Ekanem

Voluntary Counselling and Testing (VCT) for Human Immunodeficiency Virus: A Study on Acceptability by Nigerian Women Attending Antenatal Clinics

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.

Contraceptive prevalence among young women in Nigeria

Abstract In almost all societies in the world there is an increase in sexual activity among young persons (10 – 24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies. This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years. Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p < 0.05) among the single sexually active women (38.5%) than among the married women (7.7%). Only 7.3% of respondents are currently using a contraceptive method. The main methods in use were condoms and pills. There is an unmet need for contraceptives among young women in Nigeria. It is necessary to improve these young womens abilities to protect themselves against unwanted pregnancies.

Food hygiene behaviour among hospital food handlers

One hundred and sixty one food handlers in two hospital settings were evaluated for their knowledge and practice of certain aspects of food hygiene. They were also screened for nasal carriage of Staphylococcus aureus as well as for enteric pathogens and parasites. Positive responses to selected food hygiene behaviours such as handwashing before handling food and daily change of clothes were very high and encouraging. However, only a very small proportion (28.6%) were observed to have actually washed their hands especially between handling cooked and uncooked foods. The nasal carriage of Staphylococcus aureus was 24%. The significance of the isolation of the different enteropathogens is discussed. From an epidemiologic perspective, the foodhandlers were individuals from the lower socioeconomic class with low level of education. Because of their unique role in the hospital community, there is a need for continuous medical surveillance of this group of employees. Also a periodic in-service programme of health education on food safety and hygiene should be introduced to alert them of their responsibilities.

Sources of Contraceptive Commodities for Users in Nigeria

Background Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. Methods and Findings A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. Conclusion Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills.

Community-based survey of unwanted pregnancy in Southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria

Summary Estimates of maternal mortality are crucial to inform the planning of reproductive health programmes and guide advocacy. The aim of this study was to obtain a population-based estimate of maternal mortality in Lagos State, Nigeria. The sisterhood method was used in 2008 to carry out the survey using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within 6 weeks after childbirth. The survey involved 4,315 respondents who provided information on 9,910 ever married sisters. The life-time likelihood (risk) of maternal death for women aged 15–49 years was found to be 0.0239 or 1 in 42. The estimated maternal mortality ratio was 450 per 100,000 live births with a 95% CI of 360 and 530. Out of 111 reported deaths, 35 (31.5%) occurred during pregnancy, 49 (44.1%) occurred during delivery and 27 (24.3%) within 6 weeks of delivery.

Field Epidemiology" Methodological Constraints and Limitations in the Developing World

Abstract Effective planning for health services and facilities requires knowledge of not only theillnesses prevalent in a community but also of the quantity, distribution and the factors affecting their occurrence. In many developing countries, such information is not readily available because of gross inadequacies in the demographic, vital and health statistics collection system. In the absence of a reliable data source, well designed epidemiological surveys may provide clues on the health status of the community. However, the conduct of epidemiological surveys in this part of the world is subject to setbacks, limitations and constraints. Some of the limitations and constraints confronting epidemiologists are discussed. Their implications in the possible malpractice of epidemiology in developing countries should be of much concern.

Some epidemiologic and clinical features of cervical cancer in Lagos, Nigeria.

Between 1980–84, 114 cases of cervical cancer were seen at the Lagos University Teaching Hospital (LUTH). Eighty-six satisfied our criteria for inclusion in this analysis. The majority of the patients presented at a rather late stage when the tumour had metastasised beyond the cervix to the pelvic wall. The mean age of the cases was 52.4 years and the highest age-specific frequency was in women 45 – 54 years of age. Seventy percent (60/86) of the cases were Christians and only 22% were Muslims. No ‘never-married’ woman was found among the cases. The mean number of children per case was 5.6. Attribute-specific frequencies were also high for post-menopausal and low social class women. A more systematic population-based morbidity survey is desirable for the elucidation of the epidemiologic pattern of cervical cancer in Nigeria. An analytic study is necessary to identify risk factors for the disease in this part of the world.

Unmasking inequalities : sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story

Introduction Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. Materials and methods The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Results Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894–1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. Discussion The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations—as in the urban slums of Lagos.

Causes of maternal mortality in Lagos State, Nigeria

Background: Maternal mortality remains a major problem in many parts of the world including Nigeria.Understanding the causes of maternal mortality is crucial in confronting the challenge of unyielding high rates. The aim of this study was to determine the direct and indirect causes of maternal mortality in Lagos State, Nigeria. Materials and Methods: The study is a descriptive cross-sectional survey. The study population consisted of adults residing in Lagos State, Nigeria. The sample size used for this study was 29,988. The respondents were selected by multistage sampling from all the local government areas in the state. Data were collected using a structured interviewer-administered questionnaire. Data entry, cleaning, validation and analysis were done using Statistical Package for Social Sciences version 15.0. Results: Among the 29,988 respondents, 306 (1.0%) gave a history of married sisters who died during pregnancy, childbirth or during the postpartum period. Of the 306, 138 (45.1%) died during pregnancy; 107 (34.9%) died during childbirth, and 61 (19.9%) died during the postpartum period. Abortion, ectopic pregnancies and hypertension were the most commonly mentioned cause of death during pregnancy, while anemia, prolonged labor and obstructed labor were the common causes during childbirth. Human immunodeficiency virus/acquired immunodeficiency syndrome , infection and malaria were the common causes of maternal death during the 6 weeks after end of pregnancy/childbirth. Conclusions and Recommendation: Over half of the maternal deaths in Lagos State occurred during labor and immediately postpartum. Community education on the importance of having skilled attendants at delivery must be provided. Emergency obstetric care should be available, accessible and affordable at health facilities, and efforts must be made to prevent unwanted pregnancies and unsafe abortions by increasing contraceptive use. The malaria control efforts should be intensified.