Factors associated with exclusive breastfeeding in Ibadan, Nigeria.

Although nationwide efforts to promote exclusive breastfeeding began in Nigeria in 1992, data on this type of infant feeding are still generally scarce. Current status breastfeeding data were obtained from 2794 mothers, enrolled from randomly selected infant welfare clinics in Ibadan, Nigeria, to evaluate factors that are associated with exclusive breastfeeding. The exclusive breastfeeding rate dropped from 57.4% at 1 month to 23.4% at 6 months. Using multiple regression analysis, younger age of infant (P < .0001), higher maternal occupation (P < .05), and delivery in tertiary (P < .0001) or secondary (P < .0001) health facility were predictive of exclusive breastfeeding. Mothers 24 years or younger and primiparous mothers were less likely to breastfeed their babies exclusively (P < .01 and P < .05, respectively). Additional programs are needed to meet the needs of at-risk mothers, who should be identified and counseled.     

Menstrual regulation in Ibadan, Nigeria.

Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.     

Benign hydatidiform mole in Ibadan, Nigeria.

A study was conducted to analyze 61 patients with benign hydatidiform mole (HM) who were admitted to the University College Hospital in Ibadan, Nigeria, during a 5-year period. The hospital incidence of HM was 1:205 pregnancies, and the condition was seen most commonly in young women, probably because early marriage is customary in our culture. Management of the condition generally was conservative because of the patients' youth. There was no correlation between HM and parity. Vaginal secondaries due to an embolic phenomenon were detected in 5% of the patients. Subsequent pregnancies followed within 6 months of treatment because the majority of the patients failed to heed medical advice to delay pregnancy for 2 years. No diagnostic problems were encountered in the patients who became pregnant during the follow-up period.     

Trends in postabortal mortality and morbidity in Ibadan, Nigeria.

Illegally induced abortion at the University College Hospital, Ibadan increased steadily over a 10-year period (1980-1989) despite increasing availability of family planning services. Abortion was the commonest cause of death in the gynecology service during the period of the study and constituted 36.6% of fatalities. The majority of patients (76.2%) did not accept contraceptives. Almost one-third of the illegal terminations were performed by physicians. Although the percentage of deaths decreased, the contribution of physicians to these fatalities increased, and accounted for 6/9 (66.7%) of fatalities in 1989. This circumstance probably signifies a defect in physician training and ability to perform abortion aftercare. Physicians should be trained in abortion care and laws changed in conjunction with greater drive to improve contraceptive utilization and reduce the incidence of unsafely induced abortion.     

STI/HIV co-infections in UCH, Ibadan, Nigeria

Sexually transmitted infections (STIs) are poorly recognised and inadequately treated in Nigeria in spite of the fact that it constitutes a major risk for HIV transmission. This study was carried out to ascertain STI/HIV co-infection rate and to obtain relevant socio-demographic and reproductive health data associated with STIs. This information is urgently needed for designing STI/HIV control strategies. All consenting patients with history suggestive of STI, who attended STI clinic at the University College Hospital, Ibadan, between March and November 2001 were enrolled in the study. Of the 210 patients seen, 98 (46.7%) were males while 112 (53.3%) were females (p > 0.05). One hundred and fifty six (74.3%) of them were aged 20-39 years while only 10 (5.1%) were adolescents. Twenty (9.5%) had laboratory diagnosis of STIs, out of which 6 (30%) were also HIV positive. Among those with STIs, 8 (40%) had gonorrhoea, 8 (40%) had candidiasis, while 4 (25%) were positive for Trichomonas vaginalis. None of the patients' sera was positive for Treponema palladium antibody HIV prevalence rate in the study was 21.9%. Highest rate was found in patients aged 20-29 years while no adolescent and no one over 50 years old was HIV positive. Five (62.5%) of the patients with gonorrhoea were also HIV positive, a lower percentage (25%) of those with trichomoniasis were positive for HIV, while none of those infected with candidiasis was HIV positive. STI/HIV co-infection rate was 30%. This study reveals a high STI/HIV co-infection rate, indicating that there is a need for proper management of STIs as a way of reducing the spread of HIV infection in Nigeria.     

Experience of sexual coercion among adolescents in Ibadan,Nigeria

This study surveyed 1,025 adolescent students and apprentices in Ibadan, Nigeria, to document their sexual behaviour and experience of sexual coercion including verbal threats, unwanted touch, unwanted kiss, assault, deception, drugging, attempted rape, and rape. Sixty five per cent of male and 48% of female apprentices were sexually experienced, compared to 32% of male and 24% of female students. More males than females reported sex with multiple partners and contact with a sex worker while females had exchanged sex for money and gifts. Fifty five per cent of all the subjects had been victims of at least one type of sexual coercion, the commonest being unwanted kiss and touch of breasts (47%). Although both males and females were victims of coercion, females were disproportionately affected--68% of female students and 70% of apprentices had experienced one coercive behaviour, compared to 42% of male students and 40% of apprentices. Female apprentices fared worst, with 19% of them raped. The main perpetrators of the coercion were persons well known to the victims including neighbours, peers and boy/girlfriends. We recommend multiple intervention programs including skills training for young persons, sensitisation workshop for training health workers, and media advocacy for the public to challenge stereotypes that favour sexual coercion of adolescents.     

Advanced cervical carcinoma in Ibadan, Nigeria: an appraisal of radiation therapy.

This is a retrospective study of 500 patients with advanced cervical cancer (FIGO Stages IIB, III and IVA) who were seen and managed at the University College Hospital Ibadan between 1988 and 1992. External pelvic radiation therapy plus intractivary radioactive caesium brachytherapy was mainstay of treatment. Complete response to therapy was recorded in 68% of patients with stage IIB, 57% in stage III and 41.2% of patients in stage IVA. In patients with stage IIB, the local tumour control was 65%, in stage III patients 54% and in patients with stage IV 41%. The cumulative rates of survival at 5 years (for all the patients-with stage IIB, III and IVa) were 41.5%. The cumulative rates for disease-free survival at 5 years was 25.5%. Radiotherapy as the sole treatment modality in the management of advanced cervical cancer in Ibadan has yielded poor results as revealed in this study. There is an urgent need to evolve a new treatment policy with the aim of improving the response rate and survival in this group of patients.     

Electronic communication with patients for breastfeeding support.

The Internet has become an important tool for patients seeking to expand their knowledge of health conditions and medications. Breastfeeding initiation and duration increase because of physician encouragement. Therefore, electronic communication potentially provides additional opportunities for physicians to inform, reassure, encourage, and support breastfeeding families. An e-mail from a breastfeeding mother may deal with a topic well-suited to e-mail communication, such as information on the safety of specific medications during breastfeeding, or may deal with a concern that would make observation of breastfeeding necessary. Physicians have expressed qualms about electronic communication with patients due to privacy, malpractice liability, time, and reimbursement issues. Strategies to optimize e-mail communication include establishing a turnaround time for responses, informing patients of privacy issues, establishing what types of messages are appropriate over e-mail, and setting limits for when an e-mailed concern escalates to a need for an office visit.     

Perceptions of sexual coercion: learning from young people in Ibadan, Nigeria

This study explored the problem of sexual coercion from the perspectives of 77 young people aged 14-21 in Ibadan, Nigeria, the behaviours they perceive to be sexually coercive and the contexts in which these occur through four narrative workshops. Participants were drawn from two secondary schools and 15 apprentice workshops. All four groups identified similar coercive behaviours and developed narratives of the events that typically lead up to them. Behaviours included rape, unwanted touching, incest, assault, verbal abuse, threats, unwanted kissing; forced exposure to pornographic films, use of drugs for sedation and traditional charms for seduction, and insistence on abortion if unwanted pregnancy occurs. Men were typically the perpetrators and young women the victims. Perpetrators included acquaintances, boyfriends, neighbours, parents and relatives. All the narratives revealed the inability of young people to communicate effectively with each other and resolve differences. The results suggest the need for life-skills training that facilitates communication, seeks to redress gender power imbalances, teaches alternatives to coercion as a means of resolving conflict over sexual relations and respect for sexual and reproductive rights, and provides victims with information on appropriate services, support and referral.     

Factors influencing gestational age at antenatal booking at the University College Hospital, Ibadan, Nigeria.

In order to achieve the aim of improved outcome of pregnancy for mother and fetus, early booking (first antenatal visit), prior to 14 weeks' gestation is usually recommended. A survey of information on personal data, index pregnancy, reasons for booking at a particular gestational age, past obstetric history and medical history of 205 pregnant women attending the antenatal booking clinic at the University College Hospital, Ibadan, Nigeria was carried out using a structured questionnaire. The mean gestational age at booking was 21.82 (+/-7.0) weeks. Only 29 patients (14.1%) booked before 14 weeks. The reasons given for early booking among them were the perceived benefits of such practice (41.4%), physician's recommendation (34.5%) and occurrence of complication(s) in previous pregnancy (24.1%). Illness in the index pregnancy and nulliparity were the only factors found to significantly favour early booking. The need to educate women of the reproductive age group, who are potential mothers, on the benefits of early booking was recommended.     

