African Journal of Reproductive Health: 26 years and soaring

No Abstrac

Prevention of morbidity and mortality from induced and unsafe abortion in Nigeria

These proceedings are from a seminar organized by the Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University, Ile-Ife (Nigeria) in collaboration with the Population Council. The primary purpose of the multidisciplinary seminar was to identify the determinants of the high rate of mortality and morbidity from unsafe abortion in Nigeria. The specific objectives were: 1) to identify measures that could be undertaken on a short- and long-term basis to reduce the rate of abortion-related mortality, and 2) to set an agenda for research into abortion in Nigeria. The seminar consisted of oral presentations on related topics by researchers and women\u27s health advocates, in-depth formal and informal discussions of the issues by the participants, and a workshop session. Based on the discussions, the participants agreed that it was necessary to liberalize the abortion law in the country, improve postabortion care, and focus on primary prevention of unwanted pregnancies

Rights versus Responsibilities of Health Care Workers in Nigeria: Changing the Narrative in the COVID-19 Era

The outbreak of the coronavirus disease (COVID-19) in December 2019 and its spread to 216 countries within the first eight months has created a huge strain on health systems across the world. Health care workers (HCWs) at the fore-front of combating the pandemic are largely at risk of infection with the number of infected HCWs increasing daily in many countries. Prior to the outbreak of COVID-19, focus of laws and policies have largely been on the responsibilities of HCWs with little or no attention paid to their rights and protection. The increased rate of infection among health workers and the inadequate conditions under which HCWs have carried out their lifesaving responsibilities during the pandemic has created the need to change the narrative by focusing on policy formulation and implementation to ensure that HCWs rights are protected. We endorse the widespread use of the WHO recommendations on Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities of Health workers, including key considerations for occupational safety and health. Keywords: Coronavirus, health policies, protection of health care workers, rights of health care workers L'épidémie de la maladie à coronavirus (COVID-19) en décembre 2019 et sa propagation dans 216 pays au cours des huit premiers mois ont créé une énorme pression sur les systèmes de santé à travers le monde. Les agents de santé (TS) à l'avant -garde de la lutte contre la pandémie sont largement exposés au risque d'infection, le nombre de TS infectés augmentant chaque jour dans de nombreux pays. Avant l'épidémie de COVID-19, les lois et les politiques se concentraient largement sur les responsabilités des travailleurs de la santé avec peu ou pas d'attention accordée à leurs droits et à leur protection. L'augmentation du taux d'infection parmi les agents de santé et les conditions inadéquates dans lesquelles les agents de santé ont assumé leurs responsabilités vitales pendant la pandémie ont créé le besoin de changer le discours en se concentrant sur la formulation et la mise en oeuvre de politiques pour garantir la protection des droits des agents de santé. l'utilisation généralisée des recommandations de l'OMS sur l'épidémie de maladie à coronavirus (COVID-19): droits, rôles et responsabilités des agents de santé, y compris des considérations clés pour la sécurité et la santé au travail. Mots-clés: Coronavirus, politiques de santé, protection des travailleurs de la santé, droits des travailleurs de la sant

Intimate partner violence: A global challenge to sustainable development

No Abstract

Triglycerides and TG/HDL‑C ratio as surrogate markers for insulin resistance in Nigerian women with polycystic ovary syndrome

Background: Dyslipidemia is one of the most perplexing metabolic consequences in polycystic ovary syndrome (PCOS). Obesity, insulin resistance (IR), and hyperandrogenism, the pervasive features of PCOS, play significant pathophysiological roles in the lipidemic aberrations associated with the syndrome.Objective: This study aimed to assess the diagnostic utility of triglyceride (TG) and triglyceride to high‑density lipoprotein‑cholesterol (TG/HDL‑C) ratio as surrogate markers for identifying IR in infertile Nigerian women with PCOS.Materials and Methods: Eighty‑seven infertile women with PCOS were selected according to the Androgen Excess Society criteria and categorized into two groups. After anthropometric measurements, fasting blood samples were assayed for plasma glucose, serum insulin, total cholesterol, TG, HDL‑C while lipoprotein ratios were calculated. Homeostasis model assessment for IR (HOMA‑IR) was used in defining IR. The areas under the receiver operating characteristic (ROC) curve analysis were used to compare the power of the serum markers, and to obtain the optimal cutoffs of TG and TG/HDL‑C with HOMA‑IR.Results: TGs correlated significantly with HOMA‑IR in the obese PCOS women. However, the areas under the ROC of potential markers showed no significant marker for HOMA‑IR. The highest area under the curve of ROC for TG belongs to the obese group with a sensitivity of 56% and specificity of 53% (TG ≥ 92.5mg/dL) as a marker of IR in obese PCOS women.Conclusion: TG and TG/HDL‑C would not be reliable markers of IR, and a concerted approach in finding surrogate markers will benefit future  investigations. Key words: Insulin resistance; Nigerian women; polycystic ovary syndrome; surrogate marker; triglyceride

Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study

BACKGROUND: Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women. Recent global cancer statistics indicate rising global incidence of breast cancer and the increase is occurring at a faster rate in populations of the developing countries that hitherto enjoyed low incidence of the disease. Worried by this prevailing situation and with recent data suggesting that health behavior may be influenced by level of awareness about breast cancer, a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Nigeria towards breast cancer. METHODS: One thousand community-dwelling women from a semi-urban neighborhood in Nigeria were recruited for the study in January and February 2000 using interviewer-administered questionnaires designed to elicit sociodemographic information and knowledge, attitude and practices of these women towards breast cancer. Data analysis was carried out using Statistical Analysis Software (SAS) version 8.2. RESULTS: Study participants had poor knowledge of breast cancer. Mean knowledge score was 42.3% and only 214 participants (21.4%) knew that breast cancer presents commonly as a painless breast lump. Practice of breast self examination (BSE) was low; only 432 participants (43.2%) admitted to carrying out the procedure in the past year. Only 91 study participants (9.1%) had clinical breast examination (CBE) in the past year. Women with higher level of education (X(2 )= 80.66, p < 0.0001) and those employed in professional jobs (X(2 )= 47.11, p < 0.0001) were significantly more knowledgeable about breast cancer. Participants with higher level of education were 3.6 times more likely to practice BSE (Odds ratio [OR] = 3.56, 95% Confidence interval [CI] 2.58–4.92). CONCLUSION: The results of this study suggest that community-dwelling women in Nigeria have poor knowledge of breast cancer and minority practice BSE and CBE. In addition, education appears to be the major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer to all women in Nigeria

The social meaning of infertility in Southwest Nigeria

There has been very little documentation of the social meaning given to infertility in many developing countries, including Nigeria, where the prevalence of infertility is known to be high. We have conducted a number of qualitative studies aimed at exploring socio-cultural issues associated with infertility in Ile-Ife, Southwestern Nigeria. Twenty-five focus-group discussions were held with knowledgeable persons in the rural and urban parts of the community to ascertain their attitudes towards infertility. The results show that community members accord great significance to child-bearing, but, they have incorrect knowledge of the causes and appropriate treatment of infertility. Focus-group participants mentioned several traditional beliefs regarding the causes of infertility from which they derived a variety of traditional and religious methods for its treatment; many affected couples use these methods of treatment, sometimes singly but most often in combination. Orthodox treatments are less often used because of perceptions of the causes of infertility and lack of confidentiality at the treatment centres. Women are more likely to suffer the social consequences of infertility; they suffer physical and mental abuse, neglect, abandonment, economic deprivation and social ostracism as a result of their infertile status. These findings have profound implications for reproductive health and reproductive rights of women in the area. Measures recommended to ameliorate the adverse consequences of infertility in the community include provision of broad reproductive health education and appropriate services; integration of infertility treatment and prevention into primary health care and the traditional system of health care delivery; and programs aimed at the empowerment of women in the area

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria : a multicenter study

This study determines maternal mortality ratios (MMR) and identifies risk factors for maternal deaths in referral health facilities in Nigeria. Results show an MMR of 2,085 per 100,000 live births in hospital facilities. Efforts to reduce MMR requires the improvement of emergency obstetric care; public health education so that women can seek appropriate and immediate evidence-based pregnancy care; the socioeconomic empowerment of women; and the strengthening of the health care system. In the past ten years contraceptive prevalence rates have remained low at 10%; antenatal attendance has remained at 64%, skilled birth attendance of 33% is one of the lowest in sub-Saharan Africa.World Health Organizatio

Assessment of the quality of antenatal and postnatal care services in primary health centres in rural Nigeria

Study findings show predictors of sub-optimal offerings of standard Primary Health Care (PHC) that include: local government area, marital status and previous childbirths. A higher proportion of maternal deaths in Nigeria occur among women living in rural areas, where barriers to maternal health include quality of care in health facilities. There is evidence of continuing under-utilization of primary care by pregnant women in poor and rural communities. Due to the small number of women who use PHC, and the non-availability of accurate records of women who use the facilities for maternal care, a sample size could not be determined beforehand.Global Affairs Canada (GAC)Canadian Institute for Health research (CIHR

Why rural women do not use primary health centres for pregnancy care : evidence from a qualitative study in Nigeria

Pregnant women in rural communities in Nigeria often do not use Primary Health Care Centres. Through focus group discussions, the study found four broad categories of reasons underlying non-use: 1) accessibility factors – poor roads and transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, inadequate drugs, abusive care by health providers, long wait times, and inappropriate referrals; 3) costs of services, including inability to pay for services even when costs are not excessive; the introduction of informal payments by staff; and 4) partner support (or lack thereof), and misinterpretation of signs of pregnancy complications.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR