Research Article ISSN: 0974-6943
Azuonwu, O et al. / Journal of Pharmacy Research 2010, 3(7),1607-1611
Available online through www.jpronline.info Prevalence and risk factors of Human Immunodeficiency Virus (HIV) in Ndoki communities of Nigeria 1
Azuonwu, O., 2 Obire. O* 3 Ramesh Putheti and 1 Nwankwo, M. Ekene Department of Medical Laboratory Sciences; 2 Department of Applied and Environmental Biology, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Nigeria. 3 Member, American association of Pharmaceutical Scientists,10314-E, Malcolm circle,Cockeysville, Maryaland, 21030. 1
Received on: 15-04-2010; Revised on: 12-05-2010; Accepted on:13-06-2010 ABSTRACT The prevalence of human immunodeficiency virus (HIV) with respect to age, occupational status, and marital status in women, men and youths visiting various Health Centers, Clinics, and Hospitals in Ndoki communities of Abia state in Nigeria was investigated. A total of one thousand and two hundred individuals within the age > 10 years were screened for the presence of HIV antibodies. The investigation was carried out by obtaining serum from the blood of the individuals by centrifugation. The serum was subsequently used for the Enzyme Linked Immunosorbent Assay (ELISA) to determine the samples that were sero-positive or sero-negative for HIV. The results obtained showed that generally, out of the total number of persons screened 180 (15%) were sero-positive for HIV while 1020 (85%) were sero-negative. Of the sero-positive persons, males constituted 56.67% while 43.33% were females. The age groups between 16 – 33 years are the most sexually active and they constituted 70.55% of the sero-positive persons. The prevalence of HIV was highest in the age group of 22 – 27 years (29.44%). The farmers, civil servants, unemployed, and students constituted 81.10% of the sero-positive persons. The prevalence of HIV in relation to occupational group was highest among the farmers (25%). With regards to marital status, prevalence was highest in the married. The married constituted 51.11%, the singles, 31.67%, while the widowed/separated was 17.22%. Statistical analysis (ANOVA) using paired t-test showed that there is no significant difference between the number of sero-positive males and sero-positive females at p=0.05. Generally, except for the age group of 16 – 21 years, the oil workers and students, the prevalence of HIV was higher in the males than the females. The findings are attributed to traditional practices of polygamy in addition to keeping concubines, poverty resulting from high unemployment rate and low HIV/AIDS awareness campaign within this region. It is suggested that personal and institutional preventive measures should be practiced by stakeholders; that voluntary confidential counseling and HIV testing should be an active component of the various health centers and treatment should be readily available for the general population and subsidized by government; that there should be adequate monitoring and evaluation of programmes by government agencies; and that government should provide industries and employment through the creation of skill acquisition programmes as to reduce the menace of poverty and HIV. Key words: Unemployment, poverty, ELISA, HIV, counseling. INTRODUCTION HIV is defined as human immunodeficiency virus. Human immunodeficiency virus is a retrovirus belonging to lenti-virus family that kills and damages cell of the body’s immune system, and progressively destroys the body’s ability to fight infections and cancer (Weber and Weiss, 2004). There are two types of HIV, HIV- 1 and HIV 2 of the two distinct sub types, HIV 1 is predominantly found within tropics. Both agents are associated with the development of progressive immunologic deterioration (Fauci, 1998). The occurrence of the dreaded disease is worldwide (pandemic). There were 40 million people living with HIV/AIDS by the end of the 2001 and in 2000 three million people died from HIV related illness, the vast majority of HIV infections occurs in developing countries (Okonofua et al., 2003). The most devastating effect of this dreaded disease is on the youth. The spread of the HIV/AIDS virus around the world has been on the increase in the number of children and youths who have been orphaned by this disease. In 2007, there was an estimated 11.4 million AIDS orphans in sub-Saharan African (Fauci et al 1998). The new face of HIV/AIDS is undoubtedly a serious problem global to leadership and youth leadership. Rural sensitization campaign in Cameroon has helped youths to be trained on healthy sexual practice, HIV prevention and transmission, testing and treatment.
*Corresponding author. Obire. O Department of Applied and Environmental Biology, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Nigeria. Tel.: + 91-234 (806)169-2017 E-mail:
[email protected],
[email protected]
The epidemiologic mode of transmission of human immunodeficiency virus (HIV) is from an infected person by: sexual exposure to infected semen, vaginal fluids and other infected body fluids during unprotected sexual intercourse with an infected person. Inoculation with infected blood, blood products and transplantation of infected organs such as bone graft or other tissues, or artificial insemination with infected semen and breast feeding of an uninfected infant by an HIV positive mother are all routes of transmission of the virus. The usage of sharps unsterilized objects such as syringes, clippers, needles that have been exposure to the blood or body fluid of an infected person is also another mode of transmission (Obire et al., 2009). The period from infection to the primary sero-conversion of illness is three to eight weeks. The period from infection to development of anti HIV antibodies is three weeks to three months. The interval for HIV infection to the diagnosis of AIDS ranges from about nine months to 20 years or longer, with a median of 12 years. There is a group of people with rapid onset of disease who develop AIDS within three to five years of infection (Lebovics et al., 1998). Because many people who have been infected with HIV have few or no symptoms initially, testing is the only way to know for sure if a person is infected with HIV. There are however an assortment of symptoms that can be associated with HIV infection, they includes fever, headache, muscle and joint pain, throat sour, rash and diarrhea. AIDS is a severe, life threatening disease that represents the late clinical stage of infection with HIV. Several weeks after infection with HIV, a number of infected individual will develop a self – limited glandular fever – like illness lasting for a week or two. Infected persons may then be freed of clinical signs or symptoms for months or years. The immune
Journal of Pharmacy Research Vol.3.Issue 7.July 2010
1607-1611
Azuonwu, O et al. / Journal of Pharmacy Research 2010, 3(7),1607-1611 system is the body’s natural defense against invading organisms which are foreign agents, such as viruses and bacteria. HIV attacks the immune system, weakening it and making the body more susceptible to infection. Some symptoms of the immune system include swollen lymph nodes in the neck, axilla or groin (Lymphadenopathy) fever/night sweat (NACA, 2007). HIV can have a profound effect on the gastro intestinal system and nutrition, presenting symptoms ranging from poor appetite to diarrhea, rapid weight loss and fatigue. Some of the most serious symptoms of HIV involving the respiratory system usually occurs later in course of the disease, these includes dry cough and productive cough, shortness of breath (NACA, 2006). Many of the symptoms of HIV are as a result of infection by other viruses fungi or bacteria which involves the skin or mucous membrane, which include skin rashes, white patches on the tongue, canker sores and apthous ulcers. Neurological and emotional symptoms of HIV includes depression, Numbness, tingling, or burning in the feet, hand or confusion, weakness, or changes in level of consciousness (Oboro et al., 2004). The risk factors associated with HIV/AIDS across rural communities in sub Saharan Africa are; poverty, gaps in the existing HIV/AIDS programmes, unemployment and illiteracy. It is a known fact that 70% of the population derives their daily low income from subsistence farming and fishing. The youths and children below the age of 15 years are more at risk because they device another means of survival which is through commercial sex. The presence of some affluent oil workers and the political class increases the prevalence of this pandemic across the tropics. Some pronounce effects such as increase morbidity and mortality, unwanted pregnancies, etc., have been identified (UNICEF, 2000). There are many gaps in the existing HIV/AIDS programmes within sub-Sahara Africa. Most of the programme activities occur in the major cities with poor coverage in remote communities or rural areas (Obire et al., 2009). There are few educational materials with insufficient programmes directed at women and youths and there is inadequate coordination of programmes, or documentation of the impact of the programs on remote communities across this Region. Partly the gaps in care are due to inadequate number of trained personnel such as health educators, counselors, social workers/medical laboratory scientist etc. Among the few that are trained, there is poor utilization and lack of motivation with non staff development or continuing education which results in obsolete or inadequate knowledge (Human, Development Report 2002 New York). Irrespective of the presence of some multinationals oil companies within the tropics, the rate of unemployment still remains high. Several young men and women lack jobs and are unable to provide their basic needs. This also is one of the risk factors associated with people living HIV/AIDS across communities in this region. Research has revealed that young graduates especially the (females) engage in prostitution as the only source of survival there by been at a high risk of this viral infection (Chimaraoke, 2001). There is a high level of illiteracy within the sub-Sahara Africa which contributes to an increase in prevalence of HIV/AIDS within remote communities across the tropics. The number of people that make use of condom is very low, while those that practice abstinence are rare. An additional factor that often goes unnoticed is the presence of stigma that becomes associated to people living with aids (PLWA) who have openly revealed their HIV/AIDS status in their community. Stigma may result is isolation, physical and verbal abuse, and even in the premature death of PLWA. To avoid these, PLWA therefore conceal their status thereby spreading the virus and disease to unsuspecting individuals. The Ndoki region is located in UKwa East Local government area of Abia state in the Niger Delta region. This region is geographically located on 250 C longititude and 380 C latitude of the south–south coast. The occupational status of this region includes farming, fishing and trading while a small population has access to white collar jobs. The social status of the Ndoki’s includes weaving of wrappers, making of hats and ethanol processing etc. The population of this region ranges from 4 million to 5 million in 2006 according to 2006 National census board.
The general aim of this study is to highlight the health impact of HIV/AIDS in Ndoki community so as to stimulate actions for proper management. The objectives of this study is to identify the gender (sex), age, occupation, and marital status of persons at high risk within the communities as to identify the groups among whom the virus/disease is most prevalent and factors that has lead to its high prevalence. To provide scientific information to health professionals and stakeholders on the health impact of the dreaded disease with the aim of provoking good control measures. MATERIALS AND METHOD Subject A total of one thousand and two hundred (1,200) consecutively recruited women, men and youths visiting the Obohia Health Center. Akwette General Hospital, Ohamble Clinic, Obonku General Hospital and Azumini General Hospital all in Ndoki Ukwa East Local Government Area. One thousand and two hundred individuals of various age and gender were screened for HIV antibodies from August to November (A period of 3 months). The eligibility criteria include age > 10, gender, occupational status, and marital status and willingness to give informed consent after counseling. Other relevant data of the patients were obtained via an interview admitted questionnaire. Methods The materials used for screening for HIV antibodies during the investigation are; A low speed centrifuge, 25µm micropipettes, EDTA bottles, Izal and sodium hypochlorite for decontamination, Disposable hand gloves, Rubber tunicates, Methylated spirit, Cotton wool, and ELISA Screening test strips for HIV. The name of the test strips is DETERMINE. It is used for in vitro diagnostic use. The DETERMINE strips for HIV-I and HIV-2 is a visual read qualitative immunoassay for the detection of antibodies to HIV-1 and HIV-2. The kit contains 100 HIV-1 and HIV-2 recombinant antigen and synthetic peptide coated test cards and it is stored at 2-30°C. The kit was manufactured by Inverness Co. LTD Japan. Manufacture date was 2008-03-10 and the expiring date is 2009-03-20. Laboratory wears like laboratory coat, mouth and nose cover, and hand gloves were put on for safety purposes. Collection of blood samples and spinning for collection of serum Blood samples were collected from the recruited women, men and youths visiting the various Health Centers, Clinics, and Hospitals in Ndoki Ukwa East Local Government Area. The samples were screened for HIV antibodies from August to November (A period of 3 months). The blood sample from each subject was collected intravenously (i/v) with 2ml syringes after their hands were tied with the rubber tunicate to aid blood sample collection. Each blood sample was aseptically transferred into an EDTA blood bottle and appropriately labeled. Each of the EDTA blood bottles was kept on a bottle rack to prevent pouring and mixing up. The blood sample was subsequently spun (spinned) at 1000 rotations per minute for a period of 5 minutes in the Low Speed Centrifuge Model 800D (Surgifriend Medicals, England) for easy and fast sedimentation or coagulation as to obtain the serum needed for the HIV antibody screening. Blood samples were allowed to completely sediment so that a pure serum is obtained. The maximum speed of the centrifuge is 4000rpm and the power source is 220 volts (Obire et al., 2009). Procedure for ELISA test ELISA Screening test strips for HIV were made available based on the total number of sera to be screened. Disposable micropipette (25µl) was used to add 25µl of each test serum to each strip. Each test strip has a control which detects anti-HIV antibody (lgG and lgM) and HIV P24 antigens and a position where the test serum is deposited. Adequate time was allowed for proper reaction to occur before results are read. A new disposable micropipette tip was used for each test serum sample to avoid mixing up of samples or contamination. Interpretation of the ELISA test results Using the ELISA HIV screening strip the interpretation of the result is that; for an HIV sero-positive result, a red/pinkish colour line develops on the space provided for the test serum. This is an indication that the test serum contains
Journal of Pharmacy Research Vol.3.Issue 7.July 2010
1607-1611
Azuonwu, O et al. / Journal of Pharmacy Research 2010, 3(7),1607-1611
RESULTS The prevalence (%) of HIV Infection among Age Groups in Ndoki Communities is as shown in Figure 1. The results obtained showed that generally, out of the total number (1,200) screened, 180 (15%) were sero-positive for HIV while 1020 (85%) were sero-negative. Of the sero-positive persons, males constituted 56.67% while 43.33% were females. The age groups between 16 – 33 years are the most sexually active and they constituted 70.55% of the seropositive persons. The prevalence of HIV was highest in the age group of 22 – 27 years (29.44%). The prevalence of HIV was highest in the age group of 22 - 27 years for both males and females and lowest in the age group of 10 – 15 years. Prevalence was lowest in the age group of 46 – 51 years for males and lowest in the age group of 46 – 51 years for females. Generally, except for the age group of 10 – 15 years and 16 – 21 years, the prevalence of HIV in all the age groups was higher in the males than in the females.
25
20
Prevalence of HIV Infection (%)
antibodies to the virus (HIV-1 and HIV-2) and thus is sero-positive to HIV. However, another red/pinkish line develops on the control to show that the strip is valid. On the other hand, if only a single red/pinkish line develops on the control after deposition of the serum, this indicates that the individual is seronegative to HIV virus. Where there is failure of development of a red/pinkish line on the ELISA test strip after the deposition of the test serum, it indicates that the strip is invalid and this must not be recorded (Obire et al., 2009).
15
Sero-positive Males Sero-positive Females 10
Sero-positive Total
5
0 Unemployed
Civil servants
Farmers
Oil workers
Students
Fishers
Self employed
Occupational Status
Fig. 2: Prevalence (%) of HIV Infection among Occupational Groups in Ndoki Communities 30
60
25
50
15
Sero-positive Males Sero-positive Females Sero-positive Total
10
5
Prevalence of HIV Infection (%)
Prevalence of HIV (%)
20 40
Sero-positive Males Sero-positive Females Sero-positive Total
30
20
10
0
0
Married
10-15 years
16 - 21
22 - 27
28 - 33 34 - 39 Age Group (years)
40 - 45
46 - 51
Widowed/separated Marital Status
Singles
Fig. 1: Prevalence (%) of HIV Infection among Age Groups in Ndoki Communities
Fig. 3: Prevalence (%) of HIV Infection among Marital Status in Ndoki Communities
The prevalence (%) of HIV Infection among Occupational Groups in Ndoki Communities is as shown in Figure 2. The prevalence of HIV was highest in the civil servant males (16.11%) and lowest in male oil workers (0.56%). On the other hand, the prevalence of HIV was highest in female farmers (12.22%) and lowest also in female oil workers (1.11%). Generally, the prevalence was highest in the farmers (25%) and lowest in the oil workers (1.67%). Except for the students and oil workers, the prevalence of HIV in all the occupational groups was higher in the males than in their corresponding groups of the females.
The results obtained from the present investigation showed that generally, prevalence of HIV was highest in the age groups of between 16 – 33 years. This age group is the most sexually active and they constituted 70.55% of the sero-positive persons.
The prevalence (%) of HIV Infection among Marital Status in Ndoki Communities is as shown in Figure 3. The prevalence of HIV was highest in both married males and females and lowest in both the widowed/separated males and females. Generally, the prevalence was higher in the males than in the females in all marital status grouping.
The farmers, civil servants, unemployed, and students constituted 81.10% of the sero-positive persons. The prevalence of HIV in relation to occupational group was highest among the farmers (25%). With regards to marital status, prevalence was highest in the married. The married constituted 51.11%, the singles, 31.67%, while the widowed/separated was 17.22%. Statistical analysis (ANOVA) using paired t-test showed that there is no significant difference between the number of sero-positive males and sero-positive females at p=0.05. Generally, except for the age group of 16 – 21 years, the oil workers and students, the prevalence of HIV was higher in the males than the females.
Journal of Pharmacy Research Vol.3.Issue 7.July 2010
1607-1611
Azuonwu, O et al. / Journal of Pharmacy Research 2010, 3(7),1607-1611 DISCUSSION This study has revealed the prevalence and risk factors of HIV infection among different age groups, occupational groups and marital status of individuals in communities of Ndoki in Abia State of Nigeria using the enzyme linked immunosorbent assay (ELISA). However, a negative Elisa test at any time does not preclude the possibility of an exposure or infection by HIV. This is so because a false negative result may occur if ELISA testing is carried out soon after infection by HIV (WHO, UNAIDS, UNICEF, 2008). This shows that the percentage of HIV sero-positive persons may in fact be higher than as reported in this study. This present study showed that the age groups between 16 – 33 years are the most sexually active and they constituted 70.55% of the seropositive persons. The expansion of the age group to 39 years will constitute 80.55% of sero-positive persons. Obire et al., (2009) reported 81.82%. WHO, UNAIDS, UNICEF (2008) stated that heterosexual sex contributes about 80% of the total HIV transmission in Nigeria In this study, the youth and young adults of between 10 to 27 years accounts for 55% of the HIV infection. WHO, UNAIDS, UNICEF (2008) stated that youths are particularly at risk as young people between the ages of 15 to 24 accounts for more than 40% of new HIV infection. It is common knowledge that youths within the age (16-27) who take drugs or engage in high risk behaviors associated with drug use also put themselves and others at risk for contacting or transmitting the virus as well as a number of sexually transmitted diseases (STD) (Nigeria Federal Ministry of Health, 1996; Oboro et al., 2004). The unemployed were also high on the list of prevalence as regards occupational status (18.33%) after the farmers and civil servants as compared to the self-employed. “It is a typical case of the idle mind being the devil’s workshop”. A major reason for the prevalence of HIV in this region is that given the main routes of spread, there are particular behaviors and practices that increase the risk of HIV infection. These are having multiple sexual partners (polygamy and sexual promiscuity) whose HIV status are unknown, engaging in unprotected sex or “unsafe sex” practices and sharing objects such as razor blades and circumcision. Generally, except for the age group of 16 – 21 years, the oil workers and students, the prevalence of HIV was higher in the males than the females. This is attributed to the fact that the males and female students and females in the age group of 16 – 21 years tend to sleep out for pleasure and financial gains and they also cheat on their partners. However, some of the HIV sero-positive female teenagers and the female children may have been victims of rape which is very rampant in the rural areas (Obire et al., 2009). In view of the long incubation period of HIV, most infected persons would be seen healthy and within this asymptomatic period, they pose a serious danger to the public by spreading the virus (Adler, 1987). Breast feeding mothers who do not know their HIV status will keep transferring the virus to their little infants who become positive to HIV and dies. Many HIV positive individuals are not on routing antiretroviral drugs. This is due to the expenses involved in incurring these drugs and the inconsistency in the supply of the drugs to rural areas. The investigation also revealed that some individuals having this virus have no knowledge about it and this could lead to an increase in the spread of this virus since many who are HIV sero-positive are not even aware that they are living with the virus. Since most communities in Ndoki where activities like blood transfusion and other health related activities take place do not have facilities for screening, it is suggested that the time is ripe for the establishment of more regional screening facilities which should be responsible for collection, screening and provision of screened blood to all health institutions within the areas of operation.
action of human immunodeficiency virus HIV and malaria presents some substantial effect on the populace of the tropics especially rural communities. Cases of malaria – associated anemia treated with unscreened blood transfusion contributed to HIV transmission in some remote communities within the tropics (Udonwa et al., 2007; Obire et al., 2009). This malaria – associated with increase in HIV viral load could lead to increased transmission of HIV and more rapid disease progression, with substantial public health implications (O, Reilly, 2004). The findings of this study are attributed to traditional practices of polygamy in addition to keeping concubines, poverty resulting from high unemployment rate, very low agricultural harvest yields as the farmers generally engage in subsistent farming with the use of crude farming implements and cannot provide three meals in a day or cater for their families all year round. The low HIV/ AIDS awareness campaign and the gap in information concerning the prevalence of HIV virus in Ndoki communities are also contributory factors. However information as those in this study will enable professionals and stakeholders to provide timely preventive measures and also improve the health care status of infected individuals. CONCLUSION AND RECOMMENDATIONS The prevalence of human immunodeficiency virus (HIV) which is the cause of the deadly disease, Acquired Immune-Deficiency syndrome (AIDS) within Ndoki communities in ABIA state has been establishment. The prevalence of the virus and of this dreaded disease is a pointer for additional call to duty for all stakeholders. There is the need to galvanized effort in other to minimize the incidence of this virus and to provide appropriate intervention for the health management of infected individuals. The results of this study are attributed to poverty resulting from high unemployment rate and low HIV/AIDS awareness campaign within this region. Currently, there is no known cure for HIV/AIDS. Although anti-retroviral drugs are presently in use for suppressing the proliferation of the virus within the system of infected persons, the routine access to anti-retroviral medication is not readily available especially in a developing country like Nigeria. There is therefore, need to urgently emphasize the prevention of HIV infection through safe sex, screened blood transfusion and non-sharing of sharp objects. Sex education and HIV/AIDS outreach/awareness campaigns (public enlightenment) should be carried out in these communities (Obire et al., 2009). It is hereby recommended that personal and institutional preventive measures should be practiced by stakeholders. The practice of safer sex and avoiding breast feeding by sero-positive mothers also decreases transmission (Fleming et al., 2005). Use of appropriate infection control measures by all health care and emergency workers should be encouraged and blood and blood products for transfusion and the donors of tissue and body fluids such as semen should be tested for the presence of this HIV marker. Sharp injuries, including needle stick injuries and parental exposure to laboratory specimen containing HIV should be dealt with according to infection control guidelines for transmission of infections diseases in the health care setting (WHO safety precaution 2006). It is also recommended that voluntary confidential counseling and HIV testing should be an active component of the various health centers. Treatment should be readily available for the general populace and subsidized by government. That there should be adequate monitoring and evaluation of programmes by government agencies such as the National Action Committee on HIV/AIDS (NACA) in other to identify challenges and pit falls, and establish components of successful programmes. That government should provide employment through the creation of skill acquisition programmes, jobs and establishment of industries as to reduce the menace of poverty and HIV. REFERENCES
As HIV spreads, it interacts with other infectious diseases. Within sub-Sahara region HIV which is an endemic infection has been superimposed on the longstanding malaria, where Plasmodium falciparum, the aetilogic agent for malaria (Niger Delta Development Commission Draft Copy, 2006). The inter-
1.
Adler M.W.(1987) Care for patients with HIV infection and AIDS in medical practice.British Medical Journal Clinical Research Ed,5(6589): 27-30.
