Ethical considerations in women's sexual and reproductive health care

No Abstract

A critic of maternal mortality reduction efforts in Nigeria

Context: Maternal mortality in Nigeria is high and occurs from direct and indirect medical causes together with non-medical causes which include socio-economic, religious, cultural and legal factors, reproductive healthfactors and health systems/health services factors. Government and Non-Governmental Organizations have over the years expended efforts towards the reversal of Nigerian's unacceptably high maternal mortality trends.Objective: This review examines major polices and programmes targeted at maternal mortality reduction in Nigeria as well as their possible outcome if any, identifies gaps attendant on these efforts, and suggests the wayforward towards a sustainable maternal mortality reduction in Nigeria.Maternal mortality reduction activities in Nigeria: Majority of these activities have been characterized by inherent poor design, lack of co-ordination with existing maternal health services and absence of sustainability mechanism, with an overall poor outcome. Amongst major maternal mortality reduction activities in Nigeria includes: Life Saving Skills (LSS) introduced by the American College of Midwifery in 1980 for emergencyobstetrics care and ultimately supported by UNICEF and WHO; White Ribbon Alliance developed by Centre for Development and Population Activities (CEDPA) in late 1990s; Prevention of Maternal Mortality Project (PMM) introduced by Columbia University in 1987 using funds from Carnegie corporation; The Making Pregnancy Safe Initiative introduced by WHO in 2000; Women and Child Friendly Health Services Initiative established in 2000 by the former Nigerian's First Lady — Late Mrs. Stella Obasanjo; United Nation Millennium Development Goals (MDGs) initiated in 2000; Women Sexual and Reproductive Rights Project initiated in 2002 by the International Federation of Obstetrics and Gynecology (FIGO) in partnership with Society of Obstetrics and Gynecology of Nigeria (SOGON) using funds obtained from Packard Foundation. Others include: Mentoring for Post Abortion Care (PAC) Services Delivery initiated by Ipas in 2007; The Integrated Maternal, New born and Child Health Strategy Initiative of the Federal Ministry of Health also initiated in 2007; and the Midwives Services Scheme (MSS) initiated by the Federal Government in 2009. Gaps identified to militate against maternal mortality reduction efforts include discontinuity and disconnect in government policies and programmes; legislation and other services emanating from change in government or between the executive and legislature within the same government; poor leadership of the health sector by the health ministries; poor coordination of maternal mortality reduction activities; poor development of human resources and health service infrastructure; inadequate funding of the health system, particularly of maternalhealth services; poor record keeping; and insufficient social mobilization activities.Recommendation and conclusion: Improving maternal mortality reduction efforts in Nigeria involves overhauling of the health system and services to render quality and affordable health care; adequate budgetary allocation and fund release for maternal health services; human resources development through recruitments, training and retraining; ensuring prudence in the development and siting of maternal health service infrastructure; ensuring program continuity between governments, and policy/legislative connect within government;developing effective record  keeping protocol for maternal health services; establishing effective socialmobilization outfits and harnessing health sector partnership for funding and other health services. Keywords: Critic; Maternal mortality reductionefforts; Nigeri

Family planning in contermporary reproductive health and rights

Family planning is re-emerging as a foremost contemporary global reproductive health issue largely on account of its implication to world's population dynamics and it's perceived influence on several aspects of human development, most of which are linked with the economy. It refers to the control of world population in relation to the available food and economic resources. Despite its significance to human development it remains elucive to many women especially in developing countries. Family planning has profound sexual and reproductive rights implications which have been recognised over the years at several international conferences. Access to family planning is a major approach to maternal mortality reduction. Social and political factors, such as religion and politically-motivated funding restrictions for family planning services, negatively impact on availability and accessibility of such services, with often devastating effects to the most vulnerable and least privileged women,especially in underdeveloped countries. Family planning and its continued development is the collective responsibility of every individual, country, or organization. Key strategies to promote family planning include domestication of provisions of international conventions on family planning into state laws, and ensuring their implementation; development of community friendly family planning services; establishment of effective family planning commodities logistics management system; emphasising on the family planning needs of special groups such as adolescents, and members of some religious denominations; and the training of family planning counsellors and assistants

Pain Relief in Postabortion Care Practiced by Healthcare Professionals in South Eastern Nigeria

Background: Postabortion care (PAC) is aimed at reducing maternal morbidity and mortality resulting from the incomplete abortion and abortion complications. The use of analgesia is an integral part of high quality PAC. Knowledge of the pattern of use of analgesia in PAC by healthcare professionals would help in planning group specific training programs for more effective PAC. Aim: This study is aimed at assessing the use of analgesia in PAC among healthcare professionals in South Eastern Nigeria.Subjects and Methods: This is a cross‑sectional questionnaire‑based survey carried out among healthcare professionals in Anambra State, Nigeria between June 1 and September 30, 2006.  Participants were chosen using a multistage sampling technique. Pretested questionnaires assessing the practice of postabortion counseling were then administered. The data were analyzed using SPSSversion 20.0 software. Frequencies were within 95% confidence limits.Results: A total of 437 health professionals were included in the study. The mean age was 38.2 (10.4) years. Formal PAC training influenced the use of analgesia positively (P < 0.001). The use of analgesia in PAC was also significantly higher among professionals working in tertiary healthcare center and private specialist hospitals when compared with other facilities (P = 0.02). In general complications were more when analgesia was not employed. Older professionals were more likely to employ pain relief in PAC (P = 0.01). Furthermore, doctors were significantly more likely to employ pain relief in PAC when compared to nurses (P = 0.001).Conclusion: This study revealed a low level of use of analgesia in PAC among the healthcare  professionals. It also demonstrated a significant association between formal PAC training and use ofanalgesia in PAC. It is, therefore, recommended that increased PAC training and re‑training activities with emphasis on the need for analgesia should be conducted for healthcare professionals to improve the quality of PAC received by clients.KEY WORDS: Pain relief, post abortion care, Nigeri

Chlamydia trachomatis IgG antibodies seroprevalence among students in two tertiary institutions in Anambra state, Nigeria: a comparative study

Chlamydia infection is a common sexually transmitted infection (STI) in humans caused by the bacterium Chlamydia trachomatis. This study assessed the seroprevalence of Chlamydia trachomatis antibodies among students in two tertiary institutions in Anambra State, Nigeria. It was a comparative cross-sectional survey using enzyme immunoassay kits for the determination of IgG class antibodies, while the multistage sampling technique was used in the selection of participants for the study. The overall prevalence of Chlamydia trachomatis antibodies observed in this survey was 14.3%, which was higher among students from the University (21.6%) than their counterparts from the College of Education (7.4%) (χ2=5.89, df=1p<0.015). Factors found to have significant effect on the seroprevalence of Chlamydia trachomatis in both institutions were: prior sexual exposure (p<0.05); unprotected sexual intercourse in the last one year (p<0.05); multiple sexual partners in the last one year (p<0.05); and presence of symptoms suggestive of STI (p<0.05). Among students in the College of Education, the place of residence significantly affected Chlamydia trachomatis seroprevalence with a preponderance towards students living off-campus (χ2=4.00, df-1, p<0.05). Hence, there is need to institute appropriate prevention and control measures against the transmission of the disease especially among those at risk of contracting the disease.Keywords: Chlamydia trachomatis, seroprevalence, sexual behaviour, students, tertiary institutions

Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey.

Background Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services. Methods Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple dimensions of health care access and screening focusing on the affordability, availability, accessibility, accommodation and acceptability components. Results About 1 in 4 (25.3%, n = 65) of the women who attended a health care facility in the past year got screened for cervical cancer. Screened women had a significantly higher number of health care providers available compared with unscreened women (mean 125 vs.12, p-value Conclusions Our findings suggest that cost issues (affordability component) and other patient level factors (captured in the acceptability, accessibility and accommodation components) were less important predictors of screening compared with availability of physicians in this population. Meeting cervical cancer screening and HPV vaccination goals will require significant investments in the health care workforce, improving health care worker density in poor and rural areas, and improved training of the existing workforce

Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study

Background: Self-medication with antibiotics is an important factor contributing to the development of bacterial antibiotic resistance. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of menstrual symptoms among university women in Southwest Nigeria. Methods: A cross-sectional survey was administered to female undergraduate and graduate students (n = 706) at four universities in Southwest Nigeria in 2008. The universities were selected by convenience and the study samples within each university were randomly selected cluster samples. The survey was self-administered and included questions pertaining to menstrual symptoms, analgesic and antibiotic use patterns, and demographics. Data were analyzed using descriptive statistics and logistic regression. Results: The response rate was 95.4%. Eighty-six percent (95% CI: 83-88%) of participants experienced menstrual symptoms, and 39% (95% CI: 36-43%) reported using analgesics to treat them. Overall, 24% (95% CI: 21-27%) of participants reported self-medicated use of antibiotics to treat the following menstrual symptoms: cramps, bloating, heavy bleeding, headaches, pimples/acne, moodiness, tender breasts, backache, joint and muscle pain. Factors associated with this usage were: lower levels of education (Odds Ratio (OR): 2.8, 95% CI: 1.1-7.1, p-value: 0.03); nonscience major (OR: 1.58, 95% CI: 1.03-2.50, p-value: 0.04); usage of analgesics (OR: 3.17, 95% CI: 2.07-4.86, p-value: <0.001); and mild to extreme heavy bleeding (OR: 1.64, 95% CI: 1.01-2.67, p-value: 0.05) and pimples/acne (OR: 1.57, 95% CI: 0.98-2.54, p-value: 0.06). Ampicillin, tetracycline, ciprofloxacin and metronidazole were used to treat the most symptoms. Doctors or nurses (6%, 95% CI: 4-7%), friends (6%, 95% CI: 4-7%) and family members (7%, 95% CI: 5-8%) were most likely to recommend the use of antibiotics for menstrual symptoms, while these drugs were most often obtained from local chemists or pharmacists (10.2%, 95% CI: 8-12%). Conclusions: This is the first formal study to report that approximately 1 out of 4 university women surveyed in Southwest Nigeria self-medicate with antibiotics to treat menstrual symptoms. This practice could provide monthly, low-dose exposures to antibiotics among users. Further studies are necessary to evaluate the impacts of selfmedication on student health

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence