Cervical cancer awareness and preventive practices: a challenge for female urban slum dwellers in Lagos, Nigeria.

Cervical cancer is the commonest gynaecological cancer in Nigeria and women of low socio-economic status are at high risk of this condition. A study was conducted on the awareness of cervical cancer, attitude towards the disease and screening practice of women residing in two urban slums of Lagos, Nigeria. It also determined the prevalence of major risk factors for cervical cancer among the women. Multistage sampling was used to select 240 women who were interviewed with a structured questionnaire and data collected was analyzed with Epi-info version 3.5.1 statistical software. Only 10 (4.2%) women in this study were aware of cervical cancer and none of them believed they were at risk of developing the disease. Most (73.3%) were willing to undergo a cervical cancer screening test. Age, education and previous history of vaginal examination were positively associated with willingness to undergo screening (p < 0.05). The respondents had a high prevalence of major risk factors for cervical cancer such as early age at sexual debut, multiple sexual partners and male partner with other female partners. Efforts need to be intensified to increase awareness of this condition and to promote low-cost cervical cancer screening among this underserved population.

An observational survey of child car safety practices in private pre-primary and primary schools in two local government areas of Lagos State, Nigeria.

OBJECTIVE: To describe child car safety practices among children aged 0-8 years. Eight schools from two local government areas (LGAs) were selected by simple random sampling. Passenger cars were observed for child seating position and restraint use at each selected school as children were being dropped off in the morning. RESULTS: Observed child restraint use was very low, as was the rate of appropriate restraint for age (10.8% and 4.2%, respectively, in Eti-Osa, and 7.0% and 1.8% in Ikeja). Child restraint use decreased with increasing age group from 25% in those below 1 year, to 12% in those aged 1-3 years, and 7.4% in those aged 4-8 years. A large proportion of restrained passengers were inappropriately restrained in a seatbelt alone. Front seating among observed child passengers was not as high as in studies from similar environments (9.4% and 17.5% in Eti-Osa and Ikeja, respectively). Factors associated with child restraint use were number of child passengers in car, and whether or not the driver wore a seatbelt. Seating position of the child was significantly associated with the relationship of the driver to the child, and driver's gender. CONCLUSION: The level of child restraint use observed in this study is unacceptably low. The relatively low prevalence of front seating while riding in cars should however be further reduced. The study recommends the enactment of specific country legislation on the use of child restraints, accompanied by multifaceted intervention programmes to improve the availability and use of child car safety seats and booster seats.

The effect of an educational intervention on improving rational drug use.

OBJECTIVE: To evaluate the effect of an educational intervention on rational drug use amongst Primary Health Care workers in two Local Government Areas (LGAs), Mushin and Ikeja, in Lagos State. METHODS: Mushin was randomly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention designed to improve prescribing practices was carried in Mushin LGA for four weeks. Drug use indicators were measured before, at two weeks and three months post intervention. RESULTS: At baseline, most of the drug-use indicators in the intervention LGA were significantly worse (p < 0.05) than the control LGA. However, at the two-week evaluation, the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3+ 2.8 to 6.3 + 2.3 (p=0.000) compared to the control LGA where there was no significant change (from 4.9+ to 4.8+2.2, p=0.647). There was also a significant increase in the percentage of patients rationally managed from 18% to 30% (p=0.0005) in the intervention LGA unlike the control LGA (from 33% to 31%,p=0.693.). The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA (+14% )compared to the control LGA (+2%,p=0.0000). The improvements were not sustained at the three-month evaluation, as most of the indicators were similar to values obtained at the baseline. CONCLUSION: The intervention programme significantly improved rational drug use in the short-term period only. Other cost effective and sustainable intervention models for improving prescribing practices should be developed.

The importance of training and supervision in quality of care.

Training of family planning service providers requires identification and selection of service providers, knowledge of their functions in the overall health team, provision of job descriptions and assessment of training needs. These can assist in the definition of training objectives and the establishment of program content. Varied teaching methodologies and aids can enrich the program and maximize learning and the venue and facilities provided for training should be accessible, appropriate in setting (using primary, secondary or tertiary facilities as necessary) and should provide an adequate standard of care. Evaluation of training performance should be regular and ongoing, with final assessment leading to recognition of training. The program should be evaluated by trainers and trainees to assist in improving the quality of the training and competence of the trainers. Finally, supervision and monitoring of performance in the workplace can be achieved by direct internal or external supervision, by indirect supervision using standing orders or guidelines, and by evaluation by managers, service providers and clients.

Analysis of women who discontinued the use of injectable contraceptive over a 14-year period in a tertiary health institution in Nigeria

Five hundred and seventy three women who had used depot medroxy progesterone acetate for contraception and had discontinued its use over a 14 year period were critically analysed. Five hundred and twenty one (90.0) of them were grand multiparae and two thirds of all the women were over 35 years of age. The majority of them gained or lost between 0.5-4 kilograms; 66.3and 82.7respectively. A discontinuation rate of 60.7was found. Changes in menstrual bleeding were found to be the main reason for discontinuation; bleeding problems (22.9) and amenorrhoea (17.5). There was no discontinuation for failure of contraception. The high rate of default (24amongst clinic depot users and 39.6amongst those who discontinued) was believed to be due to high mobility rate of our users

A study on female circumcision in Nigeria.

A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February 1984 to September 1984. Of these, 84.7% were aged between 25 and 44 years and most of them are Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised but examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised amongst the respondents, 76.7%, followed by the Ibos, 61%, and least of all the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% had theirs as adults, however, the Ibos and Yorubas had high rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers except one and she had to circumcise her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses, nevertheless, the complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications and other attendant health hazards should be embarked upon by health authorities especially amongst the tribes practising it.

PIP: A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February-September 1984. Of these, 84.7% were between 25-44 years of age and most of them were Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised by examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised among the respondents, 76.75 followed by the Ibos, 61% and lastly the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% has theirs when adult; the Ibos and Yorubas had the highest rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers with the exception of 1 and she circumcised her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses. Nevertheless, complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications, and other attendant health hazards should be issues dealt with by health authorities, especially among the tribes who practice it. (author's modified)

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.

Breast-feeding among female employees at a major health institution in Lagos, Nigeria.

The importance of breast-feeding to the health of infant and mother is discussed. However the working conditions of employed women in developing countries prevent exclusive breast-feeding once the mother has returned to work after delivery and also present obstacles to partial breast-feeding. The breast-feeding practices of women employed at a major health institution in Lagos, Nigeria are examined. Duration of breast-feeding was in inverse relation to salary level. Women on the lowest salaries had a mean duration of breast-feeding their last child of 8 months, whereas women in senior professional positions had a mean breast-feeding duration of 3.3 months. Conflicts with work responsibilities were the most commonly cited reason for terminating breast-feeding earlier than the mother desired. If a creche was available at place of work, half the women surveyed said they would breast-feed for longer. Anticipated durations, if a creche was available, would lengthen breast-feeding to 12 months for lowest paid women and to nearly 9 months for women at the higher salary levels. Present options available to the employed women who wishes to breast-feed as long as possible, namely the use of wet-nurses and expression of breast-milk, are discussed. It is concluded that the most satisfactory means of promoting breast-feeding among employed women is the provision of paid leave post delivery for at least three months and the provision of a creche at place of work. The costs should be borne by the employer, assisted by government in the form of grants and tax-relief.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of the effectiveness of the Lippes Loop, the Copper-T-200, and the Nova-T intrauterine contraceptive devices in Lagos, Nigeria.

Two hundred five women attending the Family Planning Clinic of the Department of Community Health were admitted into a nonrandomised study to compare the effectiveness of the Copper-T-200, Nova-T, and Lippes Loop intrauterine devices. Members of the study group of women were found to be older than their European counter-parts and also tended to have a higher parity (81.0% of the total group having more than three children). The expulsion rates and removal rates for bleeding and pain for Copper-T-200 and Nova-T users were respectively 6.5 and 3.8 and 5.0 and 1.5. These results were significantly lower than the rates for the Lippes Loop users which were 14.7 and 6.7, respectively. The continuation rates were higher for the Copper-T-200 (88.2) and the Nova-T (91.3) than for the Lippes Loop (75.5). These findings were essentially similar to those of other worldwide studies.

Maternal and child health and family planning in Nigeria.

PIP: In Nigeria the maternal and child health services available provide care to only a small percentage of the population, who are mainly those living in the urban areas. Over 85% of the population live in rural areas where medical facilities and coverage are lacking. As a consequence, the maternal and infant mortality rates for Nigeria as a whole remain very high. The problems facing Nigeria involve the inadequate provision of trained medical and paramedical personnel and the inefficient utilization by the community of the services provided. In a study performed in Lagos in 1970, the inefficient use of services was demonstrated by the fact that although 53% of a sample of 526 ill children were seen at the Casualty Department of the Teaching Hospital within 2 days of the onset of their illness, 12% were not seen until 2-3 weeks had elapsed since the onset of their illness. With the high infant mortality rate of over 150 deaths/1000 live births which still exists in the rural areas, mothers are unlikely to accept family planning on its own as a desirable contribution to the improvement of their health and their family's health. The experience of the family planning clinic of the Department of Community Health seems to show that noneducated women accept family planning services more easily in urban than in rural areas. The experience of the Lagos Family Planning Health Clinic has shown that a community approach to the provision of comprehensive maternal and child health and family planning service can be most successful in improving the health status of women and children in an urban setting. Use of nurse practitioners to provide care in this service has helped to increase the efficiency of the provision and delivery of health care. The provision of the new cadre health worker has commenced with the 1st training program initiated in 1979.^ieng

A comparative study of the clinical performance of two copper-releasing IUDs, Nova-T & Copper-T-200 in Lagos, Nigeria.

A non-randomised study was performed to compare the use-effectiveness of the Copper-T-200 and Nova-T intrauterine devices. It was found that generally, results compared favourably with other world-wide studies. No accidental pregnancies were experienced and no significant difference was found between the expulsion rate of the Nova-T (5.0) and that of the Copper-T-200 (6.5) and the removal rates for bleeding and pain, which were 1.5 and 3.8, respectively. The continuation rate for the Nova-T was 91.3 compared with 88.2 for the Copper-T. The total experience was based on 815 woman-months of use.

PIP: In a nonrandomized trial, Copper T 200 and Nova T IUDs were inserted in 67 and 65 women respectively during a menstrual period or within 1 or 2 days postmenstrually. Life table method by Tietze and Lewitt was used in data analysis. 70% of the patients were over 30 years in both groups. Lowest number of insertions was in the 20-24 age group for both devices. No accidental pregnancies were observed for 12 months of use for either group. Expulsion rate for Nova T was 5.0 and for Copper 200 was 6.5; the difference was not considered significant. The lower expulsion rate associated with higher age range and parity of the Lagos women confirm observation by others that increasing age and parity were associated with declining expulsion rate. Removal rates for bleeding and pain were 1.5 for Nova T and 3.8 for Copper 200. These rates are comparable with those in Europe. Continuation rates were 91.3 for Nova T and 88.2 for Copper 200. It was concluded that use of copper IUDs may help promote a more favorable attitude to use of IUDs in developing countries.

A scoring system for sick children.

A scoring chart for sick children was designed using the vital signs of temperature, respiratory and pulse rates, and the central nervous system. The scoring chart was used on 68 sick children who had been randomly selected from a child welfare clinic in Lagos. Analyses of the charts showed that although values overlapped when related to clinical impression, there was an inverse correlation with the severity of the illness. The correlation coefficient between the doctors' and nurses' scores was high. Despite the need for further modification and investigation the scoring chart was promising as a screening tool for use by people who were not doctors and, possibly in some situations, by those who were not nurses.