Journal of Pharmacy Research Vol.3.Issue 7.July 2010
1607-1611
Azuonwu, O et al. / Journal of Pharmacy Research 2010, 3(7),1607-1611 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Chimaraoke, O. I. (2001). Tasting the forbidden fruit: The social context of debut sexual encounters among young persons in a rural Nigerian Community. Afri J. Reprod. Health. 5(2): 22-29 Eleje, O. A., Osaro, E., Chijioke, A. N. (2005): The Prevalence of Hepatitis C Antibodies in Patients with HIV Infection in the Niger Delta of Nigeria. Highland Medical Research Journal 1. Etuk, S. J. Ihejieamaizu E.C. Etuk I. S. (2004). Female adolescent sexual behaviour in Calabar, Nigeria. Niger Postgrad Med. J. 11(4): 269-73. Fauci, A. S. (1988): The human immunodeficiency virus infectivity and mechanisms of pathogenesis. Science. 239: 617-72. Lebovics, E., Divorkin, B.M.m Heier, S.K., Resenthal, W.S. (1988): The hepato- billary manifestations of human immunodeficiency virus infection. Amercian Journal of Gastroenterology 83:1-7. National Action Committee on HIV/AIDS in Nigeria. HIV/AIDS Emergency Action Plan (HEAP). Abuja, Nigeria: NACA 2002. National Population Commission (Nigeria) and ORC Macro. Nigeria Demographic and Health Survey 2003 Calverton, Maryland, USA. National Population Commission and ORC Macro. 2004. National Population Commission (Nigeria). Nigerian demographic and household survey, 1999. Calverton, MD: National Population Commission and ORC/Macro, 2000. Niger-Delta Development Commission. Act Number 2, 1999. Abuja, Nigeria, National Assembly. Nigeria Delta Region Development Commission. Draft copy of the Nigeria Delta Regional Development Master Plan NDDC. Nigeria Federal Ministry of Health, (2001). A technical Report on HIV/syphilis sentinel survey among pregnant women attending ante-natal clinics in Nigeria. Abuja, Nigeria: Ministry of Health.
13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
Nigeria Federal Ministry of Health, HIV/Syphilis sentinel survey results, 1995 Abuja, Nigeria: Ministry of Health, 1995. Obire, O., Nwankwo. U. Jeniffer, and Ramesh R. Putheti. (2009). Incidence of HIV and AIDS in Ahoada, Port Harcourt, Nigeria. Electronic Journal of Biology (eJBio). 5 (2): 28 – 33. O’Reilly, B. Death of a continent in HIV/AIDS in Africa. Lagos (2001): Whitney Young Information Resources Centre, US Embassy, 26. Oboro, V. O. and Tabowei T. O. (2003) AIDS prevention programmes and sexual behaviour among secondary school adolescents in Delta State. Nigeria. Trop J. Obst and Gynaecol; 20 (1). Okonofua, F. E., Paul Coplan, Susan Collins, et al (2003); impact of an intervention to improve treatment – seeking behaviour and prevent sexually transmitted diseases among Nigerian Youths, Int J. Infect Dis 7;61 – 73. Population Reference Bureau (PRB). The world’s Youth 2000 Washington DC; PRB 2000. Udonwa. N, M. Ekpo, IA Ekanem, AV Inem. A Etokidem. Oil doom and AIDS boom in the NDR of Nigeria. Rural and Remote Health 4 (online) 2004: no 273 http/rrh.deakin.edu.au. Down loaded 24th April, 2005. UNAIDS. Africa recovering from AIDS, report on the global HIV/AIDS epidemic. Geneva. WHO, 2000. UNAIDS/UNICEF. Epidemiological fact sheet on HIV/AIDS and sexually transmitted infections, 2002 update, Geneva: WHO. UNICEF. (2000). Multiple Indicator Cluster survey. Nigeria: UNICEF, 2000. World Health Organization. Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS case Definitions for Accessed March 23, 2006. WHO, UNAIDS, UNICEF (2008) Epidemiological fact sheet on HIV and AIDS. Core data on epidemiology and response, Nigeria, WHO, Geneva, 1-25.
Source of support: Nil, Conflict of interest: None Declared
Journal of Pharmacy Research Vol.3.Issue 7.July 2010
1607-1611
