There is a dearth of information on the reference values for haematological indices particularly according to the relevant trimesters of pregnant women in Nigeria. The objective of this study was to provide reference values for Nigerian pregnant women. The study took place at the Adeoyo Maternity Hospital and the University College Hospital, both in Ibadan. This descriptive study was carried out over a period of 8 months. Subjects were apparently healthy pregnant women that satisfied the inclusion and exclusion criteria. The mean values (and 95% confidence intervals, CI) of haematological indices were as follows -- First trimester: Haemoglobin (Hb) 112.44 (101.64 - 123.25) g/l, haematocrit (hct) 35 (32 - 38)%, WBC 5.488 (4.025 - 6.950) x 10(9)/l and platelet counts 227.56 (165.21 - 289.90) x 10(9)/l;Second trimester: Hb 100.39 (97.85 - 102.92) g/l, hct 29.3 (28.5 - 30.1)%, WBC 6.57 (6.19 - 6.95) x 10(9)/l, platelet count 229.56 (211.86 - 247.26); and the Third trimester: Hb 98.06 (96.12 - 100.00) g/l, hct 29.4 (28.7 - 29.9)%, WBC 6.92 (6.53 - 7.30), platelet count 186.52 (177.67 - 195.38) x 10(9)/l. These results were compared with those of 52 non-pregnant age matched women volunteers as controls whose mean haematological indices and 95% CI were: Hb 120.51 (116.61 - 124.41) g/l, hct 36 (25 - 48)%, WBC 5.28 (2.9 - 8.7) x 10(9), platelet count 330.87 (176 - 538) x 10(9)/l. The following haematological indices: WBC, platelet counts, RBC, PCT, and PDW, of women between the trimesters showed statistical significance (p value < 0.001 in each case). The WBC is inversely proportional to the PCT and the MCV in the pregnant women was slightly raised. In this study, pregnancy is characterised by lowest values of haemoglobin parameters in trimester three and there are statistically significant differences between the WBC, platelet counts, RBC, PCT, and PDW of women between the three trimesters.

Background 30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia. MethodsWe did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia. Eligible women were aged 18-49 years in Nigeria and 16-49 years in Zambia, had chosen to receive the hormonal intrauterine device, copper intrauterine device, or implant (either a 5-year levonorgestrel-releasing subdermal implant or a 3-year etonogestrel-releasing subdermal implant), and, in Nigeria only, had access to a telephone. Women were interviewed within 100 days of receiving their contraceptive method either via telephone in Nigeria or in person in Zambia, with follow-up surveys at 6 months and 12 months. The primary outcomes were method-specific, 12-month continuation rates-ie, continuation rates of the hormonal intrauterine device, copper intrauterine device, and implant across Nigeria and Zambia. We used Kaplan-Meier methods to estimate the cumulative probabilities of method-specific continuation and a log-rank test to compare contraceptive methods. We analysed self-reported satisfaction and experiences as a secondary outcome. FindingsBetween June 25 and Nov 22, 2018, we enrolled a total of 1542 women (n=860 in Nigeria and n=682 in Zambia) receiving a long-acting reversible contraceptive. In total, 835 women (266 [32%] hormonal intrauterine device users, 274 [33%] copper intrauterine device users, and 295 [35%] implant users) in Nigeria and 367 (140 [38%] hormonal intrauterine device users, 149 [40%] copper intrauterine device users, and 78 [21%] implant users) in Zambia were included in the study analysis. The 12-month cumulative continuation rates were 86•8% (95% CI 82•1-90•4) for the hormonal intrauterine device, 86•9% (82•1-90•4) for the copper intrauterine device, and 85•0% (80•2-88•7) for implants in Nigeria. In Zambia, the 12-month cumulative continuation rates were 94•7% (89•2-97•4) for the hormonal intrauterine device, 89•1% (82•3-93•4) for the copper intrauterine device, and 83•1% (72•2-90•1) for implants. At least 71% of respondents across the timepoints were very satisfied with their method, and at least 55 (79%) of 70 reported having recommended their contraceptive method to someone else. Across the methods, the most commonly self-reported positive aspect of long-acting reversible contraceptive use at 12 months was effectiveness in Nigeria (range 93-94%) and long-lasting duration in Zambia (48-60%). Between 124 (50%) of 248 and 136 (59%) of 230 Nigerian participants and 26 (42%) of 62 and 66 (57%) of 117 Zambian participants reported nothing negati...

