Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria

Introduction Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. Methods A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. Results Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. Conclusion Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare

Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as, women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care; and these contribute to the increased incidences of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria

Baseline knowledge, practices and experiences of traditional birthd attendants (TBAs) on HIV/AIDS before commencement of training for prevention of mother to child transmission of HIV (PMTCT) in South West Nigeria

No Abstract.Nigerian Medical Practitioner Vol. 53 (6) 2008: pp. 103-10

The Physics of Family Medicine as Basis for Training of Family Physicians in West Africa

The biopsychosocial model is a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the social to the subatomic particle using the General System Theory. The aim of this paper was to bring to the attention of doctors the thinking that underpins the unique training of family physicians as specialist in West Africa. A review of relevant literature was done using internet search engines on the subject. Qualitative analysis methods included collation, theme identification and triangulation. Result revealed a major hindrance in the advancement of Family practice in West Africa as a discipline is the insistence on describing it in the terminology of traditional biomedical medicine. The traditional biomedical medicine, the doctor fits the patient's illness into a precise class linking the symptoms and signs with organic pathology and identifying single external causes. He explains the patient's illness in terms of his own worldview during the consultative process by taking a domineering stance on the assumption that he, the doctor has sufficient knowledge and skills about the positive health outcome of the individual patient. On the other hand, Family Medicine interprets symptoms in terms of its own method and objectives. Interpretation of the patient (patient-centered method) rather than the symptoms (disease-centered method) is the crux of clinical competence in family practice. This method is consistent with Einsteinian physics rather than Newtonian physics which are the basis of traditional biomedical medicine. In conclusion, the value of the biosychosocial model is not the discovery of a new scientific law, but the application of medical knowledge to the needs of each patient for which the family physician is adequately trained. This forms the basic science background for the training of family physician in West Africa as envisaged by the founding fathers in the 1980s.. Keywords: Biopsychosocial model, Dualism, Reductionism, Clinical practice, Training, family medicine. The Nigerian Medical Practitioner Vol. 51 (6) 2007: pp. 119-12

Determinants of Utilization of Maternal Health Services Among Traders in Lagos Markets

Background: Utilization of health services is a complex behavioral phenomenon, related to the availability, quality and cost of services, social structure, health beliefs and characteristics of the users. Objective: This study was carried out to examine factors influencing the use of maternal health care services amongst traders in Lagos markets. Methods: A cross sectional descriptive survey of market traders in16 markets within Lagos metropolis was conducted using a 28-item questionnaire to obtain information about the socio-demographic characteristics, knowledge about the locations of Primary Health Care (PHC) services, type of services received, perceived quality, reasons for choice and sources of alternative maternal health care. Results: The majority [73.5%] admitted awareness of a primary health care center in the area, 64% of them used them, for antenatal care [44%], delivery [34%], and family planning services [22%]. Among users, 91.6% expressed satisfaction with the services. Other sources of maternal health care used included private hospitals [66.7%], general/teaching hospitals [8.6%], chemist shops [9%] and traditional birth attendants [7.9%]. Reasons for their preferences related to better service, better attitudes and perceived proficiency of staff and proximity to home or place of trade. Utilization of maternal health services was significantly related to level of maternal education, knowledge of location of PHC, age, marital status, number of children, satisfaction with services received, perceived severity of danger signs of pregnancy and labour [

Anthropometric characteristics and blood pressure levels of spouses of hypertensive patients attending the general outpatient clinic of a teaching hospital in Lagos, Nigeria

Background: The prevalence of both hypertension and obesity have been observed to be on the increase worldwide and in Nigeria. Obesity has been identified as a major risk factor for Hypertension. The aim was to examine the anthropometric characteristics and blood pressure levels of spouses of people living with hypertension.Methods: Two hundred and thirty (230) spouses of hypertensive patients were selected by systematic sampling in this hospital based cross-sectional descriptive study at the General Outpatient Clinic of Lagos University Teaching Hospital. An interviewer administered questionnaire adapted from WHO STEP instrument was used to collect data. Blood pressure was measured with a standardized mercury sphygmomanometer. BMI and waist hip ratio were computed.Results: The mean age of respondents was 52.3 ± 9.73 years. The mean systolic and diastolic blood pressures were 128.45 ± 19.47 mmHg and 82.68 ± 11.71 mmHg respectively. More than one third (35.2%) of spouses of hypertensive patients had elevated blood pressure. Also, most (73.1 %) of respondents were either overweight or obese by body mass index while 40% of them have elevated waist circumference. Over 80% of them have elevated waist hip ratio and these factors were all significantly associated with elevated blood pressure (P < 0.05).Conclusion: More than one third of spouses of hypertensive patients are likely to have elevated blood pressure with almost threequarters being either overweight or obese. There is statistical relationship between overweight/obesity and blood pressure levels among them. Thus, there is a need to incorporate spousal case finding for obesity and hypertension in the comprehensive care offered by family physicians caring for hypertensive patients

Screening and Diagnostic Mammographic Findings Of 115 Consecutive Nigeria Women: A Two Year Study in a City Private Hospital

Mammography is the technique of examination of the breast utility low energy radiation in the range 20- 35KV. At these energy ranges it is possible to obtain high resolution films on which fat can be clearly distinguished from other soft tissue densities. Mammographic findings in 115 consecutive Nigeria women aged 18 - 65 years who attended the Health assessment clinic of Lagoon Hospital, Lagos between January 1992 and June 1994 are presented with a view to highlighting the technique of mammography and increasing the awareness of doctors as to the screening and diagnostic benefits of the investigation. We evaluated mammography findings in 115 Nigeria women to determine the indication for the use of this procedure. Women aged 30 – 39 were the commonly referred with breast lesions. Majority of the breast screened were normal. 32% were due to fibroadonoma and 1% had microcalcification. The frequency of abnormal findings was 29%. The decision on when to request for mammography could therefore be influenced by the findings in this report. Keywords: Mammography, Screening, DiagnosisNQJHM Vol. 14 (2) 2004: pp. 166-16

Attitudes and practices of students of health sciences of the college of medicine, University of Lagos, Nigeria towards people living with HIV/AIDS (PLWHAS)

No Abstract.Nigerian Quarterly Journal of Hospital Medicine Vol. 11(1-4) 2001: 20-2