- Email: [email protected]
Assessment of health needs of agricultural workers in Nigeria
PubL Hhh, Load. (1977) 91, 183-188
Assessment of Health Needs Agricultural Workers in Nigeria Adefu nke Oyemade M.D,fGlas.), D.P.H.(Glas), D.T.H.(Ibadan)
and Adedapo Oiugbile M.B., Ch.B.(Leeds), D.P.H.(Liv.), D.I.H.(Eng.), M.R.C.P.I.
Department of Preventive and Socia/ Medicine, University Coffege Hospital Ibadan, Nigeria
A survey carried out in Badeku, a small v]ltage in the Western State of Nigeria to identify some of the health needs and medico-social problems of the agricultural workers has revealed the appalling housing conditions of tile villagers, the poor environmental sanitation and the general lack of knowledge of the effects on health of such poor residential environment. The health services available are poorly utilized and this has been attributed to ignorance and adherence to traditional beliefs and practices. Any measure aimed at enhancing the health status .of.the people must .include health education, provision of good housing, environmental sanitation, better medical coverage and active participation of the community in health care delivery at the village level. Introduction
The importance o f providing good medical coverage to rural areas in Nigeria cannot be overemphasized considering that 84 700 of the people live in these parts and a high proportion o f labour force is engaged in agriculture, an important economic sector in the country. 1 It is however disappointing that the health of the agricultural workers has received very little attention and m u c h o f the literature o n the health status o f people in rural areas has applied mainly to children. 2. 3.4 In 1973, an integrated rural development project* became operative in Badeku, a small village in the Western State o f Nigeria. The project had as one o f its objectives the improvement o f the preventive and promotive health care of agricultural workers a n d their families living in rural areas. The study described in this paper f o r m e d part o f the project aimed&t defining the health needs and identifying some o f the medico-social problems of a g r o a F o f a g r i c u l t u r a l workers and their families residing in a small vittagein the Western State o f Nigeria. Material and MeL~od
The study was undertaken in Badeku, a small village situated about 27 k m north of Ibadan, the capital o f the Western State o f Nigeria. There is no available census list, but a survey conducted by the D e p a r t m e n t o f Agricultural-Economics in 1973 reported the village as *This integrated rural development project is sponsored-by the Department of Agricultural Economics and Extension, University of Ibadan and financed by the Rockefeller Foundation.
t 84
A. Ovemade and A. Oh~gbile
having a population of 2394 people and consisting of 275 family compounds.~ Badeku has a government health centre which serves the people o f tbe village and other villages witlfin a radius of 10 miles. Maternal and child welfare clinics are held weekly at this c¢: ;tre and other health activities are carried out daily from 7.30 a.m. to 3 p.m. For the purpose of the present study, 178 households were randomly selected and the heads of such households and their wives were interviewed by rneans of questionnaires which were administered by field assistants who had been previously trai ned in interviewing techniques. The first set o f questionnaires, administered to the household heads, sought to establish their ages, marital status, educational status and occupation. In addition, questions were asked about the housing conditions, water supply, environmental sanitation, cooking facilities and finally information was collected on their knowledge of hazards associated with some of their habits in the homes. The second questionnaire was administered to those wives who were of the childbearing age, that is 18-45 years and from the same selected households. As with the men, the age, marital status, educational status and occ~pation o f the women were recorded. Information was collected on the utilization of the available medical facilities with particular regard to the immunization programme for the village children, ~he antenatal care and confinement of expectant mothers and lhe extent to which these women made use of local healers. The effectivene~.s of the immunization programme was assessed by the immunization rate and this was determined by obtaining history from the mothers and by examining the child's arm for evidence o f BCG and smallpox scars. Finally, questions were asked about the fertility, childhood mortality and causes of death in the under-5"s. Results It was not possible to interview atl the women in these selected households as some went to work on the farms, others were engaged in the local palm oil processing industry which invariably took them outside their homes. In all, 332 people, 178 men and 154 women were interviewed. Ninety-five per cent of the men and 9 7 ~ of the women were illiterates; most o f the men were farmers whilst the women were mostly petty traders.
Housing Conditions The findings with regard to housing facilities and practices in the houses are summarized in Table I. The walls of all the 178 houses were built of mud, the floors were plastered with cement in 30 (16"8 ~/o), cowdung in 92 (51.7~o) and the remaining 56 (31-5~) were unplastered. The standard of ventilation was also considered. In 128(7I-9~), the windows were too small for the size of the rooms, three (J..7 ~ ) had no windows at all whilst the remaining 47 (26-4~) had medium to large windows. In 91 (51.2~) houses, cooking was done inside the houses in the adjoining passages to the bedrooms whilst the remaining 87 (48-8 %) had separate kitchens. In eight (4.5 %) houses, the method of refuse disposal was by burning whilst the remaining 170 (95-5~o) dumped their refuse in open spaces at the back of the houses or in the bush. On the question o f the method o f disposal of faeces, 10 (5.6 ~ ) households used sanitory pots ("po") inside the houses and such receptacles were later emptied into the bush, 18 (10.1 ~ ) used pit latrines and the remaining 150 (84.3 ~o) defaecated indiscriminately in the bush or in open spaces behind dwellings. Finally as shown in Table 1, all the households obtain their drinking water from a communal well during the dry and wet seasons. tA family compound consists of a group ot" households which may number from four to six, The most senior male member of any household usually becomesthe head of the household and has a great influence on the activitiesof members of the household.
Asses'sment of healUl need9 of agricultural workers in N(~eria
~ousehotd facililies
Number
185
",~
Wall of house Mud Bricks Blocks
178 ---
I00 ---
Floor of house Cemenl floor Floor plaslered wi~h co~vdung Earth floor (unplastered)
30 92 56
16.8 51-7 31-5
3 47 128
1-7 26.4 71-9
87 91
48"8 51-2
8 170
4"5 95.5
18 10 150
10-1 5-6 84.3
Ventilation Rooms without windows Rooms wiih medium/large windows Rooms wilh small windows
Cooking .[bcilities Kitchen used for cooking Cooking in corridor inside houses
Rt:fuse disposal Burning Dumping
Sewage disposal Pit latrines Sanitary pot Bush/Open space behind dwellings
Waeer supply (dry season) Ponds/Streams Wells (communal) Pipe borne water Water sttpply (wet season) Ponds/st~'earns Wells (communal) Pipe borne water
-178 --
-100 --
-I78 ~
-100 --
TABLE 2. Knowledge of health hazards associated with source of drinking water and indiscriminate defaecation Responses Health hazards No health hazards Don't know Total
Drinking from ponds and streams 92 (51-7 '.~) 4 (2-2~o) 82 (46-1 ~ ) 178 (100%)
Indiscriminate defaecatiop 14 (7.8 ~ ) 164(92,2~) 0 178 (100%)
Knowledge o f health hazards associated with certain habits o f the family T a b l e 2 s h o w s t h e n u m b e r o f h e a d s o f t i o u s e h o l d s a n d t h e i r level o f k n o w l e d g e o f h e a l t h h a z a r d s a s s o c i a t e d w i t h c e r t a i n habits o f t h e f a m i l y . N i n e t y - t w o ( 5 1 - 7 ~ o ) o f the 178 m e n i n t e r v i e w e d k n e w t h a t d r i n k i n g w a t e r f r o m p o n d s a n d s t r e a m s c o u l d be h a z a r d o u s , 82 (46.1 ~ ) w e r e n o n - c o m m i t a l whilst the r e m a i n i n g f o u r (2-2 To') felt it w a s safe. O f the 92 w h o c l a i m e d t h e r e w e r e h e a l t h h a z a r d s , 89 m e n t i o n e d c h o l e r a a n d t h r e e g u i n e a w o r m infection. O n e h u n d r e d a n d s i x t y - f o u r (92-2 Yo) o f the m e n did n o t a s s o c i a t e i n d i s c r i m i n a t e d e f a e c a t i o n w i t h a n y h e a l t h h a z a r d whilst the r e m a i n i n g 14 (7-8 f/o) did. T w e l v e o f the latter g r o u p h o w e v e r did n o t k n o w w h a t t h e s e h e a l t h h a z a r d s w e r e ; t h e r e m a i n i n g t w o m e n t i o n e d fever.
A. Oyemade am/A. Oh~gbile
186
Utilizathm of health services The number of children under 10 years immunized against the various diseases is shown in Table 3. Over 90°o o f the 246 children had never been immunized against tuberculosis, poliomyelitis and measles. One hundred and fifty-nine (64-600) had smallpox vaccination and only I I 1 (45-2 °,,) were immunized against diphtheria, whooping cough and tetanus. It is shown in Table 4 that 132 (85-7')o) o f the 154 women normally receive their antenatal care either in hospital, health centre or maternity centre whilst the remaining 22 (14.3/,,) "~ go 3o native doctors. Out o f the I32 women who receive antenatal care in these medical institutions, only 14 (10-6",) deliver there, the rest have their babies at home attended to by traditional midwives. TABLE3. Number of children under I0 years immunized against the various diseases
hnmunologcal status Immunized Not immunized Don't know Total
Tuberculos:s
Diphtheria pertussis and Tetanus
Smallpox
Poliomyelitis
4 (1-60,,3 235 (95-6 %) 7 (2-80,0)
111 (45-2 '7;) 82 (33"3%) 53 (21-5%)
159 (64-6°/,;) 15 (30-5 %;1 12 (4-9 ~,;)
,8 (3-3 %) 2,7 (96.3 %) 3 (0-4%)
6 (2.4 .%) 225 (91.5 ~) 15 (6,1 ~,)
246(300%)
246(100%)
246(100°O
246(100%)
246(100°/£)
Measles
TABLE4. Utilization of health services by expectant mothers Source of medical care Hospital/Maternity Centre/ Health Centre Native Doctor Total
Number of users 332 (85-7 ~) 22 (34-3 ~) 154 (100~)
Fertility and cMdhood mortality The average number of children born al}ve to each w o m a n in the survey in the preceding four year period to the present study was 1-3 and o u t of the 123 live births during the same period, 28 died giving a mortality o f 23 ~/~. It was not possible to get any reliable information on the causes of death in these children as most mothers were reluctant to refer to such sad events in their lives. Discussion This base-line survey has provided some b a c k g r o u n d information on the health needs and some of the medico-social problems o f the agricultural workers in Badeku, a typical village in the Western State o f Nigeria. The floors of most o f the houses were uncemented, good ventilation was lacking in m a n y homes, indoor s m o k e pollution existed in more than half o f the houses and the people's concept of environmental hygiene in relation to health and disease was poor. Such bad residential environments and their adverse effects on the health o f Nigerian children have been reported by previous researchers. 5, 6 Sofoluwe in his study showed that smoke pollution inside houses might be an important aetiological factor in bronchiolitis and bronchopneumonia a m o n g children treated in a Lagos hospital. Chipponi
Assessment of heallh needs of agricultural workers in Nigeria
187
and others in their study in 1971 in Upper Volta 7 showed that dwellings with good ventilation and cement floors have fewer airborne bacteria lhan those that were poorly ventilated and with beaten earth floors. They further showed that high counts of airborne bacleria could favour the spread of cerebro-spinal meningitis. In our study, only in 16-8'~,/, of the houses were the floors cemented whilst 51.7'~'~,~, were plastered with cowdung, a good source of tetanus infection. ~ In view of these findings, it seems that any measures aimed at improving the health status o f agricultural workers in rural areas must take into consideration the improvement o f the housing conditions. TABLE 5. Age structure of the population
of Badeku* Age group
Male ( ~ )
Female (%)
0-5 6-10 I1-15 16-20 21-25 26-30 31-40 4t--5t3 51-60 61 q-
15 18 11 9 4 9 14 13 4 3
15 |5 8 8 15 16 15 5 2 1
*Table extracted fi'om the report of a demographic survey carried out by the Department of Agricultural Economics and Extension, University of lbadan in 1973.
Most of tile illnesses that occur in rural areas are due to waterborne or faecal-borne diseases. It has been shown in this study that most of the villagers knew that drinking water from a highly polluted source might resuR in cholera and this knowledge is not unrelated to the epidemic of cholera in Nigeria in 1970 which resulted in high morbidity and mortality experience in some parts o f the country. The study however shows that the people were still ignorant o f diseases which might be acquired through indiscriminate defaecation. It is to be noted that most of the men and women were illiterates who had never been exposed to any form o f health education. It is therefore suggested that any programme designed to hnprove the standard o f hygiene must be preceded by an intensive health education campaign on causes and modes of transmission of the common diseases prevalent in the area. The immunization status o f the children in Badeku village is very poor, especially with regard to tuberculosis, poliomyelitis and measles. It may be reasonably assumed that most mothers being illiterates would probably not appreciate the value of immunization against the common childhood diseases, The importance of health education in a,"ayimmunization programme was stressed by Olugbile who in his study reported a low immunization rate in children in an urban area with relatively better medical facilit;es, b-,t h~lgh illiteracy rate. 9 There is therefore an urgent need to educate the people on the ~,'~',i~ .A immunization in early childhood. The current mass immunization programme needs to be intensified and extended to rural areas and the introduction of mobile health Clinics will provide better means of reaching the villagers especially those in remote areas.
188
A. Oyemade and A. Olugbile
Most mothers after receiving antenatal care in medical institutions prefer to have their babies a't home under the supervision of traditional midwives. Such practice is not unrelated to the traditional belief that it is a bad omen to have a child bornoutside the h o m e a n d so the traditional midwife continues to play this important role. Another factor is that the health centre does 'not provide a 24 ,hour service due to shortage of trained manpower and the reluctance o f some health personnel to work in rural areas. For these reasons, it would seem :reasonable as o f now to recognize the traditional midwives, organize for them a short training course in simple, safe and aseptic obstetric procedure and after such training, they could be incorporated into the health project under close supervision. Table 5 shows the age structure of the population of Badeku and the female predominance in tile 21-40 year age group. Some o f these y o u n g women could also be recruited, trained and deployed for health education and health care delivery at the village level. One other finding is the high mortality experience among children under four years. About a quarter o f the children died before their fourth birthday. Such high childhood mortality experience is not an u n c o m m o n occurrence in other rural areas o f West Africa?O. 1~. ~2 M a n y causes have been suggested for such high mortality, these include malnutrition, infection and low standards of child care. In conclusion, this study has revealed some o f the needs o f agricultural workers in Badeku. These include good housing conditions, environmental sanitation, improved maternal and child care and better knowledge o f the harmful effects on health o f some of the elllagers habits and practices. Such standards can only be achieved through health education, better medical coverage and involvement of the c o m m u n i t y in health care delivery at the village level. References 1. Statistical Year Book (1973). United Nations on West Africa, 16--3. '2. Morley, D. C. (1973). Transactions of the Royal Society of Tropical Medicine and Hygiene 57, 79. 3. Wennen-Van Der Mey, C. A. M. (I 968). Tropical and Geographical Medicine 20, 335. 4. Oyemade, A. (I 973). Join'hal of Tropical Pediatrics Emqronmental ChiM Health 19, No. 3B, 339. 5. Sofoluwe, G. O. (1968). Archives o f Envirzmmental Health 16, 672. 6. Oduntan (I 973) Tropical and Geographical Medicine 25, 402-9. 7. Chipponi, P., Darrigol, J., Skalova, R. & Cvjetanovic, B. (1971). Bulletin of the Worm Health Organization 45, No. 1, 95. 8. Christie, A. B. (1969). Infectious Diseases: Epidemiology and C~::'nicalPractice. p. 726. Edinburgh and London : E. S. Livingstone Ltd. 9. Olugbile, A. O. B. (1975). Nigerian Medical JournalS, No. 2, 98. 10. McGregor, I. A., Billewicz, W. Z. & Thompson, A. M. (1961). British Medical Journal it, 1661. 11. Senecal, J., Aubry, L. & Falade, S. (1962). West Afi'ican MedicalJournalii, 93. 12. Gilles, H. M. (1964). An EnvironmentalStudy of a Nigerian Village Community. p. 73. University of Ibadan Press.
Assessment of Health Needs Agricultural Workers in Nigeria Adefu nke Oyemade M.D,fGlas.), D.P.H.(Glas), D.T.H.(Ibadan)
and Adedapo Oiugbile M.B., Ch.B.(Leeds), D.P.H.(Liv.), D.I.H.(Eng.), M.R.C.P.I.
Department of Preventive and Socia/ Medicine, University Coffege Hospital Ibadan, Nigeria
A survey carried out in Badeku, a small v]ltage in the Western State of Nigeria to identify some of the health needs and medico-social problems of the agricultural workers has revealed the appalling housing conditions of tile villagers, the poor environmental sanitation and the general lack of knowledge of the effects on health of such poor residential environment. The health services available are poorly utilized and this has been attributed to ignorance and adherence to traditional beliefs and practices. Any measure aimed at enhancing the health status .of.the people must .include health education, provision of good housing, environmental sanitation, better medical coverage and active participation of the community in health care delivery at the village level. Introduction
The importance o f providing good medical coverage to rural areas in Nigeria cannot be overemphasized considering that 84 700 of the people live in these parts and a high proportion o f labour force is engaged in agriculture, an important economic sector in the country. 1 It is however disappointing that the health of the agricultural workers has received very little attention and m u c h o f the literature o n the health status o f people in rural areas has applied mainly to children. 2. 3.4 In 1973, an integrated rural development project* became operative in Badeku, a small village in the Western State o f Nigeria. The project had as one o f its objectives the improvement o f the preventive and promotive health care of agricultural workers a n d their families living in rural areas. The study described in this paper f o r m e d part o f the project aimed&t defining the health needs and identifying some o f the medico-social problems of a g r o a F o f a g r i c u l t u r a l workers and their families residing in a small vittagein the Western State o f Nigeria. Material and MeL~od
The study was undertaken in Badeku, a small village situated about 27 k m north of Ibadan, the capital o f the Western State o f Nigeria. There is no available census list, but a survey conducted by the D e p a r t m e n t o f Agricultural-Economics in 1973 reported the village as *This integrated rural development project is sponsored-by the Department of Agricultural Economics and Extension, University of Ibadan and financed by the Rockefeller Foundation.
t 84
A. Ovemade and A. Oh~gbile
having a population of 2394 people and consisting of 275 family compounds.~ Badeku has a government health centre which serves the people o f tbe village and other villages witlfin a radius of 10 miles. Maternal and child welfare clinics are held weekly at this c¢: ;tre and other health activities are carried out daily from 7.30 a.m. to 3 p.m. For the purpose of the present study, 178 households were randomly selected and the heads of such households and their wives were interviewed by rneans of questionnaires which were administered by field assistants who had been previously trai ned in interviewing techniques. The first set o f questionnaires, administered to the household heads, sought to establish their ages, marital status, educational status and occupation. In addition, questions were asked about the housing conditions, water supply, environmental sanitation, cooking facilities and finally information was collected on their knowledge of hazards associated with some of their habits in the homes. The second questionnaire was administered to those wives who were of the childbearing age, that is 18-45 years and from the same selected households. As with the men, the age, marital status, educational status and occ~pation o f the women were recorded. Information was collected on the utilization of the available medical facilities with particular regard to the immunization programme for the village children, ~he antenatal care and confinement of expectant mothers and lhe extent to which these women made use of local healers. The effectivene~.s of the immunization programme was assessed by the immunization rate and this was determined by obtaining history from the mothers and by examining the child's arm for evidence o f BCG and smallpox scars. Finally, questions were asked about the fertility, childhood mortality and causes of death in the under-5"s. Results It was not possible to interview atl the women in these selected households as some went to work on the farms, others were engaged in the local palm oil processing industry which invariably took them outside their homes. In all, 332 people, 178 men and 154 women were interviewed. Ninety-five per cent of the men and 9 7 ~ of the women were illiterates; most o f the men were farmers whilst the women were mostly petty traders.
Housing Conditions The findings with regard to housing facilities and practices in the houses are summarized in Table I. The walls of all the 178 houses were built of mud, the floors were plastered with cement in 30 (16"8 ~/o), cowdung in 92 (51.7~o) and the remaining 56 (31-5~) were unplastered. The standard of ventilation was also considered. In 128(7I-9~), the windows were too small for the size of the rooms, three (J..7 ~ ) had no windows at all whilst the remaining 47 (26-4~) had medium to large windows. In 91 (51.2~) houses, cooking was done inside the houses in the adjoining passages to the bedrooms whilst the remaining 87 (48-8 %) had separate kitchens. In eight (4.5 %) houses, the method of refuse disposal was by burning whilst the remaining 170 (95-5~o) dumped their refuse in open spaces at the back of the houses or in the bush. On the question o f the method o f disposal of faeces, 10 (5.6 ~ ) households used sanitory pots ("po") inside the houses and such receptacles were later emptied into the bush, 18 (10.1 ~ ) used pit latrines and the remaining 150 (84.3 ~o) defaecated indiscriminately in the bush or in open spaces behind dwellings. Finally as shown in Table 1, all the households obtain their drinking water from a communal well during the dry and wet seasons. tA family compound consists of a group ot" households which may number from four to six, The most senior male member of any household usually becomesthe head of the household and has a great influence on the activitiesof members of the household.
Asses'sment of healUl need9 of agricultural workers in N(~eria
~ousehotd facililies
Number
185
",~
Wall of house Mud Bricks Blocks
178 ---
I00 ---
Floor of house Cemenl floor Floor plaslered wi~h co~vdung Earth floor (unplastered)
30 92 56
16.8 51-7 31-5
3 47 128
1-7 26.4 71-9
87 91
48"8 51-2
8 170
4"5 95.5
18 10 150
10-1 5-6 84.3
Ventilation Rooms without windows Rooms wiih medium/large windows Rooms wilh small windows
Cooking .[bcilities Kitchen used for cooking Cooking in corridor inside houses
Rt:fuse disposal Burning Dumping
Sewage disposal Pit latrines Sanitary pot Bush/Open space behind dwellings
Waeer supply (dry season) Ponds/Streams Wells (communal) Pipe borne water Water sttpply (wet season) Ponds/st~'earns Wells (communal) Pipe borne water
-178 --
-100 --
-I78 ~
-100 --
TABLE 2. Knowledge of health hazards associated with source of drinking water and indiscriminate defaecation Responses Health hazards No health hazards Don't know Total
Drinking from ponds and streams 92 (51-7 '.~) 4 (2-2~o) 82 (46-1 ~ ) 178 (100%)
Indiscriminate defaecatiop 14 (7.8 ~ ) 164(92,2~) 0 178 (100%)
Knowledge o f health hazards associated with certain habits o f the family T a b l e 2 s h o w s t h e n u m b e r o f h e a d s o f t i o u s e h o l d s a n d t h e i r level o f k n o w l e d g e o f h e a l t h h a z a r d s a s s o c i a t e d w i t h c e r t a i n habits o f t h e f a m i l y . N i n e t y - t w o ( 5 1 - 7 ~ o ) o f the 178 m e n i n t e r v i e w e d k n e w t h a t d r i n k i n g w a t e r f r o m p o n d s a n d s t r e a m s c o u l d be h a z a r d o u s , 82 (46.1 ~ ) w e r e n o n - c o m m i t a l whilst the r e m a i n i n g f o u r (2-2 To') felt it w a s safe. O f the 92 w h o c l a i m e d t h e r e w e r e h e a l t h h a z a r d s , 89 m e n t i o n e d c h o l e r a a n d t h r e e g u i n e a w o r m infection. O n e h u n d r e d a n d s i x t y - f o u r (92-2 Yo) o f the m e n did n o t a s s o c i a t e i n d i s c r i m i n a t e d e f a e c a t i o n w i t h a n y h e a l t h h a z a r d whilst the r e m a i n i n g 14 (7-8 f/o) did. T w e l v e o f the latter g r o u p h o w e v e r did n o t k n o w w h a t t h e s e h e a l t h h a z a r d s w e r e ; t h e r e m a i n i n g t w o m e n t i o n e d fever.
A. Oyemade am/A. Oh~gbile
186
Utilizathm of health services The number of children under 10 years immunized against the various diseases is shown in Table 3. Over 90°o o f the 246 children had never been immunized against tuberculosis, poliomyelitis and measles. One hundred and fifty-nine (64-600) had smallpox vaccination and only I I 1 (45-2 °,,) were immunized against diphtheria, whooping cough and tetanus. It is shown in Table 4 that 132 (85-7')o) o f the 154 women normally receive their antenatal care either in hospital, health centre or maternity centre whilst the remaining 22 (14.3/,,) "~ go 3o native doctors. Out o f the I32 women who receive antenatal care in these medical institutions, only 14 (10-6",) deliver there, the rest have their babies at home attended to by traditional midwives. TABLE3. Number of children under I0 years immunized against the various diseases
hnmunologcal status Immunized Not immunized Don't know Total
Tuberculos:s
Diphtheria pertussis and Tetanus
Smallpox
Poliomyelitis
4 (1-60,,3 235 (95-6 %) 7 (2-80,0)
111 (45-2 '7;) 82 (33"3%) 53 (21-5%)
159 (64-6°/,;) 15 (30-5 %;1 12 (4-9 ~,;)
,8 (3-3 %) 2,7 (96.3 %) 3 (0-4%)
6 (2.4 .%) 225 (91.5 ~) 15 (6,1 ~,)
246(300%)
246(100%)
246(100°O
246(100%)
246(100°/£)
Measles
TABLE4. Utilization of health services by expectant mothers Source of medical care Hospital/Maternity Centre/ Health Centre Native Doctor Total
Number of users 332 (85-7 ~) 22 (34-3 ~) 154 (100~)
Fertility and cMdhood mortality The average number of children born al}ve to each w o m a n in the survey in the preceding four year period to the present study was 1-3 and o u t of the 123 live births during the same period, 28 died giving a mortality o f 23 ~/~. It was not possible to get any reliable information on the causes of death in these children as most mothers were reluctant to refer to such sad events in their lives. Discussion This base-line survey has provided some b a c k g r o u n d information on the health needs and some of the medico-social problems o f the agricultural workers in Badeku, a typical village in the Western State o f Nigeria. The floors of most o f the houses were uncemented, good ventilation was lacking in m a n y homes, indoor s m o k e pollution existed in more than half o f the houses and the people's concept of environmental hygiene in relation to health and disease was poor. Such bad residential environments and their adverse effects on the health o f Nigerian children have been reported by previous researchers. 5, 6 Sofoluwe in his study showed that smoke pollution inside houses might be an important aetiological factor in bronchiolitis and bronchopneumonia a m o n g children treated in a Lagos hospital. Chipponi
Assessment of heallh needs of agricultural workers in Nigeria
187
and others in their study in 1971 in Upper Volta 7 showed that dwellings with good ventilation and cement floors have fewer airborne bacteria lhan those that were poorly ventilated and with beaten earth floors. They further showed that high counts of airborne bacleria could favour the spread of cerebro-spinal meningitis. In our study, only in 16-8'~,/, of the houses were the floors cemented whilst 51.7'~'~,~, were plastered with cowdung, a good source of tetanus infection. ~ In view of these findings, it seems that any measures aimed at improving the health status o f agricultural workers in rural areas must take into consideration the improvement o f the housing conditions. TABLE 5. Age structure of the population
of Badeku* Age group
Male ( ~ )
Female (%)
0-5 6-10 I1-15 16-20 21-25 26-30 31-40 4t--5t3 51-60 61 q-
15 18 11 9 4 9 14 13 4 3
15 |5 8 8 15 16 15 5 2 1
*Table extracted fi'om the report of a demographic survey carried out by the Department of Agricultural Economics and Extension, University of lbadan in 1973.
