Echendu Dolly Adinma

Awareness and use of contraception by women seeking termination of pregnancy in south eastern Nigeria

Abstract Objective To determine the awareness and use of contraception by women seeking for termination of pregnancy in south eastern Nigeria. Methods A descriptive cross-sectional questionnaire based on the study of one hundred consecutive abortion seekers attending a clinic in southeastern Nigeria was utilized. Results Mean age of the respondents was (23.5±4.4) years. The majority were students (55.0%) with 64.0% having secondary education and 33.0% possesing tertiary educational qualifications. Seventy five percent were nulliparous while 49% had one or more previous pregnancy termination. The majority of the respondents (73%) were aware of contraceptive methods but only 10% had ever used including 6% using male condom. Only 38% of the respondents desired to use contraceptives after the termination of index pregnancy. Conclusions It is concluded that the majority have the high level of contraceptive awareness but contraceptive usage is shockingly low. Therefore, there is a strong need to conduct further and wide spread research not only into the various factors that influence access to contraception but also factors that promote induced abortion and overall unsafe abortion morbidity and mortality as a basis towards the enrichment of discussion related to family planning and contraception, the magnitude of abortion problems, and abortion laws in Nigeria.

Adequacy of resources for provision of maternal health services at the primary health care level in Nnewi, Nigeria

Background: To determine the adequacy of resources (human and material) for provision of maternal health services at the primary health care (PHC) level in Nnewi, Nigeria. Materials and Methods: A cross-sectional study of women utilising maternal health services in four public PHC facilities in Nnewi selected using multistage sampling technique was done. Data was collected using a mix of quantitative and qualitative methods. Quantitative data was analysed using statistical package for social sciences (SPSS) version 16, while qualitative data was reported verbatim, analysed thematically and necessary quotes presented. Results: Two hundred and eighty women were studied. The mean age of respondents was 29.2 ± 5.9 years, while 231 (82.5%) were married. Most of them (82.5%) and 184 (66.1%), had their blood pressure and body weight respectively measured, while 196 (70.0%) had tetanus toxoid vaccination. Less than half of the respondents (41.4%) had urine test for sugar, and protein, while 94 (33.8%) had blood test for anaemia. The four facilities studied had most of the equipment and drugs available but in insufficient quantities. In three out of the four facilities, the physical structures were mostly good. None of them is equipped to provide an essential obstetric care (EOC) services, while one medical doctor covered all the facilities studied. Conclusions: This study showed that none of the health facilities is equipped with the minimum equipment package, essential drugs nor staff complement required to enable them offer quality maternal health services. With advocacy, technical support and funding, strategies could be implemented to provide quality maternal health services.

Knowledge and perception of the Nigerian Abortion Law by abortion seekers in south-eastern Nigeria.

One in four pregnancies worldwide is voluntarily terminated. Approximately 20 million terminations are performed under unsafe conditions, mostly in developing countries with restrictive abortion laws. A total of 100 consecutive abortion-seekers were interviewed, to ascertain their knowledge and perceptions on the Nigerian Abortion Law. The majority (55.0%) of the respondents were students. Most of them (97%) had at least secondary education and the majority (62.0%) were within the 20–24 years age range. Only 31.0% of the women interviewed were aware of the Nigerian Abortion Law. While 16% perceived the law as being restrictive, 2% opined that ‘it was alright’; 1% perceived it as very restrictive and 12% had no opinion on the abortion law. Knowledge of the abortion law had no significant relationship with either the educational level of the respondent or the number of previous pregnancy terminations and overall demand for abortion services. It is necessary to ensure a wide dissemination of the abortion law and its provisions to the Nigerian public, in order to arm them with the necessary information to participate actively in debates on abortion law reforms.

Postabortion care counseling practiced by health professionals in southeastern Nigeria

To determine the practice of postabortion care (PAC) counseling among healthcare professionals in southeastern Nigeria.

Abortion treatment by health professionals in south-eastern Nigeria

Studies assessing the various modes of treatment for abortion and its associated complications remain relevant in the generation of data that will aid policy formulation for abortion management. This descriptive cross-sectional study was undertaken to determine the common methods of, together with the complications associated with, abortion treatment among healthcare practitioners in south-eastern Nigeria. There were 230 males and 207 females, with a mean age of 38.23 + 10.4 years. General practitioners accounted for 214 (49.0%) respondents; nurses, 161 (36.8%); specialist doctors, 56 (12.8%); resident doctors, 5 (1.1%); and community health officers, 1 (0.02%). As high as 388 (88.8%) of the respondents had treated abortion. Manual vacuum aspiration (MVA), and sharp curettage were the commonest methods of treatment accounting for 36.0% and 34.1%, respectively, while medication treatment was employed by 15.0% of the respondents. Only 41.0% of the respondents had been formally trained on the use of MVA. Some 285 (65.2%) of the respondents recorded complications during abortion treatment and these included incomplete evacuation, 30.2%; haemorrhage, 26.0%; and infection, 22.2%. A significantly higher number of complications occurred following sharp metal curretage compared to MVA, and includes incomplete evacuation, 54 (62.5%) vs 33 (38.0%) (p < 0.05); and haemorrhage, 32 (43.2%) vs 15 (20.5%) (p < 0.05). Syncope, 2 (100%) and uterine perforation, 23 (100%) occurred solely from sharp metal curettage. Building capacity of health professionals on the use of MVA, and ensuring the universal access to the equipment will enable safer abortion treatment and reduce maternal morbidity and mortality from abortion-related complications.

Sexual health knowledge, attitude and risk perception among in-school and out-of-school female adolescents in Onitsha, Anambra State, Nigeria

Aim: Young people need protective information and skills in order to reduce the risk associated with unsafe sex. This study assessed and compared the sexual health knowledge, attitude and risk perception of in-school and out-of-school female unmarried adolescents in Onitsha North Local Government Area, Anambra State, Nigeria. Methods: A comparative cross-sectional design was used in which 391 in-school female adolescents (mean age: 15.9±1.4 years ) were selected from 25 private and 17 public schools in Onitsha North Local Government Area, Anambra State, Nigeria using multistage sampling method. A comparison group of 392 out-of school female adolescents (mean age: 15.5±2.5 years) was also selected from a major market in the same Local Government Area using cluster sampling technique. Data was collected from the respondents with pre-tested, interviewer-administered questionnaires on reproductive and sexual health knowledge, risk perception and attitude, sexual behaviour, contraceptive knowledge and sources of sexual health information. Results: In-school girls demonstrated better knowledge of sexual and reproductive health compared to their out-of-school counterparts. The awareness of fertile period, contraception methods, STI and HIV transmission and prevention were all significantly better among the in-school adolescents compared to their out-of-school counterparts (P<0.05). They also had markedly higher risk perception of getting pregnant (P<0.05) or acquiring HIV infection (P<0.05) compared to their out-of-school counterparts. Conclusion: About 21% of adolescents in this study area were involved in risky sexual behaviour and this was higher among the out-of-school adolescents than their in-school counterparts. All stakeholders in the state and the Local Government Area should come together and develop interventions that would improve the sexual health knowledge and sexual risk perception of the adolescents.

Pain Relief in Postabortion Care Practiced by Healthcare Professionals in South Eastern Nigeria

Background: Postabortion care (PAC) is aimed at reducing maternal morbidity and mortality resulting from the incomplete abortion and abortion complications. The use of analgesia is an integral part of high quality PAC. Knowledge of the pattern of use of analgesia in PAC by healthcare professionals would help in planning group specific training programs for more effective PAC. Aim: This study is aimed at assessing the use of analgesia in PAC among healthcare professionals in South Eastern Nigeria. Subjects and Methods: This is a cross-sectional questionnaire-based survey carried out among healthcare professionals in Anambra State, Nigeria between June 1 and September 30, 2006. Participants were chosen using a multistage sampling technique. Pretested questionnaires assessing the practice of postabortion counseling were then administered. The data were analyzed using SPSS version 20.0 software. Frequencies were within 95% confidence limits. Results: A total of 437 health professionals were included in the study. The mean age was 38.2 (10.4) years. Formal PAC training influenced the use of analgesia positively (P < 0.001). The use of analgesia in PAC was also significantly higher among professionals working in tertiary healthcare center and private specialist hospitals when compared with other facilities (P = 0.02). In general complications were more when analgesia was not employed. Older professionals were more likely to employ pain relief in PAC (P = 0.01). Furthermore, doctors were significantly more likely to employ pain relief in PAC when compared to nurses (P = 0.001). Conclusion: This study revealed a low level of use of analgesia in PAC among the healthcare professionals. It also demonstrated a significant association between formal PAC training and use of analgesia in PAC. It is, therefore, recommended that increased PAC training and re-training activities with emphasis on the need for analgesia should be conducted for healthcare professionals to improve the quality of PAC received by clients.

Cervical cancer: Knowledge of Risk Factors and Practice of Preventive Measures among Female Primary School Teachers in Urban Anambra State, Nigeria -

Aim / Background: Cervical cancer is one of the most common forms of cancer among women worldwide. This study was aimed at establishing baseline knowledge of cervical cancer risk factors and practice of its preventive measures among female primary school teachers in urban Anambra State, Nigeria. Methods: A descriptive cross-sectional study in which data on knowledge and practice variables were collected from 250 female school teachers aged 18 to 65 years, using self-administered questionnaires. Same was analysed and data presented in frequency tables. Result: Only 15(6.4%) of the respondents felt they were at risk of cervical cancer even as 149(59.6%) had no idea of any symptom of cervical cancer; and none knew early stages of the disease could present with no symptoms. Moreover, 137(58.3%) knew no risk factor for cervical cancer while a smaller proportion knew HPV infection 20(8.5%) and cigarette smoking 23(9.8%) as risk factors. Only 1(0.4%) respondent had ever had a cervical screening as over 75% of respondents reported not knowing about the screening test as their main reason for not doing the test. About 23% of respondents would recommend cervical screening to another woman. Conclusion: This study has shown very poor knowledge of cervical cancer and its risk factors; and even a poorer practice of cervical cancer screening among the respondents. Female teachers must be well informed about this disease in order for them to give the right information to their students. Therefore, in both formal and informal settings, regular and sustained health education on cervical cancer should be directed at this group.

Challenges of data collection and disease notification in Anambra State, Nigeria

Background/Objective: Disease surveillance and notification (DSN) in Nigeria have been characterized by weaknesses such as insufficiencies in health infrastructure, scientific methods, and concepts of operation; essential human, technical, and financial resources; and international or local policies as well as lack of intra- and intersectoral collaboration. These weaknesses in DSN system thus compromise efficiency and quality of data. This study examined the challenges of data collection and disease notification in Anambra state, Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 270 healthcare workers selected by multistage sampling technique. Data collection was done using a mix method comprising interviewer administered questionnaires, health facility observational checklist, key informant interviews (KIIs), and desk review. Results: Commonest problems associated with DSN system as mentioned by the health workers were as follows: Most facility workers were not trained on DSN system (23.7%), lacked transportation (15.8%), poorly motivated/poor staff attitude (15.4%), inadequate supply of forms (11.8%), and poor funding (11.4%). An observational checklist on preparedness for DSN showed that 100% of primary and tertiary health facilities had facility records, while 81% at the secondary level had records. Only 51.9% facilities had community health officers (CHOs), while junior community health extension workers (JCHEWs) were more in primary health facilities compared to other levels of care (χ2 = 4.25, P = 0.040). Conclusion: Regular training program on DSN should be encouraged, while regular monthly supervision and quarterly meetings of health facilities should be organized for health facility workers. Regular and adequate information feedback should be emphasized.