Family Planning: Adolescents Tell Stories Of Stigma Inside Lagos Youth-Friendly Centres

BY CHIOMA UMEHA

Lagos – When women and girls have access to contraception, fewer babies and mothers die. Around the world, millions of women can’t get the contraception they want.

Numerous studies show that the ability to plan pregnancy is directly and unequivocally linked to lower maternal mortality, lower infant and under-five mortality, lower mother-to-child transmission of HIV, and a whole host of improved health indicators.

Here is just one example: when a woman spaces her births by at least three years, her newborn baby is twice as likely to reach its first birthday.

However, negative reports on sexual reproductive health (SRH) outcomes in the country show that there is a need to improve access to family planning information and services for Nigerian adolescents.

The 2014 World Health Organisation’s (WHO) report and 2013 Nigeria by our Reporter Demographic and Health Survey (NDHS) presented the worrisome statistics of Nigerian young women whose lives are cut short due to reproductive health complications.

At 576 maternal deaths per 1,000 live births, the country accounts for 14 per cent of the global burden of maternal mortality.

Statistics put the average age of first sexual experience at roughly 15 years among Nigerian adolescent mothers (NDHS 2003, 2008, 2013).

Similarly, the National adolescent fertility rate in Nigeria is 122 births per 1,000 women aged 15 to 19.

Imagine what life would be like if you were not able to make your own decisions. Take a minute and step into the shoes of a young woman who does not share the same power to make choices about family planning.

To curb maternal deaths, the Lagos State government with support from donor agencies has set up youth-friendly health care centres with care providers to offer an appropriate response to youths’ sexual reproductive health needs.

Barriers to sexual reproductive health services

But, despite the friendly-centres, gaps that limit youths’ access to SRH in the country still persist, including, poor awareness, lack of confidentiality in service delivery among others.

Our Reporter’s investigations show that many Lagos youths who are sexually active remain confronted with several barriers in obtaining necessary information about the different method of contraception, available at the youth-friendly centres.

The barriers include; provider bias, the attitude of the family planning officer, religious sentiments among others.

The issue of improving youths' access to family planning was a major agenda of a three-day capacity building workshop on investigative journalism organised recently, for Media Advocacy Working Group (MAWG) by Pathfinder In family planning International Nigeria, in Lagos.

Youths decry care providers’ attitude

At some of the Lagos-based youth-friendly centres, some adolescents who interacted with our Reporter expressed dismay over the attitude of some family planning providers.

The story of unfriendliness and poor counseling about family planning from counselors was the same from Ikotun to Alimosho, even Agege youth-friendly centres, Mary Ibrahim, aged 25 and a graduate of Economics who spoke to Our Reporter confirmed the situation. She said that the first question from a service provider at the youth-friendly centre was targeted on her age bracket.

Decrying the situation, she said; “Immediately I declared that I have three boyfriends at 25, the body language of the service provider changed. This may not be unconnected with religious sentiments, judging from her countenance. I say this because; I noticed the way she was looking at me.

“So I was neither given an opportunity of seeing a condom nor counseled properly on other options of contraception, so, I left the centre.”

Miss Ibrahim regretted that the reception from family planning providers were not warm as anticipated. “I wondered if it should have been better to have an unplanned pregnancy than to receive such cold and disdainful treatment from family planning units of a Public Healthcare Centre (PHC), despite being sexually active,” she said.

Another female youth, Yomi Martins 22, who admitted being sexually active also, decried the attitude of the health service provider she met at the Hello Lagos Life planning centre. Martins said; “The service provider was obviously furious on noticing that I was a Catholic. I guess that was why she denied me the required attention and information on family planning. She neither showed courtesy of offering me a seat nor made any attempt to make me feel relaxed before grilling me.”

Martins further lamented; “In the course of our tensed-discussion, I learned that both female and male condoms were available at the facility. Rather than giving me the female condom which I had demanded, a male condom was offered to me.”

“I decided to go with the male condom, a roll-of-four,” the visibly distraught Martins told Our Reporter, with an air of dejection.

“As if that was not enough, I became a subject of gossip in the facility. Immediately, I turned my back, I noticed one of the counselors pointing and jeering at me, while the other two wore a sneering outlook.”

For 20-years-old Adeola Esther, who is a filmmaker, she visited a PHC centre near her community, at Agege, Lagos. Following the poor responses to her questions as a teenager seeking family planning services, she had to switch role from making a personal inquiry to doing an errand for her mother. Her words; “When I noticed the facial expressions of the family planning counselors, I pretended that I was on an errand for my mother to make inquiries about family planning.”

Also, she was neither counseled nor shown any option of family planning, but was told that for her to access any available service, she must be ovulating.

Training of family planning providers

Training and retraining for family planning providers reacting, family planning experts, disagree that a woman does not need to be in ovulation to do any method, though some women still ovulate while pregnant.

Commenting, Adekoya Abiola, a retired nurse said that these service providers in these cases were bad examples and opposite of what they should be, especially in the area of counselling these youths by sharing available options of contraception with them and possibly allows these youths make an informed decision.

Mrs. Adekoya insisted that those service providers need to be trained in the right contemporary ways to help the teeming youths who need proper counseling to make the right choices about family planning.

She said youths like Mary Ibrahim, Yomi Martins, Adeola Esther may not possibly return to the centres again eventually even when they may be ready for family planning. She described their case as ‘missed opportunities’ to win for family planning and better equip the youth.

Concerning the need for experienced family planning providers in health care centres, Dr. Farouk Jega, the Country Director, Pathfinder International Nigeria said it would make a lot of difference in the health care sector.

Dr. Jega said well-informed service providers will bring about enormous change towards building trust in the adoption of family planning and increasing uptake in the country.

Also, the Pathfinder boss said that every woman, especially in developing economies like Nigeria deserves a quality family planning information.

This will enable them to make an informed decision, stating that every woman deserves quality information on family planning, he stressed.

Jega said; “Every woman no matter the age has the right to know and access quality family planning information.”

Restrictive norms and stigma 

On her part, Kosi Izundu, Programme Officer, Pathfinder International while presenting a topic on, ‘Youth and Adolescent Access to Family Planning,’ said the major challenges youth face in accessing family planning are structural barriers such as laws and policies requesting parental consent.

She added that socio-cultural barriers such as restrictive norms and stigma around adolescents and youth sexuality and individual barriers such as young people limited or incorrect knowledge of Sexual Reproductive Health (SRH).

Though the government has tried in terms of policies and laws to advance SRH, Izundu said there is the need for government to fully implement those policies.

Speaking on the topic: ‘Youth and Adolescent access to family planning in Lagos State’, Abiodun Ajayi, State Coordinator, Life Planning for Adolescents and Youths (LPAY) said some of the barriers to youth access to family planning services are; lack of access to adequate and accurate life planning information and services, providers’ bias, religious doctrine as well as policies barriers.

To tackle these issues, Abiodun said, government should integrate youth-friendly family planning services in all PHCs to meet their needs.

He said, community, religious and traditional leaders should speak positively about SRH of young people; parents should engage their children on SRH information and advocacy efforts should be made to key players by Civil Society Organisations (CSOs).

Improving Newborn Health In Oyo Communities Through Exclusive Breastfeeding

BY CHIOMA UMEHA,

Lagos – The birth of a newborn brings joy to a mother and serves to be her reward for going through the pains of nine months of pregnancy. The reverse is the case at the death of a newborn. Not only would a mother be in grief, the community and family would also be in anguish.

This used to be the picture in some communities in Oyo a year ago until the state government, community leaders, UNICEF and other partners through the Accelerated Action for Impact (AAI) Initiative stepped in to ensure that no child dies from preventable reasons.

Previously, statistics has it that in Nigeria, Oyo State is among the 15 states contributing to nearly 50 per cent newborn deaths in Nigeria.

Sadly too, the state was the third highest contributor to the newborn mortality rate in absolute numbers in the South West.

According to the Multiple Indicator Cluster Survey, (MICS) 2016/2017, Oyo shows undesirable 42 per cent of newborn mortality rate.

However, the AAI Initiative intervention devised measures secure the health and lives of an estimated 334.073 newborns and 1,670,366 under 5 children in the state.

One of the ways according to health experts is in breastfeeding because it helps to boost the immune system to fight childhood diseases. Global health says that every $1 invested in breastfeeding yields N35 in monetary terms.

The experts, who spoke at a recent media dialogue in Ibadan, with the theme ‘Improving Health Outcomes for Children in Oyo State through Accelerated Action for Impact,’ noted that the method is yielding positive health outcomes among children Oyo state.

Oyo has reduced the baseline of severe and acute malnutrition case from 16 to 12, according to a post-intervention review of NOA carried out between May and November 2018, all thanks to AAI.

One of them, Dr. Adebola Hassan, the United Nations Children Fund (UNICEF) Health Specialist, Akure Field Office, said UNICEF was engaging in various intervention programmes to assist the state in minimising the high prevalence of death of newborns in the state.

She said due to poor nutrition, improper breastfeeding, lack of immunisation and poor delivery system, among others, many newborn children had lost their lives in the state.

Hassan said that Ibadan North-East, Ibarapa North and Saki West Local Government Areas were among the six Local Governments in the state with highest infant mortality and neonatal death in the state.

She said, with various interventions by UNICEF in partnership with the state government, the trend was changing.

Similarly, Mr. Ayobami Akinola, the Assistant Immunisation Coaching Officer for Ibadan North East Local Government Area, (LGA), said under the AAI intervention, women are being educated about exclusive breastfeeding, proper immunisation, and post-natal services, among others.

During a field trip organised by UNICEF to Iwo Road PHC, Ibadan, Mrs. Akinyomi Oluwatosin, a Community Health Extension Worker (CHEW) told Our Reporter that women are now embracing exclusive breastfeeding in the facility.

Oluwatosin said the CHEWs ensures that the women breastfeed their newborn exclusively and as well keep to immunisation appointments.

She said that prior to the AAI intervention, neonatal deaths in the PHC were high, but with the intervention, there is no record of newborn deaths any more.

Mrs. Jolasinmi Adebola, Chief Community Health Extension Worker said, “Through the various interventions such as counseling and awareness, the number of women for exclusive breastfeeding has increased from 103 to 189.

Also, Dr. Khadijat Alarape, the Oyo State Nutrition Officer, said that lack of proper breastfeeding had led to the death of many newborns.

Alarape said that many mothers failed to breastfeed their children immediately after birth, which she said led to the death of many newborns in the state.

She said that rather than give breast milk to newborns, many mothers were involved in giving concoctions or herbs to their babies at birth.

Alarape said that some mothers, due to beliefs that their nipples would ‘sag’ if they breastfeed, had also neglected breastfeeding their newborns.

She urged mothers to ensure proper placement of their newborns’ mouth on the ‘areola,’ the dark portion of the breast and not the nipples to enable the baby to suck properly.

The Nutrition Officer further noted that the AAI project is changing the narrative of child health in Oyo State. “Three months, post-intervention review of NOA indicated an improved knowledge in the practice of exclusive breastfeeding.”

In addition, she said; “The severe and acute malnutrition case identified at the baseline reduced from 16 to 12 during the intervention that was carried out between May and November 2018.”

Besides, she added that the exclusive breastfeeding rate had increased from 30.4 per cent in 2013 to 49.5 per cent in Oyo State in 2017. Also, she added that the early initiation of breastfeeding has improved.

The UNICEF interventions are completely strategic following the agency’s involvement of the community, religious and traditional leaders and health workers among others.

The leaders initiated house-to-house mobilisation and sensitisation in the communities, while the health workers engaged in constant outreach programmes even in the states’ hard-to-reach areas.

Today, in Oyo, it is an offence for a pregnant woman not to visit the hospital for antenatal or fail to immunise her children. Even Landlords quit their tenants who fail to access healthcare or immunise their children. Community members now come together to mobilise women to use health facilities at no cost.

Blessing Ejiofor, UNICEF’s Media Officer, solicited media support on accurate and informed reports on preventable child death in Nigeria.

Ejiofor said the essence was to draw the government’s attention to the need to scale up action in order to reverse the ugly trend of death of the newborn.

Limited Information Frustrates Young Women From Using Family Planning

BY CHIOMA UMEHA,

Awareness and proper understanding of family planning has been recognised to reduce maternal death among young women of reproductive age between 15 and 49.

Data on Sexual Reproductive Health outcomes in Nigeria stresses the importance of focusing on adolescents. At 576 maternal death per 1,000 live births, Nigeria accounts for 14 percent of the global burden of maternal mortality (NDHS 2013/WHO 2014).

Global evidence shows that young girls bear a higher burden of maternal mortality and morbidity. Data shows that the average age at sexual debut is roughly 15 years of age among adolescent mothers in Nigeria. (NDHS 2003, 2008, 2013).

The National adolescent fertility rate in Nigeria is 122 births per 1,000 women aged 15 to 19 years. In the North Western States, it is as high as 171 births per 1,000 women aged 15 to 19 years.

To stem this, the government of Lagos State with support from partners and other donor agencies has put in place youth-friendly health care centres and trained health care providers to provide friendly services.

Despite the friendly centers, gaps that hinder youth access to SRH in the country still exist, including poor knowledge, awareness and absence of confidentiality in service delivery among others.

Many Lagos youths who are sexually active  are not equipped with adequate information on the different method of contraception available for use due to some barriers.

These barriers include: provider bias, the attitude of the family planning officer, religious sentiments amongst others.

At a 3-day capacity building workshop on Investigative Journalism organised by Pathfinder International Nigeria, in Lagos, some Lagos based adolescents who spoke to journalists have expressed dismay over the attitude of some family planning providers.

Some adolescents who visited Ikotun, Alimosho and Agege youth friendly Centres complained of poor counseling, knowledge by the family planning counselors.

According to 25-year old Halima Abdullazeez and graduate of Business Admin said the service provider’s first question was on her age bracket adding that “on learning, I have three boyfriends at 25, the body language changed outside religious concerns and countenance, I was not given an opportunity of seeing a condom or counseled properly on other options of contraception, so, I had to leave.

Miss Abdullazeez said the family planning providers the welcome was not warm as anticipated, hence wondering if it should have been better to have unplanned pregnancy to receive required attention at family planning units of Public Healthcare Centre (PHC) despite being sexually active.

Another female youth, Helen Moses 22, who acknowledged being sexually active lamented that the health service provider, she accosted at the Hello Lagos Life planning centre, was visibly furious on noticing she is a Catholic, did not give her required attention and courtesy of offering her a seat or any attempt to make her relax before supposed grilling.

Helen said that in the course of their tensed-discussion, she understood that both female and male condoms were available at the facility, but she was not given the female condom which she had demanded but a male condom was offered to her.

She decided to take away the male condom roll-of-four but concerned that at her back, she became subject of gossip.

For 20-year Ayoshe, who is a makeup artist, the PHC centre she visited was near her community and because of their poor responses to her questions as a teenager wanting to access family planning services, she had to switch role from personal inquiry to on errand for her mother.

She was not shown any options of family planning but told that for her to access any available service, must be during ovulation, which family planning experts, Mrs. Abiola Adekoya disagreed with, even though some pregnant women still ovulate whilst pregnant.

In response, a retired nurse Adekoya Abiola said that these service providers in these cases were bad examples and opposite of what they should be, especially in the area of counseling these youths by sharing available options of contraception with them and possibly allows these youths make an informed decision.

Mrs. Adekoya insisted that those service providers need to be trained in the right contemporary path to help the teeming youth who may come across them.

She posited that with the narratives aforementioned, these youngsters may not likely return to the centres again eventually even when they may be ready for family planning, describing it as a missed opportunities to win for family planning and better equip the youth.

Speaking on the need to have knowledgeable family planning providers in health care centres, the Country Director, Pathfinder International Nigeria, Dr. Farouk Jega, said it would make a lot of difference in the nation’s health care sector.

Dr. Jega said well-informed service providers will bring about enormous change towards building trust in the adoption of family planning and increasing uptake in the country and make a lot of difference.

Also, Dr. Jega said that every woman, especially in developing economies like Nigeria deserves quality family planning information so as to make an informed decision, stating that, “every woman deserves quality information on family planning. Every woman no matter the age has the right to know and access quality family planning information.

Pathfinder International Nigeria pointed out that there should be provision of quality family planning information for families, and mostly women, insisting that there should be no coercion on the part of women as far as issues on family planning is concerned.

Kosi Izundu, Program Officer, Pathfinder International while presenting a topic on ‘Youth And Adolescent Access To Family Planning’ said the major challenges youth face in accessing family planning are structural barriers such as laws and policies requesting parental consent.

She added that socio-cultural barriers such as restrictive norms and stigma around adolescents and youth sexuality and individual barriers such as young people limited or incorrect knowledge of Sexual Reproductive Health (SRH).

Though the government has tried in terms of policies and laws to advance SRH, Izundu said there is the need for government to fully implement those policies.

Abiodun Ajayi, State Coordinator, Life Planning for Adolescents and Youths (LPAY) presented the topic: ‘Youth and Adolescent access to family planning in Lagos State’, said the population of the State is about 23 million with young people aged 15-24 constituting over 4 million.

He said the unmet sexual and reproductive health needs of young persons in Lagos State is very huge, adding that according to the NDHS 2013, only 38.4 per cent of women aged 20-24, who are in marriage/union are currently using a contraceptive method while 12.3 percent of these women have an unmet need for family planning.

The risk according to Abiodun is that sexual behavior among young people is leading to unplanned pregnancy, out of school and baby dumping amongst others.

Some of the barriers to youth access to family planning services according to him are; lack of access to adequate and accurate life planning information and services, providers’ bias, religious doctrine as well as policies barriers.

To tackle those issues, Abiodun said, government should integrate youth-friendly family planning services in all PHCs that meet their needs; community, religious and traditional leaders should speak positively about SRH of young people; parents should engage their children on SRH information and advocacy efforts should be made to key players by Civil Society Organisations (CSOs).

Abiodun also urged the media to raise awareness about LPAY/FP; inform listeners, readers and viewers about steps they can take to protect themselves and others. It should also serve as a source of accurate LPAY/FP information for young people; mobilise stakeholders to play their parts in promoting FP/LPAY and regularly generate discussions on FP/LPAY.

Number Of Registered Births In Nigeria Reaches 29m

BY CHIOMA UMEHA

Lagos – A birth registration programme implemented by the National Population Commission (NPopC), with support from UNICEF, has increased the number of children between the ages of zero and 17 years registered in Nigeria by about 29 million.

According to the evaluation report launched today, for children under one year of age, the programme increased by more than 100 per cent the number of children registered -  from 3 million in 2012 to 11 million in 2016.

“Low rates of birth registration are a challenge in Nigeria,” said Mohamed Fall, UNICEF Representative in Nigeria.

