This study was conducted in Ibadan, South Western Nigeria in 2004, as part of the Reducing Exposure of Children to Lead Study (RECLES) of the University of Ibadan. Nigeria has a population of about 136 million people, at least 40 million of whom live in the South Western part of the country. Most, 60%, of the population live below poverty line and the estimated GDP per capita in 2004 was $1,000. Ibadan is one of the major urban centers in Nigeria; the largest indigenous city in West Africa with a population of about 2 million people. The population is largely engaged in small scale farming, trading and service occupations. Ibadan hosts several institutions of higher learning, of which the University of Ibadan, established in 1948, is the oldest. Along with its affiliated medical institution, the University College Hospital; the two institutions formed the base for this study. About 80% of the adult population of Ibadan is literate. There are several small and medium scale industries in Ibadan and during the 1990s, there was a car battery manufacturing company, but it closed down about 8 years ago.
In order to ensure representation of the population of the entire city, we randomly selected 40 healthy individuals by personal contact and mail, from the 5 administrative units of the city, taking care to ensure balance of religious affiliation, occupation, gender and social economic status. The individuals were invited to meet for a discussion on a pertinent health problem and were not told before hand that the topic of the discussion would be lead exposure. Recruitment continued until there was a group of ten people for each of the four groups. After arrival, participants were informed about study objective and told that each interview will last about 11/2 hours. Trained facilitators conducted the sessions and written consent was obtained from all focus groups participants. Individuals younger than 18 years of age, those unable to communicate in English or Yoruba (the indigenous language of Ibadan) or those unable to give consent were excluded from the study. Participants were given gifts worth $7:00 to cover transport and other expenses incurred in order to participate in the study.
The discussion guide for the focus group discussions was developed by EOA and CAA based on the literature and knowledge of the local environment. Facilitators occasionally interjected in the discussions using a non-directive approach to focus participants on the topic of interest and move discussions along. Following introduction, participants were encouraged to freely discuss along the themes in the discussion guide shown in Table 1. The discussions were audio-taped and transcribed by a secretary who was not part of the study team. The transcripts were then reviewed by the authors in a two step process. First, major themes were identified and these were aggregated into lists. Phrases and quotations that highlighted these themes were identified. Sub-themes within the major themes were also identified and aggregated into lists. The major themes and sub-themes from each reviewer were then compared and the lists merged. Where there were disagreements between the raters, a third person was asked to review the pertinent sections of the transcript and a consensus reached on the substance. Coding began by identifying broad conceptual themes like; knowledge of lead and lead exposure, attitudes to lead exposure, health implications and practices regarding lead exposure. Specific attention was given to the knowledge about lead, lead level testing in the home, lead poisoning and the health impact of lead exposure. Ethical approval for this study was obtained from the Oyo State Ministry of Health Ethics Committee.