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Cheques should be written in favour of “African Journal of Reproductive Health” and sent to Women’s Health and Action Research Centre, KM 11, Benin-Lagos Express way, Igue-Iheya, Benin-City, Edo State, Nigeria. P.O Box 10231, Ugbowo, Benin City.

See Table of Content Below.

Table of Content for AJRH June 2013 Edition

Editorial

Tackling maternal mortality in Africa after 2015: What should the priorities be? Annette Bazuaye and Friday E. Okonofua

Commentary and Original Research Arcticles

Confronting Maternal Mortality Due to Postpartum Hemorrhage and Unsafe Abortion: A Call for Commitment. Joseph Karanja, Projestine Muganyizi, Emmanuel Rwamushaija, Nuriye Hodoglugil, Emma Nesper Holm and Regional Experts’ Summit Group

The Impact of Family Planning on Primary School Enrolment in Sub-national Areas within 25 African Countries. Abiba Longwe and Jeroen Smits

Birth interval and its predictors among married women in Dabat District, Northwest Ethiopia: A retrospective follow up study. Gizachew Assefa Tessema, Berihun Megabiaw Zeleke and Tadesse Awoke Ayele

Delaying Sexual Debut as a Strategy for Reducing HIV Epidemic in Kenya. Elijah O. Onsomu, James K. Kimani, Benta A. Abuya, Ahmed A. Arif, DaKysha Moore, Vanessa Duren-Winfield and George Harwell

Modern Contraceptive Use among Women in the Asuogyaman District of Ghana: Is Reliability more Important than Health Concerns? Joseph Kofi Teye

Immediate postpartum versus 6-week postpartum intrauterine device insertion: a feasibility study of a randomized controlled trial. Amy G. Bryant, Gift Kamanga, Gretchen S. Stuart, Lisa B. Haddad, Tarek Meguid and Chisale Mhango

The effectiveness of Community Based Distribution of Injectable Contraceptives using Community Health Extension Workers in Gombe State, Northern Nigeria. Rabiatu A. Abdul-hadi, Moyosola M. Abass, Bolatito O. Aiyenigba, Lolade O. Oseni, Solomon Odafe,  Otto N. Chabikuli, Mohammed D. Ibrahim, Christoph Hamelmann and Oladapo A. Ladipo

Socio-Cultural Perspectives on Causes and Intervention Strategies of Male Infertility: A Case Study of Mhondoro-Ngezi, Zimbabwe. Stanzia Moyo and Itai Muhwati

The work of a woman is to give birth to Children: Cultural Constructions of Infertility in Nigeria. Ritgak A Dimka and Simon L Dein

Why women are dying from unsafe abortion: Narratives of Ghanaian abortion providers. Carolyn M. Payne, Michelle Precourt Debbink, Ellen A. Steele, Caroline T. Buck, Lisa A. Martin, Jane A. Hassinger and Lisa H. Harris

Identifying Obstetrical Emergencies at Kintampo Municipal Hospital: A perspective from Pregnant Women and Nursing Midwives. Brenda Oiyemhonlan, Emilia  Udofia and  Damien  Punguyire

The social dynamics of selling sex in Mombasa, Kenya: a qualitative study contextualizing high risk sexual behaviour. Karen M. Hampanda

Knowledge of the Human Papilloma Virus vaccine, and opinions of Gynaecologists on its implementation in Nigeria. Imran O. Morhason-Bello, Olubukola A. Adesina, Babatunde O. Adedokun, Olutosin  Awolude, Clement A. Okolo, Christopher O. Aimakhu, Babatunde O. Akinwunmi, Adesina Oladokun and Isaac F. Adewole

Exposure of media content and sexual Health Behavior among Adolescents in Lagos Metropolis, Nigeria. Onipede Wusu

Premarital Sex in Antananarivo (Madagascar): How are students freeing themselves from the Norms? Bénédicte Gastineau and Clotilde Binet

There are 3 stages in the implementation process of the project, they are:

• Needs assessment survey to describe the provision of emergency obstetrics care as it is delivered currently in eight secondary and four tertiary hospitals, in the following causes of maternal mortality in two geo-political zones of Nigeria:

(i)                 Primary postpartum haemorrhage

(ii)               Eclampsia

(iii)             Obstructed labour

• Adaptation and implementation of a set of evidence-based multi-faceted interventions  for the improvement of the quality of care for primary postpartum haemorrhage, eclampsia and obstructed labour in six of the selected hospitals (four secondary and two tertiary hospitals),
• Test of effectiveness of the intervention package by comparing maternal and      neonatal outcomes and process quality indicators in the six intervention      hospitals with six comparable control hospitals in the same geo-political zones.

WHARC is set to commence the hospital-based intervention study and it will be carried out in the randomly selected secondary and tertiary hospitals within the six geo-political zones of the country, stratified into northern and southern zones for the purpose of the study, any moment from now.

INTRODUCTION

Malaria in pregnancy (or pregnancy-associated malaria) is a presentation of illness caused by infection with the intracellular blood protozoa, plasmodium species transmitted by mosquitoes, leading to parasitaemia. It results chiefly from four (4) species of Plasmodium: P.falciparum, P.vivax, P.ovale and P.malariae. P.falciparum is the commonest and causes the most severe malarial infection. The only vector of malarial parasite is the female anopheles mosquito. Malaria results from the aggregation of red blood cells infected by Plasmodium.

In primigravidae (women in their first pregnancies),there is a much higher risk of contracting malaria and of associated complications. This is due to loss of immunity to malaria in pregnancy, especially in primigravidae. Acute malarial attacks are less likely as parity increases, that is, the more pregnancies a woman has had, the less the effect of malaria. The reason for this is unclear.

INCIDENCE

According to WHO, Approximately 50 million women living in malaria-endemic countries develop malaria during pregnancy each year. Over half of these women live in tropical areas of Africa with high transmission of Plasmodium falciparum. An estimated 10,000 of these women and 200,000 of their infants die as a result of malaria infection during pregnancy. More than half of these deaths result from malaria-induced anaemia.

SYMPTOMS AND SIGNS

Malaria in pregnancy can be asymptomatic, showing no symptoms. Asymptomatic malaria can pose dangers to the pregnant woman and the foetus. Symptomatic malaria can also occur in pregnant women. Symptomatic malaria can be uncomplicated (acute, non-severe) or complicated (severe).

Symptoms of malaria in pregnancy include fever, chills, muscle aches and headaches. Fever may alternate with periods of complete well-being. Other symptoms are general malaise, reduced appetite, nausea, vomiting, cough, diarrhoea, dark-coloured urine. Yellowish discoloration (jaundice) of the sclera of the eye and mucous membranes may result from haemolysis of parasitized red blood cells as a result of malaria.

Anaemia is one of the commonest resultant manifestations or complications of malaria in pregnancy, caused by parasitisation of red blood. A finding of a haemoglobin level of less than 11mg/dl in pregnancy is an indication for investigating for malaria in endemic areas. Haemoglobin level could fall to as low as 3mg/dl in pregnant women in malaria-endemic areas of Africa. Hepatic and renal failure can complicate malaria in pregnancy.

Shock, hypoglycaemia and electrolyte imbalances are other complications of malaria in pregnancy.  Cerebral malaria with altered consciousness/sensorium, coma or seizures can occur in complicated malaria. A bleeding disorder called disseminated intravascular coagulopathy (DIC) can also be a complication, usually from Plasmodium falciparum malaria in pregnancy.

EFFECTS OF MALARIA ON PREGNANCY

Premature labour and spontaneous abortions can result from the fever of an acute malarial attack in pregnancy, directly resulting from the stimulation of uterine contractions. Intrauterine foetal demise could also result from the fever. Spontaneous abortions can also result from asymptomatic malaria in pregnancy. Malaria in pregnancy can cause intrauterine growth restriction of foetus which leads to delivery of Low Birth Weight(LBW) babies.

Babies born to women with malaria in pregnancy may develop congenital malaria. Congenital malaria is the intrauterine infection of the foetus by transplacental transfer of Plasmodium species from the maternal circulation. Congenital malaria is, however, rare because of neonatal protective mechanisms such as maternal immunoglobulins (IgG), high level of foetal haemoglobin. Breast milk has been shown to be protective as it deprives the malarial parasite of essential growth factors.

INTERVENTIONS

The World Health Organization (WHO) recommends a package of interventions for the prevention and control of malaria in the pregnant women.

These are:  1. Use of insecticide-treated nets (ITNs) to prevent infection. 2. Intermittent preventive treatment (or Intermittent Prophylactic Therapy, IPT) to prevent asymptomatic infection among pregnant women living in areas of moderate or high transmission of Plasmodium falciparum. 3. Effective case management for malaria illness and anaemia (in symptomatic cases) and 4. Pregnant women are advised to book early for antenatal care to have the interventions provided by health professionals.

Abstract

Background

With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality.

Methods

We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level.

Findings

The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A “J” shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence.

Conclusions

The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns.

Click here for full Research Results

Results from the study clearly show that there is no well established youth friendly service in the primary health care centres of the country. In fact, their belief is that the health centres are designed mainly for pregnant women and children in terms of antenatal care and immunization respectively. The reality is that PHCs are not usually the first choice for most young people especially unmarried youths when they need reproductive health information and services. Efforts to make clinics more youth friendly have not generally brought about increased usage by young people and these youths are not likely to go to places where their needs are not recognized to be serious enough for treatment or where they are subjected to the health providers’ judgment. These perceptions unfortunately originated from their own experiences, second-hand information from peers and general reputation about the services provided at the centres.

It was therefore recommended that YFS clinics standards for guidance and clarification should be developed for the primary health care clinics based on the outcomes of this assessment and on what young people find important in clinics services. These standards can also be used as the monitoring and evaluation tool for YFS clinics. At present there is a weak foundation of youth-friendly services in primary health care clinics and it is important to improve these services so that they can be used as models for future services.

1.         Media Relations Officer

The position holder will lead the media communication activities of the Centre. She/he will be responsible for developing and implementing a media strategy, ensuring that the centre’s activities are captured in both the old and new media platforms and that key audiences are reached.  The objective of this office is to ensure that WHARC’s research activities and results are reported to broad audiences in ways that would enable proper understanding of such results and their utility for improving policies and programs in reproductive health

Person Specifications

• Possession of an HND in Journalism, Mass Communication and public relations
• Previous experience in the media or working with a public relations outlet will be an advantage
• Deep knowledge and experience in the use of computer, especially use of social media
• Some knowledge or experience in the philanthropic sector and in reproductive health programming
• 2 years’ job and employment experience.

Method of Application
Applications should be submitted in the form of an application letter for the desired position and a detailed CV that spells out previous experiences. Appropriate contact information along with the names and addresses of three referees should be provided. These should be forwarded to the following email addresses: n_abokede@wharc-online.org and neneviky@yahoo.com and copied to wharc@hyperia.com . The subject line of the email must be the title of the position being solicited.

Closing date for submission is Thursday, March 4, 2013. Only shortlisted candidates will be invited for interview. At that point, the candidates will be contacted and they will be requested to provide supporting letters from two of their listed referees.

As part of efforts towards reducing maternal mortality among rural women in Edo state, Women’s Health and Action Research Centre, (WHARC) with support from the T.Y Danjuma Foundation has renovated a healthcare centre in the state. The healthcare centre, the Oligie-Ottah Primary Health Centre (PHC) located in Orhionmwon L.G.A of Edo state, also serves the four communities of Oligie, Ottah, Idumodim and Wire-Ake. Lady Winifred Onyeonwu, Chairman Board of Trustees, WHARC, who officiated at the commissioning of the renovated Oligie-Ottah PHC, disclosed that the commitment to renovate the health centre is part of efforts to compliment the state government in the health sector and to bring free maternal health services of the state nearer to the people at the grassroots.

According to her, the Oligie-Ottah PHC which before now was in a state of disrepair with leaking roofs, shaky foundation, broken locks and easily accessed by goats and rodents, now have doors with locks, a beautiful roof, delivery beds, baby cots and has been freshly painted.

“It is no wonder that this has greatly increased patronage of the facility as women who had hitherto refused to patronise the facility because of fear of it collapsing on them can now come to the health centre to receive medical services”, she said.

The Project Officer of WHARC, Ms. Osasu Aigbogun, also explained that upon renovation of the PHC in February this year, “data collected from the health centre revealed that there has been a drastic increase in the number of deliveries as only two deliveries were each recorded in the previous months while nine deliveries were recorded in the month of February, after the renovation.”

Edo Officer for T.Y Danjuma Foundation,  Oluwatomi Ajayi, assured members of the community that more attention would be given in terms of efficient rural healthcare delivery through provision of well-equipped Primary Health Centres across the state aimed at reducing maternal/child mortality in support with the Women’s Health and Action Research Centre, (WHARC).

To read more from T.Y. Danjuma Foundation, Click here

L-R, Mr. Obayagbona, Acting Chairman and HOS Orhionmwon L.G.A, Lady Winifred Onyeonwu, Chairman Board of Trustees, WHARC, Ms. Oluwatomi Ajayi, Edo Officer, T.Y Danjuma Foundation, Dr. Aimiebenomo, Director of PHC Benin representing the Commissioner for Health and Dr. Wilson Imongan, Deputy Director, WHARC during the official commission of the newly renovated health centre.

The commitment to renovate the health centre was made when Members of the Board of Trustees of WHARC led by the Chairman, Lady Winifred Onyeonwu visited Oligie Health Centre in August 2012 as part of activities to commemorate the centre’s 2012 Board of Trustees Meeting. The health centre which was before now in a state of disrepair with leaking roofs, shaky foundation, broken locks and easily accessed by goats and rodents now have doors with locks, a beautiful roof, delivery beds, baby cots and it’s been freshly painted.

This has greatly increased patronage of the facility as women who had hitherto refused to patronise the facility because of the fear of its collapsing now come to the health centre to receive medical services. Data collected from the health centre revealed that there has been a drastic increase in the number of deliveries as only two deliveries were each recorded in the  previous months while nine deliveries were recorded in the month of February (after the renovation.)

The Health centre would be officially opened on March 22, 2013 by his Excellency, Comrade Adams Oshimhole, Executive Governor of Edo State.

Am I a woman because I am the weaker sex? Should I be sad and unhappy because I was born with the ‘XX’ chromosome that makes me a female? Should I continue to be subjected to all manner of unjust and inhumane treatment because I am a woman? Should I allow myself to be mutilated and married out as a child just because society says so? Should I be seen and also see myself as being unequal with my male counterpart? These are questions that still need answers today in the 21st century.

The International Women’s Day (IWD) started in the 19th century, borne from early socialist and political events. It highlights political rights, human rights and brings to our awareness the social struggles for women worldwide. Since its birth, it has grown in leaps and bounds to become a global day of recognition and celebration for women across developing and developed countries alike growing from strength to strength annually and addressing different gender issues as it pertains to women.

It is a global day remembering not only the negatives but commemorating and celebrating the economic, social and political achievement of women past, present and future while diligently pointing out the need for continued vigilance and action required to ensure that women’s equality is achieved and maintained in all stratum of life.

This year’s theme: The Gender Agenda: Gaining Momentum is very apt in that though civilization and movements aimed at promoting women have since resulted in women emerging in areas of repute. There are more women in boardrooms as members and even chairmen of boards, female astronauts, genetic engineers, prime ministers and women now have somewhat equal legislative rights and an increased number of women are coming up daily as role models in every profession.

However, this is hardly enough as women have still not gained the equality they deserve in areas such as women’s health, education of the girl child, violence against women as seen in female genital mutilation and rape and even choice of the spouse they will live with for a greater part of their life. All these still put women and girls at a pedestal to be looked down on in society even though they have distinguished themselves in many phases of life.

The United Nations theme for this year’s IWD is ‘A promise is a promise’: Time for action to end violence against women. This is also appropriate, although we are a very long way from where we were in the 19th century as more women now have access to education, more are able to choose to work and still have a family and the men are more aware of the female rights. However, we are still a far cry from where we ought to be. A whole lot needs to be done, we all need to contribute our quota both female and male alike to ensure the future of every female around you is bright, equal, safe and rewarding. Make the female count because she does truly count. It’s up to you!!!