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Buruli ulcer (BU), also known as Mycobacterium ulcerans disease, is the third most common mycobacterial disease worldwide. Although BU disease has been diagnosed among Nigerians in neighbouring West African countries, data on the burden of the disease in Nigeria itself are scanty. This study aimed to assess the magnitude and epidemiology of BU in the South South region of Nigeria., Methods: We conducted a cross-sectional survey in the Ogoja territory (comprising 31 communities). We undertook sensitisation programmes centred on BU in 10 of the communities. Participants were asked to identify community members with long-standing ulcers, who were then invited for evaluation. We also contacted traditional healers to refer their clients who had non-healing ulcers. All suspected cases had a full clinical evaluation and laboratory testing. Confirmed cases were given treatment in a referral hospital in the territory., Results: We diagnosed 41 clinical BU cases; 36 (87.8 %) of which were confirmed by quantitative polymerase chain reaction (qPCR). These 36 PCR-confirmed cases were diagnosed in a total population of 192,169 inhabitants. Therefore, the estimated crude prevalence of BU was 18.7 per 100,000 population, varying from 6.0 to 41.4 per 100,000 in the districts surveyed. The majority (66.7 %) of the cases were females. About 92 % of the BU lesions were located on the patients' extremities. No differences were observed between the sexes in terms of the location of the lesions. The age of the patients ranged from four to 60 years, with a median age of 17 years. All 35 (100 %) patients who consented to treatment completed chemotherapy as prescribed. Of the treated cases, 29 (82.9 %) needed and received surgery. All cases healed, but 29 (82.9 %) had some limitations in movement. Healing with limitations in movement occurred in 18/19 (94.7 %) and 8/10 (80.0 %) of patients with lesions >15 cm (Category III) and 6-15 cm in diameter (Category II), respectively. The median duration of treatment was 130 (87-164) days for children and 98 (56-134) days for adults (p = 0.15)., Conclusions: In Nigeria, BU is endemic but its severity is underestimated-at least in the study setting. There is a need to identify and map BU endemic regions in Nigeria. A comprehensive BU control programme is also urgently needed.

Aim: To determine the treatment outcomes and predictors for unsuccessful tuberculosis (TB) outcomes in rural Nigeria., Methods: Adult rural TB patients treated during 2011 and 2012 in two healthcare facilities (one urban public and one rural private) were identified from the TB treatment registers and retrospectively reviewed. Tuberculosis treatment outcomes were assessed according to World Health Organisation guidelines. Determinants of unsuccessful treatment outcomes were identified using a multivariable logistic regression analysis., Results: Between January 2011 to December 2012, 1180 rural TB patients started treatment, of whom 494 (41.9%) were female. The treatment success rate was 893 (75.7%), while the rates of death, loss-to-follow-up, and treatment failure were 129 (10.9%), 100 (8.5%), and 18 (1.5%) respectively. In the final multivariable logistic regression model, the odds of unsuccessful treatment outcome were higher among patients who received care at the urban public facility (aOR = 2.9, 95%CI: 1.9-4.4), smear-negative (1.3, 1.0-1.8) and extrapulmonary (2.7, 1.3-5.6) TB patients, human immunodeficiency virus (HIV) co-infected (2.1, 1.5-3.0), and patient who received the longer (8-mo) anti-TB regimen (1.3, 1.1-1.8)., Conclusion: Treatment success among rural TB patient in Nigeria is low. High risk groups should be targeted for closer monitoring, socio-economic support, and expansion of TB/HIV activities.

Objective/background: Tuberculosis (TB) is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies., Methods: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations., Results: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive (NSP), although the increasing trend was not statistically significant (χ(2)=1.8; p<.179)]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant (χ(2)=1.48; p<.224). Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% (all forms). Compared to the baseline, there was an increase of 31% (all forms) and 22% (NSP) in the evaluation population., Conclusion: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification., (Copyright © 2015 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

This is a qualitative, descriptive study to explore gender-related factors that influence health seeking for tuberculosis (TB) care by women in Ebonyi State, Nigeria. In-depth interviews based on interview guides were conducted with participants selected through purposive sampling in communities in the state. The results show that gender relations prohibit women from seeking care for symptoms of TB and other diseases outside their community without their husbands' approval. Gender norms on intra-household resource ownership and control divest women of the power to allocate money for health care seeking. Yet, the same norms place the burden of spending on health care for minor illnesses on women, and such repeated, out-of-pocket expenditures on health care at the village level make it difficult for women to save money for use for health care seeking for major illnesses such as TB, which, even if subsidized, still involves hidden costs such as transport fare. The opening hours of TB clinics do not favour their use by most women as they are open when women are usually engaged in income-generating activities. Attending the clinics may therefore entail opportunity costs for many women. People with chronic, infectious diseases such as TB and HIV are generally stigmatized and avoided. Women suffer more stigma and discrimination than men. Stigma and discrimination make women reluctant to seek care for TB until the disease is advanced. Policies and programmes aimed at increasing women's access to TB services should not only take these gender norms that disempower women into explicit consideration but also include interventions to address them. The programmes should integrate flexible opening hours for TB treatment units, including introduction of evening consultation for women. Interventions should also integrate anti-stigma strategies led by the community members themselves.

Objective: Knowing tuberculosis (TB) patients' satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients' satisfaction with TB services in southern Nigeria., Materials and Methods: A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction., Results: Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility., Conclusion: Patient- and health system-related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing.

SUMMARY Globally, twice as many men as women are being diagnosed with tuberculosis (TB) annually. Little is known about gender differentials in TB in Africa. A retrospective cohort analysis of routine data was conducted on adult TB patients treated between 2011 and 2012 in two large healthcare facilities in Nigeria. Gender differences in their demographic characteristics and treatment outcomes were analysed accordingly. Of 1668 TB patients enrolled, the male:female ratio was 1.4:1. The mean ages of males and females were 40.2 ± 14.7 and 36.1 ± 14.6 years, respectively (t test 6.62, P < 0.001). Male gender was associated with a higher failure to smear convert after 2 months (21.8% vs. 17.5%, P = 0.06) and 5 months (4.3% vs. 1.5%, P = 0.02) of treatment for smear-positive TB patients. Moreover, men were more likely than women to fail treatment (2.2% vs. 0.7%, P = 0.01). No significant differences exist in the treatment success rates between women and men (78.2% vs. 74.5%, P = 0.08). Adjusted analyses showed significant association between being an urban male and a HIV-infected female with unsuccessful outcome adjusted by socio-demographic and clinical factors. We found that gender disparities exist in TB profile and treatment outcomes in Nigeria and gender-specific strategies are needed to optimize TB management.

Background: Nigeria ranks 10th among 22 high TB burden countries with low TB case detection that relies on passive case finding. Although there is increasing body of evidence that active case finding (ACF) has improved TB case finding in urban slums in some parts of the world, this strategy had not been implemented in Nigeria despite the pervasiveness of urban slums in the country., Objective: To assess the yield and profile of TB in urban slums in Nigeria through ACF., Methods: A prospective, implementation study was conducted in three urban slums of southeastern Nigeria. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive and bivariate analyses were performed using SPSS., Results: Among 16,743 individuals screened for TB, 6361 (38.0%) were identified as TB suspects; 5894 suspects were evaluated for TB. TB was diagnosed in 1079 individuals, representing 6.4% of the screened population and 18.3% of those evaluated for TB. Of the 1079 cases found, 97.1% (n=1084) had pulmonary TB (PTB), and majority (65%) had new smear-positive TB. Children (<15years) accounted for 6.7% of the cases. Also, 22.6% (216) of the cases were HIV co-infected, among whom 55.1% (n=119) were females. The average number of individuals needed to screen to find a case of TB was 16., Conclusions: There is high prevalence of TB in Nigeria slum population. Targeted screening of out-patients, TB contacts, and HIV-infected patients should be optimized for active TB case finding in Nigeria., (Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

Setting: One urban tertiary care and one rural secondary care hospital in Nigeria., Objective: To compare the epidemiological characteristics and treatment outcomes of tuberculosis (TB) patients treated with an 8-month or 6-month anti-tuberculosis regimen in a low-resource setting., Design: Retrospective cohort study., Results: A total of 928 newly diagnosed smear-positive TB patients were treated with either daily ethambutol (EMB), isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) for 2 months followed by EMB and INH for 6 months (2RHZE/6EH), or the same intensive phase as the first regimen followed by 4 months of daily RMP and INH (2RHZE/4RH). The proportion of successful outcomes was 381/490 (77.8%) with 2RHZE/6EH and 373/438 (85.2%) with 2RHZE/4RH (P = 0.004). Defaulting was significantly more frequent in patients who received 2RHZE/6EH (14.3% vs. 5.5%; P < 0.001). Treatment failure was not significantly higher in patients who received 2RHZE/6EH (2.9% vs. 1.6%; P = 0.15). After adjusting for confounders, older age (adjusted odds ratio [aOR] 1.7), 2RHZE/6EH treatment (aOR 1.6) and male sex (aOR 1.5) independently predicted unsuccessful outcomes in human immunodeficiency virus negative TB patients., Conclusions: Newly diagnosed TB patients on 2RHZE/4RH have a higher treatment success rate than those treated with 2RHZE/6EH under programme conditions in a low-resource, high-burden setting. Current World Health Organization recommendations should be maintained.

Objective: To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria., Methods: Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death., Results: Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6)., Conclusions: Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme., (Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Background: The demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly., Methods: Retrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years., Results: Elderly (≥ 60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1-108), and HIV co-infection (aOR 3.6; CI 1.1-11.7)., Conclusions: Treatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.

Objective: The study sought to assess the extent to which healthcare workers (HCWs) adhere to the National Tuberculosis Program (NTP) guidelines for the diagnosis of smear negative tuberculosis in Nigeria., Method: This was a cross-sectional retrospective desk analysis of case files of 280 smear negative pulmonary TB in six States in southern Nigeria., Results: About 93% of the 280 patients had their first set of sputum smear microscopy tests done, but only 3.6% had the second set of diagnostic tests as prescribed by the NTP guidelines. Only 45.7% (128/280) received broad spectrum antibiotics after their first smear microscopy. 98% had a chest X-ray done, while 93.6% (262/280) had HIV counseling and testing (HCT), out of which 45.0% were HIV positive. Overall, only 2 patients (0.7%) were diagnosed in strict compliance with the NTP guidelines. There was no significant difference in the pattern of diagnosis of smear negative TB cases and smear positive TB cases., Conclusion: The adherence of HCWs to the NTP guidelines for diagnosis of smear negative TB is apparently sub-optimal and needs improvement., (Copyright © 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess the quality of week 8 sputum smear AFB microscopy performed by peripheral TB laboratories in Nigeria., Method: A cross-sectional review was performed of all week 8 tuberculosis sputum smear slides reported for the first quarter of 2009 by peripheral laboratories in five States of Nigeria. Each slide was reviewed by two independent external slide readers as external quality check and also crosschecked with fluorescent microscopy., Results: In Akwa Ibom, Anambra, Enugu, Kogi and Ogun States, a total of 415, 315, 231, 206 and 428week 8 slides respectively were studied (a grand total of 1595 slides studied). The wide range of conversion rates between the different States as reported by peripheral labs (83.8% in Anambra State to 98.1% in Kogi State) was also observed by the external quality check (68.4% in Kogi State to 88.0% in Akwa Ibom State). In all the States, the studied sputum conversion rates reported by the peripheral labs were significantly higher than values obtained from external quality check and fluorescent microscopy (P=0.000)., Conclusion/recommendation: There is a wide range of sputum conversion rates between States, but the conversion rate in each State is significantly higher than those of external quality check possibly indicating many false negative reports by peripheral labs. It is recommended that training and re-training of laboratory persons be continued. Internal and external quality checks should also continue to be practiced in the national TB program., (Copyright © 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

Background: In Nigeria, little is known about the profile and treatment outcomes of smear-positive pulmonary TB (SPPTB) patients with persistent smear positivity after 2 months of treatment., Methods: A retrospective cohort study was carried out to determine the characteristics and treatment outcomes of patients with persistent smear positivity after 2 months of treatment among adults with SPPTB between 2011 and 2012 in two large health facilities in Nigeria. Findings were compared with SPPTB patients who had a negative smear conversion in the same period., Results: Of 929 eligible patients, 187 (20.1%) had persistent smear positivity after 2 months of treatment. Independent predictors for persistent smear positivity were older age (p<0.001) and care at a public facility (p<0.001). Patients with persistent smear positivity had a higher proportion of unsuccessful treatment outcomes compared with those with a negative smear conversion (21.9% vs 12.4%; p<0.001), mainly due to treatment failure (p<0.001). Across treatment category (new versus previously treated cases), age group and residence category (urban versus rural), rates of unsuccessful outcomes were significantly higher among patients with persistent smear positivity., Conclusion: Treatment outcomes of SPPTB patients with persistent smear positivity were inferior to those who smear converted, with treatment failure being a major problem. This needs to be urgently addressed by the National Tuberculosis Control Programme., (© The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Early identification of determinants of tuberculosis (TB) treatment failure is urgently needed in resource-limited settings. This study describes the profile and determinants of TB treatment failure in a high-incidence setting where patients were managed at a TB control program with significant resource limitations., Methods: This was a retrospective case-control study carried out in one tertiary and one secondary hospital in Southeastern Nigeria. Cases were adult (⩾15years) TB patients with a positive sputum smear after 5months of treatment (treatment failure). Controls were adult TB patients whose sputum smear was positive at the beginning of the treatment but who were smear-negative in the last month of treatment and on at least one previous occasion (cured). Cases were compared with controls to assess determinants of treatment failure., Results: Of the 1668 TB patients registered during the study period, 985 (59%) had smear-positive pulmonary TB. Of these, 694 (70.5%) were aged ⩽40years, 602 (61.1%) were males, 707 (71.8%) were rural residents, and 898 (91.2%) received care at the private facility. The prevalence of treatment failure was 2.5%. Significant determinants of treatment failure were: older age (>40years) (P<0.001), male gender (P=0.04), previous treatment for TB (P=0.045), and positive sputum smears after two month of anti-tuberculosis treatment (0.001)., Conclusion: This study showed that the treatment failure rate among smear-positive TB patients is low in Nigeria. Education and improved clinical and laboratory interventions for the identified at-risk groups may reduce TB treatment failure in resource-limited settings., (Copyright © 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

Background. Few studies have evaluated the rate of tuberculosis (TB)/human immunodeficiency virus (HIV) coinfection and the determinants of its treatment outcomes in Africa. We aimed to determine the predictors of unsuccessful treatment outcomes in HIV-infected tuberculosis patients in Nigeria. Methods. A retrospective cohort study design was used to assess adult TB/HIV patients who registered for TB treatment in two health facilities in Ebonyi State, Southeast Nigeria, between January 2011 and December 2012. Predictors of unsuccessful treatment outcomes were determined using multivariable logistic regression analysis. Results. Of 1668 TB patients, 342 (20.5%) were HIV coinfected. Of these, 195 (57%) had smear-negative pulmonary TB and 11 (3.2%) had extrapulmonary TB. Overall, 225 (65.8%) patients achieved successful outcomes, while 117 (34.2%) had unsuccessful outcomes. The unsuccessful treatment outcomes were due to "default" (9.9%), "death" (19%), "treatment failure" (1.5%), and "transferring out" (3.8%). Independent determinants for unsuccessful outcomes were receiving care at a public facility and noninitiation of antiretroviral therapy. Conclusion. There is need for the reevaluation of the quality of public sector treatment services provided for TB/HIV patients as well as further expansion of TB/HIV collaborative activities in rural areas, and interventions to reduce mortality and default rates among TB/HIV patients are urgently needed in Nigeria.

Introduction: Prevalence of adolescent sexual activity is on the increase globally, resulting in increased risk of adverse reproductive health outcomes among them. Sources of sex information are key factors that influence female adolescents' sexual decision-making. Consequently, this study is aimed at identifying adolescents' sources of sexuality information, and its likely effect on their sexual practices among in-school female adolescents in Osisioma LGA, in southeastern Nigeria., Methodology: A total of 304 girls selected by multi-stage sampling technique were studied. Responses were elicited from them using pretested, semi-structured, self administered questionnaire. Data were analyzed using MS Excel and Epi-6., Findings: Primary and subsequent sources of sexuality information were mainly the media and peers. Families and schools mostly were not involved in provision of early sex education. Media and peer influence were predominantly negative. Female adolescents' knowledge of issues of sex was low. Premarital sex, early sexual initiation, and unprotected sex was common among them. Consequently, adverse implication of negative sexual behavior, such as unplanned pregnancies and induced abortion, was prevalent., Conclusion: The study highlights the need for increased roles of parents and teachers in early sexuality education of adolescent girls. This can be done by increasing capacity of parents to discuss sexuality issues with their children., (Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

This study is based on a population-based, descriptive questionnaire survey, the objective of which was to elicit the perceptions of women in south-eastern Nigeria on whether possession of economic/household assets by women enhanced their capacity to negotiate reproductive issues with their husbands. The findings show that the respondents believed that possession of economic/household assets by women in their communities might not necessarily increase their negotiation power in their reproductive decision-making. Other factors tend to attenuate the effects of women's possession of economic/household assets on their reproductive bargaining power. Notable among these may be social norms that implicitly arrogate control of the assets owned by the conjugal couple to the man, even when they are bought by the women. Planners of reproductive health intervention projects, policy-makers and researchers need to be aware of such sociocultural specific phenomena, which do not fit with widely held international beliefs.

Background: The objectives of this paper was to determine what female health professionals knew and felt about cervical cancer and Pap smear and their uptake of Pap smear., Methods: A questionnaire survey of 144 female health professionals at two referral hospitals with facilities for Pap smear., Results: Nurses constituted 52.8% of respondents followed by laboratory scientists (18.8%), doctors (14.6%) and pharmacists (13.9%). One hundred and thirty two (91.7%) respondents had heard of cervical cancer and 80.6% knew it was associated with vaginal bleeding. Twenty two percent could not list any risk factor A significantly greater proportion of doctors (100%) knew the purpose of a Pap smear compared to 59.2% of nurses, 50% of pharmacisits and 48.1% of laboratory scientists (p = 0.003). Only 13 respondents (9%) had everhad a Pap smear with doctors (p = 0.003) and divorced/separated women (p = 0.005) significantly more likely to have done so. Perceived non-availability of Pap smearservice was the main reason (51.3%) for not having had a Pap smear. However, 30.3% had not thought of it or did not consider themselves at risk of cervical cancer., Conclusion: Health professionals themselves need to be properly informed about cervical cancer and Pap smears because of their own needs as women and also to improve their effectiveness in educating and encouraging other women to have Pap smears. Available Pap smear services should be publicized and made more affordable.

This is an exploratory study to examine the social and cultural determinants of the teaching of HIV/AIDS sex education among secondary school teachers in Eastern Nigeria. The research analyses how teachers perceive passing their knowledge of HIV/AIDS prevention measures to their students in the context of their cultural and social norms, which restrict open discussion of sex. This is a qualitative study based on in-depth interviews with 60 teachers drawn from secondary school teachers in Eastern Nigeria, supplemented with five focus group discussions, and content analysis of teachers' lesson preparatory notes. The findings show a high level knowledge of HIV/AIDS preventive measures among teachers. However, teachers are not passing on this knowledge because of cultural and social inhibitions. In addition, teachers have not been receiving adequate training and motivation on information, education and communication for HIV/AIDS sex education. The situation calls for serious policy intervention.