Harm elimination project for unsafe abortion in Nigeria: An operations research

Context: The harm elimination model is designed to improve access to pre‑ and postabortion care including free contraception and address the challenges posed by unsafe abortion to the sexual and reproductive health of the women recruited for the study. Aims: To determine the impact of the “Harm Elimination Project For Unsafe Abortion in Nigeria” (HELPUSAN) model on the rate of decision to keep the pregnancy by women seeking termination of pregnancy and the determinants of this decision. Subjects and Methods: Over the 6‑month period of this pilot survey, all women presenting for abortion were offered preabortion and postabortion counseling and services according to the study protocol. The study did not offer abortion services based on the abortion law in Nigeria. The clients were followed up for 6 weeks and assessed on decision to continue the pregnancy or not. Results: Of 105 attendees, 12.4% declined enrolment, 59.8%had induced abortion, and 45.8% had spontaneous abortion. Among those who presented for postabortion care following induced abortion, the main method used for inducing the abortion process was drugs (80.5%). A total of 90 (97.8%) of the participants were confirmed to be pregnant of which 52 (57.8%) were viable. Also, of the 52 participants with viable pregnancies, 19 (36.5%) decided to retain their pregnancies, while 33 (63.5%) decided not to retain their pregnancies.Conclusion: Almost 40% of clients presenting as pre abortion clients decided to retain the pregnancy. This work also once again highlights the high unmet need for contraception in Nigeria.Key words: HELPUSAN; pre‑ and postabortion counseling; preventing unsafe abortion in Nigeria; unsafe abortion

Experience and use of ultrasound scan for fetal evaluation among obstetricians in an African population

Aim: To assess the experience and the use of ultrasound scan for fetal evaluation among obstetriciansMaterial and Methods: Fifty three Obstetricians who attended an international conference on Fetal Medicine and Obstetric Ultrasound scan held in May 2014 at the University of Benin Teaching Hospital were recruited for the study.Results: A large majority of the respondents (89%) reported having had knowledge of Ultrasound scan and have used it before while only 11% of the respondents have never used an ultrasound scan. The average duration of ultrasound use among those who reported having some experience was 3.30±2.13 years. Twenty nine (55%) of the respondents had ultrasound experience spanning a duration of 1-4 years while eighteen (34%) had the experience of ultrasound use of between 5-9 years. Among those who reported having some knowledge, only 30% have had formal training in ultrasonography while the remaining 70% had no formal training.Conclusion: There is a high level of awareness of obstetric ultrasonography among Obstetricians. The use of ultrasonography was low due to low levels of formal training. Developing guidelines and creating training centres for obstetricians will help improve the experience and use of ultrasonography

ABO Blood Group And Reproductive Performance

A cohort of 2839 delivered mothers between January 2000 and October 2003 were studied to investigate the influence of the ABO blood group on their reproductive performance. There were no statistical significant differences between the four ABO blood group phenotypes, in the 16 reproductive variable analysed. Blood group A phenotype constituted 22.48%, while AB, B, and O blood groups made up 1.94, 15.28 and 60.3 percent respectively. The mean age of the mothers in the study was 30.2+4.85 years. The mean height was 1.64+0.542 metres, while the mean age at menarche was 14.2+3.71 years. The parity distribution amongst the mothers in the subgroups was similar (1.52+1.63), and number of children per mother (1.33+1.47). The incidence of multiple pregnancies was highest amongst blood group B mothers (5.4%). Blood group AB mothers have more female infants, female/male ratio 1.11:1, (Chi square for linear trend =0.24, P=0.62, not significant). The ABO blood group categorization appears to have no major adverse influence on human reproductive performance. This is an important piece of information for the obstetrician who is directly involved in patients care and should be noted by the various religious bodies involved in providing health services and marriage counselling in our society. Keywords: ABO Blood Group, Reproductive performance, population mapping, gene frequencyJournal of Mining and Geology Vol. 5 (1&2) 2006: pp. 36-4

Malaria in pregnancy

Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10,000 maternal deaths and to at least 200,000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse. Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started. The Roll Back Malaria [RBM] campaign was launched as a strategy to curtail theincidence and scourge of malaria especially in the vulnerable groups including pregnant women. The Millennium Development Goals [MDGs] offer a new hope if adequately pursued to achieving eradication of malaria and its complications in pregnancy. There is need to support research into effectiveness and utilization of established and newer control measures.Keywords: malaria in pregnancy; intermittent preventive treatment; insecticide treated nets; roll back malari

Harm elimination project for unsafe abortion in Nigeria: An operations research

Context: The harm elimination model is designed to improve access to pre- and postabortion care including free contraception and address the challenges posed by unsafe abortion to the sexual and reproductive health of the women recruited for the study. Aims: To determine the impact of the “Harm Elimination Project For Unsafe Abortion in Nigeria” (HELPUSAN) model on the rate of decision to keep the pregnancy by women seeking termination of pregnancy and the determinants of this decision. Subjects and Methods: Over the 6-month period of this pilot survey, all women presenting for abortion were offered preabortion and postabortion counseling and services according to the study protocol. The study did not offer abortion services based on the abortion law in Nigeria. The clients were followed up for 6 weeks and assessed on decision to continue the pregnancy or not. Results: Of 105 attendees, 12.4% declined enrolment, 59.8%had induced abortion, and 45.8% had spontaneous abortion. Among those who presented for postabortion care following induced abortion, the main method used for inducing the abortion process was drugs (80.5%). A total of 90 (97.8%) of the participants were confirmed to be pregnant of which 52 (57.8%) were viable. Also, of the 52 participants with viable pregnancies, 19 (36.5%) decided to retain their pregnancies, while 33 (63.5%) decided not to retain their pregnancies. Conclusion: Almost 40% of clients presenting as pre abortion clients decided to retain the pregnancy. This work also once again highlights the high unmet need for contraception in Nigeria

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

BACKGROUND: Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. METHODS: The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. RESULTS: Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. CONCLUSIONS: Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction