1. 1
CHAPTER ONE
INTRRODUCTION
1.1 Backgroundto the Study
Human Immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome
(AIDs) have puzzled scientist and medical experts ever since the virus came to
existence early 1980s, for over twenty years it has been the subject of fierce debate and
the cause of countless arguments (Courtsoundis, Kwaan & Thomson; 2010).
The dominant feature of this first period was silence and the virus was unknown and
transmission not accompanied by signs and symptoms but silent enough to be noticed
by 1980, HIV has spread to at least five continents (North American, South American
Europe, Africa and Australia) (CDC; 2014). During this period of silence spread,
preventive measures were unchecked and approximately 1000-3000 persons may have
been infected
Gray, (2007) revealed that hundreds of South Africans who had been involved in AIDs
vaccine trial might have an increased risk of HIV infection as a result. The trial, which
was being conducted at the Merch Pharmaceutical Company, had been halted in the
previous month after initial results showed the vaccine to be ineffective, an outcome
that was described by leading vaccine researcher as a big blow to the field. Phumzile
and Nozzizwe (2007) stated that the plan aimed to try and reduce the number of new
infections by fifty percent and bring treatment, care and support to at least eighty
percent of all HIV-positive people and their families.
2. 2
Good news came to South African when the government finally develops an ambitious
and comprehension plan to try and tackle the epidemic after year’s inaction. The new
plan was welcomed by national and international health experts although it was made
clear that in order for the new goals to be realized there needed to be a fast track
restructuring of the health care system (Blackson, 2010).
Disease surveillance services are those services provided by organized agencies in a
systematic manner to ensuring prevention, control and management of such diseases. It
is an epidemiological practice by which the spread of disease is monitored in order to
establish pattern of progression. It is a mandatory reporting (WHO, 2012). According
to Medicine Net- Health (2014), Disease Surveillance is the ongoing systematic
collection and analysis of data and the provision of information which leads to action
being taken to prevent and control of the spread of any disease. Several disease
surveillance services exist in relation to HIV/AIDS management. Such services
include the service providers and their programmes [e.g. National Health Surveillance
Service (NHSS), HIV Programme Surveillance Center (HPSC), AIDSTER- one,
National AIDS Control Agency (NACA), US HIV/AIDS-Center for Disease Control
(CDC) etc.
Recently in Nigeria, the Minister of Health (Prof. Oyebuchi) in 2013 revealed that
Rivers State has top the leading of HIV/AID in Nigeria and Khana Local Government
is one of the component Local Governments of Rivers State. This study sattempt to
weigh up the expected impacts of Disease Surveillance Services on HIV/AIDS,
management and control in khana communities and her environs
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1.2 Statement Of Problem
Several reports have been made on the prevalence of HIV/AIDS in Nigeria and
particularly in Rivers State. However, governmental and non-governmental agencies
are working tirelessly in providing succor to the less privilege who have infected with
this evil wind (HIV/AIDS) that blows no man good. Inspite of these efforts, the
prevalence rate of HIV/AIDS in Khana was considered relatively high. This
unexpected increase of the disease borders most on the health and safety of the people
of Khana including their economy. These problems raises series of questions such as:
Is there any disease surveillance services, if there is, what are their roles and their
impact in the control of the prevalence of HIV/AIDS in the Khana Local Government
Area of Rivers State.
1.4 Significance of the Study
This study will serve as a guide into the health workers in the area on matters relating
to surveillance services, control and prevention of HIV/AIDs, and the dangers
associate with poor surveillance service on HIV/AIDs management within the Khana
community and her neighbouring communities and by extension Rivers State.
Findings in this work shall provide a data base that will enable programme planners
and implementations of policies that will be effective in the utilization of preventive
measure towards HIV/AIDS in relation Disease surveillance services. It will also help
in community mobilization and diagnosis as it relates to Disease Surveillance Services
and HIV/AIDS control. Finally, it will serve as source of enlightenment to the
community in particular and the public in general.
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1.5 Justification of the Study
Knowing that poor effective disease surveillance services on the control of HIV/AIDs
has a great negative impact on the health of man and the entire environment, it
becomes urgent to take a survey of HIV/AIDS control and the impact of disease
surveillance services in Khana Local Government Area in a bid to proffering solution
to the problems therein that will be of immense benefit to the populace. Thus, the
study is justifiable.
1.6 Broad Objective
The ultimate goal is to investigate the HIV/AIDS Control and the impact of Disease
Surveillance Services in Khana L..G.A OF Rivers State.
1.7 Specific Objectives
To achieving the aim of this study, the following specific objectives were utilized:
1. To find out the impact of disease surveillance service on the control of HIV/AIDS
2. To examine awareness level of disease surveillance service on the control of
HIV/AIDS by the community.
3. To determine the continuous monitoring of case clinical and infection control
status of reported case(s)
4. To find out the promptness in notification of reported cases of the disease.
1.8 ResearchQuestion
1. Is there any impact of disease surveillance services on the control of
HIV/AIDs in Khana?
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2. Are there levels of awareness of effective disease surveillance services by the
community?
3. Of what use is the continuous monitoring of case clinical and infection control
status of reported case(s)?
4. Are there any promptness in notification of reported cases of the disease?
1.9 Operational Definition
In this aspect the researcher decided to make classification on some certain words that
would likely appear frequently in this research work which are as follows
Evaluation: This refers to the systematic collection and analysis of data needed to
make decisions
Disease: This is a pathological condition of the body that presents a group of
symptoms peculiar to it.
Surveillance: It refers to constant observation of a place, thing or process
Health: This is a state of complete physical mental and social well being not merely
the absence of disease or infirmity.
Disease Surveillance: This ongoing systematic collection and analysis of data and this
provision of information which leads to action being taken to prevent and control a
disease.
HIV (human immunodeficiency virus): It is a lentivirus a sub-group of retrovirus that
cause the acquired immunodeficiency syndrome.
Clandestine: It is referred to secrecy, the practices of hiding information from certain
individuals or groups, perhaps while sharing it with other individuals.
Prevalence: In epidemiology is the proportion of a population found to have a
condition (typically a disease or a risk factor such as HIV/AIDs)
Itinerant: Is a person who travels from one place to another especially to perform
work or a duty.
Community: These are villages that make up K
6. 6
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter shall discuss already done works by other scholars that has direct bearing
to the study. The review of literature shall be discussed under the following sub-
headings:
1. Data base literature
2. Theoretical Framework
a. Precede Mode
b. Health Education and Prevention Model3.
c. Help-seeking behaviour mod el
d. Transformative learning theory
3. Conceptual Framework
a. An Over view of HIV/AIDS and Disease Surveillance
b. Prevalence of HIV/AIDS in Rivers State
c. HIV/AIDS Prevention and Control
d. Impact of Disease surveillance services on HIV/AIDS and Cont9rol
2.1 Data Base Literature
Several data concerning HIV/AIDS globally have been established in terms of
Prevalence, Control and Management including Disease Surveillance Services (DSS).
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However, under this heading, a concise approach is adopted in x-raying an excerpt of
the United Kingdom.
According to the Survey Report of the Pubic Health of England in 2013, Appendix 8,
HIV/AIDS in the United Kingdom between 2003 and 2012 was considered to be high
in both sexes with a corresponding increase according to their age variation. The study
revealed that <15 years in men were 375 while women (382) cases, as at 2003, and in
2012 the number cases for men (368) slightly reduces while women ( 410) was
observed to increased slightly with a higher rate than the men. For age between 25-34
years, the study revealed that men (6,006) while women (910) in 2003 with a
corresponding men (1,535) and women (981) in 2012, respectively. Also, between 35-
49 years, men (13,764) while women (4,842) was observed in 2003 and in 2012 men
(26, 895) while women (14,546) was recorded. For age > 50 years, the report
revealed that men ( 3,708) while women ( 653) was recorded in 2003 with a
corresponding values for men ( 14,936) and women (4,185) in 2012 respectively. In
the over all, men (24,535) and women (11,422) was recorded in 2003 while men
(52,061) and women (25,553) was recorded in
2012 SSPS et al.; 2013). Furthermore, it was revealed that approximately 100,000
people are living with HIV in the United Kingdom, 21,900 were undiagnosed while
77,610 have been diagnosed and accessing HIV care while 490 deaths among people
living with HIV had occurred. It was gathered that 6,360 new cases have been
observed while the ratio of men to women was highlighted as 52,081 to 77,614 in the
over all, as at December, 2012 (HSSPS et al.; 2013).
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2.2 Theoretical Framework
According to Hornby (2010), a theoretical framework is concerned with the idea and
basic principles on which a particular subject is based, rather with practice and
experiment. It could possibly exist, happen or be true, although this unlikely.
Thus, the following theories were utilized in this study:
The Precede Model
This model as posited by Green, Kinter, Deeds & Patrick (1980), stands for
predisposing, reinforcing at the enabling courses in educational diagnosis and
evaluation. It has been used in health education plan aimed at diagnosing the health
problems of a community, understanding the factors that influence the people’s
behaviour and developing intervention to promote healthy behaviour. This model is in
phases. The first is identification of health problem of the community, the second
phase makes clarification between the health problem and social problem while the
third phase include behavioural diagnosis i.e. those behaviour that has given rise to
the problem (s). This involves predisposing factor, enabling factor and reinforcing
factors. The fourth phase is the analysis of those factors (keeping factors) while the
fifth phase involves intervention and selection of decision. The sixth phase is the
implementation phase while the very last phase (seven) is the evaluation of the
intervention reached (Akinsola, 2006).It is against this backdrop this study hinges.
This model as applied in HIV/AIDS Control with specific interest to Disease
Surveillance Services helps to identify the unmet needs of programme managers,
9. 9
Health Facilitators and the Community, in analyzing their problems in terms of factors
that may inhibits effective Disease Surveillance Services in Khana Local Government
Area of Rivers State. However, findings in this study in line with phase 4, 5, 6, and 7
of this theory will build confidence of the less privilege, and proffering solutions to
HIV/AIDS via synergistic template to Disease Surveillance Services.
Health Education and Prevention Model
This theory as propounded by Court & Handy (1985) is based on the axiom that
prevention is better than cure and curative medicine has a limited capability for
managing chronic ailment are the key infectious disease. Mostly, curative side
medicine is characterized by accelerating costs and its attendant consequences.
Simply, it emphasized that all that needed to be done must be made without losing any
nut to ensuring a comprehensive success both in long and short runs. It seek to unfold
the positive impact creating of awareness through training and re-training of staff
(Akinsola 2006) on one hand educating the community for homogeneity compliance
in achieving the set target ( effective disease surveillance), aetiology of disease and
control. Furthermore, he averred that in the management of all diseases, education is
needed to persuade people to behave appropriately and in doing so, prevention is
enhanced.
Help-Seeking Behaviour Model
This account for balance between culture and illness and incorporate a number of a
health belief systems. It identifies factors affecting person in terms of illness. These
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factor ranges from signs or symptoms by seeking medical advice or help. The theory
promotes community diagnosis s well as individuals seeking advice from professionals
in the field for effective and sustainable utilization without fear or favour in a bid to
achieving set target. This theory was propounded by Becker, 1984.
Transformative learning theory
Transformative learning theory seeks to explain how humans revise and reinterpret
meaning (Taylor, 2008). Transformative learning is the cognitive process of effecting
change in a frame of reference (Mezirow, 1997). A frame of reference defines our
view of the world. The emotions that are often involved ( Ileris, 2001). Adults have a
tendency to reject any ideas that do not correspond to their particular values,
associations and concepts. It frames of reference are composed of two dimensions:
habits of mind and points of view. Habits of mind, such as ethnocentrism, are harder to
change than points of view. Habits of mind influence our point of view and the
resulting thoughts or feelings associated with them, but points of view may change
over time as a result of influences such as reflection, appropriation and feedback
(Taylor, 2008). Transformative learning takes place by discussing with others the
“reasons presented in support of competing interpretations, by critically examining
evidence, arguments, and alternative points of view. When circumstances permit,
transformative learners move toward a frame of reference that is more inclusive,
discriminating, self-reflective, and integrative of experience (ibid).
