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Background Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia. Methods The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation. Result Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25–34 (HR = 0.26; 95% CI: 0.20–0.35) and those aged 35–49 (HR = 0.17; 95%CI: 0.11–0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37–0.78), or fully (HR = 0.55; 95%CI: 0.40–0.74) and primiparous women (HR = 0.53, 95%CI: 0.33–0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02–1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28–3.46) had a higher likelihood of discontinuing these methods. Conclusion Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women’s participation in household decision-making may decrease LARC discontinuation in Ethiopia.

There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia.Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis.From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman's occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change.The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.

Background There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia. Methods Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis. Result From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman's occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change. Conclusion The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.

Little information exists about socio-economic, environmental or occupational determinants of low Apgar scores among Nigerian neonates. Mothers in lying-in wards of four hospitals in Ibadan were interviewed on socio-demographic characteristics, obstetric history and work activities during index pregnancy. Apgar scores and clinical data were extracted from case notes. Of the 1349 respondents, 20% had Apgar score7 at one minute, 4% at five minutes. Lower education, cooking with kerosene, physical exertion at work, nulliparity, hypertension in pregnancy, prolonged rupture of membranes, breech presentation and caesarean section were predictors for low Apgar scores at one minute; nulliparity, male infant and breech presentation at five minutes. Occupations with lower socio-economic status or those requiring physical exertion; tailoring, catering and hairdressing recorded higher rates of low Apgar scores at one minute (p = .08). Physical exertion at work and cooking with kerosene may be predictive of low Apgar scores and require further study.

Retained surgical sponge (gossypiboma) is a rare complication of abdominal surgery, however, it is the most common surgical item that is found to be retained. Whenever a gossypiboma occurs in the abdominal cavity following abdominal surgery, it is associated with severe morbidity and mortality, as well as medicolegal consequences. Risk factors for this problem include both patient care processes and working environment issues. The discovery may take months or years after the surgery was performed, and the complications at presentation also vary. This case followed an emergency caesarean section with the delivery of a live male infant, and the diagnosis was made 1 year after surgery. She presented with a 1‑year history of intermittent abdominal pain, which became excruciating with accompanying discharge of pus from the abdomen shortly before presentation. She had exploratory laparotomy and developed a faecal fistula on the fourth day following the extraction of the retained abdominal pack, which was conservatively managed. She was discharged on the 19th postoperative day to the outpatient clinic for further care.Keywords: Abdominal sponge; feacal fistula; gossypiboma; intra‑abdominal

Antenatal care (ANC) is a specialised pattern of care organised for pregnant women with the goal of maintaining good health and promoting safe delivery of healthy infants. It is an indispensable part of effective maternity care services. This study identified the factors responsible for absenteeism from ANC follow-up visits. It was a hospital-based prospective cross-sectional descriptive study conducted at a faith based secondary healthcare facility in Ibadan, Nigeria. Relevant data were retrieved using interviewer-administered structured questionnaires and antenatal health record cards. The major reasons identified for absenteeism were delay in receiving hospital services due to long queues at service points and understaffing. The pregnant women aged 35 years and above were the most likely to miss the visits. Therefore, there is the need for hospital administrators and health care givers to make the services patient-friendly.

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

To identify the determinants of low birth weight (LBW), preterm birth, and stillbirth, and the factors associated with paid or domestic work that affected pregnancy outcome in Ibadan, Nigeria.A cross-sectional study of women who delivered live or stillborn singleton neonates at 4 hospitals between February and June 2008. Participants were interviewed to obtain information on paid and domestic work activities during pregnancy, as well as obstetric history. Pregnancy outcomes and other clinical data were extracted from case notes.A total of 1504 mothers aged 20-45 years recorded 137 (9.1%) LBW neonates (2.5 kg), 154 (10.2%) preterm deliveries (37 weeks), and 56 (3.7%) stillbirths. There was no overall increased risk of these outcomes among working mothers. Multivariate logistic regression analysis of working mothers who had booked their deliveries revealed that lifting heavy objects at home, a clinical record of proteinuria, and hospital admission during pregnancy were associated with LBW. Predictors for preterm birth were self-reported exposure to vibration at work, nulliparity, history of preterm birth, 4 or fewer compared with more than 8 antenatal visits, and prolonged rupture of membranes. Predictors for stillbirth were low education and prolonged rupture of membranes.The results further support recommendations that physical exertion in paid and domestic work should be reduced during pregnancy.

Richard Busayo Olatunji,1 Ademola Joseph Adekanmi,1 Millicent Olubunmi Obajimi,1 Olumuyiwa Adebola Roberts,2 Temitope Olumuyiwa Ojo3 1Department of Radiology, 2Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, 3Department of Community Medicine,Obafemi Awolowo University TeachingHospital Complex,Ile-Ife, Osun State,Nigeria Background: Pre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women. Methods: OAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7–10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P

Malaria infection control remains a challenge in Africa. According to the World Health Organization, an estimated 660,000 deaths occurred from malaria infection in 2010, with Sub-Saharan Africa accounting for 90% of the mortality. The aim of this study is to assess the prevalence of peripheral malaria parasitaemia and the methods of malaria prevention commonly used among pregnant women. The study is a cross sectional survey of pregnant women attending an antenatal booking clinic in a secondary health care center in Southwest Nigeria. In addition to obtaining information about patients' knowledge of malaria infection and protection, obstetric history, general and obstetric examinations were completed, and blood film and capillary tube samples were obtained through a finger prick. Thick and thin blood films were stained and examined for identification and quantification of malaria parasite, and the capillary tube blood sample was processed for haematocritestimation. Results of 502 participants were used in the analysis; 38 (7.6%) women were positive for malaria parasite on microscopy. Peripheral malaria parasitaemia was more common among primigravidae25 (65.8%) compared with multigravidae 13(34.2%) (p-value< 0.001). The mean parasite density was higher among primigravidae, 6824.39parasites/µl compared to multigravidae, 606.69 parasites/µl. A total of 337 (67.1%) of the participants had haematocrits less than 11g/dl. Malaria prevention methods used by the participants included untreated nets 204 (40.7%), insecticide sprays and coils 211 (42.0%), and insecticide treated nets (ITNs) 87 (17.3%). Among the participants with peripheral malaria parasitaemia, one (2.6%) used ITNs compared with 21 (55.3%) and 16 (42.1%) who used insecticides and untreated nets respectively (p-value 0.032). Further analysis showed higher odds of peripheral malaria parasitaemia among those who used insecticides, and untreated nets relative to ITNs (odds ratio8.763, 95% CI 1.136 - 67.592, and odds ratio 6.993, 95% CI 0.899 - 54.411). Fewer pregnant women use ITN compared with other methods such as insecti- cides and untreated nets despite the protective benefits against malaria infection in pregnancy. Therefore, further exploration regarding improved accessibility and increased effectiveness of utilization is necessary to decrease malaria infection rates, es- pecially among pregnant women.

5606 Background: Cervical cancer remains a major global health issue still claiming the lives of African women despite the availability of screening facilities. Male involvement has paid off in enhancing uptake of contraception in Africa as reported by several empirical studies. It may be worthwhile in encouraging women uptake of the screening services. This formed the basis for this study. Methods: The study adopted a cross sectional descriptive survey that involved 350 respondents. Their involvement was assessed using a structured questionnaire with cronbach reliability coefficient of 0.78. The study was analyzed using SPSS version 16 by computing the frequency, means and standard deviations. Chi-square was employed to test the significance of associations at p < 0.05. Results: The results showed that all (n = 350) male medical staff of the hospital were aware about cervical cancer and pap smear screening test for premalignant lesions of the cervix compared to 90% and 77% observed in paramedics and non-medical groups respectively. At least, an episode of Pap smear screening test had been done by the partners of 52.4% of the medical staff; while only 30.2% and 13% of the partners of paramedics and non-medical workers respectively had undergone the test. Among those whose partners had participated in screening; 78.9% (n = 95) of the men initiated the screening. Eighty two percent (82%, n = 95) paid for their wives’ transportation while 78.9% (n = 95) have at least once followed their partners to the screening centre. Chi square result showed that men with higher level of education are likely to support their partners to participate in screening for cervical cancer (p < 0.005). There was no significant association between religion and male support for Pap smear uptake (p < 0.407). Conclusions: The study showed that the medical male workers were more involved in facilitating partners screening for cervical cancer. This may not be unconnected with their knowledge of the consequences of late identification of the disease. The study therefore concluded that knowledge of cervical cancer and its consequences by men will enhance their involvement in encouraging partners to utilize screening facilities.