Friday, 30 November 2007

Fight Against HIV/AIDS Carried To Imams

Fight Against HIV/AIDS Carried To Imams

In the continuous and combined efforts at ensuring better public health in Nigeria, the ongoing workshop organized by the Muslims Against Aids (MAIDS) in conjunction with the Public Affairs Section of the United States Consulate General is a major landmark in the fight against HIV/AIDS pandemic in the Nigeria.

‘Protecting the Ummah: Role of the Imam’ is the theme of the 3-day HIV/AIDS workshop.

Speaking at the opening, Ms Mary Lou Johnson Pizarro, Public Diplomacy Officer at the US Consulate reiterated the important role of religious leaders in the effort to reduce HIV infection and the resultant effects of the social stigma. According to her, since HIV/AIDS does not discriminate against everyone based on their race, colour, ethnic tribe or religion, there is a need to ensure that the efforts at its reduction to come from various sectors of the society. She stressed that the Imams will serve as a catalyst for change because of their influential positions in their various communities.

Pizarro said, the US Government will continue to support the fight against the spread of HIV/AIDS in Nigeria and also expect that the workshop will serve as an eye-opener for the participants who have ample opportunities of relating and practicing the things they would learn in the course of the workshop.

Capt. M.B. Ahmad, one of the workshop participants said that the role of religious leaders in the fight against HIV/AIDS cannot be over emphasized because of the influence they have over their followers. He lamented the fact that there has always being workshops on HIV/AIDS organized for various groups of people but there has not being any for religious leaders especially the Imams. While lauding the organizers of the workshop, he was optimistic that programme will serve its objectives and expectation and urged for a more regular workshops.

The training for the Imams, which will be the first of its kind in Lagos, Nigeria, has participants from the various local government areas of Lagos. The workshop which is part of activities to mark the 2007 World AIDS Day is expected to end on the 29th of November 2007.

By Akinpelumi Akinlolu

Monday, 19 November 2007

Training of non-obstetrician healthcare workers can stem haemorrhage

Dr. Sadauki and Prof. Otolorin during a session at the SOGON conference.

FRIDAY Nov 16, 2007

BENIN NIGERIA ----- The Effective competency-based training of non-obstetrician healthcare workers can lead to the successful management and prevention of Post partum haemorrhage (PPH) which has been acknowledged to be the leading cause of death among women globally and particularly in Nigeria. In the same vein, the use of anatomic models has been found to be invaluable for clinical skills development in the absence of PPH client load.

This result of the study conducted by Access to Clinical and Community Maternal, neonatal and Women’s Health Services (ACCESS, Nigeria) with the support of USAID was disseminated at the ongoing 41st scientific conference and AGM of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) by Professor Emmanuel Dipo Otolorin, Chief of Party of ACCESS, Nigeria in a presentation titled ‘Competency Based Training for the Prevention and Management of Postpartum Haemorrhage’.

According to Professor Otolorin, since PPH can be drastically reduced with the Active Management of the Third Stage of Labour (AMTSL) and other medical skills, there is a critical need to ensure that birth attendants develop skills for managing this stage and other skills such as Manual removal of placenta; Repair of episiotomy and vaginal/perineal lacerations; Repair of cervical lacerations; Compression of abdominal aorta and the Bimanual compression of uterus.

The study which showed that there was marked improvement in the competence levels of the study participants was conducted in Zamfara and Kano States in Northern Nigeria. The maternal mortality rate in northern Nigeria is estimated at 1000 per 100, 000 live births and this can be attributed to the fact that many deliveries are done with no skilled attendant present and where they are present, may lack the skills required to manage the haemorrhage. The simulated scenarios which required different cadre of health personnel such as the laboratory scientist, anesthesian, working together brought to fore the need to develop and encourage the effective collaboration/team spirit among different medical personnel.

In the study, both skilled and semi-skilled health workers were trained using Anatomic models which included childbirth simulator, Fetal model, Placenta model with velcro attachment to abdominal wall, Cloth placenta with membranes and Foam blocks. While equipment such as Delivery kit, Episiotomy repair kit and print teaching materials were used and the study participants made to use Personal protective equipment, Decontamination equipment and Sharps disposal boxes.

However, the study showed that there was a need to step down the language of the training package for Community Health Extension Workers (CHEWs) besides training more midwives and CHEWs who are closest to these women in the community. Otolorin pointed that other skills that needs to be included in the curriculum include Suturing and knot tying (simple, vertical and longitudinal mattress stitches), conducting bedside clotting test, Use of hydrostatic balloon, and the use of antishock garment.

Otolorin concluded that competence-trainings should be a regular feature in Nigerian health facilities and for personnel in different fields relevant to maternal and neonatal health. This will ensure the properly management of emergency pregnancy complications but attention should be paid to the training of the community extension workers who are the people closest to the women in resource poor settings.

*Reported by Nnenna Ike

Haemorrhage-stopping device unveiled at SOGON conference

FRIDAY November 16, 2007 BENIN, NIGERIA ----- A novel method of treating haemorrhagic shock in women during or after childbirth has been unveiled and is being advocated for use by obstetricians and gynaecologists of Nigeria. The revelation of the Non-Pneumatic Anti Shock Garment (NASG) was made at the ongoing 41st Scientific Conference of the Society of Obstetrics and Gynaecology of Nigeria (SPGON) taking place in Benin Nigeria.

Professor Oladosu A. Ojengbede, Director Centre for Population & Reproductive Health, College of Medicine, University of Ibadan Oyo State Nigeria made this known in his presentation titled ‘Management of haemorrhagic shock’.

According to Ojengbede, obstetric haemorrhage is blood loss or bleeding during pregnancy; labour and within 42 days of termination of pregnancy. When there is excessive blood loss, women go into a state of shock which is progressively more dangerous if actions are taken on time to revive the patient. The major method of managing haemorrhagic shock’ is through resuscitation, which involves oxygenation, restoration of circulation, drug therapy, further evaluation and remedy of the basic problem that led to the shock.

The NASG is constructed like a pair of open-seamed trousers with one half made of velcro material so that it can be worn by women of varying sizes. It is worn from the abdomen to the legs and works by applying external counter pressure to the lower body, such that the blood is forced back towards the head and chest when the women is in a prone position. This way, the NASG can be used for Postpartum hemorrhage, Post cesarean hemorrhage, Ectopic Pregnancy, Trauma with injury/hemorrhage below the diaphragm while stabilizing the woman for further evaluation, transporting or preparing for definitive surgical treatment.

The NASG can be applied by anybody –doctors, nurses, CHEW, health attendants, ambulance drivers etc - who has been trained and with proper monitoring for adverse effects, can be safely and comfortably used for 24 - 48 hours. The NASG is so effective, it may arrest bleeding and avoid surgical intervention and even decrease the need for blood transfusions.

Prof Ojengbede however warned that the use of anti shock garment does not avert the necessity for evaluation to identify cause of shock, management of fluid and blood replacement, and appropriate therapy.

Prof. Ojengbede and colleague testing NASG at SOGON conference.

*Reported by Nnenna Ike

Friday, 16 November 2007

Govt makes pronouncement on post-partum haemorrhage drug

FRIDAY Nov 16, 2007

BENIN NIGERIA ------As Post-Partum Haemorrhage (PPH) continues to be the leading cause of maternal deaths in Nigeria accounting for 25% of maternal mortality, the search for a drug that can be administered to women especially in rural and resource poor setting got a boost with the federal ministry of health making a pronouncement on the drug Misoprostol. This is because the burden of maternal mortality rests on the grass root population and since this drug requires little/no expertise; its use should be promoted in order to reduce PPH which hitherto is the commonest cause of maternal mortality.

Dr Moji Odeku Director at the Reproductive Health Unit of the Ministry of Health made this pronouncement on behalf of the government at the 41st Conference of the Of Gynaecology and Obstetrics Of Nigeria (SOGON) taking place in the ancient city of Benin, Nigeria from the 14th to 17th November 2007.

