Abiodun Idowu Adanikin

Influence of multiple antenatal counselling sessions on modern contraceptive uptake in Nigeria

Abstract Objective To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception. Method A total of 216 eligible pregnant women were randomised into antenatal and postnatal counselling groups. The ‘Antenatal group’ received one-to-one antenatal contraceptive counselling on several occasions while the ‘Postnatal group’ received a single one-to-one contraceptive counselling session at the sixth week postnatal check, as is routinely practised. All participants were contacted six months postpartum by telephone or personal visit, and questioned about their contraceptive use, if any. Results More women who had multiple antenatal contraceptive counselling sessions used modern contraceptive methods than those who had a single postnatal counselling session (57% vs. 35%; p = 0.002). There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group (p = 0.014). Conclusion Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception.

Resumption of intercourse after childbirth in southwest Nigeria

Abstract Objective To determine the history of resumption of intercourse after childbirth and associated contraceptive practices among women in the southwest region of Nigeria. Methods A cohort of 181 women with live births was followed up for 6 months after delivery. Enquiry about the time of first intercourse after childbirth, associated dyspareunia, use of contraception, etc was made during the postnatal clinic visits and/or by telephone contact. Results Fifty (27.6%) had coitus within six weeks of childbirth, it increased to 115 (63.3%) at three months and 127 (70.2%) by six months post-delivery. Prevalence of dyspareunia was 36.2%. Eighty three (65.4%) of sexually active women practiced contraception which was predominantly use of male condom and withdrawal method. Co-habitation with husband (adjusted OR: 6.30; 95% CI: 2.56–17.01; p = 0.001) and mode of delivery (adjusted OR: 2.45; 95% CI: 1.30–4.73; p = 0.006) were strong predictors of commencement of sexual intercourse within six months postpartum. Significantly fewer women who had Caesarean section resumed coitus within six months when compared with those who had vaginal deliveries (59.2% versus 78.4%). Perineal injury did not predict resumption of coitus or experience of dyspareunia. Conclusion In contrast to the norm, more women in southwest Nigeria are resuming coitus soon after childbirth. It is imperative to scale up counselling on postpartum sexuality and contraception within the maternal health services in this region. Chinese Abstract 摘要 目的：了解尼日利亚西南地区女性产后性生活的恢复情况及相关的避孕措施。 方法：对181名活产的女性产后6个月进行随访研究。在产后门诊复查和/或通过电话联系询问女性分娩后第一次性交的时间，相关的性交疼痛，使用的避孕方法等问题。 结果：50名（27.6%）女性产后六周内就有性生活，至产后3个月和产后6个月有性生活的女性分别增至115名（63.3%）及127名（70.2%）。性交疼痛的发生率为36.2%。83名（65.4%）性活跃的女性采用避孕措施，主要为避孕套或体外射精。与丈夫同居（校正OR：6.30; 95% CI: 2.56-17.01; p=0.001）和分娩方式（校正OR：2.45; 95% CI: 1.30-4.73; p= 0.006）是产后6个月内开始性生活的强的预测因素。剖宫产分娩的女性产后6个月内恢复性生活的比例少于经阴道分娩的女性（59.2% vs 78.4%）。会阴损伤并不影响性生活的恢复，也不增加性交疼痛的感受。 结论：与普通妇女比，尼日利亚西南部较多的女性在分娩后不久就恢复性交。在母婴保健服务中扩大对这个地区女性产后性生活和避孕知识的咨询指导势在必行

Role of reminder by text message in enhancing postnatal clinic attendance

Missing a postnatal clinic appointment affects completion of maternal care and contributes to maternal morbidity and mortality. It is unfortunate that postnatal clinic attendance has been consistently poor in Sub-Saharan Africa [1,2]. Various reasons have been adduced for this absenteeism; notably, forgetting the date, time, and possibly the location of the appointment [3]. To date, no study has considered the influence of a reminder system on postnatal clinic attendance. With mobile phone ownership increasing rapidly in the region [4], there is potential for using short message service (SMS) technology as reminders to improve postnatal clinic attendance. The aim of the present study was to test the hypothesis that SMS reminders would reduce non-attendance rates at postnatal clinics in Ado-Ekiti, Nigeria. The studywas conducted at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, from February 1 to July 31, 2013. The study protocol was approved by the hospital’s ethics committee and informed consent was obtained from each participant. The primary outcome of interest was failure-to-attend (FTA) rate. The intervention group (SMS group) comprised patients who delivered during the study period, who were scheduled to attend a postnatal clinic, andwhohad provided amobile telephone number in their hospital record. A historic control groupwas chosen, which comprised all patients who had delivered in the hospital within the preceding 6 months of the study (August 1, 2012, to January 31, 2013) andhad been given an appointment to attend a postnatal clinic. Automated SMS reminders were sent twice to participants in the intervention group, at 2 weeks and then at 5 days before their scheduled clinic appointment. The textmessage read: “Good day. This is to remind you to attend your postnatal clinic on bdateN btimeN. Thank you.” It was a one-way message sent during the day and a delivery report was obtained for each SMS sent. Record of actual clinic attendance by patients in the two groups was obtained from the outpatient scheduling system. Two-sample proportion tests were performed using Stata 11 (StataCorp LP, College Station, TX, USA) to compare FTA rate between the SMS group and the historic control group. Relative risks of non-attendance were presented with 95% confidence intervals; level of significance was set at P b 0.05. Of the 1153 women in the intervention group that delivered during the study period, 1126 (97.7%) women successfully received SMS reminders and analyses were based on those women. Among the intervention reminder group, FTA rate was 21.3% (240/ 1126) (Table 1). The historic control group consisted of 971 patients and had an FTA rate of 42.8% (416/971). Absolute reduction in FTA rate in those who received an SMS reminder was 21.5%. This represents 243 patientswhowould otherwise have been lost to postnatal followup. Patientswho received an SMS reminderwere 50% less likely to fail to attend their postnatal appointment (relative risk of FTA 0.50; 95% CI, 0.32 − 0.77; P = 0.002). The cost of sending an automated SMSwas 1.50Naira (US

Antenatal drug consumption: the burden of self-medication in a developing world setting

0.00938). The total cost for 2252 SMS reminders (1126 × 2) during the 6 months of the study was 3387 Naira (US

Combined Foley's catheter with vaginal misoprostol for pre‐induction cervical ripening: A randomised controlled trial

21.12). Extrapolation of annual cost of SMS reminderswould be US

Reshaping maternal services in Nigeria: any need for spiritual care?

42.24. In this setting, postnatal care is provided free of charge. The present study demonstrated that patients who had received SMS reminders were more likely to attend their postnatal clinic appointment (21.3% v 42.8%; P = 0.002). The outcome supports the hypothesis that SMS reminders will reduce rates of non-attendance at postnatal clinics in this setting. Mobile phone penetration in the West Africa sub-region has been unprecedented and there are now 188 million subscribers. Nigeria has the largest share of 95 million mobile phone users [5]. Virtually all homes except core rural areas have a means of mobile reach. Exploring the benefits of mobile technology in reducing maternal morbidity and mortality in Sub-Saharan Africa is a worthwhile project. The economic cost analysis of SMS reminders is negligible (US

Predictors of asymptomatic bacteriuria among pregnant women in a low-resource setting

42.24 per annum in the present study), the text is automated, and staff training is not required. It can be presumed that, since postnatal care is provided free of charge in this setting, forgetfulness of the date and time of the appointment is more likely to account for clinic absenteeism. The present study has some limitations. Firstly, the use of an historic control group raises the question that the observed difference in FTA rate may be due to seasonal variation. However, return for postnatal care in this environment has been notoriously low formany years, making this assumption of little value. Secondly, despite ascertaining that the texts had been successfully delivered, it was not possible to know whether they had been received by the correct recipients. Two-way

Awareness and practice of emergency contraception at a private university in Nigeria

This institutional-based cross-sectional study examines the burden of self-medication during pregnancy in a middle-income country setting and the impact on fetal wellbeing. Using a blend of open-ended and indication-oriented questionnaires, 346 pregnant women at term were interviewed about their pregnancy complaints and drug intake. Inferential statistical data analysis was employed with level of significance (α) set at 0.05. Excluding routine supplements and vaccinations, 251 (72.5%) women used medicines, of whom 79 (31.5%) had self-medicated. Consuming drugs without prescription was associated with increased US Food & Drug Administration (FDA) risk category (χ2 = 8.375; P = 0.015). There is therefore a need to scale up efforts towards educating women about the dangers of self-medication, while also introducing effective restrictive policies on over-the-counter drug sales.

Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance

Pre‐induction cervical ripening greatly influences the outcome of induction of labour (IOL).

Adaptation to menopause in Southwest Nigeria

BackgroundHigh maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting.MethodA total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed.ResultsMost of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one’s clergy (OR 1.82; CI 1.03-3.21; p = 0.04).ConclusionOur women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates.