Olukayode A. Dada

A randomized, double-blind, noninferiority study to compare two regimens of levonorgestrel for emergency contraception in Nigeria.

BACKGROUND Unplanned pregnancies are common in Nigeria. Much of the unplanned pregnancies is due to low contraceptive prevalence and high contraceptive user failure rates. High user failure rates suggest the important role of emergency contraception to prevent unplanned pregnancy. STUDY DESIGN Randomized, controlled, double-blind, multicenter, noninferiority trial comparing efficacy and side effects of two emergency contraceptive regimens up to 5 days after unprotected intercourse among 3022 Nigerian women: levonorgestrel administered in two doses of 0.75 mg given 12 h apart and levonorgestrel administered in a single dose of 1.5 mg. RESULTS Efficacy was similar between the treatment groups; post-treatment pregnancy proportions were 0.57% in the two-dose regimen vs. 0.64% in the single-dose regimen (risk difference 0.07% (95% CI -0.50 to 0.64). The majority of women menstruated the first day of expected menses and the groups did not differ regarding reported side effects. CONCLUSIONS This study shows the simplified emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen among Nigerian women.

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

BackgroundThe lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigerias Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria.ObjectiveThe primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country.MethodsThis will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.ManagementOverall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria.Expected outcomesThe outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Management of erectile dysfunction: perceptions and practices of Nigerian primary care clinicians

Abstract Background Erectile dysfunction (ED) is a prevalent health problem in many societies, but the diagnosis is seldom documented in primary care. The objective of this study was to investigate the perception and practices of clinicians regarding the management of ED in primary care settings in Nigeria. Methods A self-administered semi-structured questionnaire was applied to a purposive sample of clinicians attending conferences/workshops organised by the Society of Family Physicians of Nigeria and Update Courses of the Faculties of Family Medicine of the National Postgraduate Medical College of Nigeria and the West African College of Physicians. Information was obtained on their professional characteristics, experiences with the management of ED and possible barriers to the effective management of ED. Results A total of 187 completed questionnaires were analysed. Most (87.2%) of the respondents were general practitioners, while the rest were specialists in various fields (excluding sexual health) who worked at the primary care level. One hundred and forty-seven respondents (76%) reported that ED was common in their clinical practice. Over half (56.2%) of the respondents ascribed a high priority to ED management in their day-to-day clinical practice, while 33.2% and 10.6% of them ascribed medium and low priority to ED management respectively. Although 80.8% of the respondents agreed that ED patients could benefit from orthodox treatments, only 18% of them had ever prescribed any medication for affected patients; most (82%) of them either counselled or referred ED patients to secondary or tertiary care level for further management. Most of the clinicians (62%) would not take a sexual history unless the patient brought it up. The reported barriers to the management of ED include lack of a standardised protocol (64.2%), inadequate experience in ED management (85.6%), preference of patients for native medication (42.3%), and the high cost of modern medication (48.1%). Conclusion The clinicians acknowledged the high prevalence of ED in the primary care setting and recognised that they had a role to play in managing affected patients. The identified barriers to the management of the condition point to the need for education of both clinicians and patients, as well as the provision of guidelines for the management of ED in primary care settings.

Community perceptions of pre-eclampsia and eclampsia in Ogun State, Nigeria: a qualitative study

BackgroundPre-eclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in sub-Saharan Africa. When undetected or poorly managed, it may progress to eclampsia which further worsens the prognosis. While most studies examining pre-eclampsia have used a bio-medical model, this study recognizes the role of the socio-cultural environment, in order to understand perceptions of pre-eclampsia within the community.MethodsThe study was conducted in Ogun State, Nigeria in 2011–2012. Data were obtained through twenty-eight focus group discussions; seven with pregnant women (N = 80), eight with new mothers (N = 95), three with male decision-makers (N = 35), six with community leaders (N = 68), and three with traditional birth attendants (N = 36). Interviews were also conducted with the heads of the local traditional birth attendants (N = 4) and with community leaders (N = 5). Data were transcribed verbatim and analysed in NVivo 10 software.ResultsThere was no terminology reportedly used for pre-eclampsia in the native language - Yoruba; however, hypertension has several terms independent of pregnancy status. Generally, ‘gìrì âlábôyún’ describes seizures specific to pregnancy. The cause of hypertension in pregnancy was thought to be due to depressive thoughts as a result of marital conflict and financial worries, while seizures in pregnancy were perceived to result from prolonged exposure to cold. There seemed to be no traditional treatment for hypertension. However for seizures the use of herbs, concoctions, incisions, and topical application of black soap were widespread.ConclusionThis study illustrates that knowledge of pre-eclampsia and eclampsia are limited amongst communities of Ogun State, Nigeria. Findings reveal that pre-eclampsia was perceived as a stress-induced condition, while eclampsia was perceived as a product of prolonged exposure to cold. Thus, heat-related local medicines and herbal concoctions were the treatment options. Perceptions anchored on cultural values and lack of adequate and focused public health awareness is a major constraint to knowledge of the aetiology and treatment of the conditions. A holistic approach is recommended for sensitization at the community level and the need to change the community perceptions of pre-eclampsia remains a challenge.Trial RegistrationNCT01911494.

Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.

BackgroundPre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia.This study aimed to determine community health workers’ knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria.MethodsThis study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers – and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0.ResultsCommunity-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their ‘Standing Order’; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community.ConclusionCommunity-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres.Trial registrationNCT01911494.