Care for adolescent pregnancy and childbirth.

The rise in adolescent pregnancy in the 20th century has been influenced by declining age at menarche, increased schooling, delay of marriage, inadequate contraception and poverty. The main problems are preterm labor, hypertensive disease, anemia, more severe forms of malaria, obstructed labor in very young girls in some regions, poor maternal nutrition and poor breastfeeding. In many regions HIV infection is an important problem. The infants of adolescent mothers are more prone to low birth weight and increased neonatal mortality and morbidity. Antenatal care is often inadequate. The most important problem is the increased incidence of preterm labor and delivery, the youngest age groups running the highest risk. Technically, care of adolescents during labor need not differ from care of older women; most adolescents are not at increased risk during labor, although, they are more in need of empathic support. Generally, care of pregnant adolescents should be adjusted to their specific needs.

Unsafe abortion in adolescents.

Every year, an estimated 2.0-4.4 million adolescents resort to abortion. In comparison with adults, adolescents are more likely to delay the abortion, resort to unskilled persons to perform it, use dangerous methods and present late when complications arise. Adolescents are also more likely to experience complications. Consequently, adolescents seeking abortion or presenting with complications of abortion should be considered as a medical emergency. Issues requiring special attention in the management of abortion complications in adolescents are identified. Approaches to adolescent abortion should involve all levels of the health care system, as well as the community, and should include not only management of the consequences of unsafe abortion, but also post-abortion contraception and counseling. Prevention of unwanted pregnancy by providing information on sexuality, ensuring that reproductive health services are adolescent-friendly, creating a supportive environment, building young people's social and decision-making skills, and offering counseling in times of crisis are highlighted.

Upgrading obstetric care at a secondary referral hospital, Ogun State, Nigeria. The Lagos PMM Team.

PRELIMINARY STUDIES: A 1991 inventory at the State Hospital, Ota, in Ogun State, Nigeria, showed inadequate surgical equipment, drugs, blood and power supply. A time-motion study indicated substantial delays in receiving obstetric care. INTERVENTIONS: In 1994, medical officers and midwives were given refresher courses in emergency obstetric skills. In 1995, the surgical theater, labor ward and laboratory were provided with the necessary supplies and equipment. A reliable electrical supply was set up, but problems were encountered in establishing blood services. Subsequent community interventions focused on improving access and reducing delay in seeking care. RESULTS: The annual number of women with complications seen, which had been declining--from 123 in 1992 to 55 in 1994--increased to 91 in 1995. Case fatality rate (CFR) due to major direct obstetric complications did not change appreciably, i.e. it was 6.6% in 1995, as compared with 7.3%, 8.3% and 7.3% for the years 1992-1994, respectively. COSTS: The cost of hospital improvements was approximately US $46,000. CONCLUSIONS: The facility improvements were completed only recently in mid-1995. It is hoped that improved services will result in reductions in CFR and motivate more women with complications to seek hospital care, despite difficult economic conditions prevailing in Nigeria.

Factors affecting teachers' attitudes and practice of family life education in Nigeria.

PIP: Questionnaires completed by 700 secondary school teachers in Nigeria's Lagos, Kaduna, and Cross-River States revealed a generally positive attitude toward family life education. 53.56% of respondents were female and 31.5%% were or had been married. Their average age was 28.3 years. One third of the teachers were not parents, and only 15.5% had children as old as their students. The teachers expressed agreement with the importance of school-based sex education (71.6%), the potential for family planning to improve health (82.9%), concern with rapid population growth (68.7%), and awareness that teenage pregnancy and sexually transmitted diseases are major social problems in Nigeria (84.7% and 74.9%, respectively). Most identified ages 10-14 years as the ideal time to talk to children about sex. Half considered it the mother's responsibility to provide sex education, and most felt it is easier to talk to a female child. 45% of teachers agreed that contraceptive services should be available to adolescents. The factors associated with a positive attitude toward family life education were female sex, single marital status, Christian religion, and teaching in a coeducational school.^ieng

Differences between 'spacers and stoppers' amongst family planning acceptors in Lagos.

The study which is presented was carried out on 3,386 new family planning acceptors at a Primary Health Care clinic over an 11-year period. Women accepting modern family planning for stopping childbearing accounted for only 2.7% of the sample. They were older, less educated, and had higher mean gravidity, parity and number of children alive. They were also more likely to choose the IUCD over the pill. Service and policy implications of the findings are discussed.

Maternal weight and weight gain during pregnancy--can the arm circumference be used as surrogate?

A survey among pregnant Nigerian women attending an antenatal clinic showed a strong correlation between the arm circumference and weight. The sensitivity and positive predictive value of mid-arm circumference less than 23 cm for first trimester weight of less than 45 kg was 85.7% and 54.5% respectively. In the second trimester, these values for mid-arm circumference of less than 24 cm and weight less than 50 kg were 55.6% and 32.3% respectively. The specificity was high, ranging up to 99.4%. The value of the screening was found to be higher amongst primigravidas. Mid-arm circumference was however found to be insensitive for monitoring of weight gain during pregnancy. Strips based on this principle may be useful as a screening tool especially for low cadre health workers to identify pregnant women considered nutritionally at risk.

Approaches to AIDS education for the grassroots in Nigeria.

The most important aspect of reaching people at the grassroots level is to ensure their understanding by using the most appropriate language, and by ensuring that the largely illiterate population will, nevertheless, be well served by print and electronic mass media. The article also emphasizes the need to adapt educational aids to the audience they address, as well as the preference of offering interactive education.

PIP: Examining previous approaches and his own involvement, the author explains that the most effective methods for communicating the message of AIDS prevention at the grassroots level in Nigeria address the particular needs of the audience and rely on interactive education. Considering that not AIDS cure yet exists, the best hope for controlling the disease is effective health education. In places like Nigeria, where 85.3% of the population is rural, and where 54% of the mean and 77% of the women are illiterate, grassroots education takes an added importance. The author discusses educational efforts that have taken place at Fathers' Club, part of the country's family planning services, and in the market place. From experience like these, the author provides the following conclusions and suggestions: 1) people without access to social services often fail to receive AIDS education; 2) many people speak only their native language, so the conventional approach of using English -- Nigeria's official language -- proves ineffective; 3) educational forums that allow people to raise questions are the most effective; 4) the provision of additional services can help attract people in public places; 5) besides discussing the importance of condom use in AIDS prevention and family planning, a demonstration of correct condom use often makes the talks more interesting; 6) condom accessibility and acceptability can be improved by using clubs and associations as forums for AIDS education; and 7) transferring some of the responsibility of AIDS education to the members of these clubs and associations can help spread the message.

Identification of underweight women by measurement of the arm circumference.

A survey in Nigeria showed strong correlation between the arm circumference of women and their weight. This may be useful in assessing the nutritional status of women. The sensitivity and positive predictive values of mid-arm circumference less than 23 cm for maternal weight less than 45 kg was 62.3%, and 44.2%, respectively. Strips based on this principle can be used by lower cadres of health workers such as Traditional Birth Attendants, as a screening tool for women nutritionally at risk.

School teachers as primary health care workers.

Staff of preschool and primary schools in Lagos attended a one week course run by the Institute of Child Health and Primary Care to teach them some Primary Health Care skills so that they can recognize common illnesses in children and provide some preliminary care before referral. The course was well rated by participants and follow up showed that the skills had been useful to them and their various establishments. The model is recommended for replication elsewhere.

PIP: This paper discusses the attempt to increase coverage of health care delivery for preschool/school aged children by using their teachers as 1st contacts for primary health care (PHC) before referrals were made. 26 teachers from preschool and primary schools in Lagos, Nigeria attended a 1 week course run by the Institute of Child Health and Primary Care to teach them PHC skills before referrals. At the end of the course participants had to: 1) recognize common illnesses in children; 2) identify children needing immediate referrals to the hospital; 3) take temperature, sponge a child with a fever, sterilize an infant's feeding utensils using hypochlorite solution, assess the nutritional status of children; 4) list the various components and prepare a weaning diet; and 5) discuss the nutritional needs for preschool and school-aged children. All the participants improved their performance on the post-test. A year later participants and their employers were given short questionnaires. The employers rated the teachers' performance as very good and were willing to send them back for more training. The teachers were most useful in their establishments in dealing with: measles, fevers, convulsions, cuts and wounds, difficult breathing, diarrhea and vomiting, tepid sponging and temperature taking. This model is recommended for replication elsewhere. (Author's modified).

Pregnancy termination: results of a community-based study in Lagos, Nigeria.

A community survey in the Shomolu area of Lagos Nigeria showed the incidence of induced abortion to be 5.6%. Most of the abortions were carried out under medical supervision, using a combination of methods. Reasons for the abortions suggest that many were carried out on pregnancies that could have been prevented.

PIP: In Nigeria, abortion is allowed only to save the life of the woman. The violation of the anti-abortion law carries with it the stiff penalty of up to 14 years imprisonment. In spite of the stiff law, cases of bungled illegal abortions continue to be seen in the hospitals where they often present as septic abortions. The impact of illegal abortion on maternal mortality and morbidity is considerable. The incidence of abortion reported in this study (5.6%) is close to that of a previous study. This figure is probably a gross underestimation, as abortion is illegal, and women might not easily own up to having induced one. The reasons given for the abortions in this study have implications for the provision of family planning services. Illegal abortions are 10-250 times more dangerous than any kind of contraceptive measure, depending on the age of the woman, and the method used. Ignorance of family planning services is not an excuse in this sample as up to 95.2% of them knew about some modern contraceptive methods, and 85.4% were aware of the family planning services in the family health clinic in the target area. The abortees as a group have a higher rate of past use of contraception. Some of the women were afraid of complications arising from contraceptive methods. Others may have been using abstinence as a method of child spacing, which is common in this environment. Family planning services can be improved upon, especially in the areas of education regarding services available and dispelling rumors that arise about possible complications of contraceptive use. In addition, prompt treatment of complications will help to allay fears of users and potential users. Society should also be made aware of the socioeconomic and financial burden of illegal abortion.

Teaching medical students about family planning: experiences from a primary health care course in Lagos, Nigeria.

In 1979, the College of Medicine, Lagos, Nigeria embarked on a new curriculum, which places more emphasis on primary health care in line with the needs of the country. This paper discusses one aspect of the primary health care course, family planning, which involves teaching a practical subject to a large number of students within a relatively short period of time and with limited patient contact. It is hoped that some of the ideas discussed can be of use to other medical teachers faced with similar dilemmas.

Traditional child spacing practices of women: experiences from a primary care project in Lagos, Nigeria.

The study carried out within the target population of a Primary Care Project in Lagos, Nigeria, found that some changes had occurred. The traditional length of abstinence has decreased, and more women now resume sex before termination of breast-feeding. This should give rise to some concern especially if the level of adoption of modern contraception does not rise correspondingly. Other changes regarding the opinion of mothers about some of the practices, and the danger of the current trend of starting infant formula earlier in the post partum period are discussed.