“In 2011, the birth registration rate was 41 percent, which means that three in every five children were not registered. This lack of birth registration negatively affects a child’s ability to access his or her right to health care, education and many other rights.”

It was in this context that the programme was initiated to accelerate birth registration rates – particularly for children under the age of five, between 2012 and 2016.

The programme made significant improvements in strengthening the birth registration system in Nigeria. At the level of infrastructure, the numbers of NPopC Registrars/Centres increased to nearly 4000 in 2016 from about 3,000 in 2012, helping to achieve a harmonised, an accessible and efficient birth registration system, which now functions as an integral part of civil registration and vital statistics (CRVS) in Nigeria.

The programme’s use of ICT tools for birth registration introduced target-driven performance in all of the 774 Local Government Areas (LGAs) in Nigeria. The LGAs now have specified targets, reports and performance ranking.

Some key benefits of the programme are: fully sustained partnership and convergence with health interventions; innovative use of ICT tools and applications; and a strong link with the national CRVS Strategic Plan (2018-22).

The report asked NPopC, as a primary service provider, to take “greater ownership and a proactive approach” on registration of newborn children and all other children who are still unregistered. NPopC is advised to prioritize digitization, advocacy, and lobbying for more funds to effectively implement the Strategic CRVS Plan (2018-2022).

Birth registration remains pivotal to a child wellbeing in Nigeria, Overall survey results, as part of the evaluation, indicate that nearly half of the survey respondents perceived that an increase in birth, registration can help reduce child rights violations.

Scientists Seek For Establishment Of Mycology Laboratories In Nigeria

Lagos – With Nigeria contributing 20 million to the global 300 million people affected by fungal infections, scientists have urged the Federal Government to establish   Mycology Laboratories in the country.

Making the call were researchers from the fields of Mycology, Parasitology, Haematology, Microbiology, others, who stressed that it would forestall fungal epidemic.

They said, it is unacceptable for a country like Nigeria, the most populous African country not to have Mycology Laboratories.

The practitioners made this and other submissions at the Cancer Research Centre, of the Nigerian Institute of Medical Research (NIMR) at the first Annual International Conference of the Medical Mycology Society of Nigeria (MMSN).

Commenting, Dr. Rita Oladele, a microbiologist at the Lagos University Teaching Hospital (LUTH), the situation in Nigeria is really appalling, where there is no single reference laboratory for fungal infections, saying it is not a good one for the country and its citizens.

“The most depressing for me in Nigeria is that in the whole country, there is no single reference laboratory, whereas in the laboratory, a lot can be done such as training, surveillance, monitoring of disease outbreak, and collection of  data, but all these are elusive in the absence of a reference laboratory”, she stated.

Oladele however explained what could be responsible for the absence of the reference laboratory in the country, saying it could be that there is no sufficient enlightenment for those in authority on the importance of a reference laboratory in the country. Speaking on the topic: “Challenges in management of invasive fungal infections in developing countries”, Professor Arunaloke Chakrabarti, the President, International Society for Human and Animal Mycology, noted that although fungi are part of human lives, as they are eaten as foods, as well as play major roles in drug development procedures, but the same fungi are becoming a huge pain for humans.

Chakrabarti, further expressed concerns over the management of the condition in developing countries, affirmed the prevalence of fungal infections as published in the Journal Nature, to be affecting 300 million people around the world, while about 1.6 million people die from the infections annually.

The President said; “It shows that about 300 million people in the world suffers from this fungal infections, 1.6  million people die from fungal diseases, which are comparable with tuberculosis and malaria. We are bothered by the disease called tuberculosis and malaria but we are paying less attention to fungal infections. Fungi are getting so used to our body system, though; there are seven fungi that behave like bacteria in our body.

“In the world today, there is a big challenge, with fungi called Candida Auris, it has spread to about 32 countries and it is very resistant to antifungal drugs, very easily transmitted. In Africa, due to lack of Mycology Laboratories, practitioners are not able to diagnose it.

“It is only in South Africa and Kenya that this fungus has been diagnosed. I’m sure it is present in some African countries too, but since more than 50 per cent of general and commercial system of identification cannot pick this kind of fungi, then we need reference laboratory. But, Nigeria doesn’t have a reference laboratory for Mycology. We are saying the government, should do sometime urgently about this situation, and also partner with pharmaceutical companies for the availability and accessibility of antifungal drugs.”

Speaking on the consequences of fungal infections on HIV and cancer patients, Dr. Sani Aliyu, the Chairman, National Agency for the Control of AIDS, said due to the weak immune system of these set of people, they are more predisposed to fungal infections than others.

Aliyu therefore called for more enlightenment on the disease, saying fungal infections have become deadly in some countries, due to the invasive nature of the condition.

“Fungal infections are often caused by microscopic fungi that are common in the environment. Fungi live outdoors in soil and on plants as well as on many indoor surfaces and on human skin.

“There are instances where people become more predisposed to fungal infections, mostly people that are either on immuno-suppression, for example cancer therapy on people who are on intensive guidance. Thus, the essence of the conference is to discuss both the diagnostic and treatment aspects, in order to ensure patients’ safety.

Some of the presenters at the first MMSM International Conference are, Prof. Jean-Pierre Gangneux; from the Rennes Teaching Hospital and Rennes 1 University, France;  Dr. J Claire Hoving, Wellcome Trust Intermediate Fellow in Public Health and Tropical Medicine, South Africa and  Dr. Bright Ocansey, a medical laboratory scientist at New Hope Specialist Hospital Aflao, Ghana.

Also speaking were, Prof. Folashade Tolulope Ogunsola, deputy vice-chancellor Development Science at the University of Lagos;  Richard Kwizera, a medical mycologist, College of Health Sciences, Makerere University, Uganda and Prof. Ahmed Hassan Fahal, University of Khartoum.

Others are; Dr. Mark Okolo, medical microbiologist from the University of Jos; Dr. Obianuju Ozoh, a pulmonologist at LUTH;  Alex Jordan, from the Mycotic Disease branch of the United states; Dr. Iriagbonse Iyabo Osaigbovo, medical microbiologist at the University of Benin and Dr. Nicholas  Irurhe, radiologist from the College of Medicine, University of Lagos

The rest are,  Dr. Olusola Olabisi Ayanlowo, dermatologist at the Department of Medicine, University of Lagos; Dr. Olufunmilola Makanjuola, medical microbiologist and parasitologist, University of Ibadan; and  Dr. Sani Aliyu, medical officer at State House Clinic, Imperial College, London.

Lagos Restates Commitment To Promoting Good Health

It is of paramount importance for one to visit doctors at least twice a year for a proper checkup. As the saying goes; “Prevention is better than cure.”

In line with this old axiom, experts are increasingly advocating preventive healthcare to confirm that ‘a stitch in time saves nine.’

Dr. Jide Idris, Lagos State Commissioner for Health, has restated government’s commitment to promoting preventive health care in the state.

According to Wikipedia, preventive healthcare consists of measures taken for disease prevention, as opposed to disease treatment. Just as health comprises a variety of physical and mental states, so do disease and disability, which are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices.

Idris stressed on preventive healthcare during a sensitisation walk and symposium, part of activities to mark World Health Day in Lagos on Monday.

The event was organised by the state Ministry of Health in conjunction with Tolaram Africa Enterprises Limited, makers of Hypo Bleach.

The Health Ministry boss said the idea is to promote healthy living through the use of hypo, which is perceived as just a whitening agent but also a disinfectant.

Aimed at educating the participants on how to keep the environment clean to prevent common diseases, the occasion was attended by hundreds of women and youths from different walks of life.

The commissioner who was represented by Dr. Olurotimi Agbolagoriite, the Director in the Directorate of Disease Control, said one can only handle and tackle any task if one has good health.

“Consequently,” he said, “our health is very paramount in achieving our set goals in life without any hindrances.”

Emphasising on the need for every individual to maintain a healthy lifestyle, Idris said, “The world health day is targeted to boost awareness on the importance of living a very healthy lifestyle that guarantees good health, like the popular adage which says, ‘Health is wealth.”

With the growing population of over 24 million people, he also said the state government had taken a bold step to address the issue of ‘Universal health coverage,’ the theme of this year’s celebration with the launching of its health insurance scheme.

Idris added that the Lagos State Government was also committed to the provision of good and qualitative, affordable and accessible health care system for the citizens.

Also speaking, Dr. Lola Akande, Commissioner for Women Affairs and Poverty Alleviation, commended makers of Hypo bleach for organising the symposium, saying that the company had made marks by focusing on a need which had existed since the beginning of time.

Akande, who was represented by Oluwatoyin Odusanya, a director in the ministry, said the government saw Hypo brand as a partner in the progress to evolve a healthier Lagos, using multi-faceted approaches, while putting high premium on women empowerment.

On his part, Mr. Asagbra Onome, the Brand Manager of Hypo Bleach, stated that his company decided to partner with Lagos state to create awareness on the theme of this year’s event, which is “Universal Health Coverage: Everyone, Everywhere.”

     

Does Menstruation Affect Fertility

A normal menstrual cycle is usually 28 days plus or minus seven days, meaning that anything from 21 days to 35 days is normal. So those who complain that they get theirs twice a month could see how this is possible, especially if you fall into the 21-day cycle. Subtle variations are acceptable, like 21 days here this month, 25 days there next month, etc. but wide swings from days to 35 days will seem abnormal. Even then, unless this happens at least three times consecutively, it should not be concerning. This is because a woman’s menstrual cycle is subject to stress hormones so things like sadness as in death, joy as in travelling abroad, purchasing a car, etc. can trigger events that can lead to heavy flow, scanty flow or even cessation. As such, any alteration unless life-threatening is not significant until it happens through three menstrual cycles in a row. The typical thing is for the Nigerian female to start worrying about the little aberration and even having sleepless nights, a bad combination that will worsen the situation.

