Comparison of Contraceptive Methods Chosen by Breastfeeding, and Non-Breastfeeding, Women at a Family Planning Clinic in Northern Nigeria

A. ception. Conclusion: Breastfeeding rates were high among women seeking contraception. The pattern of contraception is similar among both breastfeeding and non-breastfeeding women, with injectable contraception being the preferred choice. Awareness should be raised on the safety of a wider variety of contraception available for breastfeeding women

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 < 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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Screening for postpartum depression among women in selected hospitals in Kaduna, Northern Nigeria: a cross sectional study

Background: Postpartum depression (PPD) is better detected early and treated to prevent maternal and perinatal complications. However, PPD screening is not routine in our environment. The aim of the study was to screen for those at risk of postpartum depression among women attending postnatal clinic. Methods: A cross sectional study carried out in selected hospitals in Kaduna. A questionnaire was administered to women during their 6 weeks postpartum clinic visit and information elicited on demographics, reproductive characteristics, potential confounders for PPD, and the Edinburgh postpartum Depression Scale, administered. Analysis was done using SPPS (Statistical Package for Social Sciences) with a p-value of <0.05 deemed statistically significant. Results: There were 300 participants. Majority of respondents were aged 20-29years (170, 56.7%), mean age was 27.51 ±5.759 years. Respondents were mostly well educated with 162 respondents (54%) schooled up to tertiary level, Muslim (224, 74.7%), Hausa (160,53.3%) and employed (172, 57.3%). All respondents were married, with most (266, 88.7%) in a monogamous setting and had been married for <10 years (251,83.7%). Only 17 respondents (5.7%) were at risk of PPD (EPDS score =13), while 41 respondents (13.7%) had signs of distress (EPDS score 10-12). Ethnicity, parity, baby's birthweight, baby not alive and experience of a recent stressful event were the only confounders significantly associated with the risk of PPD. Conclusions: Among respondent, 5.7% had a high risk for PPD, which is lower than what was reported in previous studies. Ethnicity, parity, birthweight, death of the baby and experience of a recent stressful were significantly associated with this risk

Time Interval to Initiation of Contraceptive Methods Following Childbirth in a Low‑resource Setting

Objectives: The objectives of the study were to determine factors affecting the interval between a woman’s last childbirth and the initiation of contraception. Materials and Methods: This was a retrospective study. Family planning clinic records of the Barau Dikko Teaching Hospital Kaduna from January 2000 to March 2014 were retrieved. Information was collected on demographics, reproductive, and contraceptive history. Data were analyzed using the SPSS version 15 software, and missing responses were excluded. Chi‑square was used as a test of association with significance level established at P = 0.05. Results: A total of 5992 client’s cards were retrieved. All were female and married. Majority were aged 25–34 years (53.1%), had completed secondary education (56%) and were Muslims (52.3%). Only 4979 cards (83.1%) had correct data on intervals and 22.1% of these clients initiated contraception within 6 months of their last childbirth. Education, religion, source of information, number of living children, desire to have more children, previous use of contraception, and type of contraception chosen were significantly associated with intervals for initiating contraception after last childbirth (P < 0.05) while the presence of complications in the last delivery was not (P > 0.05). Conclusions: Majority of women initiate contraception late after childbirth in this setting. Increased awareness on immediate/early postpartum contraception is required. Further qualitative studies will help to explore findingsof this study.Keywords: Contraception, initiation, intervals, last delivery, Northern Nigeri

Haematoma of the labia minora following consensual sexual intercourse

This is a case report of a 21-year-old woman who presented with a large hematoma of her right labia minora after consensual sexual intercourse that resolved following nonsurgical intervention

Trend of modern contraceptive uptake and its predictors among women accessing family planning service in a tertiary hospital in Northwestern Nigeria, 2000–2014

Background: Client preference and availability of contraceptives are important determinants of uptake in developing countries. In this study, we investigated the trend of contraceptive uptake and factors associated with client choice among women accessing family planning services in an urban tertiary hospital in Northwestern Nigeria. Subjects and Methods: Time-trend analysis was performed on registry data of contraceptives dispensed between January 2000 and December 2014 at the family planning unit of Barau Dikko Specialist Hospital, Kaduna, Northwestern Nigeria. Five-year periods (2000–2004, 2005–2009, and 2010–2014) were identified, and the prevalence of contraceptive methods for each period is expressed as moving averages. Predictors of client choice were determined by logistic regression expressed as odds ratio [OR] (95% confidence interval [CI]). Results: A total of 5992 family planning consultations were made during the 15-year study period. Compared with the intermediate 5 years, there was a rise from 1723 (2000 to 2004) to 2128 (2005–2009) and a decline in the final 5 years to 1912 (2010–2014). Cumulatively, the most preferred contraceptive was injectables (40.7%). Women aged ≥35 years showed significant positive association with contraceptive uptake (OR 2.243, 95% CI = 1.489–3.380; P < 0.05) for injectables (OR 13.609, 95% CI = 6.317–29.318 and OR = 0.019, 95% CI = 0.012–0.030; P < 0.05) for oral contraceptive pills. Women who had completed secondary school or more had greater odds of using intrauterine contraceptive device or implants, OR 2.278, 95% CI = 1.869–2.776, P < 0.05 and OR 5.012, 95% CI = 2.346–10.79, P < 0.05, respectively. Conclusion: Injectable contraceptive was the most common method used. Women's age and educational attainment were the major factors influencing choice and uptake of modern contraceptives