Intimate partner abuse: wife beating among civil servants in Ibadan, Nigeria

Wife beating is one of the most common forms of violence against women by husbands or other intimate male partners. Although violence against women is pervasive, there are only few studies documenting the magnitude of the problem especially among the working class. The civil service comprises of persons from all socio-economic levels and different backgrounds. They act in advisory capacity and assist those responsible for making state policy Thus, 431 civil servants of the Oyo State government service were interviewed using a 44-item self-administered questionnaire. Results revealed that prevalence of wife beating was 31.3%. Ninety one (42.5%) men had been perpetrators, while 44 (23.5%) women had been victims. Consuming alcohol and growing up in an environment where parents fight publicly were significantly associated (p < 0.05) with men beating their wives; while being young, unmarried and a parental background of fighting was significantly associated with women being beaten (p < 0.05). Female respondents justified reasons for various types of domestic violence, including beating, more than the males (p < 0.05). Younger respondents had significantly worse attitudes (p < 0.05), while married and educated respondents had better attitude (p < 0.05). "Not wanting the children to suffer" (60.7%) and "hoping that partner will change" (28.8%) were reasons given for remaining in abusive relationships. There is an urgent need for education of the women on their rights, sensitisation of the men on gender-based violence and punishment for perpetrators. Supportive care and counselling services should also be provided for victims of violence.     

Optimizing breastfeeding promotion and support in adolescent mothers.

The United States has the highest teen birth rate in the industrialized world, and adolescents continue to have the lowest rates of breastfeeding. Although individual pregnancy and parenting experiences in adolescents are modified by a variety of factors, common themes of adolescent psychology and behavior may help plan effective strategies for breastfeeding promotion and support. Breastfeeding promotion and support in adolescents need to be developmentally appropriate, patient centered, and linked to multidimensional support.     

Emergency contraception: survey of knowledge, attitudes and practice of health care professionals in Ibadan, Nigeria.

This survey was conducted to determine the knowledge, and prescribing attitudes of emergency contraception among healthcare professionals in Ibadan, Nigeria. A questionnaire was administered to 735 health care professionals in selected healthcare facilities in Ibadan. These facilities were randomly selected as part of an ongoing programme designed to introduce emergency contraceptive pills (ECPs) as a clinic based method of family planning in service delivery outlets in the city. The response rate was 87.5%, comprising nurses (59.3%) and physicians (25.0%). Others were pharmacists, social workers and administrators. The results revealed that healthcare professionals' knowledge of various methods that can be used emergency contraception is very low. Less than half (35.1%) of the respondents were aware that combined oestrogen/progestin or progestin-only pills can be used as emergency contraception. Similarly, only 26.7% and 13.3% of the respondents were aware that intrauterine contraceptive devices and mifepristone respectively could be used as emergency contraception. While only 16.3% of the respondents had ever prescribed the combined pills as emergency contraception, 10.9% and 8.2% had prescribed progestin-only pills and intrauterine contraceptive devices for this purpose in the past. Circumstances under which emergency contraception could be used vary among the respondents but 71.4% and 64.4% were of the opinion that condom breakage and sexual assault would be appropriate indications for its use. Two main sources, hospitals (68.4%) and pharmacies (8.8%) were identified by participants. It is apparent that one of the major barriers to frequent use of emergency contraception in Ibadan is the lack of awareness of its use by healthcare professionals. Therefore, there is an urgent need to educate these practitioners and include emergency contraception in the family planning curriculum of nursing and medical schools.     

Menstruation: symptoms, management and attitude of female nursing students in Ibadan, Nigeria

This study surveyed 120 student nurses from two schools of nursing in Ibadan, Nigeria to assess the symptoms experienced during menstruation, attitude towards and management of menstruation. The student nurses overall mean age at menarche was 14 years, average duration of menstrual period was five days and mean of menstrual cycle was 28 days. Out of the 120 study participants, 93% were having menstruation regularly. More participants experienced symptoms during premenstrual periods than menstrual periods. Majority (70%) used sanitary pad to manage their menstruation, 93% had positive attitude towards menstruation while only 20% consulted medical doctors whenever they experienced menstrual symptoms. Paracetamol was the drug of choice for many of the participants whenever they experienced menstrual symptoms It was recommended that authorities in schools of nursing should not overlook reproductive health needs of students. Also teaching of reproductive health education early in primary and secondary schools should be encouraged.