Vol 3-Cont J. Trop Med

Continental J. Tropical Medicine 3: 1 - 5, 2009.
© Wilolud Online Journals, 2009.
EFFECTS OF BARIUM MOUTH WASHING ON SALIVARY (AMYLASE) AMONG ESAN POPULATION

(EDO CENTRAL) OF NIGERIA.
Osadolor, H.B. and Izekor,M.E.

Department of Medical Laboratory Science, Ambrose Alli University, P,M,B 1 4 .Ekpoma, Nigeria.
ABSTRACT
The effect of certain dentifrices on the activity of saliva amylase in subjects within Esan
senatorial district of Edo state was investigated in this study with samples randomly collected
from 45 volunteers. Subjects were divided into three groups and they used various dentifrice
namely; Close-up toothpaste, Dabur toothpaste, Macleans toothpaste, chewing sticks made
from Garcinia manni, Azardiracta indica,and Xanthophyllum zanthyloides . Standard
colorimetric method was used for the determination of amylase activity. It was found that the
mean ± standard deviation values were obtained from Group I subjects: basal samples,
1432.5±518.3U/L, Garcinia manni samples, 1247.2±728.8U/L and Close-up toothpaste
samples, 2258.9±762.7U/L. for Group II subjects: basal samples, 1342.6±230.9U/L,
Azardiracha indica samples,1263.1±90.3U/L and Dabur toothpaste samples, 2323.1±947U/L.
While GroupIII subjects: basal samples, 2003.1±726.8U/L,Xanthophyllum zanthyloides
samples, 1466.9±245.8U/L and Macleans toothpaste samples, 2698±994.7U/L.The mean of
the activity of salivary amylase increased from the various basal samples in the three groups
after the use of the various toothpaste, while a decrease was observed after the use of the
various chewing sticks (p<0.05).
KEYWORDS: Effect, Mouth, Washing, Salivary (Amylase). Esan,
INTRODUCTION
Food ingestion through the mouth is mechanically broken down by the action of the teeth and chemically broken
down by the activity of saliva (Van De Graff and Fox, 1999),produced by the salivary gland which are both
accessory digestive organs.
The teeth, is one of the hard, conical structures set in the alveoli of the upper and lower jaws, used in mastication
and assisting also in articulation (Stedman’s Medical Dictionary, 1975). The teeth of humans and mammals vary in
structure and are adapted to handle food in different ways and so, is an important organ for digestion of food. The
state of the teeth is said to affect an individual’s appearance and so the health of the teeth is paramount, making the
act of dental cleaning, widely practiced.
The use of various dentifrices, which are tooth powders, toothpaste, tooth washes (any preparation used in the
cleansing of the teeth), (Stedman’s Medical Dictionary, 1975), can be dated back to 5000 years ago in Egypt, China
and India to promote general oral hygiene. The most common dentifrice used up to date are: toothpaste, which in the
developed countries is considered a necessity and used at least twice a day. Common examples include Pepsodent,
Close-up, Maclean’s Colgate etc (Van De Graff and fox, 1999). No significant study has been carried out to find out
the effect of barium mouth washing on salivary amylase. Therefore, this study aims at determining the effect of
certain dentifrices on the activity of salivary amylase in individuals within Esan senatorial district of Edo state.
MATERIALS AND METHODS

CHEWING STICK
The chewing sticks used where purchased from a hawker of the chewing stick in new market Ekpoma. All the
subjects used chewing sticks from the same sources.
TOOTHPASTE- The various toothpaste ( Close up, Macleans, Dabur) where bought from precious supermarket in
market square Ekpoma and all the various toothpastes from the same source.
1
Osadolor, H.B. and Izekor,M.E.: Continental J. Tropical Medicine 3: 1 - 5, 2009.
SUBJECTS- Forty five healthy volunteers (15 females and 30 males) aged 13-52 years, with no apparent dental
carries or gingivitis participated in this investigation. All subjects used in this study gave their verbal and written
consent to participate before recruitment into the study. The subjects were divided into three groups with 15 in each
group.
GROUP 1
Fifteen (15) subjects used chewing stick made from Garcinia manni (bitter kola stem) “Edu” in Edo and three days
later they used Close-up toothpaste.
GROUP 2
Fifteen (15) subjects used chewing stick made from Azardiracha indica, “Dangoyaro”in Hausa and three days later
they used Dabur toothpaste.
GROUP 3
Fifteen (15) subjects used chewing stick made from Xanthoxyllum zanthozyloides, and three days later they used
Macleans toothpaste.
COLLECTION OF SALIVA
BASAL SAMPLE- Whole saliva was collected from the subjects in each group in the morning (6:30 am and
7:30am) after fasting over night. Before collection of saliva, participants were asked to rinse their mouth with water.
The saliva produced during the first 2 minutes after the water rinse was expectorated. Then saliva was collected at
two minutes intervals for six minutes. The accumulation saliva was for subsequent test.
CHEWING STICK SAMPLE- After the subject have chewed the respective chewing sticks for 2 minutes before
collection of saliva, participants were asked to rinse their mouth with water and then collection of saliva was
proceeded as above.
TOOTHPASTE SAMPLES- After the subjects brushed their mouth with the respective toothpaste, participants were
asked to rinse their mouth with water and then saliva was collected as in the basal sample.
DETERMINATION OF SALIVARY AMYLASE

The colorimetric method as reported by Kaufman and Norbert (1980) was employed.
PRINCIPLE- The method uses benzylidene blocked p-nitrophenylmaltoheptaoside as substrate. Two indicator
enzymes glucoamylase, to cleave the amylase reaction products, and alpha-glucosidase to release the p-
nitrophenol., the colour developed is read calorimetrically at 420nm.
STATISTICAL ANALYSIS
The statistical parameters used in analyzing the data generated include, analysis of variance (ANOVA), differences
in mean were tested using the Tukey test and student –“t”- test. Data were considered significant at P<0.05 using the
F- distribution, q distribution and “t” value tables for ANOVA, Tukey and student-“t”-test respectively.
RESULTS/DISCUSSION
In this research results were obtained from 45 subjects comprising of 15 female and 30 male volunteers resident in
Esan Metropolis. The age bracket in this case study was between 13-52 years.
The mean ± SD of salivary amylase activity in subjects exposed to the various dentifrices is shown in Table 1
2
TABLE 1: MEAN ± SD OF SALIVARY AMYLASE ACTIVITY IN BASAL SAMPLES (PRE- USE) AND IN
SAMPLES OBTAINED POST- USE OF THE VARIOUS DENTIFRICES
DENTIFRICES
GROUP I GROUP II GROUP III
Garcinia Close-up Azardiracha Dabur Xanthophyllum Macleans
Manni toothpaste indica toothpaste zanthyloides toothpaste
SAMPLE U/L U/L U/L U/L U/L U/L
Basal sample
(Pre-use) 1432.5±518.3 1432.5 ±518.3 1342.6±230.9 1342.6±230.9 2003.1±726.8
Post-use
Dentifrice 1247.2±728.8 2258.9±762.7 1263.1±90.3 2323.1±947.0 1466.9±245.8

2698.8±994.7
From table 1, the mean ± SD of salivary amylase activity in basal samples in Group I, Group II, and Group III
individuals were 1432.5 ± 518.3 U / L, 1342.6 ± 230.9U / L and 20003.1 ± 726.8U / L respectively, while that
obtained after the use of the various dentifrices, Garcina manni, Close-up toothpaste, Azardiracha indica, Dabur
toothpaste, Xanthophyllum zanthyloides, and Macleans toothpaste were 1247.2 ± 728.8U / L, 2258.9 ± 627.0U / L,
1263.1 ± 90.3U / L, 2323.1 ± 94.0U / L, 1466.9 ± 245.8U / L and 2698.8 ± 994.7U / L respectively.
TABLE 2: COMPARISON OF SALIVARY AMYLASE ACTIVITY IN GROUP I USING TURKEY TEST.
Comparison Difference SE q q0.05(42,2) p-value
A vs B ХA = ХB
1 vs 2 185.3 153.8 1.2048 2.858 NS
3 vs 1 826.4 153.8 5.3732 2.858 p<0.05
3 vs 2 1,011.7 153.8 6.5780 2.858 p<0.05
The purpose of this study was to determine the effect of certain dentifrices on saliva amylase activity in residents of
Esan metropolis. The following mean ± standard deviation values were obtained from Group 1 subjects: basal
samples, 1432.5 ± 518.3 U/L, Garcinia manni samples, 1247.2 ± 728.8 U/L and close–up toothpaste samples 2258.9
± 762.7 U/L.
3
For Group II subjects:

basal samples, 1342.6 ± 230.9 U/L, Azardiracha indica samples, 1263.1 ± 90.3 U/L and Dabur toothpaste samples,
2323.1 ± 947 U/L while Group III subjects: basal samples, 2003.1± 726.8 U/L, xanthophyllum zanthyloides samples,
1466.9 ± 245.8 U/L , macleans toothpaste samples and 2698 ± 994.7 U/L.
The mean of the activity of salivary amylase increased from the various basal samples in the three groups after the
use of the various toothpastes while a decrease was observed after the use of the various chewing sticks.
The analysis of variance (ANOVA) and the student-t-test were use to determine whether there was a significant
difference in mean in the different groups and all the groups combined at p<0.05. The result of the ANOVA and
student-t-test showed that there was a significant difference in the various groups and all the groups combined.
Comparison of salivary amylase activity using the Tukey test showed that there was a significant difference in the
activity of salivary amylase at p<0.05 between basal sample and the various toothpaste samples and Xanthophyllum
zanthyloides sample, the chewing stick samples and the toothpaste samples except between the Close-up and
Xanthophyllum zanthyloides samples (Akande 1998).
Ernest Newbrum (1962) observed that there was a pronounced variation in amylase content of saliva between
individuals. Also Davies (1972), Ferguson and Fort (1974), Ferguson et al (1973) observed a circadian variation in
unstimulated saliva in flow rate, pH and some salivary constituents which explains the variety of salivary amylase
recorded.(Adekunle and Odukoya 2006)
The increase in the activity of salivary amylase after use of the various toothpaste which was significant compares
favorably with the result reported by Boro et al (1984), that fluoride; the active ingredient in toothpaste, increase the
activity of salivary amylase. Also Allman et al (1985) noted that the injection of NaF solution into rats causes the
stimulation of amylase secretion further supporting the result obtained. Other investigators Shahed and Allman
(1988) suggested that the stimulation of amylase secretion from parotid gland cells by NAF may be mediated by an
increase in cellular cAMP concentration, which exerts its effect, at least in part by increasing the activity of cAMP
dependent protein kinase.
Zhang and Rashket (1998) reported that black and green teas inhibited salivary amylase, hence the lack of the
significance in the difference in mean between the basal sample and samples of chewing sticks made from Garcinia
manni and Azadiracha indica which could be due to the presence of these derivatives in these chewing sticks. The
significant difference in mean between the basal samples and Xanthophyllum zanthyloides could be that tannin and
saponin is absent in this chewing stick.
Hara and Yu (1995), observed that fluoride concentration at and above 5×10 ֿ◌² M inhibited salivary amylase,
proposing that the fluoride content in the various toothpaste were not up to the above concentration since the
amylase activity was increased. The presence of calcium as an ingredient of toothpaste accounts for the increase in
amylase activity in the results which agree with the report of Mermall et al (1973).
In conclusion, the present study has revealed that the use of fluoride containing toothpaste increases the activity of
salivary amylase and hence increases the rate of digestion of starch which is beneficial to Africans, since bulk of our
diet is made up of starch.
CONCLUSION
The practice of the brushing of teeth with fluoride containing toothpaste is greatly encouraged while the use of
chewing stick such as Garcinia manni and Azadiracha indica do not have any significant effect on the salivary
amylase hence their use should be discouraged as regards the rate of starch digestion.
REFERENCES
Adekunle, A.A. and Odukoya, K.A (2006): Antifugal activities of ethanol And aqueous crude extracts of four
Nigerian chewing sticks.Ethno Botanical leaflets 30: 196-197.
4
Akande, J.K and Hayashi, Y. (1998): Potency of extract contents fromselected tropical chewing sticks against
Staphylococcus aureus and Staphylococcus auricularis. World Journal of Microbiology Biotechnology. 14: 235-238.
Boros, I., Kezzler, P. and Zelles, T. (1979): Functional changes in the Salivary glands of rats after sodium fluoride
treatment. Acta Physiological Academia Scientarium Hungaricae. 53: 155.
Boros,I., Mozsik, G.Y. and Keszler, P. (1984): Effect of F ֿ◌ on major salivary Glands. The amylase activity,
stimulated salivary flow response and CAMP levels in parotid gland of rats consuming F ֿ◌ via drinking water.
Fluoride. 17: 217-223.
Ferguson, D.B., Fort, A., Elliol, A.L. and Potts, A.J. (1973): Circadian rhythms in human protid saliva flow rate
and composition.Archives of Oral Biology. 18: 1155-1173.
Hara, K. and Yu, M.H.(1995): Effect of Fluiride on Human SalivaryAmylase Activity. America. J. 28 (2). 71-74.
Mandel, I.D. (1974): Relation of saliva and plaque to caries. Journal of Dental Research. 53: 246-266.
Mermall, H.L., Hanhula, J.R. and Reeves, W.M. (1973): Effects of cations on the activation of salivary Amylase.
Journal of Dental Research. 52: 1148-1149.
NewBrun E (1962): Observation on the amylase content and flow rate ofhuman salival flowing gustatory
stimulation. Journal Dental Research. 41 (2): 459-465.
Received for Publication: 12/08/2009

Accepted for Publication: 21/09/2009
Corresponding Author:
Osadolor, H.B. and Izekor,M.E.
Department of Medical Laboratory Science, Ambrose Alli University, P,M,B 1 4 .Ekpoma, Nigeria.
5
TUBERCULOSIS: RE-EMERGING SCOURGE, DOTS PROGRAMME IN DELTA STATE
Esume, C.O1, Onyemekeihia, U.R2, Akonoghrere, R.O1, Opajobi, A.O2

