Factors influencing contraceptives use among grandmultipara in Ile-Ife, Nigeria

Objective: To determine modifiable factors that influence contraceptive usage among grandmutiparas in a South-Western Nigerian setting.Methodology: A prospective survey was done among antenatal attendees in OAUTHC from January toDecember 2006. Using interviewer administered semi-structured questionnaire data were collected from all  grandmultiparous attendees on sociodemographic characteristics, contraceptive awareness and usage, contraceptive intentions and the role of men on contraceptives usage. Data were analysed with SPSS 11.0 and result presented in descriptive statistics.Results: The prevalence of grandmultiparity was 9.04% in the studied population, and their mean age was 36.73 + 4.7years: Eighty-one percent attended secondary school, and 65% were monogamous. Despite high level of awareness (51.6-100%) contraceptive usage was low (5.9 to 40.8%). About 90% agreed that family planning improve quality of family life. While 80% had no intention for further childbearing only 36% intended to use BTL. Sex preference was the only motivation for further childbearing in all (100%) of them.Conclusion: High literacy rate in this group did not impart positively in reducing the unmet need. Increased awareness on permanent  contraception and the role of men need to be promoted. Health education that will break the negative strongholds of cultural factors has to be introduced gradually at the primary school levels.Keywords: Contraceptive usage, Grandmultiparity, Cultural factors

Left main coronary artery disease: pathophysiology, diagnosis, and treatment

The advent of coronary angiography in the 1960s allowed for the risk stratification of patients with stable angina. Patients with unprotected left main coronary artery disease have an increased risk of death related to the large amount of myocardium supplied by this vessel. Although coronary angiography remains the preferred imaging modality for the evaluation of left main coronary artery stenosis, this technique has important limitations. Angiograms of the left main coronary artery segment can be difficult to interpret, and almost one-third of patients can be misclassified when fractional flow reserve is used as the reference. In patients with clinically significant unprotected left main coronary artery disease, surgical revascularization was shown to improve survival compared with medical therapy and has been regarded as the treatment of choice for unprotected left main coronary artery disease. Two large-scale clinical trials published in 2016 support the usefulness of catheter-based revascularization in selected patients with unprotected left main coronary artery disease. In this Review, we describe the pathophysiology of unprotected left main coronary artery disease, discuss diagnostic approaches in light of new noninvasive and invasive imaging techniques, and detail risk stratification models to aid the Heart Team in the decision-making process for determining the best revascularization strategy for these patients