She told participants that the present maternal mortality situation were basically due to the three delays namely: seeking care; accessing care and reaching healthcare. This was besides the fact that most pregnant women are anaemic and thus cannot tolerate blood loss, the lack of blood bank in most health facilities, and the socio-cultural and religious bias against blood transfusion. These trends according to her led to the study on the dug ‘Misoprostol’, a 3rd line uterotonic which is stable at room temperature, has a long shelf life and can be used at primary level were 70% of Nigerians dwell.

Dr Odeku said that the federal Ministry has since reviewed the clinical guideline and is recommending that ‘Misoprostol’ be introduced at health facility levels where it ca be administered by skilled birth attendants including doctors, nurses and midwives, and can also be administered by trained health care providers who are MLSS trained Community Health Extension Workers (CHEWS). She stressed that every effort would be made to ensure that the drug is readily available in the country and at generic dosages at affordable prices.

However, her presentation maintained that though ‘Misoprostol’ should be used for the prevention of PPH, uterotonics should be used in the following order Oxytocin, Erometrin and Misoprostol. She concluded that the information memo will be presented at the National Council on Health later in the year while a National dissemination meeting by the Minister of health would convene in December 2007. Thereafter, the ministry would commence a State training and sensitisation on the use of ‘Misoprostol’ in the 36 state of Nigeria including the FCT. This would be to enlighten the personnel who might be administering ‘Misoprostol’ in future against mis-use.
Dr Odeku urged medical personnel to embark on data gathering as an form of operation research to assess side effects, compare the cadre of the drug administrators and other relevant information as this would him in the formulation of the right policy on the drug use in Nigeria.

*Reported by Nnenna Ike

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IMNCH endorsed by Nigerian Obstetricians and Gynaecologists

Chief (Dr.) Abiola-Oshodi, 1st Vice President with Dr. (Sir) JOhn Okaro, President, SOGON.

FRIDAY November 16, 2007 BENIN, NIGERIA ----- Nigerian Obstetricians and Gynaecologists have formally thrown their weight behind the Federal government’s new initiative to effectively ameliorate the dismal state of the maternal and child care delivery in Nigeria. The initiate known as the Integrated Maternal, Newborn and Child Health (IMNCH) Strategies is being spearheaded by the federal ministry of health involves the reorganization and reorientation of the health system to ensure the delivery of a set of essential interventions which will provide a continuum of care for women, neonates and children. The IMNCH strategy is a holistic approach; it replaces the competing calls for mother or child.

Dr (Sir) John Okaro, President of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) made this assertion, Thursday at the opening of the 41st Scientific Conference and AGM of the Society in Benin Nigeria. Dr Okaro was reacting to a speech made by Dr Moji Odeku, Director, Reproductive Health Unit at the Federal Ministry of Health Abuja.

In her speech, Dr Odeku said, the IMNCH represents the articulation of bold and new thinking on how to fast-track comprehensive action to turn around maternal and child health in the country. It pulls together in a practical continuum, an evidence-based maternal, newborn and child health framework for achieving Millennium Development Goals. Since maternal and neonatal mortality are often the result of a badly managed pregnancy and home delivery without a skilled birth attendant, the thousands of needless deaths would be prevented by implementing the integrated maternal, newborn and child health interventions.

She maintained that the new initiative would only be effective when bodies of medical professionals such as SOGON buy in into it and thus reduce the numerous parallel-running programmes on maternal and child healthcare. According to Odeku, IMNCH is a multisectoral approach which can only work when the different sectors acknowledge their roles and start implementing the responsibilities accruing to the roles.

She maintained that a sustained investment and a systematic phased gradation of essential IMNCH interventions, integrated in a continuum of care is required — when these interventions are in place the lives of many more mothers, infants and children will be saved. While commending the Edo State government for the new directive of tree treatment for pregnant women and children under five years, Odeku urged every state government to make adequate investment plans for the human resource and health facility in the areas under their jurisdiction so that the roll-out of IMNCH would yield lasting impact.

Responding, Dr. Okaro, asserted that maternal death, stillbirths and newborn deaths are strongly linked to deliveries which take place outside of health facilities, without properly trained birth attendants in attendance, or in health centres which are not equipped or staffed to handle emergency obstetric or neonate crises. He hoped that with the roll-out and implementation of the IMNCH strategy, the problems of not having skilled attendants, health centres without necessary facilities to deal with obstetric emergency and all the other problems that the members of the Society face in the discharge of their duties.

It is hoped that integrating maternal, newborn and child healthcare services will provide an opportunity for the health sector to eliminate unhelpful dichotomies (i.e. mother vs child, short term vs long term, skilled care vs community approaches, and intrapartum vs continuum of care) that stifle funding and lead to confusion and ultimately cost lives.

The SOGON Conference is a 4-day event with the main theme being Intersectorial collaboration for improving maternal and Neo-natal Health, while the Subthemes are Prevention of Cervical Cancer, Post-partum Haemorrhage.

*Reported by Nnenna Ike

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Thursday, 15 November 2007

SOGON conference begins: Experts call for adherence to WHO recommendations

Prof. Emmanuel Dipo Otolorin, Chief of Party, ACCESS Nigeria

THURSDAY Nov 15, 2007

BENIN NIGERIA------Prof. Otolorin, Chief of Party, ACCESS Program Nigeria has made a call to Nigerian medical professionals in the field of Obstetrics and Gynaecology to update themselves with current recommendations for the prevention of Post-partum Haemorrhage. Since PPH is the leading cause of maternal mortality globally and especially in Nigeria.

He made this call while presenting his paper titled Prevention of Post-Partum Haemorrhage the role of Uterotonics at the pre-conference workshop preceding the opening of the 41st Conference of the Society Of Gynaecology and Obstetrics Of Nigeria (SOGON) taking place in the ancient city of Benin from the 14th to 17th November 2007.

According to him, the various uterotonic agents used to prevent PPH include Oxytocin, Ergometrine and Prostaglandin analogues. However there is evidence to show the choice of Oxytocin as the first line of drug for the prevention of PPH over other uterotonics. He maintained that the large number of death experienced by Nigerian women would be reduced if proper attention is paid by medical personnel to the services rendered during a last stage of delivery. This, he said is known as Active management of third stage of labour (AMTSL)

Prof. Otolorin added the advantages of Oxytocin as being effective within 2 to 3 minutes after administration, minimal side effects, can be used on all women and that it is inexpensive. He cited its disadvantage as requiring cold chain handling and storage to maintain its potency. This he said can be remedied with the provision of solar cooling facility.

According to him, with Nigeria being in the tropics, we should be able to utilise the abundant sunlight we have with cost effective innovations. He recommended that Nigerian States should use the UNICEF prototype of solar coolant for vaccines for the storage of Oxytocin. He explained that one solar cooling facility can be procured and maintained by a number of health facilities in a State, such that there is always an availability of Oxytocin in health centres for use by women during delivery.

To ensure that the AMTSL is enhanced such that women do not die of PPH in Nigeria, there is need for an intersectoral approach to the services offered at that period. There should be an efficient collaboration among the different medical personnel, from the midwives, the laboratory scientist, doctors and even the people outside of the health facility. The government’s role would be in the provision of utilities such as electricity, water, and drugs supply at all times to health facilities.

Benin cultural troop at the opening ceremony of the SOGUN Conference.

*Reported by Nnenna Ike

Failure of CEDAW, NIRH bills passage retrogressive

Dr. (Sir) John Okaro, President, Society of Gynaecology and Obstetrics of Nigeria (SOGON)

Failure Of CEDAW, National Institute of Reproductive Health Bills Malicious And Retrogressive---SOGON

THURSDAY November 15, 2007 BENIN, NIGERIA ----The failure of the National Institute of Reproductive Health (NIRH) and the CEDAW Bills at the Nigerian legislative houses has been described as malicious and retrogressive in view of the fact that these bills would have started a marked reduction in the number of women who die in Nigeria due to pregnancy-related complications and their natural roles as women. Though Nigeria contributes only 2% of the world population, she contributes up to 10%of the deaths of women who die from pregnancy with an estimated 53,000 dying every year!

Prof (Sir) John Okaro, President of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) made this assertion, Wednesday at the Pre-Conference Press briefing of the 41st Scientific conference and AGM of the Society. According to him, the failure of passage of the National Institute of Reproductive Health (NIRH) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), both women-friendly Bills would make the Nigerian statistics on maternal and neonatal deaths remain unacceptably high because of the misconception that the bills will promote abortion.

The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) is the only human rights treaty which affirms the reproductive rights of women and targets culture and tradition as influential forces shaping gender roles and family relations, while the National Institute of Reproductive Health (NIRH) sought to promote the reproductive health of the vulnerable –all women. The Convention provides the basis for realizing equality between women and men through ensuring women's equal access to, and equal opportunities in, political and public life -- including the right to vote and to stand for election -- as well as education, health and employment. State parties agree to take appropriate measures against all forms of traffic in women and exploitation of women.

The 41st SOGON scientific conference kicked off yesterday Wednesday 14, 2007 in the ancient city of Benin in Nigeria, with the body calling on the media to wake up to its responsibility of educating the Nigerian masses with the view of reducing the three delays that lead to maternal mortality in Nigeria. His words, ‘the press is the bulwark of the future of the Nigerian women, and thus the future of Nigeria. Only the effective partnering of the Press with the medical professional associations would bring about the needed change amongst the populace and even among policy makers.’

Prof. Ladipo, Executive Director AFRH Ibadan, Oyo State, Nigeria

Professor Ladipo, Executive Director of Association for Reproductive and Family Health Ibadan, reiterated that only the proper understanding of the three delays by all would lead to a reduction in the deaths of Nigerian women during pregnancy. The Press should educate Nigerians about the delays at home, delay in getting to a health facility and the delay in accessing medical care at the facility. According to him, ‘Addressing these delays require that we provide appropriate education to our people, and we raise their level of confidence in the health system, then at the same time, make provision for community midwives who will reside at the communities to be available and skilled. A lot more still needs to be done from the point of view of improving the man power, improving the commodity supply, ensuring that electricity is regular, ensuring that water supply is regularly available, and ensuring that the morale of the health workers themselves is improved.’

Professor Emmanuel Dipo Otolorin, Country Director of ACCESS Nigeria called for more political commitment towards issues that concern women and children from the Nigerian polity. He called on the political leaders to take necessary steps that would ensure that posterity remembers them for good, by making statements and taking the actions to implement them. According to him, ‘Leadership should not be about oneself and the gains for one’s family, it should be about what I helped other people to achieve, what legacies I was able to put in place that would make people to remember me for good.’

The fact that about 53,000 women die annually in Nigeria is a grim realty that Nigeria policy makers have not firmly grasped in the past. These women die mainly from complications during pregnancy and delivery which include excessive bleeding after delivery, sepsis, pregnancy associated high blood pressure, anaemia, malaria and unsafe abortion. Most of these deaths are preventable if the society is better enlightened, social amenities in place and the health system given a boost of motivated personnel, drug supply and the right equipment to handle emergency obstetric complications.

The SOGON Conference is a 4-day event with the main theme being Intersectorial collaboration for improving maternal and Neo-natal Health, while the Subthemes are Prevention of Cervical Cancer, Post-partum Haemorhage.

*Reported by Nnenna Ike

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Friday, 9 November 2007

MacArthur Foundation pledges to lower maternal mortality in Nigeria

During last month’s Women Deliver conference in London, the president of the John D. and Catherine T. MacArthur Foundation, a private US based grant- making organization, announced that the Foundation will invest $11 million to reduce maternal deaths due to post partum hemorrhage in Nigeria and India.

This substantial investment includes the distribution of anti shock garments, a low cost neoprene suit that helps to stabilise women who are bleeding after child birth, as well as the uterus-contracting drug misoprostol to prevent bleeding, a calibrated blood collection drape to diagnose bleeding, and transportation to get patients to a health facility for assessment and treatment as appropriate. This promises to be very useful as 23 percent of Nigeria’s maternal deaths are due to hemorrhage, particularly in rural areas where transportation to health facilities is often delayed due to poor roads and poor communication.

The anti shock garments are made of lightweight neoprene and resemble the bottom part of a wetsuit. Originally it was developed for use on the battlefield. One of its benefits in a resource-poor environment is that it can be manufactured inexpensively and is reusable up to 100 times. When the suit’s five Velcro closures are tightened around the patient’s body, the compression stops blood from flowing to the lower extremities and forces it back to the hearths, lungs, and brain to counteract the shock. The results are immediate, buying time to transport the woman to a health facility where she can receive care. The woman can even remain in the garment for two to three days, if necessary.

According to a release by Pathfinder International, an organization that provides women, men, and adolescents with access to quality family planning and reproductive information, the introduction of the intervention package will happen in three waves. Pathfinder International and its partners will conduct outreach at the national and local levels to educate policymakers and local leaders about its benefits. Then they will provide training to over 900 health care personnel working in 500 sites and 500 traditional birth attendants working in communities. This training will enable health workers to implement the life-saving interventions and to ensure that women who are referred from the community will receive appropriate care once they reach the hospital. Finally, Pathfinder International will raise awareness among community members about complications that can be remedied with the help of the anti-shock garment.

The grant money allocated by MacArthur Foundation will not only go towards the anti shock garments and health packages for women, but also to addressing other indirect causes of maternal mortality include poverty, income inequities, underdevelopment, gender disparities, poor education, conflicts, food insecurity, and other social determinants of health.

Women Deliver was the biggest conference on women’s health in the last 20 years. Over 1,500 politicians including Ministers from Africa and Asia, human rights activists, NGOs, faith based organisations, health professionals and economists met at London's Excel Conference and Exhibition Centre to assess progress made in preventing maternal deaths and promoting child survival since the 1987 Safe Motherhood conference in Nairobi, Kenya.

*Reported by Amanda Hale

Thursday, 8 November 2007

Malnutrition is a leading cause in child deaths

A recent release from Population Reference Bureau in Washington D.C. showed that malnutrition plays a prominent role in the deaths of about 16, 000 young children every day, and virtually all of them in the developing world. This a yearly toll of almost six million children lost to malnutrition. According to the report, nearly 50 per cent of all young children in the developing world do not receive enough iron in their diets, endangering their mental and physical development.

"Malnutrition is the underlying cause of millions of deaths, but lacks public recognition because it does not kill young children directly, as does pneumonia or diarrhea," said Bill Butz, PRB's president. "Many of these deaths could be averted through nutrition measures that are known to be effective, often at low cost."

In Nigeria, where fertility rates continue to rise, women give birth to an average of six children during their lifetime. With so many children born annually, the population has skyrocketed. This means that many children are left without the proper nutrition or vitamins needed to fully develop their bodies into adulthood. According to Doctors Without Borders emergency coordinator Ton Koene, malnutrition in Nigeria is a growing and dangerous problem. Koene worked in southern Borno state in Northern Nigeria during a measles epidemic in 2005, and saw first-hand the effects that malnutrition had on the young population. Out of the 2,500 children screened in southern Borno state, between one to two per cent suffered from severe acute malnutrition (SAM).

"This is quite alarming and particularly unacceptable in conflict-free Borno state," said Koene.

Such a high rate of malnutrition is caused by a number of factors. For one, a large number of young mothers stop breastfeeding too early and are unable to give their babies a healthy, varied diet. Chronic food insecurity is another factor. According to Koene, severe droughts throughout the northern region of Nigeria upset the food supplies of families living there.

To respond, Doctors Without Borders set up several therapeutic feeding centers in Borno state to give malnourished children up to eight meals of special high-protein milk around the clock until they gained enough weight to be released. When little ones were too weak to swallow, they were fed through a tube to their stomach or put on a drip. This process lasted up to six weeks.

Koene suggests that in order to prevent the issue of malnutrition in Nigeria, the government has to deal with deeply rooted social and cultural aspects and to get involved into development issues such as agricultural schemes and long-term education.

"The sad part is that so many child deaths can be prevented through micronutrient supplies or a more effective agricultural system," said Koene. "The government just need to implement these things to see a difference."

*Reported by Amanda Hale