COLLEGE OF MEDICAL SCIENCES

PREVALENCE AND DETERMINANTS OF FOOD INSECURITY AMONG HOUSEHOLDS IN BENIN CITY

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Abstract
BACKGROUND: Food security is essential for human survival, encompassing consistent access to sufficient, safe, and nutritious food. It is defined by four key dimensions: availability, access, utilization, and stability, all of which must be met simultaneously. Food insecurity arises when these dimensions are compromised, leading to inadequate food access. Globally and in Nigeria, its prevalence remains high, driven by factors such as poverty, population growth, and environmental challenges. Food insecurity is associated with adverse health outcomes, including malnutrition and chronic diseases, and negatively impacts education, productivity, and economic growth. AIM: The study aimed to assess the prevalence, determinants, knowledge and perception of food insecurity among households in Benin City, Nigeria and the coping strategies adopted. METHODS: This study employed a community-based descriptive cross-sectional design conducted in Benin City, Edo State, Nigeria, among 500 heads of households. A multistage sampling technique was used to select participants. Data were collected using a pretested, interviewer-administered questionnaire adapted from validated tools, including the Food Insecurity Experience Scale and the Coping Strategies Index. Data analysis was performed using IBM SPSS version 27. Descriptive statistics were presented as frequencies and percentages, while associations were tested using Chi-square or Fisher’s exact tests. Logistic regression was used to identify predictors of food insecurity, with significance set at p < 0.05. Results were presented in prose, tables and bar charts. RESULTS: The mean age of respondents was 51.9 ± 11.9 years, with majority within the 45–54 years age group. The majority 403 (80.6%) were males. The prevalence of food insecurity among households was 383 (76.6%). Food insecurity was higher among respondents aged ≥65 years (86.4%; p = 0.010), married respondents (85.7%; p = 0.004), those with primary education (95.3%; p < 0.001), retired respondents (94.3%; p = 0.017), and those with skill level 2 (85.8%; p < 0.001). It was also higher in households with monthly income ≤ ₦180,000 (84.1%; p < 0.001) and monthly food expenditure ≤ ₦100,000 (82.5%; p < 0.001), and among respondents with good perception of food insecurity (81.5%; p = 0.008). Married respondents had higher odds of food insecurity (OR = 2.135; p = 0.008). Higher education (OR = 0.272; p = 0.017), employment (OR = 0.210; p = 0.012), higher skill level (OR = 0.458; p = 0.001), and home ownership (OR = 0.592; p = 0.040) were associated with lower odds, while increasing number of children increased the odds of food insecurity (OR = 1.236; p = 0.047). Overall, 57.2% of respondents had good knowledge of food insecurity, and 52.0% had a good perception of food security. Knowledge of food insecurity was associated with marital status, where a higher proportion of respondents who were not married had good knowledge (66.4%; p = 0.020). Higher proportions of respondents with monthly household income ≤ ₦180,000 (63.3%; p = 0.003) and those who spent ≤ ₦100,000 on food (61.7%; p = 0.010) had good knowledge of food insecurity. Marital status was associated with lower odds of good knowledge (OR = 0.505; p = 0.007). Higher education increased the odds of good knowledge (OR = 2.351; p = 0.005), while higher skill level reduced the odds of having good knowledge (OR = 0.657; p = 0.036). Perception of food insecurity was associated with level of education, where a higher proportion of respondents with tertiary education had good perception (55.7%; p < 0.001). A higher proportion of respondents with access to a nearby food market also had good perception (55.0%; p < 0.001). Higher education increased the odds of good perception (OR = 3.380; p < 0.001), while access to a nearby food market increased the odds of good perception (OR = 2.777; p < 0.001). Food insecurity status (OR = 1.880; p = 0.004) and good knowledge of food insecurity (OR = 0.515; p = 0.013) were also associated with good perception of food insecurity. The most common coping strategies included consumption of less preferred foods (64.4%), reduction in portion sizes (57.2%), and reduction in the number of meals per day (54.2%). CONCLUSION: The study found that about three-quarters of households were food insecure. Marital status, education, employment, skill level, income, food expenditure, number of children, and housing tenure were important determinants. More than half of respondents had good knowledge and about half had good perception, but many households still used coping strategies such as reducing meal frequency and consuming less preferred foods. The findings reflect widespread food insecurity among households in the study area.
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INFLUENCE OF EXPOSURE TO ONLINE SEXUAL CONTENT ON THE SEXUAL BEHAVIOUR OF YOUTHS IN UGBOWO, BENIN CITY.

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This study examines the influence of exposure to online sexual content on the sexual behaviour of youths in Ugbowo, Benin City. With the increasing accessibility of the internet and digital media, young people are frequently exposed to sexually explicit materials, which may shape their attitudes, perceptions, and practices regarding sexuality. The study adopts a descriptive survey design to assess the level of exposure among youths and its relationship with their sexual behaviour. Data were collected through structured questionnaires administered to selected respondents in the study area. Findings are expected to reveal the extent to which online sexual content contributes to early sexual initiation, risky sexual practices, and changes in sexual attitudes among youths. The study further explores moderating factors such as peer influence, parental guidance, and media literacy. The results aim to provide insights for parents, educators, and policymakers on the need for effective sexual education and digital media regulation to promote healthy sexual development among youths.
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EVALUATING THE PERCEIVED IMPACT OF RADIOGRAPHY PRACTICES ON RADIOGRAPHERS WORKING IN EDO STATE HOSPITALS.

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Radiography is expected to be a profession where practitioners perform diagnostic imaging procedures while adhering to standard safety protocols, ergonomic principles, and best practices designed to safeguard their physical and psychological well-being. This study set out to evaluate the perceived impact of radiography practices on radiographers working in Edo State hospitals. A total of 95 questionnaires were distributed, with 82 valid responses analysed, representing an 86.3% response rate. The findings revealed that conventional procedures such as chest X-rays, extremities, and abdominal radiography dominate daily workflow, while advanced modalities like MRI and mammography are less frequently performed. Most radiographers reported conducting more than 15 procedures per day, reflecting a heavy workload. The analysis of physical health challenges showed that musculoskeletal complaints, particularly lower back pain, fatigue, and joint or limb pain, were the most significant, while skin and eye irritation was less frequently perceived. On the psychological front, stress, burnout, and overwork due to limited staffing were highly rated, though many radiographers still indicated some degree of job satisfaction. Pearson correlation confirmed a significant positive relationship between radiographic practices and both physical and psychological health outcomes, establishing that workload and procedural demands directly influence the well-being of radiographers in Edo State. The study concludes that radiographic practice in Edo State is marked by a reliance on high- volume conventional imaging, which, while essential for service delivery, has notable consequences on radiographers’ health. The physical burden of repetitive procedures and patient handling, combined with the psychological pressures of heavy workload and limited institutional support, significantly affect professional well-being. Keywords: Practice, Radiography, physical health, musculoskelectal.
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UPTAKE AND LEVEL OF UTILIZATION OF ELECTRONIC HEALTH RECORD SYSTEMS ACROSS SELECTED HOSPITALS IN BENIN CITY, EDO STATE.

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Background: Electronic Health Record (EHR) systems are increasingly recognized as essential components of modern healthcare delivery, with the potential to improve patient outcomes, enhance data management, reduce medical errors, and strengthen health system efficiency. Despite these benefits, the adoption and effective utilization of EHR systems in many low- and middle-income countries, including Nigeria, remain low and with influence ranging from multiple individual, institutional, and infrastructural factors. Objective: This study aimed to determine healthcare workers’ knowledge of EHR systems in patient care, assess their attitudes toward EHR utilization, determine uptake and the level of EHR utilization, and identify factors influencing their use across selected hospitals in Benin City, Edo State. Methods: A analytical cross-sectional study design was conducted among 478 healthcare workers selected from public and private hospitals using a multistage sampling technique. Data were collected using a structured, pre-tested, self-administered questionnaire comprising sections on socio- demographic characteristics, knowledge, attitude, utilization, and factors influencing EHR use. Knowledge and utilization scores were categorized based on a 70% cut-off, while attitude was assessed using a 5-point Likert scale which was grouped into appropriate and inappropriate responses and scored using a cut-off of 70%. Data were analyzed using SPSS version 27. Descriptive statistics were summarized as frequencies and percentages, while inferential analysis was conducted using chi-square tests and fisher’s exact and multivariate logistic regression to identify predictors of HER in line with study objectives. Statistical significance was set at p < 0.050, and 95% confidence interval. Results: The majority of respondents were aged 20–39 years (86.8%), with a mean age of 31.22 ± 8.32 years, and females constituted 63.4% of the study population. Nurses formed the largest professional group, and most respondents had less than five years of professional experience. Awareness of EHR systems was high (93.3%), and an equal proportion demonstrated good knowledge (93.3%). Respondents showed strong knowledge in areas such as data privacy, reduction of medical errors, and improvement of healthcare delivery. A majority of respondents (78.2%) had a positive attitude toward EHR utilization, with most agreeing that EHR systems improve patient management (98.1%) and enhance the speed of care delivery (93.3%). However, a considerable proportion expressed neutrality regarding preference for EHR over paper-based records, indicating a transitional phase in adoption. EHR systems were available in most facilities (84.7%), and utilization was high across multiple domains, including clinical documentation (94.1%), patient registration (93.3%), prescribing (92.1%), and laboratory result access (90.6%). Utilization patterns varied significantly by profession and facility type at the bivariate level. Multivariate logistic regression analysis identified knowledge level, sex, and facility type as independent predictors of EHR utilization. Respondents with poor knowledge were significantly less likely to utilize EHR systems compared to those with good knowledge (OR = 0.22; 95% CI: 0.06–0.86; p = 0.029). Male respondents had lower odds of utilization compared to females (OR = 0.32; 95% CI: 0.11–0.89; p = 0.029), while those working in private facilities were less likely to utilize EHR systems compared to those in public facilities (OR = 0.15; 95% CI: 0.03–0.74; p = 0.019). Factors such as training (OR = 5.83; 95% CI: 2.46–13.81; p = <0.001), stability of electricity supply (OR = 7.25; 95% CI: 1.88–27.94; p = 0.004), and availability of hospital policy (OR = 1.99; 95% CI: 1.15–3.47; p = 0.014) were significant predictors of utilization at the multivariate level. Conclusion: This study demonstrates that healthcare workers in Benin City possess relatively high levels of knowledge, positive attitudes, and increasing level of utilization of EHR systems, indicating a strong foundation for digital health integration. However, persistent gaps in training, infrastructure, and organizational support limit optimal utilization. Addressing these challenges through targeted capacity building, improved infrastructural investment, and strengthened institutional policies will be critical for maximizing the benefits of EHR systems and improving healthcare delivery outcomes.
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IMPACT OF MENSTRUAL CYCLE PHASES ON THE PHYICAL PERFORMANCE IN UNIVERSITY OF BENIN FEMALE-STUDENT ATHLETES.

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Background The menstrual cycle is a fundamental biological process that introduces considerable hormonal variability, affecting both physiological and psychological functioning in women. Although female participation in sports has grown, research focusing on women’s athletic health remains scarce, especially within African settings where cultural norms and structural barriers often marginalize menstrual health considerations. Aim This research investigated the impact of menstrual cycle phases on physical performance, symptom profiles, and self-management strategies among female athletes at the University of Benin, Nigeria, to generate evidence informed recommendations for cycle aware training and athlete support. Methods Fifty three female athletes participated in this repeated measures study. Physical performance indicators strength, endurance, agility, and reaction time—were evaluated across the menstrual, follicular, ovulatory, and luteal phases. Data on body weight fluctuations and self-reported symptoms were analyzed using repeated measures ANOVA and Pearson’s correlation tests, with significance set at 0.05. Results Significant phase dependent variations in physical performance were observed (p < 0.05). Strength, endurance, and agility were lowest during the menstrual phase, improved during the follicular and ovulatory phases, and declined slightly in the luteal phase. Reaction time was also slower during menstruation. Although body weight remained relatively stable, a significant phase related difference emerged, with slightly lower weight during the menstrual and follicular phases and higher values during ovulation and the luteal phase. A negative correlation was found between changes in body weight and endurance between the ovulatory and luteal phases (r = −0.313, p = 0.023). Frequently reported symptoms included cramps and fatigue during menstruation, bloating during ovulation, and irritability during the luteal phase. Approximately 40 percent of athletes did not track their cycles, and coaches were largely unaware of the performance variations linked to menstrual phases. Conclusion Menstrual cycle phases significantly influence physical performance among female athletes. The conventional “one size fits all” training model fails to accommodate their unique physiological changes. Individualized, cycle sensitive training programs that incorporate menstrual tracking and athlete coach communication are essential to enhance performance, reduce injury risk, and promote well being.
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ASSESSMENT OF KNOWLEDGE OF STROKE AMONG CLINICAL UNDERGRADUATES IN THE SCHOOL OF BASIC MEDICAL SCIENCES, UNIBEN.

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Background: Stroke remains one of the leading causes of death and long-term disability worldwide, with an increasing incidence in low- and middle-income countries such as Nigeria. Early recognition and appropriate response to stroke symptoms are critical to improving outcomes. Medical students, as future healthcare providers, play a vital role in promoting stroke awareness and emergency response. Objective: This study assessed the level of knowledge of stroke, its risk factors, warning signs, and appropriate emergency responses among clinical undergraduate students in the School of Basic Medical Sciences (SBMS), University of Benin. Methods: A descriptive cross-sectional survey design was employed. A structured, self- administered questionnaire was distributed to 322 clinical undergraduates selected through stratified random sampling. Data were analyzed using descriptive and inferential statistics, including frequency, percentage, and chi-square tests at a 0.05 significance level. Results: Findings revealed a generally high level of stroke awareness among respondents. Most participants (94.1%) correctly identified the brain as the organ affected by stroke, and 98.4% recognized that stroke is preventable. Hypertension (77.0%), old age (73.3%), and diabetes were the most frequently identified risk factors. Paralysis of one side of the body (78.6%) and speech difficulty (77.3%) were the most recognized warning signs. A significant association existed between level of study and knowledge of stroke risk factors (p = 0.035) and between gender and planned response to stroke events (p = 0.02). Conclusion: Clinical undergraduates of the University of Benin demonstrated commendable theoretical knowledge of stroke, its risk factors, and warning signs. However, gaps remain in the understanding of lifestyle-related risk factors and practical emergency response.
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COMPARATIVE IMPACT OF LAPAROTOMY AND THORACOSTOMY ON RPP OF PATIENTS: A GUIDE TO POSTSURGICAL PHYSIOTHERAPY PRESCRIPTION BY

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Background:
Laparotomy and thoracostomy are major invasive procedures that impose distinct physiological stresses on the cardiovascular system. The rate-pressure product (RPP), an index of myocardial oxygen demand, provides a reliable measure of cardiovascular workload following surgical interventions. Understanding how these procedures influence RPP is essential for physiotherapists
in planning safe and effective post-surgical rehabilitation.
Methods:
An observational prospective cohort design was employed. Forty surgical patients with a mean age (CTTD: 44.0 ± 12.43 years; Laparotomy: 42.4 ± 23.12 years) were recruited through simple random sampling and assigned to two groups: laparotomy (n = 20) and closed-tube thoracostomy drainage (CTTD) (n = 20). Cardiovascular parameters—systolic blood pressure (SBP) and pulse rate (PR)—were recorded preoperatively and at 24, 48, and 72 hours postoperatively using an automated monitor. RPP was computed as SBP × PR. Pain intensity was assessed using the Visual Analogue Scale (VAS). Data were analyzed using descriptive statistics, paired and independent t-tests, and repeated measures ANOVA, with significance set at p < 0.05.
Results:
Thirty-one patients (20 laparotomy, 11 CTTD) completed the study. Baseline SBP, PR, and RPP were comparable between groups. Both groups exhibited postoperative fluctuations in SBP and PR, yet RPP remained relatively stable across all time points. Paired t-tests revealed no significant changes in RPP within groups, though the laparotomy group showed significant reductions in PR at 24 and 48 hours (p < 0.001). Repeated measures ANOVA confirmed no significant time effect on RPP in either group (CTTD: F (3, 30) = 0.929, p = 0.439; laparotomy: F (3,57) = 1.536, p = 0.215). Between-group comparisons showed no significant RPP differences at any interval (p > 0.05). Mean VAS scores were similar (CTTD: 3.00 ± 0.82; laparotomy: 3.20 ± 0.76).
Conclusion:
Laparotomy and thoracostomy procedures exert comparable effects on myocardial workload, as indicated by stable RPP values across postoperative periods. These findings suggest that cardiovascular responses following both surgeries are similar and that physiotherapy prescriptions should be guided by individualized patient assessment rather than procedure type alone.
Keywords:
Laparotomy, Thoracostomy, Rate Pressure Product, Myocardial Workload, Postoperative Physiotherapy, Cardiovascular Response.
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co-supervisor

USE OF ARTIFICIAL INTELLIGENCE CHATBOT IN FACILITATING SELF- MEDICATION PRACTICES AMONG UNDERGRADUATE STUDENTS IN BENIN CITY, EDO STATE

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Background: Artificial intelligence (AI) chatbots are increasingly being used as source of health information, particularly among undergraduate students who are highly engaged with digital technologies. These tools provide instant, interactive, and personalized responses to healthrelated queries, which may influence health-seeking behaviors. One growing concern is their role in facilitating self-medication, defined as the use of medicines without consultation with qualified healthcare professionals. While AI chatbots may improve access to health information and empower individuals to make decisions, their unregulated use raises concerns about misinformation, inappropriate drug use, delayed diagnosis, and adverse health outcomes. Despite the increasing global use of AI technologies, there is limited evidence on how undergraduate students in Nigeria utilize AI chatbots in relation to self-medication practices. Understanding students’ knowledge, attitudes, and patterns of use is essential for informing public health interventions and policies. Methods: An analytical cross-sectional study was conducted among undergraduate students in Benin City, Nigeria. Data were collected using a structured, self-administered questionnaire adapted from UTAUT and related acceptance models that assessed socio-demographic characteristics, knowledge of AI chatbots, attitudes toward their use in health decision-making, and prevalence of their use in facilitating self-medication. Knowledge and attitude scores were computed and categorized into levels. Data analysis was performed using appropriate statistical software. Descriptive statistics such as frequencies and proportions were used to summarize variables, while inferential statistics, including chi-square tests, were used to examine associations between variables. Statistical significance was set at p < 0.05.Results: The mean age of respondents was 21.50±3.138 years, with females constituting the majority (78.4%). Awareness of AI chatbots was universal, and about four-fifth of respondents demonstrated good knowledge, with Gemini being the most correctly identified tool. Despite this high awareness, only a small proportion had received formal training on AI or chatbots. About seven-tenth of respondents expressed a positive attitude toward AI chatbot use, perceiving these tools as convenient and useful for obtaining quick health information, although concerns regarding reliability and safety remained common. The prevalence of AI chatbot use for self- medication was considerable, with nearly one-third of respondents reporting use for advice on symptoms, possible diagnoses, and treatment options. ChatGPT was the most commonly used chatbot for self-medication, followed by Gemini. Despite the prevalence of use, the frequency of chatbot utilization for self-medication was mostly occasional or rare. Sex and guardians occupation were significant predictors of good knowledge. Attitude toward AI chatbot use was a strong predictor of prevalence. Respondents with a positive attitude were significantly less likely to use AI chatbots for self-medication compared with those with a negative attitude (OR = 0.178, p < 0.001) Conclusion: Despite high awareness and good knowledge of AI chatbots among respondents, concerns about reliability and safety in self-medication persisted. About one-third had used AI chatbots, mainly ChatGPT, for self-medication. Knowledge, attitude, guardians’ occupation, and social media use significantly influenced utilization, highlighting the need for targeted health education, improved digital health literacy, and regulatory frameworks to ensure safe and responsible use of AI chatbots in healthcare decision-making.
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USE OF AI CHATBOTS IN INFLUENCING MENTAL HEALTH STATUS AMONG UNIVERSITY UNDERGRADUATES IN BENIN CITY, EDO STATE

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BACKGROUND
Mental health disorders among university students are an increasing public health concern globally, particularly in low- and middle-income countries where access to formal mental health services remains limited. Simultaneously, artificial intelligence (AI) chatbots are increasingly being integrated into students’ academic and social activities, with emerging interest in their potential role in mental health support. This study aimed to assess the knowledge, attitudes, uptake, utilization, factors influencing use, and mental health status associated with AI mental health chatbot use among undergraduate students of the University of Benin, Benin City, Edo State, Nigeria.
METHODS
An analytical cross-sectional study was conducted among 436 undergraduate students of the University of Benin, Benin City, Edo State, Nigeria, using a pretested self-administered structured questionnaire. Respondents were selected using a multistage sampling technique. Data collected were analyzed using IBM SPSS version 25.0. Statistical significance was set at p < 0.050 at 95% confidence interval.
RESULTS
The mean age of respondents studied was 21.84 ± 3.97 years. Nearly all respondents demonstrated awareness of AI chatbots, while approximately nine-tenths had good overall knowledge. However, awareness of clinically validated mental health–specific chatbots such as Woebot and Wysa was very low. About three-quarters of respondents demonstrated positive attitudes towards AI mental health chatbots. Uptake of AI chatbots was near-universal (96.6%), driven predominantly by general-purpose platforms such as ChatGPT for academic purposes. Uptake of clinically validated mental health-specific chatbots such as Woebot and Wysa was negligible. Only a small proportion reported using AI chatbots specifically for emotional support or mental health-related purposes. Ethnicity and level of study were identified as significant predictors of good knowledge of AI chatbots. Respondents with good knowledge had significantly higher odds of positive attitudes towards AI mental health chatbots (OR = 4.003; CI = 1.940–8.258; p < 0.001). Peer influence, anonymity, affordability, and privacy concerns significantly influenced AI chatbot utilization. High utilization was significantly associated with academic level and religion. Nearly three-fifths (59.9%) of respondents screened positive for depression. High AI chatbot utilization (OR = 1.753; CI = 1.083–2.836; p = 0.022) and high dependency (OR = 2.173; CI = 1.039–4.542; p = 0.039) were identified as significant predictors of depression.
CONCLUSION
Despite high awareness, positive attitudes, and near-universal uptake of AI chatbots among undergraduate students, awareness of clinically validated mental health–specific platforms remain low. Depression was highly prevalent among respondents, and high AI chatbot utilization and dependency were significantly associated with depressive symptoms. There is need for targeted digital mental health literacy programmes, institutional regulation of AI mental health tools, and integration of safe, evidence-based digital mental health interventions within university settings.
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WATER SANITATION AND HYGIENE PRACTICES AMONG PUBLIC SECONDARY SCHOOL STUDENTS IN EGOR-LOCAL GOVERNMENT AREA BENIN-CITY EDO STATE

