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Background on Country of Origin

Nigeria is the most populous black nation in Africa with an estimated 112 million people. Nigeria is located on the West Coast of Africa, along the Gulf of Guinea, occupying approximately 356,670 square miles (slightly larger than twice the size of the state of California). The country is a federal republic consisting of 30 states, and 543 local governments. Nigerians capital city, Abuja, is located in the center of the country.

In 1960, Nigerian achieved independence from British rule and a relatively peaceful and prosperous time followed. However, the large agricultural sector failed to keep up with the rapid population growth, and Nigeria, once a large exporter, now has to import food. Nigeria has large oil reserves, but since 1973 oil profits have diminished at a rapid rate, due first to political instability, and later to falling oil prices. A western style democracy was attempted in 1979, but collapsed in 1983. In 1993, attempts were made to restore the 1979 constitution, but this also failed. Currently, a repressive military regime controls the country.

The People

Nigeria is a complex cultural, linguistic, and social mosaic with over 250 ethnic groups speaking many different languages and dialects. Members of each ethnic group are typically concentrated in one area; however, many have migrated to urban areas, thus producing modern cities composed of mixed ethnic groups, with problems sometimes resulting. Ethnic rivalry and jealousies exist as part of the Nigerian culture although many ethnic groups are related to one another in some way.

Nigerians are basically classified into two groups: (1) Nilotic Africans (Arab-type) and (2) Black Africans; and the various ethnic groups fall into one of these two categories. There are four main groups of people in Nigeria, the Hausa (21%), Yoruba (20%), Ibo (17%), and Fulani (9%). The average population density in 1991 was 248 people per square mile, and approximately 35% of the total population lives in urban areas.

Major Ethnic Groups

Hausa-Fulani: Found predominantly in the northern states of Sokoto, Katsina, Kano, Bauchi, and Kaduna. Most are Muslim with their culture being greatly influenced by their religion. Their age-long traditions of testing manhood and the giving away young girls for marriage is still observed.

Yoruba: Found in southwestern Nigeria and most live in the states of Lagos, Ogun, Oyo, Ondo, Kwara, and part of Edo. Many are highly urbanized, but retain strong kinship bonds.

Ibo: Found in the southeast states of Anambra, Imo, Abia, part of Delt, and part of Cross River. The Ibo are known for their hard work and resourcefulness. Traditionally farmers, today a significant number of them have become traders.

Edo: This group is found in Benin (Edo) state.

Ijo: (also known as Zons): Found in the riverine areas of Ondo, Delta, and Rivers states. They are basically fishers with their home made on stilts over the water.

Ibibio: Found principally in mainland Akwa Ibom.

Kanuri: This group is found in Borno state. They have a long history and tradition as old as the Fulanis, but are found at the opposite end of the country.

Jukun: This group is known for being war-like and live primarily in Gongola and Benue states.

Nupes: Most live in the Niger state.

Note: There are many other smaller groups who are identified with either their tribal marks (scarring) or their mode of dressing. With modernization and intertribal marriage, many traditional ties and practices are changing or being lost.

History of Immigration

Immigrants to Nigeria are drawn from neighboring nations by economic opportunity. In 1983 Nigeria ordered all resident aliens to leave the country, ostensibly because of economic conditions. At that time about 700,000 Ghanaians left, along with many others from African and Asian countries. Since then, Nigerians have immigrated in large numbers to Europe and North America. In the 1990s, a few Nigerians came to Western countries as political refugees. Some of these refugees experienced extreme repression and torture.

Culture and Social Relations

Allegiance to family and kinship systems, as well as to village is strong. Marriage often occurs at an early age (at least for females) and childbearing also begins at an early age. Polygamy is legal and practiced in Nigeria, but there are decreasing numbers of polygamous relationships. Wealthy and/or powerful men tend to have more wives (as many as six or seven ñ which exceeds the limit of four imposed by Islam). Men are dominant among Muslims, Christians, and those who practice traditional religions.

In Nigeria, families tend to live together in one village or area of a town. Mothers are the primary care givers in the family, but receive help and support from the extended family. In most families men are dominant and make most of the decisions. The extended family system and the community have been an important support to parents. This traditional support for families is changing as a result of families moving from rural to urban areas in search of work or educational opportunities.

In Nigeria, significant numbers of children do not go beyond elementary school. Among Nigerians living in the west, however, the usual expectation is that children will graduate from college.

Communications

Although English is the official language, there are over 250 different languages spoken in Nigeria. The most widely spoken language is Hausa.

At least among immigrants and when interacting with westerners, Nigerians usually are soft-spoken. In contrast to some other refugee or immigrant groups, there is a tendency among some Nigerians to be very insistent about receiving services to which they feel entitled.

Religion

There is no state religion. About 50% of Nigerians are Muslim and 40% are Christian. The range of commitment, belief, and practice varies in each religion. Although most people practice Islam or Christianity, many also engage in practices derived from indigenous (traditional) religions.

Islam is a monotheistic faith, i.e., belief in one God, Allah. It is based on the Qur'an which is considered to be the final and complete inspired word of God revealed to the prophet Mohamed by the angel Gabriel. The Qur'an is the authoritative scripture of Islam and along with the Hadiths (the Says and Doings of the Prophet Mohamed) is used as a guide for all matters of faith and practice. All Muslims are expected to believe and practice the Five Articles of Faith and the Five Pillars of Faith. Islam is described in greater detail in the section on religions.

Health Care Practices and Beliefs

Traditional healers (sometimes called "surgeons") in Nigeria often focus on maintaining a balance between the invisible world of the deities, ancestral spirits of good or evil, and other beings inhabiting the "other" world. Spirit causation remains a significant part of the traditional medical system, and the presence of disease or illness may be seen as a warning sign that there is an imbalance with either the natural or the spirit world.

Traditional (magic or spirit-oriented) healers are thought by some Nigerians to belong to a special species of human beings with mystical powers and attributes, including the ability to commune with the spirit world and seeing through walls. Traditional medicine is often preferred over modern health-care practices ñ especially for culture-bound disorders such as "Ode Ori" (a disorder that includes a variety of somatic complaints, as well as symptoms of depression and anxiety). Modern-health care facilities are often sought as a secondary source of care, when traditional methods of healing have failed.

There also is widespread use of medicinal plants to treat illness in Nigeria. Studies of such plants, including those used for peptic ulcer, asthma, pain, and other problems show significant degrees of efficacy for many treatments. Other treatments, e.g., inducing vomiting or giving cow urine to treat upper respiratory infections, are harmful.

Among Nigerians in the west, these traditional beliefs seems much less an issue. Illness and health are seen as biomedical issues and treatment in clinics and hospitals is readily sought. One interesting and common belief among Nigerians is that epilepsy is a communicable disease, hence persons with epilepsy should be avoided.

Approximately 60% of adult Nigerian women have undergone female genital cutting (FGC) during infancy, usually Type I or II. The practice is decreasing, especially among urban women. Web sites concerned with the issue include http://www.fgm.org/ and http://rainbo.org. For a more extensive discussion and current classification of FGC, readers are also referred to the section on Refugee Women in this site.

Unsafe abortions are common in Nigeria and are a significant source of morbidity and mortality among younger women. Natural and traditional methods of contraception are preferred over barrier or artificial means.

Traditional Nigerian diets are high in fats and more traditionally minded persons view obesity as positive.

Health Care Problems and Issues of Nigerians in the West

Long-term sequelae of diseases endemic to Nigeria should be a concern when providing health care to newly arrived Nigerian immigrants or refugees in the west. Among the more common tropical diseases in Nigerian are:

  • Onchocerciasis (a form of filariasis; also called river blindness) causes eye lesions/blindness, subcutaneous nodules, and pruritic rash. Onchocerciasis is caused by black flies (river flies) and is seldom seen outside of Africa and Latin America.
  • Schistosomiasis causes obstruction, dysfunction, and pain in any of the many organs/systems that may be affected, including gastrointestinal, respiratory, genitourinary, hepatic, and other. Schistosomiasis is caused by freshwater parasites (flukes) living in feces-contaminated water. Flukes may live in a particular part of the host for as long as 20 years laying eggs and causing organ damage, especially in mucous membranes.
  • Yellow fever occurs in Africa, but is unlikely to be seen in North America as the incubation period is 3-6 days. It is transmitted by mosquitoes and symptoms range from mild flu-like symptoms to headache, fever, jaundice, nausea, vomiting, and hemorrhage (epitaxis, bleeding gums, hematemesis, or melena.
  • Malaria is endemic to much of Africa Asia, and Latin America. The classic symptoms are severe fever, chills, sweats, and headache. In some case symptoms may not be as severe, and may also include diarrhea, abdominal pain, dyspnea, and myalgia. Splenomegaly is common. Less commonly, a grave condition, including hemolysis, jaundice, anemia, renal failure, and hemoglobinuria may also occur. Relapse occurs, but is less common in patients with the falciparum form of malaria common in Africa.

HIV and other STDs are common in Nigeria. Nigerian men have a high incidence of prostate cancer. Because of traditional diet patterns, the relative prosperity of Nigerians in the west, and other risk factors, cardiovascular disorders should become common among Nigerian men and women; and diabetes should also be a concern as middle age approaches.

Medical problems most commonly seen in newly arriving refugees from African countries (Ackerman, 1997; Gavagan & Brodyaga, 1998) are noted below. Please see the Infectious Diseases section for updates and discussion of these problems.

  • Malnutrition
  • Intestinal parasites (Enterobius, Trichuris, Strongyloides, and Ascaris)
  • Filariasis
  • Leishmaniasis
  • Hepatitis B
  • Tuberculosis
  • Low immunization rate
  • Dental caries
  • Typhoid fever
  • Malaria
  • Trachoma
  • Syphilis
  • Dengue fever
  • HIV infection
  • Diarrheal illnesses
  • Hansen's disease

Recommended laboratory and other tests include:

  • Nutritional assessment
  • Stool for ova and parasites
  • Hepatitis B surface antigen
  • Hemoglobin or hematocrit
  • VDRL
  • HIV
  • PPD
  • Peripheral smear for malaria should be considered

Other problems that practitioners should be especially alert to are cervical cancer, ectoparasites, and post-traumatic stress disorder.

Authors: Mindy Early, Sharon McKinney, & Jenny Murray (Baylor University School of Nursing)

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Resource Materials and References

Ackerman, L. K. (1997). Health problems of refugees. Journal of the American Board of Family Practice, 10(5), 337-348.

CIA Factbook: http://www.odci.gov/cia/publications/factbook/ni.html

Gavagan, T. & Brodyaga, L. (1998). Medical Care for immigrants and refugees. American Family Physician, 57(5), 1061-1068.

Geissler, E.M. (1994). Pocket Guide to Cultural Assessment. St. Louis, Mosby.

Onishi, N. (2000, Jan 9). Islam meets Africa and Islam bows. New York Times. Section 4, page 20.