Maternal Obesity: Know more about it

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Obesity is defined as having an excessive amount of body fat. A formula based on height and weight — called the body mass index (BMI) — is often used to determine if a person is obese.  Maternal Obesity however refers to obesity (often including being overweight) of a woman during pregnancy.

Obesity during pregnancy increases the risk of a number of obstetric complications for both mother and child and is associated with significant maternal mortality and morbidity including increased risk of maternal death, pre-eclampsia and gestational diabetes mellitus. For the offspring of obese mothers, there is a higher incidence of foetal distress, stillbirth and neonatal death.

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Hypertensive Disorders in Pregnancy: Do you know enough about it?

gestational-hypertensionBlood pressure is the force exerted by the blood pushing against the artery walls. When the pressure in the arteries becomes too high, it’s called high blood pressure, or hypertension.

A blood pressure reading is given as two numbers. The first number represents the pressure created when your heart beats (systolic pressure); the second number is the pressure when the heart is at rest between beats (diastolic pressure).  Your blood pressure (measured in millimetres of mercury, or mm Hg for short) is recorded regularly during your pregnancy. It is recorded as a higher (systolic) pressure and a lower (diastolic) pressure – for example, 120/70 mm Hg, or 120 over 70.

High blood pressure is defined as a reading of 140/90 or higher, even if just one of the numbers is higher. If you have high blood pressure, or hypertension, your heart has to work harder to pump the blood around your body.

Most pregnant women with high blood pressure have healthy babies, but a few have problems. High blood pressure problems occur in 5 percent to 10 percent of all pregnancies in the Nigeria. Globally, by conservative estimates, hypertensive disorders are responsible for 76,000 maternal and 500,000 infant deaths every year thus remaining one of the leading causes of maternal and infant illness and death. Continue reading

INTERNATIONAL DAY AGAINST DRUG ABUSE AND ILLICIT TRAFFICKING/ WORLD DRUG DAY 2015 #WDD15

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The 26th of June every year has been set out by the United Nations office on Drugs and Crime as the International Day against Drug abuse and Illicit Trafficking.  Established by the United Nations General Assembly in 1987, this day serves as a reminder of the goals agreed to by Member States, which Nigeria is a part of, of creating an international society free of drug abuse.

In a statement given by the Executive Director of the UNODC, Mr. Yury Fedotov, to mark the day he says “Today is an important day for focusing on the threat of the production, trafficking and use of illicit drugs. Robust action is needed to strengthen criminal justice systems, break-up the criminal networks who deal in misery and suffering, and to nurture health and human rights-based responses.”

Truly, Drug abuse and trafficking causes immeasurable pain and suffering to those who end up becoming addicted to these substances. Drug abuse hurts the people who take drugs AND the people around them, including families, kids, and babies who aren’t yet born. It also hurts the body and the brain, sometimes forever.

Depending on the drug, it can enter the human body in a number of ways, including injection, inhalation, and ingestion. The method of how it enters the body impacts on how the drug affects the person. For example: injection takes the drug directly into the blood stream, providing more immediate effects; while ingestion requires the drug to pass through the digestive system, delaying the effects.

Most abused drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. When drugs enter the brain, they can actually change how the brain performs its jobs. These changes are what lead to compulsive drug use, the hallmark of addiction.

Recreational use of prescription drugs is a rising epidemic causing a serious problem with teens and young adults. Studies have show that a teen is more likely to have abused a prescription drug than an illegal street drug with many youths believing prescription drugs to be safe because they were prescribed by a doctor or a pharmacist. However taking them for nonmedical use to get high or “self-medicate” can be just as dangerous and addictive as taking illegal street drugs.

There are very serious health risks in taking prescription drugs. This is why they are taken only under the care of a doctor. And even then, they have to be closely monitored to avoid addiction or other problems. Many pills look the same. It is extremely dangerous to take any pill that you are uncertain about or was not prescribed for you. People can also have different reactions to drugs due to the differences in each person’s body chemistry. A drug that was okay for one person could be very risky, even fatal, for someone else.

Prescription drugs are only safe for the individuals who actually have the prescriptions for them and no one else. Due to their potential for abuse and addiction, many prescription drugs have been categorized in the same category as opium or cocaine. These include Ritalin and Dexedrine (stimulants), and the painkillers OxyContin, Demerol, Roxanol, Codeine.

Many illegal street drugs were at one time used or prescribed by doctors or psychiatrists but were later banned when the evidence of their harmful effects could no longer be ignored. Examples are heroin, cocaine, LSD, methamphetamine and Ecstasy.

Abuse of prescription drugs can be even riskier than the abuse of illegally manufactured drugs. The high potency of some of the synthetic (man-made) drugs available as prescription drugs creates a high overdose risk. This is particularly true of OxyContin, Codeine and similar painkillers.

Many people don’t realize that distributing or selling prescription drugs (other than by a doctor) is a form of drug dealing and is as illegal as selling heroin or cocaine, with costly fines and jail time.

TYPES OF ABUSED PRESCRIPTION DRUGS

Prescription drugs that are taken for recreational use include the following major categories:

  1. Depressants:Often referred to as central nervous system (brain and spinal cord) depressants, these drugs slow brain function. They include sedatives (used to make a person calm and drowsy) and tranquilizers (intended to reduce tension or anxiety) such as Rophynol.
  2. Opioids and morphine derivatives:Generally referred to as painkillers, these drugs contain opium or opium-like substances and are used to relieve pain such as Codeine.
  3. Stimulants:A class of drugs intended to increase energy and alertness but which also increase blood pressure, heart rate and breathing.
  4. Antidepressants:Psychiatric drugs that are supposed to handle depression.

A person who abuses drugs may not realize they have a problem until pronounced effects of drug abuse are seen, often physically. While drug abuse effects on the body vary depending on the drug used, all drug abuse negatively impacts one’s health.

Common effects of drug abuse on the body include sleep changes and decreased memory and cognitive abilities. Other common physical problems include:

Injuries

More deaths, illnesses and disabilities stem from substance abuse than from any other preventable health condition. Today, one in four deaths is attributable to illicit drug use. People who live with substance dependence have a higher risk of all bad outcomes including unintentional injuries, accidents, risk of domestic violence, medical problems, and death.

Health Problems

The impact of drug abuse and dependence can be far-reaching, affecting almost every organ in the human body. Drug use can:

  • Weaken the immune system, increasing susceptibility to infections.
  • Cause cardiovascular conditions ranging from abnormal heart rate to heart attacks. Injected drugs can also lead to collapsed veins and infections of the blood vessels and heart valves.
  • Cause nausea, vomiting and abdominal pain.
  • Cause the liver to have to work harder, possibly causing significant damage or liver failure.
  • Cause seizures, stroke and widespread brain damage that can impact all aspects of daily life by causing problems with memory, attention and decision-making, including sustained mental confusion and permanent brain damage.
  • Produce global body changes such as breast development in men, dramatic fluctuations in appetite and increases in body temperature, which may impact a variety of health conditions.

Effects On The Brain

Although initial drug use may be voluntary, drugs have been shown to alter brain chemistry, which interferes with an individual’s ability to make decisions and can lead to compulsive craving, seeking and use. This then becomes a substance dependency.

  • All drugs of abuse – nicotine, cocaine, marijuana, and others – effect the brain’s “reward” circuit, which is part of the limbic system.
  • Drugs hijack this “reward” system, causing unusually large amounts of dopamine to flood the system.
  • This flood of dopamine is what causes the “high” or euphoria associated with drug abuse.

Behavioral Problems

  • Paranoia
  • Aggressiveness
  • Hallucinations
  • Addiction
  • Impaired Judgment
  • Impulsiveness
  • Loss of Self-Control

Birth Defects

There is an increasing percentage of women who use illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and heroin during pregnancy. These and other illicit drugs may pose various risks for pregnant women and their babies. Some of these drugs can cause a baby to be born too small or too soon, or to have withdrawal symptoms, birth defects or learning and behavioral problems. Additionally, illicit drugs may be prepared with impurities that may be harmful to a pregnancy.

Finally, pregnant women who use illicit drugs may engage in other unhealthy behaviors that place their pregnancy at risk, such as having extremely poor nutrition or developing sexually transmitted infections.

There are lots of reasons why people take illegal drugs. Some take them to escape problems while others are bored, curious or just want to feel good. People may be pressured into taking drugs to “fit in” with a particular crowd or to rebel or get attention. Drug users come from all kinds of backgrounds. They are male and female, young and old, rich and poor, working and unemployed, from the city and the countryside—it does not matter.  Drug use can affect anyone.

“Efforts against illicit drugs must be connected to our work to promote opportunities through equitable and sustainable development.  We must continually strive to make the weak and fragile stronger.  The United Nations General Assembly special session on the world drug problem, to be held in April 2016, can advance this cause, with countries sharing knowledge and forging common solutions.

On the International Day Against Drug Abuse and Illicit Trafficking, let us raise awareness about the value of applying a balanced approach to these problems based on an understanding that sustainable development can and must catalyze change across all these fronts” Ban Ki-Moon, UN Secretary-General

Sickle Cell & Pregnancy

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Sickle cell disease often becomes more severe – and pain episodes more frequent – during pregnancy, particularly in the third trimester. A pregnant woman with sickle cell disease is more likely to have a miscarriage, still birth, preterm labor, or a low-birth-weight baby and Sickle cell pregnancies are almost always considered high risk.

Ideally, women with sickle cell disease should receive preconception counseling. This is because with early prenatal care and careful monitoring, women with sickle cell disease can have a healthy pregnancy and successful delivery.Women with sickle cell are more prone to pain episodes during pregnancy, especially during the third trimester. Continue reading

Nigeria gets US$500m from the World Bank to improve Maternal and Child Health

world-bank-670In an article written by Ndidi Chukwu for Health Reporters, The World Bank Group’s Board of Executive Directors have approved a US$500 million International Development Association (IDA) credit to significantly improve maternal, child, and nutrition health services for women and children in Nigeria. By improving access to higher quality health services, the new development financing will help Nigeria to achieve its “Saving One Million Lives (SOML) Initiative,” which was launched by the Federal Ministry of Health in October 2012 to save the lives of the more than 900,000 women and children who die every year in Nigeria from largely preventable causes. “Saving One Million Lives is a bold response from the Nigerian government to improve the health of the country’s mothers and children so they can survive illness and thrive.  This, in turn, will also contribute to the social and economic development of Africa’s largest economy,” said Benjamin Loevinsohn, a Lead Health Specialist and Task Team Leader for the new project.

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APC and PDP on Improving Maternal and Child Health in Nigeria

As we approach the new date for the presidential elections, we decided to use the additional time provided by the postponement to scrutinize the two leading party manifestoes on health in a bit more detail. While there are other parties also in the race, we have chosen for convenience to focus on the manifestoes of the two front-runner parties – the People’s Democratic Party (PDP) and the All Progressives Congress (APC).

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The APC in its manifesto has a section on healthcare.

Within the healthcare section of its manifesto, the APC says that it will:

Prioritize the reduction of the infant mortality rate by 2019 to 3%; reduce maternal mortality by more than 70%; reduce HIV/AIDs infection rate by 50% and other infectious diseases by 75%; improve life expectancy by additional 10 years on average through our national healthy living program.
Increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently).
Increase the quality of all federal government owned hospitals to world class standard within five years.
Invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector.
Provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS.
Boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.

The PDP section on health says that:
The party shall present a comprehensive health-care policy for the country, the essential aim of which shall be:

Health-care for all citizens;
Free medical services in all institutions of learning; and
Free medical services to the aged and the handicapped.

As its strategy, it says that: PDP in government shall:

Ensure that all Nigerians, particularly the young and the aged, shall have access to free medical services;
Provide free immunization to all children;
Progressively establish primary health centre, equipped with pharmacies, within the reach of every Nigeria, particularly the rural dwellers.
Progressively provide General Hospitals in all Local Government headquarters; specialist hospitals in all State Capitals.
Encourage research into traditional medical, practices and integrate these practices into the orthodox medical system.
Equip and expand the teaching Hospitals in the country;
Embark on mass training of paramedical personnel to meet the needs of our ruralpopulace;
Encourage more students to train as medical doctors;
Provide special incentives for medical practitioners and other medical Personnel with particular emphasis in those located in remote areas;
Stimulate the local production of medical drugs and other supplies;
Encourage family planning by providing family planning services and materials free of charge;
Regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against exploitations; and
Make and enforce stringent laws against the manufacturing and sale of fake and adulterated drugs; and promote a healthy physical environment by intensifying the present periodic environmental sanitation exercises.

Generally speaking, both main parties promise to raise the number of medical doctors, provide free healthcare for children and the elderly, improve the quality of government/teaching hospitals, fight fake and adulterated drugs and boost the local pharmaceutical industry. In addition, the APC wants to improve maternal and child health, invest in cutting-edge technology and reduce the prevalence of infectious diseases, while the PDP aims to achieve universal healthcare, offer free medical services in all institutes of learning and free healthcare for the handicapped, improve the quality of private hospitals, promote environmental sanitation exercises, offer free family planning, increase medical personnel especially in rural areas, integrate traditional medical practices and increase the number of general hospitals, specialist hospitals and primary health centres.

Full Article on Nigeria Health Watch

Dr. Luther-King Fasheun: Improving Maternal Health in Nigeria through Partnership

Embedded image permalinkIt is no longer news that Nigeria is a peculiar country, a nation with huge human and natural resources, and whose diversity of peoples and internal geographies is a blessing. Sadly, it is also not news that the country represents at least 10% of the global maternal mortality burden, with a currently estimated maternal mortality ratio (MMR) of 487 per 100,000 livebirths (as at 2011). However, the well thought-out targets of the Ending Preventable Maternal Mortality (EPMM) Working Group present the country with an unprecedented opportunity to change the tide, improve livelihoods for its women and families, and aim to eliminate preventable maternal mortality within a generation, harnessing the right tools and interventions, at the right scale and quality, as well as building on the success factors in the chase for the Millennium Development Goals (MDGs), including the harnessing of a burgeoning private sector and surging political will for improved health outcomes for women, families, and communities.

Based on the EPMM Working Group targets, the proposed MMR target for Nigeria is ‘less than 100 per 100,000 livebirths by 2035, with country-specific milestones, with the expectation that Nigeria will cross one milestone within every 5 year interval.’ For Nigeria, I humbly recommend that the country-specific 5 year interval milestones be context-driven on a State by State basis, given that Nigeria has 36 States, with one Federal Capital Territory (FCT, Abuja). While the federal government provides strategic guidance and robust supportive frameworks for implementation of reproductive, maternal, newborn and child health (RMNCH) interventions for the entire country, the infrastructural and health systems challenges of Nigeria, as well as the resources available to mitigate these challenges, are mainly State-driven. More so, because of the vast population and heterogeneity of Nigeria, as well as the strategic importance of the country to the attainment of global goals, I wish to strongly recommend that the EPMM Working Group sets State-by-State targets, working in partnership with the Nigerian Federal Ministry of Health, and governments of all the 36+1 States.

A State-by-State framework must not shy away from the interconnectedness of States, and the virtual nature of geographic borders, especially because of the very mobile nature of Nigerian women and families, as well as unavoidably shared natural resources, for example. To this end, there should be significant cooperation and sharing of insightful knowledge, under the leadership of the Federal Ministry of Health, and with the assistance of NGOs, CSOs, bilaterals and multilaterals. In this manner, Nigeria presents a window of opportunity to show the world a model that works to eliminate inequities to the last mile, helping to reach global set goals and targets for maternal mortality ratio (MMR) reduction.

The adoption, last year, of the Maternal Death Review (MDR) surveillance mechanism, at the National Council on Health (NCH) meeting, marked a watershed in the history of Nigeria, as it demonstrated a readiness for evidence-based policy frameworks that will mitigate Nigeria’s huge maternal mortality burden. This policy adoption is being followed through with full vigour. Even more recently, the Presidential Summit on Universal Health Coverage promises a new guiding light for the elimination of inequities and barriers to access to healthcare, especially at the primary healthcare level, where the key to unleashing tremendously scaled-up interventions, to save the lives of mothers and children, exists.

Source: Maternal Health Task Force Blog

Maternal Health in Nigeria: Emerging Priorities through Survey

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“Nigeria’s population is only two percent of the world population, but we contribute about 10 percent of the maternal mortality,” said Oladosu Ojengbede, professor and director of the University of Ibadan’s Center for Population and Reproductive Health

Despite efforts to achieve Millennium Development Goal 5 – reduce the maternal mortality ratio by three-quarters compared to levels in 1990 and achieve universal access to reproductive health – Nigeria has seen only modest improvements to maternal health, said a panel of experts participating in a live videoconference in both Abuja and Washington, DC, on December 17.

Nigeria has seen only modest improvements to maternal health in the last 15 years

The simulcast event was preceded by a day-long policy workshop in Abuja with 40 participants from a wide array of stakeholders, including the ministry of health, development partners, NGOs, traditional leaders, health organizations, and the media.

Results from Nigeria’s most recent National Demographic and Health Survey indicate the maternal mortality ratio stood at 576 per 100,000 live births in 2013, compared to 800 deaths per 100,000 live births in 2003 – a 52 percent decline since 1990. Through roundtable discussions, participants identified five key factors to Nigeria’s maternal mortality that must be addressed to accelerate progress.

Five Central Challenges

The first roundtable, led by Dr. Chris Agboghoroma, secretary general of the Society of Gynaecology and Obstetrics of Nigeria, identified quality of care as a critical area for improvement. “The quality of care in most public and private facilities varies significantly from poor to near excellence,” he said. This inconsistency causes women to lose confidence in health services and leads some to refuse services altogether. To improve quality, said Agboghoroma, Nigeria needs dedicated departments in the ministries of health with motivated staff to enforce standards in training institutions.

The second roundtable focused on the provision of integrated services. Dr. Hadiza Galadanci, an obstetrician and gynecologist consultant, said the lack of skilled health care providers, poor infrastructure, and lack of commodities, like family planning, makes it difficult to provide integrated services for women at health facilities. She called for the full involvement of traditional and religious leaders and a more comprehensive curriculum for health workers. Workers should not only be trained in reproductive health services, family planning, or maternal health as individual specialties; they should be able to treat any woman that walks into a facility with a need, she said.

“The quality of care in most public and private facilities varies significantly from poor to near excellence”

Dr. Adesegun Fatusi, provost at Obademi Awolowo University, spoke for the third roundtable. He identified social determinants – such as poverty, child marriage, home delivery without aid or use of a skilled birth attendant, and cultural or religious opposition to family planning – to be consistent contributors to poor maternal health outcomes. There must be macroeconomic, “pro-poor” policies within the health sector that specifically address the poverty rate and provide social protection for the most vulnerable, he said. In addition, stronger legal provisions that protect against child marriage, engaging community leaders, and prioritizing education within households and throughout communities, especially for girls, is required to change social norms, said Fatusi.

The fourth roundtable focused on knowledge gaps and research needs. Efficient data collection, reporting, and funding allows for the interpreting of maternal health trends and translation into policy, said Dr. Oluwadamilola O. Olagun, a project manager with theWhite Ribbon Alliance. In Nigeria, an estimated 38 percent of deliveries take place in health facilities, which means over 60 percent take place outside a facility. A mechanism for collecting maternal health data from all delivery points is therefore essential, she said.

Often, there is also a disconnect between research findings and implementation, which delays progress. More government involvement is needed in research projects and the benefits of these findings need to be better articulated to the government, said Olagun.

Ojengbede spoke for the fifth roundtable, which focused on policy. For maternal health policies in Nigeria to be more successful and sustainable they require political commitment and incorporation into legal frameworks, said Ojengbede. The ministries of justice, health, and civil service organizations working on maternal and child health play an important role. They must support legislation on the state and national levels to ensure accountability and implementation, he said, rather than relying on ad hoc efforts led by third parties.

“Fertilizers to Improve the Fruits of Our Labor”

“It is evident that Nigeria does not lack expertise or insightful discussions,” said John Townsend, vice president and director of reproductive health at Population Council, serving as a discussant in Washington, DC. “However, the issue of moving intervention to scale and getting services to people still needs to be addressed.”

The perception of maternal health must be changed

The importance of execution was well noted by workshop participants. Galadanci called for more comparative research that shows which programs are working in different states to determine which should be expanded. Ojengbede pointed out that Nigeria’s response to the Ebola crisis was very efficient; it created a national sense of emergency which spread awareness quickly. Likewise, the perception of maternal health must be changed so improving conditions for women and children is seen as a national duty for all.

Ojengbede expressed optimism about the outcome of the workshop and Nigeria’s ability to tackle these important issues. “The government and fellow participants both 100 percent agree that the recommendations from this dialogue will be applied like fertilizers to improve and increase the fruits of our labor,” he said.

Dr. Wapada Balami, director of the family health department in the Federal Ministry of Health, said the recommendations would be forwarded to the Honorable Minister of Health, who will set up a committee to advise him on the meeting’s results. “This will help in shaping reproductive, maternal, and newborn health policies in the country.”

Source: New Security Beat