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Background: Water, Sanitation, and Hygiene (WASH) practices are essential for adolescent health, dignity, and academic performance. Inadequate knowledge, poor attitudes, and limited facilities in schools contribute to waterborne diseases, absenteeism, and reduced learning outcomes. Despite sensitization efforts, misconceptions about WASH remain common among secondary school students, influenced by age, sex, family structure, and socioeconomic background. Strengthening WASH education and infrastructure is critical to improving hygiene practices and reducing risks.

Objective: To assess the level of knowledge, attitudes, prevalence, and determinants of WASH
practices among secondary school students in Egor Local Government Area, Edo State, Nigeria, with the aim of identifying gaps and making recommendations for improved hygiene management in schools.

Subjects and Methods: An analytical cross-sectional study was conducted among 550 secondary school students selected through a multistage sampling technique. Data were collected using a pretested self- administered questionnaire and analyzed with IBM SPSS version 27.0. Associations between socio- demographic characteristics and WASH knowledge, attitude, and practice were tested using chi-square statistics, with statistical significance set at p < 0.05 at 95% confidence.

Results: The mean age of respondents was 14.05 ± 1.85 years, with females comprising 60.4%. Awareness of WASH was moderate (71.9%), with teachers (48.3%) and parents (27.0%) as the main sources of information. Good knowledge of WASH was found in 177 (46.5%) respondents, while 204 (53.5%) demonstrated poor knowledge. Age was significantly associated with knowledge: students aged ≥17 years had higher odds of good knowledge (OR = 9.52; 95% CI =3.21–28.23; p < 0.001) compared to those aged 10–13 years. Female students were more likely to have good knowledge than males (OR = 1.78; 95% CI = 1.17–2.71; p = 0.007). Junior secondary students (JSS) were significantly less likely to have good knowledge compared to senior secondary students (SSS) (OR = 0.005, 95% CI = 0.001–0.017, p < 0.001). This finding confirms that class level, reflecting both age and curriculum exposure, is a critical determinant of
WASH knowledge. Parental occupation also influenced knowledge, with students whose fathers were in skill level 4 jobs having higher odds of good knowledge (OR = 2.41; 95% CI = 1.31– 4.43; p = 0.036). Mother’s occupation showed similar associations (OR = 3.12; 95% CI = 1.45– 6.71; p = 0.004). Attitudes toward WASH were generally positive, but determinants were significant. Students with good knowledge were more likely to have positive attitudes (OR = 2.82; 95% CI = 1.34– 5.92; p = 0.006). Conversely, not living with both parents reduced the odds of positive attitude (OR = 0.40; 95% CI = 0.21–0.76; p = 0.005). The prevalence of good WASH practices was encouraging but not universal. While handwashing after toilet use was common (74.8%), fewer students practiced handwashing before meals (51.2%) or recognized the need for gender-separated toilets with nearby handwashing facilities (49.3%). Good knowledge increased the odds of good practice (OR = 2.21; 95% CI = 1.17–4.19; p = 0.015), while lack of privacy in hostels or public toilets was significantly associated with poor menstrual hygiene practice (OR = 1.70; 95% CI = 1.01–2.87; p = 0.047).

Conclusion: Although awareness and knowledge of WASH were encouraging, substantial gaps remain in practical knowledge, attitudes, and consistent hygiene practices. Younger students and males were more likely to have poor knowledge, while family structure and privacy issues influenced attitudes and practices. Improving school- based health education, expanding the role of health clubs, strengthening WASH facilities, and providing private, girl-friendly spaces are essential to promote safe practices, reduce disease burden, and enhance academic performance among secondary school students.
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