1
Department of Pharmacology and Therapeutics, Delta State University, Abraka-Nigeria. 2Department of Medicine,
Central Hospital, Warri, Department of Biochemistry, Delta State University, Abraka
ABSTRACT
Tuberculosis is a common and deadly infectious disease caused by mycobacterium
tuberculosis and abbreviated as TB for Tubercle bacilli. It affects various organs of the body
and is known by different names. Signs and symptoms include cough of greater then 3 weeks,
unintended weight loss, fatigue, pleurisy, slight fever, night sweating, chill and loss of appetite.
Although the cause, diagnosis, treatment and prevention of Tuberculosis are known,
paradoxically the disease continues to be a scourge and an increasing public health challenge
that the WHO declared it a global emergency. The existence of Tuberculosis dates back to
many centuries. It has been present in humans since antiquity even before recorded history.
About one-third of the worlds population (2 Billion people) is currently infected with TB, 6-
10% of people who are infected (but who do not have HIV) become sick or infectious at some
time during their lifetime. Over 5 million people develop active TB annually. Approximately 2
million deaths arise from the disease yearly, one new infection occurs every second Approach
to a person afflicted with tuberculosis had gone through primordial phases until March 24th
1882 Robert Koch’s discovery of mycobacterium tuberculosis led to the recognition of
tuberculosis as an infectious disease. This also led to intervention for interrupting transmission
from person to person. The discovery of Streptomycin in 1943 revolutionalized the mystery of
TB and brought drug treatment to TB between 1943 and 1952; two more TB drugs,
Paraminosalicylic acid (PHS) and Isoniazid (INH) were discovered. Rifampicin and
Ethambutol were subsequently added. Resurgence in cases of tuberculosis is attributed to the
HIV/AIDS scourge. There are now Resistant strains to a single drug in every country surveyed.
More so, strains of TB resistant to all major antiTB drugs have emerged. Drug resistance has
been associated with inconsistent or partial treatment and Patients who do not take antiTB
medicines regularly for the required period. The aim of this review is to bring to light the
reemergence of this of this scourge in the face of HIV pandemicity and also to highlight on
current approach to a TB patient.
KEYWORDS: Tuberculosis, Re-emerging, Scourge, DOTS, Programme, Delta State
INTRODUCTION
Tuberculosis is a common and deadly infectious disease caused by mycobacterium tuberculosis and abbreviated as
TB for Tubercle bacilli. It most commonly affects the lungs (Pulmonary Tuberculosis) but it can also affect the
Central nervous System, lymphatic System, Gastrointestinal and genitourinary tracts, the bones and joints.
Other names by which tuberculosis is known include-consumption (because it seem to consume people from
within), Phthisis pulmonalis, white plague, scrofula (LS), Kings evil, Tabes mesenterica, lupus vulgaris and wasting
disease. (Encyclopedia Britanica, 1911; NIH medical Encyclopedia, 1998). Tuberculosis spreads through air borne
droplets when a person with the infection coughs, talks, spits sings or sneezes (Rajita et al 2000).
Signs and symptoms include cough of greater then 3 weeks, unintended weight loss, fatigue, pleurisy, slight fever,
night sweating, chill and loss of appetite.
Although the cause, diagnosis, treatment and prevention of Tuberculosis are known, paradoxically the disease
continues to be a scourge and an increasing public health challenge. The existence of Tuberculosis dates back to
many centuries. It has been present in humans since antiquity even before recorded history ( Rajita et al 2000,
Rothschild et al 2001, Konomi et al 2002).There are references to TB in third century BCE Chinese and second
century BCE Indian texts. Plato and Hippocrates wrote about it around 400BC. It was commonly called
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Esume, C.O et al.,: Continental J. Tropical Medicine 3: 6 - 13, 2009.
consumption disease, a cause of death of hundreds of thousands of people in late 18th and 19th centuries. This was
when Tuberculosis in close groups was first observed and assumed to have a genetic cause, since it was commonly
seen in families (Rajita et al 2000).
On March 24th 1882 Robert Koch’s discovery of mycobacterium tuberculosis led to the recognition of tuberculosis
as an infectious disease. This also led to intervention for interrupting transmission from person to person. He
received a Nobel Prize in Physiology or Medicine in 1905 for this discovery (7/51). In 1859 the first tuberculosis
sanatorium was opened in Sakolowski, Poland by Harmann Brehmer(8/50). Tuberculosis patients were now treated
in sanatoria in late 1880’s in many parts of the world by various modalities which include exposure to fresh air,
exercise and nourishment. About 50% of patients recovered or had long term remission (Rajita et al 2000). This
remission could be due to improved nutrition and body defense mechanism. Between 1914 and 1923, the
metropolitan life insurance company conducted the Framingham tuberculosis project using community Nurses to
visit homes of their clients, to do assessment, teach health practices and collect data for research purposes, mortality
fell by 68 % (Rajita et al 2000).
By 1906, Albert Calmette and Camille Guerin at the pasture institute in France, developed the Bacilli Calmette
Guerin (BCG) Vaccine, which was first used in Humans in 1921(Rajita et al 2000).The discovery of Streptomycin
in 1943 revolutionalized the mystery of TB and brought drug treatment to TB between 1943 and 1952; two more TB
drugs, Paraminosalicylic acid (PHS) and Isoniazid (INH) were discovered. The sanatoria began to close in the early
70’s as TB could now be treated on outpatient basis. Cure rates increased gradually until the 80’s when there was a
re-emergence of the scourge as a result of HIV/AIDS pandemic (Rajita et al 2000). Since then, the management of
TB has been a great challenge to medical science.
DISCUSSION
Epidemiology:
About one-third of the world’s population (2 Billion people) is currently infected with TB
(http://www.niaid.nih.gov/publications/microbes.htm,
http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION 5), 6-10% of people who are infected (but

who do not have HIV) become sick or infectious at some time during their lifetime. Over 5 million people develop
active TB annually. Approximately 2 million deaths arise from the disease yearly, one new infection occurs every
second (WHO).
An infectious person that is untreated could infect 10-15 persons per year. People who are HIV positive are very
much more likely to develop the illness.
Up to 35 million people worldwide could die of TB over the next 2 decades unless greater action is taken to treat
and prevent the disease. Nigeria ranks fourth among the countries with the highest TB Burden. Approximately
200,000 case of TB occurs annually of which 50% are smear positive.
The Disease has been on the rise since 1980 with its spread concentrated on south East Asia and the Sub-Saharan
Africa.
In 1993 the WHO declared TB as a global emergence, the first disease so classified in the history of the
organization.
FACTORS RESPONSIBLE FOR RESURGENCE

1. HIV/AIDS PANDEMIC: Worldwide an estimated one-third of the 40 million people living with
HIV/AIDS are co-infected with TB. TB is a leading cause of death among people living with HIV
accounting for approximately 13% of AIDS related deaths worldwide (WHO).
2. Poverty and lack of access to medical care. Most of the Nations with heavy burden of TB are poor
countries.
3. Drug Resistance
7
4. Crowed living conditions.
DRUG RESISTANT TB
Until 50 years ago, there was no cure for TB. There are now resistant strains to a single drug in every country
surveyed. More so, strains of TB resistant to all major antiTB drugs have emerged (WHO 2004). Drug
resistance has been associated with inconsistent or partial treatment and Patients who do not take antiTB
medicines regularly for the required period. Also prescription of wrong treatment regimen and inconsistent drug
supply are implicated in emergence of drug resistant TB.
While drug resistant TB is generally treatable, it requires extensive chemotherapy of up to 24 months: it is

prohibitively expensive (100 times more).
The directly observed therapy, short course (DOTS) is the recommended TB treatment strategy by WHO.
DOTS
It is a highly recommended method by WHO and consists of closely supervised treatment to be sure every dose
is taken to the end of the course.
It ensures compliance and cure and prevents development of drug resistance. The DOTS programme consists of
5 elements.
ELEMENT 1
There should be political commitment with increased and sustained financing, to foster National legislation
(Pinet, 2001). However current finding is inadequate. Even with Adequate finding, manpower is deficient
especially in Africa. (WHO 2004, WHO/HTM/TB/2005).
ELEMENT 2
There should be early case detection through quality assured Bacteriology.
Bacteriology remains the recommended method of TB case detection (WHO). This should include sputum
smear microscopy, sputum culture and drug susceptibility testing (DST).
There should be a strengthened laboratory network. This includes a wide network of properly equipped
laboratory with trained personnel and well resourced and fully functioning reference laboratory (WHO).
ELEMENT 3:
There should be a standard treatment with supervision and patient support and use of most effective
standardized short course regimen using fixed dose drug combinations (FDDC). Factors that make patients to
interrupt or stop treatment should be identified. DOTs must be carried out in a context-specific and patient
sensitive manner. Supervision and patient support must be undertaken at Health facility, work place, in
community or at home.
Treatment should be provided by a treatment partner or treatment supporter acceptable to the patient and is
trained and supervised by health services personnel. Physical, financial, social, and cultural as well as health
system barrier to access of treatment services should be identified. For example services should be free or
highly subsidized and providers who practice close to the patient should be involved. Psychological and legal
support should be offered, gender issues addressed and staff attitude improved.
ELEMENT 4
Effective drug supply and management system: There should be a reliable system of procurement and distribution,
and drugs should be available free of charge.
8
ELEMENT 5
Monitoring and evaluation system: Recording and reporting system should be effective and free communication
between central and peripheral levels maintained, with a standardized recording of individual patient data and
outcome of treatment.
DOTS IN DELTA STATE

It is the same as for National TB and leprosy control programme (NTBLCP).
TARGET FOR CONTROL OF TB
1. To detect at least 70% of the estimated infectious (smear positive) cases.
2. To achieve a cure rate of at least 85% of the detected smear positive cases by 2005.
3. By 2050 to eliminate TB as a public health problem(WHO 2007)
COLLECTION OF SPUTUM
Three samples are required:
On Day 1, the patient provides sputum on the spot, On Day 2, the patient produces and brings early morning sample
to the clinic. On the third day, the patient produces another on the spot sputum.
INTERPRETATION OF RESULT
Negative – O
Positive – scanty,+, H, + + +
APPROACH TO A TB SUSPECT.
Cough 3 weeks or more – Collect 3 sputum specimen
Sputum AFB Microscopy
AFB +++
AFB +00
++0 AFB 000
++sc sc 00
+sc 0
sc sc sc
sc sc 0 Broad spectrum
antibiotics for 7 days
Repeat 3 sp ecimens and review
after 2 weeks.
1 or more All negative

positive No Improvement
improvement (No TB)
Repeat 3
specimens
2 or 1 or All negative
more more
positive positive
Refer to Medic al
Officer for further
investigation
NO TB
Treat as TB YES TB
Medical Officer to
decide on further
action.
Fig 1: Approach to a TB Suspect
CLASSIFICATION OF TB PATIENTS
1. New cases (N) have never had TB or have taken Anti TB drugs for less than 4wks.
2. Relapse (R): TB patient who received treatment and declared cured or completed a full course of treatment
and has once again developed sputum-smear positive TB.
3. Treatment failure (F): While on treatment remain or becomes smear positive 5 months or later after start of
treatment.
4. Return after default (RAD): Patient who completed at least 4 weeks of treatment and return smear positive
after at least 8 weeks of interruption of treatment.
5. Transfer in (TI): Patient already requested for treatment in one LGA who is transfer to another LGA were
he/she continues treatment.
6. Other (O): Do not fall into these categories.(NTBLCP)
9
TREATMENT REGIMEN
1. Category 1- Short course therapy for new cases. This is presented in figure 2
2. Category 2- Retreatment therapy for relapse, treatment failure, Return after default and others. This is
presented in figs.3 and 4
DRUGS USED IN NTBLCP

R-Refampicin
Z-Pyrazinamide
T-Thiacetazone
H-Isoniazid
S-Streptomycin
E-Ethambutol
These drugs could be used as loose tablets or in drug combination.
CHILDREN (0-14YEARS)
Category 1 regimen for new cases (Children 0-14 years ): 2RHZ/6TH
Pre-
Pre-treatment weight
Regimen 15-
15- 10-
10-14kg 8-9kg < 8kg
19kg
Intensive phase: daily s upervised f or 2
months
3 2 1½ 1
Combined tablet of RHZ (60mg
+30mg+ 140mg)
Continuation phase: daily for 6 months
( monthly collection) 2 1 ½ ½
Combine d tablet of TH (50mg+100 mg)
Remark: If a child is HIV-positive TH should be replaced with RH daily supervised

for 4 months, same dosage as during intensive phase.
ADULTS
Category 1 regimen for new cases (Adults): 2RHZE/6EH
Regimen Pre-
Intensive phase: daily s upervised f or 2 months >55 kg 40-

40-55kg 25-
25-39kg
(E) Ethambutol 400mg 3 2 1½
(H) Isoniazid 100mg )

(R) Rifampicin 150mg ) combined tablet 4 3 2
(Z) Pyrazinamide 400mg 4 3 2

( monthly collection)
(E) Ethambutol 400mg ) 2 2 1

(H) Isoniazid 150mg ) Combined tablet
Figure 2: Regimen for new cases
ADULTS
Category 2 regimen for new cases (Adults): 2RHZE/6EH
Regimen Pre-
Intensive phase: daily supervised for 2 months >55 kg 40-

40-55kg 25-
25-39kg
(H) Isoniazid 100mg ) 4 3 2

(R) Rifampicin 150mg ) combined tablet
(Z) Pyrazinamide 400mg 4 3 2
(E) Ethambutol 400mg 3 2 1½
Add in the first two months daily:

(S) Streptomycin injection 1 gram 0.75gram 0.5 gram
Continuation phase: supervised 3 ti mes a week
for 5 months.
(R) Rifampicin 150mg ) 4 3 2

(H) Isoniazid 100mg ) Combined tablet
(H) Isoniazid 100mg 2 1 1
(E) Ethambutol 400mg 4 3 2
NB:
Streptomycin should NOT be given to pregnant women.
Patients > 45 years should not be given more than 0.75g of
streptomycin irrespective weight.
Fig.3 Retreatment therapy for relapse, treatment failure, Return after default
10
CHILDREN (0-14YEARS)
Category 1 regimen for new cases (Children 0-14 years ): 2RHZ/6TH
Regimen Pre-
Intensive phase: daily s upervised ffor

or 2 months 21-
21-33kg 11-
11-20kg 5-10kg

(R) Rifampicin 150mg ) combined tablet 2 1 ½
(Z) Pyrazinamide 400mg 2 1 ½

(T)
(T) THiacetazone 50mg
50 mg )
(H) Isoniazi d 100 mg ) combi
combi ned tablet.
tablet. 2 1 ½
Remark: If a child is HIV-positive TH should be replaced with RH daily supervised
for 4 months, same dosage as during intensive phase.
Category 2 regimen for relapses, failures, RAD and others (Children 0-

14years): 2RHZE/RHZ/5RHZ
Regimen Pre-
Intensive phase: daily ssupervised

upervised for 3 months 21-
21-33 kg 11-
11-20kg 5-10kg
(S) Streptomycin 500mg 500mg 250mg
(E) Ethambuthol (ages 6-

6-14) 150mg 100mg -
Ethambuthol should NOT be given children
below 6 years.
(H) Isoniazid 100mg ) 2 1 ½

(R) Rifampicin 150mg ) Combined tablet 2 1 ½
(Z) Pyrazinamide 400mg

Continuation phase: daily supervised for 5
months

(R) Rifampicin 150mg ) Combined tablet 2 1 ½
2 1 ½
(Z) Pyrazinamide 400 mg
Fig 4: Retreatment therapy for relapse, treatment failure, Return after default
STOP TB STRATEGY
WHO has developed a new guideline for programmatic management of drug resistant TB. In 2006 WHO launched
the new STOP TB.
STRATEGY:
The core of this strategy builds on the success of DOTS while recognizing the key challenges of TB/HIV (WHO
2007).
ELEMENTS OF STOP TB STRATEGY

1. Pursuing high quality DOTS expansion and enhancement, making high quality services available and
accessible to all those who need them.
In 2004, 184 countries (including all 22 of the high burden countries which account for 80% of the world
TB cases) were implementing DOTS in at least part of the country (WHO 2007).
2. Addressing TB/HIV, MDR-TB and other challenges. There is hope in achieving the target by 2015.
3. Contributing to health system strengthening. The national TB control programme must contribute to overall
strategy to advance financing, planning management as well as effective information and supply systems.
4. Engaging all care providers: All cadre of health care providers must be engaged.
5. Empowering people with TB and communities.
6. Enabling and promoting research with development of new diagnostics, drugs and vaccines.
The strategy is to be implemented over 10 years, (2006-2015) and one global plan is a comprehensive assessment
of the action and resources needed to implement the “stop TB strategy” and to achieve the following targets.
- Millennium development goal (MDG) 6,
- Target 8. Halting and begin reversal in the incidence of TB by 2015.
- By 2005 detect at least 70% of new sputum smear-positive TB cases and cure at least 85% of
the cases.
- By 2015: Reduce TB prevalence and death rate by 50% relative to 1990 (7.5m cases, 2.5m
deaths).
-
11
- By 2050: Eliminating TB as public health problem (one case per million populations) (WHO
2007).
PROGRESS TOWARDS TARGET

In 2004, approximately 50% of new smear positive cases were detected under DOTS. This is likely to have
exceeded 60% in 2005; just short of the 70% target. The treatment success in the 2003 DOTS cohort of 1.7million
patient was 82% on average, which was close to the 85% target.
In 2006 the WHO global TB control report concluded that 3 ( of 6) WHO regions are likely to have met both 2005
target, while 7 of the 22 high burden countries are likely to have met the 2005 targets(WHO 2007).
FUTURE
Several vaccines are being developed, the first recombinant TB vaccine entered into clinical trials in USA in 2004,
sponsored by the National Institute of Allergy and Infectious Disease (NIAID) (National Institute of Health News 26
January 2004).
A study done in 2005 showed that DNA TB vaccine given with chemotherapy can accelerate disappearance of
bacteria as well as to protect against re-infection in mice (Ha et al 2005). It will take 4-5 years to be available in
humans.
The only vaccine currently in phase 111 trails is MVA85A, which is being tried in South Africa, is based on
genetically modified vaccine virus (Ibanga et al 2006).
CONCLUSION
Tuberculosis is a preventable Disease. TB cannot be controlled anywhere, except it is co ntrolled everywhere. If the
STOP TB strategy is implemented as set out in the Global plan, the resulting improvement in TB control should
reverse the rise of TB incidence by 2015, and have the prevalence and death rates in all regions except Africa and
Eastern Europe.
REFERENCES
Disseminated tuberculosis (http://www.nlm.nih.gov/medlineplus/ency/article/0006.htm) NIH medical Encyclopedia.
Am J Infect Control. (1998) Aug; 26(4):453-64.
Drug and multidrug- resistant tuberculosis (MDR-TB). (http://www.who.int/tb.dotsplus/en/index.html)
HA SJ, Jeon BY, Youn JI, Kim SC, Cho SN, Sung YC. (2005). Protective effect of DNA vaccine during
chemotherapy on reactivation and reinfection of Mycobacteriu9 Tuberculosis. Gene Ther.;12(7):634-8
Human resources development for TB control: report of a consultation held on 27 and 28 August (2003). World
Health Organization/Rockfeller Foundation,Geneva, 2004 (WHO/HTM/TB/2004.340)
Ibanga HB, Brookes RH, Hil. (2006). Early clinical trials with a new tuberculosis vaccine, MVA85A, in
tuberculosis-endemic countries: issues in study design. Lancet Infect Dis. 6(8):522-28
Infectious Disease, Tuberculosis (http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=5
Konomi N,Lebwohl E, Mowbray K, Tattersall, Zhang D. (2002). Detection of mycobacterial DNA in Andean
mummies.J Clin Microbial. 40(12):4738-40
McCarthy OR (2001). The key to the sanatoria.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1281640) J R Soc Med (8)413-7
Nobel Foundation (1905).The Prize in Physiology or Medicine

(http://nobelprize.org/nobel_prizes/medicine/laureates/1905).
12
National Institute of a llergy and infectious diseases (NIAID). Microbes in Sickness and in Health.
(http://www.niaid.nih.gov/publications/microbes.htm)
National Institute of allergy and infectious diseases (NIAID). First U.S. Tuberculosis Vaccine in 60 years Begins.
National Institute of Health News 26 January (2004).
http://www2.niaid.nih.gov/newsrooom/releases/corixatbvac.htm)
Pinet G. (2001) Good practice in legislation and regulations for TB control: an indicator of political will.Geneva,
World Health Organization, WHO/CDS/TB/2001.290
Rajita R. Bhavaraju, Lee B Reichman. (2002). Tuberculosis information on Healthline. The Gale Group
Inc.,Macmillan reference USA, New York, Gale Encyclopedia of Public Health.pg 1-3
Rothschild BM, Martin LD, Lev G, Bercovier H, Bar-Gal GK, Greenblat C, Donoghue H, Spigelman M,
Brittain D. (2001) “ Mycobacterium tuberculosis complex DNA from an extinct bison dated 17,000 years before the
present”. Clin Infect Dis. 33(3):305-11.
Task Analysis- The basis for development of training in management of tuberculosis. Geneva, World Health
Organization (WHO/HTM/TB/2005.354)
Tuberculosis (http://www.1911encyclopadia.org/Tuberculosis)The 11th edition of the Encyclopedia

Britanica,(1911).
Tuberculosis. http://www.who.int/mediacentre/factsheets/fs104/en/
WHO/Tuberculosis. (2007) Fact Sheet NO.104

Esume, C.O,
Department of Pharmacology and Therapeutics, Delta State University, Abraka-Nigeria.
13
SEXUAL BEHAVIOURS AND CONDOM USE IN SELECTED FISHING COMMUNITIES OF KAINJI LAKE
BASIN, NIGERIA
1
Olowosegun, Toyin, 2Akangbe, Jones Adebola, 1Olowosegun, Oluwatoyin Motunrayo, 1Sule, Attairu Mohammed,
1
Sanni, Abdulwahab Omeiza &1 Ifejika, Philip Ikechukwu.
1
National Institute for Freshwater Fisheries Research, P.M.B.6006, New Bussa, Niger State, Nigeria
2
Department of Agricultural Extension & Rural Development, University of Ilorin, P.M.B.1515, Ilorin, Kwara
State, Nigeria
ABSTRACT
This paper has highlighted the sexual behaviour and the use of condom among the fisherfolk in
some selected fishing communities in the Kainji lake basin. The sample was taken from Yauri
emirate in ten fishing communities. This finding revealed that 76.0% of the respondents were
still in their active age, 15 – 45 years. 58.7% were into polygamy, sexually active with multiple
relationships. 74.0% of respondents of them have heard of condom and its uses but the desire
of respondents to protect themselves and use of effective measures like the condoms is lacking
in the study area. 62.2% of respondents perceived the condom as a protective devise for
individual against possible HIV infection during any sexual activity. There is a high level of
knowledge about the condom and its protective role against infections but does not translate
safe sex in the fishing communities. Various health programmes for the eradication of STIs
diseases had not been well extended to fishing communities. However, some recommendations
were made to fight against health related problems, especially HIV/AIDS
KEYWORDS: Behaviour, Sex, Condom, Fisheries and HIV/AIDS
INTRODUCTION
The prevalence rate of HIV/AIDS is on the increase and fisheries sector is more vulnerable because of the likelihood
of involvement in high-risk sexual behaviour for monetary gain.
Males, more than females, are often under intense pressure to initiate sexual activity, even when they still lack
adequate information on sexual matters (WHO,1996, and Macphail and Campbell 2001). It is a fact that HIV/AIDS
is contracted mainly through sexual activities. Several million people worldwide have been infected with Human
Immunodeficiency Virus (HIV), the causative agent of Acquired Immune Deficiency Syndrome (AIDS). According
to Chikonzo (2005), Sub-Saharan Africa is the region of the world most affected by HIV/AIDS. An estimated 25.4
million people are living with the disease and approximately 3.1 million new infections occurred in 2004. Keating,
et al. (2006) observe that, "HIV/AIDS is a serious concern in Nigeria today because the estimated annual deaths as a
result of the disease have increased from 50,000 in 1999 to over 350,000 in 2004." The Nigerian HIV/AIDS
situation is no better than in most African countries ravaged by the disease. In the pilot study, it was reported that
out of the 20 million HIV cases in the world in December 1995, 11 million (35.5%) were from Sub-Saharan Africa,
and 4.8 million (5.2%) Nigerians had tested positive for HIV (Komolafe 1999).
The distribution of self-reported number of sexual partners in Nigeria among sexually active individuals has been
shown to be similar to those reported in many East and Southern African countries (Orubuloye, et al, 1993), but
there are sharp differences in the reported number of HIV infections between Nigeria and most East and Southern
African countries. Nigeria reportedly has an estimated 1 million people infected with HIV (WHO, 1995). This
estimate represents between one and two per cent of the total sexually active population, while estimates among the
sexually active population in some East and Southern African countries are higher than 30 per cent (US Bureau of
the Census 1997). Knowledge of AIDS as an incurable disease is widespread in sub-Saharan Africa, but sexual
behaviour putting this knowledge into practice is known to be lacking (Orubuloye et al 1990; Mbizvo et al. 1994;
Okojie et al, 1995). Gender inequality, bred by stereotypical cultural norms and expectations that are difficult to
change, strongly influences heterosexual relationships in an unhealthy way (Sen, Germain and Chen, 1994). . In
some cultures, sexual experience is viewed as a rite of passage for boys. Social norms can reinforce the notion that
controlling women is a sign of masculinity, contributing to acts of sexual violence and transactional sex (Finger,
Thapa, Jepeobhoy et al 2004). It is pertinent to put into perspective the sexual behaviour of the fisheries sector since
14
Olowosegun, Toyin et al.,: Continental J. Tropical Medicine 3: 14 - 21, 2009.
it is central to the awareness of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV).
However, this study, therefore, is aimed at determining sexual behaviours and use of condoms in selected fishing
communities of Kainji Lake Basin.
METHODOLOGY
Kainji lake basin comprises of Niger and Kebbi States with the following neighbouring emirates Kontagora, Borgu
and Yauri. For this study, the sample was taken from Yauri emirates from the following communities: Wara, Wawu,
Tunga Mairuwa, Zamare, Rukubalo, Yauri, Rashe Salkawa, Hella, Barashi Tunga Alhaji Sharo. The selections of
these communities were based on accessibility, level of fisheries activities and traditional institutions. A total of 187
questionnaires and 20 interview guides for key informants were administered in the above communities and further
subjected simple descriptive statistical analysis.
RESULTS AND DISCUSSION

On the socio – economic characteristics as shown in Table 1, on sex, 63.6% of the respondents were males while
36.4% were females. Male population predominate in the fishing communities. The variation may be as a result
women restriction to their household that is, they are in Purdah, which buttresses the findings of gender studies
carried out in the northern Nigeria (Yahaya, 1999). It can be assumed that the men are more likely to be aware of
this deadly disease to support the findings of experts that almost twice as many men as women were aware of
HIV/AIDS. (UNAIDS, 1998)
76.0% of the respondents were still in their active (reproductive) age, that is, 15 – 45 years. 24% were above 46
years. These ages are the active and productive years in agricultural production and they are crucial to agricultural
development. The study revealed young people, implying that they were in sexually active ages and it corroborates
the findings of NDHS, 2003, UNAIDS, 2001 that majority of those who are prone and contract the HIV/AIDS virus
fall under the age of 30 years. Thus, they are the very people who are vital to the economic future of the rural
communities where poverty is dominant.
Majority (78.1%) of the respondents were married, 21.4% were single while 0.5% were widow. This indicates
tendency for sexual continuation, irrespective of their marital status among the people of the fishing communities.
On religion, 84.5% practice Islam, only 15.5% practiced Christianity and 0.5% claimed to be idol worshipper. With
this finding the religion of majority supports a man to have more than one wife, and therefore enhances multiple
sexual relationships in the study area. Majority (58.7%) were into polygamy, 2.1% were monogamous and 49.2%
could not response. This is not surprising because it has buttressed religion as a factor that supports multiple sexual
relationships among the people.
On educational background, Only 18.7% had primary education and the same percent for respondents who had
secondary school education. More than half of the respondents (57.2%) had no formal education. This is a reflection
of the areas in which the study was carried out and also the fact that the many of the people are not interested in the
western education. Some of the fishing communities are more interested in sending their children to Quaranic
School within and outside the community than attending western education. This has made them not see the need for
at least primary school in their immediate environment. Therefore, the low level of western education may affect the
knowledge of devastating HIV/AIDS that is ravaging globally.
Fisheries sector provides livelihood strategies to its dwellers. The study revealed that 84.5% of the respondents had
their primary occupation in fisheries related activities and only 15.5% were into skill labour (such as welding,
carpentry) and trading in other products. 27.8% of the respondents had secondary occupation such as firewood
cutting, food hawking and haulage. The result confirms the high mobility in labour among fisherfolk. The finding
corroborates Neiland et al, 2005 that combination of activities ranging from catching, processing, trading and
transportation are important occupation in the fishing communities.
15
Table 1. Socio - economic characteristics of the Respondents

Characteristics Frequency(F) Percent (%)
Sex
Male 119 63.6
Female 68 36.4
Total 187 100
Age
15-25 45 24.1
26-35 55 29.4
36-45 42 22.5
46-55 28 15.5
Above 55 17 9.1
Total 187 100
Marital status
Single 40 21.4
Married 146 78.1
Widowed 1 0.5
Separated - -
Divorced - -
Total 187 100
Number of wife
One 4 2.1
Two 59 31.6
Three 27 14.4
More than three 5 2.7
No response 92 49.2
Total 187 100
Religion
Islam 157 84.5
Christianity 29 15.5
Idol 1 0.5
Total 187 100
Education
Primary 35 18.7
Secondary 35 18.7
Tertiary 5 2.7
Adult education 5 2.7
No formal education 107 57.2
Total 187 100
Primary occupation
Fishing 23 12.3
Farming-fishing 23 12.3
Trading in fish 15 8.0
Processing of fish 40 21.4
Boat construction 27 14.4
Craft/gear making 7 3.7
Skilled labour 5 2.7
Others 47 24.2
Total 187 100
Secondary occupation
Skilled labour 1 0.5
Firewood cutting 2 1.1
Food vendor 45 24.1
Transporting 4 2.1
No response 135 72.0
Total 187 100
16
Table 2: showing Sexual behaviour, Common Diseases and Prevention in the Fishing Communities.
Age of first sexual intercourse Frequency(F) Percent(%)
10-15 65 34.8
16-20 74 39.6
21-25 23 12.3
26-30 10 5.3
Above 30 4 2.1
No response 11 5.8
Total 187 100
Partners since age 12 years
One 39 20.9
Two 30 16.0
Three 13 7.0
Above three 21 11.2
No response 20 10.7
Total 187 100
Never had any sexual relation
Still too young for sex 8 4.3

Too old for sex 5 2.7
A decision to abstain 10 5.3
Don’t consider it necessary 2 1.1
No reason 2 1.1
No response 160 85.6
Total 187 100
If married when did you start
married life(year)
1-5 19 10.2
6-10 34 18.2
11-15 50 26.7
Above 15 14 7.5
No response 70 37.4
Total 187 100
Number of sexual partners before
marriage
Between 1 and 4 60 32.1

Between 5 and 9 17 9.1
Over 10 24 12.8
None 71 38.0
No response 15 8.0
Total 187 100
About 62.5% of them said they became sexually active between ages 15-20.They have started having sexual
intercourse in that age bracket. 10% became sexually active before age 10. Others (34.9%) cannot remember the
exact period they had first sexual intercourse. 16.9% have had 1-2 sexual partners since they were 12years old.
11.6% had 3-4 sexual partners since then, 8.3% had above 5 partners, and 28.2% had 5 or more sexual partners.
Most respondents (68.1%) live with one partner, 21.9% live with two, 7.5% live with three, 2.5% live with four. On
individual premarital experiences, 6.0% of the respondents had over 10 sexual partners before marriage, 7.0% had
17
Table 3 showing distribution of condom use among respondents in the fishing communities
Variable Frequency (F) Percent (%)
Use of condom during sex
Yes 38 20.3
Never 141 75.4
I can’t remember 2 1.1
No response 6 3.2
Total 187 100
Use of condom in the past 12
months
Yes 26 13.9
No 149 79.7
No response 12 6.4
Total 187 100
Unprotected sex in last
12 months
Yes 97 51.9
No 79 42.2
No response 11 5.8
Total 187 100
Knowledge of condom
Yes 156 83.4

No 28 15.0
No response 3 2.6
Total 187 100
Uses of condom
Contraception 12 6.4
Prevention of HIV/AIDS 93 49.7
To avoid STIs 52 27.8
I don’t know 30 16
Total 187 100
Perception of use of condom
Promote sexual misbehavior 46 24.6

and immorality
Protects against HIV 104 55.6
Does not protect 100% 10 5.3
Reduces pleasure 7 3.7
Can cause disease 9 4.8
Something for young people 1 0.5
No response 10 5.3
Total 187 100
Accessibility of condom in the
village
Yes 65 34.8
No 114 61.0
No response 8 4.2
Total 187 100
Reason for non use of condom
Not sold in the Village 5 2.7

Difficult to find 8 4.3
Too expensive 5 2.7
Partner refused 3 1.6
Hate condom 25 13.4
Living with partner 29 15.5
Trust partner 17 9.1
Partner didn’t insist 6 3.2
See no point to use it 9 4.8
No response 80 42.8
Total 187 100
18
between 5-9 partners, 29.9% had between 1 – 4 and 57.0% said they had none. 9.3% said they have had extra
marital sex while 86.5% claimed that they never did; 3.5% others did not response. 1.0% had experienced extra
marital sex with over 10 persons in the past 12 months, 4.1% with between 5-9 persons, 18.4% with between 1-4
persons, and 76.5% had none. This percentage is worrisome and it suggests widespread practice of multiple sex
partners even among those that are married. This practice is risky and capable of fuelling the spread of STIs, HIV
and unwanted pregnancies in the communities.
On the sexually transmitted disease(s) 72.6% was aware and could mention at least one of the diseases. Only 30%
claimed ignorance sexually transmitted diseases. 52.9% of the respondents could mention one if not all of the
symptom associated with sexually transmitted diseases while 47.1% don’t know the signs of the diseases. Majority
of men and women of reproductive age had knowledge on the symptoms and management of common STIs. It is
believed that because of the wide prevalence of the infections, individuals are quite familiar with them. They are
easily treated or so it seems by the local patent medicine dealers or the traditional healers.
On condom use, majority(74.0%) of respondents of them have heard of condom and its uses while 25.7% said they
have no knowledge of condom 11.6% said condoms are used for contraception, prevention of HIV and to avoid
STIs; 10.6% said condoms are used for contraception only; 40.7% said they are used for HIV prevention; 17.5%
said they are used to prevent STIs; 18.5% said they do not know what they are used for; 1.0% others did not respond
at all. Majority (62.2%) of respondents perceived the condom as a protective devise for individual against possible
HIV infection during any sexual activity. 14.3% of respondents believe that condoms may promote “sexual
misbehaviour and immorality” especially among young persons. 4.2% think that it does not guarantee a 100 per cent
protection against possible infection. In fact, 4.2% said condom is only meant to be used by young people. 3.1% feel
that it reduces the level of pleasure and satisfaction obtained during sexual intercourse which corroborates the
findings of Oswatt and Matsen (1993) in their survey reported that about 8% of their respondents with multiple
partners use condom during sexual intercourse while about 90% do not use condom and Strider and Beaman (1989)
reported that majority of sexually active persons do not use condom because of the following reasons: Spontaneous
sexual response, decreased pleasure for self and partner, they are inconvenient and uncomfortable and decrease
feeling.
12.6% simply could not say clearly how they perceive condom and its use, perhaps, due to their little knowledge
about the commodity contrary to the finding of Thompson et al. (1996) that respondents’ perception on the use of
condom is that they perceive condom as ineffective, and interfering with pleasure. 87.7% knew the points where
condoms can be purchased in their communities. Similarly, 57.8% of the respondents said that condom can easily be
accessed in their places of migration. 18.6% said while condom can be accessed, it is however difficult to secure in
terms of cost and point of purchase. While 23.6% others reported that it is not accessible at all. Majority of the
respondents have agreed that they abstained from sex while away from his home (38.3%), and 2.3% use of condom.
5.7% of respondents simply don’t know what to do for protection supported the works of Akande 1994 that majority
of sexually active persons do not use condom during intercourse, condom use was not perceived as necessary in
sexual encounters involving a regular partners and Singh, et al (1997) and Baggaley et al. (1997) that respondents
who were sexually active do not use condom and some inconsistently use condom with causal partners. There is a
high level of knowledge about the condom and its protective role against infection.
CONCLUSION
This paper has highlighted the sexual behavior and the use of condom among by the fisherfolk in some selected
fishing communities in the Kainji lake basin. This finding revealed that the people are sexually active with multiple
relationships but the desire of respondents to protect themselves and use of effective measures like the condoms is
lacking in the study area. There is a high level of knowledge about the condom and its protective role against
infections but does not translate safe sex in the fishing communities. Various health programmes for the eradication
of STIs diseases had not been well extended to fishing communities. However, the following recommendations will
assist the fishing communities to fight against health related problems, especially HIV/AIDS;
• Provision of health facilities and health personnel in fishing communities
• The establishments of Sex Education Support Organization in enlightening the people on a broad - based
community approach.
19
• Provision of behaviour change messages on Reproductive Health and HIV/AIDS in the region.
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Olowosegun, Toyin
National Institute for Freshwater Fisheries Research, P.M.B.6006, New Bussa, Niger State, Nigeria
Email: toyin_motunrayo@yahoo.co.uk
21
FACTORS ASSOCIATED WITH PREMATURITY IN WARRI NIGER DELTA; AN EIGHT YEAR REVIEW
G I Mcgil Ugwu
Dept of Paediatrics, Delta State University, Abraka.
ABSTRACT
Prematurity is a major cause morbidity and mortality in developing countries. The factors
associated with preterm births in Warri over an eight year period include, low socioeconomic
class, place of antenatal care, antenatal complications notably hypertension in pregnancy,
fever, anaemia and bleeding in pregnancy. Other associated factors include multiple gestations,
previous history of abortion and prematurity. Trauma and fetal abnormalities were not major
factors associated with preterm deliveries. Economic empowerment and improvement of the
antenatal care, with better assess to specialist obstetricians and adequate treatment of fever in
pregnancy will greatly reduced the incidence of prematurity.
KEYWORDS: Prematurity, neonatal death, babies, management, obstetricians, treatment
INTRODUCTION
Prematurity is a major cause of neonatal death in Nigeria. (Bolanle et al., 2007, Ezechukwu et al., 2004) Many
factors have been associated with premature births.(Etuk et al., 2005) Adequate management of such babies require
skilled and dedicated staff, making it both capital and labour intensive to manage these babies, a luxury not so
available in Nigeria. Warri is an oil city in the south- south region of Nigeria and the major hospitals for the
management of preterms are the Central Hospital, a government hospital and GN Children’s clinic, a private
children’s clinic. These hospitals serve three local government areas with a combined population of two million
three hundred and fifty people using the 2006 census in Nigeria.(Federal Republic of Nigeria, 2007) The aim of this
review is to find the factors that are associated with premature births in Warri Niger Delta, which may help in public
health education in the area. This study involves the premature babies managed in these hospitals between 2000 and
2007.
MATERIALS AND METHOD

On presentation the following information were obtained: the age of the mother, marital status, the occupation of
parents, place of residence, educational status of parents, the gynaecological and obstetric history of the mother, the
history of the involved pregnancy, gestational age of the pregnancy, any event precipitating the delivery such as
strenuous activities, previous abortions whether induced or spontaneous. Presence of anaemia, hypertension, use of
drugs or any illness in that pregnancy were also asked for.
RESULTS
Six hundred and thirty nine patients were seen within the said period. Tale 1 shows the number of preterms
managed per year between year 2000 and 2007.
TABLE 1: SHOWING THE NUMBER OF PREMATURE BABIES SEEN PER YEAR
YEAR NUMBER OF PRETERMS SEEN

2000 65
2001 88
2002 76
2003 95
2004 76
2005 79
2006 83
2007 77
TOTAL 639
22
G I Mcgil Ugwu: Continental J. Tropical Medicine 3: 22 - 28, 2009.
Of these, two hundred and ten had no identifiable cause for the premature delivery (32.9%) one hundred and twenty
had multiple factors. Table 2 shows the identifiable factors.
TABLE 2 SHOWING: IDENTIFIABLE FACTORS
IDENTIFIABLE FACTORS
1 SCIO-ECONOMIC CLASS
2 PLACE OD ANTENATAL CARE
3 AGE OF MOTHER
4 PREVIOUS HISTORY OF ABORTIONS, PRETERM DELIVERY,
ATTEMPTS TO ABORT CURRENT PREGNANCY
5 ANTENATAL COMPLICATIONS IN CURRENT PREGNANCY
6 MULTIPLE GESTATION
7 TRAUMA
8 FETAL MALFORMATIONS
Social class was a major factor in our review. Three hundred and sixty were in the lower social class, while two
hundred were in the middle class, and seventy nine were in the high class. The classification is according to (Krieger
and colleague. 1997) Fig 1 is a bar chart showing the numbers according to the social class of the parents
360
NUMBER OF PATIENT
200
79
LOW MIDDLE HIGH SOCIAL CLASS

FIG 1 A BAR CHART SHOWING: THE NUMBER OF PRETERMS ACCORDING TO THE
SOCIOECONOMIC CLASS OF PARENTS
Another major contributing factor is the place of antenatal care and delivery one hundred and ninety eight mothers
were managed in maternity homes run by midwives, while one hundred and fifty five were delivered by traditional
birth attendants. One hundred and twenty were delivered at home. Infact over 74% were not seen by obstetricians.
Fig 2 is a histogram showing the place of antenatal care of the mothers
23
164 Hosps and Specialist
Maternity 198
Private Clinics
TBA 157
NUMBER OF PATIENT
Home 120
FIG 2 SHOWING: THE NUMBER OF PRETERMS DELIVERED AT VARIOUS PLACES
The age of the mother had no influence as three hundred and thirty eight of these pretrems were delivered by
mothers between 20years and forty years, giving a percentage of 54.1%. The age distribution of the mothers is
shown in table 3
TABLE 3 SHOWING: AGE DISTRIBUTION OF THE MOTHERS

AGE RANGE OF MOTHER NUMBER OF PATIENTS
LESS THAN 20YEARS 200
20-30YEARS 260
30-40YEARS 138
MORE THAN 40YEARS 41
There was previous history of preterm delivery, abortion, spontaneous or induced in two hundred and forty cases,
representing 39.3%. Infact, one of the patients was delivered at 26wks+ by illegal abortion but the parents decided to
keep the baby when they saw how vigorous her cry was after delivery, and she is alive till date. Table 4 shows the
influence of these factors
24
TABLE 4 SHOWING: THE INFLUENCE OF PREVIOUS PRETERM DELIVERY, RECURRENT OR ILLEGAL

ABORTION OF ATTEMPT TO ABORT IN THAT PREGNANCY
PREVIOUS HISTORY OF PRETERM DELIVERY NUMBER

AORTION OR ATTEMPTS IN THAT PREGNANCY
PREVIOUS PRETERM DELIVERY 86
HISTORY OF RECURRENT ABORTION 80
PREVIOUS HISTORY OF ILLEGAL ABORTION 60
ATTEMPTS TO ABORT IN THAT PREGNANCY 14
TOTAL 240
Mothers of two hundred and forty of these babies had antenatal complications. The various complications and their
numbers are represented in fig 3
Hypertension in
pregnancy
pregnancy
NUMBER OF PATIENT
100
Fever in
Pregnancy
Anemia in
70
40
hemorrhage
Antepatum
30
FIG 3 SHOWING: THE COMPLICATIONS IN PREGNANCY ASSOCIATED WITH PRETERM BIRTHS
Pregnancy induced hypertension was the commonest antenatal event precipitating preterm delivery, followed by
fever in pregnancy.
Multiple gestations were also a contributing factor as one hundred and seventy one of the babies were products of
multiple gestations. This gives a percentage of 26.6%. The order of the multiple pregnancy is shown in table 5.
25
TABLE 5 SHOWING: THE ORDER OF MULTIPLE PREGNANCY
ORDER OF MULTIPLE PREGNANCY NUMBER

TWIN PREGNANCY 150
TRIPPLET PREGNANCY 20
QUADRUPLET PREGANCY 1
TOTAL 171
In only fifty cases was trauma responsible for the premature delivery, and seven were delivered malformed.
DISCUSSION
The social class of the parents is a major associating factor in preterm births. This is keeping with the observation by
Azikeh in Benin (Azikem 2003) but at variance with the findings of Etuk et al. in Calabar Warri, Benin and Calabar
all belong to the south –south region of Nigeria. However Etuk and colleagues did recognize the effect of the misery
associated with the introduction of the structural adjustment programmme (SAP) by the Babaginda administration in
Nigeria in the mid-80s, and preterm delivery. Moreover, prematurity is in blacks in developed countries (Robert,
Dwight 1998) There is a strong correlation between prematurity and low socio-economic status.( Barbra et al., 1998)
Another major associated factor is the place of antenatal care. Mothers of over 74% of our patients were not seen by
obstetricians. Infact a significant percentage 33% were attended to by the traditional birth attendants or
churches/healing homes who do not employ midwives. These attendants hardly recognize antenatal complications
such as malaria or anemia which are known to induce premature labour. (Sowumi 2003, Guard 2004)
Age of the mother was not a major contributing factor as most of our patients were delivered by mothers between
the ages of 20years and 40years. This is keeping with the findings by Etuk et al in Calabar Nigeria. (Etuk et al.,
2005).
Previous histories of abortion or premature delivery were major associated factors and this is a similar experience by
others. (Okonofua et al., 1994, Espilin et al., 2008, Spong et al., 2007). Okonofua et al., 1994 noted that most of the
criminal abortions in Nigeria are carried out by quacks and this often leads to cervical incompetence. (Okonofua et
al., 1994) One of our patients was a product of induced abortion at 26wks+. The parents decided to keep the baby
after seeing the vigor of the girl after delivery and the child is still alive today.
Multiple gestation is a well known cause of preterm delivery worldwide. (Etuk et al., 2005), Preemies for Africa
2009, Nanninin et al., 2004) and the findings here are similar and the higher the order of multiplicity, the higher the
incidence of preterm birth.( American Rep Health 2009).
Antenatal complications notably hypertension in pregnancy were also found to be associated with pretem deliveries
( Babara et al., 2007, Magee et al., 2008) The preterm delivery results from either spontaneous labour or decision to
terminate the pregnancy earlier should either the mother or the baby be in danger arising from eclampsia or placental
insufficiency respectively. These are the two major effects of pregnancy induced hypertension on the mother and
child respectively.(Carmel Lyoid 2007, Kirstie Flood 2008).
Trauma and fetal abnormalities had very minimal effect in the observations noted, probably because gross
abnormalities leading to fetal loss occur much earlier in the pregnancy
CONCLUSION
In conclusion therefore, prematurity remains a major cause of morbidity and mortality. The factors responsible for
preterm deliveries are very preventable and can be addressed in the context of maternal and child health
26
ACKNOWLEDGEMENT
I most sincerely thank Lady E N Ugwu for immense contribution to this study. I also appreciate the assistance of Dr
Bawa
REFERENCES
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111
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Azikeh ME (2003): Pre-term Labour and Delivery. In: Clinical Obstetrics.. Okpere E (ed). Section C; pp 203-209.
Benin City, University of Benin Press
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Nelson’s textbook of Pediatrics 18th edition; Saunders Publishers. Kliegman, Behrman, Jenson and Stanton Eds:
page 703
Sowunmi A. (2003): In: Contemporary Obstetrics and Gynaecology in developing countries. Okonofua F and
Odunsi K (Eds), pp 502-513. Benin City Women’s Health and Action Research Centre.
EI Guard W, Pronest J, Carles G/ Largeand M, EI Gareh N, Montoya Y, Arbelle P (2004): Severe aaemia and
pregnancy outcome. Gynaecol Obstet Biol Report (Paris), Oct’ 33 (6 part 1): 506-509
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Holingen, Calla Mineau, Geraldine P Varner, Michael W (2008): “ Estimating Recurrence of Spontaneous Preterm
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http://www.sapreemies.2a.org/premature/multi: html
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multiple gestation Families: Academy Health Meeting (2004; San Diego California) sited on 30TH August 2009 @
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American Society for Reproductive Health. Patient’s Fact Sheet. Complications of multiple gestation. Sited on 30TH
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Magee L.A, MP Omstien, P vonDadelszen (2008): Management of Hypertension in Pregnancy. British Medical
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G I Mcgil Ugwu
P O Box 3217 Warri Delta State
E-Mail: Gnclinic@Yahoo.Com
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Continental J. Tropical Medicine 3: 1 - 5, 2009.

© Wilolud Online Journals, 2009.

EFFECTS OF BARIUM MOUTH WASHING ON SALIVARY (AMYLASE) AMONG ESAN POPULATION

Osadolor, H.B. and Izekor,M.E.

KEYWORDS: Effect, Mouth, Washing, Salivary (Amylase). Esan,

MATERIALS AND METHODS

DETERMINATION OF SALIVARY AMYLASE

GROUP I GROUP II GROUP III

Garcinia Close-up Azardiracha Dabur Xanthophyllum Macleans

Manni toothpaste indica toothpaste zanthyloides toothpaste

SAMPLE U/L U/L U/L U/L U/L U/L

Dentifrice 1247.2±728.8 2258.9±762.7 1263.1±90.3 2323.1±947.0 1466.9±245.8

TABLE 2: COMPARISON OF SALIVARY AMYLASE ACTIVITY IN GROUP I USING TURKEY TEST.

Comparison Difference SE q q0.05(42,2) p-value

1 vs 2 185.3 153.8 1.2048 2.858 NS

3 vs 1 826.4 153.8 5.3732 2.858 p<0.05

3 vs 2 1,011.7 153.8 6.5780 2.858 p<0.05

For Group II subjects:

Received for Publication: 12/08/2009

TUBERCULOSIS: RE-EMERGING SCOURGE, DOTS PROGRAMME IN DELTA STATE

Esume, C.O1, Onyemekeihia, U.R2, Akonoghrere, R.O1, Opajobi, A.O2

KEYWORDS: Tuberculosis, Re-emerging, Scourge, DOTS, Programme, Delta State

http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION 5), 6-10% of people who are infected (but

FACTORS RESPONSIBLE FOR RESURGENCE

4. Crowed living conditions.

While drug resistant TB is generally treatable, it requires extensive chemotherapy of up to 24 months: it is

DOTS IN DELTA STATE

Cough 3 weeks or more – Collect 3 sputum specimen

Sputum AFB Microscopy

1 or more All negative

Fig 1: Approach to a TB Suspect

DRUGS USED IN NTBLCP

Remark: If a child is HIV-positive TH should be replaced with RH daily supervised

Intensive phase: daily s upervised f or 2 months >55 kg 40-

(E) Ethambutol 400mg 3 2 1½

(H) Isoniazid 100mg )

(Z) Pyrazinamide 400mg 4 3 2

(E) Ethambutol 400mg ) 2 2 1

Figure 2: Regimen for new cases

Intensive phase: daily supervised for 2 months >55 kg 40-

(H) Isoniazid 100mg ) 4 3 2

(Z) Pyrazinamide 400mg 4 3 2

(E) Ethambutol 400mg 3 2 1½

Add in the first two months daily:

(R) Rifampicin 150mg ) 4 3 2

(H) Isoniazid 100mg 2 1 1

(E) Ethambutol 400mg 4 3 2

Intensive phase: daily s upervised ffor

(H) Isoniazid 100mg )

(Z) Pyrazinamide 400mg 2 1 ½

Category 2 regimen for relapses, failures, RAD and others (Children 0-

Intensive phase: daily ssupervised

(S) Streptomycin 500mg 500mg 250mg

(E) Ethambuthol (ages 6-

(H) Isoniazid 100mg ) 2 1 ½

(Z) Pyrazinamide 400mg

(H) Isoniazid 100mg )

ELEMENTS OF STOP TB STRATEGY

PROGRESS TOWARDS TARGET

Drug and multidrug- resistant tuberculosis (MDR-TB). (http://www.who.int/tb.dotsplus/en/index.html)

Infectious Disease, Tuberculosis (http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=5

McCarthy OR (2001). The key to the sanatoria.

Nobel Foundation (1905).The Prize in Physiology or Medicine

Tuberculosis (http://www.1911encyclopadia.org/Tuberculosis)The 11th edition of the Encyclopedia