11. 11
It simply decipher our attitude even though the programme managers are trained, they
are human and came from society can react negatively sometime which can exercise a
corresponding negative impact on surveillance knowing the nature of HIV/AIDS its
discriminating tendencies in a typical developing country like ours. Educating the
mind (point of view) is seen as re-creating consciousness and building one an
egalitarian society in the long and short term for freer society of HI V/AIDS using
Disease Surveillance Services (DSS).
2.3 ConceptualFramework
An overview of HIV/AIDS and DiseaseSurveillance Services
It is likely that we will never know who the first person was to be infected with HIV,
or exactly how it spread from tha t initial person. Scientists investigating the
possibilities often become very attached to their individual 'pet' theories and insist that
there is the only true answer, but the spread of AIDS could quite conceivably have
been induced by a combination of many different events. Whether through injections,
travel, wars, colonial practices or genetic engineering, the realities of the 20th century
have undoubtedly had a major role to play. Nevertheless, perhaps a more pressing
concern for scientists today should not be how the AIDS epidemic originated, but how
those it affects can be treated, how the further spread of HIV can be prevented and
how the world can change to ensure a similar pandemic never occurs again (Mandel, et
al.; 2007). The 1970s saw an increase in the availability of heroin following the
Vietnam War and other conflicts in the Middle East, which helped stimulate a growth
in intravenous drug use. As a result of sharing unsterilized needles and syringes, HIV
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was passed on among injecting drug users (IDUs). Due to this repeated practice many
IDUs continue to be infected with HIV (Greener, 2002).
AIDS was first clinically discovered in1981 at the United States. The initial cases were
a cluster of injecting drug users in homosexual men with no known cause of impaired
immunity who showed symptoms of pneumocystis carinii pneumonia (PCP), a rare
opportunistic infection that was known to occur in people with very compromised
immune systems. Soon thereafter, an unexpected number of homosexual developed a
previously rare skin cancer called Kaposi’s Sarcoma (Ks) (Friedman-Kien, 1981)
Many more cases of PCP and Ks emerged, alerting U.S centres for disease control and
prevention (CDC) and a CDC task force was form to monitor the outbreak
(Basavapathruni & Anderson, 2007).
In the early days, the CDC did not have an official name for the disease, often
referring to it by way of the disease that were associated with it, for e.g.
lymphadenopathy, the disease after which the discovers of HIV originally named the
virus. They also use Kaposi ’s sarcoma and opportunistic infections. The name by
which a task force have been set up in 1981, at one point, the CDC coined the phrase
“The 4H disease”, since the syndrome seemed to affect Haitian, homosexuals,
hemophiliacs, and heroin users. In the general press, the term “GRID” which stood for
gag-related immune deficiency, had been coined (CDC, 2014).
However, after determining that, AIDS was not isolated to the Gag community. It was
realized that the term “GRID” was misleading and the term AIDS was introduced at a
meeting in July 1982. By September 1982 the CDC started referring to the disease as
13. 13
AIDS (Bolly et al.; 2010). In 1983, two separate research groups led by Robert Gallo
and Luc Montagnier independently declared that a novel retrovirus may have been
infecting people with AIDS, and published their findings in the same issue of the
Journal Science. Gallo claimed that a viruses his group had isolated from other human
T-Lymphotropic virusus (HTLVS) and his group newly isolated virus HTLV-III. At
the same time, Montagniers group isolated a virus from a person presenting with
swelling of the lymph nodes of the neck and physical weakness, two characteristics
symptoms of AIDS. Contradicting the report from Gallo’s group, Montagnier and his
collegues showed that core proteins of this virus were immunologically differently
from those of HTLV-I Montagnier group named their isolated virus lymphadenopathy-
associated virus (LAV) as these two viruses turned out to be the same, in 1986, LAV
and HTLV-III were renamed HIV (Aldriched et al,; 2000; Over 1992and
Ogden,2005). Both HIV-1 and HIV-2 are believed to have originated in non-human
primates in West-Central African and were transferred to humans in the society early
20th century. HIV-1 appears to have originated in southern Cameroon through the
evolution of SIV(CPZ), a simian immunodeficiency virus (SIV) that infects wid
chimpanzee subspecies Pan troglodytes troglodytes) The closest relative of HIV-2 is
SIV (SMM a virus of the sooty Mangabey Cercocebusatys atys) an old monkeys living
in coastal West African (from southern Senegal to Western Co’te d’ voire). New world
Monkeys such as the Owl Monkey are resistant to HIV-I infection, possibly because of
a genomic fusion of two viral resistance genes. HIV- I is thought to have jumped the
species barrier on at least three groups of the virus M, N and O.
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Prevalence of HIV/AIDS
Human Immunodeficiency virus infection and acquired immune deficiency syndrome
(HIV/AIDS) is a spectrum of conditions caused by infection with human
immunodeficiency virus ((CDC, 2003; Vogel et al.; 2010).
Following the initial infection, a person may experience a brief period of influenza-like
illness; this is typically followed by a prolonged period without symptoms. As
infections, that does not usually affect people, who have working immune systems.
The late symptoms of the infection are referred to as AIDS. This stage is often
complicated cystic pneumonia, severe weight loss, a type of cancer known as Kaposi’s
sarcoma or other AIDS-defining conditions (JUN and WHO,2007).
HIV is transmitted primarily via unprotected sexual intercourse (including anal and
oral sex) contaminated blood transfusions, hypodermic needles, and from mother to
child during pregnancy, delivery or breastfeeding, some bodily fluid such as saliva and
tears do not transmit HIV. Prevention of HIV infection, primarily through safe sex and
needle-exchange programs, is a key strategy to control the spread of the disease. There
is no cure or vaccine; however, antiretroviral treatment can slow the course of the
disease and may lead to hear-normal life expectancy, while antiretroviral treatment
reduces the risk of death and complications from the disease. These medications are
expensive and have side effects. Without treatment, the average survival time after
infection with HIV is estimated to be 9-11 years, depending on the HIV sub-type
(UNAIDS & WHO, 2007). Genetic research indicates that HIV originated in West
Central African during the nineteenth or early twentieth century. AIDS was first
15. 15
recognized by the United States Centers of Disease Control and Prevention (CDC) in
1981 and its cause –HIV infection was identified in the early part of the decades. Since
its discovery AIDS has caused an estimated 36 million deaths. As of 2012,
approximately 35.3 million people are living with HIV globally HIV/AIDS is
considered pandemic (A disease outbreak which is present over a large area and
actively spreading).
HIV/AIDS has a great impact on society, both as an illness and as a source of
discrimination. The disease also has significant economic impacts. There are many
misconceptions about HIV/AIDS such as the belief that it can be transmitted by casual
non-sexual contact, the disease has also become subject to many controversies
involving religion. It has attracted international medical and political attention as well
as large scale finding since it was identified in the 1980’s.The prevalence o HIV/AIDS
is so high that it cut across all the continent with higher rate as the days goes-by,
hence, the global attention as observed today (Smith et al.; 2006).The following signs
and symptoms often occurs:
Acute Infection
The initial period following the contraction of HIV is called acute HIV or Primarily
HIV or Acute Retroviral Syndrome (ARS) (Mandell Bennett, and Dolan 2010). Many
individuals develop and influenza-like illness or a mononucleosis illness 2-4 weeks
post exposures while others have no significant symptoms occurs in 40-90% cases and
most commonly include, fever, large tender lymph nodes, throat inflammation a rash,
headache, and one or sores of the mouth and genitals. The rash which occurs in 20-
16. 16
50% of cases presents itself on the trunk and is maculopapulr, classically; some people
also develop opportunistic infections at this stage ( Blankson, 2010). Gastrointestinal
symptoms such as nausea, vomiting or diarrhea many occur, as many neurological
symptoms of pheripheral neutropathy or civilian-Barre syndrome the duration of the
symptoms varies, but it’s usually once or two weeks (Usauerbruch, T; Rockstroh, JK
2010). Due to their non-specific character, these symptoms are not often recognized as
signs of HIV infection.
Acquired immunodeficiency syndrome (AIDS) is defined in terms of a CD4+ T cell
count below 200 cells per unit or the occurrence of a specific disease in association
with an HIV infection. In absence of a specific treatment, around half of people
infected with HIV develop AIDS within 10years. The most common initial condition
that alert to the presence of AIDS are Pneumocystosis pneumonia (40%) cachexia in
the form of HIV wasting syndrome (20%) and esophageal candidiasis other common
signs include recurring respiratory tract infection (Mandell, et al 2010) Opportunistic
infections may be caused by, bacteria, fungi, viruses and parasites that are normally
controlled by the immune system. Which infection occurs partly depends on what
organisms are common in the person’s environments. These infections may affect
every organ system (Achalu, 2007, Aria, 2007).
Clinical Latency
The initial symptoms are followed by a stage called clinical latency, asymptomatic
HIV or chronic HIV. Without treatment, the second stage of the natural history of HIV
infection- can last for about three to over 20 years (on average, about eight years).
17. 17
While typically there are few or no symptoms at first near the end of this stage. Many
people experience fever, weight loss, gastrointestinal problems and muscle pains
(CDC, 2003). HIV/AIDS is a global pandemic. As of 2012 approximately 35.3 million
people have HIV worldwide, with the number of new infection that year being about
2.3 million. This is down from 31million new infections in 2001. Of these
approximately 16.8million are woman and 3.4 million are less than 15 years old. It
resulted in about 1.34million death in 2013 down from a peak of 2.2 million in 2005
(UNAIDS 2011). People with AIDS have an increased risk of developing various viral
cancers including Kaposi ’s Sarcoma, Burkitt’s lymphoma, primary central nervous
system lymphoma and cervical cancer occurs more frequently in those with AIDS due
to its associations with human papillomavirus (HPV) conjunctival cancer (of the layer
which lines the inner of the eyelids and the white part of the eye) is more common in
those with HIV. AIDS frequently have systematic symptoms such as prolonged fevers,
sweat (particularly at night) swollen lymph nodes, chills, weakness and weight loss,
Diarrhea is another common symptom present in about 90% of people with AIDS.
They can also be affected by diverse psychiatric and neurological symptoms
independent of opportunistic infections and cancers.
(US department of health and human service 2010) developed persistence generalized
lymphadenopathy, characterized by explained, non-painful enlargement of more than
one group of lymph nodes (other than in the groin) for over three to six months. t HIV-
1 infected individuals have a detectable viral load and in the absence of treatment will
eventually progress to AIDS, a small proportion (about 5%) retain high level of CD4+
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T cells (T helper cells) without antiretroviral therapy for more than 5 years.
(Blackson, 2010). This individual as classified as HIV controllers or longterm non-
progressors (LTNP) are those who maintain a low or undetectable viral load without
antiretroviral treatment who are known as “Elite controllers” or elite suppressors they
represent approximately 1 in 300 infected persons. The transmission of HIV/AIDS
includes the followings:
Sexual transmission: The most frequent mode of transmission of HIV is through
sexual contact with an infected person. The majority of all transmission worldwide
occurs through heterosexual contacts. However, the pattern of transmission varies
significally among countries. In the United States as of 2009, most sexual transmission
occurred in men who had sex with men with this population accounting for 64% of all
new cases (CDC, 2012). Others sources are
Body fluid
Blood transfusion
Through Shapes and needle stick injuries
Mother to child transmission etc.
HIV/AIDS Prevention and Control
Achalu (2007) reported HIV/AIDS can be prevented or controlled by
1. Adopting safe sexual practice (i.e. using condom)
2. Do not share sharps or razor
3. Ensure that blood are screened before use
4. Ensure that all medical equipments are sterilized before use
5. Apply safety measures in dealing patient
6. Know your HIV/AIDS STATUS
7. Do not forget to go for period medical check-up
19. 19
8. Discard used sharps proper in sharps containers
9. Disinfect all suspected beddings room or material with appropriate disinfectants
10. Report suspected cases to appropriate authority
11.Early diagnosis, medication or management is better than being late. This also
conform with WHO (2003) and (AIDSTER- ONE, MMIS, UNICEF,WHO and
USAID, 2007)
Impact of Disease Surveillance Services
Disease Surveillance Services (DSS) is information based activity involving the
collection, analysis and interpretation of large volume of data originating from variety
of sources (NHSS, 2012) report. The UNAIDS/WHO working group on global
HIV/AIDS and STI Surveillance maintained that HIV/AIDS and sexually transmitted
infections (STIs) is a joint effort of WHO and UNAIDS. The UNAID and STI
surveillance, initiated in November 1996, is a coordination and implementation
mechanism for UNAIDS and WHO to compile and improve the quality of data needed
for informed decision-making and planning at national, regional and global levels. The
primary objectives of working group is to strengthen national, regional and global
structures and networks for improve monitoring and surveillance of HIV/AIDS.
For this purpose, the working group collaborates closely with WHO regional offices,
national AIDS programmes and a number of national and international institutions. It
therefore consists of several stakeholders that include:
UNAIDS (Epidemiology, monitoring and evaluation team)
WHO/FCH/SRM (Surveillance, monitoring and evaluation and research team).
WHO/NMH/MSD (Mental health and substance dependence)
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Such impacts among others could be viewed as follows:
1. The working group gathers examples of best practices and experiences from all
regions on the country level and uses them to develop global guidance and training
materials to be used in designing, monitoring, and evaluating national surveillance
system. Existing HIV systems are still often base on the model develop by the WHO
global programme on AIDS at the end of the 80’s which was based on the experience
gain in the African epidemic.
2. The second generation HIV Surveillance has been developed through series of
collaborative meeting, the new system builds on the existing HIV Surveillance
activities focuses more on the monitoring of mature epidemics, the adaptation of the
tools to slow progressing epidemics and the more consistence collection and the use of
behavioral for risk assessment and evaluation of preventive interventions.
3. The scale-up of services for ART, preventing mother-to-child transmission of
HIV (PMTCT) and HIV counseling and testing has led to an increase in the numbers
of adults and children being tested and diagnosed with HIV infection. Accurate data
are needed on adults and children diagnosed with HIV infection to facilitate estimation
of the treatment and care burden, to plan for effective prevention and care
interventions and assess care interventions. WHO therefore recommends that countries
consider conducting reporting of newly diagnosed cases of HIV infection in adults and
children?
4. The requirements for the confidentiality and security of HIV surveillance data
are the same as for AIDS-related reporting. Provider-initiated reporting will be
21. 21
required to increase the completeness, timeliness and efficiency of HIV case reporting.
Laboratory-initiated reporting alone will be insufficient for reporting HIV, as other
surveillance information from the health care provider or medical records will be
required. For the purposes of HIV case definitions for reporting and surveillance,
children are defined as younger than 15 years of age and adults as 15 years or older.
5. It has impacted positively in terms of awareness campaign, education of
citizenry, sensitization and accessibility to drugs, sorting and encouragement of
funding by Nations etc.
Stigma Associated With HIV/AIDS
AIDS stigma around the world in a variety of ways including ostracism, rejection,
discrimination and avoidance of the infected people; compulsory HIV testing without
prior consent or protection of confidentiality; violence against HIV infected
individuals or people who are perceived to be infected with HIV; and the quarantine of
HIV infected individuals. (UNAIDS, 2006). Stigma-related violence or the fear of
violence prevents many people from seeking HIV testing, returning for their result, or
securing treatment, possibly turning what could be a manageable chronic illness into a
death sentence and perpetuating the spread of HIV [ Ogden, 2005; Nyblade (2005)]
Economic Impacts Of HIV/AIDS
HIV/AIDS affects the economics of both individuals and countries. The gross
domestic product of most affected country have decreased due to lack of human
capital (Bell, Datarajan and Gersbach, 2003) . Without proper nutrition, health care
22. 22
and medicine, large numbers of people die from AIDS-related complications. They
will not only be unable to work, but will also require significant medical care. It is
estimated that as of 2007 there were 12 million AIDS Orphans. Mandell, Bennutt, and
Delan (2010). Many are cared for by elderly grandparents (Greener, 2002).
HIV/AIDS affect young adult, reduces the taxable population, and in turn-reducing
the resources available for public expenditures such as education and health services
not related to AIDS resulting in increasing pressure for the state’s finances and slower
growth of the economy. This causes a slower growth of tax base, an effect that is
reinforce if there are growing expenditures on treating the sick, training (to replace
sick workers), sick pay and caring for AIDS Orphans. This is especially true if the
sharp increase in adult mortality shifts the responsibility and blame from the family to
the government in caring for the orphans (Greener, 2002).
At the household level AIDS cause both lack of income and increased spending on
health care. A study in Cote d’voire) showed that household having a person with
HIV/AIDS spent twice as much on medical expenses as other households.
This additional expenditure also leaves less income to spend in education on other
personal or family investment (Over, 1992)..
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CHAPTER THREE
RESEARCHMETHODOLOGY
3.1 Introduction
This chapter deals with the methods and procedures used in the study. It includes the
followings;: Research Design, Population of Study, Sample Size and Sampling
Techniques, Research Instrument, Validity of Instrument, Reliability of Instrument,
Method of Data Collection and Method of Data Analysis
3.2 ResearchDesign
The descriptive survey design was adopted in carrying out this research. This design
was considered most appropriate for the study because it used in a situation where the
independent variable(s) cannot be directly manipulated (Dike & Roseline, 2010;
Adiele, 2013). It sets out the procedural outline for the conductof any given
investigation (Wodi, 2005). It provides simple but discrete summaries about the
sample and the measures ( Gokana, 2013).
3.3 Population of the Study
Ogundipe, Lucas & Sani (2006) described it as the total of all elements, subject or
numbers that possessesa specified set of one or more common definite attributes.
Khana Local Government Area had a population of about 294, 217 according to the
National Population Census (NPC) in 2006. Thus, in this study, the population
comprises married and unmarried women and men of childbearing age, respectively.
24. 24
3.4 Sample Size and Sampling Techniques
In determining the sample size for this study, the Yaro Yamene formula (Appendix 2)
was used. Thus, an approximate total of 400 were calculated for this study as the
sample size representing the true population. Four (4) communities were selected as a
representative of the Khana Local Government Area for the study. The purposive
sampling technique was adopted to select the subjects.
3.5 ResearchInstrument
The researcher relied mostly on the questionnaire which included both dichotomous
(YES or NO) and Likert (strongly agree, disagree and strongly disagree) typified
questions. The questionnaire was sectioned into A, B & C. Section A discusses socio-
demographic data of respondents, Section B elicit information about the impacts of
disease surveillance services and the levels awareness of the respondents while Section
C was use to retrieve information on the continuous monitoring and promptness in
notification of reported cases. A sum total of 13 questions were utilized in the
questionnaire. Data were also obtained from interviews, text-books, journals, internet,
news paper, and personal observation
3.6 Validation of Instrument
To validate the instrument for this study, the researcher sent the prepared
questionnaire to pass through the scrutiny and litmus test of my supervisor before it
was approved for the study. Furthermore, my supervisor ensured that the items in the
25. 25
questionnaire represent some knowledge (i.e. correlate perfectly with the stated
objective and the research question). This validates the instrument.
3.7 Reliability of Instrument
In testing the reliability of the instrument, the test-re-test method was employed. 15
questionnaires were administered to 15 persons within an interval of two weeks at a
selected Tai Local Government Area outside the study area. The responses obtained
from the respondents were marked X and Y, respectively. The obtained data was
analyzed using ProductMoment Correlation Coefficient (r), and the reliability index
was computed to be 0.5 (Appendix 3).
3.8 Procedure for Data Collection
Data were administered to the respondents with the assistance of four (4) of the
researcher’s colleagues who understands the Khana language to ease interpretation
where necessary. The process lasted for only two days. All the questionnaires were
retrieved by researcher’s colleagues and handed over to the researcher.
Technique for Data Analysis
The retrieved data were analyzed using simple percentage and bar chart statistical
tools.
26. 26
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
Introduction
This chapter will present and analyze data collected in course of conducting this
research work. Data were analyzed based on the questions developed in the
questionnaires in line with the four research questions (Chapter, one).
SectionA. Socio-demographic Data
Table 4.1 Descriptive statistics offrequency and percentage showing distribution
of respondents by Age
S/No Response
(years)
Frequency Percentage (%)
1. 15-24 150 37.5
2. 25-34 170 42.5
3. 35-44 55 13.5
4. 45 and above 25 6.25
Total 400 100
(Source: Field survey, 2015).
Table 4.5 showed that 150 respondents representing 37.5% where age (15-24) years,
170 respondents representing 42.5% where age (25-34), 55 respondents representing
13.5% where age (35-44) years, 45 and above had 25 respondents representing 6.25%.
Table 4.2 Descriptive statistics of frequency and percentage showing
distribution of respondents by Marital Status.
Marital Status Frequency Percentage (%)
Single 95 23.75
Married 180 45
Divorced 20 5
Separated 60 15
Widowed 45 11.25
Total 400 100
(Source: Field survey, 2015).
27. 27
Table 4.2 above shows the distribution of respondents with respect to their marital
status. A total of 95 (25.75) of respondents stated that they were single, 180
respondents representing 45% of the sample size reported that they were married, 20
(5%) respondents stated that they were divorced, 60 (15%) respondents indicated that
they were separated while 45 respondents representing 11.25% of the sample size
stated that they were widowed.
Table 4.3 Descriptive statistics of frequency and percentage by Sex
Items Statement Response Frequency Percentage %
What is your Sex Male
Female
180
220
45
55
Total 400 100
(Source: Field Survey, 2015)
In table 4.3, 180 respondents representing 45% were males while 220 representing
55% were female.
Table 4.4 Descriptive statistics of frequency and percentage showing distribution
of respondents by educational status.
S/No Response Frequency Percentage (%)
1. Primary 200 50
2. Secondary 150 37.5
3. Tertiary 50 12.5
Total 400 100%
(Source: field survey, 2015).
The table 4.4 above displays the distribution of respondents with respect to the
educational statuses. The highest number of respondents, 200, representing 50% of the
sample size stated that they have attained primary education only. 150 (37.5%)
28. 28
respondents stated that they had acquired secondary education while 50(12.5%)
respondents indicated that they had as well acquired tertiary education.
Table 4.5 Descriptive Statistics of respondents showing distribution by Religion of
Respondents
S/No Religion Frequency Percentage (%)
1 Christianity 295 73.75
2 Islam 35 8.75
3 African Tradition 40 10.00
4. Others 30 7.50
Total 400 100.00
(Source: field survey, 2015).
Table 4.5 shows religion of respondents. Out of 100 percent of respondents, 73.75%
were Christians, 8.75% were Islam, 10.00% were of African Tradition and 7.50% were
of other religion not mention in the list.
Section B: Impact of DSS & the levels of awareness of the Respondent
Table 4.6 Descriptive statistic of knowledge Of DSS Unit in the community
Item statement Response Frequency Percentage %
Knowledge of DSS Yes
No
190
2I0
47.50
52.50
Total 400 100%
(Source: Field Survey, 2015)
In Table 4.6, 190(47.50%) were percentage for those who says yes there is Disease
Surveillance Services (DSS) while 210(52.50%) said they have taught of it.
29. 29
Table 4.7: If, Do you agreed that it has impacted tremendously to the control of
HIV/AIDS?
Response Frequency Percentage (%)
Strongly Agree 60 15.0
Agree 110 27.5
Strongly Disagree 160 40
Disagree 70 17.5
Total 400 100
(Source; field survey, 2015)
From table 4.7 above, 60 (15.0%) respondents strongly agreed that DSS has impacted
on the control of HIV/AIDS, 110 (27.5%) also agreed that DSS has impacted
tremendously to the control of HIV/AIDS in the community. 160 (40%) respondents
strongly disagreed that DSS has not impacted to the control of HIV/AIDS and 70
(17.5%) respondents disagreed that DSS has not impacted tremendously to the control
of HIV/AIDS in the community.
Table 4.8: Are you aware that DSS is effective in the control of HIV/AIDS?
Item statement Response Frequency Percentage %
Knowledge of DSS Yes
No
159
241
39.75
60.25
Total 400 100%
(Source: Field Survey, 2015)
In Table 4.8, 159 (39.75%) respondents stated that ‘yes’ DSS is effective in the control
of HIV/AIDS while 241 (60.25%) respondents stated that ‘no’ DSS is not effective in
the control of HIV/AIDS.
30. 30
Table 4.9: Have you ever gone for one information or the other as if affects
HIV/AIDS in the community?
Item statement Response Frequency Percentage %
Knowledge of DSS Yes
No
149
251
37.35
62.75
Total 400 100%
(Source: Field Survey, 2015)
In Table 4.9, 149 (37.35%) respondents stated that ‘yes’ they have gone for an
information affecting HIV/AIDS while 251 (62.75%) respondents stated that ‘no’, they
have not gone for any information as it affects HIV/AIDS.
SectionC
Table 4.10: Do you agree that the continued reported critical and infected
HIV/AIDS records are used for positive planning?
Response Frequency Percentage (%)
Strongly Agree 10 2.5
Agree 130 32.5
Strongly Disagree 190 47.5
Disagree 80 20
Total 400 100
From table 4.10 above, 10 (2.5%) respondents strongly agreed that the continues
reported critical and infected HIV/AIDS records are used for positive planning, 130
(32.5%) respondents also agreed that the continues reported critical and infected
HIV/AIDS records are used for positive planning while 190 (47.5%) respondent
strongly disagreed that the continues reported critical and infected HIV/AIDS records
are not used for positive planning and 80 (20%) also disagreed that the continues
reported critical and infected HIV/AIDS records are not used for positive planning.
31. 31
Table 4.11:Does the community notify DSS promptly in cases ofHIV/AIDS or
any other disease?
Response Frequency Percentage %
Yes
No
171
229
42.75
67.25
Total 400 100%
(Source: Field Survey, 2015)
In Table 4.11, 171 (42.75%) respondents stated that ‘yes’ the community do notify
DSS promptly in cases of HIV/AIDS or other diseases while 229 (67.25%)
respondents stated that ‘no’, the community do not notify DSS promptly in cases of
HIV/AIDS or other diseases.
Table 4.12: If no, why are they not notifying service providers?
Response Frequency Percentage (%)
Due to stigmatization 60 15.0
Due to ignorance 110 27.5
Lack of DSS in the community 160 40
Fear of expenditures (cost) 70 17.5
Total 400 100
From table 4.12 above, 60 (15.0%) respondents stigmatization is the reason why they
don’t notify the service providers, 110 (27.5%) respondents stated that ignorance was
the reason why they don’t notify the service providers, 160 (40%) respondents also
stated that lack of DSS unit in the community was the reason why they don’t notify the
service providers while 70 (17.5%) respondents stated their own reason as fear of
expenditures (cost).
32. 32
CHAPTER FIVE
DISCUSSION, SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1 DISCUSSION OF FINDINGS
Research question 1: Is there any impact of DSS in the control of HIV/AIDS?
From the study conducted, it has been revealed that there are impacts of DSS on the
control of HIV/AIDS. These impacts could be negative or positive with a higher
degree. From 4.7 it has been revealed that 60 (15.0%) of the respondents strongly
agreed that DSS has caused positive impacts with agreed 110 (27.5%) while strongly
disagreed had 160 (40%) and 70 (17.5%) respectively. This means that there is no
impact of the DSS on HIV/AIDS in the study area. The implication of this is that
higher rate of HIV/AIDS occurrence could be perceived, effective data related to
HIV/AIDS could be dashed and this could affect further planning of policies and
implementation process within the study area and by extension, the state.
Research Question 2: Are there levels of awareness of effective DSS in the
community?
Table 4.8 is used to discuss this research question. The table revealed that 159
representing 39.75% stated that there is awareness while 241 representing 60.25% said
there is no awareness. This means that the people of Khana local government are not
aware of effective DSS in the community. This corroborates with table 4.7. however,
table 4.9 further reveals that 251 (62.75%) maintained that there are levels of
awareness on effective DSS in the community while 149 (37.35%) stated that there is
33. 33
awareness level. This is in line with table 4.8. Thus, the Khana people are not aware of
DSS services. The reason could be as a result of ignorance in the part of the
community or lookwarmness on the part of government officers that represent the
zone.
ResearchQuestion3: Of what use is the continued monitoring of case clinical and
infection control status of reported cases?
Table 4.10 was utilized to analyze the above stated research question. The table
revealed that 35% agreed that the continued monitoring helps in policy planning and
implementation process of both government and non-governmental agencies facilities
available while 67.5% disagreed that the continued monitoring has not impacted in any
level in the process of healthcare delivery with reference to HIV/AIDS control. This
implies that activities of personnel or agencies saddled with the responsibilities of DSS
are not effectively doing the job as fashioned. Implication is that there could be
expected rise of HIV/AIDS control as poor awareness level is observed in this study.
