Using therapeutic support: my hands-on experience as a psychiatric nurse.

1. Therapeutic support is an indispensable tool in clinical nursing,regardless of specialty area. 2. Nurses are being increasingly recognized as more effective therapists who bring broader perspective because of being caregivers for the client's physical needs. 3. Nurses, especially those who work in psychiatric units, require more than what basic nursing programs currently provide in psychiatric nursing education.

Polypharmacy: its cost burden and barrier to medical care in a drug-oriented health care system.

In order to determine the economic and therapeutic implications of the prescriber habit in a drug-oriented health care system, data were collected on the provisional diagnosis, prescribed drugs, and their cost and procurement pattern among 1450 pediatric outpatients in a Nigerian University Teaching Hospital. It was found that on average, about five drugs were prescribed for each patient, and there was a tendency to prescribe more expensive and sometimes unnecessary drugs. The more the number or higher the cost of drugs prescribed, the less patients procured them. It is therefore recommended that health care authorities and physicians in similar settings should review their drug policies and prescribing habits in order to discourage polypharmacy and the high cost of chemotherapy, with their attendant barrier to medical care.

Prelacteal feeds and breast-feeding problems.

PIP: The infant feeding experiences of 210 mother-child pairs delivered in 5 settings in Benin City, Nigeria, were compared to evaluate the influence of health workers and health services. One purpose of the study was to identify specific practices that discourage breastfeeding. The delivery settings included a university teaching hospital, a state government hospital, a voluntary agency hospital, a privately run maternity home, and home deliveries. 85% of mothers simultaneously breastfed and bottle-fed their infants; only 9% of infants were exclusively breastfed, with little variation among the 5 groups. The length of time preceding onset of breastfeeding ranged from 1.8 days among infants delivered by traditional birth attendants to 2.6 days for those delivered in the university hospital. The voluntary agency hospital dissuaded mothers from bottle-feeding during the immediate postpartum period while the teaching hospital fed formula to infants soon after birth (prelacteal feeds). The private maternity home also practiced prolacteal feeding until the mothers could produce enough milk, while the government central hospital did not appear to follow any set policy regarding bottle-feeding. Traditional birth attendants were not reported to impose any position on infant feeding. 93% of respondents stopped breastfeeding because of problems related to inadequate milk supply, congested breasts, biting, or the infant's refusal to suckle. The average duration of breastfeeding ranged from 5.2 months among infants delivered at the teaching hospital to 9 months among infants delivered at home. There was an association of 3 factors; early onset of bottle-feeding, significantly shorter duration of breastfeeding, and a higher incidence of feeding-related problems. Also apparent was a lack of knowledge regarding the value of colostrum and the physiology of lactation.^ieng

The changing pattern of post-partum sexual abstinence in a Nigerian rural community.

With a structured interview schedule, this study surveyed the pattern of post-partum sexual abstinence in a Nigerian rural community where facilities for active contraception were absent. It was found that the younger generation observed significantly shorter abstinence period (P less than 0.01). Without contraception, the resultant increased period of sexual contact among couples may considerably raise the fertility of the population. The need for family planning services is therefore indicated, preferably integrated into primary health care programmes designed to reach rural communities.

Circumcision: its nature and practice among some ethnic groups in southern Nigeria.

A questionnaire survey carried out in five rural communities in mid-southern Nigeria documents the degree and range of male and female circumcision practices among Bini, Esan, Etsako, Ijaw and Ukwuani ethnic groups. Two hundred and eighty adults (154 males and 126 females) reported on themselves and their 1417 children (757 sons and 660 daughters). Circumcision of both sexes remains widely practised, though the timing of the event and extent of surgery show wide variations among, and sometimes, within ethnic groups. The commonest reason for the practice is a strong desire to continue ethnic traditions. Altered sexual urge for women, increased sexual performance for men, protection of baby's health, as well as general reproductive and aesthetic consideration are also important reasons. Traditional surgeons usually perform the operation and few complications were reported to be associated with the procedure in either sex. Female circumcision in this area is not as destructive or mutilating as in some Arabic and East African cultures. Because of the relatively low rate of complications a major campaign against circumcision in these areas does not at present seem warranted.