Evaluation of Primary Health care delivery services in selected Local Government Areas of Bayelsa State

¹Akpe, A. & ^2*Ephraim-Emmnauel, B.C.

¹Department of Community Health Sciences, Bayelsa State College of Health Technology.

²Department of Dental Health Sciences, Bayelsa State College of Health Technology.

^*Corresponding Author details: E-mail: benchike2002@yahoo.com, Tel: +234-806-003-8135

Abstract

Background and Aim: Nigeria through the National Primary Health Care Development Agency has adopted a minimum standard which is expected to be used in the primary health care sector. This study thus aimed to evaluate the primary health care delivery services provided in primary health care facilities in selected Local Government Areas in Bayelsa state.

Materials and methods: A descriptive study design was utilized in this study. A multi-stage sampling technique was employed to select the facilities used in the study. The data collected was analyzed using the SPSS statistical software version 21.0. Percentage differences and analysis of variance (ANOVA) were also performed to determine the difference between the required quantities (standard) with the available quantities in selected facilities in the LGAs and significance level was set at p < 0.05.

Results: Compared to the required standard, Sagbama had 0.67 (65%) of medical officers while Kolokuma/Opokuma had 0.50 (50%). Brass and Ogbia had none. Also, with respect to the female ward, the mean required quantity is 1.97. Sagbama and Ogbia got 1.49 (75%) of the standard, Brass local government got 1.80 (91.4%) of the standard required quantity while Kolokuma/Opokuma had 1.67 (84.7%).

Conclusion: The delivery of primary health care in Bayelsa State in terms of facilities, equipments and personnel is not up to standard using the WMHCP and the minimum standard of primary health care in Nigeria as measuring standards. The provision of the lacking primary health care facilities etc.; was recommended.

Keywords: Evaluation, Primary Health Care, Services, Bayelsa, Nigeria.

Introduction

Primary Health care (PHC) plays a fundamental and central role in the health care delivery system worldwide as it offers families cost effective services that are within their reach (Adeyemo, 2005) Nigeria through the National Primary Health Care Development Agency (NPHCDA)(2007-2012) has adopted a minimum standard which is expected to be used in the primary health care sector. It entails the health posts, health centres and the comprehensive health centres. The standard document contains the requirements needed in each facility by type such as personnel, equipment, services that should be rendered in a category of facility (NPHCDA, 2007-2012). The essence of primary health care is for individuals and families to utilize the services as their first port of call when faced with health issues. These should also be gotten at a cost that is affordable by all categories of people. (Thomas, Wakerman & Humphreys, 2015).

Health care delivery in Nigeria has been rated low, in 2000, the WHO (2013) placed Nigeria 187^th position among the 191 member countries for service performance, since then not much difference has been made despite tremendous efforts in the provision of health care since independence (Country studies , 2014). One of such efforts is the adoption of the WMHCP in 2007. (NPHCDA, 2007). Most nations have their standards in health care provision for their population in terms of personnel, equipment, services rendered in the facilities, drugs required and the facility by type needed in a given population size. Adeyemo (2005) asserted that most facilities are dilapidated with equipment and infrastructures being absent or out of use. Omoleke (2005) carried out a study to examine the management of primary health care services in Nigeria and found that performance was poor at the grass root. Another study was also carried out in four states (Kaduna, Lagos, Cross Rivers and Yobe) and it was discovered that there was low performance in terms of the services provided. Though primary health care centres were established based on the principles of equity and accessibility, the urban centres in Nigeria were reported to benefit more when compared with their rural counterparts (Abdulraheem, Olapipo & Amodu, 2012).

According to Olakunde (2012) achieving successful health care financing system continues to be a challenge in Nigeria, but there is the need to investigate the standard of delivery of Primary Health care using a standard known as the Ward Minimum Health Care Package (WMHCP) provided by the World Health Organization which was adopted by the National Primary Health Care Development Agency (NPHCDA, 2007-2012). This study thus set out to evaluate the Primary Health Care delivery services provided in primary health care facilities in the selected Local Government Areas in Bayelsa state. This study brought to light the need to ensure that standards were met for better service delivery and in turn increased patronage. This study also served as a means of information to government of the levels at which the primary health care system operates in order to cause policy makers to improve on budgetary allocation and supervision of primary health care services and make provision for communities lacking primary health care facilities.

Materials and Methods

The research design was a descriptive study design within which a comparative study was carried out using the ward minimum health care package (WHO standard document) to compare the available items in the facilities. The population of the study consisted of all government owned primary health care facilities in 4 selected Local Government Areas (LGAs) in Bayelsa state. A multi-stage sampling technique was employed to select the facilities used in the study. First a purposive technique was adopted to select four Local Government Areas (LGAs) to be part of the study and 20% of the wards in the selected LGAs was selected randomly and one facility was also randomly selected to be included the study.

Sagbama LGA has 14 wards, the ballot method was used in selecting the wards and health facilities that were included in the study. In wards with just one facility, the available facility was automatically selected to be part of the study. This procedure was done in the other selected LGAs. Ogbia LGA has 13 wards, 20% is 2.6 approximately 3 wards. Kolokuma/Opokuma (KOLGA) has 11 wards, 20% is 2.2 approximately 2 wards, while Brass LGA has 10 wards, 20% is 2 wards and one facility each was selected randomly from the selected wards in the selected LGAs. The sample size was one health facility of 20% in each of the selected wards in each of the selected LGAs of Bayelsa state. Data was collected from the primary health care facilities and the staff from the health facility helped to provide the available items requested on the check-list. The instrument for data collection was a check-list derived from the Ward Minimum Health Care Package (NPHCDA standard document). The Ward Minimum Health Care Package is a standard document of the World Health Organization, adopted by the National Primary Health Care Development Agency (PHCDA) in Nigeria. Hence the reliability of the instrument is ascertained. The data collected was statistically analyzed using the SPSS statistical software version 21.0. Percentage differences and analysis of variance (ANOVA) were also performed to determine the difference between the required quantities (standard) with the available quantities in selected facilities in the LGAs. Significance was set at p < 0.05. In order to conduct this study under required ethical standards for biomedical research, ethics clearance to conduct this research was sought and gotten from the research ethics committee of the University of Port-Harcourt. Permission to conduct this study was gotten from required Primary Health Care authorities in Bayelsa State.

Results

Table 1: Mean required quantity and available quantities of equipment at selected primary health care Centres.

Table 1 shows that with respect to the female ward, the mean required quantity is 1.97. Sagbama and Ogbia got 1.49 (75%) of the standard, Brass local government got 1.80 (91.4%) of the standard required quantity while Kolokuma/Opokuma had 1.67 (84.7%) of the required standard equipments in the female ward. Considering labour ward, the minimum required mean is 1.57. However, Sagbama had 1.47 (93.6%), Brass got 1.54 (98.1%), Ogbia had 1.51 (96.2%) and Kolokuma/Opokuma had 1.52 (96.8%). This result revealed that the sampled primary health centres were within tolerable limits. The table also shows the distribution of available equipments for laboratory among various selected primary health centres. From the result, Kolokuma/Opokuma has equipments closer to the standard 3.57 (72.4%), followed by Sagbama 3.48 (70.6%) and Ogbia 3.48 (70.6%) each; while Brass had 3.36 (68.2%). For dressing and injection room, Sagbama centre had 1.26 (63%) when compared with the required quantity, Brass centre had 1.39 (69.5%), Ogbia had 1.27 (63.5%) while Kolokuma/Opokuma had 1.21 (60.5%) only. Under family planning unit with mean required quantity of 4.44, Sagbama had 3.30 (74.3%), Brass centre had 2.67 (60.1%), Ogbia had 2.44 (54.9%) and Kolokuma/Opokuma had 3.12 (70.3%). The child and infant welfare unit was also considered and the table showed that Sagbama had 1.67 (87.4%), Brass 1.28 (67%), Ogbia had 1.48 (77.5%) while for Kolokuma/Opokuma, there was no available record. For first stage room unit, Sagbama centre had 1.45 (83.3%), this was followed by Ogbia centre which had 1.43 (82.1%), then Kolokuma/Opokuma having 1.30 (74.7%) of the required equipments and finally Brass had 1.29 (74.1%). Regarding the nutrition unit, the available equipments compared with the required standard was 2.21 (57%) from Sagbama and 2.0 (51.5%) from Ogbia. There were no available records from Brass and Kolokuma/Opokuma. From Sterilization Unit, Sagbama had 1.37 (85.6%), Brass had 1.45 (90.6%) while Ogbia and Kolokuma/Opokuma had 1.40 (87.5%) and 1 (62.5%) respectively. The minimum standard in terms of equipments for Cleaning & Utilization unit also showed that Sagbama had 1.96 (28.8%), Brass had 3.50 (51.5%), for Ogbia it was 2.09 (30.7%) and Kolokuma/Opokuma had 2.17 (31.9%). This is an indication that Cleaning & Utilization unit had been far below the minimum standard of primary care services. The result from Linen store unit showed that Sagbama had 3.36 (29.9%), Brass had 3.71 (33.1%), Ogbia had 3.83 (34.2%) and Kolokuma/Opokuma showed 4.21 (37.6%). This result showed that Linen store unit is below the minimum standard in terms of equipments. The consulting cubicle unit was also considered and the result showed that Sagbama had 1.19 (68.4%), Brass had 1.34 (77%) while Ogbia had 1.33 (76.4%) and Kolokuma/Opokuma got 1.24 (71.3%). The result from staff room revealed that Sagbama had 1.29 (57.3%), Brass had 1.0 (44.4%), Ogbia also had 1.25 (55.6%) while Kolokuma/Opokuma had 1.31 (58.2%). For records unit and male ward when compared with the required standard, Sagbama got 1.14 (72.6%) and 1.38 (59.2%), Brass got 1.36 (86.6%) and 1.72 (73.8%), Ogbia had 0.95 (60.5%) and 1.44 (61.8%) while Kolokuma/Opokuma had 1.21 (77.1%) and 1.33 (57.1%) respectively. Statistically significant difference of the available services from the required standard for the primary health care facilities in Bayelsa State was also found. (p < 0.05).

Table 2: Mean required personnel and available number of personnel at selected primary health care centres.

Table 2 shows the mean required personnel and available number of personnel at selected Primary Health Care Centres. Compared to the required standard, Sagbama had 0.67 (65%) of medical officers while Kolokuma/Opokuma had 0.50 (50%). Brass and Ogbia had none. For Community Health Officers (CHO), all the selected centres had the minimum required number of CHO’s. An average of 4 nurses/midwives were expected in each centre, however Sagbama centre had 2.00 (50%), Kolokuma/Opokuma had 2.50 (62.5%) of midwives/nurses, Brass had 0.67 (16.8%) and Ogbia had 0.33 (8.25%). For CHEW, a minimum of 3 CHEWs was required but Sagbama, Brass and Ogbia had 1.67 (55.7%) each while Kolokuma/Opokuma got 1.5 (50%). It is required that at least 1 pharmacy technician must be in each primary health centre, showed that Sagbama, Brass and Ogbia had 0.67 (67.0%) while Kolokuma/Opokuma met the required number. Out of the 6 required JCHEW required from each centre, only 1.00 (16.7%) was found across the sampled centres. For environmental officer, Brass, Ogbia and Kolokuma/Opokuma had none however, Sagbama had 0.67 (67.0%). Also an average of 0.67 (67.0%) medical record officers was found across Sagbama, Brass and Ogbia. Only Kolokuma/Opokuma met the minimum number for laboratory technicians. Surprisingly both Sagbama and Kolokuma/Opokuma had more than the minimum number required for health attendant/assistant. The table also revealed that only Kolokuma/Opokuma centre had the minimum number of security personnel. For general maintenance staff, all had more than the minimum required number. Statistically significant difference of the available personnel in the primary health care facilities in Bayelsa State was found when compared with the minimum standard.

Table 3: Distribution of communities having health facilities

From Table 3 above, it was found that out of 66 communities; only 9 (13.6%) communities in Kolokuma/Opokuma had health facilities. Out of 244 communities, only 10 (4.1%) communities had health facilities in Brass. In Ogbia LGA, it was found that out of 50 communities, 29 (58.0%) had health facilities. Finally, in Sagbama LGA, out of 47 communities, only 30 (63.8%) had health facilities. Analysis of the variance showed a statistically significant difference between the number of primary health care facilities in Bayelsa State and the minimum standard for number of health facilities (p < 0.05).

Discussion of Findings

In this study there is uniformity of the available services across the various health facilities that were selected however certain services were not provided in all the selected primary health care facilities. This is in disagreement with Metibola (2009) in a study that revealed a uniformity of common services provided in primary health facilities among urban cities. It also disagrees with Abdulraheem (2012) who found no similarity in the Primary health care services among the rural facilities. These findings are similar to those of Obembe, Osungbade, Olumide, Ibrahim & Fawole, (2014) who reported that the available community health extension workers in the facilities meet the required standard but the JCHEWs were far below the required standard. This finding of reduced junior community health health extension workers was also reported in this study. This could have been due to the long embargo on employment in the state. Also, those that were JCHEWs had progressively studied further to become CHEWs or CHOs, thus creating a gap in this cadre of personnel. The percentage difference of available equipment in the selected facilities in the LGAs does not meet the minimum required standard. This is in agreement with Shriprasad (nd) who reported that the personnel in the facilities were dissatisfied with the available equipment. The facilities in the communities we also grossly inadequate compared to the required number per settlements. However, a good number of wards in the selected LGAs met the standard of the Ward Minimum Health Care Package (2007) that requires at least one health facility in every political ward. In course of the study, it was discovered that a good number of health workers had not reached their facilities for a period longer than 3 months with a number of the facilities being under lock and key while some facilities were overgrown with grasses. It was also discovered that payment systems to Health Personnel in Government primary health care centres was not regular and there was improper supervision of primary health care activities and projects in the studied areas.

Conclusion

The delivery of primary health care in Bayelsa State in terms of facilities, equipments and personnel is not up to standard using the WMHCP and the minimum standard of primary health care in Nigeria as measuring standards and this could be the cause of the skipping and dwindling patronage of primary health care facilities in Bayelsa state.

Recommendations

In light of the findings of this study, the following recommendations were made:

• Adequate provision of equipment to carry out the routine services in the health facilities.
• Communities who are first beneficiaries of the available services should make frantic efforts in the provision of the services that are not available in the health facilities by collaborating with the primary health care personnel and NGOs in the community.
• Government and political office holders, especially ward representatives (Councilors) should ensure that there is at least one primary health care facility in the wards they represent.
• There should be thorough supervision of PHC activities in the community especially the services that are delivered in the facilities.
• Employment of personnel in lacking cadres to fill the gap deficit and deployment
• Primary health care coordinators should be conversant with the minimum standard for primary health care for them to use it as a monitoring tool and the standard for the establishment of a primary health care facility.

Suggestions for further studies include the evaluation of primary health care delivery in Nigeria, a comparative assessment of the tiers of health care delivery in Bayelsa state as well as an assessment of primary health care personnel training institutions in the Niger Delta region of Nigeria.

References

Abdulraheem I. S, Olapipl A. R & Amodu M.O. (2012). Primary health care service in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology;4(1), 5-13. Retrieved from http://elibrary.costech.or.tz/greenstone/collect/openacce/index/assoc/HASHd8d8.dir/OA000035.pdf

Adeyemo D.O (2005). Local Government and Health Care delivery in Nigeria J. Hum. Ecol; 18(2). Retrieved from http://www.krepublishers.com/02-Journals/JHE/JHE-18-0-000-000-2005-Web/JHE-18-2-000-000-2005-Abst-PDF/JHE-18-2-149-160-2005-1297-Adeyemo-D-O/JHE-18-2-149-160-2005-1297-Adeyemo-D-O-Full-Text.pdf

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Obembe, T.A., Osungbade, K.O., Olumide, E.A., Ibrahim, C.M. & Fawole, O.I. (2014). Staffing situation in PHC facilities in FCT, Nigeria. Implications for attraction and prevention Policies. American Journal of Social and Management Sciences, 5(2).

Omoleke, I.I. (2005primary health care services in Nigeria: constraints to optimal performance g 2005 Apr-Jun;14(2):206-12. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16083247

Olakunde, B.O. (2012) Public health care financing in Nigeria: Which way forward? Annals of Nigeria Medicine. Retrieved from http://www.anmjournal.com/arti cle.asp?issn=0331-3131;year=2012;volume=6;issue= 1;spage=4;epage= 10;aulast=Olakunde

Shriprasad, H. (nd) Performance Analysis of Primary Health Care Centres: A Case Study. Minor Research Project. Retrieved from http://www.sdmcujire.in/userfiles/MRP/Shriprasad_H_MRP.pdf

Thomas, S.L, Wakerman, J and Humphreys, J.S (2015) Ensuring equity of access to primary health care in rural and remote Australia – what core services should be locally available? International Journal for Equity in Health. Retrieved from http://equityhealthj.biomedcentral.com/articles/10.1186/s12939-015-0228-1

The post Evaluation of Primary Health care delivery services in selected Local Government Areas of Bayelsa State appeared first on Nigerian Biomedical Science Journal.

¹Okafor J C (PhD), ¹Salum S S (PhD), ²Obianagha NF (PhD) and ³Anetor JI (PhD)

¹Department of Pathology, School of Health and Medical Sciences, State University of Zanzibar.

²Department of Chemical Pathology and Immunology Olabisi Onabanjo University Nigeria

³Department of Chemical Pathology University of Ibadan

ABSTRACT

Many industrial chemicals are known to have a negative impact on human reproduction, particularly occupational and environmental exposures to heavy metals such as lead. The risk is generally believed to be directly correlated with both increasing concentrations and durations of exposure .

Methodology: This was a cross sectional study carried over six months. A total of 100 lead exposed male workers comprising 50 lead acid battery chargers and 50 auto painters within Surulere LGA of Lagos State were used in this study. Subjects were all Nigerians within the age bracket of 18 and 60 years randomly selected and their durations of exposure to lead were classified as less than five years and above five years. Blood lead levels (BLL) were determined in the whole blood using the Atomic absorption spectrophotometer (AAS). Reproductive hormones were done by ELISA. Semen parameters were assessed according to WHO standard procedures. Data were analyzed using Student’s‘t’ test and Pearson’s correlation coefficient.

Results: The BLL in > 5 years exposure category was significantly higher than the < 5 years exposure category in AP and BC (p< 0.008, p< 0.02 respectively); demonstrating dose-response relationship. Positive correlations at both durations of exposure (r=0.916, p=0.0001; r=0.788, p=0.0001); (r=0.461, p=0.047; r=0.499, p< 0.040) were observed between lead and prolactin in AP and BC respectively. In contrast, negative associations (; r= -0.727, p=0.0001; r= –0.753, p=0.0001 ) were observed between lead and testosterone levels at > 5 years exposure category for AP and BC respectively. No correlation was observed between lead and gonadotropins, LH and FSH at both durations of exposure in AP and BC. Inverse and significant associations at both durations of exposure (r= -0.391, p=0.044; r= -0.439, p=0.039) and (r= -0.359, p< 0.049; r= -0.412, p< 0.041) were observed between lead and total sperm count in AP and BC respectively. No dose relationship was established between lead and total sperm count.

Conclusion: Lead suppresses the reproductive pathway in lead workers through a probable mechanism of hyperprolactinaemia, which in turn may directly block testosterone synthesis and may culminate in decreased sperm count, ultimately manifesting in reduced fertility state which may not be severity dependent

KEY WORDS: Lead, battery chargers (BC), auto painters (AP), duration of exposure.

INTRODUCTION

The reproductive effects of lead are complex and appear to involve multiple pathways, not all of which are fully understood [1].Many studies on the male reproductive system of animals have revealed lead as a toxicant for testicular tissue and functions [2,3]. These include significant reductions in the number of spermatozoa within the epididymis in mice administered with lead acetate (0.25% and 0.50%) in drinking water and arrested spermatogenesis in rats [4, 5]. Some studies suggest that abnormalities of spermatogenesis are induced by exposure to lead while other researchers have failed to demonstrate correlations between lead and semen volume, abnormal sperm and sperm concentration among workers exposed to high lead levels [ 6, 7].

Reproductive hormones play an important and complicated role in the regulation of spermatogenesis and sperm development. [1 ]. The result of experimental studies in rats have shown that the effects of lead involve multiple action sites on male reproductive hormones although the most important part of these disorders probably occurs in the hypothalamic-pituitary-testosterone (HPT) axis [ 8, 9]. It is understood that depending on intensity and severity of lead exposure and duration, signals within and between the rats hypothalamus and pituitary gland appear to be disrupted by lead . On administration of lead acetate in water to rats showed a dose-related increase in gonadotropin releasing hormone (GnRH) mRNA and no effects on the serum concentrations of hypothalamic GnRH or LH, suggesting that there may be a compensating mechanism in the HPT axis [ 10].

In addition to animal studies, some researchers [11] reported a positive correlation between serum LH levels and duration of occupational lead exposure. It is therefore unclear, if male reproductive issues in persons exposed to lead are mostly related to the disruption of reproductive hormones or due to lead’s direct effects on the gonads, or both? This question had been difficult to answer, because lead, especially at high levels, is capable of adversely affecting many organs or systems in the body. Although lead can potentially reduce male fertility by decreasing sperm count and motility, inducing abnormal morphology and affecting functional parameters; not all studies have been able to clearly demonstrate such effects [1].

METHODOLOGY

This was a cross sectional study carried over six months. A total of 100 lead exposed male workers comprising 50 lead acid battery chargers and 50 auto painters within Surulere LGA of Lagos State were used in this study. Subjects were all Nigerians within the age bracket of 18 and 60 years randomly selected and their durations of exposure to lead were classified as less than five years and above five years. The Ethical approval was obtained from the Institutional Review Board of the Nigerian Institute for Medical Research, Lagos State. Informed consent of the subjects was gotten through the aid of a well structured questionnaire. Verbal presentations of the summaries of the hazards of lead exposure were made to the sample population to encourage voluntary participation of the subjects. Inclusion criteria were all participants in the study and it was purely voluntary. We excluded from the study those on any systemic diseases, those on fertility drugs, those who smoke, all those with history of drugs/substance abuse, all women and those on immune suppressive drugs. The control samples comprised of 50 males office workers who had never been occupationally exposed to lead.

SAMPLE COLLECTION

A . Blood

Ten milliliters of venous blood were collected from each subject. The samples were divided into three equal parts in lead-free heparinized tubes, EDTA bottles and plain bottles. The samples were collected in the morning between 8am and 10am and those for lead were done within three hours of collection. Samples in the plain bottles were allowed to clot, centrifuged, separated and the serum stored at -4^oC until analyzed.

B. Semen

All semen samples were collected between 7am and 10am and brought to the laboratory less than one hour after collection. The method of collection was masturbation and the samples were introduced into clean sterile lead free universal containers. All the subjects observed a seven day abstinence from sexual intercourse, cigarette, coffee and alcohol consumption according to WHO guidelines [12]. All the semen samples were allowed to liquefy for more than 20 minutes

Laboratory Analysis:

Blood lead levels (BLL) were determined in the whole blood using the Atomic absorption spectrophotometer (AAS).

Principle: The energy absorbed by atoms excited from the ground state is characteristic of those atoms. If light with the same wavelength characteristics as the radiation absorption of the element to be analysed is passed through a curtain of flame containing those atoms in the excited state, the amount of light energy absorbed will be proportional to the concentration of the element.

Reproductive hormones were done by ELISA.

Principle: The hormonal ELISA assay is based on simultaneous binding of human hormone to two monoclonal antibodies, one immobilized on microwell plates, the other conjugate with horseradish peroxide (HRP). After a washing step, enzyme substrate is added. The enzymatic reaction is proportional to the amount of reproductive hormone in the sample. The reaction is terminated by the addition of a stop solution. Absorbance is measured on a microplate reader.

Semen parameters were assessed according to WHO standard procedures. The morphology (%), motility (%), volume (mL) and the total count (million/mL) of the various semen samples were all analyzed. Log-transformation (base 10) was required and therefore computed for semen volume (mL), total sperm count(million/mL), percentage of sperm motility (%), motile sperm count (%) [21]

RESULTS

Discussion

A significant finding in this work was the reliability of blood lead levels as a measure of the duration of exposure in both the auto painters and the battery chargers. This indicates that the exposure to lead fumes and dusts in the workplace significantly increased the blood lead levels of the workers exposed to lead proportionately to duration of exposure. The work showed clearly that the mean lead levels of the above 5yrs group were statistically significantly higher for both exposed workers when compared to that of the less than 5 years group. The significant high level of prolactin recorded from this study could be stress induced. The high increase of prolactin among lead workers was collaborated by other workers [13, 14]. The increase might be due to dopaminergic depletion structure (TIDA : Tuberoin fundibular Dopaminergic Neurone Population). Lead might have acted on the HPA –axis with TIDA as its target in an indirect “dopamine-depletion” mechanism. The measurement of prolactin in males might thus provide opportunities for early identification of excess exposure to neurotoxic chemicals affecting dopaminergic control of Pituitary Secretion even before the onset of diseases. Some workers [15] observed that elevated levels of prolactin decreases the levels of gonadal testosterone in Men via prolactin interference with secretion of gonadotropin-releasing hormone. Other workers have suggested other mechanisms by which hyperprolactinaemia lead to reproductive dysfunctions apart from the inhibition of the GnRH. [ 16, 17].These include blockade of the effects of gonadotropins at the gonadal level. It could also be by the impairment of the accessory sex glands indicating a possible interaction between prolactin and testosterone. There could equally be a direct impairment of sperm quality indices.

The study recorded no significant difference in the levels of LH and FSH of both the auto painters and battery chargers when compared with the controls. And there was no correlation between these two hormones and lead at both durations of exposure in auto painters and battery chargers. It is therefore plausible that the high level of prolactin recorded in this study among the lead workers may have caused a decrease of the testosterone levels via other mechanisms other than the inhibition of the trophic hormones leading to the decline in the total sperm counts of the lead workers.

A negative association was shown between lead and testosterone at the 5 years and above duration of exposure. However the total sperm count and prolactin showed negative and positive correlations respectively at both levels of exposure. We view this as a clear indication of no dose response relationship between lead and prolactin and also between lead and total sperm count. The implication is that the toxic effect of lead on the reproductive pathway may not be severity dependent.

Some workers [18 ] had shown that the toxic effect of lead in male reproductive system is on the glycogen rich sertoli cells which are damaged thereby depleting the glycogen content of the cells and depriving spermatids the required nourishments therefore preventing them from maturing into viable spermatozoa [19]. It has been observed that alterations in sperm chromatin stability may be the most probable mechanisms involved in lead toxicity effects on spermatogenesis at low duration of exposure [20]

Generally in most of the developing countries like Nigeria, methods of hygienic control and close medical supervision of the workmen are very poor. Usually there is lack of comprehensive and systemic environmental monitoring and regular official inspection of the workplace. It was not entirely surprising to record such results. It is plausible that sustained high concentration like for a prolonged duration of exposure will most probably have more severe effects on exposed workers.

Conclusion

Lead suppresses the reproductive partway in lead workers through a probable mechanism of inducing hyperprolactinaemia, which in turn may directly block testosterone synthesis and may culminate in decreased sperm count, ultimately manifesting in reduced fertility state which may not be severity dependent

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10. Sokol, R.Z., Wang, S., Wan, Y.J., Stanczyk, F.Z., Gentzschein, E and Chapin, R.E. (2002). Long-term, low-dose lead exposure alters the gonadotropin-realeasing hormone system in the male rat. Environmental Health Perspective, 110,971-874.15
11. McGregor, A.J and Mason, H.J. (1990).Chronic occupational lead exposure and testicular endocrine function. Human and ExperimentalToxicology,9: 371-376.
12. WHO (1999) Laboratory manual for the examination of human semen and sperm-cervical mucus interactions. 4^th Edition
13. Govoni S, Battaini F, Fernicola C, Castelletti L, Trabucchi M. (1987) Plasma prolactin concentrations in lead exposed workers. Journal of Environ Pathology, Toxicology and Oncology ;7:13–15.
14. Lucchini R, Albini E, Cortesi I, Placidi D, Bergamaschi E, Traversa F, (2000). Assessment of neurobehavioral performance as a function of current and cumulative occupational lead exposure. Neurotoxicology ;21:805–811.
15. Scott I and Jacob R (2000) Hyperprolactinaemia and erectly disfunction. Review in Urology, 2(1) ; 39-42
16. Weber, R. F.A. (1983).Hyperprolactinaemia and male reproductive functions. A Ph.D Thesis, Erasmus University Rotterdam
17. Huang, W.J., Yey, J.Y., Kan, S.F., Chang, L.S and Wang and P.S. (2001). Effect of hyperprolactinaemia on the testosterone production of rat leydig cells.Journal of CellularBiology, 80(3): 313-320
18. Timbrell, J.A and Waterfield, C.J. (1994).Biomarker in toxicology, New uses for some old molecules. T.E.N.1: 10-14
19. Monsees,T.K., Franz, M., Gedhardt, S., Winterstein, U., Schill, W.B and Hyatpour,.J.(2000). Sertoli cell as a target for reproductive hazards.Andrologia,32, 239-246
20. Sallmen, M. (2001).Exposure to lead and male fertility. International Journal of occupational medicine and Environmental Health, 14, 219-222.
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The post Effect of duration on fertility status of Nigerian Males occupationally exposed to lead appeared first on Nigerian Biomedical Science Journal.

Authors: Dinkorma T. Ouologuem1 Cheick O. Kone1 Bakary Fofana1 Bakary Sidibe1 Amadou H. Togo1 Demba Dembele1 Sekou Toure1 Sekou Koumare1 Ousmane Toure1 Issaka Sagara1 Abdoulaye Toure1 Adama Dao1 Ogobara K. Doumbo1† Abdoulaye A. Djimde1 Affiliations: 1Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Science, Techniques and Technologies of Bamako, Bamako, Mali Corresponding author: Abdoulaye Djimde, adjimde@icermali.org Dates: Received: 02 Feb. 2018 Accepted: 30 Sept. 2018 Published: 06 Dec. 2018 How to cite this article: Ouologuem DT, Kone CO, Fofana B, et al. Differential infectivity of gametocytes after artemisinin-based combination therapy of uncomplicated falciparum malaria. Afr J Lab Med. 2018;7(2), a784. https://doi. org/10.4102/ajlm.v7i2.784 Note: †, 1956-2018 Copyright: © 2018. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. African Journal of Laboratory Medicine ISSN: (Online) 2225-2010, (Print) 2225-2002     Read online: Scan this QR code with your smart phone or mobile device to read online.

Background

Malaria is still a major public health problem in numerous parts of the world. Malaria still affects 216 000 million individuals each year with 445 000 deaths worldwide.¹ The global agenda for malaria elimination and eradication may never succeed without a thorough understanding of gametocyte biology and the true effect of the various interventions on malaria transmission. Gametocyte development and viability are essential for the perpetuation of Plasmodium life cycle by enabling both transmission from the human host to the mosquito vector^2,3 and the spread of resistant parasites.

Plasmodium gametocyte development within the human host is a tedious process involving the differentiation from asexual to sexual forms to accommodate metabolic requirements, environmental changes and sexual reproduction.^4,5 Plasmodium gametocytes are conventionally classified into five distinct stages (stages I–V) but only the immature stage I gametocytes and the mature stage V gametocytes are detectable in the peripheral blood of a malaria-infected patient.^6,7 The other stages (stage II, III, IV) are sequestered in the bone marrow and possibly other internal organs.^6,8,9 Gametocytes do not cause any symptoms in the infected human host, but the presence of competent circulating gametocytes and their duration in the bloodstream, which varies from 3 to 4 weeks,¹⁰ are directly responsible for malaria parasite transmission to the Anopheles vector.¹¹ However, gametocytogenesis and gametocyte transmission to the mosquito vector constitute a population bottleneck in the Plasmodium life cycle as only a minute number of parasites enter the

mosquito bloodmeal and gut.¹² Monitoring the density and infectiousness of circulating gametocytes is necessary for a better assessment of malaria transmission in endemic areas.

Gametocyte development within the human host is influenced by various factors, including host and parasite genetic factors, immune response, mosquitoes’ gut microbiota and the exposure to antimalarial drugs.^13,14,15 Several clinical and in vitro studies reveal that most antimalarial drugs currently in use can promote or impair gametocytogenesis and to some extent affect sexual reproduction within the mosquito vector.¹⁶ The 8-aminoquinoline primaquine is presently the only clinically used antimalarial drug displaying potent activity against all Plasmodium species and gametocyte stages,¹⁶ but its side effects on glucose-6phosphate dehydrogenase-deficient individuals hinder its use in large-scale elimination strategies.^17,18 The 4-aminoquinoline chloroquine was shown to increase the production of fully competent gametocytes both in vitro and in vivo.^19,20 In contrast atovaquone, artemisinin and the antifolates (sulfadoxine and pyrimethamine) have been shown to impair gametocyte development and

infectivity.^{20,21,22,23,24} The gametocyte developmental stages affected by antimalarial drugs is poorly understood. The antimalarial treatment represents a stress factor that triggers differentiation of the asexual form into the gametocytes.^25,26 This process may be more prevalent with drug-resistant parasites compared to sensitive ones.²⁷ Hence, the selective pressure exerted by the antimalarial drugs on the parasite may contribute to the spread of resistant parasites through the development and transmission of drug-resistant gametocytes.²⁸ Therefore it becomes essential to assess the emergence of resistant strains and the impact of treatment on gametocytogenesis and gametocyte infectivity.

Artemisinin-based combination therapies (ACT) are recommended in most malaria-endemic countries²⁹ with the expected benefit to reduce gametocyte carriage.³⁰ Indeed, the fast killing action of artemisinin and derivatives on asexual parasites results in the decrease of circulating stage V gametocytes.³⁰ Artesunate has been reported to reduce posttreatment transmission of gametocyte to Anopheles mosquitoes but does not abolish gametocyte infectivity entirely.³¹

With the increased interest in malaria elimination, understanding the impact of ACT regimens and other antimalarial drugs with different pharmacodynamic properties on gametocyte development and transmission becomes a key issue. Here, we report an in vivo assessment of the impact of artemether-lumefantrine, artesunateamodiaquine and artesunate-sulfadoxine-pyrimethamine on circulating gametocytes density and their infectivity.

Methods

Ethical considerations

The protocol (NCT00452907 on ClinicalTrials.gov) was reviewed and approved by the ethical committee of the Faculty of Medicine, Pharmacy, and Dentistry, University of Bamako (No 05-20 dated 22 June 2005). Each participant (or legal guardian for minors) gave fully informed written consent before enrolment.

Study sites

This study was conducted in Bougoula-Hameau, a periurban village of approximately 7000 people located near the city of Sikasso in southern Mali. Plasmodium falciparum is hyperendemic with seasonal peaks in this village. Parasitemia prevalence rates range from 40% to 50% during the dry season (January–April) and 70% to 85% during the rainy season (May–December).³² Approximately 10% – 20% of the local population are gametocyte positive with an average gametocyte density of 23 gametocytes/µl.³³ The main malaria vectors in the Sikasso region are Anopheles gambiae and Anopheles funestus with a sporozoite rate of 6.4% at the end of the rainy season and an entomological inoculation rate (EIR) of 0.032 infected bites per person per night.³⁴

Study design, volunteer follow-up and sample collection

This is a sub-study of a previously published randomised controlled clinical trial, which was conducted from July 2005 to July 2007 to compare the efficacy of three ACT regimens: artemether + lumefantrine (Coartem®, Novartis, Basel, Switzerland), artesunate + amodiaquine (Arsucam®, SanofiAventis, Paris, France), and artesunate (Sanofi-Aventis, Paris, France) + sulfadoxine-pyrimethamine (Fansidar®, Roche, Burlington, North Carolina, United States).³⁵ Briefly, patients aged 6 months and above were enrolled in the clinical study if they satisfied the following inclusion criteria: weighed ≥ 35 kg, resided in the study village, were able to receive oral treatment, had an axillary temperature ≥ 37.5°C, and had Plasmodium sp. infection with a parasite density between 2,000 and 200,000 asexual forms per microlitre of blood. As described previously by Sagara et al.,³⁵ 780 volunteers were enrolled and 260 were randomly assigned to one of the three treatment arms and drug efficacy was assessed according to the World Health Organization 2003 protocols.³⁶ Briefly, blood samples were collected on Days 1, 2, 3, 7, 14, 21, 28 and any day of recurrent illness. Smears were made, Giemsastained and read on site for asexual parasites and gametocytes quantification. Parasite count was performed against 300 leucocytes and gametocyte count was performed against 1000 leucocytes.

To evaluate gametocyte carriage following ACT administration, all participants who were gametocyte carriers at Day 0, 1, 2, 3, 7, 14, 21 and 28 were selected.

Direct skin feeding procedures

Gametocyte infectivity was defined as the presence of oocyst in the midgut of the Anopheles mosquito 8 days after a gametocyte containing blood meal. The infectivity of circulating gametocytes following treatment was evaluated by direct mosquito feeding experiments performed on gametocyte carriers before and after oral ACT administration on Day 0 and Days 3, 7, 14, 21 or 28. The test group was recruited among patients randomised in the main study,³⁵ while the control group was recruited among patients presenting with malaria symptoms, who were gametocyte positive by microscopy but were not included in the main study. Gametocytes carriers from the control group did not receive any antimalarial drugs at the time of infectivity assessment. To avoid repeated exposure to direct skin feeding, each volunteer underwent direct skin feeds only once during the entire study. In addition, the infectivity experiments were only performed on those days when adequate numbers of 3–5 days old mosquitoes were available to the team.

Wild female Anopheles gambiae s.l. collected from the same study site were allowed to lay eggs. Mosquitoes were kept in semi-natural conditions in field insectaries set up in the village. For each feeding experiment, 3–5 days old offspring (F1) reared in the insectaries were used. Up to 60 F1 female mosquitoes were starved for about 12 h and held in 2 small screened-cups containing 30 mosquitoes each. They were then allowed to blood-feed for 5–10 min on the leg of a 6–18 years old consenting volunteer.

After feeding, unfed mosquitoes were removed the same day, and only fed mosquitoes were kept in the insectaries as described above. 8 days post feeding, a group of at least 15 mosquitoes per carrier were dissected, their midguts pulled out in 0.5% mercurochrome for oocyst detection and quantification. Oocyst numbers, abdomen stages, date and other observations were recorded on data sheets. Oocysts were counted under light microscopes 10 times for each mosquito.

Statistical analysis

For the analysis of the direct skin feeding experiment, feeding experiments for Days 3–28 were lumped together in each treatment arm. To calculate the oocyst prevalence, for each treatment arm, the number of positive mosquitoes was divided by the total number of mosquitoes dissected for that treatment arm). The oocyst positivity for each ACT regimen was compared to that of the control group using the chisquare test. All data were analysed and reported using Stata software version 14.0 (StataCorp. 2015, College Station, Texas, United States).

Results

Evolution of gametocyte carriage and gametocyte density following artemisinin-based combination therapy treatment

A total of 129 volunteers were gametocyte carriers in the artemether-lumefantrine arm, 123 in the artesunateamodiaquine arm and 124 in the artesunate-sulfadoxinepyrimethamine arm. Following treatment initiation, gametocyte carriage significantly increased in the artesunateamodiaquine and artesunate-sulfadoxine-pyrimethamine arms (Figure 1). From Day 0 to Day 3, gametocyte carriage

Gametocyte carriage (%)

14

12

10

Follow-up days

8

6

4

2

0

Day-

0

Day-

2

Day-

3

Day-

7

Day-14

Day-21

Day-28

AL arm

ASSP arm

ASAQ arm

AL, artemether-lumefantrine; ASAQ, artesunate-amodiaquine; ASSP, artesunate-sulfadoxine/ pyrimethamine.

FIGURE 1: Gametocytemia carriage evolution by treatment arm.

TABLE 1: Characteristics of the volunteers subjected to direct skin feeding assays.

AL, artemether-lumefantrine; ASAQ, artesunate-amodiaquine; ASSP, artesunate-sulfadoxine/ pyrimethamine.rose from 6.1% to 10.2% in the artesunate-amodiaquine arm (p = 0.005) and from 7.0% to 9.8% in the artesunatesulfadoxine-pyrimethamine arm (p = 0.02). Overall, the prevalence of gametocyte carriage in the artemetherlumefantrine arm steadily decreased from Day 0 to Day 28, while for the artesunate-amodiaquine and artesunatesulfadoxine-pyrimethamine arms the prevalence of gametocyte carriage increased from Day 0 to Day 7 before declining (Figure 1).

Infectivity of gametocytes before and after treatment with artemisinin-based combination therapy regimens

Overall 21 consenting volunteers in the control arm, 8 in the artemether-lumefantrine arm, 6 in the artesunateamodiaquine arm, and 15 in the artesunate-sulfadoxinepyrimethamine arm underwent direct skin feeding. The mean age of volunteers was comparable between groups

(Table 1).

Overall we dissected 698, 253, 174, and 602 mosquitoes to measure oocyst positivity at baseline, post-artemetherlumefantrine, post-artesunate-amodiaquine, and postartesunate-sulfadoxine-pyrimethamine treatment, respectively (Table 2).

The oocyst positivity rate in the control group was 11.7% (82/698) (Figure 2). For volunteers treated with artemether-lumefantrine,

TABLE 2: Mosquitoes dissected per treatment arm and days of feeding.

Study day No. of mosquitoes used for direct skin feeding experiment

AL, artemether-lumefantrine; ASAQ, artesunate-amodiaquine; ASSP, artesunate-sulfadoxine/ pyrimethamine.

Oocyst posivity (%)

0

10

20

30

40

50

BASELINE ASSPAL

Treatment arms

ASAQ

*

*

*

AL, artemether-lumefantrine; ASAQ, artesunate-amodiaquine; ASSP, artesunate-sulfadoxine/ pyrimethamine.

FIGURE 2: Oocyst positivity rate by treatment arm.

the overall positivity rate was significantly higher than that of the control group (11.7%, n = 698 vs 30.0%, n = 253; p < 10⁻⁴) (Figure 2). Likewise the oocyst positivity rate following artesunate-amodiaquine treatment was significantly higher than that of the control group (11.7%, n = 698 vs 40.2% n = 174; p < 10⁻⁴) (Figure 2). In contrast, the oocyst positivity rate following artesunate-sulfadoxine-pyrimethamine treatment was significantly lower than that of the control group (11.7%, n = 698 vs 7.9%, n = 602; p = 0.03) (Figure 2).

Discussion

The goal of this study was to determine the impact of different ACT regimens on Plasmodium falciparum gametocyte carriage, density and infectivity to Anopheles gambiae s.l. following artemether-lumefantrine, artesunate-amodiaquine and artesunate-sulfadoxine-pyrimethamine treatment. We measured P. falciparum gametocyte density of consenting volunteers suffering from acute uncomplicated malaria and gametocyte infectivity to Anopheles mosquitoes before and after ACT administration. From the direct skin feeding experiments of this study, we show that post-artemetherlumefantrine and post-artesunate-amodiaquine treatment gametocytes are more infectious to Anopheles gambiae s.l. than post-artesunate-sulfadoxine-pyrimethamine treatment gametocytes or non-drug treated controls. Since artemisinin derivatives, including artesunate and artemether, are rapidly metabolised in vivo into dihydroartemisinin, the observed differences in infectivity could be dependent on the partner drugs (i.e. lumefantrine, amodiaquine and sulfadoxinepyrimethamine). However, one cannot rule out the effect of differences in artemisinin derivative pharmacokinetics and pharmacodynamics between regimens. Co-exposure to artemisinin derivative and the partner drugs albeit for a short period could impact gametocyte biology differently from any of the individual drugs. In addition, drug administration timing differs between artemether-lumefantrine and artesunate-amodiaquine or artesunate-sulfadoxinepyrimethamine. While artemether-lumefantrine was given twice daily for 3 days, artesunate-amodiaquine and artesunatesulfadoxine-pyrimethamine were administered once daily for 3 days. A number of studies have investigated the effect of antimalarial drugs on gametocyte density and infectivity.^19,31 Beavogui et al. revealed that sulfadoxine-pyrimethamine considerably increased gametocyte carriage in the population but the infectivity of these circulating gametocytes was very low.²² Further investigation by Kone et al. showed that the low infectivity following sulfadoxine-pyrimethamine treatment was due to pyrimethamine, which is known to prevent male gametocyte exflagellation.²³ In addition, 4-aminoquinoline chloroquine, which is chemically related to amodiaquine, has been shown to induce the production of fully infective gametocytes both in vitro and in vivo.¹⁶ These studies support the observed decrease of infectivity with artesunatesulfadoxine-pyrimethamine treatment and the increase of infectivity with artesunate-amodiaquine seen in this study. Although gametocyte infectivity was different between the tested ACT regimens, the small number of carriers tested may be a limitation of this study. Additional infectivity studies with higher numbers of gametocyte carriers need to be conducted to further investigate these findings. In addition, the mechanisms involved in antimalarial drugs and gametocyte biology ought to be thoroughly studied.

To investigate gametocyte dynamics in the peripheral blood, gametocytes carriers were included in this study.³⁵ Baseline gametocyte carriage was significantly higher in the artemether-lumefantrine arm compared to both artesunateamodiaquine and artesunate-sulfadoxine-pyrimethamine. That observation may have occurred by chance as the study was a randomised controlled trial; therefore this could not be attributed to a selection bias.³⁵ There was no difference in gametocyte density between the treatment arms at baseline. Gametocyte carriage significantly decreased in all treatment arms between Day 0 and Day 28. This result confirms numerous previous findings.³⁰ However, while gametocyte prevalence in the artemether-lumefantrine arm decreased steadily from Day 0 to Day 28, there was a significant increase in the artesunate-amodiaquine and artesunate-sulfadoxinepyrimethamine arms from baseline to Day 3 with a plateau until Day 7. This rise after ACT administration corroborates previous work^38,39 and could be a consequence of the stress induced by the treatment.^26,40,41 These data suggest that artemether-lumefantrine may affect gametocytogenesis differently from artesunate-amodiaquine or artesunatesulfadoxine-pyrimethamine.^24,42,43 Conversely, the dosing schedule of artemether-lumefantrine, which is taken every 8 h instead of once daily as for artesunate-amodiaquine and artesunate-sulfadoxine-pyrimethamine, could also play a role in the above observations.

We show that artesunate-amodiaquine and artemetherlumefantrine decreased gametocyte carriage in the treated population while both ACTs increased gametocyte infectivity to the mosquitoes. The effect of these ACTs in reducing gametocyte carriage can be a direct result of their active and fast killing action on asexual forms, leaving them no or little chance to differentiate into gametocytes. ³⁰ However, the few that manage to differentiate into gametocytes appear to be well fit for infecting the mosquitoes, hence their increased infectivity. Conversely, sulfadoxine-pyrimethamine sharply increases gametocytes but those gametocytes appear to be less fit for infecting the mosquitoes.^{22, 23} Pyrimethamine was also shown to hamper sporogonic development of P. falciparum in the Anopheles mosquitoes.⁴⁴ These could explain the decrease in infectivity of post artesunatesulfadoxine-pyrimethamine gametocytes.

Gametocytes were detected and quantified by light microscopy, which is an important limitation of this study. Thus, gametocyte carriage and gametocyte density are likely to be underestimated with our approach. The use of molecular tools^7,45,46,47 and gametocyte quantification after purification³⁸ could have yielded higher proportions of gametocyte carriers and gametocyte density.

We also cannot exclude the possible modulation of the mosquitoes’ gut microbiota by the ACTs used in this study. The Anopheles gut microbiota is known to influence the sporogonic cycle¹⁵ and some drugs, such as antibiotics, have been shown to change the composition of mosquitoes’ gut resident microbes.⁴⁸

Conclusion

Antimalarial drugs influence gametocytogenesis and their impact on gametocyte density and viability are likely to differ from one combination therapy regimen to another. Evaluation of transmission potential in malaria-endemic areas requires more studies assessing the influence of current antimalarial treatment on gametocyte development and clearance in vivo, and the infectivity of post-treatment gametocytes. Understanding the potential impact of antimalarial drugs on the spread of resistant strains and malaria transmission will require a fine assessment of their effects on gametocyte biology and the mechanisms involved.

Acknowledgements

We thank all the volunteers who participated in this study, the local guides of Bougoula-Hameau, the data management staff of the Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Mali, for managing the clinical data and the staff of the Regional Hospital of Sikasso, Mali, for their great collaboration during the study. We are indebted to M. Siaka Traore who allowed us to use one his huts as field insectaries.

Competing interests

The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.

Sources of support

This work was supported by the European and Developing Countries Clinical Trial Partnership (EDCTP) fellowship grant (2004.2.C.f1 to A.D.) and by Sanofi (ARTEN-L-00848).

Authors’ contributions

D.T.O. conducted the data analysis and data interpretation, and drafted the manuscript. S.T., S.K., B.F., B.S., A.H.T., and D.D. contributed to the clinical studies. C.O.K., A.D., and A.T. contributed to the entomological studies. O.T. and I.S. contributed to the study design and the statistical analysis. O.K.D. (deceased) critically reviewed the manuscript. A.A.D. contributed to the design of the study, oversaw data collection, analysis and interpretation, drafted the manuscript and approved the final version. All authors mentioned in the article approved the manuscript.

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34. Thera MA, D’Alessandro U, Thiéro M, et al. Child malaria treatment practices among mothers in the district of Yanfolila, Sikasso region, Mali. Trop Med Int Health. 2000;5(12):876–881.
35. Sagara I, Fofana B, Gaudart J, et al. Repeated artemisinin-based combination therapies in a malaria hyperendemic area of Mali: Efficacy, safety, and public health impact. Am J Trop Med Hyg. 2012;87(1):50–56. https://doi.org/10.4269/ ajtmh.2012.11-0649
36. World Health Organization. Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria [homepage on the Internet]. 2003 [cited 2018 Jan]; Available from: http://www.who.int/malaria/ publications/atoz/whohtmrbm200350/en/
37. Toure YT, Doumbo O, Toure A, et al. Gametocyte infectivity by direct mosquito feeds in an area of seasonal malaria transmission: Implications for Bancoumana, Mali as a transmission-blocking vaccine site. Am J Trop Med Hyg. 1998; 59(3):481–486. https://doi.org/10.4269/ajtmh.1998.59.481
38. Karl S, Laman M, Moore BR, et al. Gametocyte clearance kinetics determined by quantitative magnetic fractionation in melanesian children with uncomplicated malaria treated with artemisinin combination therapy. Antimicrob Agents Chemother. 2015;59(8):4489–4496. https://doi.org/10.1128/AAC.00136-15
39. Carmona-Fonseca J, Arango E, Blair S. Gametocytemia in falciparum malaria treated with amodiaquine or artesunate. Biomedica. 2008;28(2):195–212. https://doi.org/10.7705/biomedica.v28i2.91
40. Carter R, Miller LH. Evidence for environmental modulation of gametocytogenesis in Plasmodium falciparum in continuous culture. Bull World Health Organ. 1979;57(Suppl 1):37–52.
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42. Kumar N, Zheng H. Stage-specific gametocytocidal effect in vitro of the antimalaria drug qinghaosu on Plasmodium falciparum. Parasitol Res. 1990;76(3):214–218. https://doi.org/10.1007/BF00930817
43. Lelièvre J, Almela MJ, Lozano S, et al. Activity of clinically relevant antimalarial drugs on Plasmodium falciparum mature gametocytes in an ATP bioluminescence ‘transmission blocking’ assay. PLoS One. 2012;7(4):e35019. https://doi. org/10.1371/journal.pone.0035019
44. Bray RS, Burgess RW, Fox RM, Miller MJ. Effect of pyrimethamine upon sporogony and pre-erythrocytic schizogony of Laverania falciparum. Bull World Health Organ. 1959;21:233-8.
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The post Differential infectivity of gametocytes after artemisinin-based combination therapy of uncomplicated falciparum malaria appeared first on Nigerian Biomedical Science Journal.

Adesoji AT, Onuh JP, Bagu J, Itohan SA

Department of Microbiology, Federal University Dutsin-Ma, Nigeria.

Abstract

Background: Multidrug resistant Staphylococcus aureus in clinical and environmental samples is a global problem. Data comparing antibiogram of bacteria from these two sources in Nigeria is scarce. Therefore, this study compares antibiogram of isolates from both sources from Dutsin-Ma, Katsina State, Nigeria.

Methodology: A total of 120 and 150 clinical and aquatic samples respectively were collected for a five months period. Samples were analyzed for isolation of S. aureus using mannitol salt agar. Bacteria identification were carried out using standard biochemical characterization. Antibiogram of the isolates were determined using disc diffusion methods and comparison with Clinical Laboratory Standard Institute (CLSI)’s Standard.

Result: A total of 120 and 45 S. aureus were isolated from both clinical and aquatic samples respectively. Highest (100.0%) resistance to cloxacillin was observed among isolates from each source. Clinical and aquatic isolates showed least resistance of 20.0% and 48.0% respectively to gentamicin. All isolated S. aureus (165) from this studies were multidrug resistant with different antibiotic resistant pattern.

Conclusion: This study revealed that multidrug resistance strains of S. aureus can be isolated from both clinical and drinking water sources, hence, a public health significance that calls for urgent attention by clinicians and public health workers.

Keywords: Clinical isolates, aquatic isolates, s. aureus, multi-drug resistant.

DOI: https://dx.doi.org/10.4314/ahs.v19i1.11

Cite as: Adesoji AT, Onuh JP, Bagu J, SA I. Prevalence and antibiogram study of Staphylococcus aureus isolated from clinical and selected drinking water of Dutsin-Ma, Katsina state, Nigeria. Afri Health Sci. 2019;19(1). 1385-1392. https://dx.doi.org/10.4314/ahs.v19i1.11

Introduction

S. aureus, is a facultative aerobic, Gram-positive cocci which has an inherent ability to ferment carbohydrates, producing quite a number of pigmentation ranging from white to deep yellow (on mannitol salt agar). They are easily identified by detecting the presence of deoxyribonuclease (DNase), catalase enzymes and coagulase proteins produced by them.¹

S. aureus has been implicated in many nosocomial infections² including some invasive infections such as nosocomial bacteremia and septicemia (sepsis).³ MRSA is a major public health concern and is responsible for both hospital-and community-associated infections worldwide.^4,5,6,7,8,9 Although ubiquitous in nature, the occurrence and distribution of these organisms have been reported to be influenced by geographical location, type of hospital and studied population.¹ Moreover, there are few studies in Nigeria that compare antibiogram of this bacterium based on these different criteria.

The presence of S. aureus from the environment, especially different types of water available for human consumption and/or recreation has also been reported, and may be regarded as one of the genera frequently isolated from water supplies as Heterotrophic Plate Count

Available literature showed the isolation of S. aureus from water across the globe.^{10,11,12,14,15,16,17,18} Conversely, there is, information on the isolation of S. aureus from Dutsin-Ma drinking water.

Researchers have reported that the presence of the organism in high concentrations in swimming pools¹⁷ and bathing beaches¹⁴ were associated with the skin and eye infections of the bathers.^15,16 However only few studies have reported this phenomenon especially in Nigeria. Likewise, studies have also shown that most S. aureus isolated from bathing water came from their users themselves^17,18 and may therefore indicate a possible relationship between clinical and environmental (drinking water) isolates. Hence, this study seeks to compare the antibiotic resistance profiles of S. aureus isolated from both clinical and selected drinking water environments from DutsinMa, Katsina State, Nigeria.

Materials and methods Study area and sample location

The study was carried out in the town of Dutsin-Ma, Dutsin-Ma local government area, Katsina State, Nigeria which lies between the geographic coordinates of 12^o27’17’’N, 7^o29’29’’E.¹⁹ The local government has an area of 527 km² and has the Zobe Dam lying to the South of the town.²⁰ Federal University Dutsin-Ma clinic and General hospital Dutsin-Ma were two hospitals selected for isolation of clinical S. aureus while drinking water samples were collected for aquatic S. aureus from selected wells, boreholes, tanks etc. from this same environment.

Ethical approval

Ethical approval was obtained from Federal University Dutsin-Ma clinic and Dutsin-Ma General Hospital. Informed consent was also obtained from patients sampled.

Samples and samples collection

A total of 120 clinical samples (from nasal, ear, pus, wound, and skin surfaces) were collected from patients from Federal university Dutsin-Ma clinic and General hospital Dutsin-Ma between April and August, 2016. Also, 150 water samples (comprising tap, borehole, tank, reservoir and well water from the water board, Abuja road, Kofa community, Federal University Dutsin-Ma students’ hostel, and Doctors’ campus, all in Dutsin-Ma) were aseptically collected for the purpose of this research during the same period.

Clinical samples were collected using sterile swap sticks while the water samples were collected using sterile sample bottles (20mls). All samples were transported within six hours of collection to the Laboratory of Department of Biological Sciences, Federal University Dutsin-Ma, Dutsin-Ma, Katsina State, Nigeria. Thereafter, samples were cultured on mannitol salt agar (MSA) for isolation of S. aureus.

Bacteria isolation, identification and characterization

Swap sticks used for clinical sampling were streaked on blood agar (to detect their hemolytic ability) and mannitol salt agar (MSA) in sterile petri dishes for isolation of S. aureus. Afterwards, plates were incubated at 37^oC in an incubator. blood agar plates were observed after 24 hours, while the mannitol salt agar were observed after 48 hours incubation for visible growth.²¹ In order to obtain a distinct colony, bacteria isolated were sub-cultured by re-streaking on blood agar and MSA. Distinct colonies were isolated and stored on nutrient agar slants at 4⁰C in a refrigerator.

For the water samples, 1ml each was pipetted into a sterile petri dish, thereafter, 20ml of sterile mannitol salt agar was poured into it using pour plate method. It was then rocked gently to mix and allowed to set. Inoculated agar plate was afterwards opened briefly for 30 seconds in an incubator set at 37⁰C, so as to remove condensed water on its surface. Thereafter, covered, inverted and inoculated at 37⁰C for 24 to 48hrs in the same incubator. Using their colonial appearance such as size, shape, consistency, color, elevation and the differential characteristics such as pigmentation, suspected discrete colonies of S. aureus were sub-cultured by re-streaking on nutrient agar plates to obtain a pure culture according to guidelines.²² Distinct well-separated yellow colonies and creamy white colonies on MSA and blood agar respectively were picked aseptically and stored on nutrient agar slants at 4⁰C for further biochemical characterization.

Each organism was subjected to some preliminary biochemical tests such as gram staining, catalase, mannitol fermentation, blood heamolysis and slide coagulase test.²³

Antimicrobial susceptibility testing

This was determined by the agar diffusion technique as recommended by the Clinical Laboratory Standards Institute (CLSI) guidelines²⁴ on Mueller-Hinton agar (Oxoid) using the following antibiotic impregnated disks (Abtek Biologicals Ltd): gentamicin (10μg), cefuroxime (30μg), ofloxacin (5μg), cloxacillin (5μg), ceftazidime (30μg), ceftriaxone (30μg), erythromycin (30μg) and augumentin (30μg) for gram positive bacteria. The procedure includes inoculation of stock cultures stored at 4^oC on nutrient agar slants into 10ml of nutrient broth which was then incubated overnight at 37^oC. Thereafter, serial dilution of 10¹ into sterile distilled water was carried out. Afterwards, 1 ml of the culture solution was transferred into sterile petri dishes. Thereafter, sterile Mueller-Hinton agar that has been cooled to 55^oC in water bath was poured into each and allowed to solidify. However, another 1 in 10 dilution factor was also plated out on nutrient agar for each test for determination of viable count so as to know the average number of colony used during the susceptibility tests. Antibiotic sensitivity disc was later placed on one of the solidified Mueller-Hinton plates sterilely and both plates were incubated at 37^oC in an incubator overnight. Zone of inhibition seen round the antibiotic disc the following day were measured while diameter was categorized as resistant, intermediate and sensitive after comparing with Clinical and Laboratory Standards Institute (CLSI) standard for each bacteria isolate.²⁴ Those that were resistant to three or more classes of antibiotics, were classified as multidrug resistant.

Statistical analysis

The relationship between antibiotic resistant profiles and the sample locations (environmental and clinical) isolates was determined using chi-square two ways contingency table. The Qi Macros statistical software for excel was used for the analysis.

Results

A total of 150 water samples and 120 clinical samples were collected, out of which 45 and 120 S. aureus organisms were isolated respectively (Table 1).

Antibiotics resistant to environmental isolates showed the highest (100.0%) resistance to each of cloxacillin (CXC) and augmentin (AUG), the lowest (48.9%) antibiotic resistance was recorded for gentamycin (GEN) (Table 2). The observed resistance for clinical isolates demonstrated the highest (100%) resistance to each of erythromycin (ERY) and cloxacillin (CXC) with the lowest (27.5%) resistance to ofloxacin (OFL) (Table 2). However, the antibiogram profiles conducted on the isolates revealed a significant (P<0.05) association between both isolates (environmental and clinical) and resistance to antibiotics. Chi-Square analysis can be found on supplementary Table 1.

Table 2: Antibiotic resistance pattern of S. aureus from different sources

X²= 54.885, P=1.571×10^-9

CODE: OFL: Ofloxacin, AUG: Augmentin, CAZ: Ceftazidine, CRX: Cefuroxime, GEN: Gentamycin, CTR: Ceftriaxone, ERY: Erythromycin, CXC: Cloxacillin

The study also identified 28 antibiotic resistance pat- augmentin (AUG), ceftazidine (CAZ) was the most freterns. The multiple antibiotic resistance pattern cloxa- quently observed pattern (Table 3). All isolated S. aureus cillin (CXC), erythromycin (ERY), cefuroxime (CRX), (165) from this studies were multidrug resistant with different antibiotic resistant pattern.

Table 3: Multiple antibiotic resistance pattern among S. aureus isolates from the clinics and environment

OFL: Ofloxacin, AUG: Augmentin, CAZ: Ceftazidine, CRX: Cefuroxime, GEN: Gentamycin, CTR:

Ceftriaxone, ERY: Erythromycin, CXC: Cloxacillin

Discussion

Over the past decade, the percentage of S. aureus from clinical specimen that are multidrug-resistant has been steadily increasing around the world,²⁵ a phenomenon which has affected the timely administration of appropriate choice antibiotics.²⁶ Out of 150 water samples collected from 6 drinking water sources in this study, a total of 45 S. aureus were isolated. However, from a total of 120 clinical samples collected across different body sites: skin, nasal cavities, ear, wound and pus, of patients randomly selected from the study area, 120 S. aureus were isolated (Table 1).

Possible reasons for low prevalence of S. aureus from the aquatic environment could be due to the pre-treatment process through which the water had undergone, and also due to the fact that the inhabitants of the community have not had constant contact with the water, since S. aureus is a normal flora of the body. However, highest (60.0%) occurrence of S. aureus from nasal cavities, followed by pus (12.5%), wound (12.5%), skin (8.3%) and the least from ear (6.7%) were observed among clinical samples. This finding is consistent with other findings which reported highest (94.0%) colonization in extranasal site²⁷; and also a highest (46.8%),²⁸ (65.9%)²⁹ occurrence from pus. However our findings contradict that of some researchers who reported least isolation of S. aureus from nasal cavities.^1,30 The result of this study which revealed a least occurrence of S. aureus from wound (12.5%), skin (8.3%) and ear (6.7%) could be because these samples were collected from wounds which had undergone pre-treatment with antiseptics which had consequently reduced the microbial load on the wound site. This finding is consistent with other literature which reported a least (8.0%) colonization from wounds²⁷ and no isolation from the ear.^1,31

Among the water samples, Isa-Kaita’s reservoir showed the highest prevalence (40 %) of the isolates, probably due to the constant contact with the inhabitants of the community. On the other hand, Isa Kaita’s tank and Kadangaru’s well both recorded the least number of isolates (8.9 %) (Table 1). This findings agree with others who also reported the presence of S. aureus in drinking water in the city of Portugal.¹¹ Although this high microbial contamination may be due to poor hygiene and sanitary conditions in and near the water sources,³² the propinquity of the water sources to dumpsites and latrines is a possible source of contamination.³³ Unfortunately, this kind of setting is peculiar to the Dutsin-Ma community in Katsina State where this study was carried out.

It is worthy to note that although S. aureus is not a bacteria indicator of fecal contamination, its presence in drinking water is of great public health importance. When present in large quantity, S. aureus in water intended for human consumption are potential health threats, especially if these strains possess determinants of antibiotic resistance^12,18,34 as suggested by this study. These resistance genes can be transferred to normal bacteria present in the GIT of the consumers if the genes are present on mobile genetic elements like integrons and its cassette, plasmid, transposon and insertion sequence These have been reported to be the most virulent and multidrug resistant among all of the HPC bacteria recovered from water supplies in South Africa.³⁴ They can form biofilms in major distribution channels. This harbors potential waterborne pathogens and can also serve as a reservoir for transferable resistance genes to other potential bacterial species.^11,12 Moreover, if they eventually cause diseases, treatment will require the administration of antibiotics (usually beta lactams). However, considering how important some of these beta-lactams have become over the years, both as first-line therapy for severe and mild infections,³⁵ resistance to them will affect their timely administration,²⁶ and this could increase mortality rate, and of course affect the economy.³⁶

The result of the antibiogram conducted on clinical isolates, revealed a highest (100.0%) resistance to both cloxacillin and erythromycin, followed by cefuroxime (94.2%) (Table 2). The least (20.0%) resistance was demonstrated against gentamicin. When compared to the samples from drinking water sources, a similar result was obtained. The isolates demonstrated a highest (100%) resistance to both cloxacillin and augumentin, followed by cefuroxime (97.8%) and ceftazidime (97.8%). The least resistance was demonstrated against ofloxacin (0.00%) and gentamicin (48.9%) (Table 2). This agrees with other findings which also reported a low (7.1%) resistance to gentamicin.³⁷ The resistance to the antibiotics tested may be attributed to the production of beta-lactamase, an enzyme that inactivates β-lactam rings in β-lactam antibiotics and closely related antibiotics. A similarity in the antibiotic resistance pattern displayed by the isolates could suggest a possible link between the isolates from the clinic and that from the water environment. Therefore, work is ongoing on the molecular typing of these bacteria isolates for any clonal similarities.

Among the clinical isolates, resistance to 5 antibiotic groups (42.5%) were the most commonly observed antibiotic resistance pattern, while resistance to 8 groups (2.5%) was the least prevalent. On the other hand, the environmental isolates demonstrated highest resistance to 7 groups (48.9%) of the antibiotics tested, while a least resistance to 4 groups (4.4%) was recorded. The multiple antibiotic resistance pattern cloxacillin (CXC), erythromycin (ERY), cefuroxime (CRX), augmentin (AUG), ceftazidine (CAZ) was the most frequently observed pattern (Table 3).

Conclusion

This study has for the first time, given a comparative insight into the antibiogram study of S. aureus isolated from clinical and selected drinking water of Dutsin-Ma town, Katsina State, Nigeria. The findings of this study reveals that Dutsin-Ma water sources are laden with multidrug resistant strains of S. aureus. These multidrug resistant S. aureus isolated from drinking water may transfer their resistant determinant to bacteria in the gastrointestinal tract (GIT) of consumers if present on mobile genetic elements such as plasmid and transposon, thereby, prolong treatment time and lead to an increase in mortality rate if bacterial infection arise. The result presented in this study may explain, in part, the increasing misuse of antibiotics, poor hygiene and sanitation practices including human attitudes such as dumping of refuse or untreated sewage in and around this water sources in the study area. This study hereby recommends the provision of potable water, modern sanitary and sewage disposal facilities and creation of awareness to the people in the community, of the risk associated with consumption of contaminatedwater. Also, the results of this study suggests the imperative need to reassess policies on antibiotics use as well as develop new antibiotics to curb the problems posed by resistant strains.

Acknowledgements

We appreciate the technical support of all the technical staff of the Department of Microbiology, Federal University Dutsin-Ma, Katsina State, Nigeria. Dr. Matouke Moise of Department of Biological Sciences, Baze University, Abuja, Nigeria is also appreciated for volunteering to analysis some of the data statistically.

Financial support

This research was self-sponsored by the researchers.

Conflict of interest None to declare.

Ethical approval

Not required for water samples collection but was obtained before sampling of clinical samples from human in the hospitals.

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The post Prevalence and antibiogram study of Staphylococcus aureus isolated from clinical and selected drinking water of Dutsin-Ma, Katsina state, Nigeria appeared first on Nigerian Biomedical Science Journal.

Oluchi G Otuneme¹, Oluwasola O Obebe², Titus T Sajobi³, Waheed A Akinleye¹, Taiwo G Faloye¹

1. Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Ogun State, Nigeria.
2. Department of Veterinary Parasitology & Entomology, University of Ibadan, Oyo State, Nigeria.
3. Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria.

Abstract

Background: In recent years, the prevalence of schistosomiasis, a neglected tropical infection, has increased in underprivileged rural communities characterized by poverty.

Objective: This cross-sectional community-based study was carried out to determine the prevalence of urinary schistosomiasis in a neglected community of Apojola community, South-Western Nigeria at two points in time, spaced three years apart

Method and results: A total of 145 participants were screened and 44.1% were diagnosed to have urinary Schistosoma haematobium infection after sedimentation and microscopy. The prevalence of schistosomiasis among females was higher (45.3%) than that among males (42.4%) but not significantly different (0.723). The prevalence of participants with light infection (26%) was significantly higher than those with heavy infection (11.0%). The predisposing factors with statistically significant association with Schistosoma haematobium infection were age (0.000), level of education (0.002), eating/selling of snails (0.037), occupation (0.000), drinking water (0.001), swimming (0.008), and washing in a river (0.019).

Conclusion: These findings indicate that the study area is still endemic to urinary schistosomiasis after three years of research and school-age children and teenagers are the populations at risk of urinary schistosomiasis. Community health education on the cause, mode of transmission, prevention, and prompt treatment of schistosomiasis is recommended.

Keywords: Urinary Schistosomiasis, neglected community, Nigeria.

DOI: https://dx.doi.org/10.4314/ahs.v19i1.5

Cite as: Otuneme OG, Obebe OO, Sajobi TT, Akinleye WA, Faloye TG. Prevalence of Schistosomiasis in a neglected community, South western Nigeria at two points in time, spaced three years apart. Afri Health Sci. 2019;19(1): 1338-1345. https://dx.doi.org/10.4314/ahs.v19i1.5

Introduction

Schistosoma haematobium infection is known worldwide as an important chronic and debilitating disease mainly affecting underprivileged rural Communities characterized by poverty, poor sanitation and hygiene^1,2.

Schistosomiasis is one of the occupational associated infection that can be transmitted to a susceptible host or through recreation that involves contact with water infested with the free living cercariae that penetrate the skin and develops to maturity in the human^3,4. Other probable Schistosomiasis has been effectively controlled in many countries but its burden remains high especially in sub Saharan Africa including Nigeria.^4,5,3factors that influence transmission include environmental factors, water development schemes and people migration³.

In Nigeria, the burden of Schistosomiasis is enormous with an estimate of 101.3 million people at risk^6-9. The huge burden has been associated with water resources and development schemes such as irrigation projects, rice/fish farming and dams^10,11.

and behaviour change programs; and occasionally, snail Chemotherapy, water, sanitation and hygiene, education control has been suggested as an important aspect of schistosomiasis control programmes and Entomology, ¹². However, a better understanding of prevalence and risk factors for schisto-somiasis is important in controlling the disease. The high prevalence of urinary schistosomiasis obtained from Apojola community 3 years ago justified the need to assess the extent of control measures. As at the time of visit, Apojola still lack basic amenities such as sanitation facilities, a non-functional water borehole, good roads, health centre and electric power distribution. The present study was designed to determine the prevalence of schistosomiasis in a neglected community of Apojola, south-western Nigeria at two points in time, spaced three years apart

Study area

This study was ‘conducted between May and July 2017 in Apojola community located around Oyan dam reservoir in Abeokuta North local Government Area, Ogun State, Nigeria. Oyan river is located 07° 58’N and 03° 02’E with a catchments area of 1610km². The reservoir has a length of 27km with a maximum width of 67km.and was primarily built to provide hydroelectric power and provide water for domestic and industrial uses. It also meant to supply water for an irrigated project of about 3,000 ha as well as provide fishing ground for the adjoining communities. Inhabitants are immigrant fishermen, a mixture of Moslem Hausas and Christian Idomas (figure 1) Ethical, recruitment, enrolment and sample collection

Figure 1: Map showing the sampling sites in South-western Nigeria

Before the beginning of the study, the objectives and plan were explained to the village authorities to get their cooperation and permission to conduct the survey. The heads informed all the residents to gather at the village square where they received explanation about the objectives of the survey, benefits and their involvement. A total of 181 participants gathered at the village square and only 145 adults who agreed voluntarily to participate and children with parental consent were included in the study. They received labelled containers and were instructed to bring urine samples. Structured questionnaire was administered to each participant to obtain socio-demographic, sanitation and water hygiene information which was then analysed to determine associated risk factors to Schistosoma infection. The protocol for this study followed ethical procedures/guidelines and was approved by the Olabisi Onabanjo University Teaching Hospital, Sagamu (OOUTH) research ethics committee with protocol no OOUTH/HREC/57/2016.

Parasitological procedures

Urine samples were stored in closed containers using ice park and transported to the laboratory to determine the prevalence and intensity of S. haematobium infection. In the laboratory, 10ml of each urine sample was centrifuged at 5000 rpm for 5 min. The supernatant was discarded to leave the sediment, which was placed on aclean glass slide and covered with a coverslip. These slides were observed microscopically using x40 objective lens for the presence of terminal-spined ova of eggs of S. haematobium. A positive sample was indicated by the presence of ova of S. haematobium and expressed as number of eggs/10ml of urine¹³, and the intensity of infection was graded as heavy (> 50 EP10 mL), moderate (10-49 EP10mL) and light (1-9 EP10 mL). A negative sample was indicated by the absence of parasite eggs¹³.

Data analysis

Data entry and analysis were carried out using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). Appropriate univariate and bivariate statistics were employed. Frequency tables and percentages were used to display categorical data. The Chi square was used to compare categorical data. Statistical significance was determined at the level of p < 0.05.

Sociodemographic characteristics of study participants

A total of 145 urine samples were collected and analysed for urinary Schistosomiasis. The characteristics of the study participants are shown in Table 1. The age range of the study participants was (5–59 years). Of the 145 participants, 59.3% (86/145) were female and 40.7% (59/145) were male, giving a gender ratio of 1.46: 1 (females: males). The majority (55.2%) of the participants were of the age range 5–15years (figure 2). 68.3% of the study participants had primary school education and 58.6% of

the participants are students (Table 1) Prevalence of schistosoma haematobium

The overall prevalence of Schistosoma haematobium infection in the study population is 44.1%. Urinary schistosomiasis was more prevalent among females (45.3%; 39/86)

Table 1: Socio-demographic characteristics of participants in a neglected community, Nigeria

Variables Frequency %

Figure 2: intensity of Schistosoma haematobium infection among participants

than in males (42.4%; 25/59). However, there was no significant different between Schistosomiasis and gender (0.723). There was an association between Schistosoma haematobium infection and variable such as age (0.000), level of education (0.002), eating/selling of snails (0.037), occupation (0.000), drinking water (0.001), swimming

(0.008), and washing in river (0.019) (Table 2)

Intensity of Schistosoma haematobium

The intensity of infection of participants is shown in Figure 2. Light, moderate and heavy infections were detected in the study using centrifugation method for the egg

count. Of the 145 persons examined for urinary Schistosomiasis in the study area, 61% (n=88) were found to be negative for the presence of Schistosoma haematobium egg, 2% (n=3) were excreting between 1-9eggs/10ml, 26% (n=38) were excreting between 10-49eggs/10ml urine, while 11.0% (n=16) were excreting above 50 eggs/10ml urine.

Discussion

The study showed a high prevalence of Schistosoma haematobium infection among resident of Apojola community, Nigeria. Previous studies in Nigeria^14-17 and other countries like Ghana¹⁸ and Cameroon¹⁹, reported a comparable prevalence of Schistosoma haematobium infection.

However, data from various parts of Nigeria^20-22, showed lower prevalence than that obtained in the present study. Factors including poverty, ignorance, poor living conditions, inadequate sanitation and water supplies as well as deplorable personal and environmental hygiene characteristic of many rural communities have been suggested as reasons for variation in prevalence of infection²³. The frequency of infection was higher among the female participants compared to the male counterpart, although there was no statistical significance in the association. A study carried out in Nigeria found similar results²⁴ while others reported the opposite^25,26. The fact that fetching water and washing clothes are seen as female responsibilities in Nigeria, suggests the likely reason for Schistosoma haematobium infection preponderance among females. In the present study, prevalence was higher among schoolaged participants and the association was statistically significant. Previous studies reported higher infections among younger age group in Nigeria²⁷, Malawi²⁸ Cameroon²⁹ and Cote d’Ivoire³⁰. The higher prevalence among younger age group is not surprising. This is because this same group are the most commonly found in persistent and unrestrained water contact activities such as bathing and swimming. In addition, participants’ levels of education and occupation showed a statistical association with urinary schistosomiasis. This is supported by the findings of some previous study that associated higher infections with different level of education and occupation^31,32. The higher prevalence may be suggestive of their frequency of going to the river. In addition, the high illiteracy and neglect levels of the parents, observed in the study area, can lead to the non-education of preventive measures to their children, therefore influencing transmission pattern

Eating/selling of snails, using the stream as a source of drinking water, swimming, and washing in a river were significantly associated with Schistosoma haematobium infection. In accordance with our findings, previous studies reported similar observations^9,33,28. Water contact activities and traditional agricultural practices such as washing, fishing, bathing, and farming may influence the transmission of the disease in many parts of Nigeria.

Furthermore, the prevalence of participants with light infection was significantly higher than those with heavy infection. The higher prevalence of light infection reported here was in accordance with findings of Uneke et al.,³⁴ an indication that the distribution of schistosomiasis in endemic communities fits a negative binomial curve, with most infected individuals harbouring low worm burdens and only a small proportion having heavy infections³⁵. However, according to Secor et al.,³⁶, the aggregation of worm load in a small percentage of infected individuals may have various explanations including genetic vulnerability and the implication of these epidemiologic results are important to our understanding of the dynamics of the Schistosoma haematobium infection and its control in the populations studied.

We acknowledge some limitations of our methodology. This study had to rely on sedimentation method instead of the ideal filtration technique. In addition, our study was conducted on a smaller scale instead of the ideal larger scale. Thus, the prevalence rates of schistosomiasis are likely to be underestimated

Conclusion

The prevalence of 62%³⁷ obtained 3 years ago compared with present 44.1% prevalence obtained in the study area shows that participants in Apojola community and its environ are still plagued with urinary Schistosomiasis. It seems that adequate control measures had not been deployed to this endemic zone of schistosomiasis. Therefore, there is an urgent need for Government to mount successful control interventions such as the provision of safe water supply, development of recreational water bodies to avoid contact with present infested water, control of snail vector, public awareness and education regarding urinary schistosomiasis in the area.

Also, the report from our study is an indication that the school age children and teenagers are the population at risk of schistosomiasis. Control measures should, therefore, be targeted more on this at-risk group in the study area.

Acknowledgments

The authors would like to express their appreciation to Apojola community for given consents prior to sample collection

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors

Competing interests

The authors declare that they have no competing interests.

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The post Prevalence of Schistosomiasis in a neglected community, South western Nigeria at two points in time, spaced three years apart appeared first on Nigerian Biomedical Science Journal.

¹Ogbomade, Ronami S., *²Ephraim-Emmanuel, Benson C., ³Okorie, Uzoma C.

1. Department of Science Foundation, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
2. Department of Dental Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
3. Department of Community Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.

Corresponding author*: Ephraim-Emmanuel, Benson Chukwunweike.

Phone Number: +234-806-003-8135 Email: benchike2002@yahoo.com

Abstract

Background and Aim: Oral habits are complex patterns of learned behavior that is characterized by muscle contractions which are usually related with a number of factors occurring in the individual practicing the habit. They have the capacity of causing dental health problems. It is thus the aim of this study to determine the prevailing oral habits and related factors.

Materials and methods: A descriptive research design was used. This study was conducted among primary school children. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The instrument for data collection was a structured self-administered questionnaire. The instrument was distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. Ethical considerations, permission, consent and confidentiality were ensured for this study.

Results: 77.2% of children of study respondents were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced. However, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). Major measures utilized to stop these habits included flogging the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the oral habits (19.6%).

Conclusion: The practice of oral habits is a problem within the study area. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to stop the habit. It is however recommended that oral health education programmes be provided to improve awareness of the deleterious effects of oral habits on oral health. Emphasis should also be placed on the use of positive rather than negative reinforcement as a measure to enhance cessation of the habit.

Keywords: Oral habits, Malocclusion, Primary School Children, Yenagoa, Nigeria

Introduction

Habits have been described as complex patterns of learned behavior characterized by repetitive actions which occur involuntarily. Within the context of the oral cavity, oral habits are complex patterns of learned behavior that is characterized by complex muscle contractions which are usually related with a number of factors occurring in the persons practicing the habit. These could include fear, anger, ease of tension, hunger, sleep etc. ^(1,2).

These habits are basically classified as being nutritive and non-nutritive. The nutritive habits include oral habits related with sucking action of a child including bottle feeding as well as breast sucking. However, for the purview of this study, the non-nutritive class of oral habits is more of interest. These oral habits include nail biting, finger sucking, lip sucking etc. They are those habits which occur in relation to the mouth and could be initiated by prevailing events and circumstances being experienced by the individual practicing the habit. These circumstances include boredom, fatigue, hunger, emotional stress etc. ^(2,3). They are prevalent among children especially in the infantile period of life but have also been reported among older individuals. It is however generally believed that the habit stops spontaneously. ^(1,3). Various manifestations of poor dental health including dental caries, periodontal disease, malocclusion, poor oral seal, speech defects etc; could occur depending on the nature of an oral habit, onset of the habit as well as its duration ^(4). Those who practice these habits for more than six hours in a day generally tend to develop more serious dental health problems than those who do so for lesser amounts of time in a day. ^(1,5-8). In order to stop the occurrence of these habits, a number of measures have been utilized. These include application of interceptive orthodontics, motivation of the child to stop the habit, placing distasteful liquids on the nails or fingers, oral health education, behavioral treatment as well as the use of anti-anxiety medications etc. Seeing that the severity of oral health problems that are likely to occur are directly proportional to the length of occurrence of the offending oral habits, it is essential that oral health education targeted at improving awareness of the adverse effects of these habits be encouraged ^(1,9). The problem of oral habits being one for which children are especially susceptible and which can be initiated by circumstances normal to every human could certainly be prevalent among children residing in Yenagoa, Bayelsa State, Nigeria. There is however no published reports to confirm this.

It is thus the aim of this study to determine prevailing oral habits within the study area as well as factors known to stimulate its occurrence and measures geared at arresting its occurrence.

Materials and Methods

A descriptive research design was used in the assessment of oral habits practiced among school children in Yenagoa. This was adequate as it effectively enabled description of the study variables in its natural setting. This study was conducted in primary schools located in Ekeki Yenagoa Local Government Area of Bayelsa State and the targeted population was the primary school children attending these schools. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The spin-a-bottle random sampling technique was then used in selecting the required number of primary schools to make-up our sample size at Ekeki, Yenagoa. The instrument for data collection was a structured self-administered questionnaire. The instrument was divided into two sections. Section A to collect demographic data while section B to elicit information on the oral habits of the children. The questionnaires were distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. The instrument was retrieved from the children one week later. For the purpose of this study, the research instrument was submitted to a dental professional who assessed it for both content and face validity. Upon collation using the Microsoft Excel software, data was presented on tables, charts and expressed as frequencies and percentages.

Ethics clearance to carry out this research was gotten from the Project Research and Ethics Committee of the Bayelsa State College of Health Technology. Permission to carry out this study was sought from the school authorities. Participation for the study was on a voluntary basis and informed consent was sought from the parents and guardians of the primary school children. Data collected from participants was treated as confidential.

Results

Altogether, 230 questionnaires were distributed and 184 were retrieved and completed properly. This gives a response rate of 80%. Majority of the respondents was female (51.6%) and 48.4% were male. 35.3% of the respondents were aged between 7 and 9 years, 32.1% aged between 4 and 6 years amongst other age groups. The demographic data of our study respondents’ is shown on Table 1.

Table 1: Demographic data of respondents

Practice of Oral Habits

Regarding the practice of oral habits among the participants of this study, multiple responses were entertained regarding oral habits practiced and when the habits were practiced the most. Most of them (77.2%) were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced among the children. As at the time of this present study, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits which they earlier manifested. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). This information is shown on Tables 2, 3 and 4 as well as on Figure 1.

Table 2: Practice of oral habits

Table 3: Oral habits practiced in the past (before this study)

Table 4: Oral habits being practiced presently

Figure 1: When the oral habits are practiced

Stopping the Oral Habit

Among the 142 participants that had practiced oral habits, 24.6% of the parents/guardians of the participants of this study did not do anything to stop the habits. However, among the 75.4% who did something to stop the habit; the major measures utilized to stop these habits included flogging/whipping the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the practice of the oral habits (19.6%), creating distractions such as engaging the children in activities, shouting at the children etc; as well as placing bitter leaf on the hand or in the mouth of the child practicing the oral habit. This information is shown on Table 5.

Table 5: Measures carried out to stop the oral habits

DISCUSSION

The occurrence of oral habits has been reported to be a common problem among paediatric patients which has the ability to affect the quality of life of the individual ^(7). Considering that oral health is an integral part of general health and that the general health plays a role in ensuring general quality of life, it is important that these kinds of problems be tackled as quickly as possible whenever they are noticed ^(10). Specific initiators of these habits including hunger, boredom, anxiety, anger, tiredness as well as fear should also be quickly addressed whenever implicated. The use of positive reinforcement in these cases is of utmost importance in order to relieve the emotional stress that is likely involved in the practice of the oral habit ^(5).

This study revealed that a majority of the respondents affirmed that their children practiced oral habits in the past and still continued practicing them. This is a finding that is corroborated by the findings of other authors who reported similar results regarding the practice of oral habits among children ^(11). The implication of this is that this condition is one that is of public health concern considering the age group it mostly affects as well as the problems it may pose to the quality of life of the affected individuals. This thus calls for a more globalized strategy to adequately prevent its occurrence as well as nip it in the bud in the shortest possible time whenever noticed ^(11). The findings of Pruthi et al, (2013); however do not support the present study findings as they reported a prevalence of deleterious oral habits of 25.9%. The reason for this could have been because of the ages of 12 and 15 years used in selecting their study population ^(12).

Fingernail biting, finger sucking and teeth grinding (bruxism) were the most reported habits practiced by the children in this study. This finding agrees with those of authors who reported similar findings in their studies especially regarding nail biting ^(3,8). There is however a significant implication of this finding in that the reported habits in this study have been reported to be directly related with psychological/emotional disturbances. The occurrence of these habits thus implies that measures need to be taken to relieve or treat the emotional/psychological disturbance which in turn helps in stopping the habit. ^(5,10,13). However as seen in this study, the most utilized method of stopping the habit was flogging the children or meting out punishments to them. These forms of negative reinforcement have been shown to be capable of further worsening the emotional or psychological disturbance affecting those manifesting the habit and thus strengthen the practice of the habit rather than stop it ^(5). It is however noteworthy to point out that some form of positive reinforcement through encouragement was also utilized in this study to stop the habits. It is recommended that positive reinforcement methods are utilized in these situations because if the emotional or psychological disturbance can be corrected, it makes it easier for the habit to be stopped as well as boost the self-confidence of the individual especially in children ^(1,14).

In our study, sleep, boredom, hunger and anger were found to be the most reported factors that occurred during the practice of the oral habits. These are similar to findings in other studies that reported similar circumstances to influence the occurrence of oral habits ^(13). It is necessary to point out that to any of the circumstances reported to influence the occurrence of oral habits, the specific remedy should be provided in order to aid the cessation of the habit. In the case of hunger, food is required; for emotional disturbances involving anger or anxiety, effort should be made to pacify the angry or anxious emotion. This could be in form of positive reinforcement. Engaging the child in productive activities or distraction with toys following a gentle withdrawal of the part of the body being used during the habit, could also be utilized as a remedy for boredom etc ^(1). Interceptive orthodontics, a branch of dentistry that provides treatments that effectively help in the cessation of oral habits should however be incorporated when the need arises especially in cases of compulsive oral habits ^(11,12).

Generally, it is more beneficial to prevent the occurrence of oral habits or to provide necessary information to encourage prompt cessation of the habit when noticed. Preventive measures could include provision of dental health education programmes to provide enlightenment on the issue of oral habits and how to prevent its occurrence. Education should also be provided on how to differentiate between acquired oral habits (which could be easily stopped as the child grows older) from compulsive oral habits which are more inclined towards emotional imbalance initiators ^(5).

CONCLUSION

The practice of oral habits is a problem in the area in which this study was conducted. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to curb the habit. It was however recommended that less of negative reinforcement and more of positive reinforcement methods be utilized in helping to stop these habits considering that most of the habits were non-nutritive in nature and could have been precipitated by emotional or psychological imbalances which are best managed by adequate support and motivation of the child.

Authors’ contributions

Ephraim-Emmanuel, Benson C. and Okorie UC developed the manuscript protocol, were involved in literature search and review for this manuscript. They were also involved in conducting the study and development of the final manuscript. Ogbomade, Ronami S. was involved in the revision process of the manuscript as well as in development of the manuscript transcript. All authors have approved the write-up of the final manuscript for publication. There are no conflicts of interest regarding this manuscript.

REFERENCES

1. Shahraki N, Yassaei S, Moghadam MG. Abnormal oral habits: A Review. J Dent Oral Hyg,2012;4:12-5. DOI:10.5897/JDOH12.001. ISSN 2141-2472. Available online at http://www.academicjournals.org/JDOH
2. Kharat S, Kharat SS, Thakkar P, et al. Oral habits and its relationship to malocclusion: A Review. J Adv Med Dent Sci Res, 2014;2:123-6.
3. Almonaitienė R, Balčiūnienė I, Tutkuvienė J. Prevalence of oral habits and their impact on facial parameters in Lithuanian children 4 to 9 years of age. Medicinos,2013;19:31-8.
4. Joelijanto R. oral habits that cause malocclusion problems. Int Dent J,2012;1:86-8.
5. Jyoti S, Pavanalakshmi GP. Nutritive and non-nutritive sucking habits – effect on the developing oro-facial complex; a review. Dent, 2014;4:203. DOI:10.4172/2161-1122.1000203.
6. Chour RG, Pai SM, Chour GV, et al. Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old children in Davangere city. J Ped Dent,2014;2:37-43. DOI: 10.4103/2321-6646.137676. Available online at: www.jpediatrdent.org
7. Suchita MT, Sheetal R. Tongue thrusting habit: A review. Int J Contemp Dent Med Rev, 2015. DOI: 10.15713/ins.ijcdmr.26.
8. Giugliano D, Apuzzo F, Jamilian A, Perillo L. Relationship between Malocclusion and oral habits. Cur Res Dent,2014;5:17-21. DOI: 10.3844/crdsp.2014.17.21
9. Gowri SS, Chetan K. Tongue thrust habit – A review. Ann Essences Dent,2009;1:14-23.
10. Leme MS, Barbosa TS, Gavião MBD. Relationship among oral habits, orofacial function and oral health-related quality of life in children. Braz Oral Res., (São Paulo), 2013;27:272-8.
11. Lagana G, Masucci C, Fabi F, et al. Prevalence of malocclusions, oral habits and orthodontic treatment need in a 7- to 15-year-old schoolchildren population in Tirana. Prog in Orthod,2013;14:12. Available online at: http://www.progressinorthodontics.com/content/14/1/12
12. Pruthi N, Sogi GM, Fotedar S. Malocclusion and deleterious oral habits in a north Indian adolescent population: A correlational study. Eur J Gen Dent,2013;2:257-63.
13. Seraj B, Shahrabi M, Ghadimi S, et al. The prevalence of bruxism and correlated factors in children referred to dental schools of Tehran, based on parents’ report. Iran J Ped,2010;20:174-80.
14. Aasim FS, Manu B, Sudeep CB, et al. Oral habits and their implications. Ann Medicus,2014;1:179-86.

The post Assessment of Oral Habits among School Children in Yenagoa, Bayelsa State, Nigeria appeared first on Nigerian Biomedical Science Journal.

Louis Odeigah¹, Shittu O Rasaki¹, Ajayi F Ajibola², Ameen A Hafsat³, Abdullateef G Sule⁴, Yusuf Musah⁵

1. Department of Family Medicine, University of Ilorin Teaching Hospital, Kwara State, Nigeria.
2. Department of Anatomy, Kwara State College of Nursing and Midwifery, Ilorin. Tel: +2347036999373. 3. Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin.
3. Department of Family Medicine, Ahmadu Bello University, Teaching Hospital, Zaria, Nigeria.
4. Department of Medicine, Federal Teaching Hospital Ido-Ekiti, Nigeria.

Author details:

Shittu O Rasaki Tel: +2348035062687. Email: oorelopehospital@gmail.com, Ajayi F Ajibola,Tel: +2347036999373. Email: jimmyayayi30001@yahoo.com, Odeigah O Louis,. Email: lodeigah@yahoo.com, Ameen A Hafsat: Tel: +2348033937472. Email: hafkam2005@gmail.com, Abdullateef G Sule: Tel: +2348065535088. Email: gbensule@yahoo.com, Yusuf Musah: Tel: +2348033750480. Email: yusmusah@yahoo.com

Abstract

Background: The consequences of high risk sexual practices (HRSP) are enormous among adolescent senior secondary school students. They therefore need to have sufficient knowledge of HRSP.

Aim Objectives: The study gauged the level of knowledge and perceptions of high risk sexual behavior among senior secondary school students in Ilorin, Nigeria with a view to improving their understanding of the current trends in HRSP.

This was a quantitative, cross-sectional, descriptive study of adolescent secondary school students in Ilorin East Local Government Area. Multi – stage sampling method involving 3 stages was used. A semi-structured interviewer administered questionnaire was used to obtain data. Informed consent of respondents was obtained. The data was analyzed using SPSS windows software package version 17.

Results: Majority, 305 (69.5%) of the students were between 16 – 20 years. The major source of information was from movies, 42.5%, and the internet, 24.7%. Twenty-three percent (23.1%) had poor knowledge of HRSP. Thirty-eight percent (38.1%) did not consider indiscriminate sexual intercourse as HRSP while 27.9% still believed that unprotected sexual practice is safe. Thirty-four percent (34.2%) did not know that sex with multiple partners is a HRSP while 34.4% did not know that oral –genital sex is unsafe. Over thirty-two (32.9%) perceived that engaging in sex made them mature among peers. Twenty-four (24.7%) did not perceive any danger in keeping multiple sexual partners while 15.3% would still engage in unprotected sex.

Conclusion: The students had relatively poor knowledge and perceptions of HRSP. Quite a number did not consider indiscriminate sexual intercourse as HRSP. An appreciable number did not perceive any danger in keeping multiple sexual partners or being engaged in unprotected sex. Counselling on the dangers of HRSP should be a component of the school health services so as to curb the complications of HRSP in our secondary schools.

Keywords: Knowledge, attitude , perception , high risk sexual practices, Nigeria.

DOI: https://dx.doi.org/10.4314/ahs.v19i1.20

Cite as: Odeigah L, Rasaki SO, Ajibola AF, Hafsat AA, Sule AG, Musah Y. High risk sexual behavior among adolescent senior secondary school students in Nigeria. Afri Health Sci. 2019;19(1). 1467-1477. https://dx.doi. org/10.4314/ahs. v19i1.20

Introduction

An adolescent is defined by the National Adolescent Health Policy in Nigeria as an individual between the ages of 10 and 24 years. This age group makes up one third of Nigeria’s total population of 180 million¹ whereas the World Health Organisation (WHO)² defines an adolescent as an individual between ages 10 to 19 years. It is

© 2019 Odeigah et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

the most turbulent stage of human development and it is characterized by indiscriminate sexual escapades.³ The National Family Health Survey (NFHS)⁴ defines high risk sexual behavior as sexual intercourse with somebody who is neither a spouse nor a cohabitating partner. Factors that predispose to high risk sexual practices are: early sexual debut, cultural practices, drug abuse and illiteracy. The mean age of 15 years for sexual debut has been reported in Nigeria.⁵ Religion, government policies, socioeconomic status, place of residence, family, gender, constitute distant conceptual framework on adolescent sexual risk taking in Nigeria while the mass media, communication, peer influence, contraception, and early marriage constitute the proximal factors.

Adeyemo and colleagues’⁶ in their study indicated that female adolescents with higher religiosity scores were more likely to initiate sex at a later age.. Studies have documented the association between socio-economic status and sexual behavior.^7-8 High levels of family cohesion lead to bonding, and low levels of cohesion indicate poor family support, which could lead to a family dysfunction. Low family cohesion is associated with adolescent sexual risk behavior.⁹

The Bello et al in their study¹⁰ showed that the mean age of sexual initiation was 15±2.6years with more than a quarter (28.3%) of the respondents having sexual exposure and about 40 percent having more than one sexual partner and over a third had their first sexual exposure the same day they met the partner (37.6%).¹⁰

Multiple sex, is sexual intercourse with more than one partner. Homosexuality is romantic behaviour between members of the same sex. The most common terms for homosexual people are lesbian for women and gay for men.¹¹ Two percent (2%) to 13% of the world’s population are homosexual.12 Having multiple sex partners is a sexual risk taking behavior. Izugbara et al showed that respondents were aware that having multiple sex partners was a risk factor for several negative health outcomes, including contracting, sexually transmitted infections – STIs.¹³

Anal sex is sexual acts involving the anus. It involves, pegging, anilingus, fingering and object insertion. Pegging is the form of practice whereby the female wears a penis- like object and inserts it into the anus of the female partner. Anilingus is oral stimulation of a person’s anus. Fingering is the insertion of fingers into the sexual partner’s anus/vagina. The risks associated with these practices include trauma, ano-rectal fissures, rectal prolapse, infections and anal cancer.¹⁴

Oral sex is any sexual activity involving the stimulation of the genitalia by the use of the mouth and tongue.¹⁵ Terms identified in this form of sexual practice are: cumillingus which is oral sex performed by females, fellatio refers to oral sex performed by males while anilingus refers to oral stimulation of a person’s anus.

Transactional sexual relationship is a situation whereby gifts, (monetary/non-monetary) and services are given or collected in exchange for sex.¹⁶ This is common in sub-Saharan Africa due to the extreme poverty in this region.¹⁷ The threat of reproductive health hazards confronting the youth in Nigeria should be a focus of research and advocacy. The problem associated with youth sexuality, such as unprotected sexual activities and inability to negotiate safe sex become readily apparent.¹⁸ This study is therefore aimed at assessing the level of knowledge of HRSB aswell as the perception of HRSP of secondary school students in Ilorin, North Central Nigeria.

Methods

Ilorin is the state capital of Kwara State with an estimated population of 847,582 as at 2007. Ilorin metropolis consists of 3 local governments namely; Ilorin East, Ilorin West and Ilorin South which consist of 12, 12 and 11 wards respectively with numerous communities. IlorinEast local government area has an area of 486 km² and a population of 204,310 as at 2006. Ilorin East has her headquarters in Oke-Oyi and consist of communities such as Apado, Sango, Sabo-Oke, Oke-Ose, Sobi, Maraba and Okelele among others.

This research was approved by the Ethical Committee of the Kwara State, the Kwara State Ministry of Education and the school authority. Informed consent of respondents was obtained. This was done through a section of the questionnaire in which respondents indicated their willingness to participate in the study voluntarily. Respondents were also made to understand that they could voluntarily withdraw at any time of the study. There are 40 secondary schools in the local government area; 24 public and 16 private which have the population of senior secondary students of 8,952 and 1,170 respectively. These bring the total population of senior secondary school students in the local government area to 10,122. It is in this local government area that we have prominent secondary schools such as Government Secondary School (GSS) Ilorin, Saint Anthony’s Secondary School Ilorin, Cherubim and Seraphim (C&S) College Ilorin among others. The senior secondary school curriculum mandates biology as a compulsory subject for students and parts of the body and reproduction are areas covered in this subject. This gives the students a basic knowledge and understanding of the body and sexuality. The communication channels through which information is passed to the general public in Ilorin include newspapers, radio, television, billboards and postal. There are two major television stations in the city which are Nigerian Television Authority (NTA), Ilorin and Kwara Television. The prominent radio stations based in Ilorin include Radio Kwara, Midland FM, Royal FM and Unilorin FM.

The major social settings that influence sexual behaviour of adolescents in Ilorin include the presence of popular beer parlors all around the local government area. Also, female sex workers are found in identified hotels and some are also found on the streets where they receive patronage. There are also night clubs and relaxation centers that host parties and settings that create avenues for many high risk sexual practices. These places and activities influence the perception of adolescents to sexual practices since they are aware of such avenues and also sometimes they see what goes on in such places. Also, this will affect perception of lifestyle modification towards health promotion.

It is also important, to note that the Kwara state ministry of Health and Kwara State Agency for Control of AIDS (KWASACA) carry out activities on HIV/AIDS such as awareness programmes and public sensitization on the mass media among other activities. The role of the activities of non-governmental organizations (NGOs) on HIV/AIDS has also been important in the prevention and control of the disease in the local government areas and the state at large.

This was a cross-sectional, descriptive study of secondary school students in Ilorin-East local government area. Ten senior secondary students selected for the study were given interviewer administered questionnaire in order to acquire information on the knowledge, attitude and perception of high risk sexual practices.

The minimum sample size used was determined using the Andrew Fischer’s¹⁹ formula for studying population greater than 10,000, degree of accuracy desired, which is set at 0.05, standard normal deviation which is set at 1.96 which corresponds to the 95% confidence level. Prevalence of a factor within the study population (63% – percentage of adolescents found to be already sexually active in Ilorin by Araoye and Fakeye)²⁰. The calculated sample size was 400. However, 450 was used to increase the power. Multistage sampling method involving 3 stages was used.

Stage one – There are forty (40) secondary schools in Ilorin-East local government area. Simple random sampling was used to select 10 schools out of the 40 secondary schools. This was done through balloting. The population of the senior secondary students in each of the selected schools was gotten during the advocacy visit. Proportionate allocation of respondents sampled in each of the 10 schools selected was done using the population of the schools, to estimated total population and sample size for the study.

Stage two – The class of the schools exist as natural strata. Stratified random sampling was used to determine the number of students sampled in each of the classes and arms of the selected schools. The senior secondary is divided into levels (SSI, SSII and SSIII). Also, proportionate allocation of respondents from each level was used. Total Population of Senior Secondary School Students in the 10 Schools Sampled was 6348. The Sample Size was 450

Total Population of senior secondary school students

Stage three– Simple random sampling was done to select the respondents from each of the schools and class levels. A semi-structured interviewer administered questionnaire was used as the instrument to obtain data from the respondents. The questionnaire was in three sections viz: Demographic data of the respondents, assessment of the knowledge of respondents of high risk sexual practices and assessing the perception of respondents to high risk sexual practices. Respondents were also made to understand that they could voluntarily withdraw at any time of the study. Data collected were strictly confidential. Quantitative data was collected through the use of semi- structured interviewer administered questionnaire. The data sheets were sorted, collated and coded. Data entry was carefully done. The analysis of data collected was done using SPSS windows software package version 17. The responses were coded after the collection of the raw data and were correctly analyzed based on the objectives of the study. Chi-square was used to test significance level.. Results obtained were presented as percentage and in the form of tables and charts. The total package of the analysis is a reflection of the broad objectives of the study as well as the socio-demographic data of the respondents at the level of significance at P = 0.05.

The specific objectives identified the socio-demographic variable of respondents, the level of knowledge of high risk sexual behavior as well as the perception towards high risk sexual behavior among secondary schools in

Ilorin.

Results

Table 1 shows the socio-demographic characteristics of respondents. Majority 305 (69.6%) of the respondents were between ages 16-20 years. The male among the respondents were 254 (58.0%) while the female accounted for 184 (42%) respondents. The predominant religious groups were found to be Christianity and Islam accounting for 50.0% and 49.3% of respondents respectively. The Yorubas were the predominant ethnic group accounting for 342 (78.1%). The other ethnic groups found among respondents classified under ‘Others’include Ebira, Isoko, Ishekiri, Nupe, Fulani and Baruba. The family sizes of majority (65.1%) of the respondents were found to be 6-10 people.

Table 2 shows that 167 (38.1%) did not consider indiscriminate sexual intercourse as HRSP while 61.9% were aware of condom use. Also, (117) 26.7% did not know that multiple sex partners is a HRSP. A proportion of 122 (27.9%) did not know that unprotected sex with a partner of unknown status was a HRSP. Respondents’ knowledge of anal sex as a HRSP showed that 150 (34.2%) did not

know that anal sex is a HRSP. Homosexuality was not known to be a HRSP by 156 (35.7%). The proportion of respondents that did not know that oral-genital sex is a HRSP was 151 (34.4%). A proportion of 305 (69.9%) and 308 (70.3%) knew that giving and receiving sex in exchange for money/gift/service are HRSP. Three hundred and five (69.6%) knew that sex for money was a HRSP.

Knowledge of respondents on high risk sexual practices

Table 2– frequency distribution of respondents’ knowledge on high risk sexual practices

Knowledge of respondents on high risk sexual prac- Table 3 shows the proportion of respondents who cor-

tices rectly answered 7-10 questions on risky sexual practices.

Table 3 – frequency distribution of respondents’ knowledge score on high risk sexual practices

One hundred and one (23.1%) had poor knowledge.

Table 4 shows the frequency distribution of respondents’ perception toward HRSP. One hundred and forty four (32.9%) felt engaging in sex makes one to be considered as mature among peers while 208 (47.5%) felt there was no spiritual attachment to sex. There were 56 (12.8%) of respondents who could be friends with homosexual colleagues. Most of the respondents 333 (73.7%) considered it to be shameful to pay or collect money/service in exchange for sex while 108 (24.7%) did not perceive any danger in keeping multiple sexual partners. Also, 67 (15.3%) would still engage in unprotected sex if opportunity presented. Majority 387 (88.7) agreed that unbridled sex freedom should not be allowed while 353 (80.5%) believed that students caught in any form of sexual practice should be severely punished.

Table 4 – frequency distribution of respondents’ perception towards high risk sexual practices

Response Yes (%) No (%) Indifferent

(%)

allowed in the school

Table 5 – frequency distribution and chi-square significance of respondents on knowledge level on high risk sexual practices and socio-demographic characteristics

Discussion

This study assessed the knowledge and perception of high risk sexual practices among respondents sampled from 10 senior secondary schools in Ilorin-East Local Government of Kwara State. Out of the 450 respondents sampled 438 questionnaires were valid and completed. The response rate was 97.3%.

Majority of the students were between 16 – 20 years and with a mean age of 16.23 + 4.75. The expected age for the students in the senior secondary level of education was between 13 and 19 years. This is a reflection that they were relatively young and sexually active. This was confirmed by the National Demography Health Survey (NDHS) which revealed that nearly half (48.6%) of adolescents aged 15 – 19 were sexually active (NDHS, 2008).²¹

The study showed that males are more prone to high risk sexual behavior than females. This is because their libido is generally greater than that of females and continues even to old age while that of female diminishes as they get older. This made Hoffman,²² Kirby²³ and Dryfoss²⁴ state that interventions that use attitude change to change behavior may be more effective among females than among males. Osarenren²⁵ also stated that young men have a very strong passion about sex and they try to satisfy themselves quite indiscriminately.

The respondents were found to be mainly of the Yoruba extraction which is a reflection of the ethnic distribution of the Ilorin populace according to census and previous studies.²⁶

The family sizes of respondents were found to be predominantly 6-10 people (65.1%).There has been previous studies that conform to this finding.^27,28 The family as a unit of care can mitigate adolescent problems. High levels of family cohesion lead to bonding and low levels of cohesion indicate poor family support, which could lead to a family dysfunction. Family members also exert influence on adolescents through their own modeling of risk behavior and through shared core family processes.

The cumulative knowledge on high risk sexual practices was 65.1% which is consistence with previous studies.²⁹ About, 23.1% of respondents still have poor knowledge of high risk sexual practices which show that a proportion of secondary school students still need to be educated on high risk sexual practices. The relatively high knowledge about these high risk sexual practices should not be sufficient reason to stop discussing the perceived high level of unsafe sexuality behavior among secondary school students.^27,30 Therefore, there is need to review health education strategies towards ensuring not only knowledge but also practice of safe sexual behaviour.

One third of the respondents did not consider indiscriminate sexual intercourse as HRSP. This is lower than two thirds recorded by Akanle and co-workers.³¹ Majority of the respondents know that unprotected sex is unsafe hence the need to be protected during sex. In this study two thirds were aware of condom use. This is comparable to the study of Folayan et al,³² but a departure from the study by Asekun – Olarinmoye and colleagues²⁷ who reported that there was no much difference between those using condom and those who didnot.

The level of knowledge on sex for money, gifts and services being HRSP was higher than that in the study by Odu and colleagues³³ in South West Nigeria where one third of the respondents received gifts or services for sex. The study established that it is shameful to pay or collect money/services in exchange for sex. At the national level, about 10 percent of females and 26 percent of males aged 15-24 years engaged in transactional sex in 2005.³⁴ Wusu et al.,²⁹ found that factors influencing involvement in transactional sex include poverty, broken homes, peer influence and desire to make cheap money. The data from this study suggest that most students who engaged in transactional sex rarely used measures of protection such as condoms and most of the partners who engaged students in risky sexual behaviour were of higher social and economic status.³⁴ This inequality in social and economic status makes it very difficult for the students to negotiate safe sex, hence increasing their vulnerability to sexually transmitted infections (STIs) and HIV.³⁴

The knowledge on genito-oral sex as HRSP was higher, hence better off than that of the study of Morhason– Bello¹⁰ in Nigeria where half of the respondents practiced oral sex. Folayan et al,³² found out that oral sex was practiced by 15.1% male and 23.5% female adolescents. Male to male oral sex was reported by 7.6% adolescents while 12.0% adolescents reported female to female anal sex. Similarly, Folayan et al, also found out that anal sex was practiced by 5.6% males and 3.4% female. Male to male anal sex practice was reported by 2.2% adolescents; male to female anal sex was reported by 5.9% adolescents and female to female anal sex was reported by 0.8% adolescents. More than 11.6% males engaged in heterosexual anal sex.

Similar, multiple sex partners were recorded as HRSP by more than one third of the respondents. This is an improvement in knowledge over the two third of the respondents who practiced multiple sex in a study in South West Nigeria. The study shows that there is danger in multiple sexual partners.

Majority agreed that unbridled sex freedom should not be tolerated and those caught in any form of HRSP should be severely punished. This is in conformity with previous studies.¹⁶ This is an example of right perception that helps in preventing HRSP among secondary school students.

There are a number of sources through which information is received by the public. Higher proportion of respondents in this study identified that their major source of information on high risk sexual practices was movies and internet. Quite a considerable proportion also got information from friends and classmates. This finding is consistence with previous studies which found that movies, friends and internet are the major sources where information about high risks sexual practices were obtained.³⁵ In some studies, school mates were key sources of information about sexual practices across the classes: some respondents in the entry class (77.9%), 65.7% in the mid-class and 78% in the exit class reported that they got information about sexual practices from their school mates. More than half of the respondents in the exit class (58.3%) reported that their source of information about sexual practices was the Internet.¹³

Conclusion

The knowledge and perception of HRSP among adolescents in senior secondary school in Ilorin East Local Government is poor. There are still quite a number of students who could not identify some of the high risk sexual practices while others held wrong perceptions about these practices. Therefore, there is need for health education on high risk sexual practices among these students.

Conflict of interest None.

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