Most of tile illnesses that occur in rural areas are due to waterborne or faecal-borne diseases. It has been shown in this study that most of the villagers knew that drinking water from a highly polluted source might resuR in cholera and this knowledge is not unrelated to the epidemic of cholera in Nigeria in 1970 which resulted in high morbidity and mortality experience in some parts o f the country. The study however shows that the people were still ignorant o f diseases which might be acquired through indiscriminate defaecation. It is to be noted that most of the men and women were illiterates who had never been exposed to any form o f health education. It is therefore suggested that any programme designed to hnprove the standard o f hygiene must be preceded by an intensive health education campaign on causes and modes of transmission of the common diseases prevalent in the area. The immunization status o f the children in Badeku village is very poor, especially with regard to tuberculosis, poliomyelitis and measles. It may be reasonably assumed that most mothers being illiterates would probably not appreciate the value of immunization against the common childhood diseases, The importance of health education in a,"ayimmunization programme was stressed by Olugbile who in his study reported a low immunization rate in children in an urban area with relatively better medical facilit;es, b-,t h~lgh illiteracy rate. 9 There is therefore an urgent need to educate the people on the ~,'~',i~ .A immunization in early childhood. The current mass immunization programme needs to be intensified and extended to rural areas and the introduction of mobile health Clinics will provide better means of reaching the villagers especially those in remote areas.
188
A. Oyemade and A. Olugbile
Most mothers after receiving antenatal care in medical institutions prefer to have their babies a't home under the supervision of traditional midwives. Such practice is not unrelated to the traditional belief that it is a bad omen to have a child bornoutside the h o m e a n d so the traditional midwife continues to play this important role. Another factor is that the health centre does 'not provide a 24 ,hour service due to shortage of trained manpower and the reluctance o f some health personnel to work in rural areas. For these reasons, it would seem :reasonable as o f now to recognize the traditional midwives, organize for them a short training course in simple, safe and aseptic obstetric procedure and after such training, they could be incorporated into the health project under close supervision. Table 5 shows the age structure of the population of Badeku and the female predominance in tile 21-40 year age group. Some o f these y o u n g women could also be recruited, trained and deployed for health education and health care delivery at the village level. One other finding is the high mortality experience among children under four years. About a quarter o f the children died before their fourth birthday. Such high childhood mortality experience is not an u n c o m m o n occurrence in other rural areas o f West Africa?O. 1~. ~2 M a n y causes have been suggested for such high mortality, these include malnutrition, infection and low standards of child care. In conclusion, this study has revealed some o f the needs o f agricultural workers in Badeku. These include good housing conditions, environmental sanitation, improved maternal and child care and better knowledge o f the harmful effects on health o f some of the elllagers habits and practices. Such standards can only be achieved through health education, better medical coverage and involvement of the c o m m u n i t y in health care delivery at the village level. References 1. Statistical Year Book (1973). United Nations on West Africa, 16--3. '2. Morley, D. C. (1973). Transactions of the Royal Society of Tropical Medicine and Hygiene 57, 79. 3. Wennen-Van Der Mey, C. A. M. (I 968). Tropical and Geographical Medicine 20, 335. 4. Oyemade, A. (I 973). Join'hal of Tropical Pediatrics Emqronmental ChiM Health 19, No. 3B, 339. 5. Sofoluwe, G. O. (1968). Archives o f Envirzmmental Health 16, 672. 6. Oduntan (I 973) Tropical and Geographical Medicine 25, 402-9. 7. Chipponi, P., Darrigol, J., Skalova, R. & Cvjetanovic, B. (1971). Bulletin of the Worm Health Organization 45, No. 1, 95. 8. Christie, A. B. (1969). Infectious Diseases: Epidemiology and C~::'nicalPractice. p. 726. Edinburgh and London : E. S. Livingstone Ltd. 9. Olugbile, A. O. B. (1975). Nigerian Medical JournalS, No. 2, 98. 10. McGregor, I. A., Billewicz, W. Z. & Thompson, A. M. (1961). British Medical Journal it, 1661. 11. Senecal, J., Aubry, L. & Falade, S. (1962). West Afi'ican MedicalJournalii, 93. 12. Gilles, H. M. (1964). An EnvironmentalStudy of a Nigerian Village Community. p. 73. University of Ibadan Press.