Antenatal drug consumption: the burden of self-medication in a developing world setting

This institutional-based cross-sectional study examines the burden of self-medication during pregnancy in a middle-income country setting and the impact on fetal wellbeing. Using a blend of open-ended and indication-oriented questionnaires, 346 pregnant women at term were interviewed about their pregnancy complaints and drug intake. Inferential statistical data analysis was employed with level of significance (?) set at 0.05. Excluding routine supplements and vaccinations, 251 (72.5%) women used medicines, of whom 79 (31.5%) had self-medicated. Consuming drugs without prescription was associated with increased US Food & Drug Administration (FDA) risk category (?(2)?=?8.375; P?=?0.015). There is therefore a need to scale up efforts towards educating women about the dangers of self-medication, while also introducing effective restrictive policies on over-the-counter drug sale

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones

Sociocultural barriers to family planning in the high fertility context of Nigeria

Despite several family planning interventions, there has been little improvement in contraceptive use in Nigeria where fertility rates have remained high for the last few decades. Using a mixed-methods approach, this thesis aims to understand the pertinent factors underlying the resistance to fertility decline in the country, with a focus on social and cultural barriers to family planning. The analyses are based on quantitative data drawn from the 2013 Nigerian Demographic and Health Survey (NDHS) and qualitative data collected from a semi-urban residential area in Ekiti State. The findings of the thesis are presented in a three paper format. The first analysis applied life tables and proportional hazard regression to NDHS data to examine the association between child mortality and fertility behaviour.The findings show that recurrent experience of child deaths exacerbate the risks to higher parity transition. The second analysis used couple dataset from the NDHS to investigate the influence of men’s contraceptive perceptions on family planning demand and use. The findings highlight that men’s perception of contraception as women’s business did not significantly influence family planning demand, however their concern that wife’s contraceptive use may lead to promiscuity was associated with lower demand for family planning and higher traditional method use. The third analysis used vignette and thematic analysis from qualitative data to examine couples’ contraceptive decision-making processes and wife’s empowerment to adopt family planning in situations where husband opposed family planning. The findings demonstrate imbalance in power relation and decision-making within marital relationships, and that women are poorly empowered to overtly use contraceptives when opposed by their partners.The findings direct the need to adopt targeted approach focusing on couples, and reorient policy and program efforts for FP counselling and behavioural changes in men. Interventions aimed at reducing fertility in Nigeria should aim at promoting child survival and family planning concurrently

Adaptation to menopause in Southwest Nigeria

Little attention has been given to the treatment of menopausal symptoms in Africa. Reasons for this include the hot tropical climate and febrile illnesses that mask hot flushes, large bone mass of black women offering inherent protection against osteoporosis-induced fractures, and an extended family system contributing to women’s psychological adjustment to menopause [1]. However, there is growing concern that these assumptions may not be true and that a significant proportion of menopausal women may be tolerating reproductive health burden in silence [2]

海運に於ける競爭と獨占(二)

BackgroundAnaemia in pregnancy is associated with adverse maternal and fetal outcome. Unfortunately, in developing countries its prevalence has continued to rise. To improve the situation, iron supplement is routinely prescribed during pregnancy. We therefore examine the impact of the intervention as being currently practised in our clinical setting.MethodsIn total, 255 prenatal clinic attendees who had more than 8 weeks of prescribed iron supplements were sampled. Data was obtained on their socio-demographic features, haemoglobin concentration at booking, compliance with iron supplements and third trimester haemoglobin value.ResultsObserved iron supplementation compliance rate was 184(72.2%). There was a significant drop in mean haemoglobin (Hb) concentration between the two time points (booking Hb: 32.56±2.99; third trimester Hb: 31.67±3.01; mean diff: 0.89±3.04; t = 4.673; 95% CI= 0.52–1.27; p= <0.001). Anaemia increased from 132(51.8%) to 150(58.8%) by the third trimester. Increase in anaemia occurred in both iron-compliant and non-compliant groups. Non-compliance however had higher odds of predicting anaemia by the third trimester (OR: 1.83; 95% CI: 1.03–3.26; p: 0.04).ConclusionAlthough iron supplementation is still a good intervention in developing countries, it is not sufficient to reduce overall prevalence of anaemia by the third trimester. There is a need to look beyond the approach and reinforce the importance of better feeding practices, food fortification and reduced frequency of pregnancies

Return for postnatal check: current situation in a Nigerian tertiary health institution

Objective: This study aims to determine the current prevalence of postnatal clinic attendance among parturients who delivered in a Nigerian teaching hospital.Methods: A two year review of obstetric record of women who delivered in the hospital from July 2010 to June 2012 and were scheduled to attend Postnatal Clinic was done. The list was cross checked with the postnatal clinic record to know patients who kept their appointment by attending the clinic. A frequency table was generated and data were analyzed.Results: In the first year, out of 1267 women 264 (20.8%) returned for postnatal clinic. During the second year, 1651 women delivered in the hospital while 759 (46.0%) came back for postnatal clinic. Aggregate prevalence of postnatal clinic attendance among the parturients was 35.1%.Conclusion: Most parturients who had hospital delivery do not return for postnatal clinic in our environment.<br/

Comparative study of rectal misoprostol to oxytocin infusion in preventing postpartum haemorrhage after caesarean section

Aims: This comparative study aimed to compare the efficacy of rectal misoprostol to oxytocin infusion in preventing primary postpartum haemorrhage after caesarean section.Methods: Fifty pregnant women with identifiable risk factors for post-partum haemorrhage who delivered baby by caesarean section were randomized to receive 600 ?g rectal misoprostol and a placebo infusion intravenously or placebo rectally and a 20 iu oxytocin infusion. Post-operative blood loss four hours after surgery was estimated by application of pads of known weight.Results: The mean immediate four hours post-operative blood loss was not significantly different between the rectal misoprostol and oxytocin infusion group (100.08 ± 24.85 ml versus 108.20 ± 29.93 ml; p =0.144) and the change between the pre-operative and post-operative hematocrit was similar.Conclusions: Post-caesarean section rectal misoprostol has comparative efficacy to oxytocin infusion in preventing post-partum haemorrhage. It is recommended for use as alternative uterotonic in settings where there is low refrigeration capacity

Sociodemographic factors associated with anaemia in pregnancy at booking for antenatal care

Late patronage of antenatal care by women in low-resource areas makes timely intervention at correcting anaemia difficult. This study aimed to identify modifiable sociodemographic factors that predict anaemia before commencing antenatal care and make appropriate recommendation. A survey of sociodemographic features and haemoglobin concentrations of 232 women booking for antenatal care was conducted. Anaemia was diagnosed in 119 (51.3%), of which 87 (37.5%) had mild anaemia and 32 (13.8%) were moderately anaemic. There was no severe anaemia. Anaemia was highest among respondents who were ? 35 years of age, Muslims, of Igbo ethnicity (64.3%), single (55.0%), student/unemployed (58.8%), nulliparous (57.3%) and those who registered at ? 21 weeks’ gestation (54.2%). Only occupation of the woman showed association with anaemia before antenatal care (p = 0.007). A personal source of income may reduce anaemia in pregnancy; and it is advisable to have a social welfare package for unemployed pregnant women

Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance

Objectives: To determine the basis for the clinical suspicion of foetal distress, the instituted managements and delivery outcome in a tertiary hospital in sub-Saharan Africa with limited capability for advanced foetal monitoring.Methods: It is a 3-year retrospective analysis of all the obstetrics cases with intrapartum foetal distress.Results: There were 301 cases reviewed. The birth asphyxia incidence rate was 233/1000 live births and the perinatal death rate was 47/1000 live births. Suspicion of foetal distress was premised on the presence of persistent tachycardia or bradycardia during intermittent auscultation. Main resuscitative measures were left lateral repositioning of patient, fast saline infusion, intranasal oxygen administration and discontinuation of oxytocin infusion, if any. Only 124 (41.2%) of all the cases had delivery achieved within 2?h of diagnosis. Mean decision-delivery interval by caesarean section was 2.93?±?2.05?h. Socio-demographic factors (p=?0.001) and pregnancy risk category (p?=?0.002) influenced incidence of birth asphyxia.Conclusion: To reduce subsisting high perinatal morbidity and mortality in sub-Saharan Africa, it is best that at the least referral hospitals should have advanced facilities for foetal monitoring and shortened surgical intervention time