Practice of healthy timing and spacing of pregnancy (HSTP), experience from a low resource setting

Context: Healthy Timing and Spacing of Pregnancy (HTSP) refers to the optimal time that a woman should conceive for the healthiest outcomes for the mother and the baby.Objective: This study assessed the adherence by Nigerian women of childbearing age to the WHO recommendations of optimal time to be observed by women before embarking on another pregnancy after child birth or a miscarriage.Materials and Methods: This was a cross-sectional descriptive study of 400 consecutive women attending the antenatal clinic of the University of Abuja Teaching Hospital. Interviewer administered questionnaire was used to collect information relating to healthy timing and spacing of pregnancy. The data was analyzed using SPSS windows version 20. Chi square test was used to test for associations between categorical variables with the level of significance set at p<0.05.Results: Two hundred respondents (50%) had birth to pregnancy interval of less than 24 months, while 14(3.5%) had birth to pregnancy interval of greater than 60 months. Overall, 249(62.2%) of women had an unhealthy timing or spacing of their pregnancies. Three hundred and forty (85%) were aware of at least a modern method of contraception but only 42(10.5%) had used contraceptives in the past. Awareness of normal inter-pregnancy interval of at least 24 months was seen in 271 (67.8%) women.Conclusion: Non-adherence to WHO's concept of HTSP is high in Nigeria's Federal Capital Territory. Awareness of the benefits of contraceptive use and HTSP amongst women of child bearing age needs to be stressed.Keywords: Healthy Timing and Spacing of Pregnancy, Antenatal Clinic, Abuja

Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria

Background: Anaemia in pregnancy and HIV infection are two common public health issues in sub-Saharan African with Nigeria bearing the greatest burden. The duo occurring together poses a higher risk of morbidity and mortality for both the foetus and the mother. We therefore conducted this study to determine the burden of anaemia and other haematological abnormalities among HIV positive pregnant mothers on antiretroviral therapy who attended antenatal clinical services in our health institution.Methods: A 10-year retrospective review from January 2010 to December 2019 of medical records of HIV positive mothers on highly anti-retroviral therapy in attendance for antenatal clinical services in our health institution was carried out for the above objectives. Information extracted were, age, HIV status, gestational age at delivery, type of antiretroviral drugs used, duration of use, haemoglobin level, platelet, and complete blood count at booking of the positive mothers.Results: Of a total of 330 HIV positive mothers seen during the review period, 82.7% were from rural communities, 88.8% were from middle socio-economic class, 80.0% were Christians, and 80.3% started their highly active antiretroviral therapy before their index pregnancy. Most, 51.5% and 42.7% were on zidovudine, lamivudine and nevirapine, and tenofovir with lamivudine and lopinavir boasted ritonavir combinations, while 94.2% were on 1st line antiretroviral medication. Their mean age, gestational age at delivery, and parity were 31.11±4.7 years, 38.57±3.1 weeks, and 2.0±1.6 respectively. The prevalence of anaemia, thrombocytopenia and leucopoenia were 36.1%, 4.8%, and 6.7% respectively while their mean CD4 cell count and viral loads at the point of booking were 543.63±283.7 cells/μl, and 2953.02±1619.9 copies/ml. The two maternal variables that showed significant relationship with haemoglobin concentration of <10 gm/dl was mother’s level of education x2=6.29, p=0.043, and her socio=economic class, x2=10.162, p=0.006.Conclusions: There is high burden of anaemia among HIV positive mothers on antiretroviral therapy in our environment. The prevalence of thrombocytopenia and leucopoenia was much lower. The burden of maternal anaemia was associated with maternal level of education and her socio-economic class

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

Background: Long-acting reversible contraceptives (LARC) are methods used in the prevention of pregnancy that are long lasting. They are effective and efficacious methods of contraception and return to fertility after removal is prompt. Objectives was to determine the uptake of long-acting reversible contraception and assess the characteristics of acceptors of these methods in the area.Methods: This was a retrospective study of clients’ who visited the family planning unit of the University of Abuja teaching hospital over a 5-year period, from 01 January 2015 to 31 December 2019. Information on socio-demographic characteristics and specific methods selected were extracted from their records and represented on simple tables, graphs, and charts.Results: A total of one thousand eight hundred and ninety-one (1,891) clients accepted available methods of contraceptives during the five-year study period. One thousand seven hundred and twenty-four (1,724) accepted LARC (91.1%) while only one hundred and sixty-seven (167) accepted non-LARC (8.9%). Majority 946 (54.9%) of the clients that accepted LARC were aged between 30-39 years and clients less than 20 years were 22 (1.3%). Clients with parity 3 and above were 1162 (67.7%), and majority of LARC acceptors wanted more children 1145 (66.4%). Amongst the LARC acceptors, most of the clients opted for subdermal implant either Jadelle or Implanon 940(49.7%). Three hundred and ninety-eight (23.1%) discontinued a form of LARC during the study period while 1127 (65.4%) continued with one form of LARC or another.Conclusions: The uptake of LARC in this region is very high. Teenagers and low parity rarely attended the family planning clinic

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Trends and pattern of sexual assault in North Central Nigeria

Sexual assault is assuming an alarming status and usually leaves a devatating effect on women and girls who fall victim. The aim of this study was to determine the trend and pattern of sexual assaults. This was a retrospective cohort study. Case notes were retrieved from gynaecological emergency unit from January 2016 to December 2018. A total of 45 Case folders were collected. The information from the case notes were entered into a structured proforma. A total 2250 gynaecological emergency cases were seen and out of these 45 were victims of sexual assault, giving the prevalence of sexual assault to be 2.0%. A large proportion 84.4% were noted in children less than 16 years of age. There was delay in presentation as only 40% did so within 24 hours of the incidence. In 84.4% of the cases, the victim had a relationship with the alleged assailant and the assault was said to have occured most times in the home of the assailant. In 95.5%, vaginal penetration was the commonest and threat of violence was the commonest method of overcoming the victims. About 42.2% victims did not have a human immunodeficiency virus screening test done for various reasons. In conclusion, gender-based violence and other practices that affect the health of women and children negatively, and sexual assault against children and adolescence are still prevalent in our clime as seen from this study. (Afr J Reprod Health 2021; 25[5]: 79-83