Journal of Kinetics and Health Education Perspective.Volume 5, December,2012 1 www.jokhep.com | [email protected] | +2348033413018 Nursing Intervention for Patients with Goitre in the Health Care Delivery System in Nigeria By Dr. Fidelis Uchendi Okafor, Ph.D. Department of Nursing Science, University of Benin, Benin City. [email protected]08037442403 & Joan Chukwura, M.Sc. Department of Nursing Science, University of Benin, Benin City. ABSTRACT Thyroid hormones are very important for the normal functioning of the various organs of the body. When the production and availability of these hormones are impaired, as would occur in goitre caused either by hyperthyroidism or iodine deficiency, organ functions could be adversely affected. Iron deficiency is a major threat to health of people across the globe and the introduction of the universal salt iodization (USI) programme is an important step towards controlling this deficiency. Various diagnostic measures are available including adequate observation of symptoms in order to obtain accurate information about patient’s disease status. Treatment could be in form of chemotherapy, radiotherapy with radioactive iodine or surgery. Nurses need to have good background knowledge in order to adequately care for patients with goitre. In this article, the thyroid gland, its hormones and abnormalities is discussed followed by the epidemiology of goitre, its causes and clinical manifestations. The diagnostic plan is enumerated followed by medical management and nursing intervention for patients with goitre. It is therefore recommended that public heath talks should be organised by nurses to reduce the scourge of goitre in the society. The people are encouraged to use iodised salt, vegetables and fruits in their meals. INTRODUCTION Thyroid gland is a highly vascular butterfly-shaped endocrine organ connected by an isthmus situated in the lower neck anterior to the trachea. Thyroxine (T 4 ), Triiodothyronine (T 3 ) and calcitonin (thyrocalcitonin) are the hormones secreted by the thyroid gland. T 4 and T 3 (collectively referred to as thyroid hormones) are necessary for cell replication and ultimately normal growth and brain development. In other words their main role is to control cellular metabolic activities. They influence every major organ of the body through their effects on cellular metabolism. On the other hand calcitonin reduces high plasma level of calcium by increasing its deposition in the bone. Iodide in the form of iodine is instrumental and essential for the synthesis of thyroid hormones (Greenstein, Gould & Trounce, 2004; Smeltzer, Bare, Hinkle, & Cheever, 2008). The release of thyroid hormones; by thyroid gland is controlled by thyroid stimulating hormone (TSH) from the anterior
Transcript
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
Department of Nursing Science, University of Benin,
Benin City. ABSTRACT Thyroid hormones are very important for the normal functioning of the various organs of the body. When the production and availability of these hormones are impaired, as would occur in goitre caused either by hyperthyroidism or iodine deficiency, organ functions could be adversely affected. Iron deficiency is a major threat to health of people across the globe and the introduction of the universal salt iodization (USI) programme is an important step towards controlling this deficiency. Various diagnostic measures are available including adequate observation of symptoms in order to obtain accurate information about patient’s disease status. Treatment could be in form of chemotherapy, radiotherapy with radioactive iodine or surgery. Nurses need to have good background knowledge in order to adequately care for patients with goitre. In this article, the thyroid gland, its hormones and abnormalities is discussed followed by the epidemiology of goitre, its causes and clinical manifestations. The diagnostic plan is enumerated followed by medical management and nursing intervention for patients with goitre. It is therefore recommended that public heath talks should be organised by nurses to reduce the scourge of goitre in the society. The people are encouraged to use iodised salt, vegetables and fruits in their meals. INTRODUCTION Thyroid gland is a highly vascular butterfly-shaped endocrine organ connected by an isthmus situated in the lower neck anterior to the trachea. Thyroxine (T4), Triiodothyronine (T3) and calcitonin (thyrocalcitonin) are the hormones secreted by the thyroid gland. T4 and T3 (collectively referred to as thyroid hormones) are necessary for cell replication and ultimately normal growth and brain development. In other words their main role is to control cellular metabolic activities. They influence every major organ of the body through their effects on cellular metabolism. On the other hand calcitonin reduces high plasma level of calcium by increasing its deposition in the bone. Iodide in the form of iodine is instrumental and essential for the synthesis of thyroid hormones (Greenstein, Gould & Trounce, 2004; Smeltzer, Bare, Hinkle, & Cheever, 2008). The release of thyroid hormones; by thyroid gland is controlled by thyroid stimulating hormone (TSH) from the anterior
pituitary gland through a negative feedback mechanism. Thus decreased plasma level of the thyroid hormones causes increased output of TSH which in turn increases the output of T4 and T3
. Furthermore, thyrotropin-releasing hormone (TRH), secreted by the hypothalamus exerts a modulating influence on the release of TSH from the pituitary gland (Smeltzer, Bare, Hinkle, & Cheever, 2008).
Figure 1. Anatomy of the thyroid gland (http:www.triofoundation.com/gfx/Thyroid_Diagram.jpg) The abnormality in thyroid function is generally divided into two, namely: hypothyroidism and hyperthyroidism. Hypothyroidism is a suboptimal availability of thyroid hormones to the body while hyperthyroidism is an increased plasma level of the thyroid hormones with the overall effect of raised metabolic rate (Greenstein, et al, 2004). Goitre is an enlargement of the thyroid gland. Over-secretion of thyroid hormones (hyperthyroidism) is usually associated with goitre (toxic goitre). The severe form of hyperthyroidism is known as Grave’s disease which is an autoimmune disorder. In addition, goitre also commonly occurs with dietary iodine deficiency. Here lack of iodine leads to reduced level of thyroid hormones which in turn causes an increase in TSH culminating in hypertrophy of the thyroid gland (Smeltzer, Bare, Hinkle & Cheever 2008) where it is referred to as endemic or simple goitre. An individual is said to be euthyroid if the thyroid function is within normal range. The term nodular goitre is used where the thyroid gland is nodular because of areas of hypertrophy. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis and thyroid malignancy, they constitute an entity described as non-toxic nodular goitre, which occurs both endemically and sporadically ((Tonacchera, Pinchera, & Vitti, 2010). However, these nodules may slowly increase in size and cause local pressure; some may become malignant, while some are associated to a hyperthyroid state eventually requiring surgical therapy ((Smeltzer, Bare, Hinkle & Cheever 2008). Epidemiology of Goitre Iodine deficiency is a major threat to the health and development of population worldwide, particularly among preschool and pregnant women. When the requirement for iodine are not met, thyroid hormone synthesis is impaired, resulting in a series of functional and developmental abnormalities collectively referred to as iodine deficiency disorders (IDD) including goitre (Andersson, Takkouche, Egli, Allen, & de Benoist, 2005). In addition iodine deficient goitre is common in iodine-deficient areas (Bakhsh, Kirov, Gregory, Williams, & Ludgate, 2006).
Nigeria is one of the endemic goitre regions with an estimated 9 million sufferers and a large variation among the various states of the country. The four main goitre endemic states in Nigeria include Taraba, Benue, Nassarawa and Ebonyi. It has been asserted that there is high prevalence of production and consumption of non-iodised salt in these states (This Day, 2007, Abua, Ajayi, & Sanusi, 2008, Daily Champion, 2010). Universal salt iodization (USI) is the iodization of all salt used for human and animal consumption and is the main strategy used to control iodine deficiency (World Health Organisation, 1996). World Health Organisation (WHO) recommends that salt be iodized to a concentration of 1 part in 100,000. As part of the strategies to reduce the prevalence of IDD in Nigeria, the Universal Salt Iodisation Programme was also introduced in Nigeria following the World Health Organisation directives in 1996 (Abua, et al, 2008). Furthermore, hyperthyroidism affects women eight times more frequently than men with onset usually between the second and fourth decades of life (Tierney, McPhee, & Papadakis, 2005). The incidence of non-toxic multi-nodular goitre increases with age (Nygaard, Hegedűs, Gervil, Hjalgrim, Søe -Jensen,& Hansen, 1993). Causes of Goitre Some of the causes of goitre as recorded by Greenstein, et al (2004) & (Smeltzer, Bare, Hinkle & Cheever 2008) include;
o Simple or endemic goitre is caused by insufficient intake of iodine especially in areas where the natural supply of iodine is deficient. Insufficient mean dietary iodine (less than 40fg/day) causes an increase in TSH secretion, which in turn causes thyroid hypertrophies leading to goitre. Additionally, it could be caused by excessive ingestion of goitrogenic substances like iodine or lithium used in treatment of bipolar disorders.
o Hyperthyroidism could be caused by thyroiditis and excessive ingestion of thyroid hormone in the treatment of hypothyroidism. It may also occur following emotional shock or stress though this relationship is not fully understood. Generally in hyperthyroidism there is an excessive release of thyroid hormones.
Clinical Manifestations The summary of clinical manifestations of goitre from Waltman, Brewer, & Lobert, (2004) & (Smeltzer, Bare, Hinkle & Cheever 2008) includes;
o Simple goitre usually presents as a mid-line lump in the neck without symptoms. However, when excessive it may compress on the trachea leading to compromised respiratory function.
o Goitre due to hyperthyroidism is more symptomatic, manifesting in a group of signs and symptoms often referred to as thyrotoxicosis including increased appetite, dyspnoea on exertion, diaphoresis, heat intolerance, palpitations, irritability and nervousness. Others include sleep disturbance, fatigue, exophthalmia (bulging eyes), blurred vision and/or diplopia, fine resting tremors, weight loss, diarrhoea and irregular menstruation.
o Clinical manifestations of nodular goitre are related to those of growth or functional autonomy. Symptoms are typically those of local pressure (dysphasia, globules sensation, cough or dyspnoea) or cosmetic complaints and are difficult to evaluate objectively. It is mandatory to rule out malignancy, for which purpose fine-needle aspiration biopsy is the gold standard (Fast, Nielsen, Bonnema, & Hegedűs, 2009).
Subjective and Objective Diagnostic Plans The diagnostic plans for goitre as discussed in (Smeltzer, Bare, Hinkle & Cheever 2008) & Tonacchera, et al, (2010) A combination of clinical manifestation, comprehensive medical history-taking and physical examination/ neck palpation will generally give a picture of the diagnosis for goitre. The thyroid gland is enlarged, soft and may pulsate; a thrill is often palpated, and a bruit is heard over the thyroid arteries as a result of increased blood flow to the gland. However, it is important to confirm the diagnoses with laboratory and radiological examinations, some of which are listed below.
Measurement of the serum Thyroid- stimulating hormone (TSH) concentration. This test is of high sensitivity and is the best screening test for thyroid function. Normal range is 0.4 - 6.15 µU/mL - Serum FREE T4. - Radioactive iodine uptake test to measure iodine uptake by the thyroid gland using tracer dose of iodine
123 (
This is used to confirm abnormal TSH result.
123
- Fine-needle aspiration biopsy for detecting malignancy. It provides the most direct and precise information about a thyroid nodule
I). There is high uptake in hyperthyroidism and low uptake in hypothyroidism
- Ultrasonography (US) of the thyroid gland. Others include elastography and scintigraphy. - Computed tomography (CT) scan and magnetic resonance imaging (MRI) - Further a combination of cytology and molecular testing improves the diagnostic accuracy for better
prediction of malignancy in thyroid nodular disease. Medical Management of Goitre Goitre could be managed either pharmacologically or surgical or by combined therapy. Endemic goitre is treated by increasing iodine in the diet to correct the iodine imbalance. Oral supplementary iodine (Lugol iodine) can be used as a replacement drug for synthesis of thyroid hormones (Greenstein, et al, 2004, Mustapha, 2008, & Smeltzer, et al, 2008). Iodization is not without side effects and has been known for many years that an increase in the incidence of hyperthyroidism often occurred after iodization. It usually affects older subjects who had a longstanding goitre and is due to increased sensitivity of the thyroid gland to iodine in amounts which would be well tolerated by normal subjects (Phillips 1997). Therefore it is important to monitor thyroid levels during and following treatment. When surgery is recommended, it is advisable to have patient in euthyroid state through treatment with anti-thyroid medications and iodide to reduce the vascularity of the goitre thus reducing post operative complications like haemorrhage and haematoma (Greenstein, et al, 2004 & Smeltzer, et al, 2008). The treatment of hyperthyroidism depends largely on the underlying cause and is aimed at reducing hyperactivity, reduce symptoms and prevent complications. A combination of therapies is often used including anti-thyroid agents, radioactive iodine and surgery (Smeltzer, et al, 2008). Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine (131
Antithyroid medications are used either to block the synthesis of hormones (carbimazole, propylthiouracil and methimazole) or suppress the release of thyroid hormones (sodium iodide, potassium iodide, saturated solution
I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non- toxic goitre. Side effects are few and the five year risk of hypothyroidism is 22%. (Nygaard, et al, 1993, Fast, et al, 2009). Radioiodine is administered orally and is rapidly absorbed and retained in the thyroid gland where it destroys only thyroid cells. However, patient will eventually go into hypothyroid state requiring treatment.
of potassium iodide (SSK), dexamethasone). Beta-blockers (propranol) are used to treat symptoms like tachycardia, tremor, sweating and anxiety (Greenstein, et al, 2004 & Smeltzer, et al, 2008). Surgery (thyroidectomy) is reserved only for special circumstances in recent time unlike in the past when it was the fundamental treatment option for hyperthyroidism. It is performed now only on patients allergic to anti-thyroid medications, those with large goitres and in patient with a need for rapid normalisation of thyroid function (Pearce & Braveman 2004, Smeltzer, et al, 2008). A subtotal thyroidectomy is often performed where almost all the thyroid tissue is removed. Furthermore, all the three treatment modalities for hyperthyroidism share the same complications including relapse or recurrent hyperthyroidism and permanent hypothyroidism (Smeltzer, et al, 2008). Nursing Intervention Strategies Nursing intervention in the management of goitre is usually in form of health promotion, disease prevention, care of hospitalised patients and ensuring that patients reach their optimal level of health and function through adequate community follow-up care. Health Promotion and Disease Prevention The role of the nurse in the intervention programme of the Goitre patient is health promotion which enables people to increase control over, and improve their health leading to reduction and prevention of disease (health gain), enhances autonomy and informed decision-making (empowerment) and increased social participation (Naidoo, &Wills, 2000). The nurse ensures that contacts with people (example, school nurse, industrial nurse and in antenatal clinics) serves as opportunity to impact knowledge about their health needs to them. In places where goitre is endemic the nurse need to enlighten people on the need to use iodized salt (WHO, 1996), encourage them to partake in health screening and to seek medical help, if they notice any form of thyroid abnormality. Care of Hospitalised Patients with Goitre When patient is admitted with either simple goitre or hyperthyroidism, it is crucial that the nurse make proper nursing diagnosis and identify their nursing care needs. Some nursing diagnosis of patient with simple goitre might include disturbed body image related to neck swelling and deficient knowledge related to normal nutrition and treatment measures (Waltman, et al, 2004, Smeltzer, et al, 2008). In patient with disturbed body image related to neck swelling, the nurse aims towards encouraging patient to employ new coping methods and acceptance of their appearance through good grooming, dressing and presentation of self. The nurse also promotes social interaction and contacts with new and existing support networks like friends, family and colleague at work. These help to improve patients self esteem. Where there is deficient knowledge related to normal nutrition and treatment measures, the goal of nursing care would be to provide patient with information about the disease process and the need for adequate dietary intake of iodine. Further, the patient is informed about their plan of care including investigations, medications, and surgery so as to encourage cooperation and compliance. However, the nursing in providing information gets down to the level to the patient depending on their knowledge base and previous exposure. Additionally, patients with hyperthyroidism need a lot of understanding and reassurance because of the alteration in emotional status as well as physical appearance which often are part of the disease symptoms. Improving nutritional status is paramount in offsetting the imbalanced nutrition less than body requirement. The nurse also provides a relaxed and cool environment to encourage patient to rest. The family of patient needs reassurance and encouragement in order to cope with the significant changes that occur in such patient. Community Follow-up Care
Patient on discharge should be fully equipped with information on how to continue with self-care at home. This information include the coping measures, need to adhere to medication regimen, need for increased dietary intake of iodine through iodized salt and seafood, identifying potential complications and compliance to follow-up appointments (Greenstein, et al, 2004 & Smeltzer, et al, 2008). Patient could be followed up by the community nurse where this service is available. Fundamental to delivering adequate nursing intervention to patient with goitre is a sound knowledge of the anatomy, physiology and pathophysiology of the thyroid gland including the various treatment modalities for the patient group. Secondly, the nurse also needs a good interpersonal relationship particularly in relating with patients with hyperthyroidism. Summary, The author has clearly examined the structure and function of thyroid gland and the pathophysiology of goitre. The epidemiology of the disease (goitre) in various states in Nigeria, causes, clinical manifestations both subjective and objective indexes were fully highlighted in the review. Medical management which consist of pharmacological therapy and surgical intervention were discussed. Nursing intervention strategies in the management of goitre which include the promotion of health, preventive of disease, care of the hospitalised patient and community follow up care were all x-rayed in the discourse. Recommendation In view of the enormity of the disease in the society, it becomes expediently recommended that public health instruction be given by nurses and other health care providers to reduce the incidence of goitre in the endemic community. These are achieved through teaching of the causes, clinical manifestations and treatment of goitre in schools, market places, community town halls, churches etc. The people are encouraged to use iodised salt; if possible, it can be distributed in the clinics and health centres to augment the sales in the market. Significantly, people in the endemic region should be encourage to perform their screening test for serum thyroid-stimulating hormone (TSH) concentration for normal functioning of thyroid gland. Conclusion. The thyroid gland and its hormones play a vital role in maintaining normal metabolic activities of the various organs of the body. An abnormality in the function of the thyroid hormones thus affects this function. Goitre which is caused by either iodine deficiency or hyperthyroidism is one of the conditions of the thyroid gland which the nurse encounters either in clinical practice or in the community. There are various clinical manifestations of this condition as well as diagnostic investigations that help in the diagnosis of goitre. Treatment is aimed towards optimising function with minimal side effects. The nurse plays a very important role in the care of patient with goitre as well as in health promotion activities to prevent and control the occurrence of goitre particularly endemic goitre. The nurse needs to be well informed on the normal and abnormal functions of the thyroid gland in order to be knowledgeable doer in caring for the patient group. There is need for more evidenced-based nursing articles on this topic to inform clinical practice, nursing education and further research on the topic.
Andersson, M., Takkouche, B., Egli, I., Allen, H. E., & de Benoist, B. (2005) Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bulletin of the World Health Organisation 83(7): 518-525. 5 Adequacy of dietary iodine in two local government areas of Cross River State in Nigeria. Pakistan Journal of Nutrition 7(1): 40-43. Bakhsh, A., Kirov, G., Gregory, J. W., Williams, E. D., & Ludgate, M. (2006) A new form of familial multi-nodular goitre with progression to differentiated thyroid cancer. Endocrine-Related Cancer. 13: 475-483. Daily Champion Newspaper (25th February 2010) NAFDAC to partner UNICEF on Goitre endemic states. Accessed on 24th July 2011. Downloaded from http://allafrican.com/stories/201002250353.html Fast, S., Nielsen, V. E., Bonnema, S. J., & Hegedűs, L. (2009) Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. European Journal of Endocrinology. 160: 517-528. Greenstein, G., Gould, D., & Trounce, J., (2004) Trounce’s Clinical Pharmacology for Nurses (17th
ed). Edinburgh: Churchill Livingstone.
Mustapha, R. O., (2008) The easier approach to pharmacology for all health professionals (2nd
ed). Ilorin: Adewumi Printing Press.
Naidoo, J., Wills, J. (2000), Health promotion: Foundation for practice (2nd
Edition), London, Balliere Tindall &Royal College of Nursing
Nygaard, B., Hegedűs, L., Gervil, M., Hjalgrim, H., Søe -Jensen, P., & Hansen, J. M. (1993) Radioiodine treatment of multinodular non-toxic goitre. British Medical Journal. 307: 828-832. Pearce, E. N. & Braveman L. E. (2004) Hyperthyroidism: advantages and disadvantages of medical therapy. Surgical Clinics of North America. 84(3), 833-847. Phillips, D.I.W., (1997) Iodine, milk, and the elimination of endemic goitre in Britain: the story of an accidental publ ic health triumph. Journal of Epidemiology and Community Health. 51: 391-393. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H., (2008) Brunner & Suddarth’s Textbook of medical-surgical nursing (11th
ed). Philadelphia: Lippincott Williams & Wilkins.
This Day Newspaper (4th November 2007) NAFDAC Take Anti-Goitre campaign to Taraba. Accessed on 24th July 2011. Downloaded from http://allafrica.com/stories/200711050801.html Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (Eds) (2005) Current medical diagnosis and treatment. New York: Lange Medical Books/ McGraw-Hill.
Tonacchera, M., Pinchera, A., Vitti, P., (2010) Assessment of nodular goitre. Clinical Endocrinology & Metabolism. 24 (1) 51-61. Waltman, P.A., Brewer, M., & Lobert, S., (2004) Thyroid storm during pregnancy: a medical emergency. Critical Care Nurse 24: 74-79. Accessed 21 March 2011 from cnn.aacnjournals.org World Health Organisation (1996) Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO document WHO/NUT/96.13. Diagram of the thyroid gland. Accessed on 28/03/2011. Downloaded from http://www.triofoundation.com/gfx/Thyroid_Diagram.jpg
ENHANCING READING COMPREHENSION SKILLS OF THE NIGERIAN COLLEGE STUDENT
By
Lekia Nwikina; Leesi Kaegon; Blessing Asaah and Cordelia Okechukwu Department of Educational Management,
Faculty of Education University of Port Harcourt
Abstract The purpose of the paper was to enhance the reading comprehension skills of the Nigeria college student. To this end, the causes for difficulties in reading comprehension, prerequisites, processes of, and strategies of reading comprehension were examined. Particularly discussed were the activities which the student must undertake before, during and after reading. Beside other things it was recommended that the student should recognize the relationship between reading and writing. As he reads he should jot down notes, use arrows, diagrams, outlines, table lines, charts, concept maps and other visuals to help him understand and later recall what he read. He should feature his reading of long materials with breaks and reward himself during these breaks and after readings. He should make honest evaluation of his reading and rethink using concept maps as tools. The institution should consider students’ reading problem, as the institution’s management problem to be tackled squarely.
Introduction
A student in the College of Education, Polytechnic or University has a load of
academic work to cover. He has a great deal of materials to read – textbook chapters, articles,
handouts and the likes on his various courses. He has lots of term papers, tests, assignments
and examinations to write. Essentially, he must be able to read and comprehend adequately
what he reads if he is to succeed in his academics in the institution, and in life generally.
Unfortunately, not all students who enter College have reading background, fully prepared
for the new challenges of college reading (Carter, Bishop & Krarib, 2002).
Hargrove and Poteet (1984) define reading comprehension as, “process of making
sense of written ideas through meaningful interpretation and interaction with language – The
student’s performance in the course examinations, course continuous assessment, tests and
term papers are also contingent on his reading and comprehension abilities.
Rutler (1980) writes that there are also strong ties between reading difficulties and
antisocial behaivour, that reading retardation may predispose the student to develop conduct
problems. He argues that:
Because reading is such an essential skill at school, reading failure may be a potent source of discouragement, loss of self-esteem and antagonism which may contribute to the development of delinquent activities. With status and satisfaction through schoolwork denied to him – (he) may rebel and seek satisfaction with activities running counter to everything the school stands for (p. 279).
Nwideeduh (2005) alludes to this relationship in his eloquent discourse on cultism
and examination malpractice in Nigerian higher education. He demonstrates strongly that
reading and related problems are also serious management problems in Nigerian higher
education that require urgent managerial attention. Students’ frequent failure in external
examinations owing to reading problems do not augur well for the students, their parents,
their future employees, the institution and the society generally.
This paper examines some causes for difficulties in reading comprehension,
prerequisites for achievement in reading comprehension and the strategies to promote
reading compression. It stresses particularly the three processes in reading comprehension
before, during and after reading. It also offers some recommendations for promoting reading
comprehension in Nigerian institutions of higher learning.
Causes for Difficulties in Reading Comprehension
Harris and Sipay (1980) suggest many reasons for poor progress in reading
comprehension, which may also affect Nigerian students. These include general intellectual
level below the average range; lack of opportunity to practice language; speech and hearing
impairments, all of which restrict vocabulary development. Thompkins (2003) opines that
comprehension problems sometimes relate to students’ lack of fluency or limited vocabulary
knowledge, but more often than not, students who do not comprehend seem not different
Word-by-word reading may cause poor comprehension; often the student is forced to
reread material just decoded in order to understand it. An inappropriate test, and slow reading
may also cause poor comprehension, as can inadequate sight vocabulary or a lack of well-
developed word recognition techniques. Inability to concentrate or to maintain attention also
results in poor comprehension (Thompkins, 2003).
Harris and Sipay (1980) indicate that, students who read sentence by sentence or are
overly reliant on oral reading during the beginning stages of reading may have poor
comprehension. They indicate also that easy or beginning storybooks may lead to poor
comprehension if students rely on the pictures to communication the content of story rather
than the words of the author. The student may become dependent on the pictures and lack the
motivation to read the story.
Poor instruction of students by teachers may also be a cause of poor comprehension.
Citing Durkin (1979), Hargrove and Poteet (1992) report that poor comprehension also
results when reading instructions for students do not prioritize on comprehension and when
the teaching of other subjects like Social Studies and Christian Religious Studies are not
viewed as opportunities to teach comprehension. This corroborates the United State of
American National Research Council (1999), cited in Lerner et al (2006), which notes that
the reading problems of many adolescents and adults reflect reading difficulties that were not
resolved during their early years. The important of these is that the poor reading
comprehension of many Nigerian tertiary students is consequential to reading instructional
laxities in their school years prior to their coming to higher education.
Eggen and Kauchak (2006) lend support to this argument in their statement that:
Effective teaching provides a foundation on which expertise is built, and that expert teachers go beyond this threshold to construct lessons that help students acquire a deep and thorough understanding of the topic they study (including reading comprehension) (p.7).
Prerequisites for Achievement in Reading Comprehension
Harris and Sipay (1980) in discussing the prerequisite skills needed for development
of comprehension skills identify the possession of adequate vocabulary size as vital to
expects to learn – from the reading assignment and from the course. The student
should also take a look at the end of chapter, summaries and conclusions. These can
give an idea of what the author covers and what he or she considers important.
Turnbull, Turnbull, Shank and Smith (2004) affirm that these help the student to
visualize information in an organized fashion and to understand the direction they are
taking when they need to learn and later recall.
The student should get organized and be set with necessary tools for the reading
material. These include:
(a) A pencil or pen to write notes in the margin (b) A highlighter to indicate key passages in the text (c) A copy of the assignment (d) A pad of paper and/or index cards for note taking if the material is complex. (e) A dictionary to check the meaning and pronunciation of unfamiliar words.
The student should give himself time. He should get a watch for timing himself as he
reads the passage. Timing how long it takes to read a representative chunk of material
provides him with a rough measure of his reading speed, although this may vary
depending upon the complexity of the material. This may also help the student to
determine an aspect of his learning style, his attention span, length of time he is able
to sustain attention. However, the student should know from the onset that reading is
not a race, and faster readers are not necessarily better readers. The act of reading is
designed to increase one’s knowledge and open up new ways of thinking. It can help
one achieve new levels of understanding and get him to think more broadly about the
world and its inhabitants. Speed matters far less than what we take away form what
we have read. The key to good reading is understanding – not speed. (Feldman 2004).
2. Activities While Reading that Enhance Reading Comprehension
What the student is doing while he is reading is very important. He does several
things including the following: Ellis (2003) suggests that before one dives into reading the
first paragraph, he should take a moment to reflect on what he already knows about the
subject. He should do this even if he knows nothing; this technique prepares his brain to
The student must stay focused. He must keep distracting thoughts at bay and focused
on the material he is reading. This is often not easy but the following considerations
may help:
(a) Read in small bites. If the student thinks that a material will take say 4 hours to complete he should break it for two or more separate sessions of 2 or 1 hour.
(b) Take a break. The student should plan to take some breaks to reward and enjoy himself, perhaps with snacks or watch TV.
(c) Deal with distraction. This may be done by writing down on a paper the solution of the distracting problem. He should make all efforts to stay in focus, not distracted. Ellis (2003) suggests that the student should use the Power Process “Be here now” when he notices his attention wandering; he should gently bring it back to the present.
The student should write while he reads. As shown above writing is one of the most
important aspects of reading. He should be free to underline, jot notes, place checks,
marks on the pages, draw arrows, construct diagrams and other annotations or
mnemonics on his books as he reads. In order words he should own his book or make
it his own. The student should therefore be involved in the following activities while
reading:
Rephrase key points. He should make notes to himself, in his own words, about what
the author is trying to get across; should think about the material and rewrite it in
words that are his own. This has the advantage of (1) making the material his,
something he understands and made a part of his own knowledge base, (2) by trying
to summarize a key point in his own word it makes clear whether he truly understands
it; (3) the very act of writing engages an additional type of perception – involving the
physical sense of moving a pen. This helps in learning the material in a more active
way, (4) it helps the student study the material later – not only will the key points be
highlighted, but the notes will quickly bring him up to speed regarding his initial
thoughts and impressions.
The student needs to highlight or underline key points or information. Very often the
first or last sentence in a paragraph or the first or last paragraph in a section presents
the key point. The student should read through the whole passage to be able to
Armstrong, D.G. & Savage, T.V. (1998). Teaching in the Secondary School: An Introduction. New Jersey: Prentice- Hall. Carter, C., Bishop, J. & Kravits, J. (2002). Keys to College Studies: An Introduction. New Jersey: Prentice-Hall. Eggen, P.D. & Kauchak, D.P. (2006). Strategies and Models for Teachers: Teaching Content and Thinking Skills. Boston: Pearson. Ellis, D. (2003). Becoming a Master Student. Boston: Houston Mifflin Company. Feldman, R.S. (2004). Power Learning: Strategies for success in college and life. Boston: McGraw-Hill. Ferret, S.K. (2003). Peak Performance: Success in College and beyond. New York: Glencoe & McGraw-Hill. Good, T.L. & Brophy, J.E. (2000). Looking in classrooms. New York: Longman. Harris, A.J. & Sipay, E.R. (1980). How to increase reading ability. New York: Longman. Hargrove, L.J. & Poteet, J.A. (1984) Assessment in special education: The education evaluation. New Jersey: Prentice-Hall. Lerner, J. & Kline, F. (2006) Learning Disabilities and related disorders: Characteristics and teaching strategies. Boston: Houghton Mifflin Company. N.T.I. (2010). Manual for the re-training of primary school teachers; Social Studies. Kaduna: National Teachers Institute Press. Nwideeduh, S.B. (2003). “The menace of cultism in Nigerian Universities”. In S.B. Nwideeduh (ed) Trends and issues in managing universities in Nigeria (pp. 221-257). Owerri: Springfield. Rutler, M. (1980). Helping troubled children. Middlesex: Penguin. Taiwo, O.; Longe, L. & Ijeoma, W. (1999). Macmillan Primary English Course. Lagos: Macmillan. Thompkins, G.E. (2003). Literacy for the 21st
Century. New Jersey: Pearson Education.
Turnbull, R.T., Turnbull, A., Shank, M. & Smith, S.J. (2004). Exceptional Lives: Special education in today’s schools. Boston: Pearson.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
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Abstract
Many companies, private individual sponsors, firms, industrial managements and corporations spend large sums of money on sports programmes for a derived advantage of boosting their sales. Despite the fact that many sports administrators make efforts to obtain sponsorship for sports programmes, not many are successful, and the chances of success continue to dwindle even in recent times. This study investigated inhibitors to sponsorship of selected sports programmes in Oyo State. Four hypotheses were stated based on the problems identified by the researchers. A total of five hundred respondents were selected through systematic sampling technique for the study. They comprised of company staff, sports administrators, civil servants, school sports masters, businessmen, sport journalists and sports enthusiasts.. Five hundred copies of self developed questionnaire were administered on the respondents; however, only four hundred and fifty copies were retrieved. Data collected were presented using simple percentages and chi-square statistical tool was employed in testing all the stated hypotheses at 0.05 significance level. The study revealed that funding, bloated budget, hooliganism as well as embezzlement and fraud have a significant influence on sponsorship of selected sports programmes in Oyo State. It was recommended that sports associations should develop effective marketing strategies and seek professional advice in order to make sports very attractive to corporate organizations and investors. Sports and corporate bodies’ awareness campaign about benefits derivable from sports should be increased. Accountability should be the watchword of sports administrators.
out that nations use sports to establish their superiority and supremacy over others. This
attitude is expansively demonstrated in government preparations for international events such
as Olympic Games, World Cup, Common Wealth Games and All African Games. Sports
occupy a prominent place in the social and national development of Nigeria. It is a big
venture which requires huge amount of money to manage. Asagba, (1994) asserted that,
sports is a costly venture, both in terms of money, energy and resources, this is why it is not
practicable to run sports with a limited source of fund. The above statement buttresses the
fact that sports is capital intensive, hence more than enough fund is needed to manage sports
programmes.
Money is the backbone of successful sports programmes. It is the foundation on
which sports programmes are built, Asagba, (1994) posited that even if we have brilliant
administrators and beautiful programmes designed by them, without effective sponsorship,
their effort cannot be appreciated. This emphasizes that the extent to which money is needed
depend on the type of competition, sports, local or international. The rate at which the cost of
facility and equipment and their maintenance grow yearly is high, thus much money is
needed for sports at a point in time. Morakinyo (2000) stated that, as the years roll by,
administrators of higher institutions are finding it extremely difficult to finance sports;
whether at the intramural level or the intercollegiate level. Igbanugo (1992) submitted that,
funding is an important aspect of sports and seems to be at the root of the administrative
problems that are being encountered by university sports.
It is pertinent to know that, only through effective sponsorship can adequate provision
be made for facility and equipment; recruitment of sports personnel; the up-keep of
sportsmen and women such as: feeding, transportation, lodging, medical, production of
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
27
trophies and medals; and allowances, all these cost money. According to Igbanugo, (1992)
and Ibikunle (1994), sports require a huge capital outlay. Morakinyo, (2000) also revealed
that the huge capital outlay is required for the provision and maintenance of facility and
equipment and supplies. He further stated that inspite of the astronomically rising cost of
funding sports in higher institutions, government subventions to them are shrinking every
year. This may be an inhibitor to sponsorship of selected sports programmes. A good
administrator must budget properly, for sports programmes to achieve good results and good
sporting experience for both athletes and personnel. Money is a morale booster, so coaches,
athletes and administrators should be adequately rewarded, as a means of motivation and
challenge for others to work harder. This brings about a large turn-out for sports, thus more
competitions.
Government is the major source of sponsorship of sports administration in Nigeria.
Funds come in terms of grants and subventions to the concerned ministries and parastatals.
However, government cannot finance sports alone, because of other pressing needs that
require funding. Efforts should be made to support funding of spots administration.
Morakinyo, (2000), revealed thus “because university administrators encounter the reality of
poor financial situations, they now encourage sports administrators to source for funds from
other sources”. It is a common practice to look for sponsors, and one is not surprised that
business organizations like the soft drink giants, Coca-Cola and Seven-up bottling Company
plc, Nigeria Breweries plc and other important corporations like Nigeria National Petroleum
Company, Globacom Plc, MTN Plc, Central Bank of Nigeria, Shell B. P. Plc., Industrial
General Insurance, Union Bank Nigeria Plc,. Cadbury Nigeria Plc and Mobil Nigeria Plc. All
have contributed to the improvement of sports preparations in major competitions (Ibikunle,
1994).
Many companies, private individual sponsors, firms, industrial managements and
corporations spend large sums of money on sports programmes for a derived advantage of
boosting their sales. Such industries as Chalmers Manufacturing Company, Wisconsin,
United States of America, would spend fortune on sporting activities like, Basketball,
Bowing, Baseball and shooting. In Nigeria, as a whole, worthy of note are these sponsored
competitions, Coca-Cola Challenge Cup Competition, Coca-Cola U-18 Football Competition,
(1996) NNPC- U – 13 Football Competitions (1996), Shell Football Competition (2000),
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
28
Globacom League, Milo Basketball Competition seven-up Basketball Competition, Mobil
Track and Field.
Ironically, Morakinyo, (2000) argued that inspite of the fact that many administrators
in sports organization do seek for sports sponsorship, not many are successful, and the
chances of success continue to dwindle even in recent times. This could be attributed to a
number of factors ranging from changes in the policy and strategy of corporate bodies to
sports related challenges. Some companies would not sponsor sports perhaps due to certain
inhibitors (social and economic obstructions). To this effect, this study reviewed factors such
as bloated budget, embezzlement and fraud, funding of sports, hooliganism, that may be
inhibitors to sponsorship of sports programmes in Oyo State. This study examined factors
that militate against effective sponsorship of selected sports programmes in Oyo State.
Statement of the problem
The enormous responsibilities of the government coupled with the ever rising costs of
funding needed to oil the machineries governance affects quite a number of government
ministries and parastatals and programmes, sports inclusive. However, an understanding of
the fact that government alone cannot finance sports, particularly at this time of economic
recession makes it imperative that other sources of funding must be sought. Morakinyo,
(2000), advocated that government should hands off financing sports. He observed that
governmental efforts at funding sports in terms of subventions to the sports sector are
shrinking every year; voluntary individuals and corporate bodies’ contributions to
sponsorship of sports is also depreciating and this has led to a situation whereby sports
proposals for sponsorship are not successful. Many clubs and competitions are fading away
and Nigerian athletes are not featuring enough in international competitions, and also low
laurels
Hence, this study sought to find out factors militating against effective sponsorship of
selected sports programmes in Oyo State.
Hypotheses
The following hypotheses were tested:
(1) Funding of sports will not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State.
(2) Bloated budget will not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
29
(3) Hooliganism will not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State.
(4) Embezzlement on the part of the administrators will not be a significant inhibitor to
sponsorship of selected sports programmes in Oyo State.
Methods and procedure
The descriptive survey research design was used for this study.
The population for the study consists of management and staff of public liability
companies, sports associations, sports council administrators, journalists and sports
enthusiasts in Oyo State. The systematic random sampling technique was used for selection.
The participants consists of 500 (Five Hundred) respondents from selected companies and
sports bodies. 25 members of staff from 10 selected companies were systematically picked
from their staff lists; 50 sport journalists from ten media houses, 10 members each from 12
sports associations, 50 coaches and 30 sports followers who were accidentally picked at
Adamasingba stadium during a sports competition.
Instrumentation
The research instrument adopted was a self developed close ended, Likert-type
questionnaire. It was divided into two sections, A and B. Section A contains items on
personal data of the respondents, while section B sought information on the variables under
study.
Analysis, Results and Discussions
The descriptive statistics of mean, frequency and percentage were used to describe the
demographic data while inferential statistics of chi-square (x2) was used to test the
hypotheses at 0.05 level of significance.
Hypothesis 1
Funding of sports will not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State.
ITEMS SD % D % A % SA % TOT
AL
X2C
X2T df LEVEL OF
SIGNIFICA
NCE
REMARKS
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
30
Table 1: Analysis of responses on whether funding of sports is an inhibitor to sports
sponsorship in Oyo State.
The above table shows a calculated chi-square value of 1.0 and a chi-square table value of
16.92 at 0.05 alpha level. It could be observed that the calculated chi-square value is lesser than the
table value, hence hypothesis one was not rejected. The table also shows that higher number of
respondents agreed. Therefore, funding of sports has no significant influence on sponsorship of
selected sports programmes in Oyo State.
Hypothesis 2
Bloated budget will not be a significant inhibitor to sponsorship of selected sports programmes in
Oyo State.
Table 2 :Analysis of responses on whether bloated budget of sports is an inhibitor to
sports sponsorship in Oyo State.
26 36 9.0 58 14.5 157 39.3 149 37.3
27 35 8.8 52 13.0 160 40.0 153 38.3 Not
400/
100
1.0 16.92 9 0.05 Significant
28 34 13.
3
53 13.3 157 39.3 156 39.0
29 37 9.3 56 14.0 160 40.0 147 36.8
ITEMS SD % D % A % SA % TOT
AL
X2C X2T df LEVEL OF
SIGNIFICANCE
REMAR
KS
16 108 27.0 102 25.5 119 29.8 71 17.8
17 67 16..8 118 29.5 132 33.0 83 20.8
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
31
The above table shows a calculated chi-square value of 18.58 and a chi-square table value
of 12.60 at 0.05 alpha level. It could be observed that the calculated chi-square value is greater than
the table value, hence hypothesis two which stated, that bloated budget has no significant influence
on sports sponsorship in Oyo State was rejected. The table also shows that higher number of
respondents strongly disagreed.
400/
100
18.5
8
12.6
0
6 0.05 SIGNIFI
CANT
18 65 16.3 121 30.3 132 33.0 82 20.5
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
32
Hypothesis 3
Hooliganism would not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State.
Table 3: Analysis of responses on whether Hooliganism is an inhibitor to sports sponsorship
in Oyo State.
ITEM SD % D % A % SA % TOTAL X2 XC 2 Df T LEVEL
SIGNIFICANCE
REMARKS
5 73 18.3 103 25.8 104 26.0 120 30.0
6 74 18.5 104 26.0 107 26.8 115 28.8
7 72 18.0 107 26.0 107 26.8 114 28.5
8 72 18.0 100 25.0 105 26.3 123 30.8
9 73 18.3 108 27.0 105 26.3 114 28.5
400/
100
3.18
36.42
24
0.05
NOT
SIGNIFICANT
10 77 19.3 101 25.3 108 27.0 114 28.5
11 77 19.3 101 25.3 105 26.3 117 29.3
12 67 16.8 107 26.8 107 26.8 119 29,8
13 79 19.8 98 24.5 105 26.3 118 29.5
Table three above shows a calculated X2C of 3.18 and a table X2t value of 36.42 at 0.05 alpha
levels. It could be observed that calculated chi-square value is lesser than the table X2t value, and
also a larger number of respondents strongly agreed. Therefore, hypothesis two which stated that,
“Hooliganism has no significant influence on sponsorship of selected sports programmes in Oyo
State,” was not rejected.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
33
Hypothesis 4
Embezzlement and fraud on the part of the administrators would not be a significant
inhibitor to sponsorship of selected sports programmes in Oyo State.
Table 4: Analysis of responses on whether Embezzlement and Fraud is an inhibitor to sports
sponsorship in Oyo State.
ITEM SD % D % A % SA % TOTAL X2 XC 2 df T LEVEL
SIGNIFICANCE
REMARKS
14 91 22.8 118 29.5 90 22.5 100 25.0
400/
100
37.81
9.49
4
0.05
NOT
SIGNIFICANT
15 169 42.5 75 18.8 68 17.0 88 22.0
The above table shows a calculated chi-square value of 37.81 and a table chi-square value of 9.49
at 0.05 alpha level. It could be observed that the calculated chi-square value is greater than the
table value. The hypothesis which stated that “Embezzlement and Fraud on the part of the
administrators would not be an inhibitor to sponsorship of sports programmes in Oyo state. Hence,
hypothesis stated above was rejected. The table also shows that greater number of respondents
strongly agreed, that embezzlement and fraud on the part of the administrator has a significant
influence on sponsorship of selected sports programmes in Oyo State.
Discussion of findings
Hypothesis One
“Funding of sports would not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State”.
According to table one, to test this hypothesis, responses of the participants to items, 26, 27,
28, 29 were used to develop a frequency distribution table for analysis. The result obtained shows
that the calculated chi-square value is less than the chi-square .table value. Consequently,
hypothesis one was therefore not rejected.
This goes to say that funding of sports has no significant influence on sponsorship of
selected sports programmes in Oyo State. However, this result contradicts the finding of Igbanugo
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
34
(1992). Igbanugo (1992) stated that “funding is a very important aspect of sports and seems to be at
the root of administrative problems” that is being encountered by university sports.
Hypothesis Two
“Bloated budget would not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State”. In testing this hypothesis, responses of subjects to items, 16, 17 and 18
were used to develop a frequency distribution table. The observed chi square value were then used
to generate the expected value. The result obtained revealed that the calculated chi-square value
exceeded the table value for chi-square, hence hypothesis two was rejected. It implies, therefore
that bloated budget has a significant influence on sponsorship of selected sports programmes in
Oyo State. Morakinyo (2000), stated that budget should be taken as a working plan for the
organization, it is the means by which the administrator can achieve his objectives apart from using
the budget to measure the results obtained. This goes to say that bloated budget has a significant
influence on sponsorship of selected sports programmes in Oyo State.
Hypothesis Three
“Hooliganism would not be a significant inhibitor to sponsorship of selected sports
programmes in Oyo State”.
According to the figures shown in table three, in testing the hypothesis, subjects’ responses
were used to develop a frequency distribution table. The observed values obtained were used to
generate the expected values for comparative purposes.
The results obtained shows that the calculated chi-square value is less than the table chi-
square value. Hence, hypothesis three was not rejected.
Therefore, it could be said that, hooliganism has no significant influence on sponsorship of
selected sports programmes in Oyo State.
The instinct theory hold the view that aggression is innate and that man is born with it, as
an in-built defense mechanism.
Aggression is a survival attribute. Alderman (1974), supports this view by saying that
athletic competition is necessary for man to indulge his aggressive tendencies in a socially
acceptable manner.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
35
Hypothesis Four
“Embezzlement and Fraud on the part of the administrators would not be a significant
inhibitor to sponsorship of selected sports programmes in Oyo State.
The result obtained shows that the calculated value exceeded the table value for chi-square.
Thus the hypothesis was rejected. This shows that embezzlement and fraud on the part of an
administrator has a significant influence on sponsorship of selected sports programmes in Oyo
State. This finding was supported by the responses of subjects to items 14 and 15 in which a total
of 65.1% respondents strongly disagreed. Ikulayo (1991), stated that many people are dissatisfied
with the ways sports is managed in this country. This is due to the numerous administrative
bottlenecks, utilization of inappropriate personnel …, coupled with frequent changes of leaders”.
Additionally, Morakinyo (2000) revealed that there is also the presence of fraudulent practices,
duping …. and embezzlement, and of recent, computer fraud which hamper sponsorship of
selected sports programmes in Oyo State.
Therefore, embezzlement and fraud have significant influence on sponsorship of selected
sports programmes in Oyo State.
Conclusion
Based on the findings, it was concluded that funding, bloated budget, hooliganism embezzlement
and fraud on the part of the administrator of sports are inhibitors to sponsorship of selected sports
programmes in Oyo State.
Recommendations
Consequent upon the conclusions in this study, the following recommendations were made:
i. Corporate organizations and private individuals should increase their investment in sports
through sponsorship for effective development of sports in Nigeria.
ii. Government should increase their support for sports funding by increasing subventions and
allocations to Associations and ensure that the fund is spent for the purpose.
iii. Each sport association should develop effective marketing strategies and where necessary,
seek professional advice, in order to make sport attractive to corporate organizations and
investors.
iv. Sports associations should also try to develop attractive sports programmes for sponsorship
by individuals and organizations.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
36
v. Sports Administrators should create in individuals and corporate bodies awareness, about
benefits derived from sports.
vi. More studies should be carried out in the following areas;
(a) Sponsorship and revenue generation in sports
(b) Benefits derived from sponsorship of sports programmes.
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Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
38
RELATIONSHIP BETWEEN LACK OF ACCESS AND LOW UTILIZATION OF HEALTH SERVICES: A STUDY OF RIVERINE LOCAL GOVERNMENT
Abstract The purpose of this study is to find out the relationship between lack of access and low utilization of health services in riverine Local Government Areas (LGAs) of Rivers State. One hypothesis was generated to guide the study. Survey design was adopted for the study. The population adopted for the study covers the residents of riverine LGAs of Degema, Asari-Toru, Akuku-Toru, Andoni, Bonny, Okrika, Opobo-Nkoro and Ogu-Bolo in Rivers State. Simple random sampling technique and accidental sampling technique are used to select a sample size of six hundred (600) respondents for the study. Questionnaire was the instrument used for data collection. The instrument was face validated by professionals and its reliability co-efficient value of 0.68 was established for the study. Demographic data of the respondents are analyzed, using percentage while the hypothesis for the study was tested at .05 level of significance using Pearson Product Moment Correlation. The result of the study reveals that lack of access to health centres for health services has a significant relationship with low utilization of health services in riverine LGAs of Rivers State. Based on this finding, it was recommended, among others that the state and local governments should provide efficient and effective water transportation system to those communities where health centres are not located to others where same are available for easy access to health services. Keywords: Relationship, Lack of Access, Low Utilization, Health Services, Riverine, Local Government Areas, Rivers State
Introduction The issue of access is an important factor that could improve or lower the utilization of health services in Nigeria. Consequently, access and utilization of Primary Health Care (PHC) services improve where there are less issues of distance and shortage of health services. But on the contrary, distance may pose problems if 80% of PHC services are not available for utilization (Thaddeus and Maine, 1994). Distance exerts dual influence on access of health services. Long distance can be an actual obstacle to accessing health services which may be a disincentive to even those trying to seek healthcare, while short distance influences people to access health services positively (Thaddeus and Maine, 1994). In these circumstances, it is crystal clear that the ability and inability to ensure good roads, affordable transport fare, and availability of health services and proximity of health centres will certainly influence either positively or negatively the access and utilization of health services in any country (Fieldler, 1981). Thus, there is no gainsaying the fact that access seems a major factor in health services utilization because the lesser the access, the lesser the utilization of health services, and the more the access, the more the utilization of health services in Nigeria. Thus, these seem to agree with Thaddeus and Maine (1994) findings, in which they explained that access in most cases, functions well in the utilization of health services where distance and available health services are not issues. In consonance with the aforementioned views, Leslie and Gupta (1989) argue that people access preventive health services in Ogun State of Nigeria, only when the health services are available within three kilometres from their residents. Sequel to this, Odusanya, Alufohai, Maurice, Clemens and Ahonkhai (2003) explain that over 75% of people in most rural areas and impoverished urban areas of Nigeria have no access to modern health facilities and services. Udoh (1987), in his exploratory study of maternal and child health knowledge, beliefs and practice in rural Calabar, finds that 90% of respondents see access as a major factor for clinic visits. In congruence with Udoh (1987), Onokerhoraye (1999), in his study of access and utilization in Delta State, argues that better health statuses of the people will be achieved if 90% of PHC services are improved, and health centres established at near proximity for better accessibility and utilization of same.
Consequently, in the 60s, 70s, 80s and 90s, access to utilization of health services was a major hindrance in Nigeria, especially in the study areas where terrain seems extremely difficult. Beyond the difficult terrain in the study areas during the aforementioned periods, there were few health centres with minimal health services for the people. Again, these few health centres were in sorry state of dilapidation. In this situation, the people in the study LGAs suffered from all kinds of diseases and illnesses, hence the low utilization of the few available health services.
Based on the foregoing, in 2007 the Rivers State government established PHC centres with equipped health services in most communities of the state, in so much that she can achieve high health services delivery and utilization among beneficiaries. Even when these seem to be achieved, some communities in riverine LGAs where the PHC centres are not located, and which have difficult terrains, are still faced with the problem of low utilization of health services that is still begging for attention. This is the problem that impelled the study to investigate the relationship between lack of access and low utilization of health services in riverine LGAs of Rivers State.
Hypothesis There is no significant relationship between lack of access to health centres for health services and low utilization of health services.
Methodology Survey design was used for the study. The population of the study covers residents of riverine LGAs of Rivers State. Also, this covers all beneficiaries of health services in the study LGAs of Rivers State. A sample size of 600 respondents was randomly selected for the study. The selection was done through the use of simple random sampling technique and accidental sampling technique. Thus, simple random sampling technique was used to select two riverine LGAs of Asari-Toru and Bonny in Rivers State. Also, simple random sampling technique was used to select three communities of Ifoko3, Krakrama and Minama from Asari-Toru LGA, and Utumbi, Ibipi and Lakiri from Bonny LGA while the accidental sampling technique was used for the selection of respondents for the study. The instrument used for data collection was the questionnaire. The face validity of the instrument was established by professionals in Measurement and Evaluation, Faculty of Education, University of Port Harcourt, Port Harcourt. Furthermore, test-retest method of reliability was used to determine the reliability value of 0.68 of correlation co-efficient for the study. The researcher administered the copies of the questionnaire with the help of four (4) research assistants; and they collected same immediately the responses were completed by respondents. The statistics used for the study are percentage and Pearson Product Moment Correlation. Percentage was used to analyze demographic data while Pearson Product Moment Correlation was used to test the hypothesis for the study.
Results The results of the study are presented in Tables 1 and 2. Table 1 results deal with demographic data of respondents while Table 2 result deals with the tested hypothesis for the study.
Table 1: Demographic Data of Respondents Demographic characteristics No. of respondents Percentage
Marital status Single 96 16 Married 252 42 Divorced 36 6 Separated 156 26 Widowhood 60 10 Religion Christianity 348 58 Islam 24 4 Traditional religion 156 26 Other religions 72 12 Educational Status First School Leaving certificates (FSLC)
132 22
West African Senior School Certificates (WASSC)
216 36
Degree 252 42 Occupational Status Fishing 96 16 Crop farming 96 16 Civil service 120 20 Trading 156 26 Other occupations 132 22 Health Status Not sick 264 44 Sick 180 30 Recovered 156 26 Local Government Asari-Toru 276 46 Bonny 324 54 Source: Field survey, 2012. The results of marital status show that 96 respondents, representing (16%) were single, 252 (42%) were married, 36(6%) were divorced, 156 (26%) were separated, while 60(10%) were widows and widowers (widowhood). For religion, the results show that 348 respondents, representing (58%) were Christians, 24(4%) were Muslims, 156(26%) were members of traditional religion, while 72(12) were members of other religions. For educational status, the results show that 132 respondents, representing (22%) had FSLC, 216 (36%) had WASSC, while 252 (42%) are degree holders. Furthermore, the results for occupational status indicate that 96 respondents, representing (16%) were fish farmers, 96(16%) were crop farmers, 120(20%) were civil servants, 156(25%)were traders, while 132(22%) were engaged in other occupations. For health status, the results reveal that 264 respondents, representing (44%) were not sick, 180 (30%) were sick, while 156 (26%) were recovered. Finally, for Local Government residence, the results show that 276 respondents, representing (46%) reside in Asari-Toru; while 324(54%) reside in Bonny.
Table 2: Analysis of the Relationship between Lack of Access to Health Centres for Health Services and Low Utilization of Health services Variables ∑ X ∑ 2X ∑ XY r ∑Y ∑ 2Y Lack of access to health centres
10704
23573
287482
0.58*
Low utilization of health services
10998
54654
*significant at .05, critical r =.062, degree of freedom (df) = 598 Source: Field survey, 2012. The result of the analysis as presented in Table 2 shows that the calculated r value of 0.58 is higher than the calculated critical value of .062 at .05 level of significance with 598 df. With this result, the null hypothesis that there is no significant relationship between lack of access to health centres for health services and low utilization of health services is rejected. This result therefore means that there is a significant relationship between lack of access to health centres for health services and low utilization of health services in the riverine LGAs of Rivers State.
Discussion of Finding The result of the hypothesis reveals that lack of access to health centres for health services has a significant relationship with low utilization of health services in the riverine LGAs of Rivers State. The finding of this hypothesis is in agreement with the view of Odusanya, et al (2003), they explain that over 75% in most rural areas and impoverished urban areas of Nigeria have no access to modern health facilities and services. Again, Udoh (1987) in an exploratory study of maternal and child health knowledge, beliefs and practice in rural Calabar finds that 90% of respondents see access as a major factor for clinic visits. Thus, the studies of Odusanya, et al (2003) and Udoh (1987) show the relevance of access to the study. Conclusion Considering the research finding, it is obvious that lack of access to health centres for health services has significant relationship with low utilization of health services in riverine LGAs of Rivers State. This is in consonance with Thaddeus and Maine (1994) who explained that distance may pose problems if 80% of PHC services are not available for utilization. In this situation therefore, the study exposes some windows of research on issues of attitude to health services; and issues of location of health centres in riverine LGAs of Rivers State, and indeed in other LGAs with similar riverine terrain in Nigeria.
Recommendations Based on the finding of the study, the following recommendations are made: 1. That government at all levels should encourage public enlightenment campaigns
on the relevance of health services to the beneficiaries. 2. That the state and local governments should provide efficient and effective water
transportation system to the communities where health centres are not located to others where same are available for easy access to health services.
3. That the state and local governments should ensure that more health centres are established in each of the riverine communities, in order to encourage the beneficiaries of health services to enhance their access and utilization of same.
Fieldler, J.L. (1981). A review of the literature on access and utilization of medical care with special emphasis on rural primary health care. Journal of Social Science and Medicine, (17) 319-324.
Leslie, J. & Gupta, E.R. (1989).Utilization of formal service for maternal nutrition and health care in the third World. Washington D.C. International Centre for Research on Women: 1-76.
Odusanya,O.O., Alufohai, J.E., Maurice, F.P., Clemens, R. & Ahonkhai, V.I. (2003). Short term evaluation of rural immunization programme in Nigeria. Journal of the National Medical Association, (5) 175-179.
Onokerhoraye, A.G. (1999). Access and utilization of modern health care facilities in the petroleum-producing region of Nigeria: Takeni Programme in International Health, Harvard School of Public Health. Boston. Harvard School of Public Health:20.
Thaddeus, S. and Maine, D. (1994). Too far to work: Maternal mortality in context. Journal of Social Science & Medicine, (8) 1091-1110.
Udoh, A.A. (1987). An exploratory study of maternal and child health knowledge, beliefs
and practice. Ikot Omin. Calabar Rural MCH/FP Project: 1-60.
Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
45
SOCIO-ECONOMIC FACTORS AS PERCEIVED DETERMINANTS OF MATERNAL MORTALITY AMONG WOMEN OF CHILD-BEARING AGE IN
AKINYELE LOCAL GOVERNMENT AREA OF OYO STATE NIGERIA BY
ADEMUYIWA OLUSEGUN. A
FEDERAL COLLEGE OF EDUCATION (SPECIAL) OYO
OYO STATE, NIGERIA
ABSTRACT
The focus of this study was to find out the socio-economic determinant of maternal mortality
rate in Akinyele Local Government Area of Ibadan Oyo State. A total number of ninety
respondents were the sample of the study. The descriptive research statistics was adopted, while
random sampling technique of fish bowl without replacement was used to select the sample from
the pregnant women attending Moniya Primary Health centre. A self structured and validated
questionnaire with Cronbach Alpha at 0.80 was used for data collection and four sets of
hypotheses were tested by using linear regression at 0.1alpha level. The effects of the
independent variables were found to be significant to maternal mortality rate in Akinyele Local
Government Area of Oyo State. Based on these findings it was recommended that the Federal,
States and Local government should design programme that will improve the social and
economical status of the people living in Akinyele Local Government and other rural areas to
improve the level of health standard of those that are living in rural environments and make
health services available, accessible and avoidable to reduce maternal mortality rate to the barest
minimum.