Objective: To determine the effect of self-medication with chloroquine and pyrimethamine on malaria infection and anaemia during pregnancy. Subjects and Methods: The study involved 210 women who attended Ade Oyo Maternity State Hospital, Ibadan, Nigeria. Of these, 156 were pregnant women while 54 were not pregnant (controls). Of the pregnant women, 66 were primigravidae, while 90 were multigravidae. History of treatment of malaria with antimalarial drugs was obtained from the subjects. Gravidity and gestation period were also documented. Two millilitres of blood was withdrawn from each subject, for haematological parameters. Thin and thick films were prepared for malaria parasite identification and quantification. Results: Of the primigravidae and multigravidae 68 and 16.4%, respectively, had taken antimalarial drugs prior to booking. Among primigravidae, only18% of those with drugs compared with 32% without drugs were malaria-positive. The parasite density was significantly lower among those who took antimalarial drugs than among those who did not (976 ± 60 versus 2,421 ± 78, p < 0.05). Similarly, among multigravidae, only 16.4% of those who took antimalarial drugs compared with 34% of those who were not malaria-positive. The parasite density was also significantly lower in multigravidae with drugs than among those without drugs (350 ± 45 versus 1,000 ± 65, p < 0.05). The prevalence of anaemia (packed cell volume, PCV <33) was high, 89% in primigravidae and 70% in multigravidae. Severe anaemia (PCV <21) was more common in malaria-positive primigravidae and multigravidae than in malaria-negative women. Conclusion: The findings indicate that self-medication with chloroquine and pyrimethamine at booking was able to reduce the prevalence of malaria and anaemia in pregnancy.

Background: Several organizations in Nigeria are leading pilot introduction programs of the levonorgestrel intrauterine system (LNG-IUS). We conducted a qualitative assessment of providers’ experiences across the five programs and an analysis of service delivery costs in one program. Methods: We conducted 20 in-depth interviews (IDIs) with providers. We used project expenditure records to estimate incremental direct service delivery costs of introducing the LNG-IUS in 40 social franchise clinics supported by the Society for Family Health (SFH). We then compared the direct service delivery costs per couple years of protection (CYP) for the LNG-IUS to other family planning methods. Results: Providers appreciated the therapeutic benefits of the LNG-IUS, especially reduction of heavy bleeding. They said that women generally accepted bleeding changes with counseling but noted complaints about spotting and mixed acceptability of amenorrhea. Providers indicated being comfortable with both the insertion and removal process and believed their equipment and infection prevention protocols were adequate. Lack of awareness among women, limited availability, current pricing, and resistance to uterine placement among some women were perceived as barriers. The estimated direct service delivery cost of introducing the LNG-IUS in pilot settings, inclusive of up-front provider training costs, was USD 34 per insertion. Direct service delivery costs at a ‘steady state’ (i.e., without training costs included for any method) of the LNG-IUS per CYP was similar to that of other contraceptive methods distributed in Nigeria. Conclusion: Providers’ positive experiences with the LNG-IUS and direct service delivery costs per CYP that align with those for other methods suggest that the LNG-IUS could be an important addition to the method mix in Nigeria. Product introduction strategies will need to address both the supply and the demand sides, as well as consider appropriate pricing of the LNG-IUS relative to other methods and particularly the copper IUD.

BackgroundIn developing regions, an estimated 214 million women have an unmet need for family planning. Reaching Family Planning 2020 (FP2020) commitments will require a shift in modern contraceptive promotion, including improved access to long-acting reversible contraceptives (LARCs). Until now, a lack of market data limited understanding of the potential of LARCs to increase contraceptive access and choice.MethodsFrom 2015, the FPwatch Project conducted representative surveys in Ethiopia, Nigeria, and Democratic Republic of Congo (DRC) using a full census approach in selected administrative areas. In these areas, every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, market share, availability, price, and outlet readiness to perform services.ResultsFifty-four percent of outlets in Ethiopia had LARC commodities or services available at the time of the survey, versus 7% and 8% of outlets in Nigeria and DRC, respectively. When present, LARCs were usually available with at least two other methods (99%, 39%, and 84% of public health facilities in Ethiopia, Nigeria and DRC, respectively). Many public facilities had both implants and IUDs in stock (76%, 47%, and 53%, respectively). Lack of readiness to provide LARCs was mostly due to a lack of equipment, private room, or the commodity itself. Market share for implants in the public sector was 60%, 53%, and 37% of Couple Years of Protection (CYP) in Ethiopia, Nigeria, and DRC.DiscussionLimited availability of LARCs in Nigeria and DRC restricts contraceptive choice and makes it difficult for women to adopt and use modern contraception consistently. Brand-specific subsidies, task shifting, and promotion of methods that require less equipment and training are promising strategies for increasing uptake. Substantial government investment is required to improve availability and affordability. Investment in implants should be prioritized to make progress towards FP2020 commitments.