Jokhep volume 5 december 2012

Journal of Kinetics and Health Education Perspective.Volume 5, December,2012
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Nursing Intervention for Patients with Goitre in the Health Care Delivery System in Nigeria
By
Dr. Fidelis Uchendi Okafor, Ph.D.
Department of Nursing Science,
University of Benin,
Benin City.
uchendifidelis2001@yahoo.com
08037442403
&
Joan Chukwura, M.Sc.
Department of Nursing Science,
University of Benin,
Benin City.
ABSTRACT
Thyroid hormones are very important for the normal functioning of the various organs of the body. When the production and availability of these hormones are impaired, as would occur in goitre caused either by hyperthyroidism or iodine deficiency, organ functions could be adversely affected. Iron deficiency is a major threat to health of people across the globe and the introduction of the universal salt iodization (USI) programme is an important step towards controlling this deficiency. Various diagnostic measures are available including adequate observation of symptoms in order to obtain accurate information about patient’s disease status. Treatment could be in form of chemotherapy, radiotherapy with radioactive iodine or surgery. Nurses need to have good background knowledge in order to adequately care for patients with goitre. In this article, the thyroid gland, its hormones and abnormalities is discussed followed by the epidemiology of goitre, its causes and clinical manifestations. The diagnostic plan is enumerated followed by medical management and nursing intervention for patients with goitre. It is therefore recommended that public heath talks should be organised by nurses to reduce the scourge of goitre in the society.
The people are encouraged to use iodised salt, vegetables and fruits in their meals.
INTRODUCTION
Thyroid gland is a highly vascular butterfly-shaped endocrine organ connected by an isthmus situated in the lower neck anterior to the trachea. Thyroxine (T4), Triiodothyronine (T3) and calcitonin (thyrocalcitonin) are the hormones secreted by the thyroid gland. T4 and T3 (collectively referred to as thyroid hormones) are necessary for cell replication and ultimately normal growth and brain development. In other words their main role is to control cellular metabolic activities. They influence every major organ of the body through their effects on cellular metabolism. On the other hand calcitonin reduces high plasma level of calcium by increasing its deposition in the bone. Iodide in the form of iodine is instrumental and essential for the synthesis of thyroid hormones (Greenstein, Gould & Trounce, 2004; Smeltzer, Bare, Hinkle, & Cheever, 2008). The release of thyroid hormones; by thyroid gland is controlled by thyroid stimulating hormone (TSH) from the anterior

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pituitary gland through a negative feedback mechanism. Thus decreased plasma level of the thyroid hormones
causes increased output of TSH which in turn increases the output of T4 and T3. Furthermore, thyrotropin-releasing
hormone (TRH), secreted by the hypothalamus exerts a modulating influence on the release of TSH
from the pituitary gland (Smeltzer, Bare, Hinkle, & Cheever, 2008).
Figure 1. Anatomy of the thyroid gland
(http:www.triofoundation.com/gfx/Thyroid_Diagram.jpg)
The abnormality in thyroid function is generally divided into two, namely: hypothyroidism and
hyperthyroidism. Hypothyroidism is a suboptimal availability of thyroid hormones to the body while
hyperthyroidism is an increased plasma level of the thyroid hormones with the overall effect of raised metabolic
rate (Greenstein, et al, 2004).
Goitre is an enlargement of the thyroid gland. Over-secretion of thyroid hormones (hyperthyroidism) is usually
associated with goitre (toxic goitre). The severe form of hyperthyroidism is known as Grave’s disease which is
an autoimmune disorder. In addition, goitre also commonly occurs with dietary iodine deficiency. Here lack of
iodine leads to reduced level of thyroid hormones which in turn causes an increase in TSH culminating in
hypertrophy of the thyroid gland (Smeltzer, Bare, Hinkle & Cheever 2008) where it is referred to as endemic or
simple goitre. An individual is said to be euthyroid if the thyroid function is within normal range.
The term nodular goitre is used where the thyroid gland is nodular because of areas of hypertrophy. In the
absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis and thyroid malignancy, they constitute
an entity described as non-toxic nodular goitre, which occurs both endemically and sporadically ((Tonacchera,
Pinchera, & Vitti, 2010). However, these nodules may slowly increase in size and cause local pressure; some
may become malignant, while some are associated to a hyperthyroid state eventually requiring surgical therapy
((Smeltzer, Bare, Hinkle & Cheever 2008).
Epidemiology of Goitre
Iodine deficiency is a major threat to the health and development of population worldwide, particularly among
preschool and pregnant women. When the requirement for iodine are not met, thyroid hormone synthesis is
impaired, resulting in a series of functional and developmental abnormalities collectively referred to as iodine
deficiency disorders (IDD) including goitre (Andersson, Takkouche, Egli, Allen, & de Benoist, 2005). In
addition iodine deficient goitre is common in iodine-deficient areas (Bakhsh, Kirov, Gregory, Williams, &
Ludgate, 2006).

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Nigeria is one of the endemic goitre regions with an estimated 9 million sufferers and a large variation among the various states of the country. The four main goitre endemic states in Nigeria include Taraba, Benue, Nassarawa and Ebonyi. It has been asserted that there is high prevalence of production and consumption of non- iodised salt in these states (This Day, 2007, Abua, Ajayi, & Sanusi, 2008, Daily Champion, 2010). Universal salt iodization (USI) is the iodization of all salt used for human and animal consumption and is the main strategy used to control iodine deficiency (World Health Organisation, 1996). World Health Organisation (WHO) recommends that salt be iodized to a concentration of 1 part in 100,000. As part of the strategies to reduce the prevalence of IDD in Nigeria, the Universal Salt Iodisation Programme was also introduced in Nigeria following the World Health Organisation directives in 1996 (Abua, et al, 2008).
Furthermore, hyperthyroidism affects women eight times more frequently than men with onset usually between the second and fourth decades of life (Tierney, McPhee, & Papadakis, 2005). The incidence of non-toxic multinodular goitre increases with age (Nygaard, Hegedűs, Gervil, Hjalgrim, Søe-Jensen,& Hansen, 1993).
Causes of Goitre
Some of the causes of goitre as recorded by Greenstein, et al (2004) & (Smeltzer, Bare, Hinkle & Cheever 2008) include;
o Simple or endemic goitre is caused by insufficient intake of iodine especially in areas where the natural supply of iodine is deficient. Insufficient mean dietary iodine (less than 40fg/day) causes an increase in TSH secretion, which in turn causes thyroid hypertrophies leading to goitre. Additionally, it could be caused by excessive ingestion of goitrogenic substances like iodine or lithium used in treatment of bipolar disorders.
o Hyperthyroidism could be caused by thyroiditis and excessive ingestion of thyroid hormone in the treatment of hypothyroidism. It may also occur following emotional shock or stress though this relationship is not fully understood. Generally in hyperthyroidism there is an excessive release of thyroid hormones.
Clinical Manifestations
The summary of clinical manifestations of goitre from Waltman, Brewer, & Lobert, (2004) & (Smeltzer, Bare, Hinkle & Cheever 2008) includes;
o Simple goitre usually presents as a mid-line lump in the neck without symptoms. However, when excessive it may compress on the trachea leading to compromised respiratory function.
o Goitre due to hyperthyroidism is more symptomatic, manifesting in a group of signs and symptoms often referred to as thyrotoxicosis including increased appetite, dyspnoea on exertion, diaphoresis, heat intolerance, palpitations, irritability and nervousness. Others include sleep disturbance, fatigue, exophthalmia (bulging eyes), blurred vision and/or diplopia, fine resting tremors, weight loss, diarrhoea and irregular menstruation.
o Clinical manifestations of nodular goitre are related to those of growth or functional autonomy. Symptoms are typically those of local pressure (dysphasia, globules sensation, cough or dyspnoea) or cosmetic complaints and are difficult to evaluate objectively. It is mandatory to rule out malignancy, for which purpose fine-needle aspiration biopsy is the gold standard (Fast, Nielsen, Bonnema, & Hegedűs, 2009).

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Subjective and Objective Diagnostic Plans
The diagnostic plans for goitre as discussed in (Smeltzer, Bare, Hinkle & Cheever 2008) & Tonacchera, et al, (2010)
A combination of clinical manifestation, comprehensive medical history-taking and physical examination/ neck palpation will generally give a picture of the diagnosis for goitre. The thyroid gland is enlarged, soft and may pulsate; a thrill is often palpated, and a bruit is heard over the thyroid arteries as a result of increased blood flow to the gland.
However, it is important to confirm the diagnoses with laboratory and radiological examinations, some of which are listed below.
Measurement of the serum Thyroid- stimulating hormone (TSH) concentration. This test is of high sensitivity and is the best screening test for thyroid function. Normal range is 0.4 - 6.15 μU/mL
- Serum FREE T4.
- Radioactive iodine uptake test to measure iodine uptake by the thyroid gland using tracer dose of iodine 123 ( This is used to confirm abnormal TSH result.
123
- Fine-needle aspiration biopsy for detecting malignancy. It provides the most direct and precise information about a thyroid nodule I). There is high uptake in hyperthyroidism and low uptake in hypothyroidism
- Ultrasonography (US) of the thyroid gland. Others include elastography and scintigraphy.
- Computed tomography (CT) scan and magnetic resonance imaging (MRI)
- Further a combination of cytology and molecular testing improves the diagnostic accuracy for better prediction of malignancy in thyroid nodular disease.
Medical Management of Goitre
Goitre could be managed either pharmacologically or surgical or by combined therapy.
Endemic goitre is treated by increasing iodine in the diet to correct the iodine imbalance. Oral supplementary iodine (Lugol iodine) can be used as a replacement drug for synthesis of thyroid hormones (Greenstein, et al, 2004, Mustapha, 2008, & Smeltzer, et al, 2008). Iodization is not without side effects and has been known for many years that an increase in the incidence of hyperthyroidism often occurred after iodization. It usually affects older subjects who had a longstanding goitre and is due to increased sensitivity of the thyroid gland to iodine in amounts which would be well tolerated by normal subjects (Phillips 1997). Therefore it is important to monitor thyroid levels during and following treatment. When surgery is recommended, it is advisable to have patient in euthyroid state through treatment with anti-thyroid medications and iodide to reduce the vascularity of the goitre thus reducing post operative complications like haemorrhage and haematoma (Greenstein, et al, 2004 & Smeltzer, et al, 2008).
The treatment of hyperthyroidism depends largely on the underlying cause and is aimed at reducing hyperactivity, reduce symptoms and prevent complications. A combination of therapies is often used including anti-thyroid agents, radioactive iodine and surgery (Smeltzer, et al, 2008).
Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine (131
Antithyroid medications are used either to block the synthesis of hormones (carbimazole, propylthiouracil and methimazole) or suppress the release of thyroid hormones (sodium iodide, potassium iodide, saturated solution I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non- toxic goitre. Side effects are few and the five year risk of hypothyroidism is 22%. (Nygaard, et al, 1993, Fast, et al, 2009). Radioiodine is administered orally and is rapidly absorbed and retained in the thyroid gland where it destroys only thyroid cells. However, patient will eventually go into hypothyroid state requiring treatment.

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of potassium iodide (SSK), dexamethasone). Beta-blockers (propranol) are used to treat symptoms like tachycardia, tremor, sweating and anxiety (Greenstein, et al, 2004 & Smeltzer, et al, 2008).
Surgery (thyroidectomy) is reserved only for special circumstances in recent time unlike in the past when it was the fundamental treatment option for hyperthyroidism. It is performed now only on patients allergic to anti- thyroid medications, those with large goitres and in patient with a need for rapid normalisation of thyroid function (Pearce & Braveman 2004, Smeltzer, et al, 2008). A subtotal thyroidectomy is often performed where almost all the thyroid tissue is removed. Furthermore, all the three treatment modalities for hyperthyroidism share the same complications including relapse or recurrent hyperthyroidism and permanent hypothyroidism (Smeltzer, et al, 2008).
Nursing Intervention Strategies
Nursing intervention in the management of goitre is usually in form of health promotion, disease prevention, care of hospitalised patients and ensuring that patients reach their optimal level of health and function through adequate community follow-up care.
Health Promotion and Disease Prevention
The role of the nurse in the intervention programme of the Goitre patient is health promotion which enables people to increase control over, and improve their health leading to reduction and prevention of disease (health gain), enhances autonomy and informed decision-making (empowerment) and increased social participation (Naidoo, &Wills, 2000). The nurse ensures that contacts with people (example, school nurse, industrial nurse and in antenatal clinics) serves as opportunity to impact knowledge about their health needs to them. In places where goitre is endemic the nurse need to enlighten people on the need to use iodized salt (WHO, 1996), encourage them to partake in health screening and to seek medical help, if they notice any form of thyroid abnormality.
Care of Hospitalised Patients with Goitre
When patient is admitted with either simple goitre or hyperthyroidism, it is crucial that the nurse make proper nursing diagnosis and identify their nursing care needs. Some nursing diagnosis of patient with simple goitre might include disturbed body image related to neck swelling and deficient knowledge related to normal nutrition and treatment measures (Waltman, et al, 2004, Smeltzer, et al, 2008).
In patient with disturbed body image related to neck swelling, the nurse aims towards encouraging patient to employ new coping methods and acceptance of their appearance through good grooming, dressing and presentation of self. The nurse also promotes social interaction and contacts with new and existing support networks like friends, family and colleague at work. These help to improve patients self esteem.
Where there is deficient knowledge related to normal nutrition and treatment measures, the goal of nursing care would be to provide patient with information about the disease process and the need for adequate dietary intake of iodine. Further, the patient is informed about their plan of care including investigations, medications, and surgery so as to encourage cooperation and compliance. However, the nursing in providing information gets down to the level to the patient depending on their knowledge base and previous exposure.
Additionally, patients with hyperthyroidism need a lot of understanding and reassurance because of the alteration in emotional status as well as physical appearance which often are part of the disease symptoms. Improving nutritional status is paramount in offsetting the imbalanced nutrition less than body requirement. The nurse also provides a relaxed and cool environment to encourage patient to rest. The family of patient needs reassurance and encouragement in order to cope with the significant changes that occur in such patient.
Community Follow-up Care

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Patient on discharge should be fully equipped with information on how to continue with self-care at home. This information include the coping measures, need to adhere to medication regimen, need for increased dietary intake of iodine through iodized salt and seafood, identifying potential complications and compliance to follow- up appointments (Greenstein, et al, 2004 & Smeltzer, et al, 2008). Patient could be followed up by the community nurse where this service is available.
Fundamental to delivering adequate nursing intervention to patient with goitre is a sound knowledge of the anatomy, physiology and pathophysiology of the thyroid gland including the various treatment modalities for the patient group. Secondly, the nurse also needs a good interpersonal relationship particularly in relating with patients with hyperthyroidism.
Summary,
The author has clearly examined the structure and function of thyroid gland and the pathophysiology of goitre. The epidemiology of the disease (goitre) in various states in Nigeria, causes, clinical manifestations both subjective and objective indexes were fully highlighted in the review. Medical management which consist of pharmacological therapy and surgical intervention were discussed. Nursing intervention strategies in the management of goitre which include the promotion of health, preventive of disease, care of the hospitalised patient and community follow up care were all x-rayed in the discourse.
Recommendation
In view of the enormity of the disease in the society, it becomes expediently recommended that public health instruction be given by nurses and other health care providers to reduce the incidence of goitre in the endemic community. These are achieved through teaching of the causes, clinical manifestations and treatment of goitre in schools, market places, community town halls, churches etc. The people are encouraged to use iodised salt; if possible, it can be distributed in the clinics and health centres to augment the sales in the market. Significantly, people in the endemic region should be encourage to perform their screening test for serum thyroid-stimulating hormone (TSH) concentration for normal functioning of thyroid gland.
Conclusion.
The thyroid gland and its hormones play a vital role in maintaining normal metabolic activities of the various organs of the body. An abnormality in the function of the thyroid hormones thus affects this function. Goitre which is caused by either iodine deficiency or hyperthyroidism is one of the conditions of the thyroid gland which the nurse encounters either in clinical practice or in the community. There are various clinical manifestations of this condition as well as diagnostic investigations that help in the diagnosis of goitre. Treatment is aimed towards optimising function with minimal side effects. The nurse plays a very important role in the care of patient with goitre as well as in health promotion activities to prevent and control the occurrence of goitre particularly endemic goitre.
The nurse needs to be well informed on the normal and abnormal functions of the thyroid gland in order to be knowledgeable doer in caring for the patient group. There is need for more evidenced-based nursing articles on this topic to inform clinical practice, nursing education and further research on the topic.
REFERENCES

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Andersson, M., Takkouche, B., Egli, I., Allen, H. E., & de Benoist, B. (2005) Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bulletin of the World Health Organisation 83(7): 518-525.
5 Adequacy of dietary iodine in two local government areas of Cross River State in Nigeria. Pakistan Journal of Nutrition 7(1): 40-43.
Bakhsh, A., Kirov, G., Gregory, J. W., Williams, E. D., & Ludgate, M. (2006) A new form of familial multi-nodular goitre with progression to differentiated thyroid cancer. Endocrine-Related Cancer. 13: 475- 483.
Daily Champion Newspaper (25th February 2010) NAFDAC to partner UNICEF on Goitre endemic states. Accessed on 24th July 2011. Downloaded from http://allafrican.com/stories/201002250353.html
Fast, S., Nielsen, V. E., Bonnema, S. J., & Hegedűs, L. (2009) Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. European Journal of Endocrinology. 160: 517-528.
Greenstein, G., Gould, D., & Trounce, J., (2004) Trounce’s Clinical Pharmacology for Nurses (17th ed). Edinburgh: Churchill Livingstone.
Mustapha, R. O., (2008) The easier approach to pharmacology for all health professionals (2nd ed). Ilorin: Adewumi Printing Press.
Naidoo, J., Wills, J. (2000), Health promotion: Foundation for practice (2nd Edition), London, Balliere Tindall &Royal College of Nursing
Nygaard, B., Hegedűs, L., Gervil, M., Hjalgrim, H., Søe-Jensen, P., & Hansen, J. M. (1993) Radioiodine treatment of multinodular non-toxic goitre. British Medical Journal. 307: 828-832.
Pearce, E. N. & Braveman L. E. (2004) Hyperthyroidism: advantages and disadvantages of medical therapy. Surgical Clinics of North America. 84(3), 833-847.
Phillips, D.I.W., (1997) Iodine, milk, and the elimination of endemic goitre in Britain: the story of an accidental public health triumph. Journal of Epidemiology and Community Health. 51: 391-393.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H., (2008) Brunner & Suddarth’s Textbook of medical-surgical nursing (11th ed). Philadelphia: Lippincott Williams & Wilkins.
This Day Newspaper (4th November 2007) NAFDAC Take Anti-Goitre campaign to Taraba. Accessed on 24th July 2011. Downloaded from http://allafrica.com/stories/200711050801.html
Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (Eds) (2005) Current medical diagnosis and treatment. New York: Lange Medical Books/ McGraw-Hill.

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Tonacchera, M., Pinchera, A., Vitti, P., (2010) Assessment of nodular goitre. Clinical Endocrinology & Metabolism. 24 (1) 51-61.
Waltman, P.A., Brewer, M., & Lobert, S., (2004) Thyroid storm during pregnancy: a medical emergency. Critical Care Nurse 24: 74-79. Accessed 21 March 2011 from cnn.aacnjournals.org
World Health Organisation (1996) Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO document WHO/NUT/96.13.
Diagram of the thyroid gland. Accessed on 28/03/2011. Downloaded from http://www.triofoundation.com/gfx/Thyroid_Diagram.jpg

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ENHANCING READING COMPREHENSION SKILLS OF THE NIGERIAN COLLEGE STUDENT
By
Lekia Nwikina; Leesi Kaegon; Blessing Asaah and Cordelia Okechukwu
Department of Educational Management,
Faculty of Education
University of Port Harcourt
Abstract
The purpose of the paper was to enhance the reading comprehension skills of the Nigeria college student. To this end, the causes for difficulties in reading comprehension, prerequisites, processes of, and strategies of reading comprehension were examined. Particularly discussed were the activities which the student must undertake before, during and after reading. Beside other things it was recommended that the student should recognize the relationship between reading and writing. As he reads he should jot down notes, use arrows, diagrams, outlines, table lines, charts, concept maps and other visuals to help him understand and later recall what he read. He should feature his reading of long materials with breaks and reward himself during these breaks and after readings. He should make honest evaluation of his reading and rethink using concept maps as tools. The institution should consider students’ reading problem, as the institution’s management problem to be tackled squarely.
Introduction
A student in the College of Education, Polytechnic or University has a load of academic work to cover. He has a great deal of materials to read – textbook chapters, articles, handouts and the likes on his various courses. He has lots of term papers, tests, assignments and examinations to write. Essentially, he must be able to read and comprehend adequately what he reads if he is to succeed in his academics in the institution, and in life generally. Unfortunately, not all students who enter College have reading background, fully prepared for the new challenges of college reading (Carter, Bishop & Krarib, 2002).
Hargrove and Poteet (1984) define reading comprehension as, “process of making sense of written ideas through meaningful interpretation and interaction with language – The

heart of all the act of reading is obtaining appropriate meaning.” Reading comprehension is the “ability to understand what you read” – it is a process that “requires you, the reader to make meaning form written words”. (Carter, Bishop & Kravits, 2002).
Lerner and Kline (2006) suggest that reading comprehension depends on what the reader brings to the written material and that it is a thinking process. This corroborates the submission of John Locke (1706), cited in Ellis (2003:12) that “Reading furnishes the mind only with materials of knowledge; it is thinking that makes what we read ours”. The relationship between thinking and comprehension is further stressed by Eggen and Kauchak (2006) when they argue that “Learning is a consequence of thinking. Retention, understanding, and the active use of knowledge can be brought about only by learning experiences in which learners think about and think with what they are learning” (p. 71). There is also a strong relationship between reading and writing. Lerner and Colleague (2006) report that “as students writes, their reading skills improve. Readers and writers are constructing meaning. Readers construct meaning from the author’s text; writers compose or construct meaning as they write”.
Elaborating on the above, Thompkin (2003) citing Irwin (1991) describes comprehension as the reader’s process of using prior experience and the author’s text to construct meaning that is useful to the reader for a specific purpose. For a writer, comprehension is similarly described as “a process of using prior experiences to create a text that will be meaningful to that written for a specific purpose” (p. 252). According to her, readers do many things as they read in order to comprehend what they are reading and writers do similar things to create meaningful text.
Students who lack adequate comprehension of what they read may have difficulty conducting meaningful independent research and producing written report of projects that are creative and original. Yet, this is an important partial requirement for completing a diploma or degree programme in many Nigerian tertiary institutions. It is therefore not surprising why some Nigerian students spend several years beyond the stipulated minimum time to either complete or abandon their academic programmes. It is also not surprising why many students appear to experience much stress, burnout and lack of joy in their academic career. The

student’s performance in the course examinations, course continuous assessment, tests and term papers are also contingent on his reading and comprehension abilities.
Rutler (1980) writes that there are also strong ties between reading difficulties and antisocial behaivour, that reading retardation may predispose the student to develop conduct problems. He argues that:
Because reading is such an essential skill at school, reading failure may be a potent source of discouragement, loss of self- esteem and antagonism which may contribute to the development of delinquent activities. With status and satisfaction through schoolwork denied to him – (he) may rebel and seek satisfaction with activities running counter to everything the school stands for (p. 279).
Nwideeduh (2005) alludes to this relationship in his eloquent discourse on cultism and examination malpractice in Nigerian higher education. He demonstrates strongly that reading and related problems are also serious management problems in Nigerian higher education that require urgent managerial attention. Students’ frequent failure in external examinations owing to reading problems do not augur well for the students, their parents, their future employees, the institution and the society generally.
This paper examines some causes for difficulties in reading comprehension, prerequisites for achievement in reading comprehension and the strategies to promote reading compression. It stresses particularly the three processes in reading comprehension before, during and after reading. It also offers some recommendations for promoting reading comprehension in Nigerian institutions of higher learning.
Causes for Difficulties in Reading Comprehension
Harris and Sipay (1980) suggest many reasons for poor progress in reading comprehension, which may also affect Nigerian students. These include general intellectual level below the average range; lack of opportunity to practice language; speech and hearing impairments, all of which restrict vocabulary development. Thompkins (2003) opines that comprehension problems sometimes relate to students’ lack of fluency or limited vocabulary knowledge, but more often than not, students who do not comprehend seem not different from their classmates.

Word-by-word reading may cause poor comprehension; often the student is forced to reread material just decoded in order to understand it. An inappropriate test, and slow reading may also cause poor comprehension, as can inadequate sight vocabulary or a lack of well- developed word recognition techniques. Inability to concentrate or to maintain attention also results in poor comprehension (Thompkins, 2003).
Harris and Sipay (1980) indicate that, students who read sentence by sentence or are overly reliant on oral reading during the beginning stages of reading may have poor comprehension. They indicate also that easy or beginning storybooks may lead to poor comprehension if students rely on the pictures to communication the content of story rather than the words of the author. The student may become dependent on the pictures and lack the motivation to read the story.
Poor instruction of students by teachers may also be a cause of poor comprehension. Citing Durkin (1979), Hargrove and Poteet (1992) report that poor comprehension also results when reading instructions for students do not prioritize on comprehension and when the teaching of other subjects like Social Studies and Christian Religious Studies are not viewed as opportunities to teach comprehension. This corroborates the United State of American National Research Council (1999), cited in Lerner et al (2006), which notes that the reading problems of many adolescents and adults reflect reading difficulties that were not resolved during their early years. The important of these is that the poor reading comprehension of many Nigerian tertiary students is consequential to reading instructional laxities in their school years prior to their coming to higher education.
Eggen and Kauchak (2006) lend support to this argument in their statement that:
Effective teaching provides a foundation on which expertise is built, and that expert teachers go beyond this threshold to construct lessons that help students acquire a deep and thorough understanding of the topic they study (including reading comprehension) (p.7).
Prerequisites for Achievement in Reading Comprehension
Harris and Sipay (1980) in discussing the prerequisite skills needed for development of comprehension skills identify the possession of adequate vocabulary size as vital to

progress. The student must have a good command of the meanings of many words in order to develop adequate reading comprehension. A wide background of experiences can assist the student in acquiring a large vocabulary, as does extensive reading. The student must also understand that some words have more than one meaning. He must master idiomatic expressions and figurative language or constructions.
The authors cited above indicate also that the ability to read and organize materials into phrases is necessary to reading comprehension just as the understanding of punctuation marks is also necessary. A minimal level of decoding skills is a prerequisite to comprehension. Insufficient speed of decoding may also interfere with comprehension; this therefore needs to be improved. Knowledge of English syntax appears important to good reading comprehension for as Adams, Anderson, and Durkin in Hagrove et al (1984:193) say “to change order is to change meaning. Expressions like “off day” and “day off” – “demonstrate this”
As Thompkins (2003) suggests students who have built a flourishing reading background and who are appropriately motivationally disposed in whatever purpose for which they read, whether for information or enjoyment, may comprehend what they read. Many English course series used in Nigerian schools, the Macmillan for example, appear to be designed for boasting students experiences, building their vocabularies and comprehension ability. They contain topics, stories and activities (coloured with graphic and semantic organizers) in every aspects of life in Nigeria. They also include Teacher’s Book and Workbook which provide instructions for assignments and tests on concepts to be done at home and in the class Taiwo, Longe, & Ijeoma 1999). Students who adhere to their teachers’ instructions on the use of the materials have often improved their performance in reading comprehension.
Strategies to Promote Reading Comprehension
The US National Reading Panel (2000) cited in Lerner and Kline (2006) suggests the following strategies for promoting reading comprehension.
1. Comprehension monitoring. This implies that students need to learn how to be aware of their understanding of the material.
2. Cooperative learning. Students should learn reading strategies together.

3. Use of graphic and semantic organizers. Students take graphic representations of the materials to assist their comprehension.
4. Question answering. Students should answer questions poised by teachers and receive immediate feedback.
5. Question generation. Students should ask themselves questions about various aspects of the story.
6. Story structure. Students should learn how to use the structure of the story as a means of helping them recall content in order to answer questions about what they have read.
7. Summarization. Students should learn to integrate ideas and to generalize from the text information.
Students are involved in several activities before, during and after reading to promote comprehension. Lerner and Colleagues (2006) suggest that before reading a story or a material, they need motivation and interest in the reading material, review the vocabulary, build background information, and they need to predict what the story will be about. During reading, students need to direct attention to difficult or subtle dimensions of the story, reading silently and monitor their own comprehension. After reading they should summarized or retell the story, talk or think about what they liked and what they wished had been different in the story, create graphic organizers, put pictures of story events in order, link background information, and talk or think about the characters in the story. Some of these activities and steps are illustrated or elaborated by other researchers. For examples, Ellis (2003), Ferrett (2003) and Feldman (2004) all agree on the following procedures or activities to promote reading comprehension.
1. Activities before Reading that Enhance Reading Comprehension
 Preparation to Approach Reading: The aim is to become familiar with advance organizers. These include: outlines, overviews, section objectives, or other clues to the meaning and organizations of the material that the student is reading. Most textbooks have built in organizers, chapter outlines, a set of questions at the end of each section. The student can also create his own advance organizers by skimming

materials to be read sketching out the general outline of the material he will be reading. Advance organizers help the student to recall material better after reading.
 The Point for Reading Assignment: Before the student begins reading the material he also needs to think about what his goal is. Is it for pleasure, previewing information, enhancing classroom lecture, background information, understanding ideas, finding facts, memorizing formulars and data research questions or analyzing and comprehending a difficult or complex subject or for examination? The goal for reading should help in determining which reading strategy to adopt. He may not be expected to read everything with the same degree of intensity. He may feel comfortable skimming some items while others may require putting in maximum effort, especially if it is a material on which he is to be tested.
The student also needs to understand the point of view of the material itself: what he is reading – a textbook, an essay, an article? If it is an essay or article, why was it written? Was it to prove a point?; to give information?, or to express the author’s personal feelings. Knowing the author’s purpose can help a great deal as he reads.
 The Student needs to Start with the Frontmatter. If the reading materials are a textbook, the student should start by reading the preface and/or introduction and scanning the table of contents, the frontmatter. This can help because it is there that the author explains, often more personally than elsewhere, what he considers important. Knowing this gives sense of what to expect to read.
This can help the student get inside the author’s head, obtain insight into his goals, values and strategies in writing the book. Feldman (2004) says by reading the frontmatter, the student can “personalize the author to gain insight into the kind of person he is. The information – will provide a mental ‘hook’ on which you can hang the new ideas to which you will be exposed” (p. 150).
 The student needs to provide a context for reading by creating his own advance organizers. He should skim through the table of contents which shows the main headings of what he will be reading. As he reads over the outline, he should consider how the new material in the book may relate both to what he knows and what he

expects to learn – from the reading assignment and from the course. The student should also take a look at the end of chapter, summaries and conclusions. These can give an idea of what the author covers and what he or she considers important. Turnbull, Turnbull, Shank and Smith (2004) affirm that these help the student to visualize information in an organized fashion and to understand the direction they are taking when they need to learn and later recall.
 The student should get organized and be set with necessary tools for the reading material. These include:
(a) A pencil or pen to write notes in the margin
(b) A highlighter to indicate key passages in the text
(c) A copy of the assignment
(d) A pad of paper and/or index cards for note taking if the material is complex.
(e) A dictionary to check the meaning and pronunciation of unfamiliar words.
 The student should give himself time. He should get a watch for timing himself as he reads the passage. Timing how long it takes to read a representative chunk of material provides him with a rough measure of his reading speed, although this may vary depending upon the complexity of the material. This may also help the student to determine an aspect of his learning style, his attention span, length of time he is able to sustain attention. However, the student should know from the onset that reading is not a race, and faster readers are not necessarily better readers. The act of reading is designed to increase one’s knowledge and open up new ways of thinking. It can help one achieve new levels of understanding and get him to think more broadly about the world and its inhabitants. Speed matters far less than what we take away form what we have read. The key to good reading is understanding – not speed. (Feldman 2004).
2. Activities While Reading that Enhance Reading Comprehension
What the student is doing while he is reading is very important. He does several things including the following: Ellis (2003) suggests that before one dives into reading the first paragraph, he should take a moment to reflect on what he already knows about the subject. He should do this even if he knows nothing; this technique prepares his brain to accept new information.

 The student must stay focused. He must keep distracting thoughts at bay and focused on the material he is reading. This is often not easy but the following considerations may help:
(a) Read in small bites. If the student thinks that a material will take say 4 hours to complete he should break it for two or more separate sessions of 2 or 1 hour.
(b) Take a break. The student should plan to take some breaks to reward and enjoy himself, perhaps with snacks or watch TV.
(c) Deal with distraction. This may be done by writing down on a paper the solution of the distracting problem. He should make all efforts to stay in focus, not distracted. Ellis (2003) suggests that the student should use the Power Process “Be here now” when he notices his attention wandering; he should gently bring it back to the present.
 The student should write while he reads. As shown above writing is one of the most important aspects of reading. He should be free to underline, jot notes, place checks, marks on the pages, draw arrows, construct diagrams and other annotations or mnemonics on his books as he reads. In order words he should own his book or make it his own. The student should therefore be involved in the following activities while reading:
 Rephrase key points. He should make notes to himself, in his own words, about what the author is trying to get across; should think about the material and rewrite it in words that are his own. This has the advantage of (1) making the material his, something he understands and made a part of his own knowledge base, (2) by trying to summarize a key point in his own word it makes clear whether he truly understands it; (3) the very act of writing engages an additional type of perception – involving the physical sense of moving a pen. This helps in learning the material in a more active way, (4) it helps the student study the material later – not only will the key points be highlighted, but the notes will quickly bring him up to speed regarding his initial thoughts and impressions.
 The student needs to highlight or underline key points or information. Very often the first or last sentence in a paragraph or the first or last paragraph in a section presents the key point. The student should read through the whole passage to be able to determine the key information to underline.

 Use arrows, diagrams, outlines, tables, time lines, charts, and other visuals to help understand and later recall what is read. If there are three examples given for particular point, the student should number them. If a paragraph discusses a situation in which an earlier point does not hold, he should link the original point to the later point by an arrow. If a sequence of steps is presented, he should number each step.
Ellis (2003) stresses that the student should deface his books. Use it up. Have fun writing and colouring in it. The purpose of marks in a text is to create signals for reviewing. Underlining or highlighting can save lots of time when he studies for test. It offers secondary benefit. When he reads with pen or pencil in his hand, he involves his kinesthetic senses of touch and motion. Being physical with book can help build strong neural pathways in his memory.
Representing the material graphically can help the student think about it, the connections and points in it, in new and different ways. Rather than considering the material sorely in verbal terms, he now adds visual images. The act of creating visual annotations will not only help him understand the material better, but also to ease its later recall.
 Look up unfamiliar words in a dictionary. Even though the student may be able to figure out the meaning of an unfamiliar word from its context, he should use a dictionary to be sure of the meaning and the pronunciation.
 It is instructive that reading textbooks takes energy, even if one does it sitting down. There is a story about corporate presidents – that they usually wear out the front of their chair first. The student should approach reading assignment like company president. Sit up. Keep his spine straight. Use the edge of the chair and should avoid reading in bed – except for fun.
3) Activities after Reading that Enhance Reading Comprehension
What the student does after reading is also of crucial importance. He needs to evaluate, truthfully and honestly his own understanding, what he knows as a result of his reading. Feldman (2004) suggest the steps or activities listed below:
 The student needs to identify the main ideas and themes and their value to him personally. He should try to determine the take-home message of the material he has read. Sometimes the main ideas and themes are spelled out, but at other times they

have to be deduced. Evaluating the main ideas and themes of how they relate to the student will help him understand and remember them more easily.
 He should prioritize the ideas. This means that the student should make a list of the main topic covered and try to rank them in order of importance. He should ask himself, of all the information that is presented, which is the most crucial to the main message and which is the least crucial?
 He should think critically about the arguments presented in the reading. Do they seem to make sense? Are the author’s assertions reasonable? Are there any flaws in the argument? Would authors with a different point of view dispute what is being said? How would they build their own argument?
 The student should pretend he is explaining the material (talking out loud-about the material) to a fellow classmate who missed the assignment. He should summarize the material aloud, as if he was talking to another person. Feldman asserts that, talking out loud does two things. First it helps the student to identify weak spots in his understanding. Talking to himself helps him nail down concepts that are still not clear to his mind. Second, because he is transforming the written words into the spoken word, he is thinking about information in another way, which will help him to remember it better.
Any such form of repetitions learning is acceptable. It enhances automaticity. This results from over learning a skill or concept to the point that it can be remembered or performed with little conscious effort. This is important because it reduces the demand on one’s limited working memories (Armstrong & Savage, 1998).
The student should be honest to himself. If he had drifted off while he was reading, he should go back and reread the passage. This should be done within 24 hours of reading the material. A review within 24 hours moves information from one’s short-term memory to his long-term memory. It can save him hours later on (Ellis, 2003).
The student should pat himself on the back. Just as he has done during each of his reading breaks, he should reward himself for completing the reading passage and rethink what he has read. The best way for the student to rethink an assignment is to reread it, along with the note he had taken. The benefits of this are much. Feldman opines that, by rereading

the student transfers material from his short-term memory to his long-term memory, cementing what he had learned into memory. It thus solidifies information so that it will be remembered far better over the long haul.
Rereading may take far less time than he did reading the first time, since it is not necessary to reread word for word. The student already knows what is important and what is not, so he can skim some of the less important material. But it is wise to reread the more difficult and most important material carefully, making sure that he fully understands what is being discussed and why. Rethinking the central activity in rereading the passage should help in completing the student’s understanding and to be able to answer any question he had earlier about the material.
The student should create concept map as a rethinking tool. Concept mapping is a method of structuring written material by graphically grouping and connecting key ideas and themes. In contrast to an outline, a concept map visually illustrates how related ideas fit together. The pictorial summary gives the student another handle to store the information in memory and it focuses his thinking on the key ideas from the material read. Eggen and Kauchak (2006:187) describe concept map as “a strategy that helps learners to construct visual relationship among concepts”. There are many other advantages of concept map. It not only forces the student to rethink the material in his notes in a new style, but also helps him to tie together the material for a given session. More, it helps him to build a master concept map later when he is studying the material for a final exam.
In a concept map, each key idea is placed different part of the map, and related ideas are placed near it – above, below, or beside it. A typical concept map looks somewhat like a map of the solar system, which the largest and most central idea is in the centre (the ‘sun’ position), and related ideas surrounding it at various distances. It may also look like a large tree, with numerous branches and sub-branches radiating from a central trunk. As Eggen and Kauchak (2006), National Teachers Institute (NTI, 2010) have demonstrated concept mapping capitalizes on the effects of organization, imagery, and the dual-processing capabilities of working memory to make relationships between concepts meaningful.
The student should be appreciative of the truth that he is not alone in the battle to overcome difficulty comprehension or to succeed in reading comprehension. Some students

in his class are excellent readers, some are weak. Students should work cooperatively in pairs or small groups, reading to one another or discussing the meaning or implications of the text – The strong readers sharing their methods and model with the weak (Good & Brophy, 2000).
Another effort to comprehension is the weekly or monthly review. This step can be very short – four or five minutes assignment. Simply going over the notes, reading the highlighted part of the text, or the concept map. The student should recite more of the complicated point. The purpose of these reviews is to keep the neural pathway of the information open and make them more distinct. That way, the information can be easier to recall. The student can accomplish these short reviews anytime, anywhere, if he is prepared. He can conduct a five-minute review while he is waiting for a bus to arrive or for water to boil. Three-by-five cards are a handy tool. He should write down formulas, concept maps and facts on cards and carry them with him. These short review can be effortless and a fun.
Sometimes longer review periods are appropriate. For example, if he found an assignment difficult, he can consider reading it. Start over, as if he had not seen the material. Sometimes a second reading will provide him with surprising insights. Decades ago, psychologist identify the primacy-recency effect, which suggests that one can most easily remember the first and last items in any presentation. Previewing and reviewing reading is a powerful way to put this theory to work for the student (Ellis, 2003).
Conclusion
The student needs to involve himself in several activities before, during and after reading a material to enhance his comprehension. He should recognize the relationship between reading and writing; monitor his comprehension, should use arrows, diagrams, outlines, table lines and charts, pictures, other visuals and jot down notes to help understand and later recall what is read. He should make honest and truthful evaluation of his reading. He should feature long reading session with several breaks and should reward himself during this after completion. He should rethink soon after reading, using concept map as a tool.
Recommendations

The College Administration should be cognizant of the relationship between students’ ability to read effectively, their academic success and students’ discipline. The administrators should provide a facility for remedial instruction for students having reading problems. The management and dispensing of this facility which should be a Students Affairs responsibility should be well publicized and students should be encouraged to use the services. It is shortsighted and preposterous to think that all the College students can read effectively. The institution should consider students reading comprehension problems as also its management problem to be tackled squarely. The student should work cooperatively with other students in pairs or in small groups, reading to others or discussing the meaning or implications of the text to benefit from the stimulations and models of the stronger readers.

References
Armstrong, D.G. & Savage, T.V. (1998). Teaching in the Secondary School: An Introduction. New Jersey: Prentice- Hall.
Carter, C., Bishop, J. & Kravits, J. (2002). Keys to College Studies: An Introduction. New Jersey: Prentice-Hall.
Eggen, P.D. & Kauchak, D.P. (2006). Strategies and Models for Teachers: Teaching Content and Thinking Skills. Boston: Pearson.
Ellis, D. (2003). Becoming a Master Student. Boston: Houston Mifflin Company.
Feldman, R.S. (2004). Power Learning: Strategies for success in college and life. Boston: McGraw-Hill.
Ferret, S.K. (2003). Peak Performance: Success in College and beyond. New York: Glencoe & McGraw-Hill.
Good, T.L. & Brophy, J.E. (2000). Looking in classrooms. New York: Longman.
Harris, A.J. & Sipay, E.R. (1980). How to increase reading ability. New York: Longman.
Hargrove, L.J. & Poteet, J.A. (1984) Assessment in special education: The education evaluation. New Jersey: Prentice-Hall.
Lerner, J. & Kline, F. (2006) Learning Disabilities and related disorders: Characteristics and teaching strategies. Boston: Houghton Mifflin Company.
N.T.I. (2010). Manual for the re-training of primary school teachers; Social Studies. Kaduna: National Teachers Institute Press.
Nwideeduh, S.B. (2003). “The menace of cultism in Nigerian Universities”. In S.B. Nwideeduh (ed) Trends and issues in managing universities in Nigeria (pp. 221-257). Owerri: Springfield.
Rutler, M. (1980). Helping troubled children. Middlesex: Penguin.
Taiwo, O.; Longe, L. & Ijeoma, W. (1999). Macmillan Primary English Course. Lagos: Macmillan.
Thompkins, G.E. (2003). Literacy for the 21st Century. New Jersey: Pearson Education.
Turnbull, R.T., Turnbull, A., Shank, M. & Smith, S.J. (2004). Exceptional Lives: Special education in today’s schools. Boston: Pearson.

24
INHIBITORS TO SPONSORSHIP OF SELECTED SPORTS PROGRAMMES IN OYO STATE.
BY
DR. ANDREW OLU FADOJU
DEPARTMENT OF HUMAN KINETICS AND HEALTH EDUCATION
UNIVERSITY OF IBADAN, OYO STATE, NIGERIA.
<dokitafadoju@yahoo.com>
&
OPEOLUWA AKINSANMI OYEDELE
DEPARTMENT OF HUMAN KINETICS AND HEALTH EDUCATION
UNIVERSITY OF IBADAN, OYO STATE, NIGERIA
<opeoyedele@yahoo.com>

25
Abstract
Many companies, private individual sponsors, firms, industrial managements and corporations spend large sums of money on sports programmes for a derived advantage of boosting their sales. Despite the fact that many sports administrators make efforts to obtain sponsorship for sports programmes, not many are successful, and the chances of success continue to dwindle even in recent times.
This study investigated inhibitors to sponsorship of selected sports programmes in Oyo State. Four hypotheses were stated based on the problems identified by the researchers. A total of five hundred respondents were selected through systematic sampling technique for the study. They comprised of company staff, sports administrators, civil servants, school sports masters, businessmen, sport journalists and sports enthusiasts.. Five hundred copies of self developed questionnaire were administered on the respondents; however, only four hundred and fifty copies were retrieved. Data collected were presented using simple percentages and chi-square statistical tool was employed in testing all the stated hypotheses at 0.05 significance level. The study revealed that funding, bloated budget, hooliganism as well as embezzlement and fraud have a significant influence on sponsorship of selected sports programmes in Oyo State. It was recommended that sports associations should develop effective marketing strategies and seek professional advice in order to make sports very attractive to corporate organizations and investors. Sports and corporate bodies’ awareness campaign about benefits derivable from sports should be increased. Accountability should be the watchword of sports administrators.
Keywords: Sports, Sponsorship, Inhibitors, Corporate bodies, Marketing

26
Introduction
Sports is a unifying instrument that unites human beings, irrespective of race, gender, class and other parameters. Awosika (1988) asserted that sports has become a unifying factor in the country and it has become an essential ingredient towards nation building. Sport is one industry that has enjoyed government patronage, an institution that has uplifted its development, ( Morakinyo & Aluko, 2009, Fasan, 2004), Morakinyo & Aluko (2009), found out that nations use sports to establish their superiority and supremacy over others. This attitude is expansively demonstrated in government preparations for international events such as Olympic Games, World Cup, Common Wealth Games and All African Games. Sports occupy a prominent place in the social and national development of Nigeria. It is a big venture which requires huge amount of money to manage. Asagba, (1994) asserted that, sports is a costly venture, both in terms of money, energy and resources, this is why it is not practicable to run sports with a limited source of fund. The above statement buttresses the fact that sports is capital intensive, hence more than enough fund is needed to manage sports programmes.
Money is the backbone of successful sports programmes. It is the foundation on which sports programmes are built, Asagba, (1994) posited that even if we have brilliant administrators and beautiful programmes designed by them, without effective sponsorship, their effort cannot be appreciated. This emphasizes that the extent to which money is needed depend on the type of competition, sports, local or international. The rate at which the cost of facility and equipment and their maintenance grow yearly is high, thus much money is needed for sports at a point in time. Morakinyo (2000) stated that, as the years roll by, administrators of higher institutions are finding it extremely difficult to finance sports; whether at the intramural level or the intercollegiate level. Igbanugo (1992) submitted that, funding is an important aspect of sports and seems to be at the root of the administrative problems that are being encountered by university sports.
It is pertinent to know that, only through effective sponsorship can adequate provision be made for facility and equipment; recruitment of sports personnel; the up-keep of sportsmen and women such as: feeding, transportation, lodging, medical, production of

27
trophies and medals; and allowances, all these cost money. According to Igbanugo, (1992) and Ibikunle (1994), sports require a huge capital outlay. Morakinyo, (2000) also revealed that the huge capital outlay is required for the provision and maintenance of facility and equipment and supplies. He further stated that inspite of the astronomically rising cost of funding sports in higher institutions, government subventions to them are shrinking every year. This may be an inhibitor to sponsorship of selected sports programmes. A good administrator must budget properly, for sports programmes to achieve good results and good sporting experience for both athletes and personnel. Money is a morale booster, so coaches, athletes and administrators should be adequately rewarded, as a means of motivation and challenge for others to work harder. This brings about a large turn-out for sports, thus more competitions.
Government is the major source of sponsorship of sports administration in Nigeria. Funds come in terms of grants and subventions to the concerned ministries and parastatals. However, government cannot finance sports alone, because of other pressing needs that require funding. Efforts should be made to support funding of spots administration. Morakinyo, (2000), revealed thus “because university administrators encounter the reality of poor financial situations, they now encourage sports administrators to source for funds from other sources”. It is a common practice to look for sponsors, and one is not surprised that business organizations like the soft drink giants, Coca-Cola and Seven-up bottling Company plc, Nigeria Breweries plc and other important corporations like Nigeria National Petroleum Company, Globacom Plc, MTN Plc, Central Bank of Nigeria, Shell B. P. Plc., Industrial General Insurance, Union Bank Nigeria Plc,. Cadbury Nigeria Plc and Mobil Nigeria Plc. All have contributed to the improvement of sports preparations in major competitions (Ibikunle, 1994).
Many companies, private individual sponsors, firms, industrial managements and corporations spend large sums of money on sports programmes for a derived advantage of boosting their sales. Such industries as Chalmers Manufacturing Company, Wisconsin, United States of America, would spend fortune on sporting activities like, Basketball, Bowing, Baseball and shooting. In Nigeria, as a whole, worthy of note are these sponsored competitions, Coca-Cola Challenge Cup Competition, Coca-Cola U-18 Football Competition, (1996) NNPC- U – 13 Football Competitions (1996), Shell Football Competition (2000),

28
Globacom League, Milo Basketball Competition seven-up Basketball Competition, Mobil Track and Field.
Ironically, Morakinyo, (2000) argued that inspite of the fact that many administrators in sports organization do seek for sports sponsorship, not many are successful, and the chances of success continue to dwindle even in recent times. This could be attributed to a number of factors ranging from changes in the policy and strategy of corporate bodies to sports related challenges. Some companies would not sponsor sports perhaps due to certain inhibitors (social and economic obstructions). To this effect, this study reviewed factors such as bloated budget, embezzlement and fraud, funding of sports, hooliganism, that may be inhibitors to sponsorship of sports programmes in Oyo State. This study examined factors that militate against effective sponsorship of selected sports programmes in Oyo State.
Statement of the problem
The enormous responsibilities of the government coupled with the ever rising costs of funding needed to oil the machineries governance affects quite a number of government ministries and parastatals and programmes, sports inclusive. However, an understanding of the fact that government alone cannot finance sports, particularly at this time of economic recession makes it imperative that other sources of funding must be sought. Morakinyo, (2000), advocated that government should hands off financing sports. He observed that governmental efforts at funding sports in terms of subventions to the sports sector are shrinking every year; voluntary individuals and corporate bodies’ contributions to sponsorship of sports is also depreciating and this has led to a situation whereby sports proposals for sponsorship are not successful. Many clubs and competitions are fading away and Nigerian athletes are not featuring enough in international competitions, and also low laurels
Hence, this study sought to find out factors militating against effective sponsorship of selected sports programmes in Oyo State.
Hypotheses
The following hypotheses were tested:
(1) Funding of sports will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
(2) Bloated budget will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.

29
(3) Hooliganism will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
(4) Embezzlement on the part of the administrators will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
Methods and procedure
The descriptive survey research design was used for this study.
The population for the study consists of management and staff of public liability companies, sports associations, sports council administrators, journalists and sports enthusiasts in Oyo State. The systematic random sampling technique was used for selection. The participants consists of 500 (Five Hundred) respondents from selected companies and sports bodies. 25 members of staff from 10 selected companies were systematically picked from their staff lists; 50 sport journalists from ten media houses, 10 members each from 12 sports associations, 50 coaches and 30 sports followers who were accidentally picked at Adamasingba stadium during a sports competition.
Instrumentation
The research instrument adopted was a self developed close ended, Likert-type questionnaire. It was divided into two sections, A and B. Section A contains items on personal data of the respondents, while section B sought information on the variables under study.
Analysis, Results and Discussions
The descriptive statistics of mean, frequency and percentage were used to describe the demographic data while inferential statistics of chi-square (x2) was used to test the hypotheses at 0.05 level of significance.
Hypothesis 1
Funding of sports will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
ITEMS
SD
%
D
%
A
%
SA
%
TOTAL
X2C
X2T
df
LEVEL OF SIGNIFICANCE
REMARKS

30
Table 1: Analysis of responses on whether funding of sports is an inhibitor to sports sponsorship in Oyo State.
The above table shows a calculated chi-square value of 1.0 and a chi-square table value of 16.92 at 0.05 alpha level. It could be observed that the calculated chi-square value is lesser than the table value, hence hypothesis one was not rejected. The table also shows that higher number of respondents agreed. Therefore, funding of sports has no significant influence on sponsorship of selected sports programmes in Oyo State.
Hypothesis 2
Bloated budget will not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
Table 2 :Analysis of responses on whether bloated budget of sports is an inhibitor to sports sponsorship in Oyo State.
26
36
9.0
58
14.5
157
39.3
149
37.3
27
35
8.8
52
13.0
160
40.0
153
38.3
Not
400/
100
1.0
16.92
9
0.05
Significant
28
34
13.3
53
13.3
157
39.3
156
39.0
29
37
9.3
56
14.0
160
40.0
147
36.8
ITEMS
SD
%
D
%
A
%
SA
%
TOTAL
X2C
X2T
df
LEVEL OF SIGNIFICANCE
REMARKS
16
108
27.0
102
25.5
119
29.8
71
17.8
17
67
16..8
118
29.5
132
33.0
83
20.8

31
The above table shows a calculated chi-square value of 18.58 and a chi-square table value of 12.60 at 0.05 alpha level. It could be observed that the calculated chi-square value is greater than the table value, hence hypothesis two which stated, that bloated budget has no significant influence on sports sponsorship in Oyo State was rejected. The table also shows that higher number of respondents strongly disagreed.
400/
100
18.58
12.60
6
0.05
SIGNIFICANT
18
65
16.3
121
30.3
132
33.0
82
20.5

32
Hypothesis 3
Hooliganism would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
Table 3: Analysis of responses on whether Hooliganism is an inhibitor to sports sponsorship in Oyo State.
ITEM
SD
%
D
%
A
%
SA
%
TOTAL
X2
XC
2
Df T
LEVEL SIGNIFICANCE
REMARKS
5
73
18.3
103
25.8
104
26.0
120
30.0
6
74
18.5
104
26.0
107
26.8
115
28.8
7
72
18.0
107
26.0
107
26.8
114
28.5
8
72
18.0
100
25.0
105
26.3
123
30.8
9
73
18.3
108
27.0
105
26.3
114
28.5
400/
100
3.18
36.42
24
0.05
NOT SIGNIFICANT
10
77
19.3
101
25.3
108
27.0
114
28.5
11
77
19.3
101
25.3
105
26.3
117
29.3
12
67
16.8
107
26.8
107
26.8
119
29,8
13
79
19.8
98
24.5
105
26.3
118
29.5
Table three above shows a calculated X2C of 3.18 and a table X2t value of 36.42 at 0.05 alpha levels. It could be observed that calculated chi-square value is lesser than the table X2t value, and also a larger number of respondents strongly agreed. Therefore, hypothesis two which stated that, “Hooliganism has no significant influence on sponsorship of selected sports programmes in Oyo State,” was not rejected.

33
Hypothesis 4
Embezzlement and fraud on the part of the administrators would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
Table 4: Analysis of responses on whether Embezzlement and Fraud is an inhibitor to sports sponsorship in Oyo State.
ITEM
SD
%
D
%
A
%
SA
%
TOTAL
X2
XC
2
df T
LEVEL SIGNIFICANCE
REMARKS
14
91
22.8
118
29.5
90
22.5
100
25.0
400/
100
37.81
9.49
4
0.05
NOT SIGNIFICANT
15
169
42.5
75
18.8
68
17.0
88
22.0
The above table shows a calculated chi-square value of 37.81 and a table chi-square value of 9.49 at 0.05 alpha level. It could be observed that the calculated chi-square value is greater than the table value. The hypothesis which stated that “Embezzlement and Fraud on the part of the administrators would not be an inhibitor to sponsorship of sports programmes in Oyo state. Hence, hypothesis stated above was rejected. The table also shows that greater number of respondents strongly agreed, that embezzlement and fraud on the part of the administrator has a significant influence on sponsorship of selected sports programmes in Oyo State.
Discussion of findings
Hypothesis One
“Funding of sports would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State”.
According to table one, to test this hypothesis, responses of the participants to items, 26, 27, 28, 29 were used to develop a frequency distribution table for analysis. The result obtained shows that the calculated chi-square value is less than the chi-square .table value. Consequently, hypothesis one was therefore not rejected.
This goes to say that funding of sports has no significant influence on sponsorship of selected sports programmes in Oyo State. However, this result contradicts the finding of Igbanugo

34
(1992). Igbanugo (1992) stated that “funding is a very important aspect of sports and seems to be at the root of administrative problems” that is being encountered by university sports.
Hypothesis Two
“Bloated budget would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State”. In testing this hypothesis, responses of subjects to items, 16, 17 and 18 were used to develop a frequency distribution table. The observed chi square value were then used to generate the expected value. The result obtained revealed that the calculated chi-square value exceeded the table value for chi-square, hence hypothesis two was rejected. It implies, therefore that bloated budget has a significant influence on sponsorship of selected sports programmes in Oyo State. Morakinyo (2000), stated that budget should be taken as a working plan for the organization, it is the means by which the administrator can achieve his objectives apart from using the budget to measure the results obtained. This goes to say that bloated budget has a significant influence on sponsorship of selected sports programmes in Oyo State.
Hypothesis Three
“Hooliganism would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State”.
According to the figures shown in table three, in testing the hypothesis, subjects’ responses were used to develop a frequency distribution table. The observed values obtained were used to generate the expected values for comparative purposes.
The results obtained shows that the calculated chi-square value is less than the table chi- square value. Hence, hypothesis three was not rejected.
Therefore, it could be said that, hooliganism has no significant influence on sponsorship of selected sports programmes in Oyo State.
The instinct theory hold the view that aggression is innate and that man is born with it, as an in-built defense mechanism.
Aggression is a survival attribute. Alderman (1974), supports this view by saying that athletic competition is necessary for man to indulge his aggressive tendencies in a socially acceptable manner.

35
Hypothesis Four
“Embezzlement and Fraud on the part of the administrators would not be a significant inhibitor to sponsorship of selected sports programmes in Oyo State.
The result obtained shows that the calculated value exceeded the table value for chi-square. Thus the hypothesis was rejected. This shows that embezzlement and fraud on the part of an administrator has a significant influence on sponsorship of selected sports programmes in Oyo State. This finding was supported by the responses of subjects to items 14 and 15 in which a total of 65.1% respondents strongly disagreed. Ikulayo (1991), stated that many people are dissatisfied with the ways sports is managed in this country. This is due to the numerous administrative bottlenecks, utilization of inappropriate personnel …, coupled with frequent changes of leaders”. Additionally, Morakinyo (2000) revealed that there is also the presence of fraudulent practices, duping …. and embezzlement, and of recent, computer fraud which hamper sponsorship of selected sports programmes in Oyo State.
Therefore, embezzlement and fraud have significant influence on sponsorship of selected sports programmes in Oyo State.
Conclusion
Based on the findings, it was concluded that funding, bloated budget, hooliganism embezzlement and fraud on the part of the administrator of sports are inhibitors to sponsorship of selected sports programmes in Oyo State.
Recommendations
Consequent upon the conclusions in this study, the following recommendations were made:
i. Corporate organizations and private individuals should increase their investment in sports through sponsorship for effective development of sports in Nigeria.
ii. Government should increase their support for sports funding by increasing subventions and allocations to Associations and ensure that the fund is spent for the purpose.
iii. Each sport association should develop effective marketing strategies and where necessary, seek professional advice, in order to make sport attractive to corporate organizations and investors.
iv. Sports associations should also try to develop attractive sports programmes for sponsorship by individuals and organizations.

36
v. Sports Administrators should create in individuals and corporate bodies awareness, about benefits derived from sports.
vi. More studies should be carried out in the following areas;
(a) Sponsorship and revenue generation in sports
(b) Benefits derived from sponsorship of sports programmes.
References
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Alabi, A.T. (2008). Decision making in schools. The Craft of educational management Ibadan: Reginason. Ohio State University.
Alderman, R. B. (1974), Psychological Behaviour in Sports
Asagba, B. (1994), Administering Sport without pecuniary tears. . Philadelphia: Sauders.
Journal of Academy of Sports Administration
Awosika, Y.B (2000.) National Sports Festival. 21 Pp. 7-11.
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Awosika, Y. B (1988). Recreation through recreation: The real future. In Ajala, J. A. (Ed.) Reacreation education for health and national challenges. Lagos: Toklast Enterprises. (4), 56-61. Century and Sports Development in Nigeria. Abuja: Federal Ministry of Sports and Social Development. Pp. 56-63.
Awosika, Y.B (1997) Management and Marketing of Sports in Educational Institutions. A paper presented as a Guest speaker at National Institute for Sports
Bucher, C.A. (1983): , Lagos.
Administration of Physical Education and Athletic Programmes,
Berkowitz, E. Kerin, R. and Rudelius, W. (1986): St. Louis, Mosby Company.
Sports Marketing
Comte, E. and Stogel, C. (1990): “Sports: A 63.1 Billion Industry” , St. Louis, Mosby and Co.
The Sporting News
Ensor, R.J. (1987): “The Corporate View of Sports Sponsorship”, , January 1, Pp. 60-61.
Athletic Business
Fasan, C. D. (2004). Introduction to Sports Management. Lagos; Beulah Publishers. . September.
Fasan, C. O. (1994): Introduction to Sports Administration
Fasan, C.O. (1997) Strategic Management and Marketing of Sports and the Challenges ahead. , Lagos, Beulah Publishers.
Paper presented at the National Institute for Sports.
Ikulayo, R.B. (1991): Societal Attitude and its Influence on Privatization and Commercialization of Sports in Nigeria, in Seminar on Lagos.
Privatization and Commercialization of Sports in Nigeria; Nigeria, Lagos, F.G. Press.

37
Ikulayo, P.B. (1990): Societal Attitude and its Influence on Privatization and Commercialization of Sports
Igbanugo, V.C. (1992). Financing University Sports. in Nigeria. Paper presented in a seminar on the commercialization and privatization of sports in Nigeria held at the National Instituted for Sports, Lagos.
Journal of Nigeria
Lerdner, R. (1982): Academy of Sports Administration. (1 &2).
Applying Marketing Technology Spectator Sports.
Meenagham (1984) London. Transworld Publishing Ltd.
Commercial Sponsorship.
McVaughan J. (1984): Charlottesville V.A. Micchie.
Commercial Sponsorship
McGeeham, P. (1987): “Signing 3m-An Olympian Effort” . West Yorkshire, England MCB University Press.
Advertising Age
Morakinyo, E . O, & Aluko, E . O (2009), Sports Funding and marketing as Predictors of Sports Development in Selected Sports Federations of the Federal Ministry of Sports and Social Development in Nigeria, Nigerian journal of sports management; vol. 3. Pp 54-65 Morakinyo, E.O. (2000), Factors Militating Against Collegiate Sports Sponsorship in Nigeria. , November 9, Pp. 11- 13.
Paper presented at the 1st African Regional Congress of ICHPER’s Held in University of Lagos,
Odegbami, S. (1990): on 16th – 20th October.
N igerian Football 1960-1990
Pound, R.W. (1989): Sponsorship and the Olympic Games. Market and Olympism. Lousane Committee International Olympic. , Lagos: Worldwide Sports Limited.
Olympic Message
Smith, M.D. (1976), No. 24.
Precipitants of Crowd Violence
Spiro, H.T. (1982). Sports, New York University, Mimem Paper.
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Schilling, G. (1977), “Aggression and Violence in Sports”, New York: John Wiley.
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Sleight, W.J. (1989), . Brussel: Mimeographal.
Sponsorship: What is it and How to Use it
Wilson, N. (1988), , Woolon: McGraw Hill.
The Sports Business
Webster, N. (1993): London: Piatkins.
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Williams F.S. (1994): July/August Pp. 8-10.
Fund Raising for Sport and Recreation. Canada: Human Kinetics.

38
RELATIONSHIP BETWEEN LACK OF ACCESS AND LOW UTILIZATION OF HEALTH SERVICES: A STUDY OF RIVERINE LOCAL GOVERNMENT AREAS OF RIVERS STATE
By
Comrade Christian Chigozi Oriji (Ph.D)
Email: comradechristianoriji@yahoo.com
C/o Oriji, May Menuchim
Academic Planning Unit
University of Port Harcourt,
Port Harcourt
Abstract
The purpose of this study is to find out the relationship between lack of access and low utilization of health services in riverine Local Government Areas (LGAs) of Rivers State. One hypothesis was generated to guide the study. Survey design was adopted for the study. The population adopted for the study covers the residents of riverine LGAs of Degema, Asari-Toru, Akuku-Toru, Andoni, Bonny, Okrika, Opobo-Nkoro and Ogu-Bolo in Rivers State. Simple random sampling technique and accidental sampling technique are used to select a sample size of six hundred (600) respondents for the study. Questionnaire was the instrument used for data collection. The instrument was face validated by professionals and its reliability co-efficient value of 0.68 was established for the study. Demographic data of the respondents are analyzed, using percentage while the hypothesis for the study was tested at .05 level of significance using Pearson Product Moment Correlation. The result of the study reveals that lack of access to health centres for health services has a significant relationship with low utilization of health services in riverine LGAs of Rivers State. Based on this finding, it was recommended, among others that the state and local governments should provide efficient and effective water transportation system to those communities where health centres are not located to others where same are available for easy access to health services.
Keywords: Relationship, Lack of Access, Low Utilization, Health Services, Riverine, Local Government Areas, Rivers State

Introduction
The issue of access is an important factor that could improve or lower the utilization of health services in Nigeria. Consequently, access and utilization of Primary Health Care (PHC) services improve where there are less issues of distance and shortage of health services. But on the contrary, distance may pose problems if 80% of PHC services are not available for utilization (Thaddeus and Maine, 1994). Distance exerts dual influence on access of health services. Long distance can be an actual obstacle to accessing health services which may be a disincentive to even those trying to seek healthcare, while short distance influences people to access health services positively (Thaddeus and Maine, 1994).
In these circumstances, it is crystal clear that the ability and inability to ensure good roads, affordable transport fare, and availability of health services and proximity of health centres will certainly influence either positively or negatively the access and utilization of health services in any country (Fieldler, 1981). Thus, there is no gainsaying the fact that access seems a major factor in health services utilization because the lesser the access, the lesser the utilization of health services, and the more the access, the more the utilization of health services in Nigeria. Thus, these seem to agree with Thaddeus and Maine (1994) findings, in which they explained that access in most cases, functions well in the utilization of health services where distance and available health services are not issues.
In consonance with the aforementioned views, Leslie and Gupta (1989) argue that people access preventive health services in Ogun State of Nigeria, only when the health services are available within three kilometres from their residents. Sequel to this, Odusanya, Alufohai, Maurice, Clemens and Ahonkhai (2003) explain that over 75% of people in most rural areas and impoverished urban areas of Nigeria have no access to modern health facilities and services. Udoh (1987), in his exploratory study of maternal and child health knowledge, beliefs and practice in rural Calabar, finds that 90% of respondents see access as a major factor for clinic visits. In congruence with Udoh (1987), Onokerhoraye (1999), in his study of access and utilization in Delta State, argues that better health statuses of the people will be achieved if 90% of PHC services are improved, and health centres established at near proximity for better accessibility and utilization of same.
Consequently, in the 60s, 70s, 80s and 90s, access to utilization of health services was a major hindrance in Nigeria, especially in the study areas where terrain seems extremely difficult. Beyond the difficult terrain in the study areas during the aforementioned periods, there were few health centres with minimal health services for the people. Again, these few health centres were in sorry state of dilapidation. In this situation, the people in the study LGAs suffered from all kinds of diseases and illnesses, hence the low utilization of the few available health services.

Based on the foregoing, in 2007 the Rivers State government established PHC centres with equipped health services in most communities of the state, in so much that she can achieve high health services delivery and utilization among beneficiaries. Even when these seem to be achieved, some communities in riverine LGAs where the PHC centres are not located, and which have difficult terrains, are still faced with the problem of low utilization of health services that is still begging for attention. This is the problem that impelled the study to investigate the relationship between lack of access and low utilization of health services in riverine LGAs of Rivers State.
Hypothesis
There is no significant relationship between lack of access to health centres for health services and low utilization of health services.
Methodology
Survey design was used for the study. The population of the study covers residents of riverine LGAs of Rivers State. Also, this covers all beneficiaries of health services in the study LGAs of Rivers State. A sample size of 600 respondents was randomly selected for the study. The selection was done through the use of simple random sampling technique and accidental sampling technique. Thus, simple random sampling technique was used to select two riverine LGAs of Asari-Toru and Bonny in Rivers State. Also, simple random sampling technique was used to select three communities of Ifoko3, Krakrama and Minama from Asari-Toru LGA, and Utumbi, Ibipi and Lakiri from Bonny LGA while the accidental sampling technique was used for the selection of respondents for the study. The instrument used for data collection was the questionnaire.
The face validity of the instrument was established by professionals in Measurement and Evaluation, Faculty of Education, University of Port Harcourt, Port Harcourt. Furthermore, test-retest method of reliability was used to determine the reliability value of 0.68 of correlation co-efficient for the study. The researcher administered the copies of the questionnaire with the help of four (4) research assistants; and they collected same immediately the responses were completed by respondents. The statistics used for the study are percentage and Pearson Product Moment Correlation. Percentage was used to analyze demographic data while Pearson Product Moment Correlation was used to test the hypothesis for the study.
Results
The results of the study are presented in Tables 1 and 2. Table 1 results deal with demographic data of respondents while Table 2 result deals with the tested hypothesis for the study.
Table 1: Demographic Data of Respondents
Demographic characteristics
No. of respondents
Percentage

Marital status
Single
96
16
Married
252
42
Divorced
36
6
Separated
156
26
Widowhood
60
10
Religion
Christianity
348
58
Islam
24
4
Traditional religion
156
26
Other religions
72
12
Educational Status
First School Leaving certificates (FSLC)
132
22
West African Senior School Certificates (WASSC)
216
36
Degree
252
42
Occupational Status
Fishing
96
16
Crop farming
96
16
Civil service
120
20
Trading
156
26
Other occupations
132
22
Health Status
Not sick
264
44
Sick
180
30
Recovered
156
26
Local Government
Asari-Toru
276
46
Bonny
324
54
Source: Field survey, 2012.
The results of marital status show that 96 respondents, representing (16%) were single, 252 (42%) were married, 36(6%) were divorced, 156 (26%) were separated, while 60(10%) were widows and widowers (widowhood). For religion, the results show that 348 respondents, representing (58%) were Christians, 24(4%) were Muslims, 156(26%) were members of traditional religion, while 72(12) were members of other religions.
For educational status, the results show that 132 respondents, representing (22%) had FSLC, 216 (36%) had WASSC, while 252 (42%) are degree holders. Furthermore, the results for occupational status indicate that 96 respondents, representing (16%) were fish farmers, 96(16%) were crop farmers, 120(20%) were civil servants, 156(25%)were traders, while 132(22%) were engaged in other occupations.
For health status, the results reveal that 264 respondents, representing (44%) were not sick, 180 (30%) were sick, while 156 (26%) were recovered.
Finally, for Local Government residence, the results show that 276 respondents, representing (46%) reside in Asari-Toru; while 324(54%) reside in Bonny.

Table 2: Analysis of the Relationship between Lack of Access to Health Centres for Health Services and Low Utilization of Health services
Variables
ΣX
Σ2X
ΣXY
r
ΣY
Σ2Y
Lack of access to health centres
10704
23573
287482
0.58*
Low utilization of health services
10998
54654
*significant at .05, critical r =.062, degree of freedom (df) = 598
Source: Field survey, 2012.
The result of the analysis as presented in Table 2 shows that the calculated r value of 0.58 is higher than the calculated critical value of .062 at .05 level of significance with 598 df. With this result, the null hypothesis that there is no significant relationship between lack of access to health centres for health services and low utilization of health services is rejected. This result therefore means that there is a significant relationship between lack of access to health centres for health services and low utilization of health services in the riverine LGAs of Rivers State.
Discussion of Finding
The result of the hypothesis reveals that lack of access to health centres for health services has a significant relationship with low utilization of health services in the riverine LGAs of Rivers State. The finding of this hypothesis is in agreement with the view of Odusanya, et al (2003), they explain that over 75% in most rural areas and impoverished urban areas of Nigeria have no access to modern health facilities and services. Again, Udoh (1987) in an exploratory study of maternal and child health knowledge, beliefs and practice in rural Calabar finds that 90% of respondents see access as a major factor for clinic visits. Thus, the studies of Odusanya, et al (2003) and Udoh (1987) show the relevance of access to the study.
Conclusion
Considering the research finding, it is obvious that lack of access to health centres for health services has significant relationship with low utilization of health services in riverine LGAs of Rivers State. This is in consonance with Thaddeus and Maine (1994) who explained that distance may pose problems if 80% of PHC services are not available for utilization. In this situation therefore, the study exposes some windows of research on issues of attitude to health services; and issues of location of health centres in riverine LGAs of Rivers State, and indeed in other LGAs with similar riverine terrain in Nigeria.

Recommendations
Based on the finding of the study, the following recommendations are made:
1. That government at all levels should encourage public enlightenment campaigns on the relevance of health services to the beneficiaries.
2. That the state and local governments should provide efficient and effective water transportation system to the communities where health centres are not located to others where same are available for easy access to health services.
3. That the state and local governments should ensure that more health centres are established in each of the riverine communities, in order to encourage the beneficiaries of health services to enhance their access and utilization of same.

REFERENCES
Fieldler, J.L. (1981). A review of the literature on access and utilization of medical care with special emphasis on rural primary health care. Journal of Social Science and Medicine, (17) 319-324.
Leslie, J. & Gupta, E.R. (1989).Utilization of formal service for maternal nutrition and health care in the third World. Washington D.C. International Centre for Research on Women: 1-76.
Odusanya,O.O., Alufohai, J.E., Maurice, F.P., Clemens, R. & Ahonkhai, V.I. (2003). Short term evaluation of rural immunization programme in Nigeria. Journal of the National Medical Association, (5) 175-179.
Onokerhoraye, A.G. (1999). Access and utilization of modern health care facilities in the petroleum-producing region of Nigeria: Takeni Programme in International Health, Harvard School of Public Health. Boston. Harvard School of Public Health:20.
Thaddeus, S. and Maine, D. (1994). Too far to work: Maternal mortality in context. Journal of Social Science & Medicine, (8) 1091-1110.
Udoh, A.A. (1987). An exploratory study of maternal and child health knowledge, beliefs and practice. Ikot Omin. Calabar Rural MCH/FP Project: 1-60.

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