The reason for this could be as a result of poor health education on the part of the
inhabitants and lack of enthusiasm on the part of the concerned personnel super
imposed by the stigma and the communicability rate of the disease attached to
HIV/AIDS in this part of the country. Though, this inhibits the WHO standards of
healthcare personnel practices.
Research Question 4: Are there promptness in the notification of reported cases
of the disease?
Table 4.11 and 4.12 were utilized to objectively answer the above stated question. In
table 4.11 42% said that the indegens notify DSS promptly while 67.25% said they do
34. 34
not. The reasons for which the community did not report cases promptly could be as a
result of stigma attached to HIV/AIDS in this part of the country both in culture and
moral values. Also, it could be as a result of ignorance or poor awareness level and so
on the part of the inhabitants of the community.
Lack of DSS and low level performance (table 4.8) and ignorance and stigmatization
(table 4.12) could have been responsible for these actions.
Summary
The purpose of this study is to examine HIV/AIDS and Disease Surveillance impact in
the control of HIV/AIDS in Khana Local Government Area of Rivers State. Four (4)
research questions were formulated; a descriptive design was employed for the study
with a sample size of 400. The study was conducted in Khana Local Government Area
of Rivers State and questionnaires were used to elicit information from respondents.
Simple frequency percentage technique was utilized as the statistical tool for data
analysis. It was found out that the impact of DSS on the control of HIV/AIDS was
very low. Low level of awareness on the part of the indigenes of Khana was very low.
Conclusion
The study reviewed that awareness level on the impact of DSS was very low and that
cases of HIV/AIDS were not reported promptly as there were no effective DSS units in
the community. It can be further concluded that disease surveillance services enhances
the HIV/AIDS control and should therefore be encouraged in the community.
35. 35
Recommendation
The following recommendations are relevant for the study;
There should be enough trained DSS personnel who have the passion for the
work in a bid to achieving the millennium development goals (MDGs) as it
relates to HIV/AIDS in the study area.
There should be sensitization, health education and awareness campaign at all
levels in the community using the language they best understand in a bid to
douse their ignorance.
There should be effective monitoring of HIV/AIDS related cases at all levels to
alleviate the sufferings of the people and boosting their encouragement that will
have an alternative positive impact in policy development and implementation
within the study area.
36. 36
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Ahmed S. Creanga AA, Gillespie D.G and Tsui, A.O (2010); Economic
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Anyanwu, J.I; Ezegbe, B.N; Eskay, M (2003); FamilyPlanning in Nigeria:
a Myth or Reality? Implications for Education. Journalof Education
and Practice. ISSN 2222 – 1735 (paper) ISSN 2222-288. Vol. 4 No.
15; 108-118. www.iiste.org.
Arie, J. Zuckerman (2007): Principles and Practice of Clinical Virology. 6th ed.
Hoboken, New Jersey.
Blankson, M.C, Baggaley R.F., Wang L. Masse B, White R.G., Hayes R.J., Alary
M. (2009): Heterosexual Risk of HIV-1 Infection per Sexual Act:
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Coutsoudis, A; Kwaan, L; Thomson, M.(2010): Prevention of Vertical
Transmission of HIV-1 in Resource-Limited Settings. Expert review of
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Case Definition for HIV Infection. Morbidity and mortality weekly report.
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Dimensional ApproachLecture Monograph. 1st ed. Elabanabari Publishers.
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1st ed. Desired Publishers. Lagos State. ISBN: 978-34740-4-9
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38. 38
APPENDIX I
QUESTIONNAIRE
Rivers State College of Health Science and Technology
Schoolof Public Health Nursing
P.M.B 5039
Port Harcourt
15th March, 2015.
Dear Respondent,
Attitude and Practice ofModern Family Planning Methods amongstWomen of
Childbearing Age (15-49)years in Okrika LocalGovernment Area of Rivers
State, Nigeria.
Herein under, is a questionnaire on the above subject matter. It is strictly intended to
elicit necessary and relevant information about your community for the sole purposeof
academic study.
Moreso, if the project work is accomplished it will go a long way to be a benefit to the
community, individuals and family and by extension, the government.
With humility, I solicit for your kind co-operation in providing necessary information
needed, please. I will also ensure that all information given shall be treated with
utmost confidentiality.
Yours faithfully,
Tam Princewill (Mrs).
(Researcher)
39. 39
Instruction:Please tick ( √) in the appropriate place where applicable.
SECTION A: SOCIO DEMOGRAPHIC DATA
1. What is your age?
(a) 15-24 (b) 25-34 (c) 35-44
(d) 45 and above
2. What is your educational status?
(a) Primary education (b) secondary (c) tertiary education
3. At what age do start practicing family planning?
(a) 15-25 (b) 26-35 (c) 36-45 (d) 46 and above
4. At what level of educational status did you start practicing family planning?
(a) Primary level (b) Secondary level
(c) Tertiary level of education
SECTION B: Disease Surveillance Services
5. Have you any knowledge about Disease Surveillance Services?
(a) Yes (b) No
6. Have you gone for one information or the other about HIV/AIDS control?
(a) Yes (b) No
7. Are you aware of DSS services in your community?
(a) Yes (b) No
8. If, Do you agreed that it has impacted tremendously to the controlof
HIV/AIDS?
a) Strongly Agree b) Agree c) Strongly Disagree d) Disagree
9. Are you aware that DSS is effective in the control of HIV/AIDS?
(a) Yes (b) No
10. Do you agree that the continued reported critical and infected HIV/AIDS
records are used for positive planning?
a) Strongly Agree b) Agree c) Strongly Disagree d) Disagree
40. 40
APPENDIX II
Sample size determination using Yaro Yame method viz;
N = N/1+N(0.05)2
Where n = desired sample size
N = Population of the study 2222026
e = Tolerable error (0.05)
1 = Theoretical constant
Therefore,
= 222026/1+222026 ( 0.05)2
= 399.82
= 400