Introduction
Pregnancy is a vital event in the life of a woman from the time of conception to the postnatal
stage. Pregnancy is also seen as the act of bringing forth a new offspring. Bearing forth a new
offspring is an expectation of wives and husbands and the challenges (death of women) from it
remains a mystery to both husband and the wife globally even with the advent of technology and
science. Pregnancy have physiological and psychological challenges to both the wife and the
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46
husband. The death of woman during the stages of pregnancy and delivery are alarming and
poses a global challenge most especially to the developing countries of the world. The death of a
woman in childbirth is a tragedy, and wasteful event that carries with it a huge burden of grief
and pain. Pregnancy is not a disease but pregnancy related health problem and complication can
result to morbidity and mortality. Half a million women die each year due to pregnancy related
complications and 95% of them are from developing world and the lifetime risk of a woman
dying of pregnancy related causes in developing countries is 1:40 as compared to 1:3600 in
developed world. (Adeyanju, 2006). Going with the above definitions maternal mortality is
known as the death of woman as a result of pregnancy, labour and peuperium complications.
Odukoya (2007) viewed maternal mortality as the rate at which women die as a result of
pregnancy. World Health Organization (WHO 2010) affirmed that maternal mortality (MM) is
the death of a woman during pregnancy, labour, or as a result of pregnancy consequences’
within 42 days of delivery or abortion while Maternal Mortality Rate (MMR) is the total number
of maternal death registered during the year from causes attributed to pregnancy and childbirth
per 1000 register birth including both live and stillbirths. Maternal Mortality Rate is one of the
issues that determine the quality of available health care in a particular community and it is
always present tragedy to the family of the decease as it is irreversible. The death may occur as a
result of direct complication of pregnancy, such as pre-eclipsia, severe anaemia in pregnancy,
obstructed labour, and postpartum hemorrhage as a direct cause resulting from diseases usually
present before pregnancy but aggravated by the effect of the health on the pregnant women such
as hypertension, diabetes mellitus, sickle cell diseases renal failure or as a result of social factors
which include age, culture, ignorance and poverty, (Akinkugbe 2005). Evidence from studies
from maternal mortality has shown that the death of women as a result of pregnancy and labour
adds up to 600,000 women each year.
Maternal mortality represents one of the widest health gaps between developed and
developing nations, with 99 percent of all maternal deaths occurring in developing countries. Less
than one percent of maternal deaths worldwide occur in developed counties, there are
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47
approximately 27 maternal deaths per 100,000 live births each year. In developing countries, the
average is 18 times higher, at 480 deaths per 100,000 (Akinkugbe2005).
Several studies have been carried out on MMR yet an accurate statistics, of maternal mortality as
well as other vital statistics in health are not available even if it is available it is not adequate in
Nigeria, because many unregistered birth occur at homes (Ojo 2003). The above study is supported
by (Chukwu 2009, Ajayi 2008 and Adeyanju 2007). A retrospective study was conceptualized to
document the number and pattern of obstetric deaths at the Central Hospital, Benin City, over a ten
year period, to identify common causes of maternal deaths and proffer relevant interventions by
Eghe, and Lawrence (1997-2007). They found out that the overall maternal mortality rate (MMR)
was 518/100,000 and MMR was 30 times higher in unbooked pregnant women as compared to the
booked patients, while 60% of maternal deaths occurred within 24 hours of admission.
A survey across the six geopolitical zones of Nigeria in 2004 by the society of
Gynaecology and Obstetrics of Nigeria revealed mean maternal mortality ratio ranging from 727
to 7,523 per 100,000 live births from participating hospitals. These figures are unacceptably high
even by African standard. Existing data indicated that inadequate facilities and poor access to
available services are associated with the high maternal mortality in developing countries and
the major causes of maternal mortality in these countries including Nigeria were identified as
haemorrhage, sepsis, eclampsia, obstructed labour and complications of induced abortion,
anaemia, malaria and chronic diseases. Bright (2010) confirmed that Nigeria maternal mortality
rate is higher when compared with other developed countries of the world due to social
inequalities. Even though the major causes of MM may be unavoidable, if it occurs despite the
availability and the use of all the necessary facilities, personnel and equipment, competent
doctors and midwives or direct as a result of complication of pre-existing diseases such as those
mentioned above.
High maternal mortality rate is a major problem and of a greater concern globally since the MM has an implication on social and economic development of any nation that is affected because women of reproductive age are described by many scholars as having a greater percentage in the labour market globally (WHO 2010, Smith 2008 Adekunle 2008). It was
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48
further stated that by virtue of their numbers they are major consumer of health services. Women composed two-third of the population in developing countries such as Nigeria. Therefore if death is occurring among such age group it will be alarming and affect the national economy. (Akinkugbe 2005). Many of the scholars in the field of obstetrics affirmed that women who became pregnant at their teenage are at risk of obstructed labour. Otubu (2011) affirmed that there are many causes of MMR among the teenage mothers, he also appreciated that obstructed labour is one of the leading causes of maternal mortality among the teenage mothers. Obstructed labour may occur as a result of, the failure of the descent part of the fetal presenting part to successfully pass through the birth canal in spite of adequate contraction of the uterus. Several studies associated this problem with fault of the passage which is the pelvic girdle or the passenger (the foetus) itself. The former may be too narrow while the latter may be too big to allow the foetus to come out successfully.
PREVALENCE Africa 640/100,000
Indirect causes 20% Severe bleeding 24% Infection 15% Unsafe abortion 13% Eclampsia 12% Obstructed labour 9% Other direct causes 8%
KEY
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49
Asia 420/100,000 Latin/America 270/100,000 Europe - 10 / 100,000.
Source; The World Bank report of 2011 Pitkin and Smith (2004) when comparing the rate of MM in the other countries of the world rated Africa as the continent that has the highest percentage of MMR. It was also stated that women by their nature are subjected to marked social economical and psychological stress which if not cared for may reduce their level of health. Therefore this study examined the socio-economical factors as determinant to material mortality rate in Akinyele Local Government Area Oyo State. Akinyele local government was created in 1976. It is bounded on the East by Lagelu Local Government Area, on the North by Afijio Local Government Area, on the South by Ibadan North Local Government Area and the West by Ido Local government Area.
Akinyele local government with 12 wards has a very large population and it is inhabited by different tribes namely: Yoruba, Ibo, Hausa, Fulani, Nupe, Tiv, Efik most especially at the Ojoo/Sasa area of the local government. Akinyele local government covers an area of 575 square killometres: The Local government is made up of twelve wards. Research Hypotheses The following hypotheses were tested:
1. There will be no significant relationship between maternal mortality and economic factor.
2. There will be no significant relationship between maternal mortality and availability of health facilities.
3. There will be no significant relationship between maternal mortality and accessibility to health facilities.
4. There will be no significant relationship between maternal mortality and utilization of Health Facilities.
Methodology The descriptive research design was used for the study. The descriptive design is best
used to gather organize, present and analyze data for the purpose of describing the occurrence of
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50
an event within a particular group (Akuezilo 2003). The sample of this study was made up of ninety pregnant women attending Moniya Primary Health Center in Akinyele Local Government Area Oyo State.
Data was collected by the use of validated self structured questionnaire from the respondents on the variable selected for the study by using Cronbach alpha at 0.008. The instrument consists of 34 items; a four likert scale was utilized for all items. The results of the respondents were subjected to analysis of variance. The results of the analysis are presented in figures and tables below.
There will be no joint effect of independent variables (Economic Factors, Availability of Health
Facilities, accessibilities of health facilities and Utilization of Health Facilities) on maternal
Mortality.
Results and Analysis
MODEL SUM OF
SQUARES
DF MEAN
SQUARE
F SIG.
Regression
Residual
Total
5753.819
8251.605
14005.424
6
243
249
958.970
33.957
28.241 .000
R = .640
R2
Adj R
= .409 2 = .405
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51
It was shown in the table above that the joint effect of independent variables (Economic Factors,
Availability, Accessibility and Utilization of Health Facilities) on Maternal Mortality was