I am teaching you now not to fret over any of such changes, and by not fretting and thus not releasing stress hormones, your cycle may just restore to normalcy in the next month. Apart from regularity, most people in Nigeria worry about the colour, the quantity of blood flow, especially how scanty and the number of days of flow, when less than their usual number of days. It is like Nigerian women like to lose blood going by how much they fret over discrepancies and they think it is such a natural order of things that cannot be interfered with. It is almost heretical to alter the course of menses in Nigeria that most people cannot even take pain medications for painful menses because the natural order may be upended.

I can understand this ignorance on the part of patients but when a multiplicity of them tell me that they were told by their doctors not to take pain medications for painful periods, then I am about ready to do away with science, embrace religion the Nigerian way and proclaim that we need deliverance!! When i tell some Nigerian girls that most girls like them in the USA take medications that make them not to have their monthly periods, their palpable disbelief is always summed up in the corollary question, ‘where does the bad blood go?’ My answer is that there is no bad blood because unless the uterine lining is stimulated to prepare for a baby and then no baby eventually there is nothing to shed in menses. Here in the USA, most girls are on the oral contraceptive pills to prevent unwanted pregnancy. They take 21 tabs once daily and for the next seven days thereafter take a placebo that lets them have their menstrual flow. Some do not even want to have that, so they just jump to the other 21 tabs in the next pack and continue cyclically like that. Others who do not have the discipline for daily medications resorted to the taking Depo-Provera injections every three months with same result.

At present, the fad is to have an implant called Nexplanon placed in the body after making a short cut into the skin, and for eight years no pregnancy will occur and invariably no menses. With these innovations in the world, we in Nigeria are still worried that our period flow dropped from four days to three days, etc.

An established menstrual irregularity can be investigated with checking the blood count to ascertain the extent of blood loss, checking coagulation profile to see proneness to bleeding, doing hormonal assays to ascertain menopausal status, doing ultrasound of the pelvis for structural abnormalities and then surgical interventions like diagnostic and therapeutic D&C and finally laparoscopy.

Adelusi-Adeluyi To Address Executive Dialogue On Ecomony, Pharmacy Growth

Prince Julius Adelusi-Adeluyi, former Nigerian Minister of Health and president of the Nigeria Academy of Pharmacy, is billed to address an Executive Dialogue on Public and Private Sector Collaboration for Economic Growth in the Pharmaceutical Sector. This dialogue will hold in Sandton, South Africa, on February 14.

Prince Adelusi-Adeluyi who is also the founder and Chairman of Juli PLC will speak on “Solutions and measures to combat counterfeit medicines”. The problem of fake and counterfeit medicines has plagued Nigeria and many developing countries for decades.

According to Adelusi-Adeluyi, “the problem of fake and counterfeit medicines has grown increasingly complex over the years and only a multi-pronged approach that has both the private and public sectors acting in concert is best placed to address it effectively.” He added that “an executive dialogue of this nature that seeks to inspire multi-sector collaboration, therefore, is clearly in the right direction as the plague of fake and counterfeit medicines impacts considerably on the economic growth of the pharmaceutical industry.”

Other speakers expected to grace the high level Executive Dialogue include Professor Helen Reese, Chair of the South African Health Products Regulatory Authority, Ms. Precious Matsoso, Director General of the South African Department of Health, Dr. Timothy Kedijang, Chairperson of the Pharmaceutical Industry Association of South Africa,Dr. GustaafWolvaardt, Managing Director of the Foundation of Professional Development among many others.

The Executive Dialogue, by bringing experts from both the public and private sectors together is expected to unravel key policy approaches that will facilitate more result-oriented collaboration between governments at different level and the extended pharmaceutical value chain. Policy proposals arising from the discourse will be made available to national governments in key emerging markets.

The Executive Dialogue is organized by Inspirational Development Group of South Africa in association with the Foundation for Professional Development.

Index Case Finding, A New Way To Identify Adolescents With HIV

Chioma Umeha

Research has shown that knowing one’s HIV status can help in making healthy decisions to prevent acquiring or transmitting the Human Immune Virus (HIV).

Nigeria is home to 10 per cent of Adolescents Living With HIV(ALHIV) globally, that is about 240,000, according to a project initiated in response to the 2016 National Adolescents and Young Peoples (AYP) HIV strategy.

However, this number is not reflected in HIV Testing Services (HTS) and Antiretroviral Therapy (ART) services, hence the need to identify Adolescents Living With HIV and put them on treatment.

To this effect, a new study seeks to find adolescents living with HIV, link them to treatment, and ensure they remain in treatment.

It also seeks to observe and document factors that facilitate successful scale - up in identification and treatment of AYP living with HIV in service programmes in three States in Nigeria including, Lagos State.

However, the study uses family-based and index case finding approaches as an entry point to identify AYP aged from 10 to 24 years.

The methods include family attending HIV treatment sites, support groups as well as Orphan and Vulnerable Children’s (OVC) programmes.

These approaches involved determining HIV prevalence of persons from age 10 to 24 recruited through family attending treatment and support sites.

It further entailed ascertaining predictive factors for identifying AYP living with HIV who were recruited through family attending HIV treatment and support sites within Lagos State.

The review of the study carried out with the support of Lagos State Aids Control Agency (LSACA) in collaboration with Positive Action for Treatment Access (PATA) and United Nations Children’s Fund (UNICEF) in Lagos was a major agenda recently, in the state.

The review was aimed at intensifying HIV response for adolescents and young people in the state.

Speaking at the event, Mrs. Victoria Isiramen, UNICEF HIV Specialist said, “Young people are the present, and we need to engage them. Many say it is not easy finding young people; maybe because they do not come out.

“The index finding is a way of identifying adolescents with this virus and putting them on treatment. This work was done in Benue, Federal Capital Territory and now Lagos.

“UNAIDS believes that our children should be born free and live free of HIV, and we at UNICEF promise to give in our best.”

Isiramen said, “It has identified that we have more females with this virus than males.The partnership keeps HIV response for adolescents and young people (AYP) in focus and together we can find and save adolescents and young people living with HIV.What we are doing is to ensure that the AYP have a friendly and welcoming service so as to keep preventing this ailment.”

Giving the breakdown of the index case she said; “8525 index cases were identified; 105 known positives; 42 per cent aged between 10 and14-years-old tested positive; 10156 adolescents and young people traced and tested; 36 per cent adolescents and young people tested positive.

She added that 50 per cent aged 10-14 years tested positive and 8 percent adolescents and young people aged 20-24 years tested positive.

The UNICEF HIV Specialist said the index adult cases were identified through support groups and anti retroviral clinics located in public health facilities.

She said while the index sibling cases were identified through the ART clinics and, Orphan and Vulnerable Children (OVC) programmes run by non-government organisations located in Lagos State.

Isiramen said that the index-case finding tool was used to collect details of children and AYP in the care of the index adults and index siblings.

She however said that the National Client Intake Form was administered to children and AYP identified through the index cases that were tested for HIV through this project, adding that a questionnaire was also administered to the AYP identified, to assess their socio-demographic information, sexual behaviour and practices.

According to her, “Data collection was monitored to assure quality. Data was analysed to determine the HIV sero-discordancy rate; differences in HIV sexual risk behaviour and practices of HIV-positive and HIV-negative AYP; and predictors for HIV positivity.

“Ethical clearance of the study was obtained from the Nigeria Institute of Medical Research Institutional Review Board.”

Making his presentation, Isaac Moses in a Project Review of PATA said, “It was found that index case finding was more efficient for recruiting children and younger adolescents than older adolescents and young persons.

“That the approach increased the number and proportion of AYP accessing HIV testing and ART services at facilities. A large proportion of children and siblings 57.3 per cent of index cases did not know their HIV status.”

Moses said 36 HIV positive AYP were identified, equally spread between males and females.

He said, study also found a proportion of wards/children of index cases practicing unprotected vaginal sexual intercourse.

Significantly, he said, more HIV-positive than HIV-negative AYP use condoms during vaginal sexual intercourse.

Moses said “the highest rates of HIV positivity yield was found within the AYP aged 10-14 year-old: 42 percent. In the overall study, as high as 5.7 per cent of HIV-negative AYP are eligible for Pre -exposure Prophylaxis, (PrEP).”

On recommendations, Moses said the study posits that index case finding through family approach is an efficient way of generating high yield rates for HIV testing for AYP.

He said that targeted HIV testing of AYPs who are married, have a positive history of sexually transmitted infection, symptoms of tuberculosis, and or are aged 20-24-year-olds will likely yield high HIV positivity rates.

He states, “When index case finding approach is to be used; recruitment of the first to fourth children of index cases will likely yield more HIV positivity cases.

“Access to pre-exposure prophylaxis (PrEP) needs to be prioritised for sexually active HIV-negative AYP.

“Studies need to be conducted to learn how to best reach HIV-positive AYP through messaging on protected sexual intercourse, the value of accessible treatment, viral suppression, and non-transmission of HIV infection.”

Studies should include filter questions, as non-respondents to questions on age of sexual debut and history of sexual intercourse are more likely to have high risk sexual behaviour, a history of sexual assault or be HIV positive, he explained.